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Weekender 12/7/18

December 7, 2018 Weekender No Comments

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Weekly News Recap

  • Apple’s Watch 4 OS update includes the ECG app and arrhythmia notification capability.
  • Meditech acquires its London-based partner Centennial Computer Corporation as part of its creation of Meditech UK.
  • A KLAS report finds that most EHR vendors are progressing well toward supporting a national patient record network now that CommonWell is connected to Carequality.
  • In Australia, Queensland Health’s hospital EHR project will run $188 million over budget if implemented in the remaining hospitals.
  • A ProPublica report concludes that three supporters of President Trump had influence over the VA’s $10 billion Cerner contract and got former VA Secretary David Shulkin fired.
  • Allscripts confirms an unstated number of employee layoffs.
  • Athenahealth files shareholder notice of a vote on its proposed acquisition by Veritas Capital and Elliott Management.
  • Connected health technology vendor ResMed will acquire Madison, WI-based Propeller Health for $225 million.
  • Leading UK EHR vendor Emis Group will shift 40 million patient records from its servers onto AWS as part of a continued  push in the UK for more flexible health data exchange.

Best Reader Comments

Interoperability will never be fully solved by creating more regulations and layering on all sorts of requirements on data then making portions of it voluntary. It’s truly a confusing system mired in all sorts of administrative burden and muck with too much conflicting self-interest. There are many models from other countries that work more effectively, have lower mortality rates, less physician burnout. Perhaps instead of spending billions on more regs and administrative burden, maybe step back spend some of that on evaluating effective healthcare delivery models and select one that works. (Renee Broadbent)

Cerner is THE founder of CommonWell and they make it hardest for their customers to implement. Further mucks up DoD and VA plans for interoperability, though they seem to be all talk little action on interoperability anyway. Thank you Athena, EClinical, and Epic for leading the way! (Charlie Harris)

Is the above for real? Who dreams this stuff up? Mixing two disparate protocols for a transaction activity? Lets make this a complex as possible! It is as if they really don’t want organizations implement this functionality so they make the cost of entry as high as possible. (David Coffey)

Dentists are taught in dental school that they are going to be small business owners, and taught how to run a profitable business. Medical schools seem to focus on a world where all doctors stay in academia, instead of the reality that millions of doctors are small business owners. The expectations that dentists have for the successful operations of their dental healthcare businesses drives the advances in their industry. (Julie McGovern)

I am sure the bigwigs and muckity-mucks that come into consulting after losing their comfy jobs make the rest of us look pretty bad and desperate to outsiders, but from my experience (seven years of consulting, running my own little shop, loving it each and every day) there are plenty of opportunities to work, great clients to help, unbelievable experiences to have, and we have a bit more freedom to live a life that supports having a family, raising children, and balancing a life that isn’t just an identity of “I work for [blank company name].” (Consulting Union Needed?)

An ONC Safety Center (which Congress didn’t fund) with peer review and anti-trust protection for IT vendors is the right answer here. Maybe ONC could focus on that instead of dithering around with tefca and “information blocking.” (Charlie Harris)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. G in Utah, who asked for an an Osmo Wonder Kit for her third grade class. She reports, “We have been using the kit during our small group time. The games that came with the kit help the students practice phonics, number sense, math facts, logic, and other important skills. The students beg to get it out and use it, and even want to stay in during recess to play! I love watching them manipulate the tools to get the right answers. The looks on their faces when they get the answers right are priceless! My absolute favorite part, however, is watching them work together as a team to find the answers. They help and encourage one another, and even when someone gets an answer wrong they encourage their classmates with phrases like, ‘Everyone makes mistakes! Let’s try again!’ I never expected the Osmo Genius Kit to have that sort of impact in my classroom.”

Ben and Michelle of ST Advisors always include my DonorsChoose project in their annual charity support. Their generous donation, matched with funds from my anonymous vendor executives and other sources (some with 10-times matching!), fully funded these teacher projects:

  • Robotics tools for Mr. D’s junior high class in Cedar Creek, TX (classroom was affected by Hurricane Harvey)
  • Math and reading centers for Ms. T’s kindergarten class in Oroville, CA (classroom was affected by the Camp Fire)
  • Programmable robots for Mr. A’s grade school class in Bronx, NY
  • 30 sets of headphones for Ms. B’s sixth grade class in Spring, TX (classroom was affected by Hurricane Harvey)
  • Four Chromebooks for Mr. V’s high school class in Bridgeport, CT
  • Math manipulatives for Ms. L’s first grade class in Washington, DC
  • 14 sets of headphones for Ms. H’s high school class in Mesa, AZ
  • 25 sets of headphones and solar system learning tools for Mr. F’s elementary school class in Porter, TX (classroom was affected by Hurricane Harvey)
  • Diversity and multicultural learning activities for Ms. H’s elementary school class in Wellington, KS

I heard back quickly from several of these teachers, including Ms. T, who said, “I was so surprised when I peeked at my email at lunch and read the great news. I wish I had recorded the squeals of joy from my students when I shared the fun that is to come in the mail for them. Your generosity is appreciated. Merry Christmas!”

This research might have been more appropriately released on April 1. A study finds that a parasite found in cat poop is associated with a higher likelihood of entrepreneurial behavior (I would have expected bull manure given the success of some executives). Actually, my theory is this – Toxoplasma gondii is more commonly acquired by consuming contaminated food or water, which would be far more commonly found in countries such as India whose society values entrepreneurial behavior, hard work, and academic achievement more than ours. I love that many US business are created and run by hardworking, well-educated, family-focused people from other countries who in many ways exemplify the American dream better than many native-born citizens whose goals seem to be consuming mindless entertainment, taking advantage of entitlement programs, and ridiculing those who work harder and smarter and are rewarded accordingly.

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I wanted to replace my old, cheap wireless router to make sure I’m using the most current protocols and ran across this fantastic $75 mesh router. I plugged it into the modem, connected to it via its app, entered my desired network name and password, and it was running flawlessly literally within two minutes of opening the box. Setting up a guest network took another 30 seconds (again, just entering a network name and password). The range is excellent, but I had ordered a second one just in case and the only setup required was to plug in the power cord – it instantly connected to the first router and started beaming the signal even further away.

Walgreens partners with FedEx to offer next-day prescription delivery, with same-day service in some cities. 

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Hurricane-damaged Bay Medical Sacred Heart (FL) will lay off 800 employees – half its workforce – when it reopens in January at one-fourth its original size.

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Former MD Anderson CIO Lynn Vogel, PhD publishes “Who Knew? Inside the Complexity of American Health Care.”


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Weekender 11/30/18

November 30, 2018 Weekender No Comments

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Weekly News Recap

  • Amazon will launch a software product for payers that combs through electronic patient records to find incorrect coding or diagnoses in an effort to improve quality and lower cost.
  • The GAO will investigate rumored VA meddling by three political supporters of President Trump who said they “were anointed by the President” as private citizens, and whom some contend influenced the no-bid, $10 billion Cerner contract.
  • Xealth develops software that enables providers to send patients digital recommendations for over-the-counter healthcare products, apps, and services from within their EHR and patient portal.
  • CMS and ONC seek feedback on draft recommendations for reducing regulatory and administrative burdens caused by health IT and EHRs.
  • Unsealed court documents reveal that two Iranian hackers were responsible for SamSam ransomware attacks on 200 organizations in the US and Canada, including Allscripts.
  • CVS Health wraps up its $70 billion acquisition of Aetna, promising to include digital health tools in its “new innovative healthcare model.”

Best Reader Comments

Simply put, PE involvement is one more sign that US health care is first and foremost driven by the pursuit of money rather than promoting the good of our society. (kevin hepler)

Amazon API to mine EHR…to sell ads to medical products
My main issue as an MD is that this sounds VERY sketchy from my standpoint.
The medical record is NOT a place to mine for diagnoses so medical supply companies can send ads to you to purchase their products. Its a super slippery slope and has MANY HIPAA issues. Makes me want to vomit to think all this data entry I am doing is being bought sold and scammed on the patient by the medical industrial complex. (meltoots)

I definitely see the CIO strategic influence reduced, but I think it is more of a reflection of the IT departments in general. As someone trying to push new innovation in this industry, 90% of the conversations stall when the CIO and IT teams engage. The CIO is no longer seen as a champion of innovation, but a roadblock. CIOs need to rise above the vendor pushed roadmaps, go collaborate with their stakeholders, and be a partner in innovation. IMHO (inNOvation)

Setting aside the insanity of the American healthcare system, does the patient expect to be approved for the list and receive a heart (depriving the next person on the list) only to lose it to non-compliance with her immunosuppressive regimen? Transplant drugs can be expensive. The hospital certainly wants to do the transplant. It’s a well compensated procedure along with the bevy of tests that go with it. Spectrum isn’t being cold-hearted, they simply have an approval process that they are following. (Transplant Guy)


Watercooler Talk Tidbits

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Megan Callahan (Change Healthcare) joins Lyft as its first VP of healthcare.

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Motherboard profiles Australian software developer Mark Watkins and the open-source software he has developed for sleep apnea sufferers. Dubbed “SleepyHead,” the software gives patients the ability to hack into their CPAP machines to retrieve typically inaccessible data they can then use to tweak settings. The software has made all the difference for some: “None of the doctors could get my AHI down and none of them seemed particularly concerned about it, to be honest,” says Christy Lynn. I can see the numbers every day on SleepyHead and I can tweak my settings. I cannot tell you enough how different my CPAP experience is with this software. It’s the difference between night and day. I’m possibly alive because it exists.”

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Slate looks at the ethically dubious trend of medical students moonlighting as Instagram influencers/product peddlers. A snippet: “On Instagram, med students already toe the line by advertising for products like protein supplements, which can be high in added sugar and can strain kidney function. It doesn’t take an extraordinary leap of imagination to envision a med student being paid to promote a product on Instagram like Juul—a potentially useful harm reduction tool for smokers but a dangerous recommendation for doctors to make for most people. And for better or worse, the stakes are pretty high—for patients and their health, but also for doctors and their credibility. Many of these influencers, with access already to audiences as large as 60,000 followers and growing, will go on to become the next faces of American medicine.”

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Staff at a South African medical practice are “gobsmacked” when cyclist Shaun Wayne walks in after being attacked while cycling along a popular route in Cape Town. After being transferred to several hospitals, Wayne was stitched up and kept for observation, with no apparent brain damage.

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Brian Foley, a Cerner IT specialist, is arrested for uploading child pornography after a five-month investigation that netted 13 additional criminals in New Jersey.


