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Weekender 2/26/21

February 26, 2021 Weekender No Comments

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Weekly News Recap

  • Allscripts and Teladoc Health release quarterly results.
  • Healthcare Bluebook acquires the quality division of Quantros.
  • Innovaccer raises $105 million at an implied valuation of $1.5 billion.
  • Redox announces a $45 million Series D funding round.
  • Google Health expands the pilot of its EHR search and data presentation tool, which it has named Care Studio.
  • IBM is rumored to be looking at selling IBM Watson Health.

Best Reader Comments

When resource limited, and dealing with existing systems and a legacy of choices, “apps are dead” can sound a little blasé and soundbite-y. Now add in organizational politics, budgeting, and available skill sets. The choices get more complicated. Absent those factors though, there’s a lot to like about “apps are dead”. You get a single code base that supports all devices. Support lines tend to be simpler too. But sometimes? An old app can do a better job than the new replacement! (Brian Too)

I think the green passport idea is great. It might allow the free market to push the vaccine-hesitant to get on board when businesses and airlines start advertising special privileges for passport holders. The problem in the US, though, is that we can’t seem to get a nationwide IT system for anything unless it involves the IRS. (Bob)

We should challenge developers (I am one) to think critically. Also, bugs aren’t exclusive to coding errors. (RobLS)


Watercooler Talk Tidbits

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Two Vanderbilt University Medical Center physicians publish “From Two Doctors,” a newsletter that highlights the pandemic’s unsung heroes. Assistant Professor of Clinical Medicine Michelle Izmaylov, MD is a published author of fantasy fiction books and medical essays, while Thea Swenson, MD is a medical resident who formerly worked in health IT startup marketing and product development. Both are first-generation Americans, from Russia and Vietnam, respectively. 

A technology reporter whose broken collarbone left him with his arm in a sling for six weeks describes how accessibility technology helps people with disabilities. Topping his personal experience list is AI-based transcription for typing on all devices, which taught him that voice typing on his phone is three times faster than finger typing. He likes the dictation and voice control technology of Google Docs best. Runner-up accessibility winners are biometric authentication, password manager apps, and finger swipe typing.

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PCP versus demanding customer: In Australia, D-list reality show celebrity Yvie Jones complains in a profanity-filled Instagram post that she saw her doctor about a lump on her neck and while there, he suggested that she see a dietician. She declared that she has been “weight-shamed by my doctors for years” and said that she and many others “would rather die than be spoken so poorly to” by doctors who “never focus on what we’re there for.” She has previously posted recaps, sometimes with photos, of her other medical issues, including case of hives following a cat allergy, peri-menopause, iron deficiency, abdominal cramping, a back problem, depression, and weight loss surgery.

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NHS England urges people to ignore the medical advice of celebrity huckster Gwyneth Paltrow, who claims that her COVID-19 infection and the resulting long COVID were successfully treated with her expensive, Goop-branded nutritional products. If faux COVID cures aren’t your thing, the college-uneducated GP will be happy to sell you – hopefully delivered in an unlabeled package – an $80 candle that smells like her vagina.


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Weekender 2/19/21

February 19, 2021 Weekender 1 Comment

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Weekly News Recap

  • Intelerad acquires Lumedx.
  • IBM considers selling IBM Watson Health.
  • Former Nuance CEO Paul Ricci joins Qualifacts as president and CEO.
  • Zocdoc receives $150 million in growth financing.
  • Innovaccer is valued at $1 billion based on a reported new investment.
  • Dexcom launches a venture capital fund.
  • Sharecare’s SPAC deal values the company at $4 billion.
  • GAO recommends that the VA stop its Cerner implementation until critical issues are resolved.

Best Reader Comments

“Apps are dead.” I’m curious what healthcare readers think about that comment. (Matt Ethington)

Syringa Hospital. Why in the world is a board involved in this level of operations? They should only be approving, or not, the CEO’s financial outlay for the acquisition. If the CEO can’t get the leadership team on the same page, the board has another, bigger problem. (Jamey)

There are probably less than 100 employees at this hospital. There just aren’t that many management staff above line managers. The board is probably composed of community leaders who may have some experience in the area either in IT or just organization in general. It isn’t easy running 15 bed rural hospitals on shoestring budgets. (IANAL)

The developer’s opinion and the comment represent the age-old battle between developer’s who view the system as “working as designed” and the users who are just trying to make an appointment. In this case, I’m betting the specification did not mention that users should not be able to make multiple appointments for the same dose. The developers either missed the difference between the two doses or just let anyone make as many appointments as possible. Clearly the system was not working as required. I loved the comment it allowed our technical folks who don’t normally interface with customers the opportunity to do that … what a rewarding experience. (AllHatNoCattle)

Agree that if the clinician isn’t checking the transcription, then that is on them. With the number of scribes and “speech processors” out there, I have yet to find one that is much above 95% per word accuracy — the more complicated the word, the lower the accuracy. With a word count of 171, which eight were recorded incorrectly in this missive? (AnInteropGuy)

For the “lung cancer” versus “tongue cancer” mistake, I’d think that something suggesting the correct diagnosis could have helped. “Note indicates lung cancer, lung cancer not documented as patient diagnosis.” No idea how difficult that would be to not trigger on false positives, but it could help fill out a patient’s problem list and medical history. (AI what?)


Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Ms. D in Kentucky, who asked for online instruction resources for home using during “COVID days.” She reports, “My class is very grateful to receive this generous gift. I have become a full-time virtual teacher with more than 50 students. These supplies have helped lessen the cost of that I would have had to purchase for my students.”

I read most news on my tablet and find myself avoiding the Washington Post even though I subscribe to it because I despise the app’s layout, navigation options, and inability to view reader comments. Not to mention that there’s no way to forward an article to my email so I can remember to mention it in HIStalk. I found a better way — place the browser link on the IPad’s home screen and skip the app. The navigation is better, “send to” works, comments display, and it feels a lot more like something worth paying for.

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The New York Times covers the thousands of medical school graduates who aren’t chosen for the limited number of US medical residency slots, leaving them with an average of $200,000 in student loans and no ability to work as a doctor. The US has at least 10,000 such graduates, many of them Americans who went to medical schools in the Caribbean or other countries whose chances of landing a residency are about 50%. Medical schools have increased their enrollment, but residency positions — which are funded by CMS – remain capped. Experts say the offshore medical schools that recruit American students sometimes overstate the history of their graduates being matched and thus eventually employed.

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Hospitals in Texas are collecting buckets of rainwater and using portable toilets as storm-related water shortages affect even the largest facilities. Patients are being double-roomed and boarded in hallways, dialysis patients are showing up in hospital EDs because dialysis centers are closed, patients who are ready for discharge can’t leave, and hospital employees are sleeping over because they can’t get home. Hospitals are also seeing patients with carbon monoxide poisoning due to improper use of generators and heaters. About 100 hospitals in southeast Texas declared an internal disaster in hoping to avoid receiving new patients by ambulance. Meanwhile, the CFO of a natural gas company owned by billionaire Dallas Cowboys owner Jerry Jones giddily tells investors with Enron-level greed and indifference to the misery of others that the weather “is like hitting the jackpot” as the company is selling natural gas “at super premium prices.”

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New York-born Indian-American actress, film maker, and former physician Lakshmi Devy, MD serves as the writer, director, and lead actor in “When the Music Changes,” which address rape and assault. She previously made “Daro Mat” (which translates to “Don’t Be Afraid,”) a short film that is available on YouTube.

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Missouri Baptist Medical Center COVID-19 ICU nurse, family nurse practitioner, and first-time mother Mandi Tuhro, RN, MSN describes the challenges of watching patients die, trying to find time to pump breast milk, feeding her son overnight, and dealing with the fact that at 30 years old, “there’s not a single facet of my life right now that I’m not needed, and that is a heavy feeling.”

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Clark County, Indiana health officer and Colts fan Eric Yazel, MD writes a letter to the team’s general manager every year to offer his service as quarterback. He’s perhaps not the perfect candidate, as he admits to the GM: “A less visionary GM might be given pause by my age (44),  mediocre BMI, and relative lack of any athletic experience.” The GM called him back this year just to be nice, but Yazel ignored the call because it came from a Houston area code and “I thought it was the Texans calling. I will listen to some other options, but I am not going inter-division.”


