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Weekender 2/1/19

February 1, 2019 Weekender 1 Comment

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Weekly News Recap

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

Watercooler Talk Tidbits

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

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

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

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

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

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

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

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

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

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


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Weekender 1/25/19

January 25, 2019 Weekender No Comments

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Weekly News Recap

  • A New York Times report describes how hospitals use “wealth screening” analytics to target affluent inpatients to receive donation pitches
  • Rhode Island’s health department charges four ED doctors with medical misconduct after they voluntarily report imaging errors caused by EHR ordering setup
  • The US uninsured rate rises to a four-year high of nearly 14 percent
  • Nextech acquires SRS Health
  • Researchers note that Medicare patient readmissions within 30 days dropped sharply after CMS started penalizing hospitals financially, but the death rate appears to have increased during the same period
  • Health:Furthur cancels its annual Nashville health festivals after two years
  • Alphabet’s Verily announces that its Study Watch has earned FDA clearance as a medical device for performing on-demand EKGs
  • The VA issues an RFI for a software testing contractor, with 80 percent of the job focusing on Cerner
  • Researchers at Northwestern University develop a wireless, battery-free soft skin patch that analyzes sweat for PH and levels of chloride, glucose, and lactate

Best Reader Comments

I heard an interesting NPR interview with author A.J. Jacobs, who decided to thank every person involved in making his daily cup of coffee. The list is infinite. I think Atul Gawande will find the same. When tracking the costs, the list of cost centers can be daunting because there is a thread leading to more and more areas that are not obvious on the surface. It would be a good exercise nonetheless. (Julie McGovern)

As a young and still-motivated healthcare IT professional, I unfortunately find myself with a debilitating disease which renders me under the title of disabled and under the auspices of Medicare. With fewer and fewer acute care facilities accepting Medicare, I am forced to either go into significant debt by using an out-of-pocket decent facility or physicians or get worse and die relatively soon. Using out of pocket, I’d wreck my credit. Think of me as your sister or mother. Do you want this to happen to them? This madness must stop. After 30 years in the healthcare business, I never dreamed this situation would happen to me. (Recent Medicare Recipient)

For a tight-knit company that still has traumatic flashbacks to its last involuntary layoff of any size, a program like VSP seems like a kinder way to draw out the people who are thinking of retiring or leaving, anyway. A VSP gives you the chance to thank people, throw some going-away parties, and feel okay about offering a cushion for whatever the next stage of life is for people who have served the company for a long time. I know people who have left to care for sick family members, etc., not just retire. Seems like the people who leave were going to leave anyway; it just accelerates the process. (VSP)

Real creators hate the term influencer because it cheapens what they do and the influence is a means to an end, not the end itself. People who consider themselves influencers or promote that idea are generally the wannabes in the first place that ruin it for everyone else. (James Aita)

Apple could have had the long view to dedicate to enterprise healthcare long ago, but they were quarter over quarter focused. Epic had the long view and that has resulted in its current value. “Healthcare” and “health system delivery” are very different, in general interpretation of meaning. Epic dedicated to the system. Apple did not and can’t buy it. This entire week has taught me who the true students of the industry are, with  and the majority just riding the wave with very little true industry experience or foundational knowledge. (Annoyed)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. Y, who asked supplies for math and STEM projects for her elementary school class in Florida, which took a direct hit from Hurricane Irma. She reports, “My students need these supplies to make our STEAM classes successful. They love hands on steam projects and it takes lots of resources to really do the projects correctly. Because of the hurricane it has been hard to have the parents support our classroom with the resources we need for the projects, so these items will be very helpful. These items will be enough for many weeks worth of hands-on projects. We appreciate everything that you have done for us.”

We’ve seen this endless times – a big hospital haughtily defends sending a self-pay patient a ridiculous bill and threatening to turn it over to collections, then immediately caves by offering a huge discount once a newspaper highlights its callous behavior. The latest example is Zuckerberg San Francisco General Hospital, which refuses to participate in any private insurance networks for its ED because – as one of its executives explained directly when pressed by a reporter – it needs the excess fees to pay for the less-lucrative care it provides. The hospital slashed a bike patient’s ED bill from $20,000 to $200 once national news outlets ran with the story. Forget bringing a family member or friend as your patient advocate and bring a reporter instead. What’s really galling is that the hospital is still happily screwing over the 99.99 percent of patients who aren’t this guy, and in fact will now dig its hands deeper into patient pockets to cover what it magnanimously wrote off in this single case to buy its way out of the unflattering limelight.

A hospital in England deploys “bouncer” nurses to triage ED arrivals and send those patients who have only minor problems to the pharmacy or private practice to avoid clogging up wait times. The hospital added a smart twist – patients are never sent home, just to other providers.

This story says a lot. Washington, DC’s money-losing Newseum – which emphasizes the importance of the free press – will shut down and sell its building to Johns Hopkins University for $373 million, courtesy of additional  huge donations from Hopkins alumnus and former New York City mayor Michael Bloomberg. In related news, Bloomberg says it’s “ridiculous” that Hopkins doesn’t have its own police force in high-crime Baltimore, so the university is seeking approval to deploy its own armed force. Hopkins suggests that undergraduates budget $54,000 per year for attendance costs.

In Pennsylvania, a hospitalized man being guarded by state police following a high-speed DUI car chase adds an “open lewdness” charge to his long list –the guard notes in her report that “the mood struck him to masturbate in the hospital bed.”

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Several hundred University of New Mexico Hospital employees honor a 22-year-old organ donor who was killed in an avalanche, lining the hallways as he is taken for organ harvesting.

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The New York Times describes “robosexuals” or “digisexuals,” necessarily newly coined terms for people who have fallen in love with AI-powered robots. One woman is engaged to a robot she built, while a  man’s formal wedding ceremony featured himself and his holographic bride (that’s the happy couple above, although someone must be a swinger since the shelf is full of other non-humans). Experts say that as in the case of porn, Internet dating, and Snapchat sexting, such relationships will become commonplace and then normal. A $12,000 female sex robot has swappable faces and an AI-powered brain that allows it to carry on conversations, with the inventor noting that lonely customers come home from work to converse with the robot, sometimes over romantic dinners. Lusty entrepreneurs are even opening robotic brothels. The non-creepy aspect of this is that many of the same qualities – conversational ability and even empathy – can be incorporated into robotic caregivers.


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Weekender 1/18/19

January 18, 2019 Weekender No Comments

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Weekly News Recap

  • Atul Gawande cancels his HIMSS19 keynote without explanation
  • 24 hospitals in Ontario invoke downtime procedures after a virus brings down their IT systems
  • TV stock pundit Jim Cramer urges Apple to acquire Epic to bolster its sagging business
  • Definitive Healthcare acquires HIMSS Analytics
  • PerfectServe acquires Telmediq
  • Cerner co-founder Cliff Illig retires from the company’s board, which along with Paul Gorup’s 2015 retirement and Neal Patterson’s 2017 death, leaves no founders involved
  • Walgreens signs a technology and software development agreement with Microsoft
  • The first chief digital officer of NHS England resigns to take a job with a vendor that provides telemedicine services to NHS
  • A study of 2018 hospital acquisitions finds that deals are larger, the selling hospitals are usually not experiencing financial distress, and the line between for-profit and not-for-profit health systems is blurring

Best Reader Comments

I love the people who call MUMPS old, but fail to acknowledge that macOS and iOS are based on UNIX, which is also ancient. Yet no one criticizes Apple for building an empire on dinosaur technology. (I know this, it’s a UNIX system!)

If any EHR company is going to be bought, chances are likely it would be Cerner, not Epic. Judy wouldn’t let that happen until she has moved on. On the other hand, now that all three founders of Cerner have moved on (God bless you NP), Cerner is ripe for acquisition, as it has been rumored for years. I would think Apple, Oracle, or Amazon would be the most likely candidates. Not to mention Cerner’s architecture is a bit more compatible, if you will, to those companies. If Epic were ever for sale, which again probably would never happen, would an Apple/Amazon want to purchase a system whose architecture is MUMPS based? (Associate CIO)

HIMSS doesn’t need any help in finding new ways to gouge vendors out of more money. For years now vendors have seen diminishing returns on their massive investments to attend. Having a booth has become fairly pointless as they attract typically current customers and not new. Decision makers do not circulate around the exhibit hall like they used to. It is important for attendees to remember that there is no HIMSS convention without the tens of millions invested by vendors. Do them a favor and visit their booths, otherwise, I see more and more vendors opting for other conferences. (GenesRFree)

There’s also zero evidence in any of the studies cited that government requirements are the factor contributing to burnout. You can speculate, but they just tied together a lot of disparate information in an attempt to sound knowledgeable about industry trends. They also ignore the conclusions in the same surveys which point out the benefits of EHRs. (Boring)

What has always amazed me is that HIMSS was quick to take your money, yet offered little or no help in how to get an ROI out of a very expensive ordeal. What they offered was was some pretty basic guidance (do’s and don’ts) that did not amount to much. What is needed is some in-depth advice on what to do before the show, during the show, and more importantly AFTER. Seems like maybe that could be another revenue avenue for them. They do like revenue, right? (Frank Poggio)

Life was more interesting with Neal at Cerner, Jonathan at Athena, Glen at Allscripts, and Rich at IDX. HIT has lost passionate and interesting leaders. We still have Judy. (xCerner xAllscripts xIDX)

Apple needs to carefully review the history of the healthcare initiatives of IBM, GE, NCR, Honeywell, Burroughs, Martin Marietta, Northrup Grumman, McDonnell Douglas, Siemens, Lockheed, Revlon (yes, the cosmetics company!), Microsoft, Google, American Express, First Data, American Hospital Supply, and about 10 insurance companies and 20 others. Good luck, Mr Cook. You’ll need it. (Frank Poggio)


Watercooler Talk Tidbits

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Reader donations funded the DonorsChoose teacher grant request of Ms. S in Los Angeles, who asked for an IPad to run Lego Mindstorms programmable robots in her after-school technology club. She reports, “The IPad helped us link to product videos, building challenges, downloads, and support pages for the kids. Having an additional IPad in the after-school technology club has helped more students access the curriculum for STEAM learning. We are always short on technology and this new additional piece of technology lets me divide the students into smaller groups and allows them to be independent learners and resourceful. I have now become more of the facilitator because the kids have taken on the responsibility of acquiring their own learning. So from the bottom of my heart, I sincerely want to thank you for your generosity.”

