Weekender 2/23/18

February 23, 2018 Weekender Comments Off

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Weekly News Recap

Duke Health earns the first Stage 7 analytics recognition from HIMSS Analytics.
Practice Fusion, which is being acquired by Allscripts, abandons its ad-supported free EHR program, announcing that it will start charging each physician user $100 per month.
A leaked Nokia memo says that the company sees no way for its digital health business to become significant, less than two years after creating the business by acquiring France-based Withings for $190 million.
A JAMA editorial calls for CMS to release Medicare Advantage encounter data.
Google researchers publish their work in which they applied deep learning to eye photos to accurately identify cardiac risk factors such as age, gender, smoking status, blood pressure, and likelihood of having a heart attack.
Siemens announces that it will take its Siemens Healthineers medical technology business public in the next few months.
The House Committee on Veterans’ Affairs grills VA Secretary David Shulkin on the VA’s FY2019 budget request, questioning the project cost and interoperability capabilities of the Cerner system the VA wants to buy.

Best Reader Comments

I’ve been able to really get in and do more work as the CMIO once I understood the company’s mission, vision, and yearly metrics, i.e. executive dashboard. Are they focusing on telehealth this year, pop health, decrease CAUTI, CLABSI, readmissions, etc.? Which one is the darkest red? Be sure to focus some time there. This gets you immediate cred with the execs and the docs if you can deliver something to them into their live environment sooner than later that is easy to use, intuitive, and aligns to the execs’ dashboard. (David Butler)

I’d like to hear more from Ed about his perspective on the current state of professional organizations in terms of their true value and the ability for execs to truly benefit from participating. Beyond local chapters – which by their very nature are limited in breadth of participants – there aren’t many intimate opportunities available. Everything seems to be centered around and in bed with HIMSS. It’s just getting too big and too overtly commercial. Do execs really benefit from these mammoth organizations and infrequent – sometimes only once a year – opportunities for networking and thought leadership development? (SteveS)

Partners will find the savings from their cuts of coders as fool’s gold. There are a lot of hidden costs running an outsourcing development organization. (BeenThere)

Watercooler Talk Tidbits

Readers funded the DonorsChoose teacher grant request of Ms. M in Florida, who asked for programmable Bee-Bots and a robot mouse for her K-5 STEM classes. She reports, “My kids love these little bees and mouse. Bee-Bot is fun for all ages, but it’s a great introduction to younger kids for learning how to code. That is what the coding mouse does as well. Both of them are very similar but have the same effect and are a lot of fun for the kids to play with and learn from. Thank you so much for supporting our classroom, believing in STEM education, helping us teachers, and giving the students a hands-on education.”

CNBC notes that Amazon has launched a lineup of 50 private labeled over-the-counter drugs that it calls Basic Care, potentially drawing foot traffic away from drug chains that make most of their money from walk-ins. Amazon sells a 500-table bottle of ibuprofen 200 mg for $7, about the same as Walmart but nearly half off the price charged by CVS, Walgreens, and Rite Aid. Costco’s Kirkland brand – also sold via Amazon as well as in its stores – has the best price I’ve seen at just $10 for 1,000 tablets.

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A review of “Grey’s Anatomy” by trauma surgeons finds that it gives trauma patients an unrealistic expectation of what their stay might look like. TV trauma patients died three times more often than in real life, most went straight from the ED to the OR vs. 25 percent of actual cases, and only a small number of patients transferred to a long-term care facility vs. the real 22 percent. Half of patients left the hospital within a week of serious injury vs. the real-life 20 percent and OR surgeons are often shown not wearing masks and protective eyewear to allow the audience to recognize them. The authors worry that unrealistic patient expectations, fueled by the listing of a medical advisor in the credits, may affect hospital satisfaction scores.They summarize,

American television medical dramas tend to rely on storylines that feature rare diseases, odd presentations of common diseases, fantastic and/or quirky injuries, and mass casualty events, all framed within a ‘realistic’ representation of a typical US hospital. In addition, the dramatic construct of a television serial lend to deviations from reality or accuracy in an effort to preserve the ability to communicate a story within the constraints of a one-hour show.

Maine debates whether veterinarians should be exempt from the state’s prescription monitoring program.

A reader forwarded this mail-merged bulk email from the marketing person at a cloud services company who forgot to the add personalization to her HIMSS pitch. Not only did she recover brilliantly with a witty follow-up email, I’m impressed with her credentials – she has a PhD in neuroscience and co-founded a company that makes a line of bold-flavored organic sauerkraut (Lemon Ginger, Moroccan Fusion, Vindaloo Curry, and Green Chile). They’re offering Colorado beer (hopefully not Coors) at their HIMSS booth happy hour, although the sauerkraut sounds a lot more interesting.

The HIMSS conference is just over a week away. The weather in Las Vegas should be OK, with daytime highs in the mid-60s and nighttime lows in the mid-40s with some clouds and little chance of rain. I was happy to find that even though MGM-owned hotels all charge for parking now, the Venetian-Palazzo complex still doesn’t and that even includes valet (which I used every day last time). Lyft is a good alternative – I’ve had better luck with it in Las Vegas than Uber.

