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Weekender 6/15/18

June 15, 2018 Weekender No Comments

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Weekly News Recap

  • GPB Capital acquires Maryland-based RCM/EHR vendor Health Prime International.
  • Inspirata acquires Caradigm from GE Healthcare
  • Former IBM employees say Watson Health’s troubles stem from the company’s inability to successfully merge the assets of its acquired Phytel, Explorys, and Truven Health
  • The VA announces plans to create a device implant registry

Best Reader Comments

I think many rural providers/clinicians feel like they are forgotten or not considered in the larger healthcare picture. (Kallie)

Digital health / telemedicine is going to be the cheap, low-quality option that serves the masses while high-touch, in-person visits with an actual physician is going to be the gold standard that is expensive in 10 years. You already see this playing out in the wealth management industry and healthcare will be no different. (Lazlo Hollyfeld)

Someone can have full knowledge of what the #MeToo movement is about and still feel that it should be acceptable to acknowledge a male’s contributions to his field. Even if that guy has his flaws, although admittedly, I don’t know how big they are – the news coverage seems sensationalistic and other accusations are somewhat vague. (Clustered)

I love my 20+ year marketing career, but there are definitely “special internal challenges” faced by marketing teams that other teams like finance and development would never have to deal with, i.e. everyone knows how to do marketing. (Christine)


Watercooler Talk Tidbits

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We provided STEM materials for Ms. H in Alabama, whose DonorsChoose teacher grant request explained that her school provides at-home services to special needs children who have experienced significant vision or hearing loss. She reports, “This means the world to me and my students. By providing our students with materials to TAKE HOME is amazing. We have never had the opportunity to send materials home with students before. The materials have allowed the students the ability to show off their progress and things we have been working on at school to their parents. Students are going to succeed above and beyond due to your generosity.”

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Also checking in was Ms. H from Ohio, whose first graders received take-home math and science materials. She says, “When we opened the boxes, they were excited that they would be able to take these materials home with them. They were happy that they would get to use these with their families at home. We have been able to help build and grow our math and science skills. These resources create meaningful and engaging activities for the students.”

Uber files a patent application for an AI-powered enhancement to its app that would analyze a user’s typing mistakes, walking patterns, and time and location in the hopes of identifying ride requesters who are drunk, allowing the company to alert the driver (who might be paid more to deal with an intoxicated passenger) and possibly to decline to dispatch a shared ride.

This it fascinating. Forty years ago in June 1978, punk rock band The Cramps played at a California state mental hospital, caught on low-quality videotape despite pre-HIPAA patient confidentiality concerns. The fascinating part is that the band overcame a puzzled, tepid reception to rock the place out and dance with the residents. Lead singer Lux Interior (who died of aortic dissection in 2009 at 62) bluntly told the audience, “Somebody told me you people are crazy, but I’m not so sure about that. You seem to be all right to me.”

Forbes profiles the billionaire founder of a Minnesota hearing aid company that he started by buying an existing business for $13,000, after which he built it into the country’s largest hearing aid manufacturer. It’s not a feel-good recap, though, as the company has struggled since the founder moved on to charitable efforts and misdeeds by his assigned replacements – one of them his stepson – have led to loss of market share as innovation stalled.

A hospital in Vancouver that caters to “birth tourism” — in which expectant mothers from China have their babies delivered there to earn them instant Canadian citizenship — sues a since-vanished mother from China whose baby required a $300,000 stay. The hospital, which has been labeled a “passport mill” along with untold numbers of “baby houses” that market to cash-paying foreigners, delivers an average of one baby per day to parents from China.

Coming this fall: Two-Point Hospital, a PC video game that’s interesting to me because of odd items in the make-believe hospital: old-fashioned radiators, live plants in most rooms, and a Sega videogame in the lobby.


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Weekender 6/8/18

June 8, 2018 Weekender No Comments

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Weekly News Recap

  • Jonathan Bush resigns as CEO of Athenahealth, which will review its options to sell, merge, or continue operating as a private company
  • Apple releases an API that gives developers access to information stored in Health Records and HealthKit for building apps
  • Microsoft acquires open source repository GitHub for $7.5 billion in stock
  • A Stanford Medicine poll finds that more than half of doctors are dissatisfied with EHRs and desire short-term changes that include user interface redesign
  • Teladoc acquires virtual visit competitor Advance Medical to expand its international offerings
  • Illinois rejects Cerner’s challenge of the EHR selection of Epic by its customer, University of Illinois Hospitals

Best Reader Comments

Immelt’s comments are classic. Not a word about patients, clients, or employees. Sounds like my data is more valuable than my health. Certainly happy I am not a patient, client, or employee associated with Athena. (Duh)

For anyone at Athena to pretend this is a surprise is disingenuous at best. I have seen JB make inappropriate comments in person several times. The truth is that Athena stock value was served, or at least not harmed, by having a manic, headline-grabbing, consequences-be-damned CEO until now. (Healthcare Consultant)

“To ensure Athenahealth maximizes shareholder value.” Music to the ears of every current and future customer, right? (Sam Lawrence)

Dredging up every bad action in one’s past by a third party who wasn’t personally involved for the purpose of affecting public opinion negatively fits the definition of mud-slinging quite well. Especially when both the real women involved stated that they forgave and support him. (Dr. Gonzo)

Device overuse is like so many other issues: other people have the problem, but certainly not me! (Kevin Hepler)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose project of Ms. H in Nebraska, who asked for gloves and hats for her third graders, many of whom are recently immigrated refugees who don’t have warm clothes for recess or waiting for the bus. She says, “This winter, we have been able to play outside more often than in the past. Being able to go outside to run and burn off energy keeps my students more focused during the school day and provides a time to interact with peers and practice social skills. The students take very good care of their hats and gloves. They were so excited when I told them they would be able to take them home when we didn’t need them at school anymore. Some of them said they would keep them safe so they would have them next year.”

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Johns Hopkins University honors its MPH graduate Virginia Apgar on what would have been her 109th birthday. She graduated medical school from Columbia; was steered away from male-dominated surgery into anesthesiology (which was almost all nurses back in the 1930s); created the Columbia’s Division of Anesthesia and was the only member of it for several years; and as a medical school professor, developed the baby health-measuring and still universally used Apgar Score in 1952.

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Bloomberg profiles billionaire dermatologists Katie Rodan and Kathy Fields, whose celebrity-endorsed and infomercial-pitched acne product Proactiv made them rich in the 1990s, after which they started skincare product manufacturer Rodan + Fields, sold it to Estee Lauder in 2002, and bought it back as a multi-level marketing company in 2007 that now does $1.7 billion in annual revenue. It’s fascinating when you go to a dermatologist’s office how much of their business involves peddling big-profit vanity products and procedures that have next to nothing to do with the curative arts. Some of them seem more like those white-coated cosmetics makeover people in the mall than real doctors.

CNBC runs Jonathan Bush’s goodbye email to Athenahealth employees, saying that “working for something larger than yourself is the greatest thing a human can do” but acknowledging that the qualities that made him useful to the company for 21 years “are now exactly the things that are in our way” and that the company will heal “whatever wounds my own weaknesses have inflicted.”

Medicare trustees, most of whom are Republican government officials, say the White House’s elimination of the individual mandate and the Independent Payment Advisory Board as well as its tax cuts will cause its hospital insurance trust fund to be depleted in 2026. It says that dismantling of the Affordable Care Act is causing more people to be uninsured, leaving Medicare to have to pay hospitals disproportionate share subsidies.

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Delaware hospitals are storing photos and footprint scans of newborns in their EHRs and sending electronic copies to the National Center for Missing & Exploited Children. The technology is provided by Fairfield, CT-based CertaScan Technologies, which charges a per-baby fee that the hospitals say is less than $10 and that eliminates the cost and aggravation of inkpad-and-paper capture. The company also provides 24×7 access to a specialist who can confirm a baby’s identity.

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The San Diego paper covers the nascent bio-economy, where patients are paid “sequencing subsidies” by researchers who need more DNA. Today’s model is that consumer DNA testing companies like 23andMe and Ancestry sell the information directly to drug companies, while companies like Nebula Genomics  propose to create a marketplace between donors and buyers.

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Puma and MIT Design Lab are working on Deep Learning Insoles, a shoe insert that analyzes sweat compounds to send real-time fatigue and performance information to the user’s smartphone. Under the hood (or foot) is technology from Penn startup Biorealize, which offers the Microbial Design Studio desktop bioprototyping studio for designing, growing, and testing genetically modified organisms.

A New York man sues CVS for HIPAA violations and for causing him “severe mental injury”of an unspecified nature when a drugstore employee mentions to his wife that their insurance won’t cover his new prescription for Viagra.


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Weekender 6/1/18

June 1, 2018 Weekender 1 Comment

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Weekly News Recap

  • France-based Withings buys back the consumer digital health business it sold to Nokia two years ago and will restore the brand to the market
  • Providence St. Joseph Health modifies its EHR to store patient advance directives and display them to clinicians during care events
  • IBM reportedly lays off a significant number of employees of its Watson Health business
  • Orion Health lays off 177 employees and is rumored to be pursuing a sale of some or all of the company with unnamed parties
  • Personal injury lawyers in Philadelphia are buying geofencing-powered advertising campaigns to identify smartphone users who are in hospital EDs and so they can solicit lawsuit business afterward

Best Reader Comments

Zane: HISsie 2018 nomination + a lock on “Biggest Sore Winner” in a one-horse race. (Another Dave)

Why is it that every time IBM announces another quarterly loss (is this the 25th or 26th consecutive quarter?) that the people who have been busting their tails for years are the ones who unceremoniously get let go while the people in leadership continue to collect their massive salaries and are pretty much immune to any excision-related actions? (Genteel Giant)

Are there really so few women or people of color who making newsworthy HIT career moves? (ellemennopee87)

Keeping current on industry trends is smart, and I think writing thoughts and trends down in your own words (versus just skimming) industry news, if even just a couple sentences a day or even per week, is a good way to stay current. (Kallie)

Practice Fusion is a little clunky in some areas, very slick in others, but the great thing about it is that it’s continually improving. Someone there really cares about users and keeps making the little refinements that make the physician’s day easier. Hopefully, whoever they are, they’ll stick around after the Allscripts acquisition! We’re paying the $100/provider/month for now and we’ll see how it goes. (Dr. Herzenstube)

Is Sutter claiming that there were not any adverse events due to all records of all patients having gone black in one fell swoop? Did any patients die from the delays in care? (Sandi Green)


Watercooler Talk Tidbits

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Reader donations funded a three-day academic camping trip in the Santa Monica Mountains for Ms. V’s fifth grade class in urban Los Angeles. She reports, “The project made a world of difference in the lives of so many students such that they are able to have the resources that they need in order to be able to succeed in a natural learning environment. Going to fifth grade camp has been such an incredible experience for my students, not only for learning academic science standards, but also for learning how to work together. For some of the students, it’s the first time that they’ve ever spent the night away from their parents, and it’s truly special to be able to share this with them and their friends.”

In Canada, a Nova Scotia doctor says it’s not fair that the province has singled him out for enforcing its “no new EMRs” policy as it tries to implement a big-picture system in a project started years ago. He says he’s the only one of 15 orthopedic surgeons who is stuck using a paper-based system since his peers ignored the ban and implemented EMRs.

A private addiction hospital in Scotland opens a rehab program for people addicted to trading cryptocurrencies, mostly young males and casino workers. 

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Documentary filmmaker Ken Burns gives Mayo Clinic a preview of scenes from the upcoming film he executive produced titled “The Mayo Clinic: Faith, Hope, Science.” It will air on PBS in September.

HBO Documentary Films is creating a film covering the rise and fall of Theranos.

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A drug company rep who struggled to push its Subsys fast-acting fentanyl spray that costs $25,000 per prescription because patients were “already addicts” was told to literally beg pain management doctors to prescribe its drug, according to a newly unsealed whistleblower lawsuit. Salespeople report taking doctors to strip clubs and shooting ranges, posing as medical practice office staff to convince insurers to cover the prescriptions, and hiring a male doctor’s girlfriend once he agreed to “turn on the Subsys switch.” The former rep says her employer, Insys Therapeutics, hired a former stripper and escort service manager as a sales executive, along with another rep who was described by her boss as being “dumb as rocks” but willing to have sex with doctors. He described the ideal candidate for an open drug rep position: “A doctor’s girlfriend, son, or daughter. Banging a doctor, that would be perfect.” The company reportedly also developed a script to push reps into selling the drug for off-label uses and used a mail-order pharmacy that didn’t question prescriptions for excessive doses and quantities.

A small study of doctors in two safety net hospitals finds that providing emergency-only hemodialysis to undocumented immigrants contributes to the physicians’ professional burnout due to: (a) seeing patients needlessly suffer and die for non-medical reasons; (b) their lack of control over the treatment criteria; (c) the moral distress that results from seeing care decisions made for non-medical reasons and only after gaming the system; and (d) being inspired for advocacy. 

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A New York gynecologist files a $1 million defamation lawsuit against a patient who gave him bad reviews of her one and only visit. The patient claimed that the doctor’s business practices are “very poor and crooked” on Facebook, Yelp, and doctor review sites after she was stuck with a $427 bill when he billed her insurance for a new-patient visit plus sonogram instead her covered annual exam. The practice says the doctor has to base his clinical decisions on patient need, he always gives new patients a sonogram, and it’s not his job to keep current on the intricacies of every insurance company. The patient claims that after the reviews, the practice publicly posted her entire medical record in retaliation. Dim-witted Yelpers reacted as they always do – they flocked to Yelp to leave their own scathing reviews of the doctor, making sure to include a hefty dose of ethnic insults because he was born in Korea. Scouting Yelp, the woman has also left lengthy, bitter one-star reviews for a dentist (“I don’t know why anyone would put up with this type of abuse”), a professional women’s association (“everything was not explained to me”), a gym (“I suffered a terrible trapezius injury”), and Fedex (“all of their services are a rip off in my opinion”). Maybe doctors need their own version of a doctor-shopper database to share information about patients likely to complain, lie, or sue. Meanwhile, nothing in this story alters my perceived reality that while I use Yelp regularly, it attracts more unintelligent, sour, and writing-challenged users by far than other review sites like Tripadvisor and OpenTable. Yelp desperately needs the ability for readers to filter out the results (and ratings contribution) of users whose reviews are consistently unhelpful or untrustworthy, especially those one-review contributors who are almost certainly company plants.

