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

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.”

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.

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

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.

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

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.

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

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.”

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.”

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.

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

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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.

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.

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

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.

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.

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.

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.”

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.

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.

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.

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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Weekender 9/21/18

September 21, 2018 Weekender No Comments

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Weekly News Recap

Pathologists at Memorial Sloan Kettering Cancer Center complain that its executives and board members received equity in pathology decision support company Paige.AI after MSKCC gave the company exclusive access to its archive of patient tissue slides
Boston Medical Center, Brigham and Women’s Hospital, and Massachusetts General Hospital collectively pay $999,000 to settle patient privacy complaints related to the in-hospital taping of the TV show “Boston Med”
Athenahealth shares drop sharply on the news that activist investor Elliott Management will pass on acquiring the company at its previously offered price of $160 per share, citing problems it found during due diligence
Waystar announces its acquisition of Connance
Aramark sells its Healthcare Technologies business to clinical engineering and asset management company TriMedx for $300 million
The impending arrival of Hurricane Florence in the Southeast motivates HIEs to connect their systems, hospitals to offer free virtual visits, and HHS to temporarily waive several HIPAA Privacy Rule requirements

Best Reader Comments

It’s not the one with the best algorithm that wins – it’s the one with the best data. (MLtrainedMD)

I expect we’ll see more unfortunate deals like the Paige one over the next few years as clinical organizations with good reputations cut deals with AI/ML companies. 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)

I think a lot of women exclude themselves from some pursuits early on in life (computers, science, leadership roles, etc.). Therefore they don’t develop those aptitudes, and therefore there just aren’t a lot of qualified women out there to be hired into those roles. (And therefore, when there is a qualified woman, they can be subjected to more skepticism and scrutiny than others.) Some say the solution is to hire by quota. But if there is an insufficient number of qualified female applicants, then that just results in hiring unqualified ones into roles that others may be better qualified for. Which is (a) not fair, and (b) also creates a credibility problem for the hapless woman. And it renders awards / promotions to women in these roles essentially meaningless, even if they were given based on merit (because people will assume they were quota-driven). Not an easy problem. (Clustered)

I’ve taught research methods and sampling methods for 45 years. I’ve written books and articles about research methods etc. KLAS is the example I use of the worst possible false “research” presentations. Only a fool would pay attention to a KLAS rating. It is a means of selling KLAS reports and of favoring vendors who pay for KLAS reports. I’m not saying they intend to deceive, but their design does that. Period. Thus, even if they wanted to be truthful, they can’t be with their research approach. It has no statistical validity. It’s an advertising tool. (Ross Koppel)

Watercooler Talk Tidbits

Readers funded the DonorsChoose teacher grant request of Ms. E in Michigan, who asked for a handheld carbon dioxide meter and map printing supplies for the Girls Club air quality mapping project. She reports, “The members of my Girls Club love to do science activities, and taking them home with them to report back was even more exciting. The girls went through and took data for their own homes, businesses, and even the school. It was interesting to see the areas of high and low concentration of carbon dioxide at different places. Some were surprised at the results, especially the levels coming form our school! Thank you for bringing a science project to life that allowed my girls to become real scientists.”

A new California law requires hospitals to make plant-based meals – as recommended by the AMA and the American College of Cardiology – available to patients.

Italy’s anti-establishment movement gets a law passed that allows parents to attest that their kids have been given 10 mandatory vaccines without providing proof, promoting personal choice in claiming scientific arrogance, drug company influence, and supposed connections to cancer and autism. One group of doctors publicly claims that eating nuts is more effective that vaccines for preventing illness (insert your own nut-related pun here).

California’s private surgery center accreditation agencies, which are paid directly by their surgery center customers, often approve facilities that have been decertified by Medicare; that are being run by medical professionals who have lost their licenses or who were caught practicing outside the scope of their training; or that have high complication or death rates. One of those private accreditors is Joint Commission. In a fun overlap of events, an endoscopy center earned its “widely recognized symbol of quality” the same day state health inspectors declared “immediate jeopardy” when they saw a newly hired receptionist disinfecting endoscopes.

FDA’s warning letter to a Addison, IL pharmaceutical testing laboratory cites problems with quality control, staff training, unsuitable equipment, and the owner’s operation of a microbrewery in the same space where yeast counts were measured, with FDA dryly noting that “A brewery employee was also preparing beer kegs in this area. In addition, laboratory test media, open beer bottles, and brewing materials were co-mingled within the same refrigerator.” The website of Seery Athlone Brewing touts that its owner – who also owns the lab – has a degree in microbiology and “more than 30 years of experience in fermentation – perfect for brewing!”

Life insurance company John Hancock will require policyholders to wear activity tracking wearables to earn its discounted premium rate, extending the practice of its Vitality program that offers discounted trackers such as the Apple Watch. That company found that its policyholders lived 13-21 years longer than average, which instead of implying that using fitness trackers improves health, might instead suggest that those customers were healthier to begin with and agreed to prove it by having Big Brother monitor their exercise levels in return for life insurance discounts.

A man is admitted to the hospital in critical condition after he and his partner, high on a date rape drug, decide (after what I’m sure was thoughtful deliberation) to boil 15 eggs and insert them into the southern rather than the northern opening of his alimentary tract.

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Weekender 9/14/18

September 14, 2018 Weekender 5 Comments

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Weekly News Recap

Cigna invests $250 million in a new corporate venture fund that will target companies working in the areas of care delivery and management, digital health and retail, and insights and analytics.
Memorial Sloan Kettering Cancer Center (NY) CMO José Baselga, MD comes under fire (ultimately resigning) after media outlets report he failed to disclose his financial ties to research journals in which he was published.
Cerner President Zane Burke announces he will leave the company November 2. John Peterzalek, EVP of worldwide client relationships, will assume Burke’s responsibilities and the title of chief client officer.
Former VA Secretary David Shulkin, MD joins Sanford Health (SD) as chief innovation officer.
Apple introduces the fourth iteration of the Apple Watch, featuring fall detection and heart monitoring features that include the ability to record ECGs.
General Atlantic invests $200 million in new cancer care company OneOncology, which aims to bring the latest in oncology care to patients in community settings using technology from Flatiron Health.

Best Reader Comments

Re: 340b comments. Sounds awfully familiar. Regulatory bodies ask for public comment, then that process is abused via copy/paste comments and identity theft to support corporate positions. At what point do we start prosecuting people for this? (340b)

With Zane out the door as a scapegoat for the first three years of DoD vaporware delivery, who does Cerner send up next to stammer empty assurances to Congress? John Peterzalek? Or does the world finally get to meet Brent Shafer? (Vaporware)

Mediware /Wellsky…marketing runs rampant again! Their PR states: “We stand at the forefront of innovation that will eliminate the fragmentation that exists in health and community care… By integrating its offerings under one brand, WellSky is better positioned to partner with providers and organizations to create and sustain communities that thrive.

Please explain how re-branding under one new name really accomplices product integration for customers when their 30 diverse products hardly talk to one another?? They probably spent big bucks to come up with this new name. Would be better spent on developing code that really integrates their 30 disparate product lines. Whatever you brand it doesn’t matter, Wellsky is still a tornado of flotsam. (HISjunkie)

Watercooler Talk Tidbits

Researchers uncover a 2016 Amazon patent for a transport system in which a human worker would sit in a metal cage atop a robotic trolley, an engineering design they call “an extraordinary illustration of worker alienation, a stark moment in the relationship between humans and machines.” Amazon reps contend the company has never and will never develop such a system, adding that sometimes even bad ideas get submitted for patents. Given the company’s intensified focus on lowering employee healthcare costs, I can’t help but wonder what sort of ICD-10 codes might be warranted at its future employee clinics by injuries sustained within the hypothetical people-movers.

