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Weekender 10/18/19

October 18, 2019 Weekender No Comments

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Weekly News Recap

  • Microsoft and Nuance announce plans to work together to use ambient sensing and conversational AI to help doctors document encounters.
  • Google hires former National Coordinator Karen DeSalvo, MD, MPH to the newly created position of chief health officer.
  • Change Healthcare is reportedly looking for a private equity buyer for its Connected Analytics unit, which includes the Ansos staff scheduling system, at a potential price in the $300 million range.
  • The VA pilots making telemedicine services available at local VFW posts.
  • Northwell Health extends its Allscripts Sunrise agreement through 2027.
  • A KLAS report finds that customers of acquired health IT vendors are equally split among being less satisfied and more satisfied, with just 20% saying nothing changed.
  • Centra (VA) resumes billing and collections following a three-month hiatus that it says was caused by Cerner software problems.

Best Reader Comments

This is inspiring and has so much more potential for healthcare. So many new reimbursements focus on patient engagement (CCM, RPM, PCM, BHI, CoCM). Like Dr. Bhavan and her team at Parkland demonstrated, patient involvement / engagement creates better outcomes. We focus so aggressively on the delivery of healthcare, but who has studied the receipt? Think of this for a second: we’re at a place in healthcare where actively and persistently involving the patient is viewed as disruptive and innovative. Dr. Bhavan’s model included education and team work – to make it easy for the patient – and they certainly did their part yielding massive reduction in re-admission and higher satisfaction. (Matt Ethington)

For those of us who participate in this [Epic] market as HUMAN resources (FTE or contractor), it is a strange situation to learn that after working hard to be offered a role /,contract, your customer / employer will have to submit you to Epic for ‘approval’ before they agree to grant you access to both (a) the resources at Epic’s UserWeb and (b) potentially access to Epic at the client site (even if you’ve been hired). It’s a sobering moment to jump from one employer to another or in and out of the contractor-FTE world to learn that you are not actually in charge of the outcomes of your own decisions and that you never agreed to the terms that are being imposed on your life and livelihood. (Code Jockey)

The restrictions that Epic places on his customers, employees, and third parties on hiring is so frustrating. While I understand they want to protect their IP and reduce poaching, it creates such a toxic attitude among their employees and frustrations to employees who have life changes that require them to move away from Epic. Rather than being able to utilize your skills in the free market, they use a big stick to hold people hostage. They extend those restrictions on their own customers, keeping them from hiring really qualified people that could help make them successful and avoid really expensive consulting costs. It also make hiring Ex-Epic people in the Madison job market incredibly risky because many are just trying to burn their one-year non-compete rather than looking for a longer term role. (Epically Annoyed)

I’ve worked on two Cerner implementations and two Epic implementations. The Cerner implementations had, in my opinion, sleazy salesmen who showed up to take the director out to lunch, drinks, strip clubs, or whatever it took to get the sale and expand the services. The Epic implementations, I never saw any of that going on, not that some client sites didn’t want to be wined and dined and tried to get the Epic AC/AMs to do that. I think you are correct in stating that because Epic is not a public company, Judy does not have the Wall Street pressure, but I also think there is just a generally more clean approach from Epic overall. (X-Tream Geek)

While that [in-hospital employee] telemedicine booth is kind of odd, I think a lot of people still underestimate how much employees don’t want their employer to have permanent access to their full health record, regardless of what kind of end user confidentiality might sit between other colleagues and their data. I know a lot of people who would gladly talk to a booth over anyone that’s also employed by their employer. Though I would bet there’s some type of interoperability that exists between their existing records and this vendor. (Sam Lawrence)

Insurance exists because people overall are risk averse, but from your comments, that’s not you. You sound pretty confident of the outcome, so you prefer to gamble. It’s interesting that if you take the gamble and lose, it’s not actually you paying for it. If you’re uninsured or under insured today (because you don’t feel like you need it), and then a catastrophic event happens, your fellow taxpayers will be conducting a wealth transfer to you. Would you plan on refusing it because it’s unfair to them? You’re also gambling that by the time you need the healthcare system, all the Boomers will be gone and the rational Gen X, Gen Y, and Gen Z folks will vote in an affordable and responsible system. This is a huge gamble, and by George I’d love if it ended up going your way. However, the idea that once the Boomers are gone the way will be clear for sweeping reform is a massive oversimplification of US healthcare politics. (TH)

The youngest Baby Boomers are 54, so they have another 25+ years of living to do before they hit the median life expectancy, by which time us Gen Xers will be in our 60s and the Millennials will be experiencing back spasms, trick knees, and menopause, so we’ll all be oldheads together. GenZ is going to come along and wipe us all out, which is fine – they are the ones really inheriting the mess, so if they want to transform society “Logan’s Run” style, I can’t say I blame them. (HIT Girl)


Watercooler Talk Tidbits

A hospital doctor in England fails to convince a review board that the reason he squeezed a nurse’s bottom was euphoria that was caused by a drug interaction between his allergy pill and Pet Remedy, a calming spray he was using on his dog during a thunderstorm.

The Ohio Board of Pharmacy cites three former pharmacists at the now-closed Mount Carmel West Medical Center (OH) for failing to intervene when high doses of opioids were ordered by ICU doctor William Husel, DO, who faces 25 counts of murder involving inpatient overdose deaths. The board noted that the pharmacists sometimes did not verify drug withdrawals from automated dispensing cabinets until after the drugs had already been administered.

Experts say hospitals are creating an “epidemic of immobility” in which hospital patients are forced to stay in bed, contributing to muscle weakness that can cause life-threatening falls afterward. One study found that one-third of patients aged 70 and older left the hospital more disabled than when they were admitted. Patients are often forced to remain in bed, but may do so voluntarily due to pain or weakness, IV lines that make it hard to walk, a lack of employees to help them, and the reluctance to walk down hospital hallways in flimsy gowns.

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Identical twins who work as nurses at Piedmont Athens Regional Medical Center (GA) work together for the first time in helping deliver another set of twins. That’s Epic photobombing behind them.

Peyton Manning stars in a fun video spot for the children’s hospital bearing his name at Ascension St. Vincent in Indianapolis, to which Manning has donated a reported $50 million since 2007. He played quarterback for the Indianapolis Colts for 14 seasons through 2011.  


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Weekender 10/11/19

October 11, 2019 Weekender No Comments

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Weekly News Recap

  • Mednax will sell its MedData business to private equity firm Frasier Healthcare Partners for between $250 million and $300 million.
  • DCH Health System (AL) agrees to pay Russian hackers after an October 1 ransomware attack forced it to divert patients and revert to paper processes.
  • Membership-based primary care company One Medical hires several banks to help it prepare for an IPO.
  • Patient engagement vendor Relatient acquires patient self-scheduling and waitlist software developer Everseat.
  • Cerner reveals details about “Project Apollo,” new cloud-based technology that will leverage the company’s previously announced partnership with AWS.
  • Researchers determine that 25% of healthcare spending – between $760 billion and $935 billion per year – is wasteful.

Best Reader Comments

Re: Putting off health care for financial reasons. According to GoFundMe’s CEO, one third of all campaigns are for medical expenses. Folks are literally begging strangers for money to help them pay their medical bills. (Kermit)

My “great expectation” would be that every time someone makes an entry into my medical record, that I would get a notification say that “X just entered something into your medical record. If this is appropriate, do nothing. If this is an error, please call us”. I feel this way because I was a victim of an identity mix-up with inappropriate merging of my record with someone else’s. Patient awareness like what happens with my credit care/bank might go a long way to reducing errors – and maybe it might make patients feel more responsible for their records at the same time. (Joe Schneider)

Sucks about athena but it is a hard market at a hard time. It looks like everybody will be stuck with CPSI until Allscripts buys them out and puts Evident out to pasture. (2Bad)

re: NextGen acquiring Topaz. The ‘agnostic’ market that NextGen has attempted to build (Eagle Dream Analytics, Entrada Mobile etc) continues to struggle with execution, two to three years in for analytics and mobile. If they could fix that problem, NextGen could be a different company. I don’t know if Topaz is another agnostic unicorn attempt but if the company doesn’t figure out how to execute, it will still be the same old NextGen regardless of the shade of lipstick on the pig. (ellemennopee)


Watercooler Talk Tidbits

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Ghanian teenager Mustapha Haqq develops a predictive analytics model that uses AI to diagnose breast cancer. Because of poor Internet access in his area, Haqq walked several miles to an Internet café, where he taught himself to code and develop the model using resources from UC Irvine. “Internet access is expensive,” he says, “but thanks to the generous support of my parents – who made some sacrifices to give me a chance to complete a few online courses – I built sufficient coding skills to start developing solutions to some of the problems affecting our community.” Haqq has gone on to launch several coding clubs for students of all ages.

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CNN profiles Olawale Sulaiman, MD a professor of neurosurgery and spinal surgery at Ochsner (LA) and founder of RNZ Global, which provides spinal surgeries and medical training in the US and his homeland of Nigeria. Sulaiman has taken a 25% pay cut to spend time – up to 12 days every month – caring for patients in Nigeria at little to no cost. “I believe that happiness doesn’t come from what you get, rather, it comes from what you give,” he said. “There is always room to give; you don’t need to be a millionaire to give.”

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National Library of Medicine researchers call for “no-selfie zones” after determining that 259 people died attempting to take death-defying pictures of themselves between 2011 and 2017.

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Restaurant franchise company Chanticleer Holdings decides to spin off its dining assets, which include the Hooters chain, so that it can merge with cancer drug maker Sonnet BioTherapeutics. @VentureValkyrie has started a tweet thread to crowdsource names for the newly combined company.


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Weekender 10/4/19

October 4, 2019 Weekender 2 Comments

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Weekly News Recap

  • Northwell Health (NY) will work with Allscripts to develop a cloud-based EHR incorporating voice recognition and artificial intelligence.
  • Walmart will pilot several programs across the country to connect its employees to healthcare services that it hopes will offer quality care at more affordable prices.
  • Private equity firm Francisco Partners will acquire laboratory information systems vendor Orchard Software.
  • Beginning next year, the VA will automatically share health data with community providers using the Veterans Health Information Exchange.
  • Siemens Healthineers subsidiary Siemens Medical USA will acquire ECG Management Consultants from Gryphon Investors.
  • FDA issues an alert about Urgent/11, a cybersecurity vulnerability found in IPnet third-party software that attackers may exploit to take over medical devices and hospital networks.
  • After laying off half its staff this summer and filing for Chapter 11 earlier this month, UBiome will cease operations and liquidate assets.
  • Canada’s New Brunswick Medical Society will close Velante, the for-profit company it created in 2012 as the sole EHR provider for the province’s doctors.