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Weekender 2/12/21

February 12, 2021 Weekender 3 Comments

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Weekly News Recap

  • Fourteen large health systems form Truveta to provide anonymized patient data for research.
  • Value-based care coordination and payments vendor Signify Health prices its IPO at a valuation of $5.3 billion.
  • Cerner meets Q4 earnings expectations, beats on revenue.
  • CPSI misses Wall Street’s expectations for both revenue and earnings.
  • HHS OCR enters its 15th settlement involving providers that failed to provide patients with timely copies of their medical records.
  • Nuance acquires Saykara.
  • A security researcher finds problems with 30 popular health apps and their APIs.
  • Duke spinout Clinetic, which monitors EHR activity to identify patients for clinical trials and next care steps, raises $6.4 million in equity.

Best Reader Comments

It seems like Cerner is going for the data play for their growth. That’s what Allscripts told Wall Street for the past five years and they never were able to execute on it. The solution in that space is not really a technology as much as it is a social process. Maybe they can pull it off. On a different note, CPSI seems to be more in the outsourced to Overseas billing business than in the EHR business these days. (IANAL)

This seems to me to be part of an ongoing problem space that really shouldn’t be part of a free market society. We have seen many examples of VCs buying facilities and clinics then turning them into profit centers. Be that through purchase of rural hospitals and using the lab systems to “outsource” labs at many multiples of the normal cost, or hospitals aggressively pursuing clinical debt up to and including leans on homes and garnishment. The stories are numerous and from credible sources (KHN, NPR, DOJ). Frankly, we shouldn’t allow venture capitalists into our health systems — their mission is to turn a profit and they use the opaqueness of the HC system to do that. A $46,000 rabies shot that normally costs $3,000? (AnInteropGuy)


Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Ms. P in Pennsylvania, who asked for three sets of books covering math, space, and the environment for her elementary school class. She reports, “These books have made a big difference in our classroom. Since I am teaching virtually, I have recorded myself reading the books to the children. This way they can go back and listen whenever they wish. There are definite favorites. I don’t blame the children, I have my picks too. When we return back to in-person classes, these books will have a special home. They will have there own special shelves for easy access for the children. I can see them being read for years to come.”

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A patient in Canada who is undergoing treatment for throat cancer panics when new CT scan results that he saw on MyChart referred twice to his lung cancer. He couldn’t reach his oncologist, but the hospital connected him with the radiologist, who apologized that the transcription system had misheard his dictated “tongue” and instead documented “lung.” The patient says of his stressful reaction, “It confirmed my impression that the healthcare system has yet to establish an effective way for caregivers and patients to communicate except through in-person, video, or telephonic visits. I’ve not been successful in getting questions answered using the Cancer Centre’s Patient Support Line. And so far, MyChart has mostly wasted my time or misled me … I’m struck that when I read my CT report, I saw immediately that the reference to ‘lung’ was anomalous. If a layperson can see an anomaly, could we train an AI to catch one? Don’t dismiss the thought. I certainly don’t want a robot that autocorrects CT reports. But I do want one that can register surprise when something unexpected happens.”

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NASA will offer 1,000 employees, including astronauts, a Fitbit Charge 4 device and Fitbit’s Ready for Work app to help them decide whether they are experiencing COVID-19 symptoms and should stay home from work during the critical pre-flight period. The app tracks resting heart rate, heart rate variability, and respiratory rate and allows users to self-report symptoms, temperature, and possible COVID-19 exposure.

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This is American culture and its healthcare system in a nutshell. Tessica Brown uses Gorilla Glue spray adhesive as a replacement for hair spray in a pinch, then spends 22 hours in the ED trying to get it removed. The daycare owner was finally freed of her adhesive hair net by a plastic surgeon, but meanwhile earned dozens of millions of TikTok video views, raised $22,000 in a GoFundMe to cover her medical bills for “this unfortunate ordeal,” and is reportedly planning to sue Gorilla Glue for misleading her (she denies reports that she’s suing). Not to be outdone, a fellow Louisiana resident – who previously earned his 15 minutes of fame on Dr. Oz for participating in the “ice cream challenge” of licking the contents of a carton of ice cream and putting it back on the store’s freezer shelf for someone else to buy — attempts to prove that Brown was exaggerating by gluing a Solo cup to his lip, then videoing himself triumphantly licking it off. That didn’t work as planned and he, too, ended up in the ED, where doctors peeled the cup off.

A UK hospital asks midwives to change their childbirth-related terms to be more inclusive – “mother” will be replaced by “birthing parent;” “her” will be retired in favor of “them;” “maternal” will become “maternal and parental;” and the new term for “father” will be “co-parent.”

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A Texas nurse whose car was pinned between two semi trucks in the early morning 100-car I-35W accident that killed six people crawls out through her trunk to free herself, hops the highway barrier to hitch a ride with a co-worker going the opposite direction, and goes to work.

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Cerner Charitable Foundation Program Manager Allison Chael worked her other job as a Kansas City Chiefs cheerleader last weekend. Each team had to choose eight members of its cheerleading squad — the Chiefs have 33 cheerleaders on the roster – and they were not allowed on the playing field for this year’s game.

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Cheering on the other side of the Super Bowl field was Tampa General Hospital ICU nurse and Buccaneers cheerleader Anastasia Lusnia, RN.


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Weekender 2/5/21

February 5, 2021 Weekender No Comments

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Weekly News Recap

  • Netsmart acquires GPM.
  • Nordic acquires Bails & Associates.
  • HIMSS confirms that HIMSS21 remains on track pending further COVID-19 developments, but with a virtual component added.
  • Zyter acquires Casenet.
  • KLAS announces Best in KLAS winners.
  • Sharecare acquires Doc.ai.

Best Reader Comments

A “dead” language (a proprietary one at that!) put food on my table and a roof over my head for 31 years until I was laid off in 2014. Alhough that effectively ended my coding career, I was able to apply all of the software life cycle best practices to become a Product Analyst in which I design the look, feel, and flow, and have a team of ‘modern’ developers do the magic. (Marshall)

I couldn’t agree more with Dr.Van Vert, but as a patient, I often feel woefully ill equipped to create an informed advance care plan. Besides revive or DNR, yes or no to breathing machine / feeding tube? There may be other decisions to be made, such as pacemaker, surgery, antibiotics for repeated UTI. What about relatives who disagree and fight my wishes? What about if my AD is not avail at time of crisis? IMHO, there is still much work to be done to educate patients and family members so that the conversations, once normalized, can be meaningful. (Kathy Kastner)

Ultimately though, this cannot simply be about end-of-life. You need to open the doors to patient priorities and issues throughout the entire healthcare system. We’ve got one big initiative called person-centered care. When you ask the patient upfront what they expect from the care episode, this sends that message. (Brian Too)

So, if I get this right, you were shown an internal error message as an end user (patient). One that should have gone to the user who selected the document in the first place or someone who could actually do something about the error. To say this is a poor user experience is putting it mildly. (AnInteropGuy)

I work for a CRM vendor and so I have that lens on as I read your story. What I see is that the actual test went just fine, it was your entire experience around the clinical event that caused you frustration. Imagine if through a series of coordinated text, emails, calls, chats you were guided exactly where to go, and were given the results in the appropriate context? Yes, there were some physical plant issues (CRM can’t help with dust bunnies), but aside from that, it was all communication. As one health system leader said recently, “the contact center is the new waiting room,” If your health system had a Digital Front Door, you would have had a better experience. (Brendan Ward)


Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Ms. T from Texas, who asked for a ring light so her students can see her better while she is teaching virtually from home. She reports, “My wonderful students and I would like to thank you for your generous contribution. Teaching virtually has been a great challenge. With the light ring, my students have been able to see me much better on camera.I really, truly appreciate everything that you have done for us.”

A science futurist website questions whether the DNA information of 18 million people that is stored by Ancestry.com is safe in the hands of its private equity owner, Blackstone, which has pledged to find new ways to “package and sell data” as a revenue stream. A finance professor says, “[Blackstone] owns healthcare companies. They own insurance companies. They own retail companies. So they can identify spending behavior, health care expenses, actual health outcomes for individuals.” The article also questions how genetic information will be protected when 23andMe goes public via a SPAC that is owned by Virgin’s Richard Branson.

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In the UK, a COVID-19 conspiracy theorist is banned from hospitals – except for emergencies and scheduled appointments – after filming empty hospital hallways to prove that the British government is lying about the pandemic.

