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Curbside Consult with Dr. Jayne 12/2/19

December 2, 2019 Dr. Jayne No Comments

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I’m happy to report that I’ve survived the Thanksgiving holiday despite the intersection of bizarre karmic forces that had me working in the clinic most of the week as well as hosting Thanksgiving Dinner. I worked Black Friday and the weekend as well, so I haven’t fully recovered. Next, I’ll have nearly two weeks free of clinical care, then some scattered shifts before the scheduling gods smack me down again with a five day streak of 12+ hour days before we head into 2020.

I don’t know what our schedulers are thinking at times, but I suspect they’re scheduling around the day-off requests of the full time and higher-ranking physicians. I’ve asked for fewer shifts in the new year, so hopefully I can regain my sanity.

Truthfully, I don’t mind working Black Friday and it’s become a bit of a tradition for me. I’m not much of a shopper and value my sleep too much to be getting up at the crack of dawn to hunt for bargains. Most of the patients who come in are actually sick and it’s a privilege to help them. Many of them put off care because of holiday preparations and having family in town and now they’re in bad shape.

Most of the primary care offices in the area were closed, so their choices were limited. One cardiology office I called had a message that they would be closed until January 2, so either something funny is going on with the practice or they accidentally recycled their Christmas out-of-office message from last year.

We started the day with more than a little trepidation. The team that was on for Thanksgiving noted they had issues with our EHR communicating with our drug dispensing system. They were not able to get it resolved due to lack of holiday support from the tech teams. Fortunately for us it was working, and by noon, we had seen more than twice our usual volume of patients. As soon as we would empty the waiting room, another batch of patients would arrive. It was well after 3 p.m. before any of us were able to sneak off to the kitchen to eat the previous day’s catered leftovers.

I have to say that our leadership understands that well-fueled staffers are happy staffers. They had pizza delivered the day prior to Thanksgiving, a full holiday spread on the day itself, and the random arrival of dozens of tacos and burritos on Black Friday.

The holiday patient mix is always an interesting one. We had several hospital transfers for influenza, pneumonia, and out-of-control diabetes. We saw kidney stones, raging urinary tract infections, and a couple of lacerations that should have been taken care of the day before, except people didn’t know we were open. There were even a couple of people who had a little too much holiday merriment and came in for IV hydration. Strep throat, sinus infections, and plenty of lingering colds rounded out the day.

I was glad to see the severity of illness dropping as the day went on since we were all getting pretty worn out by dinner time. We had a brief surge of people who came in after their shopping was done, which always makes me a little aggravated since they were out spreading germs when they should have been at home with some soup and a vaporizer. The rest of the weekend was a different story, with moments of calm punctuated by anxiety-provoking stroke symptoms, head trauma, and a myocardial infarction that was smoothly transferred to the hospital.

On days like these, I’m grateful for the EHR and the ability to have default documentation that works for patients with similar symptoms. We tweak them as we need to, but it’s still fast, and as long as you’ve personalized your defaults, the notes are of good quality.

Of course, there are always providers who don’t personalize their options, which is how you wind up with visit notes that have exam findings that you’re sure the physician in question didn’t do. Or they don’t use the defaults at all, which leads to slow documentation and plenty of physician frustration. I definitely couldn’t document this fast on paper, even when I worked in an emergency department that used paper templates designed for rapid documentation based on the patient’s presenting issue.

People often ask me why I continue to do as much clinical work as I do. The real answer is that I enjoy it. I enjoy the people I work with and the organization I work for. We have an outstanding workplace culture. Frankly, compared to being a CMIO, it’s like being on vacation. Everyone knows their roles and responsibilities and how to work together as a team, despite the fact that we work with different combinations of people and at different locations all the time.

It’s a fail-fast environment. People who can’t get it done don’t last very long. They give people the tools they need to be successful, and if it’s not a good fit, they’re not going to subject the rest of the team to poor performance. I never played on a select sports team, but I imagine it might feel a bit similar. I’m willing to put up with wacky scheduling in order to stay on a high-performing team.

We no longer have an annual company holiday part  since it has been moved to the spring after flu season is over. But this year, the staff has organized their own get-together. Sometimes people just want to get away from their co-workers at the end of the day, so it’s great being at a place where people like each other enough to want to spend time together. We’ll be bowling the night away along with a “rob your neighbor” gift exchange, which based on the sense of humor held by many of my co-workers, should be highly entertaining.

I was honored to be invited since I don’t think all of the physicians were on the guest list. At least we know that if anyone has too much holiday cheer or sprains something during the “crazy bowl” part of the evening, we’ll be well cared for in the morning.

What does your company do to celebrate the holidays or thank the team for its hard work? Leave a comment or email me.

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Email Dr. Jayne.

HIStalk Interviews Michelle O’Connor, President, Meditech

December 2, 2019 Interviews No Comments

Michelle O’Connor is president and chief operating officer of Meditech of Westwood, MA.

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Tell me about yourself and the company.

I took over as president about six months ago. I was previously chief operating officer over operations and primarily development. I am now being reintroduced to a great leadership team that is responsible for our customer experience implementation and client services. We are re-engineering how we look at implementation to improve the physician experience and how we can improve customer experience as we continue to service them moving forward.

It is uncommon for companies to move developers into key executive roles, and Meditech is also different in that most of its executives have spent their entire working lives with Meditech. What is the company’s philosophy as the folks who founded the company and worked early in its 50-year history are handing over the reins to the next generation of leadership?

Part of the preparation for me taking over this role has been succession planning, which has been in the works at Meditech for many years. I’ve been in development, but previously I did work in implementation and worked on human resources with our staff management process re-engineering. I’ve done a lot of work with our staff, how we run the company internally and how we operate everything.

Working in development, I get introduced to the customer fairly regularly. Not necessarily in servicing and implementation, but I do work directly with them. That was especially true when we changed to an Agile development world, which I implemented seven or eight years ago when we started Expanse development. We engage our customers directly into the development process.

The plan for me to take over this role has been very well thought out. I’m prepared for what I need to do to take on more responsibility. That doesn’t mean that we don’t still have Hoda Sayed-Friel working more directly with our business partners and our professional services division and Helen Waters working with our marketing and our sales team. Those strengths help balance my role.

How does Meditech do business differently than competitors whose executives come and go from other health IT companies?

The value that Meditech brings to the table is that we look at what we need to do, we set a direction, and we move forward. Who would have thought that our senior VP of product development would have said in around 2010 when tablets came out that, “This is what we need to do in the future. We need to have mobile electronic health records.” We had just purchased LSS Data Systems. 

Because we are a technology company, we stay abreast of healthcare’s needs. We are able to pivot, move, and make decisions that allow us to do the right thing for the healthcare industry. We’ve been in the industry for 50 years. We have a touch on what customers need. By promoting from within, we allow ourselves to grow, evolve, and change to support it.

Meditech provides systems that go beyond core clinical or EHR functionality into modules that support nearly every aspect of a hospital’s operations in a long list of non-clinical departments. How hard is it to provide that breadth of systems?

I started with the revenue cycle product, which taught me the entire system and how things all come together. I look at non-healthcare technology companies and I can’t think of another industry that has to provide the level of service and the amount of functionality that we do. Meditech is one of the only vendors left that does financials. We are competitive with Cerner and Epic in the EHR, pharmacy, and lab space, but we provide financials and general ledger as well. It helps that we have been in business for 50 years.

It’s difficult for vendors to get into healthcare because our customers expect that level of integration. They expect that when you register in the lab system and populate a document that the pathologist reviews that we also drop a charge that goes over to revenue cycle so that your cost accounting system can deal with it and your general ledger can handle it. Then you send out a check for AP to do an overpayment to a patient. That’s totally expected of any of the vendors right now.

What are the biggest changes or trends you’re seeing across health systems?

Of course there is consolidation, but in terms of technology trends, I see providers who need to outsource their IT services through private clouds or what we’re going to be offering as the public cloud. It has become so complex for our organizations to support themselves. It’s a big change for them having public clouds handling the infrastructure and some of the help desk services. That’s one of the reasons we’re getting into the hosting business in offering Meditech as a Service or through Google.

We’re also doing it because of security concerns. Security is a huge risk. How many healthcare systems have been taken down for weeks and months from ransomware, and how did that disruption affect their overall business operations? A CIO recently told me that security is outside the EHR, but I think security is something that we as an EHR vendor have to do, to provide a system that can be highly secure. How can we do that more effectively and more cost-effectively?

We’re seeing a lot of announcements from health IT vendors who are partnering with Amazon, Google, and Microsoft, not just for hosting, but for using their embedded technologies to change the way they design and build their software. How will your relationship with Google change Meditech as a product and as a company?

It has already changed us, to be honest. In January, we’re releasing our first cloud-based product, High Availability Snapshot, where we are providing the ability for a customer to have access to the electronic health record through Google Cloud services. If they get hit with ransomware and their systems are down, they can go directly to the public cloud through a cellular connection and get a snapshot of that patient’s record. They can at least know what was done to the patient prior to their system going down while they recover from their disaster.