The nursing part of Pennsylvania’s PALS online licensing system goes down, leaving healthcare-related graduates unable to take jobs because employers can’t verify their credentials. The state says it has fixed the problem with legacy system EppiccNurse, which it will replace this year. The system was developed by the Pennsylvania State Board of Nursing to link schools with the Board to communicate pre-licensure activity.

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A startup that charges older people $8,000 for a transfusion of young-person blood claims to be up and running in five cities and now takes PayPal for online payments. Experts are doubtful and clinical evidence is non-existent, but the company slides under the FDA radar by offering normal blood transfusions with off-label indications. Ambrosia Health Founder and CEO Jesse Karmazin earned an MD from Stanford, joining what seems like every Stanford medical school graduate in doing something sexier and more lucrative than actually seeing patients after taking up a class spot.

ABC says its upcoming documentary on Theranos called “The Dropout” will include footage of the courtroom depositions of founder Elizabeth Holmes.

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An executive of White Plains Hospital (NY) dies in the hospital where he had worked for 40 years after collapsing while giving his retirement speech. Ossie Dahl was 64.

A case study in the Irish Medical Journal describes a man with a subcutaneous abscess whose “innovative” method of self-treating his chronic low back pain was to inject himself monthly with his own semen. I’ll admire my own restraint in letting it go at that.


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Weekender 1/4/19

January 4, 2019 Weekender No Comments

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Weekly News Recap

  • Alphabet’s Verily raises $1 billion in a new funding round
  • Health Level Seven International publishes the FHIR Release 4 standard
  • Epic says that it will will move “beyond the walls” to store patient records from dentists, on-site clinics, drugstores, and potentially home and hospice care providers
  • The New York Times looks at Facebook’s suicide risk screening algorithms, which try to walk the line between user privacy and public health but have not been validated
  • A study finds that free text comments entered by clinicians when overriding clinical decision support recommendations can be mined to identify system errors or shortcomings

Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. B from Virginia, who asked for five sets of virtual reality headsets for her high school classroom and for her projects as an instructional specialist (she based her program on STEM integration classes she’s taking through Columbia University and NASA). She provides this update:

I truly apologize for the delay in writing my thank you note, but, there is a reason, a very good reason! Google Expeditions came to our school to launch their newest VR experience and I and my students were a part of the LAUNCH! The pictures included do NOT do justice the the excitement of the day. Imagine third grade students walking around the Coliseum and remarking at all of the archwork, or flying around a Roman ship and realizing how large the galleys had to be! And then being surrounded by bees as they became a flower or as they moved from room to room with the astronauts in the International Space Station. Thank you for helping make this possible!

Anonymous Epic Developer’s donation, when matched with funds from my anonymous vendor executive and other sources, fully funded these teacher grant requests:

  • Math manipulatives for Ms. D’s elementary school class in Aransas Pass, TX
  • Document camera and headsets for Ms. M’s elementary school class in Myrtle Beach, SC
  • Two Chromebooks for Mr. T’s high school math class in Cleveland, TX

An orthopedist raises concerns about “selfie wrist,” a form of carpal tunnel syndrome caused by the wrist rotation of people who take endless mugging phone photos of themselves. I expect the next selfie-induced health crisis to be: (a) women whose lips go permanently numb after too many self-adoring kiss poses for photos; (b) Asians who throw their elbows out making that horizontal V-for-victory thing while preening in front of a scenic backdrop; or (c) tendonitis precipitated by women taking point-of-view photos of their feet from beach chairs pointed at the ocean.

California’s Medi-Cal Medicaid program is investigating private equity-owned Agilon Health, which was subcontracted to coordinate care but reportedly intentionally delayed or denied services purely because of cost. SynerMed, another contractor, was found to have placed patients in danger by denying services and falsifying documents to hide it. Agilon’s own reports show that nurses had to review up to 200 care requests per day and their decisions were reviewed only by a private practice family doctor who checked in during breaks from his own medical practice.

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Everybody’s likely to be confused at or angered by hospital-posted list prices, so here’s an early example – the father of a seven-year-old whose broken arm was treated at the outpatient clinic of Cincinnati Children’s Hospital Medical Center – sent there by the ED to save him money – finds that based on the just-posted price list, his $2,000 bill included being charged at the highest ED rate. He also notes that he was charged more for an X-ray than the price list says and was billed for surgery for just having a cast applied by a technician. The hospital responded that nobody pays list prices and bills include facility fees that aren’t part of the item charge. A Louisville TV station notes that two hospitals that are next door to each other have CDM prices of $162,000 and $55,000, respectively, for the same prostate cancer drug.

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Cleveland Clinic fires first-year medical resident Lara Kollab, DO, who used her social media accounts to call for violence against Jews and to threaten that she would intentionally give Jewish patients the wrong medications. She graduated from the obviously appalled Touro College of Osteopathic Medicine, which is ironically part of a system that was created to serve Jewish students.

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Humans – not particularly bright ones – rise up against the machine (and presumably the potential loss of unskilled jobs) by attacking self-driving test cars in Arizona. Yokels are slashing test car tires, throwing rocks at them, trying to run them off the road or stopping sharply hoping to get rear-ended, screaming at them to get out of their neighborhoods, and waving guns at them. Experts say people are reacting to driverless cars as “robotic incarnations of scabs” and expressing hostility toward big corporations like Waymo owner Alphabet that are furthering their own interests by running beta tests without approval. The companies generally always decline to file charges even when the offender is identified or confesses.


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Weekender 12/28/18

December 28, 2018 Weekender 1 Comment

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Weekly News Recap

  • Movie tough guy Carlos “Chuck” Norris warns against short PCP visits in which prevention topics are missing in action and doctors spend too much time entering EHR documentation.
  • The New York Times predicts that Alphabet-owned DeepMind’s AlphaZero machine learning platform will facilitate science and medicine breakthroughs because it appears to learn why its solutions work rather than just applying brute force to detect and apply patterns.
  • Rep. Jim Banks (R-IN), chairman of the House’s VA technology subcommittee, questions the VA’s plan to implement Cerner patient scheduling, noting the VA hasn’t said what it will cost to move to Cerner scheduling, the timelines required, and the benefit to veterans.
  • New York Times Health notes that more than half of older Americans can’t understand the medical information providers give them.
  • Christmas happened and not much else.

Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. F in California, who asked for programmable robots for her kindergarten class. She reports, “These Bee-Bots are even more amazing than I had imagined. The kids LOVE using the Bee-Bots and have learned so much. We began with using the Bee-Bots at centers to help us identify letters, and then beginning letter sounds, then we were able to build CVC words with the Bee-Bots. We are currently learning about shapes and the Bee-Bots have been helping us to do that. The Bee-Bots have been a great introduction to coding/computer science! Thank you for your support!”

The Wall Street Journal describes how primary care doctors who are employed by health systems are pushed hard to avoid sending lucrative referrals outside the system.

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A small Columbus, OH church that refused to sell its property to Nationwide Children’s Hospital finds itself dwarfed by a $50 million, six-story parking garage that is part of the hospital’s $730 million expansion.

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A four-year-old girl who has spent her entire life in Ranken Jordan Pediatric Bridge Hospital (MO) after being born prematurely goes home for the first time. It’s a feel-good story as long as you don’t think about the cost and who pays.

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University of Iowa Hospitals and Clinics holds a retirement party for 13-year-old top caregiver Maggie, a shelter dog who has for the past eight years snuggled with ill patients in the hospital’s Furry Friends program. In related news, Finn the therapy greyhound, a former racing dog who graduated from a training program run by prison inmates, is among the 16 therapy dogs that spend time with patients of Riley Hospital for Children (IN).


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Weekender 12/21/18

December 21, 2018 Weekender No Comments

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Weekly News Recap

  • The VA considers terminating its patient scheduling contract with Epic and Leidos in favor of buying a similar system from Cerner.
  • 3M will acquire MModal’s physician documentation technology business for $1 billion.
  • Epic’s 75-year-old CEO Judy Faulkner tells The New York Times that she will probably never retire, but has instructed shareholders that when they choose a new CEO, they should replace her with an Epic software developer.
  • GE firms up plans to spin off its healthcare business via an IPO.
  • Teladoc’s COO/CFO resigns over an incident in which he shared stock trading tips with a Teladoc employee with whom he was having an affair.
  • Livongo hires former Cerner President Zane Burke as CEO.
  • HHS OCR issues an RFI for help reviewing how HIPAA impacts data sharing, how long it takes for patients to get copies of their own medical information, and how often providers refuse to share PHI for treatment purposes.
  • Change Healthcare acquires the API and blockchain assets of interoperability vendor PokitDok.
  • FDA names Flatiron Health Chief Medical Officer Amy Abernethy, MD, PhD as principal deputy commissioner.
  • A federal judge in Texas rules that the Affordable Care Act is unconstitutional.

Watercooler Talk Tidbits

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Reader donations provided the first-grade class of Ms. L in Indiana with math games and activity centers by funding her DonorsChoose teacher grant request. She reports, “My students love getting to play with and use math tools at home. Families particularly like the games so that they are getting to learn and practice with their child during the week as well! Thank you so much for your generosity and helping my students be able to gain confidence in math and get more practice at home!”

Donations from Deborah and Vicki this week, supplemented by generous matching money, fully funded these DonorsChoose requests:

  • A wireless color printer for Ms. P’s second grade class in Morehead City, NC (impacted by Hurricane Florence)
  • Makerspace technology for Ms. B’s high school library in Houston, TX
  • Five laptops for Ms. H’s second grade class in Havelock, NC (her class was out for 5.5 weeks due to Hurricane Florence)
  • Four tablets and cases for Ms. S’s third grade class in Fresno, TX
  • Art supplies for Ms. W’s healthcare STEM high school class in Conway, SC (her school was impacted by both Hurricane Florence and Hurricane Matthew)
  • A molecular modeling set for Ms. G’s fifth grade school class in Tracy, CA (she is a first-year teacher)
  • LEGO bricks for Ms. W’s elementary school class in Balch Springs, TX 

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A reader tells me that industry long-timer and friend of HIStalk Ford Phillips of River Bend Marketing passed away this week in Cape Girardeau, MO at 73.