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A man who made money on last week’s wild ride of GameStop stock spends his profits on gifts for patients at Children’s Hospital of Richmond, where his son receives treatment for neurofibromatosis. John Theobald explains, “If a kid that’s stuck at the Children’s Hospital wants unicorn curtains, I’m going to get them unicorn curtains, as opposed to a slush fund.” Another investor, a 20-year-old student who made $30,000 in profit, donated Nintendo Switch games and consoles to his local children’s hospital.

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Mother Jones finds that online nurse groups, including that of the ANA, are filled with COVID-19 vaccine disinformation. Nurses who post that they have been vaccinated are being attacked, threatened, and accused of harming their unborn children. 

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A 10-year-old boy and his mom’s friend head out after Monday’s snowstorm to clear the snow off cars of employees at Westerly Hospital (RI) so they could get home to their families faster.

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In Canada, International Space Station astronaut and primary care physician David Saint-Jacques, PhD, MD returns to the medical front lines to work on the COVID-positive unit of McGill University Health Centre, where he completed his residency. He says, “In the space between the people who have no symptoms and the people who die from them, there are people who will get through it, but who get very sick, who really go through hell, on oxygen, pumped full of drugs, in the hospital, with an impact on their families. Now is not the time to let our guard down, even though we’ve all had enough.”


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Weekender 1/29/21

January 29, 2021 Weekender 2 Comments

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Weekly News Recap

  • Athenahealth pays $18.25 million to settle federal False Claims Act allegations related to paying kickbacks to increase sales from 2014-2020.
  • GetWellNetwork acquires Docent Health.
  • Sharecare acquires Doc.ai.
  • ECRI lists its top 10 health technology challenges for 2021.
  • Symplr acquires Phynd.

Best Reader Comments

My take is that more public pricing will mostly affect hospitals that are undifferentiated and not capital efficient. So your-well branded academic system will still attract those with the ability to pay, your ruthlessly cost conscious commercial chain will actually benefit from the public knowing how much cheaper they are, and your community / rural hospital with decent volume already mostly gets the customer who has no other options. It ain’t fun for inefficient hospitals to close, but it also ain’t fun to be price gouged for medical care. (IANAL)

If you have to be short of something, you want to be short of vaccine. We can get more vaccine. I’m confident of that now. Now the converse: You are short of physicians. How long does it take to train a physician? How much money does it take to train a nurse or pharmacist? What are the hurdles you need to jump to open a new PH Office? It’s all difficult, costly, and there are years-long lead times. According to the Milken Institute, there were 133 experimental therapies as of April 2020. There were 49 in clinical trials. Holy cow! We will be up to our eyeballs in vaccines and treatments very soon. I’m guessing by summer 2021. And all those physicians, nurses, pharmacists, and public health offices will be waiting. They will scale up the vaccine rollout like crazy. (Brian Too


Watercooler Talk Tidbits

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A Mississippi man complains to the local TV station that a hospital wouldn’t let him in because he refused to wear a mask. He says he can’t breathe through a mask, wears a bandanna instead, and says he has a doctor’s note explaining his situation, but the hospital says he refused to wear any face covering even after they called his doctor, who said he should have no problem wearing a mask.

Stormont Vail Hospital (KS) defends giving its fundraising board members COVID-19 vaccine by saying that “our team members include our boards.”

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Former Athenahealth CEO Jonathan Bush buys the Maine oceanfront home of former environmental lawyer and two-time candidate for governor Eliot Cutler in the most expensive home sale in the state in 2020 at $7.55 million. The 15,455 square foot home features a 5.5 acre oceanfront lot with 650 feet of shore frontage, gymnasium with sauna and steam rooms, heated pool, tennis court, a 4,000-bottle secured wine vault, and a four-bedroom guest house. It was originally listed at $11 million.

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Employees of St. Mark’s Hospital (UT) launch a GoFundMe campaign to buy a car for ED environmental services worker and employee of the month Michael Piper, who showed up for his night shift on a freezing New Year’s Day when buses weren’t running after riding his bicycle 37 miles to work.


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Weekender 1/22/21

January 22, 2021 Weekender 2 Comments

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Weekly News Recap

  • Micky Tripathi is named National Coordinator.
  • The co-founder of The COVID Tracking Project says that the recently implemented HHS Protect COVID hospital status database is working well and urges the Biden administration to continue its use.
  • Philips announces plans to acquire medical device integration vendor Capsule Technologies for $635 million in cash.
  • ONC says it will invest $20 million in vaccine-related interoperability projects.
  • An appeals court vacates MD Anderson’s $4.3 million civil money penalty for losing three unencrypted mobile devices that contained the PHI of 35,000 patients, challenging HHS’s ongoing interpretation of HIPAA requirements and its method of setting penalty amounts.
  • Cerner replaces its chief client and services officer and chief legal officer and hires a CFO.

Best Reader Comments

I’ve been arguing with my health law friends that HHS and the conservative compliance lawyer mindset were wrong viewing HIPAA violations a some form of strict liability. I feel vindicated for now since I think the Fifth Circuit got this correct. 1. The technical requirements are met by simply not being negligent. You have implemented encryption? you make reasonable efforts to encrypt the data? Good enough. Perfection isn’t required. Doing more isn’t required. 2. Disclosure is an affirmative action, not merely just loss. It’s active. It’s participative. This construction fits nicely inside the framework. It also addresses the risk of loss to nation-state actors or those who are intent on stealing data. That’s not a punishable “disclosure” that’s a theft. 3. And I realize that HHS updated its penalty guidance, but this makes it very clear: outside some intentional acts, the penalties aren’t business-ending penalties. Yay for reasonableness of courts. (HIPAA Relieved)

The concept that that would not be considered a breach is mind boggling. I fully support the capriciousness but it shouldn’t be allowed to be pushed down to the staff level. In 2017 we all knew that we had to dictate it from an IT organization. (Jeremy)

Cerner Chairman and CEO Brent Shafer may wish to check out his own uCern “ideas” space to get a sense of how his peeps are doing on “strengthening relationships, delivering on promises, innovating faster, and executing on strategies.” There are loads of ideas that are no-brainers and/or have had significant support for many (5+) years, yet are not yet implemented or have been rejected as not on the road map. Other ideas point out serious safety risks, but are said to be working as designed (WAD), although they would be better termed WAHD (working as horribly designed). (CernerClient)


Watercooler Talk Tidbits

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You as an HIStalk reader provided Ms. S’s elementary school class in Mississippi with 30 sets of individual, high-quality headphones in responding to her Donors Choose teacher grant request. She explains why she needed them: “Each year, I’ve bought headphones for my students completely out of pocket. The headphones which I get are usually a cheaper brand, which don’t tend to last long. I am so thankful for your support on this project! My students absolutely loved opening up the box and finding the beautiful headphones inside! Thank you for believing in us, and thank you for supporting our cause.”

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California’s UCI Health will spend more than $1 billion to build 144-bed UCI Medical Center Irvine-Newport. That is $7 million per bed.

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The state of Colorado dismantles a temporary COVID-19 hospital that was built in April 2020 inside Denver’s Colorado Convention Center, which the state leased for $60,000 per day for a year. None of its 2,000 beds were ever occupied.

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A St. Louis TV station profiles 65-year-old pulmonologist Steven Brown, MD, who monitors 100 ICU patients per night – most of them on ventilators with COVID – from his living room as a physician with Mercy’s Virtual Care Center. He says it is hard to watch patients die remotely, in one case seeing four patients expire in a single hour.

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A husband and wife who had been married for 70 years die together and within minutes of each other of COVID-19 in Riverside Methodist Hospital (OH), three days before their appointment to receive COVID-19 vaccine on would have been the husband’s 90th birthday. The family said in their obituary, “We are devastated to lose them both at the same time. But, we are blessed that they walked together, hand in hand, through the Gates of Heaven into Eternity, never having to face ‘Until Death Do Us Part.’”

A 29-year-old nurse who inspired her hospital co-workers by singing “Amazing Grace” after a 12-hour shift caring for COVID-19 patients – captured by a colleague in a video that went viral – sings it again in scrubs at the Lincoln Memorial Reflecting Pool to President-elect Biden and a national TV audience in the National COVID-19 Memorial. Lorie Marie Key, RN works for St. Mary Mercy Livonia Hospital (MI).