Perhaps Amazon should consider installing these on its warehouse floors: EIR Healthcare in Philadelphia starts a “tiny hospital” movement with the development of a prefabricated modular hospital room that comes pre-wired with fall-detecting sensors and a smart TV. CEO Grant Geiger boasts that “it should be the only option worth considering when building new hospital construction from this point forward.”

The Washington Post looks at the increase in electric scooter-related trips to the ER, interviewing emergency docs in seven cities – all of whom have seen a spike in injuries since shared scooter services became available in their areas. Start-ups like Bird, Lime, and Skip are riding on the coattails of ride-hailing and bike-sharing companies thanks to investments from Uber, Alphabet, and Sequoia Capital. Yet their business practices are being called into question by riders who end up in the ER with severe injuries due to mechanical malfunctions. “Injuries are coming in fast and furious,” says Scripps Mercy Hospital (CA) Chief of Medical Staff Michael Sise. “It’s just a matter of time before someone is killed. I’m absolutely certain of it.”

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Weekender 9/7/18

September 7, 2018 Weekender No Comments

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Weekly News Recap

Athenahealth prepares to take second-round bids as inside sources report that Cerner and UnitedHealthcare have passed on buying the EHR vendor.
Theranos tells shareholders it will dissolve and will work to pay off its creditors with remaining cash on hand.
Atul Gawande, MD taps former Comcast digital health GM Jack Stoddard to be COO of the still unnamed joint healthcare venture of Amazon, Berkshire Hathaway, and JPMorgan.
Verity Health (CA) files for Chapter 11 in an effort to survive the health IT missteps of Patrick Soon-Shiong, MD who acquired the health system in July 2017.
Tabula Rasa Healthcare acquires EHR vendor Mediture and its third-party administrative services subsidiary EClusive for $22 million.

Best Reader Comments

Methinks the emperor has donned new clothes ~ Argonaut Project -> Da Vinci Project (Clarence)

The travesty of the new normal known as outpatient procedures begins when the patient shows up at the crack of dawn to begin the process and extends through the point where, barely awake from anesthesia, the patient is thrust from curbside wheelchair onto waiting vehicle having been expected to digest postop instructions just reviewed. . . . Reminds me of medical care in a third world hospital where family provides food, bedding and nursing. (Kevin)

Watercooler Talk Tidbits

Readers funded the DonorsChoose teacher grant request of Ms. M in North Carolina, who asked for STEM craft materials related to the Winter Olympics and flexible floor seats. She says, "Students were excited when they opened the boxes and saw all the materials that our classroom received. They wanted to use the flexible seating right away. They also wanted to start on our Olympic projects right away and couldn’t wait until the next today to come to school. We have set up a rotation schedule for students to use the flexible seating. Our next step for using the materials is to create bobsleds that the students can race. We are always creating STEM projects in our classroom that connect to our math and science standards."

Nestle attempts to pivot from a peddler of sugary treats to the frontrunner in nutritional wellness with its Wellness Ambassador program. Initially rolled out in Japan, participants send pictures of their food via an app that then recommends special supplements and lifestyle adjustments. The program also offers a home DNA and blood testing kit to give users a more in-depth health and wellness workup. Campbell Soup made a similar move when it acquired Habit, a meal delivery service that combines DNA and blood profiles to make dietary recommendations.

Road warriors beware: Scientists determine that luggage trays at airport security checkpoints harbor more cold viruses than do any other areas within the facility, including toilets. It’s a timely observation given the spate of news this week pertaining to flights with sick passengers. A New York-bound flight from Dubai was quarantined after 100 people on board complained of feeling ill. Public health officials tested all 549 people on board for MERS; none tested positive for the syndrome, though nearly a dozen were sent to the hospital with flu-like symptoms.

CMS mistakenly sends Medicare termination letters to 38,000 Blue Cross and Blue Shield of Minnesota beneficiaries, blaming the mix up on bad data from the health plan.

IBM is developing a drone that, when paired with a companion app, could monitor a user’s health data to determine if they’d benefit from a cup of coffee, which it would then deliver.

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Weekender 8/31/18

August 31, 2018 Weekender No Comments

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Weekly News Recap

The first FDA-approved digital pill will soon be offered to Medicaid patients in certain markets suffering from schizophrenia and bipolar disorder.
At Epic UGM, CEO Judy Faulkner sheds more light on the company’s One Virtual System Worldwide initiative, which would give health systems across the globe the ability to share data across a single network.
Debt-ridden Verity Health System, acquired by Patrick Soon-Shiong last year, will file bankruptcy in the next few weeks thanks in part to poor health IT decision-making.
Harris Computer Systems acquires Iatric Systems, which it will run as an independent business unit.
23andMe will turn off API access to its anonymized data sets, telling developers that they can access company-generated reports but not the underlying data.
Two key leaders of the VA’s Cerner implementation have turned in their resignations – Chief Medical Officer Ashwini Zenooz, MD and Chief Health Information Officer Genevieve Morris.

Best Reader Comments

The Politico story about Verity Health and Patrick Soon-Shiong is depressing to read, he drove a stake into the heart of that company. I looked back at my comment after the original sale and did a double take at the date, it only took him a year to bring it down. People need to stop agreeing to work with this guy, he’s a con man. (DrM)

Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Mrs. H from North Carolina, who asked for a laptop and case for her high school class. She reports, "The laptop you gave my students is helping them in numerous ways. For example, we used it when they were learning about permeability and porosity. They were able to research ideas about what they were observing and then post their results and comments on Google classroom to share with other students. We have also taken the laptop on a recent field trip to an aquarium to post comments and pictures about the student’s new discoveries and unique experiences. We made bottle rockets from recycled 2-liter bottles, then went outside and tested their bottle rockets. At that point, the students also created a live data sheet to record hang time, rocket mass, and general weather conditions. The data sheet was then shared online with the entire class. As a result, no paper or time was wasted and everyone could give positive feedback. Thank you for your generosity in helping my students to use technology in learning and doing real science!"

Indiana University Health updates its dress code, giving staff the option to display tattoos, sport non-natural hair dye, and even choose their own socks. (Tongue piercings are still verboten.) The hospital decided to make the changes in an effort to encourage employees to be themselves while still maintaining a professional image. “We knew that many of our caregivers had tattoos that they were hiding and that just didn’t feel genuine to us,” says Chief Nurse Executive Michelle Janney, RN. “Actually what we’re saying is use good judgment and we trust you.”

Cerner co-founder Cliff Illig and members of the late Cerner co-founder Neal Patterson’s family attend a ribbon-cutting for Neal Patterson Stadium, Oklahoma State University’s renovated soccer venue. Patterson, an OSU graduate, donated $10 million to the stadium’s renovations before he passed away last year. Patterson and Illig seem to be big soccer fans, having bought the Sporting Kansas City football club in 2006.

In Missouri, Burwood Group Senior Account Executive and cover band lead singer Stephanie Varone experiences a homecoming of sorts when she returns to Kauffman Stadium – home of the Kansas City Royals – to sing the national anthem. Varone first sang the anthem there 31 years ago, and has performed for similar crowds at Wrigley Field and Fenway Park.