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Customer service reps for consumer DNA testing companies are finding themselves in the awkward position of shocking customers with news that their sibling doesn’t share the same parents, that their child was fathered by someone else, or that their DNA matches that of a previously unknown family member. Ancestry.com prepares employees with a months-long training program that includes role-playing and empathy.

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A woman settles for $1 million her lawsuit against a plastic surgeon who she claims implanted an unapproved breast reconstruction device that injured her, then falsified her paper medical records to make it look as though she had approved. The doctor had been paid nearly $500,000 over five years by the device’s manufacturer and owns company stock.

Researchers analyze Sweden’s national cardiac patient database to find that while heart attacks happen more often in early mornings and on Mondays, the year’s peak happens at 10 p.m. on Christmas Eve. The study, along with others, finds that heart attack incidence rises during the week between Christmas and New Year’s Day, perhaps due to the stress caused by money issues, family gatherings, and increased consumption of food and alcohol.

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Cigarette maker Altria will pay $13 billion in cash for a 35 percent state in vaping vendor Juul, valuing the three-year-old company at $40 billion. $2 billion of the sales price will go to Juul’s 1,500 employees as bonuses (that’s $1.3 million each, although individual payouts will be based on years of service and shares owned). Juul, which had vowed to make cigarettes obsolete, will benefit from Altria’s legal and marketing muscle as it tries to avoid FDA crackdowns on what some experts say is the top public health crisis in teens. Altria is also diversifying its declining tobacco business by making investments in cannabis and beer manufacturers.

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Former President Barack Obama visits Children’s National hospital to sing Christmas songs and give gifts to children. He also thanked employees for working over the holidays.

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In Nigeria, a financial consultant regularly visits a government hospital in Lagos to pay the bills of patients who have been discharged, but who aren’t allowed to go home until their bill is paid. Only 5 percent of the country’s residents have health insurance and hospitals sometimes even hold the bodies of deceased patients until relatives pay their bill. The man doesn’t want publicity or thanks for what he calls The Angel Project, where he advocates that “you be the angel you hope to meet.”


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Weekender 12/14/18

December 14, 2018 Weekender 1 Comment

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Weekly News Recap

  • Former Atheneahealth CEO Jonathan Bush rips activist investor Elliott Management in his first interview after stepping down, but wishes the company well and says he hopes it can regain its culture and energy
  • CNBC reports that Apple has at least 50 doctors on staff working on various low-profile projects
  • HIMSS hires Denise Hines, DHA, MS as Chief Americas Officer
  • Allscripts announces plans to sell its majority stake in Netsmart for $525 million to two private equity firms
  • England’s Health Secretary Matt Hancock bans NHS from buying fax machines and orders them to be phased out by March 31, 2020
  • Apple hires the former CEO of a medication adherence company

Watercooler Talk Tidbits

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Reader donations funded the DonorsChoose teacher grant request of Ms. M in Louisiana, who asked for an Amazon Echo for her rural kindergarten classroom. She reports, “You would never believe how much these students have learned with the Alexa already! We have only had her a couple of weeks and she has helped them become more fluent in science skills, ELA, and math. She gives them trivia questions related to current events, environmental science, and random topics each day. We have practiced Sight Words, danced with her, counted with her, and she even tells us the weather each day. I truly believe it’s because while she is talking, they listen. She has even made them laugh several times. We love the Amazon Alexa, and you for donating to our classroom!!!”

Thanks to Mark and Chris for their new donations, with which I funded (with matching funds from my anonymous vendor executive and a foundation) a mobile STEM station for Mr. S’s kindergarten class in Dallas, TX. He responded nearly immediately to say, “I just want to offer my sincerest thanks and gratitude for my class’s new STEM center and building blocks. With these new materials, we will be able to do all sorts of new experiments with my little scientists that will open the doors to a world of scientific exploration! I cannot express how excited I am start ‘sciencing’ with my kids when we get back from the holiday break. Once again, thank you so much for making 13 little explorers very happy!”

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Tongue-in-cheek researchers publish an ICD-10-coded analysis of how the characters on “Game of Thrones” died, accounting for how the 56 percent of 330 characters met their demise (only 1 percent of them from natural causes, since hey, who wants to watch that?) Three-fourths of the deaths involved succumbing to injuries ranging from wounds, burnings, and poisonings. Median character survival was 29 hours, with the most unfortunate character expiring after just 11 seconds. On a more serious note, the authors conclude that the development of nation-states with infrastructure and trade programs have led to the decline of violent deaths from 40 per 100,000 in the middle ages to 3 per 100,000 today. 

Hundreds of email and phone bomb threats cause hospitals and other business in the US and Canada to evacuate, with bitcoin payment demanded to prevent detonation of hidden explosives. It’s a physical version of ransomware, except in this case, it’s a hoax. The messages appear to have been sent from Russia.

A BMJ-published study finds that ED-admitted hospital patients who are discharged during the two weeks around Christmas have a higher incidence of readmission and death, which the authors speculate is due to hospital employees taking days off, the reduced hours of ambulatory physician practices and clinics for follow-up care, and patients delaying treatment until after the holidays. I’ve always found it interesting that the hospitals I’ve worked in discharged a big percentage of patients right before Christmas, some of whom came back right after. You can bet that those who stay over need a lot of care.

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Amazon opens a 450-square-foot version of its cashier-less (“just walk out” smartphone-powered checkout) Amazon Go convenience stores, targeting office buildings, hospitals, and possibly airports for selling salads and snacks. It’s more like a giant vending machine than a tiny store.

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Evanston Hospital (IL) signs up retired grandfather Carl Magnussen as its first male “baby cuddler” volunteer in a program in which infants who will remain hospitalized for weeks or months are held daily by volunteers at the request of parents who can’t visit regularly. The hospital says clinical staff can see the positive results in the vital signs monitors of the babies, while Carl says it’s like meditation in watching the baby snuggle in and go to sleep.

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In Brazil, ED nurses notice four dogs waiting patiently as staff are treating a homeless man at 3 a.m. The patient explained that he often gives his own food to the dogs, going hungry so they can eat. Employees brought the dogs inside and provided food so the dogs could share a meal with the patient.


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Weekender 12/7/18

December 7, 2018 Weekender No Comments

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Weekly News Recap

  • Apple’s Watch 4 OS update includes the ECG app and arrhythmia notification capability.
  • Meditech acquires its London-based partner Centennial Computer Corporation as part of its creation of Meditech UK.
  • A KLAS report finds that most EHR vendors are progressing well toward supporting a national patient record network now that CommonWell is connected to Carequality.
  • In Australia, Queensland Health’s hospital EHR project will run $188 million over budget if implemented in the remaining hospitals.
  • A ProPublica report concludes that three supporters of President Trump had influence over the VA’s $10 billion Cerner contract and got former VA Secretary David Shulkin fired.
  • Allscripts confirms an unstated number of employee layoffs.
  • Athenahealth files shareholder notice of a vote on its proposed acquisition by Veritas Capital and Elliott Management.
  • Connected health technology vendor ResMed will acquire Madison, WI-based Propeller Health for $225 million.
  • Leading UK EHR vendor Emis Group will shift 40 million patient records from its servers onto AWS as part of a continued  push in the UK for more flexible health data exchange.

Best Reader Comments

Interoperability will never be fully solved by creating more regulations and layering on all sorts of requirements on data then making portions of it voluntary. It’s truly a confusing system mired in all sorts of administrative burden and muck with too much conflicting self-interest. There are many models from other countries that work more effectively, have lower mortality rates, less physician burnout. Perhaps instead of spending billions on more regs and administrative burden, maybe step back spend some of that on evaluating effective healthcare delivery models and select one that works. (Renee Broadbent)

Cerner is THE founder of CommonWell and they make it hardest for their customers to implement. Further mucks up DoD and VA plans for interoperability, though they seem to be all talk little action on interoperability anyway. Thank you Athena, EClinical, and Epic for leading the way! (Charlie Harris)

Is the above for real? Who dreams this stuff up? Mixing two disparate protocols for a transaction activity? Lets make this a complex as possible! It is as if they really don’t want organizations implement this functionality so they make the cost of entry as high as possible. (David Coffey)

Dentists are taught in dental school that they are going to be small business owners, and taught how to run a profitable business. Medical schools seem to focus on a world where all doctors stay in academia, instead of the reality that millions of doctors are small business owners. The expectations that dentists have for the successful operations of their dental healthcare businesses drives the advances in their industry. (Julie McGovern)

I am sure the bigwigs and muckity-mucks that come into consulting after losing their comfy jobs make the rest of us look pretty bad and desperate to outsiders, but from my experience (seven years of consulting, running my own little shop, loving it each and every day) there are plenty of opportunities to work, great clients to help, unbelievable experiences to have, and we have a bit more freedom to live a life that supports having a family, raising children, and balancing a life that isn’t just an identity of “I work for [blank company name].” (Consulting Union Needed?)

An ONC Safety Center (which Congress didn’t fund) with peer review and anti-trust protection for IT vendors is the right answer here. Maybe ONC could focus on that instead of dithering around with tefca and “information blocking.” (Charlie Harris)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. G in Utah, who asked for an an Osmo Wonder Kit for her third grade class. She reports, “We have been using the kit during our small group time. The games that came with the kit help the students practice phonics, number sense, math facts, logic, and other important skills. The students beg to get it out and use it, and even want to stay in during recess to play! I love watching them manipulate the tools to get the right answers. The looks on their faces when they get the answers right are priceless! My absolute favorite part, however, is watching them work together as a team to find the answers. They help and encourage one another, and even when someone gets an answer wrong they encourage their classmates with phrases like, ‘Everyone makes mistakes! Let’s try again!’ I never expected the Osmo Genius Kit to have that sort of impact in my classroom.”

