News 8/3/16

Top News

Theranos CEO Elizabeth Holmes could have spoken on many interesting topics at AACC — the company’s troubled Edison finger-stick analyzer, her CMS death penalty for running labs, the lab results that were “recalled” because they were wrong, the spectacularly failed relationship with Walgreens, and the government’s criminal probe – but instead uses her American Association for Clinical Chemistry conference podium time to pitch a new product, the Theranos MiniLab, which contains the same old specimen processing equipment that other vendors sell, just squeezed into a smaller box.

I doubt the assembled laboratorians gave her a standing ovation since they already have all the equipment and the specimen volume they need. It’s also not likely going to be less expensive than existing analyzers. Surely the only people even more puzzled than the assembled lab multitudes were the irrationally exuberant investors who pumped money into the company thinking it was a Silicon Valley high flyer but now realizing that it is, at best, a hardware huckster whose only potential revenue can be blocked by CMS and the FDA.

For her speech, the empress wore physical clothes at least, but not her traditional black turtleneck. She should have come out in it and then done the Steve Jobs “one more thing” move to intro the MiniLab.

That sounds like an embarrassing pivot to me, wasting the time of a ton of scientists to talk up a hardly revolutionary work-in-progress, non-FDA approved gadget that may never see the light of day (and reading sing-song from a PowerPoint script in her slightly disturbing voice besides). Shame on AACC for giving her stage time without requiring her to provide the usual slides, data, and publications in advance to justify it. The best part of the day came as she was introduced to the Rolling Stones song “Sympathy for the Devil,” of which the aggregated volume from the packed auditorium wouldn’t have filled a Nanotainer.

Reader Comments

From Connecting the Dots: “Re: Aledade. Its founder Farzad Mostashari and its primary funders are undertaking a public lobbying campaign. I assume they’re doing a lot of back-channel lobbying with CMS as well. They may be right on the merits, but the changes they propose will benefit them financially as well.” Mostashari opines that “CMS needs to halt the march to health care gigantism,” while Venrock partner, Aledade board member, and former White House advisor Bob Kocher tells the WSJ audience “How I Was Wrong About ObamaCare” in staying on the same message. Both articles say that hospital and medical practice consolidation is bad for cost and quality, not to mention Aledade’s bottom line as a small-practice ACO operator. They were happy to encourage industry consolidation in their former government jobs and are now using that employment history to gain a public platform from which to offer their potentially profitable penance. That doesn’t mean they are wrong, but it does indicate that perhaps less-vested experts from outside the same White House administration would provide a more objective opinion.

From Night Train: “Re: health IT news outlets. The other sites repeat their articles and overlap each other. They also don’t investigate much – they just repeat news releases. I only read HIStalk in depth (for the amusing commentary, if nothing else). I scan the headlines in other outlets and only follow a link to a topic that might be interesting.” Peer60 helped me do a CIO/CMIO survey of where health IT people get their news and one CIO respondent emailed this comment afterward. I’m very happy with the results so far. Nobody’s ever done anything like that as far as I know. Thanks for responding or at least for not sending me a nasty message for invading your personal inbox space, which I found from my earlier Epic survey happens every now and then. It takes 2 seconds to delete an unwanted message vs. 60 to craft an indignant response, so I’m a bigger fan of the former.

From Spillway: “Re: grammar pet peeve. Business people using ‘incent’ and ‘incentivize’ as an ugly substitute for ‘encourage.’” I’m struggling with “incent” being wrong since that leaves “incentive” without a verb form. At least it’s better than one of my most-hated IT non-words, “administrate.”

From Straight Talk: “Re: Vince Ciotti’s analysis of ratings services. How much longer are vendors going to be held hostage to these companies and pay the exorbitant fees? Everybody complains about how much they charge and how little value they derive from the reports, yet they continue to purchase the drivel they publish.” They are volunteers rather than hostages, free to stop paying anytime they want. Therefore, I would challenge the assertion that they don’t receive value, even if it’s the extortionate kind where they’re afraid how they will be ranked if they don’t pony up. I’ve received quite a few responses from my survey of hospital and practice executives who have read those reports or contributed data to them. The most striking answer so far matches my experience – people feel pressured to complete a survey even though they aren’t the organization’s best-qualified  person. I still feel ashamed that many years ago, I provided an IT-centric view of a radiology information system to KLAS even though I had no hands-on experience with the product as a user.

HIStalk Announcements and Requests

We provided a programmable robot kit for Media Specialist Ms. B in South Carolina in funding her DonorsChoose grant request. She added the robot to the media center’s MakerSpace, where students can program it on the iPad.

Webinars

August 10 (Wednesday) 1:30 ET. “Taming the Beast: CDS Knowledge Management.” Sponsored by LogicStream Health. Presenters: Luis Saldana, MD, MBA, CMIO, Texas Health Resources (THR); Maxine Ketcham, clinical decision support analyst, THR; Kanan Garg, senior applications analyst, THR; Patrick Yoder, CEO, LogicStream health. This presentation will review THR’s systematic process for managing clinical decision support assets, including identifying broken alerts, addressing technical and clinical issues, modifying order sets, and retiring tools that have outlived their usefulness. Attendees will learn how THR uses a robust knowledge management platform to better understand how clinicians are interacting with their clinical content to maintain their order sets and reduce the number of alerts fired.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Cerner announces Q2 results: revenue up 8 percent, adjusted EPS $0.58 vs. $0.52, meeting revenue expectations and beating on earnings.

Drug maker GSK and Verily Life Sciences (the former Google Life Sciences) will invest $700 million to create Galvani Bioelectronics, which will develop miniaturized implantable devices to alter nerve impulses in treating chronic conditions such as arthritis, diabetes, and asthma.

The patent office awards McKesson Health Solutions a patent for the inner workings of McKesson Provider Manager. My eye was drawn to the spelling of “HIPAA” as “HIPPA” inside and its reference to Portico Systems, the provider management system vendor McKesson acquired in 2011. 

A study finds that a small group of biosimilar drugs — which are nearly identical versions of patented biologics — are as safe and effective as their expensive counterparts that have caused 54 percent of the growth in prescription drug spending since 2010. The study addressed the anti-tumor necrosis factor drugs Enbrel, Humira, and Remicade, which collectively sell $20 billion worth each year. The top eight biologic drugs whose patents are about to expire are projected to generate $200 billion per year for drug companies by 2020, but biosimilars will cost considerably less.

Sales

Salinas Valley Memorial Healthcare System (CA) will add Web Ambulatory and Oncology to its Meditech 6.1 migration, while Meadows Regional Medical Center (GA) will upgrade to 6.1 and add Critical Care, Web Ambulatory, Surgical Services, and BCA. 

East Jefferson General Hospital (LA) chooses Kaufman Hall’s Axiom Software for budgeting, long-range planning, capital planning, and performance reporting.

Wyckoff Heights Medical Center (NY) chooses Allscripts Sunrise and Staff Augmentation. According to the hospital’s website, Meditech is the current vendor.

Stormont Vail Health (KS) selects Orion Health’s Rhapsody Integration Engine.

People

Michael Saad is named VP/CIO at University of Tennessee Medical Center after serving as interim.

London-based cancer survivor and Cerner trainer Robin Chard dies of a heart attack Sunday while riding in the Prudential RideLondon charity bike event to raise money for cancer research. He was 48. Donations to his Just Giving pledge page, from which he hoped to raise $500 for Cancer Research UK, have reached $77,000 since his death was announced.

Announcements and Implementations

VMware AirWatch announces AirWatch Express for fast setup of apps, email, and Wi-Fi on mobile devices. The cost is $2.50 per device per month and the company offers a 30-day free trial.

Clockwise.MD announces that 10 million patients have used its online scheduling service.

Stanley Healthcare uses InterSystems HealthShare to integrate its RTLS product with hospital EHRs.

Government and Politics

Former White House healthcare policy adviser Bob Kocher, MD says in a Wall Street Journal op-ed piece that he was wrong in favoring hospital and medical practice consolidation to improve quality. Now he says that having providers owned by a single organization is “more likely to be a barrier to better care” as independent primary care doctors create more savings and quality improvement than big, hospital-centric health systems. Kocher also says he underestimated the time it would take for doctors to effectively use EHRs, with his estimated 3-5 year timeline lengthened by delays demanded by organized medicine. He concludes, “Large health systems deliver ‘personalized’ care in the same way that GM can sell you a car with the desired options. Yet personal relationships of the kind often found in smaller practices are the key to the practice of medicine.” Reader comments were sometimes savage, pointing out that the never-practiced physician Kocher was all for government meddling in healthcare until he left to work for VC firm Venrock and small-practice focused Aledade and only then published his pseudo-apology for it in suggesting even more government regulation that is also self-serving.

Aetna joins other big insurers in threatening to cut back on its money-losing exchange-sold policy business, saying those patients are seeking more care than the company expected and that drug costs are a big problem.

A New York doctor is convicted of Medicare fraud after billing the government for submitting $25 million in claims for surgeries he didn’t actually perform, some of them on patients who had died. Most interesting to me, other than the magnitude of the fraud that took HHS a long time to uncover, is that nobody asks Medicare patients to validate the services they supposedly received. It seems to me they should have some responsibility for reviewing the bill and perhaps even being rewarded for seeking less care that is questionable or unnecessary. CMS might also want to watch daytime TV to see what products are pitched to seniors as being free by companies that make it clear they know how to check the right boxes (accurately or not) to get Medicare to foot the bill. Anyway, back to this case — the Pakistani-born weight loss and wound care doctor was previously reported as billing Medicare $85 million in just two years, of which the government obligingly paid $7.7 million. He billed 600 surgeries on one 81-year-old woman, making $300,000 on her alone. His lawyer proclaims his innocence, blaming the doctor’s poor handwriting and lack of knowledge about CPT codes.

Privacy and Security

A Ukrainian hacker downloads 100,000 internal Word and PDF documents of a urology group owned by Mount Carmel Health System (OH), some of which contained PHI. All of the practice’s documents are freely available on the hacker’s shared Google Drive. 

Technology

It’s always interesting when technology does nothing but make readily available information more available, such as when people cry “privacy invasion” when Zillow reports home and tax data that it mostly gets from less-obvious but still-public government files. Homeowners are going ballistic over Google’s phone GPS apps Waze and Maps, complaining that they are sending high traffic volume through their shortcut streets that few people knew about before.  Neighbors are falsely reporting street blockages to the Waze app and erecting homemade “No Through Traffic” signs hoping to force re-routing, although Waze says that practice doesn’t work because other drivers will instantly report that they don’t see the accident , also warning that it will suspend users who file false reports. The company says its job is to spread traffic most efficiently over the available road grid even though homeowners don’t like having their secret shortcut exposed. 

Other

Nebraska Orthopaedic Hospital (NE) postpones surgeries Friday and Monday after unspecified computer downtime.

Hospital ICUs are loosening their ICU visiting hours after studies find that patients do better with their families around. That’s hardly a surprise, and given the frequency of hospital mistakes, it’s good for everyone for patients to have visitors to serve as a second set of eyes. Hospitals are just about the last organizations to limit visitor hours like prisons or 1960s college dorms.

Sponsor Updates

• Aprima will host its user conference August 5-7 in Dallas.
• CapsuleTech, Clinical Architecture, and CoverMyMeds will exhibit at the Allscripts Client Experience August 9-11 in Las Vegas.
• CenterX will exhibit at the NCPDP Workgroup Meeting August 3-5 in Cincinnati.
• Optimum Healthcare IT achieves the top rating among consulting services vendors in the KLAS Midterm Performance Review, earning a score of 94.9. 
• Crossings Healthcare releases the latest edition of its newsletter.
• The local newspaper interviews new CTG President and CEO Bud Crumlish.
• Cumberland Consulting Group completes Revitas implementation for BPO client Ferring Pharmaceuticals in 90 days.
• Vital Images is showcasing its imaging interoperability solutions at AHRA in Nashville this week.

Blog Posts

• Meeting MIPS: 4 Major Ways to Measure Up for MACRA (AdvancedMD)
• With Business Mobility, It’s Personal and Professional (AirWatch)
• IT and Disease Management: Heart Failure (Arcadia Healthcare Solutions)
• How HIT Vendors Price Their Solutions (Catalyze)
• CareSync Clients Are Well-Positioned For MACRA Success. Why? (CareSync)
• Enhancing Team and Leadership Performance through LEAN Principles (Culbert Healthcare Solutions)

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates.Send news or rumors.
Contact us.

Monday Morning Update 8/1/16

Top News

A newly published Apple patent suggests that the company is interested in allowing iPhone users to connect with a physician, send the doctor their HealthKit-collected information, and then initiate a telemedicine session from their iPhones.

The inventor is Todd Whitehurst, MD, PhD, a former Apple director of hardware development who now holds the same position at Google Life Sciences. He has previously worked on implantable devices for glucose monitoring, drug infusion, and neurostimulation. Whitehurst holds more than 50 patents involving implanted medical devices and has applied for many dozen more.

Reader Comments

From Frank Poggio: “Re: evidence-based medicine. It’s really evidence-based political medicine, as evidenced by the mammography battle three years ago. Every doctor and patient should read ‘Snowball in a Blizzard’ by Steven Hatch, MD. It says doctors are guessing all the time but have led the public to believe the Marcus Welby / Dr. House version of their role, making patients and families angry when there is a misdiagnosis or treatment failure. It will take a very long time and big attitude change to reverse the misconception.” Hatch wrote the book following 2009’s guidelines by the US Preventive Services Task Force that called for a reduction in mammograms because their diagnostic value is less than previously believed, which cause outrage in women (and in providers who make a lot of money performing mammograms) who felt the recommendation was a form of rationing. Interestingly, Hatch concludes that doctors pay less attention to patients with symptoms that are hard to interpret because the doctors are frustrated by their own limitations.

From Hundred Dollar Baby: “Re: Covenant Health. I looked up attestation data to see which systems their hospitals use.” This is great, thanks. According to the attestation data, seven of Covenant’s hospitals (including the big ones) run McKesson Horizon, one uses Meditech 6.0, and one is a Medhost user. All of the systems will apparently be replaced with Cerner. Hospitals that bought McKesson’s sketchy vision of integrating all of its acquisitions to form a cohesive system are paying big to correct their mistakes, but on the other hand, evidence was ample to predict the current state.

From Specific Gravity: “Re: Preservation Wellness Technologies. Rumor has it that the patent troll, which lost its infringement lawsuit against Epic, is now suing Epic’s customers.” Unverified. The company doesn’t even bother to run a website in pretending that it’s a real business rather than a patent troll. I provided some background a couple of months ago:

The “inventor” apparently runs Carlo Coiffures, a beauty salon in New York. The lawsuit was brought by a Texas corporation with a Texas mail drop address that filed the suit in the rural Eastern District of Texas, which attracts 25 percent of the patent lawsuits filed in the entire US because that district’s troll-friendly practices make it hard for defendants to get a ridiculous lawsuit dismissed. A fascinating episode of “This American Life” describes a building in Marshall, Texas (population 24,000) whose long corridors contain locked offices representing the only physical presence of companies whose entire business is filing frivolous patent infringement lawsuits.

HIStalk Announcements and Requests

Thirty-seven percent of hospitals told AHA surveyors that they allow patients to electronically submit their own information to the hospital, but only 12 percent of my survey respondents reported having that option as patients. New poll to your right or here: as a patient, how much value would you place on CMS’s hospital star rating system? Click the poll’s Comments link after voting to explain why you do or don’t trust CMS’s data as a predictor of hospital quality.

Vince Ciotti is working on his review of healthcare software rating services such as KLAS, Black Book, and others. If you work for a hospital or medical practice and have read a software rating report in the past year from any company, can you take a couple of minutes to complete my survey to give Vince a broader look at that market? You’re also welcome to send me your thoughts. Thanks.

We funded the DonorsChoose grant request of Mr. F in Florida, who asked for programmable robot for his elementary school technology class. He reports, “Thanks to your donations, my students were able to bring their coding skills to practical use by controlling the Sphero robot. Not only did my students wait desperately for their turn with the Sphero, but they used their time to learn how to code it to do even more. I thank you for your generosity and faith in my class as well as myself to put your donations to good use.”

I had another busy day of unfollowing low signal-to-noise Facebookers who post frequent political rants, relentless mugging selfies, and updates about teams and sports that don’t interest me (which is all of them). I rarely look at Facebook but it felt good to take action, sort of like that dashboard-mounted toy that releases stress by letting you shoot imaginary death rays at bad drivers. 

I’m wondering if death rates rise early in each calendar year among people who buy their health insurance through Healthcare.gov or state exchanges. Open enrollment runs November 1 through January 31 and many folks have to start over because their insurer pulls out or changes the plans it offers. They have to:

• Try to find a decently qualified PCP who will take a new patient.
• Get a “new patient” appointment sooner than several months out with that new PCP.
• Obtain referrals for ongoing conditions if the new plan requires it or if their old specialist doesn’t take their new insurance.
• Hope for no surprises that their maintenance meds, especially the expensive specialty ones, are covered by their new plan (since insurance companies  can’t tell you cost or coverage until the policy takes effect, they’re buying blind).
• Avoiding getting medical care because of the multi-thousand dollar deductible that resets January 1, meaning they have to pay every expense out of pocket.

Listening: new from reader-recommended Look Park, mellow, folky-style pop with lots of hooks by Chris Collingwood from the unfortunately defunct Fountains of Wayne. I’m also pondering the definition of “country” music – it seems you just stick a cowboy hat on a random musician’s head (some not even US-born, like Keith Urban), add fiddle and pedal steel to the otherwise pop mix, and dumb down the lyrics to include only mournful warblings or throaty backwoods swagger affecting a fake Southern accent. I’m not entirely sure it’s even a real genre any more except as an easier route to pop stardom, where the faux country trappings are quickly dropped (see: Taylor Swift).

Last Week’s Most Interesting News

• CMS adds star ratings to its Hospital Compare website, with some highly regarded hospitals performing poorly and criticizing CMS’s methodology as flawed, especially for academic medical centers and hospitals in economically challenged areas.
• Consumer health site Sharecare acquires the population health business of Healthways.
• A report finds that 88 percent of known Q2 ransomware infections involve healthcare organizations.
• ONC announces funding availability for a cyber threat information sharing service as previously called for by the White House.
• University of Mississippi Medical Center pays $2.75 million to settle HIPAA charges related to the 2013 theft of a laptop.
• Athenahealth announces poor quarterly results and the planned year-end departure of EVP/COO Ed Park.

Webinars

August 10 (Wednesday) 1:30 ET. “Taming the Beast: CDS Knowledge Management.” Sponsored by LogicStream Health. Presenters: Luis Saldana, MD, MBA, CMIO, Texas Health Resources (THR); Maxine Ketcham, clinical decision support analyst, THR; Kanan Garg, senior applications analyst, THR; Patrick Yoder, CEO, LogicStream health. This presentation will review THR’s systematic process for managing clinical decision support assets, including identifying broken alerts, addressing technical and clinical issues, modifying order sets, and retiring tools that have outlived their usefulness. Attendees will learn how THR uses a robust knowledge management platform to better understand how clinicians are interacting with their clinical content to maintain their order sets and reduce the number of alerts fired.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Recent webinars and their associated YouTube video views are:

• Your Call is Very Important (185)
• Provider-Led Care Management: Trends and Opportunities in a Growing Market (198)
• Ransomware in Healthcare: Tactics, Techniques, and Response (896)
• rise of the small first letter vendors (223)
• Six Communication Best Practices for Reducing Readmissions and Capturing TCM Revenue (132)
• Looking at the Big Picture for Strategic Communications at Children’s Hospital Colorado (222)

Acquisitions, Funding, Business, and Stock

Meditech reports Q2 results: revenue up 3 percent, EPS $0.44 vs. 0.46.  Product revenue was flat while service revenue increased 4 percent.

Cognizant acquires Toronto-based digital design firm Idea Couture.