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Weekender 8/24/18

August 24, 2018 Weekender No Comments

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Weekly News Recap

Medicaid Transformation Project signs up 17 leading health systems to develop solutions to improve the healthcare and social needs of the 75 million Americans who are on Medicaid
Employer-focused primary care clinic operator Paladina Health gets a $165 million investment
A New Yorker article describes the hostile shareholder attack launched last year on Athenahealth by activist investor Paul Singer’s Elliott Management and the company’s history of using shady tactics to pressure CEOs to cave
CNBC reports that primary care group One Medical is discussing a possible $200 million fund raise
The VA gives its providers the ability to automatically view the immunization and medication histories of those patients who are also Walgreens pharmacy customers
Anthem settles its huge 2015 data breach for $115 million

Best Reader Comments

New generations can learn from pioneers’ and predecessors’ successes and failures, not make same mistakes on new technology. A patient automated post-discharge call system is a part of larger business (financial, clinical, CRM) and technology ecosystems. Technology is key component of effective “solution,” but no more than culture, goals/metrics,org structure, supportive processes / technologies, and right staff (level, role, skills). Payments models are complex and in flux; Medicare and Medicaid future uncertain, human factors play a huge role in these processes. ROI is challenging. (Ann Farrell)

The IT vendors game the system, and with these scores submitted by profit-driven IT vendors, CMS seems to come up with comparative ratings. I’m hoping some sensible person can establish a true and accurate performance evaluation system. I wonder if all this has contained the rate of Medicare spending? (Mipsvendor)

Watercooler Talk Tidbits

Readers funded the teacher grant request of Ms. F in Florida, who asked for action cameras and storage for her STEM charter school third grade class. She reports, “Thank you for donating to my students’ project. This project was one that they specifically asked me to write. They love taking pictures and videos and even more so they love watching or looking at pictures or videos of themselves and their friends. They were so excited when I told them this project was funded, and even more excited to start using the cameras. It has become a reward in the class to be the class photographer for the day. With this I have started to teach them how to upload their pictures, edit them and publish them. This project is one that will continue to be fun for my students and will be extremely useful for class projects, class field trips, and memories of our time together in class. Thank you for your support!”

A GAO report finds that while the perceived high cost of health insurance turned some consumers away from buying policies on Healthcare.gov, HHS also intentionally reduced the 2018 coverage numbers by slashing advertising by 90 percent, cutting navigator funding by 42 percent, and shortening the enrollment period.

This week sees a second huge investment in primary care practices – Paladina Health (DaVita’s former employer clinic business that was sold this year for $100 million) raises $165 million for expansion and acquisition. One Medical has raised $350 million and Iora Health has taken in $100 million in investment. The Bloomberg article notes that UnitedHealth Group’s Optum now has at least 30,000 doctors on its payroll, while companies like Walmart and GM are contracting directly with health systems to provide employee health services.

A New York Times article observes that while FDA requires drug manufacturers to prove that their products are safe and effective, that doesn’t answer the question of how their safety and effectiveness compares to that of similar drugs, which would help prescribers choose more wisely.

Another New York Times article says NYU’s elimination of medical school tuition for all students is noble but misguided, suggesting that the med school should follow the lead of NYU’s own law school in waiving tuition only for those students who commit to lower-paying public service jobs or who practice in underserved areas.

A Tincture article decries the healthcare expense of erecting billion-dollar hospital buildings such as those of Stanford, Boston Children’s, and the Denver VA hospital. A snip:

It is true that hospitals (excuse me, “health systems”) are diversifying — building/buying satellite locations, freestanding emergency rooms, urgent care centers, and physician practices — but those big buildings remain the locus, and their sunk costs weigh on hospitals’ finances … What I want to see are images of services being delivered where I am, focused around me, aimed at my convenience — not at the convenience of the people delivering my care … Don’t donate money for hospital expansion / renovation plans. Don’t buy bonds for them, either. Don’t sit passively on hospital boards that push for them or expensive new equipment. Instead, we should be questioning: how can a “hospital” most impact our communities’ health? What kinds of investments in our communities’ health can they be making? How we do push healthcare and health down as close to where and how people live as possible?

The Boston endocrinologist whose questionable claims that vitamin D deficiency is “pandemic” spawned creation a billion-dollar lab and supplement industry has been paid by companies that sell those products. Just about every other researcher has concluded that Americans get plenty of vitamin D and wouldn’t benefit from supplements or tanning beds.

A contract firm’s security guard is arrested at St. Francis Hospital (TN) after being caught having sex with the corpse of a patient whose body was being prepared for organ harvesting.

TV news always tries to leave you laughing with a vapid, irrelevant story, so here’s one that’s hilarious yet relevant. A Deloitte survey of C-level executives finds that 74 percent of those in healthcare say their understanding of blockchain technology is “excellent” to “expert.” These are no doubt the same executives who can’t perform even basic laptop tasks unaided, who pay secretaries to print out their emails so they can read them on paper, and who sympathize with hospital departments who send an employee off to Best Buy with a procurement card to buy PC and networking equipment because the IT process isn’t immediately gratifying. Only 39 percent of executives in all industries think blockchain is overhyped and 43 percent say blockchain is among their top five strategic priorities. This is the greatest gift a blockchain snake oil salesperson could ask for – clueless yet overconfident executives anxious to get on a questionable innovation bandwagon despite a complete lack of a business case.

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Weekender 8/17/18

August 17, 2018 Weekender No Comments

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Weekly News Recap

Best Buy acquires GreatCall, which offers emergency response services and digital health devices for seniors, for $800 million
Alphabet invests $375 million in data- and technology-focused insurance startup Oscar, following participation by two Alphabet subsidiaries in a funding round a few months ago that valued the company at over $3 billion
Amazon, Google, IBM, Microsoft, Salesforce, and Oracle pledge to support interoperability at Monday’s Blue Button 2.0 Developer Conference
The Wall Street Journal posts another critical review of IBM Watson Health for oncology, saying that “the diagnosis is gloomy” for Watson’s ability to improve cancer treatments.

Best Reader Comments

What do Amazon, Google, IBM, Microsoft, Salesforce, and Oracle have in common? No impact in healthcare interoperability despite multiple attempts. (Fourth Hanson Brother)

How does their “support” of interoperability actually translate into something meaningful? Are they going to somehow put the screws to organizations (both vendors and healthcare groups) who are have a greater incentive to protect their own revenues? (RobLS)

The 10% of reality that isn’t perception trumps the 90% at the most inconvenient times. (LFI Masuka)

Watson for Oncology isn’t an AI that fights cancer, it’s an unproven mechanical turk that represents the guesses of a small group of doctors. (Mechanical Turk)

Watercooler Talk Tidbits

Readers funded the DonorsChoose teacher grant request of Ms. C, who asked for LCD writing boards for her Tennessee kindergarten class. She reports, “We have been using our LCD Writing Tablets every day! My students love to use these boards to practice writing sight words, short vowel CVC words, their names, numbers, and so much more. They have eliminated the mess of dry-erase markers and promote student engagement. They allow me to check my students’ answers and work easily, provide corrections, and allow students to make necessary corrections quickly. These boards are currently one of our favorite things in the classroom. Thanks so much!”

In Spain, a woman who is growing tired of her ED wait (does that make her an impatient patient?) torches the place by igniting an oxygen bottle, requiring the hospital’s evacuation.

A new University of Vermont Medical Center federal filing is published in the middle of heated negotiations with unionized nurses who are working without a contract, likely to be emboldened by the news that it pays two executives more than $2 million, or 29 times the average RN salary. The health system says what health systems and universities always do when huge salaries are made public – we have to pay competitively compared to other academic medical centers to attract and keep executive talent.

New York University will make its medical school tuition-free regardless of financial need, hoping that graduates saddled with reduced debt will consider less-lucrative jobs in primary care and research. Students won’t have to pay the medical school’s $55,000 tuition, but they will still need to cover their estimated $29,000 in living expenses. The announcement was made at the med school’s white coat ceremony, drawing a standing ovation since the change takes effect immediately.

A New York hospital requires visitors to show ID to get an ID badge – which contains their photo and destination — printed with invisible ink that disappears after 24 hours. I’m always surprised that hospitals have few visitor-related incidents other than in the ED since visiting hours have been extended, anyone can wander the halls unmolested (except for the nursery), and security guards rarely wander patient floors. I’ve seen visitors fighting with each other and with employees, family members who tried to kill a patient in their bed, and gang or romantic rivals launching beat-downs at the nursing station. I once talked a newly hospitalized patient out of the gun he was waving around in his room, although I’m still not sure why I thought that was a good idea. It was a small hospital without real security guards and I was the only male on the floor at the time, ill-advisedly succumbing to the impulse to help the frightened the nursing staff and hoping that I had accurately characterized the patient as confused but harmless.

