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Monday Morning Update 11/5/18

November 4, 2018 News 10 Comments

Top News

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From the Allscripts earnings call following release of poor quarterly numbers that sent shares down 19 percent Friday:

  • The company will launch a formal sales process for its share of Netsmart, which it says is a complex transaction because of the terms of the joint venture agreement between the companies. 
  • Netsmart’s Q3 business performance was “lighter than we expected” and executives on the call repeatedly stated how much better the Allscripts numbers would have been without Netsmart (which isn’t exactly talking up a planned divestiture), although CEO Paul Black said, “we are very bullish about Netsmart’s prospects whether or not a transaction is ultimately consummated in the near term.”
  • Northwell Health extended its TouchWorks agreement for another five years. Questioned by an analyst about whether Northwell (which is the largest customer of Allscripts) will also extend its Sunrise agreement, President Rick Poulton waffled, saying only that Northwell has one year left on its managed services agreement and that it’s not a high-margin business.
  • The company says it and its competitors know that the EHR and revenue cycle solutions market is mature and the churn isn’t going to generate a lot of net profit for anyone. Allscripts will ramp up services offerings to offset the decline.
  • The company again did not mention its previously highly touted Avenel EHR that was unveiled at HIMSS18.
  • Allscripts hopes to increase the margin of the former McKesson EIS business from single-digits to 18-20 percent.
  • The company says retention of customers of the formerly free Practice Fusion is strong after Allscripts started charging for it, adding that Allscripts is blending that business in with its payer and life science offerings (Practice Fusion runs drug company ads and sells de-identified patient data to pharma).

Reader Comments

From Lil’ Mob: “Re: Healthcare Informatics sold. HIStalk is the rare, independent voice in this space.” Vendome sells Healthcare Informatics magazine to another publisher whose goal is helping vendors “bring their services and products to market” (which I take to mean that seldom is heard a discouraging word that might make the ad salespeople’s job harder). For example, the four most important news stories of last week were not flattering to vendors – ProPublica’s critical assessment of the VA’s Cerner implementation, poor quarterly results from Allscripts and NextGen Healthcare, and Orion Health’s desperation-fueled sale of Rhapsody. None of those stories appear on the websites of the magazines that finished most closely (but still way behind) HIStalk in Reaction Data’s C-level provider survey. They instead ran with these questionably useful stories:

  • Is emotional support part of AI’s future in healthcare?
  • In Northern Virginia, Rethinking ACO Strategies—For PCPs and Specialists
  • Royole’s bendy-screen FlexPai phone unveiled in China

HIStalk Announcements and Requests

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Most poll respondents are proud of what their employer sells. New poll to your right or here: what are your HIMSS19 plans?


Webinars

November 7 (Wednesday) 3:00 ET. “Opioid Crisis: What One Health Plan is Doing About It.” Presenter: Samuel DiCapua, DO, chief medical director, New Hampshire Health Families; and chief medical officer, Casenet. Sponsor: Casenet. This webinar will describe how managed care organization NH Health Families is using innovative programs to manage patients who are struggling with addiction and to help prevent opioid abuse.

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


Acquisitions, Funding, Business, and Stock

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Information management technology vendor OpenText will acquire competitor Liaison Technologies for $310 million in cash.

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England’s NHS Digital will eliminate 500 jobs in a restructuring, about 20 percent of its staff.

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Apple turns in record Q4 numbers driven by jacked-up prices rather than increased sales or innovation. Shares sank Friday after the company announced that it will no longer provide individual unit sales or average prices, which would lead to the conclusion that (a) the company plans to hold price-insensitive fanboys hostage to make its numbers; and (b) Apple would rather not publicize the fact that it’s milking the cash cow harder (in a mature market in which its products are the highest priced) by increasing services and add-on revenue per customer, which isn’t very transparent for a traditionally transparent company. Much of the market won’t pay baseline prices of $1,300 for an IPhone, $1,800 for a Macbook Air, $399 for an Apple Watch, or $799 for an IPad Pro. Meanwhile, the company kicks the latest dent in the universe in an enhancement to the IPad, which will no longer offer a headphone jack. 


People

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Dean Smith, MD, MBI (US Department of State) joins GlobalMed Telemedicine as CMIO/SVP of government relations.


Announcements and Implementations

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Epic signs an agreement to give insurer New York Life direct access to its EHR to extract information for people who are applying for life insurance.

PatientPing adds the capability to tag patients who are covered under bundled payment models.


Government and Politics

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The Federal Trade Commission shuts down a Florida company that sold $100 million worth of worthless health insurance plans, saying that Simple Health Plans LLC misled purchasers into thinking that its medical discount program – which cost up to $500 per month — was actual insurance. The “insurance” does not cover pre-existing conditions or prescriptions, pays a maximum of $100 per day for hospitalization, and has a yearly cap of $3,200 and even then only if the patient is hospitalized for 30 days or more. The government’s restraining order also calls for seizing the owner’s $1 million bank account and his Lamborghini, Range Rover, and Rolls-Royce.


Privacy and Security

Defunct Georgia-based Best Medical Transcription pays $200,000 to settle charges that it exposed the information of patients of Virtua Medical Group (NJ) to Internet searches, a problem reported by a patient who Googled herself and found her own medical records. The New Jersey attorney general also banned Best Medical owner Tushar Mathur from doing business in the state.


Other

Kaiser Health News notes that Epic can’t handle vital signs entered between 1:00 a.m. and 2:00 a.m. on the Sunday when daylight saving time ends because those entries will be deleted when the clock is set back, forcing hospitals to document manually until after the time change. The articles says that nurses at Johns Hopkins and Cleveland Clinic date their entries after the time change to 1:01 a.m., but add a note that the vital signs were actually taken an hour after the previous entries rather than just one minute.

Steve Ballmer becomes the latest rich person to donate millions to a hospital, leading me to implore the financially fortunate to support public health, not expensive healthcare service vendors (even if their customer base consists of heartstring-tugging children). Seattle Children’s doesn’t really need Steve’s $20 million – last year it had a $224 million profit on $1.4 billion in revenue – and it’s a shame that such tech titan largesse is always focused on their home cities like Seattle, San Francisco, and Palo Alto.

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A Boston Globe magazine piece called “Losing Laura” describes the death of a 34-year-old woman who walked to the ED of Somerville Hospital while experiencing an asthma attack but couldn’t get in because of a confusingly marked entrance and the inability of 911 operators to pinpoint her precise location on the campus. She collapsed outside a locked glass door through which she could see the ED waiting area, and a hospital nurse who went outside to look for her from the 911 call didn’t notice her on the ground. I’m at least a little bit sympathetic to the hospital, which is otherwise being sued and cited by the state – EDs in suburban hospitals were not usually designed for walk-up access in life-threatening emergencies. The article notes that while Uber and Lyft drivers are guided directly to their fares with near-perfect accuracy, the FCC requires cell providers to locate a 911 caller only to within 300 meters.

In India, a judge who is annoyed at deciphering illegible doctor handwriting on injury and death reports requires them to print and sign transcribed copies from their computers. The same court previously ordered doctors to write legibly and fined those who didn’t, but the problem persisted.

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The author of the bestselling “PH Miracle” book series, who claimed that an acidic diet causes disease and offered treatments around that principle, is ordered to pay $105 million to a cancer patient who sued him for negligence and fraud. The author, who had already served jail time for practicing medicine without a license, advised the patient – who was also a former employee of his — to forego traditional cancer treatment and instead let him take over with sodium bicarbonate IVs administered at his $3 million ranch.


Sponsor Updates

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  • Lightbeam Health Solutions employees team up with Habitat for Humanity in Dallas.
  • LogicStream Health will exhibit at the National Association for Healthcare Quality Conference November 5-7 in Minneapolis.
  • CitiusTech names seven industry leaders to its advisory board.
  • CHIME elects Meditech EVP Helen Waters to the CHIME Foundation Board.
  • Mobile Heartbeat will host a user group meeting November 7-9 in Sunny Isles Beach, FL.
  • Netsmart will exhibit at the National Hospice and Palliative Care Organization Fall Conference November 5 in New Orleans.
  • Nordic will host a reception during the Population Health and Connect Summit November 7 from 6:30-8:30pm in Madison, WI.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the Michigan Critical Access Hospital Conference November 8-9 in Traverse City.
  • OnPlanHealth announces a partnership with the Dallas-Fort Worth Hospital Council.
  • Meditech recaps its Physician and CIO Forum.
  • KLAS recognizes PatientSafe Solutions and Voalte as top vendors in its “Decision Insights: Secure Communication 2018” report.
  • Pivot Point Consulting will exhibit at the 2018 HIMSS Virginia Fall Conference November 5-7 in Williamsburg, VA.
  • The SSI Group will exhibit at the Georgia HFMA Fall Institute November 7-9 in Savannah.
  • Sunquest Information Systems will exhibit at the ATLAS Medical User Group November 6-7 in Chicago.
  • Waystar will exhibit at CHUG Southeast November 8-10 in Nashville.
  • Surescripts will exhibit at the NextGen User Group Meeting November 11-14 in Nashville.
  • SymphonyRM will host a networking event at HCIC18 November 6 from 7-10pm in Scottsdale, AZ.
  • AMIA includes TriNetX VP of Informatics Matvey Palchuk in its inaugural class of fellows.

Blog Posts


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Contacts

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News 11/2/18

November 1, 2018 News 4 Comments

Top News

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ProPublica investigates the VA’s no-bid, $10 billion Cerner project, with these findings:

  • Trump advisor and son-in-law Jared Kushner pushed the no-bid selection of Cerner, naively assuming that interoperability would be automatic if VA and DoD used the same company’s product. “The premise of all of this is incorrect,” a former project official now concludes, adding, “We thought it made perfect sense until we looked under the hood.”
  • The VA team, which justified choosing Cerner without a bidding process by claiming it would create “seamless care,” has stopped using that term and now just says VA doctors will be able to see DoD records, which they can already do with their old systems.
  • The White House rejected qualified candidates for CIO and other oversight roles and instead proposed former Trump campaign officials who have no health IT experience.
  • One of those rejected candidates was former Sutter Health CIO Jon Manis, who questioned the role of Bruce Moskowitz, MD — the physician member of the Mar-a-Lago group of Trump supporters that was reported to be meddling in VA affairs – and feared that the project’s politics and instability would make the job impossible.
  • Since-fired VA Secretary David Shulkin, MD sent Cerner reps packing when they showed PowerPoints instead of something real, explaining that he planned to hold Cerner to a higher standard than just installing its standard software. He expected to create a single lifetime health record with computerized decision support.
  • A group of hospital executives warned the VA that Cerner’s off-the-shelf product and VA-DoD data synchronization would not by itself achieve the VA’s goal of seamless care.
  • The VA’s project to mine EHR data for key clinical insights was abandoned with the selection of Cerner, which turned out to not have those capabilities.
  • Cerner was found to be missing key VA capabilities such as Agent Orange exposure, spinal cord injury, and PTSD.
  • Intermountain Healthcare CMIO Stan Huff told the VA, “If you install Cerner as an off-the-shelf product, your clinicians are going to be extremely unhappy and everybody is going to ask why did you spend billions of dollars for a crappy system.”
  • The DoD has proposed sending only 1-3 years of service member and dependent records to the VA’s new system.
  • Since-resigned VA CHIO Genevieve Morris could not get VA clinicians to participate and found herself in a political power struggle with new CIO Camilo Sandoval (no health IT experience), John Windom (whose expertise is procurement), and Rich Stone, MD (the VA’s top health official).
  • The VA spent at least $874,000 on a kickoff event held at Cerner’s headquarters, where Morris and Windom argued over stage time and walk-on songs and tried to gloss over the project’s convoluted org chart.
  • Cerner’s internal progress report rates the project’s alert level as “yellow trending towards red.”
  • The DoD is so concerned about VA’s project oversight that they have proposed taking the project over, although the Pentagon’s lawyers said that probably isn’t legal.

Cerner has reportedly emailed veterans groups to warn them of “negative media coverage, including a piece from ProPublica.”


Reader Comments

From Fortune Teller: “Re: Medicare’s Patients Over Paperwork initiative. Do you have a prediction on what to expect?” I’ll let readers and Dr. Jayne chime in on the proposed changes to E&M codes, office visit documentation, and other paperwork that were first floated by CMS a year ago. It’s hard to separate meaningful HHS/CMS announcements from the political rhetoric spouted by its campaigner-appointees, so I’ve quit trying.


HIStalk Announcements and Requests

I added a “Add/Read Comments” button at the bottom of this post. It will make it easier to add a comment after reading. Let me know what you think.

Mrs. HIStalk shamed me into accompanying to seeing yet another movie (a rarity for me), in which case I give “First Man” a B- for being dull, presumably accurate, and nausea-inducing for using the “shaky cam” such that living room scenes are far harder to watch than when Gemini and Apollo spacecraft are careening wildly through space (“The Right Stuff” is about a hundred times better in every way). Before that, I laughed out loud at the preview of awful-looking sing-along, Queen-approved puff piece “Bohemian Rhapsody” as the audience all reflexively ducked to avoid being gored by the massive fake teeth of Freddy Mercury (Rami Malek).


Webinars

November 7 (Wednesday) 3:00 ET. “Opioid Crisis: What One Health Plan is Doing About It.” Presenter: Samuel DiCapua, DO, chief medical director, New Hampshire Health Families; and chief medical officer, Casenet. Sponsor: Casenet. This webinar will describe how managed care organization NH Health Families is using innovative programs to manage patients who are struggling with addiction and to help prevent opioid abuse.

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


Acquisitions, Funding, Business, and Stock

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Orion Health finalizes its sale of Rhapsody to technology investment firm Hg, enabling Rhapsody to launch as an independent company in Boston under the leadership of former McKesson executive Erkan Akyuz. The company, which offers health data integration software, plans to increase staff by 40 percent over the next 18 months.

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Bloomberg reports that Elliott Management and Veritas Capital have teamed up to bid on Athenahealth. Veritas acquired GE’s ambulatory care, revenue-cycle, and workforce management software business for $1 billion in April.

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Allscripts reports Q3 results: revenue up 16 percent, EPS $-0.20 vs. –$0.16, missing Wall Street expectations for both. Shares were down 9 percent in early after-hours trading Thursday following the announcement.

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NextGen Healthcare, in its first quarterly report since changing its name from Quality Systems, Inc. on September 10, reports Q2 results: revenue down 2 percent, adjusted EPS $0.24 vs. $0.22, beating earnings expectations but falling short on revenue. Shares dropped 24 percent on the news, valuing the company at $968 million. From the earnings call:

  • Customer attrition rate in the trailing 12 months was higher than expected at 13.9 percent, as “Epic clients continue to sweep through their physician practices and as Cerner continues to convert the Siemens ambulatory base post-acquisition.”
  • The company will “sort of be proactive. We’re actually getting in and optimizing those clients long before they ever even think about whether or not there is a different opportunity available for them within their local ecosystem.”
  • The company has eliminated the COO role that was vacated with Scott Bostick’s resignation in September 2018, with sales and services now reporting directly to the executive team.
  • The company will add new financial services and contract management offerings.
  • Long implementation cycles with all-in customers reduced the conversion of bookings to revenue.
  • President and CEO Rusty Frantz said in response to an analyst’s question about one-time accruals that it was “my least favorite one-time accrual … lowering the management incentive plan because our expectations on revenue are not what they were at the beginning of the year.”
  • NextGen isn’t seeing any sales benefit of Athenahealth’s tribulations, saying that ambulatory physicians look purely at products rather than investor-side activity.
  • The company is making a push to upgrade the 50 percent of its clients that are on older product versions and will eventually implement end-of-life support.

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Meditech reports Q3 results: revenue down 2 percent, EPS $0.52 vs. $0.47. Product venue slipped 7 percent due to implementation delays.


People

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McKesson CEO John Hammergren will retire on March 31, 2019. to be replaced by President/COO Brian Tyler.

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PeraHealth hires industry long-timer Greg White (PerfectServe) as CEO.


Sales

  • Hawaii Health Information Exchange will implement NextGate’s cloud-based provider registry and enterprise master patient index.
  • Asquam Community Health Collaborative (NH) signs a managed services agreement with Huntzinger Management Group for LRGHealthcare and Speare Memorial Hospital. Asquam’s IT staff will become Huntzinger employees.
  • Citizens Medical Center (TX) selects automated pre-bill coding analysis software from Streamline Health Solutions.
  • Lake Regional Health System (MO) will implement Cerner Millennium in collaboration with University of Missouri Health Care.
  • Inova Health System (VA) will expand the rollout of Spok Care Connect clinical alerting beyond its initial implementation at Inova Fairfax Hospital.

Announcements and Implementations

Adventist Health System (FL) implements Glytec’s EGlycemic Management System at 33 facilities in seven states.


Government and Politics

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Cerner Government Services President Travis Dalton provides an update on the company’s DoD and VA software implementation efforts, highlighting workflow and care improvements made at the initial DoD implementation sites and the company’s receptiveness to progress reports from those facilities, which, as he acknowledges, have been seen by some as setbacks. He adds that the company is ready to kick off implementations at military medical facilities in California and Idaho.

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HHS re-launches the Healthcare Cybersecurity and Communications Integration Center as the Health Sector Cybersecurity Coordination Center. HC3 will operate under the authority of the Department of Homeland Security. The initial HCCIC suffered from organizational delays and leadership setbacks tied to allegations of ethics violations that led to an OIG investigation.


Privacy and Security

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A reader sent this Reddit-posted breach item claiming that employee and dependent information from Cerner’s health plan was posted to a company wiki and had been visible internally for nearly a year. I reached out to Cerner and received this response:

Some data about associate benefits was posted on a password-restricted intranet site. The personally identifiable information was not exposed or accessed by anyone from outside the company. The data was viewed by a small group of associates, all of whom have had extensive HIPAA training. Due to the limited nature of the exposure, we determined that this did not constitute a data breach and we are not formally reporting this matter.


Other

IBM’s Red Hat acquisition will enable it to move Watson Health services to a hybrid cloud model, which the company says will give customers easier access to data for analytics and AI projects. Initial converted data sets will include claims and patient data from IBM’s Truven Health Analytics, Explorys, and Phytel acquisitions.

A Kaiser Health News report says that precision medicine for cancer treatment sounds good, but insurers cover the cost poorly if at all because the treatments are off label and evidence is lacking that they extend lifespan. The article profiled a breast cancer patient who can’t afford the $17,000 per month cost of AstraZeneca’s drug, and after the story ran, the drug company immediately offered to comp it (thus proving that in our unbelievably screwed-up healthcare non-system, the biggest shortage we have isn’t of doctors or other clinicians, but rather reporters).