Best Reader Comments

Re: Walmart connecting employees to health services around the country. I like the concept. I would love to be able to go to the best of the best for treatment of a very serious illness if my insurance allowed. The travel, the hotel, etc., to be arranged and paid for through my insurance. I would welcome that. If I had serious heart problems, I would want to go to the Cleveland Clinic; if I had a rare form of cancer, I would want to go to MD Anderson; if I had kidney disease, I would want to go to Johns Hopkins. Will the next generation of Healthcare define Centers of Excellence around the country for various diseases and allow the insured to pick? I gotta say, it is a concept that I am slowly warming up to as I watch what Walmart and Amazon are up to. (X-Tream Geek)

I think naughty lists based on reports generated from the EHR are the way to go. It’s also easy to automate with the IT team. First time you mess up, automated email at the end of the week with quick note about what not to do. Second time, note+policy with manager cc’ed. Third time someone calls you. Fourth time … (Santa)

RE: Your comment: “I can’t recall an EHR vendor in recent memory putting boots on the ground at a single client site to design, develop, and implement a product before releasing it to the market. ” GE Healthcare attempted to do the same thing (well…kinda) with Intermountain Healthcare 2007-2013. GE invested approx $500M and the final product wound up being a meager ‘white board’. The project essentially killed the careers of numerous execs as well as what was left of IDX/GE. (leftcoaster)

Re: HealthTech “Influencers” — I agree on all shared above, and I know Mr.HISTalk has well documented his concerns over the years (as well as created a brilliant suggested scoring system), so I won’t elaborate on the lunacy of such lists. EXCEPT to comment that the most glaring concern are those named whose role is marketing on behalf of an organization/group/client. Marketing Brand experts should be invisible, not found on these lists. Especially considering the fact that they likely have a very warm fuzzy relationship with a publisher as they are the go between for the client. That does not make them an “influencer”. Their sole job is making money off of media placements and brand recognition, NOT to revolutionize technology for improved health delivery or outcomes like some on the list. I find it VERY poor form for the publisher to do a favor to recognize the man who brands himself and actually believed he is changing healthcare. Worst part….said man inspires countless others like himself, and is creating a small army of brand promoters. I kind of feel like John Legend in the R.Kelly documentary…..no one else in music would speak up. Often times when I do, I receive countless IMs from people telling me they agree with me, but refusing to go on record. Folks….can we change this, or is this social media world such that we just have to roll with it? (BehindtheScenes)


Watercooler Talk Tidbits

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In Florida, AdventHealth and Philips commit to becoming anchor partners of Metro Development Group’s third Connected City. The mixed-use development will offer residents concierge telemedicine services, a wellness park, and on-site Advent services including a standalone ER.

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Healthcare fraudster Jesse Lopez will spend more time behind bars after attempting from jail to hire a hit-man to kill her husband, a witness in her court case. Lopez was previously found guilty of posing as a nurse and performing unlicensed medical procedures at the Drop It Like It’s Hot Weight Loss Clinic and Jesse’s Gym in Florida.

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Saratoga Hospital (NY) will move some of its non-clinical operations to an anchor space in nearby Wilton Mall in order to free up space on its campus for more patient care. Information systems employees will be among the first to transition to the former Sears space.

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Micron Technology has developed a toilet that uses artificial intelligence to analyze a user’s waste to diagnose potential health issues. CEO Sanjay Mehrotra urges skeptics to “[I]magine smart toilets in the future that will be analyzing human waste in real-time every day. You don’t need to be going to visit a physician every six months. If any sign of disease starts showing up, you’ll be able to catch it much faster because of urine analysis and stool analysis.”

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Kaiser Health News profiles the secretive world of Instagram dolls, a community of women who have taken to the social media platform to share their cosmetic surgery journeys. 

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In Virginia, Joel Smithers, MD is sentenced to 40 years for prescribing over a half million doses of opioids – at least one prescription per patient – since opening his practice in 2015.

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Weird News Andy asks, “Perhaps they should start a new one and put up the names of those responsible?” St. Mary’s Regional Medical Center (ME) officials apologize for a “Wall of Shame” kept by employees that mockingly showcased pictures and details of patients with disabilities. Kept on the inside of a cabinet door, the collage was discovered and reported on in 2016 by an employee who told administrators about it. Citing a toxic work environment, she later quit after colleagues retaliated against her by looking up her medical records and discriminating against her because of her own disability. St. Mary’s has been quick to assure the media that no identifying patient details were kept on the wall.


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Weekender 9/27/19

September 27, 2019 Weekender No Comments

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Weekly News Recap

  • FDA releases draft guidance explaining how it will determine if a clinical decision support software product should be regulated as a medical device.
  • Emids is acquired by a private equity firm.
  • Prescription discount service GoodRx adds virtual visits.
  • Amazon launches a virtual medical clinic for its Seattle-area employees.
  • China’s Ping An Good Doctor reaches 300 million registered users of its online healthcare platform.
  • CHIME, AMIA, and other groups ask Congress to address specific information blocking issues and to extend the timeline for enforcement.
  • University of Kentucky HealthCare diverts patients over several days after a registration system update causes a system crash.
  • Campbell County Health (WY) diverts patients following a ransomware attack.

Best Reader Comments

If your organization is resistant to change (like most acute orgs) and not receptive of feedback (like most places with bad politics), you should probably keep your mouth shut. If you can’t, you should quietly leave. If you want to be a hero, volunteer after work or donate some money to a good cause. In general, sacrificing yourself on the molehills of office politics is a bad way to achieve moral goals. (DifferentIndustry)

One thing that always startled me as a someone who entered healthcare from a different field is how low quality healthcare management is. In private practice, you often have MDs trying to be managers. A general manager at McDonald’s has more well- developed management skills than these people. Sometimes they eventually realize that they don’t have what it takes and cede the role to a clinic manager or the practice is small enough that everyone learns how to work around them. The acute side is where you get real pathological relationships due to the scale, low pay for middle managers, and lack of competitive pressure. Every office has politics, but if people are incentivized to backstab, they will backstab. (Diseased)

Re: downloading health data. One more manifestation of the consistent phenomenon (see: open notes, patient portals) that patients are less fascinated by their heath data than we imagine. Most find this information to be either unpleasant, confusing, inaccurate, or some combination of these. A small core of patients find access to be essential, but it is a very small fraction. Assuming that all patients want to see their info makes us think we are failing. But maybe we need a different denominator.(Andy Spooner)

If I may, I’d like to add my two cents about why patients don’t download their data. I, for one, do download my data, especially the visit summary. But it is usually a waste of time and paper/ink because the substance of the discussion I had with my provider(s) is rarely reflected in the note. It’s more of a CYA note so pretty useless to me if I want to go back and try to see what the doc said in past visits. I even had a couple of physicians who dictated their notes AFTER I downloaded the note so the only thing entered in the visit note was PMH, Meds, VS, etc. Very disappointing. (Eyes Wide Open)


Watercooler Talk Tidbits

In England, twins who were mistakenly assigned the same NHS number at birth 37 years ago still have problems booking services, getting the right meds, and following up on appointments whose reminders are sent to the other sibling. NHS says it can’t talk about individual cases, but the problem is most likely to happen when patients share a last name, data of birth, and address.

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A woman receives 500 letters at her home address from UnitedHealthcare that are addressed to “State of Maine DHHS.”

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ProPublica congratulates itself on its story about non-profit Methodist Le Bonheur Healthcare’s aggressive pursuit of unpaid hospital bills in which it sued 6,500 patients, many of them living in poverty. The hospital was shamed by the report into offering more generous financial assistance, eliminating court-ordered interest on medical debt, and eliminating attorney fees. The feel-good story ignores the obvious – patients who didn’t pay their bills now don’t have to (unlike many patients before them), the hospital will surely find other ways to squeeze money out of patients once the headlines fade, and the problem of super-high hospital bills remains. The pea has simply been moved under a less-noticeable shell. Interesting facts from the health system’s tax forms:

  • It paid its current CEO $1.6 million and its “senior advisor” and former CEO $1.3 million in its most recent tax year.
  • The CIO was paid $469,000, the CTO made $337,000, and the chief health information officer earned $370,000.
  • Cerner was among its five highest-paid vendors, with $13.3 million in maintenance costs for the year.

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The stored stem cells of 56 cancer patients at Children’s Hospital Los Angeles are lost when the hospital’s freezer fails. CHLA apologized for the failure and for sending the notification letters addressed to the children instead of their parents. On a positive note, they bought a new freezer.

A Staten Island doctor is arrested for trading opioid prescriptions for sex, with 20 of his patients filling prescriptions for 100,000 oxycodone tablets.

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Former San Diego Chargers team doctor David Chao, MD  — an orthopedist whose history includes DUIs, a DEA investigation, 20 malpractice lawsuits, and a revoked medical licensed that was stayed in a settlement – launches a subscription football injury service called the Injury Index for gamblers under his moniker “Pro Football Doc.”

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A New Zealand woman credits her throat cancer recovery to a retired New Jersey pediatrician and cancer survivor who gave her a second opinion on Facebook. Sajjad Iqbal, MD wrote a 2017 book titled “Swimming Upstream: My Struggle and Triumph Over Cancer and the Medical Establishment: New Hope in Cancer Treatment.”


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Weekender 9/20/19

September 20, 2019 Weekender 1 Comment

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Weekly News Recap

  • Australia’s Queensland Health struggles with its new EHR and ERP systems.
  • Alphabet restructures its DeepMind health business to report to Google Health.
  • Warburg Pincus acquires behavioral health and human services EHR company Qualifacts for over $300 million.
  • Jonathan Bush (Athenahealth) joins video and office visit provider Firefly Health as executive chair.
  • Leidos sells its Leidos Health EHR implementation and consulting business to private equity firm A&M Capital.
  • Specialty practice EHR, PM, PACS, and AI chat bot vendor OrbCare is reportedly nearing insolvency just six months after announcing a $2 million seed round.
  • Livongo’s shares drop below their July 25 initial offering price after its first quarterly report shows widening losses.

Best Reader Comments

I don’t think people in general really care that much about their information getting out there or the government having it. People hand all their data over to Facebook, there is no organized movement around data leaks, and there has been very weak opposition to the Patriot Act or the Snowden leaks. The reason that we don’t have a national patient identifier is largely a result of it being bad for special interests. In the US political process, if you have a large sum of money you can always drum up “grassroots” efforts to stall legislation or pay politicians in power to pretend to hold a view. (People)

The term “copy / paste” is used excessively in a way that obscures problems with current EMR use. Plagiarizing someone else’s free-text information should be seen as very bad. Regurgitating your own previous note with minimal or no changes is merely bad and more responsible to the note bloat issue cited. But talking about the “past medical history” that autopopulates most EMR notes as if it were somehow reliable and true is naive. At minimum it’s often either incomplete or redundant and, worse, internally contradictory. Worse yet, free text narrative history notes from specialists often contradict medical history imported elsewhere into the selfsame note. Are there any examples where this sort of thing had legal ramifications? (Robert D. Lafsky)

The real irony is that in 1965, the AMA was vehemently opposed to Medicare. They claimed it would ruin the doc-patient relationship and make docs wards of the state. They were right — it has ruined the relationship, and given their income levels today, most of which comes from taxes, they are wards. Poor things. They must be gleeful just thinking about Bernie’s Medicare for all. (Frank Poggio)


Watercooler Talk Tidbits

A sexual harassment lawsuit brought by a since-deceased ED doctor against her hospital employer continues, with her husband claiming that the stress of her boss’s rejected sexual overtures followed by his work-related retaliation led her to die of gallbladder cancer in 2017 at 53.

