Weekender 3/22/19

Weekly News Recap

• A Reddit “Ask Me Anything” with Providence St. Joseph Health EVP / Chief Digital Officer and venture fund manager Aaron Martin gets ugly with charges of layoffs and a hostile work environment for female employees
• A France-based online medical appointment app vendor’s funding round values it at more than $1 billion
• Fortune’s cover story, “Death By 1,000 Clicks: Where Electronic Health Records Went Wrong,” says EHRs are an “unholy mess” after taxpayers spent $36 billion on their use
• Health Catalyst hires investment bankers to begin its IPO process
• The payment model of England’s NHS, which is based on a medical practice’s location, raises concern as the private company behind the GP at Hand video consultation app draws 40,000 Londoners to its practice
• Change Healthcare files IPO documents
• A survey finds that nurses who work in a positive work environment like their EHRs better and have a higher appreciation for their role in patient care

Best Reader Comments

Having sold EHR software before the government started subsidizing buying as well as after its no surprise the monetary “savings” haven’t been realized. Most physicians under-coded visits prior to using an EHR as they feared failing an audit of required documentation. Using an EHR allows faster accurate coding, which means higher medical costs. When physicians used paper to document care, they usually made very brief notes with the patient in the exam room. Then they spent hours dictating progress or writing progress notes after business hours. This delay often led to missing information in the notes. Many charts were unreadable or missing when needed. The paper records were far from perfect and hid many more medical errors. (Matt)

No one took the time to redesign the healthcare process [before designing EHRs] and develop roles and tasks that automation could efficiently support. A quick read of the Toyota Production System’s approach to adopting new technology shows how backward EHR adoption has been. We do have great examples in health care where automation was handled properly. Voice recognition reduced radiology turn around times to minutes from days. Lab automation and electronic communication linked robotic testing results to the medical record with near instantaneous availability. Bedside MARs measurably improved patient safety. But when it came time to do the big one, we dropped the ball. (Steve O’Neill)

There’s not a Theranos story [with journalism investigating the EHR industry], but there is a story of companies that grew much too quickly, are governed largely by crisis and chaos, have an ethos of “put something out there and fix it later” (or, promise something and create it later), are operated at all levels but the very top mostly by 20-somethings, and have had plenty of lapses of both execution and ethics in the post-HITECH boom. (Fred)

Back in the very first days of the MU program, I sat in a meeting room at a state hospital association conference and heard a CMS regional administrator say, “We won’t pay for that which we can’t measure,” i.e, if you are documenting in a way that makes it difficult or impossible to collect data and compare how you’re doing with other providers, we aren’t going to pay you. Lab results, vital signs, and drug administrations are all relatively easy to collect data for measurement. Medical necessity pass/fail rates are fairly easy. Acceptable Use Criteria will make diagnostic imaging more easily measurable. CPOE made order patterns measurable. Specificity in documentation to get to the most specific diagnosis code possible is measurable. MU was in large part about making as much information as possible measurable. That it took billions of dollars to get an industry notoriously resistant to any oversight in how they function was a feature, not a bug. (MEDITECH Customer)

Physicians are in such limited supply and command such high salaries that the entire clinic or unit orient themselves around having the MD always operate at the “top of their license.” This means that the MD interaction with the patient will consist of 1.) dispensing whatever information only the MD and no one else in the clinic can dispense. 2.) doing the bare minimum to ensure that the patient is billed for number one. Doctors will not get paid >100 dollars an hour to look people in the eye, have a conversation or connection, take a clinical measurement, have an original thought, etc. All of those things can be done by a medical assistant or a nurse or someone cheap. We could assign a scribe to every physician so the wouldn’t ever have to touch an EHR; I think doctors would be marginally happier but not significantly. The reality is that physicians are now employees and no longer run the show. Like the rest of us employees, the only meaningful changes will come from unions or the legislature.(SelfInflictedWound)

I have been in the healthcare industry for years and am guilty of not having a PCP. I had never really thought about the “relationship” aspect of a physician and why it would be beneficial to have someone engaged in my care that has seen me over a period of years rather than a quick trip in when I am not feeling well. Technology continues to change how we interact and socialize with others. It will be interesting to see how the doctor-patient connections morph as technology continues to be more readily available and acceptable in new areas. (Steph M.)

Watercooler Talk Tidbits

Readers funded the DonorsChoose teacher grant request of Ms. T in Texas, who asked for 35 calculators for her elementary school class (I’m not exactly sure what kind of class, but she mentions that all students are girls who have overcome adversity). She reports, “Students today have easy access to a lot of technology, but they are not always taught how to use it correctly. One thing I have noticed in the past is that students struggle to use calculators correctly. This causes a problem as they progress in school and have more access to them and are expected to use them in Algebra. The impact of your gift is that now, students at my school have the ability to be taught how to properly use a calculator before reaching the upper level math classes. Thank you for allowing them this introduction!”

Researchers working with a woman who can detect Parkinson’s disease based on the smell of patients create a diagnostic test as a result, using mass spectrometry to isolate the four compounds that are most responsible. The former nurse can also detect cancer and tuberculosis, which will be the subject of another round of research.