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A nurse in Germany who is serving a life sentence for killing two hospitalized patients confesses to killing at least 100 more in two hospitals, explaining that he enjoyed trying to resuscitate the patients he chose randomly to inject with arrhythmia-inducing drugs. Authorities and the families of his alleged victims question why he wasn’t caught sooner, even in one case in which he was caught in the act of injecting a patient but was allowed to work for another two days, during which time he killed another one. Hospital records showed that death and resuscitation rates doubled when he was working, a nice piece of analytical work in every way except timeliness.


Sponsor Updates

  • Mobile Heartbeat attains 100,000 monthly active users of its MH-CURE unified clinical communications platform.
  • EClinicalWorks will exhibit at AAP 2018 November 3-5 in Orlando.
  • Allina Health CIO Jonathan Shoemaker and Health Catalyst win CHIME’s 2018 Collaboration Award.
  • Nuance shares results following Piedmont Healthcare’s implementation of the company’s clinical documentation products.
  • Formativ Health publishes a new white paper detailing ways providers can grow and maintain their patient panels.
  • Kids Rock Cancer Center shares how FormFast has benefitted its care team.
  • Glytec publishes a new e-book, “Hypoglycemia in the hospital. Why is it costing you millions and what can you do?”
  • CHIME names Nuance Communications VP Kali Durgampudi its 2018 Foundation Industry Leader.
  • Bumrungrad International Hospital in Thailand implements the InterSystems TrakCare EHR.
  • ChartLogic parent company MedSphere supports federal efforts to alleviate the opioid epidemic.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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Morning Headlines 11/1/18

October 31, 2018 News 1 Comment

Athenahealth Is Near Deal With Veritas Capital, Elliott

Bloomberg reports that Elliott Management and Veritas Capital have teamed up to bid on Athenahealth.

DoD and VA Update: Early Results, Fine-tuning and Next Steps

Cerner Government Services President Travis Dalton updates stakeholders on the company’s DoD and VA software implementation efforts, noting it is “well positioned” for the DoD’s next phase at medical sites in California and Idaho.

HHS rolls out cyber center successor (to criticism)

Government officials cry foul over long-delayed HHS efforts to re-launch the fractious Healthcare Cybersecurity and Communications Integration Center as the Health Sector Cybersecurity Coordination Center.

Rhapsody Announces Completion of Acquisition by Hg, Launches as Independent Company Under New Leadership

Orion Health finalizes its sale of Rhapsody to Hg, enabling Rhapsody to launch as an independent company in Boston under the leadership of former McKesson executive Erkan Akyuz.

News 10/31/18

October 30, 2018 News 3 Comments

Top News

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Seattle-based 98point6 raises $50 million to expand its chat-powered “virtual primary care” unlimited service that costs a flat $20 per year for the first year, then $120 in following years.

The company’s 15 doctors serve patients in 38 states.

Millennials and others for whom convenience is paramount will probably love turning a doctor visit into a text chat, but calling it “primary care” seems like a stretch since it’s just responding in kneejerk fashion to user-reported symptoms, with no effort made to provide continuity of care or chronic condition management. Anyone want to spend $20 to give it a test drive and let me know how it turns out? I bet the $20 deal doesn’t last long. 

I’m interested that the company’s terms of use include a binding arbitration clause, leading me to question (a) does that clause really prevent malpractice lawsuits and instead force plaintiffs into arbitration with no class action option? (legal precedents suggest yes), and if so, (b) why don’t more doctors include binding arbitration clauses in their “new patient” forms with hopes of getting more reasonable judgments than are often awarded by juries made up of mostly retirees, students, and the unemployed?


Reader Comments

From Doyenne: “Re: Cerner share price. It’s dropping due to ‘Cernover,’ in which whole metropolitan areas like Seattle, Chicago, and the Bay Area are switching. Contracting: Seattle Children’s and University Washington. Implementing: University Illinois Chicago, Northwestern. Implemented: Dallas Children’s, Packard Children’s, Royal Children’s (Melbourne), University of Utah, Loma Linda, John Muir.” Unverified, and I agree only somewhat. Certainly Epic’s focus on academic medical centers has given it high-profile customers that created regional momentum, but Cerner is still turning in good numbers due to diversification even as Epic has inflicted obvious pain. Cerner talks less these days about big hospital wins, ambulatory, revenue cycle, and CommonWell and instead reassures investors about population health, IT services, non-US sales, sales outside the Millennium base, and its perfectly timed contracts with the DoD and VA (all of which conveniently avoid butting heads with Epic). The biggest questions are how the company will perform given the questionably credentialed replacements it chose for Neal Patterson and Zane Burke; the good or bad PR that will result from whatever happens with DoD and VA; and diversifying its business to meet Wall Street growth expectations while avoiding becoming a GE-like unfocused conglomerate that behaves like a dull mutual fund. Quite a few companies stumble after they lose a fire-breathing visionary leader, but like Apple, Cerner can always keep booking add-on sales of services, accessories, and questionably improved new models to an existing client base that is reluctant to shop elsewhere. My bottom line: while Epic’s business is solely focused on EHR customers and it’s hard to beat (and getting harder) in that market, Cerner is not limited to EHR sales, and investors price its shares accordingly even though we hospital-centric insiders see Epic as the unstoppable juggernaut.

From Splainin’ to Do: “Re: startups. This health IT site is charging startups to have their updates and company profiles published as fake news. Do it!” No thanks. That site didn’t even register in the Reaction Data survey of C-level health system executives and charging vendors to run their biased content seems to be yet another way to send readers fleeing. You can sell your integrity only once and you can’t buy it back afterward. I take an infrequent look at the content, advertisers, and overall excellence of sites similar to mine and I don’t see many ideas I’d want to emulate.


Webinars

November 7 (Wednesday) 3:00 ET. “Opioid Crisis: What One Health Plan is Doing About It.” Presenter: Samuel DiCapua, DO, chief medical director, New Hampshire Health Families; and chief medical officer, Casenet. Sponsor: Casenet. This webinar will describe how managed care organization NH Health Families is using innovative programs to manage patients who are struggling with addiction and to help prevent opioid abuse.

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


Acquisitions, Funding, Business, and Stock

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IBM will acquire Red Hat for $34 billion, apparently hoping to reverse years of declining revenue by trying to compete with entrenched cloud computing competitors such as Amazon and Microsoft. IBM’s bet-the-farm investment in Watson Health may well become the Previous Shiny Object as the company moves to its more familiar roots in enterprise software in hopes of placating impatient shareholders. I’m pretty sure Red Hat customers aren’t thrilled.


People

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Cantata Health promotes Krista Endsley to CEO. NTT Data sold its healthcare software business to GPB Capital to create Cantata Health in April 2017, which tapped former NTT Data SVP/GM Mike Jones as CEO through April 2018 when Endsley joined Cantata as president.

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Oncology analytics vendor Cota Healthcare hires industry long-timer Mike Doyle (QPID Health) as president and CEO.

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PatientSafe Solutions hires Tim Needham (Burwood Group) as chief commercial officer.


Announcements and Implementations

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A KLAS report on secure communication finds that while ambulatory providers are focusing on simply exchanging messages securely, health systems are moving toward broader, enterprise-level platforms that include interfacing and support for multiple workflows (Voalte and Vocera are furthest along in offering a true communication platform, KLAS concludes). The top vendors (in terms of market consideration, customer retention, and performance) are TigerConnect, Voalte, and Epic. Potential disruptors are Telmediq and PatientSafe Solutions, which have high win rates and quality scores, while KLAS says Spok and Imprivata are losing business due to lagging development.

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Mason, OH-based startup Clarigent Health will commercialize technology developed by Cincinnati Children’s Hospital that assesses suicide risk by analyzing conversations between patients and their therapists or doctors.

Dimensional Insight launches Measure Factory, an automation engine that extends its Diver Platform to support data governance and data integrity.

LabCorp adds support for Apple Health Records, which will allow patients to send their lab results to their IPhones. Some Twitterati were puzzled why it only supports IPhones, with the obvious answer being that while Apple is #2 in mobile phone OS behind Android, there’s no Apple Health Records counterpart in Android (Google Fit is mostly just activity tracking).

Partners HealthCare and Lifespan end their merger talks, with Partners forging ahead with plans to acquire Lifespan competitor Care New England Health System. 


Other

In Australia, a report blames Cerner for May 2017 outages at seven Queensland Health hospitals, refuting the health system’s initial claim that the downtime was caused by ransomware. Investigators say Cerner has refused to provide system logs covering the incident. Cerner is the leading candidate to win a new bid for a patient administration system and insiders report executive pressure to avoid putting the company in a bad light.

Fascinating: a Utah insurer rolls out a “pharmacy tourism” option in which patients who take expensive drugs will be given plane tickets to San Diego, a ride across the border to Tijuana, and $500 as a cash bonus to buy their drugs in Mexico, where they are so much cheaper that the insurer still saves money. Hopefully Mexico won’t build a big, beautiful wall to keep medical tourism invaders out. 

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Weird News Andy comes up with a seasonally appropriate thriller that leads him to conclude, “Always go for the $5 teeth; the $3 teeth will get you every time.” An Alabama woman completes her Halloween ensemble with $3 fake teeth, only to find that the included temporary glue was (at least in her case) permanent. The emergency dentist, in true Halloween fashion, debated whether to saw or drill away the plastic with the risk of making her permanently scary, but as the woman describes, he eventually “picked and pulled and I squealed like a baby.”

And in a WNA Halloween Two-fer, a surgery professor says students have spent so much time in virtual worlds that they fare poorly at hands-on surgical work that requires thinking in three dimensions and “actually doing things.” The instructor recommends pumpkin-carving as good training because it is “one example of using sharp instruments with great delicacy and precision on a hard surface with a soft inside to create something that you have got in your mind and then you have to make it happen.”


Sponsor Updates

  • Glytec publishes an ebook titled “Hypoglycemia in the Hospital: Why Is It Costing You Millions and What Can You Do?”
  • EClinicalWorks posts a podcast titled “Tools and Training to Target Physician Burnout.”
  • Vocera will resell QGenda’s provider scheduling system in the federal healthcare market and the companies will integrate their systems.
  • CarePort Health expands its product, analytics, and customer success teams.
  • Impact Advisors is named to Modern Healthcare’s list of largest revenue cycle management firms.
  • AdvancedMD will exhibit at APTA PPS November 7-10 in Colorado Springs.
  • Waterloo MedTech awards Agfa Healthcare with its 2018 Award of Distinction.
  • Aprima will exhibit at the AAP National Conference & Exhibition November 3-5 in Orlando.
  • CarePort Health will exhibit at the ACMA 2018 Leadership Conference November 5-7 in Huntington Beach, CA.
  • CompuGroup Medical will exhibit at the AMP 2018 Annual Meeting & Expo November 1-2 in San Antonio.
  • CoverMyMeds will make its RxBenefit Clarity real-time benefit check tool available to Allscripts users.
  • CTG, Cumberland Consulting Group, and Dimensional Insight will exhibit at the CHIME Fall CIO Forum October 30-November 2 in San Diego.
  • Diameter Health will present at the AMIA 2018 Annual Symposium November 3-7 in San Francisco.

Blog Posts


Contacts

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

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Monday Morning Update 10/29/18

October 28, 2018 News 8 Comments

Top News

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From the Cerner earnings call following a small revenue miss that sent shares down 11 percent on Friday: (CERN shares are down 19 percent so far in 2018 vs. the Nasdaq’s 2 percent gain):

  • Q3 bookings were up 43 percent over last year, although revenue was up just 5 percent due to lower-than-expected software and technology sales.
  • The company expects its DoD and VA business to drive growth as financially-challenged providers and lack of regulatory incentives reduce private sector market urgency (“there isn’t anything that’s forcing clients to get deals done.”)
  • The company expects the federal government business, along with the replacement market, to carry the company until HealtheIntent revenue grows. It notes that its population health business has grown slower than projected.
  • Chairman and CEO Brent Shafer says Cerner will be the partner of choice for healthcare innovation.
  • Chief Client Officer John Peterzalek says Cerner is a leader in interoperability and expects to benefit if the government issues interoperability mandates.
  • The company expects its $10 billion VA contract to deliver $1 billion in annual revenue by 2022, although task order timing makes the growth irregular.
  • CFO Marc Naughton says that selling population health tools can deliver $3-4 per member per month, but adding services such as those enabled by its deal with Lumeris could increase that PMPM amount to $15.
  • The company’s ITWorks outsourcing business generates single-digit margins, but selling software and services into that client base can yield 40 percent margins.
  • Naughton, responding to a question about monetizing the data Cerner holds, says he sees eventual opportunity, but regulatory limitations make it a non-focus area for now.
  • Four more DoD sites will go live in early 2020.
  • The company hasn’t decided how the VA work will be divided among Cerner and its partners even though the company originally mentioned a 50-50 split as a placeholder.
  • Cerner will continue with its R&D spend and will focus on business segments that can deliver $100 million in revenue.

Reader Comments

From Jules Verne: “Re: webinars. What advice do you have for getting more registrations?” I get insight from the webinars we do since I see the stats for clicks, registrations, and attendance. My conclusions:

  • Make the goal to educate, not to sell something (we struggle endlessly trying to make this point with the junior marketing people of vendors). Potential audience members won’t sign up for what promises to be a sales pitch and they won’t sit through a webinar that turns into one.
  • Get customers or outside experts as presenters. Nobody will give up an hour of their day to hear a company marketing person’s perspective on population health or analytics.
  • Make sure the presenter is prepared. It’s shocking when during rehearsal the presenter (usually enlisted from a health system) has never seen the slides, doesn’t know what they’re supposed to talk about, or delivers a presentation that doesn’t match the abstract.
  • A product overview or demonstration is not a broadly educational topic and won’t generate many signups. On the other hand, even a handful of attendees is fine if they become prospects. Evaluate success accordingly. We did one super-specialized webinar that drew only five attendees, but they were good leads for the niche product and the vendor was smart to realize that a couple of self-qualified prospects was much better than 100 uninterested attendees (but a marketing person might have, from their perspective, seen it as a failure).
  • Include on the registration page a descriptive abstract and an honest description of the target audience. Sometimes companies get only a small percentage of those who looked at the registration page to actually register, which means something on that page made most of them bail (most likely the webinar description, speaker bio, or asking for too much information to register).

HIStalk Announcements and Requests

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Previous polls found that most of us health IT people don’t really care whether our doctors use EHRs and we prefer old-fashioned doctor-patient relationships over evidence-based medicine and technology. Last week’s poll demonstrated more of the puzzling “do as I say, not as I do” dichotomy between our jobs vs. what we want for ourselves and our families as patients, as nearly none of us (me included) keep their own medical information in electronic form.

New poll to your right or here: are you proud of the products or services your employer offers?

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Mrs. H bribed me to see “A Star Is Born” with her, and while the movie was good and the acting was terrific (actor-director Bradley Cooper admirably mimicked a singer and singer Lady Gaga excelled as an actor), the key moment for me occurred early in the movie, when I excitedly elbowed a startled Mrs. H to point out that Gaga’s character Ally was wearing a Yes tee shirt (although from their forgettable 1978 “Tormato” tour, I later found by Googling).

Listening: Rebelution, a California-based, highly literate reggae band whose UC Santa Barbara-graduated members are described in articles decrying cultural appropriation as “fratty white guys” (apparently those magazines believe that reggae is the exclusive domain of dreadlocked, spliff-brandishing Rastafarians who refer to everyone as “mon” and whose rainbow-colored clothing and revolution-inciting musical messages are obscured by ganja clouds). At least the bass player’s first name is Marley. Sample lyrics: “Whether you want love or money, good fortune or fame, you want a brand new car, you want the world to change. You better take some action right now, because there’s nothing in the world that you can’t get, so don’t fill your life with confusion and regret, you better take some chances right now.” I’m listening to more reggae these days because it’s one of few genres that haven’t been overproduced into unlistenable vacuity. I’m also enjoying refreshingly non-explicit hip-hop from Common, who I also liked in AMC’s western series “Hell on Wheels.”


Webinars

October 30 (Tuesday) 2:00 ET. “How One Pediatric CIN Aligned Culture, Technology and the Community to Transform Care.” Presenters: Lisa Henderson, executive director, Dayton Children’s Health Partners; Shehzad Saeed, MD, associate chief medical officer, Dayton Children’s Health Partners; Mason Beard, solutions strategy leader, Philips PHM; Gabe Orthous, value-based care consultant, Himformatics. Sponsor: Philips PHM. Dayton Children’s Health Partners, a pediatric clinically integrated network, will describe how it aligned its internal culture, technology partners, and the community around its goal of streamlining care delivery and improving outcomes. Presenters will describe how it recruited network members, negotiated value-based contracts, and implemented a data-driven care management process.

November 7 (Wednesday) 3:00 ET. “Opioid Crisis: What One Health Plan is Doing About It.” Presenter: Samuel DiCapua, DO, chief medical director, New Hampshire Health Families; and chief medical officer, Casenet. Sponsor: Casenet. This webinar will describe how managed care organization NH Health Families is using innovative programs to manage patients who are struggling with addiction and to help prevent opioid abuse.

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


Acquisitions, Funding, Business, and Stock

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Politico reports that Epic announced at its annual developer meeting that it will reduce its fees for listing third-party software in its App Orchard. One software company’s CEO had previously said that listing a simple HHS family planning questionnaire on the the app stores of Epic and Cerner would cost $750,000 per year. With the change, early-stage startups will pay just $100 per year to gain access to Epic’s API documentation and testing sandbox, then will pay an unstated higher amount once their product is released.

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From the Roper Technologies earnings call, following a Q3 report in which it beat both revenue and earnings expectations (the diversified company owns Sunquest, Strata Decision, Atlas Medical, SoftWriters, CBORD, and several other health IT vendors):

  • The company promoted COO Neil Hunn to president and CEO in late August, moving Brian Jellison to executive chairman due to health problems. Hunn came from MedAssets
  • The company’s Medical and Scientific Imaging segment, which represents 29 percent of Roper’s revenue, increased quarterly revenue 11 percent to $380 million.
  • Sunquest’s US business declined in “mid-single digits” while expanding globally, with 2019 expectations for Sunquest continuing to trend down due to competitive pressure. Roper says it will be “rebasing the North American business” of Sunquest. It also notes that it paid only 10 times EBITDA to acquire Sunquest for $1.42 billion in cash in 2012. 