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Several biohackers who believed the health claims of “hydrogen-infused water” company Trusii say they were scammed into taking out high-interest loans of up to $12,000 to buy its home water fountain, with the company promising to send them monthly checks if they posted glowing social media reviews of its health benefits. Trusii’s owners say they’re the victims of mob mentality, it’s their competitors organizing the bad PR, and that they actually overpaid users, some of whom didn’t meet its testimonial requirements. The CEO was arrested in February for alleged scams related to his previous used car business.

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University of Michigan will build a $920 million, 264-room patient tower that it says is “an investment in Michigan Medicine’s mission of advancing health to serve Michigan and the world.” Existing semi-private rooms will be converted into private rooms, adding a net bed count of 154 (at a cost of $6 million per bed).

NPR notes that government-employed doctors in Venezuela earn less than $2 per month, forcing them to live on free food provided by local merchants and bus money offered by patients. At least half of the country’s medical employees have left the country or changed jobs, not just because of wages, but because Venezuela’s economic woes under an authoritarian government have left it without medical supplies, drugs, and hospital air conditioning as annual inflation rates have risen to 10,000,000%. Doctors report being fired or threatened for complaining about patient endangerment due to situations such as having to use their cellphone lights to perform surgery.

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A 23-year-old Iowa State football fan whose on-camera ESPN College GameDay sign asked viewers to Venmo him beer money receives $1,600 in donations, leading him to decide to buy one case of Busch Light and send the rest of the money to University of Iowa’s Stead Family Children’s Hospital. Anheuser-Busch – owned by Belgium-based InBev – promoted his cause and offered matching funds. The donation total now exceeds $350,000.


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Weekender 9/13/19

September 13, 2019 Weekender No Comments

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Weekly News Recap

  • Surescripts cuts off prescription data access to Amazon’s PillPack mail order pharmacy.
  • The premier of Queensland, Australia promises to investigate a 14-hospital downtime of several hours that was caused by a Cerner upgrade.
  • Apple announces that it will partner with several high-profile healthcare institutions to conduct studies related to hearing, women’s health, and heart health using its new Research app.
  • Mayo Clinic signs a 10-year partnership with Google in which Google Cloud will provide Mayo with data hosting, cloud computing, analytics, and machine learning and AI.
  • Bayfront Health St. Petersburg (FL) pays $85,000 to settle HHS OCR’s first case under the Right of Access requirement to give patients complete copies of their medical record within 30 days.
  • Hackers breach DDS Safe, a cloud-based records retention and backup solution that is sold to dental practices, and use it to install ransomware on the computers of hundreds of dental practices.

Best Reader Comments

Private equity can jump in the line of who all are screwing the consumer –bloated organizations, vendors charging five times what it would cost out of healthcare, solutions bought not needed, physicians making a fortune off their patients’ problems, and hospital execs stuffing pockets while driving up costs. Next up: pediatric offices charging based on parent fear level. (Overcharged)

I use PillPack and one of the things that appealed to me was that it took five minutes to sign up and they had my insurance information and prescription information without my needing to supply it. If this had been manual, I would have never signed up. (To be or not to be)

Is a really high deductible and co-pay actually “coverage” or just the illusion of coverage? (Brian Dale)

I’m honestly thrilled that a hospital / health system got nailed for obstructing access to patient records. It’s overdue. As a hospital, I owe it to my patients to assure that they can get to their records in a timely manner. I don’t always know why they need it, and it isn’t my problem. It is their information. They should have a right to it. (MEDITECH Customer)

In effect, Epic aptitude testing tries to determine if you are a smart person. The assumption is, if you are a smart person, you can be a good IT analyst. Good grief! Only your job history proves that and I already have that. (Brian Too)

Epic doesn’t tell you how you do on the exams, but you can assume you did well if you’re offered the job. Carl Dvorak, in a new hire class, told us that the aptitude and personality tests were better predictors of how well Epic employees would perform than their college major, job history, college, etc. (Publius)

Worked in a border city in a prior life — we had hospitals in both states. One state required a physician signature on every individual script, the other allowed batch signing. EMR workflow was a nightmare, as was physician adoption for the physicians that worked in both hospitals. (Was A Community CIO)

Burnout is a real condition, but for most of organized and academic medicine, it has provided a handy new topic to generate more content for sale and consultation fees. (Kevin M. Hepler)

If the AMA was fighting for us, they would be loudly demanding truly radical restructuring of US health care rather than tweaking the existing one with apps, conferences, wimpy comments on CMS rule-making, etc. The solution to our problem isn’t going to come from the AMA until they recognize that they helped to create the problem. (Joe Schneider)

That’s the nature of implementation in general. People who have previously done the exact same thing as you need command a premium salary. Most of the work isn’t really that complicated and is just grunt work. Therefore vendors provide the grunts and let the high-powered implementation people go become consultants that the customer can pay high salaries if that’s what the customer wants to do with their money. (Grunt)

I like where you are going with a basic skepticism of feedback you receive from folks who have not yet bought your product. In the startup world, a little book called “The Mom Test” has become the standard for the “customer discovery” process, in which you learn that people desperately want to tell you what they think you want to hear – and it’s usually not helpful. (Michael Burke)


Watercooler Talk Tidbits

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The Seattle newspaper recites yet another example of The Joint Commission giving a hospital a glowing review while state inspectors were nearly simultaneously threatening to shut it down for safety problems, highlighting the Commission’s self-proclaimed role as being the non-punitive advisor to hospitals that want to improve.

Google adds naloxone-finding tools and addiction recovery meeting locations to Maps.

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An 86-year-old Georgia doctor who operates a weight loss clinic is arrested for illegal drug distribution and money laundering, charged with taking cash from former NFL linebacker Sedrick Hodge for providing him with prescription medications to sell on the street.

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San Diego physician Murray Alsip, DO discovers that he can continue practicing medicine even after a heart transplant left him unable to see patients in an office by signing on as a telemedicine doctor with MDLive. Alsip previously met with the former girlfriend of 20-year-old man whose heart he received so she could hear it beating in his chest.


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Weekender 9/6/19

September 6, 2019 Weekender 2 Comments

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Weekly News Recap

  • Cerner lays off at least 250 employees as part of a cost reduction effort intended to deliver investor-promised operating margin targets.
  • OptimizeRx acquires RMDY Health.
  • AMA releases 2020 CPT, which includes several new codes to cover digital communications with patients. 
  • The Commons Project Foundation announces plans to work with partners to develop an Android alternative to IOS-only Apple Health Records.
  • ONC chooses The Sequoia Project as Recognized Coordinating Entity for TEFCA.
  • AMA and AHA ask for changes to proposed HHS rules that would force hospitals to share medical records with their patients, expressing concern that patients won’t understand them or that they won’t be aware of the possible exposure of their information to third-party apps.
  • Walmart launches a standalone health clinic pilot that will offer primary care, dental, labs, X-ray, audiology, and mental health counseling.

Best Reader Comments

[Regarding the Vince Ciotti interview] Wow, what a great interview! Also, THANK YOU for compiling his PowerPoint presentations into one PDF document! Vince is right! “You can only learn from the past. You can’t learn from the future. It’s not here yet. The mistakes made in the past will be made in the future unless you learn from them and change them. It’s such a priceless thing.” As a young female millennial in healthcare IT, I am appreciating this wisdom and am determined to go through all 1,438 slides. Thanks for conducting a great interview! Wonderful answers Vince! (Weird_Female_Millennial_JCV)

Thinking about the situation for two seconds, many health IT discussions about burnout make no sense. Has burnout among medical assistants increased a huge amount since EHRs or EHR-heavy requirements were put in? Not really, so the source here is probably not the EHR. What’s the rate of burnout among VA staff, who have an EHR that on the clinical side is hugely unusable? It’s about 1/2 that of elsewhere. So it doesn’t seem like the EHR is a driving factor here. Why does your job suck? Probably management. If management came by with a survey asking why your job sucked, would you check the box that says “management sucks?” Only if you were a baby in the corporate world.(tEHRibble)

M&A is not an eventuality, it’s a deliberate strategy. It is so across all industries, including hospitals. How does any business grow in a zero-growth industry? M&A. Any company’s mission and responsibility lies with its shareholders. Some folks struggle with the realization that healthcare is not an altruistic endeavor, not any more at least. (El Comadante)

The reason that you don’t have to ask “Star Trek” computers three times is that the “Star Trek” computers understand meaning. This is what is missing from all the classic voice recognition systems to date. (Brian Harder)


Watercooler Talk Tidbits

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A survey by the UK’s Royal Society for Public Health finds that the most toxic feature of social media – even more so than the content posted by users — is the “like” button.

An oncologist in Australia admits that she was overly influenced by “the opioid industry” when she entered practice in the early 2000s, where drug company reps casually convinced her that the company’s opioid was safe while paying for her journal subscriptions and lunch, which was a small investment given that her resident’s father was flown by a device manufacturer to a Scottish castle to discuss coronary stents. She recommends that doctors be educated on “the insidious influence of drug companies” that vie for their attention when they have little time to critically evaluate company claims. 

Scammers are using AI-powered voice impersonation software to call company insiders and convince them to transfer money to foreign accounts or to divulge sensitive internal information.

Rennova Health, the publicly traded (but Nasdaq-delisted) lab and software company that bought and closed Jamestown Regional Medical Center (TN) after walking away with employee tax and Social Security withholding, confirms that is behind on employee paychecks at the recently acquired Jellico Community Hospital (TN) and has cancelled the employee health insurance plan while continuing to withhold their premium payments. Rennova Health’s CEO, an Irish citizen who lives in the Bahamas, sued a Tennessee state senator in July 2019 for calling him an “Irish gangster” who came to Tennessee to cheat locals after the company closed JRMC. His primary business interest appears to be a chain of toxicology labs. Several struggling rural hospitals have been acquired and eventually closed by similar lab companies that are anxious to bill at higher hospital rates, which lasts only a short while before insurers stop paying. RNVA shares are trading at $0.0001, valuing the company at basically nothing.

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Just because you can doesn’t mean you should. A 74-year-old rural Indian villager becomes the world’s oldest new mother after delivering IVF-created twin girls. Mom, who was hospitalized for her entire pregnancy, says she was inspired to give birth 30 years after the onset of menopause when a 55-year-old neighbor became pregnant. Dad is 80.


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Weekender 8/30/19

August 30, 2019 Weekender 3 Comments

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Weekly News Recap

  • Life insurance startup Ethos, which uses predictive analytics based on a customer’s EHR data rather than a medical exam to predict lifespan, raises $60 million in Series C funding round.
  • A KLAS-convened customer review of Cerner’s revenue cycle management progress finds that the user base feels the Cerner is listening, but they are frustrated with lack of progress since the initial meeting a year ago and are questioning both Cerner’s ability to execute and its sense of urgency.
  • Epic holds its UGM in Verona, WI.
  • Private equity firm Warburg Pincus acquires a majority interest in therapy EHR vendor WebPT.
  • Health Catalyst files its first quarterly earnings report following its July 25 IPO.
  • Politico reports that the VA’s initial rollout of Cerner will be delayed several months to October 2020.
  • A VA OIG report finds major backlogs of paper records scanning from outside providers at eight VA facilities, with some records going back to 2016 still piled up in storage rooms.

