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Weekender 6/14/19

June 14, 2019 Weekender 2 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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Weekender 6/7/19

June 7, 2019 Weekender No Comments

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Weekly News Recap

  • A breach of American Medical Collection Agency exposes the information of 19 million of patients of national lab companies LabCorp and Quest Diagnostics
  • The six former National Coordinators express their support for the proposed interoperability rules of ONC/CMS
  • CVS announces plans to reconfigure 20% of each drugstore’s space into HealthHubs that will offer health and wellness services as well as kiosks and digital health tools
  • A KLAS report on newly developed small-hospital inpatient EHRS from Athenahealth, EClinicalWorks, Epic, and Meditech finds that only Meditech has brought sites live 
  • Vendor members of the HIMSS Electronic Health Record Association raise “significant concerns” about proposed federal rules covering interoperability
  • Politico details problems with the implementation of Epic in Denmark’s Copenhagen region

Best Reader Comments

The cost of implementing a slicker front end essentially best-of-breed system [Athenahealth’s inpatient system) that presents great, but functions horribly in the real world, was too much. Hospital executives who were enamored by the presentation and sales pitch were not aware of the fact that best-of-breed was fully vetted and wholly rejected by the industry. They just got a front row seat and the results have not been surprising. It’s hard enough for a hospital who can afford the required staff to implement a complete proven system with proven implementation methodology. Imagine trying to do that with a IT staff usually one-fifth the size of most community hospitals who could afford a traditional cost structure install – – – as your vendor tries to piece together a system using interfaced stopgap third-party modules that are the absolute core elements for safe workflows within an acute care setting. (Freedom’s just another word for nothin’ left to lose)

Poor Judy got cheated. $3.6 billion? No way. The company grosses $2.9 billion per year and the typical successful high-tech company sells for over five times gross. She owns at least 80% per other stories I read, so 5 X $2.9 billion X 0.8 = $11.6 billion. I think she should sue Forbes for publishing fake news. Judy is numero UNO! (HISJunkie)

I’d be interested to see how many places are using Home Health from Epic. That’s a new market they entered. They have the skill and ability to create a new product. They could easily come up with a LTC product quickly, give a sweetheart deal to the first few clients to test it out, and then sell it. Another facet would be if we see more consolidation in the healthcare space. Maybe hospital chains start buying SNF and LTC chains. If that happens, Epic would be foolish to not move into the space. (Ex epic)

Interoperability became a regulatory issue because despite making all that money on MU largesse, EHR vendors were not moving the ball on interop. On the one hand, EHRA vendors talk about innovation, and on the other hand, they claim that creating an API-based, standardized data exchange system is too onerous for them? Some of the reasons that you laid out are valid, but they are a direct result of poor application and data architectures of these platforms. If I have to take a guess, these vendors, over the years, have added new functionality and features without taking a pause to re-architect some of the core aspects of their systems and without making an investment into paying down the technical debt. As a result, many, if not all of these systems are being held together by duct tape and baling wire and even the smallest change causes big ripples in an integrated system, leading to tremendous testing and bug fixing efforts. But if interop is important (which most people agree that it is), then EHR vendors just need to suck it up and do it. (NonInterOp)

Everyone forgets the complexity of the underlying terminology mapping and integration if the goal is seamless exchange of meaningful information. I don’t see M or SQL as barriers. There are training and adoption barriers, contextual barriers in the meaning of something someone is documenting, true issues in working with legacy documentation that was created before any semantic standards were defined, and most vendors have a potpourri of applications running in their suites. Simple API calls aren’t so simple, especially when clinical teams rely in the integrity of the information. (NonInterOp)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. P, who needed help paying for bus transportation to take her special education fifth- and sixth-graders to a farm and home museum in their rural Maine followed by a visit to a college campus. She reports, “Our trip to Page Farm and Home Museum was amazing! Our students enjoyed every moment of this experience. They were able to see many objects that they read about in ‘Farmer Boy,’ from oxen yokes to sleds, tinware, butter churns, ice harvesting tools, spinning wheels, looms, and more. All of these 19th century tools and implements were described in the book so it was exciting for students to see them for real. Another trip highlight was visiting the University of Maine campus and eating lunch at the student union. Our students used their money skills to choose and purchase their meals in a real-world setting. We then ate at tables in a cafeteria-type room, mingling with university workers and students, thus raising their aspirations to consider college as a future endeavor. In all, the field trip was a huge success. Thank you for your generosity in sponsoring this experience for our students.”

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A former intensivist pleads not guilty in Ohio court to charges that he intentionally killed 25 patients by ordering fentanyl overdoses. The attorney for William S. Husel, DO argues that he was practicing “comfort care” for end-of-life patients by ordering fentanyl doses of 500 to 2,000 mcg and several grams of midazolam, all of which were dutifully removed by nurse via overrides from the hospital’s Pyxis dispensing cabinet. It would seem that some nurses and pharmacists might need to have their professional conduct reviewed as well, and indeed some of them have been named in a civil suit. Dispensing cabinet overrides very often are the symptom of questionable technology, workflow, or clinical practice and there’s not much excuse for not monitoring them carefully.

Some great local journalism in Missouri profiles the “cast of characters” who have used struggling rural hospitals to bill insurers at higher rates for questionable lab tests. Among them is Seth Guterman, MD, president of EHR vendor EmpowerSystem, who is being sued by Aetna for taking control of a rural Oklahoma hospital under his People’s Choice Hospital company and running up its lab billing to $21 million per year, a process that a lawsuit says he repeated at other Aetna-affiliated facilities.

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A healthcare cyberattack report by cloud endpoint protection vendor Carbon Black notes that hackers are going after administrative records of physicians that can be used to fraudulently bill Medicare and other insurers. They are also breaching systems that contain medical insurance information, offering for sale such items as a forged BCBS insurance card and forged prescription labels that buyers use to justify drug test results and to carry drugs through airport security. 

I’m enjoying the tight, pleasurable LinkedIn writing of ED doctor Louis M. Profeta, MD, who also wrote the 2010 book “The Patient in Room Nine Says He’s God.” He explains why he searches for the Facebook of patients who died of overdoses or driving while drunk or texting before notifying their families:

I’m about to change their lives — your mom and dad, that is. In about five minutes, they will never be the same, they will never be happy again. Right now, to be honest, you’re just a nameless dead body that feels like a wet bag of newspapers that we have been pounding on, sticking IV lines and tubes and needles in, trying desperately to save you. There’s no motion, no life, nothing to tell me you once had dreams or aspirations. I owe it to them to learn just a bit about you before I go in. Because right now . . . all I am is mad at you, for what you did to yourself and what you are about to do to them.

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Virginia’s medical board finds that an urgent care doctor and owner left for a week-long vacation while requiring his unlicensed staff to continue diagnosing, treating, ordering tests, and prescribing controlled substances. The board found that Khaled Moustafa, MB created phony visit notes afterward to make it appear that he was following regulations and to bill insurance companies. The doctor’s license was revoked, but his clinic is still open for business, with patients been seen by the doctor’s wife, who is also a doctor.  

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The group that bought Athenahealth’s lakefront Maine corporate retreat in March announce just three months later that they will close it as a destination for weddings and other events, saying it presents too many problems to operate profitably. The couple whose hotel operating company eventually bought the 387-acre resort sued Athenahealth last year, claiming Athenahealth was reneging on its promise to sell it to their hotel operating company for $7 million. Athenahealth paid $7.7 million for the property, which the county values at $14 million, in 2011. It includes a gym, a bowling alley, two event centers with 40,000 square feet of space, 106 cabins, hiking trails, and a mountaintop executive retreat overlooking Penebscot Bay.

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A 22-year-old roofer in Scotland who was performing his signature party trick of swallowing a coin is rushed to the hospital when it becomes lodged in his throat. He’s probably not the best source of advice on the topic, but here’s his root cause analysis: “It was weird because it always goes according to plan, as it would come out in the toilet later. I could feel it in my chest but I just kept on drinking … my dad thinks I’m an idiot.”


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Weekender 5/31/19

May 31, 2019 Weekender No Comments

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Weekly News Recap

  • The latest funding round of precision medicine platform vendor Tempus values the company at $3.1 billion
  • Cerner initiates a $0.18 quarterly dividend for shareholders, its first
  • Cincinnati-based Bon Secours Mercy Health announces plans to sell its majority share in a revenue cycle management subsidiary, netting $1.2 billion on its 2016 investment of $60 million
  • Cardinal Health makes a $10 million investment in home medical monitoring technology and monitoring services vendor Medically Home Group
  • Change Healthcare files an amended prospectus for a $200 million IPO that doubles the value indicated in its mid-March filing
  • The VA opposes a Senate bill that would create an independent advisory committee to oversee its $10 billion Cerner implementation

Best Reader Comments

Tempus got a $3.1 billion valuation without any peer-reviewed data on the veracity of its precision medicine claims? Without any randomized clinical trials? Oh, well. We live in a world where a company putting out green color scooters on city sidewalks can get valuation in billions of dollars, so why not? (TempusInATeapot)

I’m still trying to get my head around why people insist that privately held companies that are still very profitable are “struggling” because revenues are down. The key being the slight decline in overall revenues was clearly predicted in advance. Maybe the major shareholders have a little heartburn because of unreasonable expectations borne out of the MU honey pot days, but the companies still are very healthy. (Smartfood99)

I had an interesting interaction with an insurance pre-auth department. They claimed that they needed my knee MRI report faxed to them because of HIPAA. I told them I didn’t have a fax machine, and why didn’t they have a secure portal for these? They again claimed HIPAA, but said there were several third party websites I could use to upload a PDF to and they would fax on my behalf, and better yet, some had free trial periods. (Bob Smith)

I did consulting about a decade ago for a teaching hospital that was being built to advise on how to make sure the layout promoted it being “EHR ready.” I was handed the outlines of the medical ICU floors and they had left so little space that they were either going to have to choose call rooms or tiny conference / charting rooms on the same floor. When I pointed that out, I was told that they couldn’t change any of that, and the space was going to be offices for the ICU leadership, so no call rooms or conference rooms. Turns out a committee had put together their high-level requirements and handed it to the architects who had returned these designs, and at that point, it was too late to make any changes. (DrM)

The brand new multi-million dollar building at our medical center eliminated conference rooms and working areas for clinicians. This means there is no place to sit at a desktop computer and actually do work or make phone calls. The computers in the patient rooms are ergonomic disasters. Plus, it’s difficult to concentrate and write efficiently when patients or families are asking questions. Patient privacy will be infinitely more challenging without any available private areas to discuss clinical issues. They did, however, install a faux fireplace in the oncology infusion center to make it seem more welcoming and homey. (Anonymous)

Is Epic still growing? Not if you read between the lines. Last year they said they hired 400 new employees. Now they say turnover is 10%, others say 20,% maybe it’s 15%. Either way that’s means replacing at least 900 employees per year. Looks like they may be cutting back or at best be in a holding position. Makes sense since Judy said a few months ago in a news article they are done building, and with the end of HITECH money, that juggernaut is over. The hospital market is clearly saturated, and a month or so ago, an Epic VP stated they want to move into other levels of care, like LTC, rehab, etc. But those markets are also saturated with some very well established vendors and Epic does not buy other companies. Is the writing on the wall? (HISJunkie)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. A in Washington, DC, who asked for math manipulatives for her pre-K class. She reports, “The math manipulatives you have provided will help to develop math skills during our center time and small group instruction. My kids are using the math manipulatives to practice counting, measurement and sorting. They are so excited to practice math now! Each student has a favorite manipulative they like to use. They like to make groups of five and 10, find out how many items are needed to make the scale go up or down and mix up all of the manipulatives and sort them according to shape, size, or feature. Thank you again for your donation and for making math accessible and fun!”