A 59-year-old woman who suffers from early onset dementia is sent from a local hospital to Oregon Health & Science University for urgent heart bypass surgery and valve repair. She then developed a post-op infection that left her hospitalized for a month, after which OHSU billed her for the $227,000 part of her stay that her insurer wouldn’t cover because the hospital is out of its network. Her husband, whose Social Security payments of $1,900 per month make up the family’s entire income, says the hospital never told him about the out-of-network costs or offered a transfer to an in-network hospital. The couple is relieved that OHSU finally agreed to write off the bill under a charity waiver obtained with the help of a non-profit group, but resents getting collection calls for six months.

Bizarre: the Buffalo Wild Wings restaurant chain rolls out a March Madness “Jewel Stool” that is comfortable for men who have just undergone vasectomies, with the idea coming from data pulled from Athenahealth’s netowrk indicating that urologists perform 41 percent more vasectomies on the first Friday of March Madness compared to the typical Friday. Urology practices like the one above are even running March Madness snip specials.

A retired, Harvard-trained cardiologist whose restaurant waitress daughter asked him to cover a busboy shift saves a choking woman just five minutes into the job by performing the Heimlich maneuver.

In Case You Missed It

• News 3/22/19
• EPtalk by Dr. Jayne 3/21/19
• News 3/20/19
• HIStalk Interviews Cedric Truss, DHA, Director Health Informatics Program, Georgia State University
• Curbside Consult with Dr. Jayne 3/18/19
• Monday Morning Update 3/18/19

Get Involved

• Join my Rolodex to provide occasional news reaction or ideas
• Contribute regularly as a provider CIO, IT director, or informatics nurse (anonymous or not)
• Be interviewed (providers)
• Deliver an educational webinar (providers)
• Sponsor
• Report a news item or rumor (anonymous or not)
• Sign up for email updates
• Connect on LinkedIn
• Contact Mr. H

Weekender 3/15/19

Weekly News Recap

• Rutland Regional Medical Center (VT) experiences its second email-related breach
• Australian imaging software vendor Mach7 fires its CEO and eliminates the CTO role as part of a restructuring and cost-cutting program that it hopes will propel its US growth
• An investment analyst thinks Apple will expand the Watch’s medical sensors and then sell the data of wearers to their doctors for $10 per patient per month
• Hill-Rom announces that it will acquire mobile clinical communications vendor Voalte for up to $195 million
• An investigative report finds that medical device manufacturers have been able to hide widespread patient safety issues by using the FDA’s alternate summary reporting program

Best Reader Comments

The thing that gets me about the Theranos story was that even at the peak of their hype, everyone I spoke with in the healthcare field could see that it was fishy as heck and no one I know was surprised when it turned out to be BS. (Dr. Herzenstube)

I hadn’t thought of Amazon serving up order sets, but they’re actually doing some of the most sophisticated order sets out there. (Mike Z)

You’re right on the money. There is no magic bullet to burnout but this type of article that talks real / no frills techniques that can be done today. This is exactly what our teams should be focused on. (TX Trainer)

I’m sure there are plenty of physicians, regardless of specialty, who could speak to a patient via a telemedicine “robot” and convey empathy. So please blame any outrage on the individual purveyor of bad news and not on all physicians or all robots. (Compassionate cyborg)

It will be fascinating to monitor Cerner’s encounter-based EHR’s acceptance as well as how they will decide to address functional nuances in the VA (and DoD). Cerner’s EHR is designed for a “clinically driven revenue cycle” – a help or hindrance to the VA and DoD? (Art_Vandelay)

Watercooler Talk Tidbits

Readers funded the DonorsChoose teacher grant request of Ms. P in Virginia, who asked for books that emphasize individuality and tolerance, lap desks, and camp tables for her first grade class. She reports, “It was wonderful to be have these read-aloud titles in the classroom. I frequently turn back to the books when I feel my students needed a reminder about how to treat others with empathy and tolerance. The books’ message also reached first graders in other classes, as I loaned the titles to other teachers on my teaching team. Thank you for allowing me to bring these resources into my classroom!”

Turkey’s government opens a 3,810-bed, $1.15 billion hospital in Ankara, with the country’s medical association expressing concerns that “central hospitals are not cost effective and they impact public health quite negatively.” The medical association notes that European cities have mostly moved away from building mega-hospitals in favor of building several smaller ones. They have mostly abandoned the public-private partnership model that is being used to open 30 new hospitals in Turkey, in which a contractor pays the construction cost, then rents the building back to the government. Armchair geographers take note – Turkey is in both Asia and Europe and Istanbul is the only city in the world that straddles two continents.

A North Carolina hospital warns employees that using legal but unregulated CBD oil could get them fired because some products contain traces of THC that will trigger a positive drug test.