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Weekender 5/25/18

May 25, 2018 Weekender 1 Comment

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Weekly News Recap

  • A KLAS report on hospital EHR market share finds that most new sales in 2017 were to hospitals of under 200 beds, Epic led by far in overall net hospital count change, and CPSI and Allscripts lost more than 30 net hospitals each last year.
  • Epic tells the Illinois Procurement Board that no conflict of interest existed in University of Illinois-Chicago’s choice of Epic over Cerner, saying Epic was cheaper, state law required Cerner to be excluded from demonstrating because it scored so poorly, and that the hospital is a customer of both vendors and thus knows what it’s doing in choosing Epic.
  • ONC announces an $80,000 contest to entice developers to create apps that will help users identify, record, and report potential health IT safety issues in real time.
  • A New York Times article says that hospital EHRs are a “medical records mess” that impede research efforts because of incompatible data formats and the reluctance of health systems to share their patient data.
  • The House passes a bill that would require the VA to provide Congress with regular updates on its Cerner project and to notify lawmakers promptly if it experiences contract or schedule changes, milestone delays, bid protests, or data breaches.
  • The US Supreme Court sides with Epic and two other companies in finding that mandatory employee arbitration and non-disclosure agreements are enforceable, meaning employees may not organize together to file workplace-related class action lawsuits.
  • Cerner President Zane Burke blames an unnamed competitor (presumably Epic) for publicizing negative reports about the DoD’s MHS Genesis project, labeling the resulting coverage as “fake news” in the company’s annual shareholder meeting.
  • President Trump says he will will nominate acting VA Secretary Robert Wilkie to the permanent position.

Best Reader Comments

It’s tough to get my head around why Congress would take the time and effort to pass an oversight bill when the oversight already in place is wholesale ignored. Literally days after Genesis’s best efforts are measured as basically failing and late in every aspect, the project is rewarded with a $10b vote of confidence. It’s just an incredibly lazy lack of leadership/stewardship. The word that comes to mind is “laughable,” but to taxpayers and veterans, it’s really not funny. (Vaporware?)

If you read the majority and dissenting opinions, this is clearly the correct decision from a legal standpoint. Unless you’re advocating for judicial activism, which I would hope no one is. To be clear, I think this is a bad thing and gives too much power to corporations, but from a purely legal standpoint as the laws are written, this interpretation is correct. (Former Epic Billing)

It has been no secret that while a good chunk of Epic is liberal leaning, and while Epic — like other EHR vendors — has benefitted from government’s largesse (nothing wrong there) like a good old capitalist organization, it has often chafed at any sort of government regulations of its business or labor practices. Board seat, token compensation, campaign support etc. goes a long way to help politicians forget their principles.(Stolen Supreme Court Seat)

Regarding Cerner’s negative reports about the DoD’s MHS Genesis project as “fake news,” HIStalk pages for the last decade are filled with “news” about health systems tearing out Cerner systems and replacing them with Epic, notably, Mayo, Aurora Health, etc. Was that all fake? I suspect DoD will regret their decision like all those other large (but smaller than DoD) systems dissatisfied with Cerner. (FakeNews)

I guess the logical conclusion to Cerner’s poor initial performance with the federal government is that Epic has moles in the Pentagon leaking information to Politico that is somehow “fake.” (AynRandWasDumb)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request from Ms. W in Georgia, who asked for a programmable robot to launch an after-school STEM Club. She reports, “My students love our new Lego Mindstorm kits. We are incorporating them into our gifted classroom lessons and also into an afternoon STEM Club. They will be used by many students. In the after school program, students are working in groups to build a robot of their choosing. They will also spend several days coding their robots. They are just beginning to learn coding skills, so this is an excellent opportunity for them to improve in this skill. I am working hard to create students who are excellent problem solvers and know how to use critical thinking to work in collaboration with others in groups. Again thank you so much for your generosity! You are making a difference in the lives of my students!”

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Waystar donated $1,000 to my DonorsChoose project in honor of a customer attendee of their HIMSS conference event, which when matched by my anonymous vendor executive, fully funded these classroom projects:

  • Math manipulatives and calculators for Ms. K’s fifth grade math class in Indianapolis, IN
  • Math and science books for Ms. P’s elementary school class in Greenacres, FL
  • Math manipulatives for Ms. C’s elementary school class in Norfolk, VA
  • Science toys for Ms. W’s headstart class in Philadelphia, PA
  • Headphones for Ms. D’s first grade class in Indianapolis, IN
  • Guided math materials for Ms. G’s elementary school class in Baytown, TX
  • An Apple TV for Ms. V’s elementary school class in Houston, TX
  • Lap desks and floor cushions for Ms. T’s kindergarten class in Vista, CA
  • Makerspace supplies for Ms. W’s elementary school library in Dawson, MN
  • Headphones for Ms. C’s first grade class in Victoria, TX
  • Programmable robots for Ms. H’s elementary school class in Atlanta, GA
  • STEAM accessories for Ms. G’s preschool class in Russell, KY
  • Programmable robots for Ms. R’s elementary school class in Immokalee, FL
  • A field trip to University of Maine for Ms. P’s elementary school class in Winterport, ME
  • A Chromebook for Ms. M’s elementary school class in Las Vegas, NV

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I nearly always choose teachers from schools in low-income areas. As an example, here’s how Ms. M describes her Las Vegas school that’s getting a Chromebook:

I work at a Title I school in a very low-income area in Las Vegas, Nevada. Unfortunately, too many students are homeless (living in cars, shelters, or on the streets). Many students come to school wearing the same clothes all week. Eighty-five percent of our students receive free lunches, all students are provided with free breakfast, and some students qualify to receive bags of food over the weekend to feed them and their families. My school’s diverse population of students come from all over the world and speak a variety of different languages. In fact, many students come to my school hearing English for the first time. Since my students are very underprivileged, they usually do not have access to technology at home. Despite so many hardships, my students are excited about school and eager to learn. I have a passion for teaching and they have a passion for learning. Coming to work doesn’t feel like work at all!

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A small group of nurses at Zuckerberg San Francisco General Hospital wants the Facebook CEO’s name removed, saying that Facebook performed unauthorized research in tweaking the news feeds of individual users to see how they reacted and is trying to obtain data-sharing agreements with the American College of Cardiology and other institutions. One nurse says city residents should have a say in the name since they fund most of its operation, while another says the name scares patients. The group suggests naming the hospital after local political activist and drag queen Jose Julio Sarria, who died in 2013 at 90.

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A ProPublica report says insurers have no incentive to aggressively negotiate doctor and hospital prices since they just pass the cost through to patients with a profit margin added. It profiles a patient – a former insurance company actuary — who fumed at being stuck with a 10 percent co-pay for a $71,000 partial hip replacement at NYU Langone, which sent him an error-filled bill that neither the hospital nor the insurer would investigate. Medicare would have paid the hospital only $20,000. The hospital, which had a $300 million operating profit in 2017, responded by turning his $7,100 bill over to a collections agency and then sued him, with its attorney saying in court, “The guy doesn’t understand how to read a bill … Didn’t the operation go well? He should feel blessed.”  

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Parliament, the 50-year-old funk band best known for late 1970s hits like “Flash Light” and “Aqua Boogie,” releases its first album in 38 years titled “Medicaid Fraud Dogg.” Leader George Clinton says it explores “the inner workings of the corrupt modern American medicinal machine.” Click the above cover of the single “I’m Gon Make U Sick O’ Me” for some sophomoric humor.

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Pittsburgh police arrest a man who kept showing up at hospital codes at UPMC Presbyterian (PA), finally caught when employees realize they don’t know the badge-less responder.

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In England, the finale of BBC’s “Hospital” documentary series draws national attention to the shortage of ICU beds at Nottingham Queen’s Hospital.

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Also in England, an elderly couple is reunited with the car they lost five days before after forgetting where they parked for a hospital appointment. The hospital’s lot was full, so the woman – 79-year-old retired psychiatric nurse Hilda Farmer, who paid for a hospital space before finding there were none – had to park a half hour’s walk away and then couldn’t remember the way back. Her granddaughter’s Facebook appeals led to the car being found. Farmer commented afterward, “Aren’t we lucky to live in a country where an old aged pensioner’s car gets national news coverage? Thank God we live in England.”


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Weekender 5/18/18

May 18, 2018 Weekender No Comments

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Weekly News Recap

  • The VA signs a 10-year, $10 billion contract with Cerner for its new EHR.
  • Sutter Health experiences a 27-hour downtime of Epic and other systems at some of its facilities that was caused by activation of a fire suppression system in one of its data centers.
  • A GAO report finds that providers sometimes overcharge patients for copies of their medical records and patients sometimes struggle to get their own information.
  • Elliott Management complains publicly that Athenahealth has ignored its $7 billion takeover offer and says it might offer even more money if given access to the company’s books.
  • A newly declassified April 30 Department of Defense evaluation of the military’s four MHS Genesis pilot sites concludes that the system “is neither operationally effective or operationally suitable” and says it is inadequate for managing and documenting care delivery.

Best Reader Comments

I empathize with providers who negotiate with many many plans, each with their own waivers, to give a price for every procedure/ bundle and therefore price transparency is a non-trivial problem for them. And, I don’t want them to publish their fictitious list price. As a cash-strapped buyer who just wants to know what I will be billed when my PCP orders a dermatology test for a sun spot that I’ve had for 10 years, what am to do? My first inclination is to at least publish the Medicare price. (David)

I absolutely hate when non-clinical people compare healthcare with any other industry. My question – how would this restaurant change its business model if it is mandated that anyone who comes in through a special side door has to be given free burgers? It is not the cost transparency that is causing the problem, it is the cost bloat. The costs are higher than anywhere else. And, let’s not forget the fact that someone’s extra cost/waste is another person’s income, be it pharma industry or doctors. (Restaurant and hospital)

The government actually worsened the opioid crisis by threatening financial penalties to MDs that did not meet patient satisfaction with pain control. The Joint Commission also made similar threats, including their love of the fifth vital sign and recommending the overprescribing of narcotics. So now, they have swung the pendulum fully opposite. Its about time to let MDs be MDs and stop the madness. (meltoots)

With MHS Genesis, I think the majority correctly see the pilot as a test. (Maybe I’m just projecting.) I can’t fathom how any vendor would treat the pilot as anything but their opportunity to put their best foot forward. I think this IS the best foot we’re going to get from these guys. It’s a test and the grade is F. (Vaporware?)

When I was at Epic, this is why I didn’t want Epic to win the DoD bid. There is no way Epic could’ve gotten the level of control they normally have over the project, which is still (unfortunately) necessary to get decent results.(Dodged a Bullet)

We can all bash Cerner as much as we want, and they have earned their fair share of the blame, but the fact is it didn’t matter who won this bid, we still would have had major issues using a commercial product in the Government arena. At its core, the problem isn’t Cerner, Epic, or any of the actual technology vendors. It’s the federal government, an organization that continues to go unchecked. (Associate CIO)

The Big Winner here is Leidos which holds the contracts for the DoD in place systems (CHCS the current EMR, which Leidos/SAIC says it claims proprietary IP rights and won’t let any other company touch) and other third-party applications. Contracts for development, support, and sustainment. So, the Big Whiner is Cerner. Why? Because it’s in Leidos’ best interest to slow play the DoD as long as humanly possible. The MHS Genesis project will run horribly over budget and Cerner will take a black eye and whine about it the whole time. (Big Winner Big Whiner)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Mrs. J in Arkansas, who asked for three programmable robots for her third grade class. She reports, “The Ozobots are amazing! My students have gone crazy over them. They are using color coding markers to manipulate and program the robots, coding them to make different moves and change colors. My students are collaborating, thinking critically, and working together while they experiment and learn to code. All of these skills are critical in preparing them for their future.”

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Also checking in was Mrs. M from North Carolina, who asked for 20 Hear Myself Sound Phones for her first graders. She says, “It was a dream of ours that we never thought would be possible. You have made it a reality. They just arrived and the students have already used them. We practiced as a whole group and they could not believe how their voice sounded through the phone. We will use them regularly. It was like they were hearing themselves read for the first time all over again. It was such a joy to watch and we have you to thank for that.”

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I subscribed to Texture even before Apple bought the “Netflix for magazines” company a few weeks back. Its app offers current plus back editions of 200 magazines, allows downloading issues for offline reading, and presents a cool dashboard of new articles that your reading history suggests that you will like, all for $6.95 per month. It replaces subscriptions I had paid for at one time or another, such as Consumer Reports, National Geographic, Wired, Smithsonian, PC World, and Rolling Stone.

A rehab tech at MacNeal Hospital (IL) is sentenced to 10 years in prison for burglarizing the homes of 18 widowed, female patients he was caring for as inpatients after he confirmed with them that they lived alone. Some of the patients are suing the hospital for failing to protect their information.

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The Department of Justice charges a Texas rheumatologist with a $240 million fraud scheme in which he falsely diagnosed patients with rheumatoid arthritis so he could bill for drug administration. The doctor had been reprimanded by the state in 2009 for excessive ordering of lab and radiology tests. The photo above is of his patients’ medical records that were stored in “an unsecured and dilapidated barn” where he tried to hide them from Medicare. The DOJ estimates that the doctor made $50 million from the alleged scam, allowing him to buy extensive commercial and residential real estate in the US and Mexico, two Puerto Vallarta penthouses worth $2 million each, an Aspen condo, a Maserati, and a million-dollar private jet. It’s nice that they caught him, but as usual, puzzling that it took so long under CMS’s pay-and-chase model. His practices are in and near McAllen, Texas, the subject of a 2009 article by Atul Gawande in which Gawande noted that the tiny, poor town had the highest medical costs in the US other than Miami, which Texas locals attributed to everything from malpractice costs to overuse to fraud.