We are working on interoperability changes and API changes that will primarily use Google services. In addition, Meditech itself is lifting and shifting – I actually saw that term in a dictionary recently — lifting and shifting our EHR to run on a private cloud or on premise to the public cloud. As we’re doing that, we’re making significant changes to how Meditech systems are architected in order to run in the public cloud.

Our newest app is Expanse Now, which will be coming out early next year. It is voice enabled and it’s a Google services app as well. Creating new apps, building interoperability standards within the cloud services, and re-engineering our entire EHR to run in the cloud are the three primary things that we’re going to be using cloud services for.

How will these cloud services relationships change the health IT competitive landscape?

When we decided to write our product on a tablet and make it mobile, we made a concerted effort to build it based upon web infrastructure and not do direct apps, to allow us to have a cloud-based product working with on-prem. At that particular time, the clouds weren’t ready for us. Our goal was always to get Expanse into the public cloud. Honestly, it’s been a little quicker than I thought it was going to be.

A year ago, Meditech itself moved our entire operations to the cloud. Then we were going to move our EHR into the cloud. We accelerated that. Not only was it something we felt we could do, we found that with our infrastructure, we could do it much more quickly than we originally thought.

Expanse is getting the recognition that it deserves right now. The industry is seeing it as a great mobile platform to run electronic health records and to give our physicians mobility. Our nursing product recently gave them mobility as well. By doing it through the cloud, we’re giving our customers the ability to get there a lot quicker than they might have been able to if they were doing it on-prem.

There’s a lot more hardware and infrastructure needed to run these systems and costs are higher. By providing them through cloud services, we’re able to get them to the customer quickly without the high capital expenditure and to provide it more economically.

You’re sleeping behind enemy lines in being surrounded by a lot of Epic-using big academic medical centers. How would you, as a patient and a competitor, describe the state of interoperability in the Boston area?

You’re asking me a difficult question. I have elderly parents who have been going through the healthcare system pretty regularly over the past year. Interoperability in our industry is not good, the ability to share a record from a physician’s office to a hospital and to be transitioned to a tertiary care center or to a rehab center. We need to do better as an industry.

We believe that through our Traverse interoperability service, through using CommonWell, and by continuing to push upon using interoperability standards, that healthcare can get better if we all play together. We all work well together. We have seen a lot of the industry doing that. You see vendors coming together with CommonWell, Carequality, and things like that to push the standards. I know the government doesn’t think that we’ve been moving fast enough, but we all want to move data along more quickly to make sure that patients can be taken care of more effectively.

One thing you don’t know about me is that I really believe in what we do. Being in the industry for 31 years, we provide a tool that allows caregivers to deliver care to patients. We take that very seriously from a patient safety perspective and from a fiscally responsible perspective.That comes down to who we are as a company and who I am as a person. I truly believe that it doesn’t matter if you’re running Epic, Meditech, Cerner, or Allscripts — everybody has to be able to interoperate. Even if you have two different Epic systems, they still have to interoperate.

Are customers demanding better interoperability and system usability, or have their own internal policies and deployment choices made the EHR what it has become?

A lot of it goes back to the original question. It’s a lack of understanding of the complexity of the healthcare system and the data in which the systems are out there. Vendors are willing to share the data, especially defined data sets. It’s a matter of making sure that healthcare systems themselves understand that they have to share the data. But how difficult is it to share the data when it’s so vast and deep, and what is the actual data that needs to be shared? It’s not debits and credits. It’s not your ATM. It’s a lot more complex than that. If we all continue to work together, we’re going to get through this in the short term.

What population health management technologies are customers using or requesting?

We have a couple of perspectives on population health. There is managing patients that you’re seeing through through our registries within our ambulatory product. We have a robust system for managing the population of patients that you’re seeing. Then there’s the overarching population health, where you’re given the panel of patients that you’re responsible for managing.

We believe that we need to continue to provide the system in which you care for your patients, the system in which you are seeing what care gaps a patient might have, and things like that. But we’re not the insurance company that has the algorithms to figure out which patients are higher at risk. We are using a system called Arcadia to manage that by gathering all the claims, then providing back into the workflows of the caregivers and practice managers what needs to be done to take care of the patients.

Do you have any final thoughts?

After 50 years, Meditech has continued to evolve and change. We are the leading vendor that has been in this industry the longest. We’ve had a number of accolades. We had PCI and we had the first handheld nursing tool. We continue to use technology to move us forward. Expanse is live and people are seeing the difference in delivering care with the mobile platform that we’re providing. They continue to see Meditech provide technology to the delivery of care to provide better service than we’ve ever provided.

Our founder Neil Pappalardo always wraps up all of his conversations with, “The best is yet to come.” I truly do believe that.

Morning Headlines 12/2/19

December 1, 2019 Headlines No Comments

Qld Health risks patient admin system failure after halting overhaul

In Australia, an auditor’s report warns that Queensland Health’s decision to push back replacement of its 30-year-old corporate information system places it at risk since the system hasn’t been vendor supported since 2015.

‘Black hole’ of medical records contributes to deaths, mistreatment at the border

The Department of Homeland Security’s inadequate software and sloppy paper record-keeping has caused treatment delays and lapses of care for migrants in its custody.

Doctors and techies are clashing at digital health companies, and one start-up exec is seeking a fix

A CNBC report finds that doctors working at digital health companies are sometimes seen as the unwelcome voice of reality in calling out product or company flaws that impact health.

Monday Morning Update 12/2/19

December 1, 2019 News 7 Comments

Top News

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CNBC’s Chrissy Farr looks at doctors who join digital health companies but then clash with the development side of the house.

Those involved say that doctors are accustomed to making decisions solo rather than being the “token hire” who is expected to rubber stamp developer decisions. They are sometimes seen as the unwelcome voice of reality in calling out product or company flaws that impact health, as “first, do no harm” clashes with “move fast and break things.” 

A diagnostics company CEO “flipped out” when a newly hired doctor questioned the clinical and business wisdom of using staffing company doctors to write testing prescriptions without reviewing patients thoroughly.

A former digital health doctor says she has yet to meet a happy healthcare person in the digital health field.

Developers complain about the black-and-white opinions of doctors who are not used to being challenged, while doctors bristle at the Silicon Valley emphasis on “obsessively delighting” users that doesn’t make sense in medical situations.


Reader Comments

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From Jagged Little Pill: “Re: Walgreens. Wasted no time after the story you reported on October 30 about closing many of their owned clinics. It’s curious they didn’t wait until after the holiday rush, when it’s nearly impossible to get into your primary care office. I imagine that the nurse practitioners are running to new jobs as fast as they can.” Retail clinics were the hottest thing going not long ago, and it seemed like a great fit for Walgreens to boost its “health hub” concept by offering medical services. The lesson to learn is that publicly traded companies veer in reactionary fashion from one strategy to the next in a desperate search for quarterly earnings, which are hard for huge companies to find, and Walgreens is considering going private and thus needs to preen its financials to chum the private equity sharks. In the mean time, Walgreens seems happy to lease its back-of-store real estate pop-up style to third-party clinic operators and UnitedHealth Group insurance sales centers while also opening Jenny Craig weight loss centers. Remember, too, that this was the company that jumped with zero due diligence into an ultimately embarrassing Theranos partnership that also vacated its drugstore premises. WBA shares are down 30% in the past year and 13% in the past five. 

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From Holiday Journal Time: “Re: hospital EHR alerts. It’s hard for clinicians to argue that alerts are a huge burden when they spend less than one minute per month on them.” Researchers look at how much time Duke University Health System providers spend dealing with the 75 most common interruptive alerts generated by Epic that represent 95% of the alert total, calculating the on-screen time between alert presentation and dismissal (“dwell time.”) Most alerts were closed within three seconds and providers spent just one minute per month dealing with them, leading the authors to postulate that it’s the interruption that alerts create — rather than the time required to manage them — that contributes to burnout. However, the authors excluded drug-drug and drug-duplicate alerts, which are the most common, because they weren’t able to calculate times. It should also be noted that quickly dismissed alerts aren’t necessarily a good thing – it’s likely that users are just reflexively clicking to get rid of the majority of them that are not helpful while missing the critical ones. I also note the financial success of co-author UCSF Department of Medicine chair Bob Wachter, MD,  whose conflict of interest statement in the article includes book royalties, compensation and stock options for serving on the boards or advisory boards of several companies, a royalty stake in one company, and a consulting arrangement with a startup that pays cash and stock.


HIStalk Announcements and Requests

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Two-thirds of poll respondents have had their employment forcibly cancelled, but 61% of them said that their long-term career benefited as a result. HappyCIO lost their executive position in a purge, but used the opportunity to relocate for a move up that had been stymied by excessive contentment. An unexpected layoff three years ago forced nurse informaticist Quilmes Boy to rebuild his resume and rush into ill-suited jobs that weren’t good fits, but he’s happy in a new job now even though it pays less. Michael’s pharma employer was set to lay him off after taking paternity leave but instead transferred a co-worker, but he’s sorry he stuck around given the obvious writing on the wall. Marshall was RIF’ed by new vendors at 55 years of age because he was above an arbitrary Excel-sorted salary row, but he used his contacts and knowledge to recover in a different role. Charles took a common path – his vendor employer laid him off, but he took job in a hospital’s IT department.