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Security experts warn that hackers can modify the USB ports of airport phone charging stations, allowing them to access user data or install malware. The fix is obvious – use your wall charger instead.

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A startup is developing software that can be used to deploy a drone in response to reported incidents or 911 calls, allowing first responders a live look at a fire or accident scene within 30-90 seconds even though they won’t arrive for 8-15 minutes. 

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An orthopedic surgeon opens a coffee shop in the lobby of Lake Health Beachwood Medical Center (OH), with 100% of the proceeds being donated to a local charity that helps single mothers buy homes. The Ethiopia-born doctor is one of the highest-volume shoulder surgeons in the US.

The Chinese scientist who was widely condemned by his peers for creating the world’s first genome-edited babies says he’s getting inquiries from shady fertility clinics offering to pay him to show how he did it so they sell those services .

The Chicago Tribune profiles a practicing 100-year-old optometrist who says he has no plans to retire. “I work because I feel I’m doing some good … I enjoy it. It’s not work as far as I’m concerned.”

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Fascinating: the doctor behind those ubiquitous online ads in which he begs us to “throw out this vegetable now” is found to be an integrative health MD who runs a variety of questionable websites that sell expensive herbal products and books for weight loss and constipation. He never says what vegetable everyone should throw it is and the ad uses photos of different ones, but it’s likely corn. The article also notes that the ads are known as “chumboxes,” sponsored pay-per-click content that baits people into clicking ads featuring miracle cures, ads triggered by the viewer’s IP address to offer what appear to be local services, and those that tease about something that is “weird.” Keep in mind that they exist only because people are stupid enough to click on them.


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Weekender 5/24/19

May 24, 2019 Weekender No Comments

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Weekly News Recap

  • Agfa is reportedly considering the sale of its health IT business
  • Medical drone delivery company Zipline’s latest investment round values it at $1.2 billion
  • ONC finds little interoperability improvement among office-based physicians since 2015
  • Google promotes Glass from its skunkworks division in releasing a new enterprise version aimed at software developers
  • JP Morgan buys medical payments processor InstaMed for more than $500 million

Best Reader Comments

Any complex software that you spend a lot of time in, you’d better learn it well. Most people do that but if you invest your time in resentment instead, you get nowhere. For highly skilled software users, they memorize key application pathways. It becomes second nature to them, to the point they don’t even think about it. Then for every work task, the only application questions that arise are: 1). Do I already know how to do this? 2). If I don’t, do I think my application can do it and I just need a nudge to get there? (Brian Too)

Cerner has this as well, it is called the Lights On Network. A current customer can log into LON (Lights On Network) and look at all of their timers, usability metrics, playbook scores as well as compare themselves to other like-sized Cerner Customers. It is a very useful tool if you choose to use it. You can see how many clicks it takes to fill out documentation, the amount of time a physician takes for a particular process and you can drill down into the individual users to determine who may be struggling or not even using the system. It is a very underrated tool. (Associate CIO)

Patients want to know who is grabbing their info. Follow-up: that part of the law got specifically wiped away. It’s also noted in the first comment of the proposed rule (long document, but it’s in there). (Richie)

As a former EHR implementer, specifically into physician practices, your article is honestly depressing. These are the EXACT same physician complaints that I heard when I was implementing over 15 years ago! NOTHING HAS CHANGED. You hit the nail on the head. Many docs are all too eager to blame the EHR for problems that have always been there (overscheduling, refill management issues, unwillingness to change habits). I worked with those groups for years and honestly gave up on it because I felt we couldn’t ever really win, as the EHR vendor. (Kallie)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. H in North Carolina, who asked for five laptops for her first grade class (they were out of school for six weeks following school damage from Hurricane Florence). She reports, “We absolutely love our new laptops. We use them every day. We are so very thankful for you kind generosity to our classroom. It has helped our learning in. So many different ways. Our new laptops have sparked so much new learning for all of my students.”

Journal of Hospital Medicine publishes a fun, informative article titled “I, EHR” that is written from the EHR’s perspective to its physician users. It includes tips for integrating an EHR into practice – explain to the patient what you’re doing in the EHR, stop typing and listen when the patients starts to tell a relevant story, use the EHR’s data and images to illustrate medical talking points, and add a photo of the patient and personal information about them to add richness to notes. It concludes,

I know I am annoying. I am over-programmed, leading to novella-length notes, “pop-up fatigue,” and overloaded in-baskets. Clearly, I am not the brains of the partnership (that will always be you). But talented medical informatics specialists are working hard to improve me. I dream of the day when I will create a truly seamless experience for you and your patients. In the meantime, I can foster a continuous integration of workflow, where all you have to do is talk to your patient. I take care of the rest … The future holds even more promising ways in which we may work together. My computer-aided image analysis could help you to improve the accuracy of your diagnoses. Perhaps telemedicine will further increase access to specialists in rural areas, so that we can continue to serve the most vulnerable populations. Machine learning algorithms may continue to enhance our ability to determine which patients require urgent hospitalization.The possibilities to put me to work are endless.

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CNBC describes the 34,000-square-foot Bel Air mansion built by a celebrity nose job plastic surgeon who expected to flip the $70 million property into a $180 million sale. His mistiming was spectacular – the luxury market was glutted and foreign buyers became scarce, so now he’s hoping to unload at $120 million, which would still net him $60 million in cash. The house next door that was listed at $250 million has been cut to $150 million. The doctor says he’ll just live in the house if he can’t sell it – he would just need to sell his existing $20 million home first. It’s hard to fathom that all of this excess is funded solely by people who don’t like how their noses look.

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Henry Ford Hospital says that someone stuffed an ED patient’s lice-infested clothes under the pad of a gurney, leading to a PR nightmare incident in which a patient who was the next gurney’s occupant was found covered in the bugs.


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Weekender 5/17/19

May 17, 2019 Weekender No Comments

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Weekly News Recap

  • A large survey of clinicians finds that the #1 predictor of positive EHR experience is training, with EHR personalization also being a major contributor
  • Cerner will connect its systems to state prescription drug monitoring databases via DrFirst
  • AliveCor earns FDA clearance for its consumer device that offers a six-lead ECG and expanded arrhythmia detection
  • Wolters Kluwer’s malware attack takes down its systems, some of them healthcare related
  • Former National Coordinator David Brailer, MD, PhD urges support for HHS’s proposed interoperability rules, saying that the federal incentive program should have made sure that EHRs could share information and defined medical information as belonging to the patient

Best Reader Comments

Re: Anti-poaching clauses. I negotiate them into all of my major agreements, if they’re not already there. Typically the vendor has it one sided that you can’t hire their employees and I make it reciprocal. (Was a Community CIO)

Healthcare data is complex, and while advancing FHIR will help, the fact is healthcare organizations need to invest in an enterprise healthcare data strategy and platform to really leverage the power of data. The EHR is just not that platform. The challenges of healthcare data are too complex for EHR vendors and they do no one a service when then try to position themselves as having more capabilities than they do. (Wow)

There’s a lot of very professional sales people out there selling products designed to help your health system solve problems, to get better, to better care for patients, to improve processes, to drive more revenue. Your industry is being disrupted while you sit in your office not taking phone calls from dreaded vendors trying to help. (Mike Bull)

One person comments on how there is no indication that sharing of data has decreased the cost of care, or increased the quality. I encourage you to please visit ARHQ.gov or HBR.org and review the numerous articles showing positive outcomes. I also dare you to find a single study not published by an EHR vendor that demonstrates that the EHR has done anything to improve the quality or cost of care. (Dissent)

Here are some hard truths: clinical data isn’t shared because it doesn’t profit your doctor and the health system to do so. EHR vendors built their systems to suit their health system masters and use their size anti-competitively, just like health systems do. Existing patient portals are a joke. This rant is indicative of those in this industry that proudly proclaim “I’ve been in healthcare for 30 years” but don’t understand that they are clearly part of the problem and won’t take responsibility for the state it’s in. (Disruption Please)

Rethinking regulations to protect patients by enforcing rational HIPAA-protected interoperability, including both doctor-to-doctor exchange, but also patient to their chosen apps with full awareness, audit abilities, and responsibilities similar or under HIPAA for those app providers. Force apps to protect patient data in a reasonable and accountable manner similar to health providers. (Love Fishin Too)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. K in Wisconsin, who asked for a “Jeopardy”-like game system for her elementary school class. She reports, “This gaming unit is very successful in my class and is especially good with the students that may not be good at paper assessments, whether it be ESL or special education students. This provides a different and motivating way to assess the students rather than a more traditional way. They are always asking to use this technology!”

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The Baltimore paper reports that Johns Hopkins Hospital has filed 2,400 lawsuits against patients with unpaid bills since 2009, many of whom live in economically depressed East Baltimore where its multi-billion campus sits. The lawsuit totals made up less than 0.1% of the hospital’s annual revenue of $2.4 billion.

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In England, University of Cambridge digitizes its 500 favorite examples from the trove of 80,000 handwritten medical records from the 1700s, with the notes of doctors including bizarre references to astrology, witchcraft, and treatment with horse dung. The records, translated into readable English, mention a man who got gonorrhea after “violating another’s wife,” a recommendation of bloodletting for a woman who “will not permit her husband to have the use of her body,” and a man bitten by a rabid dog who followed the prevailing wisdom of the time by eating the dog’s liver.

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French police add 17 new cases to its investigation of an anesthesiologist who is accused of tampering with OR equipment so that surgery patients were overdosed on drugs, then rushing in to revive them to show off his skills. Investigators noted that in the 24 surgeries that are being reviewed, in which nine patients died, the anesthesiologist was “most often found close to the operating room.”

Dietitians in Oregon question why a bill failed that would have required hospitals and long-term care facilities to offer plant-based meals, speculating that the Oregon Dairy Farmers Association influenced the state’s dietitian group. Some hospital nutrition experts said the bill would have limited the choices of patients who don’t eat meat, but who are OK with dairy products.

A Nevada doctor whose Kentucky Derby exacta and trifecta bets both hit is elated to learn that the payoff is $600,000, but he receives only $35,000 because the Reno casino’s fine print notes that it isn’t a pari-mutuel location and thus caps player wins to avoid “taking on unlimited liability, which no one would want to do.” 

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The Massachusetts medical board suspends the license of former Fox News contributor and celebrity psychiatrist Keith Ablow, MD, finding him to be an immediate threat to public health in alleging that he had sex with patients, stole their controlled substances, pointed a gun at employees, and fraudulently renewed his license.