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In another DOJ action, the former CEO, CFO, and executive director of now-bankrupt NJ-based medical billing company Constellation Healthcare are charged with an elaborate $300 million investment fraud scheme. The FBI arrested former CEO Parmjit Parmar — who also runs an investment firm, is an investor in Cancer Treatment Services International, was producer of “Before the Devil Knows You’re Dead,” and is a former fighter pilot with his own fleet of jets and aviation company who claimed to make more than $1 billion per year — near his 39,000 square foot mansion that he apparently was able to keep despite a 2011 foreclosure for the $26 million he still owed on the property. He reported in a 2008 interview that the recession “doesn’t affect me at all,” having just purchased a new Bentley for himself and a BMW for his girlfriend even as he was spending $20 million to build a tiger refuge in Texas.

A former MD Anderson research assistant – now a school nurse – is found by the federal government to have submitted her own falsely labeled blood samples for those of 98 research study participants, requiring the resulting studies to be retracted.


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Weekender 5/11/18

May 11, 2018 Weekender 5 Comments

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Weekly News Recap

  • The VA says it will make a decision on how to proceed with a Cerner contract by May 28.
  • Mayo Clinic goes live on Epic.
  • Virtual visit provider HealthTap dismisses founder and CEO Ron Gutman after investigating high employee turnover and reports about abusive conduct.
  • A DoD OIG report finds that Navy and Air Force treatment facilities have not consistently implemented security protocols to protect patient information in EHRs and other system.
  • Athenahealth shareholder Elliott Management makes an all-cash offer for the remainder of the company it doesn’t already own, valuing it at up to $6.9 billion and sending ATHN shares soaring.

Best Reader Comments

FAMIA – if they model it after the ACMI fellowship, I think it could be successful. ACMI is full of academics who don’t have a clue about real world issues that Informaticists “in the trenches” deal with, and so would be nice to have some formal recognition for those of us who actually get things done (instead of just write about them, like lots of ACMI members). (Alphabet Soup)

Back in spring 2017, UIC had a meeting with vendors to kick off the procurement process. I was there with my company and Cerner people were in the room as well. Impact Advisors was introduced to all as the group that would be helping UIC. No one objected, including Cerner. Then many months later when Cerner finds out that they lost the bid to Epic, suddenly it is all about a conflict of interest with Impact Advisors. The more likely explanation is that this is just about sour grapes. Time to look for another reason for why Cerner lost. I got one – maybe UIC also figured out that the Cerner Revenue Cycle is not good. (Abe is watching)

In addition to the immediacy benefit of the 1800s anesthesia / antisepsis comparison was that anesthesia benefited the physician (no screaming patient as I cut him/ her open) and antisepsis benefited the patient. Doctors will always do what’s best for them. Every time you ask a physician to do something you need to find a way that it will benefit him/ her and the quicker, the better. (Was a Community Hospital CIO)

Athenahealth has always struggled with monetizing the data because they don’t own the data. They own the right to use de-identified aggregate data (which they use in things their flu trend reporting), but most of the valuable applications of data in healthcare require PHI that is either not de-identified or is easily re-identified, which Athena doesn’t have the right to sell. So much as they would like to monetize the data, it’s always been out of their reach. (Debtor)

It amazes me how much blame Facebook has successfully deflected onto Cambridge Analytica. (Martin Shkreli)

Athena will be out of the hospital space and focus exclusively on their core ambulatory when this merger happens. Total available market for hospital is shrinking with market pressure from new and increased entrants to the small hospital space. There is no path to profitability in that race to the bottom. Look for them to try and reinvent as an app maker. (Crazy Joe)

The #2 female finisher of the Boston Marathon this year is a nurse anesthetist, and #4 is a registered dietitian. Apparently health care makes good runners. Oh, and the #5 female finisher (nurse practitioner) worked a 10-hour shift the day after the Marathon, after driving home from Boston to NYC. (Kermit)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. R in Arizona, who asked for headphones for her classroom’s listening centers. She reports, “My students are now able to record themselves and listen and review their fluency. They have headphones that allow them to listen to audiobooks in groups and listen to their intervention program. These headphones will be helpful when going into AzMerit as there will be a listening portion and many of my students do not have access to headphones. My students loved that they can fold the headphones and use the microphone on any device we have available for the day in the classroom.”

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Also checking in was Ms. G from Texas, who asked for Dash Robots to introduce her students to coding and robotics. She says, “Thank you for allowing my students to have the opportunity to experience coding in this fun and engaging way. My kids love Dash and they are so engaged when using them in the Maker Space. At this time my kids are completing the challenges that Dash gives them. This will prepare them for the next step, which is a robot competition. The kids are practicing for the big day! They will be competing with their robots to complete some mazes and other exciting activities. All this was possible thanks to you. Thank you again for your donation and for making a difference in my students’ education.”

President Trump appoints TV huckster Dr. Oz and “Incredible Hulk” actor Lou Ferrigno to HHS’s sports, fitness, and nutrition council.

Ireland attempts to name its new national children’s hospital as “Phoenix Children’s Health,” but is forced to reconsider when Phoenix Children’s Hospital (AZ) threatens to sue over the name. An executive of Ireland’s Children’s Hospital Group tried to contact the US hospital about the proposed name, but the email went astray because he misspelled “Phoenix” as “Pheonix” in the email address.

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TV actor Ken Jeong rushes from the stage of his stand-up gig to attend to an audience member who was having convulsions. He’s qualified – he earned his MD degree from University of North Carolina at Chapel Hill School of Medicine in 1995, completed an internal medicine residency at Ochsner Medical Center (LA), and maintains a California license, although he no longer practices medicine. He developed and starred in the ABC sitcom “Dr. Ken” that ran from 2015-2017. His wife is also a doctor.

Mayo Clinic prepared for its Epic go-live this week by warning employees that parking areas will be restricted May 5-25 to squeeze in the 2,200 on-site consultants and Epic employees involved.

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Medical ethics professor Arthur Caplan, PhD criticizes the “root for your roots” advertising campaign of DNA testing company 23andMe that urges American soccer fans whose team was eliminated to instead root for World Cup soccer teams based on shared genetics from the company’s database. He says there’s already too much racism in soccer as “soccer hooligan bigots” taunt minority athletes and notes that countries aren’t neatly sorted out by genetic racial groups, also adding:

There is no correlation between genetics and who is a member of a nation’s soccer team.  People from many ethnic and racial backgrounds play for many nations. There is no Argentinian or Croatian team genotype. And why would information about your genetic ancestry lead you to root for a particular athlete or team? How about the team’s skill, not their skin color or biological makeup?

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Self-proclaimed “OB-GYN and media personality” Draion Burch, DO wins the trademark application protest brought against him by rapper, music producer, and Beats founder Dr. Dre. The patent office didn’t buy Dre’s argument that consumers would be confused by the similarly named media personalities. Dr. Drai, as he prefers to be called, is apparently not especially proud of his DO degree since he insists on just being called “Dr.” in his noted scholarly works such as “Discover 20 Strange but True Secrets About the Vagina” and the penetrating commentary in his opus titled “20 Things You May Not Know About the Penis.”

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A Missouri woman is hospitalized with facial injuries after a wild turkey crashes through the windshield of the van in which she is riding. She is OK, but the turkey is not. She was not reported to have echoed the comments of WKRP GM “Big Guy” Arthur Carlson in failing to say, “As God is my witness, I thought turkeys could fly.”


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Weekender 5/4/18

May 4, 2018 Weekender 2 Comments

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Weekly News Recap

  • In the UK, Health Secretary Jeremy Hunt brings in Eric Topol, MD to lead a review of how to best train NHS staff on using new technologies including AI, digital health, robotics, and genomics.
  • Reports surface that a West Palm Beach physician with ties to President Trump’s inner circle may be behind the VA/Cerner contract delay.
  • Fitbit will use Google’s Cloud Healthcare API to share user data with providers via their EHRs.
  • Beth Israel Deaconess taps CIO John Halamka, MD to lead its new Health Technology Exploration Center, which will explore the role of emerging technologies like blockchain and IoT in healthcare delivery.
  • Cerner shares drop after the company reports lower than forecasted Q1 revenue of $1.29 billion.

Best Reader Comments

Moskowitz: ‘I know because I have to use it!’ The gall of a physician user pointing out that Cerner powerpoints don’t align with Cerner reality. (Vaporware?)

Have to ask: Is Bruce Moskowitz,the next nominee to head the VA? I mean, he is a doctor after all and that qualifies him for pretty much anything. Also: Would blockchain have prevented Trump from writing his own medical assessment (“healthiest individual ever elected to the presidency.”)? (Recovering CIO)

They absolutely seem lost since Neil died. It looks like no one wants to make decisions or set a direction. I was hoping the new CEO would step in and set a new direction, but that doesn’t seem to be, at the moment. The Siemens acquisition was interesting. They were basically buying market share and being the low cost ($1B being low, all things considering) they have basically made their money back. However, what they have done with Financials is baffling to me. One would have thought they would have taken the good parts of Soarian Financials and what little good parts there are with Millennium and create a new product. Yet, they have kept both lines and are still selling both financial systems. I mean, 3 years seems to be plenty of time to architect a new Revenue Cycle platform considering their resources …. The UIC issue you have to take as an outlier. Yes, Cerner pursued legal action but the fact remains, they are actually right in this context, whether we like it or not. Was the procurement process followed, NO. It is very clear, especially when Impact Advisors put in writing that they would ONLY bid on Epic work, should Epic win the bid. That is a clear conflict of interest, any way you slice it, and thus, violated the procurement process the state of Illinois has. Not to mention, Epic Implementation costs were NOT in the final bid, which again, was a requirement of the RFP. You may hate Cerner, and fine whatever, to each his own, but the FACTS are that there were violations of State Procurement and thus the selection process has to happen all over again. Epic probably still wins and the outcome is the same, but that isn’t the point. If anything, this is almost more on Impact than it is UIC. I mean, really, when you are doing a vendor selection, you NEVER state that you would ONLY support one vendor over the other. You have to stay neutral through the whole process. (Associate CIO)


Watercooler Talk Tidbits

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We funded the teacher grant request of Ms. H in Texas, who asked for STEM game night activities for her special education class. She reports, "I cannot thank you enough for your donation to our classroom. My students and I have formed an obsession with STEM projects. My students love to learn about jobs they could have in the future based on information provided in the STEM activity. I have students that, at a young age, are picking what they would love to be when they grow up based off of these activities. My students are able to explore, plan, build, and report at a higher level due to these interactive STEM activities."

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“Big data” (and “Big Brother” for that matter) takes on new meaning in China, where manufacturing companies have taken to outfitting workers with brainwave-monitoring helmets in an effort to keep tabs on their levels of concentration, anxiety, depression, and rage. One brain science academic in China ominously explains that, “When the system issues a warning, the manager asks the worker to take a day off or move to a less critical post. Some jobs require high concentration. There is no room for a mistake.” The technology is also being rolled out in hospitals to help staffers keep an eye on potentially violent patients.

NBC investigators get back unexpected results during the course of a report on at-home DNA testing kits. Results from Orig3n DNA’s $29 kit were included in a seven-page report that listed attributes like strong muscle force and cardiac output, but failed to note the DNA in question was in fact from a dog.

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Boston Marathon officials decide to award prize money to non-elite runners who finished with faster times than their professional counterparts. Fifth-place finisher Jessica Chichester, a nurse practitioner from Brooklyn, will take home $15,000. She has jokingly claimed that “[f]requent hand washing and Lysol-ing everything” have been key to her running success.

Bill Gates turns down a semi-serious job offer from President Trump after he asks about the White House’s vacant science advisor position during a meeting in the Oval Office on global health security.


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Weekender 4/27/18

April 27, 2018 Weekender 4 Comments

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Weekly News Recap

  • A proposed HHS rule would retarget the Medicare and Medicaid EHR Incentive Programs to “a new phase of EHR measurement with an increased focus on interoperability and improving patient access to health information.”
  • Kansas-based transcription firm Medantex takes down its customer web portal after security researcher Brian Krebs notifies the company that its audio recordings and site administrative functions were wide open to any Internet user.
  • Doctor on Demand raises $74 million in a Series C funding round led by Princeville Global and Goldman Sachs Investment Partners.
  • Rear Admiral Ronny Jackson, MD withdraws his nomination for VA Secretary after Senate Democrats publish allegations against him that include giving out prescription drugs to staffers, drinking to excess while on the job, and managerial misconduct.
  • The FDA launches a digital health incubator and announces it will tweak its pre-certification software program to better accommodate AI-powered technology.