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Weekender 8/10/18

August 10, 2018 Weekender No Comments

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Weekly News Recap

CMS releases a draft rule that would overhaul the Medicare Share Savings Program
UnitedHealth Group is reportedly the only non-financial company that’s in the running to acquire Athenahealth
Northwestern Medicine (IL) lays off 60 IT employees after completing its Epic go-live
CVS Health adds MinuteClinic-branded virtual consults from Teladoc to its CVS Pharmacy app
Doctor appointment booking service Zocdoc postpones its announced pricing changes after practices complain about being charged $35 to $100 for each booked appointment instead of paying just an annual fee
Allscripts announces that it will sell its joint venture stake in behavioral technology vendor Netsmart
Henry Ford Health (MI) signs its first direct contract with an employer, touting Epic’s MyChart as a patient perk for GM employees

Best Reader Comments

Auto insurance is required in all 50 states, with two limited exceptions: NH, where you are still personally liable for damage done, and VA, which requires you to pay $500 annually if you don’t want to insure. The premise for these laws actually map quite well to healthcare. Imagine without the legal requirement – one person without insurance crashes, damages a building, injures a bunch of people, and ultimately declares bankruptcy to avoid the expense for liability. Everyone else gets to cover the tab. Requiring insurance puts money into the system to spread some of the risk. (Ummmmm)

CommonWell hooks itself up to the rest of the world! Only three years late and still not generally available. (DoD will be first in line once it’s ready, so as to exhibit “leadership,”right?) This is the great golden spike moment for interoperability – except with the Carequality Railroad traversing the entire continent to connect CommonWell San Francisco trolley network. (Vaporware?)

[Project] branding becomes important at this scale. With departmental or smaller implementations, using the vendor/product as a brand isn’t usually a problem. However once you hit “whole organization” level systems, as you do with an organization-wide EMR/EHR, putting a bit of distance between you and the primary vendor becomes important. (Brian Too)

I worked in an organization that had policy of renaming all vendor systems to a name of the organization’s choosing. Although this might seems confusing, it was actually very useful. Many implementations consisted of more than one licensed product so calling it the name of the dominant product wasn’t accurate. It also reinforced the notion that it was our system running our processes for our patients and members. The name was first coined for the initial implementation and stayed with the system through retirement. Our marketing people were definitely involved because the names were thoughtfully chosen and reflected the purpose of the system and the aspirations of the organization for the benefits it would bring. (A Rose By Any Other Name)

Watercooler Talk Tidbits

Reader donations funded the DonorsChoose teacher grant request of Ms. J in Missouri, who asked for building materials for her classroom of mostly refugee students whose primary language isn’t English. She reports, “This has been an extremely valuable learning tool in the classroom and very motivating for the students. We have done three challenges so far. The one in the pictures was to build a house. It had to have certain components, like a window, a door, some furniture on the inside. When the students finished their creations, they shared about them (first with a partner, then with the whole group). The reason I had them share with a partner first was so they could improve their houses with additional ideas. They really like their remodeling stage. Once we shared out as a whole group, the students wrote about their houses. We have done similar projects with math shapes and animals. The students love it when we get out the Legos. They are excited to hear about the challenge and their discussions of what fits in the expectations and what does not are amazing. Their reasoning is incredible. Thank you for providing these experiences for my students. Their ability to use their language and reasoning to convey their ideas will serve them very will as they move through school. We know that they are learning – even if they just see it as ‘Lego Challenges.’ We are grateful for all you do to support the growth of students — linguistically, socially, and academically.”

In Germany, neuroscientist and empathy expert Tania Singe, PhD is accused by current and former colleagues of being overly controlling and prone to bullying. They claim she had little empathy of her own, reserving her harshest behavior for pregnant employees — denying moms-to-be parental leave, calling them slackers who would need to work twice as hard to make up for their absence, and telling one who had miscarried that she would no longer be allowed to keep doctor appointments during work hours.

CNBC gets a first look at augmented reality headset Magic Leap, which has been shrouded in secrecy during its seven years of development and $2.3 billion in investment. The $2,300 developer’s edition is now available and the writer’s experience was mixed, saying it’s pretty cool to view a 3-D world being displayed on untethered goggles, but it’s hard to describe what the device does, there’s no way to show real screenshots since the human brain does the processing, it has limitations with ambient brightness and displaying human-like field of vision, and it will probably take years to get the product ready for mass consumption. Potential medical uses include supporting surgeries and offering chats with an AI-powered image of a doctor, but then again those use cases didn’t save Google Glass.

The ambulatory surgery center lobbying group urges members to post positive comments on locally republished copies of a Kaiser Health News article that describes the lax state of ASC regulation. KHN found that state rules vary widely such that oversight of injuries and deaths can be minimal and doctors who have lost their hospital surgical privileges for misconduct are free to open their own surgery centers. One surgery center for colonoscopy had two patients die in the same month during what is normally among the safest of surgical procedures, and in at least 17 states, surgery centers don’t have to report patient deaths.

A Pittsburgh local news site’s guest op-ed piece by healthcare transformation organization Lown Institute says UPMC’s planned $2 billion expansion should not be allowed or the health system should be stripped of its non-profit status, observing that UPMC receives $200 million per year in tax breaks but wants to build three high-profit specialty hospitals (cancer, transplant, and heart care) that don’t address local health needs such as obesity, asthma, binge drinking, and health disparities. UPMC wants to market the hospitals to wealthy patients abroad and wants to build two of them in suburbs where the percentage of insured residents is higher. UPMC CEO Jeffrey Romoff says, “UPMC desires to be the Amazon of healthcare.” Romoff was paid $6.9 million in UPMC’s most recently reported fiscal year, joining 32 UPMC executives who earned more than $1 million.

A New York Times opinion piece written by a hospice nurse and book author says more attention should be paid to the gut feelings of nurses, which she says aren’t really feelings but rather the clinical judgment that results from years of personal observations and experiences. Theresa Brown, RN, PhD notes that doctors generally ignore those feelings as documented in the EHR’s nurse notes. She talks up the Rothman Index, which combines EHR data – including that generated by nurses – to provide an early warning system for detecting at-risk patients. I interviewed co-creator Michael Rothman, PhD way back in 2010, but his comments are even more valid today:

We extract the amount of risk which is inherent in the value of each of these measurements and come up with a single score. Now in a sense, that’s what a doctor or nurse does when they go in. They come up with an overall sense of how the patient is and a good doctor does it well, or a good nurse does it well. But the problem is if a doctor is rushed, a nurse is rushed, how completely can they really evaluate all the data that’s there? Even even more importantly, do they really know how that patient was the day before when maybe this is the first time they’ve ever seen the patient? Getting that trend is very difficult to do, even if you’re a doctor and you’re sitting down and studying what’s in the medical record. It’s hard to figure out what the trend is, especially if it’s a gradual deterioration.

There’s one other thing, and that is, doctors tend to look at three things when they’re doing an evaluation. They look at vital signs, they look at lab tests, and they look at the last doctor’s notes. However, there is a source of information that they tend to overlook, and that is the nurse’s assessments. The nurses do what is called “the head to toe assessment” of the patient. It’s something that’s taught at nursing school. They evaluate each physiological system and they record it on the computer. Really, doctors don’t look at it. One of the things that we’ve done is we’ve said, “Hey, this is actually very valuable information about how someone is.” So we used nursing data in the calculation of our score. It gives the doctor access to something that he doesn’t normally look at.

Total property values of Madison and Dane County, WI have exceeded that of the city and county of Milwaukee for the first time even though Milwaukee has nearly triple the population of Madison. Dane County’s population grew by 40.7 percent from 1988 to 2017 – largely driven by technology companies such as Epic — while Milwaukee County had just a 1.5 percent increase.