You may recall that after HIMSS18, it’s two straight years in Orlando since HIMSS moved HIMSS19 from Chicago to there, the second time it cancelled McCormick Place (the first time over expensive but indifferent union labor, the second over hotel room rates).

Since there’s no HIStalkapalooza this year, here’s a nostalgia-inducing video from what’s probably my favorite one of all time, the 2012 version in Las Vegas that was sponsored by ESD. I recognize a bunch of folks in the video. The Palazzo restaurant we held it in closed a year later. What you probably don’t know (I just now remembered myself) is that it was originally booked for a Mexican restaurant also in the Palazzo called Dos Caminos that closed without warning on November 15, 2011 following a rent dispute, but the amazing ESD folks had First Food & Bar locked down just a few days later. I seem to recall that their pear-ginger martini was a hit.

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Weekender 2/16/18

February 16, 2018 Weekender 1 Comment

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Weekly News Recap

Drug maker Roche pays $1.9 billion to acquire oncology EHR and precision medicine vendor Flatiron Health, started just a few years ago by two guys in their 20s who were backed by Google Ventures (now Alphabet).
Nokia will conduct a strategic review of its digital health business, which it formed just two years ago by acquiring connected health hardware vendor for $212 million, after which it wrote down most of the cost.
Fitbit acquires app-powered health coaching vendor Twine Health with intentions of moving into chronic care management.
HHS’s budget request would cut ONC’s budget from $60 million to $38 million, while HHS OCR would see its budget reduced by 20 percent.
The White House’s proposed budget would give the VA an initial $1.2 billion to implement Cerner.
The VA says Cerner passed an external interoperability review, with contract signing expected by the end of February.
American Academy of Family Physicians gives HHS and ONC a list of specific actions it would like to see to reduce the health IT burdens of clinicians.
CPSI takes a $28 million impairment charge due to poor revenue and high development costs of its acquired American HealthTech post-acute care product.

Best Reader Comments

A price comparison tool that is integrated with an e-prescribing tool, ideally within an EHR sounds easy enough, but when I think of the frequent changes of PBM pricing and insurance formularies being integrated and updated in the EHRs, not to mention try to envision the extra time this would take the providers (doctors and/or nurses) to review that and discuss with the patient, I just see more time spent in the visit, not less. I’m trying to imagine my aging parent having that conversation with the doctor. (My Two Cents)

Doctors didn’t spend six years in medical school to learn how to help their patients find the cheapest pharmacy. Of course there should be transparency in pricing. But let’s not waste physicians’ time by putting more administrative work on their plates. (Debtor)

This approach – company running its own health programs — has been tried a dozen times before going back to the 1940s. They’ve even run their own clinics, hired own docs, etc. Doesn’t change much. The real irony is that the problem started when companies gave health care as a fringe bene to avoid wage increases and kept expanding benes year after year. Came back to bite’m hard. The only way a company today can really reduce health care costs is to deny expensive procedures to their employees (using whatever excuse they can come up with…same way HMOs do it). And based on 50 years of experience, I doubt they have the fortitude to do that. (HIS Junkie)

it is much easier for the President/CEO/Board to make high level, structural changes to an organization. Moves like M&A or even divestitures. Those organizational changes can be done over a timeframe of months. Restructuring the internal support systems to reflect the new organizational structure typically takes several years. Not that I’m complaining! Those C-level org changes give you a clear mandate and direction for where your business IT systems need to go. And there’s a deep well of work to be fulfilled in order to get there. However this also means that IT can fall far behind the curve of what the organization needs. (Brian Too)

Watercooler Talk Tidbits

Readers funded the DonorsChoose teacher grant request of Mrs. N in New York, who asked for STEM books, supplies, and take-home lab kits for her middle schoolers. She reports, “My students’ faces lit up when I showed them the materials and they could not believe that they would be able to take them home! They wanted to use the materials immediately and could not put the books down. Since the kits are in such high demand, I use a raffle system to distribute them every Friday. Students can keep the kits from Friday to Friday and they will also be used in class on Friday afternoons. This way, more students can benefit from the resources, At the end of the day each Friday, the kits will go home with different students. Thank you for supporting science education outside of the classroom. My students and I are extremely grateful and fortunate to receive funding for our Mobile Science Labs.”

I’ve been overwhelmed with LinkedIn-powered cognitive dissonance lately as I try to reconcile self-stroking descriptions of prior job performance with associated short tenures. Could a person really have driven a gazillion dollars’ worth of new sales, massively improved a product or service, or masterminded the creation of endless synergies, all in a short time? And if so, how did their former employer not collapse completely after the devastating loss of such a key employee? I’m extra suspicious when the follow-up to their lustrous performance was either extended unemployment or independent, non-specific “consulting,” suggesting that their claims aren’t surviving close examination by prospective employers.

