Monday Morning Update 1/29/18

Top News

Outcome Health’s co-founders – CEO Rishi Shah and President Shradha Agarwal – step down from their management roles as part of a settlement with investors who had claimed that the company misled them about its performance.

Shah and Agarwal will remain on the company’s board as chair and vice-chair, respectively. They will also join Outcome Health’s equity investors and lenders in investing $159 million to improve its technology and customer operations.

Outcome Health will expand its board to include new independent directors and will launch a search for a new CEO. It will also hire an outside firm to audit the performance of its waiting room ad campaigns, which was the subject of an investigative report suggesting that the company had inflated the numbers. Several big-name investors then alleged that the company had defrauded them of $500 million.

A May 2017 fund raise valued Outcome health at nearly $6 billion, with the 31-year-old Shah’s stake worth $3 billion.

Reader Comments

From Digital Dork: “Re: Apple Health Records. I don’t see why everyone is so excited. Patients can get the same information from their provider’s patient portal. It doesn’t even include OpenNotes.” I’m surprised that the perpetually underperforming health IT industry expected more from Apple’s beta release. The important takeaways are:

• It’s Apple — which has high consumer trust and high adoption rates — connecting via FHIR to EHRs. That’s significant news in itself.
• Patients don’t like and use patient portals all that much. Replacing little-used portals with an IPhone-stored aggregated record is a pretty big deal to consumers.
• Apple can extract and display whatever information the FHIR standard supports. The beta isn’t the end of Health Records development and it’s early to be whining about what it doesn’t do instead of celebrating the fact that Apple was interested enough in patient EHR data to use it as an IPhone differentiator in an increasingly Android world.
• If enough IPhone users want OpenNotes, diagnostic images, or anything else that’s stored in the EHR, they may eventually get it.
• It’s a big deal to give app developers a way to build and sell their products without the permission or participation of EHR vendors.
• Health systems may be overwhelmed with patients wanting their data or demanding that errors they find in it be corrected.

From Apple The InfoBlockers: “Re: Apple Health Records. Your source said they were more comfortable working with Apple, but patients have a right to their data. Why does it bring over a subset of data but not pathology reports, radiology reports, notes, and genomic data? ONC railroaded the public with Meaningful Use that didn’t give patients the full data from their EHR, but this gets the word out about patient-centric interoperability. It also puts to bed excuses by provider / vendor info-blocking consortia like DirectTrust, who have argued that patients can’t participate without in-person identity verification and the Halamka argument that ‘we don’t make patient data available because nobody wants it.’ FHIR is one of the most powerful info-blocking tools out there  and Argonaut in particular is a forum where providers define use cases that work behind the backs of patients. But that game is up since supporting a FHIR interface via a patient portal token means you can support it with any application the patient wants.” It may be that a tiny percentage of patients want to see their entire medical record, and even though there’s always the paternalistic fear that they might apply that information unwisely, I agree it’s their right. However, the average IPhone user is probably more interested in appointments, messaging, and quick access to lab results than second-guessing their pathology notes. Also recall that this is a beta release, a minimum viable product whose development will surely continue if demand exists. The reader observes that only three of the participating health systems use OpenNotes and Health Records doesn’t extract it anyway, so the patient portals of those three Epic sites will offer more information. I’m all for enhancing electronic records access, but what makes me really angry are the extortionate prices health systems charge patients to get even paper copies of their own records, especially when in-house technology makes producing them nearly effortless.

From Madison Ashley: “Re: Apple Health Records. The story in a Madison newspaper says Microsoft has shut down HealthVault just like Google did its Health app in 2011.” It doesn’t say that, only that some of its software has been turned off (it’s referring to the just-retired HealthVault Insights). However, an error-filled article posted on a questionable health IT news site boldly declared that Microsoft has “shut down HealthVault,” only one of many mistakes it cluelessly stated as fact  — HealthVault insights has not been “around since 2007,” HealthVault was never renamed to HealthVaults Insights, and Microsoft hasn’t ended its “mHealth app experiment” (although it might as well). Be careful who you trust for health IT news.

From Bob: “Re: HIMSS exhibitor staff rules. I’ve search endlessly trying to find your rules from a few years ago, such as no talking on cell phones or to each other.” I’ve riffed a few ideas out several times over the years, so since I get asked several times each year right about this time, I started a permanent list. See my “Tips for HIMSS Exhibitors” and send me your additional ideas.

HIStalk Announcements and Requests

It’s a nearly even split on whether Epic is an impediment to innovation. Dev says the risk-averse health systems that spend hundreds of millions of dollars on Epic demand stability and that difficulty of integration is also a factor, adding that organizations can’t continue to wait two years for Epic to implement something and then take another year to run it by their in-house steering committees. Vic says both Epic and Cerner discourage third-party participation in installation, enhancements, and maintenance. Hermanator says its leadership, not the brand of EHR, allows provider organizations to innovate. Ex-Epic says the company’s aversity to PR and marketing mean customers, employees, and the health IT industry are kept in the dark, adding that Epic’s no-acquisition policy runs contrary to Silicon Valley, where everyone wins when side projects or acquisitions can change the world in the right hands.

New poll to your right or here, as a follow-up to the Apple Health Records announcement: which of these activities have you performed on your phone?

Check out the responses to “What I Wish I’d Known Before … Implementing a Vendor’s Cloud-Based Application.” After that, please take 60 seconds to weigh in on the new topic, “What I Wish I’d Known Before … Bringing an Ambulatory EHR Live.”

I’ve talked to a few former KLAS employees about how their process works. I would be interested in talking to a couple of additional people just so I get the full picture, all anonymously of course. Contact me.

Listening: Massachusetts-based Speedy Ortiz, which overcomes an obviously limited inventory of talent to create some pretty good grungy rock. They donated their last tour’s proceeds to Girls Rock Camp Foundation. The singer studied math and music for two years before taking a poetry degree from Barnard College. The music is edgy enough to be interesting even when it’s not all that great. There’s also the new album from pastor and songwriter Cory Asbury, who crafts polished and highly listenable worship music.

Welcome to new HIStalk Platinum Sponsor DocuTAP, which I’m sure will interest Dr. Jayne given her not-great EHR experience in her urgent care practice. The Sioux Falls, SD-based company is the industry-leading technology provider for urgent care centers, offering a tablet-based PM/EHR, patient engagement, revenue cycle management, and business intelligence solutions. EHR features include a chart room to track patient wait times and complaints, templates that can be modified per provider and per clinic, automatically generated procedure codes, single-tap order sets, and automated E/M coding. DocuTAP also streamlines occupational medicine and workers’ compensation workflow that includes converting all forms to be filled out electronically and supporting employer-specific fee schedules. It offers connectivity with ACOs, state HIEs, and local hospitals. DocuTAP acquired Clockwise.MD in April 2017, allowing it to offer patient self-scheduling, wait time viewing, text reminders, and automated post-visit surveys. The company provides 24/7 support and offers certified remote hosting. Users benefit from two-minute charting, a $10 per visit revenue increase, and 15-minute shorter wait times. Thanks to DocuTAP for supporting HIStalk.

For those questioning DocuTAP’s two-minute documentation claim, here’s a video showing it in action.

Webinars

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.

February 14 (Wednesday) 2:00 ET. “Time is Money: Aurora Health’s Journey of Implementing and Advancing Cost Accounting.” Sponsor: Strata Decision Technology. Presenter: Patrick Nolan, VP of finance, Aurora Health Care. Aurora Health Care’s implementation of Strata’s Decision Support module involved not only building an improved cost accounting model, but improving the process to engage a cross-functional team in cost development. It now has accurate, consistent cost data to support decision-making. Aurora’s next phase will be to use actual procedure and visit times to allocate costs. This presentation will provide a detailed view into both the implementation and future direction of the Strata Decision Support program within Aurora.

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

Sales

St. Vincent’s Health Australia will expand its use of Vocera’s badge- and smartphone-based communication across its 15 hospitals and 17 senior care facilities.

Perry County Memorial Hospital (MO) chooses Cerner Millennium delivered by the CommunityWorks model.

Four-hospital Alameda Health System (CA) chooses Epic in a $200 million project. The health system nearly went broke following billing struggles after its $77 million implementation of Siemens (now Cerner) Soarian and NextGen in 2011.

Decisions

• North Shore Medical Center (FL) switched from a Medhost EDIS to Cerner in late 2017.
• Stephens County Hospital (GA) will go live with Wellsoft’s EDIS in February 2018.
• Astria Sunnyside Hospital (WA) will switch from Meditech to Cerner in mid-2018.
• Washington County Regional Medical Center (GA) will replace Empower Systems with an inpatient EHR not yet chosen.

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

Scott Decker (MDLIVE) joins Homecare Homebase as president.

Announcements and Implementations

Allscripts says it has restored all systems after its January 18 SamSam ransomware attack. Meanwhile, Surfside Non-Surgical Orthopedics (FL) files a class action complaint against Allscripts, saying the outage caused it to lose revenue and spend money coordinating with patient. The practice says the industry has known about SamSam ransomware since March 2016 and Allscripts failed to take reasonable security measures to protect its systems. None of this has affected Allscripts shares, which are up 7.1 percent since the attack vs. the Nasdaq’s 6.13 percent.

A new Reaction Data report asked 133 radiologists and radiology administrators about the potential use of AI in diagnostic imaging. Most respondents say it’s going to a big deal, although practicing radiologists are skeptical. The report notes that folks who say they aren’t all that familiar with AI also responded that it’s important, a case of what Reaction data calls FOMO (fear of missing out). Most respondents say they will implement some form of AI by 2020, while imaging centers surprisingly seem to have fallen far behind hospitals in progress so far. IBM leads in AI mindshare even though nobody reported implementing anything from IBM – most of the progress is in breast imaging and Hologic, GE Healthcare, Google, and ICAD lead the pack.