A New York Times article notes that doctors “disappear without a word” when they leave a practice with a non-compete agreement in which the old employer refuses to tell their patients how to contact them. The CEO of Iowa Clinic, which is being sued by three urologists who argue that their termination makes their non-compete agreement unenforceable, says such agreements are “good for the patients because they help to provide stability within a practice and ensure continuity of care.” One of the clinic’s patients disagrees, saying that, “somehow they lost sight of patient care and were more concerned about the bottom line.”

OnMed rolls out a phone booth-like telemedicine station that allows online consultations via a a video consultation that includes remotely-controlled vital signs measurement and automated drug dispensing. In-session privacy features include automatic door locking, windows that turn opaque, and speakers that can’t be heard from outside. Patients are identified using 3D facial recognition and the doctor’s credentials are displayed on the screen. UV lighting sterilizes the booth between visits.

A University of Miami Health System fires a sex-change surgeon for posting pictures of his cases on Instagram under the account @sexsurgeon, including a Valentine’s Day post showing a removed penis shaped into a heart labeled, “There are many ways to show your LOVE.”

In Case You Missed It

• News 3/15/19
• EPtalk by Dr. Jayne 3/14/19
• Readers Write: To Douse the Flames of Physician Burnout, Target the Four Biggest Time-Wasters in the EHR
• HIStalk Interviews Mike Mardini, CEO, National Decision Support Company
• News 3/13/19
• Curbside Consult with Dr. Jayne 3/11/19
• HIStalk Interviews Guillaume de Zwirek, CEO, Well Health
• Monday Morning Update 3/11/19

Get Involved

• Join my Rolodex to provide occasional news reaction or ideas
• Contribute regularly as a provider CIO, IT director, or informatics nurse (anonymous or not)
• Be interviewed (providers)
• Deliver an educational webinar (providers)
• Sponsor
• Report a news item or rumor (anonymous or not)
• Sign up for email updates
• Connect on LinkedIn
• Contact Mr. H

Weekender 3/8/19

Weekly News Recap

• Livongo’s planned Q3 IPO could bring in $1 billion
• Carestream Health sells its health IT business to Philips
• Northwestern Memorial Hospital fires dozens of employees for looking at the EHR records of actor Jussie Smollett
• Amazon, Berkshire Hathaway, and JPMorgan Chase name their healthcare venture Haven
• FDA Commissioner and digital health advocate Scott Gottlieb, MD resigns
• Newly formed Beth Israel Lahey Health says it will eventually consolidate its multiple EHRs into a single product

Best Reader Comments

There is no long road to interoperability. There are data solutions right now that can curate and harmonize all the data that’s out there. FHIR is not going to be a magic bullet either. Healthcare organizations have to stop waiting for Judy to figure it out and invest in an enterprise data strategy and platform. (BK)

A single-payer system that rams real metrics down our throats will engage value-based care as a viable alternative. The original Obamacare bill had a subscription-based expansion of Medicare, i.e. a 25-year-old could pay premiums directly to Medicare for enrollment. Medicare would effectively be setting the floor for premium costs, and commercials would have to come down and offer better services to compete. This absolutely is the way we are trending and will happen at some point. The question is when, and will the healthcare systems/HIT be ready to change to really win the business of patients with VBC. (SinglePayor)

I shouldn’t be, but I am surprised how often I see vendors and providers hyping up value-based care. Upside only arrangements don’t count. Payments based on weak quality metrics aren’t important to consumers. Prices aren’t available to consumers. Where is the value? Most hospitals and health systems have about 5 percent of payments tied to VBC. My opinion is that the only providers who can claim VBC: true IDNs and those that offer a significant number of bundles (Geisinger’s proven care model). If you talk to hospital CEOs and CFOs, it’s very rare to find VBC in their top 10 priorities. My sense is that vendors are driving the hype. (Desperado)

Watercooler Talk Tidbits

Readers funded the DonorsChoose teacher grant request of Ms. D in Massachusetts, who asked for classroom speakers for her elementary school class. She reports, “These speakers have been a lifesaver for my classroom. I use them for all my lessons and for brain breaks for my Littles. For math warm-ups, we often watch videos that help my students learn to count to 100 by 1s, 2s, 5s, and 10s. In reading, I was able to find audio and videos on books that we are reading in the classroom. During indoor recess, I often put on videos of different habitats and they love to just sit on the carpet, listen, and see different worlds. The girls love the speakers on Just Dance Friday, where if the class has earned enough reward points, we turn the classroom into a dance floor. Thank you for the donation to my classroom.”

Median monthly rent for a one-bedroom apartment in San Francisco has risen nine percent in the past year to $3,690. That’s before the upcoming flood of tech IPOs creates thousands of new company millionaires who are anxious to kick off their conspicuous consumption by buying houses, throwing lavish parties, and buying boats even as financial planners warn them that their counterparts at Groupon and Snap did the same until their shares went down in flames. A real estate analytics expert predicts that one-bedroom condos will be worth at least $1 million in five years and single-family homes will average $5 million.

Company swag at Livongo’s first user group meeting included a day’s use of partner company’s continuous glucose monitor patch, reminding everyone about just how big a business diabetes (or the threat of it) is in the US as Livongo barrels toward its $1 billion IPO.