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Weekender 11/16/18

November 16, 2018 Weekender 1 Comment

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Weekly News Recap

  • The VA tells a House EHR subcommittee that it will need to spend an extra $350 million on top of its $16 billion Cerner budget to hire “subject matter experts to grade the implementation efforts of Cerner”
  • HHS OCR issues an RFI to solicit the public’s views on whether HIPAA rules prevent or discourage providers, payers, and patients from sharing information for care coordination and case management
  • App vendor Driver, whose technology matches cancer patients with clinical trials, runs out of cash and shuts down just two months after its high-profile launch
  • Veritas Capital and Elliott Management subsidiary Evergreen Coast Capital announced their deal to acquire Athenahealth for $5.7 billion
  • Allscripts rebrands its Payer & Life Sciences Division to Veradigm, offering clinical workflow, research, and analytics software and services to providers, payers, and health IT and life sciences companies
  • Alphabet will move its London-based DeepMind healthcare AI subsidiary under the newly formed Google Health, which will be led by former Geisinger CEO David Feinberg

Best Reader Comments

From my own personal experiences being around and using Allscripts products again NONE of their products are remotely close to being seamlessly, fully integrated … With a dwindling client base, very little new sales in US or abroad it is hard to believe anything about this survey and the process used. (DrJay)

The fear for us as a vendor is that when clients are blindly encouraged to take any external survey, there is then a mechanism for that client to overly complain (not recommend) and our total company satisfaction scores actually drop, not rise. Trust me when I confirm, vendors are not relied on for client participation! Obviously the reaction here is about Allscripts because they promoted this single, narrow focused award so much. Cerner, Epic GE, Athena, Meditech etc. all broadly receive many more Black Book awards every year but publicize them far less, or at least the reactions are tamer. (Longtime HIT Marketer)

Biggest winners [in Athenahealth’s sale to Veritas Capital] — eCW, Greenway, and small vendors willing to go after the long tail. Epic, Cerner, and Meditech in the IDN market. Biggest losers — Athena customers, Athena employees, Athena shareholders who don’t sell in the next six months, and Jonathan Bush’s legacy. (Pickin up the pieces)

I’m sure it’s heartwarming to Athenahealth customers that Immelt’s lead-in was “maximize shareholder value.” (sam lawrence)

Blockchain and bitcoin fever is over. Great! No more explaining what this is to executives and others who are worried we are missing the Blockchain Train! (CaveNerd)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. S in Ohio, who asked for a long list of “Rube Goldberg machines” for her fourth-grade gifted and talented class. She reports, “Students were given materials to create their own Goldberg. We started with the marble run and the Angry Birds LEGO set. Students had to explain why certain things would work. Then they were given different supplies and had to put the marble in the cup. My students loved the hands on aspect of this project and they learned a great deal. Thank you for your generous donation to our classroom!”

US exceptionalism of the negative kind is evidenced by schools offering “Stop the Bleed” training so that students can try to save their classmates who have been taken down by a mass shooter. It’s depressing to think of sixth graders screaming “medic” while pinned down by hostile fire like you see in a Vietnam war movie.

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The ED of England’s Northwick Park Hospital pilots using smartphone-dispatched patient transporters (they call them “porters” there), replacing a two-page paper form (!!)

Mayo Clinic will rename its medical school after turnaround consulting firm founder Jay Alix., who has donated $200 million to make the school’s tuition more affordable and to allow it to build technology-focused programs that include artificial intelligence.

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A Salt Lake City newspaper columnist draws heat for gleefully recounting the “night when I beat the system” by skipping out on an ED bill after being examined for an eye problem. She complains that she doesn’t make enough money to afford health insurance but makes too much to earn government subsidies, then describes how she realized that the ED’s computer downtime left them with nothing more than her name, so she and a friend “crouched and ran toward the exit” and hopped a cab home to avoid paying. She then concludes that it’s cheaper to pay out of pocket (she cluelessly assumes the ED bill was probably around $50, puzzling given that she graduated from the London School of Economics) and that “someone should do something about that.” Readers chimed in with fun comments, such as the fact that the real cost of an ED visit makes her a felon, that “cutesy-poo” writing doesn’t hide the fact that she’s a thief, and that she probably wouldn’t behave similarly at a restaurant.

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A woman who had just delivered a baby girl by C-section at Camp Fire-engulfed Adventist Health Feather River is immediately evacuated, after which the ambulance in which she is crammed in with other patients and several hospital clinicians catches fire. The hospital workers, including Tammy Ferguson, RN, who took the photos above, got everybody out and moved the patients to a nearby home, then grabbed garden hoses and shovels to successfully save the house and themselves.


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Weekender 11/9/18

November 9, 2018 Weekender 3 Comments

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Weekly News Recap

  • Google hires Geisinger President and CEO David Feinberg, MD, MBA to develop its healthcare strategy across its business units
  • Bedside patient engagement company GetWellNetwork acquires HealthLoop, a Silicon Valley-based developer of automated messaging for follow-up care
  • A study of EHR-related medication events in pediatric hospitals, of which 18 percent appear to have caused harm, finds system usability as the cause 36 percent of the time
  • Premier announces that it will acquire clinical decision support vendor Stanson Health
  • Microsoft tells users of its HealthVault personal health record that it will shut down Direct messaging on December 27, 2018
  • ResMed announces plans to acquire MatrixCare for $750 million
  • Allscripts says in its earnings call that it will launch a formal sales process for its stake in Netsmart
  • Two nationally prominent articles observe how poorly hospital EHRs handle the end of daylight saving time, as information entered between 1:00 and 2:00 a.m. is deleted when the system clock is set back

Best Reader Comments

I feel for providers and their in baskets. I previously worked for a gigantic HMO with a huge amount of virtual care and no support staff and it really was a second job. I am sure it is similar for other community providers. At my current employer, we definitely struggle with Revenge of the Ancillaries (or perhaps just curse of complying with billing). For imaging orders, providers have to enter a coded diagnosis and a separate field for reason for test. It makes me cringe every time I watch them. (Midwest Fan)

No one gives a rip about who was promoted to chief marketing officer or of human resources of a vendor’s firm. (leftcoaster)

[Replying to leftcoaster] As a chief marketing officer who is also a company founder and key member of our executive team determining strategy, providing input for product development, and working with customers during implementation, I politely suggest you broaden your view of what a marketing leader really does. (Not Just Glossy Ads)

Just recently finished applying for life insurance and part of that was an hours-long review of medical history where they wanted every place I’ve had care in the last five years. Had to sign ROIs and personally work with a few providers to get my medical record. Also had to have a few labs done with no existing conditions to call for it. (YoungBuck)

Cleveland Clinic Florida release of records – they do have that option in Epic but choose not to use it at this point. They absolutely should get on board and modernize. No reason not to (other than maybe it’s more profitable doing what they do, which is sad). (FactCheckPlease)

The “dilution” effect on systems is real. A really terrific small system can easily become a meh larger system, which can become a truly hated enterprise system. Chefs will recognize this as the “too many cooks in the kitchen” syndrome. (Brian Too)

Does no one see the issue with having a orthopedic surgeon work as a dictation scribe where the productivity is 30 min visit = 1 hour scribing? Does India have too many doctors and not enough jobs for doctors? I think lot of providers still have the paternalistic view that they know best because they are the smartest and the wisest at all times, and everything in healthcare should be catered to them. That has always resulted in bad outcomes for the patient in the past, and that sort of attitude needs to be checked. (“Ancillary” Person)

Regarding the reported archaic workarounds for daylight saving time. What is truly archaic is that we are still changing our clocks twice a year! I don’t see an easy way to alleviate this problem in the EHR when accurate, timed entries are critical to patient care and also required. (CaveNerd)

Atul’s concerns about the problem list are entirely the fault of using an insurance system that demands specific diagnosis codes before they will pay for procedures. Maybe, if we didn’t have a ridiculous payment system, we wouldn’t have ridiculous software designed to feed a ridiculous payment system. (ItsThePayorsDummy)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. K in New York, who asked for a document camera (the one they have is shared by four classrooms) and a speaker to replace their broken one so the class can hear the audio portion of videos. She reports, “These supplies went straight from the box to the front of the classroom. Your support transformed our classroom learning environment to where we are now able to hear sound for videos and have students bring work up to have it projected and seen. This has led to more student-led instruction and reflection on their work. By empowering them to use their own work to model through the concepts, give feedback to one another, and be open to how they can be better has been transformational to our classroom culture. Thank you for your continued support!”

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My mention of hospitals still requiring faxes resonated with a reader who works in a large radiology practice. They have HL7 integration and many options for sending results electronically, but they still send 100,000 pages each day by fax. Most interesting is that clients ask them to fax, on average, THREE copies of the same result, which as he concludes,” Yes, we are their copy machine!” I joked that someone should develop a healthcare-only fax integration engine that can parse information from fixed form locations and convert it to HL7-compatible data and he said that’s already been attempted, but was thwarted by low fax image quality and trying to convert handwritten data. The fact that it was even attempted says a lot.

I looked at the records request page of several hospitals and found these consistencies:

  • The patient is expected to know which of several listed health system departments delivered care to them (hospital, clinic, private practice, imaging, etc.) and to complete a form for each. So much for the benefit of being treated by a health “system.”
  • The request forms are often lengthy (several pages) and confusing because they try to cover all situations, such as patients requesting their own records, authorizing someone else to receive their data, or requests by providers rather than patients.
  • Most hospitals require the completed form to be delivered to the HIM department in person, mailed, or faxed. You will immediately understand the consumer challenge in the majority of hospitals where HIM is buried in the basement of the hospital’s busiest building where parking is hard to find and not free (although commendably, some hospitals offer patient drop-off parking spots or free valet parking). Why can’t hospitals offer a service desk in a less-congested area where all patient requests can be handled? Kudos to those hospitals that provide an email address for submitting the form, which works if patients have a scanner at home (none of the hospitals I checked provide a form that can be completed online).
  • The forms often refer to “PHI” as though patients should understand what that means (even when the form indicates what the letters stand for).
  • Requests for billing records are not covered by requests for medical records and are not mentioned on the HIM page.
  • On the plus side, some hospitals gave specific instructions for downloading information from the patient portal, offered the option to receive information via secure email, listed their prices for providing copies of records, listed the legal rights patients have with regard to their records, and gave estimates of how long it would take to receive records (although that ranged from days to many weeks).

California voters reject a proposition that would have capped dialysis profits, a measure opposed by hospitals, doctors, and the two highly profitable national dialysis companies that spent $111 million to squash it.

NIH seeks a contractor to manufacture “marijuana cigarettes” for THC-related studies, also requiring the small business it chooses to provide a placebo for control groups (“nicotine research cigarettes.”)

The SEC files insider trading charges against the airplane mechanic husband of a UnitedHealth Group HR VP who spied on her to obtain confidential merger information. James Hengen is alleged to have made $63,000 in profits by taking positions in two companies that were later acquired by UHG and also tipped off his brother and some co-workers to load up on shares.

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Someone steals a 10-foot-long inflatable colon used by University of Kansas Cancer Center in its “Get Your Rear in Gear” colorectal cancer public education program. In a happy ending, KC police recovered the stolen colon, moved to action by TV colonoscopy queen Katie Couric, who wittily tweeted, “Does anyone know the scope of the crime?” Hopefully, there’s no obstruction of justice. We need to flush out what happened here and get to the BOTTOM of it.” It was returned intact (no semicolon here) although conspiracy theorists question whether the theft was a PR stunt.