Best Reader Comments

All the hullabaloo around UIC’s Epic and Cerner mess is pretty pointless. And so are the Black Book and KLAS results. Nobody, absolutely nobody (and that includes providers, patients, IT support people) is delighted with either Cerner or Epic (13 clicks to get the right information out in ICU from Epic!!!). At the end of the day, these are two highly mediocre products with not much daylight between them in an industry that has traditionally not asked much from its IT vendors probably because as an industry, it itself doesn’t believe in excellence in customer service. To paraphrase an old computer science term: “mediocrity in, mediocrity out.” (John Yossarrian)

I’m not struck by the infighting or backstabbing; that’s par for the course at a complicated organization as you describe. I am struck — shocked even — that you’ve got physicians who want to be involved in decision making during the implementation. Maybe we all have finally learned that if you’re at the table, you get to make decisions. All too often, docs who were begged to come to meetings but are “too busy” are upset at the final result they see at go-live! (Craig Joseph, MD)

I have seen a mixed bag of tricks for these situations. There is no specific singular “path” for for every organization or hospital/medical center to follow. “Buy in” starts with ownership and who has control of the purse strings- for instance, one hospital contracted their anesthesiologist and the anesthesia group contracted their nurse anesthetist who did not want to use the electronic surgical record. “ Buy In” came when we worked with the anesthesia group to give them the “WIIFM” (What’s In It Form Me) benefits of using the EHR. Once we had anesthesia on board. We worked with the nurse anesthetist groups “key influencers” to gain their willingness. ultimately, the organization made the EHR trading mandatory and they agreed to pay for RNA’s time spent learning to use the EHR which turned out to be the biggest “buy in.” We worked out the residency problems by coming to the conclusion the organization would hire scribes in emergency areas. These methods may not have worked in another organization or another part of the country. It also depends on whether they have unions and the budget. (Lisa Hahn, RN)

On the whole conference thing and engaging the audience. If the purpose of a conference (or one of the main purposes) is to educate an audience, and if the lecture is one of the least effective methods for educating an audience, then it would follow that trying some different techniques to engage the audience would make sense. There’s a pretty great story of how Professor Eric Mazur changed his teaching at Harvard (physics), when he discovered his students really didn’t learn anything (just memorized). You can take a deep dive on that here. My point is not that a cheesy unmotivational speaker is good, but rather that most presentations done in a lecture format deliver far less educational value than methods that engage the learner. I get that you are a no-nonsense guy, and I really don’t want to hug people I don’t know either, but we can do better than a talking head and a PPT. (jp)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose grant request from first-year teacher Ms. P in Louisiana, who asked for math manipulatives and whiteboard supplies for her Grade 7-8 special education math class. She checks in, "Thank you for your support of my students in our classroom! Our class operates 2-5 years below grade level, but still needs to access seventh-grade material. With your help, our new math ‘toys’ have made a tremendous difference in their understanding and ability to conceptualize many abstract math practices. Thank you again for being a champion and cheerleaders for our class."

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In Australia, Royal Adelaide Hospital comes under fire for spending money on memos instructing staff on how to open doors that don’t even appear to be new. The hospital made news in February after a software failure led to a power outage during two surgeries.

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After being fired from the Texas Health and Human Services Commission for unspecified HIPAA violations, the agency mistakenly mails Tracy Ryans a box full of state assistance applications that include Social Security numbers, billing statements, check stubs, green card certificates and driver’s license copies. The matter has since been referred to the OIG, which is looking into any HIPAA-related transgressions.

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California investigators attribute the capture of suspected Golden State Killer Joseph James DeAngelo to DNA samples and genealogical websites, though 23andMe, Ancestry.com, and MyHeritage have denied any involvement. Privacy experts have been quick to point out that law enforcement can access genetic information from these companies.

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It’s all about perspective.


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Weekender 4/20/18

April 20, 2018 Weekender 3 Comments

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Weekly News Recap

  • The Illinois state procurement board recommends voiding University of Illinois Hospitals’ $62 million Epic contract, saying that Cerner’s bid was lower and referring the issue to the state’s Executive Ethics Commission after noting that Impact Advisors was involved in the selection and could have been awarded implementation services work as a result.
  • Livongo Health acquires Retrofit.
  • VA Interim CIO Scott Blackburn, who was heavily involved in its plan to implement Cerner, resigns and is replaced by the White House with by the Trump campaign’s former data director.
  • A study finds that app-issued medication reminders don’t help people with high blood pressure bring it down.
  • Hospital chain Community Health Systems lays off at least 70 Nashville-based corporate IT employees.

Best Reader Comments

Regarding VA software: The most interesting part of this is the conflict of interest with Leidos leading the Epic MASS project. SMS was part of the Lockheed acquisition with Leidos. SMS/Leidos was required to rebid on the MASS project in 2017 with an updated ROM. Leidos leads the DoD Cerner implementation, and now the Epic MASS scheduling implementation. Given the history surrounding the Coast Guard failed Epic install in 2016, this seems like a conflict of interest for sure. (Douglas Herr)

Providers prefer MHS Genesis to AHLTA, the absolute worst EMR ever. And yet, AHLTA is still more interoperable, because AHLTA is connected to the read-only Joint Legacy Viewer (JLV) and Genesis is not. Live for a year and connected to nothing and no one. It’s either “can’t” or “won’t” and neither is an acceptable answer. (Vaporware?)

Is it a good or bad thing that Dr. Jeffrey Johnson stopped practicing (at this hospital at least) because he wouldn’t learn how to use an EHR? I don’t know if it’s good or bad. But I wouldn’t want my money riding on the chance that a 75 year-old obstetrician is keeping up with the latest practice standards and could really do the job that an OB-GYN needs to do. I would not be surprised if some of his colleagues are relieved. Something had to “force” him into retirement, maybe it’s good that it was this. (Filutanion)

Mumps evolved to Standard M before InterSystems consolidated its dominance on the M market, and Caché to this day not only fully implements Standard M, but all the modern object-oriented extensions are built seamlessly on top of Standard M. Another current Standard M implementation is GT.M Many people don’t realize that M(umps), being the original NoSQL platform, is very well suited for the type of data processing that’s needed in healthcare. (Eddie T. Head)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. M in Philadelphia, who asked for headphones for the classroom learning center. She reports, “The headphones have been great for students to use during their time on the computers. There is no longer a noise distraction to the other students who are working on something other than the computer. The students who are on the computers can hear the sound more clearly now that they have headphones. I’m so glad that the students are now able to go to their centers and produce quality work with a noise distraction! We are so grateful!”

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We also supported Mrs. I’s South Carolina classroom project to promote gender and ethnic diversity in STEM fields, proving it with a camera and supplies. Individual students passed along their thoughts:

  • The STEM career project really helped me get more insight on what I want to be. It gave me an exposure on what to expect and what classes I need to focus on in high school and in college. I appreciate the fact that we had a guest speaker and she was great! (Samantha)
  • Thank you for your generous donation to us. Thank you for making it possible for us to get exposed to the different carriers on the STEM fields. The STEM career project has made me more aware of the field in OB-GYN and has made me feel like I am ready for my future. The guest speaker made me realize that money is not everything. I learned that the love for the profession is more important and should be what drives you to do your best every day. (Joseph)
  • The project has really opened my eyes and it is making me want to strive for greatness. I am not happy with the number of years I have to be in school to become a medical doctor. But I would still try, because the guest speaker was a minority and I believe that if she could do it, then I can do it too. She taught me to keep going and never give up no matter what.

I’m all-Android except for my aging IPad Mini, so I rarely have reason to visit the Apple Store. I dropped in today to check out the new 9.7” IPad since I think it’s probably the best tablet available in that price range ($329, although it’s galling that Apple still charges a lot for extra memory instead of supporting SD cards like Android tablets do). The store seems to have gone downhill – it was slightly crowded (less than I recall from my last visit) and I was happy not to be waiting for the Genius Bar, but employees ignored me even though they were just standing around. I asked an Apple guy who was steadfastly avoiding eye contact about the tablet and he just pointed at a table and said, “First two corners.” Nothing in the whole store was labeled or priced, so you had no idea what you were looking at, and had those products been truthfully labeled, the sign would have said “overpriced and uninspiring.” I may still end up with their tablet since they’ve priced it low since it’s little improved from the old one, but the experience so far was memorable only in negative ways. It feels like that dent in the universe is repairing itself.

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InteliSys Health CEO Tom Borzilleri told me in a recent interview that CVS and Walgreens charge a lot more for prescriptions than independent or grocery store pharmacies despite consumer perception that they’re the price leaders. A new Consumer Reports article proves Tom to be correct. The magazine price-checked a one-month supply of five commonly prescribed generic drugs and found a range of $66 (from HealthWarehouse.com) to $928 (CVS). Independent pharmacies were among the cheapest, but the range was huge ($69 to $1,351). I hadn’t heard of HealthWarehouse.com, but it looks great for cash-paying patients – it sells a 90-day supply of generic Lipitor for $19.80, for example. They also sell over-the-counter drugs, diabetic supplies, and veterinary prescriptions (their prices for flea and tick meds are really low).

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Bloomberg profiles data mining company Palantir Technologies, started by Peter Thiel and other former PayPal executives. The article describes JP Morgan’s use of the product to monitor its bank employees, summarizing it as “an intelligence platform designed for the global War on Terror was weaponized against ordinary Americans at home” as it analyzed bank employee emails, browser histories, GPS locations reported from company-issued phones, recorded phone call transcripts, and printer and download activity. It is being used by police departments in several US cities and those agencies can now identify more than half of US adults. JP Morgan invested in the company as well, but the company cut back on its use after it was exposed. Palantir has scandals of its own: it admitted to stealing some of its technology (claiming it had a right to do so because it was for the greater good) and it pitched programs to sabotage liberal groups, spy on and infiltrate progressive activist groups, run bot-powered social media campaigns, and plant false information to discredit liberal groups.The company, once exposed, used the Cambridge Analtytica excuse – they say it was the unauthorized work of a single rogue employee. Palantir offers healthcare solutions such as clinical trials analysis, fraud detection, and value-based care analysis for insurers.

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I missed this first time around. An office design ideas site profiles the new Chicago digs of Strata Decision Technology. This is one more reason I know I’d make a terrible CEO – I would be too cheap to spend more than the bare minimum on everything, so my company’s offices would like like one of those unfinished farm garages made of sheet metal.

“Big Pasta” fights back against the low-carb movement, with companies such as Barilla funding the research behind mass market headlines such as “Eating Pasta Linked to Weight Loss in New Study.” This is a reminder for those who don’t understand that not all research is created equal: (a) someone has to fund a study to begin with, and the funder often has a financial interest in the findings; (b) studies that don’t deliver the hoped-for findings are often buried while the favorable ones are promoted; and (c) headlines are chosen for clickbait value rather than for scientific validity, with the publisher basically colluding with the study funder to make the findings seem a lot more significant and trustworthy than the underlying research supports. Highly-touted studies should always be approached with skepticism – who paid, who did the work, what methodology did they use, and how generalizable are the results?

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Hiral Tipirneni, candidate for the Arizona House and a former ER physician who hasn’t practiced following a 2007 malpractice judgment, takes heat from her opponents for running a campaign ad showing herself in scrubs but wearing an Apple Watch that indicates the photo was made long after her physician days were over. 

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Princeton University will hold an on-campus memorial service for highly influential professor and health economist Uwe Reinhardt on Saturday, April 21. He died November 15, 2017 at 80 after a 50-year Princeton career.

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Yale health economist Zack Cooper, PhD isn’t impressed with the just-announced consumer health platform project between Independence Health and Comcast.


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Weekender 4/13/18

April 13, 2018 Weekender No Comments

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Weekly News Recap

  • FDA approves IDx’s AI-powered diabetic retinopathy screening system for use by PCPs.
  • Theranos lays off most of its remaining employees, having cut its 2015 headcount of 800 down to around 20.
  • Mayo Clinic offers voluntary severance packages to 400 transcriptionists whose it no longer needs because of speech recognition.
  • The Coast Guard announces that it will piggyback on the DoD’s Cerner contract, with the additional contract cost yet to be determined.
  • Netsmart acquires Change Healthcare’s home and hospice care software solutions.
  • Facebook acknowledges that it tried to convince the American College of Cardiology to share de-identified patient data with it.

Best Reader Comments

I have to beg for de-identified data for EHR testing purposes, but Facebook gets it wholesale from a professional organization. If this isn’t a HIPAA violation, particularly with the re-identification plans, what is? And who can be called upon to get medical data protected properly? (Kitty)\

I’m not sure I’d want to pay for Facebook’s ad targeting or trust that they could re-identify data correctly. (1) Facebook flagged me with their African-American multicultural marketing flag. I am in fact a white Midwesterner who didn’t even encounter a black person until college, so even if they couldn’t tell from the hundred pictures they have of me, it’s not like I’m steeped in African-American culture. It’s very flattering that Facebook feels I empathize, but I’m pretty sure no actual person would identify me this way. (2) After I looked up Chicago the band, I got ads for weeks about events happening in Chicago the city. If this is representative of their big data skills, let’s hope that Facebook isn’t starting a self-driving car business anytime soon. (Midwest User)

While healthcare is much more complex than banking, the bankers had their game together very much earlier. I could travel 2000 miles and withdraw cash from my bank account in 1990. I would still have problems today to give a doctor 2000 miles away ANY electronic access to my medical records. (Fat Hertime)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request from Ms. O in Texas, who reports on her class’s use of a programmable robot. “My students are having a blast making our Lego robot. They learned quickly that they would need to talk to each other to figure out which part came next. Once this was established, the quick building began. They have loved putting this robot together so much that I do not think they realize how much they were learning. My students are using area and perimeter with the robot, along with following directions from pictures (no teacher help). Next they will be coding the robot to walk and move around. Thank you so much for bringing this activity to my students.”

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We provided after-school STEAM project kits for Ms. P’s special needs K-5 class on a Native American reservation in Idaho. She reports, “After showing everything and talking about them, the students wanted to make slime first! I was so amazed at how much they listened to and remembered the information about polymers. The students have stepped up to the plate and have accepted the challenge to work together to figure things out. They are coming up with so many more ideas than I thought they would. They love to be able to take turns to be the teacher to explain their project. You are a hero to me and my students. They recognize that we wouldn’t have these things without your help.” 

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I downloaded Facebook’s archive of information it knows about me (click Settings, then “Download a copy of your Facebook data.”) even though I do basically nothing on Facebook, rarely look at it, and don’t use Messenger or any app. The archive included:

  • All contacts from my phone (the contact name I assigned and their phone number)
  • Every login date and time
  • Facial recognition data
  • Messages
  • Ads I’ve clicked
  • A huge list of advertisers who uploaded a contact list with my info (a subset is above), an odd lot that included politicians from states I’ve never even visited, Dierks Bentley, drug companies, bands, and for some unknown reason, a ton of rappers. 

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CB Insights mined its earnings call transcripts to see how often Wall Street analysts suck up to company executives while asking them questions and found that use of “great quarter, guys” peaked in 2008, although the most common compliment remains, “Congratulations on a great quarter.” I’m signing up to see how often analysts use trite terms in asking questions like, “Can you provide some color around that number?” 