Privacy and Security

Hackers steal more than $500 million in cryptocurrency from a Tokyo-based digital currency exchange startup.

Other

In England, a newspaper’s report says doctors are being pressured to manipulate patient EHR data to avoid hospital penalties for missing ED treatment time targets. Sources say they are changing admission times, performing phony patient transfers that sometimes makes it hard to find those patients, and discharging and then readmitting patients to restart the clock. NHS standards require patients to be assessed within four hours of entering the ED and to be held no longer than 12 hours before being admitted, although the stopwatch starts only when they are taken to an exam room rather than when they show up, excluding their wait time watching My Lady Her Honour Judy.

Google AI researchers publish (in a non-peer reviewed, non-medical open access journal) their work on extracting full EHR data from 215,000 hospitalized patients (from UCSF and University of Chicago Medicine) to successfully predict in-hospital deaths, unplanned readmissions, prolonged stays, and discharge diagnoses. The authors conclude that analyzing the full EHR with deep learning methods provides predictions that are more accurate than other predictive models that require data harmonizing and a pre-defined statistical model.

A proposed Singapore bill addresses the country’s National EHR (NEHR):

• Providers will contribute the electronic information of all patients to the NEHR.
• The core data set will include the patient profile, events, diagnosis, surgery procedures and notes, discharge summary, medications, lab reports, radiology reports, immunizations, and allergies.
• Patients can opt out, but their information will still go to the NEHR. It will, however, be made invisible to providers.
• Telemedicine will be regulated.

Sponsor Updates

• Sunquest Information Systems will offer several presentations at the Precision Medicine World Conference January 23-24 in Mountain View, CA.
• Surescripts will exhibit at the NACDS Regional Chain Conference February 4-7 in Fort Lauderdale, FL.

Blog Posts

• Urgent Care Trends to Watch in 2018 – The Year of the Patient (DocuTAP)
• 4 Security Tips for the New Year (Salesforce)
• 5 Tips for Dealing with Medical Practice Employee Turnover (Solutionreach)
• Balancing Act: Managing Outcomes and Costs for Medicare & Medicaid Populations (Medecision)
• Can the Healthcare industry get into the Millenial mindset? (TransUnion)
• Bringing doctors into the loop. (Voalte)
• 27 Stats That Show What Consumers Expect from Brand Communication (West)

Contacts

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

Tips for HIMSS Exhibitors

Every year I get several emails asking me to repost the “HIMSS vendor rules” that I’ve rattled off a few times over several years. The problem is that I’ve never made an exhaustive list or committed to maintaining it – it was just a series of stream of consciousness complaints about sloppy exhibitor practices that frustrated me as an attendee. I often called out undisciplined booth staffers who turned an expensive HIMSS exhibit into “the world’s most expensive telephone booth.”

I decided to try to recapture some of those thoughts in one place after I received recent requests for “the list” now that HIMSS is fast approaching. Here’s what I came up with. Send me your additions, especially if you – unlike me – have worked a booth and have a non-attendee viewpoint that I lack.

My conclusion is this. HIMSS exhibition costs are among a company’s most significant investments (especially for small companies) and the cost/revenue meters are running every minute that the exhibit hall is open. Don’t spend a fortune on exhibiting without a plan.

Pre-HIMSS Preparation

Define success goals. What is your company trying to get out of exhibiting? Is it X number of leads or contacts per hour? Doing X number of demos? Just staying hello to existing customers? Getting rid of all the optimistically ordered crappy swag and going to parties? Everyone working the booth should know what the company hopes to gain from their exhibit hall presence and how their contribution to those outcomes will be measured.

Develop two conversations that every booth staffer must demonstrate: a 10-second elevator pitch covering the problem the company solves and a two-minute version for those who seem interested after hearing the shorter spiel. The wording is as important as any marketing message since it will be repeated hundreds of times in the high-stakes exhibitor game, so get it right and make sure everyone can deliver it well. Trade show messaging is different than any other form of contact with customers and prospects, so don’t let staffers – even the salespeople – wing it.

Define how to qualify a visitor as a prospect and the actions that will ensue – disengagement if they aren’t, deeper engagement if they are. It’s OK to break off a conversation with sincere thanks for stopping by and a goodbye handshake. For chattier non-prospects who don’t take the hint, define a “rescue me” hand signal triggers the appearance of a profusely apologizing co-worker who reminds you that you have a fictitious previously scheduled visitor waiting.

Create a plan for getting even hot prospects in and out of the booth within 10 minutes of saying hello. Don’t waste their time and yours by trying to wear them down into signing a contract right there on the show floor. It’s fine if they want to stick around afterward, but the plan should address what needs to happen within that 10-minute window to make it a success. Then move on to other prospects.

The 10-minute model visit should include who else needs to be brought in or how handoff to another booth staffer with specific knowledge or skills will take place. Nobody likes being walked all over the booth while you’re hunting for someone who turns out to be in an impromptu company meeting.

Perform role-playing to make sure everyone is on the same page for all likely situations (snooping competitors, reporters looking for a story, loudly complaining customers, newly sold customers looking for validation, or attendees asking about job opportunities). Don’t use the “X number of dollars per hour” booth time stage for rehearsal. 

Define dress expectations. Company shirts? Suits? Specific colors? Don’t leave it up to the discretion of staffers. Casual is fine unless the company sells abstract services rather than a physical product, in which case more formal dress might be appropriate in conveying success and strength.

Define clearly what your company does on your booth. Second- and third-tier vendors sometimes don’t realize that most of us don’t know who they are or what they do. Say so clearly on booth materials so encourage attendees to veer off their determined path to check your booth out.

Set up a quiet cocktail party or dinner – at the appropriate cost level for your intended audience and potential benefit – and offer promising prospects who drop by the booth an invitation. Don’t just hand them out en masse or try to arrange something at the last minute. The only negative is that attendees come with fully-loaded schedules, so maybe a nearby lunch would be a good substitute. HIMSS Bistro works great, is inexpensive, offers healthy options, and is located just off the show floor.

If you plan to offer giveaways, consider fun items for the attendee to bring home to their children.

Booth Layout

Use high-top tables and stools that encourage qualified prospects to move into one-on-one conversations, but not so comfortable that visitors and booth staff sprawl on them because their feet are tired.

Instead of swag giveaways that encourage trick-or-treat behavior from people who aren’t really prospects anyway, offer coffee, juice, soda, and water. Place it in a comfortable seating area free of barriers, but assign someone to work that area and strike up conversations, giving the evil eye to people from other companies trying to freeload.

Bring enough people to handle, but not overwhelm, visitors. That’s based on booth size and in-booth activities. A 10×10 booth will seem overloaded if there’s more than a couple of people working since the visitor might not have a place to stand or sit, while an oversized but understaffed exhibit feels dead or leaves visitors unacknowledged. Have backups readily available that can be summoned when needed but free to do other work nearby while waiting.

Choosing Booth Staff

Don’t assign booth duty as reward or punishment. Define the individual roles and choose for them the best people who actually want to work the show. Enthusiasm wins.

Rotate booth staff frequently to keep energy levels up.

Strive for diversity and make sure the male and female staffers don’t huddle around each other like a middle school dance.

Assign some non-management technologists or non-sales subject matter experts to be available for bonding with their prospect peers and for answering questions without resorting to salesperson bluffing. However, don’t let them interact with visitors without having a more people-facing handler managing the process.

Don’t choose smokers. The inevitable scent will turn off many attendees and those folks will require frequent smoke breaks that someone else will have to cover.

It is perfectly fine for a small company to hire contract booth staff, even if they are chosen primarily because of appearance (rightly or wrongly, attractive booth staff often deliver better results). However, those contractors should be educated in advance about the company, its solutions, and how to make a quick handoff to an expert after the initial contact. Obviously they should dress appropriately and be prepared to interact professionally with high-level visitors. Provocatively-clad “booth babes” are never, ever a good idea for the HIMSS conference.

Assign a single person to be in charge of the entire booth and the people working in it at all times. Like the on-duty restaurant manager, their job is to keep staffers motivated, make sure they follow the plan, provide help when needed, and intervene in a “good cop” kind of way when needed. That person is the boss of everyone during exhibit hall hours, even of other employees who outrank them.

The CEO should be present in the booth for at least part of the time, and not just chatting with cronies on an isolated couch. Assign them a handler who will facilitate an introduction to good prospects but who will protect them from being bothered otherwise. Unlike other booth staff, the CEO should be in full-out executive suit/dress mode to convey their position of authority and to make a good impression on prospects and passersby. The CEO may well be the company’s best relationship builder and closer, so use them wisely. Admit it – when you walk by the booths of Epic or Athenahealth, you are slyly looking around to see if Judy Faulkner or Jonathan Bush are there.

Preparing the Booth Staff

Put out a specific schedule with who will be where, including breaks off the show floor for bathroom visits, lunch, checking voice mail, etc.

Map out who will stand where and what responsibilities they have.

Put friendly, gregarious people on the booth’s perimeter. They don’t have to be experts – they are like a barker whose job it is to get people comfortable enough to cross into the carpeted space. They should be quick to make eye contact, greet the person by name, and move them into the next phase (watching a demo, getting literature, etc.) The aisles around the booth are the most important real estate in the exhibit hall and getting prospects to leave them to enter the booth is the most important objective.