This is smart: Wisconsin biohealth industry advocate BioForward awards seven “scholarships” that will help selected Wisconsin health IT companies cover the cost of attending HIMSS18 to make business connections. The winners are Yahara Software, Ancilla Partners, Healthio, Alithias, Spaulding Medical, Wellbe, and Physician Compass.

A reader ran across a year-old AMIA promotional video, which he or she describes as, “nothing but stock video clips string together almost at random, like it was made by an intern or new graduate hired right into the marketing department who knows nothing about the field of informatics.” It’s tough to try to explain informatics with a video, but this one is really puzzling – watch it with sound off and try to figure out why clips of someone staring at a mountain, flipping book pages in a meeting, and hugging a returning soldier in the airport would add value to the narrative that describes informatics. I blame the ever-increasing tendency of lazy readers to require pictures – even obviously irrelevant or gratuitous ones – before they will begrudgingly read or listen to a few words. Your local TV news is a good example, featuring meaningless video recycled from old stories and talking heads who were hired for looks instead of brains talking “on the scene” in front of a darkened building where a crime occurred 12 hours before.

Athenahealth’s investor presentation from this week includes a photo of company leadership, raising the obvious question: where de women at? It looks a fraternity’s yearbook photo. They have two females on their 11-member board, but otherwise, it’s all testosterone-powered. Allscripts has one woman on its seven-member executive team and zero of nine on its board. EClinicalWorks doesn’t list its executives. Cerner has two female executives of 10 and two of 10 on its board. Meditech has five females among its 12 executives, clearly a frontrunner in declining to create a no-girls-allowed treehouse.

The Houston newspaper covers a Walmart program that sends employees who have specific, serious conditions to hospitals such as Memorial Hermann and Johns Hopkins for treatment that the company pays for entirely as a single, bundled payment. Interestingly, 40 percent of those sent to Memorial Hermann turn out to not need the surgery they were told by their local doctor or hospital that they had to have, raising the possibility of widespread inaccurate diagnosis or overtreatment.

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This is exciting and seemingly mostly overlooked. SpaceX’s Falcon 9 launch Saturday will carry two satellites that will allow the company to test the feasibility of offering Starlink global, satellite-powered broadband service. The satellites will be placed in a 300-mile low Earth orbit that allow offering gigabit-level service with latency of only 25 milliseconds vs. the long round trip (600 milliseconds) and thus slow service provided by current Hughes satellites orbiting at 22,000 miles. The Starlink plan, which calls for nearly 12,000 connected satellites, was approved by the FCC this week. Ponder both the business and societal benefit of fast, globally available, and cheap broadband service. It’s especially important, now that the FCC has killed net neutrality, to give consumers broadband alternatives that don’t involve digging up streets to lay cable.

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Weekender 2/9/18

February 9, 2018 Weekender 2 Comments

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Weekly News Recap

Former GE CEO Jeff Immelt is named board chair of Athenahealth.
Former CMS Acting Administrator Andy Slavitt launches United States of Care, a non-profit that hopes to spur development of healthcare policies that allow all Americans to obtain health insurance and avoid medical bankruptcy.
JPMorgan CEO Jamie Dimon assures the company’s healthcare banking customers that its venture with Amazon and Berkshire Hathaway won’t really be disruptive, but instead is an effort to lower the employee healthcare costs of the three companies through price negotiation.
A review by the Economist finds that the number of prescription-only digital health apps that have earned FDA approval is rising sharply.

Best Reader Comments

Regarding Dolin, I think looking at pics of infants and toddlers being sadistically abused makes you permanently toxic. Just because he’s out of jail doesn’t mean there won’t be social consequences for his depravity. I get what you’re saying, but I would find it difficult to have collegial feelings for the man. It wouldn’t make for a very productive work environment. (Sorry)

Those C-level org changes give you a clear mandate and direction for where your business IT systems need to go. And there’s a deep well of work to be fulfilled in order to get there. However, this also means that IT can fall far behind the curve of what the organization needs. Imagine the C-suite doing an M&A deal every 1-2 years. Meanwhile bringing those accreted organizations into payroll, into G/L, into EMR, into ERP, into purchasing, into HR. That can take 4-5 years or more, especially if the entire organization must be re-done around a new system.(Brian Too)

I was pretty bummed to hear about Jamie Dimon hitting the phones to play down the JPMorgan / Amazon / Berkshire deal. Either they’re lying to their healthcare clients and they actually do want to do something disruptive or they shouldn’t even bother because they won’t move the needle. If JPMorgan and Amazon can’t bargain based on volume already, I don’t know what makes them think they’ll be more successful together. Group purchasing is probably more beneficial in the small / mid market. They want to attack healthcare costs, yet they don’t seem to want to cut any of the cost. (MN fan)