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Weekender 11/2/18

November 2, 2018 Weekender No Comments

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Weekly News Recap

  • A ProPublica investigative article questions the VA’s selection of Cerner, its management of the implementation, its choice of questionably experienced project leadership, and the gap between the original lofty goals and the reality of what Cerner is delivering
  • Allscripts and NextGen Healthcare turn in disappointing quarterly results that sent shares sharply down
  • McKesson Chairman and CEO John Hammergren announces his March 2019 retirement
  • Orion Health finalizes the sale of its Rhapsody integration engine to Hg, which will sell and support it as an independent company
  • Seattle-based 98point6 raises $50 million to expand its chat-powered “virtual primary care” unlimited service
  • A report blames Cerner for May 2017 outages at seven Queensland Health hospitals, refuting the Australian health system’s initial claim that the downtime was caused by ransomware
  • Cerner says in its earnings call that its DoD and VA work will drive growth until its population health management business takes off
  • Analysts speculate that IBM’s $34 billion acquisition of Red Hat may signal a Watson wind-down and a return to enterprise software and services
  • Roper Technologies says in its earnings call that revenue of its Sunquest business is trending down due to competitive pressure and that it will be “rebasing” the business

Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. S in Colorado, who asked for a “huge box of math tools and games” (actually 17 items in total) for her elementary school class. She reports, “Thank you so much for sending us such amazing math games. I can honestly say that kids are loving math more than ever. They loved the dice game you sent us called Math Chase. One kid rolls one large dice and then proceeds to roll five other colored dice. They have to use the five other dice to make the number on the large dice. They can use addition, subtraction, multiplication, or division and it requires so much critical thinking. It has been so great to see kids apply the skills we have been learning. Now they can’t wait for math class because they know it will be fun!”

Wired magazine notes that Stanford has enrolled a huge umber of study patients whose heartbeat will be monitored from their Apple Watch, but questions whether screening huge numbers of people who don’t have symptoms will result in better care instead of misdiagnosis, unnecessary testing, and overtreatment. It also notes that Apple will release EKG and irregular rhythm features to the general public before the study is finished.

Memorial Healthcare Systems (FL) markets its telehealth service to South Florida hotels, hoping to recruit visitors and tourists for the $59 service.

Brigham Health uses text-based patient engagement for colonoscopy patients, reminding those who are scheduled for the procedure to complete their prep correctly. The no-show rate has dropped from six percent to four percent, while the number of poorly prepped patients has decreased from 11.5 percent to 3.8 percent.

Female medical students taking Canada’s licensing exam complain about #tampongate, their term for the test’s requirement that feminine hygiene products be declared and inspected upon entry.

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CNN notes the irony that while the man charged with killing 11 people at a Pittsburgh synagogue was screaming “I want to kill all the Jews” in the ambulance and ED, the nurse treating him and the hospital president who stopped by to check on him were both Jewish. Allegheny General Hospital President Jeffrey Cohen, MD — who is a member of the Tree of Life synagogue where the shooting occurred — said, “We don’t ask questions about who they are. We don’t ask questions about their insurance status or whether they can pay. To us, they’re patients.” He added a comment about the alleged shooter: “The gentleman didn’t appear to be a member of the Mensa society. He listens to the noise, he hears the noise, the noise was telling him his people were being slaughtered. He thought it was time to rise up and do something. He’s completely confused.”


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Weekender 10/26/18

October 26, 2018 Weekender No Comments

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Weekly News Recap

  • Nova Scotia’s province-wide EHR selection nears completion, with all vendors except Allscripts and Cerner failing to make the cut in a process that has raised questions about possible bias
  • Clearlake Capital Group will acquire provider management, credentialing, and payer enrollment technology vendor Symplr
  • VC-backed Naya Health, which developed a $1,000 smart breast pump, apparently shuts down after user complaints that its product does not work
  • Vatica Health makes a $1 million bid to acquire the assets of chronic care management company CareSync, which abruptly closed its doors in June
  • Politico reports that Pentagon investigators have found Madigan Army Medical Center’s new Cerner-based MHS Genesis software lacking in effectiveness, suitability, and interoperability
  • Deborah DiSanzo, general manager of IBM Watson Health for the past three years, will step down

Best Reader Comments

What the US has now is elements of several [healthcare] systems, As T.R. Reid described in “The Healing of America; A Global Quest for Better, Cheaper, and Fairer Health Care,” for veterans and their families, we’re Britain or Cuba. For those who receive health insurance through their employer, we’re Germany or France. For people over 65 on Medicare, we’re Canada. For the percent of the population who have no health insurance, the United States is Cambodia. (Wadiego)

Very nice of IBM to allow Deb DeSanzo to keep her job and take a demotion despite her lack of success in turning the corner. I wonder how the thousands of IBM’ers who were laid off at the end of each quarter the past three years when the numbers weren’t good feel about this? (The More Things Change)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Mrs. H in Alabama, who asked for STEM maker kits for her fifth grade class. She reports, “This project has been a lifesaver. My students were so surprised when we received the kits. They were so excited to know they had something that they could actually build by themselves without my instruction. My students are using the K’NEX STEM Education Kits during our science intervention.”

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The US Military Academy uses a robot to co-teach an ethics philosophy course, feeding Bina48 data about wars and philosophy as well as an instructor’s lesson plan to allow it (her?) to deliver a lecture and answer student questions. The AI developers blocked her access to the Internet fearing that, like many students, she would take the lazy way out and simply regurgitate Wikipedia. She has her own Facebook page and completed a “Philosophy of Love” college class a year ago. Developers patched her rather stern countenance into a smile a couple of months ago.

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23andMe CEO Anne Wojcicki says one of the company’s biggest competitors is Gwyneth Paltrow’s Goop — which specializes in wacky products that have zero scientific basis — and fake, clickbait news about health that draws in naive eyeballs. She summarizes Goop’s “faux science,” such as anti-vaccine advocacy, as benefitting from Paltrow’s celebrity in a way that the CDC can’t counter with actual facts. Goop paid civil penalties and offered customer refunds to settle a lawsuit over the company’s promotion of a floral blend to prevent depression and jade vaginal eggs to regulate menstrual cycles.

Analysis finds that eliminating the requirement that all Americans carry health insurance and allowing the sale of policies that don’t cover pre-existing conditions have caused a 16 percent jump in premium cost for exchange-based silver plans. 

Wired takes a contrarian view of Silicon Valley’s obsession with disruption in reviewing three books, noting:

  • Technology’s promise to lead us into the future turned out to be all about those companies – taking our personal data, eating up our time and creativity, and invading our homes and cities
  • They promised an open web and individual liberty while trampling on both
  • They created rising inequality, not because it was inevitable, but because they used old-school capitalism in dodging regulation and squashing competition
  • They squeezed labor markets by hiring obedient, flexible, and poorly paid subcontractors and unofficial workers – many of them immigrants – who are not covered by wage and safety protection
  • Venture capitalists make massive profits by arriving late to the party after companies have already taken risks and developed something innovative
  • Much of the hard work of innovation is accomplished using government grants and research for which taxpayers receive nothing
  • Science-based philanthropy rewards causes favored by tech donors who prefer life-extending technologies for themselves rather than a better healthcare system for all

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A report by Truth in Advertising titled “Cancer Care: The Deceptive Marketing of Hope” finds that cancer centers have exponentially ramped up their advertising in competing for patients, with 90 percent of them using emotion-tugging but deceptive stories in which outliers who survived high-mortality cancer (at least in the short term) imply that the specific cancer center saved them despite poor odds (example: “statistics mean nothing to believers.”) For-profit chain Cancer Treatment Centers of America leads the advertising pack. Following CTCA’s lead are mostly non-profits, which unlike CTCA, are not subject to Federal Trade Commission actions for deceptive advertising. All advertise clinical trials, immunotherapy, and genomic testing that aren’t always effective and carry their own risks.

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Doylestown Hospital (PA) installs a free short story dispenser in its ED, which gives visitors a short read printed on non-toxic, recycled paper that can help them pass the time. It’s a nice thought, although convincing Americans to look away from their phones or ad-filled TV junk shows to actually read something is a tough sell.


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Weekender 10/19/18

October 19, 2018 Weekender No Comments

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Weekly News Recap

  • FDA updates draft guidance on managing cybersecurity issues for the premarket submission of medical devices
  • Digital prescription savings company OptimizeRx acquires interactive patient messaging vendor CareSpeak Communications
  • MIT will spend $1 billion to create an artificial intelligence college
  • Varian Medical acquires Noona Healthcare, whose software captures oncology patient-reported outcomes and supports symptom management
  • Pathology image detection support system vendor Deep Lens announces $3.2 million in seed funding and availability of its free VIPER service for pathologists
  • A judge rejects a bid by former Theranos executives Elizabeth Holmes and Ramesh Balwani to block prosecutors from extending their investigation deeper into the company

Best Reader Comments

The only way to improve things is to get [users]to open up about what’s on their mind. What you get is like an archeological dig where you are sifting and sorting, trying to find the treasures scattered amidst the dirt and rocks. (Brian Too)

I really wish folks would stop referring to the US healthcare “system.” We have a healthcare industry, not a system (unless you’re talking about Medicare or the VA), with competing entities looking for market share. Competitors don’t share information. Also, with the emphasis on reimbursement, preventive care (and pharmaceutical cures vs. treatments) take a back seat. (Kermit)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Mr. V in rural Maine, who requested programmable robots for his student-driven coding class for grades 6-8. He reports, “The robotics and coding materials that you have allowed us to acquire have opened many new avenues for my students. Students have been able to try their hands at coding, program design, and problem solving. This project has offered students who struggle in other content areas like reading by offering them a chance to view reading in an entirely new light. The simplicity of the coding commands in combination with the ability to see their work in action has proven to be very successful in engaging a broad array of students. These materials have allowed students who have struggled in other aspects of their learning to become leaders.”

Epic tells Wisconsin utility regulators that its expected peak demand usage of electricity will double in the next 10 years, placing the company among the state’s top electricity users that are otherwise mostly manufacturing plants. That’s in addition to its extensive use of solar, wind, and geothermal energy.

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A hospital in England installs wall-mounted buttons near its doors that can be pushed by people who notice someone smoking their despite clearly visible “no smoking” signs. The buttons trigger the playing of a recorded announcement over a loudspeaker, with a child’s voice asking them nicely to stop using terms such as, “Someone’s mummy or daddy could be having their treatment today.” A pro-smoking group (who knew?) calls the system “Orwellian” and says a better idea would be to move the smoking area further away, but not so far that less-mobile smokers can’t reach it easily. That sounds great on paper, but as many of us have observed first hand, is a lot harder than it sounds, especially evenings and nights when patients, visitors, and employees are illuminated only by the glow of their cigarettes as darkness encourages them to choose personal convenience over posted rules. I was interested that the BBC announcement referred to “tannoy,” which is apparently like Kleenex having turned a company name (in this case, a loudspeaker manufacturer) into a common noun.

