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Weekender 12/18/20

December 18, 2020 Weekender Comments Off

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Weekly News Recap

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

Best Reader Comments

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

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

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

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

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

Watercooler Talk Tidbits

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

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

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

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Weekender 12/11/20

December 11, 2020 Weekender Comments Off

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Weekly News Recap

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

Best Reader Comments

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

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

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

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

Watercooler Talk Tidbits

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

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

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

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

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Weekender 12/4/20

December 4, 2020 Weekender 2 Comments

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Weekly News Recap

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

Best Reader Comments

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

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

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

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

Watercooler Talk Tidbits

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

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

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

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

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

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

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Weekender 11/27/20

November 28, 2020 Weekender Comments Off

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Weekly News Recap

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

Best Reader Comments

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

Watercooler Talk Tidbits

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

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

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

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

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

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Weekender 11/20/20

November 20, 2020 Weekender 4 Comments

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Weekly News Recap

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

Best Reader Comments

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

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

Watercooler Talk Tidbits

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

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

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

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

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Weekender 11/13/20

November 13, 2020 Weekender Comments Off

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Weekly News Recap

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

Best Reader Comments

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

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

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

Watercooler Talk Tidbits

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

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

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

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

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

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Weekender 11/6/20

November 6, 2020 Weekender Comments Off

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Weekly News Recap

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

Watercooler Talk Tidbits

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

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

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

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Weekender 10/30/20

October 30, 2020 Weekender Comments Off

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Weekly News Recap

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

Best Reader Comments

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

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

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

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

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

Watercooler Talk Tidbits

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

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

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

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

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Weekender 10/23/20

October 23, 2020 Weekender Comments Off

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Weekly News Recap

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

Best Reader Comments

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

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

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

Watercooler Talk Tidbits

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

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

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

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

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

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

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Weekender 10/16/20

October 16, 2020 Weekender Comments Off

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Weekly News Recap

Private equity firm JLL Partners acquires analytics solution vendor MedeAnalytics from Thoma Bravo.
Digital check-in vendor Clearwave acquires Odoro.
Allscripts announces plans to sell its CarePort Health care coordination business to WellSky for $1.35 billion.
Providence forms Tegria, a healthcare services business comprised of nine companies that the health system has invested in or acquired.
HealthStream acquires ShiftWizard.
Online texting-only mental therapy provider Talkspace tells providers it will cover their legal costs if they are caught providing services in states where they aren’t licensed.

Best Reader Comments

Just wondering. What happened to blockchain as the savior of IT? (Former CIO)

The DOD,VA, and USCG connecting to CommonWell FEELS like it should be big news (five years late notwithstanding), but reading the press release and the word Cerner is nowhere to be found. Are the federal legacy systems live on CommonWell before the flagship? Will any of them ever turn on Carequality, so they’ll have someone on the other end to exchange with? (vaporware?)

CarePort was the combination of three different Allscripts companies Allscripts acquired. ECIN (a company Glen Tullman company with Jeff Surges as CEO), Canopy (acquired by A4 prior to Allscripts acquisition), and CarePort (acquired by Allscripts). If you sum up the values of all three companies at their acquisition price, it isn’t as crazy a price. Still a good transaction, just not as good as it appears at first glance. (OhMDRX)

Wow that is way more than I thought Allscripts would be able to get for CarePort. The other sellable assets seem to be Veradigm and 2bprecise. Would 2bprecise stand up to an acquiring firm’s due diligence? As far as the core business goes, does Cerner has the appetite to buy and gut the whole company? I can’t think of a way that one of Allscripts EHR or EHR-adjacent software assets could be peeled off and sold separately. Practice Fusion could potentially go with Veradigm. (IANAL)

As an IT director working to launch one of the major telehealth platforms at our healthcare organization, I have been flabbergasted to find that their system is not a certified EHR and is unable of sending out industry-standard CCDs (e.g. lack the ability to include regular data set of problems, discrete medication data, allergy data, etc.) back to our EHR. They really only use the CCD as a vehicle to send over nicely formatted PDFs, which are a pain for clinicians to navigate and view to in our EHR to get the gist of what happened during the encounter. (Caveat Emptor)

t would be great if the telehealth / retail health / urgent care style practices would plug into an HIE or something, but that only benefits the PCPs,, health systems, or whoever can capture the referral. The margins in tele / retail / urgent are much thinner so there has to be a strong business case for interoperability before something gets done. Maybe PCP / health systems could pay Teladoc / Walgreens / big urgent care chain for the integration. Otherwise, these places didn’t take MU money, so they can only be incentivized with the stick when the stick comes down on everybody. (LowlyITworker)

Watercooler Talk Tidbits

Readers funded the Donors Choose teacher grant request of Ms. C in Washington, DC, who asked for three laptops for her kindergarten class. She reports, “Thank you for helping us with our technology. It really hard to get more tech for our students. This is very helpful and beneficial to my students and me during testing. My students are going to be super excited and these are right on time. We recently had computers that the sound went out on. So having replacements makes it even better. Thank you for being the reason my students smile when opening new laptops.”