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A man smashes the front window of a Utah medical clinic and makes off with a gumball machine provided for its pediatric patients. Surveillance video shows that the machine’s size prevented the thief from closing his car’s rear door, so he drove off with it hanging open.


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Weekender 5/10/19

May 10, 2019 Weekender No Comments

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Weekly News Recap

  • DocuTAP and Practice Velocity merge
  • Harris Healthcare acquires Uniphy Health
  • The Chartis Group changes private equity owners
  • The Practice Fusion unit of Allscripts is served a criminal grand jury subpoena related to EHR certification and anti-kickback statute issues
  • Astria Health blames its EHR conversion and contracted RCM vendor for its Chapter 11 bankruptcy
  • HHS asks people to share their stories about obtaining copies of their health records or the sharing of them among providers
  • Grahame Grieve is named the winner of the 2019 Glaser Award

Best Reader Comments

If you can’t down load your record, it isn’t due to a lack of regulation. You need to change doctors if they don’t offer it. (A)

Evidence is scant as to all the innovation and data sharing actually reducing the cost of healthcare. CMS and ONC need to face this fact and stop hyping every supposed innovation that comes down the street. (Bill Spooner)

Our industry’s lack of transparency in costs to the patient is inexcusable. It should be a simple question to ask a doctor’s office “how much will this cost me?” Our industry’s answer: It depends on how many topics you bring up and their associated medical complexity, whether the doc prescribes a medication, what associated tests he runs, what unrelated services he adds on (in your and his mutual best interests, of course), and how much time he decides to spend documenting. It also depends on your insurance policy (which neither one of us is knowledgeable about), so it may be fully covered, may just be a co-pay, perhaps co-insurance, or perhaps you will have to pay the full adjusted amount because of your unmet deductible. And there is an off chance that you will be forced to pay the full amount billed if our provider is not on your insurance because he decided that he gets paid more by not contracting. So, in short, today’s visit will be anywhere between $0 and $500 (and we won’t know the final answer until 45 days from now). And, because of this discussion, we just wasted the first 10 minutes of your 15 scheduled minutes with the physician. It’s insanity. (It’s Insanity)

The reality is that a majority of sales professionals aren’t very good at their jobs. If sales professionals are truly making a “cold call,” that means they’re going down a contact list name by name without doing research. I have a tremendous amount of success by calling hospital executives (CEOs, COOs, CNOs), but it takes a considerable amount of planning work. If you’re shooting from the hip and hoping to get lucky, you are making the rest of us look bad. Look at LinkedIn profiles sales professional in HIT space — typically 1.5 to three- year stints. One or two of these short stints over a long career can be explained (acquisition, RIF, etc.), but if it is a pattern, then it’s an obvious tell that they aren’t good at selling. The HIT sales community is super washed up. Lots of old vets who aren’t working too hard. Also many frat bro types who show up to conferences with suit pants altered to show socks and expect to be taken seriously by mostly old hospital execs. (Desperado)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. B in Texas, who asked for headphones for her sixth grade class. She reports, “It has made a huge difference. It has helped them gain independence as they are working. We have used them in many ways already! For example, the students were collecting information on South Asia and the headphones enabled them to listen to videos about specific events and people. They were able to take notes and work at their own pace. Another way the headphones have been used is to help students that need to listen to test questions. They can take a test at their own pace and rewind to hear the questions again. They enjoy being independent. We are the only class in the school that has a class set, so other teachers borrow them when we are not using them or if we have extras. Your donation is helping HUNDREDS of students!”

A former technical support contractor pleads guilty to taking down Oregon’s Medicaid management system in 2016 in retaliation for being laid off by Hewlett Packard Enterprise.

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Mount Sinai Healthcare System (NY) launches a sports bar-themed prostate education and treatment center in partnership with Man Cave Health, with the waiting room featuring leather couches, ESPN running on a 70-inch TV, framed local sports memorabilia, and a device charging station that looks like a bar. The non-profit Man Cave Health offers a toll-free appointment booking line and says that while it hopes to roll out sports-themed rooms in all NFL cities, it will consider other concepts. I can say that given my lack of interest in sports (actually more like disdain) that I would prefer sitting in a traditional waiting room, although I used to get my hair cut at one of those sports-themed chain barber shops (because they offered free draft beer, snacks, and big leather chairs while waiting) in which the ladies who performed your services while wearing referee shirts were obviously chosen using criteria mostly unrelated to their tonsorial talents.

Massachusetts General Hospital pays $5.1 million to settle a malpractice lawsuit with former Boston Red Sox pitcher Bobby Jenks, whose blames his career-ending surgical complications on his surgeon, who he claimed was overseeing another surgery simultaneously. MGH says the surgeon performed the complete surgery, but Jenks failed to follow discharge instructions because he didn’t call immediately to report his complications.

Hospitals struggle to treat John Doe patients who are unable to identify themselves, many of them pedestrians and cyclists who aren’t carrying ID when they are hit by a car. Fingerprints can’t be used unless it’s a criminal matter. The health IT aspects include use of a system that generates a “trauma alias” fake name and the negative impact of HIPAA, where anyone calling to inquire about a missing friend or relative cannot be given information that would help identify a patient as one they know.

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A Texas state representative launches a Twitter attack on Baylor professor, pediatrician, and vaccine expert Peter Hotez, MD, PhD, declaring his work with vaccines to be “sorcery,” accusing him of practicing “self-enriching science,” and being a “typical leftist trying to take credit for something only The Lord God Almighty is in control of.” I checked the background of Rep. Jonathan Stickland, a 35-year-old Republican from Plano (above) — he quit high school but later obtained a GED, studied sales in community college, and worked as a pest control technician. He has previously opined that “rape is non-existent in marriage,” called an online critic “a bratwurst-loving homo,” and declared that “healthcare is not a right.”

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A hospital in South Africa brings a lion into the facility (via the back door, to avoid scaring patients) to receive the first of four radiation treatments for cancer.


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Weekender 5/3/19

May 3, 2019 Weekender 3 Comments

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Weekly News Recap

  • Allscripts announces Q1 results that beat earnings expectations but fell short on revenue
  • Meditech’s Q1 saw reduced revenue, operating income, and net cash from operations although unrealized security gains pushing earnings dramatically higher
  • Capsule Technologies acquires Bernoulli Health
  • Cerner filings indicate that activist investor Starboard Value made its run on the company’s board two days after Brent Shafer announced his new “operating model”
  • A new KLAS report on hospital market share finds that Epic beat Cerner handily in new hospital gains excluding Cerner’s one-time VA deal, with Cerner losing 65 Millennium hospitals vs. Epic losing one
  • HHS announces that it will use its discretion to reduce maximum annual HIPAA fines based on level of culpability

Best Reader Comments

Life in rural America is in a serious long-term decline and has been for decades. De-industrialization has just piled on, especially in smaller towns in the Midwest, Northeast, and the South to a lesser degree especially since 2000. The only area that has avoided this trend is smaller (and relatively newer towns) in the SW and West which never had much, if any, of a manufacturing base to begin with. They have been able to pivot more easily to the current economic model especially if they attract tourists year-round and/or have a higher education institution which has remained competitive. If smaller towns are declining economically and demographically, there is going to be less of a need for community hospitals especially those with aging physical plants which are costly to remain and run. The trend is going to be ASC/outpatient wherever possible and more micro-hospitals/hospital-at-home. There will still be a need for facilities to treat emergency patients but that is going to be a much more complex issue from a political and economic standpoint. Coming back full circle, there is still going to be a market for community hospital IT software but it will be one that is in long-term decline and largely a maintenance market that lives of the 16-20% annual software and maintenance feeds vendors charge (more if they host it). What is likely going to emerge is software to support new models of care and much smaller facilities. It just won’t have the $$$ that an enterprise community hospital system has to it. (Lazlo Hollyfeld)

Being an IT person and a long time athlete who has used FitBits, heart rate monitors, and training logs, I figure that the right way to handle the data stream from personal monitoring devices, logs, etc. is for vendors to develop an integrated approach that uses certified devices, periodically calibrated if necessary, feeding data streams to repositories. For example, this could include a bundle of devices for an elderly person with CHF. These might include a few things. One would be a scale, expecting twice-daily readings to check for rapid weight gain due to non-compliance with diuretic. Another would be a smart pill dispenser to track medication adherence … Between the data stream and the clinician would be carefully tuned algorithms that would decide when to alert a licensed provider like an advice nurse in a call center … Once these packages are matured and the value in preventing admissions / readmissions has been demonstrated, I would envision PCPs ‘prescribing’ the bundles, with all of the associated intelligence and process, to their patients. Kaiser Permanente was doing some futures work on this kind of thing a couple of years ago. (Dr. J Fanboy)

I agree 100% with Vaporware and that Cerner has made a deal with the devil with the DoD contract. That is just an opinion based on my experiences. However what isn’t an opinion is that Cerner is a publicly traded company that has to answer to forces that Meditech and Epic do not. It is not an opinion that Cerner has caved to the pressure of profit-seeking investors and it will fundamentally impact the way the manage and pay their talent as well as their development and support expenditures. Do you honestly think that having to balance a huge contract with a notoriously difficult customer in the most open and public way, while at the same time trying to please shareholders demanding more profit now, is conducive to being a responsible steward for your private and community hospital partners? (You don’t need a weatherman to know …)

Whichever vendor you attach to the feed trough basically becomes the de facto in-house IT / development shop for the federal government. The in-house VistA talent that was swept out was expensive, but at least they made an EHR that worked when you turned it on. (Vaporware?)

Churn rate is of course a concern for all vendors not named Epic, however their entry in to selling directly in to hospitals they used to flat out say no to is indicative they know that the acquisition advantage they have is running out of targets. The cat is out of the bag that selling off to the large chain doesn’t cut costs for the community and it doesn’t improve services. The hospitals that have managed their money and capital commitments have been able to resist having to sell of to rid themselves of debt. Many communities take great pride in having their own independent hospital. In short the assumption that every community hospital will end up being owned by Epic or Cerner running systems isn’t set in stone. (Smartfood99)

I also am on board with you as it pertains to Cerner’s terrible attempts at RCM. I mean really, how hard is it to build a reliable financial system? That is what many of us though when Cerner bought Siemens, that Soarian financials would be the go-forward strategy. But instead, for the first three years post merger, Cerner actually still sold Millennium and Soarian Financials and customers were confused and pissed at the same time: why the option? With Cerner’s cash on hand and number of employees, why the hell can they not figure this out? They are so worried about always being first to market. Screw first to market, just make your product the best product. God rest his soul, but this falls on Neal. This should have been corrected years ago, but like that dog in the movie Up, Neal would pick a direction and then see a squirrel and completely lose focus. (Associate CIO)

I actually am more optimistic about Meditech beating Cerner than you. I think the Neal Patterson Cerner would have swallowed the entire lower part of the market and then there would be a Cerner-Epic duopoly. This private equity firm seems to be trying to move Cerner’s focus from gaining market share to milking their customer base. I doubt the corporate suit they have in charge now has the original vision or an alternative vision that he can articulate to the board and shareholders. That could drive the Cerner offering to a price nearer to Epic’s. With the cash-strapped community hospitals or penny pinching for-profits, that could make the cheaper, good-enough Meditech Expanse more tolerable. (SelfInfllictedWound)

I have come to a general conclusion about a lot of this. The EHR is a proxy for a lot of the irritants for clinicians, even if the EHR isn’t the underlying cause. To oversimplify while getting to the point, most physicians are employees now. As an employee, you do what your employer tells you to do. You can complain, but you’ll do as you are told. Or resign. Or get fired. Ouch. I can appreciate how this means some loss of status and independence for physicians. On the other hand, what do you think working life is like for most people? Medicine is a noble profession, but when you attempt to lean on that in order to support privileged working conditions, I don’t think that will go well. (Brian Too)


Watercooler Talk Tidbits

The local paper says that most dentists in Olean, NY haven’t implemented EHRs, some of them wary after seeing the “billing disaster” of Glens Falls Hospital in implementing Cerner. One local dentist uses digital imaging, but says, “When I need to read what I wrote about a patient, I have a paper record … because there can always be a system failure.” Most of the 48% of US dentists that don’t use EHRs question their value and security even though they agree that it’s easier to read online than on paper.