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Acclaimed rapper-songwriter Lazarus encourages his fans to get COVID-19 vaccine, a recommendation that carries extra credibility because his other job is as Kamran Rashid Khan, DO, a Las Vegas family medicine physician.


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Weekender 1/15/21

January 15, 2021 Weekender No Comments

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Weekly News Recap

  • Health and technology leaders, including Epic and Cerner, announce their participation in the Vaccination Credential Initiative, which hopes to provide patients with digital proof of their COVID-19 vaccination.
  • QGenda acquires Shift Admin.
  • Walgreens announces plans to develop an extensive customer engagement, care integration, and health marketplace platform.
  • Flo settles FTC charges that it shared the ovulation data of 100 million users with Facebook, Google, and other companies while telling them it was keeping that information private.
  • AdventHealth says its replacement of Cerner, Athenahealth, and Homecare Homebase will cost $660 million.
  • Federal prosecutors say that Theranos destroyed its laboratory information system database that it had hoped to use to prove fraud and use of unreliable tests.
  • ONC releases United States Core Data for Interoperability Draft Version 2 for public comment.
  • Central Logic acquires Acuity Link.
  • Tech-enabled Medicare Advantage insurer Clover Health begins trading on the Nasdaq in a reverse merger with a SPAC that values the company at $7 billion.

Best Reader Comments

It’s kind of absurd that you’re talking about robotic process automation as an innovation. Using computers to automate navigation and administration of our bloated regulatory structures is not innovation. It doesn’t help patients or improve care in any way. It only helps organizations improve their bottom line. The best innovation we could unleash would be to adopt a single payer healthcare system. Innovation should be focused on improving care, not doing paperwork. (Elizabeth H. H. Holmes)

In my opinion, workflow design (and of course system design) questions are often difficult conceptual problems, and they take a good deal of focused thought to come up with a sensible answer. Confounding the problem is the fact that a good design, once clearly laid out, is deceptively easy to follow and understand, leading to the mistaken idea that it was equally easy to come up with. Thus people don’t generally have an adequate appreciation for the task of design. Thus they sometimes aren’t prepared to devote the time and focus actually required. As my high-school English teacher used to tell us: “Anyone can take a simple problem and make it complicated. It takes a genius to take a complicated problem and make it… anyone? anyone?” (Clustered)


Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Ms. K in Illinois, who asked for several books for her elementary school class. She reports, “These books have been such a wonderful addition to our classroom library. They are so popular that I cannot keep them on the shelves and students eagerly wait for their classmates to finish the next book in the series. While it previously felt like a struggle to get some of my students to read, now, nearly every student in my class is found reading whenever they get a chance. When students finish their work before others, they take out their book and read. When students need to take a short break from instruction, they take out their book and read. When students go home at the end of the day, they take out their book and read. These books have made such a positive change to our classroom, and it would not have happened without your help.”

Microsoft patents a “Black Mirror”-like process of turning data about a person – even a dead one – into a chatbot that includes a 3D rendering, a voice, and the trained ability to converse like that person.

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The family of a nursing home patient who was allowed to install a security camera in his room to monitor his care captures him dying after his oxygen cannula dislodges. The footage shows the 80-year-old patient, who was infected with COVID-19, gasping for air just after 4 a.m. after not being checked for nearly four hours and with a nurse call button that was draped over the bed railing where he couldn’t reach it. His daughter noticed his situation, but her calls to the facility were not answered and nobody came to its door when she frantically showed up in person.

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Two Chicago-area broadcasters launch a podcast that covers the history of Edgewater Hospital, which was built as a high-end facility in 1929 for patients like Frank Sinatra, was the birthplace of Hillary Clinton and serial killer John Wayne Gacy, and then was closed in 2001 after its management company and some of its doctors were caught running a massive fraud scheme. The hospital became a popular destination for urban explorers who found the interior to be intact from the moment the doors were closed until it was mostly torn down in 2017.

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A new nurse in North Carolina has photos taken with her 98-year-old great-grandmother, who graduated from nursing school in 1942.

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The director of performance improvement at Ascension St. John Medical Center runs 46 miles from another Ascension hospital in a 10-hour tribute to “nurses and the marathon they run every day.” Wyatt Hockmeyer gave out 85 medals to healthcare workers in the two hospitals on behalf of Medals4Mettle, which awards medals that have been donated by endurance athletes to those who are fighting serious illness.


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Weekender 1/8/21

January 8, 2021 Weekender No Comments

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Weekly News Recap

  • Optum announces its intention to acquire Change Healthcare.
  • Harris acquires Obix.
  • TigerConnect acquires Critical Alert.
  • Intraprise Health acquires HIPAA One.
  • Cedar Gate acquires Enli.
  • Haven announces its shutdown.
  • ONC publishes Cures Act developer resources.
  • Hospitals begin publishing their negotiated rates and prices for shoppable services.

Best Reader Comments

This was the best hope for CHNG who hadn’t realized their IPO dreams, Optum was the only one that could afford them. For employees, the CHNG strike price for stock options was $18, so maybe some of the employees whose McK deferred bonus programs were transferred to CHNG stock options at the merger will be able to finally cash out 4 years later! (CHNG maker)

What users are GREAT at, is telling you that you did it wrong. Long after the job was done, and after the project stage that would allow you make it right. Mostly, the programmers are left to imagine the solution on their own. Some organizations employ systems architects, designers, and even plain managers who will do mock-ups, role-playing, workflow analysis. Not once have I ever had the opportunity with those people. They cost money and take a great deal of organizational willpower and discipline. Steve Jobs was famous for envisioning a finished system. He’d then follow the implementation to make sure the design & implementation followed the plan. He’d keep after managers and programmers, keep them on track. He’d even kill products that didn’t live up to his expectations. Steve Jobs was famous for being an exception, an outlier. In the real world, most systems go through a laborious process, slowly evolving from something terrible into something better. (Brian Too)

Community-based Pediatricians are also in vital patient-facing roles. I’ve heard too many reports of hospital billing staff and work-at-home admins getting their vaccines while non-hospital-employed primary care physicians are left to fend for themselves. (Chip Hart)

Online advertising is a massive industry, and healthcare providers and pharmaceutical companies participate the same as anyone else. Websites and internet service providers can very easily identify who you are. They know your name, age, sex/gender, and where you live by the time the page finishes loading. They know what other websites you go to. They know what medical conditions you look for on search engines. They are all legally allowed to freely sell, exchange, and reconnect this data however they want. Your healthcare provider doesn’t need to sell identified data when your online presence is basically screaming out your name, everything post you’ve liked, the web pages you’ve visited, etc. (Elizabeth H. H. Holmes)

Despite all the talk about upcoming consumerism in health care, the reason for such dismal patient experience is precisely this. Patients don’t control the purse string (even though it is their forking money). All they can do is fill up a toothless HCAHPS paper survey three months after their encounter with the health system. And this is of course true not only for hospitals but for every single aspect of our medical care “system.” (Ghost_Of_Andromeda)

Healthcare organizations need to change how they proactively reach out and engage customers as we enter 2021. We all understand the value of precision medicine, but we now need precision engagement. Other consumer service industries have long employed sophisticated data science to predict and influence customer behavior. It has resulted in (1) more loyal customer relationships and (2) increased lifetime value. In healthcare, we are still relying on generic notifications. We need to be identifying our highest risk customers, prioritizing what we talk to them about, and then personalizing the channel selection, the message selection, and the time of communication. (Michael Linnert)

The same people who rant about freedom and tyranny would do well to read about the smallpox epidemic that began in 1775. We have direct insight into how the Founders acted during a disease outbreak, and I can assure you they did not act in the interest of individual freedom, because they were intelligent and principled enough to understand responsible population health management even then. The United States doesn’t have a COVID crisis as much as we have a selfishness crisis. (Elizabeth H. H. Holmes)


Watercooler Talk Tidbits

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Readers funded the teacher grant request of Ms. B in South Carolina, who requested 12 books for her kindergarten class. She showed her class the books on a day in March and stayed late to create a book bin, but in-person learning was cancelled that same day. She contacted the publishers and authors to seek permission to record herself reading the books for her class, sometimes getting approval and sometimes getting a firm “no” or no response. She filmed herself reading those books where she received approval and reports, “My students LOVED seeing me reading books that they had chosen. I even had a parent contact me to let me know that her son couldn’t believe he was seeing me on TV and shared a short clip she filmed of him watching me read. I was excited to see how excited he was. Parents started engaging more and looking forward to these read aloud followed by book discussions on Zoom. Many parents were surprised to learn how deeply their student could dive into a book and understand not just overall themes, but also underlying themes. These books have given my students and their families so much more than I could have ever imagined. Thank you for believing in the power of print and giving me the opportunity to make such a huge impact.”