Best Reader Comments

State-specific regs are problematic for HIT and for clinical care in a broader sense, particularly when states have specific documentation or regulatory requirements that differ from national ones. State specific regs include those related to reportable conditions, privacy, mental health or substance use and complicate EHR design since they vary from state to state. Particularly in the electronic era, having a single standard would be much more efficient. (Federalist)

Insurance companies getting their hands on EHR data concerns me less since the ACA restricted what they can base premium prices on. (TheSnarkIsWhyImHere)

Medicare doesn’t hire doctors (like the NHS in England does, paying them salaries). Doctors submit bills to Medicare on a fee-for-service basis. Even Medicare Advantage (private insurers providing Medicare coverage for about 30-40% of the seniors) works through doctors sending bills to someone. There are projects underway to come up with other ways of paying doctors for Medicare, involving reward for achieving better overall costs and how well patients do, as measured in different ways. It still involves sending bills.The lament comes in because seeing patients and sending bills involves dozens of different payers and contracts and systems of rules and mechanics of getting paid. If there was just “one payer,” it would get simpler. (Randy Bak)

Although some like to point to foreign countries like Canada, Finland, etc. as good single-payer systems. every one of those countries has at least a two-payer system. The government system,and the private pay (or private supplemental insurance) to cover faster care or non-covered items. So I wouldn’t worry about the rev cycle folks being on the street to soon. (Frank Poggio)

I’m a fan of the Israeli healthcare system. They have several HMOs, under pretty strict government oversight. The result is a quasi-competitive system that offers a government-mandated basket of services. The cost of their healthcare isn’t outrageous, they have shown they can innovate within their economic structure (a common complaint about single-payer is stifling innovation), and the outcomes are better than the USA. I tire of the arguments against single-payer that suggest we do nothing. Clearly, we have a cost and quality problem in this country. Doing nothing is not a strategy for success. (Jim Bresee)

[With regard to health IT salespeople] I never misrepresent myself to employers or clients. That is how I can hold my head high, even when I’m in a room with one of my sales reps who decides to “do their job” despite my guidance. Because I will interject and say “technically” or “in the interest of full disclosure,” the client will light up with appreciation and the sales rep will be enraged. Those instances typically result in a successful long-term relationship with the client. As Mr.HISTalk shared, there are many good reps. But there are all way too many who are doing their job, which often times doesn’t align with being fully transparent. (Katie Goss)

[On clinical decision support systems replacing EHRs as clinician-facing technology] An EHR is a enterprise-wide. mission-critical transaction system. A CDSS is akin to a Mangement Decision Support System in commercial industry, and I know of no situation where a MDSS has totally replaced a SAP or Oracle transaction system. (Frank Poggio)

I’ve often noticed how many of the sales management folks (from directors to VPs and even to a couple of CEOs) have fallen from grace (they have quotas too!) and eventually end up down the food chain again. Sales is an interesting business and the people at the top making the big decisions and big bucks are not always the best strategists. Sometimes just the best BSers! (Eyes Wide Open)


Watercooler Talk Tidbits

Healthcare long-timer and Tincture editor Kim Bellard quotes an AI expert’s recommendation to substitute “magic fairy dust” for “AI” in any article that mentions it, which helps determine how realistically the author or expert is describing unproven technology. He also quotes healthcare debunker Jen Gunter, MD, who rails against bad information as well as click-desperate news sites that either misrepresent the latest medical study (intentionally or not) or label it with a misleading headline that will be echoed endlessly on social media with no critical review.

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An Atlantic writer spends $1,300 on products from the “pretty, blonde 20-somethings” working in the luxurious storefront of Gwyneth Paltrow’s so-called “wellness” company Goop. She emitted foul body order from some wacky vitamin combos, attracted attention with a $80 “healing energy” crystal water bottle, couldn’t figure out how to use the $42 tinted face oil, and found that the Martini Emotional Detox Bath Soak resembled raw sewage when dumped into her bath water. She liked some of the expensive products, but summarizes:

For these products to be considered successful, the result wouldn’t necessarily be a stronger, more resilient, more competent me, or a more peaceful relationship with my body. It would be a person who is better-dressed, who hasn’t succumbed to the indignities of visible aging, whose hair doesn’t frizz, who never goes back for seconds at dinner … the company’s products embrace one of America’s oldest health myths: that physical beauty is proof not only of a person’s health but of her essential righteousness. If the outside is perfect, the inside must be too … Wellness companies can feel predatory, even those not making Gwyneth Paltrow richer. It’s a largely unregulated industry, and it operates in an environment of open desperation. Many women justifiably mistrust the ways conventional doctors address their concerns and treat their pain. Goop, influential in ways that would make most gurus and healers envious, has helped introduce millions of people to “experts” who argue that HIV doesn’t cause AIDS and that drinking celery juice can treat cancer.

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NICU staff at Riley Hospital for Children at IU Health North (IN) hold a graduation party for baby born at 23 weeks weighing 20 ounces. Four months later, she was discharged weighing 8 pounds, 6 ounces. I’m assuming that other hospital employees were less enthused at the same moment in trying to collect the massive bill generated as a by-product of the miracle.

The FBI arrests a Michigan doctor who it says planned to kill a condo HOA lawyer and his own attorney by injecting them with fentanyl.

Leaked emails from a regulatory affairs physician with chemical company Monsanto show that the doctor wanted to “beat the sh*t” of members of advocacy group Moms Across America for urging the company to stop selling genetically modified seeds and Roundup. The president of an environmental group says that Bayer is “reeling” after paying $63 billion for Monsanto last year, only to be hit with negative publicity as “the company that gave us DDT, Agent Orange, and PCBs.”

A veteran running late for his appointment at the St. Louis VA hospital uses its valet service to park his new car, following the valet’s instructions to just leave his car with the keys on the dash. Afterward, the valet said someone drove off with it, but the third-party valet company isn’t returning his calls to explain why it would allow someone to take the car without presenting a claim ticket. The car turned up two weeks later damaged, empty of his personal belongings, and tricked out with a new window tint job.


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Weekender 8/23/19

August 23, 2019 Weekender 1 Comment

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Weekly News Recap

  • Revenue recovery software vendor Ontario Systems is acquired by an investment firm.
  • Allscripts announces availability of Apple Health Records in its EHRs.
  • A watchdog group publishes emails detailing the involvement of the “Mar-A-Lago crowd,” including an associate of President Trump, with the VA’s contracting with Cerner.
  • EHealth Exchange announces go-live of a national, single-connection gateway service.
  • A Nature article covers the responsible use of machine learning in healthcare.
  • Several investment firms are reported to be in discussions to buy Emids Technologies.
  • Ciitizen rates hospitals on how effectively they respond to patient requests for copies of their information.
  • An OIG report finds that the VA’s overdue, over-budget scheduling project is nearly finished, just in time to be replaced by its Cerner implementation.

Best Reader Comments

[From the author of a report predicting that clinical decision support systems will replace EHRs as the primary physician interface] CDS are now mostly point solutions, but the CDS vendors are expanding their reach and are discovering something interesting: the more they expand, the more EHR data is required. At some point most of the data in an EHR is then in the CDS. We have not reached that point yet, but when that happens, it makes logical sense to invert the model, where an EHR gates most health It functionality and change it to a model where the EHR is actually subordinate to a more user friendly interface: likely one that looks a lot like a CDS … The essential notion is solid: EHRs are not user friendly, but CDS generally are. This is an unstable dynamic and we believe that someone will move to address the problem. Also, we did talk to practically every CDS vendor as well as every EHR vendor and healthcare delivery organization. The interesting thing is that the idea that CDS would take over did not come from the CDS community, but came from the healthcare delivery community. (Mike Jude)

[To the author of the report above] You make some sweeping assertions without any basis in fact. “EHRs are not user friendly, but CDS generally are” – what is this conclusion based on? You assert “CDS are often developed in response to specific pain points: new regulations, new dosing requirements, etc.” Are there any serious CDS systems certified for Meaningful Use AND in general adoption by doctors at the point of care? And on what fact base do you assert that EHR vendors don’t “incorporate human factors to ensure low impact human interactions?” (Supporting good decisions)

[Referencing an article on Apple Health Records] How will access to my EHR data help me “shop for high value health care services” and “avoid the need to repeatedly supply data for entry?” These discussions are without substantive support in any fashion that I can see. I hope my tax dollars did not pay for this. (FormerCIO)

The ACR AUC system is ridiculous for specialist physicians. I am a board certified orthopaedic surgeon who knows when I need an MRI or CT scan. At what point does the system trust me to make a decision about the care of my patients? After two MOC exams? After 20 years in practice? Am I an outlier with studies? No. So if ACR wants to do AUC, then have the radiologists do it, not me. I know what study I need and want to care for my patients. If you think you know better, then you take over the care of the patient when you deny the test. (meltoots)


Watercooler Talk Tidbits

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Millennials who document every potentially enviable aspect of their lives on Instagram are hiring professional photographers to shoot both natural and C-section childbirth, with full-time birth photographers elbowing doulas out of the way to charge up to $4,000 at trendy hospitals like Cedars-Sinai and UCLA. They leave business cards in exam rooms and with providers who hand them out. OBs aren’t always thrilled with the potential additional malpractice exposure of having everything recorded in photos or video and hospital policies are often inconsistent or non-existent.

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A dozen of Facebook’s low-paid content moderators – contracted from Accenture to review up to 800 pieces of disturbing user content such as child sexual abuse in a single shift – accuse Accenture of trying for force company-provided “wellbeing counselors” to disclose the details of their trauma sessions in what they say is a violation of HIPAA.

SimplyVitalHealth, which offers “blockchain-based solutions to emerging value-based healthcare programs,” returns $6 million to investors after the SEC charges it with conducting an unregistered securities offering in the form of an Initial Coin Offering.

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Google DeepMind co-founder Mustafa Suleyman takes indefinite leave from the artificial intelligence company.

University Medical Center of El Paso disputes President Trump’s claim that its surgeons left the OR to see him in during his post-shootings visit there, reassuring the public that in no case would that ever happen. The president said surgeons came out of ORs in both El Paso and Dayton in a spontaneous showing of “the love for me.” 

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A Miami plastic surgeon self-styled as “Dr. Slimthick” whose billboards offer Brazilian butt lifts financed at $30 per week is found to have falsified most of the credentials claimed on his website. The local paper checked his background in running a story about one of his patients, a 35-year-old woman who remains in critical condition a month after he performed her procedure. His cosmetic center is offering a silicone implants or liposuction for $3,500 if you’re in the market.

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A Texas woman faces 20 years in prison after being accused after subjecting her healthy son to 323 hospital and clinic visits and 13 major surgeries in the first eight years of his life in a case of Munchausen syndrome by proxy. She had also started several online fundraisers for the boy, claiming that he was dying from a genetic disorder and later from cancer. She had placed him on a lung transplant list and enrolled him in hospice care, caught only when employees of a Dallas hospital called child protective services. 

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Wolfson Children’s Hospital (FL) posts a video of 15-year-old Yanira Guzaman, who was able to stand for the first time and dance with her father at her quinceañera thanks to spina bifida treatments and a new power chair.