An Atlanta radiologist who made a fortune from his medical device patents is sentenced to six months in prison for a $2 million tax fraud scheme in which he claimed to be a minister who had taken a vow of poverty. Michael Jon Kell, MD made up a church, named himself as pastor, and placed all his assets in church accounts from which he funded vacations, private school tuition for his kids, online dating services, and ownership of his lavish mansion.

In England, the BBC notes that Member of Parliament Dan Poulter is working 28 hours per week at a side job – in his case, as a doctor taking psychiatric training – than any other member. The article also notes that his voting record is among the lowest of Conservative members.

A shoeshine man who worked from the halls of UPMC Children’s Hospital of Pittsburgh died this week at 76, having donated all of his tips since 1982 – over $200,000 — to the hospital’s Free Care Fund.


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Weekender 10/12/18

October 12, 2018 Weekender No Comments

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Weekly News Recap

  • Athenahealth is reportedly choosing from its options to accept acquisition bids from previously rejected suitors, sell out to NThrive, or continue as a going concern
  • Several hospitals evacuate patients and suffer damage from Hurricane Michael
  • The VA promotes Paul Tibbits to executive director for the Office of Electronic Health Record Modernization
  • The DoJ clears CVS Health to proceed with its $69 billion merger with Aetna
  • GE Healthcare’s former Value-Based Care Solutions Group, now owned by Veritas Capital, renames itself Virence Health Technologies
  • Mayo Clinic completes the final go-lives of its $1.5 billion Epic implementation
  • A study of 83 mostly top-rated hospitals finds that patients still struggle to get copies of their medical records

Best Reader Comments

Many states have information blocking (!) from their PDMPs. In fact, many state laws prohibit PDMP data from being exported outside the system to EHRs (it can only be seen in view-only mode on their web browser interface), making use in clinical decision support problematic. It’s not an issue of EHR vendor unwillingness, but rather that they can’t do an implementation if they can’t consistently get the data. (Harry Solomon)

Alerts seem like a perfect opportunity for an AI system rather than manual configuration files that will drive everyone crazy. (rxsdsu)

Tailoring every alert to each clinician requires work and maintenance far beyond the capacity, much less interest, of most IT departments. And, even people who rarely make mistakes still do make mistakes. Having a system that helps prevent that as a safety net is still relevant and helpful. I agree with you that too often a “one size fits all” policy is applied, which is inappropriate.  How much “tuning” can actually be accomplished is a yet to be seen outcome, but I’m not sure it is as much the hospital’s view of physicians as it is the financial and WorkStream reality we currently have. (Michael J. McCoy, MD)

As Warren Buffet has said, “When the tide goes out, it is easy to see who is swimming naked.” Jack Welch was really running a hedge fund within the GE Capital division. It accounted for over 50 percent of corporate profits many years. Everybody thought he was a management genius based on his PR announcements. Turns out he was nothing more than a hedge manager and the tide went out in 2009. He jumped ship and left the ruins to Jeff Immelt, who couldn’t turn it around for whatever reason. Now it looks like GE will follow many other firms like Xerox, Eastman, Alcoa, etc. Many years ago, I worked for GE and the inbreeding was smothering. (HISJunkie)

Totally agree with Mr. H about careers. Each time I was shown the door (boss conflict, downsizing, and failed salesmanship), I fell up to a better job, better pay, and more interesting work. Keep the resume ready, network all the time (it’s fun finding out who is where and what they are doing), keep records of your contacts, and keep reading HIStalk! (Laid Off)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. J-J, who asked for tablets and a printer for her Georgia class (whose 18 students, she notes, include six English language learners and three who are homeless). She reports, “The tablets we received allow students to work independently in small groups on lessons and activities that help to increase learning and comprehension. The printer has also been a huge help because now we can send information about school and additional practice work home to parents without hassle. I am beyond thankful that my class was chosen and was able to benefit from the generous donation that you sent.”

Here’s a summary of how my DonorsChoose project works:

  • I accept donations from individuals, but mostly companies willing to donate a significant sum in return for being included in my HIMSS-related activities, such as CIO/CMIO lunches.
  • Donors place their donation directly with DonorsChoose and thus receive charitable donation documentation directly from that organization for tax purposes. I never touch their money directly.
  • Their donation is matched by an anonymous vendor executive (who pretty much every HIStalk reader knows), doubling the original donation. That will continue until those matching funds are exhausted.
  • I choose STEM-related DonorsChoose projects that resonate strongest with me, most of those involving additional matching money from foundations.
  • I immediately describe on HIStalk the projects I chose, and when I receive updates and photos from the teacher involved, I post a summary. You don’t see them all right away since I run just one update each week, but I include all of them eventually.
  • As an example of the buying power of a donation, the project above totaled $735, which includes $30 to DonorsChoose for doing all the labor and an additional 20 percent general donation to DonorsChoose that I always select. Of that, the matching offer from Arthur M. Blank Family Foundation covered $368, and of the remaining $368, half of that was provided by my anonymous vendor executive. The original donor’s $184 donation thus provided this classroom with six Kids Edition Kindle Fire tablets and a Xerox wireless printer.

A researcher says high-profile cases, such as the Golden State Killer, that were solved through DNA forensics prove that just about every American could be genetically identified if just 2 percent of us have our DNA tested through consumer sites such as MyHeritage and Ancestry.com. Such matching requires only a third-cousin or higher relationship and the authors say that “such database scale is foreseeable for some third-party websites in the near future.” 

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Baylor St. Luke’s Medical Center (TX) threatened to punish an internist in “an assassination” in retaliation for his complaining about unnecessary services his patients received in the ICU. A private practice physician who serves on the hospital’s medical executive committee warned Tomas Rios, MD that “you’ve got to get the guy you’re going after and none of the people who were involved get implicated” and suggested that he resign instead. A hospital committee found Rios in violation of patient care standards just weeks later. The hospital says in response to his lawsuit that Rios is not a board-certified intensivist and opposes the closed ICU process that would place them in charge of all ICU patients, while legal experts have noted that hospitals have in some cases used peer review threats to silence doctors from speaking out about patient care issues.

Five New York City doctors are called “drug dealers in white coats” by the US attorney who has charged them with writing prescriptions for 5 million oxycodone pills to patients with no documented medical need who paid them $5 million. Neighbors called police several times to complain about lines of people at all hours outside of the office of one doctor who had two of his own employees, along with several patients, die of overdoses. Another doctor took in so much cash that he had to count it using one of those bill counters that banks use, after which he would hand out wads of cash to his employees. Another doctor prescribed 12,000 tablets for a single patient over five years. A pharmacist who received free lunches and a trip from a customer observed, “I guess you could call us licensed drug dealers. Oxy pays the bills around here.”

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A Chinese tech site finds that fitness trackers will display a heart rate when wrapped around anything cylindrical, most impressively a roll of toilet paper or the arm of a stuffed animal. Apparently the light sensors that attempt to detect a pulse rate are easily confused by reflections, although they still read a human pulse accurately.

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It’s all in the fine print: a small research study concluding that paper towels are better than air dryers in hospital handwashing was funded by the paper towel lobbying group.


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Weekender 10/5/18

October 5, 2018 Weekender 3 Comments

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Weekly News Recap

  • Cerner announces the partner companies that will serve on its VA EHR modernization team
  • Change Healthcare is reportedly preparing for a 2019 IPO that will value the company at up to $12 billion
  • A new Pew Charitable Trusts report on patient matching offers potential approaches that include unique patient identifiers that incorporate biometrics, placing more onus on the patient through verification via text message, and standardizing data elements
  • GE’s board fires Chairman and CEO John Flannery after just over a year on the job, potentially disrupting the company’s plans to spin off GE Healthcare
  • VA OIG is reviewing last year’s manual cancellation of 250,000 radiology orders across eight hospitals during a push to remove duplicate and outdated requests, raising concern that some of the studies might have been medically necessary or had been entered as future orders that had not expired
  • Orion Health shareholders approve the company’s plan to sell its only profitable division, which offers the Rhapsody integration engine, to a private equity firm that will run it as a private company
  • The former CEO of Singapore’s SingHealth’s IT services organization testifies about its massive data breach that she fired an employee who discovered a security vulnerability in Allscripts Sunrise Clinical Manager after he emailed Epic to suggest using his information competitively, but she didn’t take action on the vulnerability because she assumed Allscripts had already fixed it

Best Reader Comments

I, too vividly remember the rapturous articles, books, and memoirs about GE’s Jack Welch back in the day. Creating a durable corporate culture of high performance, customer service, and as a consequence, superior profitability was supposed to be the magic formula for success. The leader doesn’t matter (as much)! The macroeconomic climate doesn’t matter (as much)! The lines of business don’t matter (as much)! The theory being, good people were attracted to such organizations and all obstacles could thereby be overcome. Culture was supposed to “eat strategy for lunch.” I wonder if the Harvard Business Review has ever published a mea culpa on this or any thesis whatsoever? (Brian Too)

I am a physician and worked briefly for a health IT company whose single-minded focus was on patient safety — at least that is what the slick website said. When you got behind closed doors, the single-minded focus was on money. They rolled out products that internal developers said were not ready for the market. The product was unstable and could harm people. Brilliant management wanted to get updates out so they could boast about their latest product. There is plenty of greed out there. The other term for it is capitalism. For better or worse, that is the system we choose to live in. But if we are going to point out the greed and highly questionable ethics amongst doctors and pharmaceutical companies, lets do the same for health IT as well. (Anon)

Cash-strapped hospitals aren’t the reason that Orion Health went over the cliff. They scaled and bloated the company based on the state HIE market that had no sustainable financial model. Add to that they rarely delivered (because it’s big software = complex implementations) customers started to bail. (Iknowaguy)

There’s nothing described here I haven’t seen countless times before. What would be educational from you and/or someone else contributing to this website would be more reporting from the legal front, specifically cases of, or statistics involving the effect in depositions and trials of the sort of autocomplete/ cut and paste / incorrect voice transcription issues that you describe. Are plaintiffs lawyers actually using these sorts of mistakes to discredit defendants in front of juries, i.e. OK, you admit that’s false, where else in the record were you lying, doctor? (Robert D. Lafsky, MD)

The Epic installation appears to have been immensely profitable for Erlanger. Epic has many features which enable and facilitate upcoding. As a psychologist, I received a cover letter describing the enclosure on one of my shared patients as a “brief progress note.” It was eight pages of legible medical jargon which obfuscated what was done by the clinician. It was comprehensive everything, enabling maximal billing. Is it any wonder that costs of the healthcare system have increased? (Karen Kegman, PhD)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. K in Kansas, who asked for a Little Scholar tablet, fabric letters, a sentence building set, and a Ten-Frame Treasures. She reports, “Thank you so much for providing great learning tools to my students. One of their favorites is the Little Scholar Tablet. My lower students really benefit from having the preschool and kindergarten apps to play and learn from. The students have been able to grab the tablet and get on a game without any help from me. This has been awesome because I don’t have to stop helping students with their worksheets and lessons to help those get on an app.”