Workplace wellness programs show recent evidence that already-healthy people are the most active participants even when there is a small pot of cash (incentive) to be earned for demonstrating healthy behaviors for anyone participating. Similarly, providers will leave incentives on the table all day long, but if you send along a negative payment adjustment, providers will roar for more time. In the sticks and carrots analogy, carrots don’t seem to work in healthcare. (ellemennopee87)

To my fellow IS colleagues, don’t let disgruntled physicians or bedside providers distract you from your mission to serve the patient. Also remember that doctors are not upset with EHRs and IT most of the time — they are upset at healthcare in general. The EHR and IS tend to be a lightning rod for physicians to leverage their frustrations at. I am very empathetic to practicing physicians today and feel that if I can help save a few clicks or get them home sooner, then they will care for my mom, sister, friends, etc. much better. (Dave Butler, MD)

Watercooler Talk Tidbits

Readers funded the DonorsChoose teacher grant request of Mrs. T, who asked for take-home science and math games and backpacks to carry them in for her Michigan elementary school class. She provides an update: “The package was brought by our school secretary to the room right in the middle of our math lesson and also right during my principal’s visit for teacher observation. I apologized later to the principal for her not getting to see the whole math lesson and her reply was, ‘I loved it. You could feel the energy level skyrocket in the room when the secretary brought the box. I could tell how excited the kids were about this project.’ I have heard so many great comments like the little girl who came in smiling and said ‘I beat my Dad every time. I know lots more about force and motion then he does!’ I had two girls who were thrilled they were each taking home a backpack because they were having a sleepover together that weekend and said they would get to play the games out of each others’ pack. Thank you so much for helping make this year more fun and letting the kids feel special when they walk out of school with a backpack or win a game against their parents or sibling.”

Be careful getting your science news from Inc. or the several other crappy sites that ran this as sensationalized news. The researcher whose scholarly paper was turned into clickbait clarifies that, while a particular silicone product seemed to stimulate hair follicle growth in the lab and that same product is “reportedly” used by McDonald’s in its fryers, consuming it alone won’t cure baldness. He was baffled and then alarmed after seeing reader comments asking how many fries they need to eat to regain their tresses.

A nurse who sought care in a hospital in England for a mental health crisis is told that she’ll have to sleep on a row of chairs because no beds are available. Security camera footage shows her being groped by another patient as employees walk by without concern. The man admits that he kissed the woman, but says he didn’t sexually assault her, adding, “If she had told me ‘don’t’ I would have been like, OK, of, course, I’m a gentleman.” The man was found guilty, while the hospital assures the public that it was “an isolated incident.”

SNOMED International announces that its SNOMED CT clinical terminology will be used in the GE Healthcare’s Athlete Management Solution at the Winter Olympic Games. It also mentions a project called Olympic Healthcare Interoperability, which apparently will support cross-system athlete information exchange and portability to upcoming Olympics.

Cardiologist and retired UC Irvine medical school professor John Longhurst, MD, PhD and his wife Cherril are killed when their single-engine plane crashes near San Diego. Newspaper accounts suggest that they were the parents of Chris Longhurst, CIO at UCSD Health.

The low-carb diet that I’ve been on for a couple of weeks has delivered spectacular results (zero hunger pangs, significant weight loss, improved mental clarity presumably due to better insulin control even though I’m not diabetic), so I was interested in this article. A comprehensive, 262-patient study finds that a low-carb diet combined with virtual adherence coaching from Virta Health yielded dramatic improvement in people with Type 2 diabetes:

HbA1c was lowered from 7.6 to 6.3 percent on average
Participants lost an average of 12 percent of their body weight
94 percent of insulin-using participants either reduced their dose or were able to go off insulin completely
Every person who was taking an oral medication for diabetes no longer needed it

This will send ICD-10 wags searching for the right code. A Maryland hunter is airlifted to a hospital when the goose that someone in his party shot fell out of the sky onto his head, rendering him unconscious with head injuries.

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Weekender 2/2/18

February 2, 2018 Weekender Comments Off

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Weekly News Recap

Advocate Health Care announces that it will replace Cerner and Allscripts with Epic as part of its merger with Epic-using Aurora Health Care.
A Nextgov review finds that the VA wasted $2 billion on three failed EHR projects from 2011-2016, adding the cost of the abandoned HealthVet effort to the GAO’s estimate of $1.1 billion.
Epic issues a rare press release to tout “One Virtual System Worldwide,” which allow Epic-using sites to communicate electronically, perform patient data searches, and schedule patient appointments with other Epic sites.
Amazon, Berkshire Hathaway, and JPMorgan Chase create an independent company to reduce their employee healthcare costs in unspecified ways.
A GAO report urges the Coast Guard to make an EHR decision following its failed $60 million attempt to go live on Epic that left it working with paper records, with some members of Congress questioning why the USCG doesn’t follow the lead of the DoD and VA and implement Cerner.
Digital advertising vendor Outcome Health announces that its two co-founders will leave their executive roles and will take board positions as part of the company’s settlement with investors who say they were defrauded by inflated advertising performance claims .
Allscripts restores access to its hosted systems more than a week after a ransomware attack.
The Best in KLAS 2018 report is released.