The mainstream press notices that the proposed HHS interoperability rule would also require hospitals to publish the actual prices they have negotiated with insurers. You needn’t wonder where the AHA stands on this issue.

The hospital gown that Kurt Cobain wore in Nirvana’s headlining set in Reading Festival 1992 has been put up for auction by a fan who says Courtney Love gave it to him during a vigil after Cobain’s suicide in 1994. Cobain was pushed onto the stage in a wheelchair while wearing the gown, sang a few lyrics from Bette Midler’s “The Rose,” and then pretended to collapse before springing up to rip through a 25-song set whose bootleg is prized by collectors as one of the band’s best, all to dispel rumors that he wouldn’t make the show because of his drug addiction.

A six-year-old boy whose parents refused to have him vaccinated becomes Oregon’s first pediatric tetanus case in 30 years, with his family refusing to continue the vaccine series that was started during his 57-day hospital stay that cost $800,000.

The parents of a 21-year-old who died in a skiing accident hire a lawyer to force Westchester Medical Center (NY) to save a sample of his sperm with the hope of “preserving some piece of our child that might live on,” but the court will have to decide what happens to the sample since the son didn’t give his permission. He was the only child of the couple, who is from China, and that country’s previous one-child policy has resulted in his having no male cousins to carry on the family lineage. Ethicists say that policies and laws aren’t consistent and there’s the question of who would choose the egg donor and raise the child.

Pop-up, spa-like stores are offering to freeze the eggs of women who worry about the ticking of their biological clocks, hosting champagne parties to convince prospects to pay $5,000 for the procedure and the first year of freezer time. One chain features Dr. Oz on its board, reassuring patients that their medical care will be overseen by someone who has won seven Daytime Emmy Awards.

In Case You Missed It

• News 3/8/19
• EPtalk by Dr. Jayne 3/7/19
• Readers Write: HIMSS, Innovation, and the Infomercial
• HIStalk Interviews Randall, An Anonymous Health System CIO
• News 3/6/19
• Curbside Consult with Dr. Jayne 3/4/19
• HIStalk Interviews Michael Schmidt, Managing Director of Strategic Innovations, Orlando Health
• Monday Morning Update 3/4/19

Get Involved

• Join my Rolodex to provide occasional news reaction or ideas
• Contribute regularly as a provider CIO, IT director, or informatics nurse (anonymous or not)
• Be interviewed (providers)
• Deliver an educational webinar (providers)
• Sponsor
• Report a news item or rumor (anonymous or not)
• Sign up for email updates
• Connect on LinkedIn
• Contact Mr. H 

Weekender 3/1/19

Weekly News Recap

• Medsphere acquires Wellsoft
• WellSky acquires HCS
• House VA committee Chairman Mark Takano (D-CA) chastises VA Secretary Robert Wilkie for failing to turn over documents related to the Mar-A-Lago trio’s influence on VA software purchasing decisions
• Crossover Health acquires Sherpaa Health’s technology platform
• More than half of surveyed home care clinicians say they can’t access the hospital EHR records of their patients to reconcile patient medications
• Cedars-Sinai pilots the use of Alexa-powered devices in patient rooms to route their verbal requests and to control their TVs

Best Reader Comments

Over the past month, I’ve been seen several times a week at different specialists within Emory. Every time I’ve checked in, I’ve been handed a printed medication list, asked to make any edits or changes on the paper, these are then confirmed verbally by both nurse and clinician in the exam, and by the next visit (sometimes two hours later, sometimes five days), the new printed list is always accurate. The changes are reflected in the patient portal too (which is to be expected, but God knows that doesn’t always happen…). They’re also the first healthcare org I’ve visited where *every* person who comes into the exam room confirms my name, DOB, and why I’m there. They even squirt on hand sanitizer as they’re walking in the room. Those are seemingly small things, but it’s been one of the most cohesive patient experiences I’ve ever had the pleasure of being involved in, especially considering my case is pretty complex and I’m bouncing around different offices all the time. (AtlantaPatient)

Every time I visit a provider (many different EHR systems), I bring a “yours truly”-generated, printed copy of my current meds (generic name, brand name, dosage, type, instruction; e.g., ALENDRONATE SODIUM (FOSAMAX) 70 MG TABLETS, 1 tablet by mouth weekly) because many of my meds are ordered by different providers. In addition, I take the time to explain the differences between the list they are viewing on their screens and my list. Last, I personally ask the provider to make sure they update their information exactly as I have noted in my list, which typically includes some additions, deletions, dose changes, etc. When I later recheck via my portal to see if the updates occurred (often having to wait until the next provider visit), I notice the same, damn, original list! When I later inquire as to why my requested updates have not been entered in their system, typically the response has been, “Our system doesn’t accept the information in the manner you provided.” (Woodstock Generation)

I wonder/wish if there was a way to quantify how much of Epic’s perennial higher ratings comes from the fact that they made extensive training with proven methods a mandatory part of their contract and implementation? (Smartfood 99)

Watercooler Talk Tidbits

Readers funded the DonorsChoose teacher grant request of Ms. I in California, who asked for take-home science projects for her dual-immersion (English and Spanish) fourth grade class whose families are mostly farm workers. She reports, “With your donation, my students were able to work on science projects we normally would not be able to do in fourth grade. Many of my students were so excited at having the ability to look at things under the microscope and would run out to the yard to find things to bring back in to look at. My students particularly liked the bubble science project and looking at different books about projects to do at home with their parents. Any project that allows a student time to spend with their parents is more beneficial than you would imagine.”