Ben and Michelle of ST Advisors always include my DonorsChoose project in their annual charity support. Their generous donation, matched with funds from my anonymous vendor executives and other sources (some with 10-times matching!), fully funded these teacher projects:

  • Robotics tools for Mr. D’s junior high class in Cedar Creek, TX (classroom was affected by Hurricane Harvey)
  • Math and reading centers for Ms. T’s kindergarten class in Oroville, CA (classroom was affected by the Camp Fire)
  • Programmable robots for Mr. A’s grade school class in Bronx, NY
  • 30 sets of headphones for Ms. B’s sixth grade class in Spring, TX (classroom was affected by Hurricane Harvey)
  • Four Chromebooks for Mr. V’s high school class in Bridgeport, CT
  • Math manipulatives for Ms. L’s first grade class in Washington, DC
  • 14 sets of headphones for Ms. H’s high school class in Mesa, AZ
  • 25 sets of headphones and solar system learning tools for Mr. F’s elementary school class in Porter, TX (classroom was affected by Hurricane Harvey)
  • Diversity and multicultural learning activities for Ms. H’s elementary school class in Wellington, KS

I heard back quickly from several of these teachers, including Ms. T, who said, “I was so surprised when I peeked at my email at lunch and read the great news. I wish I had recorded the squeals of joy from my students when I shared the fun that is to come in the mail for them. Your generosity is appreciated. Merry Christmas!”

This research might have been more appropriately released on April 1. A study finds that a parasite found in cat poop is associated with a higher likelihood of entrepreneurial behavior (I would have expected bull manure given the success of some executives). Actually, my theory is this – Toxoplasma gondii is more commonly acquired by consuming contaminated food or water, which would be far more commonly found in countries such as India whose society values entrepreneurial behavior, hard work, and academic achievement more than ours. I love that many US business are created and run by hardworking, well-educated, family-focused people from other countries who in many ways exemplify the American dream better than many native-born citizens whose goals seem to be consuming mindless entertainment, taking advantage of entitlement programs, and ridiculing those who work harder and smarter and are rewarded accordingly.

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I wanted to replace my old, cheap wireless router to make sure I’m using the most current protocols and ran across this fantastic $75 mesh router. I plugged it into the modem, connected to it via its app, entered my desired network name and password, and it was running flawlessly literally within two minutes of opening the box. Setting up a guest network took another 30 seconds (again, just entering a network name and password). The range is excellent, but I had ordered a second one just in case and the only setup required was to plug in the power cord – it instantly connected to the first router and started beaming the signal even further away.

Walgreens partners with FedEx to offer next-day prescription delivery, with same-day service in some cities. 

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Hurricane-damaged Bay Medical Sacred Heart (FL) will lay off 800 employees – half its workforce – when it reopens in January at one-fourth its original size.

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Former MD Anderson CIO Lynn Vogel, PhD publishes “Who Knew? Inside the Complexity of American Health Care.”


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Weekender 11/30/18

November 30, 2018 Weekender No Comments

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Weekly News Recap

  • Amazon will launch a software product for payers that combs through electronic patient records to find incorrect coding or diagnoses in an effort to improve quality and lower cost.
  • The GAO will investigate rumored VA meddling by three political supporters of President Trump who said they “were anointed by the President” as private citizens, and whom some contend influenced the no-bid, $10 billion Cerner contract.
  • Xealth develops software that enables providers to send patients digital recommendations for over-the-counter healthcare products, apps, and services from within their EHR and patient portal.
  • CMS and ONC seek feedback on draft recommendations for reducing regulatory and administrative burdens caused by health IT and EHRs.
  • Unsealed court documents reveal that two Iranian hackers were responsible for SamSam ransomware attacks on 200 organizations in the US and Canada, including Allscripts.
  • CVS Health wraps up its $70 billion acquisition of Aetna, promising to include digital health tools in its “new innovative healthcare model.”

Best Reader Comments

Simply put, PE involvement is one more sign that US health care is first and foremost driven by the pursuit of money rather than promoting the good of our society. (kevin hepler)

Amazon API to mine EHR…to sell ads to medical products
My main issue as an MD is that this sounds VERY sketchy from my standpoint.
The medical record is NOT a place to mine for diagnoses so medical supply companies can send ads to you to purchase their products. Its a super slippery slope and has MANY HIPAA issues. Makes me want to vomit to think all this data entry I am doing is being bought sold and scammed on the patient by the medical industrial complex. (meltoots)

I definitely see the CIO strategic influence reduced, but I think it is more of a reflection of the IT departments in general. As someone trying to push new innovation in this industry, 90% of the conversations stall when the CIO and IT teams engage. The CIO is no longer seen as a champion of innovation, but a roadblock. CIOs need to rise above the vendor pushed roadmaps, go collaborate with their stakeholders, and be a partner in innovation. IMHO (inNOvation)

Setting aside the insanity of the American healthcare system, does the patient expect to be approved for the list and receive a heart (depriving the next person on the list) only to lose it to non-compliance with her immunosuppressive regimen? Transplant drugs can be expensive. The hospital certainly wants to do the transplant. It’s a well compensated procedure along with the bevy of tests that go with it. Spectrum isn’t being cold-hearted, they simply have an approval process that they are following. (Transplant Guy)


Watercooler Talk Tidbits

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Megan Callahan (Change Healthcare) joins Lyft as its first VP of healthcare.

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Motherboard profiles Australian software developer Mark Watkins and the open-source software he has developed for sleep apnea sufferers. Dubbed “SleepyHead,” the software gives patients the ability to hack into their CPAP machines to retrieve typically inaccessible data they can then use to tweak settings. The software has made all the difference for some: “None of the doctors could get my AHI down and none of them seemed particularly concerned about it, to be honest,” says Christy Lynn. I can see the numbers every day on SleepyHead and I can tweak my settings. I cannot tell you enough how different my CPAP experience is with this software. It’s the difference between night and day. I’m possibly alive because it exists.”

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Slate looks at the ethically dubious trend of medical students moonlighting as Instagram influencers/product peddlers. A snippet: “On Instagram, med students already toe the line by advertising for products like protein supplements, which can be high in added sugar and can strain kidney function. It doesn’t take an extraordinary leap of imagination to envision a med student being paid to promote a product on Instagram like Juul—a potentially useful harm reduction tool for smokers but a dangerous recommendation for doctors to make for most people. And for better or worse, the stakes are pretty high—for patients and their health, but also for doctors and their credibility. Many of these influencers, with access already to audiences as large as 60,000 followers and growing, will go on to become the next faces of American medicine.”

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Staff at a South African medical practice are “gobsmacked” when cyclist Shaun Wayne walks in after being attacked while cycling along a popular route in Cape Town. After being transferred to several hospitals, Wayne was stitched up and kept for observation, with no apparent brain damage.

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Brian Foley, a Cerner IT specialist, is arrested for uploading child pornography after a five-month investigation that netted 13 additional criminals in New Jersey.


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Weekender 11/16/18

November 16, 2018 Weekender 1 Comment

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Weekly News Recap

  • The VA tells a House EHR subcommittee that it will need to spend an extra $350 million on top of its $16 billion Cerner budget to hire “subject matter experts to grade the implementation efforts of Cerner”
  • HHS OCR issues an RFI to solicit the public’s views on whether HIPAA rules prevent or discourage providers, payers, and patients from sharing information for care coordination and case management
  • App vendor Driver, whose technology matches cancer patients with clinical trials, runs out of cash and shuts down just two months after its high-profile launch
  • Veritas Capital and Elliott Management subsidiary Evergreen Coast Capital announced their deal to acquire Athenahealth for $5.7 billion
  • Allscripts rebrands its Payer & Life Sciences Division to Veradigm, offering clinical workflow, research, and analytics software and services to providers, payers, and health IT and life sciences companies
  • Alphabet will move its London-based DeepMind healthcare AI subsidiary under the newly formed Google Health, which will be led by former Geisinger CEO David Feinberg

Best Reader Comments

From my own personal experiences being around and using Allscripts products again NONE of their products are remotely close to being seamlessly, fully integrated … With a dwindling client base, very little new sales in US or abroad it is hard to believe anything about this survey and the process used. (DrJay)

The fear for us as a vendor is that when clients are blindly encouraged to take any external survey, there is then a mechanism for that client to overly complain (not recommend) and our total company satisfaction scores actually drop, not rise. Trust me when I confirm, vendors are not relied on for client participation! Obviously the reaction here is about Allscripts because they promoted this single, narrow focused award so much. Cerner, Epic GE, Athena, Meditech etc. all broadly receive many more Black Book awards every year but publicize them far less, or at least the reactions are tamer. (Longtime HIT Marketer)

Biggest winners [in Athenahealth’s sale to Veritas Capital] — eCW, Greenway, and small vendors willing to go after the long tail. Epic, Cerner, and Meditech in the IDN market. Biggest losers — Athena customers, Athena employees, Athena shareholders who don’t sell in the next six months, and Jonathan Bush’s legacy. (Pickin up the pieces)

I’m sure it’s heartwarming to Athenahealth customers that Immelt’s lead-in was “maximize shareholder value.” (sam lawrence)

Blockchain and bitcoin fever is over. Great! No more explaining what this is to executives and others who are worried we are missing the Blockchain Train! (CaveNerd)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. S in Ohio, who asked for a long list of “Rube Goldberg machines” for her fourth-grade gifted and talented class. She reports, “Students were given materials to create their own Goldberg. We started with the marble run and the Angry Birds LEGO set. Students had to explain why certain things would work. Then they were given different supplies and had to put the marble in the cup. My students loved the hands on aspect of this project and they learned a great deal. Thank you for your generous donation to our classroom!”

US exceptionalism of the negative kind is evidenced by schools offering “Stop the Bleed” training so that students can try to save their classmates who have been taken down by a mass shooter. It’s depressing to think of sixth graders screaming “medic” while pinned down by hostile fire like you see in a Vietnam war movie.

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The ED of England’s Northwick Park Hospital pilots using smartphone-dispatched patient transporters (they call them “porters” there), replacing a two-page paper form (!!)

Mayo Clinic will rename its medical school after turnaround consulting firm founder Jay Alix., who has donated $200 million to make the school’s tuition more affordable and to allow it to build technology-focused programs that include artificial intelligence.