Give everyone a list of known customer attendees (culled from the HIMSS registration list) so they can be greeted warmly and personally instead of being pitched unknowingly as a stranger.

Before the Hall Opens

Relieve booth staffers of all other responsibilities. Leave them free and energized to complete the expensive project you started when you bought a booth.

Confiscate the phones of everyone who is working the booth.

Do a booth staffer huddle 10 minutes before the hall opens to make sure that everyone is dressed neatly (no bagel debris lodged between their teeth), their phones have been surrendered, everybody knows about the day’s special activities or presentations, and their energy level has been elevated just before the doors open. It’s really embarrassing to have your people sitting around drinking wake-up coffee and comparing notes about last night’s wild party as prospects are walking by.

When the Show Floor Is Open

Make it an inviolable rule – enforced by the booth manager — that people working in the booth cannot sit, talk to each other (unless trying to get a visitor’s question answered), use their phones, or eat. Do those things away from the booth. Prospects will move on if they feel they’re invading the space of those on duty. No exceptions, and if you didn’t free up their time so they can focus on visitors, shame on you.

Keep the trash cans emptied and handbags and luggage out of sight. That seems minor, but it makes an impression.

Always have a greeter working the aisle. They need to hand off quickly and get back to their greeting job.

Remember that even when booth staffers are away from the booth, they’re still wearing a nametag identifying their employer, so business-appropriate behavior is mandatory. Save the swearing, romantic recruitment, calls to headhunters, and product and co-worker gripes for a different setting. Or, at least tell them to flip their badges over so nobody who is overhearing knows who they are.

Resist the urge to let folks bail out early because there’s no foot traffic. Some C-level decision-makers intentionally use slow exhibit hall hours to seek information without the frenzy.

Use the time before the exhibit hall opens and closes, as well as the slow last day of the exhibits, to cruise the hall looking for opportunities to partner, acquire, or hire. Many companies find that they get more value from their interactions with other vendors than with prospects, often outside of their own booth.

As the show winds down, find similar but non-competing vendors and offer to share leads.

Managing the Visitor Encounter

The greeter should turn the visitor over quickly and smoothly to someone else so they can keep working the perimeter.

Ask the visitor if it’s OK to scan their badge. Not only to capture their information, but to keep them in the booth a few seconds longer while both parties decide how interested they are.

Engage in a friendly manner with demo shoulder-surfers. They probably aren’t trying to steal trade secrets but rather are just avoiding wasting their time and yours with premature engagement. It’s certainly OK to say hello and ask if they need any help.

Don’t disparage competitors. It will sound like sour grapes.

Define the documentation that should result from a visitor visit – badge scan, business card, or information sheet? Capture the conversation so that any follow-up is seamless – what are their organization’s problems or who should follow up?

Don’t assume that a visitor’s job title disqualifies them as a decision-maker. Provider organizations often make decisions that start with a lower-level department employee who is sent out to fact-find.

Don’t assume that consulting company attendees aren’t worth talking to. They are probably looking for products they can recommend to their clients or looking for partnership opportunities.

Weekender 1/26/18

Weekly News Recap

• Apple announces Health Records, which will allow IPhone users to collect and store information from the EHRs of participating providers.
• Executives of Practice Fusion will reap millions when the company is turned over to Allscripts for $100 million vs. a one-time self-valuation of $1.5 billion.
• Allscripts Professional EHR/PM users experienced prolonged outages as the company struggled to recover from last week’s ransomware attack.
• The CEO of Hancock Health (IN) explains why he decided to pay a hacker’s demanded $55,000 ransom.
• Microsoft retires HealthVault Insights.
• Former pharma executive Alex Azar is confirmed as HHS secretary.
• North Carolina health systems Novant and Wake Forest Baptist Health allow patients to combine their Epic MyChart information into a single view.
• Open source EHR vendor OpenMRS receives a $1 million donation from a philanthropy organization started by one of its patch contributors.

Best Reader Comments

Can the patient manually add info to their file? Can they choose which info they want to share? Could they hide diagnoses, medications, etc.? I would think providers would be skeptical about the completeness and accuracy of patient-provided info. (Kermit)

How will Apple market this app to Epic MyChart users? Positives: Can likely have info from multiple providers in one location instead of pulling up MyChart accounts from each provider. Negatives: I didn’t see any patient access or billing topics and no provider messaging. So, user would still need to access MyChart to view upcoming visits, manage appts,. make payments, complete forms/questionnaires, update demographics, start an E-Visit. (Lynn Geren)

This is no surprise to many of us. I have been commenting here for years that PF was inflating (lying about?) its number of users. This is just a continuation of that pattern. (Numbers skeptic)

Epic actually created this initiative with Apple. 10 of the 13 sites involved are Epic sites and each of them will tell you Epic supported them in this endeavor. Epic has had Lucy and VDT and full access for Open Notes sites for a very very long time. (Nope)

I’m not sure I get what Novant and Wake have done. Happy Together is baked into Epic with the most recent version. The patient controls the joining of the MyChart instances across provider instances. Sounds more like marketing to me. (Defiant)

There are lots of after-market solutions for downtime EMRs and “lite” charts like the one Dr. Jayne described, and these often will pay for themselves after just once downtime. It’s a smart investment. (Cosmos)

A T&A implementation is perhaps the most complex project an organization undertakes for many of the reasons stated in the post. The main reason is that management is unaware or does not acknowledge the varying pay practices across their organizations. They underestimate the implications of these practices and are unprepared to deal with them during a T&A project. It is not unusual to find that these practices are costing organizations millions of dollars a year, year after year. I ask clients, are you prepared to pay everyone to policy? (Alan Bateman)

You can’t get comfortable and coast [in your current job]. If you do, you’ll wake up one morning and find yourself out the door when least expected. (HIS Junkie)

Both on purpose and unintentionally, as organizations seek out better solutions and question massive spend, bids can tilt towards the current vendor or away from it. As information is gathered across the organization, departments seek out wants and nice-to-haves framed against the current system. Often this leaves the current vendor in an unfair position, but just as often, the new vendor simply and smartly addressed weaknesses of competitors.(Don’t think twice it’s alright)

Watercooler Talk Tidbits

HIStalk readers funded the DonorsChoose teacher grant request of Ms. T from the South Bronx of New York asked for 50 STEM take-home self-exploration kits covering everything from solar mechanics to tin can robots for her middle schoolers. She reports, “Since the kits are self-contained, they can read and follow directions and carry out the various experiments on their own. They will then demonstrate their experiments for the class on Monday. This will give them an opportunity to show what they have learned. They will be the expert as they field questions from their peers. Some students are shy about making presentations. This will give them another opportunity to develop and practice their public speaking skills.”

A NEJM opinion piece on physician burnout describes a University of Colorado team-based family medicine ambulatory care model redesign called APEX that has dropped clinician burnout rates from 53 percent to 13 percent, improved vaccination and referral rates, and reduced patient wait times. Provider productivity improvements made it cost-neutral. The patient’s visit starts with a medical assistant who gathers data, reconciles meds, lays out the visit, and identifies preventive care opportunities before the physician or PA enters the exam room. The MA stays in the room to document the visit, and after the clinician leaves, works on patient education and health coaching. The medical director says pre-APEX exam rooms were like “texting while driving,” but now the computer doesn’t intrude between clinician and patient, allowing the clinician to focus on synthesizing data, performing the physical exam, and making medical decisions without distraction.

A Los Angeles TV station’s investigation finds that up to 25 percent of reviews on Google, Facebook, and Yelp – including those for healthcare professionals such as dentists – are fake. A Beverly Hills dentist says he’s puzzled at several glowing reviews featuring reviewers whose profile photos feature images of minor TV celebrities, stock photos, or those of random people. I suspect that the dentist is in fact quite familiar with phony review services offered cheaply on Fiverr and other sites  – why would anyone post glowing fake reviews otherwise?

The non-profit, invitation-only Healthcare Innovators Professional Society (HIPS) for chief innovation officers and chief strategy officers launches from Texas Medical Center. Memorial Hermann CIO and Chief Strategy Officer David Bradshaw said that as a founding member, he’s looking forward to networking “without the chaos and scale of other major healthcare societies and conferences.” Membership is limited to 33 people and is not only free, it also covers the full cost of attending HIPS-related events, the first of which will be October 2-4 in Houston. I admire that the provided lunches feature Houston-specialty food by Goode Co BBQ and Lupe Tortilla.

A newspaper reviews the bizarre patient cases that have been reported in BMJ Case Reports. They include:

• A man who nearly blinded himself by mistaking Super Glue for eye drops
• A woman with Crohn’s disease symptoms that were being caused by pieces of a Heinz plastic container lodged in her intestines
• A woman’s suspected eye lesion that turned out to be Christmas card glitter
• A heavy smoker’s suspected lung cancer that was actually part of a toy set that had been lodged in his lung since he was seven years old

In Case You Missed It

• News 1/26/18
• EPtalk by Dr. Jayne 1/25/18
• Insider Report: Apple Brings Provider Medical Records Into the IPhone
• HIStalk Interviews Brent Lang, CEO, Vocera
• News 1/24/18
• Curbside Consult with Dr. Jayne 1/22/18
• Monday Morning Update 1/22/18
• What I Wish I’d Known Before … Replacing My Hospital’s Time and Attendance System

Get Involved

• Join my Rolodex to provide occasional news reaction or ideas
• Contribute regularly as a provider CIO, IT director, or informatics nurse (anonymous or not)
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• Sign up for email updates
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News 1/26/18

Top News

CNBC sheds light on the millions of dollars that Practice Fusion’s executives will reap when the company’s fire sale to Allscripts at 1/15 of its one-time, self-assessed value is completed.