I’m not finding much I like among the Oscars “Best Picture” nominees. I though “Bohemian Rhapsody” was toe-tapping, formulaic fiction and “Roma” was beautifully filmed and directed but never really went anywhere. I rented “Green Book” and surely it’s the worst movie to ever win, full of clichés, filmmaking mistakes, and an eye-rollingly sappy story that first presents just a tiny bit of racial unjustice to make us privileged white people feel shame, then let us off the hook with a heavy-handed, feel-good message that we’re all decent people who just need to understand each other better to get along (ample evidence, much of it contemporary, to the contrary). I’m seeing “BlacKkKlansman” next, but it has tough competition from “A Star Is Born,” which ranks above the best movies I’ve seen (I’ve watched it at least four times and will happily do so again). “Green Book” is a middling movie at best, joining other embarrassing Best Picture winners like “The Artist,” “Shakespeare in Love,” and “Chariots of Fire.”

NPR reports that the car problem diagnostic process used by the Magliozzi brothers in its former “Car Talk” program is being used to teach medical students how to solve patient problems by collecting data, defining the problem, and choosing from several possible solutions.

The newly launched Onward offers a “post-breakup concierge service” for outsourcing-comfortable millennials who are “leaving cohabitation” and don’t have friends or family nearby to help. Customers pay $99 to have their housing and moving managed and can buy extra services such as therapist matching, weekly check-ins, and personalized neighborhood guides. It even manages to work in the meaningless millennial word magnet of “curated.”

This might be more dramatic than a Steve Jobs “one more thing” reveal. A surgeon in Barcelona, Spain directs a remote surgery via 5G-powered, high-definition video from the stage of the Mobile World Congress conference. 

Cleveland Clinic confiscated 30,000 weapons from patients and visitors in 2018, which might be a gauntlet throw-down to inner city trauma centers that surely see more weapons (and the result of them) in their EDs.

A baby whose entire life of 572 days was spent in Oishei Children’s Hospital (NY) goes home for the first time, saved by “countless” surgeries after being born weighing just over one pound. He was cleared for discharge months ago after 10 months in the NICU and five in the PICU, but the family couldn’t find homecare nurses who could care for his ventilator. A GoFundMe project has raised $3,700, which will probably cover a few hours of his 19-month hospitalization and none of lifetime expenses afterward (the family needs 16-20 hours of nursing help each day). Meanwhile in Japan, a baby born at just 9.45 ounces leaves the hospital after five months.

A hospital in Jamaica, where pollution makes tap water unsafe to drink, installs hydropanels from Zero Mass Water that absorb water vapor from the air to create 800 gallons of drinking water each month.

A study finds that crematorium workers are exposed to radiation when processing the bodies of people who have undergone radiation therapy or PET scans, with the urine of the single employee tested showing radioactivity that apparently came from inhaling volatilized radiopharmaceuticals. An expert but suggests that crematory workers wear masks and gloves, which seems like an excellent idea.

Illinois health officials warn anyone who flew through Chicago’s Midway Airport last week that they may have been exposed to measles, courtesy of an unvaccinated passenger who flew while infectious. A second warning was issued to anyone who visited Delnor Hospital, where he sought treatment.

Officers from police, fire, and emergency medical departments in Arkansas mobilize via a fellow officer’s Facebook request to line the highways leading to Arkansas Children’s Hospital, where a nine-year-old boy with a terminal illness was making what is expected to be his final journey.

In Case You Missed It

• News 3/1/19
• EPtalk by Dr. Jayne 2/28/19
• HIMSS Financial Highlights
• News 2/27/19
• Curbside Consult with Dr. Jayne 2/25/19
• HIMSS19 Reader Impressions
• Monday Morning Update 2/25/19

Get Involved

• Join my Rolodex to provide occasional news reaction or ideas
• Contribute regularly as a provider CIO, IT director, or informatics nurse (anonymous or not)
• Be interviewed (providers)
• Deliver an educational webinar (providers)
• Sponsor
• Report a news item or rumor (anonymous or not)
• Sign up for email updates
• Connect on LinkedIn
• Contact Mr. H

