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Weekender 4/3/20

April 3, 2020 Weekender 1 Comment

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Weekly News Recap

  • HHS and CMS issue a long list of waivers and rules that relax limitations on telehealth billing, off-premise hospital services, PA/NP/CRNA supervision, COVID-19 testing, and sharing of patient information by business associates.
  • Microsoft warns hospitals about VPN vulnerabilities that may attract ransomware hackers.
  • FCC allocates $200 million to help providers buy telehealth equipment and services.
  • CereCore lays off employees as its parent, HCA Healthcare, implements COVID-related expense cuts.
  • The Department of Defense pauses its MHS Genesis Cerner implementation to focus on COVID-19.
  • HHS asks hospitals to share COVID-19 testing data and to send bed capacity and supply inventory information to CDC via emailed worksheets.
  • Apple develops a COVID-19 screening website and app in partnership with the federal government.

Best Reader Comments

10+ years after the HITECH act, countless billions of dollars being invested into EHRs, and endless hype about information exchanges, the government solution right now is to have everyone send VPOTUS a spreadsheet. (Low-Tech Act)

The dysfunction and regulatory ridiculousness of our health care system is laid out in perfect form when you look at all of the items CMS must DEREGULATE in an health care emergency — with the only interpretation being that more are completely unnecessary burdens on the physicians and other health professionals working day in and day out to treat patients. Absolute absurdity all around. (Regulatory Overreach)

If even a small portion of these comments [from HIMSS20 exhibitors] are true and come to fruition – and I agree overall – HIMSS will be greatly diminished. I wonder how many people HIMSS have laid off? And whether leaders are taking a haircut? Or will they cut and run? Sorta sucks that many of us – myself sort of included, but here I am – hesitate to share our true feelings for fear of being blacklisted, lose points, have the powers that be think poorly on our comments, etc. HLTH Forum in October WILL BE the canary in the coal mine for healthcare events in 2020. (ShimCode)

I think the way to be prepared for a once-every-100-year event is not by maintaining a large, expensive, and underutilized permanent bed capacity, but having detailed plans and the necessary supplies/materials to expand temporarily in an emergency. In spite of clear history and warnings from epidemiologists, we don’t seem to have done a very good job preparing for this eventuality at the organization, state, or national level. I’m not saying the challenges aren’t herculean, just that they should not have come as a surprise. (Surprised surprised)


Watercooler Talk Tidbits

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Readers funded the Donors Choose teach grant request of Ms. H in Maryland, who asked for STEAM lab equipment for her class. She reported a few weeks ago, “The additions to our classroom were a surprise to our students. I waited until it was time to go home to display them. The looks on their faces were PRICELESS! I told them to write their questions on paper and being them to me the next day. I allowed students in groups of four to demonstrate how to use each activity in front of the rest of their peers. Each one of these have become a regular part of our day. For example, during our past Fun Friday Lab, I constructed an obstacle course for students to build and navigate the robot through. There were three rules to this Lab. 1) you must work with a partner, 2) you cannot use your hands or feet at any time while operating the Robot, and 3) When assisting with navigation, you must use directional words (left, right, forward, backward etc.). As you can see in the pictures, this is their favorite activity. This week we are adding the robot with the Twister mat to practice coding algorithms.”

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The National Bobblehead Hall of Fame and Museum is accepting $25 pre-orders for a version featuring the federal government’s Anthony Fauci, MD, with $5 of each sale being donated to the American Hospital Association.

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The $3.5 million Philadelphia home of private equity tycoon Joel Freedman, owner of shuttered Hahnemann Hospital, is vandalized after the city’s mayor accused him of demanding an excessive price to reopen the facility to increase COVID-19 patient capacity. Freedman bought the money-losing, safety net hospital for $170 million in early 2018, then closed it and filed bankruptcy for the hospital business while splitting off the land to develop condos.

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Montefiore Medical Center (NY) insists that the New York Yankees ponchos it included in bags of personal protective equipment for clinical staff were gifts, disputing the statements of employees who said they were told to wear them as PPE.

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FDNY thanks employees of hard-hit Elmhurst Hospital during shift change. BBC News profiled “the young doctors being asked to play God” at the hospital, which called nine codes in a single 12-hour shift on Wednesday, of which none of the COVID-19 patients survived.

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Meanwhile, zealots are using #filmyourhospital to offer video proof that the lack of ambulances and foot traffic outside hospitals means that coronavirus is a media hoax, a psychological operation, an excuse to implement martial law, or the first step toward imposition of digital currency to create “one world order.” Some of the filmers chased hospital and ambulance employees down the street to demand an explanation for the scam.

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A good Samaritan in Detroit uses $900 of his savings to offer free gas for nurses at Detroit Medical Center.


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Weekender 3/27/20

March 27, 2020 Weekender No Comments

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Weekly News Recap

  • UC San Diego Health publishes a description of Epic enhancements it created to address COVID-19, including tools for screening, ordering, secure messaging, and support for video visits.
  • Scripps Research launches a wearables study that hopes to identify viral illnesses more quickly.
  • Several organizations form the COVID-19 Healthcare Coalition, a data-driven effort to address coronavirus challenges.
  • CMS offers exceptions and extensions for MIPS and MSSP.
  • HIMSS announces that it will not offer refunds or credits to exhibitors and sponsors of the cancelled HIMSS20.
  • The HCI Group begins hiring up to 600 people to staff its COVID-19 telephone triage service for hospitals.
  • Thoma Bravo calls off discussions related to selling Imprivata for up to $2 billion, citing market volatility.
  • UK Prime Minister Boris Johnson meets with technology and healthcare startups to ask them for help in addressing coronavirus.

Best Reader Comments

New York hospital bed shortage? For over 40 years, the State of NY and many other states have beaten hospitals up via a payment system that pushed / punished them to close beds. (FLPoggio)

It’s always been understood that HIMSS was a vehicle for vendors to interact with prospects and clients. But they have aligned their focus on leveraging all HIMSS community members to realize the greatest revenue they can, and by way of their recent investments, they have continued to focus on media, conferences, and other marketing ventures, combined with their lucrative lobbying business. I believe that it is time for “reset” for HIMSS and even CHIME, which I was also a member of and also I’ve allowed my membership to lapse. The vendors provide the greatest percentage of revenue to HIMSS and they need to demand more. I believe this year provides vendors to determine if they are getting value out of HIMSS and I suggest they collaborate or work in a unified manner to make HIMSS serve them better. HIMSS needs you more than you need them. (HIMSS Insider)

I’m on a copious number of healthcare groups on Linkedin and it’s almost sickening how everyone is trying to get brand recognition from the crisis. Some have real things to offer, like a free year’s licensing to virtual visit module, but most seemed to be forced to use the crisis as a way of saying “we get it” and/or “we get it, and btw, think of us when you buy.” I understand. If I were a software exec at a virtual VP meeting, I would feel pressure to tell the marketing folks to come up with a C19 message and get it out there. Not so fast, though – everyone else is doing the same and you will look like a C19 make-money pile-on. (Dave S.)

One message I’d really like to get out is that a lot of us in healthcare, even administrative, do not have time for 30-60 minute webinars. So many people are working from home right now and have all the time in the world, so they aren’t realizing that many of us actually have LESS free time because we’re trying to navigate healthcare rules which are changing at least once daily. Please please please use your time to put together fact sheets with important information we can use, and make them as brief and to the point as possible. (A-M)


Watercooler Talk Tidbits

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Readers funded the Donors Choose project of Ms. B in Arizona, who asked for programmable robots for her gifted middle school class. She reports, “My students are being helped by the Ozobot coding robots because they have to use collaboration in tandem with critical thinking skills. The most exciting thing about the product is that they can code the robot to go on any path they can imagine. There is a lot of trial and error but it provides the students the opportunity to fail forward. The cool thing about this technology is it is accessible to all of my students, especially my girls. No one was intimidated by the idea of coding, instead they opened up the boxes and got down to work!”

Phelps Health (MO) asks Missouri University of Science and Technology to help address an expected shortage of caregiver masks and face shields. The few students remaining on campus set up a 3D printer farm that can run 24 hours per day. Students on the design team who worked since fall on now-cancelled design competition entries say they are energized to be performing positive, meaningful work.

Another shortage in New York: foster dogs, as applications from stay-at-home workers surge 10-fold. Rescue organizations are happy for the fostering help, but worry that joblessness will increase the number of pets that are surrendered.

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The FBI kills a Missouri extremist in a shoot-out that followed a sting operation in which the man hoped to buy a vehicle packed with explosives and use it to bomb a local hospital for treating patients with COVID-19, which he believed to be a Jewish plot.

A Kentucky hospital lays off 300 employees, 25% of its workforce, due to declines in non-COVID-19 business.

Airbnb hosts are evicting traveling healthcare workers in fearing they will bring the coronavirus into their homes. One Las Vegas landlord demanded that her ED nurse tenant vacate the premises within 24 hours as a “choice I’m making to protect myself,” then threatened to seize all of her belongings if she refused to leave. Healthcare workers in India, England, and Japan have reported being harassed and threatened, while hospitals in Australia warn nurses not to wear their scrubs in public after some were spat on or refused entry into stores.

A hospital nurse quits due to lack of personal protective equipment, warning that other frontline workers may resign after watching friends being put on ventilators or dying and then realizing they could be exposing their own families. Meanwhile, a Tennessee doctor says the state health department suggested using diapers and swimming goggles if PPE isn’t available.

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A California ICU doctor who treats COVID-19 patients moves into a tent in his garage to prevent exposing his family to coronavirus, urging everybody to stay home as he “voluntarily became homeless to protect my family.” 

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Time to dust off those orthopedist jokes. Hospital police officers arrest UConn Health orthopedic surgeon Cory Edgar, MD, PhD after he intentionally coughed on two other employers and was observed disregarding space and safety concerns. I note with wonderment that he holds both a bachelor’s and a master’s in molecular and cell biology.

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Bicycle companies rush to offer a replacement bicycle to an ICU doctor in England whose $2,000 Ribble bicycle was stolen from a locked area while he was treating COVID-19 patients. Dan Harvey says he will donate the bike to charity after the crisis ends and will put bike companies in touch with other staff members who don’t have transportation.

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An unidentified man thanks staff at Morristown Medical Center (NJ) for his wife’s treatment by holding a sign up to the ED’s back window. Nurses took a photo, but don’t know the identity of the man or his wife.