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Talkspace, which offers online counseling and therapy, claims it has 1 million users, is marketing services to employers, and is contemplating an IPO. A Verge review from late 2016 wasn’t complimentary, noting:

  • Therapists are hired as 1099 independent contractors and bear all the responsibilities since the company says it’s not a medical provider. The company pockets half of their billed amounts.
  • Talkspace owns the medical records of patients and therapists don’t have access to them once they’ve stopped working for the company, making the patient transition difficult.
  • Therapists are required to follow scripts.
  • The company set a rule that therapists could not complain about it internally on its Slack channels.
  • Patients are anonymous, so therapists have no way to contact authorities if they appear to be a threat to themselves or others.
  • Therapists say the company places client retention above all else.
  • Talkspace’s terms of service agreement says patients should not make health or well-being decisions purely on their use of the service, which they add is not a substitute for face-to-face therapy sessions.

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Kaiser Family Foundation SVP Larry Levitt notes that despite this short-term insurance plan’s name and choice of cover stock photos, it doesn’t cover mountain climbing injuries. The plan – of the type the Trump administration wants to roll out more widely – also doesn’t cover pre-existing conditions, prescriptions, pregnancy and childbirth costs, kidney disease, skin conditions, long-term care, sports injuries, or injuries incurred while under the effects of alcohol or drugs. The insurer also has no provider network, which I assume means that services will be billed as out-of-network visits with the patient being balance-billed – the plan pays a flat 150 percent of Medicare-allowable expenses and you’re on your own after that. I checked premium prices for a 30-year-old male in Chicago and they ranged from $88 to $177 per month with deductibles from $1,500 to $5,000. It may be better than having no insurance at all for some people (like those who don’t expect to actually require care), but make no mistake, those having it could be wiped out financially very, very easily from the unjustifiably high charges generated in a single hospital or ED visit.  

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Japan-based drug maker Otsuka, whose antipsychotic drug Abilify is available in a “smart pill” form using technology from Proteus Digital Technology, has owned California winery Ridge Vineyards since 1986. The company says the winery is profitable, but its other use is for executives to entertain business partners during the JP Morgan Healthcare Conference in January.

BMJ Case Reports describes an ED patient who complained of dry heaves and thunderclap headache after eating one of the world’s hottest chili peppers in a contest, causing reversible cerebral vasoconstriction syndrome in his brain that could have caused a stroke or heart attack. The article didn’t mention his final standing on the leaderboard. 

Police file charges against a nursing student who was shadowing staff nurses at Lahey Hospital and Medical Center (VT) after he was caught hiding a video camera in an employee restroom. A housekeeper found the pen-sized device almost immediately. He wasn’t smart — a review of the camera’s contents clearly showed his face and ID badge as he recorded himself adjusting the camera’s angle to face the toilet.

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Stat excerpts fun stories from the new book (due to be released on May 21) about Theranos, written by Wall Street Journal reporter John Carreyrou, who exposed the scandal:

  • Theranos faked a demo of its non-functional technology to drug company executives way back in 2006, and when the CFO of Theranos heard about it and raised concerns, Elizabeth Holmes fired him on the spot.
  • The head of the software development team bragged that he could write the company’s software faster in Flash, after which someone noticed a “Learn Flash” book on his desk.
  • Elizabeth Holmes hired her brother – who had no obvious qualifications – as a product manager, after which be brought on several of his Duke University fraternity brothers to form what insiders called the “Therabros” or “The Frat Pack.”
  • A former employee heard Holmes speak in a higher-pitched voice, leading them to speculate that she intentionally speaks in public in a low baritone to fit in with Silicon Valley’s male-dominated executive culture.
  • Carreyrou writes that Holmes had a romantic relationship with Theranos President Sunny Balwani, breaking up with the man 20 years her senior only after she had to fire him as the company’s story began unraveling.

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Bizarre: a plastic surgeon in Germany is arrested for unintentionally killing a woman he met online for sex by sprinkling cocaine on that particular part of his anatomy to which she was voluntarily providing oral attention.


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Weekender 4/6/18

April 6, 2018 Weekender No Comments

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Weekly News Recap

  • Orion Health Group announces a cost-cutting program and reorganization following release of poor annual results that sent shares down to a 52-week low.
  • The State Department issues an RFI for an EHR following its failed attempts to install Epic as part of the Coast Guard’s halted implementation.
  • GE Healthcare sells its health IT offerings to Veritas Capital for $1.05 billion in cash.
  • Former VA Secretary David Shulkin disputes White House statements that he resigned, indicating that he was fired and thus raising legal questions about President Trump’s right to choose the DoD’s Robert Wilkie as his interim replacement and the possibility of legal challenges of any documents that Wilkie might sign such as the on-hold contract with Cerner.

Best Reader Comments

I would love to see more physicians embracing their role as leaders on a large, heterogeneous care team rather than technicians who operate in isolation and are subject to forces beyond their control. I don’t think many physicians perceive themselves as clinical leaders, but if they did, they could find many resources available that help teach the necessary principles and skills. (Adam K.)

I have to think that the big IDNs like Kaiser Permanente that use Epic and offer genomic testing to certain sectors of their patient population will be doing big things with data mining as more and more people in their populations have their genomes sequenced. If they could get to the point where they had 2 million people with genomic records married with multi-year structured data like what gets captured in Epic, it might be possible to discern some interesting patterns. If you add in the possibility of analyzing the gut biome, too, I have to think that we’ll be seeing an acceleration in discoveries and an improvement in targeting therapies – true personalized medicine. (CanHardlyWait)

National approaches are fraught with dangers to personal privacy and have a predisposition to stifling innovation. There’s also no good way to handle changing priorities – e.g., if a state reduces its opioid problem and has something else more important that it feels it needs to fund, the state approach allows it to focus on their state needs. A federal approach (e.g., like Meaningful Use) tends to be a one-size-fits-all, which we know is not good. Find a way to address these and you’ll find me supportive of national consolidation. What I am in favor of is a national approach to the issue with the ability to share state-level information with minimal cost or impact on workflow. (Joe Schneider, MD)

Interoperability is extremely valuable if done the right way. However, physicians and institutions must first learn to trust each other or the value is diminished. If one facility does a CT, MRI etc. and the next facility insists on repeating the test because they only trust their own techs, there is diminished return with increased patient frustration and patient cost. (Barbara)

The current PDMP process is a bad process. Improvements will only make a better bad process. The logical approach is to scrap the current submission process and move to real time using modern standards submission such as the NCPDP standards. (David)

You would not have to look very far to find some very large healthcare IT vendors being run by teams of middle-aged white men with zero software experience who all come together from company XYZ with light healthcare delivery experience. IV bag and alcohol swab logistics are very important, and while they are in fact delivered, they are definitely not healthcare delivery. Little diversity. Exorbitant compensation. Meager results. And still we wonder why. (ellemennopee87)


Watercooler Talk Tidbits

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Teacher Ms. E in New York asked for a library of 30 books via DonorsChoose, saying that her kids “have the cards stacked against them because they are minorities from the South Bronx” and asking in her request, “Could you be the ‘somebody’ that helps?” HIStalk readers were indeed that somebody who funded her project. She reports, “Thanks to you, my students are now able to read new books from popular series such as ‘Fly Guy’ and ‘Elephant and Piggie.’ They are spending any free time they have in the classroom reading the books with their buddies and I am so excited that they are now part of our classroom library. Thank you so much for supporting my students. Donors like you are truly the best and we appreciate your generosity immensely!”

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Also checking is Ms. F, who asked for take-home STEM activities for hew New Mexico classroom of 48 students. She says, “These math games have been such a fun and exciting addition to our math classroom. When they came in, the kids were amazed and couldn’t wait to play. It is truly a blessing to have supporters that understand that kids should enjoy learning and want to help make it possible. Now that we have learned how to play most of the games in class, I am getting ready to check them out to students to take home and play with their families next week. When I told them that they could borrow the games they were astonished and very excited for the opportunity. Thank you again for making this possible.”

Listening: last year’s solo release from former Megadeth guitarist Marty Friedman, whose music covers more genres than just metal shredding, although he does that really well. His band explodes with energy, especially Kiyoshi Manii, who is one of the most aggressive and technically competent bass players I’ve heard (not even considering that she’s a tiny Asian female). I’m also enjoying the recent reunion of Seattle-based hip hop band Common Market, celebrating the 10-year anniversary of its fabulous album “Tobacco Road.”

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Forbes notes that Humana has offered to buy Kindred Healthcare’s home division for $800 million as Humana itself is rumored to be the subject of acquisition talks with Walmart. If both transactions go through, that would allow Walmart to extend beyond the walls of its pharmacies and retail clinics into the homes of patients.

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Drug maker AbbVie buys itself five more years of monopoly pricing for the  world’s top-selling drug Humira, paying off a second company to refrain from marketing a cheaper version. Humira’s price has increased from $19,000 per year in 2012 to $38,000 today, generating annual sales of at least $18 billion. US patients pay multiples more than those in other countries, of course, nearly triple what those in France, Japan, and Norway are charged.

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Also related to drug pricing: Bloomberg notes the success of a pair of Chicago consultants who teach drug companies the tricks needed to raise their prices by up to 4,000 percent. Their recommended methods include pressuring health plans to keep paying, using specialty pharmacies, covering patient co-pays, use analytics to find insurance policy holes that will support price hikes and to target likely prescribers, and providing big bonuses to aggressive salespeople. The consultants started as executives for a struggling drug company that has raised the price of one product from $500 to $2,500 in five years, earning the company’s CEO a single-year payday of $93 million. 

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Surgeons at Memorial Hermann ask a brain surgery patient to play her flute during the operation so they could tell if they had fixed her hand tremor problem, which they did.

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This seems entirely pointless, yet something Millennials would pay for. Lydian Dental offers concierge dentistry serviced out of designer RV-like clinics on wheels in trying to make dentist trips “fun.” The oh-so-hip design team also specified staff uniforms of workout pants and tee shirts bearing quippy phrases (“all up in your grill” and “nice mandibles”), instruments that remain hidden until needed, and iPads with Dre Beats headphones. The target market of the four-clinic company is clear given its smug use of insufferable hipster terms such as “aspirational,” “curate,” “touchpoints,” and their hope to “transform a transaction into an experience.” They will probably succeed – recall that endless studies have shown that Millennials don’t care how restaurant food tastes, it’s how enviable it looks when posted to Instagram that keeps them coming back.

Bizarre: a woman takes an Ancestry.com DNA test that predicts a “parent-child” relationship with the former OB-GYN who had treated her parents for infertility. The doctor had suggested a fertility procedure in which the mother would be inseminated with a mixture of sperm from her husband and a donor who met their specifications for height, eye color, and hair color. Apparently the doctor decided that the ideal donor was himself.


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Weekender 3/30/18

March 30, 2018 Weekender No Comments

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Weekly News Recap

  • South Australia reportedly halts the rollout of its troubled, Allscripts-powered EPAS systems.
  • President Trump fires VA Secretary David Shulkin via Twitter and nominates as his replacement White House Physician Rear Admiral Ronny Jackson, MD, who has no significant management experience.
  • Investors in the largely defunct lab startup Theranos sue the company, hoping to get some of their money back from the proceeds of selling the company’s patents and by going after the rumored $100 million fortune amassed by former President Sunny Balwani.
  • FDA says it will expand its digital health pre-certification program to more companies by the end of the year.
  • Finger Lakes Health (NY) pays a hacker an unnamed sum to recover its systems after a week of ransomware-caused downtime.
  • Israel announces plans to make the health data of its 9 million citizens available to researchers and private companies for work on preventive and personalized medicine.

Best Reader Comments

Can someone explain the value of LinkedIn? It’s handy when looking someone up at times, but the amount of spam and vendors asking to make a connection is overwhelming. (2 antisocial?)

Women tend to use LinkedIn differently – more privacy settings and fewer public announcements, posts, or interactions. I wouldn’t be surprised if this extends to other aspects of online identity, like being less likely to email Mr. HIStalk to notify him of a promotion. (People/ LinkedIn)


Market Research Study Reader Feedback

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Reader Steve works for a market research company and applauds my calling out of offshore firms whose reports – written in nearly undecipherable fractured English — fail to notice that companies they cover have been acquired or have exited the market. He provides this commentary.

I’m increasingly seeing the industry plagued by “report factory” outsourced studies. As you rightly state, the model seems to increasingly involve investment in masses of PR on every topic and keyword imaginable, yet always with high growth forecasts to entice busy health tech execs and VC’s desperate for data to reach for their Amex. More interesting is that if you dig into many of these firms, their report announcements are copycat replicas (same forecast title and keyword, just different company name).

Here are five quick pointers to aid in calling BS on these cowboys.

  1. Contact the analyst behind the report. A quick email conversation or phone call is the quickest way to know (a) if they know what they are talking about, and (b) if they even exist. Also check their LinkedIn / Google press mentions. Good analysts should build up a reasonable online presence of industry press mentions and well-written market insights.
  2. Ask for a detailed view of how the data is put together. The best analysts and firms are acutely aware of the accuracy of their data and both the pros and cons of their chosen methodology. I expect every party that is seriously interested in my research to grill me on methodology behind it.
  3. Beware of big growth rate headlines. Markets go both up and down. I’m still yet to see one of the report factories putting out PR showing a market decline.
  4. Buying market research should not be a single interaction. You are buying a report, but also included should also be analyst time and support to help you disseminate the information, ask questions, and mine the knowledge of the author. The best analysts I know are not just good at producing reports and PR, but as advisors to their customers. Avoid firms where analyst access is restricted or interaction is limited to an account manager or salesperson.
  5. Question timelines. Good data and insight takes time to put together. Market research based on primary research (vendor or consumer) involves investment financially as well as established industry relationships. There are rarely shortcuts that can be made. Compiling a high-quality, detailed report on complex markets is not possible in a few weeks. Short timeline reports usually resort in low quality, mistake-laden research or a very expensive bookend.

Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. F in West Virginia, who asked for programmable Lego robots for her special needs high school class. She reports, “We have been very busy learning about coding. My students have learned the hard way that you must follow ALL directions in order or your creation will not work. I get excited when they come in and show their classmates what they have done and what they have learned. When their creations run, they are so proud of themselves, and when they don’t, my students don’t get frustrated (which is a really big deal) —  they just look to see what they did wrong. Thank you for making learning exciting for my students and for building skills and confidence!”

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First grade special education teacher Ms. M from North Carolina says of the math games we provided, “My students have a hard time grabbing these new math concepts, but I have learned that learning through play makes retention much easier. The students are showing signs of understanding and they are able to focus on the problem at hand. Some have even told me they did not want my help, that they wanted to try to figure it out themselves, now this blew me away. I am ever so grateful for your generosity with this project and this great new way for my kiddos to learn math concepts.”

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The US Attorney’s Office wants to take millions of dollars and several replica cars as part of its investigation into their Cleveland owner’s for-profit addiction treatment companies, which submitted $49 million in Medicaid claims in 29 months of which $31 million was paid. The reproduction cars, which were used in Hollywood movies, include a 1981 DeLorean from “Back to the Future,” a 1959 Cadillac hearse from two “Ghostbusters” movies, and a Batmobile replica.

A California OB-GYN on the first day of his medical malpractice trial rushes to the aid of a prospective juror who is undergoing cardiac arrest, raising concerns that the doctor’s actions might bias jurors in his favor. More interestingly, James Nilja, MD is one of several former drummers for rock band The Offspring and is rumored to have suggested the band’s name. He parted ways with the band in 1987, with front man Dexter Holland explaining in a blog post that, “He was so intent on getting into medical school that he didn’t really even practice with us much, which is part of why he‘s not our drummer any more … I hope his patients don‘t find out that he once helped write a song called “Beheaded!” Here’s video of the now-doctor playing in the band in 1987.


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Weekender 3/23/18

March 23, 2018 Weekender No Comments

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Weekly News Recap

  • A comment made by a member of the House Appropriations Committee suggests that the VA’s cost to implement Cerner will be at least $16 billion, of which Cerner as prime contractor will be paid $10 billion.
  • RCM outsourcer Constellation Healthcare Technologies files Chapter 11 bankruptcy, accusing former executives of falsifying its financials and blaming the high debt it took on to fund acquisitions.
  • Former Vice-President Joe Biden calls for HHS to cite providers for data blocking if they fail to give patients their information electronically within 24 hours of their request.
  • A New York Times article says the NIH’s $1.4 billion “All of Us” data collection project that hopes to enroll 1 million people is moving slowly, spending a lot of money, mired in the challenge of harvesting information from disparate EHRs, and facing the reality that the US doesn’t have enough DNA sequencing machines to handle the load.
  • The IPO of Siemens Healthineers in Germany raises $5.2 billion.

Best Reader Comments

HIMSS is a necessary evil. From my perspective (i.e. for my role/life) it’s overly focused on “hospitals” and “information technology” (I get that’s a feature, not a bug – this was, after all, the Hospital Management Systems Society). Not every problem in healthcare is going to be solved using software in a hospital. Most of them are probably not. But every year, in rolls HIMSS with big booths from the heavy-iron hospital vendors (Epic, Cerner, Meditech, et al.) looking to meet with CIOs who are focused on incremental improvements to ancient and inadequate systems. All of the “education” sessions at HIMSS are some combination of hopelessly in the weeds and a veiled pitch for a piece of software that I don’t really want to buy. I really don’t need to sit in some nosebleed seats to hear Peyton Manning or Magic Johnson tell me something about healthcare. The best part of HIMSS is the Mos Eisley Cantina that is the basement or adjunct hall where HIStalk usually camps out. In those 10×10 booths are the dreamers and builders who might really be the next big thing. HIMSS has to exist, real work does get done there, but it’s really pretty deep in the machinery of the healthcare system. Will HLTH be different? I don’t know, but I’m willing to give it a shot. (Debtor)

Do we really mean data? Most of what I see in motion, even with interoperability initiatives and FHIR APIs, are records — which is to say, documents and text representing the documentation of care, mostly in a legal medical record sense. As a clinician, I can say that, no doubt, this information has use and value, especially compared with the alternative. Still, it is far from computable. Biden’s interest in data sets shows he is reaching for the latter, and I am beginning to think the lack of distinction is really a problem, expectations-wise. Hopefully, ongoing progress in natural language processing (is the language really that natural?) will save us (by which I mean, me, the clinician) from fixing it, by becoming even more of a data entry worker. (Randy Bak)

Orwellian Aeron chair: If sitting is the new smoking, I’m sure this exercise motivator will have some real health benefits. Perhaps a little electroshock to get us up and about on a regular basis? I’m looking forward to Weird News Andy’s updates covering the exhaust analysis feature: colon cancer screening, dietary recommendations, etc. (Another Dave)

Epic, Athena, Allscripts, NextGen, Cerner, and others are all doing the same thing – they have open APIs, but make it very difficult to get approved to access data. (Annon)

I agree that it’s unfair and irresponsible to lay this [social determinants of health] at the feet of physicians. They certainly aren’t in control of all the economic and social factors that inform the health of this country, but its equally unfair to point the finger at patients themselves as if all the external circumstances that impact them (housing, job, food access, sexism, racism, homophobia, you name it) are 100 percent in their control, as well. (HIT GIrl)

I work in an IT department of a large IDN. The physician salaries and perks are obscene. We talk about all “waste” in health dollars, but I would like to see all these hospital costs out in open and distinguish between the costs borne by the hospital for conducting the tests and costs due to physician salaries / payments. Looking at what goes on in our system, physician compensation is the biggest elephant in the room. (IT Guy)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. C in Utah, who asked for science books for her Friday morning STEAM lessons. She reports, “We have been so excited to open our boxes and find high-interest books for our third graders. Our class is excited to start planning our projects to demonstrate their understanding of a major science standard in third grade: interactions between living and non-living things. We have already started looking through our books. The kids can’t put them down!”

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We also funded the request of Ms. A, who asked for an air quality meter for a project her fifth grade class in Pennsylvania is doing. She says, “Students are taking turns taking home the air quality meters every three or four days. They have found enough places in their own home to check air quality from the attic to the bathroom to their stinky brother’s room to the basement. Students are recording their results in science notebooks that they take home with the books, but when they come back to school, they transfer their data to a shared spreadsheet. The kids love looking at the results. I can’t wait until everyone has had a chance to take the meters home. Then we can really explore what the numbers mean, and I can teach the students how to create graphs using Google Sheets.”

Listening: the cover of “Zombie” by otherwise forgettable metal band Bad Wolves, which while missing the seething Irish anger of the original by the Cranberries and its late singer Dolores O’Riordan, offsets it with searing guitars. O’Riordan died the day she was scheduled to perform the vocals with the band on the recording, so they released it her honor instead. Speaking of angry political songs of that era on SNL, there’s the prophetic sneering thrash of 1989’s “Rockin’ in the Free World” by Neil Young. But arguably the most discomforting social protest song ever was Billie Holiday’s 1939 “Strange Fruit.” Switching to something new, there’s a just-released album from hard rock band Dorothy.

Our booth neighbor down in the basement of HIMSS18 was integration platform vendor MuleSoft. Some of their self-absorbed sales guys were kind of rude to Lorre and Brianne, but maybe they knew what was coming —  Salesforce just bought the company for $6.5 billion.

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ProPublica reports that IBM – panicked by competition from more nimble and often global competitors and its own failure to execute – has intentionally ditched its older, higher-paid workers to replace them with cheaper newbies and offshore workers while breaking US age discrimination laws or using loopholes to avoid them. Techniques include:

  • Laying off older workers in telling them that their skills were outdated, but then hiring them as contractors at a lower rate
  • Encouraging laid off employees to apply for other company jobs, but telling managers not to hire them
  • Requiring laid off employees to pursue age discrimination complaints via private arbitration rather than lawsuits
  • Using employee privacy as an excuse for not publishing legally required layoff lists that would allow those employees to see how many of those laid off were older
  • Labeling layoffs as retirement even when the employee refused to acknowledge it as such
  • Using what IBM called “lift and shift” to lay off US employees and send their work offshore, causing IBM to now have more employees in India than in the US

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Meanwhile, Bloomberg says that GE sent former CEO Jeff Immelt packing with millions of dollars in parting gifts but has reduced benefits to employees and retirees in an attempt to make its financial numbers look better. Example: the company changed its pay schedule to push the final paycheck of 2016 to a week later, improving its year-end cash flow position; it implemented an “unlimited vacation day” policy that also means it doesn’t have to pay out the unused days as severance; and it replaced merit raises with bonuses tied to unstated objectives. The article notes, “GE has lost more than $100 billion in market value since CEO Jeff Immelt announced his retirement in June, and not because anyone misses him.”

A sharp Vox opinion piece observes that Facebook is like casinos, cigarette manufacturers, and companies that sell alcoholic beverages – it makes most of its massive profit from addicts who feel depressed and lonely and are therefore less healthy after using its product. It concludes that Facebook is “optimized for fakeness” in deliberately turning news consumption into a confirmation bias machine even as it kills off the business model of real news sources.

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Researchers find that a substantial portion of Americans – even those with health insurance – take a big financial hit after being hospitalized. A significant number of those patients never return to work, are disabled, or require unpaid recovery time. A health economist questions whether health insurance is enough to to protect people from significant income loss, as other countries also offer wage insurance, mandatory paid sick leave, and disability insurance.

Drug companies are merrily jacking up prices even as the White House claims that it will intervene, as 20 drugs had price increases of over 200 percent since January 2017. Leading the pack was skin cream SynerDerm, whose price has increased 1,500 percent. Its main ingredients: water and vegetable oil.


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Weekender 3/16/18

March 16, 2018 Weekender No Comments

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Weekly News Recap

  • Theranos CEO Elizabeth Holmes settles SEC fraud allegations by agreeing to pay a penalty, give up her company shares, and not serve as an officer or director of a publicly traded company for 10 years.
  • A blog post from UCSF’s Center for Digital Health Innovation says EHRS can never be a “comprehensive health record” since important patient health information is created elsewhere.
  • Epic CEO Judy Faulkner says the company won’t challenge the VA’s no-bid Cerner selection, but estimates the government could have saved at least $3 billion by choosing Epic.
  • Inovalon announces that it will acquire Ability Network for $1.2 billion.
  • Epic confirms that it will integrate Nuance’s AI-powered virtual assistants into its software.
  • Cerner says the VA’s planned go-live will begin in Q4 2019 with pilot sites and will then involve 48 waves that will be completed in 2027.

Best Reader Comments

With respect to Holmes, she DOES still face jail time. The settlement with the SEC covers only civil – not criminal – charges. The SEC has no criminal enforcement capability. The DoJ can pursue criminal charges if they deem it worthwhile. (Debtor)

My opinion / observation is that CommonWell is vaporware and it’s largely due to Cerner’s leadership or lack thereof. Athena went elsewhere to do real exchange. McKesson and Allscripts stopped talking about it. Cerner used it to land the ultimate whale in the DoD and has delivered LESS THAN the Joint Legacy Viewer for interoperability. With the DoD and VA combined, my family of five is in for about $250 to Cerner. For that price, I think I’m entitled to my equivalent of a Yelp review. (Vaporware?)

It’s very much en vogue to simply say API over and over again, but the fact remains – at some magical moment in time, you need as much data as relevant to the situation in order to make the best decision possible. APIs don’t actually accomplish that in general, and in the contrived example where one might try, you’d have the slowest computer system known to man. (UCSF only semi correct)

Agree with the interoperability problems in non-medical systems. It is only because we users demand a high level of accuracy that we complain so bitterly about the difficulties and errors. There are less complex data systems out there that perform much worse than the top tier of EHRs, but lives are not on the line, so we let it ride and only complain under our breath. (Graduated When?)

Thanks for highlighting Dan Linskey’s session. I was huddled out in the Boston suburbs with my kids on those awful days, but last Thursday evening, I felt as if I was standing next to Linskey – heart racing – listening to “Channel 1” in the middle of Boylston street. I cannot recall a more emotionally immersive experience. I will wonder all year how it is that I stumbled upon that talk at 5:30 – bleary-eyed as I left the exhibit floor. (Neil)

KLAS for validation. CIOs I work with generally find KLAS credible because the comments they read reflect the experiences they’ve had. They also conduct their interviews in person, which helps. Maybe not statistically bullet proof, but still credible, IMO. (Ex Epic)

Thank you for including this comment: “I’ve been the recipient of a couple of sexist comments this week – things that people would never, ever say to a male CMIO – so we definitely have a long way to go.” So many of my male colleagues just frankly don’t believe or seem skeptical that this behavior is as widespread as it is, suggesting that it’s only the creeps who make comments like that and that the comments are rare. Nope. (Kallie)

Love or hate KLAS, they have made both the provider buyer community and the vendor seller community pay them for telling them what to do. First, you have to understand the founders of KLAS are all prior leaders of HIS vendors and topnotch salesmen from days gone by. They were very successful in that world and they simply used those skills and tools they honed selling hospitals IT systems to sell them on needing someone to measure the vendor community and the vendor seller community on needing someone to tell them what they clients wanted and what their competitors where doing. It’s the perfect storm of a sales job and all of you bought it. They knew no vendor could pass up the notion of competing against its competitor, as healthcare is such a lead/follow vertical that once any provider stated they used KLAS, then others just followed because no one wants left out. (Real KLAS)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. C in New Jersey, who asked for take-home science kits for her elementary school class (note that the photos were taken in the homes of students). She reports, “As soon as I received the materials and displayed them in the room, the students went wild! They could not wait to pick a kit and take it home to do some extracurricular learning! What is so great about the kits is that the students will be able to use them year after year. I already have students in the upcoming grade looking forward to science because of the wonderful materials we now have in our room. Thank you so much for keeping our students engaged in learning in and out of the classroom! Your donation will reach many young minds this year and in years to come!”