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New poll to your right or here: Does a patient own the data that a provider has recorded about them? TH made a good devil’s advocate argument last week – it’s true across all industries that you don’t own data that’s about you, and without the interpretation and validation of the provider who captured and recorded it, it’s not worth much (try selling a drug company a worksheet containing a list of your prescriptions and your blood pressure reading history). An extension of that argument might be that if the patient owns it, why can’t they insist that the provider change or delete it? Is having a right to obtain your data necessarily synonymous with owning that data? Is it different than credit scoring companies that know nearly everything about every American and make fortunes selling their most private information freely, giving the subject of that information little control or recourse?

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Welcome to new HIStalk Platinum Sponsor AGS Health. The revenue cycle management and business process outsourcing company provides billing, coding, analytics, and data integration solutions to healthcare providers all over the US, with $35 billion in annual managed receivables and 24 million charts coded by 6,000 degreed, certified specialists each year. A large academic medical center decreased its denials inventory by 72% by implementing 70 AGS-recommended front-end coding fixes while saving 40% of its outsourcing coding denial management costs, while another major organization decreased its A/R days by 10% and resolved 85% of aged receivables within six months of working with the company. The company recently named industry long-timer Patrice Wolfe (Medicity) as CEO. Thanks to AGS Health for supporting HIStalk. 

I’m struggling to comprehend while still working down the Thanksgiving leftovers that it’s just over three weeks until Christmas and just 98 days until HIMSS20 kick offs.

Speaking of holidays and HIMSS, it’s that slow time of year in which Lorre can work more closely with prospective HIStalk sponsors than in the crazy January and February that follows, when every company is trying to make themselves heard above the vendor din. I suggested she offer inducements of the wacky variety – (a) giving new sponsors an hour or two of Smokin’ Doc standee time in their HIMSS booth for the surprising number of people who want selfies; and (b) providing extra hand-holding for those 10×10 booth-dwellers who, like us in previous years, are questioning the value of their significant investment for the other 362 days of the year.


Webinars

December 10 (Tuesday) 1:00 ET. “Move on from the age of the inefficient EHR.” Sponsor: Intelligent Medical Objects. Presenters: Jim Thompson, MD, physician informaticist, IMO; Obaid Baig, product manager, IMO. The EHR seems more like transactional workflow system rather than an intuitive clinical documentation tool, creating the possibility of loss of data consistency and the need for manual workarounds. The presenters will describe how to turn an EHR into a powerful tool that can help improve workflows and documentation so that clinicians can focus on care, not coding and reimbursement.

Previous webinars are on our YouTube channel. Contact Lorre to present your own


Acquisitions, Funding, Business, and Stock

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Consumer Reports observes that the list price for arthritis drug Humira has jumped 78% in five years, but most of the increase went to the pharmacy benefit manager middlemen (CVS Caremark, Express Scripts, and OptumRx) that took a bigger cut of its $5,174 per month list price. AbbVie generates $20 billion per year in Humira sales, but PBMs are pocketing 40% of its 2019 cost.


People

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Analytics technology vendor SymphonyCare hires Brad Case (Estrella Health) as chief strategy officer. He was previously chief development officer for predecessor company Symphony Corporation, which was sold to Influence Health in 2013 and then re-acquired by SymphonyCare’s founder and former CEO Ravi Kalla in 2017.

Todd Helmink (ConnectiveRx) joins secure messaging app vendor QliqSoft as chief revenue officer.


Privacy and Security

Great Plains Health (NE) is taken offline in a ransomware attack, leading it to cancel non-emergency appointments and procedures.


Other

In Australia, an auditor’s report warns that Queensland Health’s decision to push back replacement of its 30-year-old corporate information system – following allegations of conflict of interest within the replacement team — places it at risk since the system hasn’t been vendor supported since 2015. The system was provided by Australia-based ISoft, which sold itself in IBA in 2007 following a newspaper’s disclosure of financial irregularities. A replacement will cost Queensland Health at least $150 million.

Politico reports that the Department of Homeland Security’s inadequate software and sloppy paper record-keeping has caused treatment delays and lapses of care for migrants in its custody. Immigrations and Customs Enforcement announced plans to implement EClinicalWorks in 2014, but advocates complain that ICE’s information isn’t shared with other government agencies and medical providers.

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A travel website author visits Arizona-based MedAire, which provides ground-to-sky advice for airline crews who are attending to distressed passengers. It notes that unlike what you see in movies, airlines don’t usually ask whether there’s a doctor on board, preferring to deal with a known factor rather than checking passenger medical credentials or distressing travelers with a public announcement.


Sponsor Updates

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  • StayWell team members in Daly, CA serve meals at the North Peninsula Food Pantry & Dining Center.
  • Zynx Health will exhibit at the Institute for Healthcare Improvement National Forum December 8-11 in Orlando.
  • LiveProcess will exhibit at the National Healthcare Coalition Preparedness Conference December 2-4 in Houston.
  • Health Catalyst will host a patient safety reception at the Institute for Healthcare Improvement December 9 in Orlando.
  • NextGate will exhibit at the HIMSS Southern California Chapter 2019 CXO Symposium December 2 in Yorba Linda.
  • Netsmart consolidates its Ozark and Springfield offices in Missouri.
  • Redox previews its new podcast.
  • SymphonyRM publishes a new case study, “Health System Drives 15% Increase in Patient Visits, 380% Annual Wellness Visit Growth.”
  • Visage Imaging will exhibit at RSNA December 1-5 in Chicago, where it will demonstrate semantic annotations for Visage 7 as a work in progress.
  • The Marketing Trends Podcast features Vocera Chief Marketing Officer Kathy English.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.Get HIStalk updates. Send news or rumors.
Contact us.


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Morning Headlines 11/28/19

November 27, 2019 Headlines No Comments

Ransomware detected in Great Plains Health computer network

Great Plains Health (NE) cancels some services and reschedules others in the wake of a ransomware attack discovered Monday night.

Sands agrees to meet with Allscripts chief

Allscripts CEO Paul Black will meet with Bahamian Health Minister Duane Sands, MD to discuss the government’s unfulfilled $18 million contract with the software company.

OCR Secures $2.175 Million HIPAA Settlement after Hospitals Failed to Properly Notify HHS of a Breach of Unsecured Protected Health Information

Sentara Hospitals (VA) will pay OCR $2 million to settle potential HIPAA breach notification violations related to its failure to notify all patients impacted by a billing-related breach in 2017.

Morning Headlines 11/27/19

November 26, 2019 Headlines No Comments

MUSC says one of its spinoff companies has saved it millions in pharmacy costs

Medical University of South Carolina says drug purchasing software that was developed by one of its IT network engineers is saving it millions by looking for the best price in the supply chain at any given moment.

Amazon launches medication management features for Alexa

Amazon works with Omnicell to give Alexa users in Ohio the ability to set up medication reminders and request prescription refills from Giant Eagle Pharmacy.

Deep 6 AI Raises $17M Series A Led by Point72 Ventures to Accelerate Clinical Trial Recruitment

Patient-matching clinical trial software vendor Deep 6 AI raises $17 million.

GE Healthcare Expands Intelligent Health Ecosystem with Launch of Edison Developer Program to Ease AI Adoption for Providers

GE Healthcare launches the Edison Developer Program to give developers access to algorithms and applications based on its Edison intelligence platform.

Activist Starboard Value reportedly takes stake in CVS Health

Activist investor Starboard Value takes an undisclosed stake in CVS Health and enters into talks with its management.

News 11/27/19

November 26, 2019 News 7 Comments

Top News

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Federal prosecutors charge the two founders and two other executives of waiting room advertising technology vendor Outcome Health with fraud, claiming that the company inflated its revenue over a six-year period to help it raise $1 billion in funding, of which at least $225 million went directly into the pockets of the founders.

Indicted are the company’s former CEO Rishi Shah (33), former President Shradha Agarwal (34), former CFO Brad Purdy (30), and former EVP Ashik Desai (26).

Fascinating claims from the SEC litigation document:

  • A company salesperson warned Shah that company fraud was widespread, to the point that client performance reports were being edited directly in PowerPoint.
  • Desai joined the company as a 19-year-old intern, then became EVP over analytics.
  • Agarwal wasn’t really a co-founder even though the company positioned her as such. Shah’s original co-founder, an unnamed university classmate, left in November 2009. It was apparently Derek Moeller, who resigned as president to buy a Seattle-area company that recycles plastic into garden growing containers.
  • Shah had described the company’s “chicken and egg” problem, where it needed ad revenue to install more waiting room devices, but needed the devices to raise revenue. He decided to start forecasting the number of offices and device and sell that ad space even though it wouldn’t be available for months, which he later admitted in a meeting of entrepreneurs that, “It’s fraud, right, I mean you’re selling something you don’t have.” The company billed and recognized the full amount immediately.
  • The “selling of futures” became such an ingrained part of the company’s culture that its analysts were tasked with producing scheduled “delta report” that tracked the difference between claimed offices and devices with the real, lower number.
  • The company’s controller warned the executives that GAAP revenue recognition is based on actual delivery of ads rather than upfront invoicing, after which they kept the controller in the dark about the “delta reports.”
  • Desai falsified an ROI study in showing that Outcome’s ads boosted prescription counts by 27% in six months with a confidence level of 80%, when the actual figure was a 4% increase with 71% confidence. That allowed the company to claim that the ads generated $2 million in drug company revenue vs. the actual $116,000. For another drug ad, the company claimed that prescriptions increased 35% from Outcome ads when they actually decreased 3%.
  • In a Theranos-like move, a newly hired Outcome COO found himself out of a job within three weeks of warning Shah of the falsified ROI reports. He wasn’t named in the filings, but it was Vivek Kundra, a former White House CIO and Salesforce EVP who is now COO of CRM software vendor Sprinklr. His LinkedIn omits his nine-month stint with Outcome Health.
  • Also Theranos-like was that the company was exposed by a Wall Street Journal investigative report.