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Weekender 3/20/20

March 20, 2020 Weekender No Comments

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Weekly News Recap

  • Hospitals ask the federal government for a $100 billion bailout to offset their costs of diagnosing and treating COVID-19.
  • COVID-19 predictions and recommended federal government actions dominated the news.
  • HHS announces that it will allow physicians to practice across state lines, although individual states must waive their own requirements.
  • HHS OCR relaxes its requirements on the use of consumer video technologies such as Skype and FaceTime for offering telehealth services.
  • Telemedicine companies struggle with a high volume of demand that strains their infrastructure and provider availability.
  • WebMD acquires StayWell.
  • Epic cancels its XGM conference.
  • Cerner asks all employees who are able to work from home to do so.

Best Reader Comments

We are a hospital with numerous clinics making about $350 million per year in gross revenue with an average profit margin of 1.3% over the last 10 years. Our best estimate is that we will lose $10 million per month that this continues. That doesn’t even take into account our cash reserves that keep us afloat, which are being decimated in the market. We absolutely will see hospitals go bankrupt and/or be acquired this year without a bailout. (Bobby Bailout)

[COVID-19 testing data]. Epic has released functionality (COVID-19 Pulse Dashboard) that will aggregate de-identified data across their organizations. Considering they boast that their organizations cover half the US population, I would think they should be able to get some good aggregated data soon. Hopefully they do a good job of collecting the right metrics and cooperating with research institutions to help bring out some of this data. I hope Cerner is also looking to or already is doing something similar considering they also have a large share of US population. (AC)

I will think twice before ever booking our hotel rooms through OnPeak again. If we would have booked through the hotel directly, we would have been able to cancel with no fees. If you book with OnPeak/HIMSS, you lose your shirt. For what? A small room discount? Live and learn. (Jennifer)

On the practice side, most places have a little door barricade set up. People get a symptom check in the barricade one by one before they get in the waiting room area. People are told to call for instructions before approaching the clinic. On the hospital side, most of the clinical folks I’ve talked to have been told not to talk about internal details with the public. (What)


Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Ms. P in California, who asked for robotics programming blocks for her kindergarten class. She reports, “The Cubelet blocks were exactly what I needed to connect computer science principles to solving real world problems. Our first experiment with the Cubelets was a simple challenge, to connect the blocks so their robot would move around the table and then stop. The kids were so excited to work together, every member of the group was trying different combinations and excitedly chiming in suggestions. I listened to these five year olds problem solve and collaborate and thought, ‘Wow. These are exactly the 21st Century skills that they need to be practicing.’ Thank you so much for giving us these high interest, durable robot blocks. You’ve made my class very happy, and given me a tool I will be using frequently in the future.”

Carnival offers the federal government use of some of its cruise ships as temporary healthcare facilities for non-coronavirus patients in major coastal cities, potentially freeing up hospital beds for treating COVID-19.

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China exonerates a Wuhan doctor it had reprimanded for warning about the coronavirus outbreak in an almost unheard-of admission by the Communist Party that it made a mistake. The party apologized to the family of Dr. Li Wenliang, who died of COVID-19. The government’s treatment of the doctor stirred uncommon public anger, with complaints that it was hiding outbreaks, punishing journalists, and valuing its own image over public safety. Several citizen journalists and critics were arrested and some disappeared after sharing information online about the outbreak. Insiders also claim that Wuhan’s claim of zero new cases is untrue because the local government suspended testing and discharged quarantined, symptomatic patients early to make President Xi Jinping look good during his scheduled visit there.

Italy presses 10,000 final-year medical school students into COVID-19 service, waiving the final exams normally required to put them on the front lines nine months early.

A California private practice doctor offers appointment-only drive-up coronavirus testing outside his office, with cash prices starting at $200. He has performed 40 tests, received eight results, and identified one positive patient. Mask shortages have forced him to buy from Craigslist scalpers.

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Ten conferences that have been cancelled at the Orlando’s Orange County Convention Center have hit the area with a $363 million economic impact. HIMSS is mentioned as working by mid-February to arrange on-site medical services to convince exhibitors not to pull out. The local paper intercepted emails from HIMSS in which it expressed dissatisfaction with the Visit Orlando convention bureau, which it said was not supporting the conference by agreeing to distributing attendee health information at local hotels. The photo above was taken on Wednesday, March 4, the day before HIMSS20 was cancelled.

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Fox’s “The Resident” TV drama, which is filmed in Atlanta, donates masks, gowns, and other supplies to Grady Hospital. “Grey’s Anatomy” and “Station 19” have donated masks and gloves to a Los Angeles fire station.


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Weekender 3/13/20

March 13, 2020 Weekender 2 Comments

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Weekly News Recap

  • COVID-19 dominates the national and healthcare news.
  • Use of telemedicine ramps up to meet COVID-19 screening and management needs.
  • HealthjStream acquires nurse scheduling app vendor NurseGrid, which offers the #1 most downloaded app for nurses.
  • FormFast changes its name to Interlace Health.
  • Final versions of the federal government’s interoperability and patient access rules are published.
  • HIMSS announces plans to offer some HIMSS20 sessions virtually.
  • Organizers cancel most of their upcoming conferences due to coronavirus concerns, including AMIA.

Best Reader Comments

Heading from a lot of friends inside of Epic that things are getting rough. No guidance from HR or the COVID team on what people are to do if schools close, no telework option given to any staff in the Verona office, some divisions (Implementation) have been given the guidance to attend all meetings via WebEx but that they still must physically come to campus. Little to no transparency from the leadership team, and they appear to be one of the only major tech company not implementing remote work. (Ex-Epic)

Epic’s travel policy is not right. They may think that they are helping us, but these people who go from one hospital to another may act as pollinators for COVID-19. We have already determined to cut all non-employees visiting our clinics and hospitals. (CMIO @ Med Centre)

Will 2021 finally be the year of the PHR now that these ONC rules came out? B.Well’s gimmick is to make the employer pay for it, though they can only swindle employers out of looking at the apps adoption rate for so long. IMO there isn’t enough value in a PHR to run a business. You either have to keep your costs extremely low or make money some other way. To me, two models come to mind. The Linux model, in which some devs do it as a passion project for awhile until it gets big enough that some institutional players start chipping in, maybe with some consulting opportunities with big health system or payer orgs. Or the Facebook model, in which you make it free for the consumer and sell their data. (What)

The big thing that’s missing for me personally is any accountability for breaches of apps or app vendors. My reading of the summary is that app vendors will not be HIPAA covered entities even if they are accessing and storing PHI. ONC is basically waving their hands saying consumers and app vendors can figure this out for themselves with a Terms of Service agreement. Key language from the summary: “In effect, this places more of an obligation on the party requesting the EHI and the individual to attempt to satisfy the precondition by providing a consent or authorization.” (Elizabeth H. H. Holmes)

I find there are two main reasons companies attend [the HIMSS annual conference]. Large mega vendors and even the larger names use it as a current customer meet and greet, and a chance to take them to dinner / schmooze (which they should be doing the other 51 weeks of the year anyway). The other are startups looking for investors or partners. Most don’t return the next year. Due to HIMSS rules on booth location based on seniority (I don’t disagree, just noting), these newbies are relegated to the basement level in building 2, or on the back wall of row 2400, where no one seems to go. Every time I’m asked about conference attendance as a key marketing tool, I tell the company my views. Even during a couple of job interviews I went against what I thought they wanted to hear, but was surprised they agreed with me. I’m not saying having a booth at conferences is a total bust, but isn’t a major tool in revenue growth for the majority of attending companies. Yes, I’m sure I’ll get some pushback from a few here where their effort pays off, but I’m betting it is a small slice of all vendors. (Contrary Ann)


Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Ms. A in New York City, who asked for sensory play tiles for her class of autism and multiple disability students. She reports:

It is my honor and privilege to be working as a New York City public school teacher. It is in thanks to donors such as yourselves, who have enabled me to do my job even better. I am filled with such joy that you choose to help my students. It means so much to me to bring them an engaging educational experience that has meaning for them. My students inspire me every day, which I have seen inspires wonderful donors such as yourself.

I have already started using the sensory tiles and it is starting to make a difference for my students. Students who are in sensory overload are able to use them to self-soothe and get back to our lesson. We also use them for our lessons to show how colors mix and how force causes the colors in the tiles to move. They are so wonderful on so many different levels. These will allow my students to have an engaging experience exploring Science and STEM and keep control of their senses. Thank you for your kindness!

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Brilliantly making lemonade from the unfortunate HIMSS20 lemon is Medic.Life, which missed the chance to demo its upcoming “smart toilet” but touts its ability to detect virus markers in urine samples for early detection.  

Facebook, Ebay, and Amazon try to throttle back advertisements from price-gouging sellers of face masks and hand sanitizer.

The Los Angeles Times writes about doctors whose medically related poetry is published in medical journals, whose editors say they turn down a lot of badly written poems, but seek out those whose vivid imagery invokes an emotional reaction. A retired internist wrote this one:

Tell Me

Tell me the night silence
on the locked Alzheimer’s ward is broken
by a yell from room 206,

that an old man with flattened
nose and crumpled ears,
whose family moved away to Arizona,

whose doctor never comes
to visit, is standing
in the middle of that room, naked,

his freckled face a clenched fist,
urine and feces running
down his legs.

Then tell me that the fat one, twelve
years on the job,
working her second shift because

someone’s car won’t start,
comes with a pan
of warm water, a sponge and a towel;

how, back in bed, he
cries, You know—
I’m in the ring tomorrow with Killer
;

how a tiny smile begins, how
her hand reaches out
to flick down his wild flame of hair.

Now tell me again
why you don’t believe in angels.


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Weekender 3/6/20

March 6, 2020 Weekender 1 Comment

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Weekly News Recap

  • HIMSS cancels HIMSS20 at the recommendation of its medical advisory panel.
  • SymphonyAI Group acquires TeraRecon.
  • RevSpring acquires Loyale Healthcare
  • Allscripts misses Wall Street revenue and earnings estimates for Q4.
  • HIMSS announces that President Trump will become the first sitting president to address a HIMSS annual conference.
  • GoodRx apologizes and makes changes in response to a Consumer Reports investigation that found the prescription discount app shares patient information with 20 online companies.