Bizarre: doctors coin the term “Snapchat dysmorphia” to describe teens who seek plastic surgery to “look better in their selfies” and to make them look like their Snapchat-filtered selves.The JAMA Facial Plastic Surgery article summarizes,

Social media apps such as Snapchat and Facetune are providing a new reality of beauty for today’s society. These apps allow one to alter his or her appearance in an instant and conform to an unrealistic and often unattainable standard of beauty … it can be argued that these apps are making us lose touch with reality because we expect to look perfectly primped and filtered in real life as well. Filtered selfies especially can have harmful effects on adolescents or those with BDD [body dysmorphic disorder] because these groups may more severely internalize this beauty standard.

Of course hacker conference attendees would quickly figure out how to override a hotel’s thermostat and then tweet out instructions so colleagues can try it at their own hotels. The guy above was asked whether it’s a tampering felony to mess with a hotel’s thermostat, which is says isn’t because it’s an intended feature of the thermostat (as long as the hotel doesn’t make guests sign a EULA before using, he says with nerd tongue in cheek).

A 2 1/2-year-old toddler leaves Boston Children’s Hospital for the first time, having spent her entire life on a ventilator until she received a double lung transplant in September. It’s a feel-good (no pun intended) story as long as you can suppress your curiosity about what it cost and who paid.

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Weekender 8/3/18

August 3, 2018 Weekender No Comments

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Weekly News Recap

Global Payments will acquire AdvancedMD from Marlin Equity Partners for $700 million
Bob Wilhelm (Adreima) joins emergency and urgent care IT vendor T-System as CEO
Athenahealth reports Q2 results: revenue up 10 percent, adjusted EPS $1.08 vs. $0.51
Meditech reports Q2 results: revenue up 7.1 percent, EPS $0.65 vs. $0.39
Cerner reports Q2 results: revenue up 6 percent, adjusted EPS $0.62 vs. $0.61, beating analyst expectations for both
HHS OIG fines EClinicalWorks $132,500 for failing to file timely reports of patient safety-related software issues
President Trump nominates Marine Corps veteran James Gfrerer to be the VA’s assistant secretary for IT, commonly referred to as its CIO
The DoD justifies paying Leidos up to $1.1 billion more for its EHR implementation by mentioning the unstated cost of adding the Coast Guard while redacting the list of “as a service” requirements and their associated costs

Best Reader Comments

We must remember that in the paper or analog days, most clinicians took notes while speaking to patients so that they had a medical record of what transpired during the visit. These notes (SOAP, scribbles, whatever) were retrieved when the patient returned and/or when the clinician revisited the patient (e.g., in the hospital) so that the clinician had a handy memory jogger and/or quick analysis of the patient’s progress, test results, etc. Because the earliest EHRs were based on existing clinician workflows, the EHRs merely copied the paper workflow routines. What’s pitiful is that 40+ years later, the usability factors of the most popular EHRs have not changed, with companies blaming external regulations as the reason entire product rewrites have not occurred to make the EHRs more 21st century (e.g., Facebook-like) and less 20th century, while still storing key information. (Woodstock Generation)

We all knew that was going to be the case. I’ve been on client side where Cerner says, “That wasn’t in the RFP, but for $400k, we can add that in. Gee, thanks.” (Ex-Epic)

I recall launching an evidence-based focused program for a large academic facility, just to learn that the #1 reason we lost out to patients or companies was because the large academic facility on the other side of the same city included a free golf swing analysis. (Katie Goss)

Very insightful. Key insight: provider organizations spent a fortune on an OS, and now they have to go buy apps to get any value out of the effort. (Robert D. Lafsky, MD)

Watercooler Talk Tidbits

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Reader donations funded the teacher grant request of Ms. C in California, who asked for two Kindles for programming her middle school class’s Dash and Dot robots. She reports, “With the new Kindle Fires, my class had only increased their passion for computer science and coding. We have been using our robots daily and integrating it in our curriculum to help them learn from many different perspectives. The students are really excited when they come to school and always ask if we will be coding today or using robots.”

A CNBC LinkedIn search finds that Apple’s employee health clinic unit called AC Wellness has hired at least 40 people recently, most of them focused on wellness rather than healthcare services delivery. The program is rumored to be led by Sumbul Desai, MD, previously of the Stanford Center for Digital Health.

A study by non-profit “patent detectives” I-Mak finds that manufacturers of the 12 best-selling drugs in the US have tried to stifle generic competition by filing an average of 71 patents per drug. Each of the top drugs has been on the market for at least 15 years and all but one have gone up in price, with an average hike of 68 percent.

Walmart announces that it will not renew its contract with price transparency technology vendor Castlight Health, with the news sending CSLT shares down 26 percent and forcing the company to embark on a restructuring and cost-cutting project.

The White House issues a rule that will allow less-expensive, short-term health plans, aka “junk plans,” to be renewed for up to three years versus the previous three months. The plans, which are not required to meet ACA requirements, typically don’t pay for prescriptions, pre-existing conditions, mental health, substance abuse, or maternity and may include low lifetime maximum payouts or tiny daily payments for hospital stays. Minimal coverage also gives insurers a profit margin of 50 percent or more on premiums versus the 20 percent maximum as ACA plans require. Everybody understands both the problem these plans solve (high premiums) and those they create (people won’t understand the coverage limits or will become expensively ill while covered by a plan that offers them little financial help). They also create profound questions:

Nobody can afford the cost of major and/or long-term medical care, so is it OK for people to under-buy insurance such that their short-term cost savings require the rest of us to pay their bills – maybe for life — via Medicaid or cost-shifting charity care?
Should sicker people to be charged more for insurance or to make them pay a higher portion of their medical bills depending on their risk, the same as most other forms of insurance? What if they can’t afford it?
Is it OK to be forced into bankruptcy over medical bills?
Americans barely understood health insurance even with the mandated coverage and easy comparisons the ACA introduced, so what small-print secrets will be stuffed into the plan documents they ignore when buying this new “insurance?”
Aren’t we really just playing the shell game in allowing providers to charge wildly high prices for health services that provide questionable value while we argue over “who pays” versus “what it costs” in pretending that healthcare is like other services in which smart consumers buy only what they need and shop around for the best price?

Pediatrician, vaccine expert, and author Paul Offitt, MD says in a new book that scientists need to be able to explain themselves concisely in interviews and on social media to offset the passionate but wrong medical ideas spread by celebrities, activists, and politicians. He notes widespread misconceptions about genetically modified organisms and glutens, suggesting looking at the shelves of Whole Foods to see social denialism at work.

A 26-year-old woman who swears that her new diet of only beef, salt, and water cured her depression and arthritis solicits online donations and sells Skype consultations to support her “carnivore diet.” She has also given her year-old daughter nothing but breast milk and beef so far.

Maybe Theranos should have worked on this. A group of four tech-powered pharma anarchists develops plans for a homebrew MicroLab powered by a $30 computer that they’ve programmed to create drugs cheaply, so far allowing anyone to make their own naloxone, HIV drugs, and abortion-inducing drugs. The government and drug companies don’t make it easy for the group to obtain the raw ingredients, so they buy OxyContin from street dealers to modify into naloxone. They explain,

The rhetoric that is espoused by people who defend intellectual property law is that this is theft. If you accept that axiomatically, then by the same logic when you withhold access to lifesaving medication, that’s murder. From a moral standpoint, it’s an imperative to enact theft to prevent murder. So yeah, we are encouraging people to break the law. If you’re going to die and you’re being denied the medicine that can save you, would you rather break the law and live or be a good upstanding citizen and a corpse?

Apple becomes the first company to achieve $1 trillion in market value, having gone from near-bankruptcy to become the US’s most valuable publicly traded company. Hopefully we won’t see a Y2K-type effect from financial reporting technology firms that didn’t anticipate the need to express market cap to 13 digits.