Reader Comments

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From Dr. Herzenstube: “Re: Exponential Medicine conference earlier this month. I’m wondering if any HIStalk readers went and can comment on whether it’s worth the astronomical price tag?” The Exponential Medicine conference was held early in November at the Hotel del Coronado in San Diego, with a registration fee of $4,750 and “favorable rates” offered to non-profit and government employees. It’s run by TED-aspiring Singularity University, which despite its name and .org web address, is a for-profit company rather than a real university, offering programs to rich executives instead of poor students. The web page is a thicket of buzzwords (“curate,” “reimagining,” “blockchain,” and “recharging” at yoga sessions and dinners under the stars) and speakers ranged from the mildly interesting to the clearly self-promoting, entertaining the junketeers who lived it up far from the prying eyes of their patients who are being bankrupted by their expense-bloated bills. I’m sure everybody had a good time, though.

From Eriksson: “Re: Cerner in Sweden. See this article.” The ComputerSweden article says that Region Skåne has postponed its Cerner implementation because the company has failed to understand the extend of Millennium changes that are needed to support the Swedish Patient Data Act. The region chose to store its data in Cerner’s cloud – unlike another region that is hosting its own system locally – and US cloud data protection is too weak to comply with Swedish law. Cerner has proposed sending patient data to 12 of its business units across nine countries, but the region wants processing of its most sensitive patient information to be performed within Sweden. The impact of the EU’s more stringent approach to privacy is creating interesting challenges for vendors based in the US, where privacy requirements are often contained in negotiated contractual terms rather than in enforced laws. Some of Sweden’s requirements:

  • Systems must have adequate access control to ensure that only people who need to see a patient’s information for their jobs can do so.
  • The patient has a right to block data from the view of their own provider and from other EHR-using providers.
  • The patient has a right to see their information.
  • The provider must provide a patient with a list of healthcare entities that have accessed their data so they can determine whether it was justified.
  • A provider can see the information of a patient of another provider only if they also have a current patient relationship, if the patient has consented, and if the person accessing the information checks a box to indicate that they understand before proceeding.

From Insider: “Re: KLAS. Changing vendor scores right as we approach final submissions for Best in KLAS. Scores from the question added earlier this year, ‘Does this vendor consistently exceed your expectations?’ will be eliminated from the scoring algorithm, effective today. It will be restored to the algorithm on July 1, 2020 to give all clients who were interviewed within an 18-month window the chance to answer this question before it affects a vendor’s KLAS scores.” Seems reasonable, although you wonder why KLAS walked its decision back and why it didn’t anticipate problems. Timing might suggest that some lesser-performing vendors complained once they saw how their scores would be affected.


HIStalk Announcements and Requests

In the spirit of Thanksgiving, here’s an anonymized, excerpted version of an email that a reader  — a former big-time CIO and industry long-timer whose name you would recognize unless you’ve been living under a rock — sent to Lorre this week, which touched her (and then me) deeply in putting life into perspective:

I want to say thank you to Mr. H and associates for this really valuable blog. I became disabled a while ago from a head injury that forced me to retire from healthcare, with a long road to recovery. Your blog helps, as it challenges me to remember stuff (my memory is episodic) and to get up to speed in the never-ending drama we call healthcare here in the US.

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I’m distracted today by the sharply divisive debate that has been raised by the AP Stylebook’s Twitter – do you “pre-heat” the oven or do you just “heat” it? I would argue that you do neither and rather “set” the oven and wait until it reaches temperature (since you’re heating the food, not the oven), but given the choices, I’m going with B since I also don’t like the terms pre-authorize, pre-arrange, pre-board, pre-medicate, pre-order, pre-pay, pre-wash, and pre-record for the same reason — “pre” doesn’t modify the word, but rather is a lazy shortcut to what should be a procedural instruction (heat oven to 350 degrees, then put in the turkey). I dislike “pre-existing conditions,” but I don’t have a better replacement unless it would be “pre-coverage conditions,” and but even then you might have had coverage, just with a different insurer.


Webinars

December 10 (Tuesday) 1:00 ET. “Move on from the age of the inefficient EHR.” Sponsor: Intelligent Medical Objects. Presenters: Jim Thompson, MD, physician informaticist, IMO; Obaid Baig, product manager, IMO. The EHR seems more like transactional workflow system rather than an intuitive clinical documentation tool, creating the possibility of loss of data consistency and the need for manual workarounds. The presenters will describe how to turn an EHR into a powerful tool that can help improve workflows and documentation so that clinicians can focus on care, not coding and reimbursement.

Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Government and Politics

Politico calls out the well-funded effort by healthcare’s profiteers to shut down anything that looks like socialized medicine (such as Medicare for All), including the American Hospital Association, America’s Health Insurance Plans, individual insurance companies, biotech companies, Chambers of Commerce, health systems, and trade associations. Their talking points, which omit the real motivation of preserving the patient-funded golden goose, are that Americans would lose choice (like they have a lot of choice anyway), everybody would be forced into a “one size fits all” system, and Americans would pay more and wait longer for worse care. The AMA has pulled out of the group, with the remaining members publicly accusing it of caving in to the liberal left. Healthcare companies spent $568 million lobbying the 535 members of Congress in 2018 alone, more than any other industry, and their bucks seem to be working since nobody is doing much to upend the healthcare cash register.


Other

Google Health posts a video describing the EHR search project it is doing with Ascension. It contains a mock-up of the combined information dashboard, which to my eyes looks little different from the standard tools provided by Epic, Cerner, and other EHR vendors, with the biggest differentiator that it combines information from multiple EHRs for those ever-expanding big health systems that are in perpetual replacement mode. The search function could be useful depending on how much intelligence powers it beyond simple text string scanning. The doctor who’s narrating is Alvin Rajkomar, MD, who is coming up on three years with Google, but also continuing his practice as a UCSF hospital medicine attending.

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CNBC reports that medical students and residents are teaching themselves to perform surgical procedures by watching unvetted YouTube videos. The article cites a study of 68,000 videos that show how to perform a fracture procedure, of which only 16 met even the most barebones criteria, such as identifying the on-camera person who was doing the teaching. UCSF’s Atul Butte made a good point on Twitter about potential oversight, however – textbooks aren’t regulated and at some point you have to trust your doctor for choosing appropriate learning material. After all, the surgeon who would have taught them in person could have been incompetent.

A study finds that US life expectancy, unlike that of most wealthy countries, has declined for three straight years after 60 years of increasing longevity, with key contributors being midlife drug overdoses, suicides, and organ system diseases. I suppose the glass half full side of the argument is that this is an indictment of our society, not our hospitals, and even the authors dismiss our dysfunctional health system as a cause and instead point to lack of social and support systems, poor education, and lack of living wages, all of which lead to “deaths of despair.” The largest number of excess deaths occurred in Pennsylvania, Ohio, Kentucky, Indiana, and Florida.

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Medical University of South Carolina says drug purchasing software that was developed by one of its IT network engineers is saving it millions by looking for the best price in the supply chain at any given moment. It has spun the company off as AscendRx, with the former IT employee Jonathan Yantis serving as CEO. I would tell you more, but the company’s Squarespace website returns a “Website Expired” error.

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Geisinger says its researchers can predict arrhythmia and death using AI analysis of ECG data, but our HIStalk AI expert Alexander Scarlat, MD provides a critique, which should always be employed before believing any attention-seeking AI headline since it’s never as straightforward as it sounds:

  • Mortality is by definition an imbalanced dataset (since more people lived than died) so area under the curve is not an appropriate metric. F1 score would be better suited.
  • It isn’t surprising that AI performed better in analyzing raw ECG data than humans. It’s like showing a cardiologist the actual ECG rather than a summary of its features.
  • Someone could die with a normal ECG for two reasons – either their cause of death wasn’t cardiac related or the model could be predicting on perhaps a 0.51 chance of being abnormal, barely over the default 0.5 cutting point.
  • The neural network should have been queried on the reasons and features it made it decide on the abnormal ECG.