A London hospital installs a vending machine that dispenses vegan meals for employees, the first of 500 such machines that vegan meal subscription company Vibrant Vegan will install in NHS hospitals by 2023. The meals, which cost $6.50, can be microwaved or heated inside the machine in four minutes.

Jaines Andrades started working at Baystate Medical Center in 2010 at 19 as a custodian cleaning the ORs, graduated as a nurse four years later, then became a nurse practitioner in trauma surgery.

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Weekender 10/9/20

October 9, 2020 Weekender Comments Off

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Weekly News Recap

Apple releases Health Records on the IPhone for users in the UK and Canada.
Dignity Health’s St. Joseph’s Hospital and Medical Center (AZ) will pay $160,000 for failing to provide a patient with a copy of their medical records.
Harris adds Australia to its operating areas with its acquisition of Meridian Health Informatics.
Universal Health Services completes part of its recovery from a cyberattack.
Four health IT companies are acquired by private equity firm The Carlyle Group and will operate under the single brand of CorroHealth.
HHS issues a second $10 million contract to TeleTracking Technologies for its HHS Protect COVID-19 hospital data collection system
Clinical trials software vendor EResearch Technology is hit by a ransomware attack.
Meditech will end its status as an SEC public reporting company by de-registering its shares to go private.

Best Reader Comments

[On Hims-style telemedicine] The reason it costs so much is because he sees a physician who the health system has to pay a couple hundred grand a year and the health system itself has high overhead (rent, administration, etc.) that it needs to bring in revenue to cover. Medicare for all isn’t going to change that cost equation unless it puts substantial downward pressure on physician compensation. Hims has got it worked out where they have low labor costs for a variety of reasons and they’ve got low overhead besides marketing spend. Why can’t someone replicate that for prescription renewals or other routine, almost secretarial care? (IANAL)

Treating depression or anxiety isn’t just a matter of writing a quick script. The same is true of virtually any legitimate prescribing. If a drug is sufficiently powerful to work in treating a clinical condition, then it’s also likely to have some potential for side effects, interactions with other drugs, or be problematic depending on the patient’s underlying health conditions. Making those determinations and identifying whether the patient is best served by medication and/or psychotherapy, isn’t a 5 minute process nor is it best served by seeing a different person for 5 minutes every year. (MedicareForAll)

Traditional doctors are way too expensive to be handling these issues for the young and low income. People might get suboptimal treatment via episodic care, but paying out the nose for every little thing harms people in its own way. We can’t choose the option that protects health system incomes over patient incomes every time. Americans just do not have the money. Sometimes paying a lot less for care that is a little lower quality is what people want. (Associate CIO)

Watercooler Talk Tidbits

Readers funded the Donors Choose teacher grant request of Ms. R in Pennsylvania, who asked for a history book series for her third grade class. She reported in early March, “When I told my students that we were getting new books, a huge cheer went up in the classroom! When I told them what books we were getting, they were even more excited! The students have been reading our new books since they were delivered to the room, and you can tell how much they love them. After reading a book, students have the opportunity to share their book with other students. This gives students a chance to practice their summarizing skills (as they tell others about their book) and their persuasive skills (as they convince others to read the book). But most importantly, it gives them a chance to share their love of a book and give others a chance to enjoy the book as well.”