Tech expert and newly appointed New York Times opinion contributor Kara Swisher weighs in on the naivete of inexperienced, closed-culture, California-happy social media technology executives who won’t acknowledge the harm their products cause:

Facebook, as well as Twitter and Google’s YouTube, have become the digital arms dealers of the modern age. All these companies began with a gauzy credo to change the world. But they have done that in ways they did not imagine — by weaponizing pretty much everything that could be weaponized. They have mutated human communication, so that connecting people has too often become about pitting them against one another, and turbocharged that discord to an unprecedented and damaging volume. They have weaponized social media. They have weaponized the First Amendment. They have weaponized civic discourse. And they have weaponized, most of all, politics.

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Weekender 7/27/18

July 27, 2018 Weekender No Comments

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Weekly News Recap

CMS proposes site-neutral payments in which hospital-owned practices won’t earn higher rates for billing as a hospital outpatient department
Internal IBM documents indicate that Watson Health has made unsafe treatment recommendations
The White House reverses its decision to halt ACA risk adjustment payments, citing the need to keep small insurers solvent and participating in the exchange markets
The Department of Defense increases its MHS Genesis budget by $1.1 billion to include implementation of Cerner at the US Coast Guard and to add on items that were included in the VA’s Cerner contract
The Senate confirms Robert Wilkie as VA secretary
England’s new Health Secretary Matt Hancock announces $640 million in additional technology funding
LabCorp continues to restore its systems following a July 13 ransomware attack
Arizona state records reveal that Banner Health’s poorly managed Epic-to-Cerner conversion at its acquired Tucson facilities caused medical errors and staff frustration

Best Reader Comments

“Healthcare is the only industry that requires its highest-educated, lowest-supply professionals to perform data entry work.” You mean documenting what you do to care for your patients? I can’t think of a single other job where a person doesn’t have to demonstrate, one way or another, that they did their work in order to get a paycheck. (HIT Girl)

So England has gotten over the NPfIT systems implementation failure? At least enough to try something else? (Brian Too)

Maybe its just me, but CMS is completely tone deaf for frontline MDs. This latest salvo of a ‘remedy’ is yet another nightmare. More complex quality reporting, changing the name (AGAIN) to Promoting Interop instead of MU, ACI, etc. Requiring the exact same counting, numerators, denominators, attesting nightmare AND now adding in AUC the CMS answer to pre-auth of MRI CT etc. (Meltoots)

Regarding poll results – thank you for reporting on this even though it is not, strictly speaking, healthcare news. It’s important, both in the realm of politics as well as fly-by-night news stories trumpeting the latest poll results of private companies. Reminds me of the old joke – five out of six surveyed researchers say Russian Roulette is completely safe. (Cosmos)

Re: Epic’s growth is mostly due to its hospital customers acquiring more facilities. While true, one could also argue that their product makes it easier for organizations to consolidate on their platform. (RobLS)

Re: lifestyle information for sale by data brokers. It’s really sad that so many people are so clueless as to how they’re constantly being measured and scored and basically discriminated against. IMO, population health has nothing to do with helping populations, but rather being able to measure and score groups and then drill down to individuals so they can be ‘managed’ for profit. One day there will be a revolt and I suspect it won’t be pretty. (Blocked by Gurus)

Watercooler Talk Tidbits

Readers funded the DonorsChoose teacher grant request of Ms. B in Georgia, who asked for tablets, a charging station, and magnetic tiles for her class’s STEAM time. She reports, “It feels like Christmas every time we have new ‘gifts’ brought to our class from DonorsChoose. I am so grateful for supporters like you. You truly understand the struggle that teachers face every day to provide our kids with great education. Technology is so important today and not just for playing video games. Teaching STEAM allows my kids to explore the world in our class. Thank you for being apart of my class and making learning fun.”

Montefiore Medical Center (NY) suspends a radiology resident pending an investigation after an anonymously written, blog-type article claims he is responsible for white nationalist writings that were published under a different name. The website Medium took down the article because it violated its policy against “doxxing” by including his home address, email, phone number, and links to his social media accounts. Netizens predictably took the article as gospel and rushed to judgment to get the “white supremacist doctor” fired after which Montefiore dutifully distanced themselves from him at least temporarily, raising interesting questions: (a) what if the article is wrong?, and if it is, then (b) who pays for his permanently harmed reputation? or, if it’s accurate, then (c) is it OK to fire someone for their off-the-job beliefs or writings, no matter how repugnant they might be?

Investigators execute search warrants to obtain the Fitbit data and social media account logins of a missing 20-year-old University of Iowa student, hoping the FBI can find electronic clues to her disappearance.

The New York Times magazine snarkily rips the fake science, elitist aspirational pretensions, and massive but questionably earned profits of Gwyneth Paltrow’s Goop. A snip:

The weirder Goop went, the more its readers rejoiced. And then, of course, the more Goop was criticized: by mainstream doctors with accusations of pseudoscience, by websites like Slate and Jezebel saying it was no longer ludicrous — no, now it was dangerous. And elsewhere people would wonder how Gwyneth Paltrow could try to solve our problems when her life seemed almost comically problem-free. But every time there was a negative story about her or her company, all that did was bring more people to the site — among them those who had similar kinds of questions and couldn’t find help in mainstream medicine … “I can monetize those eyeballs,” she told the students. Goop had learned to do a special kind of dark art: to corral the vitriol of the internet and the ever-present shall we call it cultural ambivalence about G.P. herself and turn them into cash.

A large-scale study finds that one in six Americans have a past-due healthcare bill on their credit report, 11 percent of them at age 27 after losing the option to remain covered by the health insurance of their parents. Medical debt drops at 45 years of age when 30 percent of people carry health insurance.

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Surprise, CA worries about the future of its one-bed hospital that it voted to sell to a 34-year-old private investor from Denver who planned to use it for lab and telemedicine billing from his nutraceutical and lab companies. Beau Gertz hasn’t been around, websites for his businesses have been taken down, four of his former employees say everybody has been laid off, and his office landlord says the space is empty.

Cincinnati’s Shriners Hospital for Children, which treats only pediatric burns, says its future is uncertain since such burns are increasingly uncommon and outpatient treatment reduces the need for inpatient beds.

In Netherlands, the medical complaints board reprimands a doctor who asked the family of a nursing home resident with dementia to hold her down so he could administer a euthanasia IV drip after she refused to drink the sedative-containing coffee that was supposed to have been given first. Dutch law allows anyone over 75 years of age to participate in assisted suicide, but legal questions remain when the person’s mental status is unstable.

An opinion piece written by two doctors says that physicians aren’t experiencing “burnout” (PTSD-like symptoms of exhaustion and cynicism that suggest a failure of resilience) but rather “moral injury,” the lack of ability to deliver high-quality care as trained because of the health system’s patient-marginalizing requirements. They say,

In an increasingly business-oriented and profit-driven health care environment, physicians must consider a multitude of factors other than their patients’ best interests when deciding on treatment. Financial considerations — of hospitals, health care systems, insurers, patients, and sometimes of the physician himself or herself — lead to conflicts of interest. Electronic health records, which distract from patient encounters and fragment care but which are extraordinarily effective at tracking productivity and other business metrics, overwhelm busy physicians with tasks unrelated to providing outstanding face-to-face interactions. The constant specter of litigation drives physicians to over-test, over-read, and over-react to results — at times actively harming patients to avoid lawsuits.

Patient satisfaction scores and provider rating and review sites can give patients more information about choosing a physician, a hospital, or a health care system. But they can also silence physicians from providing necessary but unwelcome advice to patients, and can lead to over-treatment to keep some patients satisfied. Business practices may drive providers to refer patients within their own systems, even knowing that doing so will delay care or that their equipment or staffing is sub-optimal.

Mom-recorded video of a dad dancing to celebrate the discharge of his 15-month-old son from Children’s Hospital of Philadelphia after a 32-day stay for Down syndrome and leukemia lights up the Internet. Says father Kennith Thomas of Merchantville, NJ, “Don’t every look at a situation and think the worst. I want people to look at their situation and flip it and change the perspective.”