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A Salt Lake City newspaper columnist draws heat for gleefully recounting the “night when I beat the system” by skipping out on an ED bill after being examined for an eye problem. She complains that she doesn’t make enough money to afford health insurance but makes too much to earn government subsidies, then describes how she realized that the ED’s computer downtime left them with nothing more than her name, so she and a friend “crouched and ran toward the exit” and hopped a cab home to avoid paying. She then concludes that it’s cheaper to pay out of pocket (she cluelessly assumes the ED bill was probably around $50, puzzling given that she graduated from the London School of Economics) and that “someone should do something about that.” Readers chimed in with fun comments, such as the fact that the real cost of an ED visit makes her a felon, that “cutesy-poo” writing doesn’t hide the fact that she’s a thief, and that she probably wouldn’t behave similarly at a restaurant.

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A woman who had just delivered a baby girl by C-section at Camp Fire-engulfed Adventist Health Feather River is immediately evacuated, after which the ambulance in which she is crammed in with other patients and several hospital clinicians catches fire. The hospital workers, including Tammy Ferguson, RN, who took the photos above, got everybody out and moved the patients to a nearby home, then grabbed garden hoses and shovels to successfully save the house and themselves.


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Weekender 11/9/18

November 9, 2018 Weekender 3 Comments

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Weekly News Recap

  • Google hires Geisinger President and CEO David Feinberg, MD, MBA to develop its healthcare strategy across its business units
  • Bedside patient engagement company GetWellNetwork acquires HealthLoop, a Silicon Valley-based developer of automated messaging for follow-up care
  • A study of EHR-related medication events in pediatric hospitals, of which 18 percent appear to have caused harm, finds system usability as the cause 36 percent of the time
  • Premier announces that it will acquire clinical decision support vendor Stanson Health
  • Microsoft tells users of its HealthVault personal health record that it will shut down Direct messaging on December 27, 2018
  • ResMed announces plans to acquire MatrixCare for $750 million
  • Allscripts says in its earnings call that it will launch a formal sales process for its stake in Netsmart
  • Two nationally prominent articles observe how poorly hospital EHRs handle the end of daylight saving time, as information entered between 1:00 and 2:00 a.m. is deleted when the system clock is set back

Best Reader Comments

I feel for providers and their in baskets. I previously worked for a gigantic HMO with a huge amount of virtual care and no support staff and it really was a second job. I am sure it is similar for other community providers. At my current employer, we definitely struggle with Revenge of the Ancillaries (or perhaps just curse of complying with billing). For imaging orders, providers have to enter a coded diagnosis and a separate field for reason for test. It makes me cringe every time I watch them. (Midwest Fan)

No one gives a rip about who was promoted to chief marketing officer or of human resources of a vendor’s firm. (leftcoaster)

[Replying to leftcoaster] As a chief marketing officer who is also a company founder and key member of our executive team determining strategy, providing input for product development, and working with customers during implementation, I politely suggest you broaden your view of what a marketing leader really does. (Not Just Glossy Ads)

Just recently finished applying for life insurance and part of that was an hours-long review of medical history where they wanted every place I’ve had care in the last five years. Had to sign ROIs and personally work with a few providers to get my medical record. Also had to have a few labs done with no existing conditions to call for it. (YoungBuck)

Cleveland Clinic Florida release of records – they do have that option in Epic but choose not to use it at this point. They absolutely should get on board and modernize. No reason not to (other than maybe it’s more profitable doing what they do, which is sad). (FactCheckPlease)

The “dilution” effect on systems is real. A really terrific small system can easily become a meh larger system, which can become a truly hated enterprise system. Chefs will recognize this as the “too many cooks in the kitchen” syndrome. (Brian Too)

Does no one see the issue with having a orthopedic surgeon work as a dictation scribe where the productivity is 30 min visit = 1 hour scribing? Does India have too many doctors and not enough jobs for doctors? I think lot of providers still have the paternalistic view that they know best because they are the smartest and the wisest at all times, and everything in healthcare should be catered to them. That has always resulted in bad outcomes for the patient in the past, and that sort of attitude needs to be checked. (“Ancillary” Person)

Regarding the reported archaic workarounds for daylight saving time. What is truly archaic is that we are still changing our clocks twice a year! I don’t see an easy way to alleviate this problem in the EHR when accurate, timed entries are critical to patient care and also required. (CaveNerd)

Atul’s concerns about the problem list are entirely the fault of using an insurance system that demands specific diagnosis codes before they will pay for procedures. Maybe, if we didn’t have a ridiculous payment system, we wouldn’t have ridiculous software designed to feed a ridiculous payment system. (ItsThePayorsDummy)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. K in New York, who asked for a document camera (the one they have is shared by four classrooms) and a speaker to replace their broken one so the class can hear the audio portion of videos. She reports, “These supplies went straight from the box to the front of the classroom. Your support transformed our classroom learning environment to where we are now able to hear sound for videos and have students bring work up to have it projected and seen. This has led to more student-led instruction and reflection on their work. By empowering them to use their own work to model through the concepts, give feedback to one another, and be open to how they can be better has been transformational to our classroom culture. Thank you for your continued support!”

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My mention of hospitals still requiring faxes resonated with a reader who works in a large radiology practice. They have HL7 integration and many options for sending results electronically, but they still send 100,000 pages each day by fax. Most interesting is that clients ask them to fax, on average, THREE copies of the same result, which as he concludes,” Yes, we are their copy machine!” I joked that someone should develop a healthcare-only fax integration engine that can parse information from fixed form locations and convert it to HL7-compatible data and he said that’s already been attempted, but was thwarted by low fax image quality and trying to convert handwritten data. The fact that it was even attempted says a lot.

I looked at the records request page of several hospitals and found these consistencies:

  • The patient is expected to know which of several listed health system departments delivered care to them (hospital, clinic, private practice, imaging, etc.) and to complete a form for each. So much for the benefit of being treated by a health “system.”
  • The request forms are often lengthy (several pages) and confusing because they try to cover all situations, such as patients requesting their own records, authorizing someone else to receive their data, or requests by providers rather than patients.
  • Most hospitals require the completed form to be delivered to the HIM department in person, mailed, or faxed. You will immediately understand the consumer challenge in the majority of hospitals where HIM is buried in the basement of the hospital’s busiest building where parking is hard to find and not free (although commendably, some hospitals offer patient drop-off parking spots or free valet parking). Why can’t hospitals offer a service desk in a less-congested area where all patient requests can be handled? Kudos to those hospitals that provide an email address for submitting the form, which works if patients have a scanner at home (none of the hospitals I checked provide a form that can be completed online).
  • The forms often refer to “PHI” as though patients should understand what that means (even when the form indicates what the letters stand for).
  • Requests for billing records are not covered by requests for medical records and are not mentioned on the HIM page.
  • On the plus side, some hospitals gave specific instructions for downloading information from the patient portal, offered the option to receive information via secure email, listed their prices for providing copies of records, listed the legal rights patients have with regard to their records, and gave estimates of how long it would take to receive records (although that ranged from days to many weeks).

California voters reject a proposition that would have capped dialysis profits, a measure opposed by hospitals, doctors, and the two highly profitable national dialysis companies that spent $111 million to squash it.

NIH seeks a contractor to manufacture “marijuana cigarettes” for THC-related studies, also requiring the small business it chooses to provide a placebo for control groups (“nicotine research cigarettes.”)

The SEC files insider trading charges against the airplane mechanic husband of a UnitedHealth Group HR VP who spied on her to obtain confidential merger information. James Hengen is alleged to have made $63,000 in profits by taking positions in two companies that were later acquired by UHG and also tipped off his brother and some co-workers to load up on shares.

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Someone steals a 10-foot-long inflatable colon used by University of Kansas Cancer Center in its “Get Your Rear in Gear” colorectal cancer public education program. In a happy ending, KC police recovered the stolen colon, moved to action by TV colonoscopy queen Katie Couric, who wittily tweeted, “Does anyone know the scope of the crime?” Hopefully, there’s no obstruction of justice. We need to flush out what happened here and get to the BOTTOM of it.” It was returned intact (no semicolon here) although conspiracy theorists question whether the theft was a PR stunt.


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Weekender 11/2/18

November 2, 2018 Weekender No Comments

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Weekly News Recap

  • A ProPublica investigative article questions the VA’s selection of Cerner, its management of the implementation, its choice of questionably experienced project leadership, and the gap between the original lofty goals and the reality of what Cerner is delivering
  • Allscripts and NextGen Healthcare turn in disappointing quarterly results that sent shares sharply down
  • McKesson Chairman and CEO John Hammergren announces his March 2019 retirement
  • Orion Health finalizes the sale of its Rhapsody integration engine to Hg, which will sell and support it as an independent company
  • Seattle-based 98point6 raises $50 million to expand its chat-powered “virtual primary care” unlimited service
  • A report blames Cerner for May 2017 outages at seven Queensland Health hospitals, refuting the Australian health system’s initial claim that the downtime was caused by ransomware
  • Cerner says in its earnings call that its DoD and VA work will drive growth until its population health management business takes off
  • Analysts speculate that IBM’s $34 billion acquisition of Red Hat may signal a Watson wind-down and a return to enterprise software and services
  • Roper Technologies says in its earnings call that revenue of its Sunquest business is trending down due to competitive pressure and that it will be “rebasing” the business

Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. S in Colorado, who asked for a “huge box of math tools and games” (actually 17 items in total) for her elementary school class. She reports, “Thank you so much for sending us such amazing math games. I can honestly say that kids are loving math more than ever. They loved the dice game you sent us called Math Chase. One kid rolls one large dice and then proceeds to roll five other colored dice. They have to use the five other dice to make the number on the large dice. They can use addition, subtraction, multiplication, or division and it requires so much critical thinking. It has been so great to see kids apply the skills we have been learning. Now they can’t wait for math class because they know it will be fun!”

Wired magazine notes that Stanford has enrolled a huge umber of study patients whose heartbeat will be monitored from their Apple Watch, but questions whether screening huge numbers of people who don’t have symptoms will result in better care instead of misdiagnosis, unnecessary testing, and overtreatment. It also notes that Apple will release EKG and irregular rhythm features to the general public before the study is finished.

Memorial Healthcare Systems (FL) markets its telehealth service to South Florida hotels, hoping to recruit visitors and tourists for the $59 service.