I took advantage of some great third-party matching to fully fund these Donors Choose projects, courtesy of funds from my Anonymous Vendor Executive:

Math manipulatives, calculators, and whiteboards for Ms. C’s high school geometry class in Blountsville, AL.
A second monitor for remote learning instruction for Ms. M’s high school class in Belfast, ME.
Seating, supplies, educational toys, and arts and crafts supplies for Ms. D’s special education class in Scranton, AR.
An Apple TV for remote learning streaming for Ms. E’s second grade class in Los Angeles, CA.
Hands-on math tools for Ms. K’s special education class in Tucson, AZ.
A document camera for Ms. V’s fourth grade class in Los Angeles, CA.
Laptop and phone stands and calendar and weather charts for the elementary school class of first-year teacher Ms. S in Houston, TX
Books and reading materials for Ms. A’s elementary school class in Los Angeles, CA.
Reading circle carpet and learning activities for Ms. G’s kindergarten class in Houston, TX

Doctors of osteopathic medicine — whose DO credential allows them to practice identically to their allopathic (MD) peers – worry that political arguing over the hospital treatment rendered to President Trump by Sean Conley, DO has caused some to question why the president isn’t being treated by a “real doctor.” Some people confuse DOs with chiropractors because they receive extensive extra training in the musculoskeletal system (75% of whom don’t use it in their practice) and focus on preventive medicine, and in fact MD training is moving more toward that of DOs in its newfound emphasis on prevention and holistic medicine. It gets more complicated for foreign-trained doctors, whose diploma may show MBBS, MBChB, BMED, BMBS, or other credential that is equivalent to an MD, some of whom misstate their LinkedIn credential as having earned an MD degree from a school that does not issue that credential. I’ve read that surgeons in the UK are addressed as Mr., Miss, Ms. or Mrs., which is interesting, and I’ve seen quite a few health industry folk in the US append “Dr.” in front of their names for possessing degrees that are not only non-medical, but in some cases are from unaccredited schools or were conferred as honorary degrees, where using the “Dr.” title is just plain wrong. And of course it is never correct to bookend the social title with the professional credential, in the form of “Dr. John Smith, MD.”

The Denver Broncos honor five of their cheerleaders who are healthcare workers in their day jobs, among them an ED nurse practitioner, a physical therapist, and a trauma nurse.

A traveling nurse who spent two months on the COVID front lines in New Jersey this spring donates a kidney to a one-year-old boy.

The China-based manufacturer of a $200 Bluetooth-controlled male chastity belt sex toy responds to a reported security flaw — in which hackers could lock every one of the devices worldwide or steal user information — by suggesting that users could break the device open with a screwdriver if needed. One of the security researchers wasn’t enthused at that prospect, saying, “The forceful use of a screwdriver in close proximity to a very sensitive area of the anatomy seems very unwise,” which might be explained by the company’s tagline, “love hurts.”

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Weekender 10/2/20

October 2, 2020 Weekender Comments Off

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Weekly News Recap

A GAO report says that state prescription drug monitoring program databases would be more useful in patient care if they were more widely integrated with EHRs.
Nordic acquires Tasman Global.
The VA sets October 24 for its first Cerner go-live.
Epic and M Health Fairview offer Epic sites free use of an algorithm that can diagnose COVID-19 from chest X-rays.
A study finds that a high percentage of Apple Watch notifications of atrial fibrillation don’t result in a corresponding diagnosis and were likely not useful, also noting that nearly one-third of the patients who sought medical care as a result should not have been using the tool because they fall outside of FDA guidelines because of age or known AFib.
HHS and ONC launch a program with the American Board of Family Medicine to measure the use and potential burdens of health IT by office-based physicians.
UnitedHealthcare and Anthem end their no-cost coverage of telehealth visits that are not related to COVID-19.
A malware attack at Universal Health Services takes down computer and phone systems at 250 facilities, with some hospitals closing departments and diverting patients.
Allegheny Health Network (PA) and a Pittsburgh investor create an innovation hub that will provide seed funding to companies that are involved in diagnostics, therapeutics, medical devices, and health IT.

Watercooler Talk Tidbits

Readers funded the Donors Choose teacher grant request of Ms. M in Texas, who asked for hands-on STEM kits for her middle school class. She reports, “They were excited to work with all the different kits. I began each lesson with an objective, explanation, and expectations. The kits were an extension to the lessons taught. My students couldn’t finish their work fast enough to get to the hands-on part of the lesson. It is really exciting to see students eager to learn. They were engaged the whole time. It was very interesting to see how students would come up with alternative solutions to the problems they were facing.”

A Virginia couple who found a bat under the bedsheets with them is given a $500 hospital estimate after insurance to get rabies shots. The hospital charged $36,000, leaving them with a $7,000 cost after their deductibles.