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This is the best “excessive hospital charges” story ever. A three-year-old girl sticks a shoe from her Polly Pocket doll in each nostril. Her mother was able to remove one of them with tweezers, but the urgent care was unable to extract the second one and advised taking her to a Dignity Health hospital’s ED. Mom says the doctor there removed it within one second, having had ample practice with slippery Tic Tacs. She was billed $2,659 ($1,732 for the hospital, $927 for the doctor) and her family is stuck paying the full amount because of her high-deductible insurance plan. The hospital declined to provide the methodology behind its price, but scolded Mom in an emailed response to a media inquiry that she should have understood her plan better and gone to urgent care. Medicare would have paid the hospital $101, which you could argue is either a defense or indictment of why they charged her more. By the way, Dignity’s CEO made $10.3 million last year, the CIO made $2.3 million, and 27 executives exceeded $1 million in compensation.


Sponsor Updates

  • HIMSS names Audacious Inquiry Director Lindsey Ferriss a 2019 Extraordinary Women in Health IT awardee.
  • Datica and InterSystems will exhibit at AWS re:Invent December 2-5 in Las Vegas.
  • Spok earns top secure messaging and clinical communications honors in Black Book’s annual cybersecurity study.
  • ISalus Healthcare integrates prescription price transparency and electronic prior authorization solutions from CoverMyMeds with its EHR and practice management software.
  • Elsevier Clinical Solutions, Hyland, and InterSystems will exhibit at RSNA December 1-5 in Chicago.

Blog Posts


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Contacts

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Morning Headlines 11/26/19

November 25, 2019 Headlines No Comments

U.S. charges former Outcome Health executives in $1 billion fraud

Prosecutors charge former Outcome Health CEO Rishi Shah and former president Sharha Agarwal with fraud in a 26 count-indictment related to a six-year scheme during which they billed clients for ads that never ran and inflated revenue.

MD Revolution, Inc. announces strategic acquisition of Falcon Care, LLC to expand Care Management services and appoints Kyle Williams CEO

Medicare care management and patient engagement company MD Revolution acquires competitor Falcon Care.

Former Kaiser Permanente CTO Mike Sutten Joins Innovaccer as Chief Digital Officer

Former Kaiser Permanente CTO and SVP Mike Sutten joins Innovaccer as chief digital officer.

WELL Health to Acquire Trinity Healthcare Technologies, Canada’s Second Largest OSCAR Provider

Canadian primary care and software company Well Health Technologies acquires open source EHR vendor Trinity Healthcare Technologies for $5.4 million.

Curbside Consult with Dr. Jayne 11/25/19

November 25, 2019 Dr. Jayne 3 Comments

Clinician burnout continues to be a hot topic, so this American Academy of Family Physicians article caught my eye. It looks at the possibility that being able to better address the social needs of patients might reduce the possibility of burnout. I’m not surprised by this – physicians and other clinicians are trained to do their best to address all their patients’ issues, whether they are purely biological, psychosocial, or somewhere in between.

In many residency programs, we have all kinds of ancillary providers that help us do these things. My training program had PhD pharmacists, social workers, diabetic educators, dieticians, and psychologists to which we could refer our patients for a variety of services. Need a patient to receive education on anticoagulant drugs, their long-term monitoring, and the need for dietary changes? Check. Want to enroll a patient in smoking cessation clinic? Check. Newly diabetic patient who needs supplies and training? You got it. Patient who needs help navigating Medicaid enrollment or applying for supplemental nutrition assistance? Done.

When I headed out into practice, however, I was on my own to try to deliver many of these services. Even referring to subspecialists often became a battle that was made worse depending on the patient’s insurance coverage, ultimately resulting in the patient not receiving needed services.

At one point in time early in my career, only one of the city’s practices was taking new neurology patients who had Medicaid, which made the wait to see a consultant nearly a year long. This led to primary care physicians trying to do what they could to manage complex neurological issues that they weren’t trained to handle. You don’t have to ponder to hard to see where that could cause stress and burnout.

Not much has changed in the last couple of decades, although at times it’s a little easier to get patients in to see subspecialists, or maybe I’ve just built up enough friendships to be able to call in more favors. There are other more complex issues that we can’t solve through a phone call to a friend or classmate. Maybe it’s housing issues, transportation issues, or food insecurity. These are the types of issues that the study mentioned was looking at, along with whether inability to address patients’ social needs was a contributing factor to primary care clinician burnout. The authors went on to note that increasing services in the practice to address social needs tended to reduce burnout and improve clinician morale.

The study noted that participating physicians were concerned about how addressing social needs would impact their workflow. I’m curious about how those physicians went about adding services or training staff to address social needs and how that impacted not only the workflow, but the practice bottom line. Theoretically, some of the new care models, such as Comprehensive Primary Care Plus or Primary Care First, should provide additional funds to cover these additional services. However, it’s still not going to be enough.

A friend’s EHR has the ability to link out to transportation resources for patients, such as Uber. However, the practice has to pay for the transportation, leading to an ongoing internal conflict about which patients should receive those services. Independent physicians can make these decisions locally, but employed physicians are often subject to the whims of their owners, and productivity and case mix determines which physicians (and therefore patients) receive additional support and which don’t.

On the technology side of healthcare, we face similar difficult decisions. We have limited budgets and requests for more projects than we could possibly fund or staff. At one of my large health system clients, decisions often impact broad swaths of patients. Are we going to focus on systems to improve labor and delivery workflows this year, or fund the initiatives that the heart failure program has requested? How many patients would benefit from either approach? What about the community diabetes screening initiative, or the dental care mobile van? Should we look just at patient count, or go further to see how interventions would impact people over time?

At one point, money earmarked for optimization of frontline nursing workflows was diverted to cover consulting services needed to complete a required regulatory upgrade. This led to a relative revolt by some of the staff involved in advocating for projects that didn’t get the nod.

The emotions felt by some of the IT staff were no different than what was probably felt by the physicians in the study. In particular, those whose projects weren’t taken forward felt disenfranchised and often had a profound sense of loss. Some of those whose projects succeeded had something akin to survivor’s guilt as they watched other worthy initiatives wither. It also engendered a sense of fear and concern, with people wondering whether their project would be the next one to be defunded or otherwise not fully implemented. Sure, projects get canceled in every industry, but I think my colleagues in healthcare IT feel it more acutely because they know their work has the direct ability to impact patients’ lives.

The emotions become even more acute when you are working for organizations that are sitting on billions of dollars of resources, but may not be spending as much on patient care as they should. The marble lobby of the tertiary referral hospital is particularly luxurious (and the fountain is pretty darned impressive), but neither of those see patients. They don’t make up for the negative emotions felt by the clinical staff that empties the exam room trash cans every other day because the housekeeping budget was cut and services are only provided on even days. The luxury boxes at the ballpark and the over-the-top billboards are also a visible reminder of the money the health system is willing to spend on non-patient-care activities.

As the old adage goes, you have to spend money to make money, but somehow that spending is becoming less palatable when healthcare is on the line and patients are literally dying due to lack of basic interventions.

It’s easy to see why people in healthcare are burned out, no matter where you work or what your role is. Our inability to meet our patients’ needs is only a proximal cause, with many root causes beneath. I’m cautiously optimistic about new models of care that might help alleviate suffering or reduce gaps in care, but it may take years to determine how successful they really are. In the meantime, we need to support each other and continue to try to come up with innovative ideas to solve some of the most difficult problems humanity faces.

What would make you feel less burned out? Leave a comment or email me.

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Email Dr. Jayne.

Morning Headlines 11/25/19

November 24, 2019 Headlines No Comments

110 Nursing Homes Cut Off from Health Records in Ransomware Attack

Nursing home IT vendor Virtual Care Provider is hit by ransomware, taking down electronic patient records, Internet service, email, billing, and phone systems across 80,000 PCs and servers running hundreds of nursing homes in 45 states.

Google-linked fund seeds Berkeley medical AI startup

Google’s venture fund invests $4 million in radiology workflow optimization software company Rad AI.

Hospital Computer Firm Insists – We Did Our Job

Allscripts defends its work on an $18 million software implementation in the Bahamas that has resulted in no applications live after three years and $8 million in payments.

USDA Invests in the Expansion of Rural Education and Health Care Access

The USDA announces $42.5 million in grants for 133 distance learning and telemedicine projects in 37 states and two territories.

Monday Morning Update 11/25/19

November 24, 2019 News 6 Comments

Top News

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Wisconsin-based nursing home IT vendor Virtual Care Provider, Inc. is hit by ransomware, taking down electronic patient records, Internet service, email, billing, and phone systems across 80,000 PCs and servers running hundreds of nursing homes in 45 states.

The hacker is demanding $14 million to provide the encryption key, which the company says it can’t afford.

VCPI says some of its client facilities may be forced to shut down due to their inability to order drugs, generate bills, and pay employees.

Ironically, VCPI sells IT security and HIPAA risk analysis services.


HIStalk Announcements and Requests

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Over 80% of poll respondents think that Ascension’s data analysis agreement with Google is legal, but two-thirds also think the relationship is unethical.

New poll to your right or here: Have you ever been laid off or otherwise lost a job other than for performance issues? Click the poll’s Comments link after voting to share your experience.

