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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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Weekender 8/3/18

August 3, 2018 Weekender No Comments

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Weekly News Recap

  • Global Payments will acquire AdvancedMD from Marlin Equity Partners for $700 million
  • Bob Wilhelm (Adreima) joins emergency and urgent care IT vendor T-System as CEO
  • Athenahealth reports Q2 results: revenue up 10 percent, adjusted EPS $1.08 vs. $0.51
  • Meditech reports Q2 results: revenue up 7.1 percent, EPS $0.65 vs. $0.39
  • Cerner reports Q2 results: revenue up 6 percent, adjusted EPS $0.62 vs. $0.61, beating analyst expectations for both
  • HHS OIG fines EClinicalWorks $132,500 for failing to file timely reports of patient safety-related software issues
  • President Trump nominates Marine Corps veteran James Gfrerer to be the VA’s assistant secretary for IT, commonly referred to as its CIO
  • The DoD justifies paying Leidos up to $1.1 billion more for its EHR implementation by mentioning the unstated cost of adding the Coast Guard while redacting the list of “as a service” requirements and their associated costs

Best Reader Comments

We must remember that in the paper or analog days, most clinicians took notes while speaking to patients so that they had a medical record of what transpired during the visit. These notes (SOAP, scribbles, whatever) were retrieved when the patient returned and/or when the clinician revisited the patient (e.g., in the hospital) so that the clinician had a handy memory jogger and/or quick analysis of the patient’s progress, test results, etc. Because the earliest EHRs were based on existing clinician workflows, the EHRs merely copied the paper workflow routines. What’s pitiful is that 40+ years later, the usability factors of the most popular EHRs have not changed, with companies blaming external regulations as the reason entire product rewrites have not occurred to make the EHRs more 21st century (e.g., Facebook-like) and less 20th century, while still storing key information. (Woodstock Generation)

We all knew that was going to be the case. I’ve been on client side where Cerner says, “That wasn’t in the RFP, but for $400k, we can add that in. Gee, thanks.” (Ex-Epic)

I recall launching an evidence-based focused program for a large academic facility, just to learn that the #1 reason we lost out to patients or companies was because the large academic facility on the other side of the same city included a free golf swing analysis. (Katie Goss)

Very insightful. Key insight: provider organizations spent a fortune on an OS, and now they have to go buy apps to get any value out of the effort. (Robert D. Lafsky, MD)


Watercooler Talk Tidbits

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Reader donations funded the teacher grant request of Ms. C in California, who asked for two Kindles for programming her middle school class’s Dash and Dot robots. She reports, “With the new Kindle Fires, my class had only increased their passion for computer science and coding. We have been using our robots daily and integrating it in our curriculum to help them learn from many different perspectives. The students are really excited when they come to school and always ask if we will be coding today or using robots.”

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A CNBC LinkedIn search finds that Apple’s employee health clinic unit called AC Wellness has hired at least 40 people recently, most of them focused on wellness rather than healthcare services delivery. The program is rumored to be led by Sumbul Desai, MD, previously of the Stanford Center for Digital Health.

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A study by non-profit “patent detectives” I-Mak finds that manufacturers of the 12 best-selling drugs in the US have tried to stifle generic competition by filing an average of 71 patents per drug. Each of the top drugs has been on the market for at least 15 years and all but one have gone up in price, with an average hike of 68 percent.

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Walmart announces that it will not renew its contract with price transparency technology vendor Castlight Health, with the news sending CSLT shares down 26 percent and forcing the company to embark on a restructuring and cost-cutting project.

The White House issues a rule that will allow less-expensive, short-term health plans, aka “junk plans,” to be renewed for up to three years versus the previous three months. The plans, which are not required to meet ACA requirements, typically don’t pay for prescriptions, pre-existing conditions, mental health, substance abuse, or maternity and may include low lifetime maximum payouts or tiny daily payments for hospital stays. Minimal coverage also gives insurers a profit margin of 50 percent or more on premiums versus the 20 percent maximum as ACA plans require. Everybody understands both the problem these plans solve (high premiums) and those they create (people won’t understand the coverage limits or will become expensively ill while covered by a plan that offers them little financial help). They also create profound questions:

  • Nobody can afford the cost of major and/or long-term medical care, so is it OK for people to under-buy insurance such that their short-term cost savings require the rest of us to pay their bills – maybe for life — via Medicaid or cost-shifting charity care?
  • Should sicker people to be charged more for insurance or to make them pay a higher portion of their medical bills depending on their risk, the same as most other forms of insurance? What if they can’t afford it?
  • Is it OK to be forced into bankruptcy over medical bills?
  • Americans barely understood health insurance even with the mandated coverage and easy comparisons the ACA introduced, so what small-print secrets will be stuffed into the plan documents they ignore when buying this new “insurance?”
  • Aren’t we really just playing the shell game in allowing providers to charge wildly high prices for health services that provide questionable value while we argue over “who pays” versus “what it costs” in pretending that healthcare is like other services in which smart consumers buy only what they need and shop around for the best price?

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Pediatrician, vaccine expert, and author Paul Offitt, MD says in a new book that scientists need to be able to explain themselves concisely in interviews and on social media to offset the passionate but wrong medical ideas spread by celebrities, activists, and politicians. He notes widespread misconceptions about genetically modified organisms and glutens, suggesting looking at the shelves of Whole Foods to see social denialism at work.

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A 26-year-old woman who swears that her new diet of only beef, salt, and water cured her depression and arthritis solicits online donations and sells Skype consultations to support her “carnivore diet.” She has also given her year-old daughter nothing but breast milk and beef so far.