Companies are using covert surveillance software to monitor their work-from home employees, reviewing their screenshots, login times, and keystrokes. One program takes a photo from the employee’s webcam at regular intervals for managers who miss the control they had when looking over the physical shoulders of employees. One employee was caught logging in at 9 a.m. and off at 5 p.m. doing nothing in between except writing two emails. I was pressured years ago by a peer executive to send her reports about screen time and browsing history of her licensed professionals, leading to our official IT position that we weren’t in the surveillance business and management must be pretty poor if the only measurable output is adequate time sitting in front of the computer.

In Quebec, a hospitalized Indigenous patient records video of nurses belittling her in French, telling her that she is “stupid as hell,” that “she’s good at having sex more than anything else,” and “who do you think is paying for this?” She died shortly afterward of what the family believes was an accidental morphine overdose by staff, leaving seven children behind. The hospital has fired one nurse and the family is suing.

Irma Dryden, a black woman who served as a nurse to the famed Tuskegee Airmen during World War II, dies at 100. The New York-born nurse was assigned to Tuskegee Airfield in Alabama as her first exposure to the Deep South, when the military was segregated and black service members weren’t allowed to eat until the white soldiers had finished. Her ashes will be interred at Arlington National Cemetery. The head of the Tuskegee Army Nurses Project observes that those in the Tuskegee Airmen were fighting Adolf Hitler over human rights, but faced segregation and discrimination in their own country and even in their own military service.

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Weekender 9/25/20

September 25, 2020 Weekender Comments Off

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Weekly News Recap

CMS is reportedly preparing to notify the 76% of US hospitals that aren’t submitting daily COVID-19 reports to HHS’s new reporting system that their Medicare payments may be halted.
A business associate of Community Health Systems will pay $2.3 million to settle charges that it failed to secure its systems even after the FBI warned it that hackers had penetrated them.
FDA launches the Digital Health Center of Excellence that will advise it on digital health policies and regulatory approaches.
Microsoft launches Cloud for Healthcare.
A KLAS Arch Collaborative survey finds that EHRs are not a significant cause of nurse burnout.
The Carlyle Group acquires a majority stake in global health research network TriNetX.
Healthcare robotic process automation vendor Olive raises $106 million.
Informatics pioneer Bill Stead, MD announces that he will retire from Vanderbilt University Medical Center’s senior leadership team after a 29-year career.

Best Reader Comments

A person’s birth sex matters in lab results and medications. How they feel does not and could get them misdiagnosed or possibly killed if I am asked to send how they identify in PID:8. If HL7 wants to add an additional field for delivering how a patient feels about their gender identity, Interface Engineers will deliver it, as we do with all fields. (Don’t Blame The Interfaces)

You aren’t wrong about birth mattering in some situations, but also important to keep in mind that deliberate mis-gendering or dismissiveness of patient gender identity can present a lot of harm to a patient. (Alex)

Congratulations to Dr. Stead. I had the pleasure – as many – at McKesson to work with him on the CPOE system. A gentleman and obvious scholar who was practical is his approach to many of the problems faced by physicians and informatics folks at the time. Dr. Stead, may the sun shine on your face and wind be at your back always. (Mark P)

Your employer / insurer wants to decrease your use of healthcare so that they don’t pay as much. Sending you advertising for healthcare (services) typically increases utilization. Care coordination is expensive in itself and often actually drives up utilization. The majority of Americans at this point are putting off some healthcare issue. Get them into a care management program and suddenly you’re paying for the issue they neglected for the last five years in order to make rent. Pay close attention to their issue and now you catch all the stuff that needs more medical attention. In conclusion, the answer to the question “Why don’t they X?” Is because X doesn’t make them money. (IANAL)

Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Ms. M in Michigan, who asked for two interactive learning tablets for her elementary school class. She reported in mid-March, “The PBS Kids tablet is a wonderful edition to our classroom. The already installed games really excite our students and help them in the areas of literacy and math. The students are also able to explore with music, art, audible stories and more. They honestly know more about the tablet than I do through exploring. We use the tablet during choice time and also during individual learning time. This tablet really helps the students to have fun, develop technology skills and learn all in one. We could not have gotten this obviously without all of you generous donors. Thank you for caring about our classroom.”

The Los Angeles Chargers team doctor punctures the lung of starting quarterback Tyrod Taylor while administering an injection into his cracked ribs just before kickoff, sending him to the hospital with breathing problems.

Time names Johns Hopkins University engineering professor Lauren Gardner, MSE, PhD as one its 100 most influential people in the world. She led the team that developed the COVID-19 Dashboard in late January in working with first-year PhD student Ensheng Dong, MS while COVID-19 was still contained to China. Her Hopkins role is as associate professor, which seems a bit light for someone who has changed the world.