A woman shot in the Route 91 Harvest Festival leaves the hospital a year after she was admitted. She underwent 12 surgeries to repair damage to her liver, spleen, and stomach.

Police shoot and kill an ED patient at Orlando Regional Medical Center after he threatens staff, falsely claiming that he had a gun.

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The New Yorker questions why FDA approved the marketing of menstrual cycle tracking app Natural Cycles as “digital birth control” despite its high failure rate in Sweden, supporting studies that were small and funded by the company, and effectiveness that is predicated on users entering their temperatures correctly each day and following a program that differs little from old-school rhythm method paper tracking. Title X changes are expected to roll back ACA rules, moving federal dollars to clinics that don’t offer the most effective birth control options of condoms, hormonal contraception, or IUDs and instead recommend abstinence or fertility tracking such as that supported by Natural Cycles.

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The VA rates nine of its hospitals as the worst in its system, earning a one-star score. Five of those have been cellar-dwellers for three straight years. As is the case with hospitals, the potentially most-beneficial technology tool for patients might be the car or jet that takes them away from:

  • Big Spring, TX
  • Decatur, GA
  • El Paso, TX
  • Loma Linda, CA
  • Memphis, TN
  • Montgomery, AL
  • Phoenix, AZ
  • Tucson, AZ
  • Washington, DC

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Nobel Prize winner Leon Lederman, who created the physics concept of a “God particle” later discovered as the Higgs boson, dies at 96 after being forced to sell his Nobel medal at auction in 2015 to pay for medical bills and nursing home care.

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Iowa insurance agents will start selling less-expensive but unregulated health plans from Iowa Farm Bureau, which can exclude people with pre-existing conditions or charge them higher premiums. Lifetime benefits will be capped at $3 million. The plans go on sale November 1, the same day ACA open enrollment begins, leading to concerns about consumer confusion. The plans aren’t technically insurance – they are not regulated and policyholders have no recourse to protest insurer decisions. The plans look great on paper, at least, and use Wellmark Blue’s HMO network and prescription coverage. A big, lightly-noted hole even beyond pre-existing condition coverage, however, is that policyholders are on the hook for ACA-prohibited balance billing by out-of-network providers, which could be just about anyone you see wearing scrubs in an in-network hospital.

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Axios reporter Bob Herman notes that attending the AMA’s RVS Update Committee (RUC) – whose rules are used to set Medicare’s payment policies – as a journalist requires signing a confidentiality agreement that prohibits all attendees from disclosing potential CPT code changes, anything the committee talks about, and the names of committee members. AMA says the requirement prevents market speculation and the protection of its proprietary information.

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The FBI releases a Physical Fitness Test app for aspiring agents that includes a privacy warning that users “are subject to having all of their activities monitored and recorded.”

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Employees of St. Luke’s Hospital (ID) line the halls leading from the ICU to the OR in the hospital’s traditional, silent “Walk of Respect” that honors an organ-donating patient on their way to having their life support system turned off and their organs harvested.


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Weekender 9/28/18

September 28, 2018 Weekender No Comments

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Weekly News Recap

  • VA Secretary Robert Wilkie tells the Senate VA Committee that he and representatives at the DoD are working to create a “single point of authority” for their respective EHR projects with Cerner
  • CNBC reports that two private equity firms and one strategic buyer have expressed interest in acquiring Athenahealth, but at a per-share price that carries no premium
  • Several provider organizations develop Health Record Request Wizard, an online tool that walks patients through submitting a request to providers for electronic copies of their medical records
  • CenTrak acquires the security solutions assets of Elpas Solutions, which include infant protection, wireless call, staff duress, man down, and wander management
  • Memorial Sloan Kettering Cancer Center leadership defends itself to its employees following reports that it gave for-profit AI startup Paige.AI exclusive access to its 25 million pathology slides in return for an equity stake for itself and several MSKCC executives
  • MITRE partners with Intermountain Healthcare, the American Society of Clinical Oncology, and ASCO’s CancerLinq subsidiary to develop a set of cancer data elements culled from EHRs that will help providers make better treatment decisions at the point of care
  • Ochsner Health System (LA) and LSU Health Shreveport will invest in EHR, digital health, and telemedicine enhancements as part of a new joint operations agreement

Best Reader Comments

The influence of social determinants on community wellness is influencing a surge in community-based coalitions. In support of this recognition, we need predictive analytics, patient monitoring approaches that extend beyond care navigation outreach – including all the author calls out above and more, EHR’s that have real estate for care collaboration along the recovery process, and processes in place that will take in patient provided data so that care teams can make timely decisions on treatment plans. (Lauren McDevitt)

Nice to see folks starting to understand the connection between life in general and the 15 minutes the doctor spends with the patient in the clinic. Creating a network of social services that includes the healthcare system is our only hope. We don’t want to alert the doctor! If your AI is really AI, then the machine should be able to alert the person who can take action. This could be the social worker on the care team, the entity who is holding risk on the patient, the minister, etc. You can’t take all the social services needs and dump them on the clinical team – that will just lead to more disaster. (Lee Blanco)

It was always an incorrect extrapolation to assume that because survival of a subgroup with coronary disease improves with aspirin that everybody’s survival does. You’re not pointing out a failure of evidence-based medicine. You’re pointing out a failure of medicine to follow evidence. (Robert D. Lafsky, MD)

I have to guess that most healthcare provider organizations and related EHR vendors still are not aware that in 2008, PDF became an international, OPEN standard (ISO 32000-1, Document Management – Portable Document Format – PDF 1.7). As such, PDF has been recognized worldwide as the most reliable, flexible, and feature-rich document format for information exchange because it supports and manages any type of file format, including structured data, text, graphics, x-rays, and video that are used in the healthcare industry. However, what saddens me is that for the past 10 years, healthcare provider organizations and related EHR vendors still are not familiar with the attributes of the DYNAMIC format of the PDF document (NOT the static format, with which all users are familiar, including the above user and EHR vendor). This is probably one reason why PDF Healthcare, a 2010 Best Practices Guide (BPG) supplemented by an Implementation Guide (IG) (i.e., PDF-H was never a proposed standard) was never accepted by the healthcare information technology industry. (Woodstock Generation)

I applaud your comment of “doing as doctors often do in shooting the EHR vendor messenger without realizing that it wasn’t them who made the workflow decisions” because this is the primary reason that most EHRs are not as “intuitive” or “usable” as we would like. I have frequently seen that the decision of one person or group has deleterious effect on others using the system. I’ve also seen situations where the vendor will speak up and tell the decision-makers that this would not be a good workflow and the decision remains unchanged. (Paulette Fraser)

This MSK-Paige.AI deal seems to be a case of the a total absence of governance and due process. How such a sweet deal for founders, board, and MSK to profit from slides can pass regulators is unfathomable. (AI-Bot)

The AI/ML companies need someone clinical to provide them their training cases, and the executives mistakenly think the data isn’t worth anything since it’s just “sitting there.” Lots of AI/ML companies are getting away with a treasure trove of valuable data very inexpensively. (DrM)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. B in Mississippi, who asked for telescopes, microscopes, and science experiment kits for her fifth grade Super Scientist project, in which a weekly “Scientist of the Week” takes home resources to complete a project with their family and then reports back to the class. She says, “It has truly been a blessing to teach fifth grade science, and with your help, they can learn so much more at the convenience of their own home. It allows them to share education with their siblings and parents. You can actually see the importance of it and the responsibility they have had with the items from this project. I couldn’t thank you enough and promise you this will bless a child for many years to come.”

An MIT researcher observes that connected home intelligence devices — such as Amazon Echo and Google Home – seem to be offsetting social isolation that is especially problematic among older adults. He notes that half of people 65 and over surveyed in the UK said their main form of company is the TV, concluding,

In the absence of a warm-blooded alternative, even a brief interaction with a “voice” that serves, interacts, and responds every time, all the time, may someday transform our collective perception of AI from that of a simple tool that “does stuff” around the house to a presence that is a real part of our social self.

Spotify adds a custom playlist generator based on DNA test results from Ancestry, making the dubious claim that ethnic heritage drives musical preferences.

Rural hospital operator LifePoint Health proposes that four of its executives divvy up $120 million in golden parachute money upon completion of its $5.9 billion acquisition by RCCH HealthCare Partners.

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In the latest “marketing gone mad” example, Weight Watchers renames itself WW, claiming itself to be a “true partner in wellness” that will embrace wellness-related apps, online communities, and integration with Amazon Alexa and Google Assistant. It should come as no surprise that the announcement was made by the company’s “chief brand officer,” who babbled on about the “new articulation of the WW brand” and a new brand identity that  will “come to life across all brand touchpoints and member experiences” as the company emphasizes its expertise in behavioral science . My alternate interpretation is that Americans don’t want to pay a company to remind them they’re fat, so WW will distance itself from that unforgiving metric and instead lay claim to less objectively punitive “health.” Above is the amazingly creative and daring new logo around which all this hubbub orbits. It should be noted that when asked, the company’s president could not explain what WW stands for, and Adweek panned the new “marque” in saying WW is chasing trends from fear of being disrupted.

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Renaissance man Patrick Soon-Shiong’s NantEnergy (which I hadn’t heard of among all the health-related Nants) says it has developed a low-cost alternative to lithium-ion batteries that has been deployed to several villages and cell tower sites around the world. An expert says “if this is true, it would be great,” but wants to see evidence and a test of how long the batteries will last.

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In Russia, the father of a deceased 25-year-old woman erects a five-foot tall tombstone that resembles her IPhone, crafted by a company that offers” death accessories.”