Sales

UNC Health Care (NC) chooses Phynd to manage and share the information of its 20,000 providers across six hospitals.

Beacon Health System (IN) will implement Cerner’s Millennium Revenue Cycle.

People

Colleen McFarlane (US Preventive Medicine) is named CEO of radiology best practice platform vendor Radiology Protocols.

Arno Laeven, who founded the Philips Blockchain Lab in the Netherlands in January 2016, will leave the company, according to reports.

Stanson Health promotes Jeremy Orr, MD, MPH to chief medical officer.

Announcements and Implementations

In Canada, Interior Health is recognized as the first health authority in British Columbia to provide patients with online access to their records, using Meditech’s MyHealthPortal.

National Decision Support Company will incorporate appropriate imaging criteria from the National Comprehensive Cancer Network in its CareSelect Imaging.

A Navicure survey finds that while most healthcare organizations value data analytics and reporting, 55 percent don’t have such a solution, although half of those are planning to implement one. Nearly three-fourths of respondents say data analytics help them improve cash flow by reducing A/R days.

Privacy and Security

I’m giving public credit to DataBreaches.net, which has become my go-to source for breach reports and from which most of the items below originated. It’s brilliantly run by an anonymous mental health professional.

Crozer-Keystone Health System (PA) notifies 900 bariatric surgery patients that their information was exposed when an employee emailed all of them using CC: instead of BCC:. I’m beginning to think that the average hospital employee isn’t sharp enough to trust with a fully capable email client. Maybe they should either have to pass a competency exam or be forced to use a dumbed-down email client that protects the organization from their inattentiveness since the “we trust everybody to do the right thing with Outlook” isn’t working too well. The reduced functionality front end could restrict the ability of users to:

• CC more than a handful of recipients.
• Click embedded links to sites that have not been previously whitelisted.
• Open attachments from external senders that have not been previously whitelisted.
• “Reply to all” to more than a handful of recipients (that’s not a privacy risk, just an annoying practice, especially when they start emailing everyone to angrily tell them to stop emailing everyone).

Prosthetic & Orthotic Care (MO) notifies patients that hacker The Dark Overlord hacked its systems on July 9. DataBreaches.net brings up an interesting point – should OCR require the covered entity to tell patients that their information is for sale on the Dark Web as it is in this case? The Dark Overlord used his signature method to gain access, a zero-day exploit in Microsoft’s Remote Desktop Protocol.

Also experiencing a breach via remote access is Jefferson Medical Associates (MS).

The FTC reverses overrules a previous decision to drop data security charges brought against lab testing firm LabMD, now saying that LabMD’s security practices failed to address even basic security to protect the information of 750,000 patients, resulting in undetected installation of file-sharing software that left the information of 9,300 patients freely available for 11 months. Note that this action plus ONC’s observation that only FTC has jurisdiction over non-covered entities and you might infer increased FTC involvement going forward. Above is Friday’s response by LabMD President and CEO Michael J. Daugherty. My November 2015 summary of the original ruling was:

The first incident was reported by Tiversa, a security vendor who was trying to sell its services to LabMD. A former Tiversa sales manager said its warning to LabMD was “the usual sales pitch” and said no breach actually occurred. The second involved documents recovered in an identity theft investigation. The judge ruled that any consumer risk was theoretical and scolded the FTC for relying on Tiversa’s “unreliable” claims. It appears that Tiversa is still in business selling peer-to-peer cyberintelligence services, while LabMD shut down after being buried in court costs and customer defection due to the now-dismissed charges. LabMD was never charged with a HIPAA violation, only with deceptive trade practices, which seems to make little sense in this case (as the judge validated).

Other

Another medical transport aircraft goes down as a Cal-Ore Life Flight plan crashes in Northern California, killing the pilot, flight nurse, medic, and patient. The flight’s operator was Air Medical Group Holdings, which was acquired by a private equity firm last year for $2 billion.

A bravely brilliant JAMA editorial questions whether it makes sense for NIH to be spending so much money on precision medicine research, which in 2016 earned $15 billion of NIH’s $26 billion in grant funding. It notes the general failure in trying to apply complex genetic information to clinical practice even in relatively simple forms, such in sickle cell anemia where detection of the causative gene 60 years ago still hasn’t provided any treatment options. It questions whether NIH should instead refocus on blue sky research that has obvious public health benefits instead of projects that are “constrained by current narratives” (in other words, chasing the latest shiny scientific object). Other points made in the article:

• The financial and clinical benefits of EHRs haven’t materialized due to lack of interoperability, the poor quality of information they collect, and their high cost.
• Most of the improvements in mortality, morbidity, and life expectancy have come from public health efforts, not medical research or interventions.
• Genetic research will probably not create big-picture improvements in care and outcomes since it will at best create high-cost, highly targeted interventions for small numbers of people, not even counting the inevitable overdiagnosis and overtreatment that intensive monitoring encourages.
• The authors recommend that NIH engage independent assessors to review the value received for research that promised specific deliverables, such as personalized medicine.
• The article questions whether NIH should be spending federal taxpayer money in funding projects to discover new drugs, tests, and technologies or instead leave that work to private industry.

I’m impressed that John P.A. Ioannidis, MD, DSc of Stanford Prevention Research Center had the courage to challenge the precision medicine-driven funding frenzy that has taken federal money away from public health programs that could have provided an immediate and far greater ROI on public health. As I’ve said many times, the US is great at heroic, expensive (meaning: profitable) medical interventions that suck up ever-increasing chunks of our federal and state budgets, but we lag much of the world in public health, exporting most of our public health expertise. Check out his interview earlier this year with “Retraction Watch” and his “Evidence-based medicine has been hijacked” article from March 2016, in which he fearlessly criticizes the trend:

As EBM became more influential, it was also hijacked to serve agendas different from what it originally aimed for. Influential randomized trials are largely done by and for the benefit of the industry. Meta-analyses and guidelines have become a factory, mostly also serving vested interests. National and federal research funds are funneled almost exclusively to research with little relevance to health outcomes. We have supported the growth of principal investigators who excel primarily as managers absorbing more money. Diagnosis and prognosis research and efforts to individualize treatment have fueled recurrent spurious promises. Risk factor epidemiology has excelled in salami-sliced data-dredged articles with gift authorship and has become adept to dictating policy from spurious evidence.

A NEJM article advocates expanding the five rights of medication ordering (right patient, drug, dose, time, route) to six, requiring prescribers to provide an indication (what the medication is for). The authors say it would reduce errors (where pharmacists might see “hydroxyzine” with an indication of “hypertension,” allowing them to call to see if they really meant “hydralazine”) and to educate patients on what each medication is for. Another strong point for me would be to allow researchers to determine from electronic data sets why a particular drug was chosen, or for payers to be able to detect prescribing without a valid diagnosis or vice versa. Challenges include extra prescriber effort, privacy concerns, how to code (if at all) the indication and how to handle multiple indications, and the system redesign required to handle the extra data element. I’ve been a fan of this idea for many years going back to when it was included on paper standardized order forms and it makes perfect sense. In fact, just as physicians are supposed to be planning discharge upon admission, maybe they should indicate and reaffirm the desired endpoint of the drug prescription, i.e. when might it be stopped based on patient response instead of just putting people on drugs for life with nobody really remembering why, which should be a big help to continuity of care since nobody likes taking responsibility for blindly discontinuing someone else’s order.

I bet attendees of the American Association for Clinical Chemistry could scalp tickets to Monday’s 45-minute talk and the following Q&A by Theranos CEO Elizabeth Holmes. My prediction is that she’ll be so scared and over-coached to avoid referencing information that is proprietary or related to the company’s criminal probe that she will either cancel with a medical or other emergency excuse or will deliver a glossy performance to an audience expecting facts and humility who will rebel at the absence of both. Maybe a black turtleneck is the opposite of a white lab coat. The damage is already done to AACC for inviting her in the first place, as pathologist Geoff Baird, MD, PhD says, “Would you have Al Capone come and talk about his novel accounting practices? Is it acceptable to allow someone to talk about science if they’ve used that science so horribly inappropriately?”

A Florida pediatrics practice mails letters to eight mothers who had criticized it on Facebook, telling them to find a new pediatrician. The mothers were appalled that they were no longer welcome at the business they had flamed, running to the local TV station to complain, with one dramatically telling the reporter in milking her moment in the limelight, “I just started stressing, and I got dizzy, and I fainted” (obviously she’s challenged by the concept of replacing a doctor she didn’t like anyway). Lots of people have courage only of the Internet kind, confidently bold in their online commentary but meekly shamed by its real-life result. The practice – like an accountant, lawyer, or plumber – can choose whoever they want as customers (if only teachers had that same right). This is like writing a Yelp restaurant review complaining that all the food was inedible, and not only that, the portions were too small.

Maybe these folks are goofing on healthcare with all those lame apps out there. Media people swoon, hundreds of people sign up for the email list, and would-be Silicon Valley investors fill the inbox of Pooper, “the Uber for dog poop,” in which app users snap a photo of the dog’s excrement to summon a Prius-driving scooper to clean it up. People keep emailing the company looking for scooper jobs. The app is an elaborate prank from a couple of guys who plan to do more of them, who explain, “We’re going to continue to put content out there that makes people question what they’re reading in the news, what they’re looking at online, and on a deeper level, what their relationship is to technology … people should be thinking about it and questioning what roles apps and the gig economy play in their lives.”

Sponsor Updates

• KLAS names HealthCast as the top-rated single sign-on vendor in its 2016 midterm report, with the company earning a score of 92.
• T-System will exhibit at Symposium by the Sea August 4-7 in Naples, FL.
• Talksoft is rated highest in the KLAS Patient Outreach 2016 Performance Report.
• TeleTracking will celebrate its 25th anniversary and record-breaking registrations at its annual client conference October 9-12 in Naples, FL.
• Valence Health Vice President of Market Solutions Ryan Smith contributes an article on hospital employee health plans to Trustee magazine.
• Huron Consulting Group will exhibit at the Studer Group’s What’s Right in Healthcare Conference August 2-4 in Chicago.
• ZeOmega publishes a case study on how SignalHealth uses its Jiva HIE to deliver patient information to its provider network.
• Xerox is a Health 2.0 Ten Year Global Retrospective nominee.
• Experian Healthcare will host a West Regional User Conference August 4 in San Diego.
• The local paper features PatientPay in its look at fintech startups in the Research Triangle area of NC.
• The local business paper cites Peer60 in its profile of Agfa HealthCare.
• The SSI Group will exhibit at the FHCA Annual Conference & Trade Show August 7-11 in Orlando.
• Sunquest Information Systems will exhibit at the AACC 2016 Annual Meeting & Clinical Lab Expo July 31-August 4 in Philadelphia.
• Surescripts will exhibit at the Aprima 2016 User Conference & VAR Summit August 4-6 in Dallas.
• InterSystems will exhibit at the AACC Annual Scientific Meeting and Clinical Lab Expo July 31-August 4 in Philadelphia.
• Intelligent Medical Objects will exhibit at Aprima’s 2016 User Conference + VAR Summit August 4-6 in Dallas.
• Pittsburgh Magazine interviews MedCPU President and Co-Founder Sonia Ben-Yehuda.
• NEA Powered by Vyne announces the release of version 4.1 of its FastAttach electronic claims attachment health information exchange solution.

Blog Posts

• Creating Alignment Between IT and the Business (Tierpoint)
• Why “No Assembly Required” is a Welcome Phrase for Fraud Investigators and Parents Alike (Verisk Health)
• Visage 7 Speaks (Visage Imaging)
• Devil of a Time (VitalWare)
• Most wired customers. (Voalte)
• Post-Discharge Communication Tips to Help Patients Avoid Readmission (West Corp.)
• Estimating patient financial obligation: in Florida, it’s the law (ZirMed)
• A Strategic Approach to Clinical Content Updates and Maintenance (Zynx Health)

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates.Send news or rumors.
Contact us.

News 7/29/16

Top News

CMS adds star ratings to its Hospital Compare website, which also offers a data download option. Of the 78 New York City hospitals listed, one (Hospital for Specialty Surgery) earned five stars, while 29 hospitals have a one-star rating.

University of Miami Health System, which earned one star, predictably argues that the methodology is flawed and that its patients are sicker, complaining that academic medical centers and safety net hospitals are treated unfairly by the rating system.

Two hospital systems that made US News & World Report’s “Best Hospitals” list earned only two stars from CMS – UPMC and Barnes-Jewish Hospital. Both point out that scores vary among their similarly run hospitals, in their minds proving that ratings are skewed by patient demographics of the hospital’s geographic area.

Reader Comments

From Gordie Gecko: “Re: NantHealth. Check out its progressive tanking in the market. Patrick Soon-Shiong is trying to announce new deals, but one success doesn’t mean he’ll always be successful. People on the inside still don’t know what the future is.” NantHealth went public a couple of months ago with a first-day closing share price of $18.59, but shares have since dropped 45 percent to around $10. Allscripts bought 15 million shares right after the IPO, so the company is down around $50 million in just a few weeks. NantHealth hasn’t filed its first earnings report yet, but its IPO documents showed an annual loss of $72 million on $58 million in revenue.

HIStalk Announcements and Requests

We funded the DonorsChoose grant request of Mr. D in Pennsylvania, who asked for three iPad Minis and cases. He reports that his students are using them to work on math and reading skills, to log their science activities, and to do research for their social studies assignments.

This week on HIStalk Practice: Cerner VP of Population Health Services Mike Heckman explains the role healthcare tech plays in managing on-site clinics for employers. Practice Fusion CMO & VP of Informatics Richard Loomis, MD shares interoperability advancement plans. Zoom+ VP defends the company’s executive exodus. AristaMD closes an $11 million Series A. Athens Orthopedic Clinic alerts patients to The Dark Overlord’s hack. Medstreaming acquires Physician Billing Partners. Epic, Allscripts, EClinicalWorks lead the vendor way in EP MU attestations. American Well CTO Jon Freshman outlines the ways in which vendors must differentiate themselves if they want to survive telemedicine’s bubble.

Webinars

August 10 (Wednesday) 1:30 ET. “Taming the Beast: CDS Knowledge Management.” Sponsored by LogicStream Health. Presenters: Luis Saldana, MD, MBA, CMIO, Texas Health Resources (THR); Maxine Ketchum, clinical decision support analyst, THR; Kanan Garg, senior applications analyst, THR; Patrick Yoder, CEO, LogicStream health. This presentation will review THR’s systematic process for managing clinical decision support assets, including identifying broken alerts, addressing technical and clinical issues, modifying order sets, and retiring tools that have outlived their usefulness. Attendees will learn how THR uses a robust knowledge management platform to better understand how clinicians are interacting with their clinical content to maintain their order sets and reduce the number of alerts fired.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

McKesson announces Q1 results: revenue up 5 percent adjusted EPS $3.50 vs. $3.14, falling short on revenue expectations but beating on profit. Revenue for the Technology Solutions business was down 2 percent, but still generated a profit of $179 million. Shareholders again voted down a proposal that would have limited executive golden parachutes, which in CEO John Hammergren’s case, involves several hundred million dollars if the company changes hands. This is probably the last time I’ll report MCK’s earnings since they are scurrying quickly away from healthcare IT.

AristaMD, which offers a referral management system, raises $11 million.

Consumer health site Sharecare, founded in 2010 by Dr. Oz and WebMD founder Jeff Arnold, acquires the population health business of publicly traded Healthways. The business and its 1,700 employees will remain in Franklin, TN. Healthways announced in 2015 that it was exploring strategic alternatives.

Oracle will buy ERP vendor NetSuite for $9.3 billion. Oracle Chairman Larry Ellison already owned nearly half of NetSuite’s shares, having funded the company when it was founded by a former Oracle executive.

Leidos announces Q2 results: revenue up 2 percent, adjusted EPS $0.68 vs. $0.77, meeting revenue expectations but falling short on earnings.

Cambia Health Solutions makes a strategic investment of unspecified amount in medical procedure buying site MDsave. I tried the four-year-old site and found that few providers offer services on it – searching for a flu shot in Cleveland turned up a handful of doctors in Tennessee and Virginia and seeking a bargain-priced colonoscopy in San Diego showed the closest willing provider at 331 miles away in Nevada.

LabCorp will acquire prenatal genetic testing company Sequenom for $302 million in cash.

Struggling would-be health insurance disruptor Oscar will cut its New York provider base in half for 2017, trimming its network from 77 to 31 hospitals as it raises rates significantly. I predict Oscar will be gone within 24 months, with one of its big insurance competitors spending very little to buy the smoking wreckage.

Sales

I mentioned that Covenant Health (TN) has chosen Cerner, and based on information I found on the  Web, I concluded that the health system is a Meditech customer. I was wrong – while Cumberland Medical Center does indeed run Meditech as I had found, the rest of Covenant does not. Covenant bought CMC in 2014.

People

Dorothy Fisher, MD (Sentara Quality Care Network) joins Forward Health Group as chief clinical officer.

HBI Solutions hires Alan Eisman (Information Builders) as SVP of sales and business development.

Accretive Health names Doug Berkson (Berkson Consulting) as SVP.

Government and Politics

A state report finds that Oregon hospitals boosted their aggregate profit by 54 percent in 2015 because of the Affordable Care Act’s Medicaid expansion, which turned their charity care into revenue-generating work whose cost was mostly footed by federal taxpayers.

Privacy and Security

Fertility app vendor Glow urges users to change their passwords after it finds a problem with the “connect a partner” feature that could expose the user’s data to third parties.

Other

A review of the rates of mortality, readmissions, and adverse events in 17 hospitals immediately before and after their 2011-2012 EHR go-live finds no significant negative impact. That’s not really surprising since common go-live problems (late meds, missed charting entries, staff confusion) aren’t going to kill patients even though they make their encounter less pleasant.

A JAMIA article defines the work required for informatics research to support precision medicine:

• Implement electronic consent and specimen tracking.
• Develop data standards to support integration and exchange.
• Develop ways to discover and translate clinically relevant biomarkers.
• Use rules and technology to ensure the quality of large datasets to make sure they will continue to be useful in the future.
• Create a precision medicine knowledge base.
• Extend EHRs with APIs that can integrate external data and that will support the development of third-party workflow and data visualization tools.
• Engage consumers outside of provider settings with user-friendly data collection tools.

Greater Madison Chamber of Commerce launches its HealthTech Capitol program and website, which “is working to establish Greater Madison as the world-class leader for health technology.” It lists 18 companies as members, with annual dues running $260 to $1,010 depending on membership level and company headcount.

ZDoggMD reflects on his medical career in his latest video, set to the tune of by Lukas Graham’s “7 Years.” EHRs get an unflattering mention.

Sponsor Updates

• Crossings Healthcare Solutions publishes its Q2 newsletter.
• Catalyze delivers HITRUST CSF certified compliant cloud solutions for Amazon Web Services workloads.
• Besler Consulting releases a new podcast, “Auditing and monitoring for compliant physician documentation and coding.”
• Boston Software Systems releases a new podcast, “Mass Updates to Your Meditech System.”
• CompuGroup Medical will exhibit at the AACC Scientific Meeting & Clinical Lab Expo July 31-August 4 in Philadelphia.
• Extension Healthcare will exhibit at the 2016 Defense Health Information Technology Symposium August 2-4 in Orlando.
• The HCI Group is again listed on the Jacksonville Business Journal’s list of “50 Fastest Growing Private Companies.”
• Healthgrades announces the 2016 Women’s Care Award recipients.
• Healthwise is certified as a Great Place to Work.
• Santa Rosa Consulting launches a Transition Management Office service.

Blog Posts

• Self-service analytics: Empower your team to make data-driven decisions [podcast] (Nordic)
• Meaningful Use Updates: 90-Day Reporting Period and More (Impact Advisors)
• 10 Ways To Prevent Delays in Delivery of Time-Sensitive Secure Text Messages (Spok)

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates.Send news or rumors.
Contact us.