Best Reader Comments

Syntactic structure and semantic context: MHS Genesis has both. They also have the largest HIT project budget in history and the full attention of the world’s largest HIT vendor. And yet, they have no connection to any of that vendor’s other sites. No connection to CommonWell. No connection to Carequality. What they do have – after coming a year late out of the gate – is a read-only viewer connection to the VA that you have to open in a separate app. Why does every five-doc clinic on Athena go live connected to Carequality, but the $5b flagship goes live with NOTHING? Vaporware. (Vaporware?)

Does Epic get to define the word “Interoperability?” It seems like the only thing they have an interest in doing is “INTRA-operability,” which is why they were passed over by DoD. It seems to be a roadblock ahead in innovation for them and I think some folks are really starting to notice. (Cheez Whiz Liz)

Would you rather but all those rolls of digital duct tape and the people to string it together, or have it done for you with no special effort? They [Epic] have been working on this stuff for years, since before I left. I don’t think any other vendor has put in that effort. Back then, it was also free. Not sure whether that’s still true. (Ex Epic)

Sequoia: passing CCDAs in a point-to-point manner does not seem to me to very disruptive approach. (Bobby)

Touting same-vender interoperability seems spectacularly uninteresting … We already have the complete syntactic structure for healthcare data and we have the full range of semantic context determined to give it appropriate meaning. What we need are the vendors to stop making the use of these well thought out and excellent protocols too costly to utilize, which they only do to continue to enforce their monopoly over patient and other clinical and revenue cycle data. (Bill)

Epic doing all of this work to connect between Epic customers is a lot more easy to accomplish since you can build in the functionality, control requirements, and control the message process / processing. If they were to try to do this for the industry, it’d be damn near impossible without buy in from all of the EMR vendors, let alone take multiple times longer. Epic communicating with Epic is a great first start and certainly leads the way in actually accomplishing something. Someone needs to pull the Band-Aid. (Johnny B)

I’ll take leadership by DOING SOMETHING over leadership-by-PowerPoint any day (I’m looking at you, CommonWell). My observation is that industries advance by someone going first and executing better, not by everybody agreeing on a lowest common denominator. (Vaporware?)

Watercooler Talk Tidbits

Readers funded the DonorsChoose teacher grant request of Mrs. A in Texas, who is rebuilding her relocated classroom following Hurricane Harvey and asked for lap desks for her fifth graders. She reports, “Now students can choose where they work, and they become more interested and invested in the learning happening in our classroom. I firmly believe my students have a greater impact of learning when they feel in control and have a voice in how they learn.”

Nashville Public Radio profiles the open source HIV care app developed for the Kenyan Ministry of Health by Martin C. Were, MD, MS, assistant professor of biomedical informatics at Vanderbilt University. Were, who is originally from Kenya, says there’s lessons learned there that make sense for the US, which like Kenya has areas that are isolated or that have low educational levels.

In England, a group led by physicist Stephen Hawkings wins a judicial review of Health Secretary Jeremy Hunt’s proposal to reform NHS by putting all of an area’s NHS bodies under an ACO with a single budget, which Hawkings calls “back-door privatization.”

India’s government announces a plan to offer free healthcare to half a billion of its poorest residents. The government, which made the announcement in advance of next year’s elections, says the program will create hundreds of thousands of jobs. The coverage would allow patients to seek care in private hospitals instead of in poorly-run government ones. Public health experts question spending so much on hospitals instead of preventive care, noting that poor people are mostly dying of conditions caused by water and air pollution, malnutrition, poor sanitation, and substandard housing.

The Onion weighs in on Amazon’s healthcare ambitions.

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Weekender 1/19/18

January 19, 2018 Weekender Comments Off

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Weekly News Recap

Allscripts-hosted EHR and e-prescribing systems go down early Thursday due to a ransomware attack.
DoD confirms that its Cerner rollout is on hold not because of problems, but rather according to the original project plan, which called for a comprehensive review of the first four pilot sites that won’t be completed until later in 2018.
Change Healthcare acquires National Decision Support Company.
Microsoft kills its HealthVault Insight app less than a year after its rollout.
Senator Jerry Moran (R-KS) questions the VA’s contract-signing delay with Cerner, asking in a letter to Secretary David Shulkin what he hopes to learn or do differently after digging deeper into Cerner’s interoperability capabilities.
The VA’s CIO says its legacy VistA system will need to remain running (and funded) for the 10 years it will take it to fully implement Cerner.
Hancock Health (IN) pays the demanded $55,000 ransom to regain access to its systems following a ransomware attack, saying it was a good business decision given the time it would have taken it to restore them from backups.
The CEO of Fairview Health Services (MN) calls for a “march on Madison” to demand that Epic encourage innovation by opening up its system and intellectual property management practices.
McKesson, 70 percent owner of Change Healthcare, says Change’s IPO could be run this year.