Weekender 2/22/19

Weekly News Recap

• Allscripts announces Q4 results that fall short of revenue and earnings expectations.
• Provider management and credentialing software vendor Symplr will acquire workforce management tech company API Healthcare from Veritas Capital
• Unsealed testimony reveals that a focus of the Amazon – Berkshire – JPMorgan healthcare organization will be to make health insurance and prescription drug prices easier to understand
• Healthcare experts file a Federal Trade Commission complaint against Facebook over security problems with its Groups functions that exposed the personal information of patient advocacy groups
• A patient of a closed Arizona hospital is prevented from obtaining life-saving surgery because her medical history is stored in an EHR that was shut down as creditors argued over payments
• HIMSS gives a preview of the “evolution of the HIMSS Brand”
• Virence Health will retire the company name it created in October 2018 and will instead operate as Athenahealth after acquiring that company five weeks later

Best Reader Comments

A Kaiser Permanente medical school makes a lot of sense for them to train physicians in how Permanente medicine works. (The Permanente Medical Groups are the for-profit physician partnerships that pair with the Kaiser Health Plans in various regions.) The KP group practice model is a different beast. They also have a mature and well-supported Epic implementation. They are able to do high-volume medicine with good quality because of the “system-ness” of how they approach things and the fact that most of their physicians don’t fight it. (KP Alum)

We have gotten a lot of value from CommonWell and have access to data in our region which is supporting care transitions. It would be helpful if folks like eCW would actually play ball with others to improve care. I am not worried about Cerner and Epic but rather the small players’ ability to share. (Patient advocate)

It’s almost shocking that hospitals in the US support their employees attending a sales show for a week, paying for expensive hotels and booze while hospital margins are slim to non-existent. (Donald Lyons)

[Pink Socks] is just a form of self-promotion and attention-grabbing that is legion at HIMSS. If you can name one objective and tangible thing Pink Socks has done, I’ll possibly change my opinion. (Lazlo Hollyfeld)

I almost feel a little bad and embarrassed for Cerner. It’s notable that MEDITECH’s “re-branded” and “old” EMR has scored higher in KLAS than Cerner’s flagship for the last two years. And celebrating your first plug and play exchange in the year 2019?! Two brave, pioneering Cerner sites are now connected to the world. Is the $5 billion DoD connected? (Vaporware?)

Watercooler Talk Tidbits

Readers funded the DonorsChoose teacher grant request of Ms. W in Minnesota, who asked for MakerSpace supplies for her elementary school’s library. She reports, “Your generous donation has helped stock our MakerSpace for the next year. They enjoyed building robots and making them move with Littlebits, as well as building bird’s nests out of paper and fabric to hold eggs when suspended from boxes. They look forward to building new things that continue to teach them about the engineering process.”

A plastic surgeon covering a New York hospital’s ED stitches and splints a woman’s mashed mashed finger, complaining to her that he’ll make only $200 for his 15 minutes of work. He then bills her insurance company $56,000 for “exploring wound extremity” and “complex repair of finger” and he doesn’t accept the woman’s insurance. The hospital said it doesn’t control what he charges because he’s not an employee. The patient is lucky to be in New York, which protects patients from surprise ED bills caused by out-of-network doctors working in EDs.

Google adds drug disposal locations to its Maps app, hoping that drug abuse will be reduced by people securely discarding their unused medications.

Nebraska hospitals complain that law enforcement agencies all over the state are releasing people who are in custody while they are hospitalized, allowing the agencies to skip paying the individual’s bill because they are no longer under arrest and are thus responsible for their own charges. A newly introduced bill would prohibit releasing a person from custody just to avoid paying for their medical care.

University of Iowa’s children’s hospital loses its second arbitration case brought by contractors that demanded more money, increasing the cost of the project that was budgeted at $271 million in 2011 to at least $370 million. The 190-bed hospital spent millions of dollars on temporary facades and overtime to prepare for its grand opening after making on-the-fly design changes that had already inflated the cost. Swapping the already-installed doors in some areas with automatic sliding doors required flying the new doors from Switzerland and operating a round-the-clock convoy to transport them from California in time for the grand opening, increasing the cost of the doors from $122,000 to $1.2 million.

The Medical Center, Navicent Health (GA) offers its heart patients the chance to donate their replaced pacemakers to dogs being treated at the University of Georgia’s veterinary school, which has implanted the refurbished devices in six dogs so far. 

In Case You Missed It

• News 2/22/19
• EPtalk by Dr. Jayne 2/21/19
• Readers Write: EMR Direction Changes in the Post-Growth Era
• Readers Write: Measuring to Drive Continuous Improvement in Digital Health Management
• Readers Write: Why Integrated Behavioral Healthcare is More Important than Ever
• News 2/20/19
• Reader Survey Results 2019
• Curbside Consult with Dr. Jayne 2/18/19
• Monday Morning Update 2/18/19

Get Involved

• Join my Rolodex to provide occasional news reaction or ideas
• Contribute regularly as a provider CIO, IT director, or informatics nurse (anonymous or not)
• Be interviewed (providers)
• Deliver an educational webinar (providers)
• Sponsor
• Report a news item or rumor (anonymous or not)
• Sign up for email updates
• Connect on LinkedIn
• Contact Mr. H