In England, the family of a 64-year-old woman who died in the hospital says that another patient was annoyed by the woman’s snoring, so she beat the woman on the head with a cup. The hospital expressed condolences, but says “it is clearly not possible for staff to supervise all patients individually round the clock.” It makes you wonder why hospitals can’t work like hotels, where rooms are locked to keep unauthorized people out, but employees use a master key whose activity is tracked. That wouldn’t work in hospitals with the illogical and universally despised “semi-private” (meaning not private at all) rooms.

A Mississippi anesthesiologist says he has spent $30,000 on lawyers and notification letters after someone broke into his practice’s offsite storage unit and stole the paper medical records of 14,000 patients. I had an immediate mental image of the “Storage Wars” gang shining flashlights onto his stacks of cardboard boxes in formulating their bidding strategy.

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The former girlfriend of a California radiologist captures security video of him crawling through her back yard and peering into windows. The doctor was already on medical probation for a series of arrests related to domestic issues and was previously fired as a locum tenens radiologist by a hospital for inaccurate reports, inappropriate behavior, and unstated mental issues.

An Idaho man whose wellness multi-level marketing company has given him a $4.5 billion net worth creates a $500,000 legal defense fund for people who are being pressured by medical debt collectors. He provides as an example Medical Recovery Services, which he describes as, “We’ve got an outfit operating in Idaho Falls, a debt collection agency, that’s more interested in running up attorney fees than they are in collecting medical debt,” describing one of his own employees whose unpaid bill of $294 was turned over to collectors who inflated it to $6,000.

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Bizarre: in England, a 26-year-old “serial prankster” who enjoyed startling his girlfriend by repeatedly faking his own suicide – by squirting ketchup on himself to look like he’d been stabbed and pretending to have an anaphylactic reaction from eating nuts while driving – dies from brain swelling after tying sweatpants around his neck to make her think he had hanged himself on the stairs. 


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Weekender 4/26/19

April 26, 2019 Weekender No Comments

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Weekly News Recap

  • Cerner announces Q1 results that meet Wall Street’s revenue and earnings expectations
  • Seattle-based genetic testing and health coaching startup Arivale shuts down after burning through $50 million in funding
  • CPSI announces plans to acquire patient engagement vendor Get Real Health
  • Bain Capital hires financial advisors to help it assess the potential sale of RCM vendor Waystar
  • The FTC files an antitrust lawsuit against Surescripts for allegedly monopolizing the e-prescribing market
  • Athenahealth lays off 200 employees
  • HHS announces CMS Primary Cares, two value-based care payment models launching in 2020 that it says will cover at least 25% of Medicare beneficiaries and providers
  • HHS opens Draft 2 of its Trusted Exchange Framework and Common Agreement for public comment

Best Reader Comments

The EHR’s screen can be really busy and have many redundant ways of doing similar workflows. This causes some levels of frustration because various trainers or local support folks will show different ways to accomplish a task (at times it’s the incorrect / non-best practice way). I remain empathetic to my colleagues as I know that they are constantly flooded (brain blocking) from all the tech tips etc. However, I just encourage them to “make it yours” via personalization of the user interface and data entry areas a little at a time. Over a few months, they’ll find that they are recouping a few minutes a day. (Dave Butler)

I’ve not been directly involved with IBM Watson Health, but from its beginning, I have always seen Watson as a hammer looking for a nail. Not to say that it doesn’t work (I don’t know), but it is an expensive way to already do what humans do pretty well, like diagnose patients. At best, it probably is 10 years ahead of its time, before the needs and questions appear that it best answers. (Prof. Moriarty)


Watercooler Talk Tidbits

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Ms. V in Texas asked for an Apple TV for her Houston-area students — all of them English language learners and many of them living in temporary housing following Hurricane Harvey — via a DonorsChoose teacher grant request. She reports, “The Apple TV has impacted my classroom in ways I didn’t even imagine. I have seen students more engaged and excited about lessons in class. The students are eager to answer and ask many questions while learning! My students love when I use the iPad connected to the Apple TV. I am able to walk around the room while I teach. This allows me to keep an eye on student engagement as well as incorporate the students into the lesson. My students enjoy being able to show their work on the iPad as well. I have downloaded an app that allows me to put PDFs on my iPad, which include worksheets, textbooks, etc. With this app, I am able to teach from these items and students are able to write over them. It’s amazing! This technology has changed the way I teach for the better, I am so grateful for these wonderful resources!”

Wisconsin Public Radio covers the “My Life, My Story” project in which volunteers talk to hospitalized VA patients about their lives and enter their story into the EHR. One of the project’s organizers says, “”The [electronic medical] record is a mess. If you were to try to get a sense of someone’s life from that record, it might take you days.” The idea came from a VA medical resident who realized that residents rotate out of a given facility quickly, but patients in the resident clinic stay the same as they just keep meeting new doctors. A survey found that 85% of clinicians find it worth their time to read the stories of their patients to help them communicate with them as individuals.

I guess North Korea is out of network – the federal government reportedly approved paying (but apparently never actually paid) a $2 million hospital bill to gain the release of detained US citizen and University of Virginia student Otto Warmbier, who was sentenced to 15 years of hard labor for removing a hotel’s propaganda sign. It’s not exactly value-based care, either – Warmbier was returned in a coma and died shortly afterward, with a US court finding the North Korean government liable for his torture and death.

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A former pediatric resident who was fired by UK Hospital (KY) in 2017 for possessing child pornography on his work computer is charged with that crime. The Linkedin of Ryan Keith, DO extols his residency performance without noting its undistinguished end, but he has since found a career (likely not long-lasting, if I were betting, given new media exposure) as a quality associate at IV manufacturer Baxter Healthcare.

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In Australia, an ED doctor is suspended for six weeks for posting patient photos online, proclaiming that mental illness involves “the only language these people understand is the language of violence,” posting anti-gay comments, and posting explicit photos of his psychiatrist wife with the warning that a failed marriage “would end in murder.” A litany of his bizarre online commentary reveals some truly disturbing beliefs, which he says are irrelevant because he’s a great doctor.

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A 19-year-old “Instagram butt model” and “influencer” convinces a Beverly Hills plastic surgeon – himself a self-proclaimed influencer – to declare her posterior free of surgery in what she says is “the first certified real booty.” I’m torn among directing my scorn to the US healthcare system, to social media, or to those so easily “influenced” by vapid societal non-contributors. 

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An Oregon pediatrician who courts antivaxxer parents lobbies against a proposed bill that would eliminate non-medical exemptions for vaccination, all while pitching his YouTube channel, anti-vaccine book, nutritional supplements, and detox clinic.

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The local paper profiles Duke Health spinal surgeon Oren Gottfried, MD, who has earned 100 on-screen TV credits for creating medical plot lines for TV dramas and then ensuring that they are portrayed accurately. He’s about to get his first on-screen appearance on “Chicago Med.”


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Weekender 4/19/19

April 19, 2019 Weekender No Comments

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Weekly News Recap

  • IBM halts sales of Watson for Drug Discovery due to low demand
  • Healthcare data integration vendor Redox raises $33 million
  • The New York Times profiles the Butterfly IQ device that transforms a smartphone into an ultrasound scanner
  • Provider management, credentialing, and payer enrollment technology vendor Symplr acquires competitor IntelliSoft
  • InterSystems adds a provider directory to the newly renamed HealthShare Unified Care Record
  • Vermont HIE struggles with opt-in vs. opt-out participation
  • The number of India-based doctors who support their US counterparts as remote scribes is rapidly increasing
  • China’s WeDoctor provides government-required health checks to villages as a way to collect patient data to train their AI-powered systems
  • Babylon Health ramps up staffing and spending

Best Reader Comments

I think it remains to be seen if physicians and other healthcare leaders are ready to move from anecdotes to numbers, the concept “numbers do not lie.” I have already commented upon the conflation of quantitation, plus emotions, and also enjoyed your reference to one of our (many) limitations. Ultimately, it is my personal opinion modern society is currently seeking too many answers, placing too much hope, in so-called AI/ML. I also believe “magic” AI/ML solutions may produce serious answers, some decade. However, in (current) reality, there is simply limited data granularity access for research, in the context of an increasing number of mixed/blurred physical & electronic “threats” in major news headlines. I think some of these headlines are hype, a form of Security Theater. (Andrew M. Harrison)

We are lousy at the foundational steps, among which is rigor in the process by which we document what we do in a computer-processable way so that we can then extract from large-enough populations accurate data about the best approach to taking care of people. And right now, the EHR is such a PIA that for the foreseeable future, garbage-in is winning. As a tiny example, the average physician is far more concerned (and needs to be concerned, for practical reasons) with getting a term on the chart that gets him paid than getting a term on the chart that reflects what he wanted to say. (James E. Thompson)

Interesting thought experiment: take Epic or Cerner with their current workforce and give them five years and a billion dollars. Starting from scratch, no existing code or documentation, they could either build a new system or try to replicate their current system from their own memory.  Could they build a competing system? My answer would be very unlikely. (AC)


Watercooler Talk Tidbits

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Ms. H in Georgia was happy to have her DonorsChoose teacher grant request funded by HIStalk readers, which has allowed her elementary school students to experiment with programmable robots. She says, “Where is Botley? Are we going to play with Botley? These are the questions I get at least twice a week since I introduced Botley to my students three weeks ago! Kindergartners and first graders are so excited to learn and they love how cute Botley is. They are slowly learning not only what Botley can do, but how to code so that Botley can do what they tell him to do. For students who come from economically disadvantaged areas, our students aren’t exposed to all of the things that their more advantaged peers are. Botley is able to bring a much-needed to skill to our students. What I love about Botley is that students are learning that their input can alter what Botley does. This is much like real life, in that individual actions or input can have an impact on what someone else does! Thank you again for believing in our students enough to fund this wonderful project.”