A Virginia TV station profiles Nigerian-born otolaryngologist Samkon Gado, MD, who played football for Liberty University, spent six years as an NFL running back, went to medical school and residency, and is now back in Virginia working in an ENT practice with his former college roommate and football teammate. His dream was medical school, not pro football, so he hoped for a four-year NFL career to pay for medical school. He finished his residency caring for COVID-19 patients in St. Louis.

Friends and family of a former World War II Army nurse celebrate her 100th birthday with drive-by greetings. Georgia-born Virginia George says of her post-war move to Binghamton, NY, “I came here over 70 years ago and I haven’t been warm since.”

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Weekender 9/18/20

September 18, 2020 Weekender 3 Comments

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Weekly News Recap

Amwell raises $742 million in its IPO.
Provation acquires EPreop.
MDLive secures investment totalling $75 million.
Change Healthcare announces plans to permanently close its Nashville headquarters.
Amazon opens up its HIPAA-compliant Alexa skill program to interested app developers.
Apple adds a blood oxygen monitoring feature to the newest version of Apple Watch.
Kaiser Permanente launches Virtual Plus, a virtual-forward health plan for members in six Washington counties.

Best Reader Comments

Over the last few years, I have seen a lot of fancy AI driven care coordination tools, I have seen commercials from payers and health systems on how they are taking better care of their members and patients. But personally (for myself and for my family), I have not seen any improvement in how care is delivered to me. I have never ever received an individualized outreach from my insurance company (AI-driven or not) or my provider regarding the risks that I may face. I still struggle on hard to navigate websites to find the right provider. I still fumble through five different patient portal accounts to keep track of my own data. Even during the last six months of COVID-19 crises, I have not received even a generic email of empathy from my current insurance provider. Is the root cause of this complete lack of consumer care the fact that in the employer-driven medical care insurance world, the only customer that insurers like UMR have to please is the benefits manager at the employer? And those benefits managers typically don’t seek feedback from employees on whether they are satisfied with the insurance options? (US_MedicalCare)

Watercooler Talk Tidbits

Readers funded the Donors Choose grant request of first-year teacher Ms. A, who asked for STEM resource kits for her California kindergarten class. She reports, “My students and I want to thank you for your generosity to our project, STEM in Kinder. These supplies are being used every day during our science time. My students were very excited when they first saw the supplies arrive. Once again, I cannot thank you enough for your help with this project. Most importantly, thank you so much for supporting my students and me. Especially this year it will make a huge difference in the lives of my students while they are learning from home.”

A veterinarian at an Illinois zoo asks a “human doctor” to perform a hysterectomy on a monkey with a rare form of uterine cancer. OB-GYN Justin Hinzman, MD performed the procedure, noting that it felt strange because the patient was the size of a human toddler.

The Philippines banned nurses from leaving the country to work elsewhere because of its own COVID-19 needs, but working conditions there are so bad that most of those whose travel was denied aren’t working as nurses anyway. The country previously encouraged them to seek overseas employment that paid multiples of what they could earn at home, allowing them to send money back to their families. They make up 4% of the US nurse total.

A North Dakota doctor is arrested in a prostitution sting operation at Hong Kong Spa, a massage parlor he owns. An employee says he is a “false owner” who was paid by the real owners to put his name on the business license.

A hospice nurse makes the wish of a 50-year-old terminal cancer patient happen when she gets a private pilot to fly him to his son’s first high school football game of the season, an away game that was too far for him to travel by car.

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Weekender 9/11/20

September 11, 2020 Weekender 1 Comment

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Weekly News Recap

Hyland will acquire Alfresco.
Amwell’s IPO plan values the company at $3.6 billion.
Zocdoc’s former CEO sues the company, claiming his co-founders and the CFO ousted him in a coup.
A federal court dismisses a patient’s lawsuit against University of Chicago Medical Center and Google for using his data for machine language training.
HIMSS confirms that a HIMSS20 exhibitor has filed a class action lawsuit against it over refund policies for the cancelled conference.
VA accelerates its Cerner implementation plan for VISN10 in the Midwest.