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Maybe Theranos should have worked on this. A group of four tech-powered pharma anarchists develops plans for a homebrew MicroLab powered by a $30 computer that they’ve programmed to create drugs cheaply, so far allowing anyone to make their own naloxone, HIV drugs, and abortion-inducing drugs. The government and drug companies don’t make it easy for the group to obtain the raw ingredients, so they buy OxyContin from street dealers to modify into naloxone. They explain,

The rhetoric that is espoused by people who defend intellectual property law is that this is theft. If you accept that axiomatically, then by the same logic when you withhold access to lifesaving medication, that’s murder. From a moral standpoint, it’s an imperative to enact theft to prevent murder. So yeah, we are encouraging people to break the law. If you’re going to die and you’re being denied the medicine that can save you, would you rather break the law and live or be a good upstanding citizen and a corpse?

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Apple becomes the first company to achieve $1 trillion in market value, having gone from near-bankruptcy to become the US’s most valuable publicly traded company. Hopefully we won’t see a Y2K-type effect from financial reporting technology firms that didn’t anticipate the need to express market cap to 13 digits.  

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Tech expert and newly appointed New York Times opinion contributor Kara Swisher weighs in on the naivete of inexperienced, closed-culture, California-happy social media technology executives who won’t acknowledge the harm their products cause:

Facebook, as well as Twitter and Google’s YouTube, have become the digital arms dealers of the modern age. All these companies began with a gauzy credo to change the world. But they have done that in ways they did not imagine — by weaponizing pretty much everything that could be weaponized. They have mutated human communication, so that connecting people has too often become about pitting them against one another, and turbocharged that discord to an unprecedented and damaging volume. They have weaponized social media. They have weaponized the First Amendment. They have weaponized civic discourse. And they have weaponized, most of all, politics.


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Weekender 7/27/18

July 27, 2018 Weekender No Comments

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Weekly News Recap

  • CMS proposes site-neutral payments in which hospital-owned practices won’t earn higher rates for billing as a hospital outpatient department
  • Internal IBM documents indicate that Watson Health has made unsafe treatment recommendations
  • The White House reverses its decision to halt ACA risk adjustment payments, citing the need to keep small insurers solvent and participating in the exchange markets
  • The Department of Defense increases its MHS Genesis budget by $1.1 billion to include implementation of Cerner at the US Coast Guard and to add on items that were included in the VA’s Cerner contract
  • The Senate confirms Robert Wilkie as VA secretary
  • England’s new Health Secretary Matt Hancock announces $640 million in additional technology funding
  • LabCorp continues to restore its systems following a July 13 ransomware attack
  • Arizona state records reveal that Banner Health’s poorly managed Epic-to-Cerner conversion at its acquired Tucson facilities caused medical errors and staff frustration

Best Reader Comments

“Healthcare is the only industry that requires its highest-educated, lowest-supply professionals to perform data entry work.” You mean documenting what you do to care for your patients? I can’t think of a single other job where a person doesn’t have to demonstrate, one way or another, that they did their work in order to get a paycheck. (HIT Girl)

So England has gotten over the NPfIT systems implementation failure? At least enough to try something else? (Brian Too)

Maybe its just me, but CMS is completely tone deaf for frontline MDs. This latest salvo of a ‘remedy’ is yet another nightmare. More complex quality reporting, changing the name (AGAIN) to Promoting Interop instead of MU, ACI, etc. Requiring the exact same counting, numerators, denominators, attesting nightmare AND now adding in AUC the CMS answer to pre-auth of MRI CT etc. (Meltoots)

Regarding poll results – thank you for reporting on this even though it is not, strictly speaking, healthcare news. It’s important, both in the realm of politics as well as fly-by-night news stories trumpeting the latest poll results of private companies. Reminds me of the old joke – five out of six surveyed researchers say Russian Roulette is completely safe. (Cosmos)

Re: Epic’s growth is mostly due to its hospital customers acquiring more facilities. While true, one could also argue that their product makes it easier for organizations to consolidate on their platform. (RobLS)

Re: lifestyle information for sale by data brokers. It’s really sad that so many people are so clueless as to how they’re constantly being measured and scored and basically discriminated against. IMO, population health has nothing to do with helping populations, but rather being able to measure and score groups and then drill down to individuals so they can be ‘managed’ for profit. One day there will be a revolt and I suspect it won’t be pretty. (Blocked by Gurus)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. B in Georgia, who asked for tablets, a charging station, and magnetic tiles for her class’s STEAM time. She reports, “It feels like Christmas every time we have new ‘gifts’ brought to our class from DonorsChoose. I am so grateful for supporters like you. You truly understand the struggle that teachers face every day to provide our kids with great education. Technology is so important today and not just for playing video games. Teaching STEAM allows my kids to explore the world in our class. Thank you for being apart of my class and making learning fun.”

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Montefiore Medical Center (NY) suspends a radiology resident pending an investigation after an anonymously written, blog-type article claims he is responsible for white nationalist writings that were published under a different name. The website Medium took down the article because it violated its policy against “doxxing” by including his home address, email, phone number, and links to his social media accounts. Netizens predictably took the article as gospel and rushed to judgment to get the “white supremacist doctor” fired after which Montefiore dutifully distanced themselves from him at least temporarily, raising interesting questions: (a) what if the article is wrong?, and if it is, then (b) who pays for his permanently harmed reputation? or, if it’s accurate, then (c) is it OK to fire someone for their off-the-job beliefs or writings, no matter how repugnant they might be?

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Investigators execute search warrants to obtain the Fitbit data and social media account logins of a missing 20-year-old University of Iowa student, hoping the FBI can find electronic clues to her disappearance.