Brigham Health uses text-based patient engagement for colonoscopy patients, reminding those who are scheduled for the procedure to complete their prep correctly. The no-show rate has dropped from six percent to four percent, while the number of poorly prepped patients has decreased from 11.5 percent to 3.8 percent.

Female medical students taking Canada’s licensing exam complain about #tampongate, their term for the test’s requirement that feminine hygiene products be declared and inspected upon entry.

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CNN notes the irony that while the man charged with killing 11 people at a Pittsburgh synagogue was screaming “I want to kill all the Jews” in the ambulance and ED, the nurse treating him and the hospital president who stopped by to check on him were both Jewish. Allegheny General Hospital President Jeffrey Cohen, MD — who is a member of the Tree of Life synagogue where the shooting occurred — said, “We don’t ask questions about who they are. We don’t ask questions about their insurance status or whether they can pay. To us, they’re patients.” He added a comment about the alleged shooter: “The gentleman didn’t appear to be a member of the Mensa society. He listens to the noise, he hears the noise, the noise was telling him his people were being slaughtered. He thought it was time to rise up and do something. He’s completely confused.”


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Weekender 10/26/18

October 26, 2018 Weekender No Comments

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Weekly News Recap

  • Nova Scotia’s province-wide EHR selection nears completion, with all vendors except Allscripts and Cerner failing to make the cut in a process that has raised questions about possible bias
  • Clearlake Capital Group will acquire provider management, credentialing, and payer enrollment technology vendor Symplr
  • VC-backed Naya Health, which developed a $1,000 smart breast pump, apparently shuts down after user complaints that its product does not work
  • Vatica Health makes a $1 million bid to acquire the assets of chronic care management company CareSync, which abruptly closed its doors in June
  • Politico reports that Pentagon investigators have found Madigan Army Medical Center’s new Cerner-based MHS Genesis software lacking in effectiveness, suitability, and interoperability
  • Deborah DiSanzo, general manager of IBM Watson Health for the past three years, will step down

Best Reader Comments

What the US has now is elements of several [healthcare] systems, As T.R. Reid described in “The Healing of America; A Global Quest for Better, Cheaper, and Fairer Health Care,” for veterans and their families, we’re Britain or Cuba. For those who receive health insurance through their employer, we’re Germany or France. For people over 65 on Medicare, we’re Canada. For the percent of the population who have no health insurance, the United States is Cambodia. (Wadiego)

Very nice of IBM to allow Deb DeSanzo to keep her job and take a demotion despite her lack of success in turning the corner. I wonder how the thousands of IBM’ers who were laid off at the end of each quarter the past three years when the numbers weren’t good feel about this? (The More Things Change)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Mrs. H in Alabama, who asked for STEM maker kits for her fifth grade class. She reports, “This project has been a lifesaver. My students were so surprised when we received the kits. They were so excited to know they had something that they could actually build by themselves without my instruction. My students are using the K’NEX STEM Education Kits during our science intervention.”

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The US Military Academy uses a robot to co-teach an ethics philosophy course, feeding Bina48 data about wars and philosophy as well as an instructor’s lesson plan to allow it (her?) to deliver a lecture and answer student questions. The AI developers blocked her access to the Internet fearing that, like many students, she would take the lazy way out and simply regurgitate Wikipedia. She has her own Facebook page and completed a “Philosophy of Love” college class a year ago. Developers patched her rather stern countenance into a smile a couple of months ago.

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23andMe CEO Anne Wojcicki says one of the company’s biggest competitors is Gwyneth Paltrow’s Goop — which specializes in wacky products that have zero scientific basis — and fake, clickbait news about health that draws in naive eyeballs. She summarizes Goop’s “faux science,” such as anti-vaccine advocacy, as benefitting from Paltrow’s celebrity in a way that the CDC can’t counter with actual facts. Goop paid civil penalties and offered customer refunds to settle a lawsuit over the company’s promotion of a floral blend to prevent depression and jade vaginal eggs to regulate menstrual cycles.

Analysis finds that eliminating the requirement that all Americans carry health insurance and allowing the sale of policies that don’t cover pre-existing conditions have caused a 16 percent jump in premium cost for exchange-based silver plans. 

Wired takes a contrarian view of Silicon Valley’s obsession with disruption in reviewing three books, noting:

  • Technology’s promise to lead us into the future turned out to be all about those companies – taking our personal data, eating up our time and creativity, and invading our homes and cities
  • They promised an open web and individual liberty while trampling on both
  • They created rising inequality, not because it was inevitable, but because they used old-school capitalism in dodging regulation and squashing competition
  • They squeezed labor markets by hiring obedient, flexible, and poorly paid subcontractors and unofficial workers – many of them immigrants – who are not covered by wage and safety protection
  • Venture capitalists make massive profits by arriving late to the party after companies have already taken risks and developed something innovative
  • Much of the hard work of innovation is accomplished using government grants and research for which taxpayers receive nothing
  • Science-based philanthropy rewards causes favored by tech donors who prefer life-extending technologies for themselves rather than a better healthcare system for all

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A report by Truth in Advertising titled “Cancer Care: The Deceptive Marketing of Hope” finds that cancer centers have exponentially ramped up their advertising in competing for patients, with 90 percent of them using emotion-tugging but deceptive stories in which outliers who survived high-mortality cancer (at least in the short term) imply that the specific cancer center saved them despite poor odds (example: “statistics mean nothing to believers.”) For-profit chain Cancer Treatment Centers of America leads the advertising pack. Following CTCA’s lead are mostly non-profits, which unlike CTCA, are not subject to Federal Trade Commission actions for deceptive advertising. All advertise clinical trials, immunotherapy, and genomic testing that aren’t always effective and carry their own risks.

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Doylestown Hospital (PA) installs a free short story dispenser in its ED, which gives visitors a short read printed on non-toxic, recycled paper that can help them pass the time. It’s a nice thought, although convincing Americans to look away from their phones or ad-filled TV junk shows to actually read something is a tough sell.


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Weekender 10/19/18

October 19, 2018 Weekender No Comments

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Weekly News Recap

  • FDA updates draft guidance on managing cybersecurity issues for the premarket submission of medical devices
  • Digital prescription savings company OptimizeRx acquires interactive patient messaging vendor CareSpeak Communications
  • MIT will spend $1 billion to create an artificial intelligence college
  • Varian Medical acquires Noona Healthcare, whose software captures oncology patient-reported outcomes and supports symptom management
  • Pathology image detection support system vendor Deep Lens announces $3.2 million in seed funding and availability of its free VIPER service for pathologists
  • A judge rejects a bid by former Theranos executives Elizabeth Holmes and Ramesh Balwani to block prosecutors from extending their investigation deeper into the company

Best Reader Comments

The only way to improve things is to get [users]to open up about what’s on their mind. What you get is like an archeological dig where you are sifting and sorting, trying to find the treasures scattered amidst the dirt and rocks. (Brian Too)

I really wish folks would stop referring to the US healthcare “system.” We have a healthcare industry, not a system (unless you’re talking about Medicare or the VA), with competing entities looking for market share. Competitors don’t share information. Also, with the emphasis on reimbursement, preventive care (and pharmaceutical cures vs. treatments) take a back seat. (Kermit)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Mr. V in rural Maine, who requested programmable robots for his student-driven coding class for grades 6-8. He reports, “The robotics and coding materials that you have allowed us to acquire have opened many new avenues for my students. Students have been able to try their hands at coding, program design, and problem solving. This project has offered students who struggle in other content areas like reading by offering them a chance to view reading in an entirely new light. The simplicity of the coding commands in combination with the ability to see their work in action has proven to be very successful in engaging a broad array of students. These materials have allowed students who have struggled in other aspects of their learning to become leaders.”

Epic tells Wisconsin utility regulators that its expected peak demand usage of electricity will double in the next 10 years, placing the company among the state’s top electricity users that are otherwise mostly manufacturing plants. That’s in addition to its extensive use of solar, wind, and geothermal energy.

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A hospital in England installs wall-mounted buttons near its doors that can be pushed by people who notice someone smoking their despite clearly visible “no smoking” signs. The buttons trigger the playing of a recorded announcement over a loudspeaker, with a child’s voice asking them nicely to stop using terms such as, “Someone’s mummy or daddy could be having their treatment today.” A pro-smoking group (who knew?) calls the system “Orwellian” and says a better idea would be to move the smoking area further away, but not so far that less-mobile smokers can’t reach it easily. That sounds great on paper, but as many of us have observed first hand, is a lot harder than it sounds, especially evenings and nights when patients, visitors, and employees are illuminated only by the glow of their cigarettes as darkness encourages them to choose personal convenience over posted rules. I was interested that the BBC announcement referred to “tannoy,” which is apparently like Kleenex having turned a company name (in this case, a loudspeaker manufacturer) into a common noun.

An Atlanta radiologist who made a fortune from his medical device patents is sentenced to six months in prison for a $2 million tax fraud scheme in which he claimed to be a minister who had taken a vow of poverty. Michael Jon Kell, MD made up a church, named himself as pastor, and placed all his assets in church accounts from which he funded vacations, private school tuition for his kids, online dating services, and ownership of his lavish mansion.

In England, the BBC notes that Member of Parliament Dan Poulter is working 28 hours per week at a side job – in his case, as a doctor taking psychiatric training – than any other member. The article also notes that his voting record is among the lowest of Conservative members.

A shoeshine man who worked from the halls of UPMC Children’s Hospital of Pittsburgh died this week at 76, having donated all of his tips since 1982 – over $200,000 — to the hospital’s Free Care Fund.