Best Reader Comments

I’m conflicted by all of this. HIMSS did make the right decision. I had decided independently last night that I wasn’t going to attend. It was the optics of it all. Healthcare workers at a convention where were we home would have advised our patients to be more prudent. That said, I miss catching up with friends. This is our annual meet-and-greet. But I couldn’t justify a week in the sun to see friends, particularly after nearly every single one of the vendors I had appointments with had cancelled earlier in the day or this week. (Samantha Brown)

My latest realization was that, while I might be able to avoid getting coronavirus, the possibility (probability) of getting swept up in a blanket quarantine (there still aren’t enough test kits) would be hugely disruptive to my life and those of my colleagues who would have to cover for me. (Randy Bak)

I posted a tweet stream last night urging HIMSS to repurpose HIMSS20 along with other recommendations. This is a tough call. But after spending a couple of days poring over evolving data and reports, for me it comes down to this: we can’t stop the outbreak, but we can flatten the curve. Having tens of thousands of healthcare workers and healthcare focused companies who are not fully trained to interact safely aggregate in an alcohol-fueled networking gathering and then disperse globally is, mildly stated, unwise. Transforming the week into a smaller event targeted on building epidemic-focused tools and services could turn this into a vital component of the global strategy to address the need. (Ross Martin)

I’m assuming HIMSS themselves has event insurance, which may help them on costs, but wouldn’t help on revenues. (Nick Kagal)

A huge problem I can see with my company’s wellness program is that it relies on medical information being self reported by the user. I’m a low-level-grunt and have zero interest in wellness, but they give a $1,000 incentive; So I signed up and told the app all the “correct answers” [BMI of 23, zero alcohol, zero tobacco, zero caffeine, 110/60 blood pressure, sleep eight hours every night, etc.] Every day I go through the motions, telling the app what it wants to hear. I’m probably one of the most “engaged” with the program, but as with everything in the wellness industry, it’s not real. It’s just a scam to extract money out of my employer. (Jose)


Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Ms. M in West Virginia, who asked for GoPro and MacBook accessories to support her special education students. She reports, “Thank you so very much for your most generous donation. My fifth grade students absolutely loved seeing our new equipment come in after our winter break. It made coming back to school a little more enjoyable for them. They especially loved all the accessories for their GoPro. This will allow them to make videos using a variety of different perspectives. They will create movies that will allow for easy transition for the upcoming fifth graders next year. They will be able to showcase the exciting events that happen at our middle school. Again, my students and I greatly appreciate your donation. You truly warmed our hearts!”

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I decided to spend a bit of my Anonymous Vendor Executive’s money on Donors Choose teacher book requests since those donations are being matched dollar for dollar this week. I’m donating in honor of the lost HIMSS20 – for the HIMSS people who worked valiantly to make it happen only to see it cancelled, those presenters who spent a lot of time and energy preparing talks that won’t be delivered, and the companies who bet big on getting ROI from a now-cancelled event. I funded these projects:

  • A classroom library for the first grade class of Ms. D in Alton, TX.
  • A set of 12 books for Ms. B’s kindergarten class in Columbia, SC.
  • A set of 14 books for Ms. R’s kindergarten class in Fayetteville, NC.
  • A set of 20 history books for Ms. S’s third grade class in Kittanning, PA.
  • Novels for Ms. J’s middle school class in Bridgeport, CT.
  • Eight books on in inclusion and diversity for Ms. P’s elementary school class in Orlando, FL.
  • Civil rights books for Ms. W’s elementary school class in Greenville, SC.
  • Classroom library books for Ms. H’s elementary school class in Rantoul, IL.
  • Books for Ms. K’s elementary school class in Chicago, IL.
  • Books for the Autism Spectrum Disorder kindergarten class of Ms. L in Bakersfield, CA.
  • A set of 20 books for Ms. M’s elementary school class in Gallup, NM.

Ms. H responded almost immediately to say, “I am literally speechless right now! I am so happy my students are getting more books! They love to read, and will be thrilled! Thank you for your big heart and for helping my classroom! I can’t wait to tell them! Thank you SO much for everything! Reading IS rich!” Ms. S said, “WOW! Thank you so much for funding our project! I just told my kiddos & they CHEERED! They are so into these books, and I just LOVE how excited they get!””

Ms. P was eloquent in her thanks for inclusion and diversity books:

In today’s polarizing society, more emphasis needs to be paid to appreciating the differences in each of us. It’s these differences that makes us fundamentally human, and we should celebrate and not criticize this beautiful uniqueness. Thank you for giving me books that will teach my kids to value the beauty that lies within us all.

A nurse union’s coronavirus survey of 6,500 members finds that 70% say their hospital employer doesn’t have enough personal protective equipment to support any surge in patients, while just 44% say their employer has provided information about identifying and responding to potential cases.

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A cosmetic surgeon gets three years of probation for ordering his staff to not call 911 for five hours after his 18-year-old breast augmentation patient stopped breathing while under anesthesia, leaving her in a vegetative state.

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The Orlando paper covers the effect of two cancelled conferences, including HIMSS20, that would have brought 60,000 people to Central Florida. Orange County’s mayor says the area is low risk, vacationers are still coming to theme parks, and only 0.3% of the area’s 75 million annual visitors come from Level 3 countries. The HIMSS20 cancellation involves 94,500 hotel room nights and $113 million in economic impact. Cheerleading and volleyball competitions will draw 50,000 people to the convention center this weekend.

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Audacious Inquiry worked with Orlando restaurant Cuba Libre to donate the food that was intended for its Wednesday networking reception to Second Harvest Food Bank of Central Florida.

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A hospital nurse in Wuhan, China posts a photo of herself holding a sign that says, “Hope that my country will assign me a boyfriend when the Covid crisis is over.” Medical workers there are writing words of encouragement on their protective suits to motivate each other.

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Also in Wuhan, a 20-something doctor asks an 87-year-old patient who had been hospitalized for a month if he wants to see the sun set.


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Weekender 2/28/20

February 28, 2020 Weekender 1 Comment

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Weekly News Recap

  • HIMSS announces that HIMSS20 will continue as scheduled with added on-site precautions to address coronavirus-related concerns.
  • Medical chat service K Health raises $48 million in a Series C funding round.
  • MIT Technology Review announces its 10 most promising breakthrough technologies, which include hyper-personalized medicine and AI-discovered molecules.
  • The VA says it hopes to go live with Cerner at its first site in July 2020, months after the originally announced date.
  • AMA releases a patient records access guide for medical practices.
  • HHS and ONC publish a report on reducing the provider burden of health IT.

Best Reader Comments

Shame on the state health system hiring Vendor A without a thorough background check of their employees and shame on Vendor A for hiring 1099 contractors who work for other companies that are bidding for the Epic work. I’m not an attorney; therefore, I don’t know if this is illegal vis-a-vis taxpayer’s or anyone’s money. However, it sure smacks of unethical practices. Independent HIT advisory consultants should have NO ties to any HIT companies, period. (Woodstock Generation)

Being in an enclosed space with 40,000 of your closest friends and their dirty germs with uncertain handwashing habits takes its toll. If they moved it to April I think we’d all be better off anyway, maybe something to think about for next year. (HIT Girl)

The entire clinical informatics community depends on places like Vanderbilt to advance the field. To see how they have restructured and refocused after their Epic implementation is exciting. We all benefit when an institution embraces their system and sets aside resources for clinical informatics research on it. (Andy Spooner)

Vendors should always compensate healthcare providers for their data with equivalent value in some form or another, including product discounts, in order to remain legally compliant. (Grant)


Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Mr. L in New Mexico, who asked for programmable robots for his sixth grade class. He says, “From your generosity, students collaborated in learning coding software, developed an understanding that making mistakes can be fun, and that by sharing laptops and robots, everyone could participate. Students had to figure out and practice several math concepts such as angles, degrees and decimals. On Saturday, January 18, 2020, students participated in a Play Shop or Robotics Workshop on the Northern New Mexico College campus. At this Play Shop, a daughter managed to teach her father coding, and a son demonstrated how to navigate a robot through a maze to his father. This resource provided a positive moment for fathers to participate in the learning process. Moments like these will always be cherished by the family. And what about hanging out with your best friends in the classroom and on a college campus? As you can imagine, there were smiles and clapping when a student opened the package containing the robot. Everybody wanted to be the first to touch and code the robot. The next steps will be to continue to share the robot, learn much more of the coding during the day and after school, participate at a RoboRave Rally on the Northern New Mexico College in March, and to participate in the RoboRave Regional Competition.”

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People are following homemade YouTube and Facebook instructional videos to perform at-home fecal transplants, which include instructions on how to find a donor and the proper use of kitchen appliances for mixing (you might want to pass on their dinner invitations).

An ophthalmologist sues a former employee for $2 million for posting a negative Yelp review that accused the doctor of making patients return for unneeded extra visits to inflate bills. The employee, who left after two months on the job, had signed an employee confidentiality agreement (thus the breach of contract part of the lawsuit) and refused to take her review down.

Digital health: police arrest a Gulf Coast Hospital (FL) employee after an elderly patient wakes up to find him licking her toes. The man, who was a sitter in the patient’s room, said he dropped his phone under her bed and accidentally touched her while retrieving it. Meanwhile, a woman sues the Florida hospital where she had received emergency mental health treatment, claiming that a male employee groped her and then asker her how much money and drugs she would need to have sex with him.

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HIMSS coronavirus recommendations or not, this is way too weird for me to even consider at HIMSS20. I would prefer the Namaste gesture, Japanese-style bowing, or that up-and-back-once head nod acknowledgment thing, if indeed any physical gesture is really needed to greet a colleague or exhibitor when you’re already looking at each other and saying hello.

Speaking of HIMSS20, Orlando weather is all over the place, with highs around 70 on some days and then 90 degrees expected mid-week. Last year’s weather on March 9 was overcast with a high of 77 and low of 64. You won’t need a coat unless you’re going home somewhere cold.


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Weekender 2/21/20

February 21, 2020 Weekender 2 Comments

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Weekly News Recap

  • Publicly traded patient survey company NRC Health falls victim to a ransomware attack.
  • Atrium Health confirms that it will replace Cerner and other systems with Epic.
  • Indian Health Services says it will replace its RPMS system, which is based on the VA’s VistA, with one or more commercial EHRs.
  • Cerner promotes Don Trigg to president and expands John Peterzalek’s customer relationship role to include services, consulting, support, and hosting.
  • Health Catalyst announces plans to acquire Able Health.
  • New York’s Department of Health says Glen Falls Hospital tried to cover up $70 million in lost revenue that was caused by a “catastrophic” Cerner billing system rollout in documents it filed in exploring a potential affiliation with Albany Medical Center.
  • Merged interoperability vendors Rhapsody and Corepoint make Lyniate their corporate name.
  • China uses virtual visits and app-based medical consultations to address COVID-19.
  • HHS OIG finds that lack of CMS oversight allowed companies to capture the information of Medicare Part D beneficiaries from its database for potential use in telemarketing scams.