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In China, an ophthalmologist whose surgical career was ended a year ago by a patient’s knife attack gets a standing ovation from a TV audience after telling them that his injury was a “pleasant surprise” because it reinforced that his work is worth doing. He specializes in treating uveitis, working in a low-paying hospital job and often helping patients pay their medical bills from his own pocket and performing free cataract surgery. He joked that the patient was unreasonable because “there were so many people in the hospital at that time, yet you stabbed me with precision – doesn’t it show your vision has recovered well?”

In Australia, charity gift shop workers who called an ambulance and comforted a homeless man who showed up in distress and later died alone hold a funeral for him in a local cathedral. The presiding bishop said during the service, “He went with full honors. I asked those present to imagine their own funeral one day and what they would like people to say about them, and how that really affects how we live now. We choose to do what is good and loving and virtuous, rather than the opposite.”

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A Pine Bluff, AR medical oncologist and UAMS professor who sold his clinic to the local hospital sends Christmas cards to 200 former patients to tell them that he and his family had decided in a Thanksgiving discussion to forgive their outstanding medical bills. Omar Atiq, MD explains that he wrote off $650,000 because, “I have never refused to see a patient for lack of funds or lack of insurance. To me, the highest honor comes when somebody puts his or her life in your hands. To be a physician or a nurse is, to me, something bigger than a transaction. But in the vast majority of the world, it is tough to be sick and it can be exorbitantly expensive to get the appropriate treatment … That people are interested in this story shows me that perhaps the less positive news we hear each day may just be a small part of who we are as humanity. Perhaps the larger part of humanity is just doing what they can to keep the world moving forward.”


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Weekender 12/18/20

December 18, 2020 Weekender No Comments

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Weekly News Recap

  • Verily announces a $700 million funding round.
  • Diameter Health raises $18 million.
  • Kyruus acquires HealthSparq.
  • Report: Amazon will expand its employee-only telehealth program to other companies.
  • Cerner acquires Kantar Health.
  • KLAS finds patient accounting from Epic and Meditech to be strong, Cerner and Allscripts less so.
  • Sonoma Valley Hospital notifies 67,000 patients of an October 11 ransomware attack.
  • CMS announces a rule that requires Medicaid managed care and insurers that sell products on the Exchanges to facilitate the exchange of patient data between payers.

Best Reader Comments

Where were the quality monitors and guardrails to catch unreported results within a reasonable timeframe? And incomplete and/or incorrect reports? I am very familiar with Epic configurations, so I know that the tools exist to provide this information internally to lab management from receipt of specimens through final reporting. No patient should have to rely on the repeated intervention of friends and/or surgeons to move the pathology process along (I experienced this myself many years ago, when a biopsy was not read for more than 2 weeks time, and it turned out to be positive for cancer; a physician friend had to intervene to get the final report released). (Witty)

I worked with an org recently that has their own application, completely over MyChart. Nothing that you see is Epic-designed and it’s missing lots of standard Epic features, but plenty of people still refer to it as MyChart. Drives the Epic team nuts, especially since it’s meant a ton of work on COVID features that could have been plugged in straight from Epic. (B)

Healthcare organizations have some structural problems to work through. There is a worker caste system in healthcare. An exceptional manager who happens to be an MA cannot manage mid level providers or doctors. Also, healthcare organizations have only recently grown to require management; much of healthcare used to be delivered by the owner-operator model and a major portion of the workforce still has not matured out of that mindset. This type of thing won’t change for at least another decade or two. The system as it exists is inefficient but can’t be changed. It will consolidate to avoid pressure until it can’t. Then competition and innovation will be able to start. (IANAL)

An issue I see here is, where is the incentive for the health system to improve? Yes, when I worked in HIT for 25 years we frequently reminded ourselves that it could be our loved ones being affected by what we do. But that never seemed to stick at some of the organizations we worked with. What other incentive is there? The biggest incentive is to keep the revenue coming in, which explains why the bills came through electronically just fine. Some good old competition in this space would go a long way. The question is how to effectively do that without compromising essential services (such as ED services and indigent care) that can’t be improved through a competitive process. When I got quotes on an MRI a couple years ago, the local academic center quoted me $6,000. I got it at a retail site for $600. Service was wonderful. (Bob)

[On COVID-19 passport-style apps] So how do you ID the right person? This will work well in countries that have unique person IDs (like China) , but we can’t have that in US. So will they use SSN? Some made up number? and what if it gets hacked and the hacker sells your ID number to a person not vaccinated? Or maybe the government is going to send you a ‘all clear’ text that you can display on your smart phone? But what if you don’t have a smart phone? I am curious to hear how all this will be worked out w/o an unique ID. (Frank Poggio)


Watercooler Talk Tidbits

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Marvel and Allegheny Health Network develop a “True Nurse Stories” superhero comic book.

A Vanderbilt study of EHR data finds that musicians are more likely to have vocal cord problems, hearing loss, anxiety, and depression, but are less likely to have heart disease, possibly due to the physical effort involved with performing.

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The president of the American Veterinary Medical Association assures anxious children that he has performed telemedicine checkups of Santa’s reindeer (noting that 30% of veterinarians are now using telemedicine versus 10% before the pandemic) and has cleared them for their Christmas Eve flight.


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Weekender 12/11/20

December 11, 2020 Weekender No Comments

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Weekly News Recap

  • Ro acquires Workpath.
  • LeanTaaS raise a $130 million Series D funding round.
  • Amazon announces HealthLake.
  • Baxter is reportedly offering to acquire Omnicell for $5 billion.
  • HHS OCR publishes draft HIPAA changes.
  • The federal government warns users of GE Healthcare radiology equipment that default passwords and open ports pose a serious security risk.
  • PointClickCare will acquire Collective Medical for $650 million.
  • HHS publishes hospital-level COVID-19 data for the first time.
  • Non-profit Commons Project announces that it has connected its CommonHealth Android health records app to 230 health systems.

Best Reader Comments

Kudos to GBMC as it was obvious they were prepared for this [systems downtime]. We walked through the downtime command center where I saw an HR station for dropping off time sheets, a clinical station with plentiful stacks of every form, and a wall of giant sticky notes with schedules and protocols including shift sign ups for taking on specific down-time roles include Runner and Safety Nurse – complete with a rack of different colored safety vests that had those roles printed in big letters on the backs. Sadly this situation seems to be more common so it was reassuring as patient that they still seemed to be maintaining safe and effective operations. (SEH)

Baxter might buy Omnicell? Surprising considering that Omnicell is the only one in this space who has kept their original structure. I’ve lost count of how many times Pyxis has changed hands. Then Omnicell ended up with Accu-Dose. Then I recall that back in the mid or late 90’s, Omnicell bought the dispensing business from Baxter. Strange. (David N)

The quality of that data [UHG’s patient data] is quite bad from what I’ve seen. The complexity of that intervention is also hard to scale. Internet advertising has a similar model of collecting data, then trying to deliver an intervention. It is really hard. People get toaster advertisements right after they bought the only toaster they will use for a decade. The successes seem to come when a company dumps a ton of money into buying ads for when someone searches or buys something even remotely related to the company’s product. New toaster means you get a ton of appliance ads and some targeted consumers actually did move and the company snags a few more sales. UHG can’t spam their members without driving up utilization and destroying their margins. (IANAL)

Here is my UHG call summary for big healthcare providers. UHG knows they can do the procedures you make your money on. They know they can do them much cheaper and they actually know exactly how much cheaper. They need to get between you and the patient to direct them to that cheaper service. They intend to do that in a couple ways. First, they intend to be much more convenient for the patient. They want to be the getting an Uber to your calling a cab. Second, they want to track the patient through time and intercept them at the right moment to get them to cheaper care. The first is possible and happening as we speak. The second is harder within the current healthcare landscape. (IANAL)


Watercooler Talk Tidbits

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TikTok names Minnesota family medicine resident Rose Marie Leslie, MD to its top 100 list of most impactful creators for her videos in which she provides health and COVID-19 information.