Decisions

  • Crossing Rivers Health (WI) replaced Evident with Epic in June 2018.
  • Ferrell Hospital (IL) will switch from Medhost to Epic in fall 2019.
  • Chatuge Regional Hospital (GA) will replace Allscripts with Cerner in October 2019.

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

Vanderbilt University Medical Center gets a federal grant to mine its 20-year EHR database and biological samples to look for biologic and genetic markers of Down syndrome.


Government and Politics

The Spokane newspaper interviewed just three veterans for its story on implementing Cerner in the VA, but those they chose were perceptive:

  • Army vet Charles Bourg, 64, questioned why Cerner got a no-bid $10 billion deal, adding that while it’s nice that the VA and DoD are trying to integrate their respective Cerner systems, it’s more important that Cerner connect to outside doctors.  He adds, “You have to go in the basement of the VA to get the records … and it can take weeks. I did get electronic records from the VA to take to the [private practice] doctor, but he couldn’t even open them up.”
  • Former Navy Seabee Charlie Monroe says he’s skeptical about the new system and fears it will take away from the time doctors spend with patients.
  • Air Force veteran Bob Brodie says the VA never paid the bill for his VA-approved stay at a private hospital, which then turned his account over to collections.

Other

A federal grand jury indicts a former IT employee of Catholic Health Initiatives for allegedly issuing $72 million in phony purchase orders to a co-conspirator’s IT consulting firm for integration services, then splitting the take.

AMIA publishes core competencies for master’s-level applied health informatics programs that can be tested after graduation.

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The Journal of the American Academy of Dermatology takes down a research paper that analyzed the effect of private equity firms buying up dermatology practices after it receives complaints from several dermatologists who have PE ties. One of them is the Academy’s incoming president, who sold his own practice to a private equity-owned management company on whose board he sits. The peer-reviewed article observed that PE firms selectively acquire practices that perform high volumes of procedures covered by private insurance and Medicare, also noting that quite a few of those practices also run profitable pathology labs.

In Russia, a woman shows up a hospital with an ultrasound order she had changed to a different procedure, then attacks the hospital doctor who refused to perform the test, throwing the order’s clipboard at him and then beating him over the head with his computer keyboard.


Sponsor Updates

  • LiveProcess will exhibit at the Delaware Healthcare Forum October 30 in Dover.
  • Meditech will exhibit at the 2018 AMIA Annual Symposium November 3-7 in San Francisco.
  • Netsmart will exhibit at the NHPCO Fall Conference November 5 in New Orleans.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the Annual Perinatal Partnership Conference October 28-30 in Myrtle Beach, SC.
  • OmniSys will add ScriptPro’s SP Central Pharmacy Management System to its Fusion-Rx interactive voice response solution for pharmacies.
  • PatientSafe Solutions, Pivot Point Consulting, Redox, and Surescripts will exhibit at the CHIME18 Fall CIO Forum October 30-November 4 in San Diego.
  • Patientco publishes a new white paper, “Improving Patient Financial Experience Through Smart Payment Technology.”
  • Voalte will exhibit at the OONE Fall Conference November 1-2 in Columbus, OH.

Blog Posts


Contacts

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

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News 10/26/18

October 25, 2018 News 1 Comment

Top News

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In Canada, the 16-month bidding process for Nova Scotia’s province-wide EHR project called OPOR (One Person One Record) comes down to the wire, with Meditech, Epic, Evident, and Harris Healthcare Group failing to make the final cut.

Only Cerner and Allscripts were allowed to bid based on results from a qualification round that was apparently based entirely on their Request for Supplier Qualification submissions, a document of around 50 pages describing each company’s qualifications. Vendors were not allowed to provide detailed documents or to demonstrate their systems. 

Evident, a smaller vendor that was an original contender, has become vociferous in its allegations of what boils down to cronyism and an unfair procurement process.

Even Epic, which wasn’t even approached by the government for a proposal, seems to have suffered from mysterious postal mishaps in not being made aware that Nova Scotia was considering its project until someone let them know in late 2016, then having its documents package delivered in time but not internally routed to the correct office by the deadline.

Meditech, which is the incumbent vendor for many of Nova Scotia’s hospitals, did not make the short list despite no particular complaints from existing users.

Vendors were told that the authority was not meeting with vendors, but Evident claims to have evidence that people involved with Cerner and Allscripts gained unfair access in social and educational settings, with Allscripts in particular having had executives participate in health authority’s “Let’s Talk Informatics” education events.

A final decision is expected by the end of the year on the project, which could cost several hundred million dollars.


Reader Comments

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From Spanker: “Re: HIMSS. Did you get this email?” HIMSS now claims that it is not only a “partner in the creation of transformative change,” but is also a leading “health and wellness association.” Any claims of health and wellness expertise or accomplishment by HIMSS or its members should be taken with a truckload of salt. It sounds good on a vision statement, but it’s insured sick people who make it rain for all of them.

From Leading Indicator: “Re: IT advice. Links here.” LI calls out three recent examples in which people who have never worked in a health system IT department – much less run one – apparently feel qualified to tell CIOs how to manage their IT organizations, dispensing painfully obvious, simplistic recommendations that usually involve soft subjects like management style or consumerism. I’m all for pontification based on experience and accomplishments (and have seen plenty of it), but possessing a TV, armchair, and beer does not make one a coach.


Webinars

October 30 (Tuesday) 2:00 ET. “How One Pediatric CIN Aligned Culture, Technology and the Community to Transform Care.” Presenters: Lisa Henderson, executive director, Dayton Children’s Health Partners; Shehzad Saeed, MD, associate chief medical officer, Dayton Children’s Health Partners; Mason Beard, solutions strategy leader, Philips PHM; Gabe Orthous, value-based care consultant, Himformatics. Sponsor: Philips PHM. Dayton Children’s Health Partners, a pediatric clinically integrated network, will describe how it aligned its internal culture, technology partners, and the community around its goal of streamlining care delivery and improving outcomes. Presenters will describe how it recruited network members, negotiated value-based contracts, and implemented a data-driven care management process.

November 7 (Wednesday) 3:00 ET. “Opioid Crisis: What One Health Plan is Doing About It.” Presenter: Samuel DiCapua, DO, chief medical director, New Hampshire Health Families; and chief medical officer, Casenet. Sponsor: Casenet. This webinar will describe how managed care organization NH Health Families is using innovative programs to manage patients who are struggling with addiction and to help prevent opioid abuse.

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


Acquisitions, Funding, Business, and Stock

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Cerner reports Q3 results: revenue up 5 percent, adjusted EPS $0.63 vs. $0.61, meeting earnings expectations but falling slightly short on revenue.

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Tesla CEO Elon Musk mentions during an earnings call that the company offers onsite clinics, a relatively new employee perk at its Fremont, CA facility that has helped the high-end auto manufacturer decrease its lost work days and days missed by 10 percent. A job posting on the company’s website hints at the need to find someone who can assist with the “development, implementation, and management of Tesla’s electronic medical record (EMR) system by developing standardized processes for on-site medical staff.”

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Medicare quality reporting company Mingle Analytics merges with care management software company SilverVue to form Mingle Health.


Announcements and Implementations

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Optum360, Waystar, and TruBridge take top spots for customer satisfaction and client experience across multiple categories in Black Book’s latest RCM technology and outsourcing solutions survey.

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EClinicalWorks adds an opioid risk smart form to its EHR, giving providers the ability to assess a patient’s risk for drug abuse and offer alternatives that align with CDC recommendations.

Philips releases IntelliVue Guardian, an mobile app that allows clinicians to view patient vital signs and early warning scores on their Android mobile devices.

Medication safety technology vendor Tabula Rasa HealthCare creates a technology and consulting division called CareVention HealthCare. 


People

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Peter Pronovost, MD, PhD joins University Hospitals (OH) as chief clinical transformation officer, where he will oversee population health, high-reliability medicine, the ACO, and digital health initiatives. Thanks to the reader who forwarded the internal announcement. Pronovost left Hopkins Medicine after seven years in February 2018 to join UnitedHealthcare as SVP of clinical strategy, was promoted to chief medical officer in June 2018, then resigned three months later.

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Healthwise appoints CMO Adam Husney, MD to the additional role of CEO.

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Health Catalyst brings on Ryan Smith (Banner Health) as SVP of client engagement; Will Caldwell, MD (Novant Health) as SVP of physician and market development; and Cathy Menkiena, RN (Encore Health Resources) and Steven Vance (Intermountain Healthcare) as VPs of professional services.

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ClearData promotes Chad Coder to VP of strategic alliances.


Sales

  • Managed care organization Virginia Premier selects ZeOmega’s Jiva population health management software.

Government and Politics

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Amazon announces that Alexa is now able to answer questions about opioids and the opioid epidemic shortly after President Trump signed the opioids-focused SUPPORT for Patients and Communities Act into law. The company’s AWS Opioid Crisis Council has also pledged to use the cloud to improve first responder access to medical records, and identify fraud using PDMP data and analytics.


Other

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A two-year OCHIN study on the feasibility of documenting social determinants of health in EHRs finds that end users need more training to ensure relevant data is entered and acted upon, especially in the area of referrals for community services. Screenings for community service referrals ended up creating unmanageable workloads.

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The New York Times looks at the ways smart thermometer maker Kinsa licenses its “illness data” – temperatures submitted by users based on ZIP codes – to help companies like Clorox better target ads. The cleaning wipes company saw interaction with its digital ads spike 22 percent with Kinsa’s help, allowing it to target markets suffering from the flu in nearly real time. While Kinsa founder and CEO Inder Singh says he’s likely to sell or share the de-identified data only with companies whose services could help Kinsa’s users, others aren’t so sure public health benevolence will win out over profit and privacy concerns. Christine Bannan of the Electronic Privacy Information Center is one such skeptic: “It’s less of a privacy question and more of an ethical question on what we think is acceptable for targeting people who are ill and what safeguards we want to have around that. I can just think of how cigarette and alcohol companies could use strategies like this, or other industries that could really have more harmful effects on people.”

Weird News Andy’s clickbait headline for this story is, “Physician, Steal Thyself.” A 79-year-old doctor borrows $300,000 from a patient to keep her struggling practice afloat, then when asked to repay the money, diagnoses the patient with dementia without any supporting evidence. The doctor says the accusation is “all lies” and that she’s been making loan payments since she borrowed the money 20 years ago, but she nonetheless voluntarily surrendered her medical license in assuming that her case is unwinnable.


Sponsor Updates

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  • The Imprivata Cares team participates in the Technology Underwriting Greater Good’s annual Tech Gives Back event by hosting a Shark Tank-style event for local middle schoolers and volunteering at a homeless shelter for young adults.
  • EClinicalWorks publishes a podcast titled “Long Distance Relationships Made Easy With TeleVisits.”
  • HCTec publishes a new case study, “Successful Training Optimization Reduces Costs While Improving Learner Experience.”
  • InterSystems will exhibit at the CHIME Fall CIO Forum October 30-November 2 in San Diego.
  • ScriptPro will offer OmniSys’s Fusion-Rx interactive voice response system for prescription refills with its pharmacy management solutions.
  • Meditech posts a video describing how Med Center Health uses quality metrics to reduce sepsis mortality and readmission rates.
  • Formativ Health adds XpertDox data to its patient engagement technology, giving providers the ability to match up patients with best-fit providers and clinical trials.
  • Strata Decision Technology recaps its Lift18 user conference, which drew 650 attendees and offered Paul DePodesta from the movie “Moneyball” (played by Jonah Hill) as a keynote presenter. The company announced Time-Driven Costing that allows health systems to understand operational costs beyond traditional cost accounting.

Blog Posts


Contacts

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

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News 10/24/18

October 23, 2018 News 1 Comment

Top News

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Clearlake Capital Group will acquire provider management, credentialing, and payer enrollment technology vendor Symplr. Terms were not disclosed.

Symplr acquired Cactus Software (provider management) in early 2016 and Vistar Technologies (provider management) in mid-2017.


Reader Comments

From Vaporware?: “Re: Cerner at DoD MHS. The system is not operable, much less interoperable, after 20 months of being live overall and Congress should get to the bottom of it. EHR stabilization is usually measured in low single-digit weeks. Any CIOs willing to compare?” Politico says that a preliminary DoD report concludes that MHS Genesis at Madigan Army Medical Center is “not effective and not suitable” – the same conclusion reached after evaluating the three previous test sites – and adds that the system is “not interoperable.”


Webinars

October 30 (Tuesday) 2:00 ET. “How One Pediatric CIN Aligned Culture, Technology and the Community to Transform Care.” Presenters: Lisa Henderson, executive director, Dayton Children’s Health Partners; Shehzad Saeed, MD, associate chief medical officer, Dayton Children’s Health Partners; Mason Beard, solutions strategy leader, Philips PHM; Gabe Orthous, value-based care consultant, Himformatics. Sponsor: Philips PHM. Dayton Children’s Health Partners, a pediatric clinically integrated network, will describe how it aligned its internal culture, technology partners, and the community around its goal of streamlining care delivery and improving outcomes. Presenters will describe how it recruited network members, negotiated value-based contracts, and implemented a data-driven care management process.

November 7 (Wednesday) 3:00 ET. “Opioid Crisis: What One Health Plan is Doing About It.” Presenter: Samuel DiCapua, DO, chief medical director, New Hampshire Health Families; and chief medical officer, Casenet. Sponsor: Casenet. This webinar will describe how managed care organization NH Health Families is using innovative programs to manage patients who are struggling with addiction and to help prevent opioid abuse.

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


Acquisitions, Funding, Business, and Stock

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Kyruus lists its ProviderMatch for Salesforce on the Salesforce AppExchange and announces a $4 million Series D investment by Salesforce Ventures, increasing its total to $76 million.

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CNBC reports that Silicon Valley-based, VC-backed smart breast pump startup Naya Health —  whose CEO had blamed the company’s sluggish start on the male-dominated VC industry despite what she claimed is a $30 billion market opportunity – has apparently shut down and left customers without support for its $1,000 device amidst complaints from some of its users that it does not work.

The company that was hired to auction the assets of the defunct CareSync asks the court to expedite a $1 million sale to risk adjustment technology vendor Vatica Health, requesting via an emergency motion to finalize any and all bids by November 5. CareSync had raised $49 million before closing abruptly in June 2018.


Sales

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Island Hospital (WA) replaces its existing electronic signature product with that of Access, integrated with Meditech. 


People

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Divurgent hires Gary Germaine (Leidos Health) as VP of client services.

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Mordecai Kramer (Baim Institute for Clinical Research) joins Carevive Systems as VP of data generation and outcomes, life sciences.

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Medtronic co-founder Earl Bakken, who created the modern medical technology industry with the company’s introduction of the first implantable pacemaker in 1960, died Saturday at 94. The former electronics repairman founded the company with his brother-in-law, working from a Minneapolis garage to offer hospital equipment repair and TV installation.


Announcements and Implementations

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Healthcare Growth Partners looks at the vendor “haves and have-nots” from EHR consolidation brought on by high overall market penetration as well as hospitals employing physicians and acquiring practices (HGP estimates that over 50 percent of doctors now work for hospitals). Cerner and Epic are winning the replacement market; specialty EHR vendors are doing well in specialized practice areas not as well served by Epic and Cerner; but Healthland, the former Siemens, the former McKesson Enterprise, and Allscripts Practice Fusion are losing ground as the “have-nots.”

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Denver Health Epic Data Architect Mark Iannucci publishes Epic UserWeb Search on the Chrome Web Store, which allows search terms prefaced with “uw” to search UserWeb or those starting with “uw sherlock” to find occurrences in Sherlock logs, all while skipping the Galaxy screen (assuming you’re already logged into Epic UserWeb and are using the Chrome browser, of course).

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Laudio releases its staff relationship management platform that allows hospital managers to manage employee recognition, accountability, burnout risk, onboarding and career development, and work issues. The founder and CEO is industry long-timer Russ Richmond, MD. 


Government and Politics

A White House-proposed rule would not only push “junk” health insurance plans (short-term and association health plans) that potentially contain extensive exclusions, it would also encourage employers to offer healthcare imbursement arrangements that give each employee a fixed dollar amount with which to purchase their own insurance, which the administration acknowledges would reduce the number of insured people. All of the new recommendations would support states offering plans that are not ACA compliant in such areas as pre-existing conditions and lifetime payment limits.


Other

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A New York Times article provides advice from chronically ill people on how to make best use of the US healthcare system (or more precisely, two ways to do that plus two suggestions for bypassing it in favor of getting informal personal advice).

Researched published in JAMA finds that use of medical crowd-funding campaigns is growing, people often ask for money to obtain treatments that are not evidenced-based or that may be harmful, meaning those who donate are helping line the pockets of practitioners who are delivering questionable care.


Sponsor Updates

  • AdvancedMD will exhibit at the American Academy of Ophthalmology event October 27-30 in Chicago.
  • IDC MarketScape names Arcadia a leader in its assessment of US population health analytics vendors.
  • TMC names Atlantic.Net a 2018 Cloud Computing Security Excellence Award winner.
  • Bluetree will exhibit at the CHIME CIO Leadership Academy 2.0 October 29-30 in San Diego.

Blog Posts


Contacts

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

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Morning Headlines 10/23/18

October 22, 2018 News No Comments

DSI’s Joseph J. Luzinski Asks Court to Speed Asset Sale of Florida-Based CareSync

Vatica Health makes a $1 million bid to acquire the assets of chronic care management company CareSync, which abruptly closed its doors in June.

MHS Genesis gets a bad review

Politico reports that Pentagon investigators have found Madigan Army Medical Center’s new Cerner-based software lacking in effectiveness, suitability, and interoperability.

Tabula Rasa HealthCare Announces the Launch of CareVention HealthCare

Tabula Rasa HealthCare launches a new division called CareVention Healthcare that will offer consulting services and technology, including its medication risk management software.

Monday Morning Update 10/22/18

October 21, 2018 News 2 Comments

Top News

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Stat reports that Deborah DiSanzo, general manager of IBM Watson Health for the past three years, will leave her role.

DiSanzo will be replaced by SVP John Kelly III, PhD, who wrote a defense of Watson Health in an August 2018 blog post in which he refuted an unflattering article by The Wall Street Journal.

DiSanzo will take a demotion to the strategy team of IBM Cognitive Solutions.

IBM announced last week that earnings from its cognitive offerings were down 6 percent year over year, although it said Watson Health is growing.