Best Reader Comments

HHS is basically acting as the caricature of a bad middle manager. Micromanaging EHR vendors despite the fact that they themselves have not been successful in performing the mandated task (Medicare Part D database, DoD project, etc.); no clear line between why they’re asking you to do something and the task itself; and ignoring both internal evidence (their own OIG) and external evidence (public comments) that contradicts their stated goal. (Elizabeth H. H. Holmes)

CPSI mentioned in their earnings that they are seeing less interest from Cerner in the small hospital market and they can sell at a higher price now that Athena is gone. (What)

Once Carolinas made the transition to Atrium, the process of implementing Epic was coming, as the other system that was acquired was running Epic. It’s not really a rip and replace like AdventHealth. It was a merger of Epic and Cerner and they determined that they wanted Epic as the integrated system. (Associate CIO)

What the authors get wrong [in urging that EHR vendors not be allowed to offer continuing medical education] is trying to compare the pharmaceutical industry to the EHR industry. With pharma, there’s a direct relationship between the pharma activity and the opportunity to influence the decision maker. If a pharma company offers CME at a fancy hotel in a desirable location, I can learn about their drug and go home to my practice and prescribe their drug immediately. With EHRs, that isn’t remotely possible. Physician input into the healthcare IT budgeting process certainly is not a direct relationship, and in most organizations, at best can be considered something we may influence but rarely have purchasing authority. (Mark Weisman)


Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Ms. L in Wisconsin, who says of the programmable robot mouse kits her class received, “Thank you so much for supporting this project! The materials arrived so quickly! My students were really excited to see the boxes arrive. We opened them together and they were gleeful when they saw the mouse robots. We spent about 20 minutes together to learn how to program the mouse robot. There was a lot of excitement. On Friday, I placed them in our robot centers. My students had a great time setting up mazes for the mouse. They then programed the mouse to reach the cheese. They still needed reminders that if the code didn’t work. They needed to start over a try a different code. With time they will get better at it.”

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The newspaper of a Shawnee, KS high school profiles sophomore Madison Vosburg’s Cerner Scholar Experience, where she is working on fine tuning Cerner’s voice assistant Gina. She works at Cerner every school day from 1 to 3 p.m. and hopes the experience will help her land a technology job, maybe even at Cerner.

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An uninsured freelancer couple who live part-time in Mexico describe their experience with having the husband’s ankle repair surgery in Tijuana for $2,000 instead of the $27,000 quoted at NYU Langone. The private practice surgeon assured the wife that his clinic was safe, his infection rate low, and his success rate high, and when asked whether a higher-priced clinic would do a better job, he said, “It’s just a foot.” The couple had qualms about the building’s shabby exterior, its lack of air conditioning, and the surgeon’s use of epidural anesthesia instead of general. The surgeon became gruff when they called him for better post-op pain control, but he explained afterward that he was frustrated at the clinic’s undertrained employees and Americans who keep showing up wanting opioids. The couple says they were sometimes frustrated with cultural differences that left them unsure how to proceed or unable to communicate with staff, but are happy with the outcome. Their doctor admitted that Mexico is like the US – you get better medical care if you have money.

A former hospital pharmacy technician pleads guilty to stealing 13,000 pills, mostly opioids, from the hospital. She found a loophole in the automated dispensing cabinet’s software that allowed her to withdraw meds for a closed unit and then delete the administration record, which bypassed the system’s tracking function.

A home inspector finds jars of human tongues stored in a house’s foundation, later determined to have been placed there by a former University of Florida professor and dental researcher who forgot them when he moved out.


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Weekender 2/14/20

February 14, 2020 Weekender No Comments

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Weekly News Recap

  • CVS talks up its in-store HealthHubs in its earnings call, saying its Aetna customers are interested in engaging with health navigators and its pharmacists can review a patient’s medical issues using both pharmacy and claims data.
  • CPSI’s Q4 results beat expectations as the company says it is benefitting from Athenahealth’s withdrawal from the inpatient market and Cerner’s declining interest in selling to small hospitals.
  • AdventHealth, which operates 67 hospital and ED facilities, announces that it will drop Cerner and several other EHRs and systems and replace them with Epic.
  • The VA pushes back its planned March 28 Cerner go-live at Mann-Grandstaff VA Medical Center (WA) until at least the end of April, saying integration isn’t ready.
  • Open Source Electronic Health Record Alliance announces that it will shut down on February 14.
  • Imprivata’s private equity owner is reportedly preparing the company for sale at a price in the $2 billion range.
  • An article whose author includes the AMA’s burnout expert calls for EHRs to report standard efficiency metrics using their log data, including measures of how doctors spend their time.
  • Nuance says in its earnings call that it will roll out its ambient clinical intelligence “exam room of the future” for five medical specialties in Q2.

Best Reader Comments

Another government response to the proposed interoperability rule that doesn’t actually address any of the privacy concerns that the letter / follow-up post contained. If he’s going to talk about walking the walk, then they need to be seriously pushing for HIPAA to be expanded in a way that accommodates the environment they’re trying to create.(Ex-Epic Chiming In)

This isn’t the first time it’s been reported that Cerner did that pricing. Same thing happened at University of Illinois Chicago. They had such an old / customized version of Cerner that it was reported that the cost to basically rebuild Cerner and modernize it was the same cost or close to it as moving to Epic. Keep in mind that Cerner’s revenue on actual licenses for Millennium is minimal at best (check the earnings report). Their largest cash cow is their consulting organization. (Associate CIO)

Nurses were “rescheduling” the patient’s meds on the Medical Record to an hour later to avoid those [late med reason question] popups. This disguised the problem of how often medications were actually being given late. Sometimes it takes empathy and seeing the problem with your own eyes before we can really make things better. More data collection does not always make a better metric and can sometimes miss the mark. (Robert Buehrig)

Those metrics look decent for ambulatory usage. You really only want EHR vendors to expose these metrics rather than try to operationalize them because you don’t want the EHR vendor to decide how much of your time you should spend writing notes. That means that it’s going to be up to your management to respond to those metrics. (What)

I do worry that the metric of “undivided attention” suggests that ANY attention the doctor pays to the information about the patient in the record is considered to be not in the patient’s best interest. One could imagine taking that to an unproductive extreme. I suspect that most patients these days are counting on the doctor’s taking the time to become informed about their care. When I go to my internist, I am counting on his putting it all together and coming up with a plan. He can’t do that without breaking eye contact with me, and I am OK with that. (Andy Spooner)


Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Ms. H in Pennsylvania, who asked for a new table for her elementary school class. She reports, “Thank you so much for our new table! This year we are lucky to have 22 students in our class, but were we pretty cramped at the old furniture that we have. Little by little I have tried to trade out our furniture for newer and more spacious materials. Thank you for being part of our growth!”

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An Illinois pediatrician who committed suicide last fall left a note that suggested he regretted falsifying medical records over a 10-year period for parents who didn’t want their children vaccinated. Van Koinis, DO practiced holistic medicine and was sought out by parents who needed falsified vaccination records to allow their children to attend school. The sheriff warns that the ambiguity of the doctor’s note may also mean that he didn’t give vaccines even when the parents assumed that he did.

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Corpus Christi, TX police arrest a hospital’s on-duty ED doctor for public intoxication after witnesses reported that he was belligerent and walking around the ED’s public area wearing only underwear.

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Overworked clinicians in Wuhan, China are shaving their heads to make it easier to don makeshift hazmat suits and are using adult diapers to save bathroom break time. China has only two doctors per 10,000 people and many of them do not have degrees. Hospitals are running out of medical supplies, protective suits and masks, and food. Some doctors have been assaulted by people who were upset about wait times, while others reported that the hospital’s entire supply of N95 protective masks had been seized by hospital executives for their own use. 

CDC mistakenly tells a San Diego hospital that several of its patients had tested negative for Covid-19 even though the samples of three of them had not yet been processed, allowing them to be returned to military base quarantine. One of the patients was later found to be infected. CDC blames an unspecified labeling error that may have been caused by the hospital’s assignment of phony patient names to protect privacy.

Kenya has spent $625 million since 2015 to lease diagnostic medical equipment from companies like Philips and GE, but more than one-third of the machines are sitting idle in hospitals that don’t have radiologists to operate them. Critics say the government should have spent the money on clinics and midwives, speculating that diverting the money into procurement contracts gave health officials a chance to line their pockets. Hospitals say they weren’t asked about their needs and in some cases received unneeded duplicate machines. The health ministry refused the auditor general’s request to review the contracts.


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Weekender 2/7/20

February 7, 2020 Weekender No Comments

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Weekly News Recap

  • The VA says the firing of Deputy Secretary James Byrne, who was the top executive over its Cerner implementation, won’t affect its planned initial go-live in late March.
  • Health IT developer platform vendor Commure exits stealth mode and names former Health Catalyst CEO Brent Dover as CEO.
  • Patient data vendor Verana Health raises $100 million from investors that include Google-owned GV.
  • Hyland acquires blockchain-powered document and content authentication vendor Learning Machine.
  • CompuGroup Medical pays $250 million to acquire several Cerner products that are marketed in Germany and Spain,
  • The CEOs of 60 health systems sign a letter opposing HHS’s proposed interoperability rules, as urged by Epic CEO Judy Faulkner.
  • Cerner’s Q4 results beat Wall Street revenue and earnings expectations.
  • MedStar Health becomes the first member of Cerner’s new Learning Health Network.
  • KLAS announces its “Best in KLAS Software & Services 2020” winners.

Best Reader Comments

What would happen with the public discourse if Facebook came out in favor of the proposed [HHS interoperability] rule because it would allow them easier access to you and your family’s medical record? Facebook then adds a new Terms of Service all users mindlessly click through which gives them the rights to attempt to access your data? If you come down differently on the philosophical debate as to whether the government should act to protect its citizens’ privacy / whether the government should be a nanny state, that’s fine. Just be careful what you wish for. If the proposed rule goes through, and some app maker or advertising platform suffers a breach, then they will likely suffer trivial consequences at worst and your complete identity and medical data will be on the internet forever. (Elizabeth H. H. Holmes)

There isn’t any enforcement occurring around layoffs that target employees who are likely to be expensive, and the toolset provided by these [employee wellness] companies are built around identifying those employees. (Jim)

What are these employer-funded health tech companies going to look like after the next recession? Not a 2008 style recession, but a regular one. Employers are going to drop these expensive services faster than they drop break room snacks or drink tickets at the Christmas party. If the renewal contracts are a year or less or if the employer pays by usage, these companies are going to drop like flies. (What)


Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Ms. W in Virginia, who asked for STEAM tools for her kindergarten class. She reports, “My students have loved centers this week, as they get to explore the new gifts! It has been so cool to see their little minds at work. They have made some really creative projects. They have used the straw builders and LEGOs to create patterns. They wrote about what they built with the magna tiles. They collaborated with their classmates to plan, create, and test their ideas with the STEAM kits. As a teacher, it was been a joy to watch them work, learn, and grow. Thank you again for providing us with this wonderful opportunity!”