Weekender 2/1/19

Weekly News Recap

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

Watercooler Talk Tidbits

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

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

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

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

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

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

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

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

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

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

In Case You Missed It

• News 2/1/19
• EPtalk by Dr. Jayne 1/31/19
• News 1/30/19
• HIStalk’s Guide to HIMSS19
• Curbside Consult with Dr. Jayne 1/28/19
• HIStalk Interviews Jason Krantz, CEO, Definitive Healthcare
• Monday Morning Update 1/28/19

Get Involved

• Join my Rolodex to provide occasional news reaction or ideas
• Contribute regularly as a provider CIO, IT director, or informatics nurse (anonymous or not)
• Be interviewed (providers)
• Deliver an educational webinar (providers)
• Sponsor
• Report a news item or rumor (anonymous or not)
• Sign up for email updates
• Connect on LinkedIn
• Contact Mr. H

Weekender 1/25/19

Weekly News Recap

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

Best Reader Comments

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

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

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

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

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

Watercooler Talk Tidbits

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

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

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

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

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

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

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

In Case You Missed It

• News 1/25/19
• EPtalk by Dr. Jayne 1/24/19
• HIStalk Interviews Sean Carroll, CEO, Arcadia
• News 1/23/19
• Curbside Consult with Dr. Jayne 1/21/19
• HIStalk Interviews Eric Widen, CEO, HBI Solutions
• Monday Morning Update 1/21/19

Get Involved

• Join my Rolodex to provide occasional news reaction or ideas
• Contribute regularly as a provider CIO, IT director, or informatics nurse (anonymous or not)
• Be interviewed (providers)
• Deliver an educational webinar (providers)
• Sponsor
• Report a news item or rumor (anonymous or not)
• Sign up for email updates
• Connect on LinkedIn
• Contact Mr. H

Weekender 1/18/19

Weekly News Recap

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

Best Reader Comments

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

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

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

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

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

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

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

Watercooler Talk Tidbits

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

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

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

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

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

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

In Case You Missed It

• News 1/18/19
• EPtalk by Dr. Jayne 1/17/19
• Definitive Healthcare Acquires HIMSS Analytics
• Machine Learning Primer for Clinicians–Part 12
• News 1/16/19
• Curbside Consult with Dr. Jayne 1/14/19
• Monday Morning Update 1/14/19

Get Involved

• Join my Rolodex to provide occasional news reaction or ideas
• Contribute regularly as a provider CIO, IT director, or informatics nurse (anonymous or not)
• Be interviewed (providers)
• Deliver an educational webinar (providers)
• Sponsor
• Report a news item or rumor (anonymous or not)
• Sign up for email updates
• Connect on LinkedIn
• Contact Mr. H

Weekender 1/4/19

Weekly News Recap

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

Watercooler Talk Tidbits

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

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

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

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

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

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

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

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

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

In Case You Missed It

• News 1/4/19
• EPtalk by Dr. Jayne 1/3/19
• Machine Learning Primer for Clinicians–Part 10
• Monday Morning Update 12/31/18

Get Involved

• Join my Rolodex to provide occasional news reaction or ideas
• Contribute regularly as a provider CIO, IT director, or informatics nurse (anonymous or not)
• Be interviewed (providers)
• Deliver an educational webinar (providers)
• Sponsor
• Report a news item or rumor (anonymous or not)
• Sign up for email updates
• Connect on LinkedIn
• Contact Mr. H

Weekender 12/28/18

Weekly News Recap

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

Watercooler Talk Tidbits

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

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

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

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

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

In Case You Missed It

• News 12/28/18
• EPtalk by Dr. Jayne 12/27/18
• Monday Morning Update 12/24/18

Get Involved

• Join my Rolodex to provide occasional news reaction or ideas
• Contribute regularly as a provider CIO, IT director, or informatics nurse (anonymous or not)
• Be interviewed (providers)
• Deliver an educational webinar (providers)
• Sponsor
• Report a news item or rumor (anonymous or not)
• Sign up for email updates
• Connect on LinkedIn
• Contact Mr. H

Weekender 12/21/18

Weekly News Recap

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

Watercooler Talk Tidbits

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

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

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

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

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

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

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

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

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

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

In Case You Missed It

• News 12/21/18
• EPtalk by Dr. Jayne 12/20/18
• Machine Learning Primer for Clinicians–Part 9
• News 12/19/18
• Curbside Consult with Dr. Jayne 12/17/18
• HIStalk Interviews Kevin MacDonald, CEO, Kit Check
• Monday Morning Update 12/17/18

Get Involved

• Join my Rolodex to provide occasional news reaction or ideas
• Contribute regularly as a provider CIO, IT director, or informatics nurse (anonymous or not)
• Be interviewed (providers)
• Deliver an educational webinar (providers)
• Sponsor
• Report a news item or rumor (anonymous or not)
• Sign up for email updates
• Connect on LinkedIn
• Contact Mr. H

Weekender 12/14/18

Weekly News Recap

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

Watercooler Talk Tidbits

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

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

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

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

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

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

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

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

In Case You Missed It

• News 12/14/18
• EPtalk by Dr. Jayne 12/13/18
• Readers Write: Once Retro, Now Current Again: Why Print is Essential to Your Health Education Program
• Machine Learning Primer for Clinicians–Part 8
• News 12/12/18
• Curbside Consult with Dr. Jayne 12/10/18
• Monday Morning Update 12/10/18