Practice Fusion stakeholders say they were misled by an executive team that was touting a a bright future even as growth was stalling, founder and CEO Ryan Howard was fired, headcount was slashed, and the company had pitched itself to 40 potential buyers starting in November 2015, receiving bids at just $50-225 million for the company that had valued itself at $1.5 billion in early 2016. A group of employees is trying to assemble enough voting shares to remove the payouts to the executives.

Allscripts was the original bidder at $225 million, but backed out when EClinicalWorks was hit by a $155 million settlement related to falsifying EHR certification testing results. Allscripts came back with its offer of $100 million in cash, which Practice Fusion accepted on January 8.

Webinars

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.

February 14 (Wednesday) 2:00 ET. “Time is Money: Aurora Health’s Journey of Implementing and Advancing Cost Accounting.” Sponsor: Strata Decision Technology. Presenter: Patrick Nolan, VP of finance, Aurora Health Care. Aurora Health Care’s implementation of Strata’s Decision Support module involved not only building an improved cost accounting model, but improving the process to engage a cross-functional team in cost development. It now has accurate, consistent cost data to support decision-making. Aurora’s next phase will be to use actual procedure and visit times to allocate costs. This presentation will provide a detailed view into both the implementation and future direction of the Strata Decision Support program within Aurora.

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

Here’s the video from this week’s Versus webinar titled ““Location, Location, Location: How to Deploy RTLS Asset Management for Capital Savings.”

Acquisitions, Funding, Business, and Stock

Mediware Information Systems acquires RCM company MedTranDirect for an undisclosed sum.

Change Healthcare retains the exclusive right to license commercial data to WebMD Health Corp. It seems there was some legal disagreement over which company had the rights to sell de-identified data to third parties after the parent company of both businesses sold them off.

Audacious Inquiry takes in its first outside investment, with Baltimore-based ABS Capital Partners buying an unspecified stake.

Allscripts is apparently still struggling to bring Professional EHR and PM back to normal following last week’s ransomware attack, with reports that some customers can’t access the system through the desktop application. The company also warns that the restored system might be slow and suggests that customers use the mobile solution when possible. Analytics Platform and Clinical Data Warehouse are still down.

Sales

Major Health Partners (IN) will implement Meditech Web EHR.

Mee Memorial Hospital (CA) chooses Cerner Millennium under the CommunityWorks cloud deployment model. The hospital has the best tagline in history: “At Mee, it’s all about you!”

Announcements and Implementations

Intermountain Healthcare will transfer 2,300 billing employees to its revenue cycle vendor R1 RCM, expecting to save $70 million in the next three years even though the employees will keep their pay rate, health insurance, and tenure at Intermountain. The health system’s COO, questioned by employees worried that the company will outsource its IT operations that include its Cerner system, says Intermountain has not yet made any IT decisions but needs to manage its costs. 

Technology

Apple announces new beta functionality within its Health app that will let patients at a dozen partner hospitals view their medical records on their IPhones. Participating EHR vendors include Epic, Cerner, and Athenahealth. More detail and insider reports here.

ZeOmega adds Change Healthcare’s InterQual Connect authorization connectivity and medical review service to its Jiva population health management software.

Government and Politics

The VA will use data, analytics, technology, and best practices from CMS to combat fraud and abuse within its programs.

One Brooklyn Health (NY) will use a $700 million investment from the state’s Vital Brooklyn plan for technology and facility improvements to its three hospitals, plus the creation of a 32-facility ambulatory network. Technology upgrades in the $70 million range will include development and installation of a system-wide EHR.

Privacy and Security

The CEO of Hancock Health (IN) provides details of its recent ransomware attack:

• The hospital believes the hackers were members of an Eastern Europe criminal group.
• They obtained (by unstated means) the login credentials of one of the IT department’s hardware vendors.
• The hackers then attacked a server at the hospital’s backup site.
• To stop the ransomware’s spread, the IT department had to immediately shut down all network and PC hardware, not easy since the attack was launched in the evening when many PC-using employees had left for the day.
• The hospital decided to pay the $55,000 ransom when it found no good way to remove the encrypted files and replace them with backup copies because the connection between the backup and live sites was compromised by the ransomware. They later found that the backup files had also been corrupted by the ransomware, which would have required paying the ransom in any case.
• Employees struggled to figure out how to buy Bitcoin, but once they paid the ransom, the hackers restored the system quickly.

Other

Healthcare Growth Partners publishes its semi-annual market review, with these interesting points:

• 36 percent of poll respondents (C-level company execs and investors) say health IT is in a bubble vs. 29 percent in 2015.
• The health IT market needs to grow 7-13 percent annually to support the current rate of investment.
• The market pushes companies to balance the long-term value creation caused by serving customers while catering to investors who expect them to innovate using buzzword-worthy technologies such as AI and blockchain.
• The most actively sought acquisitions are in population health and analytics, RCM technology and services, payer services, and infrastructure technology. Hospitals as a target market led the way by far.
• The most important acquisition characteristics are growth trajectory and recurring revenue, while strong management finished last.
• Most executives say the regulatory impact of the Trump administration won’t affect their company’s performance or acquisition strategy.
• 2017 saw zero health IT IPOs following nine, eight, and five, respectively, from 2014 to 2016.

Cabell Huntington Hospital (WV) donates $35,000 to Tri-State STEM+M School, with its VP/CIO Dennis Lee (right) making a classroom visit along with the hospital’s CEO.

Sponsor Updates

• Lightbeam Health Solutions publishes a new patient impact story featuring Mohawk Industries, “Breast Cancer Early Detection.”
• MedData will exhibit at the ASA Practice Management meeting January 27-29 in New Orleans.
• Medecision will host its annual Liberation conference March 27-29 in Dallas.
• Major Health Partners (IN) will implement Meditech’s Web EHR.
• Netsmart will exhibit at the NY Coalition for Behavioral Health Annual Conference February 1 in New York City.
• Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the Society for Maternal-Fetal Medicine’s Annual Pregnancy Meeting January 31-February 3 in Dallas.
• Infor will launch a cost analytics and accounting tool for providers this summer.

Blog Posts

• Instant insight and clinical process control critical requirements for reducing sepsis risk – Part 1 (LogicStream Health)
• Why interactive technology is improving the patient experience (Meditech)
• Calm During the Storm: Serving Clients During an Emergency (Netsmart)
• 5 Ways Health Systems Can Improve Their Cybersecurity in 2018 (Redox)
• Huntzinger Congratulates Randy McCleese, Named CIO of the Year by CHIME and HIMSS (Huntzinger Management Group)
• Take control of your organization’s road map for growth and organization efficiency (Experian Health)
• The Rise of Super SNFs and their Impact on Long-Term Care (PatientPing)

Contacts

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

Insider Report: Apple Brings Provider Medical Records Into the IPhone

Apple announced Wednesday an update to the IPhone’s IOS 11.3 beta that will allow consumers to view their EHR information from one or more participating providers within Apple’s existing Health app. I spoke to insiders at some of the beta sites to get more information.

Participating Beta Sites

The initial sites involved are:

Johns Hopkins Medicine (Epic)
Cedars-Sinai (Epic)
Penn Medicine (Epic)
Geisinger Health System (Epic)
UC San Diego Health (Epic)
UNC Health Care (Epic)
Rush University Medical Center (Epic)
Dignity Health (Cerner)
Ochsner Health System (Epic)
MedStar Health (Cerner)
OhioHealth (Epic)
Cerner Healthe Clinic (Cerner)

What Patients See

Patients will be able to view information extracted from the provider’s EHR that includes their allergies, conditions, immunizations, lab results, medications, vital signs, and procedures. The encrypted information is stored on the user’s IPhone rather than on Apple’s servers. Apple will not be able to see the information unless the user gives their permission.

The EHR-to-Apple connection goes beyond the extraction of patient-downloaded C-CDA documents, which Apple Health already supports (pictured above). Apple Health Records retrieves discrete data directly from the EHR using HL7’s Argonaut FHIR standard, triggered by the user’s interaction with Health Records.

“It’s interesting,” one provider told me, “that Apple is possibly the most proprietary, closed software and hardware vendor and Epic is sometimes seen as its healthcare equivalent, yet they are connecting using open standards. That’s awesome.”

Patients of Epic-using health systems, for example, log into their MyChart account, retrieve an authorization code, and agree to share it with Apple. They then receive a token. “The process is slick,” a provider told me, adding that the process will likely be further polished and hardened to allow hospitals to onboard more easily. Epic will most likely productize the access method via an App Orchard app.

Apple’s Motivation

It’s important to note that Apple, unlike consumer medical records competitors such as Google, sells only hardware. Apple doesn’t develop enterprise apps, sell or use patient data, or have ambitions to build or acquire an EHR company. “Their only goal is to sell more IPhones,” a health system source said, adding, “we’re a lot more comfortable working with them than other companies with less-transparent ambitions.” Having direct access to EHR information is a differentiator from Android-based competitors whose market share is increasing over the IPhone.

The IPhone presents more than just a static display. Allergies include severity levels and lab results include the provider’s normal range and an explanation of the results.

I asked an insider about the testing involved and was told that Apple “does real testing, not just the usual hospital user acceptance testing.” That person was also impressed with the depth of health IT expertise that Apple has hired.