I regularly worry that my 2.5-year-old, inexpensive Acer laptop will fail and leave me without a backup other than my Chromebook, which works great but doesn’t run some niche Windows apps that I need. I’ve been watching for a deal on something similar and saw a pre-Black Friday offer on an HP Pavilion 15z with AMD Ryzen 5, 16 GB of memory, 256 GB SSD storage, and a 15.6” touch display. I wanted 16 GB (which isn’t as common or cheap as it was a couple of years ago for some reason) and SSD since I’ve become spoiled by both, so my $480 order is in. I’ll report back after it arrives early next month.


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

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Google’s venture fund provides $4 million in seed funding to Rad AI, a radiology workflow optimization software company that was started in 2018 by a radiologist who entered medical school at 16 and now practices in North Carolina.


Sales

  • SCL Health will offer virtual services using Bright.md’s SmartExam asynchronous virtual care platform.
  • Steward Health Care chooses Health Catalyst’s Data Operating System and Rapid Response Analytics. 
  • Humber River Hospital chooses CloudWave to support Meditech and its infrastructure.

People

Cooper University Health Care promotes interim CIO Dustin Hufford, MBA to SVP/CIO


Government and Politics

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The VA says that it hasn’t worked out jurisdictional issues with the Department of Defense over patient information that will be stored in their respective Cerner systems, admitting that nobody really thought about data sharing issues when the projects were conceived. Existing laws may require veterans to make separate requests to the VA and DoD to obtain their health records despite the goal of a single record for each patient. The VA also acknowledges that its March go-live at Mann-Grandstaff VA Medical Center (WA) will involve a limited implementation that will require employees to toggle between Cerner and VistA. 


Privacy and Security

Medical researchers observe that European Union’s General Data Protection Regulation has caused problems for their studies that cross national borders outside the EU. NIH Director Francis Collins says his study of diabetics in Finland ground to a halt when NIH could not meet the privacy requirements of its national equivalent in Finland. Neither the US nor Canada are recognized by the European Union as providing adequate data protection, so researchers must sign contracts to accept Europe-based audits or to cede legal jurisdiction to the originating country’s courts. GDPR isn’t an issue when patient information is anonymized, but countries haven’t agreed on how that anonymization can be performed and some studies include sample data that cannot be stripped of identifying characteristics.


Other

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Bloomberg notes that Inovalon Chairman and CEO Keith Dunleavy, MD is a billionaire once again following a 60% run-up in the analytics platform vendor’s stock price in the past year. Timing is everything, though — the company went public in early 2015 at $27 per share and is down 36% since, while the Nasdaq rose 74% in the same period.

Allscripts defends its work on an $18 million software implementation in the Bahamas that has resulted in no applications live after three years and $8 million in payments. The company responded to a newspaper’s request for comment that it is in full compliance with the contract and is waiting on approval from the government, which says it is looking for a replacement system. Allscripts misidentified its client in the response as the “Public Housing Authority” rather than the “Public Hospitals Authority.”

Medical residents in South Korea complain that while their weekly work hours are newly capped at 80, they are seeing more patients without much help from specialists in learning new procedures. They also claim that hospitals shut off after-hours EHR access to make it look like they are complying with the hours cap, but give them other work to perform instead.

In Australia, a government review of misused private data looks at Queensland Health’s Cerner IEMR, which allows employees and staff at any of its 14 hospitals to view the records of all patients. The government worries that the hospitals don’t fully understand how to configure the system’s privacy controls, such as flagging high-profile records to warn users that any inappropriate access will be investigated. However, one hospital’s HR director says its P2Sentinel access monitoring system issues reports that aren’t that useful, leading to a huge backlog of potential inappropriate viewing incidents that the hospital doesn’t have time to investigate. 

Two Colorado state agencies announce that a bug in their tracking system allowed several batches of contaminated medical and recreational marijuana to be sold, triggering a recall of such products as Ghost Cake Killah and Grape Ape.


Sponsor Updates

  • Chilmark Research highlights Bright.md in its new report, “Primary Care for the 21st Century: Technology-enabled and On Demand.”
  • Greenway Health’s Intergy EHR receives five industry accolades in 2019.
  • Nextech Systems gives its customers access to Relatient’s patient self-scheduling, automated waitlist, and patient intake capabilities.
  • The Chartis Group announces the winners of The Chartis Center for Rural Health 2019 Performance Leadership Awards.
  • Hyland Healthcare’s Advisory Councils share insight into top health IT trends including AI, cloud, and optimization.
  • LiveProcess will exhibit at the National Healthcare Coalition Preparedness Conference December 2-4 in Houston.
  • Gartner recognizes NextGate as a ‘Notable Next-Generation EMPI Vendor.’
  • Nordic staff volunteer at The River Food Pantry and donate gifts for 65 local children.
  • KLAS Research recognizes PatientPing as a high-performing, emerging healthcare IT company.
  • SailPoint will exhibit at AWS re:Invent December 2-6 in Las Vegas.
  • Visage Imaging will exhibit at RSNA December 1-5 in Chicago.
  • Wolters Kluwer Health publishes a new report, “Mending Healthcare in America 2020: Consumers & Cost.”

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
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Weekender 11/22/19

November 22, 2019 Weekender No Comments

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Weekly News Recap

  • The American Medical Association calls for EHRs to be fully inclusive for transgender patients and expresses its support for government funding to improve public health technology, including EHR integration.
  • Government officials in Bahamas scramble to dodge blame for signing an $18 million contract with Allscripts in 2016 that was supposed to transform healthcare, but has yet to result in any installed software.
  • HHS expands its price transparency plans by proposing that both hospitals and insurers be required to publicly post their negotiated contract prices.
  • The Spokane VA hospital hires more than 100 new employees to cover its expected productivity losses during its Cerner go-live in March.
  • Kareo sells its revenue cycle management business.
  • Stanford Hospital opens its $2.1 billion, 368-bed hospital that incorporates extensive technology.

Best Reader Comments

Epic did a big enhancement a year or two ago to replace their single “sex” field with an entirely new series of fields to capture sexual orientation, gender identity, sex assigned at birth, legal sex, preferred name, preferred pronoun, etc. It was a big change for healthcare organizations to start using the functionality, but it was the right thing to do. (Anon)

Changing the behavior of core demographic information (like name and sex) is going to be a big task. It’s not a quick and easy update, but being treated with respect (by being called by your real name) from your doctor can help an already at-risk population better engage with their healthcare providers. There are additional benefits to having this be a thing the entire industry focuses on. If your EHR can handles this gracefully but your EKG system doesn’t, then you end up with unnecessary added complexity both on the IT side and on the clinician side. The AMA of course has no teeth on this, but it emphatically is something the industry should be working towards. (TH)

I have learned and I hope some of your readers will learn that you are only as good as the last day you have completed on the job and this can happen at any moment. Tomorrow’s employment is not a promise, unless you have a contract. Layoff, RIF, firing, termination… whatever you call it, the outcome is the same. I would add that career management requires constant networking, having your resume and Linked In account up to date, trusting your intuition – meaning that if if feels or looks like it is going to hit the fan, it probably is and what are YOU doing about that. (Justa CIO)

[The informatics team needs to focus on] the lifecycle of and alert intervention to ensure that the intervention remains current and clinically relevant. This is often lacking in some systems, from my experience, as it is a significant organizational commitment to do this effectively. It require having clinical ownership of the CDS intervention, so it necessitates having clinical subject matter experts and/or a medical literature review process engaged in maintenance in an ongoing fashion. (Luis Saldana)

Seeing that the fine for not being transparent with data is $300 per day, or $109,500 per year, I suspect most organizations will just eat the cost instead of paying for the additional labor that would be required to be in compliance. Or, just look for a way to increase productivity through say, an extra 10 or so MRIs per year. (MoMoney MoProblems)

Read the Mayo Clinic article on usability. Saw that microwave ovens were better, so decided to try it in clinic. It took a while to find enough extension cords, but I managed to set up my 1200-watt Amana microwave on a rolling cart and got ready to see patients. Turns out, it was very easy! I just basically kept hitting the “Add 30 Seconds” button throughout the encounter (it’s the only button I’ve ever used on it). At the end of the encounter, I got a satisfying DING! I can’t believe how much easier it was than my EHR. Amana really gets human factors! Not like those programmers at the EHR companies, with their code and data and functionality. Good riddance, I say! (Andy Spooner)


Watercooler Talk Tidbits

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Magee Women’s Hospital (PA) escorts a man whose wife was delivering their baby off its premises, struggling with how to deal with the fact that he is also a registered sex offender. The man is prohibited from having unsupervised visits with his other two children and had alerted hospital security of his conviction before he took his wife to the hospital. The hospital security department offered to escort him to his wife’s room the next day, but he declined, fearing that he would be arrested.

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In Indonesia, several motorcycle taxi drivers storm a hospital that had refused to release the body of a deceased six-month-old boy to his family because of his unpaid bill, preventing the Islam requirement of a quick burial. They left with the body, but the hospital director explained afterward that the charges had already been waived, triggering the apology of one of the drivers involved in the “humanitarian mission” who now hopes to “restore the good name of the hospital” because he didn’t know the procedure and thought it was taking too long.

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A co-founder of Firefox creator Mozilla develops Brave, a privacy-first browser that blocks the recording of browser history, offers its own password manager, and blocks all ads by default in favor of offering an optional private ad platform that allows users to “tip” their favorite sites. It claims to be three to six times faster than Chrome and Firefox. I tried it on HIStalk and the load time was the same as with Chrome.