Get Involved

• Join my Rolodex to provide occasional news reaction or ideas
• Contribute regularly as a provider CIO, IT director, or informatics nurse (anonymous or not)
• Be interviewed (providers)
• Deliver an educational webinar (providers)
• Sponsor
• Report a news item or rumor (anonymous or not)
• Sign up for email updates
• Connect on LinkedIn
• Contact Mr. H

Weekender 12/7/18

Weekly News Recap

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

Best Reader Comments

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

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

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

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

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

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

Watercooler Talk Tidbits

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

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

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

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

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

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

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

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

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

In Case You Missed It

• News 12/7/18
• EPtalk by Dr. Jayne 12/6/18
• Readers Write: What’s Good for the Dentist is Good for the Medical Doctor as Well
• Machine Learning Primer for Clinicians–Part 7
• News 12/5/18
• Curbside Consult with Dr. Jayne 12/3/18
• Monday Morning Update 12/3/18

Get Involved

• Join my Rolodex to provide occasional news reaction or ideas
• Contribute regularly as a provider CIO, IT director, or informatics nurse (anonymous or not)
• Be interviewed (providers)
• Deliver an educational webinar (providers)
• Sponsor
• Report a news item or rumor (anonymous or not)
• Sign up for email updates
• Connect on LinkedIn
• Contact Mr. H

Weekender 11/30/18

Weekly News Recap

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

Best Reader Comments

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

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

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

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

Watercooler Talk Tidbits

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

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

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

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

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

In Case You Missed It

• News 11/30/18
• EPtalk by Dr. Jayne 11/29/18
• News 11/28/18
• Curbside Consult with Dr. Jayne 11/26/18
• A Machine Learning Primer for Clinicians–Part 6
• Monday Morning Update 11/26/18

Get Involved

• Join my Rolodex to provide occasional news reaction or ideas
• Contribute regularly as a provider CIO, IT director, or informatics nurse (anonymous or not)
• Be interviewed (providers)
• Deliver an educational webinar (providers)
• Sponsor
• Report a news item or rumor (anonymous or not)
• Sign up for email updates
• Connect on LinkedIn
• Contact Mr. H

Weekender 11/16/18

Weekly News Recap

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

Best Reader Comments

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

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

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

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

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

Watercooler Talk Tidbits

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

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

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

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

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

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

In Case You Missed It

• News 11/16/18
• Black Book’s Vendor Report Methodology
• EPtalk by Dr. Jayne 11/15/18
• Reader Question: Forward Primary Care Clinics
• A Machine Learning Primer for Clinicians–Part 5
• News 11/14/18
• Looking Ahead to HIMSS19
• Curbside Consult with Dr. Jayne 11/12/18
• Veritas Capital Will Acquire Athenahealth for $5.7 Billion
• Monday Morning Update 11/12/18

Get Involved

• Join my Rolodex to provide occasional news reaction or ideas
• Contribute regularly as a provider CIO, IT director, or informatics nurse (anonymous or not)
• Be interviewed (providers)
• Deliver an educational webinar (providers)
• Sponsor
• Report a news item or rumor (anonymous or not)
• Sign up for email updates
• Connect on LinkedIn
• Contact Mr. H

Weekender 11/9/18

Weekly News Recap

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

Best Reader Comments

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

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

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

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

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

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

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

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

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

Watercooler Talk Tidbits

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

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

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

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

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

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

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

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

In Case You Missed It

• News 11/9/18
• EPtalk by Dr. Jayne 11/8/18
• A Machine Learning Primer for Clinicians–Part 4
• News 11/7/18
• Curbside Consult with Dr. Jayne 11/5/18
• Monday Morning Update 11/5/18

Get Involved

• Join my Rolodex to provide occasional news reaction or ideas
• Contribute regularly as a provider CIO, IT director, or informatics nurse (anonymous or not)
• Be interviewed (providers)
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Weekender 11/2/18

Weekly News Recap

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

Watercooler Talk Tidbits

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

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

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

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

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

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

In Case You Missed It

• News 11/2/18
• EPtalk by Dr. Jayne 11/1/18
• HIStalk Interviews Peter Butler, CEO, Hayes Management Consulting
• A Machine Learning Primer for Clinicians–Part 3
• News 10/31/18
• HIStalk Interviews Kurt Garbe, CEO, IMAT Solutions
• Curbside Consult with Dr. Jayne 10/29/18
• Monday Morning Update 10/29/18

Get Involved

• Join my Rolodex to provide occasional news reaction or ideas
• Contribute regularly as a provider CIO, IT director, or informatics nurse (anonymous or not)
• Be interviewed (providers)
• Deliver an educational webinar (providers)
• Sponsor
• Report a news item or rumor (anonymous or not)
• Sign up for email updates
• Connect on LinkedIn
• Contact Mr. H