The New York Times magazine snarkily rips the fake science, elitist aspirational pretensions, and massive but questionably earned profits of Gwyneth Paltrow’s Goop. A snip:

The weirder Goop went, the more its readers rejoiced. And then, of course, the more Goop was criticized: by mainstream doctors with accusations of pseudoscience, by websites like Slate and Jezebel saying it was no longer ludicrous — no, now it was dangerous. And elsewhere people would wonder how Gwyneth Paltrow could try to solve our problems when her life seemed almost comically problem-free. But every time there was a negative story about her or her company, all that did was bring more people to the site — among them those who had similar kinds of questions and couldn’t find help in mainstream medicine … “I can monetize those eyeballs,” she told the students. Goop had learned to do a special kind of dark art: to corral the vitriol of the internet and the ever-present shall we call it cultural ambivalence about G.P. herself and turn them into cash.

A large-scale study finds that one in six Americans have a past-due healthcare bill on their credit report, 11 percent of them at age 27 after losing the option to remain covered by the health insurance of their parents. Medical debt drops at 45 years of age when 30 percent of people carry health insurance.

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Surprise, CA worries about the future of its one-bed hospital that it voted to sell to a 34-year-old private investor from Denver who planned to use it for lab and telemedicine billing from his nutraceutical and lab companies. Beau Gertz hasn’t been around, websites for his businesses have been taken down, four of his former employees say everybody has been laid off, and his office landlord says the space is empty.

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Cincinnati’s Shriners Hospital for Children, which treats only pediatric burns, says its future is uncertain since such burns are increasingly uncommon and outpatient treatment reduces the need for inpatient beds.

In Netherlands, the medical complaints board reprimands a doctor who asked the family of a nursing home resident with dementia to hold her down so he could administer a euthanasia IV drip after she refused to drink the sedative-containing coffee that was supposed to have been given first. Dutch law allows anyone over 75 years of age to participate in assisted suicide, but legal questions remain when the person’s mental status is unstable.

An opinion piece written by two doctors says that physicians aren’t experiencing “burnout” (PTSD-like symptoms of exhaustion and cynicism that suggest a failure of resilience) but rather “moral injury,” the lack of ability to deliver high-quality care as trained because of the health system’s patient-marginalizing requirements. They say,

In an increasingly business-oriented and profit-driven health care environment, physicians must consider a multitude of factors other than their patients’ best interests when deciding on treatment. Financial considerations — of hospitals, health care systems, insurers, patients, and sometimes of the physician himself or herself — lead to conflicts of interest. Electronic health records, which distract from patient encounters and fragment care but which are extraordinarily effective at tracking productivity and other business metrics, overwhelm busy physicians with tasks unrelated to providing outstanding face-to-face interactions. The constant specter of litigation drives physicians to over-test, over-read, and over-react to results — at times actively harming patients to avoid lawsuits.

Patient satisfaction scores and provider rating and review sites can give patients more information about choosing a physician, a hospital, or a health care system. But they can also silence physicians from providing necessary but unwelcome advice to patients, and can lead to over-treatment to keep some patients satisfied. Business practices may drive providers to refer patients within their own systems, even knowing that doing so will delay care or that their equipment or staffing is sub-optimal.

Mom-recorded video of a dad dancing to celebrate the discharge of his 15-month-old son from Children’s Hospital of Philadelphia after a 32-day stay for Down syndrome and leukemia lights up the Internet. Says father Kennith Thomas of Merchantville, NJ, “Don’t every look at a situation and think the worst. I want people to look at their situation and flip it and change the perspective.”


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Weekender 7/20/18

July 20, 2018 Weekender No Comments

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Weekly News Recap

  • A survey finds that both consumers and physicians recognize the benefits of virtual care, but few consumers have experienced it and few doctors offer it
  • Tenet Healthcare considers selling its Conifer Health Solutions business for up to $2 billion
  • LabCorp shuts down its nationwide computer network when it detects that a hacker has penetrated it and is trying to access patient records
  • Draft CMS rule changes would make major changes to physician billing, the Quality Payments Program, EHR design in supporting simpler billing requirements, and telehealth coverage
  • The VA creates a committee to oversee its Cerner implement that will be led by ONC Principal Deputy National Coordinator Genevieve Morris

Best Reader Comments

No one is commenting on the CMS announcement, I suppose because no believes they are serious, or capable of executing any part of this grand plan. (DZAMD)

As a former CFO at a university medical center, a ROI of $190m that requires a $180m investment is a no-brainer — that is the people moving ahead with it have no brains! Any project as large and complex as this has at least a 90 percent probability of being 20 percent (or more) over budget. Nor did I see a contingency allowance in the budget which would allow for any mistakes. Given that, I would need to see at least a 50 percent ROI before moving ahead. Good luck UW, you’ll need it. (HISJunkie)

The communication director for BJC needs a communication director for her own messaging. You START the public statement about how bad you feel for the people whose lives you just turned upside down. You don’t bury that sentiment after two lengthy paragraphs about “market forces.” This should be a PR no-brainer in today’s hyper-sensitive environment for businesses who face these tough decisions. (AreUKiddingMe?)

“If I were a CareSync investor.” Apparently CareSync got millions from a local county development fund. That makes the county taxpayers the investors. Good luck to them recouping any money. (Blocked by Gurus)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. B, whose classroom is in “one of the most dangerous cities in America” in New Jersey, as she describes it. She asked for puzzles, books, and STEM supplies for her after-school program in which students remain on campus until 6:00 p.m. She reports, “My students were so excited when our After School Fun box arrived! Thank you again for your continued support to our school and specifically my classroom. My students come from a city that will not define their future and it is because of donors like you that make them see the possibility this world has for them!”