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This is my kind of investigative journalism. Business Insider ponders why healthcare startups such as Oscar Health, Flatiron Health, and One Medical use similar fonts in their marketing materials. The first two companies use Tiempos (pictured above), created in 2010 for a Spanish newspaper to be easily readable on newsprint. A company designer says the font is “warm and human, without being overly cute or friendly.” One Medical’s rebrand included retooling the colors closer to British racing green and moving to a customized font called GT Super, which also has print newspaper roots. The company liked that font because sans serif fonts like Helvetica can feel robotic and impersonal. Half of me wants to declare this to be total BS and a job protection act for otherwise marginally employable marketing people, but I have to admit that I subconsciously form feelings about companies based on stuff like this, no different than reacting to a person’s appearance or manner of speaking.

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Louisville-based Freedom Medical Labs, which got caught sending employees in unmarked vans to poor neighborhoods where they offered $20 to collect DNA samples along with the person’s health information, shuts down. The company blames negative publicity, but insists that its activities were legal, voluntary, and covered by the insurance of those who were testing. Several companies offer cancer genetic testing when doctors attest that it is medical necessary, and I’m guessing it’s not hard to recruit doctors if you are willing and able to pay them richly. One national company (Medvantage Consulting, above) markets the tests to people with insurance and a family cancer history and pays 15% of the $6,000 to $8,000 to anyone who brings in billable candidates.

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This is, unfortunately, medicine in America. DEA agents escort a handcuffed cardiologist Andrew Rudin, MD from the hospital that hired him just three months ago, he being one of the dozens of doctors that were arrested last week for opioid distribution. The charges involve his previous job in Tennessee, where he supervised (or didn’t, according to the DEA) a nurse practitioner who called himself “Rock Doc” in hoping to land a reality TV gig. He paid Rudin to supervise his practice (cosmetics, weight loss, platelet-rich plasma, and anti-aging), from which Rock Doc traded opioid prescriptions for cash and sex. The cardiologist is highly credentialed and accomplished, so it would be interesting to study the psychology that led him from developing ablation procedures to being hauled away in handcuffs.

Vancouver-based opioid specialist Mark Tyndall, MD, ScD – who sets up safe spaces where addicts can shoot up under supervision – is working with a tech company to develop a vending machine that can dispense prescribed opioids with recipients verified by a palm vein scan. He says the US response to the drug epidemic has been to ramp up arrests and border security, while Canada’s goal is harm reduction in keeping users alive instead of trying shut off their access to drugs.

Lime, one of the startups (were all the good ideas taken?) that is trying to push trendy rentable electronic scooters that seem to have high potential for disrupting both vehicular and pedestrian traffic until they are abandoned dysfunctional or broken, will add sensors that will slow the scooter down if the driver seems drunk. I don’t really get the appeal or understand why cities allow the services to operate, but if you care, Lime charges $1 to unlock a scooter via its app and then $0.15 per minute to ride while looking like an insufferable hipster who has freshly graduated from a skateboard and can’t bear to actually put one foot in front of another while staring into a phone.

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A 25-year-old woman being discharged from University of New Mexico Hospital steals an ambulance on her way out, crashes it into a pole, and then hops into the gurney in the back to pretend that she is a patient. She explained to the arresting officers that she was just looking for heroin, then claimed that the crash injured her, whereupon she once again became a UNM patient.


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Weekender 4/12/19

April 12, 2019 Weekender No Comments

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Weekly News Recap

  • Cityblock Health raises $65 million just three months after announcing a Series A round of $21 million
  • Partners HealthCare (MA) will equip its clinicians and researchers with the tools necessary to develop their own AI algorithms
  • Cerner bows to pressure applied by an activist investor by appointing four new board members as nominated by hedge fund operator Starboard Value
  • Microsoft announces that it will shut down its HealthVault personal health records service on November 20, 2019
  • Google Cloud opens its healthcare API for beta testing
  • Urgent care EHR/PM vendor DocuTAP and urgent care solutions vendor Practice Velocity announce plans to merge

Best Reader Comments

I’m assuming that the single-digit margin you refer to is the margin on your institution’s whole operation, and therefore represents money that is left over after the institution pays for all its costs (salaries, equipment, etc.). Your vendor’s 30% margin is, on the other hand, probably the margin on a single product – and the only costs that are covered before that 30% margin are costs that are directly related to that single product. The 30% margin goes on to pay for things like accounting department, promotional efforts including sales team (without which there would be no business), facility, investment in R&D for new products, and so on. It’s not really an apples-to-apples comparison. (Clustered)

If your primary purpose of going to HIMSS as a vendor is to get quantified leads and build sales pipeline, don’t get a booth if you are a small or mid-sized vendor. (Lazlo Hollyfeld)

I really don’t understand why half of Wall St. is just putting blind faith in Apple. This basically amounts to “healthcare is a big industry, Apple is a company that could take advantage of this industry”. Do any of these analysts realize that Apple devices and the App store are already used in healthcare? And that it’s not making an impact on patient outcomes or the company bottom line? (Elizabeth H. H. Holmes)

My understanding is Cerner is making the Soarian Financial customers migrate over to the Millennium financials. However if they are trying to meld the two together to make a super system in concert with the Millennium Clinical system (so actually three together) does anybody who has been in the EHR industry for the last 3-4 decades think that can really work this time? The EHR minefield is littered with craters of vendors who tried to create a synergy between technologies that were created under separate paradigms and methodologies. (Smartfood99)

If you are trying to attract CIOs from non-profits to your event at Pebble Beach, please don’t. Some younger CIOs may not appreciate that this could end their career. Experienced executives will know that events like this or like the one I have turned down three times – attend the Masters and then play at Augusta – are just not worth being fired for over a compliance issue. We may not like the rules, but if we choose to work in this industry successfully, we need to follow them. (Justa CIO)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. T in California, who asked for lap desks and floor cushions for her kindergarten class. She reports, “Thank you for your generous donation to give our class materials for flexible seating in the classroom. My kindergarten students were so excited to see the new lap desks and cushions. They love being able to move around the classroom more while they are working. The days are long for kindergarten students, and being able to have a more flexible seating arrangement is helping my students to have more fun while they are working. Sitting in a chair all day long is difficult, and gets boring for many students. The lap desks give my students a chance to sit in a different place in the classroom. They also feel special when they are using the flexible seating.”

Boston Children’s Hospital sues a Saudi prince who volunteered to cover the treatment cost of a two-year-old girl with a rare genetic disorder, then ignored the hospital’s bills for $3.5 million. The hospital says they wouldn’t have admitted the child without his promise of financial backing.

Those who have never worked in a hospital can’t imagine what it’s like on the front lines of human misery and emotion and to have horrible images burned forever into your brain. Example: a Texas man whose grandchild was in the PICU after being severely beaten threatens to kill the hospital’s nurses and the grandchild because employees couldn’t give him information about the child’s condition.

Apparently there’s no limit to our demand for Elizabeth Holmes-related entertainment as the Theranos story will get yet another on-screen treatment, with SNL’s Kate McKinnon playing the disgraced CEO in a Hulu limited series. I’m sensing a missed opportunity here – Holmes is tarnished for life, so why not just do her own documentary, drama, or instructional video? I bet plenty of people would pay for personal coaching in how to run a personality-driven scam.

Tesla is reported to have strong-armed the doctor who runs its on-site factory clinic to keep worker injuries off the books to make its workplace injury record look better and to reduce its self-insurance costs. One of the doctors who could be counted on to give company-friendly diagnoses was about to lose his medical license for sexually assaulting two female patients.

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New York’s health department investigates Danielle Roberts, DO for branding women with the initials of Keith Raniere and actress Allison Mack as part of their NXIVM sex-slave cult, of which she was a member. You have to wonder what could have convinced her that this was OK. She’s now hawking memberships in a holistic healing group she formed. Now every time I hear Twitterati yapping about their anemic “personal brand” I’ll think of these images.


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Weekender 4/5/19

April 5, 2019 Weekender No Comments

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Weekly News Recap

  • PatientsLikeMe seeks a a buyer after the federal government’s foreign investment review committee demands that its majority investor, a China-base firm, divest its holdings
  • Amazon announces the availability of six new HIPAA-compliant Alexa healthcare skills
  • GAO officials tell the House Veterans Affairs Committee that the VA’s poor track record of CIO leadership has harmed its IT modernization projects and will continue to do so
  • FDA names Principal Deputy Commissioner Amy Abernethy, MD, PhD to the additional role of CIO
  • Walgreens says it will accelerate digitalization of the company, make executive team changes, cut costs, and redesign stores following poor quarterly results that sent shares down sharply
  • A two-doctor ENT practice in Michigan closes for good and its partners retire after they refuse to pay a hacker $6,500 to restore their ransomware-encrypted systems

Best Reader Comments

AI is about six different things, with different methods and different targets. The fact that it gets rolled up into an undifferentiated mass screams that these are merely magic words meant to attract… well, suckers. Second, I would agree that resources could be spent better on other fronts. You mention lifestyle and similar social determinant factors. This reminds me that serious thinkers wonder whether diverting the last trillion or so marginal dollars from health care to education might actually improve public health outcomes more effectively. (Randy Bak)

Regarding the inability of financial incentives to change patient health behaviors, are the folks designing these studies basing them on any established health behavior change theories? If not, then there are good reasons that these interventions fail. (Mark Hochhauser)

Going to be really interesting when an AI says that we need to address behavioral health issues in a good portion of the population, only for us to realize that 1) there’s a huge shortage of workers; and 2) the reimbursement is not there to operationally break even. (NotTheDataYoureLookingFor)

Transfer of patient information results in decreased use of the healthcare system. Why? Because having those records available results in earlier intervention and in fewer repeated diagnostic tests. Decreased utilization of the healthcare system is important to the survival of only two parties I can think of: (1) the patient (obvious benefit), and (2) the payor (cuts costs). Therefore, we should be looking at the patients to pay, or the payors to pay [for data exchange]. No one else seems to have a dog in this fight. I realize it sounds quite callous to put it this way, but I feel it is realistic. There are indeed providers who act for the greater good and act in support of transfer of patient records. However, hoping that all providers will support timely transfer of patient info – without some inducement to do so – may be misguided. (Clustered)

The patient does not own the data. The data are about them and they have a right to see and distribute. Can they modify their record? Do they pay a record storage fee to the HC org to hold their data? If not, it’s not owned by the patient. (Data owner)

Initially or always for a percentage of tests, it might be a better idea to only give the AI verdict after the radiologist has given their opinion. You don’t want the radiologist to start being lazy/biased and lose their diagnostics chops either. (AC)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. Z in Texas, who asked for STEM activities for her pre-K class. She reports, “They were so excited to see their new center materials. I enjoyed watching their creativity come to life and coming up with new things they could make. One of the lessons we did was using the 3 Little Pigs story and how they could come up with a house that was strong. They started coming up with so many different ways to use the materials and build houses. They were even coming up with things we adults didn’t even think of! I can’t tell you how happy and eager they were to go to their new STEM center and build their own creations! From the bottom of our hearts. we appreciate you giving these children the opportunity to expand their little growing minds!”