Best Reader Comments

Inviting mediocrity to find an opportunity elsewhere sounds about right to me. Of course, some people may not be the right fit for a particular job, but if you can figure out where they excel, then you have keepers. On the flip side of that equation, if you can’t manage strong talent, then maybe you need to be a better manager. I have found that when I hire good people, they get stuff done, and the impossible becomes possible with a few more weeks of effort. Think about Mayo Clinic, their administrators are docs, they are about the mission, the mission is valid and impactful, and anything that falls outside the mission is ‘reviewed’ for relevancy. They swore an oath and the oath means something. I found that same commitment in the service — plenty of people who were mediocre, and plenty of team players who strove for excellence — you weeded the bad, encouraged the mediocre, and rewarded the excellent. (Brody Brodock)

Can’t imagine having a team full of All Stars! What a headache. Someone needs to do the work and keep the ship moving. Interesting that the bribe is top salary in the industry and keep looking over your shoulder. Can’t imagine what that does for balance and family life. And, take a vacation any time you want because no one is looking. Not so fast, when you get back you find out you lost the race for “who would you fight for competition?” Absolutely crazy. There will come a time when this generation will self destruct. (William Reay)

Watercooler Talk Tidbits

Readers funded the Donors Choose teacher grant request of Ms. W in South Carolina, who asked for civil rights books for her elementary school class. She reported in early March, “Thank you for supporting our students in reading! Through building our classroom library, you are helping to provide texts that the students can read at their own independent level and with texts that engage them. They love reading and learning about social studies topics. With a classroom as diverse as our the Civil Rights Movement is a topic that we all care about deeply. They were so excited and proud to check out and add these new texts to their individual book boxes to read this week! Thank you once again for your love and support of our students and their love of reading!”

Criminal defense lawyers for former Theranos CEO Elizabeth Holmes will arrange a psychiatric evaluation that they hope to use to support a “mental disease” defense.

Two COVID-19 field hospitals totalling 2,500 beds that were built in less than two weeks in Wuhan, China in early February were closed one month later, along with 14 other temporary hospitals, when President Xi Jinping declared that the outbreak had ended. The two big hospitals were sealed off on April 15, with state media saying they were both full at one point and that the 1,500-bed one had treated 2,000 patients.

A former EVP of struggling Wheeling Hospital (WV) will receive $10 million as his whistleblower share of the $50 million that the hospital will pay to the federal government to settle charges that it paid doctors based on the value of their patient referrals. The hospital had countersued, saying that Louis Longo was also a partner with Deloitte and did not report his concerns to the hospital’s compliance officer and instead, as a bitter former executive, decided to “extort a settlement.”

The wife of a urologist who has pleaded guilty to Medicare fraud, who was also his office nurse, is sentenced to probation for ordering employees to re-use “certain anorectal devices.”

Nephrology fellow Nyan Pyae, MD leaves the hospital after a 106-day COVID-19 stay, including 80 days in the ICU and 26 on ECMO.

Reebok’s ad campaign for a new shoe line that is tied to the upcoming movie “Wonder Woman 1984” features real-life Boston nurses.

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Weekender 9/4/20

September 4, 2020 Weekender Comments Off

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Weekly News Recap

Analytics-powered remote patient monitoring vendor Biofourmis raises $100 million.
Nordic lays off 72 employees.
The US Coast Guard goes live on DoD’s Cerner-powered MHS Genesis.
Personal health record and real-world evidence vendor PicnicHealth raises $35 million in Series A and B funding rounds.
TigerConnect acquires Adjuvant’s physician scheduling tool.
AMA releases CPT 2021.
Ascension Health announces plans to lay off 223 IT employees and outsource their jobs.
Konica Minolta will pay $500,000 to settle false claims act charges related to its acquired Viztek Exa EHR.

Best Reader Comments

”If Medicare requires use of something [CPT codes], it should be in the public domain, but there’s too much money and lobbying involved to make a change” nailed it. But isn’t money and lobbying so much of what has led to our great American non-system in the first place? (Kevin Hepler)

Any well-designed archive should require multi-level authentication to delete any study. Preferably this has at least three distinct administrators who all need to sign off on any deletion, even an individual one, let alone thousands. VNAs and even standard PACS archives don’t delete the data, but instead just change the pointer to the revised study it if a study is modified. That way you still have both studies saved. The disaster recovery data in the cloud should NEVER be allowed to be deleted by ANYONE under ANY circumstance. (Youshouldknowbetter)

Not sure why PicnicHealth was able to raise that kind of round as their pricing model is anything but sound. Maybe for the most worried well, Silicon Valley parents types (e.g. those with $$$ to spare) but for the vast populace, that pricing is a non-starter. (John)