News 7/27/16

Top News

ONC issues $250,000 in funding opportunity announcements for a cyber threat information sharing service. The application package indicates an award date of September 16 and indicates that it will choose an organization that is already performing similar cyber threat services. It expects the program to be self-funding since those organizations already charge fees for their services.

A second $150,000 cooperative grant has been issued from the Assistant Secretary for Preparedness and Response.

The grants were issued is response to a 2015 executive order that promoted private sector cybersecurity information sharing via Information Sharing and Analysis Organizations.

Reader Comments

From Pierre La Terre: “Re: health IT rag pointless stock photos. Who’s the miscreant in the green shirt?” Publications think we’re not smart enough to read news unless there’s a picture, so they struggle when there’s nothing relevant to run given that they’re just re-wording press releases and crafting zippy headlines from afar. This particular well-worn photo of a green-shirted volunteer undergoing a mock sobriety field test in 2009 came from Wikimedia Commons and lives on as an uncredited breaking health IT news photo. Any resemblance to anyone involved in the HHS fraud case is unintentional.

From Grammar Warrior: “Re: grammar pet peeve. To ‘insure’ is to protect against financial loss. To ‘ensure’ is to make sure something happens. Ensure you get it right, people!” My recent peeves aren’t new: the use of “anymore,” which despite appearing in some dictionaries, will never look right to me instead of “any more.” I’m also annoyed at the phrase “build out” in trying to give physical attributes to some abstract IT concept, like “building out the EHR” (even if you like the analogy, which I don’t, the “out” is superfluous). Also, using “that” to refer to people (“people that complain bug me”) or using “who” to refer to organizations (“the vendor who screwed up is well known.”)

From Todd Margaret: “Re: top health IT Twitterati. One of the winners lists HIStalk among ‘critical community leaders’ whose primary means of disseminating information isn’t Twitter.” I glance pretty regularly at Twitter to get a quick read on what people are thinking, but most heavy Twitter users aren’t all that influential except maybe to each other. The “influence” equation must address reader reach, reader decision-making authority, and the writer’s ability to provide information that changes the minds of those decision-makers. Twitter is best at quickly capturing prevailing opinion about big-bang events rather than influencing anyone directly.

HIStalk Announcements and Requests

We provided the elementary school class of Ms. Johnston in Colorado with five tablets and headsets in funding her DonorsChoose grant request. She provides an update: “My students could not believe that someone would give us such a great gift and they took great pride in the care of our technology. In fact, one of my students, was so moved by the donation that she was designated as a classroom tech. She was excited to carry the role as she checked on their battery powers every morning, she cleaned the technology station, she wiped the headphones down at the end of the day, and she took leadership to ensure that other students were being careful. Thank you so much for this wonderful gift. These students have been given a rare opportunity to learn and apply technology in new and creative ways. This was a memorable experience for each of us. Thank you.”

Vince Ciotti is putting together “Rating the Ratings,” a series that will review the services offered by KLAS, Black Book, HIMSS Analytics, and others. Vince would be happy to incorporate your anonymous thoughts and experiences if you send them my way. Readers have made quite a few comments over the years about their company being suspiciously overlooked, being asked to buy something to be included, and wondering why specific clients were chosen when participating in some of the services.

Webinars

August 10 (Wednesday) 1:30 ET. “Taming the Beast: CDS Knowledge Management.” Sponsored by LogicStream Health. Presenters: Luis Saldana, MD, MBA, CMIO, Texas Health Resources (THR); Maxine Ketchum, clinical decision support analyst, THR; Kanan Garg, senior applications analyst, THR; Patrick Yoder, CEO, LogicStream health. This presentation will review THR’s systematic process for managing clinical decision support assets, including identifying broken alerts, addressing technical and clinical issues, modifying order sets, and retiring tools that have outlived their usefulness. Attendees will learn how THR uses a robust knowledge management platform to better understand how clinicians are interacting with their clinical content to maintain their order sets and reduce the number of alerts fired.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Recode profiles Nomad Health, a startup whose site matches doctors to temporary assignments.

Huron Consulting Group will acquire Healthcare Services Management, with HSM CEO David Devine joining Huron as managing director. 

Venture capital-backed Boston hospital operator Steward Health Care earns its first profit, although all of it came from changes in how it funds pensions. The company still refuses to submit state-mandated financial statements, however, saying its information is proprietary.

Sales

Covenant Health (TN) chooses Cerner’s clinical, financial, and population health management systems. I think they’re a Meditech shop.

Memorial Sloan Kettering Cancer Center chooses HealthLoop for patient engagement in its newly opened surgery center.

Meditech lists several customers that are moving forward with its new Web EHR.

People

Former Military Health System CIO Eric Huweart joins government contractor Apprio as VP of military and veteran healthcare.

Wyman F. Bowers, JD, MBA (Midlands Orthopedics) is named the first CEO of the South Carolina Health Information Partners HIE.

Staffing provider AMN Healthcare hires Matt Zubiller (McKesson) as SVP of corporate strategy.

Announcements and Implementations

Athenahealth issues its MIPS Guarantee that its customers won’t lose money under the final MACRA rule, but the terms contain catches: (a) it’s only for new AthenaOne clients who go live on AthenaNet; (b) the customer gets only monthly service credits rather than cash and the total can’t exceed the amount of their monthly payment; and (c) if the customer drops Athenahealth, they forfeit their remaining credit. It’s a good marketing strategy to ramp up the customer count that Wall Street is watching intently.

Medication management app vendor Medisafe releases a version of its product for drug companies that addresses adherence, patient engagement, dose reminders, and study recruitment.

HealtHIE Nevada will offer community-based providers such as diabetes educators and behavioral health therapists subscriptions to Kno2, which will allow them to exchange documents with doctors and hospitals via Direct messaging to improve continuity of care. The Boise-ID-based company offers a $20 per month, one-user plan that provides a Direct address, allows address book searches, supports messaging and document routing, and allows creation of Direct messages from scanners and multi-function printers.

Crossings Healthcare Solutions will resell Cerner real-time end user experience monitoring from Goliath Technologies. 

Intermountain Healthcare, the AMA, and online health coaching vendor Omada Health will work together to offer diabetes prevention programs for the at-risk patients of large healthcare systems across the country.

Government and Politics

An HHS OIG survey of 400 hospitals finds that half have experienced unplanned EHR downtime, and of those, one-fourth report that it delayed patient care. Software was not the cause of downtime in any reported case – the most prevalent downtime issues were hardware failure, loss of Internet connectivity, and power failure. Only a third of respondents have a read-only EHR backup system in place that alerts users visually that the main system is down. OIG repeats its previous recommendation that OCR implement a permanent audit program to assess HIPAA compliance.

ONC updates its Health IT Dashboard with the latest count of MU-attesting hospitals by inpatient system vendor. Cerner, Meditech, and Epic lead the pack.

Former National Coordinator and Aledade CEO Farzad Mostashari, MD says in a an editorial in The Hill that MACRA will speed up consolidation of hospitals and practices without necessarily improving cost or outcomes. He recommends that CMS allow small practices to join together in virtual networks, compare small practices only against each other, and cap the potential losses under MACRA that as written can be more than 100 percent of a practice’s Medicare revenue.

Privacy and Security

Healthcare leads all industries in ransomware infections, according to a security firm’s quarterly report, making up 88 percent of all detected ransomware incidents.

Innovation and Research

The California Cancer Registry pilots real-time data collection of de-identified patient data from pathologists at 12 hospitals. They are using electronic reporting forms developed by the College of American Pathologists to capture discrete data elements rather than free text information. Public health officials hope to publish real-time surveillance data, identify cases for research, and improve quality.

Other

The Pharmaceutical Research and Manufacturers of America, which has tried to convince Congress that drug companies charge high prices only to support desperately needed research, accepts as members two companies that spend next to nothing on R&D. Horizon Pharmaceuticals bought an old drug and raised its price 600 percent the same day, with the former $2 pain pill now costing nearly $40. New member Jazz Pharmaceuticals makes nearly all of its money from a single drug whose price it doubled in two years. Actually neither company should be admitted to an organization that includes “of America” in its name since both “moved” to Ireland after acquiring companies so they could dodge paying US taxes.

In Australia, a newborn dies and another suffers permanent brain damage after a hospital contractor mistakenly installs nitrous oxide in an oxygen outlet.

In England, NHS geriatrician Kate Granger, MBChB dies of cancer at 34. Her cancer experience with an impersonal health system motivated her to create the widely adopted #HelloMyNameIs campaign that urges doctors and nurses to introduce themselves to patients and to make eye contact before treating them. She donated all of the proceeds from sale of her books and other activities to Yorkshire Cancer Centre, having hit her $328,000 goal just three days ago. She had previously received the MBE and, just before she died, a handwritten thank you letter from England’s new prime minister that started with, “My name is Theresa.”

Sponsor Updates

• Lexmark Healthcare is selected as one of eight imaging technology vendors to participate in RSNA’s Image Share Validation Program.
• PM/EHR vendor MedEvolve will offer its physician practice customers payment solutions from InstaMed.

Blog Posts

• In Just 3 Months, 25% of Patients at Marietta Memorial Engage Using MEDITECH (Meditech)

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates.Send news or rumors.
Contact us.

Monday Morning Update 7/25/16

Top News

University of Mississippi Medical Center (MS) will pay $2.75 million to settle HIPAA charges related to the 2013 theft of password-protected laptop by a visitor to the hospital’s medical ICU. OCR’s investigation uncovered the fact that entry of a generic WiFi username and password provided access to an unsecured Microsoft Access database that contained the information of 10,000 patients.

OCR concluded that UMMC’s “organizational deficiencies and insufficient institutional oversight” prevented it from undertaking risk management activities even though the hospital knew it was vulnerable. It also noted that the hospital did not perform the required patient notification following the laptop’s theft.

Reader Comments

From Sieve Crusher: “Re: US Digital Service. They’re actively recruiting. Experience in the EHR world is applicable to government work in many ways – long-time employees, legacy systems, and a culture of poor user interfaces. Silicon Valley experience isn’t needed – the government can use folks of talent. There’s also 18F, an earlier companion effort that allows remote work instead of relocation to DC, but they are backlogged with applicants.” It sounds pretty fun for someone without a family or already in the DC area since no relocation assistance is provided – it’s a one-year commitment with benefits provided and a casual work environment. Not everybody can say they spent time working for the White House.

From HER Auto Correct: “Re: article saying that EHR use decrease costs. I don’t believe it.” The 2014 article concludes that per-admission costs are 10 percent lower in hospitals that use advanced EHRs. I really dislike studies in which Database A is linked to Database B to reach a lofty conclusion implying causation vs. correlation. This is one of those. The authors sampled a 2009 inpatient treatment database and matched it up to the sometimes-accurate HIMSS Analytics database of what EHR each hospital uses. “Cost” was derived from applying the cost-to-charge ratio of each hospital to its billed charges, which is a pretty blunt measure of a hospital’s actual incremental cost, although it’s usually all we have to work with. There’s also the question of ensuring a representative sample of hospitals in all sizes and locations and selecting patients of similar complexity. All that aside, correlation is not causation and most hospitals are already using advanced EHRs, so I don’t see any practical application of the conclusions. A better study would have been to choose 10 hospitals that implemented EHRs and see how their individual costs changed afterward, although the huge problem persists in trying to factor out all other variables. One last observation: bias exists in even the topic of the study – do hospitals really expect to reduce costs by implementing EHRs? The fact that even the financially distressed hospitals don’t de-install them and go back to paper suggests a self-assessed positive ROI that may or may not be financial.

HIStalk Announcements and Requests

Poll respondents were evenly split on their opinion of the Affordable Care Act. Comments suggested that it worked fairly well if the goal was to people insured rather than to control costs or influence personal health choices. Mary C notes that ACA didn’t provide healthcare reform, only insurance reform, while Dave says insurance companies have had to resort to high-deductible plans to shield themselves from the unaddressed issue of cost control, although he also notes that individual patients benefited since ACA eliminated coverage denial of pre-existing conditions and lifetime limits. Most commenters noted that the “affordable” part is a misnomer since ACA policies cost a lot more with fewer choices and it’s just not possible to cover all of those newly insured people for the same cost, especially given that a lot of care involves expensive, late-stage interventions of limited value. HIT Project Manager boldly opines that Medicare and Medicaid should gradually phase out paying for treatment of chronic conditions that are caused by preventable behaviors, using EHRs to identify patients who ignore advice related to obesity and smoking and making them pay fully out of pocket for their treatments. Bill says just buying insurance for a bunch more people is running up the federal deficit without any evidence that quality or cost has improved. The most positive thread of commentary is that while ACA is a long way from perfect, it can be fine tuned over time.

New poll to your right or here: for those with a recent hospital visit: does the hospital allow you to electronically submit your own data into their records? I’m sure some hospitals provide a way to import wearable or questionnaire-type patient information to populate their EHRs, but I doubt it’s the 37 percent of them that a recent AHA survey found.

I was thinking as I reviewed the journal article above that I really bristle at using the word “reimbursement” to define payments to providers. You aren’t getting reimbursed – you are sending a bill and someone pays it. Especially if you run a private medical practice, a business no different than a auto body shop in expecting insurance companies to pay up.

We bought a robotics kit and books for the North Carolina gifted class of Ms. S, who explains the photos above in describing how she put the materials to work immediately. “I gave the kids the option to participate in a district competition at the end of May, explaining that many students had a big head start on them — they had begun working last fall, whereas we had started months later. However, my students were willing to take on the challenge! They competed their work through a combination of quick understanding (impressive!) and teamwork. I’m pleased to say that the construction claw project won first place in the competition! All of my students said they enjoyed the experience and would like to participate in robotics again next year. That is wonderful news, especially from students who may not be able to attend robotics camps or programs outside of the school setting.”

Last Week’s Most Interesting News

• ProPublica begins publishing the  letters OCR sends in summarizing and closing HIPAA complaints.
• Philips acquires Wellcentive.
• An HHS report to Congress identifies the lack of applicability of HIPAA to non-covered entities, such as app vendors, and outlines the non-HIPAA enforcement authority of the Federal Trade Commission.
• ONC publishes an online tool that grades the interoperability readiness of a submitted C-CDA document.
• The VA hires KLAS to provide an overview of the EHR vendor landscape.
• AMIA cautions the FDA that EHR information is not necessarily of research quality, suggesting that it focus electronic data collection efforts on clinical data warehouses or HIEs.
• Hacker The Dark Overlord posts for sale the digital assets of integration vendor PilotFish Technology and says he pushed an update to all of its clients that allowed him to steal their EHR information.

Webinars

August 10 (Wednesday) 1:30 ET. “Taming the Beast: CDS Knowledge Management.” Sponsored by LogicStream Health. Presenters: Luis Saldana, MD, MBA, CMIO, Texas Health Resources (THR); Maxine Ketchum, clinical decision support analyst, THR; Kanan Garg, senior applications analyst, THR; Patrick Yoder, CEO, LogicStream health. This presentation will review THR’s systematic process for managing clinical decision support assets, including identifying broken alerts, addressing technical and clinical issues, modifying order sets, and retiring tools that have outlived their usefulness. Attendees will learn how THR uses a robust knowledge management platform to better understand how clinicians are interacting with their clinical content to maintain their order sets and reduce the number of alerts fired.

Acquisitions, Funding, Business, and Stock

The newly formed Providence St. Joseph Health acquires doctor house call scheduling app vendor Medicast, which had previously raised $2 million but hasn’t had new funding in the past two years.

Athenahealth announces Q2 results: revenue up 17 percent, EPS $0.34 vs. $0.32, falling well short of expectations for both.  The company also announced that EVP/COO Ed Park will leave his position by the end of the year, but will likely join the company’s board. Park holds $2.3 million in stock after selling $2.2 million worth so far in 2016. ATHN shares dropped 9 percent Friday following the announcements, having shed 3.1 percent in the past year.

From the Athenahealth earnings call:

• The company has converted 40 percent of its clients to AthenaClinicals Streamlined, with those clients averaging a 10 percent improvement in same-day encounter close rate. The company notes, however, that it is working closely with a “minority” of clients who liked their old workflow better and hints that it expects to take a short-term hit on its Net Promoter Score.
• Eighty hospitals are using AthenaOne for hospitals.
• The company launched AthenaInsight.com to share information collected from its user network.
• The company admits that it’s not sure whether sales are tracking against target due to seasonality and a bottleneck in servicing inpatient demand, but also notes that the HITECH wave of “I need an EMR or I’ll be shot” is ending and that it has to adjust to the pre-HITECH world of developing by its own schedule rather than just hitting MU-driven functionality dates.
• Athenahealth notes that its population health management product has provided “a lovely little tailwind on our growth” since it can work with Epic and Cerner and that has allowed the company to add those users back to its prospect list.
• The company’s hospital win rate is 32 percent.
• Jonathan Bush says the company made a “terrible operational miscalculation” when it started allowing senior support reps to travel to client sites to provide go-live support, which caused longer telephone hold times just as Streamlined was being rolled out.
• Of the Streamlined rollout, Bush said, “Streamlined’s big mistake was that it was not an agile deployment. This was not, you get a skateboard, and then you put it back out with a handle on it, then you put it back out with a little motor on it, then you put it back out with sides, and eventually it’s a car. This was, take a skateboard, hide it, and show back up two years later with something you think will be a car, and all of the feedback that all of the customers would have had along the way comes raining down on you at once. So, we’ve had to do a lot of tuning of Streamlined once it came out of the garage. We will not be doing that kind of hide it away for years and then do a great reveal of something radically different any more in the future.”
• Bush allowed Ed Park to summarize his career in ending the earnings call, introducing him as, “The man who brought me here, who made every theoretical PowerPoint promise I made either go away or turn into actual functioning reality at scale, Ed Park.”

People

CTG CEO Cliff Bleustein, MD resigns “by mutual agreement” after 16 months on the job. He has been replaced by SVP/GM Bud Crumlish. I interviewed Bleustein two months ago. CTG shares are down 18.5 percent in the past year, giving the company a market value of $88 million.

Video visit vendor MDLive names Sanjay Patil, MD (Care Connectors) as EVP/GM of health systems strategy and transformation.

Announcements and Implementations

A new Peer60 report on cardiovascular information systems finds that hospitals expect their procedure volume to increase significantly, with the biggest driver by far being their addition of service lines, but also due to adding more providers, population growth, an aging population, and better insurance coverage. Epic and Philips are the most-recommended CVIS vendors, although nearly half of respondents say they are considering replacing their current system. Epic is the most-often considered new system by far, while McKesson is equally dominant as the vendor most likely to be displaced.   

Government and Politics

The Department of Justice charges the owner of 30 Miami-area skilled nursing and assisted living facilities with running a $1 billion Medicare fraud scheme, the largest healthcare fraud case in US history. Philip Esformes, who is also a noted philanthropist, is accused of placing patients in his facilities who didn’t quality for that level of care, then billing Medicare and Medicaid for medically unnecessary services. He and his two co-conspirators are also charged with taking kickbacks to refer those patients to community mental health centers and home care providers who also rendered medically unnecessary services. Esformes paid $15.4 million to settle charges of exactly the same thing 10 years ago, but was able to hide his identity until HHS-OIG and the FBI used advanced data analysis and forensic accounting to unravel his current operation. His father, Rabbi Morris Esformes, was charged with taking kickbacks in 2004 when he boosted his $4,000 investment in a pharmacy to $7 million in profit when its was sold two years later by sending the pharmacy all of the business from his Chicago nursing homes, which were also the subject of complaints about poor care that he attributed to anti-Jewish sentiment.

British Columbia’s health minister orders an immediate third-party review of Island Health’s $132 million Cerner implementation following physician complaints that the system is endangering patients and the switch back to paper of one hospital’s ICU and ED in one hospital nine weeks after go-live.

Acting CMS Administrator Andy Slavitt is apparently not impressed with the EHRs out there.