Apple’s Gliimpse Acquisition

Apple in mid-2016 acquired startup Gliimpse, which was developing a platform by which consumers could collect and share their health information. That company described itself as, “Gliimpse solved the hardest medical data problem, aggregation plus standardization. Our product collects data from medical portals – without human intervention – combined with self-entered plus wearable info, all shared with others. Through Oauth & APIs, partners can build consumer and analytic apps.” Some of that technology or subject matter expertise presumably found its way into Health Records. Apple is also working on a variety of health sensors.

Apple is losing smartphone market share worldwide, though it leads the industry in profits. It is not likely that an Android phone maker can muster the resources and ecosystem control to develop something similar, although Google may try if it can enlist hospital development partners. Google retired its Google Health app due to lack of adoption after just four years in 2012, before the widespread use of EHRs, interoperability standards, and personal health devices. It ended up being a little-used place for people to manually enter their own health information that was then stuck inside the app.

What the Mainstream Press is Missing

The mainstream press is dutifully re-wording Apple’s announcement, but is missing some significant but unstated points that will impact the health IT industry.

• Patients can store information from multiple health systems on their phones, turning themselves into mini-HIEs as they can simply show any other provider their aggregated information. Apple fixes the patient identification issue that plagues HIEs by requiring the patient themselves to establish the connection from the EHR patient portal’s log-on.
• Apple or a third-party developer could, at some point, add the ability for patients to push their data to a different, non-connected provider in the absence of other available integration in an app-powered form of “sneakernet.”
• Apple’s use of the FHIR standard gives it the capability to extract any information supported by the FHIR standard and the specific EHR vendor.
• Apple’s high-profile rollout will not only sell more IPhones, but will also encourage patients to press their providers to offer EHR connectivity to Health Records. It will also increase consumer use of patient portals.
• Consumers trust Apple and will be encouraged to think of their medical data as their own since it will be in the palms of their hands.
• App developers can build products that use previously inaccessible patient information, having Apple as a single, reliable data source instead of being hamstrung by a hospital’s EHR vendor and the technical intricacies of FHIR, vocabulary, and data validation.
• App developers can list their products on Apple’s App Store – as Epic and Cerner do — instead of only in the EHR vendor’s marketplace since they are directly installable by any consumer without prior arrangement, giving those apps a wide audience and easy monetization.
• Possible apps made possible by Health Records include medication information or cross-checking; further interpretation of lab results; patient education tools based on actual patient data;combining activity data that is already being collected within the existing Apple Health app with newly available provider data; and sifting through real-time information updates to provide alerting of relevant changes. 

News 1/24/18

Top News

Winston-Salem, NC’s two biggest health systems – Novant and Wake Forest Baptist Health – go live on “Happy Together,” in which the Epic MyChart instances of the respective systems are combined into a single patient view.

Novant CMIO Keith Griffin, MD said in an announcement, ““Happy Together for MyChart will allow patients to combine data from the two systems into a single view to improve their understanding of medications, lab results, plan of care, and follow-up appointments. It is truly a major step forward towards the goal of patient engagement and elimination of barriers of information and confusion.”

Novant says it will expand the program to include other Epic-using organizations.

Reader Comments

From Finance Guy: “Re: consultants. I switched to corp-to-corp because of the new pass-through tax rules. I think the 20 percent deduction will be big enough to justify the extra hassle. I don’t think most consultants will do it, though even for the extra money. Most are used to the firm holding their hands and are delusional in thinking the firm is looking out for their interests. Corp-to-corps can contribute 20 percent of their net profit to a self-employed 401(k).” I’m fascinated at how people create businesses with themselves as the only employee. I bet that practice ramped up after the ACA came into law and allowed them to buy competitively priced insurance on their own, although those days might be coming to an end. I also read about professional employer organizations, where for a small annual fee a company will permanently hire “your” employees that still work for you, offer whatever benefits (including health insurance available at big-group rates) you’re willing to pay for, and run the entire HR function, all for a single check.

From Epic Trainee: “Re: Advocate Health Care. At least 10 people from the long-time Cerner and Allscripts shop were in my Epic Implementation Overview class. New CIO and a merger with Aurora = another Epic shop.” Unverified.

From Movin’ On: “Re: bad job situations. Complaining doesn’t get you anywhere – either work with you employer’s leaders to make things better or move on. It’s time when: (a) they don’t offer career growth in your desired area; (b) you have no confidence in leadership or there’s unprofessional or unethical behavior at the top; or (c) personal reasons come up such as not wanting to relocate or travel.” I’ve hung on to jobs that made me miserable at least a couple of times because I was scared of change, it wasn’t a good time to upend my life (hint: it never is), and I secretly worried that I wouldn’t be good enough to compete with a new set of ladder-climbers. The final straw that forced me to move on – for which I was eventually grateful – was differences with a new boss. My conclusion is that unless you are anointed as a fast-tracker early on, your best path at moving up is to move out as the opportunity arises, probably at least every 3-5 promotion-free years unless you plan to live to 150. It’s OK to stay put if the prospect of change is too scary, but you then need to downsize your expectations and find some other source of ego-stroking beyond the company to whom you are unhappily selling the majority of your waking hours. I’m embarrassed when people complain about their jobs because it means they’ve settled for something they don’t like, which suggests a lack of either motivation or ability (I’m experientially jaded having suffered from both). It gets really bad when your occupational frustration, disappointment, and embarrassment bleed over into your family life and you feel personally diminished as a result. ”Spent a lifetime hunched over from the weight of a soul-sapping job” makes a poor epitaph.

From Amazon Grace: “Re: Martin Levine, MD’s role at Amazon. They posted a chief medical officer job last April to run their ‘healthcare’ practice’ that was pulled after 24 hours. It wouldn’t surprise me if that’s the role he is filling.” Seems reasonable since his background is regional chief medical officer for the highly regarded Medicare primary care practice of Iora Health. I expect Amazon is paying a big chunk of expense to pay for our overutilized, overpriced healthcare system, so they could be looking at either offering their own employee healthcare service or creating one as a business.

From Sarah: “Re: Ingenious Med. Fired CEO Joe Marabito and CRO Phil Spinelli over the weekend.” Unverified, but their bios have been expunged from the company’s executive page despite their unchanged LinkedIn profiles. I reached out to the company but haven’t heard back. Marabito joined the company in September 2016, while Spinelli came on board in April 2017.

From WorryWart: “Re: ransomware. Have you heard of patients with conditions such as STDs being blackmailed for bitcoin based on leaked PHI?” I haven’t heard of that. It doesn’t seem practical for a hacker – they would have to identify who to go after, limit their efforts to those with assets and fear of exposure, contact them electronically (email addresses are cutting edge to some practices), and come up with a fear-inducing list of people they would contact. I think the greater risk is that someone local – like a provider’s employee – gets the information and recognizes the patient as a rich target, although the threat of serving time under US extortion laws is probably a dissuader. My conclusion: hackers, like lawyers, don’t waste time on shallow pockets.

HIStalk Announcements and Requests

Last chance to tell me about ““What I Wish I’d Known Before … Implementing a Vendor’s Cloud-Based Application.” Responses are few, which likely marks an untimely demise to the reader-suggested  “What I Wish I’d Known Before …” series that will otherwise be cancelled after only the pilot episode has aired.

Need an inexpensive fitness tracker that — beyond the usual counting of steps and calories burned — includes monitors for heart rate, blood pressure, and blood oxygen? I just bought this one for less than $25 and it works great – it even includes an extra band. It’s probably not amazing, but then again, neither is my workout regimen.

I watched the premiere of “The Resident” on Hulu and it was kind of interesting, but cliche. The idea that hospitals are money-grubbing, faceless corporations led by bean-counters rang somewhat true since I’ve worked for those, but the titular protagonist with the bad-boy facial fuzz and the ability to bond only with patients he just met is a stereotypical cartoon – brilliant, cynical, anti-antiauthority, unaccepting of incompetence, quick to thrust his endless libido at convenient nurses, and full of unconventional medical methods that magically pull patients (sometimes not even his own) back from the brink after they were nearly killed by the dreaded evidence-based medicine, team care, and expert consensus. All we need, apparently, are more world-weary, narcissistic clinical cowboys who think they know more than the entire body of medical literature.

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.

February 14 (Wednesday) 2:00 ET. “Time is Money: Aurora Health’s Journey of Implementing and Advancing Cost Accounting.” Sponsor: Strata Decision Technology. Presenter: Patrick Nolan, VP of finance, Aurora Health Care. Aurora Health Care’s implementation of Strata’s Decision Support module involved not only building an improved cost accounting model, but improving the process to engage a cross-functional team in cost development. It now has accurate, consistent cost data to support decision-making. Aurora’s next phase will be to use actual procedure and visit times to allocate costs. This presentation will provide a detailed view into both the implementation and future direction of the Strata Decision Support program within Aurora.

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

Acquisitions, Funding, Business, and Stock

The state of Kentucky sues McKesson for providing pharmacies with the narcotics its not-being-sued doctors prescribed. Perhaps they should go after Kroger next for selling its overweight people Doritos and Vienna sausages.

Sales

Ohio Valley Hospital (PA) selects Parallon Technology Solutions to provide training go-live and support for its implementation of Meditech physician documentation.

Doylestown Hospital (PA) chooses the cloud-based EHR of EClinicalWorks for its 169 providers.

People

Release-of-information vendor Ciox Health hires Mike Connolly (PwC) as president of retrieval services and Leke Adesida (Anthem) as SVP/chief compliance officer.

Divurgent promotes Liz Keller to VP of client services.