InfoGard is paid to rubber stamp certifications and treats some fraud fines as the cost of doing business. I think the real story here is that HHS and the feds rely so heavily on private contractors and private industry. Teasing out why and enacting change is something not even on anybody’s radar. Fifty years ago, the feds would have just done this certification work themselves and there wouldn’t be the same mismatched incentives. Now it is outsourced three different ways, costs more, and still nothing gets done. (IANAL)

I find it interesting that the testing organization, (InfoGard) couldn’t ferret out hard-coded data. It is really as simple as sampling from the top n (100) plus alpha and noticing that every time you change the value for n the source system has to go back and redo their work. Or, asking the question, “Can you show me your dictionary for x in SQL?” then ask them to do a count of that dictionary and compare it to the expected value. If you are off by hundreds of thousands, then you hard-coded values. By that I mean, RxNorm has 70k? values in the in/min and brand TTY? If the solution under test can’t show an RxNorm table, or its equivalent (Medispan, First Databank, Multum) with a pretty close proximity to that number, then you have a Houston moment. This isn’t rocket surgery. That pattern of ask/fail/return with the correct answer wouldn’t pass a grade school teacher’s closed book exam sniff test. Just as it should never have passed their tests. (AnInteropGuy)

Have you invested in the Echo ecosystem from the beginning and participated in the evolution of functions that go way beyond just “features”? If so, you may know how it has enabled neurologically compromised seniors to have voice-activated and managed communication access they would not otherwise have, along with fall risk options, security, and safety, all for no additional cost beyond the acquisition of devices, plugs (flex), etc. The core premise of Halo is not simply for the worried well. I appreciate the non-screen and the investment in the core and am very much look forward to the evolving features and benefits. There are a lot of “worried well” gadgets out there (remember the HIMSS-aligned “Misfit” series). Halo is not one of them. (Smart Platforms)

[Paper forms are still used] because the UI of a typical paper form has been developed for several hundred years and the UI of your tablet was developed by some contractor who just learned “hello world.” Paper doesn’t freeze or run out of battery or break when you drop it or require an IT guy or struggle to be read by the tech averse. Plus the company pays the receptionist to sit their anyway and they are the only place in town that accepts your insurance. (IANAL)

Watercooler Talk Tidbits

Readers funded the Donors Choose teacher grant request of Ms. H in Michigan, who asked for math games for her readiness program for students aged four or five. She reported in early March, “The math games were used for our March into Math event that encourages parents to learn and take home math-related materials to help children continue to learn at home. This by far was the most successful mathematics event we have hosted so far. The room was completely filled. As students walked in with their parents, they immediately saw the table display of all the games and became very excited about our evening. These materials have helped us demonstrate a variety of mathematic concepts that are needed for them to be successful in pre-school as well as transitioning into kindergarten. Thank you for your support and making an impact on the lives of my students.”

CVS-owned chronic care management service Accordant apologizes to a patient who described her anxiety over COVID-19 to one of its telephone nurses, who then told the woman that she didn’t need to worry because “the CDC is lying to us and doctors are being paid to lie about COVID.”

Americans who are used to day-tripping to Mexico or Canada to buy prescriptions or medical services for much less money are “trapped in their own healthcare system” now that those borders have been closed to non-essential travel. A Texas man had dental work done in Mexico for $750 that would have cost $10,000 on this side of the border, then found that he could buy his $275 insulin for $20 there. He formerly skipped eating for days at a time to ration his insulin, calculating his lifespan at the number of days’ supply of insulin he has on hand plus three days. A pharmacy in Vancouver that has served some American customers for years is dealing with those who have been laid off, taking the distinctly non-American approach of, “We’ve sent them what they needed and we tell them, pay us when you can.”

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Weekender 8/28/20

August 28, 2020 Weekender 3 Comments

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Weekly News Recap

Amazon announces its Halo health and wellness wearable, app, and membership program, with Cerner posting its own news that it has integrated the device with Millennium.
Konica Minolta Healthcare Americas Inc. will pay $500,000 to settle federal false claims allegations that its former Viztek subsidiary fraudulently earned certification for its EXA EHR that allowed users to claim Meaningful Use funds.
The private equity owners of behavioral software vendors Qualifacts and Credible Behavioral Health announce that they will merge their respective companies.
CMS issues emergency regulations that require hospitals to report their COVID-19 capacity data daily to HHS to continue being paid by Medicare and Medicaid.
Google Cloud will invest $100 million in Amwell when the company begins public trading.
The VA implements patient scheduling in an Ohio facility in its first Cerner go-live.