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Weekender 9/21/18

September 21, 2018 Weekender No Comments

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Weekly News Recap

  • Pathologists at Memorial Sloan Kettering Cancer Center complain that its executives and board members received equity in pathology decision support company Paige.AI after MSKCC gave the company exclusive access to its archive of patient tissue slides
  • Boston Medical Center, Brigham and Women’s Hospital, and Massachusetts General Hospital collectively pay $999,000 to settle patient privacy complaints related to the in-hospital taping of the TV show “Boston Med”
  • Athenahealth shares drop sharply on the news that activist investor Elliott Management will pass on acquiring the company at its previously offered price of $160 per share, citing problems it found during due diligence
  • Waystar announces its acquisition of Connance
  • Aramark sells its Healthcare Technologies business to clinical engineering and asset management company TriMedx for $300 million
  • The impending arrival of Hurricane Florence in the Southeast motivates HIEs to connect their systems, hospitals to offer free virtual visits, and HHS to temporarily waive several HIPAA Privacy Rule requirements

Best Reader Comments

It’s not the one with the best algorithm that wins – it’s the one with the best data. (MLtrainedMD)

I expect we’ll see more unfortunate deals like the Paige one over the next few years as clinical organizations with good reputations cut deals with AI/ML companies. The AI/ML companies need someone clinical to provide them their training cases and the executives mistakenly think the data isn’t worth anything since it’s just “sitting there.” Lots of AI/ML companies are getting away with a treasure trove of valuable data very inexpensively. (DrM)

I think a lot of women exclude themselves from some pursuits early on in life (computers, science, leadership roles, etc.). Therefore they don’t develop those aptitudes, and therefore there just aren’t a lot of qualified women out there to be hired into those roles. (And therefore, when there is a qualified woman, they can be subjected to more skepticism and scrutiny than others.) Some say the solution is to hire by quota. But if there is an insufficient number of qualified female applicants, then that just results in hiring unqualified ones into roles that others may be better qualified for. Which is (a) not fair, and (b) also creates a credibility problem for the hapless woman. And it renders awards / promotions to women in these roles essentially meaningless, even if they were given based on merit (because people will assume they were quota-driven). Not an easy problem. (Clustered)

I’ve taught research methods and sampling methods for 45 years. I’ve written books and articles about research methods etc. KLAS is the example I use of the worst possible false “research” presentations. Only a fool would pay attention to a KLAS rating. It is a means of selling KLAS reports and of favoring vendors who pay for KLAS reports. I’m not saying they intend to deceive, but their design does that. Period. Thus, even if they wanted to be truthful, they can’t be with their research approach. It has no statistical validity. It’s an advertising tool. (Ross Koppel)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. E in Michigan, who asked for a handheld carbon dioxide meter and map printing supplies for the Girls Club air quality mapping project. She reports, “The members of my Girls Club love to do science activities, and taking them home with them to report back was even more exciting. The girls went through and took data for their own homes, businesses, and even the school. It was interesting to see the areas of high and low concentration of carbon dioxide at different places. Some were surprised at the results, especially the levels coming form our school! Thank you for bringing a science project to life that allowed my girls to become real scientists.”

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A new California law requires hospitals to make plant-based meals – as recommended by the AMA and the American College of Cardiology – available to patients.

Italy’s anti-establishment movement gets a law passed that allows parents to attest that their kids have been given 10 mandatory vaccines without providing proof, promoting personal choice in claiming scientific arrogance, drug company influence, and supposed connections to cancer and autism. One group of doctors publicly claims that eating nuts is more effective that vaccines for preventing illness (insert your own nut-related pun here).

California’s private surgery center accreditation agencies, which are paid directly by their surgery center customers, often approve facilities that have been decertified by Medicare; that are being run by medical professionals who have lost their licenses or who were caught practicing outside the scope of their training; or that have high complication or death rates. One of those private accreditors is Joint Commission. In a fun overlap of events, an endoscopy center earned its “widely recognized symbol of quality” the same day state health inspectors declared “immediate jeopardy” when they saw a newly hired receptionist disinfecting endoscopes.

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FDA’s warning letter to a Addison, IL pharmaceutical testing laboratory cites problems with quality control, staff training, unsuitable equipment, and the owner’s operation of a microbrewery in the same space where yeast counts were measured, with FDA dryly noting that “A brewery employee was also preparing beer kegs in this area. In addition, laboratory test media, open beer bottles, and brewing materials were co-mingled within the same refrigerator.” The website of Seery Athlone Brewing touts that its owner – who also owns the lab – has a degree in microbiology and “more than 30 years of experience in fermentation – perfect for brewing!”

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Life insurance company John Hancock will require policyholders to wear activity tracking wearables to earn its discounted premium rate, extending the practice of its Vitality program that offers discounted trackers such as the Apple Watch.  That company found that its policyholders lived 13-21 years longer than average, which instead of implying that using fitness trackers improves health, might instead suggest that those customers were healthier to begin with and agreed to prove it by having Big Brother monitor their exercise levels in return for life insurance discounts.

A  man is admitted to the hospital in critical condition after he and his partner, high on a date rape drug, decide (after what I’m sure was thoughtful deliberation) to boil 15 eggs and insert them into the southern rather than the northern opening of his alimentary tract.


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Weekender 9/14/18

September 14, 2018 Weekender 5 Comments

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Weekly News Recap

  • Cigna invests $250 million in a new corporate venture fund that will target companies working in the areas of care delivery and management, digital health and retail, and insights and analytics.
  • Memorial Sloan Kettering Cancer Center (NY) CMO José Baselga, MD comes under fire (ultimately resigning) after media outlets report he failed to disclose his financial ties to research journals in which he was published.
  • Cerner President Zane Burke announces he will leave the company November 2. John Peterzalek, EVP of worldwide client relationships, will assume Burke’s responsibilities and the title of chief client officer.
  • Former VA Secretary David Shulkin, MD joins Sanford Health (SD) as chief innovation officer.
  • Apple introduces the fourth iteration of the Apple Watch, featuring fall detection and heart monitoring features that include the ability to record ECGs.
  • General Atlantic invests $200 million in new cancer care company OneOncology, which aims to bring the latest in oncology care to patients in community settings using technology from Flatiron Health.

Best Reader Comments

Re: 340b comments. Sounds awfully familiar. Regulatory bodies ask for public comment, then that process is abused via copy/paste comments and identity theft to support corporate positions. At what point do we start prosecuting people for this? (340b)

With Zane out the door as a scapegoat for the first three years of DoD vaporware delivery, who does Cerner send up next to stammer empty assurances to Congress? John Peterzalek? Or does the world finally get to meet Brent Shafer? (Vaporware)

Mediware /Wellsky…marketing runs rampant again! Their PR states: “We stand at the forefront of innovation that will eliminate the fragmentation that exists in health and community care… By integrating its offerings under one brand, WellSky is better positioned to partner with providers and organizations to create and sustain communities that thrive.

Please explain how re-branding under one new name really accomplices product integration for customers when their 30 diverse products hardly talk to one another?? They probably spent big bucks to come up with this new name. Would be better spent on developing code that really integrates their 30 disparate product lines. Whatever you brand it doesn’t matter, Wellsky is still a tornado of flotsam. (HISjunkie)


Watercooler Talk Tidbits

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Researchers uncover a 2016  Amazon patent for a transport system in which a human worker would sit in a metal cage atop a robotic trolley, an engineering design they call “an extraordinary illustration of worker alienation, a stark moment in the relationship between humans and machines.” Amazon reps contend the company has never and will never develop such a system, adding that sometimes even bad ideas get submitted for patents. Given the company’s intensified focus on lowering employee healthcare costs, I can’t help but wonder what sort of ICD-10 codes might be warranted at its future employee clinics by injuries sustained within the hypothetical people-movers.

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Perhaps Amazon should consider installing these on its warehouse floors: EIR Healthcare in Philadelphia starts a “tiny hospital” movement with the development of a prefabricated modular hospital room that comes pre-wired with fall-detecting sensors and a smart TV. CEO Grant Geiger boasts that “it should be the only option worth considering when building new hospital construction from this point forward.”

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The Washington Post looks at the increase in electric scooter-related trips to the ER, interviewing emergency docs in seven cities – all of whom have seen a spike in injuries since shared scooter services became available in their areas. Start-ups like Bird, Lime, and Skip are riding on the coattails of ride-hailing and bike-sharing companies thanks to investments from Uber, Alphabet, and Sequoia Capital. Yet their business practices are being called into question by riders who end up in the ER with severe injuries due to mechanical malfunctions. “Injuries are coming in fast and furious,” says  Scripps Mercy Hospital (CA) Chief of Medical Staff Michael Sise. “It’s just a matter of time before someone is killed. I’m absolutely certain of it.”


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Weekender 9/7/18

September 7, 2018 Weekender No Comments

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Weekly News Recap

  • Athenahealth prepares to take second-round bids as inside sources report that Cerner and UnitedHealthcare have passed on buying the EHR vendor.
  • Theranos tells shareholders it will dissolve and will work to pay off its creditors with remaining cash on hand.
  • Atul Gawande, MD taps former Comcast digital health GM Jack Stoddard to be COO of the still unnamed joint healthcare venture of Amazon, Berkshire Hathaway, and JPMorgan.
  • Verity Health (CA) files for Chapter 11 in an effort to survive the health IT missteps of Patrick Soon-Shiong, MD who acquired the health system in July 2017.
  • Tabula Rasa Healthcare acquires EHR vendor Mediture and its third-party administrative services subsidiary EClusive for $22 million.

Best Reader Comments

Methinks the emperor has donned new clothes ~ Argonaut Project -> Da Vinci Project (Clarence)

The travesty of the new normal known as outpatient procedures begins when the patient shows up at the crack of dawn to begin the process and extends through the point where, barely awake from anesthesia, the patient is thrust from curbside wheelchair onto waiting vehicle having been expected to digest postop instructions just reviewed. . . . Reminds me of medical care in a third world hospital where family provides food, bedding and nursing. (Kevin)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. M in North Carolina, who asked for STEM craft materials related to the Winter Olympics and flexible floor seats. She says, "Students were excited when they opened the boxes and saw all the materials that our classroom received. They wanted to use the flexible seating right away. They also wanted to start on our Olympic projects right away and couldn’t wait until the next today to come to school. We have set up a rotation schedule for students to use the flexible seating. Our next step for using the materials is to create bobsleds that the students can race. We are always creating STEM projects in our classroom that connect to our math and science standards."

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Nestle attempts to pivot from a peddler of sugary treats to the frontrunner in nutritional wellness with its Wellness Ambassador program. Initially rolled out in Japan, participants send pictures of their food via an app that then recommends special supplements and lifestyle adjustments. The program also offers a home DNA and blood testing kit to give users a more in-depth health and wellness workup. Campbell Soup made a similar move when it acquired Habit, a meal delivery service that combines DNA and blood profiles to make dietary recommendations.

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Road warriors beware: Scientists determine that luggage trays at airport security checkpoints harbor more cold viruses than do any other areas within the facility, including toilets. It’s a timely observation given the spate of news this week pertaining to flights with sick passengers. A New York-bound flight from Dubai was quarantined after 100 people on board complained of feeling ill. Public health officials tested all 549 people on board for MERS; none tested positive for the syndrome, though nearly a dozen were sent to the hospital with flu-like symptoms.

CMS mistakenly sends Medicare termination letters to 38,000 Blue Cross and Blue Shield of Minnesota beneficiaries, blaming the mix up on bad data from the health plan.

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IBM is developing a drone that, when paired with a companion app, could monitor a user’s health data to determine if they’d benefit from a cup of coffee, which it would then deliver.