Industry long-timer Meg Aranow (SRG Technology) joins Brighton, MA-based urgent care EHR vendor Edaris Health as COO.

Henry Ford Health System (MI) hires Paul Browne (Tenet Healthcare) as SVP/CIO.

Announcements and Implementations

Colorado’s CORHIO goes live on Medicity’s Community Interchange, which gives clinicians CCDs for making patient care decisions.

Clinical Computer Systems, Inc. announces Obix as a Service, a cloud-based version of its Perinatal Data System.

CenTrak adds Bluetooth Low Energy beacon technology to its Enterprise Location Services infrastructure, offering advantages over off-the-shelf beacons that include interoperability, reliability, five-year battery life, and scalability. 

Four new published studies find that use of Glytec’s EGlycemic Management System improves treatment safety and effectiveness versus paper-based diabetes and insulin management protocols.

Nuance releases Dragon Medical Practice Edition 4.

Cleveland Clinic Florida describes its $4,000 per year concierge medicine program as providing “consistent, comprehensive, personalized medical care while cultivating in-depth patient-physical relationships that support patients’ health goals,” “assistance with medical records,” and “always ample time” during office visits. Apparently we rabble who are paying for visits with insurance and cash can’t expect such service.

Other

A claims analysis study finds that commercially insured Americans used less healthcare in 2016 than 2015, but rising prices  — especially drug, surgery, and ED costs — drove 2016 spending up more than any of the past five years.

The corporate communications director of Fairview Health Services walks back the CEO’s pointed criticism of Epic for being anti-innovation, soothing vendor relations with, “Given Epic’s prominence as an electronic health record provider, they are uniquely positioned to support collaboration for innovation in healthcare.” Notice that she didn’t actually say what Epic is or isn’t doing and thus contradict her boss – only that the company is “uniquely positioned.”

Sponsor Updates

• AdvancedMD will exhibit at the Expert Roadshow January 24 in Salt Lake City.
• Arcadia Healthcare Solutions will exhibit at the CCO Oregon Winter Conference & Annual Meeting January 30 in Salem.
• Dan Dodson, president of Fortified Health Security, appears on an EHealth Radio podcast.
• Besler releases a new podcast, “Examining the relationship between the concentration of Medicare Advantage plans and premiums.”
• CoverMyMeds will exhibit at the NorCal HIMSS Innovation Conference & Showcase February 1 in Santa Clara.
• Bizwomen recognizes CSI Healthcare IT Division President Kate Mays as a Headliner in Technology.
• EClinicalWorks will exhibit at the 2018 Star Ratings Congress January 29-30 in Scottsdale, AZ.
• Healthgrades names the recipients of its 2018 Distinguished Hospital Award for Clinical Excellence.
• Iatric Systems will exhibit at the HCCA Regional Meeting January 26 in Atlanta.
• Influence Health will exhibit at The Joe Public Summit January 30-31 in New Orleans.
• Kyruus will exhibit at the GA HFMA Winter Finance Summit January 24 in Atlanta.

Blog Posts

• M&A Success Dependencies: It’s Not Just About the Bottom Line (Optimum Healthcare IT)
• How San Juan Regional Medical Center Improved Compliance & Patient Engagement by Switching eForms and Electronic Signatures Vendors (Access)
• Automating Your Patient Care (AdvancedMD)
• Physician Lifestyle Profile: Dr. Michael Haghighi (Aprima)
• The Healthcare Leader Perspective: 2018 Health IT Priorities (Spok)
• The New Tax Law (Arcadia Healthcare Solutions)
• The Trusted Exchange Framework and the Pursuit of Interoperability (Datica)
• Texting Patient Information? As Long As You Take These Three Steps (Hayes Management Consulting)
• Attract More Patients with Health Education – 4 Ways to Up Your Online Game (Healthwise)
• 2017 Interoperability Round Up, and a Look Toward 2018 Priorities (Iatric Systems)
• Top 4 Cybersecurity Action Steps for Healthcare CFOs (Impact Advisors)
• Have you adopted electronic prescriptions for controlled substances? (Imprivata)
• Five Guideposts for Transforming Health Care Systems Part IV: Innovate (Ingenious Med)
• When Does PHI Apply? (Influence Health)
• Looking to 2018: How the newest innovations are reliant on a tried-and-true standard (InterSystems)
• The Power of Provider Data Management (Kyruus)

Contacts

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

Monday Morning Update 1/22/18

Top News

From the Allscripts ransomware update Sunday morning:

• The ransomware attack involved SamSam malware, but not the same strain that took down the systems of Hancock Health.
• The vulnerability that was exploited wasn’t within the Allscripts application, so self-hosted customers are not at risk.
• The many services that were taken offline strictly as a precaution have been restored.
• Professional EHR and Allscripts PM are being brought back online in a rolling basis, but clients should plan for their systems to be down Monday. Allscripts is trying to put together a view-only solution.
• Clients that have been brought back online are running normally, not on a temporary instance of their system.
• The malware does not propagate as a worm or via VPN, so client computers will not be infected.
• The company will let customers know what if any HIPAA breach reporting is required.

Allscripts hasn’t said how the malware was introduced, but SamSam’s sole method of entry seems to be unpatched installations of JBoss software, for which Red Hat released SamSam-protecting patches nearly two years ago.

I was mildly amused that to listen in on the Web-based Allscripts ransomware update Sunday morning, I had to install the notoriously buggy and unsecure Flash browser plug-in, which took forever to load, suggested adding other crap software, and required a browser restart. The Allscripts folks on the call noted that several participants couldn’t hear the Flash-powered audio and suggested trying Chrome or Firefox instead of IE/Edge. I was appreciating the potential irony of an anxious doctor dreading an EHR-less Monday morning having his or her home PC infected with Flash-enabled malware while listening to a Flash-required malware update.

Reader Comments

From Tired of the Greed: “Re: Optum Ventures. Bought several companies in 2017, including Advisory Board, because UnitedHealth Group was making so much money they wanted to put capital in the marketplace. Tax reform gave them a huge windfall that they will not be sharing with employees. Raises remain in the usual 1 to 1.5 percent range with zero bonuses for most of my department. Yet upper and senior management (all male in my division) will get nice bonuses and who knows what kind of raises. This is an old boys’ network lining its pockets and those of its shareholders on the backs of patients and physicians with cooked-up ways to deny paying for legitimate medical care.” My reactions are as follows:

• Salary and benefits exist at the intersection of supply and demand. Lack of a mass exodus means employees don’t see better options and thus implicitly accept their employment conditions. I’m sympathetic because a truly fluid employment market means being willing to relocate, travel, or take a less-satisfying job full of uncertainty and family disruption, but it’s a free market both ways.
• You can easily test your worth to the company by threatening to leave unless you get a promotion or raise, but expect the company to call your bluff. They have a ton of employees, but you have only one job.
• Don’t expect a company to be “fair.” Lofty vision statements aside, companies (including non-profit hospitals) exist solely to take in more money than they spend since failure to do so means shutting down. Your only hope is that the person you report to is fair.
• Don’t conflate gender equity with gender-neutral executive entitlement. While it’s true that executive management is dominated by males, it’s probably also true that the suits aren’t secretly doling out perks to their male underlings.
• Executives are also sometimes clueless about working in a non-executive job. I’ve had to soothe many ruffled feathers when a hospital C-level executive forgot who he (being male in this example) went off script in a department meeting and joked about his bonus being at risk if employees failed to deliver and how he liked the view from his expansive office or the convenience of his reserved parking spot hundreds of yards closer than where we peons jacked up our adrenaline levels first thing every work day jockeying for any available spot. He wasn’t evil, just cluelessly entitled and smug about his executive ascent, which he attributed to his brilliance and work ethic (both questionable given even brief observation). Executives are “Animal House’s” Douglas C. Neidermeyer, while the non-privileged are banished to the couch with Jugdish, Sidney, and Clayton.
• Companies (and people) do what someone pays them to do. If they’re making money, they are filling a market need, no matter how socially conscionable their actions are. Blame who’s paying them.
• As cold as it sounds, if you want to control your own future, you have to work for yourself instead of someone else.

From Party Shoes: “Re: HIStalkapalooza. I read HIStalk religiously every day and haven’t seen the details.” It’s amazing how many people who claim to pore over my every word somehow missed the several times I’ve mentioned that I’m not doing the event this year. TL;DR: no HIStalkapalooza this year.

From Chuck Roast: “Re: HIStalk. I read your email newsletter every day. Good job!” I stopped putting teaser bullets in the email blast for exactly this reason – people were confused into thinking it was a self-contained email newsletter rather than a single link to the real online thing. Other folks haven’t figured out that the daily headlines are in addition to the usual M-W-F full posts and complain about overlap. My advice has never changed – if you don’t check HIStalk each weekday, you are almost certainly missing something I thought was important. Just click the home page link and read down the page until you hit something you’ve already seen. The email link goes directly to that particular article, so you won’t see the other stuff there from that link.

From Bitter Pill: “Re: Amazon and Google in healthcare. How could they possibly fail?” In about a million ways, foremost being the error in seeing healthcare as, like every other industry, being driven by consumers who simply require new technology to further empower them with the threat of taking their business elsewhere. Evidence: if patients were empowered consumers, hospitals wouldn’t offer inconvenient parking, 9-5 weekday hours for non-inpatient services, halls full of roaming providers who aren’t in the patient’s insurance network, next-available appointments running weeks into the future, and inflated but incomprehensible bills. Unlike every other market, healthcare is poorly run and consumer-hostile, but full of entrenched players who can easily steamroll any outsider’s efforts to make it better at their expense.