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Hong Kong will use smartphone-connected tracking wristbands to quarantine people who have visited the Hubei province in China in their homes. Authorities will be alerted if  the wristband moves more than 100 feet from the smartphone during the two-week quarantine. Geofencing is also apparently being used, but not GPS, with the director of health saying, “These are people who have to be quarantined at home. The are not criminals, so we agree we have to respect their privacy.”

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Police arrest a man who broke into the oxygen tank room of North Memorial Health Hospital (MN) and turned off the valves that provide oxygen to patients. The man, who was previously charged with unplugging computers and TVs in the same hospital,  said he was mad at the hospital. The hospital lauded its engineering team in a statement:

The North Memorial Health engineering team is continuously monitoring the hospital environment – from temperature to humidity to oxygen levels. If any of these systems move out of a predetermined acceptable range, they quickly act to identify the cause of the problem and fix it (and they are good at what they do!). The hospital oxygen system which was affected during this incident is a system with multiple redundancies (aka several backup systems). When our engineers noticed the oxygen system pressure moving below the desired range, they quickly identified the issue and corrected it. They did this so effectively and efficiently that none of the backup systems even needed to be activated. No patients were harmed due to this system disruption.

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A North Carolina TV station takes a hidden camera into a local clinic’s stem cell treatment sales pitch to prospective patients who had been recruited by a mailed flyer,. The salesman rattled off a long list of conditions that he claimed stem cell treatments can cure, adding, “Don’t fret if you don’t see something on here that’s ailing you – we probably just ran out of room on that slide.” The station also told Carolinas Regenerative Medicine that it would be reporting that its medical director has been indicted on federal charges of distributing oxycodone, after which it removed his bio from its website. The medical claims remain, including a pitch for platelet-rich plasma treatments for erectile dysfunction.

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A psychiatrist in Australia loses his license after being found mentally unfit to see patients. The doctor claimed that President Trump ordered him to post Deep State conspiracy theories on his practice’s website, where he claimed the existence of a global Satanist pedophile ring and that 9/11 was faked. His conduct was reviewed after he complained to the medical board about his wife having an affair with another psychiatrist. When told that his license would be suspended pending improvement in his mental state, he called the council chair a “filthy dirty f&%$ left-wing slut” who, along with media reporting the story, is part of the conspiracy against him.


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Weekender 1/31/20

January 31, 2020 Weekender 2 Comments

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Weekly News Recap

  • Allscripts will pay $145 million to settle federal allegations that EHR vendor Practice Fusion, which it acquired two years ago, accepted $1 million in opioid prescribing kickbacks and falsified its ONC EHR certification.
  • Imprivata acquires mobile device access management technology vendor GroundControl Solutions.
  • HHS Secretary Alex Azar and CMS Administrator Seema Vema vow that profit-protecting “bad actors” won’t waylay HHS’s propose interoperability rules.
  • The private equity owner of wearables-powered employee wellness vendor VirginPulse reportedly is preparing to sell the company for up to $2 billion.
  • imaging and radiology workflow systems vendor Intelerad sells a majority stake in the company to an investment fund manager.
  • A Health Affairs blog post describes the funding and operational challenges of the Indian Health Service in maintaining and eventually replacing its obsolete, VistA-based RPMS enterprise and EHR system as the VA moves to Cerner.
  • Epic makes a rare public statement in explaining that its opposition to HHS’s proposed interoperability rules involve the potential of app vendors to misuse patient data and for patient family information to be inadvertently shared without the permission of those individuals.
  • Evive acquires WiserTogether.

Best Reader Comments

Healthcare data breaches since 2014 have exposed over 200,000,000 records. There are indications that there are far more health systems with Google-Ascension type of agreements than have been publicly acknowledged. The top five private DNA testing companies have the complete genome of 29 million customers with no restriction on how that data may be used or sold, and their follow-on survey questions only add more information on personal lifestyle and family history. So, what is the chance that we’re discussing whether or not to lock the barn door when a walk around the barn reveals the back wall is already gone? (BillyM)

Patients have some limited recourse with breaches, and healthcare organizations have legal requirements to attempt to prevent them. Patients have zero recourse if an app sells their data per the terms of service. People sue hospitals all the time for privacy breaches. Good luck suing an app after approving the click-through agreement. (Elizabeth H. H. Holmes)

Most care delivered to the under-65 crowd is episodic. The only people who need to consistently monitor and interact with their data are over 65 or the caregivers of the over 65. Demand for tech solutions is less among that crowd. Consumer apps in healthcare are really really hard. Most are ad supported, which means they increase utilization (more eyeballs, more ads.) (BankeMeLater)

What did happen on the financial side was fairly open access to data by consumers, who could send it to whatever financial app they wanted. Sure there were some issues, but the world didn’t end. Maybe it’s time to make the same leap of faith with healthcare data. (Bob Smith)

A huge wildcard in the plans for the proposed HHS rule is Google v. Oracle. If the Supreme Court upholds the Circuit Court’s ruling, EHRs will have to live a in a regulatory landscape where both of the following are true: (a) their APIs are protected by copyright and they are within their rights to restrict their use and charge fees for such use; and (b) their APIs must also be exposed and offered for free. If the SC upholds the ruling, EHRs will immediately sue arguing that the proposed rule is illegal (and they would be correct). (Elizabeth H. H. Holmes)

HS seems to think that clumsily opening the floodgates will be some kind of cure-all. “If we expose all of the data, it will solve all of our problems”. Sure, go ahead and pretend like Carequality, CommonWell, and CareEverywhere have done nothing for the industry. And go ahead and blame the EHRs, when it’s almost always the IT departments at healthcare organizations that are the gatekeepers. EHR vendors and hospital organizations are bringing up valid privacy concerns, and HHS and others continue to talk past them and make appeals to patient rights to access their data. (Elizabeth H. H. Holmes)

The advertising business model does not work in healthcare. Most developed countries have some sort of ban on medical advertising. The Practice Fusion story is one reason why. Most consumer software is driven by an advertising business model. Facebook, Google search, Android, Gmail, MyFitnessPal, recipe apps, etc. HHS is opening up medical data to these advertising companies. (Goodluck)

Why should Epic and its customers be held responsible under HIPAA for any breach — as an example, to Mychart — but if an app developer who has access to that same data experiences a breach, they are not held to the same standards? The federal government needs to update the HIPAA regulations to ensure that anyone who has access to PHI is held equally accountable for maintaining the privacy and security of that data. (Nael Hafez)


Watercooler Talk Tidbits

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The vacated 116,000-square-foot Palo Alto, CA building that served as headquarters for disgraced blood testing company Theranos (and the backdrop for related TV documentaries) has ironically been taken over by the medical school of Stanford, which owns the land in its Stanford Research Park. Theranos was paying $1 million per month in rent. The office from which Holmes led her fraudulent empire still has its bulletproof glass. It has a chemistry lab, which should probably be checked out by experts before using.

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Several amusing cardiologists create the Kardashian Index (K-index) in observing the perceived prevalence of fame-hungry cardiologists who lead Twitter chats about their work and medical conferences that appoint questionably accomplished but prolific Twitterati as social media ambassadors. The authors find that the issue is overblown — only 238 of 1,500 cardiologists who practice at the country’s top 100 cardiology hospitals have Twitter accounts, leading the authors to conclude that “tooting your own horn does not necessarily equate with more impactful work.”

Content moderators for Facebook and YouTube are being required by contracted by their employer Accenture to acknowledge that they may experience PTSD from reviewing disturbing content posted by their fellow humans.

An impressively large aggregation of dimwits has decided that “coronavirus” must be associated with Corona beer, leading to a huge spike in Google searches for “Corona beer virus.” That’s pretty funny until you realize that they reproduce, spread their wisdom on social media, and vote.

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Super Bowl Sunday brings forth a rash of “avocado hand,” in which unskilled, distracted, and possibly inebriated knife-wielders attempt to turn the stubbornly peeled and pitted fruit (technically, it’s a berry) into guacamole, plowing through 162 million pounds of avocado and quite a few tendons in a single day. Researchers estimate that 50,000 avocado-related knife injuries occurred from 1998 through 2017. Pro tip: the pre-made Walmart guacamole, especially the spicy version, is darned good, has a long shelf life, and may end up costing less than buying avocados yourself, at least when they aren’t on sale.

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While you’re sitting in a hospital ED on Sunday waiting to have your avocado-knife tendon injury repaired, watch the Super Bowl for Kansas City Chiefs right guard Laurent Duvernay-Tardif, who signed a $42 million contract extension in 2017 and shortly after graduated from Montreal’s McGill University with an MD and Masters in Surgery after being drafted by the NFL in his third year. He spoke only French but missed the deadline to apply for French-speaking medical schools, so he had to learn English at McGill, one of three English-taught schools in Quebec. He wants to go into emergency medicine, but his career and the limited number of McGill residency spots have placed that plan on hold. The NFL won’t let him include “M.D.” after his name on his jersey.


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Weekender 1/24/20

January 24, 2020 Weekender 1 Comment

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Weekly News Recap

  • Epic updates its software to include travel screening prompts for patients who may have traveled from China or who are experiencing symptoms of the coronavirus.
  • Columbus, OH-based analytics company Aver raises $27 million in a Series C round led by Cox Enterprises.
  • Judy Faulkner urges CEOs at some of Epic’s largest hospital customers to sign a letter to HHS Secretary Alex Azar protesting the proposed interoperability rule published last year.
  • Consumer DNA testing company 23andMe lays off 100 employees as it struggles with declining sales.
  • Epic decides to stop pursuing integrations with Google Cloud based on a lack of customer interest.

Best Reader Comments

Android permissions are a good example of one software provider using imprecise permission definitions to screw over consumers and other software makers. For example, I’m trying to copy a person’s name into an app on my phone. The app wants access to my contacts to do so; it might even request that access when I install the app. Many Android app vendors use this permission to vacuum up your whole contact list and sell it to others. You and the software developer that makes your contact list application can’t do anything about this without denying access to application data.

