Home » Weekender » Recent Articles:

Weekender 8/9/19

August 9, 2019 Weekender 1 Comment

weekender


Weekly News Recap

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

Best Reader Comments

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

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

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

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

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

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

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


Watercooler Talk Tidbits

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

image

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

image

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

image

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

image

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

image

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


In Case You Missed It


Get Involved


button


125x125_2nd_Circle

Weekender 8/2/19

August 2, 2019 Weekender 1 Comment

weekender 


Weekly News Recap

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

Best Reader Comments

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

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

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

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

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

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


Watercooler Talk Tidbits

image

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

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

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

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

image

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

SNAGHTML9c3667f

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

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

image image

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

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

image

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


In Case You Missed It


Get Involved


button


125x125_2nd_Circle

Weekender 7/26/19

July 26, 2019 Weekender 14 Comments

weekender


Weekly News Recap

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

Best Reader Comments

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

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

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

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

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

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


Watercooler Talk Tidbits

image

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

image

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

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

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

image

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

image

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


In Case You Missed It


Get Involved


button


125x125_2nd_Circle

Weekender 7/19/19

July 19, 2019 Weekender 1 Comment

weekender 


Weekly News Recap

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

Best Reader Comments

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

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

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

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

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


Watercooler Talk Tidbits

image image

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

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

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

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

SNAGHTML22289d18

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

image

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


In Case You Missed It


Get Involved


button


125x125_2nd_Circle

Weekender 7/12/19

July 12, 2019 Weekender 2 Comments

weekender 


Weekly News Recap

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

Best Reader Comments

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

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

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

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

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


Watercooler Talk Tidbits

image

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

image

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

SNAGHTML3533973

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

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

image

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

image

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


In Case You Missed It


Get Involved


button


125x125_2nd_Circle

Weekender 6/28/19

June 28, 2019 Weekender No Comments

weekender 


Weekly News Recap

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

Best Reader Comments

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

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

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


Watercooler Talk Tidbits

image

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

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

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

image

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

image

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

image

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


In Case You Missed It


Get Involved


button


125x125_2nd_Circle

Weekender 6/21/19

June 21, 2019 Weekender No Comments

weekender 


Weekly News Recap

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

Best Reader Comments

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

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

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

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

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

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


Watercooler Talk Tidbits

image

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

image

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

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

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

image

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

image

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

SNAGHTML2cbf406f

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

image

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


In Case You Missed It


Get Involved


button


125x125_2nd_Circle

Weekender 6/14/19

June 14, 2019 Weekender 4 Comments

weekender 


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

image

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!”

image

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.

image

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.

image

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.

SNAGHTML8736306

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.

SNAGHTML8672636

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.


In Case You Missed It


Get Involved


button


125x125_2nd_Circle

Weekender 6/7/19

June 7, 2019 Weekender No Comments

weekender


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

image

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.”

image

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.

image

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.

image

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.  

image

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.

image

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.”


In Case You Missed It


Get Involved


button


125x125_2nd_Circle

Weekender 5/31/19

May 31, 2019 Weekender No Comments

weekender 


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

image

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!”

image

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.

image

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. 

image

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.”

image

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.


In Case You Missed It


Get Involved


button


125x125_2nd_Circle

Weekender 5/24/19

May 24, 2019 Weekender No Comments

weekender


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

image

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.

image

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.

image

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.


In Case You Missed It


Get Involved


button


125x125_2nd_Circle

Weekender 5/17/19

May 17, 2019 Weekender No Comments

weekender 


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

SNAGHTML7e2b0f9

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!”

image

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.

image

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.

image

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.” 

image

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.

SNAGHTML81c687c

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.


In Case You Missed It


Get Involved


button


125x125_2nd_Circle

Weekender 5/10/19

May 10, 2019 Weekender No Comments

weekender 


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

image image

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.

image

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.

image image

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.”

image

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.


In Case You Missed It


Get Involved


button


125x125_2nd_Circle

Weekender 5/3/19

May 3, 2019 Weekender 3 Comments

weekender 


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.

SNAGHTML62354c5d

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.

image

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. 


In Case You Missed It


Get Involved


button


125x125_2nd_Circle

Weekender 4/26/19

April 26, 2019 Weekender No Comments

weekender


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

image image

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.

SNAGHTML3dbfc27f

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.

image

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.

image

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. 

image

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.

image

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.”


In Case You Missed It


Get Involved


button


125x125_2nd_Circle

Weekender 4/19/19

April 19, 2019 Weekender No Comments

weekender 


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

image

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.”

image

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.

image

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.

image

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.

image

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.


In Case You Missed It


Get Involved


button


125x125_2nd_Circle

Weekender 4/12/19

April 12, 2019 Weekender No Comments

weekender 


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

image image

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.

image

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.


In Case You Missed It


Get Involved


button


125x125_2nd_Circle

Subscribe to Updates

Search


Loading

Text Ads


Report News and Rumors

No title

Anonymous online form
E-mail
Rumor line: 801.HIT.NEWS

Tweets

Archives

Vince Ciotti’s HIS-tory of Healthcare IT

Founding Sponsors


 

Platinum Sponsors


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

   

Gold Sponsors


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Reader Comments

  • Code Jockey: Gotta love it when the kids show up..... After a number of years of almost constant travel and well over 700+ flights...
  • Kermit: My family's been happily using Zenni for years. Never a problem with the quality of their products. My last order was fo...
  • Cosmos: During an inpatient stay at a Boston area teaching hospital, my wife was approached by a research assistant about enroll...
  • AlphaCodeJockey: Finally, CodeJockey has a incentive to play up issues with developing custom solutions for Epic's platform as improvemen...
  • DeltaCodeJockey: I'd also point out that Epic insiders are probably right to be touchy about this topic as they get flack publicly and li...
  • Gamma Code Jockey: Code Jockey's example of an IT form that ties into Epic's system is wrong though - you are allowed to do that and you ar...
  • Bravo Code Jockey: Code Jockey - thanks a tonne for persisting and for your rational and informed responses to a lot of name calling and mi...
  • Bill O'Toole: Confirming first hand that Cape Cod Hospital was MEDITECH's first customer. My father, the Chief of Pathology, saw the i...
  • FormerCIO: Re JAMA article. How will access to my EHR data help me 'shop for high value health care services' and 'avoid the need t...
  • CommentsTwoWeeksLate: I'd be really disappointed if the "de-identified" data set contained full birth dates or zip codes. That doesn't seem t...

Sponsor Quick Links