Privacy and Security

Laser & Dermatologic Surgery Center (MO) notifies 31,000 patients that their information was exposed when its computer systems are hit with ransomware. The clinic declined to pay and instead successfully restored its systems.

The health information of nearly everybody in Denmark was exposed last year when a state office mailed two unencrypted CDs that the post office instead delivered to a China-owned bank. The CDs contained the cancer, diabetes, and psychiatric information of 5.3 million people. The bank employee realized the postal service’s mistake and took the package to the intended recipient.

Police arrest two Florida paramedics who were fired after posting pictures of themselves in their ambulances with incapacitated patients, sometimes posing them in humiliating fashion in attempting to one-up each other.

It appears the Twitter account used by hacker The Dark Overlord has been deleted and he hasn’t been heard from in a few days. I don’t know what that means

Technology

Microsoft adds appointment-booking capability to Office 365, allowing users to choose the service they need, search for for available dates and times, and book the appointment from their PC or mobile device with confirmation and reminders to follow. Users can also cancel or reschedule their own appointments. Microsoft stuff doesn’t always catch on and I doubt this product would pass HIPAA muster, but otherwise it cold be interesting for healthcare.

The Gates Foundation creates Chronos, a tool to help grantees meet the foundation’s open access requirement that their research be published broadly and with unrestricted access and re-use, including the underlying data sets. The service will pay publisher article processing charges, check compliance with policies, and track the impact of publishing activity, all to allow grantees to focus on their research rather than the processing of publishing it.

Other

The Cleveland business paper covers MetroHealth’s use of 25 EHR scribes in its ED, which reports higher-quality and more timely documentation completion.

An editorial in the Lancet ponders the role of peer-reviewed medical journals in a publishing world turned upside down by the Internet, the endless quest for profitable eyeballs, and technology that “has transformed artisans into professionals.” It frets about open access journals, research misconduct, and the lack of reproducibility in many scientific studies.

The government of Indonesia arrests 23 people, including three doctors, after finding vials of vaccine that actually contained only sterile saline in 37 hospitals and clinics. An estimated 5,000 children have received fake vaccine, inciting parents to mob a Jakarta hospital and beat one of its doctors. The government caught one person who had adulterated vaccines years ago, but fined him only $100, and had not acted on vaccine manufacturer complaints of counterfeit products going back to 2011. The government vows to re-vaccinate millions of children at no charge and has established a vaccine distribution oversight group. 

Sponsor Updates

Blog Posts

• Delayed or not, it’s time to prepare for MACRA (Nordic)
• Health care is on FHIR  (The Advisory Board Company)
• Your telehealth summer reading: Highlights from MedPAC, AHRQ, and NEJM  (The Advisory Board Company)

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates.Send news or rumors.
Contact us.

News 7/22/16

Top News

ProPublica begins posting OCR’s “closure letters” indicating the resolution of HIPAA-related complaints, noting that most of the letters involve the VA and CVS Health.

Reader Comments

From Sharing CIO: “Re: Velocity Technology Solutions. My hospital was down also. They acknowledged a hardware failure that was exacerbated by human error, poor judgment, and a failed communication strategy. This is our second outage this year – the other one was Dell, who also had hardware failure combined with the fact that humans are not perfect.” More and more people are realizing that “cloud” is synonymous with “someone else’s data center” plus the hopes that a focused vendor will operate it better than they themselves. Most of the time that’s the case, but when things go wrong, the IT department is like end users in being stuck trying to get status updates, pestering the technicians who should be trying to restore systems rather than explaining why they’re down, and backseat driving the process.

From Stealers Wheel: “Re: my article. See this link!” I never know what to do when someone sends me the PDF of a book they’re working in, a LinkedIn article they wrote, or a link to a something they’ve written for a competing healthcare IT news site. I don’t really want to read someone else’s articles or using HIStalk to promote them, so I usually don’t reply because I know someone’s ego is involved.

From LinkedInGuy: “Re: Epic. An ex-Google VP disses it.” At least he’s assertive in his cluelessness in smugly dismissing the entire healthcare IT industry on the basis of a single screenshot he doesn’t consider pretty. He’s awfully proud of his former Google background (working on games and products I’ve never heard of), so perhaps he should consider the rousing failure of Google Health, or for that matter, the horrendously awful UI and user-unfriendliness of Gmail and Google Docs, which make most healthcare software look positively cool by comparison. He seems confused  by the screen shot that he found on the Web since “most docs” don’t use a single specific EHR and the screen he illustrates is not Epic –  it’s actually a 2011-era screenshot of the Chart Talk EHR, a minor EHR player. He probably felt well informed with his tweet, but anyone who knows healthcare would infer the opposite.

From Pointy Head: “Re: work-life balance. Shouldn’t you be willing to sacrifice early in your career for later payoff?” That’s reasonable as long as you realize that the payoff might never come. There’s also that point in your career where you have to accept the reality that your career altitude has reached its zenith unless you change employers or jobs. I once worked for a health system executive who gave rather blunt but accurate advice to director-level people that applies to most everyone: if you yearn to be a C-level executive and either (a) your employer has already passed you over; or (b) you’ve hit 40, adjust expectations accordingly or perhaps start your own business if you feel your potential has been overlooked. Right or wrong, people in their 40s and certainly 50s shouldn’t confuse the hamster wheel they’re on with a career ladder in thinking they’ll get called up to the big show since the odds aren’t great. Those are the folks I hate to see busting their humps thinking they’ll somehow be rewarded accordingly.

HIStalk Announcements and Requests

We funded the DonorsChoose grant request of Ms. McMahon, who requested maker space materials for her North Carolina elementary school media center. She reports, “The STEAM activities in our media center have ignited the creative spirit in my students. They just can’t wait to show me what they have created and just love to have their creation up for display or to see their picture on our website or news program. I have noticed a great improvement in the children who were often discipline problems in the past. They are engaged and excited and just hate it when its time to leave. There is high time on task and with a few rules in place – they abide by them well so that they don’t lose the privilege of working in our Creation Stations!”

I’ve been busy un-following dozens of people on Facebook who keep droning their heartfelt but one-sided and sarcasm-heavy political commentary. I really, really wish for enhancements to Facebook and Twitter that would force users to categorize their emanations into “work,” “politics,” and “114 photos of my angelic child,” allowing me to focus on the limited segments of their thought stream that I care about instead of just muting them completely. Social media have dumbed a lot of people down in filtering the news and opinion they follow, making them believe that nearly everybody thinks like they do and emboldening them to react with vitriol and personal contempt when faced with the inevitable other side of the argument. It’s like modestly talented executives who mistake the butt-kissing of their carefully chosen yes-men underlings as confirmation of their inherent brilliance. Unfortunately, real life is beginning to more and more resemble high school.

This week on HIStalk Practice: NASA deploys telemed technology in deep-sea expedition. HHS announces $9 million in grants to help improve opioid-addiction treatment in primary care practices. AHIP points to telemedicine to help alleviate physician shortages in certain states. R-Health launches independent, physician-led ACO in Southeastern Pennsylvania. Consumer sentiment reaches underwhelming levels of outrage over latest HHS privacy/security report. Surprise, surprise: Physicians do have favorite patients (and they aren’t even the most compliant.)

This week on HIStalk Connect: 2bPrecise Chief Medical Officer Joel Diamond, MD shares his thoughts on the future of precision medicine.

Listening: Cloves, who is actually 19-year-old Australian singer-songwriter Kaity Dunstan. I would say that she reminds me a lot of Adele, other than the fact that my fastest reflex is hitting “scan” on the car radio when a song by the ubiquitous Adele comes on and I’d actually stick around for Cloves.

Webinars

None scheduled soon. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Oncology precision medicine decision support vendor N-of-One raises $7 million in a Series B round, increasing its total to $11.7 million. CEO Christine Cournoyer used to be president and COO of Picis.

Theranos hires a chief compliance officer and VP for regulatory and quality, the former being McKesson assistant general counselor for regulatory law Dan Guggenheim.

Sales

Tampa General Hospital (FL) chooses LogicStream Health’s sepsis bundle and clinical process measurement to reduce central line-associated blood stream infection.

Adventist Health System chooses MModal’s transcription and front-end speech recognition for its 41 facilities, where it will also pilot MModal’s computer-assisted physician documentation system. .

People

Pharmacy kit restocking software vendor Kit Check hires Cameron Ferroni (What’s Next Consulting?) as chief product officer.

Solid state storage array vendor Pure Storage hires Vik Nagjee (Epic) as VP/CTO of global healthcare solutions. He helped develop Epic’s hosting business.

Announcements and Implementations

Cambia Health Solutions will merge its HealthSparq and SpendWell Health offerings under the HealthSparq name, offering users the ability to compare procedures and providers and then use SpendWell’s “buy now” technology to book appointments.

University of Pennsylvania Health System (PA) will build a 540,000 square foot, 18-story Center for Healthcare Technology in downtown Philadelphia, with Penn Medicine’s IT department being a major tenant.

Scotland’s Digital Health & Care Institute innovation center hires Scottish tennis star Andy Murray as its ambassador.

The PillPack pharmacy uses APIs from PokitDok (Pharmacy Plan and Pharmacy Formulary ) to help its Medicare customers understand drug coverage and co-pays.

Government and Politics

A fascinating article profiles the White House’s  US Digital Service, a group of mostly former Silicon Valley engineers that bypasses government red tape and contractors in saving taxpayers many times its $14 million annual budget by creatively solving IT problems that have long stymied federal IT lifers. It mentions Digital Service at VA (photo above), another skunkworks project that developed a new VA benefits appeals system, created a consolidated website at Vets.gov, and figured out a way for the VA and DoD to exchange scanned documents. Everybody loves the groups except fat cat IT contractors and the internal federal government bureaucracies that created the messes the kids are sent to clean up. I liked this passage about how the group broke the VA-DoD document logjam in just a few weeks:

They did not pick a toy task, but embarked on a challenge that had bedeviled the military for years. Unbelievably (except for in government), the DoD and VA use different systems for medical records, and the two systems get along just about as well as North and South Korea. Moving a medical history from one to the other — a pretty common task, since service people by definition become veterans upon discharge or retirement — could only be done by physically scanning the military records and sending files to the VA. But even that often failed, because the VA system was very finicky about file formats … “We had good people working on that, some of our best people,” says Secretary Carter. But they hadn’t cracked the problem, and indeed, hadn’t shipped anything for over a year. Nor were they thrilled at the idea of a bunch of hacker-types appearing in medias res. “At first the people who were working on the program were insulted at the suggestion they needed help,” admits Carter. “So some of them needed to be nicely helped to understand that was a good thing.”

Privacy and Security

A corporate payroll employee of the Phoenix-based Sprouts supermarket chain falls for a phishing scam in sending the 2015 W2 statements of all 20,000 employees in response to an email disguised to look as though it came from a company executive, with some employees already reporting that the scammers are trying to steal their IRS tax refunds.

Technology

BIDMC CIO John Halamka, MD touts third-party apps that layer on top of EHRs, listing three cloud-based systems BIDMC will deploy:

The Right Place (electronic referrals for moving inpatients to post-acute care facilities).

PatientPing (encounter notification).

Collective Medical Technologies (team communication for managing patients who are regularly seen in multiple settings, such as EDs).

Other

South Shore Hospital (MA), whose proposed acquisition by Partners HealthCare was nixed last year due to anti-trust concerns, tries to raise $222 million in donations to pay for a campus expansion ($62 million) and its Epic implementation ($160 million).

Four noted experts offer their ideas for fixing healthcare:

• Change the all-or-nothing FDA review of drugs into a a Consumer Reports-type rating of safety, efficacy, and degree of available evidence and let physicians and patients decide how to use them.
• Give patients control of their electronic information as a “consumer-mediated health information exchange.”
• Improve drug competition by speeding up FDA approvals and holding drug companies responsible for cost effectiveness by putting them at risk for outcomes.
• Publish provider performance and cost data similarly to how businesses publish standardized accounting reports.
• Pay hospitals based on quality in a more consistent manner, incorporating patient-reported outcomes and collecting data electronically.

Sponsor Updates

• Winthrop Resources creates a light-hearted video about its new offering, a financial service for IT infrastructure for healthcare data centers.
• GetWellNetwork announces that 35 hospitals and clinicals implemented its Marbella mobile rounding and patient experience solution in the first six months of 2016.
• ZeOmega integrates Forecast Health’s patient risk analytics into its Jiva population health management product, adding the capability to perform predictive modeling based on social determinants of health.
• Optimum Healthcare IT is recognized as one of Northeast Florida’s fastest-growing companies.
• The St. Louis Business Journal profiles TierPoint CEO Jerry Kent.
• Valence Health will exhibit at the MAHP Summer Conference July 20-23 in Acme, MI.
• Verisk Health publishes the latest edition of The Globe newsletter.

Blog Posts

• 10 Policies and Procedures for Secure Text Messaging (Spok)
• What Is Predictive Analytics (and Why Do You Need It)? (Evariant)

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates.Send news or rumors.
Contact us.

Philips Acquires Wellcentive

Royal Philips announced this morning that it has acquired population health management software vendor Wellcentive. Terms were not disclosed.

Atlanta-based Wellcentive and its 115 employees has been placed within the Population Health Management group of Philips, which Wellcentive CEO Tom Zajac will lead.

Philips CEO Connected Care and Health Informatics CEO Jeroen Tas was quoted in the announcement as saying, “With this strategic acquisition, we will strengthen our Population Health Management business and its leadership, as health systems gradually shift from volume to value-based care, and provide more preventative and chronic care services outside of the hospital. Our sweet spot is at the point of care as we give consumers, patients, care teams, and clinicians the tools, such as remote monitoring solutions and therapy devices, to optimize care. Wellcentive’s solutions will provide our customers with the ability to collect data from large populations, detect patterns, assess risks, and then deploy care programs tailored to the needs of specific groups.”

I interviewed Wellcentive CEO Tom Zajac in August 2015.

Morning Headlines 7/20/16

Examining Oversight of the Privacy & Security of Health Data Collected by Entities Not Regulated by HIPAA

An HHS report to Congress points out the lack of applicability of HIPAA privacy and security to non-covered entities such as app vendors, saying it will work with stakeholders to address gaps and adding that the FTC has some enforcement power.

Individuals’ Ability to Electronically Access Their Hospital Medical Records, Perform Key Tasks is Growing

An American Hospital Association survey finds that more than 80 percent of hospitals allow patients to view and download their medical record information, a significant jump since 2013.

How ‘digitizing you and me’ could revolutionize medicine. At least in theory

Eric Topol, MD of Scripps Research Institute defends the administration’s decision to give Scripps a $120 million precision medicine grant to collect and study the data of 1 million volunteers.

C-CDA Scorecard (Beta Release)

ONC creates an online tool that allows testing a C-CDA document to see how well it performs against certification criteria and advanced interoperability rules.

News 7/20/16

Top News

A new HHS report prepared for Congress notes the obvious fact that non-covered entities such as wearable and app vendors are not regulated by HIPAA, a situation it calls “a gap in oversight” that people (including vendors) don’t always understand. That gap can’t be addressed by HHS since it has no power to regulate anyone other than covered entities.

The report suggests that the FTC identify best practices. It notes that FTC’s authority includes protecting consumers from possible relevant unfair or deceptive company practices such as not following their own privacy policies, failing to disclose how consumer information is used, or failing to secure the consumer information they collect.

It’s surprising to me how often knowledgeable industry insiders cry “HIPAA violation” when the party involved is clearly not a covered entity, such as when ESPN ran a photo of an NFL player’s medical records. Anyone can violate your privacy, but only a covered entity or their business associate can violate HIPAA.

The report notes that people who share their information with non-covered entities aren’t clearly protected by federal law. It also references the little-known FTC Health Breach Notification Rule that requires PHR vendors that are not covered entities to report breaches of their systems.

Reader Comments

From Lawson CIO: “Re: downtime. We experienced almost a week of downtime with our Lawson system running on Velocity Cloud starting July 1. It must have have hit many hospitals. How many others experienced it?” Affected readers using Velocity Technology Solutions are welcome to report. I reached out to the company but they declined to respond, saying they are contractually prohibited from disclosing information to anyone other than customers.

From Security Officer: “Re: The Dark Overlord’s most recent hack. The hacker gained access to a specific PilotFish dataset, but not for our environment. Do you have more information?” The Dark Overlord says he “used their [PilotFish’s] code to find exploits in all their clients … I signed a backdoor to get into their clients because I had access to their certificate signing. It got pushed out in an update a few weeks ago.” He also showed samples of the client EHR records he claims to have taken. The Dark Overlord has not previously overstated his accomplishments, so while there’s no proof so far that he breached every PilotFish client and took their PHI, I would operate under the assumption that he has and take action accordingly. I would expect his next move to be approaching those individual clients to demand payment since PilotFish turned down his demands. Confounding the issue is that some of PilotFish’s clients are HIEs and thus the information he claims to have stolen may have come from many providers, although maybe it cross-references a client table that he won’t bother linking to figure out the source.

From Kyle Smith: “Re: VA hiring KLAS to advise it on commercial EHRs. It was a sole-source selection, claiming that only KLAS can do the job. I’m sure KLAS loves the kind words, but this doesn’t really sound like an accurate reflection of the work of other folks in the industry.” What we taxpayers will get for our $160K VA payment to KLAS is a six-month membership and bringing in three KLAS people for four, half-day overview meetings. Apparently the VA thinks it needs KLAS to tell it to choose between Cerner and Epic. It is probably not realistic that they would just ask DoD how its Cerner implementation is going before deciding.

From Mr. Buyer Beware: “Re: Definitive Healthcare. For those using it as their hospital data source, they are doing automatic renewals, but they increase the price without notice. Thoughts, Mr. H?” I would have to see your agreement, but I would be surprised if it doesn’t include at least some provision for increases pegged to cost-of-living percentages or something like that. They can adjust the price however they want if the contract doesn’t name a fixed price for the agreement’s term, which then might be a good indication that you as a customer shouldn’t have signed it. Ditto the automatic renewal – if the contract doesn’t say it renews automatically, then you can refuse to pay assuming that you’re willing to stop using their services. Either way, it’s a nice courtesy (and good business) for a company let customers know about the new price well in advance so they can budget for it.

From Lifeline: “Re: taking time off from work. Like Dr. Jayne said, too many people associate their job with their identity and can’t give it up.” Job titles are like clothes – we hide behind them to prevent people from seeing us as we really are. When someone asks, “What do you do?” they are really asking, “Who are you?” with the assumption that your job defines your persona, and people often answer in that same mindset (especially executives who can’t bear the thought of not decisively differentiating themselves from us less-accomplished rabble). Folks who brag on being fully engaged in their jobs while on vacation have deathbed lessons to learn: (a) your employer and co-workers care much less about you than you think; (b) you are going to be devastated when you get fired or retire and realize all of that one-sided loyalty was misplaced as your work goes on without missing a beat in your absence; and (c) for the 99 percent of people who work at a particular job only because they need the money but would really rather be doing something else, spending more time working means spending less time living. It’s sad that people allow their identity to be subsumed into that of their employers in a form of self-enslavement. Employers have learned to maximize profits by swindling employees out of what should be their free time, now demanding their nearly undivided attention via an ankle bracelet posing as a smart phone and paying what seems like OK money for a job as long as you don’t do the per-hour math. We only think we’re immortal and the people crying graveside won’t be co-workers or customers (or in my case, readers). Welcome to the grand illusion.

HIStalk Announcements and Requests

The DonorsChoose grant request of Ms. Hughes from South Carolina was simple: her fourth graders just needed dry erase boards and markers, which we provided. She reports, “The resources provide an easy way for the students to practice drawing models, pictures, and equations all of which are used to solve a variety of math problems. The students were so excited to see the new materials when they arrived. They kept going on about how nice it was of someone to give them to us!”