We need to prevent a similar situation with regards to health care data. Imagine you are trying to copy a lab to a telehealth app so that you can get a second opinion. The app requests access to your Mychart; you click Accept. It pulls all of your health information, labs, provider notes, tests, genetic information, etc. The telehealth company then sells this data to IMS. IMS has a breach and your health data floats around the internet.

HHS does not have the skills necessary to define this type of access or permission system. Certainly the proposed rules do not mitigate the dangers of the above scenario. If HHS can’t get a healthcare data security policy properly defined and enforced, what are they doing trying to force providers to share their application data with others? (Burgers)

Yeah, can’t wait till the architecture is opened up and I can place orders with my ordering app. Then scans with my imaging app. Then diet orders in my patients’ favorite diet tracking app. Maybe I can review them all in a new Review app! The future! (App for that)

Think about it – the big 2-3 EHR vendors are going to use the ‘security’ (fear/doubt) angle for ever to try and keep the oligopoly and ‘money printer’ they have today. This is a very expected play. They also know the architecture of what they’ve built is archaic and if the market opens up, apps/innovation will take over the provider and even patient user experience pretty rapidly. Just do a google search and look at the 1990s user interfaces that the big 2-3 still use today! Btw, the gigabytes of data we voluntarily expose each day is significantly more than the amount of healthcare data we obsessively try and protect. (Tom Jackson)

Government and Politics are forever part of health technology, however, I am constantly irritated with the government mandated monopoly granted to the AMA. I will go out on a limb to state that at some point the defense for Surescripts will raise the AMA situation and draw comparisons. It would be delightful to see that play out. (Bill O’Toole)


Watercooler Talk Tidbits

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Citing health, safety, and security issues, the Department of Transportation proposes a ban on emotional support animals and restrictions on the types of service animals passengers can bring on board planes, limiting them to trained dogs. Association of Flight Attendants President Sara Nelson has echoed the frustrations of many a road warrior with her reaction: “The days of Noah’s Ark in the air are hopefully coming to an end.”

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Simulation in Motion Montana brings hard-to-access training to remote clinics that would otherwise likely go without. The nonprofit’s three mobile training labs cover over 100,000 miles annually to offer rural healthcare providers training for scenarios like childbirth, trauma, pediatric overdoses, and sepsis infection.

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Madison, WI landmark Ella’s Deli and Ice Cream Parlor closes after 41 years in business. Epic purchased the diner’s famous carousel along with other decorations and installed them in its lobby last year.

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The Atlantic looks at the role military hospitals and the federal government play as medical debt collectors, recounting the story of an uninsured trauma patient who was taken to Brooke Army Medical Center in Houston because there was no better place to receive care. Described as “one of the most unforgiving debt collectors around,” the federal government can mete out punitive action to patients who need the biggest breaks, withholding wages, tax refunds, or 15% of a person’s Social Security income without a court order. Data from the Defense Health Agency puts civilian medical debt to military hospitals at $198 million.

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Pediatric surgeon Robert Parry, MD has gained quite the following as a post-op bandage artist at Akron Children’s Hospital in Ohio. He explains his technique: “I use Telfa dressings (not an ideal art medium) and cut out the outline of the image freehand. Then I color it in using Sharpies. It doesn’t go directly on the wound — it’s protected by a Tegaderm (plastic) dressing. I’ve operated on more than 10,000 children, and all of them that needed a dressing got a drawing. From tiny newborns that weigh less than a pound to fully grown young adults. And I can’t recall anyone not enjoying it — no matter how old they are.”

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@Farzad_MD clarifies an earlier tweet about Epic’s billboard placement in Washington, DC. Meanwhile, Politico reports that Epic CEO Judy Faulkner has said she might sue HHS if they move forward with publishing the interop rules she has so publicly objected to.


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Weekender 1/17/20

January 17, 2020 Weekender No Comments

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Weekly News Recap

  • Masimo buys NantHealth’s Connected Care business for $47 million in cash.
  • ONC publishes a draft of its “2020-2025 Federal Health IT Strategic Plan” for public comment, due March 18.
  • Physicians spend 16 minutes per encounter doing EHR work, according to a Cerner study that reviewed client data from its Lights On Network.
  • Medsphere raises $40 million in new funding to support growth and pursue acquisitions.
  • R1 RCM acquires SCI Solutions for $190 million just days after SCI announced its acquisition of Tonic Health.
  • Former US Senator Bill Frist, MD launches CareBridge, a Nashville-based technology company that will use an initial $40 million in funding to improve home healthcare.
  • Teladoc will acquire telehealth platform vendor InTouch Health for $600 million in cash and TDOC shares.

Best Reader Comments

We are in the strangest time in my career, with so many mergers and acquisitions by competitors and VC firms. I started as a consultant on Millbrook/Paradigm PM and MedicaLogic/Logician EMR which became the initial GE Centricity suite, on two separate platforms smushed together. Now that product line has been acquired again. I also work with another full PM/EMR that was just acquired by a competitor who is owned by a VC. The mission of a VC is different than the traditional EMR vendor, so we’ll see how it shakes out. In the more than a decade GE had Centricity, changes were made for mandatory programs, but there was never any real product development after the acquisition. That’s always the fear, your EMR will be acquired at some point, by whom and why will dictate if the product continues to be developed or not. Everyone is for sale for the right price at the right time. (PM Consultant)

While non-competes are largely not legally enforceable – they are enforceable in operational practice. Epic practices this, or at least used to, by restricting UserWeb access, access to resources, or just general threats to the consulting firms that work with them. In this David vs Goliath fight of worker rights and hiring freedom, Epic is a Goliath that doesn’t look like it’s found a worthy David to keep it in check. It continues to not only hurt and frustrate their own employees, clients, and partners, but it also hurts local businesses in the Madison area. These local groups constantly deal with the Ex-Epic people starting jobs to only leave after a year to chase the consulting money increasing their turnover and decreasing their ability to hire reliable staff and hurting trust in hiring anything from Epic. (Epically Annoyed)

In the case of Epic, you’re now limited not only by your own non-compete, but the separate agreements that Epic has made with the various consulting firms. For instance, I left Epic in 2018 with a 1 year non-compete. When my year was almost up, I started reaching out to various hospitals and consulting firms. I heard back from several of the bigger consulting firms saying that they couldn’t even begin conversations about employment until I had been away from Epic for 1.5 years.

Due to these newer agreements between Epic and the consulting firms, I essentially had an additional non-compete that extended beyond the one I signed when I was hired. Furthermore, preventing employment conversations to even start until the wait period ends just adds extra time beyond the non-compete that you will most likely remain unemployed since you can’t get a jump start on the process. (Ex-Epic Chiming In)

If Cerner received top marks for IT hospital support, then I cannot imagine how bad it really is out there. Cerner IT support is about as helpful as the worse DMV experience you can imagine. I am a front line MD, and if they are the benchmark, then we need a whole new paradigm. EHRs are an abomination and the support of them is equally terrible. CMS and Congress did patients and MDs a HUGE disservice by enabling this artificial market for Cert EHR and its resultant disaster we all live in today. It has set back REAL innovation in EHR/HealthIT at least a decade, maybe 20 years. I’m not sure how many more articles, research, studies, etc we need to show that the current crop of EHRs are almost criminal in terms of safety, security, outcomes, burden to MDs nursing, and the ridiculous buzzword care (MACRA, ACO, Value based care) are complete and utter nonsense and HORRIBLY expensive and causing devastating damage to the practice of medicine. When will we learn that Washington DC’s policy wonk, non practicing CMS staff have NO idea how to practice medicine safely, securely, and with the help of customized technology. We do NOT need more program changes unless they are…hey…we only make a mess of things…we are getting out of the way of physicians and IT and let them actually work together instead of the data click driven nightmares they continue to pile on to us. Its time to just say no to all of this. Stop trying to fix the unfixable. When will we learn that when government runs healthcare it turns into the VA and postal service combined. (meltoots)


Watercooler Talk Tidbits

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GoodRx co-founder Stephen Buck (who also happens to be co-founder of a wine tour and experience company) turns his attention to cancer survival rates with the launch of CancerSurvivalRates.com. Using public data from the National Cancer Institute, the site offers survival rates of up to five years based on a cancer patient’s stage, grade, time since diagnosis, and histology. Buck, who bootstrapped the project with co-founder Omar Mehmood, would like to eventually sell the site to Google: “It would be ideal to maintain as a free public resource that comes up when someone searches on Google.”

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Mona Siddiqui, MD announces she will step down from her position as chief data officer within HHS. HHS CIO Jose Arrieta, who has also claimed the role of CDO under the ambiguously structured Foundations for Evidence-Based Policymaking Act, says he will hire the agency’s “first” CDO. Politico reports that she will become a VP at Humana.

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Chiropractor Gregory Johnson, DC credits his practice’s surge in popularity to Youtube, where he has gained an online following of “crack addicts” who have traveled far and wide to take advantage of his signature spine realignment known as the “Ring Dinger.” Johnson earns around $20,000 each month for the 10-minute videos he makes with his cell phone’s camera and a selfie stick.

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Goop just keeps going: Netflix will release “The Goop Lab” next week. Billed as a “docu-series,” the six episodes are, according to one critic, a thinly veiled infomercial for Gwyneth Paltrow’s pseudo-scientific lifestyle brand.

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Just what every Oscar winner wants: Academy Awards swag bags will offer urine sample collection devices and genetic testing kits to select nominees. No word yet on whether or not Goop will include one of its wacky products.


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Weekender 1/10/20

January 10, 2020 Weekender No Comments

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Weekly News Recap

  • EHR/PM vendor CareCloud, which has raised over $150 million from investors, sells itself for $17 million in cash and $41 million in total consideration.
  • Premier delays efforts to find a buyer for the company while it sorts out how its health system shareholders will respond under a new owner.
  • A high-profile project in which healthcare super-utilizers are given more aggressive care is found to have no impact on the readmission rate when studied in randomized controlled trials.
  • Healthgrades acquires Evariant.
  • Non-profit accreditor URAC acquires the programs of ClearHealth Quality Institute.
  • Nurses top Gallup’s annual list of most honest and ethical professions by far in Gallup’s annual poll of most honorable professions, with doctors, pharmacists, and dentists also finishing in the top five spots.
  • AMIA fires President and CEO Doug Fridsma, MD, PhD after five years.
  • England’s NHS receives $50 million in funding to implement single sign-on in its facilities to save clinician time.