Best Reader Comments

There are some really affordable solutions that allow patients to either pre-register online or fill out information on a tablet or other mobile device when they’re checking in. It’s more convenient for the patient and eliminates a lot of expensive data entry in the back office. You can also do things like connect to a clearinghouse to check a patient’s insurance coverage. I’m no longer surprised at how much hospitals and clinics invest in technology, but still waste time and money with manual paper processes, but it’s hard to fathom. (Greg Mennegar)

I am an Epic builder and it annoys me to no end when I pre-register and fill out all the MyChart questionnaires for an appointment at one of the “big hospitals” here in Boston only to be handed a clipboard with the same questionnaire in paper form that I am asked to fill out. I have even offered to show the front desk staff how to print out the filled out questionnaire from my chart to no avail (this has happened to me more than once and in different departments). Sometimes it is less about the lack of technology and more the lack of user training that can be the issue. (Craig Molway)

Any organization that deems it necessary to purchase higher ratings to game the system should be called out. It clearly points to an act of desperation to sell services or products that can’t stand on their own merit or reputation. This is certainly a warning sign to potential clients that an organization is willing to do all the wrong things to get a contact besides providing a high-value / quality service. (PT Franks)

I would argue that the mental / behavioral health crisis that has gained national attention to the pandemic has its roots in young people being taught that certain emotions are bad and to be avoided. If you look at metaphors, happiness is bright and full of sunshine and sadness is blue and full of clouds and rain. Who want want to admit being sad?!? To your point about the person who told you to wear a smile, it’s akin to a person asking you, “How you are?” and only wanting to hear something superficial like “good” or “not bad.” Perhaps many folks don’t have the language or skills to talk about the “bad” emotions in a meaningful way, so they choose avoidance.(Elmer Phd)

Your “compared to a year ago” poll made me smile. Exactly one year ago I was at peak misery of hot, swollen and uncomfortable, because I was nine months pregnant. I was instantly happier, healthier, and more optimistic two days later when our son was born. (What a year)

Watercooler Talk Tidbits

Readers funded the Donors Choose teacher grant request of first-year teacher Ms. N in Miami, who asked for engineering learning centers for her elementary school class. She reported in early March, “I work in a title one school with mostly students from low-income families and a low-income community. Getting gifts for the classroom makes them so excited to learn and come to school everyday regardless of what they face at home. When my students first saw the items that were donated they could not control themselves, they were so excited. They wanted to dive in right away! Some of their favorites are the turn and learn gears and the car building kit. Engineering time in my classroom is my favorite part of the day because it fosters their creativity and this time was made more special because of your donations!”

Ralph Lauren will outfit those working as “ballpersons” during the US Open with a muted uniform, with each shirt listing the name of a Mount Sinai Health System essential employee on the back. The company says bright, colorful designs didn’t seem appropriate and thinks having the names of those who have saved lives on display will celebrate the many ways in which people can make a difference. The company will also feature profiles and stories of nine of the workers on its website.

A team of 14 nurses, two neonatal nurse practitioners, three respiratory therapists, and a neonatologist worked through the night to care for 19 NICU babies at Lake Charles Memorial Hospital (LA) as Hurricane Laura hit with winds of up to 135 miles per hour early Thursday morning, taking out the hospital’s air conditioning and water. The team moved the babies, some of them on ventilators, to the hallway away from windows. The babies had been transferred there a few hours before when the women’s hospital was evacuated.

The CEO of Bristol Regional Medical Center (TN) resigns after accepting a cardiothoracic surgeon’s invitation to make the first incision in a patient despite having no medical training. The hospital also parted ways with the surgeon.

A Georgia nurse who contracted COVID-19 during a two-month assignment in New York City and then couldn’t return to hospital work because she was haunted by the experience of seeing families watching their loved ones die via FaceTime starts a company that helps businesses keep their employees safe from COVID.

The Washington Post profiles former Baton Rouge General Medical Center security guard Russell Ledet, who is now doing his third-year medical school rotation at the same hospital while completing his MD and MBA degrees. He joined the Navy out of high school and was convinced by his wife to go to college, where he doubled-majored in biology and chemistry while supporting his family with the security guard job. After finishing undergrad, he earned a PhD from NYU in molecular oncology, then started medical school at Tulane. He plans to earn triple board certification in pediatrics, general psychiatry, and child and adolescent psychiatry and then open a New Orleans mental health services clinic for marginalized communities.

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