Best Reader Comments

Epic’s model does assert the ability to use any IP in App Orchard without compensation or limitation, it’s why the few vendors I’ve spoken to are hesitant to use it. The only reason that they’re considering it is because Epic has a stranglehold on their customers. That atmosphere isn’t really innovation-encouraging. (DrM)

Amused by the fact that the most engagement an HIStalk post has received in months is due to a hospital executive saying something critical of Epic. Thin skin in Madison. Epic is Big Healthcare. With that kind of company financial success, you are going to have your critics. Comes with the turf, guys. (CheapSeats)

There’s a world of difference between updating the OS or AV software, where users shouldn’t be affected at all, and updating software that affects of the UI and workflow of knowledge workers. The number of decision-makers involved is an order of magnitude different, and simply understanding the effects of workflow changes can take far more than three months. (DrM)

So “pace of change and innovation is stifled” and “pace of change in software is too fast”? I’m confused. (Doesn’t compute)

VA CIO: Expect another 10 years of VistA in facilities during new EHR rollout. This is clear indication of how the VA and government agencies are dysfunctional. There is so much wrong with this it’s hard to decide where to begin. Interoperability issues between systems only being exacerbated over years as patients move from a region on Cerner back to a facility still on VistA. How do you call a system new 10 years after it’s installed in the organization? In 10 years the VA and DOD could be replacing Cerner with another system. (Matt)

Will this Cerner dust-up with the DoD now give us a real granular discussion on a national level as to what Interoperability really means as far as how much is exchanged, degree of exchange and access, and who is responsible for it ($$$$ from vendors or hospitals paying for the infrastructure)? More realistically, will it force Cerner deeper in to a “commitment” to the CommonWell Health Alliance? Commitment in quotes means a lot of things. Really publicizing how well (and how much) it shares between itself and the other vendors and Epic. Having to commit more resources to it, including education and architecture for their customers and hospitals using other vendors. Perhaps how Cerner has to address this could chip away at the conventional wisdom that eventually you will have to be on either Epic or Cerner. (You might say I’m a dreamer)

I played Theme Hospital as a child and always thought it was a joke that the hospital systems were out for profit. Now I write EMR software. It was the longest, darkest punchline.(ThemeHospital)

Epic doesn’t assert ownership over any the apps on their App Orchard or the hundreds and hundreds of third-party apps that work with Epic. Their model is just like Apple. And, if there are literally billions of dollars and so many smart people in Silicon Valley, why didn’t they solve healthcare automation in a hugely, bigly amazingly way by now? They’ve had that money and those smart people for a while. How did a podunk outfit out of Madison Wisconsin get the drop on all of them? Good thing they haven’t found Kansas City yet. Give us a break James. What specific innovation do you feel is being impeded? (What’s with the Fairview guy?)

Even though Apple could take IP directly from the Apple ecosystem developers, their usual model is to just buy the companies. Same is true for Google and Microsoft. The big guys get the IP in the end, but developers get an exit strategy. Because of Epic’s stance against acquiring, that option isn’t available to Orchard developers. I would be hesitant, too. (Bob)

I wonder if there should be an EHR feature where patients if they’d like can subscribe to access to their record where they get emailed every time it gets accessed with a note on who accessed it and their role? (AC)

I’ve stopped believing any story about celebrity doctors saving people on planes unless there’s photographic proof of it happening. Eric Topol figured out it’s a completely unverifiable way of getting extra publicity for whatever device he happens to be talking about at the time, and obviously Oz learned the lesson. My prediction – Oz has a show coming up about the dangers of air travel. Regular doctors respect those peoples’ privacy and don’t go humble-bragging about their clinical acumen. (DrM)

Parental Leave Policy Responses

A few folks responded to Allspice’s question about paid leave for new dads, which his company doesn’t offer.

Athenahealth – 12 weeks for mom, six weeks for dad.
Unnamed health system – no maternity, paternity or family leave. Employees have to use FMLA and cobble together PTO and short-term disability if you’ve given birth. “People always assume that because I work in healthcare, I have great health benefits, and I just respond with a slightly unhinged laugh.”
A reader from Canada – leave policy is mandated by the federal government. New moms get a maximum 15 weeks at 55 percent of average compensation, while those caring for a new child get a maximum 35 weeks at 55 percent of earnings (can be shared between parents) or 61 weeks at 33 percent of average earnings.
Epic – new moms get 5-8 weeks of short-term disability, then can use PTO to cover the rest of FMLA time up to 12 weeks. They can then come back part-time for another three months, but that’s a problem for those in travel roles. New dads get nothing. “I was back on the road 17 days after the little one was born. They will tell you that they support your time off, but if you have an escalated client, you are responsible for it, period. As a company that preaches about health and doing the right thing, they missed the boat on being progressive on this key area for welcoming a newborn.”
Merge Healthcare/IBM – IBM increased the paid time for paternity, maternity, and adoption from six weeks to 12 and even back-granted extra time for new parents.
Unnamed health system – women get short-term disability and FMLA (no specific paid maternity leave) and dads get FMLA.
Epic – no paid time off, just FMLA.
Unnamed health system – introduced a new benefit of two weeks PTO for both parents with a birth or adoption, Previously, dads got PTO/FMLA and moms got short-term disability after a two-week waiting period.
Unnamed health system – new dads get nothing outside of FMLA, moms get short-term disability if they give birth and only FMLA if they adopt.
WebPT – for birth, surrogacy, adoption, or foster care, no benefit for less than six months of service, two weeks time off for 6-24 months, four weeks for two or more years of service. Employees get two weeks for foster care.