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Telehealth vendor Dictum Health’s Virtual Exam Room and VER-Medic are featured in Discovery Channel’s new show “Sharkwrecked,” where paramedics used it to monitor the health of participants at the show’s shooting location in the Bahamas. Producers blew up a boat in the ocean, then left two men floating with sharks for two days to see what happens in simulating a real-life (yet rather far-fetched) situation. Just in case anything in Shark Week sounds like actual science, the network eliminated all doubt by featuring budget-friendly, D-list celebrities like Ronda Rousey and the massive Shaquille O’Neal, whose fear-overcoming shark dive might well trigger tsunami warnings.

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Something I learned about the Chrome browser today after months of pondering instead of simply Googling: yellow lines stacked in the scroll bar show where the most recent search term appears on the page. Remove the search term from the search box and they go away, but otherwise you can scroll to one of the lines and then you’ll see your search term highlighted in yellow in the page text.

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A woman is charged with breaking into Westmoreland Hospital (PA) on two occasions to steal soda, once by guessing the ICU door’s access code to enter its conference room, from which she left with a backpack full of drinks. The woman says she regrets her arrest since it might impact her ability to return to her paralegal studies, explaining, “I was thirsty, and it was really late at night, and there are no convenience stores really in my neighborhood. I just thought I’d get some soda. I didn’t think it was this big deal.”

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British Airways responds to a customer’s tweeted complaint by asking him to provide his personal information “to comply with GDPR,” which the dimwitted customer (among others) does by tweeting it right back at the company and to the world. A security expert baffled at why the company would try to solve problems on Twitter instead of asking the customer to call in. He also notes that British Airways allows customers to check in online only if they disable their browser’s ad blockers, after which it sends their information to many third parties.

In England, a 63-year-old NHS doctor who is upset about his pension investment losses sends messages to his financial advisor threatening to kill himself, then uses a “hire-an-assassin” site on the dark web to order the advisor killed. The National Crime Agency detected his activity while investigating the Chechen Mob’s site, finding that the doctor had chosen the first of four predefined options: kill the man, beat him, set his car on fire, or set his house on fire. The doctor entered the advisor’s address but didn’t pay the $5,000 fee, leading him to plead not guilty of attempting to solicit murder.

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Catholic Health Initiatives collaborates with AHA and Mass General to develop a set of IICD-10 codes that allow providers to document sex and labor exploitation.

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I’m not sure if this is an Amazon success or failure, but the company’s website was so busy in the first few minutes of  this week’s Prime Day that its servers bogged down, forcing IT staff to deploy a stripped-down home page and to shut off international access. The company’s auto-scaling feature apparently also failed, requiring manual server spin-up and the need for “looking at scavenging hardware.” Prime Video was slowed, Alexa experienced outages, and warehouse employees weren’t able to prepare orders. Experts say that Amazon may have a bug in its auto-scaling service, but they nevertheless marvel that all of the Amazon sites remained up despite unprecedented volume. The company’s Sable computational and storage system processed 64 million requests per second under last year’s less-busy Prime Day.

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The 63-year-old chief of cardiothoracic surgery at Jersey City Medical Center (NJ) is commissioned as a US Navy Reserve commander after receiving an age waiver for his in-demand skill. Tyrone Krause, MD, who was sworn in by his Navy ensign daughter, said, “Why don’t I just relax and sit in my back yard and drink some beer? But that’s not my style. I’ve always been on the move. And hopefully I’ll always be on the move.”


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Weekender 7/13/18

July 13, 2018 Weekender No Comments

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Weekly News Recap

  • Facebook fixes security holes that allowed third parties to harvest the names and email addresses of people who signed up for its private groups, triggered by a breast cancer group’s concern
  • A new KLAS report covering non-US EHR activity finds that Epic doubled its relatively small market share in 2017, InterSystems continued its rapid growth, and Cerner experienced moderate activity
  • Cerner partners with and takes a $266 million equity position in value-based care operator Lumeris
  • AdvancedMD acquires competitor NueMD
  • England’s health secretary Jeremy Hunt takes the foreign secretary job vacated by Boris Johnson, with the country’s culture secretary taking over as health secretary in a major government shakeup

Best Reader Comments

The biggest challenge to telemedicine is the lack of insurance coverage. Medicare (which also sets the rules for most commercial payers) has a very limit set of originating sites (locations where the patient can be during the visit). The AMA is scared to death of how this technology could negatively affect their urban/ suburban member’s pocketbooks. (Former Community CIO)

Don’t forget one independent assessment [of University of Washington Medicine’s plan to move to a single EHR] was done showed no benefits after 10 years. If you don’t think part of new savings comes from staff, you haven’t read the notes. We lost millions of dollars last year and staff reduction is the plan to fix the problem. (JoblessInSeattle)

$190M in benefits on a $180M project seems pretty convenient. How much staff are they [UW Medicine] cutting? Are these numbers real? (EpicITStaffer)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. Z in New York City, who asked for a solar bag and solar beads for a STEAM project. She reports, “Exploring solar energy concepts can be challenging. With the materials that have been provided by this grant, my students explored new concepts, conducted hands-on activities, and had a great time learning. Students focused on solar energy, which is the most abundant renewable energy source. We conducted our investigations outside in our schoolyard. Students constructed necklaces and bracelets using the solar beads and were truly amazed by the color changing reaction by the sun. We also used the solar balloons which flew like hot air balloons, except we used the sun’s energy as the heat source. Thanks again!”

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A jury orders Johnson & Johnson to pay $4.7 billion in damages to 22 women who sued the company for failing to warn them that its baby powder increases the risk of ovarian cancer because it may contain asbestos. The company says it will appeal, as it has successfully done in several similar lawsuits, and complains that the women were allowed to sue in Missouri even though most of them don’t live in that state.