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Also checking in was Mr. M from Wisconsin, whose describes his school’s area as “hardest hit by poverty, lack of jobs, mental illness, childhood trauma, and civil unrest.” We provided STEM games, which he acknowledged with, “Our students are lacking critical math skills, but they find our math book to be too confusing. We are incorporating games like Farkle into our curriculum. It is really effective because the games are fun. There is a huge push away from procedural knowledge to conceptual knowledge. What this means is they want kids to understand why the math works, but they are moving away from actually being able to do the math. I find this to be foolish. So we are working on ways to memorize numbers and how to manipulate them.”

HIStalk traffic always spikes during the HIMSS conference, this year peaking at nearly 12,000 page views and 8,400 unique visits on Wednesday, March 7. That’s not quite a record – July 30, 2015 (DoD announcement day) saw 17,000 views on 12,000 visits, sporadically making my overloaded server (since upgraded) unavailable for some of that afternoon.


I didn’t get many responses to my question about the best and worst parts of the HIMSS conference, so I’ll just list them here:

  • Best: the companies that exhibit are reaching out in more meaningful ways, with panel discussions, lunch and learning events. The worst: getting hit in the head or back by the ubiquitous overloaded backpacks. The carriers don’t seem to be aware that they have heavy luggage on their back.
  • It’s always fun seeing old friends, but my favorite part of this year was having a virtual HealthTap doc stroll up to me while I was Facetiming my kids. We had a nice conversation with the doctor, who was very friendly, and although my kids are still confused about it, we’ve had some fun conversations around the type of work I’m in. Way to stick out, HealthTap!
  • Best: networking opportunities and having a large number of products and vendors all in one place. Worst: not seeing any major new items or topics. I finished the conference thinking either I have reached some type of plateau in my knowledge and exposure to the industry and/or that the industry in general has plateaued. Considering focusing my time outside of HIMSS in the coming years.
  • Was very disappointed in the Women in HIT networking event. I was really looking forward to it and encouraged many women to pay the $45 each to go. But I can’t figure out what the money paid for. Very crowded, cold, and barely food — had to pay for dinner afterward. I truly hope there was money left over for a nice donation somewhere. A speaker or sit-down event where you can hear people talk to each other would have been nice.
  • The smoke was the worst. I enjoyed meeting folks and learning about their different technologies. As a fellow vendor, I think the other vendors were more engaging and just happy to chat. Seems attendees are truly afraid to make eye contact and get roped into conversation. I approached it truly wanting to learn about others’ ideas, needs, and experiences. Wish I had learned more from attendees.
  • Worst part: Las Vegas. Disgusting place. Why have a healthcare conference in one of the unhealthiest cities in the US?
  • While my sentiment likely won’t be popular, I was pleased to see the rise of non-native healthcare companies at the conference. High time for outside influence in what might otherwise be a generally stagnant field. The worst was hearing the perspective of first-time attendees who were disappointed to discover the lack of a patient presence. If anyone out there is ready to host a conference dedicated to patient panels, I’m all in!

I had to re-read this article carefully because it sounds like satire from “The Onion.” Elon Musk considered buying “The Onion” several years ago and has since hired its top two former executives and four other staffers to work on a secret comedy project. Musk’s reply to inquiries was, “It’s pretty obvious that comedy is the next frontier after electric vehicles, space exploration, and brain-computer interfaces. Don’t know how anyone’s not seeing this.”

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Another “Onion”-worthy story involves startup Nectome, whose tagline is, “What if we told you we could back up your mind?” The company proposes to inject preservatives into the brains of dying people while they’re on life support, in essence killing them in the hopes that the stored memories in their brains can somehow be recreated later despite lack of proof that dead tissue actually stores memories. A neuroscientist critic says, “Burdening future generations with our brain banks is just comically arrogant. Aren’t we leaving them with enough problems?”

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University of Michigan stirs up controversy by offering its donors concierge medicine services in a program it calls Victors Care that costs $2,700 per year. It promises that customers get “enhanced access and time with their primary care physician.” Its website lists just one participating doctor. Concierge medicine has become increasingly common, but is always offered by private practice doctors rather than public university hospitals.

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A NEJM article ponders the ethical challenges of using machine learning in healthcare, saying:

  • Machine learning may unintentionally offer recommendations biased against race or genetics because of the data it was trained with
  • Private companies might develop algorithms that will recommend activities that are designed to artificially inflate quality scores or increase the use of profitable products without actually improving outcomes
  • Diagnostic methods and treatment best practices may not be well enough defined to support a machine-generated conclusion
  • Physicians need to understand how the algorithms work rather than treating them as a black box since ethical challenges may result otherwise
  • Physicians are ethically bound to withhold information from the EHR to protect patient confidentiality, but that practice would skew the performance of machine learning that expects to find a complete data set

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The physician reader who sent me the article notes that while the authors worry about the perceived authority of AI-powered systems, that’s what medical records technology pioneer Larry Weed, MD proposed 50 years ago – a system in which lower-level providers interview the patient and enter their findings into the EHR, after which the doctor is offered a computer-generated list of possible diagnoses before seeing the patient. Weed wasn’t thinking about AI, though – his idea was “problem-knowledge couplers” in which technology would analyze the available patient data to provide an objective assessment, avoiding the problem in which doctors who are faced with too much data make decisions using instinct instead of relevant facts. The illustration above came from Dr. Weed’s 1983 presentation at the SCAMC conference – he was running self-developed software on a Northstar Advantage computer with 64K of memory.

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Researchers develop an open source template for a 3D-printed stethoscope, clinically validating that the $3 result works just as well as expensive models while being affordable to clinicians in developing countries. They got the idea after playing with a toy stethoscope and realizing that it actually worked pretty well.


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Weekender 3/2/18

March 2, 2018 Weekender 1 Comment

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Weekly News Recap

  • Intermountain Healthcare launches a virtual hospital that brings its 35 telemedicine programs under one roof
  • EClinicalWorks announces a cloud-based hospital system whose cost starts at $599 per bed per month with no upfront capital cost
  • R1 announces that it will acquire Intermedix’s healthcare division for $460 million
  • Apple’s plans to create an employee wellness clinic are disclosed by CNBC
  • The Wall Street Journal describes OurNotes, the follow-up project to OpenNotes that will allow patients to share their own notes with their doctor
  • Researchers find no relationship between hospitals implementing a new EHR and their credit ratings afterward

Best Reader Comments

These wellness ventures strike me as little more than internalization of the wellness programs bundled in with insurance products that work very poorly today. Per the article, Apple seems to be working with Stanford. If my goal was pop health/wellness, I wouldn’t take my advice from an academic medical center, particularly not one that’s currently trying to buy its way into the primary care market. The branding is interesting because it almost sounds more like part of Stanford’s strategy to put clinics on tech campuses (I believe they have a few in the works already). (Midwest User)

One positive of a travel-heavy job is that you have a chance to meet healthcare execs and leaders from all over the country and really get to know them versus only having a network of people in a city or metro area. Over years, it does incredible things to your professional network, not to mention giving you the ability to experience many different settings and organizations rather than just a few. (HIStalk Groupie)

Inherently there are still silos within managing the different applications, competing agendas on the vendor side and organization side, lack of integration between initiatives, and more importantly, involving IT with sign-off for any device and EHR enhancements or changes. (Sandy Walker)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Mrs. M, who asked for six Boogie Board memo pads for her high-poverty elementary school third grade class in North Carolina. She reports, “My students love using the Boogie Boards. They are fun, engaging, and offer a nice alternative to paper and pencil work. My students are in third grade and are in my bottom reading group. Their eyes lit up when they saw the Boogie Boards. It is often hard to keep them engaged. We use the boards during guided reading groups, math groups, and during word work. We plan to also use the boards to take notes from research and during quick writes. I can’t thank you enough for your donation.”

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Also checking in was Ms. M from New Mexico, who requested STEAM center materials for her elementary school class. She was nice to provide this update: “Unbelievable! You have simply made the start of the new year fantastic! We have new translucent, magnetic blocks to use on our new light table! The sensory options are endless. We have new math games to collaborate with that cover all four operations. They are more than drill and skill – they involve problem solving. It’s been a great review station. We also received two Whack-a-Mole type of games that involve NOISE and LIGHTS and SOUNDS! Most teachers hers would cringe. Not this teacher! We are soooo excited. The bottom line is, you are changing our classroom. We have supplies such as dice for multiple review stations. We have rubber bands (seems so simple) to create geometric shapes on our geo-boards. We have a light table with manipulative to create patterns, work fractions, and all of it is bright, sensory, exciting, and engaging. We have amazing new wobble stools that allow my students to wiggle and move. All of this is because of you and your amazing generosity! Nothing we write can explain how sincerely we thank you or appreciate this gift. You have a lot of choices when donating and we are grateful you found us.”

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An anonymous CIO reader working in United Arab Emirates made a very generous donation to my DonorsChoose project, to which I applied matching funds from my anonymous vendor executive and other sources to fully fund these classroom projects:

  • A tablet, case, charging station, and 3D building blocks for Ms. B’s elementary school class in Forest Park, GA
  • A wireless drawing pad, math games, and basic classroom supplies for Ms. W’s high school class in Houston, TX, which lost all of its classroom items during Hurricane Harvey
  • Math and art supplies for Ms. Y’s elementary school class in Naples, FL, which was impacted by Hurricane Irma
  • Two tablets and learning aids for Ms. W’s first grade class in Moscow, KS
  • Math centers and games for Mr. M’s elementary school class in Northglenn, CO
  • Math tools and games for Ms. S’s elementary school class in Denver, CO
  • A trip to the state aquarium on Saturday Deaf Day for the deaf students of all 15 county schools by Ms. M in New Bern, NC

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Federal authorities arrest two Southern California weight loss doctors who they claim cheated insurers and patients out of $250 million (!!) by falsifying test results to get insurers to pay for lap band surgeries. An unrelated newspaper investigation found that five patients died after having weight loss surgery performed there.

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Every year we get the dregs of the HIMSS exhibit hall booths since we don’t spend enough money with them to earn HIMSS points, so I was too depressed until yesterday to look at the exhibit hall map knowing that we’ll be in Siberia. We certainly are – we’re in the low-ceilinged, cheerless basement (Hall G) among companies I’ve never heard of, with our tiny 10×10 space sitting next to what passes for an anchor tenant down there, the Philippine Trade and Investment Center. Hall G was so dead at HIMSS12 that HIMSS hastily posted signs practically begging people to head down the easily missed staircase and they even gave out a free lunch coupon that was good only in the Hall G food court thinking that might drive traffic (it didn’t, except to the food court). This might be the year in which I’m convinced that exhibiting isn’t worth the significant cost since booths aren’t any cheaper downstairs. I implore you to bring your miner’s lamp, descend with trepidation into the labyrinth of poorly-numbered booths, and soothe our shattered self-esteem that will be on full display at Booth #11228. We exhibit only to say hi to readers and we don’t really have anything to sell, so I’m trying to convince Lorre that she should offer a new-sponsor bonus of some kind to reward companies that are brave enough to seek us out in the catacombs.

The biggest booths at HIMSS18 in terms of square footage are:

  • IBM (15,400)
  • Cerner (14,200)
  • Epic (10,610)
  • Change Healthcare (9,000)
  • Skipping a zillion more, HIStalk (100)

Things I’ll miss at HIMSS18:

  • MedData’s amazing scones, since Sands Expo Center doesn’t allow baking on the show floor
  • Bistro HIMSS, the moderately-priced, decent-quality buffet where we’ve held our CMIO lunches, since they don’t run it in Las Vegas
  • The chance to breathe air not infused with cigarette smoke
  • HIStalkapalooza

Also note that Daylight Saving Time (I just realized that the first two words should be hyphenated since they form a compound adjective) starts the Sunday morning after the conference.

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Definitive Healthcare lists the top 50 hospitals by annual revenue, in which $2 billion doesn’t even get you into the top 20.

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A Medgadget editorial says the site is struggling financially despite doing the right things journalistically – paying skilled writers, not running obnoxious ads, and not publishing clickbait or time wasting listicles. It blames Google (“an evil monopoly”) and Facebook, which control 70 percent of digital advertising even though they produce no content and use privacy-invading techniques to place ads everywhere you travel on the Web. 

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Microsoft co-founder Paul Allen will invest $125 million to fund Project Alexandria, which will work on AI that exhibits common sense. Possible applications include medical diagnosis.

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A Georgia pediatric cardiologist who admits he allowed a drug company sales rep to use his EHR password to find pediatric patients for the company’s $295,000-per-year specialty drug will get off with probation for the misdemeanor charge of wrongfully disclosing PHI.

CNBC covers the “positive stress” movement embraced by young Silicon Valley tech workers who hope that cryotherapy chambers, hot yoga, fasting, and extreme workouts will allow them to work more hours and/or to live longer.

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A startup’s dating app matches people by assigning a compatibility score based on results of a cheek swab DNA test, the fourth company over several years to try to make a business of shaky science paired with sifting through the social media accounts of users trying to quantify love. I worry about “The Onion” since headlines like these are as goofy as any they could make up.

Apple is working with police near its Elk Grove, CA repair center to figure out why they’ve received 1,600 calls to 911 from phones waiting to be fixed.

My increasing frustration with my PCP’s incompetent office staff and the lack of alternate decent doctors who accept both my insurance and new patients led me to try concierge medicine. I’m delighted with it so far. I get unlimited access to my well-credentialed, mid-career doctor (his practice is solo), appointment scheduling is online, I have his personal cell phone number, he makes house calls when needed, and his panel is just 500 patients. Just about everything is covered in the annual fee: all visits, minor procedures such as wound repair and mole removal, EKG, flu shot, labs drawn right in the office with common labs either free or cheap ($5 for HbA1c or lipid profile), inexpensive imaging ($35 for an X-ray, $225 for a non-contrast CT scan), and he even provides maintenance medications at his wholesale cost — my 90-day supply of blood pressure med cost me $6 with no extra trip to Walgreens. All of that costs just over $500 per year, which is probably even cheaper than co-pays and deductibles. My new patient session lasted nearly 90 minutes as he took a thorough medical and social history and had me sign forms so he could retrieve my medical records from the other practice (assuming the incompetent people over there can find them). I was the only person in the tiny waiting room when I arrived, and when I went back to the exam room, he was waiting for me rather than vice versa. The only aspect of concierge medicine that I don’t understand is the pricing – other similarly credentialed doctors offer pretty much the same services for up to $7,000 per year, so I like to think I’m getting a deal. 