Watercooler Talk Tidbits

Thanks to those impressively credentialed readers who signed up for my Rolodex – I really appreciate it. The link will always be listed at the bottom of the Weekender posts, along with links to other permanent and short-term opportunities to help me out or get involved. It’s heart-warming to see CIOs, other hospital executives, CEOs, technologists, consulting firm executives, and clinicians offer to provide me with occasional guidance and news reaction.

HIStalk readers provided science game night activities for the elementary school class of Mrs. S in Mississippi in funding her DonorsChoose teacher grant request. She reports, “Thank you so much for helping my students fall in love with science. It warms a teacher’s heart when they actually want to learn! They were so eager to see the new products that we got to use for our projects. Their favorite one so far has been the Augmented Reality dinosaur project. They just love that they can make it come to life with just the use of an iPad. I cannot wait for my students to use the globe next. That is our next standard in science. They will get to learn all about the seven continents and ‘see’ them just as if they were there.”

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The fun folks at Ellkay sent cool swag our way through Lorre. I thought the “15 years” mug was to commemorate HIStalk’s 15th anniversary (this coming June), but I realized in rotating the mug that it refers to Ellkay’s 2002 founding. Inside the cool cardboard container is some Ellkay honey supposedly harvested from bees kept on its roof, and even though I can’t verify its source, it’s still a great marketing idea.

A few readers let me know they got an error trying to read HIStalk Thursday afternoon. It was actually a good problem if there is such a thing – so many folks jumped on to read my Allscripts ransomware news item (to which kind readers alerted me) that my dedicated, rather high-powered server was overloaded for 30 minutes or so. Thursday didn’t set a readership record since, other than the Allscripts item, I hadn’t published anything except headlines and Dr. Jayne since Tuesday night, but it was still over 11,000 page views in a 24-hour period. Tops of all time was DoD’s Cerner announcement day, July 30, 2015, when 17,000 folks checked it out and many others weren’t able to get in, leading me to dig out my wallet to beef up the hardware yet again.

Uber hires a HIPAA-focused lobbying firm for unstated purposes, but possibly related to transporting people to medical appointments or for professionals booking rides for patients.

“The Resident” premieres on Fox Sunday night following the NFC championship game. It’s apparently cynical and darkly funny in covering healthcare ethical issues, an incompetent surgeon bullying staff to cover up his mistakes, and the never-ending quest by hospitals to boost their bottom lines.

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Weekender 1/12/18

January 12, 2018 Weekender 3 Comments

weekender

What the Heck Is This?

HIStalk Weekender is a way to close out the week in a Hawaiian Shirt Friday kind of casual way, free of the limitations of the regular M-W-F news format. It incorporates suggestions from my reader survey, such as:

Lighten the M-W-F news posts but still run interesting stuff in its own section for reading at less-busy times
Keep DonorsChoose updates but separate them from the news
Recap the week’s best reader comments that might have been missed or posted later
Provide links to the entire week’s posts for those who are catching up
Queue up items through the week to allow posting Weekender by Friday afternoon

Readers who are of the “just give me the news headlines customized to my personal interests and nothing else” genre can skip these posts and just read the daily headlines, but as I always caution, succeeding in a profession means keeping up with it instead cocooning off Facebook-style or glancing at headlines. I wouldn’t put something on HIStalk if I didn’t think it was important, debatable, or interesting to C-level executives, even if only as watercooler topics.

Weekly News Recap

Change Healthcare retools its claims management network to use blockchain, the industry’s first high-volume test at 50 million claims-related events each day.
Allscripts buys Practice Fusion for $100 million in cash.
ONC’s Genevieve Morris says regulations will be published this spring that will define and regulate information blocking.
ONC publishes a draft of its Trusted Exchange Framework.
Cerner hires former Philips North America CEO Brent Shafer as CEO and board chair.
Wolters Kluwer Health sells Provation MD for $180 million in cash.