HIMSS recaps its well-received HIMSS18 session titled “Boston Strong: Lessons Learned from the Boston Marathon Bombing” by former Boston Police Department Chief Daniel Linskey.

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Boston Children’s Hospital achieves near-miraculous recoveries by infusing mitochondria from a patient’s healthy tissue into their ischemia-damaged hearts or lungs. The experimental procedure is credited with saving the live of Avery Gagnon (pictured above), whose post-open heart surgery ischemia was immediately resolved, allowing her to be taken off ECMO. Researchers say the procedure’s low risk make it potentially useful in every major heart surgery as well as in treating other organs and diseases.

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A Texas couple whose six-year-old daughter requires around-the-clock medical care due to a chromosomal disorder considers divorcing to qualify the child for Medicaid as they are overwhelmed by $15,000 in annual out-of-pocket medical costs on top of expensive insurance premiums on a family income totaling $40,000.

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Bristol-Myers Squibb Children’s Hospital (that a hospital would be named after a drug company tells you a lot about US healthcare) rehomes the 16-foot-tall statue of Geoffrey the Giraffe that had stood in front of the former headquarters of the defunct Toys R Us.

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A Memphis woman sues her dermatologist after he greeted her during her visit with, “Hi, Aunt Jemima,” which he later admitted to reporters was a “misspoken blunder.”

This former Iowa Methodist Medical Center pharmacy technician is clever (maybe unintentionally so) in his apology to hospital patients whose injectable narcotics he swapped out with sterile water so he could use them himself — “I’m sorry for the pain I caused them.” The lawyer for several patients who are suing the hospital over the incident added his own possibly unintentional humor in declaring, “He hurt a lot of people.” The former tech will ache for his 30 months in federal prison to pass quickly.

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A man is charged with using the identity of a New Jersey doctor to bill an insurance company for $1 million in medical services using a made-up practice name and an empty, unlocked office’s address. United Healthcare paid him $46,000 before a woman noticed that her insurance was being billed for services she hadn’t received.

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California dermatologist Sandra Lee, MD – whose pimple-popping videos have earned her 3.9 million YouTube subscribers, a just-premiered TV series, and the sobriquet Dr. Pimple Popper – launches an Operation-like board game titled Pimple Pete whose objective is to extract the most fake zits. Life must be good in America if millions of people have time to be entertained by pimple videos and doctors who were trained as healers at great taxpayer expense can make a career of creating them.

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Bizarre: Michael Jackson’s former doctor – ex-cardiologist and now ex-convict Conrad Murray, who served time for accidentally killing the singer by injecting him with propofol for insomnia in 2009 – claims Jackson’s just-died father Joe chemically castrated MJ as a pre-teen so his voice wouldn’t change.


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Weekender 7/6/18

July 6, 2018 Weekender 1 Comment

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Weekly News Recap

  • England’s NHS announces December 2018 availability of a new app that will allow all citizens to book doctor appointments, order prescription refills, manage chronic conditions, and make calls to its 111 non-emergency medical helpline
  • AMIA publishes the inaugural issue of its Gold Open Access journal that will showcase the best informatics research and applications
  • UK-based private equity firm Hg will buy Orion Health’s Rhapsody healthcare integration technology business and 25 percent of its population health unit
  • Rock Health’s midyear funding review says digital health investments are growing and are attracting more experienced investors, but IPO activity is down as companies remain privately held longer
  • CNBC reports on “why telemedicine has been such a bust so far”
  • T-System President and CEO Roger Davis resigns

Best Reader Comments

For those of us out in the field working with telehealth and its various service lines, we know it is a success. Children and adults are getting the care they desperately need but cannot access, stroke victims live normal lives and when tragedy strikes, and you find yourself in the ICU it is telemedicine that helps get home quicker. Telehealth and telemedicine isn’t a narrow service for treating common complaints and sniffly noses as the writer only references. (Michelle Hager)

A significant problem that I’ve encountered is that many smaller practices and physicians don’t make plans for what they will do with their paper records when they retire. Regulations vary from state to state, but they are often responsible for maintaining and providing access to patient records for 10 years from the last patient visit and i some cases up to 25 years or more for minor patients. Storing large volumes of paper records for that amount of time is fraught with risk and expense and the records may outlive the physician and become a burden for his or her family. (Greg Mennegar)

Our company provides, as an employee benefit, Dr. on Demand for a $5 payment. It’s been excellent and especially helpful as a first step to determine whether an in-person visit is necessary. They don’t just triage — in many cases, they also diagnose and prescribe, which is a great saving of time and money for us. (Judy Volker)

I don’t know if I’d call the DoD question to Zane a zinger. Kind of “oversight 101.” The response was brilliant in a way, since you can’t perjure yourself if you never answer the question. (Ex Epic)


Watercooler Talk Tidbits

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Ms. S reports from North Carolina on the document camera and screen capacitance pens we provided for her second grade class per her DonorsChoose teacher grant request: “The document camera is such a simple yet versatile learning tool, but unfortunately with budget cuts, the math department is not allotted any. This is such a great gift. While the pictures might not have the normal wow factor that most project pictures do, please rest assured that this piece of technology is making a difference in my students’ lives. The ability to see what math skill I am demonstrating on a larger screen is much easier than trying to have all of the kids crowd around me as they try to see. Surprisingly, the styli are a crowd pleaser. They truly love that little added something.”