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A Wisconsin chiropractor tells his Facebook Live viewers that they should use pepper spray on anyone who asks them to wear a mask in a store, saying the “cool part” is that it is legal (it is not) because they are predators.

The Association of American Medical Colleges says that medical school applications are up 18% this year in what admissions officers are calling the Fauci Effect. Anthony Fauci, MD says that’s flattering, but a more realistic assessment is that prospective students are inspired by local doctors who are trying to improve individual and population health.

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A healthcare communications training company offers a telehealth version of its “Breaking Bad News Program,” in which actors simulate real-life scenarios and physicians and nurses are coached to communicate compassionately and effectively when delivering bad news to patients over a video connection. The Orsini Way company was founded by neonatologist Anthony Orsini, DO.


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Weekender 12/4/20

December 4, 2020 Weekender 2 Comments

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Weekly News Recap

  • Healthcare process automation vendor Olive acquires prior authorization platform provider Verata Health.
  • McKesson launches Ontada, an oncology technology and data business.
  • Imprivata acquires FairWarning.
  • The former GM of Uber Health launches home care provider MedArrive.
  • ONC, HL7, and other groups launch Project US@, which hopes to publish a healthcare standard for representing patient addresses.
  • Salesforce acquires Slack for $28 billion.
  • HealthStream acquires Change Healthcare’s capacity management business, including its Ansos staff scheduling system, for $67.5 million.
  • A Stat review finds that health systems are using AI to create patient COVID-19 risk scores despite a lack of evidence of real-world correlation or assurance that the training of those systems was adequately broad.
  • University of Vermont Health Network restores full access to Epic after nearly a month of malware-caused downtime.
  • Informatics pioneer Reed Gardner, PhD dies.

Best Reader Comments

I’m reluctant to be too critical of such pronouncements because they come from a desire to improve service delivery. The energy and enthusiasm this displays is worth protecting. But honestly, if there’s one thing we do know: All too often, healthcare does NOT “have to” deliver a great customer service experience. If it did, then we’d see that achieved routinely. The fact that we talk about a need is telling. (Brian Too)

Re: Olive. Not seeing it, what am I missing? They seem to have found a nice niche, but they are not what I would call revolutionary, and I don’t think their execution is anything to write home about. $1.5B valuation? Seems like this is a case of Silicon Valley easy money mania meets healthcare. (WestCoastCFO)

In spite of AMA lobbying, regulatory changes in the early 2000s allowed pharmacists to give flu shots. Costs fell, accessibility went up, public health improved, and doctors wallets weren’t quite as fat as they could be. Maybe half of flu shots still occur when people happen to be in the doctor’s office for another reason, but for the most part the doctor “establishment” has been cut out of making money on flu shots. Telemedicine cuts out your local doctor from making money on all those non-procedural, episodic office visits. Brian Too is right that your local doc is not going to do telemedicine unless it is convenient for her and the billable rates make sense. (IANAL)

Like most other people in this country, my health insurance is offered by my employer, who provides three plans for me to choose from. For the most affordable of these, if someone in my family develops some sort of serious condition, our PCP will have to be the gatekeeper before getting a referral to a specialist (likely first, one within the same organization, and MAYBE a second opinion from another group with providers known to be strong in that specialty). There’s a lot of talk about the “consumerism” of healthcare, but the idea that most people have the financial resources to just pick up and go to whatever provider of whatever service they like is blatantly false, in my opinion. (Employee)


Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Ms. M in Florida, who asked for two Chromebooks for her second grade class. She reports, “The minute we arrive in our classrooms, the children are directed to the computers to finish their IReady minutes. IReady is a math/reading program that when used properly has a huge correlation to the SAT and FSA exams the students take at the end of the year. I always find it amazing how they cannot wait to get on and never complain about getting it done. This is because the program is child friendly and offers rewards, games, and other incentives to increase student performance.”

In England, town councils are hiring an analytics software company to study the personal finances, school absences, and living arrangements of residents to identify those at risk for COVID-19. Privacy experts worry that the information could be used to predict which residents are likely to break isolation rules, also noting that the system can analyze issues such as unfaithful and unsafe sex, emotional health, dangerous pets, anger management issues, and financial struggles.

Geisinger produces a 30-minute documentary called “Five Days in May – Inside the Fight Against COVID-19.”

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Cleveland Clinic and other businesses will provide affordable Internet service to residents of the Fairfax neighborhood of Cleveland, which is America’s worst-connected large city. The EmpowerCLE wireless internet service provider has installed equipment on the roofs of two main buildings of Cleveland Clinic’s campus to boost coverage.

Reuters reports that North Korean hackers are posing as recruiters on LinkedIn and offering jobs to employees of COVID-19 vaccine maker AstraZeneca, after which they email them job descriptions that contain malware that gives them access to the employee’s computer.

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Former professional soccer player and Olympian Rachel Buehler Van Hollebeke, MD is working as a first-year family medicine resident at Scripps Mercy Hospital.


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Weekender 11/27/20

November 28, 2020 Weekender No Comments

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Weekly News Recap

  • Telemedicine kiosk vendor HealthSpot winds down its five-year bankruptcy with just $47,000 left to pay creditors after having raised $47 million.
  • The University of Vermont Health Network restores full access to Epic at all sites after a month of malware-caused downtime.
  • Germany-based health IT company CompuGroup Medical announces its intention to acquire ambulatory-focused health IT vendor EMDs for $240 million.
  • Phone-connected ultrasound transducer manufacturer Butterfly IQ will go public on the NYSE via a SPAC merger that values the company at $1.5 billion.
  • Cloudbreak Health and UpHealth Holdings use a SPAC merger to create a telemedicine company that is valued at $1.35 billion.

Best Reader Comments

That’s a lot of money for eMDs, though it isn’t clear how the financing works. At face value, it would take CompuGroup more than a decade to make their money back. It makes you wonder what Richard Atkins has been doing. He was brought in to sell Greenway Health and apparently there are buyers interested in that kind of small practice EHR business. Why can’t he make the sale? (IANAL)


Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Ms. B in North Carolina, who asked for a globe carpet for a reading area for her elementary school class. She reported in late April, “The students have really enjoyed using the bean bag and carpet for flexible seating. They race to get there every day when we have flexible seating time. It is a joy to see them being so comfortable while learning. Your donation has also brightened our learning environment. The carpet is so colorful and matches perfectly with our World theme. I am a global educator and as such tries very hard to make my students globally and culturally aware. Your carpet does that. They have tried to identify the continents and places on the carpet. Thank you for allowing my students this opportunity to be in a comfortable learning space and also to have flexible seating. They absolutely love it!”

Employees of NYC Health + Hospitals say that everybody was in favor of providing extra compensation for COVID-19 overwhelmed frontline employees as long as someone else footed the bill, turning the process into a meme: “How did your hospital reward you for being essential, and what type of pizza was it?”

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Pulmonologist Joseph Varon, MD is captured in a photo taken in Houston’s United Memorial Medical Center comforting a COVID-19 patient in the ICU in his 252nd straight day of working in the hospital.

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A recently licensed nurse’s “how it started, how it’s going” photo of herself a at graduation and then after working in the ICU shows the toll that COVID-19 takes on caregivers.

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Orthopedic surgeon Elvis Francois, MD has a big Wednesday – he is unmasked on “The Masked Singer” and is named to People magazine’s “Sexiest Man Alive” list.


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Weekender 11/20/20

November 20, 2020 Weekender 4 Comments

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Weekly News Recap

  • Private equity firm Clearlake Capital will reportedly buy the software business of revenue cycle management company NThrive.
  • Nuance sells its transcription services business and EScription technology to newly formed DeliverHealth Solutions, in which Nuance will hold a minority share.
  • Time’s list of “The Best Inventions of 2020” includes the Vocera Smartbadge.
  • Central Logic acquires Ensocare.
  • Amazon launches an online pharmacy.
  • ECRI announces that it will shut down its Partnership for Health IT Patient Safety collaborative on December 31 after seven years.
  • UC San Diego Health reports the benefits of moving UC San Diego’s student health service to Epic.
  • Researchers find that including a patient’s headshot in the EHR significantly reduced ED wrong-patient order entry errors.