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Weekender 8/9/19

August 9, 2019 Weekender 1 Comment

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Weekly News Recap

  • Allscripts announces mixed Q2 results, which include a $145 million charge toward settling any liability that results from the Department of Justice’s Meaningful Use investigation against its acquired Practice Fusion.
  • CVS beats Wall Street’s quarterly expectations and announces plans to expand its HealthHubs concept and to implement “next best action” programs for chronic care management.
  • England’s NHS announces plans to form an $300 million artificial intelligence lab.
  • Truman Medical Center pays ransomware hackers to regain access to its systems.
  • Duke Clinical Research Institute and Cerner announce a pilot project to study patient data from non-Duke sites as the initial step in forming Cerner’s Learning Health Network.
  • The DefCon cybersecurity conference creates a mocked-up hospital full of medical devices for hackers to play with.
  • A new funding round values London-based AI health services vendor Babylon Health at over $2 billion.
  • Guidehouse will acquire Navigant for $1.1 billion.
  • Beaumont Health responds to reports of IT-heavy layoffs and the recent departure of its CIO and CMIO.

Best Reader Comments

Are you getting your license in other states for telemedicine purposes?? It always interests me how you have to have to be credentialed in the state of the patient even though you are providing the service from a different state, right?. Then I think of weird examples, like if you are on the phone with a patient who is riding in a car and they drive across state lines. One second you are having a legal conversation with a person and the next second you might be breaking the law! (Creds)

Even the most tech-awarded CHIME and HIMSS hospital systems are relying on their insurance to protect the corporation (not patients’ privacy) from hackers, Shamefully, most hospital CIOs have maintained very small budgets for cyber protection solutions and put basic security on auto pilot. [Ransomware victim] Truman Medical Center is “Most Wired” since 2010, Stage 7 HIMSS Analytics since 2013, a 2015 Davies Enterprise winner, and a Cerner model show site in its home town. (Are CIOS Ignoring or Ignorant?)

We need a law that says that they can’t play around with “re-identifiable data.” At this point we’re all aware that de-identified really means “not immediately identified”, or “you have to put in some work to make identifiable again.” De-identified should become un-identifiable. Of course in order to do that, you’ll probably be destroying whatever value they’re getting out of it. But they shouldn’t get to call it de-identified, it’s still PHI/PII unless mathematically provable that you can’t use that data to get to the identity of the people. (AC)

Why is Eric Topol not brave enough to say it? If you are in hospital administration, the group that collectively lobbies for you is called the AHA. If you are a small business owner – physician, the group that collectively lobbies for you is the AMA. If you are an employee of either of those two, the group that collectively lobbies for you is called a union. Ask a nurse to explain it to you. (SelfInflictedWound)

Meditech’s sales revenue is declining again. The company’s progress seems to be one step forward, two steps back. Saying the company is profitable and the balance sheet looks good, as was heard at the shareholder’s meeting, is another way of saying they are surviving. Meditech has yet to explain to its shareholders why it suffered such a large contraction during the period of greatest expansion the market has ever experienced, placing it a very distant third behind Cerner and Epic. (Running on MT)

I’ve talked to 5+ doctors about the thought process that they use to diagnose patients. I would characterize it as being a “satisficing” approach and I don’t think that computers are going to help make it better. I’m curious, though, about the percentage of diagnoses people think are incorrect. It really depends on how you define a misdiagnosis. 10% seems reasonable. (IANAL)

What’s [tackling problems with more impact than misdiagnosis] worth in real dollars that real physicians or medical organizations are going to spend? Unless I can convince enough physicians to pay for that service, what good does that do? I have to pay for my rent and groceries, too. We can have as many clever ideas for improving outcomes and patient health as we like, but we can’t do it for free. (HIT Girl)


Watercooler Talk Tidbits

A doctor from University of Calgary’s medical school mines Alberta’s EHR to find 60 ED visits that contain the word “scooter” to determine the extend of e-scooter injuries, although he admits that word usage might compromise accuracy. He urges those using the scooters to wear a helmet, which few riders of the newly introduced rental e-scooters do. The city requires helmets for bicyclists but not scooter-riders and allows only scooters to be ridden on sidewalks. 

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Doctors eventually find that a Michigan woman who had choked on the first bite of a grilled hot dog and then experienced repeated problems afterward with breathing, talking, and swallowing had a wire embedded in her throat, which turned out to be a bristle from a grill brush. Doctors removed it and she’s fine. She urges people to use plastic grill cleaning brushes, explaining that her husband later passed a magnet over the grill and picked up 30-40 more bristles.

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A  man who was sentenced 20 years ago to jail and six months of psychiatric counseling for impersonating a doctor over a six-month period at UCLA Medical Center graduates from a Caribbean medical school at 47, admitting that it’s tough to get licensed and accepted into a US residency when his past includes forging prescriptions. His education probably isn’t helping his quest – a current student of the for-profit Saint James Medical School says the school has a minimum GPA of 2.0, an MCAT-optional admissions process, an attrition rate of 86%, an 8% first-pass NBME pass rate, and a low residency match rate. 

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Physician assistant Johnny Presley buys the recently closed Cumberland River Hospital (TN), pledging to open his fourth outpatient clinic there within four weeks and then possibly eventually adding a standalone ED. He paid $200,000 for the hospital, which had been bought for $6 million by a local hospital in 2012 that closed it after ongoing financial losses. He explains, “I might not be hardly as smart as some people or have as much money as some people, but I’ll outwork anybody. I just apply a lot of commonsense approaches. It’s a one-man show … I spent my life working in rural hospitals and rural communities and it’s a needed service in these areas. Unfortunately, it’s like time left those places, and it’s very sad. Growing up and working in them, seeing them all start to close is very sad.”

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The for-profit hospital operator that bought two Wheeling, WV-area hospitals two years ago announces plans to close them both. One started as a city hospital in 1890, while the other opened its doors in 1906.

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A jailed, 77-year-old pain management doctor in Detroit who is accused by the federal government of bilking insurers out of $500 million in a scheme involving opioid prescribing and spinal injections offers to turn his lakefront estate into a privately guarded prison if authorities will release him. Raj Bothra, MD’s most prolific prescriber, Eric Backos, MD – who “specializes” in “pain management, medication management, opioid detoxification, EMG/NCS testing to identify specific location of nerve injury, Botox therapy, and acupuncture” – prescribed 5.9 million pills from 2013 to 2018, with 86% of them being opioids and with at least two patients dying of overdoses following their visit.


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Weekender 8/2/19

August 2, 2019 Weekender 1 Comment

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Weekly News Recap

  • The VA opens director and deputy director positions to oversee its Cerner implementation.
  • Meditech reports lower quarterly revenue and earnings.
  • Cerner signs a partnership deal with Amazon Web Services.
  • The country’s biggest technology companies reaffirm their commitment to healthcare interoperability.
  • CMS announces a pilot project to display a patient’s claims data to Medicare fee-for-service providers.
  • Surescripts says Amazon-owned mail order pharmacy PillPack accessed its patient prescription records without authorization and will turn the issue over to the FBI.
  • Bain sells a majority stake in Waystar.
  • Meditech celebrates the 50th anniversary of its founding this week.
  • Kaiser Permanente hires its first chief digital officer.

Best Reader Comments

I’ve seen [inaccurate hospital patient records] more times than I can count. However the more the information gets used and the more visibility it has, you start to see incentives to clean up the problem. One of the strongest forces is when you see automation or analytical reporting, or any type of financial incentive. My standard line is, “no one cares about data quality so long as no one is using the data”. Also, we are very forgiving about data errors so long as only human beings are consuming that data and the data usage is transactional and episodic (e.g. a patient chart during treatment). As soon as you start comparing one patient chart to a bunch of other patient charts, in any systematic way, that changes. Eventually the Data Quality department gets involved, the line managers can’t justify or defend the bad documentation, nor can the clinicians, and some procedures to clean things up are put in place.It takes time but it’s a real thing. (Brian Too)

I’d like to understand how Cerner moving to AWS is innovative and “pretty disruptive.” (ellemennopee)

I’m not seeing the real value in the “Data at the Point of Care” project for any one provider. It appears that it only gives them data for Medicare FFS patients. Only about 60% of Medicare patients are still in FFS, and think about how any one provider’s patients come from a variety of commercial and public payers. Does it help provide better care overall if they can only use that data for a small percentage of their patient panel? Care is already delivered differently based on who the payer is due to network restrictions, coverage levels, and the payer’s unique quality measure requirements, does this just further that divide? Would be interested in providers’ thought. (SEH)

Interesting combo of news this week. Cerner encourages investors with their plans to boost earnings by selling patient data. Amazon’s PillPack and Surescripts scrap over access to patient medication data. Cerner announces partnership with Amazon’s AWS for hosting their customers’ systems. Hmmm, I wonder where my patient data is going to end up when I entrust it to a Cerner hospital? (YourRxAdsHere)

[Epic’s] implementation staff is green, inexperienced, and taught to walk the Epic Foundation line. They in no way have experience in a hospital, or in any sort of maintenance of the systems they implement … On the other hand, if I had to hire staff, I would hire any Epic employee in a heartbeat. They are hard workers, bright, and great presenters, I have nothing bad to say about any I have encountered. It’s their lack of true experience that bothers me. (IMPlement)

One of the reasons IT and hospital administration favor systems like Epic and Cerner is that they want to standardize across the health system. They don’t want an app to be able to come in and override their configuration. They want everyone in their system to be on the same software and they want one throat to choke for getting software to do what they want. This is especially true for the particulars of this period of time in healthcare, in which ensuring quality while reducing cost is on everyone’s mind. We aren’t designing aircraft or cruise ships or other innovative developments. We need good execution of the good ideas already out there at an attainable price. (WhoIsBuyingThat)


Watercooler Talk Tidbits

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Readers supported the teacher grant request of Ms. D in Texas, who asked for math manipulatives  for her elementary school class following the devastation of Hurricane Harvey. She reports, “Thank you so much for all you gave to my class. The games and activities you helped bring into my class has already made such an amazing impact. We love to use them in centers and the students love to play with them, but most importantly, learn with them. Words cannot describe how much these items mean to us. We recently used the fraction cards and power pen to help compare fractions! The students loved being able to hear the sound it made when they got it correct. We will continue to use these amazing materials and games to help further their learning.”

An analysis of the Democratic presidential debates by the executive editor of the liberal magazine “The American Prospect” says the candidates are ignoring and misrepresenting the top issue of voters, which is healthcare:

It’s a very strange situation for the leaders of reforming healthcare in America are too cowardly to talk about what’s wrong with healthcare in America. We know from experience that trying to play a savvy game and keeping the hospital industry on the sidelines won’t work. The hospital industry cut a deal with President Obama to eliminate the public option last time around. They’re already funding the effort to destroy reform this time. Why won’t anyone say this out loud?

Healthcare in America costs too much. We’re having a debate over how to fix it that renders invisible the very actors who charge the prices. That’s a recipe for disaster. Someone must show a modicum of guts and describe this system as it is, before it consumes us all. So far, guts are not in evidence.