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The newest faculty member at the Uniformed Services University of the Health Sciences is two years old. Shetland, a Navy lieutenant commander and clinical instructor, is a highly trained military service and therapy dog. Shetland’s job is to accustom students to the therapy dogs they will encounter in clinics, hospitals, and in veterans with PTSD so they can choose them wisely for their patients. 


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Morning Headlines 11/22/19

November 21, 2019 Headlines No Comments

Modernize public health surveillance to ease doctors’ reporting burden

The American Medical Association adopts a policy that calls for increased state and local funding to modernize public health IT systems.

VA insists it’s ready for initial EHR deployment at first go-live site in March

The Mann-Grandstaff VA Medical Center in Spokane, WA is hiring 108 more employees to cover anticipated productivity losses during its Cerner go-live on March 28.

Tools to help healthcare providers deliver better care

Google Health lead David Feinberg, MD attempts to clarify the company’s HIPAA-compliant work with Ascension, pointing out that the health system is piloting an interface concept he first mentioned at the HLTH Conference last month.

News 11/22/19

November 21, 2019 News 7 Comments

Top News

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The American Medical Association adopts a policy that calls for increased state and local funding to modernize public health IT systems. AMA also wants provider EHRs to be capable of automatically sending reportable conditions to public health agencies.

AMA is also encouraging state governments to engage state and national medical specialty societies and public health agencies when considering new mandatory disease reporting requirements.


Reader Comments

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From Fatted Calf: “Re: layoffs. Your list of the steps people go through after being laid off should have included advice.” That wasn’t the reader’s question that I was answering via my reality check, but here you go:

  1. Don’t be ashamed at being laid off and don’t try to hide the fact that you are involuntarily seeking employment. Layoffs are a failure of executives and only they should feel shame. Develop a one-sentence description of why you no longer work there (general cutbacks, product sunsetted or sold, etc.) and practice succinctly answering the question, “Why did you leave?” because it will be asked often.
  2. Set your alarm to get up early every day, dress in real clothes, keep a calendar, make calls, exercise, and treat every day like a workday whose goal is to find a new job. Lack of time is no longer an excuse.
  3. Spend a day debriefing yourself in writing. What did you like and dislike about your job and employer? What did you and they do wrong? What good and bad job decisions did you make?The only point of this is to get that crap out of your head so you can move on to more productive pursuits than moping around and second-guessing. It’s amazing sometimes how committing something to writing frees up brain storage and mental CPU cycles.
  4. Don’t badmouth your previous employer. You stayed in your rut until the choice wasn’t yours, so there’s no virtue in complaining only afterward how bad it was.
  5. Take several days to plan your ideal career and who might hire you to practice it. You have the opportunity, no matter how unwelcome, to change your preconceived notions about yourself and the niche into which your former employer placed you.
  6. Polish your LinkedIn, adding your job’s end date, changing your title for “seeking a new opportunity,” and make sure your “About” section is punchy and reflects your abilities. Please don’t use stuffy third-party wording, aka the Godcam view of yourself, such as “Seasoned health system manager” – make it personal, direct, and memorable (and include a decent headshot that isn’t cropped from a phone photo from your last beach trip). Then create one-page, one-sided resume that gets to the point with the most important information listed first. Hiring managers don’t care too much about your personal statements and they already know that you’ll provide references on request. Unless you’re applying for a low-level job, you won’t get hired via an application or resume anyway, with incompetent corporate HR departments being one big reason, so make calls and get out of the house instead of staring at your laptop trying to use IT skills alone to get hired.
  7. Attend a local conference such as a HIMSS chapter if you aren’t willing to relocate or a national conference if you are. Those can be target-rich environments for job searches, or at worst, for learning about how the world revolves outside your former company. I also got a couple of good jobs working with a recruiter who I vetted pretty carefully, so while not everyone’s experience is positive, it worked for me.
  8. Decide if you are willing to move under any circumstances. If not, then your job search and networking activities will look different than if you’re willing to relocate.
  9. Increase your visibility with LinkedIn articles, tweets, or anything else that could catch a potential employer’s eye, assuming that your insight and writing ability match your job expectations.
  10. Reach out to everybody you know via email or LinkedIn messaging and keep a worksheet of who you contacted and when. Use the six degrees of separation power of LinkedIn to figure out who might hire you and the email searching ability of Google to get that person’s work email address so you can introduce yourself. You only need to hit one home run to forget the swings and misses.

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From RansomwareHitsHome: “Re: Casamba LLC. A ransomware attacked has forced some agencies that use its software back to paper records and forms.” The California-based post-acute care EHR vendor hasn’t publicly acknowledged the attack, but this update was provided by one of its customers.

From FlyOnTheWall: “Re: Allscripts layoffs. The highest number I heard was greater than 350, but I’ll stand on my 125-150 let go until I find out more. They are in publicity damage control.” Unverified. I checked WARN notices for Illinois and Pennsylvania for the last several months and didn’t see any Allscripts entries, but WARN applies only to office closures and mass layoffs since they’re intended for giving the state rather than the employees a heads-up.


HIStalk Announcements and Requests

A reader approves of my activation of two-factor authentication to secure my Gmail accounts, but warns that the SMS-based verification option is not secure. He has first-hand experience – he lost $4,000 within minutes of someone using a SIM port hack to steal his cell phone number, which then allowed the hacker to reset the passwords for Gmail, banking, Twitter, etc. I took his advice and switched the authentication method to Google Authenticator, a free app that – like those flashing hardware dongles in the old days – generates authentication codes every few seconds. It’s like SMS messaging, except you open the phone or tablet app to get the current code and the mobile device doesn’t even need to be online at the time (unlike the SMS option). I had a few false starts in trying to figure out how to link the app to multiple email accounts from multiple mobile devices, but I finally figured it out by Googling. Another option is Google Prompt, which allows you to simply touch a phone pop-up acknowledging that it’s really you logging in on the other device, but it only works when the Gmail app is open and I don’t use it.


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.


People

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Jon McAnnis (Providence Health Plans) joins Zoom+Care as CIO.

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Regenstrief Institute promotes Indiana University School of Medicine professor Shaun Grannis, MD to VP of data and analytics.

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Nick White (Deloitte) joins Orbita as EVP of patient care solutions.

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OurHealth promotes Brian Norris, RN, MBA to EVP of population health.


Announcements and Implementations

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Orbita announces GA of OrbitaAssist, a bedside virtual health assistant designed to complement nurse call systems. Back-end software routes patient requests to the appropriate member of the care team, while front-end AI assures the patient their request is being fulfilled.

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Datica will debut its new cloud compliance technology, including end-to-end cloud managed services, in early December.

Imprivata announces OneSign 7.0, which adds single sign-on for web based applications.


Government and Politics

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Kaiser Health News publishes a retrospective look at stalled federal efforts to ensure the safety of EHRs. Ideas have included developing a database to track reports of deaths and injuries related to health IT and establishing an EHR safety center, neither of which have come to fruition due to funding and oversight issues. The issue gets even thornier thanks to a 21st Century Cures Act clause that prohibits the FDA from getting involved. Medical informaticist Dean Sittig, PhD says, “There wasn’t a lot of interest [at ONC] in talking about things that could go wrong. They gave out $36 billion. It’s hard for them to say EHRs aren’t safe.”

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The Mann-Grandstaff VA Medical Center in Spokane, WA is hiring 108 more employees to cover anticipated productivity losses during its Cerner go-live on March 28. VA officials insist they are on track to meet that deadline, but will have no qualms about pushing it back should patient safety become an issue.


Privacy and Security

Google Health lead David Feinberg, MD attempts to clarify the company’s HIPAA-compliant work with Ascension, pointing out that the health system is piloting an interface concept he first mentioned at the HLTH Conference last month.

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In the wake of Google’s Fitbit acquisition and health data trust debacle with Ascension, Wired offers step-by-step instructions on how to manage the privacy settings of popular health apps like Fitbit, Apple Health, and Google Fit. Some consumers have become so wary of Google and its plans for their health data that they have abandoned their Fitbits. One concerned user explained, “I’m not only afraid of what they can do with the data currently, but what they can do with it once their AI advances in 10 or 20 years.”


Other

A hospital in Bangalore, India will use its patient data to map areas where pothole-related injuries send up to four cyclists each day to its ED.

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Kaiser Permanente will name its new medical school after former CEO Bernard Tyson, who passed away earlier this month. The school will open next summer in Pasadena, CA and will offer free tuition to its first five graduating classes.

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A former marketing SVP of Novant Health sues the health system for reverse discrimination, claiming that as a white male, he was fired as part of a corporate diversity push and was replaced with two minority hires. David Duvall, MBA, MPH says that at least five other white male executives, including the CIO, were terminated and replaced almost immediately with “either a racial minority and/or female.” He was let go right before his five-year anniversary, when his termination would have entitled him to 18 months of base pay, 1.5 times his previous bonus, $200,000 in retirement benefits, and company-paid health insurance.