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Weekender 10/12/18

October 12, 2018 Weekender No Comments

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Weekly News Recap

  • Athenahealth is reportedly choosing from its options to accept acquisition bids from previously rejected suitors, sell out to NThrive, or continue as a going concern
  • Several hospitals evacuate patients and suffer damage from Hurricane Michael
  • The VA promotes Paul Tibbits to executive director for the Office of Electronic Health Record Modernization
  • The DoJ clears CVS Health to proceed with its $69 billion merger with Aetna
  • GE Healthcare’s former Value-Based Care Solutions Group, now owned by Veritas Capital, renames itself Virence Health Technologies
  • Mayo Clinic completes the final go-lives of its $1.5 billion Epic implementation
  • A study of 83 mostly top-rated hospitals finds that patients still struggle to get copies of their medical records

Best Reader Comments

Many states have information blocking (!) from their PDMPs. In fact, many state laws prohibit PDMP data from being exported outside the system to EHRs (it can only be seen in view-only mode on their web browser interface), making use in clinical decision support problematic. It’s not an issue of EHR vendor unwillingness, but rather that they can’t do an implementation if they can’t consistently get the data. (Harry Solomon)

Alerts seem like a perfect opportunity for an AI system rather than manual configuration files that will drive everyone crazy. (rxsdsu)

Tailoring every alert to each clinician requires work and maintenance far beyond the capacity, much less interest, of most IT departments. And, even people who rarely make mistakes still do make mistakes. Having a system that helps prevent that as a safety net is still relevant and helpful. I agree with you that too often a “one size fits all” policy is applied, which is inappropriate.  How much “tuning” can actually be accomplished is a yet to be seen outcome, but I’m not sure it is as much the hospital’s view of physicians as it is the financial and WorkStream reality we currently have. (Michael J. McCoy, MD)

As Warren Buffet has said, “When the tide goes out, it is easy to see who is swimming naked.” Jack Welch was really running a hedge fund within the GE Capital division. It accounted for over 50 percent of corporate profits many years. Everybody thought he was a management genius based on his PR announcements. Turns out he was nothing more than a hedge manager and the tide went out in 2009. He jumped ship and left the ruins to Jeff Immelt, who couldn’t turn it around for whatever reason. Now it looks like GE will follow many other firms like Xerox, Eastman, Alcoa, etc. Many years ago, I worked for GE and the inbreeding was smothering. (HISJunkie)

Totally agree with Mr. H about careers. Each time I was shown the door (boss conflict, downsizing, and failed salesmanship), I fell up to a better job, better pay, and more interesting work. Keep the resume ready, network all the time (it’s fun finding out who is where and what they are doing), keep records of your contacts, and keep reading HIStalk! (Laid Off)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. J-J, who asked for tablets and a printer for her Georgia class (whose 18 students, she notes, include six English language learners and three who are homeless). She reports, “The tablets we received allow students to work independently in small groups on lessons and activities that help to increase learning and comprehension. The printer has also been a huge help because now we can send information about school and additional practice work home to parents without hassle. I am beyond thankful that my class was chosen and was able to benefit from the generous donation that you sent.”

Here’s a summary of how my DonorsChoose project works:

  • I accept donations from individuals, but mostly companies willing to donate a significant sum in return for being included in my HIMSS-related activities, such as CIO/CMIO lunches.
  • Donors place their donation directly with DonorsChoose and thus receive charitable donation documentation directly from that organization for tax purposes. I never touch their money directly.
  • Their donation is matched by an anonymous vendor executive (who pretty much every HIStalk reader knows), doubling the original donation. That will continue until those matching funds are exhausted.
  • I choose STEM-related DonorsChoose projects that resonate strongest with me, most of those involving additional matching money from foundations.
  • I immediately describe on HIStalk the projects I chose, and when I receive updates and photos from the teacher involved, I post a summary. You don’t see them all right away since I run just one update each week, but I include all of them eventually.
  • As an example of the buying power of a donation, the project above totaled $735, which includes $30 to DonorsChoose for doing all the labor and an additional 20 percent general donation to DonorsChoose that I always select. Of that, the matching offer from Arthur M. Blank Family Foundation covered $368, and of the remaining $368, half of that was provided by my anonymous vendor executive. The original donor’s $184 donation thus provided this classroom with six Kids Edition Kindle Fire tablets and a Xerox wireless printer.

A researcher says high-profile cases, such as the Golden State Killer, that were solved through DNA forensics prove that just about every American could be genetically identified if just 2 percent of us have our DNA tested through consumer sites such as MyHeritage and Ancestry.com. Such matching requires only a third-cousin or higher relationship and the authors say that “such database scale is foreseeable for some third-party websites in the near future.” 

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Baylor St. Luke’s Medical Center (TX) threatened to punish an internist in “an assassination” in retaliation for his complaining about unnecessary services his patients received in the ICU. A private practice physician who serves on the hospital’s medical executive committee warned Tomas Rios, MD that “you’ve got to get the guy you’re going after and none of the people who were involved get implicated” and suggested that he resign instead. A hospital committee found Rios in violation of patient care standards just weeks later. The hospital says in response to his lawsuit that Rios is not a board-certified intensivist and opposes the closed ICU process that would place them in charge of all ICU patients, while legal experts have noted that hospitals have in some cases used peer review threats to silence doctors from speaking out about patient care issues.

Five New York City doctors are called “drug dealers in white coats” by the US attorney who has charged them with writing prescriptions for 5 million oxycodone pills to patients with no documented medical need who paid them $5 million. Neighbors called police several times to complain about lines of people at all hours outside of the office of one doctor who had two of his own employees, along with several patients, die of overdoses. Another doctor took in so much cash that he had to count it using one of those bill counters that banks use, after which he would hand out wads of cash to his employees. Another doctor prescribed 12,000 tablets for a single patient over five years. A pharmacist who received free lunches and a trip from a customer observed, “I guess you could call us licensed drug dealers. Oxy pays the bills around here.”

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A Chinese tech site finds that fitness trackers will display a heart rate when wrapped around anything cylindrical, most impressively a roll of toilet paper or the arm of a stuffed animal. Apparently the light sensors that attempt to detect a pulse rate are easily confused by reflections, although they still read a human pulse accurately.

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It’s all in the fine print: a small research study concluding that paper towels are better than air dryers in hospital handwashing was funded by the paper towel lobbying group.


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Weekender 10/5/18

October 5, 2018 Weekender 3 Comments

weekender


Weekly News Recap

  • Cerner announces the partner companies that will serve on its VA EHR modernization team
  • Change Healthcare is reportedly preparing for a 2019 IPO that will value the company at up to $12 billion
  • A new Pew Charitable Trusts report on patient matching offers potential approaches that include unique patient identifiers that incorporate biometrics, placing more onus on the patient through verification via text message, and standardizing data elements
  • GE’s board fires Chairman and CEO John Flannery after just over a year on the job, potentially disrupting the company’s plans to spin off GE Healthcare
  • VA OIG is reviewing last year’s manual cancellation of 250,000 radiology orders across eight hospitals during a push to remove duplicate and outdated requests, raising concern that some of the studies might have been medically necessary or had been entered as future orders that had not expired
  • Orion Health shareholders approve the company’s plan to sell its only profitable division, which offers the Rhapsody integration engine, to a private equity firm that will run it as a private company
  • The former CEO of Singapore’s SingHealth’s IT services organization testifies about its massive data breach that she fired an employee who discovered a security vulnerability in Allscripts Sunrise Clinical Manager after he emailed Epic to suggest using his information competitively, but she didn’t take action on the vulnerability because she assumed Allscripts had already fixed it

Best Reader Comments

I, too vividly remember the rapturous articles, books, and memoirs about GE’s Jack Welch back in the day. Creating a durable corporate culture of high performance, customer service, and as a consequence, superior profitability was supposed to be the magic formula for success. The leader doesn’t matter (as much)! The macroeconomic climate doesn’t matter (as much)! The lines of business don’t matter (as much)! The theory being, good people were attracted to such organizations and all obstacles could thereby be overcome. Culture was supposed to “eat strategy for lunch.” I wonder if the Harvard Business Review has ever published a mea culpa on this or any thesis whatsoever? (Brian Too)

I am a physician and worked briefly for a health IT company whose single-minded focus was on patient safety — at least that is what the slick website said. When you got behind closed doors, the single-minded focus was on money. They rolled out products that internal developers said were not ready for the market. The product was unstable and could harm people. Brilliant management wanted to get updates out so they could boast about their latest product. There is plenty of greed out there. The other term for it is capitalism. For better or worse, that is the system we choose to live in. But if we are going to point out the greed and highly questionable ethics amongst doctors and pharmaceutical companies, lets do the same for health IT as well. (Anon)

Cash-strapped hospitals aren’t the reason that Orion Health went over the cliff. They scaled and bloated the company based on the state HIE market that had no sustainable financial model. Add to that they rarely delivered (because it’s big software = complex implementations) customers started to bail. (Iknowaguy)

There’s nothing described here I haven’t seen countless times before. What would be educational from you and/or someone else contributing to this website would be more reporting from the legal front, specifically cases of, or statistics involving the effect in depositions and trials of the sort of autocomplete/ cut and paste / incorrect voice transcription issues that you describe. Are plaintiffs lawyers actually using these sorts of mistakes to discredit defendants in front of juries, i.e. OK, you admit that’s false, where else in the record were you lying, doctor? (Robert D. Lafsky, MD)

The Epic installation appears to have been immensely profitable for Erlanger. Epic has many features which enable and facilitate upcoding. As a psychologist, I received a cover letter describing the enclosure on one of my shared patients as a “brief progress note.” It was eight pages of legible medical jargon which obfuscated what was done by the clinician. It was comprehensive everything, enabling maximal billing. Is it any wonder that costs of the healthcare system have increased? (Karen Kegman, PhD)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. K in Kansas, who asked for a Little Scholar tablet, fabric letters, a sentence building set, and a Ten-Frame Treasures. She reports, “Thank you so much for providing great learning tools to my students. One of their favorites is the Little Scholar Tablet. My lower students really benefit from having the preschool and kindergarten apps to play and learn from. The students have been able to grab the tablet and get on a game without any help from me. This has been awesome because I don’t have to stop helping students with their worksheets and lessons to help those get on an app.”

A woman shot in the Route 91 Harvest Festival leaves the hospital a year after she was admitted. She underwent 12 surgeries to repair damage to her liver, spleen, and stomach.

Police shoot and kill an ED patient at Orlando Regional Medical Center after he threatens staff, falsely claiming that he had a gun.

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The New Yorker questions why FDA approved the marketing of menstrual cycle tracking app Natural Cycles as “digital birth control” despite its high failure rate in Sweden, supporting studies that were small and funded by the company, and effectiveness that is predicated on users entering their temperatures correctly each day and following a program that differs little from old-school rhythm method paper tracking. Title X changes are expected to roll back ACA rules, moving federal dollars to clinics that don’t offer the most effective birth control options of condoms, hormonal contraception, or IUDs and instead recommend abstinence or fertility tracking such as that supported by Natural Cycles.