Reader Comments

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From Vaporware?: “Re: VA’s Cerner contract. Kudos to them for transparency in listing what they bought, but it looks like they and the VA will be running different systems. Also, DoD didn’t purchase CommonWell even though 60 percent of care happens outside MHS.” The VA’s list of which Cerner systems it and the DoD bought in their respective contracts reveals quite a few differences, some of them understandable due to the types of services offered. DoD skipped quite a few modules that while not useful in battlefield hospitals, would seem to have a place in the dependent care that makes up much of its volume. The DoD passed on modules for cardiology, gastroenterology, CommonWell, most of population health management, integrated radiology dictation, and all transaction services except for automated messaging. I didn’t realize that CommonWell is something you have to buy as an upfront cost, although its documentation says that health IT vendors may charge “commodity-like” fees. Cerner previously pledged not to charge users until at least through the end of 2019.


HIStalk Announcements and Requests

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Most of us might make our living advocating medical standardization, use of technology, and applying patient care experience to our own situation, but poll respondents don’t find those to be positives when choosing our own doctor, instead valuing participative decision-making. Debtor concludes, “Here is the problem with the concept of socialized medicine in the United States. Even among an informed group, we put personal patient ‘concerns’ and ‘decisions’ ahead of evidence-based guidelines and vetted treatment protocols. I fully support your right to have concerns and make decisions about your own health,  but I’d prefer not to pay for them if they’re not supported by science.” Matt says, “We get a ton of policy push in healthcare, which we’ve seen create its own echo-chamber to the detriment (in some very real cases) of beneficial practice. It runs its course until the downstream consequences create push back and the the policy is pulled back, which creates a difficult environment for real and helpful innovation.”

New poll to your right or here: where do you keep locally stored copies of your medical information?

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Only 20 percent of providers are using biometric patient identification, with most of the remaining 80 percent saying either there’s no business case for it or because they haven’t really thought about it. They aren’t really worried about patient perception or hacker concerns. Industry Analyst Supporter of Biometrics approves “perception deception” in using phones as the biometric reader, adding, “Most folks don’t blink about their biometrics being the vehicle to access their iPads and phones, but feel that their privacy and security regulated healthcare provider asking is too invasive.” Ed A warns of potential lawsuits for providers that fail to follow laws like the Illinois Biometric Privacy Act that require obtaining patient consent and following requirements for biometric use and retention. XCIO’s health system employer biometrically verifies identity in registration areas to reduce duplicate records, insurance fraud, and inaccurate patient billing. 


Webinars

October 30 (Tuesday) 2:00 ET. “How One Pediatric CIN Aligned Culture, Technology and the Community to Transform Care.” Presenters: Lisa Henderson, executive director, Dayton Children’s Health Partners; Shehzad Saeed, MD, associate chief medical officer, Dayton Children’s Health Partners; Mason Beard, solutions strategy leader, Philips PHM; Gabe Orthous, value-based care consultant, Himformatics. Sponsor: Philips PHM. Dayton Children’s Health Partners, a pediatric clinically integrated network, will describe how it aligned its internal culture, technology partners, and the community around its goal of streamlining care delivery and improving outcomes. Presenters will describe how it recruited network members, negotiated value-based contracts, and implemented a data-driven care management process.

November 7 (Wednesday) 3:00 ET. “Opioid Crisis: What One Health Plan is Doing About It.” Presenter: Samuel DiCapua, DO, chief medical director, New Hampshire Health Families; and chief medical officer, Casenet. Sponsor: Casenet. This webinar will describe how managed care organization NH Health Families is using innovative programs to manage patients who are struggling with addiction and to help prevent opioid abuse.

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


Decisions

  • Lavaca Medical Center (TX) went live on Cerner in April 2018
  • Pershing Memorial Hospital (MO) will go live on Cerner in June 2019
  • Kennedy Health System (NJ) will replace Cerner with Epic in 2019
  • Hutchinson Health Hospital (MN) will replace Microsoft Dynamics GP with Infor for financial and supply chain management in October 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.


People

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GetWellNetwork hires Sameer Siraj (Optum) as chief product officer.


Announcements and Implementations

A new Black Book report on HIM-related technologies names these winners:

  • Nuance (end-to-end coding, clinical documentation improvement, and health information management solutions in both inpatient and ambulatory settings; CDI software)
  • Optum360 (coding and CAC outsourcing)
  • MModal (document capture and transcription)
  • 3M (coding consulting, document imaging)
  • Dolbey (medical speech recognition)
  • Revspring (patient communications and financial satisfaction)
  • Recondo (patient identification and tracking)

Other

Patients who are involved in “non-emergent” ED visits exhibit the same symptoms as ED-appropriate visits 88 percent of the time, an analysis concludes, so it’s probably not reasonable for insurers to demand that patients make an accurate ED-or-not decision. One in six ED visits could be avoided by warning patients that their insurance won’t pay for a non-emergent visits, but such a policy would also discourage the 40 percent of those patients who have ED-appropriate symptoms from going there.

A study finds that hospitals accredited by Joint Commission deliver no better patient outcomes than those certified by other private groups, while hospitals with only a state survey accreditation perform just as well as any of them.


Sponsor Updates

  • Lightbeam Health Solutions publishes a new white paper, “Data-Driven Solutions Providers and Payers Need for Value-Based Care Alignment.”
  • LiveProcess will exhibit at the Health Care Association of New Jersey event October 23-25 in Atlantic City.
  • Meditech releases a new video, “Palo Pinto Mobile Clinic Uses Meditech Ambulatory to Bridge Care Gaps.”
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the HMHB Annual Meeting & Conference October 22-23 in Atlanta.
  • OmniSys will exhibit at the McKesson Pharmacy Systems Chain & Health System User Conference October 23-24 in Pittsburgh.
  • The SSI Group will exhibit at the MAPAM Annual Fall Conference October 22-23 in South Yarmouth, MA.
  • Surescripts and ZeOmega will exhibit at the 2018 CAHP Annual Conference October 22-24 in San Diego.

Blog Posts


Contacts

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

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News 10/19/18

October 18, 2018 News No Comments

Top News

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The FDA updates draft guidance on managing cybersecurity issues for the premarket submission of medical devices. FDA Commissioner Scott Gottlieb, MD says the document, initially penned in 2014, offers “recommendations for manufacturers on how they can better protect their products against different cybersecurity risks, from ransomware to a catastrophic attack on a health system.”


HIStalk Announcements and Requests

I don’t pay much attention to the “Like” button at the bottom of each HIStalk post, but did happen to notice that Alexander Scarlat’s first Readers Write installment on machine learning had already garnered several dozen clicks. It hasn’t quite gained the notoriety of the most popular post in recent memory, which deals with remedying poor clinician engagement with health IT. Both tap into several pieces of advice I give those interested in submitting editorial:

1. Readers will give your content more credence if you write from a place of experience. Both authors of the aforementioned posts have MDs, and other in-the-trenches educational and professional experience to back up their right to editorialize. Vendor authors – unless they too have immense clinical chops – will never quite escape the subconscious bias of readers who see a company name in the byline and immediately worry their time is being wasted by someone trying to sell them something.

2. Of-the-moment topics written for an audience with significant experience working in the health IT trenches are key to a good read, and will often sustain relevance for some time. Submissions that offer a 1,000-foot view rather than diving into the nitty gritty will attract critics who aren’t afraid to lambast authors. (Granted, I try to filter those out, but some slip through.)

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3. Pop culture and humor are always good bets, provided they are in good taste. (I’m still shaking my head at the submission sent over with a curse word in the headline.) I often point interested parties to the “All I Needed to Know to Disrupt Healthcare I Learned from ‘Seinfeld’” series penned in 2015 by Bruce Bandes as a great example of original, humorous content that speaks to a timely topic.


Webinars

October 30 (Tuesday) 2:00 ET. “How One Pediatric CIN Aligned Culture, Technology and the Community to Transform Care.” Presenters: Lisa Henderson, executive director, Dayton Children’s Health Partners; Shehzad Saeed, MD, associate chief medical officer, Dayton Children’s Health Partners; Mason Beard, solutions strategy leader, Philips PHM; Gabe Orthous, value-based care consultant, Himformatics. Sponsor: Philips PHM. Dayton Children’s Health Partners, a pediatric clinically integrated network, will describe how it aligned its internal culture, technology partners, and the community around its goal of streamlining care delivery and improving outcomes. Presenters will describe how it recruited network members, negotiated value-based contracts, and implemented a data-driven care management process.

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


Acquisitions, Funding, Business, and Stock

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Gauss Surgical raises $20 million in a Series C funding round led by Northwell Health (NY) and SoftBank Ventures Korea, with help from seven other health systems. Funding thus far comes to $52 million. The company has developed tablet-based software that uses machine learning and digital imaging to monitor maternal surgical blood loss in real time.

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Digital prescription savings company OptimizeRx acquires interactive patient messaging vendor CareSpeak Communications for an undisclosed amount.

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Muscular dystrophy nonprofit CureDuchenne invests in ZappRx, and will help the vendor optimize its e-prescribing and electronic prior authorization software for Duchenne patients.

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23andMe CEO Anne Wojcicki tells Rock Health conference attendees that she hopes to soon roll out a test that will help consumers better understand how their bodies react to certain antidepressants. Price points for similar services offered by Color Genomics and Albertsons grocery store pharmacists range from $250 to $750. The FDA shut down 23andMe’s first attempt at such a test in 2013 based on the fear that consumers could misinterpret the results as medical advice.


People

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Patrick Flavin (Outcome Health) joins Arches Technology as president.

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HCTec names Salome Isbell (MedHOK) CFO, Victor Ayers (Infor) VP of professional services, and Heather Espino (Centura Health) VP of clinical solutions.


Announcements and Implementations

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Bassett Medical Center (NY) adopts Masimo’s Patient SafetyNet and Root with Vital Signs Check across its 54-bed med-surg unit.

Massachusetts EHealth Collaborative and Cognizant will provide technical and financial consulting services to the MassHealth Delivery System Reform Incentive Payment technical assistance program’s ACOs and community partners.

Partners Connected Health adds a mobile app to its PGHDConnect program, giving users the ability to securely share health data with their providers from 250 devices.


Government and Politics

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The FDA and Department of Homeland Security announce they will work together to share information on cybersecurity vulnerabilities in medical devices so that threats to patient safety can be addressed more quickly.


Privacy and Security

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Following a similar GDPR-induced move in Europe, Apple gives US users the ability to view, edit, and delete data it has collected on them using a new tool on its privacy website. The tool does not apply to data collected by and stored on Apple devices, including biometric data like fingerprints and heart rates.


Other

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The Sequoia Project creates the Interoperability Matters Advisory Group and solicits nominations for workgroup members who will provide feedback and recommendations on interoperability endeavors. I was not aware that Sequoia relinquished Carequality earlier this month to operate as a standalone entity.

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In Dublin, St. James’s Hospital goes live on expanded Cerner functionality, making it the largest EHR implementation in Ireland’s history. The three-year project was dubbed “Project Oak” as an homage to the paper the Millenium conversion will save.

Vermont Information Technology Leaders struggles to pare down the number of duplicate patient records in the state’s HIE. An audit last year found 1.7 million unique records for 624,000 residents and patients from out of town. VITL staff have deemed at least 35 percent of those to be duplicates, and hope to have that number down to 21 percent by the end of the year. The struggle for a unique patient identifier in the Green Mountain State is real.


Sponsor Updates

  • EClinicalWorks will exhibit at CHCANYS18 Annual Conference and Clinical Forum October 21-23 in Tarrytown, NY.
  • FormFast will host virtual user group meetings October 23 and 24.
  • Healthwise will exhibit at the 2018 PNEG Conference October 19-21 in Fort Wayne, IN.
  • Foundations Health Solutions wins an Excellence in Technology Award from McKnight’s for its use of Hyland OnBase.
  • Formativ Health adds Conversa Health’s AI-powered chatbot messaging tool to its line of patient engagement services.
  • Imprivata completes the Zebra Technologies Validated Program for its Mobile Device Access.
  • Casenet becomes a founding member of the private-sector Da Vinci project, which aims to leverage FHIR to improve data-sharing in value-based care arrangements.
  • ZeOmega adds MCG Health’s Cite AutoAuth prior authorization software to its Jiva population health management technology.
  • HCTec publishes a new case study featuring Montefiore Health System.
  • NHS approves Elsevier as a supplier for its NHS England Health Systems Support Framework.

Blog Posts


Contacts

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

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News 10/17/18

October 16, 2018 News 6 Comments

Top News

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Radiation oncology and software vendor Varian Medical acquires Finland-based Noona Healthcare, whose software captures patient-reported outcomes and supports symptom management.


Reader Comments

From Managing Director, Otium cum Dignitate: “Re: HIMSS Form 990. Here’s the latest from Guidestar.” I should have been more specific in saying that I couldn’t find what I assume should be the latest HIMSS Form 990. I saw this one, which covers the year ending 6/30/16. HIMSS should have filed one last year and is due to file another one this year, but they haven’t responded to my request. More interesting is the title used by this semi-retired reader, who says he just likes the title “Managing Director” and the Latin from Cicero translates to “leisure with dignity,” which is about as cool a goal as someone could set for themselves (although the occasional episode of leisure with dishonor might keep it interesting).

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From No Mas: “Re: Athenahealth’s partnership with U of Toledo. The new product for academic medical centers was supposed to be complete by now, three years after you interviewed CMIO Bryan Hinch, MD. Maybe you can reach out for an update.” I’ve emailed Bryan to see what happened since our interview about the co-development of an inpatient EHR as University of Toledo Medical Center tried desperately to unload its problematic and expiration-dated McKesson systems.

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From Robert D. Lafsky, MD: “Re: this article. I think a big reason there’s so much lately about physician ‘burnout’ is that medical training teaches you to ask ‘why’ about everything. Even if it’s wrong, there has to be a theory. But when the EMR came along, it urged doctors to not ask so many questions, just do what it says. It’s remarkable that it took this long for a major medical journal to run a piece on the theoretical basis for computerized medical information.”  The NEJM article reviews the need for ontologies (controlled, descriptive terminology that describes the semantic relationships among concepts) to overcome the limitations of incomplete, incorrect, or unsourced EHR data since those systems were designed for billing, thus having no convenient way to store behavioral phenotypes, environmental exposure, genomic sequencing data, and information collected from mobile health sensors. It notes that use of ontologies on huge data sets can discover association and even causation to create new diagnostic and therapeutic insight. The authors also suggest that clinician data entry is not a good use of their time and advocates instead collecting device information and patient-entered information electronically and greater use of speech recognition.


HIStalk Announcements and Requests

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Need consulting services? Fill out my minimally intrusive “RFI Blaster” online form (which I just rebuilt) with details about your needs and then choose one or all HIStalk consulting firm sponsors you’d like to hear from. It doesn’t get much easier.

I had another moment of music-driven cognitive dissonance in the senior citizen-filled grocery store the other day when in between sappy, buy-more-stuff music (Beach Boys, Pilot) was inserted “Break On Through (To the Other Side)” from the magnificent 1967 debut album of The Doors. I smugly felt rebellious as I noted no reaction from the older shoppers, but then I realized they were probably just suppressing the fist pumps since they were likely in their mid-20s peak rebellion years when the song charted 51 years ago. Mr. Mojo Risin’ himself would be 74 if he hadn’t broken on through to the other side at 27 in 1971. As I often say, nursing homes are now occupied by those who want to hear Pink Floyd rather than Lawrence Welk.


Webinars

October 30 (Tuesday) 2:00 ET. “How One Pediatric CIN Aligned Culture, Technology and the Community to Transform Care.” Presenters: Lisa Henderson, executive director, Dayton Children’s Health Partners; Shehzad Saeed, MD, associate chief medical officer, Dayton Children’s Health Partners; Mason Beard, solutions strategy leader, Philips PHM; Gabe Orthous, value-based care consultant, Himformatics. Sponsor: Philips PHM. Dayton Children’s Health Partners, a pediatric clinically integrated network, will describe how it aligned its internal culture, technology partners, and the community around its goal of streamlining care delivery and improving outcomes. Presenters will describe how it recruited network members, negotiated value-based contracts, and implemented a data-driven care management process.

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


Acquisitions, Funding, Business, and Stock

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Medicare Advantage insurer Devoted Health raises $300 million in a Series B round, increasing its total to $362 million. The founders are Todd Park (Athenahealth, Castlight Health, White House), his brother Ed Park (Athenahealth), and some VCs. Also on the team are former Athenahealth CTO Jeremy Delinsky and  former US Chief Data Scientist DJ Patil.


Sales

  • Oregon will integrate its prescription drug monitoring program database with EHRs and pharmacy systems using Appriss Health’s PMP Gateway.
  • Legacy Health (OR) goes live on Vynca for capturing, storing, and accessing advance care planning documents.

People

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AAFP promotes Steven Waldren, MD, MS to VP/CMIO, where he will focus on the potential impact of AI and machine learning on family medicine and continue work on reducing EHR burden.


Announcements and Implementations

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A KLAS report finds that two-thirds of health systems are just beginning to implement opioid stewardship programs, with the less-advanced ones considering best-of-breed technologies (such as drug dispensing systems that detect or prevent drug diversion) while more advanced health systems expect their EHR vendor to deliver tools to prevent and treat opioid misuse. Epic is the most-used of all technologies used in opioid stewardship programs, while Cerner is least-used.  Customers expect their EHR to integrate with prescription drug monitoring program databases, to offer opioid-specific clinical decision support and toolsets, and to include opioid stewardship capabilities in population health management.

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This is smart approach: personal health record vendor HealthLynked publishes a plug-in that allows embedding its appointment-booking function in any of the 60 million websites that run WordPress. The screenshots suggest areas of needed improvement, however, since the dates run together and displaying appointment times down to the second seems silly.

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A Reaction Data report says that only 15 percent of radiology departments still use dictation and transcription, with speech recognition dominating (although not growing) and 81 percent of respondents using Nuance and basically none of them thinking about switching to another vendor. Just over half of respondents say their speech recognition is integrated with PACS, but integration with RIS and EHR is much lower even though user satisfaction with the integration of all three is high.

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Hospital grading organization Leapfrog Group will launch safety and quality surveys of the country’s 5,600 outpatient surgery centers, noting the need as evidenced by the Kaiser Health News/USA Today Network investigation that revealed poor oversight and substandard clinical practices. Let’s hope they call out the likely majority of those centers that refuse to participate (since until competitors start publicizing their good results, there’s no incentive). The organization issues grades for 2,000 US hospitals, just over one-third of the total.