Webinars

None scheduled soon. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Cerner names its $4.45 billion, 10-building Kansas City office park that’s under construction the Innovations Campus. The first of 3,000 software engineers will move in next year, although the project won’t be finished for 10 years. The 4.7 million square foot complex — Cerner’s seventh campus outside its headquarters — was designed to house 16,000 workers. The company announced several campus design features:

• A staircase whose metal perforations contain quotes from Cerner’s founders in binary code form (I assume one of them won’t be “Tick, tock.”)
• A 100-person staircase “collaboratorium.”
• A metal panel for each of the company’s 340 patents.
• A 188-foot tall outdoor statue depicting DNA.

Sweden-based exercise and diet tracker Lifesum raises $10 million.

People

Alan Eisman (Information Builders) joins HBI Solutions as SVP of sales and business development.

Cerner hires Jeff Hurst (Florida Hospital) as SVP of RCM and president of RevWorks.

LifeImage names Janak Joshi (Deloitte) as CTO.

Santa Rosa Holdings promotes Tom Watford to CEO. He replaces company founder Rich Helppie, who will remain board chair. The company’s businesses include Santa Rosa Consulting, Santa Rosa Staffing, InfoPartners, and Fortified Health Solutions.

Gerald Greeley (Lahey Health) joins Signature Healthcare (MA) as CIO.

Janet Guptill (Tatum) joins the Scottsdale Institute as executive director. She replaces Shelli Williamson, who will become vice chair of the board.

Announcements and Implementations

In England, Wrightington, Wigan and Leigh NHS Foundation Trust  goes live on Allscripts Sunrise.

Catalyze earns HITRUST CSF certification for Amazon Web Services.

Meditech implements Access Passport for its internal electronic forms and signatures.

Government and Politics

The VA awards Leidos a prime T4NG contract in which 24 contractors are eligible to compete for $22 billion worth of IT services, network engineering, cybersecurity, and other IT work. Leidos was not included in the original list of 21 winners announced in March 2016.

An American Hospital Association survey finds that 92 percent of hospitals allow people to view their medical records online, up from 43 percent in 2013. The most widespread adoption of technology for patients is the ability for them to pay their bills online, which is offered by 74 percent of hospitals, and two-thirds of hospitals say patients can securely message providers.

A Health Affairs blog post notes that while insurers can’t be required to submit their claims to a state’s all-payer claims database, many still will do so, giving researchers a good-enough set of information. It also notes that there never was an “all” claims database since they don’t include services for which insurance wasn’t billed.

AMIA warns FDA that while most providers are using EHRs, their data is not necessarily of research quality. AMIA suggests that FDA focus its research data collection on data warehouses, whose information has been better standardized and encoded, as opposed to relying on EHR information that was intended primarily to support individual patient encounters.

ONC offers a C-CDA Scorecard that evaluates an electronically submitted C-CDA document in two ways: providing a pass/fail score to indicate whether it meets 2015 Edition Health IT Certification for Transitions of Care, and (b) issuing a letter grade indicating conformance with HL7’s advanced interoperability rules, which means the system’s vendor is more likely to be able to support interoperability.

Technology

Drug maker GlaxoSmithKline launches a mobility study of 300 rheumatoid arthritis patients using Apple’s ResearchKit.

Other

The San Francisco paper finds that UCSF Medical Center CEO Mark Laret earns an average of $556,000 each year from serving on the boards of two of the hospital’s vendors, Varian Medical Systems and Nuance Communications, who have paid him more than $5 million on top of his $1.6 million annual compensation from the hospital.

Eric Topol, MD answers tough questions about precision medicine and the $120 million in NIH grants his employer, Scripps Research Institute, has received to recruit volunteer study participants. He says about the idea of  addressing patient-specific health risks instead of sequencing their genomes,

Look, we’ve had all this risk factor and lifestyle knowledge for decades. Do we have everybody practicing a healthy lifestyle? No. I don’t want to diminish the importance of it, but a lot of people have the healthiest lifestyle in the world and they get struck by things like autoimmune diseases and Alzheimer’s.  It’s not either/or, but we need to take advantage of the fact that we can know so much about any given human being — what they are at risk for, or the environmental factor that’s causing the risk.

Kaiser Health News notes the upswing in micro-hospitals that offer EDs and primary care services but only a few inpatient beds. Sounds swell except they are usually built by big health systems trying to squeeze out competitors and bolster their bottom lines since companies that buy fancy medical equipment or build new buildings always find a way to create the demand to pay for them (not to mention the inherent inefficiency in staffing an always-open but potentially low volume building in the unfocused factory model). Walmart puts profit-boosting, scaled-down versions of their stores only where well-off people shop and hospitals are no different, so don’t expect to see mini-hospitals springing up in the downtrodden part of town. As one of my previous health system employers always said, we serve all, but market to few. As much as everyone likes to think it isn’t true, you won’t find the best hospitals and best doctors in poor or rural areas. Also true is that we’re all paying for those fancy health system buildings, the big salaries they hand out, and the enormous employee headcount that sucks up all the parking spaces for miles.

A report finds that 70 percent of physician assistants are working in specialties rather than primary care.

A drunk, off-duty NYPD officer is charged with running over four pedestrians, killing 21-year-old MIT student Drew Esquivel, who was also working on an EHR for underserved areas.

HIMSS is running a hospital CMIO’s video pitch that claims to answer the question of why being named EMRAM Stage 7 was valuable to the hospital. The answer: it let the hospital’s IT employees feel good about their accomplishments. In other words, the hospital received no value whatsoever except IT bragging rights, about which the locals who are footing the bill could not care less. Magazines and websites create a lot of vanity-driven contests and awards that providers puzzlingly don’t see as pointless.

Maine’s HHS typos the hotline number on the debit cards it gives to food stamp recipients, with the listed number actually ringing up a telephone sex line. Most surprising to me (beyond the fact that food stamps are now issued by debit card, which is a great fraud-tracking idea) is that such services still exist, although they apparently now charge directly via toll-free numbers instead of those 1-900 lines that funded a lot of late-night TV advertising in the 1990s.

Sponsor Updates

• Bernoulli Enterprise is nominated for the Health 2.0 10-Year Global Retrospective Awards in the category of Tech Company.
• Besler Consulting releases a new podcast, “Skyrocketing Costs and the Emergence of Rate Setting.”
• CapsuleTech and Direct Consulting Associates will exhibit at MHealth + Telehealth World 2016 July 25-26 in Boston.
• The local business paper features CoverMyMeds in a profile on startup jobs and spending.
• Galen Healthcare Solutions publishes a new case study, “Critical Clinical Information Demystified with Database Training.”
• Healthfinch joins the Matter community of healthcare entrepreneurs.
• Meditech recaps its history in the acute care market in Canada.
• Forbes interviews Healthgrades SVP and Head of Digital Mayur Gupta.
• InstaMed publishes a new case study, “Pediatric Practice Automates 90 percent of Patient Payment Collections with InstaMed.”
• Medecision CMO Ellen Donahue-Dalton joins the Women Business Leaders of the US Health Care Industry Foundation’s advisory board.
• ITx honors Orion Health Product Strategist David Hay with the Excellence in Health Informatics award.
• Patientco funds treatment for six patients through a partnership with Watsi.
• The local business paper profiles the applicants for Cincinnati health commissioner, including Robyn Chatman of Sagacious Consultants.
• Stella Technology announces its rebranding.

Blog Posts

• How Does the Cloud Reduce Data Loss Risk? (Catalyze)
• What Is Interoperability? (AdvancedMD)
• Wait Time Management: Why The Problem With Waiting Isn’t Waiting (Clockwise.MD)
• The Evolution of Device Management (AirWatch)
• The Final Word: Risk (Arcadia Healthcare Solutions)
• Navigating Healthcare for our Child: Things We’ve Learned (CareSync)
• A Focus on Enterprise Readiness, Not Just Getting Ready (Divurgent)
• Pediatric Post-Discharge Follow-Up: How to Get it Right (ECG Management Consultants)
• Top 3 Takeaways from #AAPL2016 (Evariant)
• Chronic Care Management: Steps in the Right Direction (CareSync)
• 7 Things to Know for Successful Provider Education (Hayes Management Consulting)
• On-Demand Access To vCISO Meets This Client’s Needs (Orchestrate Healthcare)
• Will Social Security Numbers Finally be Removed from Medicare Cards? (ID Experts)
• With Multiple EMRs, Care Management and Real Online Patient Engagement Can’t Happen (Influence Health)
• Healthcare Analytics in the Cloud: Delivering Answers “as a Service” (InterSystems)
• What does your “data-inspired future” look like? (Liaison Technologies)
• It’s Twice as Nice to be Named a 2016 Top Workplace (MedData)
• Sharing IT Insights Amid Rapid Change (Netsmart)
• A Recipe for CPOE Optimization (PatientKeeper)
• Patients Always Come First, Except When They Don’t (PMD)
• Alert: New E-Prescription Quality Guidelines (Surescripts)

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates.Send news or rumors.
Contact us.

Monday Morning Update 7/18/16

Top News

Hacker The Dark Overlord, who has breached at least three healthcare organizations and then listed their patient data for sale when they refused to pay him, advertises for sale the digital assets of a healthcare IT vendor that appears to be PilotFish Technology, which offers integration tools and middleware to several industries that include healthcare. He’s asking $500,000 for HL7 source code, signing keys, and a licensing database. He says he stole the information by gaining full root-level access to the company’s servers. The Dark Overlord listed the information for sale after the company declined to pay him the $500,000 to keep quiet.

The hacker says he has inserted a backdoor in PilotFish’s software that was pushed out in its most recent update and has since stolen the EHR records of all of the company’s customers.

Not only is PilotFish’s business at great risk, so is the information of its customers, among them Utah Health Information Network and the State of Connecticut. PilotFish launched its healthcare business in February 2014.

The Dark Overlord breaches systems using Remote Desktop Protocol exploits, so I’ll recommend again that everybody either secure it or shut it down. He also seems to prefer targeting SRS EHR clients. His latest round of tweets suggests that at least one of the providers he hacked paid him to keep quiet last week.

Reader Comments

From Sharon M: “Re; LabCorp. I’m surprised HIStalk did not cover the IT crash that affected five states. Are you so biased that you only print the favorable reports about HIT?” This comment comes from a frequent anti-EHR troll who assumes multiple identities in unsuccessfully trying to avoid being called out, which even without the technical clues would be obvious since 99 percent of readers complain that I’m too critical of health IT instead of accusing me of being a cheerleader for it. I haven’t seen any mention of LabCorp problems anywhere, so given that I did not personally have tests performed recently in those five states, I have zero information about any downtime and have received nothing from users (including the phony Sharon M). In other anti-technology news, a traffic light went out for an hour recently, so it’s time to replace all of those unreliable devices with stop signs.

From Lysander: “Re: redirects. Why do you redirect the link from HIStalk.com to HIStalk2.com? I know it was originally related to a hosting switch, although if I know your style, that inside joke might be part of the fun.” It’s been nearly 10 years since I switched from a proprietary-technology web host while temporarily running both sites to prevent readers from getting lost. That change isn’t easy to undo, I’ve learned. I had my web host look into it yet again Friday night after your inquiry and they messed things up a bit temporarily, plus the change would probably screw up links to years’ worth of articles. I’ll add that to my inside joke collection (along with smoking doctor logos) and the list of things I’m too lazy to worry about.

From Little Bit: “Re: mission and vision statements. I remember an academic medical center whose mission didn’t have one word about patients in it. There’s also an EHR vendor who talked a lot about their ‘Do Right’ principle, although I think they veered away from that one.” I’ve worked for executives who turfed off creation of mission and vision statements (they didn’t even understand the difference) to their underlings and it was a disaster. The back-stabbing, suck-up directors fought for attention in trying to distill a large, complex operation into a single overinflated, pithy sentence (it ended up with a lot of commas).  My takeaway: leaders without vision and character might as well have a crappy, eye-rolling vision statement that will be forgotten immediately because it’s not going to help anyway. My other takeaway is that committees are a poor substitute for leadership since they suck the life out of everything they do, and as such, should be limited to an advisory role to a clearly defined leader rather than to have actual power themselves. Give the buck a place to stop.

HIStalk Announcements and Requests

Three-quarters of poll respondents don’t think levying HIPAA fines improves privacy or security. New poll to your right or here: what is your overall opinion of the Affordable Care Act? You can’t just leave us hanging by voting without explaining, so click the poll’s Comments link afterward to elucidate.

Welcome to new HIStalk Platinum Sponsor Evariant. The Farmington, CT company offers enterprise-class CRM platforms for patients, consumers, and physicians that empower the marketing and physician relations teams of leading hospital networks. Evariant’s patient and consumer marketing CRM system drives targeted service line growth with attributable ROI, while its patient acquisition and engagement platform allows hospitals to target appropriate audiences for marketing as well as for education and wellness programs. Hospitals use its physician engagement technology to track referral patterns and physician loyalty in designing effective physician outreach activities. The company offers a free e-book titled “Creating Extended 360° Patient and Physician Views with Big Data Analytics.” Client success stories include Orlando Health, Wake Forest Baptist Health, University of Chicago Medicine, and Dignity Health. Thanks to Evariant for supporting HIStalk.

I found this Evariant client testimonial from University of Chicago Medicine on YouTube.

Mrs. Roepke in Missouri had never had a DonorsChoose grant request fully funded until we provided her elementary school class with interactive math stations. She says her students cheered when they opened the box and saw the electronic flashcards and are using the many tools that were included in their small group work, to the point that they even refer to the game while working in other groups, which she calls “a proud teacher moment.”

I’ve realized what I hate about the phrase “pop health,” other than the fact that it’s an annoying shorthand for “population health,” which in this industry is invariably misused in describing “population health management” or “population health management technology,” which are entirely different things. Reporters and bloggers who bandy the term about from their cheap seats in their unwillingness to enunciate the daunting four syllables of “population” haven’t earned the right to lapse into jargon. Just like it’s insulting to Marines when people who have never served in the military shout out “Semper Fi.”

Listening: the almost-new album of one of my favorite bands, the highly listenable and brilliant Nada Surf, whose stock in trade is thoughtful lyrics, sweet harmonies, and ragged independence. Their catchy, sometimes jangly power-pop is hard to beat and they exhibit the maturity of a band whose lineup hasn’t changed in nearly 25 years. I’m offsetting that with the hard-rocking operatic Finnish metal of Nightwish, who I didn’t realize has commendably added the incomparable Floor Jansen (After Forever) as lead singer.

Last Week’s Most Interesting News

• The VA takes more Congressional heat for lack of DoD interoperability and hints harder at replacing VistA with commercially available software in a Senate Appropriations Committee hearing.
• A survey finds that most doctors haven’t heard of MACRA and hate the idea of tying their income to their quality.
• OHSU pays $2.7 million to settle two HIPAA charges involving only 7,000 patients in incidents involving a stolen laptop and residents using Google Docs to store patient information.
• Imprivata and Valence Health are acquired.
• HHS issues ransomware guidance in declaring that a reportable HIPAA breach has occurred any time PHI is encrypted by malware.
• CMS levies a death sentence on lab processor Theranos, banning Elizabeth Holmes from clinical laboratory ownership for two years and halting Medicare and Medicaid payments to the company.

Webinars

None scheduled soon. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

GE Healthcare’s management consulting group signs a five-year collaboration agreement with ThoughtWire, which offers machine intelligence software that GE Healthcare will roll out as real-time process alerting and decision support.

Sales

University of Virginia Health System selects Evariant’s Physician Relationship Management and Physician Market Solver solutions for physician alignment.

The Medical Information Network – North Sound (WA) HIE adds Jiva Population Health Management to its ZeOmega rollout.

People

Commonwealth Health (PA) names Denis Tucker (Main Line Health) as CIO.

Government and Politics

England’s Secretary of State for Health and digital health supporter Jeremy Hunt is reappointed under new Prime Minister Theresa May.

The Defense Health Agency awards a five-year, $70 million to EHR Total Solutions. I found next to nothing about the company, which seems to exist purely to get military contracts. It previously reported $9 million in annual MHS contracts, so this will raise its total a lot.

A US District Court orders MedSignals CEO Vesta Brue to pay $4.5 million for grant fraud. Her Lexington, KY companies received five NIH grants to develop electronic pillboxes, but she spent the money on plastic surgery, jewelry, and massages. She will also pay restitution and serve jail time for grant fraud related to Telehealth Holdings, Inc., a company operated by her partner Jerome Hahn.

GE Healthcare sues 23-bed West Feliciana Parish Hospital (LA), complaining that it unfairly chose Hitachi Medical Systems to provide imaging equipment at a price below GEHC’s bid.

I’m tiring of the Pokemon Go phenomenon as quickly as I did other pointless, imitative fads like the Ice Bucket Challenge and the phrase “threw up in my mouth a little bit,” but this is cool: C.S Mott Children’s Hospital (MI) is using the game to get hospitalized children to leave their beds and interact with employees and other patients. That won’t be offset by the hospital influx of dolts who are hurting themselves in their rare interactions with their actual physical surroundings while staring at their phones, but it’s a small plus. Speaking of which, as I predicted last week, game developer Niantic announces monetization plans in which it will offer retailers the ability to sponsor locations on a cost-per-visit basis in hopes of boosting their foot traffic. I predict the game will be a cringingly-recalled embarrassment in six months, just like Second Life and Google Glass.

The former IT administrator of an Alaska health system faces 99 years in prison after pleading guilty to  possessing and distributing 2 million images and 13,000 videos of child pornography that obtained using the hospital’s network. He was not charged for distributing another disturbing image, the photo above from his LinkedIn profile.

The Houston paper covers the “cost versus choice” out-of-network conundrum in describing a 175-bed, oncologist-owned hospital that brings in annual revenue of $1.5 billion despite not accepting any form of insurance. Aetna sued after finding that the hospital was reducing the patient responsibility portion of its bills to in-network levels by applying a “prompt pay discount,” but was sticking Aetna for their full part of the out-of-network charges (such as $200,000 to treat an abscess). Aetna claimed racketeering, while the hospital counter-sued for being blacklisted. The judge denied Aetna’s demand for $225 million in refunds, saying it’s up to Aetna to decide what part of medical costs it pays in applying usual and customary limits.

Bizarre: several doctors in India, one of them a government official, are arrested for running a child trafficking ring from their hospital, caught as they tried to sell a four-month-old. Police are also investigating whether the doctors are running their hospital legally and whether they have actual medical degrees.

Sponsor Updates

• T-System will exhibit at the FHIMA Annual Meeting July 18-21 in Orlando.
• Stella Technology is sponsoring and exhibiting at the Redwood Mednet conference in Santa Rosa, CA this week.
• Datanami.com profiles TransUnion’s management and use of big data.
• Valence Health will host its value-based industry conference, Further 2016, September 14-16 in Chicago.

Blog Posts

• Swedish Medical Group Clinics Optimize Care Delivery with Versus Advantages Clinic (Versus Technology)
• EHRs, Interoperability, and Workflow (TeleTracking)
• OCR is doing a good thing by making us “Eat our Vegetables” (Iatric Systems)
• Hurricane Warning: Is Your Business Ready? (Tierpoint)
• Taking Action on Maternity Care Viability (Verisk Health)
• First-class calling. (Voalte)
• Report from AHIP16 – The Expanding Role of Pharmacy in Patient Care (First Databank)

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates.Send news or rumors.
Contact us.

News 7/15/16

Top News

VA CIO LaVerne Council, testifying to the Senate’s Committee on Appropriations about the future of VistA, defends the status of interoperability with the DoD. She is grilled about why the military’s diagnostic images of newly discharged veterans can’t be viewed by the VA, forcing them to start over, and why Cerner’s suicide prevention algorithms can’t populate the Joint Legacy Viewer. She answers a pointed question about why the VA and DoD can’t use the same system by saying that no existing system can meet the needs of both. Council confirms that every VA VISN has a customized instance of VistA, meaning it’s really 130 similar but not identical systems.