Vince digs through his March 1988 health IT archive with fond memories of the 1988 HMSS conference (that’s not a typo), Meditech winning the color monitor wars, and household names in laboratory information systems such as Antrim, Medizinische, Rubicon, and Hex FF. The big song then was Rick Astley’s “Never Gonna Give You Up,” which is entirely forgettable except for one thing – it later spawned the Internet meme “rickrolling,” a prank in which someone publishes a link to a video claiming to be one thing that instead launches the “Never Gonna Give You Up” video. I think I would prefer the link to launch a ransomware attack.


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Weekender 2/23/18

February 23, 2018 Weekender No Comments

weekender


Weekly News Recap

  • Duke Health earns the first Stage 7 analytics recognition from HIMSS Analytics.
  • Practice Fusion, which is being acquired by Allscripts, abandons its ad-supported free EHR program, announcing that it will start charging each physician user $100 per month.
  • A leaked Nokia memo says that the company sees no way for its digital health business to become significant, less than two years after creating the business by acquiring France-based Withings for $190 million.
  • A JAMA editorial calls for CMS to release Medicare Advantage encounter data.
  • Google researchers publish their work in which they applied deep learning to eye photos to accurately identify cardiac risk factors such as age, gender, smoking status, blood pressure, and likelihood of having a heart attack.
  • Siemens announces that it will take its Siemens Healthineers medical technology business public in the next few months.
  • The House Committee on Veterans’ Affairs grills VA Secretary David Shulkin on the VA’s FY2019 budget request, questioning the project cost and interoperability capabilities of the Cerner system the VA wants to buy.

Best Reader Comments

I’ve been able to really get in and do more work as the CMIO once I understood the company’s mission, vision, and yearly metrics, i.e. executive dashboard. Are they focusing on telehealth this year, pop health, decrease CAUTI, CLABSI, readmissions, etc.? Which one is the darkest red? Be sure to focus some time there. This gets you immediate cred with the execs and the docs if you can deliver something to them into their live environment sooner than later that is easy to use, intuitive, and aligns to the execs’ dashboard. (David Butler)

I’d like to hear more from Ed about his perspective on the current state of professional organizations in terms of their true value and the ability for execs to truly benefit from participating. Beyond local chapters – which by their very nature are limited in breadth of participants – there aren’t many intimate opportunities available. Everything seems to be centered around and in bed with HIMSS. It’s just getting too big and too overtly commercial. Do execs really benefit from these mammoth organizations and infrequent – sometimes only once a year – opportunities for networking and thought leadership development? (SteveS)

Partners will find the savings from their cuts of coders as fool’s gold. There are a lot of hidden costs running an outsourcing development organization. (BeenThere)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. M in Florida, who asked for programmable Bee-Bots and a robot mouse for her K-5 STEM classes. She reports, “My kids love these little bees and mouse. Bee-Bot is fun for all ages, but it’s a great introduction to younger kids for learning how to code. That is what the coding mouse does as well. Both of them are very similar but have the same effect and are a lot of fun for the kids to play with and learn from. Thank you so much for supporting our classroom, believing in STEM education, helping us teachers, and giving the students a hands-on education.”

CNBC notes that Amazon has launched a lineup of 50 private labeled over-the-counter drugs that it calls Basic Care, potentially drawing foot traffic away from drug chains that make most of their money from walk-ins. Amazon sells a 500-table bottle of ibuprofen 200 mg for $7, about the same as Walmart but nearly half off the price charged by CVS, Walgreens, and Rite Aid. Costco’s Kirkland brand – also sold via Amazon as well as in its stores – has the best price I’ve seen at just $10 for 1,000 tablets.

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A review of “Grey’s Anatomy” by trauma surgeons finds that it gives trauma patients an unrealistic expectation of what their stay might look like. TV trauma patients died three times more often than in real life, most went straight from the ED to the OR vs. 25 percent of actual cases, and only a small number of patients transferred to a long-term care facility vs. the real 22 percent. Half of patients left the hospital within a week of serious injury vs. the real-life 20 percent and OR surgeons are often shown not wearing masks and protective eyewear to allow the audience to recognize them. The authors worry that unrealistic patient expectations, fueled by the listing of a medical advisor in the credits, may affect hospital satisfaction scores.They summarize,

American television medical dramas tend to rely on storylines that feature rare diseases, odd presentations of common diseases, fantastic and/or quirky injuries, and mass casualty events, all framed within a ‘realistic’ representation of a typical US hospital. In addition, the dramatic construct of a television serial lend to deviations from reality or accuracy in an effort to preserve the ability to communicate a story within the constraints of a one-hour show.

Maine debates whether veterinarians should be exempt from the state’s prescription monitoring program.

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A reader forwarded this mail-merged bulk email from the marketing person at a cloud services company who forgot to the add personalization to her HIMSS pitch. Not only did she recover brilliantly with a witty follow-up email, I’m impressed with her credentials – she has a PhD in neuroscience and co-founded a company that makes a line of bold-flavored organic sauerkraut (Lemon Ginger, Moroccan Fusion, Vindaloo Curry, and Green Chile). They’re offering Colorado beer (hopefully not Coors) at their HIMSS booth happy hour, although the sauerkraut sounds a lot more interesting.

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The HIMSS conference is just over a week away. The weather in Las Vegas should be OK, with daytime highs in the mid-60s and nighttime lows in the mid-40s with some clouds and little chance of rain. I was happy to find that even though MGM-owned hotels all charge for parking now, the Venetian-Palazzo complex still doesn’t and that even includes valet (which I used every day last time). Lyft is a good alternative – I’ve had better luck with it in Las Vegas than Uber.

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You may recall that after HIMSS18, it’s two straight years in Orlando since HIMSS moved HIMSS19 from Chicago to there, the second time it cancelled McCormick Place (the first time over expensive but indifferent union labor, the second over hotel room rates).

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Since there’s no HIStalkapalooza this year, here’s a nostalgia-inducing video from what’s probably my favorite one of all time, the 2012 version in Las Vegas that was sponsored by ESD. I recognize a bunch of folks in the video. The Palazzo restaurant we held it in closed a year later. What you probably don’t know (I just now remembered myself) is that it was originally booked for a Mexican restaurant also in the Palazzo called Dos Caminos that closed without warning on November 15, 2011 following a rent dispute, but the amazing ESD folks had First Food & Bar locked down just a few days later. I seem to recall that their pear-ginger martini was a hit.


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Weekender 2/16/18

February 16, 2018 Weekender 1 Comment

 

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Weekly News Recap

  • Drug maker Roche pays $1.9 billion to acquire oncology EHR and precision medicine vendor Flatiron Health, started just a few years ago by two guys in their 20s who were backed by Google Ventures (now Alphabet).
  • Nokia will conduct a strategic review of its digital health business, which it formed just two years ago by acquiring connected health hardware vendor for $212 million, after which it wrote down most of the cost.
  • Fitbit acquires app-powered health coaching vendor Twine Health with intentions of moving into chronic care management.
  • HHS’s budget request would cut ONC’s budget from $60 million to $38 million, while HHS OCR would see its budget reduced by 20 percent.
  • The White House’s proposed budget would give the VA an initial $1.2 billion to implement Cerner.
  • The VA says Cerner passed an external interoperability review, with contract signing expected by the end of February.
  • American Academy of Family Physicians gives HHS and ONC a list of specific actions it would like to see to reduce the health IT burdens of clinicians.
  • CPSI takes a $28 million impairment charge due to poor revenue and high development costs of its acquired American HealthTech post-acute care product.

Best Reader Comments

A price comparison tool that is integrated with an e-prescribing tool, ideally within an EHR sounds easy enough, but when I think of the frequent changes of PBM pricing and insurance formularies being integrated and updated in the EHRs, not to mention try to envision the extra time this would take the providers (doctors and/or nurses) to review that and discuss with the patient, I just see more time spent in the visit, not less. I’m trying to imagine my aging parent having that conversation with the doctor. (My Two Cents)

Doctors didn’t spend six years in medical school to learn how to help their patients find the cheapest pharmacy. Of course there should be transparency in pricing. But let’s not waste physicians’ time by putting more administrative work on their plates. (Debtor)

This approach – company running its own health programs — has been tried a dozen times before going back to the 1940s. They’ve even run their own clinics, hired own docs, etc. Doesn’t change much. The real irony is that the problem started when companies gave health care as a fringe bene to avoid wage increases and kept expanding benes year after year. Came back to bite’m hard. The only way a company today can really reduce health care costs is to deny expensive procedures to their employees (using whatever excuse they can come up with…same way HMOs do it). And based on 50 years of experience, I doubt they have the fortitude to do that. (HIS Junkie)

it is much easier for the President/CEO/Board to make high level, structural changes to an organization. Moves like M&A or even divestitures. Those organizational changes can be done over a timeframe of months. Restructuring the internal support systems to reflect the new organizational structure typically takes several years. Not that I’m complaining! Those C-level org changes give you a clear mandate and direction for where your business IT systems need to go. And there’s a deep well of work to be fulfilled in order to get there. However this also means that IT can fall far behind the curve of what the organization needs. (Brian Too)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Mrs. N in New York, who asked for STEM books, supplies, and take-home lab kits for her middle schoolers. She reports, “My students’ faces lit up when I showed them the materials and they could not believe that they would be able to take them home! They wanted to use the materials immediately and could not put the books down. Since the kits are in such high demand, I use a raffle system to distribute them every Friday. Students can keep the kits from Friday to Friday and they will also be used in class on Friday afternoons. This way, more students can benefit from the resources, At the end of the day each Friday, the kits will go home with different students. Thank you for supporting science education outside of the classroom. My students and I are extremely grateful and fortunate to receive funding for our Mobile Science Labs.”

I’ve been overwhelmed with LinkedIn-powered cognitive dissonance lately as I try to reconcile self-stroking descriptions of prior job performance with associated short tenures. Could a person really have driven a gazillion dollars’ worth of new sales, massively improved a product or service, or masterminded the creation of endless synergies, all in a short time? And if so, how did their former employer not collapse completely after the devastating loss of such a key employee? I’m extra suspicious when the follow-up to their lustrous performance was either extended unemployment or independent, non-specific “consulting,” suggesting that their claims aren’t surviving close examination by prospective employers.

This is smart: Wisconsin biohealth industry advocate BioForward awards seven “scholarships” that will help selected Wisconsin health IT companies cover the cost of attending HIMSS18 to make business connections. The winners are Yahara Software, Ancilla Partners, Healthio, Alithias, Spaulding Medical, Wellbe, and Physician Compass.

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A reader ran across a year-old AMIA promotional video, which he or she describes as, “nothing but stock video clips string together almost at random, like it was made by an intern or new graduate hired right into the marketing department who knows nothing about the field of informatics.” It’s tough to try to explain informatics with a video, but this one is really puzzling – watch it with sound off and try to figure out why clips of someone staring at a mountain, flipping book pages in a meeting, and hugging a returning soldier in the airport would add value to the narrative that describes informatics. I blame the ever-increasing tendency of lazy readers to require pictures – even obviously irrelevant or gratuitous ones – before they will begrudgingly read or listen to a few words. Your local TV news is a good example, featuring meaningless video recycled from old stories and talking heads who were hired for looks instead of brains talking “on the scene” in front of a darkened building where a crime occurred 12 hours before.

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Athenahealth’s investor presentation from this week includes a photo of company leadership, raising the obvious question: where de women at? It looks a fraternity’s yearbook photo. They have two females on their 11-member board, but otherwise, it’s all testosterone-powered. Allscripts has one woman on its seven-member executive team and zero of nine on its board. EClinicalWorks doesn’t list its executives. Cerner has two female executives of 10 and two of 10 on its board. Meditech has five females among its 12 executives, clearly a frontrunner in declining to create a no-girls-allowed treehouse. 

The Houston newspaper covers a Walmart program that sends employees who have specific, serious conditions to hospitals such as Memorial Hermann and Johns Hopkins for treatment that the company pays for entirely as a single, bundled payment. Interestingly, 40 percent of those sent to Memorial Hermann turn out to not need the surgery they were told by their local doctor or hospital that they had to have, raising the possibility of widespread inaccurate diagnosis or overtreatment.

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This is exciting and seemingly mostly overlooked. SpaceX’s Falcon 9 launch Saturday will carry two satellites that will allow the company to test the feasibility of offering Starlink global, satellite-powered broadband service. The satellites will be placed in a 300-mile low Earth orbit that allow offering gigabit-level service with latency of only 25 milliseconds vs. the long round trip (600 milliseconds) and thus slow service provided by current Hughes satellites orbiting at 22,000 miles. The Starlink plan, which calls for nearly 12,000 connected satellites, was approved by the FCC this week. Ponder both the business and societal benefit of fast, globally available, and cheap broadband service. It’s especially important, now that the FCC has killed net neutrality, to give consumers broadband alternatives that don’t involve digging up streets to lay cable. 


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Reader Comments

  • Between Two Rocks: This is the main challenge for vendors. Just about everyone will say that there should only be one way to configure some...
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  • Phil Kahn: The comment you printed that "Steve Jobs was a douche" was completely inappropriate! Some people think he changed an in...
  • Michael: Kudos for asking such a difficult question and to the Histalk community for being willing to share- those responses to t...
  • AC: "I asked the doctor’s nurse to fix it, so she changed it to ‘not taking,’ but it was still listed on my portal as ...

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