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Weekender 7/20/18

July 20, 2018 Weekender No Comments

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Weekly News Recap

A survey finds that both consumers and physicians recognize the benefits of virtual care, but few consumers have experienced it and few doctors offer it
Tenet Healthcare considers selling its Conifer Health Solutions business for up to $2 billion
LabCorp shuts down its nationwide computer network when it detects that a hacker has penetrated it and is trying to access patient records
Draft CMS rule changes would make major changes to physician billing, the Quality Payments Program, EHR design in supporting simpler billing requirements, and telehealth coverage
The VA creates a committee to oversee its Cerner implement that will be led by ONC Principal Deputy National Coordinator Genevieve Morris

Best Reader Comments

No one is commenting on the CMS announcement, I suppose because no believes they are serious, or capable of executing any part of this grand plan. (DZAMD)

As a former CFO at a university medical center, a ROI of $190m that requires a $180m investment is a no-brainer — that is the people moving ahead with it have no brains! Any project as large and complex as this has at least a 90 percent probability of being 20 percent (or more) over budget. Nor did I see a contingency allowance in the budget which would allow for any mistakes. Given that, I would need to see at least a 50 percent ROI before moving ahead. Good luck UW, you’ll need it. (HISJunkie)

The communication director for BJC needs a communication director for her own messaging. You START the public statement about how bad you feel for the people whose lives you just turned upside down. You don’t bury that sentiment after two lengthy paragraphs about “market forces.” This should be a PR no-brainer in today’s hyper-sensitive environment for businesses who face these tough decisions. (AreUKiddingMe?)

“If I were a CareSync investor.” Apparently CareSync got millions from a local county development fund. That makes the county taxpayers the investors. Good luck to them recouping any money. (Blocked by Gurus)

Watercooler Talk Tidbits

Readers funded the DonorsChoose teacher grant request of Ms. B, whose classroom is in “one of the most dangerous cities in America” in New Jersey, as she describes it. She asked for puzzles, books, and STEM supplies for her after-school program in which students remain on campus until 6:00 p.m. She reports, “My students were so excited when our After School Fun box arrived! Thank you again for your continued support to our school and specifically my classroom. My students come from a city that will not define their future and it is because of donors like you that make them see the possibility this world has for them!”

Telehealth vendor Dictum Health’s Virtual Exam Room and VER-Medic are featured in Discovery Channel’s new show “Sharkwrecked,” where paramedics used it to monitor the health of participants at the show’s shooting location in the Bahamas. Producers blew up a boat in the ocean, then left two men floating with sharks for two days to see what happens in simulating a real-life (yet rather far-fetched) situation. Just in case anything in Shark Week sounds like actual science, the network eliminated all doubt by featuring budget-friendly, D-list celebrities like Ronda Rousey and the massive Shaquille O’Neal, whose fear-overcoming shark dive might well trigger tsunami warnings.

Something I learned about the Chrome browser today after months of pondering instead of simply Googling: yellow lines stacked in the scroll bar show where the most recent search term appears on the page. Remove the search term from the search box and they go away, but otherwise you can scroll to one of the lines and then you’ll see your search term highlighted in yellow in the page text.

A woman is charged with breaking into Westmoreland Hospital (PA) on two occasions to steal soda, once by guessing the ICU door’s access code to enter its conference room, from which she left with a backpack full of drinks. The woman says she regrets her arrest since it might impact her ability to return to her paralegal studies, explaining, “I was thirsty, and it was really late at night, and there are no convenience stores really in my neighborhood. I just thought I’d get some soda. I didn’t think it was this big deal.”

British Airways responds to a customer’s tweeted complaint by asking him to provide his personal information “to comply with GDPR,” which the dimwitted customer (among others) does by tweeting it right back at the company and to the world. A security expert baffled at why the company would try to solve problems on Twitter instead of asking the customer to call in. He also notes that British Airways allows customers to check in online only if they disable their browser’s ad blockers, after which it sends their information to many third parties.

In England, a 63-year-old NHS doctor who is upset about his pension investment losses sends messages to his financial advisor threatening to kill himself, then uses a “hire-an-assassin” site on the dark web to order the advisor killed. The National Crime Agency detected his activity while investigating the Chechen Mob’s site, finding that the doctor had chosen the first of four predefined options: kill the man, beat him, set his car on fire, or set his house on fire. The doctor entered the advisor’s address but didn’t pay the $5,000 fee, leading him to plead not guilty of attempting to solicit murder.

Catholic Health Initiatives collaborates with AHA and Mass General to develop a set of IICD-10 codes that allow providers to document sex and labor exploitation.

I’m not sure if this is an Amazon success or failure, but the company’s website was so busy in the first few minutes of this week’s Prime Day that its servers bogged down, forcing IT staff to deploy a stripped-down home page and to shut off international access. The company’s auto-scaling feature apparently also failed, requiring manual server spin-up and the need for “looking at scavenging hardware.” Prime Video was slowed, Alexa experienced outages, and warehouse employees weren’t able to prepare orders. Experts say that Amazon may have a bug in its auto-scaling service, but they nevertheless marvel that all of the Amazon sites remained up despite unprecedented volume. The company’s Sable computational and storage system processed 64 million requests per second under last year’s less-busy Prime Day.

The 63-year-old chief of cardiothoracic surgery at Jersey City Medical Center (NJ) is commissioned as a US Navy Reserve commander after receiving an age waiver for his in-demand skill. Tyrone Krause, MD, who was sworn in by his Navy ensign daughter, said, “Why don’t I just relax and sit in my back yard and drink some beer? But that’s not my style. I’ve always been on the move. And hopefully I’ll always be on the move.”

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Weekender 7/13/18

July 13, 2018 Weekender No Comments

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Weekly News Recap

Facebook fixes security holes that allowed third parties to harvest the names and email addresses of people who signed up for its private groups, triggered by a breast cancer group’s concern
A new KLAS report covering non-US EHR activity finds that Epic doubled its relatively small market share in 2017, InterSystems continued its rapid growth, and Cerner experienced moderate activity
Cerner partners with and takes a $266 million equity position in value-based care operator Lumeris
AdvancedMD acquires competitor NueMD
England’s health secretary Jeremy Hunt takes the foreign secretary job vacated by Boris Johnson, with the country’s culture secretary taking over as health secretary in a major government shakeup

Best Reader Comments

The biggest challenge to telemedicine is the lack of insurance coverage. Medicare (which also sets the rules for most commercial payers) has a very limit set of originating sites (locations where the patient can be during the visit). The AMA is scared to death of how this technology could negatively affect their urban/ suburban member’s pocketbooks. (Former Community CIO)

Don’t forget one independent assessment [of University of Washington Medicine’s plan to move to a single EHR] was done showed no benefits after 10 years. If you don’t think part of new savings comes from staff, you haven’t read the notes. We lost millions of dollars last year and staff reduction is the plan to fix the problem. (JoblessInSeattle)

$190M in benefits on a $180M project seems pretty convenient. How much staff are they [UW Medicine] cutting? Are these numbers real? (EpicITStaffer)

Watercooler Talk Tidbits

Readers funded the DonorsChoose teacher grant request of Ms. Z in New York City, who asked for a solar bag and solar beads for a STEAM project. She reports, “Exploring solar energy concepts can be challenging. With the materials that have been provided by this grant, my students explored new concepts, conducted hands-on activities, and had a great time learning. Students focused on solar energy, which is the most abundant renewable energy source. We conducted our investigations outside in our schoolyard. Students constructed necklaces and bracelets using the solar beads and were truly amazed by the color changing reaction by the sun. We also used the solar balloons which flew like hot air balloons, except we used the sun’s energy as the heat source. Thanks again!”