Watercooler Talk Tidbits

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HIStalk readers funded the Donors Choose teacher grant request of Mr. K, who asked for programmable drones for his New Jersey elementary school class. He reports, “I love being able to use technology to supplement and enhance my teaching experiences with my students. These drones are doing this for my students! I continually see my students working together on the touch interface of the iPad to program the drone in order to learn the basics of computer programming. With a programmable drone, my students are exposed to a level of computer science that they otherwise would not have access to.”

Healthcare imaging startup Lyfebin exposes thousands of medical images by improperly securing an Amazon Web Services storage bucket full of DICOM files. The company claimed it was phony patient data used for testing, went silent when pressed further, and then threatened to sue TechCrunch for writing about the issue.

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A medical staffing company takes down a job ad that said of the Arizona hospital for which it was seeking applicants, “Women don’t do well here” after a social media backlash.

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Atlanta Hawks basketball player Trae Young donates $10,000 to retire over $1 million in medical debt for Atlanta-area patients through RIP Medical Debt, which buys portfolios of bundled medical debt on the secondary debt market for pennies on the dollar. It’s beginning to feel like the most prevalent health insurer other than Medicare is GoFundMe.

San Francisco workers who are ancient by tech company standards – over 35, but some as young as in their 20s – are boosting their youthful, high-energy images by undergoing plastic surgery, Botox treatments, facelifts, fillers, and ab sculpting to compete with newer, younger co-workers. Some of them bring in app-filtered photos or pictures of social media influencers to show doctors how they want to look. A  female sex therapist who offers charm coaching for men whose 16-hour workdays preclude cultivating relationships says it’s ironic to see men being forced to “play the game women have always had to play to get what they want.”

Kaiser Health News notes that high-deductible health insurance plans hurts rural hospitals disproportionately because patients there have lower incomes. The deductible is applied to the first site of care, so the bigger hospitals that receive those patients when transferred get their full payment while the local hospital struggles to collect the deductible. A rural Colorado hospital says the only available plan option for local employers carries a $10,000 deductible, meaning that patients go into bad debt the first time they use it for a serious problem.

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A hospital whose life flight helicopter was mistaken as a drone by Facebook users who then urged people to shoot it down asks residents to please avoid doing so.


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Weekender 12/20/19

December 20, 2019 Weekender No Comments

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Weekly News Recap

  • The National Academy of Medicine publishes an overview and recommendations for the use of artificial intelligence in healthcare.
  • LifeLabs, Canada’s largest lab testing company, admits that it paid a hacker’s ransom to recover its systems in an October breach that affects 15 million patients.
  • Amazon Web Services adds ICD-10 and RXNorm linking to its Amazon Comprehend Medical natural language processing service.
  • HIMSS hires Tim Kelsey, CEO of the Australian Digital Health Agency, for an SVP of analytics job.
  • Hackensack Meridian Health, New Jersey’s largest health system, admits that it has paid a ransomware hacker to regain access to its systems.
  • A Florida pain management chain pays $85,000 to settle HIPAA charges that it ignored a patient’s request to send an electronic copy of their medical records to a third party.
  • Partners HealthCare announces a five-year, $100 million digital health initiative.

Best Reader Comments

The data quality problems occur because of the vendors, the practices, the clinicians, and external bias generators (Insurance, MU, etc.) These causalities all have an impact to the data at its source. Extracting data and transforming it only makes the data worse. And I find that most people working the data do not consider the source, or the destination of the data,  to understand how it was created and what the requested usage is. Lots of problems to be solved here before we start thinking that AI can create”‘whirled peas.” (HITInteropGuy)

As a parent of a teenager with type 2 diabetes using the Dexcom continuous glucose monitor synced to my iPhone, please alert your readers that this monitor does not sample blood glucose levels. In fact, it is measuring interstitial fluid ( lymphatic fluid) glucose levels and there’s quite a delta in the reading accuracy, especially during large swings. We had to stop using it because of his sports and my obsession watching his glucose levels fluctuate on a minute by minute basis.(El Comandante)

I believe one of the unstated goals of the Meaningful Use program was to reduce the number of EMRs available by creating a certification process that required significant development investment. The ONC was clearly aware that interoperability was hard, and that by reducing the number of EMRs, it becomes less of a burden. The result was a reduction in the total number of ambulatory EMRs as smaller players couldn’t afford to develop the required capabilities.A conspiracy theorist might posit that this also aligns with the fact that smaller EMR companies are not funding campaigns and lobbying efforts. The benefit of MU primarily accrued to the large EMR vendors. (Notmeaningless)

I don’t know how it is in the EMR space; I’m in the imaging space, but there the smaller players sometimes can and do develop the required certification capabilities. The hurdle is often in another place entirely — they can’t afford to invest in the certification process. That being said, not every smaller player is good in terms of capabilities. Some are downright terrible. So certification has its place, if done right. (Clustered)

Interesting that OTTO was headed by ex-Epic Sarah Green. Also another Ex-Epic just became CEO of IDX, an AI diagnostics company. Curious how many other old colleagues are now in C-Suites. (AnotherExEpic)

If this is how data ownership should work, why would this be limited to only healthcare? Credit rating agencies make huge amount of money buying, aggregating, and selling data about your credit worthiness. Online data brokers make even more money collecting and selling data about your online habits. Assuming that our society decides that “data about me” is automatically “data that belongs to me” for healthcare, does it stop there? Why would “data about my body” be more sacred than “data about my habits”? (TH)


Watercooler Talk Tidbits

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I received generous Donors Choose donations from Mark, Dana, Friend at Impact, and the IT directors of Atlantic Health System (NJ), which with matching funds from my Anonymous Vendor Executive and other sources fully funded these teacher projects, all of which involve schools in high-poverty areas:

  • Math manipulatives for Ms. O’s kindergarten class in Creedmoor, NC
  • Math manipulatives for Ms. P’s elmentary school class in Minneapolis, MN
  • A learning table for Ms. H’s elementary school class in Philadelphia, PA
  • Codable Legos for the coding club of Mr. M’s middle school class in San Diego, CA
  • Lego sets for the fourth grade class of Ms. C in Williamsburg, KY
  • Flexible seating for Ms. A’s kindergarten class in Cape Coral, FL
  • Copy paper, composition books, and cleaning wipes for Ms. C’s elementary school class in Hempstead, NY
  • Math tiles for Ms. S’s elementary school class in Woodside, NY
  • Learn to Code Ladybug for Ms. P’s kindergarten class in Dallas, TX
  • STEM Lego sets for Ms. G’s elementary school class in Baltimore, MD
  • Math manipulatives for Ms. M’s elementary school class in Yakima, WA
  • A field trip to the Discovery Lab for Ms. M’s elementary school class in Tulsa, OK
  • Programmable robotics kits for Ms. D’s elementary school class in Tamarac, FL
  • Five tablets and cases for Ms. M’s elementary school class in Magnolia, MS
  • Two Chromebooks for Ms. M’s elementary school class in Miami Gardens, FL
  • A Viewsonic projector and bluetooth speaker for Ms. P’s elementary school class in Baltimore, MD
  • Three laptops for Ms. C’s elementary school class in Washington, DC
  • STEAM sensory tiles for the children with disabilities elementary school class of Ms. A in Staten Island, NY
  • Video production equipment for Ms. M’s middle school class in New Cumberland, WV
  • Accommodations for a field trip to Washington, DC for the fifth grade class of Ms. C in Brooklyn, NY

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Surveyed doctors and nurses say that “Scrubs” and “ER” are the most realistic medical TV shows. They note that unlike what other shows portray, doctors don’t really cover everything from surgery to OB, they don’t sprint through the ED doors to meet ambulances, and they don’t usually respond to emergency cases with an insightful diagnosis of some weird problem and instead focus on stabilizing the patient.

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The families of people who die at home in France must have a doctor’s signed death certificate before moving the body, but a shortage of GPs willing to travel to the homes of patients they don’t know for a flat rate of $110 means families often must leave the body in their homes for several days. Some towns have passed laws that make dying at home illegal.

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A start-up in England invents a toilet with an “inconveniently sloped” seat that intentionally makes users uncomfortable after five minutes, citing the employer productivity benefits from shortening the average 28-minute bathroom break. This if anything proves that it’s time to make “Office Space 2.” Or to launch a startup selling corporate-issued diapers.

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Twitter hackers post flashing strobe light GIF images to followers of the Epilepsy Foundation, apparently hoping to induce seizures. I’m beginning to think that humans are too evil to allow anonymous public postings.

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A Harvard Medical School analysis of US doctor traffic tickets finds that psychiatrists are the most likely to be caught for “extreme speeding,” while cardiologists are the most common Ferrari-driving specialty.

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A teenager who was hospitalized with lupus during Christmas two years continues her annual tradition of creating Christmas tree kits for kids at UC Davis Children’s Hospital. She and her family brought 60 sets of decorated trees to the hospital.


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Weekender 12/13/19

December 13, 2019 Weekender No Comments

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Weekly News Recap

  • Hackensack Meridian Health (NJ) brings its clinical systems back online after a downtime of several days, rumored to be the result of a ransomware attack.
  • Former Outcome Health EVP Ashik Desai pleads guilty to wire fraud and agrees to cooperate with prosecutors.
  • Emergency medical services technology company ESO acquires trauma registry software vendors Clinical Data Management, Lancet Technology, and Digital Innovation.
  • Proteus Digital Health’s previously announced restructuring will include eliminating 292 jobs and closing several facilities by January 18.
  • The DoJ will look into Google’s $2.1 billion acquisition of Fitbit for possible antitrust violations.
  • Partners HealthCare (MA) will spend $100 million on a five-year digital health initiative focused on developing self-service technologies for patients.
  • BJC HealthCare (MO) lays off 200 employees as it outsources some IT services to an unnamed managed service provider.

Watercooler Talk Tidbits

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The DoJ charges 10 former NFL players for alleged fraud after they filed nearly $4 million in claims for medical equipment that was never purchased or received through a health reimbursement account plan set up for former athletes. Claims were filed for hyperbaric devices, ultrasound equipment used for imaging on pregnant women, and electromagnetic therapy devices used on horses.