Conspiracy-obsessed Internetters are spreading rumors that rapper Nipsey Hussle was killed because he was working on a documentary about an alternative health guru who died in 2016 after claiming he could cure AIDS. The rumored conspirators behind both deaths are the always-collegial drug companies, medical societies, and regulatory agencies. Leading the charge with a list of 90 doctors who were mysteriously killed (by people such as their spouses or by auto accidents) is a “health nut” with no stated educational credentials whose website is full of anti-GMO conspiracy theories; vaccine theories; a recipe for a garlic soup that can cure flu and norovirus and a flatbread that “fights cancer with every bite;” and an online store that sells CBD skin serum and some seriously wacky products (all carefully disclaimed in the footnotes as not being a substitute for professional medical advice, diagnosis, or treatment). Her husband, a DO, runs a similar site, which she promotes in videos in which she languishes on a bed with little evidence of clothing.

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An Arkansas man who is being treated at a hospital for bruises caused by bullets striking his bullet-proof vest tells staff and police officers that he and a friend were involved in a gunfight while protecting a mysterious man called “The Asset” who had hired them as bodyguards. His wife then arrived and set the record straight – the men were drinking on the back porch and dared each other to be shot while wearing a bullet-proof vest. The first man admitted that he was annoyed at being shot, so he emptied five .22 rounds into the second man’s back. Both are fine other than being charged with aggravated assault.

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US Navy corpsmen are working at trauma units in Chicago, Cleveland, and Jacksonville to gain experience with gunshot wounds, burns, and hypothermia that are likely to occur in traditional warfare but that are seen less in the military’s terrorism-related activities in countries like Afghanistan. 

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Johnston-Willis Hospital (VA) arranges for a dying mother to see her daughter graduate from high school in her hospital room, with the school principal delivering a brief commencement address followed by a  vocal performance by the college music fraternity of the graduate’s brother. The mother died the next day.

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A baby who was born in drug withdrawal and who endured a five-month hospital stay without having a single visitor is adopted by the hospital’s nursing director.


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Weekender 3/22/19

March 22, 2019 Weekender No Comments

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Weekly News Recap

  • A Reddit “Ask Me Anything” with Providence St. Joseph Health EVP / Chief Digital Officer and venture fund manager Aaron Martin gets ugly with charges of layoffs and a hostile work environment for female employees
  • A France-based online medical appointment app vendor’s funding round values it at more than $1 billion
  • Fortune’s cover story, “Death By 1,000 Clicks: Where Electronic Health Records Went Wrong,” says EHRs are an “unholy mess” after taxpayers spent $36 billion on their use
  • Health Catalyst hires investment bankers to begin its IPO process
  • The payment model of England’s NHS, which is based on a medical practice’s location, raises concern as the private company behind the GP at Hand video consultation app draws 40,000 Londoners to its practice
  • Change Healthcare files IPO documents
  • A survey finds that nurses who work in a positive work environment like their EHRs better and have a higher appreciation for their role in patient care

Best Reader Comments

Having sold EHR software before the government started subsidizing buying as well as after its no surprise the monetary “savings” haven’t been realized. Most physicians under-coded visits prior to using an EHR as they feared failing an audit of required documentation. Using an EHR allows faster accurate coding, which means higher medical costs. When physicians used paper to document care, they usually made very brief notes with the patient in the exam room. Then they spent hours dictating progress or writing progress notes after business hours. This delay often led to missing information in the notes. Many charts were unreadable or missing when needed. The paper records were far from perfect and hid many more medical errors. (Matt)

No one took the time to redesign the healthcare process [before designing EHRs] and develop roles and tasks that automation could efficiently support. A quick read of the Toyota Production System’s approach to adopting new technology shows how backward EHR adoption has been. We do have great examples in health care where automation was handled properly. Voice recognition reduced radiology turn around times to minutes from days. Lab automation and electronic communication linked robotic testing results to the medical record with near instantaneous availability. Bedside MARs measurably improved patient safety. But when it came time to do the big one, we dropped the ball. (Steve O’Neill)

There’s not a Theranos story [with journalism investigating the EHR industry], but there is a story of companies that grew much too quickly, are governed largely by crisis and chaos, have an ethos of “put something out there and fix it later” (or, promise something and create it later), are operated at all levels but the very top mostly by 20-somethings, and have had plenty of lapses of both execution and ethics in the post-HITECH boom. (Fred)

Back in the very first days of the MU program, I sat in a meeting room at a state hospital association conference and heard a CMS regional administrator say, “We won’t pay for that which we can’t measure,” i.e, if you are documenting in a way that makes it difficult or impossible to collect data and compare how you’re doing with other providers, we aren’t going to pay you. Lab results, vital signs, and drug administrations are all relatively easy to collect data for measurement. Medical necessity pass/fail rates are fairly easy. Acceptable Use Criteria will make diagnostic imaging more easily measurable. CPOE made order patterns measurable. Specificity in documentation to get to the most specific diagnosis code possible is measurable. MU was in large part about making as much information as possible measurable. That it took billions of dollars to get an industry notoriously resistant to any oversight in how they function was a feature, not a bug. (MEDITECH Customer)

Physicians are in such limited supply and command such high salaries that the entire clinic or unit orient themselves around having the MD always operate at the “top of their license.” This means that the MD interaction with the patient will consist of 1.) dispensing whatever information only the MD and no one else in the clinic can dispense. 2.) doing the bare minimum to ensure that the patient is billed for number one. Doctors will not get paid >100 dollars an hour to look people in the eye, have a conversation or connection, take a clinical measurement, have an original thought, etc. All of those things can be done by a medical assistant or a nurse or someone cheap. We could assign a scribe to every physician so the wouldn’t ever have to touch an EHR; I think doctors would be marginally happier but not significantly. The reality is that physicians are now employees and no longer run the show. Like the rest of us employees, the only meaningful changes will come from unions or the legislature.(SelfInflictedWound)

I have been in the healthcare industry for years and am guilty of not having a PCP. I had never really thought about the “relationship” aspect of a physician and why it would be beneficial to have someone engaged in my care that has seen me over a period of years rather than a quick trip in when I am not feeling well. Technology continues to change how we interact and socialize with others. It will be interesting to see how the doctor-patient connections morph as technology continues to be more readily available and acceptable in new areas. (Steph M.)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. T in Texas, who asked for 35 calculators for her elementary school class (I’m not exactly sure what kind of class, but she mentions that all students are girls who have overcome adversity). She reports, “Students today have easy access to a lot of technology, but they are not always taught how to use it correctly. One thing I have noticed in the past is that students struggle to use calculators correctly. This causes a problem as they progress in school and have more access to them and are expected to use them in Algebra. The impact of your gift is that now, students at my school have the ability to be taught how to properly use a calculator before reaching the upper level math classes. Thank you for allowing them this introduction!”

Researchers working with a woman who can detect Parkinson’s disease based on the smell of patients create a diagnostic test as a result, using mass spectrometry to isolate the four compounds that are most responsible. The former nurse can also detect cancer and tuberculosis, which will be the subject of another round of research.

A 59-year-old woman who suffers from early onset dementia is sent from a local hospital to Oregon Health & Science University for urgent heart bypass surgery and valve repair. She then developed a post-op infection that left her hospitalized for a month, after which OHSU billed her for the $227,000 part of her stay that her insurer wouldn’t cover because the hospital is out of its network. Her husband, whose Social Security payments of $1,900 per month make up the family’s entire income, says the hospital never told him about the out-of-network costs or offered a transfer to an in-network hospital. The couple is relieved that OHSU finally agreed to write off the bill under a charity waiver obtained with the help of a non-profit group, but resents getting collection calls for six months.

Bizarre: the Buffalo Wild Wings restaurant chain rolls out a March Madness “Jewel Stool” that is comfortable for men who have just undergone vasectomies, with the idea coming from data pulled from Athenahealth’s netowrk indicating that urologists perform 41 percent more vasectomies on the first Friday of March Madness compared to the typical Friday. Urology practices like the one above are even running March Madness snip specials.

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A retired, Harvard-trained cardiologist whose restaurant waitress daughter asked him to cover a busboy shift saves a choking woman just five minutes into the job by performing the Heimlich maneuver.


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Weekender 3/15/19

March 15, 2019 Weekender No Comments

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Weekly News Recap

  • Rutland Regional Medical Center (VT) experiences its second email-related breach
  • Australian imaging software vendor Mach7 fires its CEO and eliminates the CTO role as part of a restructuring and cost-cutting program that it hopes will propel its US growth
  • An investment analyst thinks Apple will expand the Watch’s medical sensors and then sell the data of wearers to their doctors for $10 per patient per month
  • Hill-Rom announces that it will acquire mobile clinical communications vendor Voalte for up to $195 million
  • An investigative report finds that medical device manufacturers have been able to hide widespread patient safety issues by using the FDA’s alternate summary reporting program

Best Reader Comments

The thing that gets me about the Theranos story was that even at the peak of their hype, everyone I spoke with in the healthcare field could see that it was fishy as heck and no one I know was surprised when it turned out to be BS. (Dr. Herzenstube)

I hadn’t thought of Amazon serving up order sets, but they’re actually doing some of the most sophisticated order sets out there. (Mike Z)

You’re right on the money. There is no magic bullet to burnout but this type of article that talks real / no frills techniques that can be done today. This is exactly what our teams should be focused on. (TX Trainer)

I’m sure there are plenty of physicians, regardless of specialty, who could speak to a patient via a telemedicine “robot” and convey empathy. So please blame any outrage on the individual purveyor of bad news and not on all physicians or all robots. (Compassionate cyborg)

It will be fascinating to monitor Cerner’s encounter-based EHR’s acceptance as well as how they will decide to address functional nuances in the VA (and DoD). Cerner’s EHR is designed for a “clinically driven revenue cycle” – a help or hindrance to the VA and DoD? (Art_Vandelay)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. P in Virginia, who asked for books that emphasize individuality and tolerance, lap desks, and camp tables for her first grade class. She reports, “It was wonderful to be have these read-aloud titles in the classroom. I frequently turn back to the books when I feel my students needed a reminder about how to treat others with empathy and tolerance. The books’ message also reached first graders in other classes, as I loaned the titles to other teachers on my teaching team. Thank you for allowing me to bring these resources into my classroom!”

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Turkey’s government opens a 3,810-bed, $1.15 billion hospital in Ankara, with the country’s medical association expressing concerns that “central hospitals are not cost effective and they impact public health quite negatively.” The medical association notes that European cities have mostly moved away from building mega-hospitals in favor of building several smaller ones. They have mostly abandoned the public-private partnership model that is being used to open 30 new hospitals in Turkey, in which a contractor pays the construction cost, then rents the building back to the government. Armchair geographers take note – Turkey is in both Asia and Europe and Istanbul is the only city in the world that straddles two continents.

A North Carolina hospital warns employees that using legal but unregulated CBD oil could get them fired because some products contain traces of THC that will trigger a positive drug test.

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A New York Times article notes that doctors “disappear without a word” when they leave a practice with a non-compete agreement in which the old employer refuses to tell their patients how to contact them. The CEO of Iowa Clinic, which is being sued by three urologists who argue that their termination makes their non-compete agreement unenforceable, says such agreements are “good for the patients because they help to provide stability within a practice and ensure continuity of care.” One of the clinic’s patients disagrees, saying that, “somehow they lost sight of patient care and were more concerned about the bottom line.”