Best Reader Comments

Cerner has a gap to close and it would help everyone if the VA pushed them to increase the clinical value of their interoperability to rival Epic’s. (Switch Clicker)

Allowing physicians to run the whole show sounds good, except it led to healthcare being a lagging adopter of technology, unsustainable cost growth, and a 17-year delay (on average) in clinical best practices receiving universal adoption. Healthcare was run like a medieval guild. That’s what physicians running everything led to and leads to. (Brian Too)

With regards to Cerner and the VA, I would agree with you. I, too, am surprised that they didn’t leverage the Leidos relationship and have them act as the primary, similar to what occurred with the DoD. To my knowledge, Cerner, on their largest government contracts, hasn’t been the direct supplier. They won the DoD with Leidos playing lead, and in the United Kingdom, they first were with Fujitsu as the primary before BT took over for Fujitsu. (Associate CIO)

It’s amazing how the ONC thinks that healthcare organizations are adopting FHIR. Not one single EMR, LIS, or RIS vendor in the US utilizes FHIR yet for interoperability. If they really want to invoke change, they need to figure out ways to either force adoption or incentivize it. (Annon)

Eva. Once again, a virtual assistant is given a woman’s name. (HIT Girl)

The amount of times I have sat in a room to have two physicians in the same organization get into a shouting match as to how something should work is uncountable. If you cannot figure out your ideal workflow, how is a vendor supposed to create software to support it? Vendors/developers still need to be in charge of creating software, there simply needs to be more input from qualified clinicians, and less regulation on the specifics regarding clicks and metrics from the government. As someone who has grown up with a laptop in hand, the state of Health IT is atrocious, and the fact that far greater strides have not been made is an absolute travesty. (Seargant Forbin)

Reducing the cost of health care with interoperability, even with the sharing of information, isn’t going to happen until physicians learn to trust the documentation and test results of other facilities. If a CT has been done at Facility A and the patient is then consulted on by Facility B, they are likely to repeat the CT since they trust their technicians. (Barbara)

I see that healthcare is similar, in more ways than clinicians know or admit, to software development in every other industrial sector. Real software solutions are built on a foundation of failure and inadequacy, slowly rising to competence. Fortunes are spent on this process. A few winners emerge over time. Sectors like Finance had the advantage of (far) fewer data elements and strong theory, widely taught (this includes GAAP and goes all the way back to Luca Pacioli). Biology is more complicated but healthcare will get there. The real question should be, why did physicians expect highly competent EMRs to exist when so few physicians bought them, used them, or participated in designing them? A market economy will build what the market supports. Low investment results in sub-par results. Except, sub-par EMRs also discourage physician adoption and chokes off investment. (Brian Too)

Watercooler Talk Tidbits

Ms. C says of the 200 sets of headphones readers provided to her Utah elementary school class in funding her DonorsChoose teacher grant request, “One project for STEAM that we are excited to use these headphones for is studying living and non-living things. We will watch live feeds and videos to see animals in their habitats, write observations, and report on our findings. Our headphones will help us hear these videos, so thank you for donating them!”

Here’s a welcome video from new Cerner Chairman and CEO Brent Shafer.

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Allscripts provided this slide in its presentation at the J.P. Morgan Healthcare conference, describing its role as an “industry consolidator.”

France-based technology company Blade launches a cloud-based, subscription-priced replacement for the PC, with an initial target audience of gamers. PCs, Macs, or mobile devices plug into the Shadow box and app, turning them into a high-powered PC (eight-threaded dedicated Xeon server, 12 GB RAM, 256 GB storage, high-end NVidia graphics card) for an annual fee of $420 in offering “the last PC you’ll buy,” at least as long as your always-on Internet connection delivers at least 15 Mbps.

An excerpt from Genome Mag’s look into the commercial and research implications of DNA theft and health data ownership:

Stanford University Law School professor Hank Greely agrees that human biology does not fit neatly into the property box. “Do you own your kidney?”’ he asks. “Well, kind of. No one can take it from you without your consent, but neither can you sell it.” And, he says, the same awkward fit holds true for data. “I’d like to think that I own my electronic health record, but do I really? I can’t keep the hospital from using it, or sharing it with an insurer, or giving it in de-identified form to a researcher, or giving it to the FBI if the FBI asks.”

Two old-money Kansas City, MO families donate $75 million each to Children’s Mercy Kansas City to form the Children’s Research Institute and to build it a nine-story, 375,000 square foot building that will house 3,000 mostly new employees.

The 15,000 square foot Chicago mansion previously rented by Outcome Health CEO Rishi Shah for $50,000 per month is listed for sale at $9.99 million, down from the previous $15 million. The house became famous when the 31-year-old paper multi-billionaire Shah fled the property OJ-style in a black Escalade to avoid being served a summons related to allegations that the waiting room advertising company misled investors.

A surgeon in England is sentenced to community service for using an argon beam coagulator to burn his initials into the livers of two patients during transplant surgery in 2013. He said it was an attempt to relieve OR tension, but the judge scolded him in letting his “professional arrogance” stray into criminal behavior even though patients weren’t endangered.

Dr. Oz rushes to the aid of a fellow airline passenger and breathlessly recounts his heroic intervention to reporters – he asked the guy to lie down and raise his legs. At least he didn’t shove a weight loss pill down his throat or apply his entertainment-level medical guidance that experts say deviates from accepted medical knowledge at least 50 percent of the time.

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