The Wall Street Journal chides itself for occasionally using clickbait-type headlines, providing lessons for all writers to avoid writing headlines that:

  • Try to sound mysterious
  • Promise readers a secret they will learn only if they click
  • Ask a question, especially one that the article itself may not answer
  • Do not match the tone of the story or that don’t assure readers that the story contains the promised details

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A Science report finds that drug companies are paying after-the-fact compensation to members of FDA’s advisory committees who recommend whether a drug should be approved, with members who passed initial conflict of interest checks being rewarded afterward with jobs, research grants, and speaking roles. A majority of review committee doctors received at least $10,000 from a drug company whose product they approved, with seven of them earning more than $1 million.

Tennessee’s attorney general unseals details about the state’s lawsuit against OxyContin manufacturer Purdue Pharma, which contains details such as:

  • 80 percent of the company’s OxyContin business came from repeat users
  • Purdue kept hard-selling doctors who were known to be diverting drugs out of state or whose licenses were restricted due to overprescribing
  • The company was warned about overdoses, muggings outside a pharmacy linked to a particular doctor, a high-prescribing clinic that had no medical equipment, a doctor’s waiting room overseen by an armed guard, practices whose parking lots were filled with cars with out-of-state plates, and standing room only waiting rooms.
  • Tennessee prescribers ordered 104 million tablets of OxyContin from 2008 to 2017, the majority of them for high doses.

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Researchers using MRI confirm our male suspicions that wearing a tie (especially one that is tightly tied with a stylish Windsor knot) restricts blood flow to the brain, which might explain why some of the dimmest people imaginable hold jobs that require their wear. It’s fun to question commonly accepted standards – why should men have to drape decorative cloth around their necks to project sincerity and authority? My observation is that for small to medium companies, guys who wear ties work for guys who do not – I’ve been to investor pitch-a-thons and you could easily tell who had money versus who needed it because the former were dressed like they just left a satisfying lunch at Golden Corral.

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Apple celebrates the tenth birthday of its App Store and the impact it has had on developers, mobile-first businesses, gaming, in-app purchases, streaming, and health and wellness.

The author of a biography of martial arts movie star Bruce Lee – who died mysteriously 45 years ago – speculates that he was killed by heatstroke after dubbing dialog for “Enter the Dragon” in a studio whose noisy air conditioning had to be turned off, compounded by the recent removal of his armpit sweat glands to prevent on-screen sweating.


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Weekender 6/29/18

June 29, 2018 Weekender 6 Comments

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Weekly News Recap

  • Amazon announces that it will acquire mail order pharmacy PillPack for a rumored $1 billion in cash
  • Cerner settles an unpaid overtime employee class action lawsuit for $4.5 million
  • The VA says it will bring three sites live on Cerner by 2020
  • GE announces that it will spin off its GE Healthcare business into a standalone company
  • A GAO report finds that the VA was spending $1 billion per year on VistA, but needs to consider how to replace the nearly 50 percent of VistA applications that don’t have a Cerner counterpart
  • Outcome Health’s two co-founders leave its board following their previous departure as executives amidst fraud claims by investors
  • Details of CareSync’s closure indicate that a planned acquisition fell through, leaving the company in such dire straits that it sent 292 employees home and closed its doors for good
  • Qualcomm seeks a buyer for a majority stake in its Qualcomm Life subsidiary, which includes the 2net remote patient monitoring system and Capsule medical device integration platform
  • Allscripts reportedly is offering voluntary retirement to a large number of employees

Best Reader Comments

My spouse has worked at several start ups (non-HIT). It’s amazing how quickly you turn from invaluable employee with critical deadlines to “sorry, you have an hour to clean out desk.” And how easy it is to put your head down to do all the work demanded of you, and then forget to poke your head up often to get the lay of the land. I would always ask, do you see lots of suits crawling around the office?” And before every hatchet, yup, sudden influx of suits in C-level area. (TXY)

Is anyone else alarmed that only 50 percent of the VistA applications will be replaced by Cerner? What “modernization” and “standardization” effort is that going to take so that there aren’t 20 versions of the same points of integration? It is a complex socio-technical environment. This needs to be done well for those who have served the United States of America. (Art_Vandelay)

Don’t expect any major changes for GE’s Healthcare business and strategy in the short-term; the unit was pretty self sufficient in terms of business operations and has had a fairly major cull, “trimming the fat” already. The bigger issue might be the split of cross-division research and development initiatives (big data analytics, IoT), harming competitiveness in the mid term. (Plucky_Brit)

As unfortunate as this is, I think what goes unmentioned is the inherent risk that comes with working at a startup. Having worked for three, I can tell you that nothing, and I mean NOTHING, that happens regarding financing, strategic partnerships, or anything related to funding is guaranteed when you are working for a startup. Is it OK to be optimistic? Absolutely. Is it OK to get excited about your prospects when you hope the company is bought out or sold in the future and you have the options to cash in your chips? 100 percent. My point is that it’s easy to become complacent, and as the CareSync case points out, the proverbial rug can be yanked at any time no matter how rosy things may seem. (John Trader)

The JAMA article which suggests that “HHS should consider creating and enforcing penalties for failure to release all relevant clinical information to treating clinicians in a timely fashion” is a terrible idea. While I agree that HIPAA both by design and by misinterpretation can cause harm I don’t think more legislation is going to fix anything. HHS has implemented a set of often vaguely written regulations for which they fine organizations heavily if they fail to implement properly. Thus, they have created the “better safe than sorry” mentality that seems to be standard operating procedure at many covered entities these days. Creating the type of penalties described would likely be a “damned if you do, damned if you don’t” scenario. (Mike Cottle)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Mr. M, who asked for math activities for his Significant Support Needs elementary school students in Colorado. He reports, “The students were ecstatic when they opened the boxes for the first time! We have already put the new tools to use. Our students are on such a variety of levels, these materials allow us to modify for each student’s ability. Using them in our small group instruction during math is the primary use. They are always allowed to use them during recess. They love the game portion of the materials. We as teachers, love the learning portion! Our student will continue learning and growing with wonderful donors as yourself. Without you, we would not be able to have such wonderful materials in our Significant Support Needs classroom.”