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OnMed rolls out a phone booth-like telemedicine station that allows online consultations via a a video consultation that includes remotely-controlled vital signs measurement and automated drug dispensing. In-session privacy features include automatic door locking, windows that turn opaque, and speakers that can’t be heard from outside. Patients are identified using 3D facial recognition and the doctor’s credentials are displayed on the screen. UV lighting sterilizes the booth between visits.

A University of Miami Health System fires a sex-change surgeon for posting pictures of his cases on Instagram under the account @sexsurgeon, including a Valentine’s Day post showing a removed penis shaped into a heart labeled, “There are many ways to show your LOVE.”


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Weekender 3/8/19

March 8, 2019 Weekender No Comments

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Weekly News Recap

  • Livongo’s planned Q3 IPO could bring in $1 billion
  • Carestream Health sells its health IT business to Philips
  • Northwestern Memorial Hospital fires dozens of employees for looking at the EHR records of actor Jussie Smollett
  • Amazon, Berkshire Hathaway, and JPMorgan Chase name their healthcare venture Haven
  • FDA Commissioner and digital health advocate Scott Gottlieb, MD resigns
  • Newly formed Beth Israel Lahey Health says it will eventually consolidate its multiple EHRs into a single product

Best Reader Comments

There is no long road to interoperability. There are data solutions right now that can curate and harmonize all the data that’s out there. FHIR is not going to be a magic bullet either. Healthcare organizations have to stop waiting for Judy to figure it out and invest in an enterprise data strategy and platform. (BK)

A single-payer system that rams real metrics down our throats will engage value-based care as a viable alternative. The original Obamacare bill had a subscription-based expansion of Medicare, i.e. a 25-year-old could pay premiums directly to Medicare for enrollment. Medicare would effectively be setting the floor for premium costs, and commercials would have to come down and offer better services to compete. This absolutely is the way we are trending and will happen at some point. The question is when, and will the healthcare systems/HIT be ready to change to really win the business of patients with VBC. (SinglePayor)

I shouldn’t be, but I am surprised how often I see vendors and providers hyping up value-based care. Upside only arrangements don’t count. Payments based on weak quality metrics aren’t important to consumers. Prices aren’t available to consumers. Where is the value? Most hospitals and health systems have about 5 percent of payments tied to VBC. My opinion is that the only providers who can claim VBC: true IDNs and those that offer a significant number of bundles (Geisinger’s proven care model). If you talk to hospital CEOs and CFOs, it’s very rare to find VBC in their top 10 priorities. My sense is that vendors are driving the hype. (Desperado)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. D in Massachusetts, who asked for classroom speakers for her elementary school class. She reports, “These speakers have been a lifesaver for my classroom. I use them for all my lessons and for brain breaks for my Littles. For math warm-ups, we often watch videos that help my students learn to count to 100 by 1s, 2s, 5s, and 10s. In reading, I was able to find audio and videos on books that we are reading in the classroom. During indoor recess, I often put on videos of different habitats and they love to just sit on the carpet, listen, and see different worlds. The girls love the speakers on Just Dance Friday, where if the class has earned enough reward points, we turn the classroom into a dance floor. Thank you for the donation to my classroom.”

Median monthly rent for a one-bedroom apartment in San Francisco has risen nine percent in the past year to $3,690. That’s before the upcoming flood of tech IPOs creates thousands of new company millionaires who are anxious to kick off their conspicuous consumption by buying houses, throwing lavish parties, and buying boats even as financial planners warn them that their counterparts at Groupon and Snap did the same until their shares went down in flames. A real estate analytics expert predicts that one-bedroom condos will be worth at least $1 million in five years and single-family homes will average $5 million.

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Company swag at Livongo’s first user group meeting included a day’s use of partner company’s continuous glucose monitor patch, reminding everyone about just how big a business diabetes (or the threat of it) is in the US as Livongo barrels toward its $1 billion IPO.

The mainstream press notices that the proposed HHS interoperability rule would also require hospitals to publish the actual prices they have negotiated with insurers. You needn’t wonder where the AHA stands on this issue.

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The hospital gown that Kurt Cobain wore in Nirvana’s headlining set in Reading Festival 1992 has been put up for auction by a fan who says Courtney Love gave it to him during a vigil after Cobain’s suicide in 1994. Cobain was pushed onto the stage in a wheelchair while wearing the gown, sang a few lyrics from Bette Midler’s “The Rose,” and then pretended to collapse before springing up to rip through a 25-song set whose bootleg is prized by collectors as one of the band’s best, all to dispel rumors that he wouldn’t make the show because of his drug addiction.

A six-year-old boy whose parents refused to have him vaccinated becomes Oregon’s first pediatric tetanus case in 30 years, with his family refusing to continue the vaccine series that was started during his 57-day hospital stay that cost $800,000.

The parents of a 21-year-old who died in a skiing accident hire a lawyer to force Westchester Medical Center (NY) to save a sample of his sperm with the hope of “preserving some piece of our child that might live on,” but the court will have to decide what happens to the sample since the son didn’t give his permission. He was the only child of the couple, who is from China, and that country’s previous one-child policy has resulted in his having no male cousins to carry on the family lineage. Ethicists say that policies and laws aren’t consistent and there’s the question of who would choose the egg donor and raise the child.

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Pop-up, spa-like stores are offering to freeze the eggs of women who worry about the ticking of their biological clocks, hosting champagne parties to convince prospects to pay $5,000 for the procedure and the first year of freezer time. One chain features Dr. Oz on its board, reassuring patients that their medical care will be overseen by someone who has won seven Daytime Emmy Awards.


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Weekender 3/1/19

March 1, 2019 Weekender No Comments

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Weekly News Recap

  • Medsphere acquires Wellsoft
  • WellSky acquires HCS
  • House VA committee Chairman Mark Takano (D-CA) chastises VA Secretary Robert Wilkie for failing to turn over documents related to the Mar-A-Lago trio’s influence on VA software purchasing decisions
  • Crossover Health acquires Sherpaa Health’s technology platform
  • More than half of surveyed home care clinicians say they can’t access the hospital EHR records of their patients to reconcile patient medications
  • Cedars-Sinai pilots the use of Alexa-powered devices in patient rooms to route their verbal requests and to control their TVs

Best Reader Comments

Over the past month, I’ve been seen several times a week at different specialists within Emory. Every time I’ve checked in, I’ve been handed a printed medication list, asked to make any edits or changes on the paper, these are then confirmed verbally by both nurse and clinician in the exam, and by the next visit (sometimes two hours later, sometimes five days), the new printed list is always accurate. The changes are reflected in the patient portal too (which is to be expected, but God knows that doesn’t always happen…). They’re also the first healthcare org I’ve visited where *every* person who comes into the exam room confirms my name, DOB, and why I’m there. They even squirt on hand sanitizer as they’re walking in the room. Those are seemingly small things, but it’s been one of the most cohesive patient experiences I’ve ever had the pleasure of being involved in, especially considering my case is pretty complex and I’m bouncing around different offices all the time. (AtlantaPatient)

Every time I visit a provider (many different EHR systems), I bring a “yours truly”-generated, printed copy of my current meds (generic name, brand name, dosage, type, instruction; e.g., ALENDRONATE SODIUM (FOSAMAX) 70 MG TABLETS, 1 tablet by mouth weekly) because many of my meds are ordered by different providers. In addition, I take the time to explain the differences between the list they are viewing on their screens and my list. Last, I personally ask the provider to make sure they update their information exactly as I have noted in my list, which typically includes some additions, deletions, dose changes, etc. When I later recheck via my portal to see if the updates occurred (often having to wait until the next provider visit), I notice the same, damn, original list! When I later inquire as to why my requested updates have not been entered in their system, typically the response has been, “Our system doesn’t accept the information in the manner you provided.” (Woodstock Generation)

I wonder/wish if there was a way to quantify how much of Epic’s perennial higher ratings comes from the fact that they made extensive training with proven methods a mandatory part of their contract and implementation? (Smartfood 99)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. I in California, who asked for take-home science projects for her dual-immersion (English and Spanish) fourth grade class whose families are mostly farm workers. She reports, “With your donation, my students were able to work on science projects we normally would not be able to do in fourth grade. Many of my students were so excited at having the ability to look at things under the microscope and would run out to the yard to find things to bring back in to look at. My students particularly liked the bubble science project and looking at different books about projects to do at home with their parents. Any project that allows a student time to spend with their parents is more beneficial than you would imagine.”

I’m not finding much I like among the Oscars “Best Picture” nominees. I though “Bohemian Rhapsody” was toe-tapping, formulaic fiction and “Roma” was beautifully filmed and directed but never really went anywhere. I rented “Green Book” and surely it’s the worst movie to ever win, full of clichés, filmmaking mistakes, and an eye-rollingly sappy story that first presents just a tiny bit of racial unjustice to make us privileged white people feel shame, then let us off the hook with a heavy-handed, feel-good message that we’re all decent people who just need to understand each other better to get along (ample evidence, much of it contemporary, to the contrary). I’m seeing “BlacKkKlansman” next, but it has tough competition from “A Star Is Born,” which ranks above the best movies I’ve seen (I’ve watched it at least four times and will happily do so again). “Green Book” is a middling movie at best, joining other embarrassing Best Picture winners like “The Artist,” “Shakespeare in Love,” and “Chariots of Fire.”

NPR reports that the car problem diagnostic process used by the Magliozzi brothers in its former “Car Talk” program is being used to teach medical students how to solve patient problems by collecting data, defining the problem, and choosing from several possible solutions.

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The newly launched Onward offers a “post-breakup concierge service” for outsourcing-comfortable millennials who are “leaving cohabitation” and don’t have friends or family nearby to help. Customers pay $99 to have their housing and moving managed and can buy extra services such as therapist matching, weekly check-ins, and personalized neighborhood guides. It even manages to work in the meaningless millennial word magnet of “curated.”

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This might be more dramatic than a Steve Jobs “one more thing” reveal. A surgeon in Barcelona, Spain directs a remote surgery via 5G-powered, high-definition video from the stage of the Mobile World Congress conference. 

Cleveland Clinic confiscated 30,000 weapons from patients and visitors in 2018, which might be a gauntlet throw-down to inner city trauma centers that surely see more weapons (and the result of them) in their EDs.

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A baby whose entire life of 572 days was spent in Oishei Children’s Hospital (NY) goes home for the first time, saved by “countless” surgeries after being born weighing just over one pound. He was cleared for discharge months ago after 10 months in the NICU and five in the PICU, but the family couldn’t find homecare nurses who could care for his ventilator. A GoFundMe project has raised $3,700, which will probably cover a few hours of his 19-month hospitalization and none of lifetime expenses afterward (the family needs 16-20 hours of nursing help each day). Meanwhile in Japan, a baby born at just 9.45 ounces leaves the hospital after five months.

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A hospital in Jamaica, where pollution makes tap water unsafe to drink, installs hydropanels from Zero Mass Water that absorb water vapor from the air to create 800 gallons of drinking water each month.