A jury orders Johnson & Johnson to pay $4.7 billion in damages to 22 women who sued the company for failing to warn them that its baby powder increases the risk of ovarian cancer because it may contain asbestos. The company says it will appeal, as it has successfully done in several similar lawsuits, and complains that the women were allowed to sue in Missouri even though most of them don’t live in that state.

HIMSS recaps its well-received HIMSS18 session titled “Boston Strong: Lessons Learned from the Boston Marathon Bombing” by former Boston Police Department Chief Daniel Linskey.

Boston Children’s Hospital achieves near-miraculous recoveries by infusing mitochondria from a patient’s healthy tissue into their ischemia-damaged hearts or lungs. The experimental procedure is credited with saving the live of Avery Gagnon (pictured above), whose post-open heart surgery ischemia was immediately resolved, allowing her to be taken off ECMO. Researchers say the procedure’s low risk make it potentially useful in every major heart surgery as well as in treating other organs and diseases.

A Texas couple whose six-year-old daughter requires around-the-clock medical care due to a chromosomal disorder considers divorcing to qualify the child for Medicaid as they are overwhelmed by $15,000 in annual out-of-pocket medical costs on top of expensive insurance premiums on a family income totaling $40,000.

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Bristol-Myers Squibb Children’s Hospital (that a hospital would be named after a drug company tells you a lot about US healthcare) rehomes the 16-foot-tall statue of Geoffrey the Giraffe that had stood in front of the former headquarters of the defunct Toys R Us.

A Memphis woman sues her dermatologist after he greeted her during her visit with, “Hi, Aunt Jemima,” which he later admitted to reporters was a “misspoken blunder.”

This former Iowa Methodist Medical Center pharmacy technician is clever (maybe unintentionally so) in his apology to hospital patients whose injectable narcotics he swapped out with sterile water so he could use them himself — “I’m sorry for the pain I caused them.” The lawyer for several patients who are suing the hospital over the incident added his own possibly unintentional humor in declaring, “He hurt a lot of people.” The former tech will ache for his 30 months in federal prison to pass quickly.

A man is charged with using the identity of a New Jersey doctor to bill an insurance company for $1 million in medical services using a made-up practice name and an empty, unlocked office’s address. United Healthcare paid him $46,000 before a woman noticed that her insurance was being billed for services she hadn’t received.

California dermatologist Sandra Lee, MD – whose pimple-popping videos have earned her 3.9 million YouTube subscribers, a just-premiered TV series, and the sobriquet Dr. Pimple Popper – launches an Operation-like board game titled Pimple Pete whose objective is to extract the most fake zits. Life must be good in America if millions of people have time to be entertained by pimple videos and doctors who were trained as healers at great taxpayer expense can make a career of creating them.

Bizarre: Michael Jackson’s former doctor – ex-cardiologist and now ex-convict Conrad Murray, who served time for accidentally killing the singer by injecting him with propofol for insomnia in 2009 – claims Jackson’s just-died father Joe chemically castrated MJ as a pre-teen so his voice wouldn’t change.

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Weekender 7/6/18

July 6, 2018 Weekender 1 Comment

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Weekly News Recap

England’s NHS announces December 2018 availability of a new app that will allow all citizens to book doctor appointments, order prescription refills, manage chronic conditions, and make calls to its 111 non-emergency medical helpline
AMIA publishes the inaugural issue of its Gold Open Access journal that will showcase the best informatics research and applications
UK-based private equity firm Hg will buy Orion Health’s Rhapsody healthcare integration technology business and 25 percent of its population health unit
Rock Health’s midyear funding review says digital health investments are growing and are attracting more experienced investors, but IPO activity is down as companies remain privately held longer
CNBC reports on “why telemedicine has been such a bust so far”
T-System President and CEO Roger Davis resigns

Best Reader Comments

For those of us out in the field working with telehealth and its various service lines, we know it is a success. Children and adults are getting the care they desperately need but cannot access, stroke victims live normal lives and when tragedy strikes, and you find yourself in the ICU it is telemedicine that helps get home quicker. Telehealth and telemedicine isn’t a narrow service for treating common complaints and sniffly noses as the writer only references. (Michelle Hager)

A significant problem that I’ve encountered is that many smaller practices and physicians don’t make plans for what they will do with their paper records when they retire. Regulations vary from state to state, but they are often responsible for maintaining and providing access to patient records for 10 years from the last patient visit and i some cases up to 25 years or more for minor patients. Storing large volumes of paper records for that amount of time is fraught with risk and expense and the records may outlive the physician and become a burden for his or her family. (Greg Mennegar)

Our company provides, as an employee benefit, Dr. on Demand for a $5 payment. It’s been excellent and especially helpful as a first step to determine whether an in-person visit is necessary. They don’t just triage — in many cases, they also diagnose and prescribe, which is a great saving of time and money for us. (Judy Volker)

I don’t know if I’d call the DoD question to Zane a zinger. Kind of “oversight 101.” The response was brilliant in a way, since you can’t perjure yourself if you never answer the question. (Ex Epic)

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Ms. S reports from North Carolina on the document camera and screen capacitance pens we provided for her second grade class per her DonorsChoose teacher grant request: “The document camera is such a simple yet versatile learning tool, but unfortunately with budget cuts, the math department is not allotted any. This is such a great gift. While the pictures might not have the normal wow factor that most project pictures do, please rest assured that this piece of technology is making a difference in my students’ lives. The ability to see what math skill I am demonstrating on a larger screen is much easier than trying to have all of the kids crowd around me as they try to see. Surprisingly, the styli are a crowd pleaser. They truly love that little added something.”

The Wall Street Journal chides itself for occasionally using clickbait-type headlines, providing lessons for all writers to avoid writing headlines that:

Try to sound mysterious
Promise readers a secret they will learn only if they click
Ask a question, especially one that the article itself may not answer
Do not match the tone of the story or that don’t assure readers that the story contains the promised details

A Science report finds that drug companies are paying after-the-fact compensation to members of FDA’s advisory committees who recommend whether a drug should be approved, with members who passed initial conflict of interest checks being rewarded afterward with jobs, research grants, and speaking roles. A majority of review committee doctors received at least $10,000 from a drug company whose product they approved, with seven of them earning more than $1 million.

Tennessee’s attorney general unseals details about the state’s lawsuit against OxyContin manufacturer Purdue Pharma, which contains details such as:

80 percent of the company’s OxyContin business came from repeat users
Purdue kept hard-selling doctors who were known to be diverting drugs out of state or whose licenses were restricted due to overprescribing
The company was warned about overdoses, muggings outside a pharmacy linked to a particular doctor, a high-prescribing clinic that had no medical equipment, a doctor’s waiting room overseen by an armed guard, practices whose parking lots were filled with cars with out-of-state plates, and standing room only waiting rooms.
Tennessee prescribers ordered 104 million tablets of OxyContin from 2008 to 2017, the majority of them for high doses.

Researchers using MRI confirm our male suspicions that wearing a tie (especially one that is tightly tied with a stylish Windsor knot) restricts blood flow to the brain, which might explain why some of the dimmest people imaginable hold jobs that require their wear. It’s fun to question commonly accepted standards – why should men have to drape decorative cloth around their necks to project sincerity and authority? My observation is that for small to medium companies, guys who wear ties work for guys who do not – I’ve been to investor pitch-a-thons and you could easily tell who had money versus who needed it because the former were dressed like they just left a satisfying lunch at Golden Corral.

Apple celebrates the tenth birthday of its App Store and the impact it has had on developers, mobile-first businesses, gaming, in-app purchases, streaming, and health and wellness.

The author of a biography of martial arts movie star Bruce Lee – who died mysteriously 45 years ago – speculates that he was killed by heatstroke after dubbing dialog for “Enter the Dragon” in a studio whose noisy air conditioning had to be turned off, compounded by the recent removal of his armpit sweat glands to prevent on-screen sweating.

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