 HIStalk Announcements and Requests

Of the 81 percent of poll respondents who don’t trust KLAS’s product rankings, half think the company is biased or caters to paying vendors.

New poll to your right or here: is Epic an impediment to innovation as Fairview’s CEO says?

I received good responses to my post on “What I Wish I’d Known Before … Replacing My Hospital’s Time and Attendance System.” Next up:  “What I Wish I’d Known Before … Implementing a Vendor’s Cloud-Based Application.” I made a list of fun future topics, but it will evaporate if few folks participate.

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.

February 14 (Wednesday) 2:00 ET. “Time is Money: Aurora Health’s Journey of Implementing and Advancing Cost Accounting.” Sponsored by Strata Decision Technology. Aurora Health Care’s implementation of Strata’s Decision Support module involved not only building an improved cost accounting model, but improving the process to engage a cross-functional team in cost development. It now has accurate, consistent cost data to support decision-making. Aurora’s next phase will be to use actual procedure and visit times to allocate costs. This presentation will provide a detailed view into both the implementation and future direction of the Strata Decision Support program within Aurora.

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

Sales

Three-hospital Astria Health (WA) will implement Cerner under the company’s CommunityWorks hosting program.

People

Amazon hires Martin Levine, MD — a geriatrician and Seattle-area medical director of Medicare primary care practice Iora Health – for an unstated role.

Other

Maybe this isn’t new, but I hadn’t noticed. Signing up for any HIMSS18 pre-conference symposium includes the Pre-Conference Plus benefit. You pay for a particular session, attend its opening keynote, but then are free to move around to other symposia during breaks (it would  be interesting to see which sessions send attendees fleeing for the doors). They all cost $350, so there’s no gaming the system by signing up for the cheapest one and then switching. I also noticed that some conference sessions now list “conference supporters” that HIMSS has convinced to spend even more money, removing yet another safe space for non-vendors trying to evade commercial pitches (you knew that was coming when HIMSS started selling escalator advertising). My brilliant ideas – pay the food court vendors to attach flyers to their $13 chicken Caesars or hire one of those Las Vegas stripper card flippers to further clog the seedy sidewalks. 

Open source EHR vendor OpenMRS – whose product is used in developing countries – receives a $1 million donation from cryptocurrency philanthropy organization Pineapple Fund (its tagline: “because once you have enough money, money doesn’t matter.”) OpenMRS learned that the person who started that organization had previously  contributed OpenMRS software patches. OpenMRS is a non-profit collaborative led by Regenstrief Institute and Boston-based Partners in Health.

Sponsor Updates

• IBM names Salesforce its preferred customer engagement platform for sales and service.
• Sunquest Information Systems will exhibit at the Precision Medicine World Conference January 22-24 in Mountain View, CA.
• Huron will exhibit at the Association of Cancer Executives Annual Meeting January 28 in Portland.
• Conduent will exhibit at the Middle Tennessee Antimicrobial Stewardship Symposium January 26 in Nashville.

Blog Posts

• How Health Policy Censorship Could Impact Public Health (Redox)
• The Anatomy of Medical Marketing (Salesforce)
• 2018 Tips & Trends for Hospital Revenue Cycle Management (The SSI Group)
• 3 Patient Satisfaction Lessons Stolen from Amazon (Solutionreach)
• Gaining momentum. (Voalte)
• Nursing Communication and the Hierarchy of Resiliency (Vocera)

Contacts

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

News 1/19/18

Top News

Some Allscripts remotely hosted systems, including its Professional EHR and controlled substances e-prescribing modules, went down due to a ransomware attack early Thursday.

Only customers whose systems are hosted in the company’s Raleigh and Charlotte, NC data centers are affected.

Allscripts hopes to restore the systems quickly from a backup.

Reader Comments

From Canary: “Re: Vindicet. Heard it is closing its doors next week.” Unverified, since my email to the company’s listed address bounced back as undeliverable. I interviewed CEO Yann Beaullan-Thong back in 2012, but the company has apparently pivoted from electronic referral technology to business intelligence and IT services. The executives listed on its site seem to have all moved on and expunged their history with the company from their LinkedIn profiles.

From Undying Like: “Re: bloat in C-suite titles. Chief Growth Officer? Chief Revenue Officer? Perhaps you should have a contest of how many C-suite titles can be created. I wonder what’s driving this growth of overhead?” I’ve forwarded your request to my Chief Contest Officer. Health systems have made up quite a few C-level titles as well, although I question whether the incumbents actually have equal standing in the mahogany-paneled C-suite. Titles are cheap.

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.

February 14 (Wednesday) 2:00 ET. “Time is Money: Aurora Health’s Journey of Implementing and Advancing Cost Accounting.” Sponsored by Strata Decision Technology. Aurora Health Care’s implementation of Strata’s Decision Support module involved not only building an improved cost accounting model, but improving the process to engage a cross-functional team in cost development. It now has accurate, consistent cost data to support decision-making. Aurora’s next phase will be to use actual procedure and visit times to allocate costs. This presentation will provide a detailed view into both the implementation and future direction of the Strata Decision Support program within Aurora.

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

Acquisitions, Funding, Business, and Stock

The Illinois Chief Procurement Office for Higher Education rejects Cerner’s protest of UI Health’s September 2017 decision to award Epic a $62 million contract, citing Cerner’s inability to “submit a proposal that showed its technical qualifications at the minimum level required” and Epic’s submission that met all of UI’s requirements on price. UI Health CFO Mike Zenn says the protest, filed in late September, has set the implementation back by three months.

Change Healthcare acquires medical guidelines technology vendor National Decision Support Company for an undisclosed sum.

In California, Petaluma Valley Hospital struggles to find new ownership after potential suitor Paladin Healthcare has second thoughts related to replacing PVH’s EHR, which is coupled with the systems of its former owner, St. Joseph Health. St. Joseph says it would be expensive to remove the hospital from its system and offered $2 million toward its replacement, which would cost $5.5 million, and Paladin said OK as long as the hospital agreed to be taken over first.

Several large health systems that operate 300 hospitals and possibly the VA will form a non-profit company that will provide generic drugs for hospitals. They will attempt to work around situations where shortages occur because only one or two companies manufacturer a generic product or where a company uses its monopoly to jack up the price of old drugs.

People

Daniel Castillo, MD (Evolution Health) joins patient decision support company WiserCare as CEO.

Carevive Systems hires Jamel Giuma (Sunquest) as VP of product management.

Sales

Deaconess (IN) chooses Stanson Health’s clinical decision support.

Digestive Care (FL) will replace its Greenway Health EHR with EClinicalWorks.

Announcements and Implementations

DirectTrust says Direct users sent 167 million message transactions in 2017, a 70 percent increase over 2016. The number of DirectTrust addresses increased 16 percent to 1.6 million.

According to his LinkedIn, former HIMSS President Steve Lieber will sell consulting services (governance development, analysis, business expansion) to associations and companies as well as acting as a technical and business advisor to start-ups, all under the newly created umbrella of Avisos Partners. Google tells me that Avisos is Catalan for “warnings.”

Government and Politics

FCW confirms that the DoD’s Cerner rollout is on a routine hold as the project plan has specified all along, not as the result of a new decision triggered by support tickets as a recent Politico report indicated. The rollout was to be reviewed through most of 2018 before implementation beyond the four pilot sites would continue and that plan hasn’t changed.

Research and Innovation

Penn Medicine researchers find that ED physicians prescribe fewer opioid pills when an EHR default setting of 10 tablets units is introduced.

Privacy and Security

Adams Health Network (IN) works to restore its servers after a January 11 ransomware attack that took down its scheduling and EHR systems. Hospital employees say their screens indicated “sorry,” common wording of the SamSam ransomware that infected Hancock Health (IN) last week, for which that hospital paid the demanded $55,000 ransom.

Aetna will pay $17 million to settle a class-action lawsuit filed after it mailed HIV medication notices to patients in envelopes with see-through windows.

Other

All of us have had this experience. Many have, like me, also had the health system flat out refuse to give me my data electronically even after I filed an HHS OCR complaint that resulted only in HHS offering it “technical assistance” when technology was not the problem at all.

Microsoft will discontinue its HealthVault Insight app less than a year after its introduction, saying that it was a research project whose insights will be used in other projects. It joins the Microsoft Band fitness tracker in the trash heap of no-longer-shiny objects. Validic was chosen to provide connectivity to the app’s patient-generated health data in a splashy May 2017 announcement.

In Canada, radiologists at BC Children’s Hospital will manually review thousands of charts after finding that integration of ultrasound results with its EHR has been disabled for a year, sometimes preventing doctors from realizing that results were available.

Bankrate’s latest Financial Security Index finds that only 39 percent of Americans have enough savings to cover an unexpected $1,000 expense, such as an ED visit. The likely choice that wasn’t mentioned for the ED example was “ignore the hospital’s bill in prioritizing cell phone and cable payments first because those companies will actually shut me off from my all-important entertainment.”

ACEP pushes back at Anthem’s decision to charge members for unnecessary visits to the ED with a TV commercial.