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Kansas City University of Medicine and Biosciences breaks ground on a $33 million simulation center that will use virtual reality and haptic (touch) technology to train its medical students. A Mayo Clinic doctor agrees that simulation is beneficial in keeping up skills, but says low-cost, low-tech versions – Mayo has residents practicing on homebrew patients made of rubber hoses and cardboard that cost as little as $5 – work just as well or better and will be the wave of the future.

Technology companies in China are hoping to cash in on the country’s $1 trillion annual healthcare spending by developing systems that can ease the bottlenecks caused by its vast doctor shortage, especially in remote areas. Among them: ambulance routing, allocating doctors by expected demand, medical image analysis, virtual visits, and Internet-only hospitals that could manage patients and sell prescriptions online.

A JAMA-published study finds that Medicare-insured seniors were in 2015 less likely to die in hospitals instead of their homes compared to 2000. It also notes that while 29 percent spent time in the ICU in their final 30 days, that percentage has leveled off. Hospice use by dying patient increased from 22 percent to more than 50 percent.

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The NFL denies the request of its only player-doctor — Kansas City Chiefs guard Laurent Duvernay-Tardif, MD – to append “MD” to his name on the back of his jersey.

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I am certain that Weird News Andy never sausage a challenge in researching just the right ICD-10 code for this story. A Philadelphia Phillies baseball fan is injured when the team mascot accidentally shoots her in the face with a duct tape-wrapped hot dog blasted into the crowd from a mobile launcher. She urges fans to pay attention to what’s happening on the field even between innings, but isn’t planning to sue for her tubesteak trauma.


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Weekender 6/22/18

June 22, 2018 Weekender No Comments

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Weekly News Recap

  • CareSync closes without warning amid rumors that the sale of the company fell through
  • McKesson is among the rumored potential acquirers of prescription discount coupon site GoodRx, which could fetch up to $3 billion
  • Surgeon, professor, and journalist Atul Gawande, MD is named CEO of the new healthcare venture of Amazon, Berkshire Hathaway, and JPMorgan Chase
  • House lawmakers will create an oversight subcommittee to monitor the VA’s $10 billion Cerner implementation
  • Quest Analytics acquires BetterDoctor
  • Verscend will acquire healthcare payments vendor Cotiviti for $4.9 billion
  • Walmart patents a system for storing a patient’s vital medical information in blockchain database housed in a wearable device
  • A judge rules that MD Anderson Cancer Center (TX) must pay $4.3 million in penalties for HIPAA violations stemming from three data breaches and non-compliance in following up with device encryption
  • The US Attorney indicts Theranos founder and CEO Elizabeth Holmes and former President and COO Sunny Balwani for fraud
  • IBM Watson Health executives tell employees that the company will scale back its hospital pay-for-performance tools business

Best Reader Comments

A few weeks ago our CEO bought some branded bike jerseys for those of us participating in a fundraiser. The jerseys are pretty sharp looking and fit well so I’ve been wearing mine frequently. It has definitely been in the back of my mind that I’m wearing a billboard and any perceived misbehavior of mine could look bad for the company. (RobLS)

The issue is not them documenting “not taking.” The issue is that the “not taking” doesn’t remain and I have to say I’m not taking the med every at every visit. Can you imagine if you’d been on an EHR for 70+ years and have to now rattle off 100 different medications that you’re not taking since you were born? Still think it’s a good design decision and patient to blame? (AC)

I hear so many complaints about how EHRs are ruining the practice of medicine by requiring doctors click this and that to document that they’ve reviewed medications, acknowledged allergies, etc. and I have to ask: what were you doing before? (HIT Girl)

What diligence process did Walgreens use to vet Theranos? They were actually marketing this stuff to their customers. I have personally been at VC retreats where Walgreens was proudly preening themselves about their Theranos partnership and the VCs were fawning all over them. (Charlie Harris)

It was so clear to me [about suicide] that this was a medical problem as obvious and in need of treatment as much as if he’d had a bad kidneys or heart disease; his brain was not functioning the way it was supposed to. Unfortunately the country he lived in was (and is) notorious for their total failure in the mental health department, and what should have been an emergency inpatient admission with immediate intervention became his wife, his daughters, his sister, and friends doing everything they could to keep him alive until he could be seen by a doctor. He was failed, and his family was failed. (HIT Girl)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose grant request of Ms. T in Texas, who asked for a STEM bundle for her kindergarten class. She reports, “Besides sparking creativity in the classroom, the STEM activities help the students dig deeper and use higher order thinking skills to create different things. These items donated have greatly impacted some of our children that have special needs and behavioral issues. For those students with behavioral issues, these items have helped the student stay focused during Center time and shown the teachers those children’s creative side. It has help those special needs students by allowing them to tinker with the items and also keep them engaged during Center time. The teachers in Room 1 greatly appreciate your generosity in donating to our classroom.”

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Healthcare billionaire Patrick Soon-Shiong closes his $500 million acquisition of the Lost Angeles Times, San Diego Union-Tribune, and several community newspapers from Tronc. Tronc, the former Tribune Publishing, has also announced that it will revert to its old name following the ongoing ridicule since its 2016 rebranding that attempted to make the company seem more contemporary, a name that major shareholder Soon-Shiong had called “silly.” The Tronc name was advocated by former chairman Michael Ferro, who has since resigned following sexual harassment allegations. He was also chairman of Merge Healthcare, sold to IBM for $1 billion in 2015.