VA Chief Information Strategy Officer David Waltman phrased an answer to a question as “until we move to a COTS solution on the digital health platform,” leaving little doubt that the VA hopes to buy a commercial product. Senator Bill Cassidy, MD (R-LA) was impressive in asking insightful questions about interoperability and federated data capabilities.

Council says the VA has engaged KLAS to build its business case (at a cost of $160,000, Politico reports) in reviewing products and options, hoping to give the next administration a business case by the end of the year. I’m not sure what KLAS has to offer that everybody doesn’t already know (it’s either Cerner or Epic – skip the RFI/RFP and just visit some sites, negotiate hard, and swallow the urge to rule out Cerner just because DoD chose it).

Reader Comments

From Dr. Nicholas Van Helsing: “Re: Theranos. I posted a few weeks ago that it was clear the Emperor had no clothes. But put a mysterious woman dressed in black turtlenecks and a somewhat strange alto voice out front and people buy it. A similar image was creatively groomed 15 years or so for Kim Polese of Marimba. Every industry rag had a story about her every month, and then she complained that the press never left her alone. She hasn’t amounted to much, but at least Marimba sold for $239 million and only deal with software, not lives. Her next venture tanked – anyone know what she’s doing today? I think Liz is headed the same way. QED.” Polese made a lot of covers because of her appearance (despite holding a biophysics degree and being influential at Sun Microsystems for coming up with the name Java) and because women-led tech companies were rare back then. That was a reflection of widespread industry chauvinism more than any ego failings she might have had. Marimba created Castanet, a technology to allow fast downloads, but the company’s fame never approached her own, especially after it hired a PR firm who decided to make her the real story. You’ll be interested to know that she landed in healthcare as board chair of ClearStreet, which offers technology to help employers and employees manage their healthcare spending.

From Dilettante: “Re: HIStalk. I don’t believe that it’s just one person writing and reading every item that appears. Tell me who is on the team and where the company offices are located.” I get that a lot. I write every word of every news post myself, with the rare exception when I take a day off and Jenn covers. I don’t leave the otherwise empty spare bedroom (no schmoozing, speaking engagements, or sucking up – that’s the beauty of being anonymous) until I’ve written something that I’ll still be proud of years later, long after thousands of readers have forgotten it. Until I lose the ability or interest to continue doing that in a way that I think is better than anyone else, it’s just me alone feeling like I’m whispering in the ear of a single reader who is just like me in having a short attention span, a low threshold for BS and corporate incompetence, and a strong interest in doing the right thing for patients and those who pay their bills. Everybody has some weird, questionably useful talent (wiggling ears or solving a Rubik’s cube, for example) and this happens to be mine.

HIStalk Announcements and Requests

We funded a significant DonorsChoose project (donating $500, which was matched by Chevron) in providing Mrs. Veltri’s Pennsylvania elementary school class with an iPad Mini and STEAM tools, books, and games. She reports, “Packages came to our door and our students could not contain their excitement. You should have seen their faces as they began to open boxes that gave them tools to explore new aspects of education. At this young age students need to explore science, technology, engineering, and mathematics to set their foundations for later on in their schooling. The blocks and tiles get them learning about these concepts at a young age and in a very exciting way!”

I asked Jenn to write an article about the return on investment vendors get for exhibiting at the HIMSS conference. Contact her if you would be willing to give some company perspective (anonymously if you would rather).

This week on HIStalk Practice: Enli Health Intelligence partners with Dell Services. Hawaii hopes to ease physician shortage with expanded access to telemedicine. Relatient partners with Uber. Flatirons Practice Management adds Mediware billing tools. HealthTap acquires Docphin. Drchrono partners with AHIMA to help HIM students. Colorado Springs Health Partners rolls out Clockwise.MD at urgent care facilities.

This week on HIStalk Connect: Involution Studios debuts digital healthcare cards. Tel Aviv University develops temporary emotion-mapping electronic tattoos. Eleven year-old helps Boston Children’s Hospital promote telemedicine legislation. Avizia and Progyny secure new funding rounds. Drones help coordinate care for wild ferrets.

Listening: new from Anderson/Stolt, a collaboration between former Yes singer Jon Anderson and former Flower Kings/Transatlantic guitarist Roine Stolt. Yes is on its sad last cash-cow legs, even more pathetic than the so-called Beach Boys with no original members left and a tribute band singer mangling its classics, so this is a pretty good substitute for the band’s prime 1970s years with Anderson / Squire/ Howe / Wakeman / White (or maybe Bruford if you’re a purist). Prog fans will be transported to the years when Yes and Genesis ruled the airwaves and concert stages. Anderson sounds great for a guy who’s 71 and who got fired from Yes in 2008 after serious lung problems kept him off the road and thus from playing the aging band’s primary keyboard instrument (the cash register). He’s also touring this fall with fellow Yes alumni Rick Wakeman and Trevor Rabin.

Webinars

None scheduled soon. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Teladoc obtains a $25 million loan and $25 million line of credit.

Care coordination software vendor Caremerge raises $14 million, increasing its total to $20 million.

Telemedicine software and services vendor Avizia raises $11 million, increasing its total to $17 million.

In Canada, Telus Health announces that it will acquires the Canadian EHR business of Nightingale Informatix, which is used by 4,000 physicians.

Patient experience software vendor Docent Health raises $15 million in a Series A funding round, increasing its total to $17 million.

Publicly traded Alere recalls all of its PT/INR blood coagulation testing systems as mandated by FDA, which found that the company’s software update did not fix a previously documented problem with incorrect results. Abbott had agreed to acquire the company for $5.8 billion last year but then tried to back out after Alere was investigated for foreign corruption probes, so naturally they’ll be trying even harder now. 

People

Randy Fusco (Change Healthcare) joins patient engagement system vendor HealthGrid as EVP of product R&D.

ID Experts hires Kimberly Holmes, JD (OneBeacon Insurance Group) as SVP and counsel for cyber insurance, liability, and emerging risks. 

Johns Hopkins All Children’s Hospital (FL) names John McLendon (MedStar Health) as VP/CIO.

Chris Hammack (Patientco) joins population health management consulting group Aegis Health Group as SVP of sales and business development.

Announcements and Implementations

In Singapore, Farrer Park Hospital goes live on Meditech 6.0.

Medecision launches Aerial for Medicaid and Medicare Advantage, a population health management system.

Colorado Springs Health Partners (CO) goes live with online check-in by Clockwise.MD at all three of its urgent care facilities.

PMD adds real-time discharge alerts to its software, allowing practices that participate in Medicare’s Transitional Care Management program  to be paid for performing follow-up within 48 hours of discharge. The company offers software for charge capture, secure messaging, health information exchange, and care coordination.

Government and Politics

Six Republican Senators introduce the EHR Regulatory Relief act that would mandate a 90-day Meaningful Use reporting window in trying to “pull the electronic medical records system out of the ditch, transforming it into something that doctors and hospitals look forward to rather than dread.” The proposed legislation would also modify the all-or-nothing MU requirements and extend the availability of hardship exemptions. Senators John Thune (R-SD), Lamar Alexander (R-TN), Mike Enzi (R-WY), Pat Roberts (R-KS), Richard Burr (R-NC), and Bill Cassidy (R-LA) are members of the Senate’s working group Re-Examining the Strategies Needed to Successfully Adopt Health IT, which somehow ended up with the contrived, catchy non-acronym REBOOT.

Meanwhile, CMS Acting Administrator Andy Slavitt tells the Senate Finance Committee that CMS is open to postponing MACRA and shortening its reporting periods.

A Politico article calls the Affordable Care Act “the secret jobs program” in which the administration–  facing a tanking economy and the loss of millions of jobs — chose preserving healthcare employment over controlling healthcare costs in deciding not to cap healthcare spending or address provider efficiency. Healthcare employment has grown 23 percent since 2005 vs. just 6 percent in non-healthcare jobs. The excellent article notes that the “poison pill” that’s included with all those jobs is ever-growing healthcare costs (healthcare creates its own demand) footed by employers, patients, and taxpayers, noting that doctors are outnumbered by non-doctors by 16 to 1, with nine of those being paper-pushers. Experts say the investment is a poor one if health doesn’t improve. Legislators have declined to face the issue because “every job is a good job” and all of them have big-employer hospitals in their districts, with healthcare and social assistance providing the highest employment in 56 percent of Congressional districts.

HHS lists a position for an IT security specialist, which contains mostly unsurprising duties except for the last two that cover prosecution and corrective action.

A Deloitte survey of physicians finds that only 50 percent of the non-pediatricians have heard of MACRA, with 32 percent of them saying they’ve heard of it but don’t actually know what it is (maybe CMS should hire drug salespeople to spread the word since they seem to get doctors to pay attention, at least when they bring lunch). Nearly 80 percent of respondents say they would rather be paid under fee-for-service or salary arrangements instead of value-based payments. Three-quarters think performance reporting is burdensome and 79 percent don’t like the idea of tying their incomes to quality (that might be the scariest number of all).

An HHS report says national health spending will hit the $10,000 per person mark for the first time this year and will continue to grow at around 6 percent annually through 2025 as the economy improves, healthcare prices rise, and baby boomers get older. It predicts that spending may be moderated by higher out-of-pocket costs and says insurers will increasingly narrow their networks in trying to avoid price increases.

Privacy and Security

Oregon Health & Science University will pay $2.7 million to settle charges stemming from two 2013 data breaches involving 7,000 patients, one the theft of a surgeon’s unencrypted laptop from his vacation home and the other caused by medical residents who stored patient information in cloud-based Google Docs. That’s a big penalty considering there’s no proof anyone actually saw or used the patient information.

Other

Healthcare Growth Partners publishes its mid-year health IT market review, which always dazzles me with its insight and brilliant writing. It notes the change since 2005 in which “solvers” (companies that do the right thing in generating profits while maximizing returns for many) now outnumber the previously dominant “exploiters” (companies that exploit inefficiencies to maximize returns for a select few), as the fee-for-service model rewards exploiters and value-based care rewards solvers. It notes that companies with just $10 million in revenue have a wide variety of investors to choose from in the immature health IT market. Respondents were mixed on whether an health IT investment bubble exists, but those who think it does point mostly at early-stage companies. There’s too much information to summarize adequately, so take a look – unless you are already an M&A expert, you’ll learn a lot by reading the report.

Greater Baltimore Medical Center (MD) celebrates its EHR go-live with what it calls a company barbeque (which it wasn’t – it was a cookout with no low and slow smoking involved). I assume it was Epic ambulatory that went live.

A funny spoof from the Gomerbloggers.

Weird News Andy helpfully provides ICD-10 code Y93.C2 (activity, hand held electronic device) for treating the idiots who are harming themselves by ignoring the real world in favor of the Pokemon Go variety. He provides examples: (a) two men fall off a San Diego cliff after cutting through a protective fence in their pursuit of a character; (b) a guy crashes his car and tears up a woman’s yard while driving and chasing an imaginary monster; and (c) a 21-year-old generously absolves the game’s maker for falling off his skateboard while hunting characters, saying, “I don’t think the company is really at fault.” Meanwhile, officials at the United States Holocaust Museum, Arlington National Cemetery, and Poland’s Auschwitz Memorial ask the game’s vendor to take their sites off its monster-hunting list to keep them from being overrun by disrespectful players. The CEO of the company that developed Pokemon Go says his goals were to get people to exercise, to encourage them to explore their neighborhoods, and to serve as an icebreaker in getting strangers together, all of which could allow the game to meet the definition of a health app except that people actually use it.

Sponsor Updates

• Ingenious Med Chief Innovation and Product Officer Todd Charest speaks at the Gwinnett Chamber of Commerce’s Wearable Technology Forum.
• InstaMed is featured in the Deloitte Health Care Current.
• Fifty-nine Meditech customers achieve the “Most Wired” distinction for 2016.
• Netsmart will exhibit at the ASU Annual Summer Institute July 19 in Sedona, AZ.
• Experian Health will host its Northeast Regional User Conference July 19 in Philadelphia.
• Following up on an Earth Day-related pledge, PatientPay donates to The Nature Conservancy for the restoration of longleaf pine forests in the North Carolina Sandhills.
• Teknovation.biz interviews PerfectServe CEO Terry Edwards.
• Sunquest Information Systems will host its 35th Annual User Group Conference through July 15 in Tucson, AZ.

Blog Posts

• Why Your Facebook Ad Won’t Work (Influence Health)
• How can Microsoft Make the Most of its LinkedIn Acquisition? (Liaison Healthcare)
• Optimizing Medicaid Population Management (Medecision)
• Is It Time for a Check-Up? (Spok)
• Two-thirds of Healthcare Leaders Know It’s Hip to Be Square. Do You? (Navicure)
• MACRA is Coming: 5 Key Things You Can Do to Get Ready (Orion Health)
• At HFMA’s 2016 ANI, Patient Payment Technology Evolves with Provider Strategy (Patientco)
• Managing the “Heart and Soul” of Your Healthcare Delivery System (Phynd Technologies)
• Let’s Start Talking (PMD)

HIStalk sponsors named among the 100 winners of Modern Healthcare’s “Best Places to Work in Healthcare 2016” are:

• CloudWave
• CTG
• Cumberland Consulting Group
• Divurgent
• Encore, a Quintiles Company
• Galen Healthcare Solutions
• Hayes Management Consulting
• Health Catalyst
• Impact Advisors
• Imprivata
• Nordic
• Santa Rosa Consulting
• The Advisory Board Company
• The Chartis Group,

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates.Send news or rumors.
Contact us.

The War on Wearables

HIStalk looks at the bad rap wearables have been getting lately. From class action lawsuits against Fitbit to digital health snake oil comments, wearables have major ground to cover when it comes to winning over providers as medically reputable devices.
By @JennHIStalk

Industry headlines would have you believe that it’s not the most opportune time to be in wearables. The consumer-friendly devices, most of them of the fitness-tracking variety, face abandonment rates of between 33 and 50 percent after the first six months of use, not to mention increasing scrutiny as to the accuracy of their measurements.

And then there’s the comment heard ‘round the health IT world: “From ineffective electronic health records, to an explosion of direct-to-consumer digital health products, to apps of mixed quality. This is the digital snake oil of the 21st century.”

The comments of AMA CEO James Madara, MD during the association’s annual meeting last month was provocative to many. Although it did have a certain clickbait ring to it, his stance was born out of an underlying concern by many in the medical field that digital health tools — of which wearables take up an increasing percentage — have yet to be fully accepted by physicians. Whether it’s accuracy, usefulness, easy integration with EHRs, or reimbursement for time spent sifting through all that data, wearables haven’t achieved the panacea status many entrepreneurs would have providers and consumers believe they’re capable of.

The Physician’s Perspective

And yet there seems to be no going back. Companies continue to work wearables into their product roadmaps, even in the face of questionable data accuracy. Elmurst, IL-based Power2Practice, for example, announced Fitbit integration with its EHR for integrative medicine last month. UK-based personal health record company Medelinked has announced a similar arrangement with Jawbone.

Clinical researchers don’t seem deterred, either. The Dana-Farber Cancer Institute’s new breast cancer weight loss study has equipped all of its participants with Fitbits to track activity and weight. The examples of academic and corporate enthusiasm for wearables could — and likely will — go on, suggesting that, like the ancient medicinal properties of snake oil, there is a grain of truth to their purported value.

Danny Sands, MD, a practicing physician at Beth Israel Deaconess Medical Center (MA), co-founder of the Society for Participatory Medicine, and chief medical officer at several healthcare companies admits to wearing a Fitbit because he likes receiving reminders that he needs to pick up the pace on a daily basis.

“I think that’s a positive step in the right direction, if you’ll excuse the play on words,” he jokes. “We have to remember that these are consumer devices. They’re not accurate clinical devices. For some people, having the Fitbit on is a motivator. I have seen firsthand how my encouragement to get a Fitbit helped one of my patients get moving and make profound changes in his life. Unfortunately, the vast majority of people who use these tracking devices don’t need to. They’re being used by the young, healthy, and wealthy, not by my patient with three chronic conditions who really should be wearing one.”

“As a primary care doctor,” Sands explains, “one of the things that is so hard and so frustrating is this issue of behavior change – how to motivate patients. If this is one more tool we can use to help motivate our patients, then I figure there’s something to it.” He adds, however, that not all physicians are comfortable recommending wearables and apps, either because they’re not familiar with what’s on the market or have no interest in diving into the back-end issues of receiving that deluge of data.

“You have to ask yourself, as a physician, is this data useful to me,” Sands says. “There it gets a little more complicated, because, first of all, there’s the issue of accuracy. Second, there’s the issue of integration with my workflow/EHR. Third, and perhaps most importantly, it’s about the volume of data that these things generate. This is only going to be useful to me in my practice if it’s information I want to see on a patient that I want to keep track of. Perhaps I’m in some sort of value-based payment contract where I have an incentive to try and keep my patients healthy. I need to figure out how to separate the signal from the noise. I need a system that’s going to show me just the data that’s important to me.”

Sands obviously isn’t convinced by the snake oil rhetoric. “Time and time again we’ve seen that a computer program in the absence of human beings providing something as well is not going to make a big difference in people’s lives. You need systems in place. You need some interface with the healthcare system. If you want to show measurable benefits, then you really have to have human beings there – some touchpoint with the healthcare system.”

The Quality vs. Quantity Conundrum

ACT | The App Association, the Washington, DC-based nonprofit that represents software companies in the mobile app community, has been keeping a close eye on the evolution of wearables in the healthcare space. “Connected devices that we think of as wearables are undergoing a significant transition,” says Executive Director Morgan Reed. “As sensors and technology improve, these devices are rapidly blurring the line separating highly accurate medical devices and something you might pick up at an airport kiosk.”

“The struggle,” he adds, echoing Sands’ comments, “will be taking all of that accurate information and presenting it to a care provider in a meaningful way. This is a place where the balance between quality versus quantity comes into play on the physician side. EHRs – loved or loathed – aren’t so much barriers, but instead have created a new paradigm in which medical apps and connected device makers must create technology that integrates seamlessly with those systems. An ideal interoperable system gives care providers access to a lot of data, but instead of just dumping it into one place, the system highlights the data that the physician needs the most, and makes it available in a usable format. Open APIs are a big part of the solution. The tech industry, regulators, and physicians need to work together to determine how best to create and implement these APIs and related standards.”

Workflow Integration will be Key

Companies like Validic are helping physicians navigate the still-murky waters of wearables integration. The Durham, NC-based company recently partnered with SAP to enable its enterprise healthcare clients to easily access patient data from wearables, clinical devices, and consumer health apps using Validic’s digital health connectivity tools. Co-founder and CTO Drew Schiller believes partnerships like these will help wearables move past the early days phase they seem to be stuck in.

“Consumer wearables as a market is still maturing, with only one IPO and a couple of exits,” Schiller explains. “We are still in the early phases of using these devices in healthcare. Given this, it’s unsurprising that there have been challenges getting adoption from providers. The ‘time to drawer’ is a concern, indicating that these devices may not have yet reached full utility.”

“The biggest barriers today have to do with presenting meaningful information in existing workflows,” he adds. “One barrier is that we are still working to understand the applications and necessary reporting mechanisms for healthcare. There are dozens of ongoing pilots, projects, and grant-funded studies looking to address these needs, and organizations like Node Health are working to bring these disparate efforts together in one place and disseminate learnings.”

“I wouldn’t say that categorically certain wearables are more conducive to integration,” Schiller points out. “However, having a single point of entry for all wearable data certainly makes things easier. Additionally, if an endpoint from the wearable already has a classification and a place in workflow, that makes the logistics of implementation much easier.”

The Biggest Impact

Despite their current shortcomings, wearables seem poised for improvement in terms of provider acceptance, ease of use and integration, overall sophistication, and, most importantly, impact on patient care.

“In the immediate term, wearables enable people to take a more active role in their health,” says Reed. “This represents a shift toward prevention instead of treatment once someone is sick. In the longer term, insights powered by mission-specific wearables and apps will be huge for physicians and patients. Patients can use connected devices to help manage chronic conditions like diabetes or complete post-operative physical therapy, all while physicians monitor progress and identify potential risks.”