Sponsor Updates

• Healthcare Growth Partners recaps the nine transactions it closed in 2017 – RPA, Ontellus, Kognito, Prognosis Innovation Healthcare, Callpointe, Symplr, OmniSys, Clockwise.MD, and High Line Health.
• PerfectServe publishes a new success story featuring The University of Tennessee Medical Center, “Streamlined follow-up appointment scheduling aims to reduce readmissions.”
• LogicStream Health launches a podcast series.
• ChartLogic parent Medsphere reports a 45 percent growth in 2017 subscription revenue.
• LifeImage celebrates its tenth anniversary with major milestones.
• MarketsandMarkets recognizes Liaison Technologies as a “Visionary Leader in the Hybrid Integration Platform Market.”
• MedData will exhibit at the ACEP Reimbursement & Coding Conference January 22-26 in Nashville.
• Meditech announces that 92 healthcare organizations implemented its Web EHR in 2017, 47 of which were new customers.
• Lane Regional Medical Center selects CloudWave hosting services for its Meditech EHR.
• W2O Group features PokitDok CTO Ted Tanner in its JP Morgan recap.

Blog Posts

• 2018 Cybersecurity Resolutions: Start Focusing on the Fundamental (Fortified Health Security)
• Agile Healthcare: Reduce toil to improve care coordination and clinical workflow (LiveProcess)
• Doctors hold the solution to the opioid crisis in our hands (Meditech)
• People with Addiction Issues Should be Able to Control Their Own Data (Netsmart)
• 2018 Rock Solid Award Winners (Parallon Technology Solutions)
• We Successfully Installed Our New EHR – Why Haven’t Things Changed? (Optimum Healthcare IT)
• Patient engagement technology: Transform into a proactive healthcare organization (Experian Health)
• Welcome, 800 Pound Gorillas (PatientKeeper)

Contacts

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

Ransomware Attack Takes Down Some Allscripts Systems

Allscripts reports that a ransomware attack has taken down some of the applications that are hosted in its Raleigh and Charlotte, NC data centers.

The company says Allscripts Professional EHR is unavailable to customers hosted in those data centers, as are instances of its electronic prescribing of controlled substances system.

Allscripts says it expects to restore its systems quickly from backups.

An Allscripts user and HIStalk reader reports that other functions have been down since this morning, including InfoButton, regulatory reporting, clinical decision support, direct messaging, and Payerpath.

The company has not acknowledged the downtime on its website or social media accounts.

I emailed a media contact but haven’t heard back. UPDATE: the Allscripts media contact provided this statement:

We are investigating a ransomware incident that has impacted a limited number of our applications. We are working diligently to restore these systems, and most importantly, to ensure our clients’ data is protected. Although our investigation is ongoing, there is currently no evidence that any data has been removed from our systems. We regret any inconvenience caused by this temporary outage.

News 1/17/18

Top News

Hancock Health (IN) pays a hacker’s demanded four bitcoin in ransom – worth $55,000 at the time of payment — to regain access to its systems. The health system’s CEO says it made business sense to pay the hacker instead of taking weeks to recover its systems.

Once paid, the hackers restored the hijacked files within two hours, allowing the health system to bring its systems back up Monday after four days’ of downtime.

Hancock Health says the hacker penetrated its systems via its remote access portal — using the login credentials of one of the health system’s vendors — to manually deploy the SamSam ransomware. That same malware took down Erie County Medical Center (NY) in May 2017 and Hollywood Presbyterian Medical Center (CA) in early 2016, both of which also paid the ransom.

Hancock Health  did not mention the attack on its website or social media until after it had recovered its systems, with the announcement saying nothing about paying ransom. The explanation is ironically positioned on its website right above the hospital’s press release touting its award for “Most Wired.”

Reader Comments

From Watcher of the Skies: “Re: tax reform’s pass-through provision. I’m wondering if more health IT consultants are setting up shop as independent contractors rather than consulting firm employees?” Readers, please weigh in. The tax bill slashed corporate tax rates from a maximum of 39 percent to a flat 21 percent. Congress then added the pass-through tax to provide similar benefits to small businesses such as sole proprietorships, partnerships, LLCs, and S-corporations, giving high earners who pay individual tax rates of up to nearly 40 percent an incentive to pass that income through a lower-taxed business entity they control. 

HIStalk Announcements and Requests

You can join my Rolodex if you’re willing to provide occasional reaction to news items and to give me ideas about things I should write about. I won’t spam you and I’ll use whatever method of communication you prefer. Example: suppose the VA announces something about Cerner – I would go to my Rolodex to see who might knowledgably comment (anonymously or not) for my write-up. Thanks.

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

Nordic acquires the revenue cycle transformation practice of The Claro Group. which says it will refocus on its core businesses of disputes, claims, and investigations.

People

Mon Health (WV) hires Mark Gilliam (Owensboro Health) as CIO.

Sam Adams (Image Stream Medical) joins Patientco as chief growth officer.

FormFast hires Art Nicholas (NoteSwift) as chief revenue officer.

Announcements and Implementations

EHNAC releases its 2018 accreditation criteria for electronic data exchange.

In China, Amcare Women’s & Children’s Hospital’s Wanliu Campus goes live on InterSystems TrakCare.

Government and Politics

Politico says the DoD is placing its MHS Genesis Cerner project on hold for eight weeks because of a large number of open problem tickets and doctor complaints about poor workflows that those doctors say were copied directly from fellow Cerner customer Intermountain Healthcare. I don’t understand Politico’s statement, however, that further installations won’t go forward until fall – the DoD’s project plan had already called for no further implementation beyond the four initial sites until late 2018 pending completion of the required independent review of cost and suitability.

Gallup finds that 2017’s 1.3 percent increase in the number of uninsured Americans is the largest single-year jump since it starting tracking the number in 2008. The number, now at 12.2 percent, peaked at nearly 18 percent in January 2014 just before the ACA’s individual mandate and Medicare expansion took effect. Subgroups with the highest rate of uninsured include Hispanics, people in households with incomes under $36,000, and those aged 26-34. The percentage of people who bought their own insurance plans – such as through exchanges – dropped 1 percentage point in the past year, the first time that number has gone down since the ACA was enacted.

Other

The CEO of Fairview Health Services (MN) tells a healthcare CEO panel that Epic is an “impediment to innovation” and calls for customers to “march on Madison.” The Twin Cities business paper quotes James Hereford as saying,

I will submit that one of the biggest impediments to innovation in healthcare is Epic, because the way that Epic thinks about their [intellectual property] and the IP of others that develop on that platform. There are literally billions of dollars in the Silicon Valley chasing innovation in healthcare, and yet Epic has architected an organization that has its belief that all good ideas are from Madison, Wisconsin. And on the off chance that one of us think of a good idea, it’s still owned by Madison, Wisconsin … There is an opportunity for us to go to Epic and say, look, you have to open up this platform. It’s for our benefit in terms of having an innovative platform where all these bright, amazing entrepreneurs can actually have access to what is essentially 80 percent of the US population that is cared for within an Epic environment. I would love for us to get together to see how we march on Madison.

Amazon posts a job for HIPAA Compliance Lead for “a new initiative,” listing among its preferred qualifications experience with FDA’s medical device approval process.

Coalinga State Hospital (CA) – a 1,500-bed, state-run psychiatric hospital for repeat sexual offenders who are receiving extended treatment — goes on lockdown when inmates riot following the hospital’s ban on electronic devices that can play media from sources other than commercially produced CDs and DVDs.

Fans watching the dramatic finish of Sunday’s Saints-Vikings football playoff game say their Apple Watches warned them they might be having heart attacks. Previous studies have proven that rabid fans, especially those with coronary artery disease, are more likely to have heart attacks when game intensity hikes their pulse rates by as much as 100 percent. Maybe people who are bored by watching sports should tune them in to lower their pulse and BP as they nod off in front of the TV.

Sega announces Two Point Hospital — a hospital management simulation game from the creators of 1997’s Theme Hospital — with a funny, infomercial-like video teaser.

Sponsor Updates

• Audacious Inquiry will exhibit at the DVHIMSS Winter Symposium January 18 in Philadelphia.
• Besler and Culbert Healthcare Solutions will exhibit at the MA/RI HFMA Revenue Cycle Conference January 18-19 in Foxborough, MA.
• Iatric Systems will exhibit at the HCCA Charlotte Regional Conference January 19 in North Carolina.
• InstaMed will exhibit at the MA/RI Chapter HFMA Revenue Cycle Conference January 18-19 in Foxborough, MA.

Blog Posts

• 2017 Brings Strong Momentum and Growth for MEDITECH (Meditech)
• The Two-Pronged Approach towards Effective Healthcare Recruiting and EHR Adoption (Leidos Health)
• The Case for Continuous Clinical Surveillance (Bernoulli)
• 6 Healthcare Trends to Watch in 2018 (Datica)
• Blockchain Healthcare: Patient Medical Records, Health Data, and More (CareSync)
• Bridging Population Health Management and Clinical Interoperability (Casenet)
• Joint Commission: Citing of Hand Hygiene Noncompliance (CenTrak)
• Why AI by Any Name is Sweet for Radiology (Change Healthcare)
• New Year’s Resolution (CTG)
• Wellness in the Workplace (Direct Consulting Associates)
• Healthcare Consolidation: What to Watch for in 2018 (Dimensional Insight)
• “They have their little phones!” (EClinicalWorks)
• 3 Key Planning Steps to a Smooth IT Transition (Hayes Management Consulting)
• Prepare and Prevent Common Due Diligence Issues in Health IT Transactions: Human Resources Considerations (Healthcare Growth Partners)
• TEFCA in a Nutshell (Impact Advisors)
• Imprivata’s cloud-based products achieve SOC 2 certification (Imprivata)
• Five Guideposts for Transforming Healthcare Systems – Part II: Centralize Governance (Ingenious Med)
• SEO for Doctors (Influence Health)
• From Barefoot to Broad-Based: How Information Management is Changing Care in China (InterSystems)
  

  ---

Contacts

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

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.
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