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A retired doctor in Ohio gets the attention of the President when his daughter’s back surgery results in an $18,000 bill for urine drug screening that had been sent to an out-of-network lab, the same test that would have cost $100 if performed in-network. He says he is “ashamed of my profession” and notes that “almost all medical bills are paid with someone else’s money.” A Houston pain management doctor owns both the surgery center and the lab.

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Missouri’s medical board places Russell Imboden, DO on probation for prescribing drugs to himself, ordering unnecessary lab tests, and treating patients with serious medical conditions with chicken bouillon, protein shakes, and controlled substances from his “cell-based regenerative medicine” clinic that focuses on “metabolic and age management medicine.” He was previously fired from a similar clinic operated by another DO that sells energy drinks, medical weight loss, homeopathic remedies, and libido enhancement.

An oral surgeon sues an anesthesiologist who supervised his Brooklyn Hospital residency for sexual harassment, claiming that the woman groped him during surgery, threatened to kill him and his mother, waved a syringe at him, and sent him messages that included text such as “How would you like my dead body on your doorstep?” and “How long do you think it takes someone to bleed out?” Pik Lee was served with a protection order and arrested, but Francisco Sebastiani says she caused his firing after he complained and then gave him a bad recommendation that lost him a residency bid.

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The new Miss England starts her NHS medical residency hours after winning the pageant. India-born Bhasha Mukherjee, MBBS, age 23 – whose family moved to the UK when she was nine — will move on to the Miss World competition. She says,

Some people might think pageant girls are airheads, but we all stand for a cause. We’re all trying to showcase to the world that actually just because we’re pretty, it doesn’t end there. We’re actually trying to use our reach and influence to do something good … I couldn’t tell if I was more nervous about the competition or about starting my job as a junior doctor.

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An East Cleveland, OH car mechanic whose high school GPA was under 2.0 and whose family includes two young children at home graduates from medical school this year at age 47 and is doing an emergency medicine residency at Cleveland Clinic Akron General Hospital. The ED chair says of Carl Allamby, MD, “He’s got people skills most doctors don’t start out with, that customer relations mentality from his years in business. We were blown away by him.”


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Weekender 7/26/19

July 26, 2019 Weekender 14 Comments

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Weekly News Recap

  • Shares of Health Catalyst, Livongo, and Phreesia begin trading with significant first-day price jumps.
  • Cerner announces plans to create a “monetized distribution model” of selling patient data to drug companies and insurers.
  • Tenet announces that it will spin off its Conifer revenue cycle management and population health business into a publicly traded company and that Conifer CEO Stephen Mooney has resigned.
  • Cerner’s Q2 earnings meet Wall Street expectations as revenue fell short.
  • Essence, parent company of Lumeris, faces CMS review for using Lumeris software to identify patients who could be billed as “enhanced encounters.”
  • AHIMA and CHIME urge the Senate to pass a House bill that would allow HHS to participate in the rollout of a national patient identifier.
  • Amazon threatens to sue Surescripts over the potential loss of access to patient prescription data for its PillPack mail order pharmacy subsidiary.
  • Tennessee creates a committee to study state EHR use for efficiency and potential fraud.

Best Reader Comments

Cerner CommunityWorks is a multi-tenant domain for critical access hospitals and community hospitals under 200 beds. I believe that Cerner is now moving this type of model to larger medium-sized hospitals but will have less per domain (CommWx can have 20+ per domain) whereas this model for say a 300-500 bed hospital may have only 3-4 customers in a domain. Also, its not technically already configured. Similar to Epic, its call the Model Experiencer where about 80% of the domain is standard / stock content and then each customer has the ability to customize about 20% of it (some rules, reports, documentation format, etc.) Implementation for CommWx is currently scheduled at 10-12 months. However, it still essentially sits on standard architecture. Now if Cerner would really commit to either AWS/Azure or true cloud, then I think that would be move the needle. (Associate CIO)

Rural broadband (broadband in general) needs to be treated as a public utility. This country should handle this the way we handled electricity in the rural South in the 1950s, take it on a a public works project, and wire everyone up. It has become a fundamental tool in communication and commerce, there is no reason (other than paying some C-level executives millions in salary and stock) why we as a country should not ensure that all of our citizens can participate in civic life. (HIT Girl)

There is no such thing as an “Epic API” whereby third-party developers can craft solutions that developers can go market to Epic clients and generate some form of income along the way. In the Epic space you have two options – share your solution with Epic as a submission for the community sharing site (whereby you explicitly grant Epic rights to ALL of your IP embedded in that solution, even if it is never added to the community site) or craft some sort of app for submission to the App Orchard whereby your application / solution is sending transactions into Epic via some very narrowly defined messages (think HL7 here). There are absolutely, hands down, 100% zero options for what (uninformed and snobby) folks may traditionally consider an API for an application whereby complementary, third-party apps can in some fashion manage or change the behavior of the parent application in the Epic space.  (Code Jockey)

In all of the time and locations I’ve done pre-implementation build, I’ve never encountered an Epic resource that fully understood the impact of the build decisions that they were leading their clients to implement. No Epic resources know / realize / are trained on the downstream impacts of their area of build or the upstream build areas that will impact their area of responsibility. Those lessons are learned and that knowledge developed only after go live, as the site implementation matures and are long after Epic has left the site. (Code Jockey)

Do you really think that Epic doesn’t share best practices with organizations during implementation? The Foundation System is more or less a best practice soup. Every organization believes they are different and special so there is no reason to believe that Providence would have any more success convincing implementing customers to change their workflows and adopt best practices. Despite staff turnover, no customer organization has more experience implementing Epic’s software than Epic itself. (But we’re special)

Outsourcing some of the business office and IT makes sense. Yes, I know that it mentions [at John Muir Health] about 500+ people badge flipping, but being someone that has worked on deals like this previously, many of those people don’t make it long term. They are re-evaluated and many are given early departure packages, keeping the cream of the crop and then backfilling virtually with people that living in lower cost of living areas. Usually look at a 30% or more reduction in staff. These resources that are kept also get leveraged across other clients as well, so that needs to be kept in mind too. Sharing resources isn’t the worst thing, its just that you need to be tight with cost, SLA’s (service levels), and customer satisfaction. Plus, by outsourcing, the burden is now on the vendor to produce, they are now the throat to choke. I have seen this model be successful but I have also seen in flop and the hospital takes things back over. Again, its a case by case basis. (Associate CIO)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. R in Florida, who requested three Chromebooks for her high school class. She reports, “Having computers accessible in a science classroom is a real game changer. The students are digital natives, and being able to translate what they are learning into a language they are familiar with using is awesome! They are able to collaborate, engage in digital simulations, conduct research , create presentations, and more! These are useful to every level I teach. From my freshman physical science students, in my Pre AICE chemistry class, to my Chem 2 honors and AP chemistry class. It is applicable in each one. I also teach theater and then I can use them for the students to do CAD design without having to sign up to go to a computer lab or wait for a computer cart to be available. Thank you!”

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Nanowear launches a study of using its sensor-powered underwear that is connected to a closed-loop machine learning system for early detection of heart failure. It monitors cardiac output, heart rate, respiratory rate, thoracic impedance, activity, and posture.

AHA and other hospital groups ask CMS to change its HCAHPS patient survey, suggesting that it reduce the number of questions from the current 27, create a digital version to improve response rates, expand it to cover transitions in care rather than just discharges, and allow patients to enter comments.

Guild members hold a garage sale to help cover the $1 million in uncompensated care provided by Seattle Children’s Hospital, whose most recent tax filings show a profit of $165 million on revenue of $1.5 billion. The hospital is running a $1 billion donation campaign.

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Malls that are desperate to fill vacant storefronts are leasing space to medical clinics, hoping against reality that someone who comes in for a flu shot or eye exam will do a bit of shopping and that clinic employees will hit Sbarro or Cinnabon for lunch.

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Police arrest a Charleston, SC pulmonologist for voyeurism after an 18-year-old tenant of one of his beach rental properties caught the doctor peering through a hole in the bathroom wall from an adjacent unfinished room. The boy and his father chased the fleeing doctor down the beach, who told them he was just the pest control guy. Investigating officers found bathroom peep holes in both of the doctor’s rental houses. He previously lost but regained his medical license after three complaints that he exposed himself to drive-through restaurant employees.


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Weekender 7/19/19

July 19, 2019 Weekender 1 Comment

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Weekly News Recap

  • Ellkay acquires X-Link.
  • John Muir Health outsources IT-related functions to Optum and transfers 540 employees to the company.
  • A study finds that follow-up is often not performed for patients with poor kidney function, with EHR configuration changes recommended to close care gaps.
  • Livongo Health’s updated IPO filing values the company at up to $2.4 billion.
  • SPH Analytics acquires SA Ignite.
  • Baring Private Equity Asia is reported to have edged out other bidders to acquire CitiusTech for $1 billion.
  • PeaceHealth lays off 50 IT employees as it centralizes tech support.

Best Reader Comments

John Muir outsources its IT and analytical functions while Providence bought an entire consulting company to go deeper into that area. Just goes to prove that nobody knows anything! People are just throwing stuff on the wall to see what will stick. (Nobody Knows Anything)

John Mui, is looking for operational efficiencies (again in theory), so outsourcing IT and business process can make sense for them. Providence, on the other hand, is looking to increase revenue, so they bought those consulting firms to accomplish a couple of goals. For starters, they are doing custom Epic development, so once they make certain changes in the system, they will then market those changes and sell them to other customers through this new acquisition (similar to what UHS did with Crossings Health Solutions via Cerner mPages). Providence also has an innovation team that is thinking up new healthcare technologies and then will most likely uses these new firms to sell/push those to other systems. This is something we are seeing more and more with the larger IDN’s like Providence, Ascension, UHS, etc. building their own business lines and are selling those solutions to the masses. (Associate CIO)

I hope the outsource deals works out for John Muir and goes better than most outsourcing. Typically the client never REALLY gets improved operations. Keeping in mind the outsource company is for profit and has to do the same and more with less people and it typically ends up being less than desired results. You sure can’t keep people on the payroll making 500K plus. (Robert Smith)

The accuracy published of 75% is only slightly better than guessing. “Metastatic carcinoma is present in 36 whole slides”…” The dataset consists of 130 de-identified WSIs of axillary lymph node specimens.” Thus, 36/130 = 27% has carcinoma, and 73% no carcinoma. Without AI, I could guess all slides are “no carcinoma” and I’ll have an accuracy of 73%. Always perform a sanity check of the baseline accuracy of “no AI.” (AI lover)

[Virtual visit versus office visit] is more comparing Netflix to going to a theater release. You won’t experience professional sights, sounds, and touch, on the other hand, you won’t have screaming kids, catch something from someone coughing on top of you, or get your feet sticky walking through the place. (AC)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. W in South Carolina, whose asked for art supplies for her high school classroom that closed for several weeks after flooding from two hurricanes. She reports, “It has been an unbelievable challenge recovering from the devastation due to the hurricanes and floods. Students were so excited when we received the materials, it was as if they were opening presents on Christmas morning. They have really taken an interest in demonstrating their learning through hands-on, creative projects and the materials have allowed us to easily differentiate learning and assessments. Furthermore, decorating the classroom and hallways with students’ work gives a sense of ownership and comfort to the space.”