A study finds that crematorium workers are exposed to radiation when processing the bodies of people who have undergone radiation therapy or PET scans, with the urine of the single employee tested showing radioactivity that apparently came from inhaling volatilized radiopharmaceuticals. An expert but suggests that crematory workers wear masks and gloves, which seems like an excellent idea.

Illinois health officials warn anyone who flew through Chicago’s Midway Airport last week that they may have been exposed to measles, courtesy of an unvaccinated passenger who flew while infectious. A second warning was issued to anyone who visited Delnor Hospital, where he sought treatment.

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Officers from police, fire, and emergency medical departments in Arkansas mobilize via a fellow officer’s Facebook request to line the highways leading to Arkansas Children’s Hospital, where a nine-year-old boy with a terminal illness was making what is expected to be his final journey.


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Weekender 2/22/19

February 22, 2019 Weekender 1 Comment

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Weekly News Recap

  • Allscripts announces Q4 results that fall short of revenue and earnings expectations.
  • Provider management and credentialing software vendor Symplr will acquire workforce management tech company API Healthcare from Veritas Capital
  • Unsealed testimony reveals that a focus of the Amazon – Berkshire – JPMorgan healthcare organization will be to make health insurance and prescription drug prices easier to understand
  • Healthcare experts file a Federal Trade Commission complaint against Facebook over security problems with its Groups functions that exposed the personal information of patient advocacy groups
  • A patient of a closed Arizona hospital is prevented from obtaining life-saving surgery because her medical history is stored in an EHR that was shut down as creditors argued over payments
  • HIMSS gives a preview of the “evolution of the HIMSS Brand”
  • Virence Health will retire the company name it created in October 2018 and will instead operate as Athenahealth after acquiring that company five weeks later

Best Reader Comments

A Kaiser Permanente medical school makes a lot of sense for them to train physicians in how Permanente medicine works. (The Permanente Medical Groups are the for-profit physician partnerships that pair with the Kaiser Health Plans in various regions.) The KP group practice model is a different beast. They also have a mature and well-supported Epic implementation. They are able to do high-volume medicine with good quality because of the “system-ness” of how they approach things and the fact that most of their physicians don’t fight it. (KP Alum)

We have gotten a lot of value from CommonWell and have access to data in our region which is supporting care transitions. It would be helpful if folks like eCW would actually play ball with others to improve care. I am not worried about Cerner and Epic but rather the small players’ ability to share. (Patient advocate)

It’s almost shocking that hospitals in the US support their employees attending a sales show for a week, paying for expensive hotels and booze while hospital margins are slim to non-existent. (Donald Lyons)

[Pink Socks] is just a form of self-promotion and attention-grabbing that is legion at HIMSS. If you can name one objective and tangible thing Pink Socks has done, I’ll possibly change my opinion. (Lazlo Hollyfeld)

I almost feel a little bad and embarrassed for Cerner. It’s notable that MEDITECH’s “re-branded” and “old” EMR has scored higher in KLAS than Cerner’s flagship for the last two years. And celebrating your first plug and play exchange in the year 2019?! Two brave, pioneering Cerner sites are now connected to the world. Is the $5 billion DoD connected? (Vaporware?)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. W in Minnesota, who asked for MakerSpace supplies for her elementary school’s library. She reports, “Your generous donation has helped stock our MakerSpace for the next year. They enjoyed building robots and making them move with Littlebits, as well as building bird’s nests out of paper and fabric to hold eggs when suspended from boxes. They look forward to building new things that continue to teach them about the engineering process.”

A plastic surgeon covering a New York hospital’s ED stitches and splints a woman’s mashed mashed finger, complaining to her that he’ll make only $200 for his 15 minutes of work. He then bills her insurance company $56,000 for “exploring wound extremity” and “complex repair of finger” and he doesn’t accept the woman’s insurance. The hospital said it doesn’t control what he charges because he’s not an employee. The patient is lucky to be in New York, which protects patients from surprise ED bills caused by out-of-network doctors working in EDs.

Google adds drug disposal locations to its Maps app, hoping that drug abuse will be reduced by people securely discarding their unused medications.

Nebraska hospitals complain that law enforcement agencies all over the state are releasing people who are in custody while they are hospitalized, allowing the agencies to skip paying the individual’s bill because they are no longer under arrest and are thus responsible for their own charges. A newly introduced bill would prohibit releasing a person from custody just to avoid paying for their medical care.

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University of Iowa’s children’s hospital loses its second arbitration case brought by contractors that demanded more money, increasing the cost of the project that was budgeted at $271 million in 2011 to at least $370 million. The 190-bed hospital spent millions of dollars on temporary facades and overtime to prepare for its grand opening after making on-the-fly design changes that had already inflated the cost. Swapping the already-installed doors in some areas with automatic sliding doors required flying the new doors from Switzerland and operating a round-the-clock convoy to transport them from California in time for the grand opening, increasing the cost of the doors from $122,000 to $1.2 million.

The Medical Center, Navicent Health (GA) offers its heart patients the chance to donate their replaced pacemakers to dogs being treated at the University of Georgia’s veterinary school, which has implanted the refurbished devices in six dogs so far. 


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Weekender 2/1/19

February 1, 2019 Weekender 1 Comment

weekender 


Weekly News Recap

  • EMDs acquires Aprima
  • Nordic acquires Healthtech Consultants
  • Harris Healthcare’s Iatric Systems acquires Haystack Informatics
  • The VA ends its pilot of Epic scheduling and will instead implement Cerner at all facilities
  • KLAS releases “Best in KLAS 2019”
  • Australia’s Queensland Health and SA Health struggle with their Cerner and Allscripts projects, respectively
  • FDA Commissioner Scott Gottlieb, MD outlines several ways in which the agency will use digital systems to make healthcare more efficient and patient focused
  • The VA’s Office of Electronic Health Record Modernization opens positions for deputy chief medical officers to help oversee its Cerner implementation

Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. K in Indiana, who asked for math manipulatives and calculators for her fifth grade class. She reports, “My students are very excited about these fun new activities. We use them daily to play math games, explain and show different math processes, and even to check our everyday calculations. Having these hands on tools will allow my current as well as my future students to learn numerous math skills. Being able to visualize, draw, and understand these foundational math skills will allow these kids to become life long learners and the future leaders of America!”

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The Internet lit up this week with endlessly retweeted “news” that scientists in Israel have confidently predicted that they will develop a cure for cancer within a year with a “cancer antibiotic.” The coverage proves that even news sites will run anything that draws clicks, actual journalism is basically dead for lack of demand and the real goal is to be first rather than best, and that consumers have no ability to realize they’re being misled. The holes in the story are ample:

  • Every website picked up the story from the Jerusalem Post without digging further.
  • The original story had just one source – an interview with the board chair of the company working on the treatment, who has no clinical credentials and is not a scientist (despite the headline). The “complete cure for cancer” quote was his. His previous experience includes running a chicken breeding operation and consulting for a business intelligence company.
  • The company lists just three employees on its website.
  • The company has not conducted any human trials, published any research articles, or enlisted the involvement of outside oncology experts, saying it doesn’t have enough money to do so. It has completed one experiment in mice.
  • The New York Post, Forbes, and Fox News ran with the Jerusalem paper’s headline without doing any research or asking local experts to evaluate the company’s claim. They backtracked a bit afterward, but the revised tweets drew just a fraction of their original uncritical stories.
  • The company backtracked after higher-quality news organizations questioned the comment, explaining that “cure” means “starting human trials within a year.”

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Federal authorities arrest three people for running “birth tourism” companies that charge wealthy, pregnant women who are Chinese citizens big money to bring them to the US for delivering their babies in hotel-like birthing houses, which under US law makes the babies immediate US citizens. The company’s websites pitched customers that their children could get US government jobs, free education through high school, and Social Security benefits even when living outside the country. The companies told the women to lie on their visa application, wear lose clothes through customs to hide their stomachs, list their destination as the Trump Hotel in Honolulu to improve their chances of being ignored by immigration officials, then fly to Los Angeles to deliver. One couple paid a hospital its indigent care rate in cash, then hit Beverly Hills for a shopping spree at Rolex and Louis Vuitton. Sixteen of the 19 people who were charged were clients who ignored court orders to remain in the US to assist with the investigation. They also skipped out on their hospital bills. Estimates suggest that up to 36,000 Chinese citizens have babies in the US each year.

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Non-profit dental insurance company Delta Dental takes heat for paying its CEO $14 million (until they fired him for having an affair with a subordinate), paying its top 10 executives more than $30 million, flying board members and their families to Barbados for company meetings, and planning to acquire a for-profit competitor. Dental insurers are minimally regulated, with no requirement that they spend a specific percentage of revenue on care, and are exempt from paying federal income tax. The company gave the excuse all non-profit healthcare companies use when caught lining executive pockets  – we have to pay well to attract top talent to benefit patients and we use outside companies to make sure pay is appropriate.

Shriners Hospitals for Children will stop offering inpatient care for children at five of its 20 hospitals, saying fewer patients need care of that level of complexity.

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A Miami plastic surgeon’s nationally marketed cosmetic surgery practice – located in a strip mall and offering discounts and payment plans to working-class Hispanic and African American patients – has had eight patients die after botched cosmetic procedures performed in assembly-line fashion. The owner had previously lost his license for allowing unlicensed employees to perform surgery and had changed the business name several times over the years.

A pain management doctor pleads guilty to stealing the IDs of his patients to obtain opioid prescriptions for himself.

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A reader sent a link to something that has zero to do with health IT, but is cool (no pun intended). A Michigan school superintendent and a high school principal create a fabulous snow day announcement, featuring amazing acting, humor, and singing to the tune of “Hallelujah.” Surprised by their video going viral, the talented duo followed up with another vortex-related video, this one set to “Frozen.” I could watch these guys all day.

Our Lady of the Lake Children’s Hospital (LA) will stream the San Diego Zoo Kids channel to patient rooms. In related news, Baton Rouge Animal Hospital will offer its patients San Diego Jail TV.


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Reader Comments

  • richie: uh... users are not the perpetrators of harm causing victimized vendors to suffer. "User are antagonists" and "align t...
  • GreatMindsThinkAlike: I actually love your idea about people being able to tag what they want. It would be nice to be able to jot a note as w...
  • Grahame Grieve: "Until the vendors are required to align to a standard" That's not enough. The vendors ship very configurable systems...
  • FRANK POGGIO: Looks like McGee skewered all the bad actors except the one primary culprit. He has not seen the enemy that is US! "We" ...
  • Woodstock Generation: Hey, I have nothing against 90s or any other music from the circa 50s to the present. And shout-outs to great album musi...
  • Randy Bak: I think the comment may have (too?) quickly stepped through single payer on the way to the ultimate worthy conclusion. ...
  • Consumerfriendly: These primary care physicians are highly paid compared to the average worker, international averages, etc. People expect...
  • David Perlmuter: Bravo! Those grown people find “adulting” tiresome and unpalatable in the context of their own health and every o...
  • TheAmericanNightmare: Politicians already take large amounts of money from corporate healthcare companies. It is really strange to hear someon...
  • Van Sims: After reading the article I feel for clinicians that are experiencing burn out. I can only imagine what it is like to ge...

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