Best Reader Comments

Cogito is more of an umbrella term for all of Epic reporting. It’s a brand more than a technology. Chronicles, which is a component of Cogito, is the piece most like OLTP because it uses the transaction processing database. Farther up the analytical stack, Cogito includes Radar, SlicerDicer, Clarity, Caboodle, Predictive Analytics, and even some AI support. All these items leave the TP database behind in order to do their thing! (Brian Too)

Part of the current benefit of the Uber style of telemedicine is that it is a nationally scaled model that outcompetes your local urgent care on price per quality visit. It is too big and remote for your local health system to crush with a location dependent monopoly. People say they want their local provider, but a telemedicine visit with their own provider is likely to cost MORE than an in person visit due to the technology overhead and the fact that the provider isn’t operating at the top of their license compared to an in-person visit, where they are prepped by an MA or possibly delegated to an NP. It’s interesting to think about the future that Kharraz proposes. In that future, I would probably prefer telemedicine until I met my deductible, then demand in-person visits. I’m not going to fiddle around with some “AI”-powered intake form and choppy video when the difference is $20 in co-pay rather than $300-plus without the deductible. The only cost reduction that could allow is having work-from-home be a perk for providers. That’s most likely going to come up in cash-strapped orgs or rural areas serviced by a provider that doesn’t want to reverse commute. (IANAL)


Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Ms. A in Michigan, who asked for engineering centers for her Grade 3-5 learners that she teaches as an auxiliary science teacher who travels to different schools every day. She reported in April, “These kits are amazing!!!! The students were so engaged. They liked seeing the real-world component and then trying to engineer a structure to resemble that image. Some students just loved using their imagination and building whatever creation they could come up with. The team work was phenomenal, solving problems and working out disagreements on what to do next or how to build. They were sharing thoughts and materials. Each kit provided different building materials so if they struggled with one type of material or build, they could try another. The kids were always surprised when it was time to clean up because they were so involved and enjoying the chance to create. Thank you so much for providing these kits for my science classes. They were used in four different buildings for grades 1-5. They really hit the design and engineering standards for every grade. I can’t wait to use them again next year. THANK YOU!”

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A Tennessee grandmother starts a 51-month prison sentence for impersonating a nurse, having been hired by eight nursing homes and home health agencies over six years by using nursing license numbers she found on the state’s online licensing system.

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The president and CEO of Sanford Health, who is not a clinician, emails employees to say that he has recovered from COVID-19, believes that he is immune, and therefore has “no interest in using masks as a symbolic gesture” and won’t be wearing one.

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Zoom eliminates its 40-minute meeting limit for subscribers to its free packages on November 26-27 to allow families to celebrate Thanksgiving safely online.


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Weekender 11/13/20

November 13, 2020 Weekender No Comments

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Weekly News Recap

  • Health Catalyst announces Q3 results that beat Wall Street expectations for revenue and earnings.
  • Providence will implement Nuance’s Dragon Ambient Experience for EHR documentation and will co-develop solutions covering other areas.
  • Australia’s SA Health is given another $146 million to complete its years-overdue implementation of Allscripts Sunrise.
  • Ambulatory surgery center software vendors HST Pathways and Casetabs announce plans to merge.
  • Managed care company Centene will acquire AI-powered healthcare analytics vendor Apixio.
  • HHS OIG imposes additional Corporate Integrity Agreement terms on EClinicalWorks, including requiring the company to notify customers that its EHR creates a material risk of patient harm.
  • Sky Lakes Medical Center says that its October 27 ransomware attack, recovery from which is continuing, will hit its bottom line hard and will require replacing 2,000 computers.
  • University of Vermont Health Network, whose systems remain offline from an October malware incident, has regained access to a week’s worth of patient schedules.
  • The VA’s 16,000-employee Office of Information and Technology publishes its fiscal year report, which primarily addresses the COVID-related challenges it met.

Best Reader Comments

I am a Livongo customer and I don’t think it has revolutionized anything. It has some nice features. You get as many strips as you want, which is good so you have extra test strips when sick. The meter keeps track of how many strips you have left and one click on your meter will order more for you. Maybe a new diabetic would find the coaches helpful. All that doesn’t look like a revolution to me. (Kathy)

Re: Bridge Connector. Stunning news. I was traveling last week and woke up to the news this morning. This has got to be one of the more epic startup failures since CareSync went bust a couple of years ago. Good luck to all those affected. (D.L. Miller)

Provider organizations should support sustained efforts to continuously pare down the EHR interaction time required by clinicians. This is not a one-time exercise. It requires highly knowledgeable and skilled individuals, though, ones with operational, clinical informatics, and IT wisdom. I would venture to say that CIOs should now track measures such as reduction of interaction time as badges of honor / performance metrics, just like in years past organizations tracked EMRAM levels. The Less is More Awards? (Azmat Ahmad)


Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Ms. G in California, who asked for STEM kits for her first-grade class. She reported in January, “Thank you so much for your generous donation! My students are going to benefit greatly from your thoughtfulness and have an enriched learning opportunity thanks to your contribution to our project. My students and I can’t wait to get this project started. They are excited to explore the STEM bins and get into engineering mode! These Stem bins are going to put their problem solving skills and creativity into high gear while learning in a fun way using fun materials. I truly appreciate your dedication to education as you are going to greatly impact my students’ learning.”

A Mississippi pharmacist who is among several defendants who are accused of defrauding insurers of $510 million in a compounding pharmacy pain cream scheme says that he gave a local doctor – who is also charged — $127,000 to buy himself a new Jaguar. The pharmacist says he wanted to keep the doctor happy to keep the prescriptions coming for cream that was billed at up to $13,000. The pharmacist said a Rush Health Systems employee scoured its patient database to find those whose insurance was likely to pay.

Utah Valley Hospitals has stopped five conspiracy theorists who have tried to bluff their way into the ICU to prove that it isn’t full as claimed. The hospital’s telephone operators are also being bothered people calling every day demanding to know if the ICU is full.

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A 63-year-old man who had spent weeks in a Jacksonville, FL hospital’s ICU recovering from COVID-19 marries his long-time fiancée the day before his discharge because they wanted hospital staff “to share the life they gave us back.”

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Hollyanne Milley, a cardiac nurse who is married to the Chairman of the Joint Chiefs of Staff General Mark Milley, saves a veteran who collapsed during a Veterans Day ceremony at Arlington National Cemetery by performing CPR. She said afterward that it was even more unusual a few years ago when she was attending an Army Ball and performed CPR in her evening gown.


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Weekender 11/6/20

November 6, 2020 Weekender No Comments

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Weekly News Recap

  • Vermont sends a National Guard cyber response team to to help University of Vermont Health Network check its computing devices for malware.
  • Healthcare integration technology vendor Bridge Connector will reportedly shut down.
  • Teladoc Health completes its acquisition of Livongo.
  • SOC Telemed begins public trading following its merger with a special purpose acquisition company.
  • The founder and former CEO of a patient-focused oncology technology company sues an investor who she says pushed her out and blocked an attractive acquisition offer.
  • Hospitals shut down and beefed up their email systems in an effort to prevent ransomware attacks.

Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. P, who asked for hands-on STEM activities for her gifted and talented grade 4-6 class in Connecticut. She reported in late April, “If you could have seen how my students faces lit up when they saw the Legos and K’Nex, excitement is an understatement. The students easily dove in to building their ideas with the new materials. We started with trying to build the tallest structure. The student jumped in to build a “skyscraper”. They found what worked to support the height of their builds and if their building could withstand a wind. Next, We moved in to their own choice creations. My fifth grade group start to build a Ferris Wheel from the K’Nex. They quickly learned the correct spacing and how to to make the structure stable enough to hold weight. They are working on making it spin from the center point. The fourth grade student were able to show their creative side in creating robots, cars, windmills and other creation from the Legos. They will be working writing stories that explain their new creations. In the future, my students will be using the Legos and K’nexs to do fraction math, test science concepts and build new inventions. My students love hands on activities. They truly enjoy being able to put their ideas in to real life practice.”

Upstate University Hospital (NY) quarantines 36 medical residents who attended an off-campus Halloween party in which a co-worker tested positive afterward. The hospital is threatening to discipline the residents for their “egregious lapse of judgment.” 

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BuzzFeed News interviews several unemployed nurses and nursing students who have turned to sex work using the OnlyFans app, which allows to collect tips from people who pay to view their nude photos and videos and to chat with them.