Moore adds that one of the most critical issues facing the healthcare system is that of the rapidly aging US population. “By 2050, there will be 83.7 million Americans over the age of 65 – that’s more than double the number just four years ago,” he points out. “Eighty percent of them will have at least one chronic condition, and a large portion will live in rural areas far from family members that could offer support. Wearables and apps are key to empowering this population, helping them to live healthier – and independently – for much longer.”

“Looking forward,” he adds, “advanced personal emergency response systems will be wearables packed with sensors and enabled by mobile apps that can track blood sugar, blood pressure, heart rate, biomarkers for medication adherence, and geofencing for Alzheimer’s patients. The sensors in these devices will then connect to a loved one’s phone, a physician’s tablet, and a medical record system. This increasingly connected approach to healthcare will lower costs and empower aging populations to live at home longer.”

Schiller concurs that wearables will be key to helping care for an increasingly elderly population. He also points out that the devices will help make up for the physician shortage we’ve all heard so much about. “We face a generation of physicians preparing for retirement and a dearth of PCP replacements. We simply won’t have the skilled workforce to maintain business-as-usual practices in healthcare. We must better leverage technology to scale reduced healthcare resources with an eye toward preventing sickness before it becomes chronic. Wearables will play a central role in this revolution.”

Present Benefits are Possible

While the revolution is in the works, wearables, for all their documented shortcomings, are capable of offering near-term benefits to physicians and patients. “Those benefits will depend on the supporting infrastructure and tools the health system and/or EHR vendor has put in place,” Schiller says. “For example, Cerner and Meditech have built smart alerting and dashboarding into their patient portals leveraging a growing list of patient-generated data from remote monitoring devices, including wearables. Health systems such as Sutter Health have realized tremendous success with wearables in comprehensive remote patient monitoring programs for chronic diseases like hypertension. Programs like these will help a physician better treat patients by knowing precisely how well or how poorly a patient is progressing in their care.“

“Long term,” he adds, “physicians will benefit from a shift toward preventative and monitoring measures. This will enable PCPs to know how their patients are doing without physically seeing them, allowing them to spend more time with patients who need care the most.”

Time – and the Market – will Tell

“We are currently witnessing Moore’s Law as applied to wearable devices,” Schiller concludes. “Wearables on the market 18 months ago are significantly inferior to the capabilities of those on the market today, and we expect to see another jump in functionality and sophistication within the next six to 12 months. I could make some specific predictions, but it makes sense to instead state more generally that the consumer technology industry will rise above these challenges to make useful, compelling, and practical devices.”

Evolent Health Will Acquire Valence Health for $145 Million

Evolent Health will acquire the majority of Valence Health for $145 million, the companies have announced. The deal, which involves $35 million in cash and the remainder in Evolent shares, excludes Valence’s state insurance cooperative contracts, which will continue to operate under a newly created entity.

Evolent CEO Frank Williams said in a statement, “The addition of the Valence Health business will provide increased scale and client diversification, and we expect it to accelerate our target timeline to Adjusted EBITDA break-even in 2017 by one to two quarters. We believe this transaction will strengthen our business strategically and financially and position it for continued growth well into the future."

Chicago-based Valence Health offers technology and consulting services to providers moving to value-based care. The company last year hired as its CEO Andy Eckert, who had previously served as CEO of Eclipsys, TriZetto, and CRC Health as well as currently serving as board chair of Varian Medical Systems.

Evolent Health, which also offers integrated solutions that help providers shift to value-based care, was formed in 2011 with The Advisory Board Company and UPMC and went public in June 2015. It has a $1.2 billion market cap as share price has risen 3 percent in the year since its IPO.

I interviewed Evolent President and Co-Founder Seth Blackley in August 2015 and interviewed Valence Health then-CEO Phil Kamp (now chief strategy officer) in March 2015.

Thoma Bravo To Acquire Imprivata for $544 Million

Imprivata will be taken private by an affiliate of private equity firm Thoma Bravo for $544 million in cash, giving shareholders a 33 percent premium to the last closing stock price.

Imprivata President and CEO Omar Hussain was quoted in a statement as saying, “We’re tremendously excited about Thoma Bravo’s investment in our company and believe this transaction represents a great outcome for our current shareholders. Given Thoma Bravo’s successful track record in both security and healthcare IT, today’s partnership is an endorsement of Imprivata’s corporate vision and our relentless focus on the customer experience — a value which has established us as the vendor of choice in healthcare IT security. We are now in a stronger position to pursue market opportunities through innovating and expanding the products and services we offer.”

Thoma Bravo’s other active healthcare IT investments include Global Healthcare Exchange, Hyland Software, Mediware, and SRS Software. It also owns Bomgar Corporation, which offers remote support and identity management solutions. 

Imprivata offers single sign-on, secure virtual desktop access, patient IT, secure messaging, and two-factor authentication. The company went public in June 2014. Share price has decreased 11 percent since.

News 7/13/16

Top News

HHS issues HIPAA guidance for ransomware attacks, saying that a reportable HIPAA breach has occurred if the malware encrypts PHI. The only exception is if the covered entity or business associate can demonstrate that the risk of PHI compromise is low, which would be difficult to accomplish in a ransomware attack.

HHS says a breach has not occurred if the user’s data was encrypted, but with a big exception –  users who are logged into a PC have made the information on their hard drive available during their session, so if that user clicks on a phishing link or opens an infected web page that triggers ransomware encryption, impermissible disclosure has occurred.

Reader Comments

From Geno Petralli: “Re: Xcite Health. A client says they’ve been bought by Athenahealth and the EncounterPro/Xcite Health program will be sunsetted and everyone moved to Athena by 1/10/17.” Here’s Athenahealth’s official response (from the head PR person) to my inquiry about this reader’s rumor:

A few hours later, I received this “partnership” announcement from Xcite Health, confirming the reader’s statement that EHR/PM vendor Xcite Health is shutting down as of January 10, 2017 and is suggesting that its now-orphaned clients switch to Athenahealth.

From Roll Liftface: “Re: HIT100 winners. This guy doesn’t appear to have a job beyond self-promotion. Next year you should mock the process by getting your readers to nominate Carrot Top or Prince.” I haven’t heard of at least half of the tweet-happy winners, who seem to participate in a lot of mutual back-scratching among the Twitterati. Twitter isn’t the real world and the job titles of some suggest more success in the former than the latter. I’m sure part of the motivation beyond self-validation is employment, but I think companies would be wary of hiring someone who spends that much time and energy tweeting.

HIStalk Announcements and Requests

Elementary school librarian Ms. H in Texas created a maker space that we stocked with programmable robots and other technology kits in funding her DonorsChoose grant request. She reports, “The younger students were in awe of this technology! I had a few even say ‘It’s Magic’ and I had to respond ‘No, it’s science!’ I had first graders screaming with joy when they got their Ozobot to follow the path they had created for it.”

Webinars

July 13 (Wednesday) 1:00 ET. “Why Risk It? Readmissions Before They Happen.” Sponsored by Medicity. Presenter: Adam Bell, RN, senior clinical consultant, Medicity. Readmissions generate a staggering $41.3 billion in additional hospital costs each year, and many occur for reasons that could have been avoided. Without a clear way to proactively identify admitted patients with the highest risk of readmission, hospitals face major revenue losses and CMS penalties. Join this webinar to discover how to unlock the potential of patient data with intelligence to predict which admitted patients are at high risk for readmission.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

The Wall Street Journal publishes fascinating factoids about Theranos CEO Elizabeth Holmes, including that her admiration for Steve Jobs (as evidenced by her black turtlenecks) led her to maintain an Apple-like secrecy about company news until the “one more thing” type public reveal. She also hired an Academy Award-winning director to film videos of herself. She is also escorted everywhere by an earpiece-wearing security detail that refers to her as Eagle 1. The article notes that her presentation to the American Association for Clinical Chemistry next month won’t include the information she originally intended since FDA said she couldn’t, so she’s going to instead focus her talk on Theranos company history (yawn). WSJ’s readers always provide insightful comments:

• Hey, investors in Eagle 1–do you guys really know what you’re doing? Heaven forbid that you actually consult with someone who actually KNOWS SOMETHING about diagnostics.
• I just hope that this story helps to shed light on the loophole in the law that allowed Theranos to promote tests that were not scientifically validated or to bring a spotlight to the many start-ups that continue to raise funds on the basis of hype and revenue growth, but without any real business plan or hope of profit.
• This is what the VC’s seemed to really lust after, the idea that Theranos was going to move the bulk of blood testing out of doctor’s offices disrupt LabCorp and Quest as if they were stodgy old taxi companies. Theranos was really an "Uber for _____" and a data hoovering company. How many more clinically relevant (but smaller and less sexy) medical companies could have been funded with the money that was wasted on this?
• I hesitate to draw any parallels between Holmes and Jobs because Jobs actually built products that worked as advertised.
• I know a former employee of Theranos. This person got out when they realized this company was all smoke and mirrors. Also, this person told me that the whole Elizabeth Holmes story is all PR driven fluff (boldly dropping out of Stanford, starting the company on her own, etc.). Holmes actually has a lot of political connections in DC and is related to the Fleischmann Yeast fortune. Why are there so many politicians on the Theranos board and very few MDs?
• It is possible that the famous Reality Distortion Field attributed to Mr. Steve Jobs might have been taken one step too far in this one case.
• She is working in that exciting grey area between novel scientific breakthrough and scam.
• Seems "Fake it ’til you make it" doesn’t work with medical technology.

Protesters picket Washington State clinic operator Zoom because it doesn’t accept Medicare or Medicaid, which the company logically replies is exactly its business model in offering quick, technology-powered local care for which Medicare pays poorly if at all. Protesters, many of them representing unions and those who want universal healthcare, issued a statement saying that population segmentation causes inefficient, lower-quality healthcare. Zoom’s CEO responds, “Don’t think that we have to be all things to all people.”

Stella Technology acquires Zigron Healthcare to expands its web and mobile app development, ETL, BI, QA, and user experience design services.

ECG Management Consultants acquires the healthcare consulting division of Kurt Salmon US.

Emergency medical services software vendor ESO Solutions – which offers an EHR and healthcare data exchange platform — receives a growth equity investment from Accel-KKR.

I missed this from a couple of weeks ago: investors including Blue Shield of California buy out MeYou Health, which offers behavior modification and social tools for health plan members. The new CEO is Rick Lee, co-founder of the acquired and then failed Healthrageous. MeYou Health company was previously owned by Healthways.

Aprima will consolidate its North Texas offices and 250 employees in Richardson, TX.

Sales

In the UK, Pennine Care NHS Foundation Trust chooses FormFast for its paperless health initiatives.

Rady Children’s Hospital – San Diego (CA) selects Strata Decision Technology’s StrataJazz for decision support, cost accounting, and contract analytics.

East Texas Medical Center Regional Healthcare System (TX) chooses Orion Health’s Rhapsody Integration Engine.

People

Jennifer Karstens (Encore Health Resources) joins Orchestrate Healthcare as area VP.

Announcements and Implementations

The American Heart Association’s Institute for Precision Cardiovascular Medicine will award 14 data-related grants in the next year and will provide winners access to Amazon Web Services to analyze and share their information. The grants will cover data mining, data methods validation, development of data analysis tools, and fellowships for scientists interested in computational biology training.

NCQA awards Premier its first Electronic Clinical Quality Measures Certification, verifying its ability to report clinical data for HEDIS and CMS EHR inventive measures.

Government and Politics

President Obama writes a JAMA paper (bylined as “Barack Obama, JD”) describing the impact of the Affordable Care Act. He describes the decrease in uninsured citizens and the elimination of cost-sharing for preventive services and lifetime coverage limits. He says reform needs to continue via CMMI, ACOs, MACRA, precision medicine, and the Cancer Moonshot. He asks Congress to revisit his original proposal to offer a Medicare-like public plan that would add competition in areas served by a small number of insurers. He also wants Congress to force drug companies to disclose their actual production costs and to give CMS the authority to negotiate prices for expensive drugs. The President warns of the influence of special interest groups:

The second lesson is that special interests pose a continued obstacle to change. We worked successfully with some health care organizations and groups, such as major hospital associations, to redirect excessive Medicare payments to federal subsidies for the uninsured. Yet others, like the pharmaceutical industry, oppose any change to drug pricing, no matter how justifiable and modest, because they believe it threatens their profits. We need to continue to tackle special interest dollars in politics. But we also need to reinforce the sense of mission in health care that brought us an affordable polio vaccine and widely available penicillin.

CMS announces that the median deductible on marketplace-issued health insurance policies is $850, down from $900 last year, when the subsidies the federal government gave to 60 percent of those policy-holders is figured in. The announcement glosses over the 40 percent of people who bought insurance from Healthcare.gov and state exchanges without federal handouts for their premiums and deductibles, the latter of which for silver-level plans are often the maximum allowed $6,800 for single coverage. As is nearly always the case in the US, the rich and the poor do well at the expense of the middle class.

The Congressional Budget Office calculates that the national debt will rise to 141 percent of the economy’s size within 20 years, eclipsing the previous high of 106 percent that followed World War II. Entitlement programs such as Medicare and Social Security are mostly responsible, along with interest payments on the ever-increasing US red ink.

Privacy and Security

A hospital in China apologizes to the parents of 6,000 newborns whose nursery videos were stolen by hackers and posted on the Internet. Experts say many website developers in China lack even basic security knowledge, adding that the hackers were probably just practicing their skills since the videos have no value otherwise.

A secretary fired by Jackson Health System (FL) for giving ESPN a photo showing the surgery schedule of football player Jason Pierre-Paul, whose finger was amputated following a fireworks accident last July 4, sues the hospital, claiming she’s had nightmares and headaches following what she says were false accusations. The hospital stands by its decision, saying they have electronic proof that she looked at Pierre-Paul’s chart at least four times and left work early the day the information was leaked. 

Other

A hospital in the Netherlands asks players of the wildly popular week-old, GPS-powered virtual reality Pokemon Go smartphone game to stop hunting the game’s imaginary monsters on its campus after several of them wander into its restricted areas. AMC’s tweet above translates to, “There is a sick Pokemon in AMC – we will take care of him. We would appreciate your not visiting.” Other businesses are facing similar headaches: a woman demands that a music festival let her daughter on its private property to play, a cafe bans the game because customers were taking up space for hours, and officials expect game-players to be injured or killed by wandering into roadways or onto railroad tracks while absorbed in gameplay. Players have run across dead bodies, been mugged in sketchy areas in the middle of the night, and admitted playing while driving. At least people who usually sit and stare at their phones all day long will finally get some exercise. I’m sure Nintendo / Niantic are quickly plotting ways to monetize their surprise hit, such as charging businesses to host destinations or to allow users to sell accomplishments back and forth, but it will probably be killed off by the next shiny object (a la Words with Friends and Second Life) before they roll something out.

I received an email touting a healthcare IT job site’s newly published “Health IT Stress Report,” which despite being overloaded with cute infographics and lofty yet lame conclusions, is based on only 470 survey respondents whose method of selection and response rate were unstated. That usually means someone stuck a survey on their website and harvested any willing, self-selected, statistically unrepresentative people who felt like filling it out.

In Canada, a survey of unstated methodology finds that only 21 percent of Quebec residents have used online health tools, causing the cheerleading digital health company authors to incorrectly conclude, “leaving 79 percent of Quebecans wanting digital tools that would allow them to take control of their personal health” (apparently the authors reckon that every single Quebec resident wants digital health tools even though they didn’t ask them.) Respondents were a lot more interested in online banking and social media even though they obligingly answered the leading questions offered about interoperability, electronic prescribing, and EHRs.

Weird News Andy labels this plastic surgeon as “selfieish.” The Ukraine doctor, whose motto is “Love is free, medicine is not,” specializes in breast augmentation and posting selfies and videos taken with his unconscious naked patients on social media. The shameless self-promotion is working – he has a year-long backlog of patients. 

Sponsor Updates

• Edward-Elmhurst Health (IL) says its physicians are saving two hours per shift by using Nuance’s Dragon Medical One cloud-based clinical speech recognition.
• Besler Consulting releases a new podcast on the comprehensive Care for Joint Replacement appeals process.
• ECG Management Consultants will present at the HFMA Region 7 Conference July 18 in Lake Geneva, WI.
• PMD CEO Philippe d’Offay is spotlighted in a Q&A about secure messaging for providers.
• Forward Health Group will participate in the National Governors Association Summer Meeting 2016 July 14-17 in Des Moines, IA.
• Impact Advisors will participate in the “Run to Home Base” fundraiser for veterans on July 25 at Fenway Park in Boston.
• Glytec CMO Andrew Rhinehart, MD offers an overview of DPP-4 inhibitors.
• HCS will exhibit at the Health Forum/AHA Leadership Summit July 17-19 in San Diego.

Blog Posts

• 10 Reasons to Attend Connect Atlanta 2016 (AirWatch)
• Four tips to improve office productivity & accelerate payments (AdvancedMD)
• How to Hack-Proof Your Medical Practice (Aprima)
• Yes, We Really Do Take Patient Calls At All Hours (CareSync)
• Tips for Employee Onboarding (CTG)
• Improving Patient Access: What’s Your 3rd Next Available Appointment? (Culbert Healthcare Solutions)
• You’ve got 1,000 questions; we’ve got answers: Nordic’s collective knowledge sharing tool (Nordic)
• Networking with Purpose (Direct Consulting Associates)
• Before Jumping on the Bandwagon … Know Your Clinical Communication Platform (Extension Healthcare)
• 5 Common EMR Data Migration Questions (Galen Healthcare Solutions)
• 4 Steps to Creating Super Users for Your System Implementation (Hayes Management Consulting)
• Interviewing – Revisiting the Practice (HCTec)
• Interface Engine Selection – 3 Things to Consider (The HCI Group)
• Treat Patient Visits Like Business Meetings? (Healthfinch)
• What a Canadian Rock Star can Teach us About Death and Dying (Healthwise)

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates.Send news or rumors.
Contact us.

Monday Morning Update 7/11/16

Top News

In what should be the death blow to lab processor and Silicon Valley technology wannabe Theranos, CMS bans CEO Elizabeth Holmes from any clinical laboratory ownership or involvement for two years and shuts Theranos off from receiving further payments from Medicare and Medicaid.

Theranos proved its incompetence even in its response to CMS’s warning letter: the company sent CMS five password-protected flash drives containing supporting information that was so screwed up that CMS couldn’t figure it out, with reports for the same accession number spread over multiple drives, information on the drives that didn’t match the contents of an accompanying paper binder, and random fax coversheets that were not associated with patient test reports (would you really want your specimens processed by a company that can’t keep documents straight?)

The company’s response to CMS’s death sentence inexplicably says it will keep Holmes as CEO, but hints that it might pivot away from the specimen processing business, possibly believing it can license its technology. That Theranos movie Jennifer Lawrence has signed up to do will either never be finished or it will hit theaters long after anyone still cares.

Meanwhile, pathology informaticist  Bruce Friedman, MD of Lab Soft News raises a good question: the American Association for Clinical Chemistry couldn’t resist giving Elizabeth Holmes stage time to promote her dying enterprise at their annual meeting that starts July 31, but shouldn’t they be even more embarrassed now that she’s been banned from the industry in which all of those actual experts work and maybe think about rescinding their questionable offer? She’s an even worse choice than some of the awful ones HIMSS has made (Dennis Quaid comes to mind). I’m starting my campaign to bring Martin Shkreli to the HIMSS stage.

Reader Comments

From Captain Ron: “Re: Epic’s search for a data visualization suite. Microsoft PowerBI, Qlik, and Tableau were in the running. After doing bake-offs, Epic decided to choose none of the above. They will support customers on any BI product they choose. Guess it’s up to the customers to build content for themselves against Clarity and Caboodle.” Unverified. 