The New York Times covers hospitals hiring “secret shoppers,” consultants who pose as patients in reporting vague symptoms to see how well employees follow procedures and practice empathy. The shoppers even have blood drawn and have some tests performed, but are trained to leave for a claimed family emergency if treatment would put them at risk. One shopper who went to the ED wearing old clothes and claimed to have no insurance found that employees didn’t introduce themselves, make eye contact, or apologize or even acknowledge issues such as blood on her arm following a draw. She returned professionally dressed and presented an insurance card and received better treatment.

A Pennsylvania hospital locks down its ED when two rival groups continue their earlier all-day fighting in what the hospital called a “riot” at 4:30 in the afternoon. Apparently those involved were not otherwise occupied with gainful employment or academic pursuits. 

Drexel University will lay off 40% of its physician group because of the impending shutdown of Hahnemann Hospital. Politics aside, presidential candidate Bernie Sanders summarized it well: “It’s insane. If you look at this thing objectively and you say that in the midst of a healthcare crisis, a hospital is being converted into a real estate opportunity in order to make some wealthy guy even more money, ignoring the healthcare needs of thousands of people, that is pretty crazy.” Although I’ll offer a more realistic assessment — the investor is just doing what investors are highly paid to do, and relying on his moral rather than his legal obligations is naive. Repeat with me in observing the obvious: people and companies do exactly whatever benefits them the most.

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A man breaks his leg minutes after renting a Bird electronic scooter, racking up a $100,000 bill from Tampa General Hospital, which says it has treated 50 such injuries in the past two months. The guy’s hipster beard was probably more appropriate for the e-scooter than his brand new walker. 

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Huntsville Hospital brings in Asteroid, a certified service dog that can accompany patients to their procedures and comfort families in bereavement. My first thought was whether the hospital has figured out a canine billing code.


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Weekender 7/12/19

July 12, 2019 Weekender 2 Comments

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Weekly News Recap

  • Corepoint Health and Rhapsody merge.
  • Waystar acquires Digitize.AI.
  • OmniSys acquires Strand Clinical Technologies.
  • Provident St. Joseph Health and Microsoft announce plans to turn a Seattle-area hospital into a Microsoft-powered “hospital of the future.”
  • IBM closes its $34 billion acquisition of Red Hat.
  • ONC announces that Executive Director Steve Posnack, MS, MHS will become deputy national coordinator when Jon White, MD steps down in mid-August.
  • Providence St. Joseph Health says it plans to create a billion-dollar business from its Engage, Bluetree, Epic Community Connect, and other non-clinical projects, also noting that it will replace Meditech in its acquired hospitals that are using it.

Best Reader Comments

As a customer, we had contractual requirements to stay at Current or Current-1 versions, 20+ years ago. IIRC, you could still run on even older versions but there was a maintenance fee premium to pay then. I’ve always thought this type of agreement struck a fair balance. It allows customers to keep the doors open and lights on even under difficult conditions. Meanwhile it creates a clear incentive to stay current and shows that the vendor places significant value on doing so. (Brian Too)

Another hospital of the future! Guess we were overdue for another new one. Twenty years from now if someone as industrious as Vince Ciotti wants to write the next history of EMR/HIS, all they will have to do is take Vince’s PowerPoints and put in the new vendor names. I hate too say it, but after 40+ years in the healthcare IT world, information technology can’t reform healthcare. People created this mess and only people (not computers, software, AI, or blockchain) can fix it. (Frank Poggio)

As a physician, I am sure you’d like it much more if someone else input factors about your patient into the EHR. Preferably someone who is not two steps removed from the source of the information. How about the patient? Citing Neal Patterson as Mr. H did just today, make the patient truly part of the team, not just an observer through a read-only portal. (Harry Solomon)

The intense rivalry among EHR venders made Epic, Allscripts, Meditech, and the others to push their limits to give providers the tools save lives, make patients healthier, and standardize processes. The healthcare industry would not been the same if it weren’t for Neal and his life’s work. His legacy reaches beyond Cerner. It’s deep within the clients, competitors, and his many protégés. R.I.P. Mr. Patterson. (King Solomon)

Providence would be far better off buying minority stock in a company and collecting dividends or getting an ROI after an acquisition. Hospitals do not know how to run for-profit tech companies. They do not have the stamina or the unique management acumen. The old adage of “stick to your knitting” really applies here. I guarantee in about 3-5 years they will have either closed it down or sold it off at a loss. (Frank Poggio)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. H in Texas, who asked for math manipulatives for her kindergarten class. She reports, “I want to start off by saying thank you for choosing my project to donate to. The students have really enjoyed the learning materials. I use the new resources during guided math time with my students who need enrichment for adding and subtracting. We use the materials so that the students would be able to add and/or subtract with objects or manipulatives. I have also used the materials in stations. When I told the students that they where getting new materials for stations, they were all super excited. When the students saw the materials, they were shouting with joy.”

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Flatiron Health’s 34-year-old CEO Nat Turner, who sold his oncology tech company to Merck for $1.9 billion in early 2018, buys a $19.5 million New York City penthouse.

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A former developer of theme park ride robots is developing teaching simulators for Boston Children’s Hospital, creating robotic trainers for practicing cleft palate surgery, gunshot wound treatment, and abdominal surgery.  

Dell Medical School researchers develop a scheduling system to accommodate its new clinic model in which patients who need to see multiple doctors remain in one office and the clinicians come to them. The medical school staff used mathematical models of actual patient visits along with clinician interviews to eliminate the multiple visits and extended time required when patients are referred in the Musculoskeletal Institute at UT Health Austin. 

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American Airlines apologizes to Tisha Rowe, MD, MBA and promises to hire a chief inclusion and diversity officer after a flight attendant insisted that she cover herself on a flight from Jamaica to Miami. She founded telemedicine provider The Rowe Network, sells online nutrition consultations, and wrote an inspirational book for girls book titled “B is for Bossy.”

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Another attention-seeking idiot makes a video involving licking something and placing then it back on the shelf, this time a 30-year-old woman who recorded her 10-year-old daughter licking a tongue depressor and then placing it back in the jar in a Florida clinic’s exam room. The pair are shown in the video pointing to the “please do not touch medical supplies” sign, then captioning the resulting Snapchat video, “Don’t tell me how to live my life.” The mother, who explained that “I was just being silly with my kids,” was charged with felony tampering with a consumer product.


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Weekender 6/28/19

June 28, 2019 Weekender No Comments

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Weekly News Recap

  • Change Healthcare goes public on the Nasdaq exchange.
  • Providence St. Joseph Health acquires Bluetree Network.
  • Sansoro Health and Datica announce plans to merge.
  • Vyne is acquired by PE firm The Jordan Company.
  • The director-general of Australia’s Queensland Health announces plans to resign following problems with its Cerner implementation.
  • UnitedHealth Group acquires PatientsLikeMe in a government-ordered fire sale.
  • The White House issues an executive order requiring providers to disclose pricing information.
  • Phreesia files for an IPO.

Best Reader Comments

From my reading of Change Healthcare’s filing, they mostly make their money from EDI and sending people bills in the mail. Is that correct? Their actual software revenue seems to be smaller and lower margin. That doesn’t seem good as software is supposed to be high margin and they will have a lot of future competition from EHR vendors on the provider side and payers’ own IT staff / Optum et al on the financial side. (WhatAreTheyCha(n)(r)ging?)

Many of our newer contracts for software require that we stay relatively current with upgrades, such as the being no more than one full release behind the current production release. These ‘N-1’ provisions seem to be good for our business and also for the vendor. The vendor doesn’t have to provide backward compatibility for five releases in use so they can put more effort into current fixes and future enhancements. They also work harder on the testing of new releases because if they don’t, half of their clients are going to be really mad because they’re taking that version. N-1 contracts also set an expectation internally with our departments. We tell them they’re getting on a treadmill and they don’t get to jump off without paying a hefty software maintenance premium for supplemental support. Upgrading also puts downward pressure on customization and shifts the emphasis to configuration, which is where it should be. (IT Vendor Mgmt)

Would be interesting to see the gap, perhaps chasm, between what Mark Roche thought the CMS chief health informatics job was going to be and what it actually turned out to be. (JeanneC)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose grant request of first-year teacher Ms. K in Washington, DC, who asked for math manipulatives for her kindergarten class. She reports, “We have been in the full swing of our addition and subtraction unit. These hands on math manipulatives have been AMAZING to help us learn! We’ve been practicing using the unifix cubes, counters, and various other objects. Having manipulatives to use has helped us to better understand the concept and to get accurate answers. Thank you so much for your support!”

A study of crowdfunding campaigns for cancer-related expenses in Canada finds that high-income, highly-educated homeowners in urban areas make up the majority of people who ask others to pay for their cancer treatments. The authors conclude that crowdfunding does little to solve problems with the healthcare system.

A Lyft driver says VCU Medical Center should have warned him that the discharged patient he was called to pick up there was delusional and talking to himself in a loud voice. Lyft says that medical facilities that are scheduling a patient’s ride should indicate whether the rider is a patient who might pose a risk to others. The hospital says it can only do so much since patient rides can be arranged by the patient themselves, their insurance company, or an outside transportation company.

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A Philadelphia pain management doctor is arrested for handing out “goodie bags” of oxycodone and muscle relaxers to patients, for which he then billed insurers more than $4,000 each.

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Wired magazine covers a University of Colorado ED doctor’s simulation class that addresses the medical realities that will be faced by astronauts on Mars. The program, held at the Mars Desert Research Station in Utah, emphasizes that the medical issues of astronauts will need to be addressed with the people and resources at hand. NASA is running risk assessments to determine which medical problems are most likely, also considering whether crew members could use videos to guide them through performing medical procedures and use 3D printers to create medical equipment.

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A newspaper fact-checking a candidate for the Florida House of Representatives who claimed to have to have — as an Orlando Health cardiologist and ED doctor — “removed 77 bullets from 32 people” after the Pulse nightclub shootings finds that she is neither a doctor nor an Orlando Health employee. State records indicate that Elizabeth McCarthy was a certified nursing assistant until 2005. She claims to have been an RN who went back to medical school who also played college basketball for both the University of Florida and Florida State University, which both schools say isn’t true.


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Weekender 6/21/19

June 21, 2019 Weekender No Comments

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Weekly News Recap

  • A private equity firm acquires EHR/PM vendor Nextech for $500 million.
  • A group of health and technology organizations develops open source cancer data standards and specifications that can be incorporated into EHRs via FHIR.
  • Drug maker Sanofi and Google announce plans to for a virtual innovation lab that will use analytics to study disease and patient treatment response.
  • Change Healthcare increases the amount of its IPO again, this time to $1.2 billion.
  • Accumen acquires Halfpenny Technologies.
  • A 23-bed critical access hospital says it paid a hacker’s unspecified ransomware demand, all but $10,000 of which was covered by cyberinsurance.