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A hospital in eastern China goes live with facial recognition check-in on a system developed by Alibaba’s healthcare group. Anyone with health insurance and a mobile payment account can register without their ID cards or phones once they have linked their accounts to the Alipay mobile payment app. The system’s 3-D cameras link to Alipay’s biometrics and the Ministry of Public Security’s photo database, which is also used by police to identify the faces of fugitives in large crowds. 

A Philips study finds that the US healthcare system captures a lot of data compared to other countries, but suffers from lack of a universal health record and low consumer satisfaction and trust.


Government and Politics

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Telemedicine vendor HealthRight and its CEO Scott Roix plead guilty to healthcare fraud and fraudulent marketing of dietary supplements, skin creams, and testosterone that its doctors prescribed without realizing how massively the company was marking up the prices. A total of four men and seven compounding pharmacies were named in charges of running a billion-dollar telemedicine fraud scheme.


Other

Another healthcare information challenge – a person’s genetic test results could change from “normal” to “abnormal” or vice versa based on new research findings, but nobody has thought about the challenges in contacting those patients or their doctors to let them know or to have them retested. A recent study found that of 1.45 million patients tested from 2006 to 2016, reclassification of mutations would have changed the reports of 60,000 of them.

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UMass Memorial Health Care lays off 17 IT employees two weeks after going live with its $700 million Epic implementation. 

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MIT will spend $1 billion to create an artificial intelligence college that will begin instruction in the fall of 2019. MIT says the intentionally used term “college” reinforces that the new organization will work across all five of its existing schools (architecture, engineering, humanities, management, and science) rather than being a school itself. It adds that the college will emphasize ethical guidelines of how AI can be used for human good.

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Amazon posts job listings for data scientists with health benefits experience to work with partners – “including the new healthcare venture” – to create healthcare and population health management solutions. Most interesting is the responsibility to “leverage big data to explore and introduce areas of healthcare analytics and technologies” and preferred experience that includes working with claims, EHR, and patient-reported data. I have a strong feeling that if Amazon ever meets high expectations for healthcare disruption that this Atul Gawande-led group won’t be its weapon of choice – while the company will learn a lot about how healthcare works, the goal is to reduce its own costs, with no guarantee that those efforts will extend outside its four walls. The company’s real disruption opportunity likely lies elsewhere and that are more easily penetrated, such as in supply chain management.

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A jarringly moving obituary written by the parents of a 30-year-old mother who died of a drug overdose last week provides a sad reminder of the toll of drug addiction on families. Some excerpts (but you should read the whole thing):

It is impossible to capture a person in an obituary, and especially someone whose adult life was largely defined by drug addiction. To some, Maddie was just a junkie — when they saw her addiction, they stopped seeing her. And what a loss for them … During the past two years especially, her disease brought her to places of incredible darkness, and this darkness compounded on itself, as each unspeakable thing that happened to her and each horrible thing she did in the name of her disease exponentially increased her pain and shame. For 12 days this summer, she was home, and for most of that time she was sober. For those 12 wonderful days, full of swimming and Disney movies and family dinners, we believed as we always did that she would overcome her disease and make the life for herself we knew she deserved. We believed this until the moment she took her last breath. But her addiction stalked her and stole her once again. Though we would have paid any ransom to have her back, any price in the world, this disease would not let her go until she was gone.

If you are reading this with judgment, educate yourself about this disease, because that is what it is. It is not a choice or a weakness. And chances are very good that someone you know is struggling with it, and that person needs and deserves your empathy and support. If you work in one of the many institutions through which addicts often pass — rehabs, hospitals, jails, courts — and treat them with the compassion and respect they deserve, thank you. If instead you see a junkie or thief or liar in front of you rather than a human being in need of help, consider a new profession.

Bizarre: Sacramento police can’t figure out what charges to file against two high school students who handed out cookies at school that contained a secret ingredient – the cremation ashes of one of their grandparents.

Weird News Andy call’s “Rocky’s Revenge” as a New York State hunter dies of a brain disorder after eating the brain of a squirrel he shot. WNA says the incidence of the variant of Creutzfeldt-Jakob disease is high around Rochester, NY, which is a long way from Frostbite Falls, MN.


Sponsor Updates

  • AdvancedMD will exhibit at the American Medical Billing Association National Conference October 18-19 in Las Vegas.
  • CompuGroup Medical will exhibit at the Arizona MGMA Annual Conference October 17-19 in Chandler.
  • Collective Medical partners with the Kentucky Hospital Association.
  • Imprivata’s Mobile Device Access completes validation for use with select Zebra devices.
  • CoverMyMeds will exhibit at the CBI Real-Time Benefit Check and ePrior Authorization Summit October 17-18 in San Francisco.
  • CTG will exhibit at the 2018 Northwest Arkansas Technology Summit October 22-23 in Rogers.
  • Cumberland Consulting Group will exhibit at the CBI Value-Based Oncology Management Forum October 23-24 in Scottsdale, AZ.
  • Direct Consulting Associates will exhibit at the Western PA Healthcare Summit October 19 in Cranberry Township.
  • Dimensional Insight will exhibit at the Value-Based Care Summit October 17 in Boston.
  • DocuTap is accepting nominations for its student scholarship program.
  • Redox will host its Healthcare Interoperability Summit November 13-14 in Denver.

Blog Posts


Contacts

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

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Monday Morning Update 10/15/18

October 14, 2018 News No Comments

Top News

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Pathology image detection support system vendor Deep Lens announces $3.2 million in seed funding and availability of its free VIPER service for pathologists.

Co-founders of the Columbus, OH-based company are CEO Dave Billiter, MBA (Cardinal Health) and President Simon Arkell, MBA (Predixion Systems).

The company is based on work first performed at Nationwide Children’s Hospital in Columbus.

I like an uncredited quote in a company blog post that says you can’t rely too much on company experts whose user experience still makes them “FORMER experts in the field.” It also notes that product feedback from anyone other than a customer should be politely answered with, “Your opinion, although interesting, is irrelevant.”


Reader Comments

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From Biometric Believer: “Re: biometric ID. Would you mind asking your readers why, with advances in technology and increased fraud, hospitals aren’t deploying more iris scanning to patient care locations?” Good question, although I would expand your question to include palm vein scanning, facial recognition, voice recognition, and other less-used forms of biometric ID that hold equally promising potential without the need to approach someone’s eyeball with a scanner. There’s no question that all of these technologies work, only that consumer perception isn’t always great and healthcare and other industries (even banking) have resisted accordingly despite its obvious utility in fraud prevention. Some problems I see:

  • Cost. Although technology costs are going down, deploying biometric readers broadly is a big expense and requires a coordination effort that you don’t want repeat often as those technologies change.
  • Workflow integration, which has been mostly solved, I expect.
  • The creep factor. Years ago I got the job of convincing nurses that our newly implemented fingerprint scanning for drug dispensing machines did not mean we were storing their fingerprints or checking them for criminal history.
  • If hackers breach your system or someone grabs a patient’s fingerprints or takes a picture of their face, your patient is screwed because unlike passwords, they can’t change their biometrics.

My conclusion is that perhaps all of these problems could be solved by using the patient’s own phone as the biometric reader. People are happily using fingerprint recognition, voice recognition, and in some cases with higher-end phones, facial recognition to identify themselves for their own security. You would think that the hospital’s reader could connect via Bluetooth, although that’s a minor patient setup issue as well. Or, to address that issue as well as the fact that not everyone has a cell phone, maybe the hospital could use its own cell phones, handing one over temporarily to the patient to provide a less-threatening biometric ID process using a familiar consumer device.

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For Biometric Believer, I created a poll for providers to say if they’re using biometric patient ID or why they don’t. Vote and then add a comment to elaborate.

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From Arthur Allen: “Re: HIStalk. I spotted a rare error in Friday’s update. The VA’s assignment of Paul Tibbits to executive director for the Office of Electronic Health Record Modernization is not a direct replacement of Genevieve Morris. Title-wise at least, Tibbits and Morris differ. She was CHIO, but was also ostensibly in charge of OEHRM. Tibbits is the exec director and they described his job a little differently as well,  more of a liaison with OIT, leaving Captain Windom in charge of OEHRM.” Good point, thanks. John Windom, III led the Cerner selection and rollout by the DoD. Arthur is Politico’s e-health editor who made me beam with his “rare” adjective.

From Kermit: “Re: pre-existing conditions. NPR has a good analysis of the nuances.” The article notes that Republican leaders recognize that it’s politically unwise to take a stand against pre-existing conditions since at least 25 percent of us have them, yet their continued efforts to dismantle the Affordable Care Act and to encourage junk insurance plans as an alternative are making them legal once again after several years. Medicare and Medicaid don’t have pre-existing condition limitations, so claims by Democrats that everyone would be impacted by ACA changes isn’t accurate. HIPAA is a factor since most Americans get health insurance through their employer and HIPAA doesn’t allow those insurers to deny coverage or price premiums based on medical history, but even that’s complicated since some HIPAA protections were moved into the ACA and might die along with it if ACA doesn’t survive legal challenges given the White House’s strategy of not defending it vigorously. TL; DR: everybody hates pre-existing conditions except politicians, who will throw those who have them under the bus if it helps their party.


HIStalk Announcements and Requests

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I ran this poll to encourage folks who are struggling with an involuntary career change. Respondents who were fired, laid off, or relocated a few years back overwhelmingly say it turned out to be a positive development.

Marketing Guy was let go the same week he and his newly pregnant wife bought a new house, but he eventually got two job offers, took one that allowed him to move his family to Europe, and rose within that company’s ranks over 10 years. His advice is to keep working hard (even if that work involves job-hunting), keep learning, and stay positive. Hermanator was fired due to office politics from a company he had helped start, but he says it was the best thing that could have happened because he then started an even better company. He advises that folks take a break, reflect, learn from any mistakes they made, focus on their strengths, and find a new opportunity they can get passionate about.

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New poll to your right or here: which would you value most highly in your personal doctor? You don’t get an “other” or intellectually lazy “all of the above” option because it’s my poll and I know what I’m trying to assess, but those who feel deprived that they weren’t given an essay question can click the “Comments” link after voting and opine away.

Old friend of HIStalk Alex Scarlat, MD (we first corresponded sometime before 2011, I found by searching my old emails) is doing fun work on his own with machine learning. Check out his DogBreed.io, which can identify a dog breed from a photo with 97 percent accuracy (giving you some idea of the excitement behind using ML for diagnostic imaging analysis). He says he wrote it in under 50 lines of Python code. Alex has also done some work with weather prediction that is showing high accuracy. I have suggested that he consider writing a primer series on machine learning for clinicians for HIStalk, a non-technical review of what’s inside the black box and where it might be good (or not so good) for healthcare applications.

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I realized that my ancient Yahoo Mail account is a treasure trove of 80,000 emails going back to August 2004, 14 months after I started HIStalk (I don’t recall which email provider I used before then). Reading the names of defunct companies, seeing email from now-retired or deceased industry people, and marveling at my energy and exuberance in my emails way back then made me nostalgic. Yahoo Mail is still the best service I’ve used and its search is excellent, so let me know if there’s something fun I should search for (people, companies, unflattering terms, etc.) I found my first-ever interview from late 2004 that I thought was lost forever (with Meditech’s Howard Messing); planning emails from the first HIStalkapalooza in 2008; and threats from an industry magazine’s publisher who was unhappy that I ridiculed a newly assigned health IT reporter who was hired from a pastry magazine.


Webinars

October 30 (Tuesday) 2:00 ET. “How One Pediatric CIN Aligned Culture, Technology and the Community to Transform Care.” Presenters: Lisa Henderson, executive director, Dayton Children’s Health Partners; Shehzad Saeed, MD, associate chief medical officer, Dayton Children’s Health Partners; Mason Beard, solutions strategy leader, Philips PHM; Gabe Orthous, value-based care consultant, Himformatics. Sponsor: Philips PHM. Dayton Children’s Health Partners, a pediatric clinically integrated network, will describe how it aligned its internal culture, technology partners, and the community around its goal of streamlining care delivery and improving outcomes. Presenters will describe how it recruited network members, negotiated value-based contracts, and implemented a data-driven care management process.

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


Acquisitions, Funding, Business, and Stock

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Four private equity firms and activist investor Elliott Management are considering placing a bid to acquire Athenahealth, sources suggest. Pamplona Capital, which was previously rumored to be interested in acquiring the company and merging it with its NThrive holding, is not listed in the latest round of rumored potential acquirers but is presumably still in the hunt. ATHN will announce earnings on Thursday. Somehow you get the feeling that Elliott’s malicious manipulation isn’t going to be good for Athenahealth, its customers, or the health IT industry, but I’m sure some money guys will figure out how to enrich themselves while creating nothing more than mayhem.

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Valley Presbyterian Hospital (CA) tries to ride the coattails of the new Neil Armstrong movie “First Man” by reminding everyone that it was the first hospital to use telemetry-based patient monitoring back in 1966, when Spacelabs took NASA’s astronaut monitoring product into healthcare.


Sales

  • Drug maker Allergan joins TriNetX’s global health research network to analyze patient cohorts, choose study sites, and determine drug study protocol feasibility.
  • The Kentucky Hospital Association joins Collective Medical’s care collaboration network to allow state hospitals to identify patients with a history of substance abuse or treats to ED staff safety as well as to identify and support complex patients.

Decisions

  • Select Specialty Hospital-Johnstown (PA) will replace Medhost with Epic in 2019.
  • Maury Regional Health System (TN) will implement Cerner in November 2018, replacing Meditech.
  • Mercy Medical Center (MA) went live with Epic in September 2018.
  • Washington County Regional Medical Center (GA) will go live with Evident financial management on November 1, 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.


People

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Wayne, PA-based behavioral health solution vendor Tridiuum hireshttps://tridiuum.com/tridiuum-expands-executive-team-with-cro/ Chris Salvatore, MBA (Halo Communications) as chief revenue officer.

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Intelligent Medical Objects promotes Eric Rose, MD to VP of clinical informatics.


Announcements and Implementations

Mayo Clinic has been going live with the Visage 7 Enterprise Imaging Platform along with its Epic go-lives, finishing up last week at its Jacksonville and Scottsdale campuses. Mayo now has a single enterprise imaging platform and diagnostic viewer along with Epic-driven interpretation workflow across its national network.

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Maitland, FL-based Therigy, which sells specialty pharmacy software for therapy support and patient assessment, says it has reached 100 million patient engagement activity and assessment responses. The company offers care plans and assessments for 20 conditions, with 900 assessments covering 400 medications.


Government and Politics

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A tweet by CMS Administrator Seema Verma implies that EHR vendors are responsible for the lack of interoperability adoption (which I’m wording intentionally as a combined technical and business problem as opposed to “lack of interoperability capability” as a purely technical issue). She says “doctors should be able to seamlessly exchange data between EHRs,” failing to note that many of them who are properly motivated already do in proving the product’s capability, while those using the very same EHR often remain as information silos.

The government of China expands its e-healthcare regulations:

  • Commercial companies can collaborate with providers to offer electronic diagnosis, telemedicine, or e-hospitals, but they can’t provide those services on their own.
  • Only licensed professionals with at least three years of clinical practice experience can offer online diagnostic services.
  • Patients can use online clinical services only for follow-up visits. Physicians must refer patients to traditional channels otherwise.
  • Remote consultation and prescribing is allowed as an adjunct to a hospital visit.
  • Controlled substances may not be prescribed as part of a telemedicine visit.

Other

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You won’t like this if you think HIMSS already has too much influence by running its own conference, media, and advertising empire and absorbing competitors by acquisition. HIMSS will help health services research organization AcademyHealth run Health Datapalooza 2019, which used to be a rather quiet conference targeting mostly federal government leaders and data wonks. You may take it to the bank (and HIMSS will) that the exhibit hall is going to get a lot bigger.

HIMSS haters might not like this, either. HHS will work with Healthbox (acquired by HIMSS a few months ago) to convene quarterly Deputy Secretary’s Innovation and Investment Summit meetings to ask investors which policies are standing in the way of innovation. Healthbox is a business accelerator that HIMSS acquired to expand its consulting, investment fund management, and startup assistance programs in uncovering yet another way to compete with its paying members.

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Speaking of HIMSS, they’ve yet to respond to my October 2 request for their non-profit Form 990 federal filing, which they are required by law to provide (but maybe not promptly), even though I notice that I fawningly and mistakenly said “please” twice in the same sentence. I’m always interested in its salaries, revenue by segment, and the occasional buried information about its acquisitions.

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The American Nurses Association’s journal celebrates National Health Information Technology Week with observations about EHR nurse documentation:

  • Data models do not accurately capture nurse assessment and interventions, focusing instead on patient demographics, diagnoses, and procedures instead of the actions that nurses take.
  • All care team members should be able to add to the electronic care plan documentation, including non-clinical information such as social determinants of health, and that documentation should be supported by health IT standards.
  • A study has found that the EHR requires 593 clicks for a nurse to complete the nursing admission assessment and that 31 percent of the required items were already documented elsewhere, motivating Vanderbilt University Medical Center to create a “click gatekeeper” team that must approve requests to add items to the nurse documentation record.

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Several prominent Memorial Sloan Kettering Cancer Center researchers update their conflict-of-interest disclosures in previously published journal articles, adding previously undisclosed financial ties to drug companies. One doctor added 31 company affiliations, while another’s updated long list of company ties includes being paid consulting fees, owning stock options, and co-founding a company. MSKCC says each journal has its own disclosure requirements and some require authors to disclose relationships unrelated to the study being published, complicating the issue.

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Weird News Andy titles this story as “CO and Old Lace.” In China, an anesthesiologist who was having an affair with the tutor of his children is sentenced to life in prison for killing his wife who refused to divorce him (his 16-year-old daughter also died as unintended collateral damage) by filling a yoga ball with carbon monoxide, removing the stopper, and placing it the trunk of his wife’s car. The deflated ball raised the suspicions of police, who then found that the doctor had ordered the carbon monoxide from his university employer claiming he needed it to perform animal tests.