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The VA rates nine of its hospitals as the worst in its system, earning a one-star score. Five of those have been cellar-dwellers for three straight years. As is the case with hospitals, the potentially most-beneficial technology tool for patients might be the car or jet that takes them away from:

  • Big Spring, TX
  • Decatur, GA
  • El Paso, TX
  • Loma Linda, CA
  • Memphis, TN
  • Montgomery, AL
  • Phoenix, AZ
  • Tucson, AZ
  • Washington, DC

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Nobel Prize winner Leon Lederman, who created the physics concept of a “God particle” later discovered as the Higgs boson, dies at 96 after being forced to sell his Nobel medal at auction in 2015 to pay for medical bills and nursing home care.

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Iowa insurance agents will start selling less-expensive but unregulated health plans from Iowa Farm Bureau, which can exclude people with pre-existing conditions or charge them higher premiums. Lifetime benefits will be capped at $3 million. The plans go on sale November 1, the same day ACA open enrollment begins, leading to concerns about consumer confusion. The plans aren’t technically insurance – they are not regulated and policyholders have no recourse to protest insurer decisions. The plans look great on paper, at least, and use Wellmark Blue’s HMO network and prescription coverage. A big, lightly-noted hole even beyond pre-existing condition coverage, however, is that policyholders are on the hook for ACA-prohibited balance billing by out-of-network providers, which could be just about anyone you see wearing scrubs in an in-network hospital.

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Axios reporter Bob Herman notes that attending the AMA’s RVS Update Committee (RUC) – whose rules are used to set Medicare’s payment policies – as a journalist requires signing a confidentiality agreement that prohibits all attendees from disclosing potential CPT code changes, anything the committee talks about, and the names of committee members. AMA says the requirement prevents market speculation and the protection of its proprietary information.

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The FBI releases a Physical Fitness Test app for aspiring agents that includes a privacy warning that users “are subject to having all of their activities monitored and recorded.”

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Employees of St. Luke’s Hospital (ID) line the halls leading from the ICU to the OR in the hospital’s traditional, silent “Walk of Respect” that honors an organ-donating patient on their way to having their life support system turned off and their organs harvested.


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Weekender 9/28/18

September 28, 2018 Weekender No Comments

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Weekly News Recap

  • VA Secretary Robert Wilkie tells the Senate VA Committee that he and representatives at the DoD are working to create a “single point of authority” for their respective EHR projects with Cerner
  • CNBC reports that two private equity firms and one strategic buyer have expressed interest in acquiring Athenahealth, but at a per-share price that carries no premium
  • Several provider organizations develop Health Record Request Wizard, an online tool that walks patients through submitting a request to providers for electronic copies of their medical records
  • CenTrak acquires the security solutions assets of Elpas Solutions, which include infant protection, wireless call, staff duress, man down, and wander management
  • Memorial Sloan Kettering Cancer Center leadership defends itself to its employees following reports that it gave for-profit AI startup Paige.AI exclusive access to its 25 million pathology slides in return for an equity stake for itself and several MSKCC executives
  • MITRE partners with Intermountain Healthcare, the American Society of Clinical Oncology, and ASCO’s CancerLinq subsidiary to develop a set of cancer data elements culled from EHRs that will help providers make better treatment decisions at the point of care
  • Ochsner Health System (LA) and LSU Health Shreveport will invest in EHR, digital health, and telemedicine enhancements as part of a new joint operations agreement

Best Reader Comments

The influence of social determinants on community wellness is influencing a surge in community-based coalitions. In support of this recognition, we need predictive analytics, patient monitoring approaches that extend beyond care navigation outreach – including all the author calls out above and more, EHR’s that have real estate for care collaboration along the recovery process, and processes in place that will take in patient provided data so that care teams can make timely decisions on treatment plans. (Lauren McDevitt)

Nice to see folks starting to understand the connection between life in general and the 15 minutes the doctor spends with the patient in the clinic. Creating a network of social services that includes the healthcare system is our only hope. We don’t want to alert the doctor! If your AI is really AI, then the machine should be able to alert the person who can take action. This could be the social worker on the care team, the entity who is holding risk on the patient, the minister, etc. You can’t take all the social services needs and dump them on the clinical team – that will just lead to more disaster. (Lee Blanco)

It was always an incorrect extrapolation to assume that because survival of a subgroup with coronary disease improves with aspirin that everybody’s survival does. You’re not pointing out a failure of evidence-based medicine. You’re pointing out a failure of medicine to follow evidence. (Robert D. Lafsky, MD)

I have to guess that most healthcare provider organizations and related EHR vendors still are not aware that in 2008, PDF became an international, OPEN standard (ISO 32000-1, Document Management – Portable Document Format – PDF 1.7). As such, PDF has been recognized worldwide as the most reliable, flexible, and feature-rich document format for information exchange because it supports and manages any type of file format, including structured data, text, graphics, x-rays, and video that are used in the healthcare industry. However, what saddens me is that for the past 10 years, healthcare provider organizations and related EHR vendors still are not familiar with the attributes of the DYNAMIC format of the PDF document (NOT the static format, with which all users are familiar, including the above user and EHR vendor). This is probably one reason why PDF Healthcare, a 2010 Best Practices Guide (BPG) supplemented by an Implementation Guide (IG) (i.e., PDF-H was never a proposed standard) was never accepted by the healthcare information technology industry. (Woodstock Generation)

I applaud your comment of “doing as doctors often do in shooting the EHR vendor messenger without realizing that it wasn’t them who made the workflow decisions” because this is the primary reason that most EHRs are not as “intuitive” or “usable” as we would like. I have frequently seen that the decision of one person or group has deleterious effect on others using the system. I’ve also seen situations where the vendor will speak up and tell the decision-makers that this would not be a good workflow and the decision remains unchanged. (Paulette Fraser)

This MSK-Paige.AI deal seems to be a case of the a total absence of governance and due process. How such a sweet deal for founders, board, and MSK to profit from slides can pass regulators is unfathomable. (AI-Bot)

The AI/ML companies need someone clinical to provide them their training cases, and the executives mistakenly think the data isn’t worth anything since it’s just “sitting there.” Lots of AI/ML companies are getting away with a treasure trove of valuable data very inexpensively. (DrM)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. B in Mississippi, who asked for telescopes, microscopes, and science experiment kits for her fifth grade Super Scientist project, in which a weekly “Scientist of the Week” takes home resources to complete a project with their family and then reports back to the class. She says, “It has truly been a blessing to teach fifth grade science, and with your help, they can learn so much more at the convenience of their own home. It allows them to share education with their siblings and parents. You can actually see the importance of it and the responsibility they have had with the items from this project. I couldn’t thank you enough and promise you this will bless a child for many years to come.”

An MIT researcher observes that connected home intelligence devices — such as Amazon Echo and Google Home – seem to be offsetting social isolation that is especially problematic among older adults. He notes that half of people 65 and over surveyed in the UK said their main form of company is the TV, concluding,

In the absence of a warm-blooded alternative, even a brief interaction with a “voice” that serves, interacts, and responds every time, all the time, may someday transform our collective perception of AI from that of a simple tool that “does stuff” around the house to a presence that is a real part of our social self.

Spotify adds a custom playlist generator based on DNA test results from Ancestry, making the dubious claim that ethnic heritage drives musical preferences.

Rural hospital operator LifePoint Health proposes that four of its executives divvy up $120 million in golden parachute money upon completion of its $5.9 billion acquisition by RCCH HealthCare Partners.

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In the latest “marketing gone mad” example, Weight Watchers renames itself WW, claiming itself to be a “true partner in wellness” that will embrace wellness-related apps, online communities, and integration with Amazon Alexa and Google Assistant. It should come as no surprise that the announcement was made by the company’s “chief brand officer,” who babbled on about the “new articulation of the WW brand” and a new brand identity that  will “come to life across all brand touchpoints and member experiences” as the company emphasizes its expertise in behavioral science . My alternate interpretation is that Americans don’t want to pay a company to remind them they’re fat, so WW will distance itself from that unforgiving metric and instead lay claim to less objectively punitive “health.” Above is the amazingly creative and daring new logo around which all this hubbub orbits. It should be noted that when asked, the company’s president could not explain what WW stands for, and Adweek panned the new “marque” in saying WW is chasing trends from fear of being disrupted.

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Renaissance man Patrick Soon-Shiong’s NantEnergy (which I hadn’t heard of among all the health-related Nants) says it has developed a low-cost alternative to lithium-ion batteries that has been deployed to several villages and cell tower sites around the world. An expert says “if this is true, it would be great,” but wants to see evidence and a test of how long the batteries will last.

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In Russia, the father of a deceased 25-year-old woman erects a five-foot tall tombstone that resembles her IPhone, crafted by a company that offers” death accessories.”


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Reader Comments

  • Lazlo Hollyfeld: It is just a form of self-promotion and attention grabbing that is legion at HIMSS. If you can name one objective an...
  • Lazlo Hollyfeld: This is the cool, angsty ‘insider’ take but it ignores that large gatherings like this present several opportunities...
  • Mr. HIStalk: It's tough when the hospital won't reopen for a year or more (if ever -- Adventist Health didn't seem to want to commit ...
  • Brian Too: I am a little disappointed Ellkay didn't bring the bees to HIMSS 2019. Can you imagine the pictures, the headlines, t...
  • NoGoodDeedGoes...: RE: Adventist Health & Paradise - your coverage is warranted, but your commentary would have been better off omitted...
  • Vaporware?: I almost feel a little bad and embarrassed for Cerner. It's notable that MEDITECH's "re-branded" and "old" EMR has score...
  • Dave N: I also am continually amazed at how many men don't wash their hands after using the restroom. Society still struggles to...
  • RE: Pink Socks: Please check the facts. Not everything revolves around Epic. Here's the original website https://pinksocks.life/...
  • Brian Too: "We’ll need a new ICD-10 code for [...] Gwyneth Paltrow’s Goop..." Might I suggest 2 ICD-10 codes? F6101 - Lif...
  • Brian Too: "...the VA’s EHR project could balloon beyond its estimated $16 billion budget..." Sorry to be cynical, but wasn't ...

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