Best Reader Comments

I’m thinking of a time-based layout, for example [for EHR information]. A little-used feature of Windows called the Reliability Monitor charts issues over time and shows a view of the health of your computer. All the information is summarized initially and you have to click on the various items to find out what they are. However by using the ideas of “What Changed” and “When,” you get a higher-level, more coherent view of what is going on. (Brian Too)

In frontline [radiology] care, I don’t necessarily need an answer, but I do need a plan. AI raising a question about something on a film can be enough. How many times do meat-based radiologists see something that “needs clinical correlation” to rule in or out something on a film? If questions remain, I can immobilize until a radiologist reading — or more likely, follow-up — gives a best answer. Incidental findings are by definition not the problem of the moment. (Randy Bak)

It’s pretty clear to me that [Vinod] Khosla’s venture capital roots require him to make profound-seeming announcements periodically, based upon the classic VC tropes that tech is always good, and disruption, so long as it is well-meaning(!), is also always good. I am reminded of Warren Buffet, who said that he only needed one good investment idea every few years. Missed opportunities were trivial in his world. For the successful VC ideas people, it is the opposite, very nearly. They announce 100 out of the next three Big Things and are proclaimed VC geniuses. (Brian Too)

[For EHR improvement], allow other groups of healthcare professionals (i.e., the ancillary healthcare professionals, such as nurses, dietitians, pharmacists, therapists, lab techs, etc.) to do the same [in highlighting and flagging chart elements as useful]. They are just as frustrated with note bloat. With good search technology, “group” (e.g., pharmacists) highlights would be able to be retrieved for future editing, reading, etc., by the intended “group.” (Woodstock Generation)

We found that the majority of healthcare practices either do not know what KLAS is or do not associate value with an HIT vendor who has a KLAS award. It often feels like we are doing KLAS’s marketing for them. The awards have become a competition between HIT vendors instead of the source of truth for buyers. (EMR vendor)

I’ve taught research methods (and survey research methods) at the University of Pennsylvania for over 30 years. I’ve published dozens if not scores of articles and books on the topic. KLAS is a marketing effort. It’s not a survey. Anyone who publishes KLAS ratings should be aware that they are not related to quality. Alas, KLAS’s business model is not based on anything other than sales. (Ross Koppel, PhD, FACMI)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. B in Ohio, who asked for supplies so her high school class could make paper roller coasters as a physics project. She reports, “Your contribution to our physical science classroom has had a tremendous impact on our energy conversion and forces and motion unit this year. My students used the donated cardstock and art supplies to design and construct their unique and epic roller coasters. Today they are analyzing the physical forces acting on their marble roller coasters, and at the end of this week, they will present their final designs and data to the class as well as several faculty members as part of a simulated marketing campaign for a coaster build at Cedar Point. The project truly embodies our school focus on engineering and has helped my students explore these important physics concepts in a hands-on and exciting way. Without your generous support, this project would not have been a possibility. The cost of supplies is one of the biggest limiting factors in education and your donations have eliminated this ceiling and helped my students to reach new heights. I hope you enjoy the photos and find as much reward in their success as I do.”

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NASA’s TRISH Launch Pad offers a 10-week program that will help health startups ”create a viable commercialization pathway to Earth’s health technology market and a secondary space market.” Areas of interest include:

  • AI-powered, EHR-integrated medical decision support that can guide deep space travelers through rendering treatment without a connection to NASA.
  • Games that can help prevent stress, depression, anxiety, and isolation.
  • A machine that can manufacture drugs and biologics in under 24 hours since the shelf life of most drugs is less than the three-year minimum deep space mission.
  • Health assessment via eye scanning.

Google says it will work on a problem called out by the Wall Street Journal, which found that at least 11 million fake businesses – most of them created for search engine optimization — show up in local search results via its Map app. A retiree called a Google-listed garage door repair company as she was stuck in her driveway, but a rogue contractor had replaced the company’s telephone number with his own. He worked on the door, demanded $728 by cash or check, then harassed her repeatedly afterward for payment even though his repaid work had to be redone. I wouldn’t assume that none of those phony listings involve medical services.

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A 46-year-old woman whose mother Brandy named her “Marijuana Pepsi Vandyck” earns her PhD, acknowledging that “Dr. Marijuana” sounds like a weed dispensary. Marijuana, who says she has never tried marijuana, did her dissertation on teacher perceptions of children with “black names” in white classrooms. She named one of her sons Heaven and he made Marijuana a grandmother with the birth of Egypt.

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In Myanmar, a 29-year-old doctor who had given up her patient care job to years ago to pursue becoming a “sexy model” loses her license when the country’s Medical Council declares that her refusal to take down social media photos indicates that she has a “behavior disorder.” The New York Times notes the irony of the country declaring her behavior immoral even as it employs military-led ethnic cleansing that has killed at least 10,000 Muslim Rohingya.

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The Internet resurfaces the story of a cosmetic surgeon in Singapore who re-evaluated his life when he was diagnosed with lung cancer and later died at 40. He had made millions when he switched from ophthalmology to aesthetics, noting that patients who refused to pay a PCP $15 for a visit would happily fork over several thousand dollars for liposuction and breast augmentation. He summarized that “patients were just a source of income, and I tried to squeeze every single cent out of these patients.” In the end, he sought comfort from people who loved him, concluding that “only when we learn how to die do we learn how to live.”

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A Texas man and his fiancé stage a mock wedding in the hospital room of Granny, his 100-year-old grandmother who was being moved to hospice care and wasn’t expected to live until the official ceremony. Granny, who was born the day World War I ended, has since been moved out of hospice and into assisted living.


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Weekender 6/14/19

June 14, 2019 Weekender 4 Comments

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Weekly News Recap

  • Allscripts announces plans to acquire specialty drug prescription prior authorization platform vendor ZappRx.
  • GE Ventures looks for a buyer for its stake in 100-plus startups that include 27 healthcare companies.
  • French company Dassault Systèmes will acquire clinical trials software vendor Medidata for $5.8 billion.
  • Epic will integrate Humana’s real-time prescription benefits checking tool within its e-prescribing workflow as the first of several steps in their newly announced relationship.
  • Switzerland-based medical Internet of Things vendor Medisanté enters the US market with the opening of an office in Bridgewater, NJ.
  • A physician’s New York Times opinion piece says corporatized healthcare is cynically taking advantage of the professionalism of doctors and nurses by assuming they will work extra hours without extra pay, with the biggest overtime culprit being the EHR.

Best Reader Comments

The reasons for interoperability failure are numerous. Different schemas, encoding sets, dictionaries, MoSCoW (Must, Should, Could, Won’t), CRUDE (Create, Read, Update, Delete, Exchangeable), document types, and enumerations. Until the vendors are required to align to a standard — the whole standard — they will not align. We also have a problem with how the documents or calls are made. Some vendors have the ability to deliver a longitudinal record selectively, others dump the whole file. Imagine a 6-8 year patient with multiple conditions and frequent visits. Take that same patient and realize that several of the technologies do not align the disease/treatment — so that longitudinal record is degraded to pure data — maybe not so pure at that. Thus you have lost information or knowledge of the patient and degraded it down to text or data. (Mr. SemanticInterop)

Those grown people find “adulting” tiresome and unpalatable in the context of their own health and every other aspect of their lives. If they do not care, the clinician still is required to or suffer the reimbursement pain unless you are in the ED, where they cease being your patient when they leave. (David Perlmuter)

As for the continued drum beat of a single-payer health system,  we would only be trading one corporate master for another, one run by politicians with ever-changing motives. At least corporate healthcare companies have a single motive in mind – profit. Politicians care about votes and they will be taking money from these large corporate healthcare companies to insure they get those votes. The only way out is for physicians to take matters into their own hands and move away from the employed physician model. (Van Sims)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. M in Georgia, who asked for math manipulatives for her third grade class. She reports, “Thank you so much for your generous donations to our classroom. Since receiving the supplies you helped us purchased, we have put them to good use! We use the sheet protectors every day in both reading and math. Students now have the ability to show their work without wasting paper by using the dry-erase markers we got, and it really helps to engage them in their learning. In addition to those supplies, the manipulatives we received have really helped transform our Guided Math centers. Students love using the color chips as counters as well as game pieces. Our classroom would not be the success it is without you, so again, thank you!”

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A 19-year-old who as a high school student noticed the facial changes of Michael J. Fox after he was diagnosed with Parkinson’s disease uses off-the shelf facial recognition software to develop a startup called FacePrint, which hopes to diagnose Parksinon’s from Facebook photos. Erin Smith has deferred her Stanford admission and is taking the product through clinical trials, also hoping to create a five-minute facial expression test that can be taken with any computing device that has a camera.

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A 12-year-old girl whose autoimmune disease requires regular IV therapy invents Medi Teddy, an IV cover that is shaped like a teddy bear to keep kids from getting scared of the IV. She’s running a fundraising project to cover the cost of 500 of the bears that she will donate to other children in the hospital.

Investor Vinod Khosla, who said years ago that technology would replace doctors, doubles down in claiming that “radiologists are toast” and that any who are left practicing 10 years from now will be “killing patients every day” because machines will do their job better. He adds that it it easier to automate the work of an oncologist than a factory worker.

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Employees of UMC Trauma Center in Las Vegas line the halls to pay respects to an 18-year-old organ donor who died in a motorcycle accident the day he picked up his high school graduation cap and gown.

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You could be the next “Doc Martin.” A fishing village in England creates a social media campaign (#WillYouBeMyGP) in hopes of recruiting a doctor to replace the one who is leaving. The brilliant promotional video features locals extolling the virtues of sunny Cornwall County and their hopes that a doctor will come there to take care of them.

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A Miami man with a long criminal record gets a cease-and-desist letter for walking around several local hospitals wearing a physician lab coat. He denies it, but he had also posted on Facebook a photo of him on hospital property wearing the coat, which contained his name, MD, and “OB-GYN.” He had also posted a photo taken at his claimed medical school graduation, although perhaps he should have realized that freshly graduated medical students would not have earned an “OB-GYN” credential before completing residency.


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Reader Comments

  • Scot Silverstein MD: I can say, unfortunately, with an exceptional degree of confidence that patients are harmed by events such as we describ...
  • Clinton Phillips: Thank you Dr. Jayne for the Veterans Operation 11/11 shout out. Medici is excited to see how many veterans we can help a...
  • @henryjones: Again what evidence do you have here that you "know that Epic demands more redactions and secrecy than other EHR vendor"...
  • Mr. HIStalk: Vikas Chowdhry gets all the credit for interviewing Dr. Bhavan. He volunteered to conduct interviews, of which this is h...
  • Expressyourself: I think the sensor part is referring to sending when you open or are in a patient's chart. Then they probably use that t...
  • Matt Ethington: This is inspiring and has so much more potential for healthcare. So many new reimbursements focus on patient engagement...
  • Eddy T. Head: "Patented sensor-based software technology in use at health systems and practices delivers actionable patient data to pr...
  • Code Jockey: Mr. HIS - you, once again, do this world a great service. For me personally I'll say thanks for posting to a document th...
  • Vaporware?: re: Queensland's Cerner project * Delayed ... check * Over budget ... check * "Not fit for purpose" ... check * Buye...
  • E!: Agreed. Epic is just generally anti-worker with their regular labor violations, over aggressive non-compete, etc....

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