Sponsor Updates

  • Intelligent Medical Objects chairman, chief innovator, and co-founder Frank Naeymi-Rad, PhD, MS, MBA will be inducted into the American College of Medical Informatics at AMIA’s annual symposium in San Francisco November 3-7.
  • InterSystems makes its IRIS Data Platform available in the Microsoft Azure Marketplace.
  • Waystar will exhibit at HFMA Region 2 Conference October 17-19 in Verona, NY.
  • Nordic will exhibit at the Georgia HIMSS Annual Conference October 16 in Atlanta.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the AWHONN Iowa Section Conference October 16 in Des Moines.
  • Recondo Technology will present at the Health Management Academy’s CFO Forum 2018 Meeting October 17-21 in Deer Valley, UT.
  • Experian Health will host its 2018 Financial Performance Summit October 22-24 in Dallas.
  • Redox partners with Smart Health Innovation Lab to help innovative healthcare startups accelerate time to integration.
  • Sunquest will exhibit at ASHG 2018 October 16-20 in San Diego.
  • Surescripts CEO Tom Skelton will keynote the Value-Based Care Summit October 17-19 in Boston.
  • T-System offers disaster relief sheets free of charge to hospitals in the path of Hurricane Michael.
  • Voalte will exhibit at the 2018 Michigan Nursing Summit October 18-19 in Lansing.
  • FormFast joins the Zen Healthcare IT Interoperability Community.
  • ZeOmega will exhibit at the 2018 CAHP Annual Conference October 22-24 in San Diego.

Blog Posts


Contacts

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

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News 10/12/18

October 11, 2018 News No Comments

Top News

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Bay Medical Sacred Heart and Gulf Coast Regional Medical Center evacuate a combined 330 patients after suffering extensive damage during Hurricane Michael’s destructive trek through Panama City in the Florida panhandle. Damage to the facilities included a collapsed roof, cracked walls, blown-out windows, and in the case of Bay Medical, cooling and plumbing issues and loss of its information systems.

Bay Medical cardiologist Sam Patel, MD told the local news Michael’s winds were, in his experience, worse than Katrina’s: “The wind damage was pretty phenomenal. Windows were being blown in and water was coming in. Luckily, none of our patients had any injuries due to the storm. It was about two to three hours of pure hell.”

The category 4 storm, which achieved wind speeds of up to 155 mph, caused the closure of four hospitals and 11 nursing homes in Florida.


Webinars

October 30 (Tuesday) 2:00 ET. “How One Pediatric CIN Aligned Culture, Technology and the Community to Transform Care.” Presenters: Lisa Henderson, executive director, Dayton Children’s Health Partners; Shehzad Saeed, MD, associate chief medical officer, Dayton Children’s Health Partners; Mason Beard, solutions strategy leader, Philips PHM; Gabe Orthous, value-based care consultant, Himformatics. Sponsor: Philips PHM. Dayton Children’s Health Partners, a pediatric clinically integrated network, will describe how it aligned its internal culture, technology partners, and the community around its goal of streamlining care delivery and improving outcomes. Presenters will describe how it recruited network members, negotiated value-based contracts, and implemented a data-driven care management process.

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


Acquisitions, Funding, Business, and Stock

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TransUnion acquires revenue cycle vendor Rubixis in an effort to strengthen its post-discharge revenue recovery services.

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Amazon patents speech analysis technology that may give Alexa the ability to detect illness and mood in a user’s voice, and then recommend and order products from Amazon’s marketplace. The patent filing also suggests that products and services from advertisers would be the first of Alexa’s suggestions.

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The DoJ clears CVS Health to proceed with its $69 billion merger with Aetna, which will operate as a standalone business once the deal closes at the end of Q4. First proposed late last year, the deal gained steam after Aetna sold off Medicity in May, and is now contingent on the payer selling off its Medicare prescription drug Part D plans. It has gotten pushback from trade associations like the AMA, which believes the merger will negatively affect patients by offering them fewer choices and, ultimately, higher prices.


Government and Politics

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The VA promotes financial management exec Paul Tibbits to executive director for the Office of Electronic Health Record Modernization. Tibbits takes over the role from Genevieve Morris, who resigned in August over differences with leadership in project direction.

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NASA pilots Wolters Kluwer Health’s UpToDate clinical decision support software aboard the International Space Station. To work around spotty Internet connectivity, astronauts are using the MobileComplete version, which gives them the ability to download content for offline access.


Sales

  • Sovah Health (VA) will implement lung cancer screening software from Eon at its Martinsville and Danville campuses.
  • Cornerstone Hospice and Palliative Care selects Netsmart’s MyUnity EHR for post-acute providers.

People

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AMIA will honor National Library of Medicine Director Patricia Brennan, RN with the 2018 Morris F. Collen Award of Excellence at its annual symposium next month.

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William Turner (GovernmentCIO) joins Healthcare Management Solutions as chief strategy officer.


Announcements and Implementations

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Penn Highlands DuBois (PA) goes live with tele-ICU capabilities from Advanced ICU Care that will connect its providers with specialists at UPMC.

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Avera Health will use an $8 million grant to develop a behavioral health team at its ECare telemedicine hub in South Dakota. Virtual services will initially cater to ED and psychiatric hospital patients, then expand to first responders.

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Urgent Care Group implements DocuTap’s EHR and practice management software at its MedCare Urgent Care facilities in South Carolina.

Surescripts sees utilization of its Record Locator & Exchange service jump 40 percent since launching last year thanks to increased adoption amongst Epic, NextGen, and EClinicalWorks users.

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Northern Light Health’s A.R. Gould Hospital (ME) transitions to Cerner as part of what seems to be a nearly system-wide roll out that coincides with a rebranding from Eastern Maine Health System.

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Good Shepherd Health Care System (OR) will go live on Epic next month through a $3 million sharing agreement with Legacy Health.


Other

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Penn Medicine launches an internal EHR campaign that it hopes will get its Epic end users thinking about how to use the software more for care delivery than documentation. The transformation project will include an innovation tournament that will pair IT staff, data scientists, and clinical educators with clinicians to create software improvements.

Public hospitals in Melbourne, Australia rake in $45 million in car parking fees thanks to daily rates as high as $35, and government officials who don’t mind turning a blind eye despite promising to lower prices. The public’s outrage has also extended to Sydney, where its Eye Hospital has earned the dubious honor of charging the highest parking rate in the country – $64 for six hours.

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Children’s Hospital of Philadelphia researchers use EHR data from its Epic system to develop an automated malnutrition screening tool that alerts providers to at-risk patients.

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Cerner CEO Brent Shafer shows off his musical chops at the company’s closing night conference bash.

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Military Makeover host Montel Williams credits the use of telemedicine by NYC paramedics with helping to save his life after suffering a rare type of stroke while working out in a hotel gym.


Sponsor Updates

  • Primus Capital’s growth investment in Hayes will support continued development of its MDaudit Enterprise revenue integrity software.
  • Elsevier provides point-of-care tools to NHS Wales in the UK.
  • The EClinicalWorks National Conference attracts over 5,000 attendees.
  • FormFast will exhibit at Health Connect Partners Hospital & Healthcare IT Conference October 15-17 in Chicago.
  • Glytec publishes a new e-book, “Hypoglycemia in the hospital: Why is it costing you millions and what can you do?”
  • Hayes will exhibit at the 2018 Revenue Integrity Symposium October 16-18 in Phoenix, AZ.
  • Iatric Systems will exhibit at the HIMSS Healthcare Security Forum October 15-16 in Boston.
  • InterSystems will exhibit at Healthcare Providers Transformation October 16-17 in Denver.
  • The American Medical Informatics Association will induct Intelligent Medical Objects CEO Frank Naeymi-Rad, PhD, MBA into the American College of Medical Informatics.
  • Kyruus will host the Annual Thought Leadership on Access Symposium October 15-17 in Boston.
  • Meditech will host the 2018 Physician and CIO Forum October 17-18 in Foxborough, MA.
  • AxialHealthcare will incorporate medication history from Surescripts into its analytics-based pain management software.
  • Diameter Health earns ONC 2015 Edition Health IT Module Certification from the Drummond Group.
  • PatientPing congratulates its national network of ACOs on generating shared savings of $270 million.

Blog Posts


Contacts

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

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News 10/10/18

October 9, 2018 News 6 Comments

Top News

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GE Healthcare’s former Value-Based Care Solutions Group, sold to private equity firm Veritas Capital in April 2018 for $1.05 billion in cash, renames itself Virence Health Technologies.

The GE Healthcare products that were included in the acquisition are revenue cycle, ambulatory, and workforce management systems previously sold under the Centricity and API Healthcare brands.

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Virence Chairman and CEO Bob Segert, appointed in mid-September, has zero healthcare experience. Former GE VP/GM and industry long-timer Jon Zimmerman will report to Segert as president.


Reader Comments

From Red Red Wine: “Re: careers. Why would you say that co-workers aren’t your friends? I socialize quite a bit with my work family at [vendor name omitted].” The people who might give you a ride to work from your oil change since they might need you to return the favor won’t be nearly as willing to serve as emergency overnight dog-sitters, listen patiently as you tearily describe your mother’s dementia, or know when and how to reach out supportively when you miss a few work days without explanation. I should probably take my own “work is not life” advice by not holding a grudge against former co-workers who I think wronged me in some way – it probably wasn’t personal that they were back-stabbing opportunists who were forged in an ugly corporate health system crucible that resembled one of those psychology experiments where a test subject will apply deadly electric shocks to an innocent victim when an authority figure insists. I guarantee that within minutes of your also-friendly employer marching you off their property in a layoff, your “work family” members are going to be unemotionally circling like vultures to get first dibs on your cubicle stuff.

From Conference Liner: “Re: Cerner naming social media influencers for CHC. Is that a thing now that HIMSS has been doing it?” Beats me. I don’t really get the point of naming “social media influencers” unless it’s to give them free registration in return for the free advertising they theoretically offer in return. It’s not as though tweeting is so hard that only Twitter experts can figure it out, or that those folks possess industry influence that correlates to their Twitter stats (since those stats don’t indicate exactly who they are influencing beyond each other). At least the Cerner-named influencers are mostly accomplished people who hold responsible jobs as recognizable subject matter experts.


Webinars

October 30 (Tuesday) 2:00 ET. “How One Pediatric CIN Aligned Culture, Technology and the Community to Transform Care.” Presenters: Lisa Henderson, executive director, Dayton Children’s Health Partners; Shehzad Saeed, MD, associate chief medical officer, Dayton Children’s Health Partners; Mason Beard, solutions strategy leader, Philips PHM; Gabe Orthous, value-based care consultant, Himformatics. Sponsor: Philips PHM. Dayton Children’s Health Partners, a pediatric clinically integrated network, will describe how it aligned its internal culture, technology partners, and the community around its goal of streamlining care delivery and improving outcomes. Presenters will describe how it recruited network members, negotiated value-based contracts, and implemented a data-driven care management process.

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


Acquisitions, Funding, Business, and Stock

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Odd: the soon-to-be-renamed Adventist Health System / Florida Hospital signs up as a multi-year sponsor of Nascar’s Speedweeks, heretofore to be reverently referred to as “Daytona Speedweeks Presented by AdventHealth.” Nascar, which must be happy to have signed a new sponsor as its attendance, TV ratings, and sponsorships continue their sharp slide, declares that “the Daytona Speedweeks brand will provide another platform for Florida Hospital to amplify their new name.” Hopefully the terms did not include requiring Florida Hospital’s doctors to wear ads on their scrubs or surgical teams to swoop in with their instruments like a pit crew to complete an appendectomy in less than 20 minutes.


People

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The National Library of Medicine promotes Clem McDonald, MD, MS to the newly created position of chief health data standards officer.


Announcements and Implementations

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China-based Tencent – which developed the globally popular (except in the US) WeChat app — will work with England-based Medopad to assess the condition of Parkinson’s disease patients by analyzing video of their movements and to alert their doctors of any deterioration. Tencent is working on other AI-related healthcare projects.

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Office Depot-owned CompuCom launches Self Healing Healthcare, a service that monitors end user devices for problems, outages, and failures.

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Blockchain-focused, UK-based health data rights organization Hu-manity.co launches in Europe to push for patients to control and manage their own healthcare data under the #My31 movement that advocates making such ownership the 31st Human Right. They’re also launching a US-only app to allow users to specify such control.


Privacy and Security

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Startup LunaDNA, backed by a DNA sequencing company, seeks SEC approval for its business plan to pay consumers for the right to sell their genetic information, the opposite of companies like 23andMe that charge people to sequence their DNA and then profitably sell their information on the sly. Donors earn shares in the “biobroker” company and post their de-identified information up for bid on its marketplace to keep a share of the proceeds.

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Google shuts down its spectacularly failed would-be Facebook competitor Google+ after deciding not to alert users that a security hole allowed their data to be hacked over several years. A Google committee advised executives that owning up to the breach would damage the company’s reputation and trigger a regulatory response a la Facebook’s Cambridge Analytica scandal, so it decided to close Google+ instead. A splendid Twitter review by former US Digital Service Administrator (and former Google employee) Mikey Dickerson says Google+’s self-proclaimed “social spine” infected the company’s other products, such as YouTube’s shared log-in and the termination of Google Reader. He concluded with a brilliant observation above. We science types appreciate Mikey’s LinkedIn tagline of “Free Radical.”

DataBreaches.net reports that virtual visit vendor MedCall Advisors has, for the second time in a month, been caught storing patient data in an unsecured Amazon S3 bucket. CEO Randy Baker did not acknowledge the courtesy notifications that were sent to him or ask those who alerted him about the exposure to delete any PHI they accessed.


Other

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Researchers advocate that EHR-powered electronic trigger tools be used to detect possible diagnostic errors and to identify patients who are at high risk of adverse events. The most obvious immediate benefit would seem to be to identify gaps in care cause by poor coordination, such as when nobody seems to have followed up on critical diagnostic results. The most limiting factor is the extent of clinical information stored as free text.

A BMJ opinion piece says the industry needs to do a better job of reducing the number of unwanted EHR alerts that consume physician time. Here’s the dilemma – we don’t let doctors individually decide based on their own practice which alerts to turn off because those “unwanted” alerts are often important, at least in the opinion of the non-doctors who maintain them. That brings up the never-ending dilemma of the purpose of the EHR – is it intended to help doctors, or instead to force administrative policies and concerns on them? I’ve worked a lot on those alerts and found these challenges:

  • Alerts are not always personalized (or cannot be personalized). A warning about a specific drug for a patient with kidney disease might be useful to a surgeon, but not a nephrologist.
  • An overridden alert, where the intended action is completed as an order, means the user, rightly or wrongly, didn’t find that alert useful.
  • On the other hand, doctors routinely fail to read EHR screens (due to alert overload, poor UI, or sloppy behavior) and will happily override a warning that prescribing 1,000 Tylenol tablets might be unwise and leave their error for someone else to catch.
  • My most important conclusion is that the quest to apply alerts universally is an illogical reflection of the collective nature of how hospitals see doctors. They know which ones have marginal skills or a record of causing patient mayhem, but they punish all doctors instead of just those who clearly need more than an average amount of electronic help to avoid screw-ups. Doctors should be regularly graded on their clinical track record, experience levels, malpractice and discipline history, and history of alert compliance, with the sensitivity of clinical alerts tuned to prevent them from making mistakes while not hindering those who rarely do so.

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A review of virtual online consultation platforms, aka virtual second opinions – specifically Medscape Consult – concludes that medical crowdsourcing can reduce diagnostic errors and increase global reach. The most valuable takeaway is that most of the doctors presenting cases were young, but most of the expert responses came from doctors over 60 years of age, suggesting that: (a) younger doctors can benefit from asking more experienced ones to weigh in; and (b) older doctors are technically comfortable enough to provide such wisdom. The authors note that they don’t have any way to determine whether those second opinions improved diagnostic accuracy, but it doesn’t matter – even if the original doctor’s conclusion was correct, having experienced peer validation provides confidence and perhaps reduces further expensive diagnostic work. Having face-to-face contact with patients is important, but this is an example of where armchair quarterbacking can provide real patient value and an opportunity for older doctors to contribute purely as an intellectual challenge without dealing with reimbursement, the limitations of a 15-minute encounter, practicing defensive medicine, or managing a patient’s entire medical life instead of just recognizing what’s wrong with them and then moving on.

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A fascinating New York Times article covers the MD-PhD co-founder of drug maker Regeneron, whose cholesterol-lowering drug is so widely useful yet so expensive ($14,000 per year) that insurers often won’t pay for it. The kicker: that co-founder is the guy who invented the drug and yet he pays full list price for his own prescription (so he claims, anyway) since the company’s insurance doesn’t cover it. He says Regeneron spent $2.6 billion to get the drug on the market and annual sales are less than $200 million.

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Pediatrics professor and New York Times contributor Aaron Carroll says the Apple Watch’s new EKG capability has quite a few negatives – few people have undiagnosed arrhythmias that don’t have symptoms, false positives and negatives can be worrisome and expensive, a Stanford study found that most of the Watch’s EKG warnings were wrong, previous large-scale studies found little value in mass population EKG screening, and that the device’s cost (which isn’t covered by insurance) means that people who would benefit most from it won’t get it. He advises, “But I’m under no illusion [Apple Watch’s activity monitoring] will help me lose weight or exercise more or improve my heart health. I own one because I want it, not because I need it.”

A Washington Post review finds that millennials often don’t have a primary care provider and don’t want one, favoring the convenience, speed, and upfront pricing of walk-in clinics and urgent care centers to meet their infrequent needs instead of PCP practices that require making appointments well in advance, cover limited hours, and send patients to the ED on evenings and weekends. The dilemma is that patients have to give up the benefits of longitudinal care because they value it less than convenience.

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Cerner Chairman and CEO Brent Shafer provides Monday’s opening keynote at the Cerner Health Conference in Kansas City, MO.

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I enjoyed this recap of the beginnings of Flatiron Health by co-founder Nat Turner, who with his also-under-30 co-founder had previously sold their ad business to Google for $80 million. They  decided to do something about cancer, figuring Flatiron would be a non-profit until they realized that “great engineers don’t work at non-profits. They tend to go to places like Facebook.” Flatiron bought oncology EHR vendor Altos Solutions with Google investment money barely after not even knowing what an EHR is, but quickly figured out how to mine EHR data to assess cancer drug effectiveness. Drug maker Roche bought the company six years after its founding in April 2018 at a $2.1 billion valuation. Cancer has made a lot of people poor, but a few people rich.

Anxious healthcare startups love to compare themselves to Uber or Facebook, but here’s a legal case where Uber can call itself the Epic of ride-sharing services. A court rules that Uber’s driver arbitration agreements are legal based on the US Supreme Court’s ruling in Epic Systems Corp. v. Lewis, which found that such employer-mandated terms preclude employees from undertaking actions as a class to address labor disputes.

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Tuesday was Ada Lovelace Day, honoring the mathematician – and arguably the world’s first computer programmer — who recognized the potential of the Analytical Engine theorized by Charles Babbage. She died at 36 in 1852 after doctors treated her uterine cancer with bloodletting. Her father was Lord Byron, although he bailed on Lady Byron early on and his daughter never knew him.