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Digital health investor, consultant, and author Terri Mead critiques her second annual visit as a participant in Verily’s Project Baseline Health, a four-year study announced in 2017 that aims to create a database of the sequenced genomes of 10,000 volunteers. Study participants like Mead also agree to wear activity trackers that share their sleep patterns, activity, heart rate, and other health metrics with Verily researchers. Her criticisms:

  • The “archaic” use of Google Forms to capture patient intake data.
  • The risk of inconsistent and unreliable data thanks to manual data entry that does not use drop-downs that are tied to medical terminology.
  • The study expressed no interest in her “female parts,” which left her assuming that they consider females “a standard deviation away from males.”
  • Lack of follow up on patient adherence to use of wearables, some of which she stopped using months before.
  • Abandonment of lung/breathing tests due to budget issues.

Sponsor Updates

  • AMIA inducts Intelligent Medical Objects VP of Customer Experience Steven Rube, MD and VP of Clinical Informatics Eric Rose, MD into its 2020 class of fellows.
  • Optimum Healthcare IT publishes a new case study, “Cerner Millenium Implementation at Ellis Medicine.”
  • The Chartis Group publishes a new paper, “Being a Digital Health System: It’s No Longer a Question of If or When.”
  • Pivot Point Consulting releases the first episode of its new Get to the Point podcast, “Flexibility vs. Interoperability. Can Clinical Documentation Do Both?”
  • Imprivata updates its OneSign authentication and access software to offer users seamless cloud-based access from any device.

Blog Posts


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Contacts

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EPtalk by Dr. Jayne 11/21/19

November 21, 2019 Dr. Jayne 1 Comment

I wrote a few weeks ago about my adventures with flu vaccines and how the charges are handled by my insurance. Kaiser Health News dug into the phenomenon this week, going farther in noting the differences in costs among one payer’s own employees. The payments ranged from $32 in Washington, DC to $85 in Sacramento.

This illustrates the results of negotiations between payers and providers, the madness of which leads to the need for entire segments of the healthcare IT industry to keep up with it. Anyone who has worked with practice management or revenue cycle systems has experienced the phenomenon and the layers of code needed to wrangle it, and I salute you. It remains to be seen whether the government will be successful in forcing providers and payers to disclose this information publicly. Efforts to do so will likely be in the courts for some time.

I’ve been doing some behind-the-scenes work on clinical guidelines, and recently tried to track down data on a drug that is supposed to be available as a generic that we couldn’t find. The Wall Street Journal made note of the problem this week as well, observing that multiple factors keep those drugs from making their way into patients’ hands. It’s a disappointing phenomenon, but an interesting read.

In other drug news, a serious outbreak in pigs is likely to cause a shortage of the critically necessary blood-thinning drug heparin. African swine fever is on the march, killing nearly 25% of the world’s pig population, particularly in China, where the majority of heparin is produced. The World Health Organization is recommending that governments stockpile heparin, so be on the lookout for extra alerts and clinical decision support needs in EHRs.

Mr. H already reported on the AMA’s call for inclusive EHRs for transgender patients, but I want to throw in my two cents. Several years ago, I worked on some focus groups with a vendor who was trying to get this done. It can be complex, because there are many variables to document, including legal status, legal name, preferred name, surgical status, hormonal status, anatomical status, genetic status, etc. The vendor was focused and had several physician advocates who would continually explain to business analysts and developers why this was important. They ultimately they got the job done.

I’ve heard rumblings from other sources that this is a big lift for a small number of patients. But without the ability to document key clinical data and use it at the point of care, it results in a subpopulation being treated differently and in ways that might actually be counter to good clinical care.

The AMA also adopted a policy to promote education on health issues related to sexual orientation and gender identity for medical students and residents. I didn’t know much about the transgender population until medical school, where I had a professor who was public about their transition. It was a tremendous opportunity for learning and understanding and made a great impact on me, ultimately leading to me having a good number of transgender patients in my practice. I’m fully supportive of efforts to make EHRs inclusive for everyone, whether it’s based on differences in gender, age, race, ethnicity, or any other characteristic that may influence health. To be the most effective, we need to be able to meet our patients “where they are” and this is one way to work towards that goal.

Measure-palooza: The American Heart Association (AHA) and the American College of Cardiology (ACC) have released updated Clinical Performance and Quality Measures for adult patients with hypertension. The new report includes 22 new measures and expands focus from blood pressure measurement to care delivery systems and approaches. Their goal is to look beyond individual provider performance.

That’s great in theory, but it’s not how most other clinical quality measures programs work. It may also add workflows to EHRs, resulting in poor usability that will be blamed on the EHR rather than an explosion of guidelines and measures. There are also mismatches in the quality numbers used by AHA/ACC, CMS, and the National Committee for Quality Assurance. I’m sure EHR requirements writers are wringing their hands at this point. The report also includes a focus on digital health, including remote monitoring for hypertensive patients.

Maybe the EHR isn’t so bad: A recent study conducted at the University of Pennsylvania Health System showed an increase in orders for certain cancer screening tests when a “nudge” alerted users from the EHR. The alerts were targeted to medical assistants who created the orders for licensed clinicians to review and hopefully discuss with their patients. Despite the increased orders, there were not significant changes in the number of patients who completed the recommended screenings within a year-long time frame.

I recently worked with a practice that raffled off a big-screen television to patients who completed home colorectal cancer screening kits within a specified time frame. I’m not sure how legal it was, but it was certainly effective at motivating patients to submit a sample.

Kudos to the clinical informatics team at Oregon Health & Sciences University, who recently implemented a drug pricing comparison tool within Epic. It factors in data points such as co-pays, deductibles, and the need for prior authorization. The information has been available to dispensing pharmacists for a long time, but moving it to the point of care is key. It doesn’t matter how effective a drug is when it’s never going to be taken because the patient can’t afford it.

My clinical practice offers cash-only prescriptions at the point of care, which simplifies things for patients who know what their co-pays are (most of our drugs are either $15 or $30). However, many of our patients have no idea what their co-pay might be and are unable to make an informed decision. Having a tool like this at the bedside would be a benefit for the rare cases when we have to prescribe more costly drugs.

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Flu season is getting well underway, particularly in the South. My practice is running low on vaccine and expects to be out by the end of the month. If you’re thinking about getting vaccinated but haven’t done it yet, time is of the essence. Three children have already died this season. If you still have plenty of vaccine, maybe an outreach campaign using those expensive population health tools is a good idea.

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Morning Headlines 11/21/19

November 20, 2019 Headlines No Comments

XSOLIS Announces Acquisition of MEDarchon

Nashville-based predictive analytics company Xsolis acquires Medarchon, a messaging and analytics business also based in Nashville, for an undisclosed sum.

Kaiser Permanente’s new medical school to be named after late CEO Bernard Tyson

Kaiser Permanente will name its new medical school, scheduled to open next summer, after late CEO Bernard Tyson.

Mount Sinai Announces Expanded Capability in Medical Research

Mount Sinai Health System (NY) will use a $2 million grant from HHS to double the computing capabilities and speed of its BODE supercomputer, giving researchers enhanced infrastructure for faster results.

Morning Headlines 11/20/19

November 19, 2019 Headlines 1 Comment

AMA adopts new policies during first day of voting at Interim Meeting

The American Medical Association adopts a policy that calls for EHRs to be able to collect the preferred name and clinically relevant, sex-specific anatomy of transgender patients.

Kareo Sells Managed Billing Services Business

Health Prime International acquires EHR and practice management vendor Kareo’s RCM services business.

Senator: ‘No Apologies’ For Deal’s Wasted $7m

Government officials in the Bahamas scramble to undo the damage done by an $18 million contract signed with Allscripts in 2016 that has yet to result in any software installations.

Governor Cooper Announces 400 New Jobs in Chapel Hill for Healthcare Technology Operations Center

A week after announcing a $25 million funding round, employee healthcare engagement company Well announces it will bring 400 jobs to a new operations center in Chapel Hill, NC.

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Reader Comments

  • Grant: "Because in 14 years of attending, I never once saw actual research, just a bunch of cherry-picked stats provided by a ...
  • Dr. Z: If you want to hear a physician's response to the CBS Epic Story, here it is: https://www.youtube.com/watch?v=qoQs162Yw...
  • Kermit: Wow, that's some first class writing, Mr. H. Thanks for an entertaining morning read. The tips are pretty good too....
  • Woodstock Generation: Re: Give me some advice Absolutely this is a conflict of interest! Shame on the state health system hiring Vendor A...
  • HIT Girl: Holding HIMSS during what is normal flu season seems like a bad idea generally. Last year all but I think three of the p...
  • Silence Dogwood: When you read the original response, it seems logical and has practical advice, and is actually educational. Here's ano...
  • CancelHIMSS: If being stuck on a luxury boat or fancy hotel is bad, can you imagine the nightmare of being stuck in a HIMSS conferenc...
  • El Jefe: Re HIMSS and COVID-19. It’s sound judgement to cancel the dang thing. To suggest that it’s too late ... tell...
  • HIT Girl: Compassion and the human element absolutely exists on EMR development teams. I've been part of that environment, at mul...
  • Bill Grana: Thanks for this commentary and I am in complete agreement. I had a similar (but less complex) patient portal experience...

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