From Neo Vespers: “Re: Glenwood Systems, Waterbury, CT. I’m a consultant looking for users of its GlaceEMR – my client is having problems and I can’t find other users.” I’ve never heard of the company or product, but perhaps someone will jump in.

From DJ D-Deadly: “Re: Politico’s e-Health News. They called you are a dirt-disher!” I resent smug attempts at cleverness in dismissing what I do as being National Enquirer-like simply because I report rumors that usually turn out to be partly or fully accurate, especially when sites make that observation even while running something they read on HIStalk and thus calling into question their entire thesis. I consider it a wash since they described me as “oracular,” which I plan to use in casual conversation every now and then. They also linked to HIStalk, unlike most of the time when reporters simply regurgitate what they’ve read here in passing it off as their original reporting.

From The PACS Designer: “Re: AI versus RI. Here in mid-2016 we’re on the cusp of a huge change in how healthcare is practiced. While artificial intelligence (AI) has been championed for decades as a solution to improved learning, healthcare will be moving toward real intelligence through the greater use of ICD-10. With the more specificity, the last year under ICD-10 Clinical Modifications (CM) has given practitioners some experience with this new format. Now on October 1 this year here in the US, we’ll begin to see the benefits of real intelligence or (RI) using ICD-10 Procedure Codes (PCS). Eric Topol from Scripps has an article highlighting where we are going with changes in healthcare through increased levels of patient engagements.” 

HIStalk Announcements and Requests

McKesson’s planned sale of its EIS business that includes Paragon will benefit Cerner the most, poll respondents say. However, nearly as many expect Meditech to gain ground from the sale. BP opines that McKesson made a mess of its acquisitions by sucking the energy out of them, noting particularly that the company spent $500 million developing Horizon Enterprise Revenue Management only to shut it down in favor of small-hospital Paragon. He or she blames offshore-onshore waffling, scope creep, cost, and competing internal projects that left provider executives disappointed and many McKesson employees bitter after never-ending waves of restructuring. Perhaps Kd’s wry comment is the most insightful – McKesson will benefit most because it’s dumping a cash sinkhole that it doesn’t really care about anyway.

New poll to your right or here: do HIPAA fines and settlements broadly increase privacy and security?

Mrs. S from Georgia says her students are using the iPad and quiz contest software we provided in funding her DonorsChoose grant request to reinforce their math skills by competing with each other.

I can’t decide if I’m comforted or horrified that even as the headlines get worse and the potential demise of our democracy seems to be creeping ever closer, disengaged citizens who are isolated from the real world by a self-created fantasy aura of phone geegaws are now obsessed with Pokemon Go. Want to fiddle while Rome burns? There’s an app for that.

Last Week’s Most Interesting News

• England’s NHS scraps its plans for a national database of EHR-extracted patient information after review committees criticizes its opt-out and consent policies.
• A Congressionally-established review committee recommends that the VA replace its old software systems – including VistA – with commercial products.
• NIH awards $55 million in grants for the recruitment of 1 million Americans for the long-term study of their personally collected data and gives Scripps Translational Sciences Institute a five-year, $120 million grant to develop apps, sensors, and processes for recruiting the “citizen scientists.”
• Catholic Health Care Services of the Archdiocese of Philadelphia pays $650,000 to settle HIPAA charges from the 2014 theft of a company-issued iPhone that contained the information of 412 patients, the first time a business associate has been charged with HIPAA violations.
• ONC announces its intention to measure national interoperability progress by using the responses to to existing AHA and CDC hospital surveys.
• A security firm’s tests find that hospitals are not always keeping the PCs and servers that control biomedical equipment current with operating system and antivirus updates, creating a digital soft spot for hackers.

Webinars

July 13 (Wednesday) 1:00 ET. “Why Risk It? Readmissions Before They Happen.” Sponsored by Medicity. Presenter: Adam Bell, RN, senior clinical consultant, Medicity. Readmissions generate a staggering $41.3 billion in additional hospital costs each year, and many occur for reasons that could have been avoided. Without a clear way to proactively identify admitted patients with the highest risk of readmission, hospitals face major revenue losses and CMS penalties. Join this webinar to discover how to unlock the potential of patient data with intelligence to predict which admitted patients are at high risk for readmission.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

People

HHS promotes acting CIO Beth Anne Killoran to the permanent position, noting that her IT experience with the Department of Homeland Security gives her strong cybersecurity capabilities.

NHS England names Keith McNeil as chief clinical information officer and Will Smart as CIO. McNeil, who is a physician, resigned as CEO of Addenbrooke’s Hospital last year just before Cambridge University Hospitals NHS Foundation Trust (which includes Addenbrooke’s and The Rosie Hospital) was placed on “special measures” for a number of patient care problems; he was also CEO when the Regulator Monitor investigated the trust’s financial challenges following its $300 million Epic rollout. Smart was CIO at Royal Free London NHS Foundation Trust, which is a Cerner shop.

Genetic testing IT systems vendor NextGxDx names Rob Metcalf (Digital Reasoning) as CEO. He replaces founder Mark Harris, PhD, who will take a demotion to chief innovation officer.

Government and Politics

The Department of Defense gives Cerner another no-bid contract for hosting its MHS Genesis EHR project, raising the project’s hosting costs from $50 million over 10 years to $74 million through the end of 2017. DoD says the extra cost won’t affect the overall $4.3 billion project budget. The Pentagon seems annoyed by the higher cost and says it may recompete the hosting contract next year. 

Technology

I’m questioning the quality of Wired’s breezy reporting in claiming that medical records are a “hot commodity” on the Dark Web, or as it dramatically intones, “the hidden recesses of the Internet” (accompanied by unrelated pictures lifted from Flickr users). They might well be a hot commodity as has been amply reported elsewhere, but this story adds nothing to the discussion. The reporter didn’t uncover a single new fact in simply reciting uncredited headlines from elsewhere and taking as gospel what some IBM guy told her about the Dark Web. She makes the puzzling assertion that hackers intentionally delete patient allergies from their medical record, which I’ve never heard of. She claims that doctors “are reluctant to use dual-factor authentication” without citing any source. She finishes by rambling off topic about steps patients can take to protect their information: don’t email information forms, make sure someone is standing by the fax machine if you fax something (does anyone really do that?), and ask why providers need your Social Security number. The overripe headline is like a movie trailer that baits movie-goers with the best scenes in ringing up their ticket purchase without delivering anything in return once they’ve settled into their seats. It’s pretty scary to see the low standard to which journalism is held these days, where desperate tricks to lure temporary eyeballs somehow continue convincing clueless advertisers to underwrite dumbed-down work.

Other

Ambulatory physicians at  University of Michigan Health System weren’t any more satisfied with Epic than with the homegrown CareWeb it replaced, a two-year study finds, refuting the common belief that post-implementation physician satisfaction improves over time in a J-curve. Instead, most measures exhibited L-curve behavior where they dropped and stayed below baseline. Physician job satisfaction decreased after Epic went live and didn’t catch up in the 25 months afterward; a majority of the doctor respondents believed throughout the two years that Epic hadn’t improved patient safety over the old system; and the EHR’s positive contribution to physician job satisfaction dropped from 62 percent with CareWeb to 8 percent with Epic.

I’ve received several “vote for me” messages via people on LinkedIn and Twitter who desperately want to be named to the pointless HIT100 list of prolific tweeters. Are they really going to be proud of winning, sprinting breathlessly to update their resumes with a faux award and feeling good about their place in the universe for having won it by strong-arming their social media contacts to support them, which suggests that those folks probably wouldn’t have chosen them otherwise?

A Wall Street Journal report says anger is building among patients who are treated in an in-network hospital but who are stuck with non-covered bills from the hospital’s out-of-network specialists. Three-fourths of ACA-issued policies provide no out-of-network coverage at all except in emergencies, and since out-of-pocket maximums don’t apply to out-of-network charges, the patient faces unlimited costs at the non-discounted rates that nobody else pays. ED doctors complain that insurers have reduce their payments knowing they have to treat their patients anyway, while insurance companies say that ED docs reject in-network rates so they can charge whatever they want on out-of-network bills.

China launches a year-long campaign that urges angry patients and their families to refrain from attacking the employees of its overloaded hospitals.

Sponsor Updates

• Valence Health will exhibit at the AHA Leadership Summit July 17-19 in San Diego.
• Huron Consulting Group will present at the AHA Leadership Summit July 17-19 in San Diego.

Blog Posts

• The Advisory Board offers RTLS Resources, Case Studies (Versus Technology)
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Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
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News 7/8/16

Top News

England’s NHS scraps its plan to create Care.data, a huge national database of patient information that was to be extracted from provider EHRs.

NHS planned to sell the partially de-identified information of patients who didn’t opt out to drug companies and other willing purchasers, but decided to end the program after two commissioned reports criticized its opt-out and consent policies as being less than transparent.

Reader Comments

From Jolter: “Re: Athenahealth. The company is not immune to the same challenges as competitors, as feedback on this software rating site about their Streamlined upgrade says. I had caught wind on their last investor call that Streamlined isn’t well regarded within their customer base. Instead of worrying about unbreaking healthcare, they should be unbreaking AthenaClinicals.” Physician customers say Streamlined has changed Athenahealth’s EHR into a click-intensive “opaque, cumbersome product” that “has made a mockery of the Athena system” that is now “the worst system I could have ever imagined,” with Athena’s support reps blaming Microsoft or whatever browser the customer is using for their many problems. A pulmonologist says Athena is “crippling my practice” and claims the company is censoring its client forum. Athenahealth is also getting publicly ripped by many customers on Facebook over the forced upgrade. One doctor summarizes Streamlined as, “When it works, it stinks. When it does not work, it really stinks.” It’s tough to keep riding the “disruptor” horse when you’re a publicly traded company worth $5.5 billion, have an installed base of customers to maintain, and need to fawn to impatient investors who constantly demand improving profits. Imagine the outraged fun Jonathan Bush would have with this seemingly major stumble if he ran Epic or Cerner. Athena has quite a few product and acquisition balls in the air, so this is where they get to prove that they earned their seat at the Wall Street table as something more than a future-promising puppy nipping at the heels of dowdier but much larger and experienced competitors.

HIStalk Announcements and Requests

We funded the DonorsChoose grant request of Mrs. D from Nevada in providing math learning games for her kindergarten students. She reports, “As I pulled each math activity out of the box, they cheered, begging me to open it! …  the students thought it was ‘amazing’ and ‘so cool’ that a complete stranger would give us math games … The real gift within that box was the gift of knowledge and understanding. For some of my students, these math games are more than just math games, they are clarity and a road to success and confidence. I have witnessed so many ‘light-bulb-moments’ while using these games. Knowing my students are grasping complex mathematical concepts (for their age) is the greatest experience!”

This week on HIStalk Practice: Sciton gets into practice support. MyIdealDoctor adds behavioral health to its telemedicine services. VITL presses for a less burdensome patient opt-out policy. HHS ramps up opioid prevention efforts, including mandatory PDMP use at FQHCs. Urgent care clinic closes in the face of telemedicine competition. AAPS caves to Brexit clickbait.

Webinars

July 13 (Wednesday) 1:00 ET. “Why Risk It? Readmissions Before They Happen.” Sponsored by Medicity. Presenter: Adam Bell, RN, senior clinical consultant, Medicity. Readmissions generate a staggering $41.3 billion in additional hospital costs each year, and many occur for reasons that could have been avoided. Without a clear way to proactively identify admitted patients with the highest risk of readmission, hospitals face major revenue losses and CMS penalties. Join this webinar to discover how to unlock the potential of patient data with intelligence to predict which admitted patients are at high risk for readmission.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Scotland-based Craneware announces record sales for the year ending June 30, with revenue rising 60 percent on $58 million worth of contracts.

Sales

UC Irvine Health (CA) chooses Infinite Computer Solutions and Optimum Healthcare IT for EHR migration.

People

Nat’e Guyton, RN, PhD (Trinity Health) joins Spok as chief nursing officer.

Bob Sullivan (IBM Watson Health) joins interactive patient technology vendor Sonifi Solutions as GM of its healthcare division.

Bob Kyte (Adventist Risk Management) replaces the recently retired Don Kemper as CEO of Healthwise.

Announcements and Implementations

Validic joins SAP’s Connected Health ecosystem, offering users of SAP Health Engagement the ability to integrate patient-generated health data.

Government and Politics

ONC issues a white paper contest for the potential uses of blockchain in healthcare, with submissions due July 29. Up to eight winners get their  travel expenses paid to present their paper at a NIST-hosted workshop September 26-27 in Gaithersburg, MD.

The government of South Australia finally funds the initial planning project for the migration of SA Health’s long-sunsetted patient administration software. The system’s vendor, Global Health, sued the government for breach of contract after it repeatedly refused to stop using the 1980s-era system, of which it is the only remaining user. The SA government has been focused on its troubled Allscripts EPAS rollout, but the state’s rural hospitals aren’t included in the implementation plan and also haven’t committed to upgrading to the current Global Health product.

Peer60 is doing research on Brexit’s impact on England’s NHS. I was curious about its preliminary results even though they’ve surveyed only 80 hospital leaders so far (out of 200+ responses expected). Respondents offered some interesting comments:

• “Prior to the referendum, both campaigns threatened Armageddon if we left/stayed in EU. They both also said we’d each receive a puppy and have champagne for breakfast if we left/stayed in EU. We’d also be better looking and lose weight if we left/stayed in the EU. None of these have come true. The distinct lack of definitive outcomes, even now, make it difficult to have an opinion, apart from the long-standing one that Westminster is full of liars and has absolutely no interest in the well-being of UK citizens.”
• “Welcome to the third world.”
• “More likely to have positive impact as will help with controls re: EU residents who do not pay UK national insurance and taxes from using NHS resources –  this service will need to be funded in the future. We can work through the staffing issue by working differently, researchers will find ways to continue to collaborate. Impact is in needing to find work around and other change.”

John Halamka suggests that CMS eliminate existing EHR certification requirements and instead require vendors to demonstrate only five specific EHR capabilities:

• Use OAUTH2/OpenID to verify trusted exchange partners.
• Use a FHIR-based query to request an electronic endpoint address.
• Use a RESTful approach to push data to an endpoint.
• Use a FHIR-based query to request the location of a patient’s records.
• Use a FHIR-based query to exchange a common data set of key elements.

The Federal Trade Commission drops its anti-trust challenge of the proposed merger of the only two hospitals in Huntington, WV following the state’s passage of a law that was intentionally written to shield hospital mergers from federal scrutiny. The FTC walks away with a warning that hospitals can work together to deliver clinical integrated care without buying each other in reducing competition, noting specifically that while it rarely intervenes in such hospital mergers, its quality and cost red flags were raised in the Huntington market.

The independent Commission on Care, established by Congress to review the VA following the wait times scandal, includes among its recommendations that the VA replace its “antiquated, disjointed clinical and administrative systems” with commercial software products and that it establish a VHA Care System CIO position reporting to the chief executive. The chair and vice-chair of the commission are both CEOs of provider organizations that use Epic (Henry Ford Health System and Cleveland Clinic).

Privacy and Security

A federal appeals rules that anyone who shares a password may be violating the Computer Fraud and Abuse Act, which is intended to address hackers. The case in question involved an employee who gave his company password to former employees, but the ruling could technically allow people to be prosecuted under federal law for sharing their Netflix log-ins.

Innovation and Research

NIH awards $55 million in precision medicine grants to study the self-contributed data of 1 million volunteers, with the lead recruiting centers being Columbia University Medical Center (NY), Northwestern University School of Medicine (IL), the University of Arizona (AZ), the University of Pittsburgh (PA), and the VA. Vanderbilt, Verily, and the Broad Institute will provide data analytics. In addition, Scripps Translational Science Institute and Eric Topol, MD (whose summary of the project is above) will  get $120 million over five years to develop apps, sensors, and processes to recruit the “citizen scientists” and give them the ability to share their collected information with their physicians. The scientist in me loves the idea, but the public health angel on my other shoulder wishes we would focus on the less-sexy blocking and tackling of reducing infant mortality, managing expensive chronic conditions, addressing social determinants of health, and resolving the ugly dichotomy of expensive “healthcare” vs. “health” in applying equal vigor to chasing goals that move the overall health needle further without having as their primary motivation the eventual lining of someone’s pocket.

Technology

The Wall Street Journal suggests that Apple fanboys resist the urge to pounce on the just-released public beta of iOS 10, warning that it’s buggy (not surprising for a beta release) and a pain to revert back to the prior version if things go wrong. The article tries to talk up a few new features, but they seem lame.

Other

Mylan Pharmaceuticals has jacked up the price of decades-old emergency allergy auto-injection EpiPen to nearly $600 per two-pack over the past few years, giving cash-poor, high-deductible insurance consumers and public service agencies the choice to either go without the drug or draw up the much-cheaper generic ampules into syringes as needed for emergency doses. The drug was prescribed 3.6 million times last year as Mylan turned its 2007 acquisition into a billion-dollar product that provides 40 percent of its profits, pushing federal legislation that encourages schools to stock the injections and to recommend two doses instead of one per allergic episode. Mylan, which has a market cap of $22 billion and makes a lot of money selling drugs to the federal government via Medicare, shifted its headquarters offshore in 2015 to dodge US taxes.

The number of HIEs has dropped from 119 to 106 as federal funding ended, a study finds, with half of the surviving ones reporting that they are not financially viable. The most prevalent HIE problems include lack of a sustainable business model, the inability to integrate HIE information into provider workflow, and lack of funding.

Another study in Health Affairs that reviewed AHA’s IT survey data finds that hospitals that use their area’s dominant EHR (usually Epic or Cerner) engaged in a lot more data exchange than their competitors that run other EHRs, which the authors speculate is because it’s easier to exchange information with other Cerner or Epic shops and that those vendors will help make it happen. My takeaway is that hospitals in a mostly-Cerner or mostly-Epic region that use different EHRs have to spend more money to exchange information and are thus less likely to do so, especially if their competitors are indifferent or hostile to the idea.

AdvancedMD tweeted out this photo of their team-building Lego derby. It’s always fun to see the folks in the trenches.

Smokers are less likely to buy health insurance than non-smokers, apparently because they are unwilling or unable to pay the higher smoker premiums allowed by the Affordable Care Act. The penalties levied for not being insured don’t seem to be working, especially when they represent only a small fraction of the cost of insurance.

I’m not entirely convinced that this Microsoft email is genuine even though he company has apologized for it, but it’s still funny to picture some low-level, corporately oppressed recruiter (whether it be at Microsoft or Epic) trying to relate to the kids he or she is recruiting by inviting them — in their cringe-worthy, baby-talk vernacular – to stop by for “hella noms” and  “dranks” just like someone’s white bread mom scanning Urban Dictionary looking for hip phrases to drop at the most embarrassing moment possible.

Sponsor Updates

• Aprima announces that its EHR/PM meets MACRA/MIPS requirements.
• ID Experts will present at the SANS Data Breach Summit August 18 in Chicago.
• Navicure will exhibit at Mississippi MGMA July 13-16 in Biloxi.
• Experian Health will exhibit at the Nebraska Association of Healthcare Access Management July 14-15 in Grand Island.
• The SSI Group will exhibit at the FSASC Annual Conference & Trade Show July 13-15 in Orlando.

Blog Posts

• Owned Media is the Best Media (Influence Health)
• What Does a Radio Shack Ad from 1991 Have to Do with Healthcare Payments? (InstaMed)
• This Isn’t “Logan’s Run” (Orion Health)
• Freedom (but no fireworks) for Physicians (PatientKeeper)
• 3 “must haves” for simplifying complex clinical communications (PerfectServe)
• Five Irresistible Reasons to Choose PeriCalm (PeriGen)
• What is a Provider to You? (Phynd Technologies)
• There’s a FHIR in the House, Don’t Get Burned (Summit Healthcare)

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates.Send news or rumors.
Contact us.