Sponsor Updates

  • Ellkay is exhibiting this week at the Cerner Health Conference, where it will demonstrate its LKArchive data archiving solution for accessing information from decommissioned legacy systems. 
  • Spok’s Connect 18 annual conference attracts 150 attendees to Scottsdale, AZ this week.
  • Smart Health Innovation Lab will offer Redox’s integration platform to companies that have graduated from its market accelerator program.
  • Howard Medical will offer Imprivata Medical Device Access on some of its medical storage carts.
  • AdvancedMD will exhibit at the American Society of Dermatologic Surgeons Annual Meeting October 11-14 in Phoenix, AZ.
  • Aprima and CompuGroup Medical will exhibit at the AAFP Annual Meeting October 10-12 in New Orleans.
  • Audacious Inquiry hires Christina Caraballo (Get Real Health) as director.
  • Arcadia will exhibit and present at the SRHO 2018 annual conference October 11-12 in Dallas.
  • Bluetree and Direct Consulting Associates will exhibit at the Health Connect Partners Hospital & Healthcare IT Conference October 15-17 in Chicago.
  • Bernoulli Health will present at the Connected Health Conference – Immersion Day October 17 in Boston.
  • Datica will present at the Cloud Native PDX meeting October 12 in Madison, WI.
  • CarePort Health will exhibit at ACMA North Carolina October 12 in Asheville, NC.
  • Diameter Health will speak at the HIMSS NE Health IT Advocacy and HIE Day October 10 in Worcester, MA.

Blog Posts


Contacts

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

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Monday Morning Update 10/8/18

October 7, 2018 News 8 Comments

Top News

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An study of 83 mostly top-rated hospitals finds that patients still struggle to get copies of their medical information (matching my appalling experience):

  • 89 percent do not allow patients to request a specific category of information to be released
  • 47 percent don’t offer an option to request the entire medical record even though all of them claim to offer that option
  • Medical records release form instructions often differ from what employees tell patients by telephone
  • Many hospitals ignore the federal requirement that they provide information in whatever format the patient wants
  • More than half of hospitals charge patients more than OCR guidelines and 8 percent say they routinely don’t meet state-mandated release timeframes
  • Trying to get to the right person by telephone is made difficult by complex phone trees and, in the case of two hospitals, no option was offered to speak with a human or to leave a message

Reader Comments

From Kenny Powers: “Re: the all-new Allscripts Avenel EHR. I haven’t heard anything about it since it was announced in March. Is it being sold yet?” I haven’t heard a peep since the buzzword-heavy announcement seven months ago. The product isn’t listed on the company’s EHR page and Googling turns up nothing. It wasn’t mentioned in the company’s August earnings call. Allscripts said it’s being used by Carlinville Area Hospital (IL), which didn’t respond to my inquiry.

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From Pure Prairie: “Re: GE. I can’t figure out how they took such a hard fall.” Chasing business and technology fads; poor strategic and operational performance by Jeff Immelt; a smothering bureaucracy that stifled innovation and encouraged executive backstabbing; unfocused acquisitions under both Jack Welch and Immelt whose interesting aspects were digested away in GE’s sluggish colon; incestuously moving the same old executives around in wildly unrelated divisions per the “GE way;” and a conglomerate strategy that left it vulnerable to big downturns in oil and financial services. GE Healthcare IT was best known for buying vendors with top-ranked products and then diving straight to the bottom as the poster child for “first to worst.”

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From Amatriciana: “Re: careers. I was laid off and could use advice.” I’ve had my share of career missteps (being demoted, boss conflicts, regretting taking a promotion after belatedly realizing that the last thing I wanted was more responsibility) and my general conclusions are these:

  • It doesn’t matter whether the seemingly undesirable change is your fault or the company’s.
  • Your self-worth or identity is not defined by what you do for money and the people you worked for or with are not your real friends. You are a vendor (of your own services) who lost a key account and life goes on.
  • Always be managing your career and your network so you aren’t caught off guard when you need to make a change quickly (OK, I’ve never done that, but I wish I had when the layoff axe began swinging and we were all scrambling simultaneously hoping to find local jobs with similar skill sets).
  • Never stop learning, even if on your own (cue my pitch for reading HIStalk as well as my original incentive for writing it).
  • The dotted lines of your career changes make sense only after the fact, when the pattern becomes clear. You never know where you’ll end up or how to get there. Serendipity is often your friend.

HIStalk Announcements and Requests

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Most poll respondents aren’t heavy users of smart speakers at home. The most common uses are setting hands-free timers, playing music or mood sounds, keeping shopping lists, checking the weather, and controlling smart plugs to turn specific items on and off. There’s apparently also an intercom feature on Echos that I didn’t know about and some folks play games on their devices. 

New poll to your right or here: for those whose company, more than five years ago, terminated you, demoted you, or forced you to move — did that turn out to be positive overall?

Thanks to these companies that recently supported HIStalk. Click a few logos to learn more about companies you don’t know much about and to thank them for making what I do possible.

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I didn’t realize what a mess I’d gotten into when a friend asked for help buying a replacement set of wired earbuds for her Phone 7, a shining example of Apple’s recent cluelessness and crappy accessory quality. That model eliminated the headphone jack for no user-benefitting reason; Apple’s Earpods (as well as the Lightning-to-3.5mm connector) are pure junk that last weeks at best, according to reviews; you can’t listen and charge simultaneously; and because of the market opportunity offered by Apple’s misstep, every product listing on Amazon is obviously fake since the reviews don’t match the product. Bluetooth is an option, but it’s pain having to charge earbuds as well as the phone itself. I finally gave up and spent $30 on the EarPods from Best Buy plus $10 for the converter cable since I was getting free shipping anyway, so at least the option is there to ditch Apple’s earbuds in favor of decent ones, at least for the few days the converter cable is likely to last before falling apart.


Webinars

October 30 (Tuesday) 2:00 ET. “How One Pediatric CIN Aligned Culture, Technology and the Community to Transform Care.” Presenters: Lisa Henderson, executive director, Dayton Children’s Health Partners; Shehzad Saeed, MD, associate chief medical officer, Dayton Children’s Health Partners; Mason Beard, solutions strategy leader, Philips PHM; Gabe Orthous, value-based care consultant, Himformatics. Sponsor: Philips PHM. Dayton Children’s Health Partners, a pediatric clinically integrated network, will describe how it aligned its internal culture, technology partners, and the community around its goal of streamlining care delivery and improving outcomes. Presenters will describe how it recruited network members, negotiated value-based contracts, and implemented a data-driven care management process.

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


Acquisitions, Funding, Business, and Stock

Gastroenterology EHR vendor GMed, acquired in mid-2015 by Modernizing Medicine, renames itself to Modernizing Medicine Gastroenterology. 


Sales

  • Hackensack Meridian Health (NJ) implements Vocera Rounds at JFK Medical Center, the health system’s 10th deployed hospital.
  • Berkshire Health Systems selects Santa Rosa Consulting to lead its Meditech Expanse implementation.

Decisions

  • Kessler Institution for Rehabilitation (NJ) switched from Medhost to Epic in March 2018
  • University of Mississippi Healthcare (MS) will replace Infor with Workday human resources software by January 2019
  • Yalobusha General Hospital (MS) implement Athenahealth in December 2017, replacing Medhost
  • Memorial Hospital (IL) will replace Evident financial management with Infor
  • Olmstead Medical Center (MN) will implement Epic in September 2018, replacing Cerner

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

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Tim Knoll (Healthgrades) joins PatientSafe Solutions as regional VP.


Announcements and Implementations

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A KLAS report on medical device security — created with CHIME and its security group AEHIS — finds that few CIOs and CISOs are confident that those devices are protected, mostly because of poor manufacturer support or due to their own lack of a device inventory. The confident respondents give credit to good policies and procedures, strong technology, and interdepartmental collaboration, although it’s anybody’s guess as to whether they are truly more secure rather than naive. Respondents say it’s tough to protect legacy devices due to outdated operating systems, lack of patching capability due to technology limitations or warranty policy, hardcoded passwords, and lack of encryption. They also say manufacturers use FDA policies as their excuse for not patching their devices, yet FDA rarely holds the device-makers responsible when their systems are breached.

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A new Reaction Data report on clinical decision support finds that 55 percent of mostly hospital-based respondents use multiple CDS solutions, with most of those provided by their EHR vendor. Caveat: I would question the accuracy of the 25 percent of respondents who say their hospital doesn’t use any form of CDS, the non-appearance of Meditech on the list among its EHR competitors, and the inclusion of Allscripts EPSi even though it offers only financial (not clinical) decision support. Non-EHR vendors with the largest presence are Stanson Health and National Decision Support Company. A 2017 study found that the imaging CDS of NDSC, which was acquired by Change Healthcare in January 2018,  holds 70 percent of that market.

EClinicalWorks will integrate its Healow mobile app with the WellWatch smart watch being developed by UK-based Care UK.


Government and Politics

The latest Bureau of Labor Statistics employment report finds that healthcare employment increased by 26,000 in September, nearly evenly split between hospitals and ambulatory services. Healthcare employment has increased by 302,000 in the past year. In other words, we’re turning the entire country into one giant hospital and then complaining that insurance costs too much and our taxes are too high.


Other

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CNBC profiles Heartbeat, a cardiology practice startup that is opening offices in New York City that will offer online tests, virtual care, and treatment plans that include exercise and nutrition components. The “fully digitized boutique cardiology practice” accepts Medicare, commercial insurance, and cash ($200 for a visit or $299 for an annual membership).

Aprima sales executive Lance Allen donates a kidney to allow his peer Mike Alfieri — who he met two years ago at a company sales meeting — to receive a transplant in a 13-person paired exchange.

Just in case watching a single shark jumping isn’t enough, BlackBerry (are they still in business, and if so, why?) announces a blockchain solution for health data storage, an operating system for secure medical devices, and a skin cancer data sharing service for researchers. The company has chased healthcare tech fads before — I haven’t heard a thing about BlackBerry’s work with (and investment in) NantHealth in early 2014.

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The Montivideo, MN paper apparently confused the local hospital’s incumbent vendor (Meditech) with its new one (Epic). I assume it’s a Community Connect implementation at a price of just $1.5 million. It’s also odd that the hospital says its existing system is “outdated” when it was supposed to have upgraded to Meditech 6.1, although maybe that never happened.


Sponsor Updates

  • Liaison Technologies will accept applications for its $5,000 Spring Semester 2019 Data-Inspired Future Scholarship through October 31.
  • LiveProcess will exhibit at the Iowa Hospital Association Annual Meeting 2019 October 9-11 in Des Moines.
  • Vyne Medical, Experian Health, The SSI Group, Surescripts, and National Decision Support Co. will exhibit at the Cerner Health Conference October 8-11 in Kansas City, MO.
  • Netsmart will exhibit at the Michigan Premier Public Health Conference October 10 in Bay City, MI.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the AWHONN conference October 11 in Freeport, ME.
  • TransUnion wins an “Outstanding Company Culture” award from the Illinois Technology Association.
  • TriNetX will exhibit at the MedImmune California Translational Science Forum October 9 in San Francisco.
  • Voalte names Candice Friestad, RN of Avera Health the 2018 Voalte Innovator of the Year.
  • Wellsoft will exhibit at the Urgent Care Association Fall Conference October 12-14 in Houston.

Blog Posts


Contacts

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

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News 10/5/18

October 4, 2018 News 4 Comments

Top News

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Cerner announces its VA EHR modernization team, with Leidos, Accenture, and Henry Schein taking on prominent roles as expected.

In announcing the 23 members, the company stressed that it will leverage investments already made by the DoD for its nearly concurrent Cerner-powered EHR revamp. VA Secretary Robert Wilkie and Defense Secretary James Mattis have said their departments will work together to ensure their new EHR systems are implemented on a unified schedule and are capable of seamlessly sharing data with civilian and government providers.

Cerner has promised to unveil a project timeline at its user conference next week.

I reviewed the list of companies Cerner has chosen as partners for its VA implementation. These are also working on the DoD’s Cerner implementation:

  • Accenture
  • Leidos
  • Henry Schein
  • Holland Square Group (Cerner-focused implementation consultants — acquired by Alku in December 2017)
  • MedSys Group (EHR consulting)
  • ProSource360 (government consulting)

These are the VA-only partners just announced:

  • AbleVets (government consulting)
  • ACI Federal  (government IT contractor)
  • B3 Group  (government consulting)
  • Blue Sky Innovative Solutions (government consulting
  • Clarus Group (a Salesforce-focused consulting firm that offers government technology services)
  • Forward Thinking Innovations (government health IT — seems to be a two-person consulting firm)
  • Guidehouse (the former PwC Public Sector consulting group)
  • HCTec (health IT and revenue cycle consulting)
  • HRG Technologies (revenue cycle services)
  • KRM Associates (government contract health IT contractor, a small husband and wife business)
  • Liberty IT Solutions (government technology contractor)
  • MedicaSoft (sells an EHR, PHR, and Direct messaging services with a founder who a lot of VA work with FHIR and is founder and board chair at the Open Source Electronic Health Record Alliance)
  • MicroHealth (government analytics, engineering, integration)
  • PM Solutions (project management)
  • Point Solutions Group (consultant staffing)
  • Sharpe Medical Consulting  (health IT consulting, medical staffing)
  • Signature Performance (revenue cycle consulting)
  • ThomasRiley Strategies (consulting)

Reader Comments

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From Plenary Session: “Re: UMass’s financial struggles. Isn’t this the kind of organization that has no business putting $700 million into Epic? Negative operating margins, historically financially strained … makes no sense.” The health system’s operating income has been all over the place, with capital renovation temporarily eating up some of its capacity. While I will defend my contention that a new EHR will amplify a provider’s existing levels of excellence (rarely moving a poor hospital to good), the mere act of choosing, buying, and implementing such a pervasive system (which requires more consensus and focus than many hospitals can muster) may either signal or create its resolve make overdue improvements. Epic also pushes its customers, steamrolling over incompetent or inertia-crippled hospital middle management with the full support of the hospital’s C-level, so don’t underestimate the motivational impact of your CEO demanding that you deliver $700 million worth of value in a rare example of holding executives accountable for true change and coordination across departments. In that regard, improved operational management and visibility may be a byproduct of implementing Epic, although it’s a shame that a software vendor that really doesn’t offer “management consulting” has to lead the charge against mediocrity. Still, hospitals happily pay to have consulting firms tell them what everybody else is doing, so at least an Epic implementation binds the organization to deliver measurable results. As much as we cheap-seaters might smirk about a health system spending hundreds of millions of dollars on software (and oh, I do), the fact is many of them are happy about their decision afterward and show improved results whether it’s Epic, Cerner, or Meditech.

From Expat Investor: “Re: Cornerstone Advisors. Allegations are that officials of its corporate owner 8K Miles forged auditor documents to move money to a sister company mostly owned by the CFO, who resigned.” The India-listed company’s external auditor also quit over the transfers between the companies, which share a CEO.  8K Miles acquired healthcare IT consulting and implementation vendor Cornerstone Advisors Group in late 2016.

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From Zeke Avarice: “Re: webinars. Why would someone watch a recording, such as on your YouTube channel?” Live webinars have just one advantage, and that’s being able to ask the presenter questions. The disadvantage is that you have to be available at the designated time, you have to pay attention at what might be an inopportune moment, and you can’t fast-forward or rewind. That’s why we archive the recording  — those get more views than the live sessions due to the long tail of people discovering them after the fact. Still, we get a lot of interest in webinars (example click counts above), although the quality of the program and the speakers drive whether people actually sign up after reading the description and not everyone who signs up is able to attend (which is why we send absentees a link to the video and a PDF of the slides).


HIStalk Announcements and Requests

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Welcome to new HIStalk Gold Sponsor Atlantic.net. The Orlando-based secure hosting solutions vendor provides HIPAA-compliant, PCI-ready, and cloud hosting from its state-of-the-art data centers in New York, London, Toronto, San Francisco, Northern Virginia, and Dallas. The company just won a “Best IoT Healthcare Platform” awards. Organizations choose the company – founded in 1994 in Gainesville, FL — for its 100 percent uptime SLA, its emphasis on security and compliance, and its award-winning service backed by support engineers with decades of experience, all at competitive prices. It offers the eight items required to deliver HIPAA-compliant hosting – firewall, encrypted VPN, offsite backups, multi-factor authentication, private hosted environment, SSL certificates, SSAE 18 certification, and a signed business associate agreement. Thanks to Atlantic.net for supporting HIStalk. 


Webinars

October 30 (Tuesday) 2:00 ET. “How One Pediatric CIN Aligned Culture, Technology and the Community to Transform Care.” Presenters: Lisa Henderson, executive director, Dayton Children’s Health Partners; Shehzad Saeed, MD, associate chief medical officer, Dayton Children’s Health Partners; Mason Beard, solutions strategy leader, Philips PHM; Gabe Orthous, value-based care consultant, Himformatics. Sponsor: Philips PHM. Dayton Children’s Health Partners, a pediatric clinically integrated network, will describe how it aligned its internal culture, technology partners, and the community around its goal of streamlining care delivery and improving outcomes. Presenters will describe how it recruited network members, negotiated value-based contracts, and implemented a data-driven care management process.

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


Acquisitions, Funding, Business, and Stock

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Change Healthcare hires underwriters for an IPO that could value the company at up to $12 billion. The prep work comes nearly a year after McKesson CEO John Hammergren said he wanted to take the company public. McKesson owns a 70 percent stake of Change, which was formed last year through the merger of its IT business and the former Emdeon.


People

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The MacArthur Foundation awards Deborah Estrin a fellowship, including a $625,000 “genius grant,” for her work on determining how data generated by smartphones, wearables, and online interactions can be used for mobile health while still maintaining user privacy. Estrin is a professor of computer science at Cornell Tech and of healthcare policy and research at Weill Cornell Medicine. She directs Cornell Tech’s Small Data Lab; and founded the Health Tech Hub at the Jacobs Technion-Cornell Institute, as well as the nonprofit, open-source software architecture startup Open mHealth.


Announcements and Implementations

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Frost & Sullvan names Medicomp Systems the winner of its 2018 North America EHR Optimization Technology Leadership Award for its Quippe productivity enhancement solutions for reducing documentation burden.

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Datica announces GA of its Cloud Compliance Management System for developers.

Collective Medical will deliver its real-time event notification and care collaboration tools through Appriss Health’s PMP Gateway integration software, used by the prescription drug monitoring programs of 43 states.