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Weekender 8/31/18

August 31, 2018 Weekender No Comments

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Weekly News Recap

  • The first FDA-approved digital pill will soon be offered to Medicaid patients in certain markets suffering from schizophrenia and bipolar disorder.
  • At Epic UGM, CEO Judy Faulkner sheds more light on the company’s One Virtual System Worldwide initiative, which would give health systems across the globe the ability to share data across a single network.
  • Debt-ridden Verity Health System, acquired by Patrick Soon-Shiong last year, will file bankruptcy in the next few weeks thanks in part to poor health IT decision-making.
  • Harris Computer Systems acquires Iatric Systems, which it will run as an independent business unit.
  • 23andMe will turn off API access to its anonymized data sets, telling developers that they can access company-generated reports but not the underlying data.
  • Two key leaders of the VA’s Cerner implementation have turned in their resignations – Chief Medical Officer Ashwini Zenooz, MD and Chief Health Information Officer Genevieve Morris.

Best Reader Comments

The Politico story about Verity Health and Patrick Soon-Shiong is depressing to read, he drove a stake into the heart of that company. I looked back at my comment after the original sale and did a double take at the date, it only took him a year to bring it down. People need to stop agreeing to work with this guy, he’s a con man. (DrM)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Mrs. H from North Carolina, who asked for a laptop and case for her high school class. She reports, "The laptop you gave my students is helping them in numerous ways. For example, we used it when they were learning about permeability and porosity. They were able to research ideas about what they were observing and then post their results and comments on Google classroom to share with other students. We have also taken the laptop on a recent field trip to an aquarium to post comments and pictures about the student’s new discoveries and unique experiences. We made bottle rockets from recycled 2-liter bottles, then went outside and tested their bottle rockets. At that point, the students also created a live data sheet to record hang time, rocket mass, and general weather conditions. The data sheet was then shared online with the entire class. As a result, no paper or time was wasted and everyone could give positive feedback. Thank you for your generosity in helping my students to use technology in learning and doing real science!"

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Indiana University Health updates its dress code, giving staff the option to display tattoos, sport non-natural hair dye, and even choose their own socks. (Tongue piercings are still verboten.) The hospital decided to make the changes in an effort to encourage employees to be themselves while still maintaining a professional image. “We knew that many of our caregivers had tattoos that they were hiding and that just didn’t feel genuine to us,” says Chief Nurse Executive Michelle Janney, RN. “Actually what we’re saying is use good judgment and we trust you.”  

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Cerner co-founder Cliff Illig and members of the late Cerner co-founder Neal Patterson’s family attend a ribbon-cutting for Neal Patterson Stadium, Oklahoma State University’s renovated soccer venue. Patterson, an OSU graduate, donated $10 million to the stadium’s renovations before he passed away last year. Patterson and Illig seem to be big soccer fans, having bought the Sporting Kansas City football club in 2006.

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In Missouri, Burwood Group Senior Account Executive and cover band lead singer Stephanie Varone experiences a homecoming of sorts when she returns to Kauffman Stadium – home of the Kansas City Royals – to sing the national anthem. Varone first sang the anthem there 31 years ago, and has performed for similar crowds at Wrigley Field and Fenway Park.


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Weekender 8/24/18

August 24, 2018 Weekender No Comments

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Weekly News Recap

  • Medicaid Transformation Project signs up 17 leading health systems to develop solutions to improve the healthcare and social needs of the 75 million Americans who are on Medicaid
  • Employer-focused primary care clinic operator Paladina Health gets a $165 million investment
  • A New Yorker article describes the hostile shareholder attack launched last year on Athenahealth by activist investor Paul Singer’s Elliott Management and the company’s history of using shady tactics to pressure CEOs to cave
  • CNBC reports that primary care group One Medical is discussing a possible $200 million fund raise
  • The VA gives its providers the ability to automatically view the immunization and medication histories of those patients who are also Walgreens pharmacy customers
  • Anthem settles its huge 2015 data breach for $115 million

Best Reader Comments

New generations can learn from pioneers’ and predecessors’ successes and failures, not make same mistakes on new technology. A patient automated post-discharge call system is a part of larger business (financial, clinical, CRM) and technology ecosystems. Technology is key component of effective “solution,” but no more than culture, goals/metrics,org structure, supportive processes / technologies, and right staff (level, role, skills). Payments models are complex and in flux; Medicare and Medicaid future uncertain, human factors play a huge role in these processes. ROI is challenging. (Ann Farrell)

The IT vendors game the system, and with these scores submitted by profit-driven IT vendors, CMS seems to come up with comparative ratings. I’m hoping some sensible person can establish a true and accurate performance evaluation system. I wonder if all this has contained the rate of Medicare spending? (Mipsvendor)


Watercooler Talk Tidbits

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Readers funded the teacher grant request of Ms. F in Florida, who asked for action cameras and storage for her STEM charter school third grade class. She reports, “Thank you for donating to my students’ project. This project was one that they specifically asked me to write. They love taking pictures and videos and even more so they love watching or looking at pictures or videos of themselves and their friends. They were so excited when I told them this project was funded, and even more excited to start using the cameras. It has become a reward in the class to be the class photographer for the day. With this I have started to teach them how to upload their pictures, edit them and publish them. This project is one that will continue to be fun for my students and will be extremely useful for class projects, class field trips, and memories of our time together in class. Thank you for your support!”

A GAO report finds that while the perceived high cost of health insurance turned some consumers away from buying policies on Healthcare.gov, HHS also intentionally reduced the 2018 coverage numbers by slashing advertising by 90 percent, cutting navigator funding by 42 percent, and shortening the enrollment period.

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This week sees a second huge investment in primary care practices – Paladina Health (DaVita’s former employer clinic business that was sold this year for $100 million) raises $165 million for expansion and acquisition. One Medical has raised $350 million and Iora Health has taken in $100 million in investment. The Bloomberg article notes that UnitedHealth Group’s Optum now has at least 30,000 doctors on its payroll, while companies like Walmart and GM are contracting directly with health systems to provide employee health services. 

A New York Times article observes that while FDA requires drug manufacturers to prove that their products are safe and effective, that doesn’t answer the question of how their safety and effectiveness compares to that of similar drugs, which would help prescribers choose more wisely.

Another New York Times article says NYU’s elimination of medical school tuition for all students is noble but misguided, suggesting that the med school should follow the lead of NYU’s own law school in waiving tuition only for those students who commit to lower-paying public service jobs or who practice in underserved areas.

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A Tincture article decries the healthcare expense of erecting billion-dollar hospital buildings such as those of Stanford, Boston Children’s, and the Denver VA hospital. A snip:

It is true that hospitals (excuse me, “health systems”) are diversifying — building/buying satellite locations, freestanding emergency rooms, urgent care centers, and physician practices — but those big buildings remain the locus, and their sunk costs weigh on hospitals’ finances …  What I want to see are images of services being delivered where I am, focused around me, aimed at my convenience — not at the convenience of the people delivering my care … Don’t donate money for hospital expansion / renovation plans. Don’t buy bonds for them, either. Don’t sit passively on hospital boards that push for them or expensive new equipment. Instead, we should be questioning: how can a “hospital” most impact our communities’ health? What kinds of investments in our communities’ health can they be making? How we do push healthcare and health down as close to where and how people live as possible?

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The Boston endocrinologist whose questionable claims that vitamin D deficiency is “pandemic” spawned creation a billion-dollar lab and supplement industry has been paid by companies that sell those products. Just about every other researcher has concluded that Americans get plenty of vitamin D and wouldn’t benefit from supplements or tanning beds.

A contract firm’s security guard is arrested at St. Francis Hospital (TN) after being caught having sex with the corpse of a patient whose body was being prepared for organ harvesting.

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TV news always tries to leave you laughing with a vapid, irrelevant story, so here’s one that’s hilarious yet relevant. A Deloitte survey of C-level executives finds that 74 percent of those in healthcare say their understanding of blockchain technology is “excellent” to “expert.” These are no doubt the same executives who can’t perform even basic laptop tasks unaided, who pay secretaries to print out their emails so they can read them on paper, and who sympathize with hospital departments who send an employee off to Best Buy with a procurement card to buy PC and networking equipment because the IT process isn’t immediately gratifying. Only 39 percent of executives in all industries think blockchain is overhyped and 43 percent say blockchain is among their top five strategic priorities. This is the greatest gift a blockchain snake oil salesperson could ask for – clueless yet overconfident executives anxious to get on a questionable innovation bandwagon despite a complete lack of a business case.


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Weekender 8/17/18

August 17, 2018 Weekender No Comments

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Weekly News Recap

  • Best Buy acquires GreatCall, which offers emergency response services and digital health devices for seniors, for $800 million
  • Alphabet invests $375 million in data- and technology-focused insurance startup Oscar, following participation by two Alphabet subsidiaries in a funding round a few months ago that valued the company at over $3 billion
  • Amazon, Google, IBM, Microsoft, Salesforce, and Oracle pledge to support interoperability at Monday’s Blue Button 2.0 Developer Conference
  • The Wall Street Journal posts another critical review of IBM Watson Health for oncology, saying that “the diagnosis is gloomy” for Watson’s ability to improve cancer treatments.

Best Reader Comments

What do Amazon, Google, IBM, Microsoft, Salesforce, and Oracle have in common? No impact in healthcare interoperability despite multiple attempts. (Fourth Hanson Brother)

How does their “support” of interoperability actually translate into something meaningful? Are they going to somehow put the screws to organizations (both vendors and healthcare groups) who are have a greater incentive to protect their own revenues? (RobLS)

The 10% of reality that isn’t perception trumps the 90% at the most inconvenient times. (LFI Masuka)

Watson for Oncology isn’t an AI that fights cancer, it’s an unproven mechanical turk that represents the guesses of a small group of doctors. (Mechanical Turk)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. C, who asked for LCD writing boards for her Tennessee kindergarten class. She reports, “We have been using our LCD Writing Tablets every day! My students love to use these boards to practice writing sight words, short vowel CVC words, their names, numbers, and so much more. They have eliminated the mess of dry-erase markers and promote student engagement. They allow me to check my students’ answers and work easily, provide corrections, and allow students to make necessary corrections quickly. These boards are currently one of our favorite things in the classroom. Thanks so much!”

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In Spain, a woman who is growing tired of her ED wait (does that make her an impatient patient?) torches the place by igniting an oxygen bottle, requiring the hospital’s evacuation.

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A new University of Vermont Medical Center federal filing is published in the middle of heated negotiations with unionized nurses who are working without a contract, likely to be emboldened by the news that it pays two executives more than $2 million, or 29 times the average RN salary. The health system says what health systems and universities always do when huge salaries are made public – we have to pay competitively compared to other academic medical centers to attract and keep executive talent.

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New York University will make its medical school tuition-free regardless of financial need, hoping that graduates saddled with reduced debt will consider less-lucrative jobs in primary care and research. Students won’t have to pay the medical school’s $55,000 tuition, but they will still need to cover their estimated $29,000 in living expenses. The announcement was made at the med school’s white coat ceremony, drawing a standing ovation since the change takes effect immediately.