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Weekender 10/30/20

October 30, 2020 Weekender No Comments

weekender 


Weekly News Recap

  • HHS/ONC extend the dates for Cures Act compliance.
  • Several US hospitals report cyberattacks as the federal government warns that Russian hackers are targeting 400 of them for ransomware, with payment demands of $10 million and more.
  • Allscripts and Cerner report quarterly results, with both beating earnings expectations but falling short on revenue.
  • HHS releases a final rule that requires insurers to report their negotiated provider rates and patient out-of-pocket costs for 500 shoppable services.
  • Blank check company Health Assurance Acquisition Corp., formed by departing executives and backers of Livongo, prepares for an IPO of up to $500 million.
  • The VA goes live on Cerner at its first site.

Best Reader Comments

Cerner put on a pretty good Cerner Health Conference given the limits of a virtual platform. The puppy and kitty cams were a nice touch. Exhibits were pretty boring — not sure how to replicate the real-time repartee even with vendors whose services you don’t need. The Cerner solutions center was a better experience and the ability to have a scheduled 15 min Zoom session with a solutions expert was much better than clustering around and fighting your way to the front to ask a 30 sec question at the in person event. Some of the most interesting workshops had a cap on attendance and they didn’t seem to record those sessions for later viewing which was unfortunate. Overall, they’ve done the best job that I’ve seen of a virtual conference. (CernerSuperUser)

Regarding the lab interface being down and no one noticing: I think every internal business user should have the expectation that their internal IT department will monitor functioning of business critical interfaces and similar processes like file transfers and ingestion. If you had outsourced operation of your IT to a vendor, you’d certainly cover things like that in a Service Level Agreement and you’d make plenty of noise if the vendor didn’t meet the SLA. If I was a lab internal customer, I’d ask the IT department 1) Is the interface between the EHR and the lab system monitored by tools for both up/down status and throughput? What are the performance thresholds for throughput that are considered acceptable? 2) Who is in IT is responsible for receiving the alerts from the monitoring tools? 3) What is your requirement for how quickly your people respond to an alert indicating a serious system or interface down condition? 15 minutes? 4) What do you consider prime hours for the lab-EHR interface? 7 x 24 including holidays, or something less than that? (Vendor Mgmt Guy)

Concerning hospitals and HIEs not allowing individual providers access to information in their systems … would this not constitute a form of information blocking? (Bill Marshall)

The training that Dr. Jayne describes would be to the level that I would be comfortable with the scribe process. That level of training is not what I see in the field today. Third party vendors who hire med school applicants, pay them $8-10 and hour, while charging $30-50 with a ‘training’ package of working with another scribe for a couple weeks — quickly weaned to a couple clinicians. Virtual scribing is even more problematic in my mind — communication is tough enough when you can see the patient and clinician — think about all the connection issues between the phone, the computer, the security of access, etc. Plus, in a clinical environment you can control who is in the ‘room’ with you. However, how do you do that when the scribe is sitting at their kitchen table while the family is making breakfast? And remember, these kids aren’t making enough to have an office they can secure themselves in. (AnInteropGuy)

In the early days (i.e March) patients had similar Dx codes to Sepsis – as that appeared to what was happening as well Covid Dx codes. I would hope that by now we’d know the difference of dying WITH Covid verses OF Covid. My guess someone from the Commercial Carriers would be able to chime in on this. Either way, I suspect some claims are stretched, but the vast majority are coded correctly. Also… if you are looking for conformational bias…. you can find it. (Silence Dogwood)


Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Ms. P in Minneapolis, who asked for math tools for her class of Pre K-2 students. She reported in March, “Thank you so much for the hands on tools we received! Students have enjoyed learning how to use them. They have been really helpful to all students because they are hands on tools. Research shows the best way to learn is by doing something and repetition. You’ve made that possible. Students can create graphs, solve algebraic problems with the balance and use the hundreds place value mats combined with our blocks to build numbers. The mini clocks have been a hit! We are appreciative of your donation.”

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Flint, MI pediatrician Mona Hanna-Attisha, MD, MPH donates her American Public Health Association 2020 Fries Prize of $60,000 to fund a pediatric public health fellowship. She found from analyzing Epic patient records that Flint’s water supply had high levels of lead due to a water supply change, triggering state and federal emergencies. 

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Teens as young as 16 are working as volunteers in Czech Republic hospitals that have had 15,000 workers, including 3,000 doctors, sidelined by COVID in the country of 10 million. Czech Republic’s infection in rate is among the highest of major countries, six times higher than that of the US.

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The mother of a 14-year-old who receives brain cancer treatment from the National Institutes of Health emails staff to see if Dr. Anthony Fauci could drop by for a selfie. Fauci said no because of social distancing, but offered to FaceTime with Benjamin Ciment, who asked him if he was relaxing (no, but hanging there, Fauci said), laughingly confirmed that NIH has a painting of him on the wall that Benjamin had seen, and asked Benjamin if his hair was dyed. Benjamin said the hair color is due to his chemotherapy treatments, to which Fauci said, “Is it really? That’s one of the positive things of the medicine —  it looks kind of cool.”


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Weekender 10/23/20

October 23, 2020 Weekender No Comments

weekender


Weekly News Recap

  • Tibco will acquire Information Builders.
  • Teladoc Health announces that several Livongo executives will leave once the acquisition has been completed.
  • LabCorp uses the capabilities of two recent acquisitions to connect patients to drug company remote clinical trials.
  • Patient safety solutions vendor RLDatix acquires provider credentialing software company Verge Health.
  • A new report from Center for Connected Medicine and KLAS finds that the surge in telehealth will end if emergency payments go back to pre-COVID levels, as 80% of health systems say they will stop doing them.
  • Allscripts files a trademark lawsuit against telemedicine and urgent care company CarePortMD, saying the name is too similar to that of CarePort Health, which Allscripts is selling to WellSky.

Best Reader Comments

HIMSS relevant to CIOs? Not for years. CHIME is on the same path. (Justa CIO)

21st Century Cures Act has been a all-hands-on-deck issue for us for the past couple of months. We were already in a good place interoperability-wise and the deadline was a good excuse to review all our data-sharing policies and settings in our system. Since in Massachusetts, children are considered medically emancipated at 12, we have had to review our proxy settings and our patient portal setup in general. As far as our providers go, they have been complaining about the notes transparency and results release changes that the Cures Act brings with it. Unfortunately a mandate is a mandate, so there is not much anyone can do to push back against the impending regulation. (Craig Molway)

In my experience, staying after resigning invariably alters the relationship with your employer and you will never be fully trusted again. Additionally, this situation will certainly leak to your peers and other workforce members who will also look at you thru a different lens. (Festus)


Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Ms. M in Alabama, who asked for headphones for her kindergarten class. She said in late February, “We are so grateful for your donation. We have increased our use of the rolling computer lab and increased our on task time for our weekly target. Your generous donation has helped students focus more on their own screen. The headphones have minimized noise distractions. The students are more engaged in completing their learning lessons. Four of my students have even increased their pass rate while engaged in their lessons. The success rate can only go up from here. It has been a game changer. We couldn’t have done it without your help!”

A former chief of prosthetics and orthotics at Walter Reed National Military Medical Center pleads guilty to accepting money, travel, and sporting events tickets from a company to which he steered $25 million in equipment business. Federal agents asked him about unexplained cash bank deposits, which he inconsistently claimed came from selling bicycles at swap meets, moonlighting, and selling moonshine.

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A New York pediatric otolaryngologist who also serves as a county legislator, an opioid addiction prevention advocate, and an ordained minister is arrested in a sting operation where be planned to swap oxycodone for sex with a prostitute with whom he has had a long-term relationship. The married father of three thought he was texting with the sex worker he has been seeing for two years, unaware that she had recently died of a heroin overdose and that she had also been working as a police informant. Undercover agents used her phone to set up meetings in several sting operations, with a least one other doctor being arrested.

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Seven South Carolina hospital nurses form an honor guard to watch over the caskets of deceased nurses in funeral homes and to provide a Florence Nightingale Tribute at their funerals.

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A $7 million donation to Novant Health by former NBA star and current Charlotte Hornets majority owner Michael Jordan has supported the opening of two Charlotte, NC family medical clinics that bear his name.

In India, ENT surgeon Arup Senapati cheers up hospitalized coronavirus patients by dancing to a Bollywood movie song on his seventh consecutive day of COVID duty before he began mandatory quarantine.


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