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A new KLAS report says behavioral health EHRs are one of the lowest-performing segments it measures due to slow development, vendor over commitment, and state-specific reporting needs. Still, frustrated customers are likely to keep their existing systems due to lack of money and competitive alternatives. Valeant would have topped the list (over Credible and Cerner, which has two offerings in Millennium and its acquired Anasazi) had it generated enough responses. No vendor scored above a 7 in “keeps all promises.”

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Buoy Health, which offers an AI-powered chatbot, wins the Robert Wood Johnson Foundation’s AU Challenge Award for patient education. I’m not really a fan of the many available online symptom checkers and I’d like to see their results validated against a an actual visit with a clinician, but this one seems OK if you like them. Startups obsess over the problem they think exists in misdiagnosis or underdiagnosis, packing PCP offices and EDs with people who need more information, have been given bad information by the computer, or who can’t afford further diagnostic work or treatments anyway. We have endless problems with our healthcare services delivery and social policies, but not diagnosing enough symptom-free problems doesn’t top the list.


Privacy and Security

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Scripps Health patient Danielle Sullivan tells the local news the health system has sent her the medical records of other patients three times in the last seven months. She has filed an HHS complaint but expects no change since Scripps hasn’t apologized and she thinks they just treat mistakes as a cost of doing business.


Other

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Healthcare celebrity Atul Gawande, MD will keynote HIMSS19 on Tuesday, February 12 in Orlando.

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Stat digs into the business case behind Mindstrong, a predictive mental health app that’s high on hype but low on clinically valid results. Founded by Paul Dagum, MD, the Silicon Valley startup has raised $30 million in funding and secured implementation agreements with a dozen California mental health departments, but has yet to publish peer-reviewed data that back up its claims. With the Theranos fallout barely out of the headlines, industry analysts have been quick to pump the brakes on panacea-like expectations and the company itself has said the app will be rolled out with caution.

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Police in San Jose, CA use a combination of video surveillance footage and Fitbit data to charge Anthony Aiello with the murder of his stepdaughter. Investigators say her Fitbit shows her heart rate spiking, rapidly slowing down, and then ceasing at the same time neighbors say Aiello was visiting. After being confronted with the data, Aiello said, “I’m done.”


Sponsor Updates

  • Frost & Sullivan honors Medicomp Systems with the EHR Optimization Technology Leadership Award for its Quippe suite of solutions.
  • FDB and PetIQ develop the industry’s first veterinary medications database that will deliver codified, up-to-date information on pet medications, structured for integration into pharmacy systems.
  • Elsevier Clinical Solutions will exhibit at the College of American Pathologists meeting October 8 in Chicago.
  • EClinicalWorks will host its 2018 National Conference October 5-7 in Nashville.
  • Healthwise and Imprivata will exhibit at the Cerner Health Conference October 8-11 in Kansas City, MO.
  • Lutheran Senior Services (MO) becomes the first Netsmart customer to exchange health data with its local health system through the Carequality framework.
  • EClinicalWorks and Healthfinch will exhibit at the AAFP Family Medicine Experience October 10-12 in New Orleans.
  • EPSi will host its Visis National Summit October 10-12 in Amelia Island, FL.
  • FormFast will exhibit at ASHRM 2018 October 7-10 in Nashville.
  • CHIME interviews The HCI Group CEO Ricky Caplin.
  • Hyland will exhibit at AHCA/NCAL 2018 October 7-10 in San Diego.
  • InterSystems will exhibit at the DoD/VA Gov Health IT Summit October 10-11 in Alexandria, VA.
  • Kyruus will exhibit at SHSMD Connections 2018 October 7-10 in Seattle.
  • Surescripts honors five EHR vendors with its 2018 White Coat Award for improving e-prescribing accuracy.
  • Pivot Point Consulting parent company Vaco hires Phillip Noe (The Adecco Group) as CIO.

Blog Posts


Contacts

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

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News 10/3/18

October 2, 2018 News 10 Comments

Top News

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A new Pew Charitable Trusts report on patient matching offers these potential approaches:

  • Implement a unique patient identifier, but given the challenges experienced with this approach in other countries, consider powering it with biometrics
  • Give patients a more active role in verifying their identity by sending text verification messages sent to to their phones
  • Standardize the data elements that are used to predict a patient match, such as making email address one of the match criteria
  • Use referential matching that goes beyond name spelling and potentially outdated addresses using third-party data sources such as the US Postal Service

Reader Comments

From Barely Constrained Capitalist: “Re: David Bradshaw of Memorial Hermann. Now working as a contractor for Cerner. Did we ever learn why he was fired from MH?” David’s LinkedIn says he’s working with a “large EMR solution provider” as a population health management advisor, which must pay a lot less than the $1.3 million he made last year. Memorial Hermann just announced plans to merge with Baylor Scott & White to form a massive health system that employs 73,000 people running 68 hospitals from the Gulf to the Oklahoma border. Most of the newco’s named executives are from BSW, so maybe he saw the CIO writing on the wall. Regardless, parting ways at that level is often the result of leadership or strategic changes that are not indicative of personal performance and certainly we don’t know (or need to know) the details of his departure. I think MH uses Cerner and BSW is mostly Epic and Allscripts, not that I would expect them to standardize IT systems. The footnote here might be that big-name CIO jobs are declining in number as their employers frantically merge and affiliate to flex their market power for self-enrichment. Oh, sorry, to deliver the efficiency improvements, reduced costs, and improved care that such mega-mergers always create in their maniacal pursuit of patient-focused excellence.

From Brangelina: “Re: HIMSS. You haven’t commented on their IRS tax filings recently.” I haven’t been able to locate their most recent reports, so I’ve emailed a request for them to send their Form 990 my way.

From Standard Spiel: “Re: clinical mobility poll. Check out these results.” The HIMSS-owned publication writes lengthy analyses of its online polls down to the fractional percentage point, but those typically generate only 100 or so anonymous responses that make any conclusions questionable. I usually get 200-400 poll responses to each week’s HIStalk question and even then I don’t spend a lot of time dissecting the statistically questionable results – it’s just a fun snapshot of what readers think that merits no further analysis.


HIStalk Announcements and Requests

Listening: new from The Sea Within, a new prog supergroup led by Roine Stolt and other members of The Flower Kings.


Webinars

October 30 (Tuesday) 2:00 ET. “How one pediatric CIN aligned culture, technology and the community to transform care.” Presenters: Lisa Henderson, executive director, Dayton Children’s Health Partners; Shehzad Saeed, MD, associate chief medical officer, Dayton Children’s Health Partners; Mason Beard, solutions strategy leader, Philips PHM; Gabe Orthous, value-based care consultant, Himformatics. Dayton Children’s Health Partners, a pediatric clinically integrated network, will describe how it aligned its internal culture, technology partners, and the community around its goal of streamlining care delivery and improving outcomes. Presenters will describe how it recruited network members, negotiated value-based contracts, and implemented a data-driven care management process.

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


Acquisitions, Funding, Business, and Stock

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At least GE’s alarming levels of suckitude weren’t limited to its now-abandoned GE Healthcare IT efforts. GE’s board fires Chairman and CEO John Flannery after just over a year on the job, seemingly shocked that he couldn’t dump ballast quickly enough to save the sinking ship he had just inherited. GE names outsider Larry Culp (who?) to replace him as CEO and board chair. Flannery shared GE Healthcare heritage with predecessor and fellow oustee Jeff Immelt, so maybe that’s not the best group to tap for leadership talent. The new guy comes from Danaher, which sells an odd mix of bioscience products (Beckman Coulter, HemoCue, Molecular Devices) and unrelated stuff like the Pantone color matching system. Above is the definitely ugly five-year GE share performance chart, in which it shed 51 percent of value while the Dow was rising 75 percent. The company’s market cap has declined to barely over $100 billion, so hopefully your employer didn’t spend a lot of cash in gifting budding executives with the how-to business books written by Neutron Jack Welch that were all the rage in the 1990s when people still admired the company. GE was among the 12 industrial giants that made up the first Dow Jones Industrial Average in 1896 and was the last of those to drop off the 30-company list in 2018. GE waved goodbye to health IT through the rear window of its submerging dump truck in April of this year, handing that business off to Veritas Capital for $1 billion. It would still like to spin off GE Healthcare, one of its few bright spots, but acquirers and investors don’t love company turmoil.


Sales

  • Thirteen-hospital ProMedica will deploy PeriGen’s PeriWatch Vigilance AI-based maternal-fetal early warning system in all of its hospitals that offer labor and delivery services.
  • Cleveland Area Hospital (OK) chooses Cerner Millennium under the CommunityWorks deployment model.

People

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Provation, fresh off its sale by Wolters Kluwer to a private equity firm, hires Tom Monteleone (Ancile Solutions) as CFO and Jim Mullen (Nextech Systems) as SVP of global sales.


Announcements and Implementations

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Australia’s Royal Adelaide Hospital will spend $7.8 million to extend its offsite paper records storage and delivery service for three years, with the failure of its over-budget, behind-schedule Allscripts implementation forcing it to store records offsite since the new hospital’s floors weren’t designed to handle that much weight. The health minister said this week that an independent committee has ruled out continuing the EPAS rollout, so it will either be overhauled or scrapped. Allscripts was supposed to have gone live four years ago at a cost of $158 million, but costs have swelled to $340 million and the rollout stalled as doctors complained that it was unsafe. The hospital might want to investigate the circumstances leading to the approval of its questionable architectural design, which looks like someone sprayed machine gun fire into an ugly airport terminal.

InterSystems announces IRIS for Health, which provides a FHIR application development framework, support for every national and regional interoperability standard, and a normalized and extensible data model. Its capability will be added to HealthShare and TrakCare products next year.

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A new KLAS report covering in-home patient monitoring, released in partnership with the American Telemedicine Association, finds that of the small number of organizations surveyed (24) and the small number of patients being monitored, most are happy with their programs despite most of them not achieving key outcomes. The report notes that the line between vendor monitoring and provider outreach is blurred and that most organizations say their program pays its own way under existing capitated and bundled payment models. Legacy vendors include Honeywell Life Care Solutions, Medtronic, and Philips, while more flexible upstarts are Health Recovery Solutions and Vivify Health.

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Researchers find that laws requiring prescribers or their delegates to check state prescribing databases caused a 7.2 percent reduction in patients with three or more opiate prescribers, but EHR integration is the holy grail. The authors note that interstate data sharing isn’t really necessary since doctor-shopping across state lines seems to be rare.

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Mitre publishes a guide to medical device cybersecurity incident response that recommends incorporating cybersecurity standards in product selection, creating an asset inventory, defining how incident command systems can support cybersecurity issues, and creating an incident response communications plan that includes external stakeholders. I admit that I glazed over pretty early on, so let me know if you see any buried pearls.

Citrus Valley Health Partners (CA) goes live on Meditech Expanse in its hospice and home care locations, with a full system go-live planed for March 2019.

Ciox launches Smart Chart, an expansion of its HealthSource clinical data exchange and aggregation platform that uses AI and NLP to extract clinical data elements from unstructured sources.

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Children’s Hospital Colorado, whose IT team is led by friend of HIStalk SVP/CIO Dana Moore, earns an Enterprise HIMSS Davies award.


Government and Politics

VA OIG is reviewing last year’s manual cancellation of 250,000 radiology orders across eight hospitals during a push to remove duplicate and outdated requests, raising concern that some of the studies might have been medically necessary or had been entered as future orders that had not expired. As an example, as many as 10 people under the direction of the radiology managers at the Tampa VA cancelled orders without consulting doctors or patients. The Columbia, SC VA topped the leaderboard with nearly 30,000 outstanding radiology orders, with public outcry pushing VA brass to vow they would clear the backlog (although maybe not in the smartest way).


Privacy and Security

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The DEA is installing license plate readers on the back of those highway signs that tell you how fast you’re going, an extension of the 2008 program in which all levels of law enforcement share data from license plate readers and surveillance cameras, some of them using facial recognition technology to identify the driver and passengers. Privacy advocates (shouldn’t that be all of us?) worry that the government could be applying algorithms to the huge database for less-transparent purposes. Genetec, the company that manufactures the license plate readers, has healthcare offerings – video surveillance, access control, and license plate tracking cameras for parking lots that can be installed in access gates or on top of security vehicles to track people parking where they shouldn’t.


Other

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Members of Connecticut’s Health IT Advisory Council – charged as the exclusive creator of a state HIE – are stunned to learn from a presentation at its September meeting that the Department of Social Services is continuing its previously failed efforts from 2007 to build a similar system that would not cover the whole state. Both organizations have received CMS funding. 

An Annals of Internal Medicine article offers ideas to balance under-diagnosis with wasteful, harmful over-diagnosis:

  1. Don’t rely excessively on lab tests, imaging, and specialist referrals to arrive at a diagnosis. Listen to the patient and trust the physical exam.
  2. Acknowledge that precision medicine increases the extent of uncertainty and should not drive less-conservative practices.
  3. Stop chasing symptoms that often defy a medical diagnosis or are self-limiting and instead watch for the usually-missed symptoms of problems caused by mental state, such as depression or anxiety.
  4. Maximize patient-provider trust and continuity.
  5. Make time to listen, observe, discuss, and reflect, which can be supported by practicing top-of-license and redesigning EHRs to support “watchful waiting.”
  6. Link treatments to diagnosis, but be careful about diagnosing a condition that isn’t treatable, whose treatment can be safely deferred, or that involves a treatment that the patient declines.
  7. Consider the potential harm in ordering diagnostic tests and the lack of rigor required to develop and use those tests wisely.
  8. Recognize that ordering more tests may seem like a good idea for reducing diagnostic errors, but it doesn’t always provide the answers that patients and providers are seeking.
  9. Don’t overemphasize early cancer detection through extensive testing that may raise false positives or result in harmful treatment by over-diagnosis.
  10. Recruit specialists and ED doctors to take a stewardship role in reducing overreliance on their services.

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Health economist Zack Cooper notes that both the newly installed president of the American College of Emergency Physicians and its president-elect work for companies that profit by charging patients for out-of-network services (physician staffing firms TeamHealth and Envision Healthcare, respectively). The key issue of new President Vidor Friedman, MD is to make insurers pay for ED visits as long as the patient thinks it’s an emergency, even if they are wrong. His employer paid $60 million last year to settle a whistleblower lawsuit involving an upcoding scheme and he was previously known for creating a lobbying group for “emergency medicine advocacy” that mostly involved protecting ED doctor payments under ACA.

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Memorial Sloan Kettering Cancer Center President and CEO Craig Thompson announces that he will give up his board positions at cancer drug maker Merck and drug research company Charles River. A 2015 report found that Thompson was making more than $750,000 annually from the companies and presumably was also granted stock options. That article also observed that while it’s easy to look up which doctors had their $15 lunch paid for by a drug company rep, it’s harder to find such board-level relationships. A 2013 analysis found that 279 university-affiliated employees served on the boards of 442 companies, earning $55 million in compensation and owning 60 million shares of stock. Thompson was sued in 2011 by previous employer University of Pennsylvania, which claimed he used intellectual property from his Penn research to start Agios Pharmaceuticals as a Penn employee in 2007 before he left for MSKCC. Apparently the many millions MSKCC pays him isn’t enough and Big Cancer is happy to use its coffers to make it rain for him and other academic researchers who help them make obscene profits on the backs of people with cancer.  


Sponsor Updates

  • Redox offers access to its interoperability platform to healthcare non-profits and public health organizations that provide access to at-risk populations through its Redox Gives program, with the first beneficiary being the Wisconsin Women’s Health Foundation, which provides free health education and support programs to women and their families and will use Redox integration to streamline referrals to the state’s First Breath stop-smoking program.
  • DocuTap and InstaMed partner to improve the patient and provider experience for urgent care centers across the US
  • The National Hospice and Palliative Care Organization will offer its members software and services from Audacious Inquiry.
  • Nordic wins a work-life balance award based on anonymous employee submissions in the large-employer category.
  • Kyruus adds Stephen Kahane, MD, MS to its board.
  • AdvancedMD will host its annual user conference, Evo18, October 3-5 in Salt Lake City.
  • The Advisory Board publishes a new briefing, “5 insights to help you address burnout.”
  • The Business Intelligence Group awards Apixio its 2018 Stratus award for AI.
  • Aprima and CompuGroup Medical will exhibit at AAFP’s annual meeting October 10-12 in New Orleans.
  • Arcadia congratulates its ACO customers on achieving $90 million in MSSP savings in 2017.
  • Greenway Health features AssessURHealth on its podcast, “Putting Possibility into Practice.”
  • Bernoulli Health will present at the Spok Connect annual conference October 9 in Scottsdale, AZ.
  • Datica will present at Techstars Startup Week Seattle October 10.
  • Burwood Group will present at the 2018 Healthcare Facilities Symposium & Expo October 8 in Austin, TX.
  • CarePort Health will exhibit at the AHCA National Convention October 7-10 in San Diego.
  • Providence Ventures Radio features Collective Medical CMO Benjamin Zaniello, MD.
  • CoverMyMeds will exhibit at the Allscripts Client Experience October 3-5 in St. Louis.
  • Crossings Healthcare Solutions and Culbert Healthcare Solutions will exhibit at the Cerner Health Conference October 8-12 in Kansas City, MO.
  • HealthShare Exchange wins the SHIEC 2018 Achievement Award for Quality and Quality Data for its work with Diameter Health to standardize member CCDs.

Blog Posts


Contacts

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

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Reader Comments

  • richie: uh... users are not the perpetrators of harm causing victimized vendors to suffer. "User are antagonists" and "align t...
  • GreatMindsThinkAlike: I actually love your idea about people being able to tag what they want. It would be nice to be able to jot a note as w...
  • Grahame Grieve: "Until the vendors are required to align to a standard" That's not enough. The vendors ship very configurable systems...
  • FRANK POGGIO: Looks like McGee skewered all the bad actors except the one primary culprit. He has not seen the enemy that is US! "We" ...
  • Woodstock Generation: Hey, I have nothing against 90s or any other music from the circa 50s to the present. And shout-outs to great album musi...
  • Randy Bak: I think the comment may have (too?) quickly stepped through single payer on the way to the ultimate worthy conclusion. ...
  • Consumerfriendly: These primary care physicians are highly paid compared to the average worker, international averages, etc. People expect...
  • David Perlmuter: Bravo! Those grown people find “adulting” tiresome and unpalatable in the context of their own health and every o...
  • TheAmericanNightmare: Politicians already take large amounts of money from corporate healthcare companies. It is really strange to hear someon...
  • Van Sims: After reading the article I feel for clinicians that are experiencing burn out. I can only imagine what it is like to ge...

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