A New York hospital requires visitors to show ID to get an ID badge – which contains their photo and destination — printed with invisible ink that disappears after 24 hours. I’m always surprised that hospitals have few visitor-related incidents other than in the ED since visiting hours have been extended, anyone can wander the halls unmolested (except for the nursery), and security guards rarely wander patient floors. I’ve seen visitors fighting with each other and with employees, family members who tried to kill a patient in their bed, and gang or romantic rivals launching beat-downs at the nursing station. I once talked a newly hospitalized patient out of the gun he was waving around in his room, although I’m still not sure why I thought that was a good idea. It was a small hospital without real security guards and I was the only male on the floor at the time, ill-advisedly succumbing to the impulse to help the frightened the nursing staff and hoping that I had accurately characterized the patient as confused but harmless.


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Weekender 8/10/18

August 10, 2018 Weekender No Comments

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Weekly News Recap

  • CMS releases a draft rule that would overhaul the Medicare Share Savings Program
  • UnitedHealth Group is reportedly the only non-financial company that’s in the running to acquire Athenahealth
  • Northwestern Medicine (IL) lays off 60 IT employees after completing its Epic go-live
  • CVS Health adds MinuteClinic-branded virtual consults from Teladoc to its CVS Pharmacy app
  • Doctor appointment booking service Zocdoc postpones its announced pricing changes after practices complain about being charged $35 to $100 for each booked appointment instead of paying just an annual fee
  • Allscripts announces that it will sell its joint venture stake in behavioral technology vendor Netsmart
  • Henry Ford Health (MI) signs its first direct contract with an employer, touting Epic’s MyChart as a patient perk for GM employees

Best Reader Comments

Auto insurance is required in all 50 states, with two limited exceptions: NH, where you are still personally liable for damage done, and VA, which requires you to pay $500 annually if you don’t want to insure. The premise for these laws actually map quite well to healthcare. Imagine without the legal requirement – one person without insurance crashes, damages a building, injures a bunch of people, and ultimately declares bankruptcy to avoid the expense for liability. Everyone else gets to cover the tab. Requiring insurance puts money into the system to spread some of the risk. (Ummmmm)

CommonWell hooks itself up to the rest of the world! Only three years late and still not generally available. (DoD will be first in line once it’s ready, so as to exhibit “leadership,”right?) This is the great golden spike moment for interoperability – except with the Carequality Railroad traversing the entire continent to connect CommonWell San Francisco trolley network. (Vaporware?)

[Project] branding becomes important at this scale. With departmental or smaller implementations, using the vendor/product as a brand isn’t usually a problem. However once you hit “whole organization” level systems, as you do with an organization-wide EMR/EHR, putting a bit of distance between you and the primary vendor becomes important. (Brian Too)

I worked in an organization that had policy of renaming all vendor systems to a name of the organization’s choosing. Although this might seems confusing, it was actually very useful. Many implementations consisted of more than one licensed product so calling it the name of the dominant product wasn’t accurate. It also reinforced the notion that it was our system running our processes for our patients and members. The name was first coined for the initial implementation and stayed with the system through retirement. Our marketing people were definitely involved because the names were thoughtfully chosen and reflected the purpose of the system and the aspirations of the organization for the benefits it would bring. (A Rose By Any Other Name)


Watercooler Talk Tidbits

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Reader donations funded the DonorsChoose teacher grant request of Ms. J in Missouri, who asked for building materials for her classroom of mostly refugee students whose primary language isn’t English. She reports, “This has been an extremely valuable learning tool in the classroom and very motivating for the students. We have done three challenges so far. The one in the pictures was to build a house. It had to have certain components, like a window, a door, some furniture on the inside. When the students finished their creations, they shared about them (first with a partner, then with the whole group). The reason I had them share with a partner first was so they could improve their houses with additional ideas. They really like their remodeling stage. Once we shared out as a whole group, the students wrote about their houses. We have done similar projects with math shapes and animals. The students love it when we get out the Legos. They are excited to hear about the challenge and their discussions of what fits in the expectations and what does not are amazing. Their reasoning is incredible. Thank you for providing these experiences for my students. Their ability to use their language and reasoning to convey their ideas will serve them very will as they move through school. We know that they are learning – even if they just see it as ‘Lego Challenges.’ We are grateful for all you do to support the growth of students — linguistically, socially, and academically.”

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In Germany, neuroscientist and empathy expert Tania Singe, PhD is accused by current and former colleagues of being overly controlling and prone to bullying. They claim she had little empathy of her own, reserving her harshest behavior for pregnant employees — denying moms-to-be parental leave, calling them slackers who would need to work twice as hard to make up for their absence, and telling one who had miscarried that she would no longer be allowed to keep doctor appointments during work hours.

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CNBC gets a first look at augmented reality headset Magic Leap, which has been shrouded in secrecy during its seven years of development and $2.3 billion in investment. The $2,300 developer’s edition is now available and the writer’s experience was mixed, saying it’s pretty cool to view a 3-D world being displayed on untethered goggles, but it’s hard to describe what the device does, there’s no way to show real screenshots since the human brain does the processing, it has limitations with ambient brightness and displaying human-like field of vision, and it will probably take years to get the product ready for mass consumption. Potential medical uses include supporting surgeries and offering chats with an AI-powered image of a doctor, but then again those use cases didn’t save Google Glass. 

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The ambulatory surgery center lobbying group urges members to post positive comments on locally republished copies of a Kaiser Health News article that describes the lax state of ASC regulation. KHN found that state rules vary widely such that oversight of injuries and deaths can be minimal and doctors who have lost their hospital surgical privileges for misconduct are free to open their own surgery centers. One surgery center for colonoscopy had two patients die in the same month during what is normally among the safest of surgical procedures, and in at least 17 states, surgery centers don’t have to report patient deaths. 

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A Pittsburgh local news site’s guest op-ed piece by healthcare transformation organization Lown Institute says UPMC’s planned $2 billion expansion should not be allowed or the health system should be stripped of its non-profit status, observing that UPMC receives $200 million per year in tax breaks but wants to build three high-profit specialty hospitals (cancer, transplant, and heart care) that don’t address local health needs such as obesity, asthma, binge drinking, and health disparities. UPMC wants to market the hospitals to wealthy patients abroad and wants to build two of them in suburbs where the percentage of insured residents is higher. UPMC CEO Jeffrey Romoff says, “UPMC desires to be the Amazon of healthcare.” Romoff was paid $6.9 million in UPMC’s most recently reported fiscal year, joining 32 UPMC executives who earned more than $1 million.

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A New York Times opinion piece written by a hospice nurse and book author says more attention should be paid to the gut feelings of nurses, which she says aren’t really feelings but rather the clinical judgment that results from years of personal observations and experiences. Theresa Brown, RN, PhD notes that doctors generally ignore those feelings as documented in the EHR’s nurse notes. She talks up the Rothman Index, which combines EHR data – including that generated by nurses – to provide an early warning system for detecting at-risk patients. I interviewed co-creator Michael Rothman, PhD way back in 2010, but his comments are even more valid today:

We extract the amount of risk which is inherent in the value of each of these measurements and come up with a single score. Now in a sense, that’s what a doctor or nurse does when they go in. They come up with an overall sense of how the patient is and a good doctor does it well, or a good nurse does it well. But the problem is if a doctor is rushed, a nurse is rushed, how completely can they really evaluate all the data that’s there? Even even more importantly, do they really know how that patient was the day before when maybe this is the first time they’ve ever seen the patient? Getting that trend is very difficult to do, even if you’re a doctor and you’re sitting down and studying what’s in the medical record. It’s hard to figure out what the trend is, especially if it’s a gradual deterioration.

There’s one other thing, and that is, doctors tend to look at three things when they’re doing an evaluation. They look at vital signs, they look at lab tests, and they look at the last doctor’s notes. However, there is a source of information that they tend to overlook, and that is the nurse’s assessments. The nurses do what is called “the head to toe assessment” of the patient. It’s something that’s taught at nursing school. They evaluate each physiological system and they record it on the computer. Really, doctors don’t look at it. One of the things that we’ve done is we’ve said, “Hey, this is actually very valuable information about how someone is.” So we used nursing data in the calculation of our score. It gives the doctor access to something that he doesn’t normally look at.

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Total property values of Madison and Dane County, WI have exceeded that of the city and county of Milwaukee for the first time even though Milwaukee has nearly triple the population of Madison. Dane County’s population grew by 40.7 percent from 1988 to 2017 – largely driven by technology companies such as Epic — while Milwaukee County had just a 1.5 percent increase.

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Bizarre: doctors coin the term “Snapchat dysmorphia” to describe teens who seek plastic surgery to “look better in their selfies” and to make them look like their Snapchat-filtered selves.The JAMA Facial Plastic Surgery article summarizes,

Social media apps such as Snapchat and Facetune are providing a new reality of beauty for today’s society. These apps allow one to alter his or her appearance in an instant and conform to an unrealistic and often unattainable standard of beauty … it can be argued that these apps are making us lose touch with reality because we expect to look perfectly primped and filtered in real life as well. Filtered selfies especially can have harmful effects on adolescents or those with BDD [body dysmorphic disorder] because these groups may more severely internalize this beauty standard.

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Of course hacker conference attendees would quickly figure out how to override a hotel’s thermostat and then tweet out instructions so colleagues can try it at their own hotels. The guy above was asked whether it’s a tampering felony to mess with a hotel’s thermostat, which is says isn’t because it’s an intended feature of the thermostat (as long as the hotel doesn’t make guests sign a EULA before using, he says with nerd tongue in cheek).

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A 2 1/2-year-old toddler leaves Boston Children’s Hospital for the first time, having spent her entire life on a ventilator until she received a double lung transplant in September. It’s a feel-good (no pun intended) story as long as you can suppress your curiosity about what it cost and who paid.


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Reader Comments

  • Jayne HIStalk MD: I don't choose the channel in the physician lounge, I just report what I see. Blame the anesthesiologist with the remote...
  • UVbeen HIStalked: I love the new verb "... you've been HIStalked ..." Whether it's a positive or negative connotation that's for the cont...
  • GenesRFree: Your first sentence points out the problem, "a piece on CNN". Turn that fake news off!!...
  • Frank Poggio: I would file these announcements under...Almost fake news....
  • ErinsDad: Unfortunately, money frequently follows the hype, before the reality sets-in... "Please be advised that on September 12,...
  • Weather Man: The terms “winter weather, “winter weather,” “winter weather advisory, and “winter storm warning,” are defin...
  • Mr. HIStalk: Thanks! You provided my "today I learned" item for the day, and one I will surely remember. I had no idea that meteorolo...
  • Ex-Epic: Semi-angry rant... I was disappointed it ended as soon as it did. The LOINC codes are ridiculous. It's all there ready...
  • THB: It IS a winter storm ... meteorological winter is defined by "weather folks" as the three coldest months of the year ......
  • Robert Lafsky: Semi-angry rant but a good one...

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