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The closure of CareSync is big news considering the company had raised at least $50 million and had announced rosy hiring projections. Here’s a timeline:

  • February 2008 – Travis Bond sells his EHR and physician practice services vendor Bond Technologies to MediNotes, which acquired by Eclipsys for $45 million a few months later
  • September 2011 – Bond forms CareSync to obtain and manage the medical records of patients
  • July 2014 – co-founder Florida State Rep. Jamie Grant is cleared of ethics violations involving his alleged use of $2.5 million of county economic development grants to fund his startup LifeSync Technologies, which created CareSync
  • October 2014 – raises $4.25 million
  • February 2015 – adds services to help practices collect payments under what would later become CMS’s Chronic Care Management program
  • October 2015 – raises $18 million
  • January 2016 – joins Athenahealth’s More Disruption Please program
  • February 2016 – fills three new VP positions
  • December 2016 – moves its office to a 51,000 square foot building in the Tampa area and announces that it will hire 350 employees in the next year, increasing headcount to 500
  • January 2017 – fills four new executive positions
  • June 2018 – the sale of the company falls through and all employees are ordered to leave the premises immediately, apparently with no severance pay or COBRA insurance option

The New York Post observes that companies are selling their private jets, noting that the announcement by GE and Athenahealth preceded the dismissal of their chief executives.

Intel forces CEO and board chair Brian Krzanich out for violating the company’s non-fraternization policy by having a relationship  with another Intel employee.

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IBM touts its AI technology by having its Project Debater challenge two experienced debaters, perhaps trying to rekindle interest from its “Jeopardy” glory days as Watson Health has achieved little since. Project Debater argued in favor of telemedicine, saying with humorous intent that it believes in the power of technology, while the human debaters said that telemedicine doesn’t offer the hands-on power of a doctor or nurse.

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Reaction to the hiring of Atul Gawande, MD as CEO of the non-profit healthcare project of Amazon, Berkshire Hathaway, and JPMorgan is mixed. Some experts noting his vision, story-telling abilities, and past criticism of the healthcare system, while others question his lack of experience in running a large enterprise and his plans to continue working as chairman of Ariadne Labs, surgeon, and New York Times author. Said one, “It starts to feel fundamentally unserious if you’re not hiring a full-time CEO. If you’re transforming healthcare, you’re reshaping the economy of Germany, effectively. It’s not a part-time gig.”


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Weekender 6/15/18

June 15, 2018 Weekender No Comments

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Weekly News Recap

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

Best Reader Comments

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

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

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

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


Watercooler Talk Tidbits

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

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

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

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

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

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

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


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Weekender 6/8/18

June 8, 2018 Weekender No Comments

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Weekly News Recap

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

Best Reader Comments

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

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

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

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

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


Watercooler Talk Tidbits

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

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

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

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

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

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

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

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

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


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Weekender 6/1/18

June 1, 2018 Weekender 1 Comment

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Weekly News Recap

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

Best Reader Comments

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

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

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

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

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

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


Watercooler Talk Tidbits

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

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

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

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

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

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

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

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

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Weekender 5/25/18

May 25, 2018 Weekender 1 Comment

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Weekly News Recap

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

Best Reader Comments

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

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

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

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

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


Watercooler Talk Tidbits

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

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

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

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

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

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

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

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

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

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

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


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Weekender 5/18/18

May 18, 2018 Weekender No Comments

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Weekly News Recap

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

Best Reader Comments

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

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

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

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

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

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

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


Watercooler Talk Tidbits

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

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

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

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

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

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

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


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Weekender 5/11/18

May 11, 2018 Weekender 5 Comments

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Weekly News Recap

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

Best Reader Comments

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

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

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

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

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

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

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


Watercooler Talk Tidbits

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

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

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

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

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

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

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

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

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

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


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Weekender 5/4/18

May 4, 2018 Weekender 2 Comments

weekender


Weekly News Recap

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

Best Reader Comments

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

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

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


Watercooler Talk Tidbits

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

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

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

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

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


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Weekender 4/27/18

April 27, 2018 Weekender 4 Comments

weekender


Weekly News Recap

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

Best Reader Comments

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

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

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

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


Watercooler Talk Tidbits

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

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

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

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

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It’s all about perspective.


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Reader Comments

  • Guy respondoing: Re: post-discharge contact. We were working with a vendor who said they would contact discharged patients via an automat...
  • A-M: Regarding the proposed Medicare fee schedule changes, have you heard anything from commercial insurances to suggest they...
  • Mr. HIStalk: Honestly, I haven't written a mailing address for so long that I don't really remember (ever since I discovered the bene...
  • Robert D. Lafsky M.D.: RE: EST vs. EDT Speaking of rules nobody knows, I'm wondering how you yourself format city, state and zip when you writ...
  • RobLS: RE: Fourth Hanson Brother Exactly what I was thinking. How does their "support" of interoperability actually transla...
  • Vaporware?: Why was facebook not invited? They've been very successful in acquiring and synthesizing all sorts of disparate data....
  • dza md: re: med students skipping class. IMHO, and speaking generally, an in-person lecture may benefit an audio learner but ...
  • Fourth Hanson Brother: What do Amazon, Google, IBM, Microsoft, Salesforce, and Oracle have in common? No impact in healthcare interoperability ...
  • Chris: NYP still uses Allscripts. I admit that I am an Allscripts employee but I must say that NYP has used my teams experience...
  • AndyWiesenthal: Where to start on your question about the value of medical education? First, while mastery of content is important, and...

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