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Former debt collection agency employee Shaunna Burns takes to TikTok to share advice on dealing with medical debt collection. In just a few weeks, she has gained over 100,000 followers and over 1 million likes. “The fact that there are people out there thinking debt equals deadbeat … debt doesn’t equal deadbeat,” she says. “I’m not a deadbeat, and I have great credit, and I’m still having to deal with debt collection. I literally spent hours a week fighting with insurance companies over stupid bills that shouldn’t have been charged … having to do all that is annoying and frustrating, and I thought if I could help one person [with the TikToks], it would be worth it.”

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Zuckerberg San Francisco General Hospital notifies 1,174 patients of a months-long privacy breach resulting from employees who failed to shred patient-identifying meal tray tickets, instead throwing them away in regular garbage bins.

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Harvard Medical School geneticist George Church develops dating app technology designed to pair users based on their DNA. Church says the app could help wipe out inherited diseases.

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Advocate Children’s Hospital  (IL) launches the Santa Connection program with help from Burwood Group and Cisco.


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Weekender 12/6/19

December 6, 2019 Weekender No Comments

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Weekly News Recap

  • Premier is reported to be working with bankers in seeking a sale of the company.
  • Waystar acquires Recondo.
  • John Halamka, MD announces that he will become president of Mayo Clinic Platform in January.
  • Agfa is negotiating the sale of its Europe-focused healthcare and imaging IT business to Italy-based clinical software vendor Dedalus for more than $1 billion.
  • Cerner names Amazon Web Services as its preferred cloud, AI, and machine learning provider.
  • A server problem causes Dexcom’s continuous glucose monitor to stop sending messages and alerts for several days.
  • T-System experiences downtime from an apparent ransomware attack.
  • Amazon Web Services unveils a healthcare transcription service for software developers.

Best Reader Comments

You don’t want the company distracted by a shiny new thing while the core competency is getting less attention. So it’s often not a question of “Oh, hey, let’s just do this other thing too.” If you were in a perfect world with an arbitrarily large number of qualified people to take on the job, then moving into these peripheral areas would be a no-brainer. In reality the value gained from the distraction needs to be more than the cost of the distraction. The technical economic term for this is opportunity cost. (TH)

We doctors should stop thinking about EHR as a “special thing.” It is just a tool to get the job done. I can ask the same questions that you asked about paper and pen documentation system and probably add a few more about accessibility across locations, storage challenges, etc. Why is no one complaining about that system of records and why was it not part of so-called “physician burnout?” The reason I believe, is that we all learnt how to use it during our training and accepted it as part of life. Rules of the game changed in the last decade and we need to get on with the program. (EHR is just a tool)

This should drive home the reality that the investor class isn’t comprised of smart people, just people who knew each other or went to the same universities and have consistently promoted and hired each other into positions of authority without any demonstrated qualifications. (HIT Girl)

If the digital companies would have seriously and thoroughly tested their products with MANY physicians and not only one SME, then maybe the EHRs of today wouldn’t have been the monstrosities that they are. (Been there)

I still can’t believe institutions like Goldman make these horrible investments. Between Outcome Health and Theranos, you’d think the investors involved would at some point ask some healthcare industry experts whether these companies were viable enough to pass the sniff tests. Readers on this site have called out the charade for both before. (Elizabeth H. H. Holmes)

The billing methodology in this country has gone totally out of control. Unfortunately, I’m in the middle of a medical situation and the last EOBs made me laugh. For a CT scan with and without contrast, the billed amount was $18K, allowable $18K, amount paid $400, patient due amount $0. How stupid is a system that allows this? If I didn’t have insurance and the provider wasn’t in the network, I’m sure they would have tried to collect the $18K. (David Pomerance)

The moral of the Outcomes Health story is that if you f*ck over @GoldmanSachs & friends for $500m you go to jail. But if you ARE @GoldmanSachs & friends and you f*ck over the US taxpayer to the tune of $62bn, we will hand over the money and allow you to keep doing it. (Matthew Holt)

While I’m (mostly) never delighted when a person loses his/her job, all David Duvall MBA, MPH needs to do is open up about 50 hospital leadership websites and then another 50 HIT vendor leadership pages and tell me where the discrimination lies. I promise you it isn’t against middle-aged white guys. (ellemennopee)


Watercooler Talk Tidbits

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The publicly traded owner of North Tampa Behavioral Health (FL) confirms that it has reassigned the facility’s 31-year-old CEO after a newspaper’s investigative report found that he had no healthcare experience and was formerly a quarterback for a pro football team’s practice squad. A company spokesperson said it’s not unusual to recruit hospital CEOs from other industries and the attributes of B. J. Coleman  include “team leadership, situational analysis, and sound decision-making.” Inspectors found that under his leadership, just four of the 96 employees who performed lab work had proper training. The kitchen’s lead cook was covering as director of dietary services even though he wasn’t qualified, so the kitchen ignored special diet requirements and sent trays containing silverware to suicidal patients.

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A Tennessee neurologist files a $25,000 defamation lawsuit against a woman who wrote a scathing Yelp review saying that he threw a tantrum when she took out her phone to record her father’s visit. She says she deleted the recording at the doctor’s request even though state law does not prohibit such recording, after which a clinic employee called her to say that phones aren’t allowed in the office. Also named in the suit is the son of the woman’s friend, who overheard her talking about it and posted a negative review on Google. Meanwhile, the negative Yelp reviews are piling up as idiots from several states who admit that they just read the online story, calling the doctor a “filthy animal” and a “nasty immigrant who is suing a real American.”

Kaiser Permanente uses text messaging to encourage 11,000 of its members to sign up for California’s CalFresh supplemental nutrition program. Kaiser didn’t have access to income data to help  choose which of its 9 million patients might benefit, so it used a census-derived “neighborhood deprivation index.”

A CMS analysis finds that the US spent more $1.2 trillion on hospitals in 2018, representing one-third of all healthcare spending. 

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NICU nurses at Brookwood Baptist Medical Center (AL) dress up newborns to celebrate their first Thanksgiving.


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Weekender 11/22/19

November 22, 2019 Weekender No Comments

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Weekly News Recap

  • The American Medical Association calls for EHRs to be fully inclusive for transgender patients and expresses its support for government funding to improve public health technology, including EHR integration.
  • Government officials in Bahamas scramble to dodge blame for signing an $18 million contract with Allscripts in 2016 that was supposed to transform healthcare, but has yet to result in any installed software.
  • HHS expands its price transparency plans by proposing that both hospitals and insurers be required to publicly post their negotiated contract prices.
  • The Spokane VA hospital hires more than 100 new employees to cover its expected productivity losses during its Cerner go-live in March.
  • Kareo sells its revenue cycle management business.
  • Stanford Hospital opens its $2.1 billion, 368-bed hospital that incorporates extensive technology.

Best Reader Comments

Epic did a big enhancement a year or two ago to replace their single “sex” field with an entirely new series of fields to capture sexual orientation, gender identity, sex assigned at birth, legal sex, preferred name, preferred pronoun, etc. It was a big change for healthcare organizations to start using the functionality, but it was the right thing to do. (Anon)

Changing the behavior of core demographic information (like name and sex) is going to be a big task. It’s not a quick and easy update, but being treated with respect (by being called by your real name) from your doctor can help an already at-risk population better engage with their healthcare providers. There are additional benefits to having this be a thing the entire industry focuses on. If your EHR can handles this gracefully but your EKG system doesn’t, then you end up with unnecessary added complexity both on the IT side and on the clinician side. The AMA of course has no teeth on this, but it emphatically is something the industry should be working towards. (TH)

I have learned and I hope some of your readers will learn that you are only as good as the last day you have completed on the job and this can happen at any moment. Tomorrow’s employment is not a promise, unless you have a contract. Layoff, RIF, firing, termination… whatever you call it, the outcome is the same. I would add that career management requires constant networking, having your resume and Linked In account up to date, trusting your intuition – meaning that if if feels or looks like it is going to hit the fan, it probably is and what are YOU doing about that. (Justa CIO)

[The informatics team needs to focus on] the lifecycle of and alert intervention to ensure that the intervention remains current and clinically relevant. This is often lacking in some systems, from my experience, as it is a significant organizational commitment to do this effectively. It require having clinical ownership of the CDS intervention, so it necessitates having clinical subject matter experts and/or a medical literature review process engaged in maintenance in an ongoing fashion. (Luis Saldana)

Seeing that the fine for not being transparent with data is $300 per day, or $109,500 per year, I suspect most organizations will just eat the cost instead of paying for the additional labor that would be required to be in compliance. Or, just look for a way to increase productivity through say, an extra 10 or so MRIs per year. (MoMoney MoProblems)

Read the Mayo Clinic article on usability. Saw that microwave ovens were better, so decided to try it in clinic. It took a while to find enough extension cords, but I managed to set up my 1200-watt Amana microwave on a rolling cart and got ready to see patients. Turns out, it was very easy! I just basically kept hitting the “Add 30 Seconds” button throughout the encounter (it’s the only button I’ve ever used on it). At the end of the encounter, I got a satisfying DING! I can’t believe how much easier it was than my EHR. Amana really gets human factors! Not like those programmers at the EHR companies, with their code and data and functionality. Good riddance, I say! (Andy Spooner)


Watercooler Talk Tidbits

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Magee Women’s Hospital (PA) escorts a man whose wife was delivering their baby off its premises, struggling with how to deal with the fact that he is also a registered sex offender. The man is prohibited from having unsupervised visits with his other two children and had alerted hospital security of his conviction before he took his wife to the hospital. The hospital security department offered to escort him to his wife’s room the next day, but he declined, fearing that he would be arrested.

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In Indonesia, several motorcycle taxi drivers storm a hospital that had refused to release the body of a deceased six-month-old boy to his family because of his unpaid bill, preventing the Islam requirement of a quick burial. They left with the body, but the hospital director explained afterward that the charges had already been waived, triggering the apology of one of the drivers involved in the “humanitarian mission” who now hopes to “restore the good name of the hospital” because he didn’t know the procedure and thought it was taking too long.

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A co-founder of Firefox creator Mozilla develops Brave, a privacy-first browser that blocks the recording of browser history, offers its own password manager, and blocks all ads by default in favor of offering an optional private ad platform that allows users to “tip” their favorite sites. It claims to be three to six times faster than Chrome and Firefox. I tried it on HIStalk and the load time was the same as with Chrome.

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The newest faculty member at the Uniformed Services University of the Health Sciences is two years old. Shetland, a Navy lieutenant commander and clinical instructor, is a highly trained military service and therapy dog. Shetland’s job is to accustom students to the therapy dogs they will encounter in clinics, hospitals, and in veterans with PTSD so they can choose them wisely for their patients. 


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