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Morning Headlines 11/27/18

November 26, 2018 Headlines, News No Comments

Mental health therapy at Walmart? It’s now a thing

Managed care company Beacon Health Options creates a new business to oversee the launch of mental health clinics in retailers like Walmart, promising virtual access to providers during peak hours.

Black Book Survey of More Than 1,500 Executives Confirms the Changing Role of the Healthcare CIO

The purchasing-decision power of hospital CIOs falls over the last three years from 71 percent to 8 percent, according to a Black Book report.

Patients discharged sooner in hospitals with highest use of electronic health records

A Case Western Reserve University study finds that patients are discharged almost four hours earlier at hospitals that use EHRs at the highest federal standard of implementation.

Curbside Consult with Dr. Jayne 11/26/18

November 26, 2018 Dr. Jayne No Comments

While many people were out doing their Black Friday shopping, I was getting clobbered at urgent care. We saw over 1,000 patients across our locations, which is similar to the patient counts that we see during the height of influenza season.

Many of the patients were coming in for fairly low-acuity problems because their primary care physicians’ offices were closed and they were concerned that their conditions would worsen over the weekend. A portion of the patients had issues that had gotten worse over the holiday, while others had holiday-related injuries.

I saw some Thanksgiving-related injuries, including a patient who was injured by a frozen turkey that fell on her, allowing me to use the ICD codes W61.42 “Struck by turkey” and Y93.G1 “Activity, food preparation and clean up.” Another injured her finger “spiralizing” a sweet potato. I couldn’t find a better code for that other than the usual wound codes, but the turkey incident was a challenge for my scribe.

It’s rough enough seeing that large volume of patients (more than 70 of them were on my schedule) but it was made more difficult by an EHR that behaved erratically. I’m pretty sure my EHR has the world’s most user-unfriendly error codes, such as, “The length argument value must be greater or equal to X” and “Error attempting to push run time parameters onto the stack.” Both of those gems allowed the user to click through without incident and allowed return of normal function, so it’s not clear why we were even seeing them. Although I’ve been in the healthcare IT world for a long time and have come to terms with just clicking through and not getting too worked up, some of my staff members were very frustrated by messages that had no meaning.

Due to increasing co-pays and concerns about crowding at the emergency room, we had multiple patients who ultimately needed transfer to a higher level of care, which can be stressful for the staff. Most of the team I worked with have been in the urgent care space a long time, so they weren’t nervous about handling patients with stroke or chest pain symptoms until emergency medical services arrived to transport them to the hospital.

It’s still challenging, though, especially when your schedule gets backed up while you’re caring for a truly sick patient while other patients are popping out to the clinical station because they feel that they’ve been waiting too long. The consumer-style expectations of our patient population continue to rise, and on a busy day full of lacerations and hospital transfers, it’s definitely harder to meet those expectations. Patients are already frustrated because their primary care physicians’ officers are closed, assuming that they have a primary physician, which many do not.

We also had an uptick in patients who were presenting to us for care after being seen at a retail clinic. They had seen a nurse practitioner only to be told that their condition was outside the scope of practice permitted at the retail clinic and that they would need to be seen by a physician for laboratory work, chest x-rays, etc.

We’re happy to take those referrals, but the patients aren’t thrilled to pay an urgent care co-pay on top of whatever was spent at the retail clinic, not to mention the time involved in leaving one facility and traveling to another. The local retail clinics vary dramatically in how they screen patients for scope of practice. Some seem to do the screening upfront and refer the patient prior to any exam, where others see the patient and then refer. The latter doesn’t make for very happy patients.

One of the more challenging parts of my day was caring for a patient who came in with what appeared to be a viral illness but that turned out to be a life-altering diagnosis. In the urgent care trenches, we’re often accused of practicing defensive medicine or ordering too many tests, but when your CT scan detects a serious cancer that the patient had no idea was present, it’s sobering. I’m sure when Monday rolls around we’ll have to deal with the retroactive authorization for the test, but it will be worth it.

I hate having to tell patients about those discoveries. It would be so much better to have a physician who knows the patient give them the news. Patients are generally glad that they have a diagnosis and a plan to move forward, even if the news is not what they expected. I’ve had several situations like this over the last several weeks and I wish there was a way to follow along with the patient’s care. In our region, though, the big health systems aren’t about to share data with an independent urgent care even though their systems are allegedly interoperable.

Today was a much easier schedule and I had a couple of hours where patients only trickled through the door, so I was able to work on some informatics projects. We’ve been faced with shortages of some of our common medications, so I worked on an analysis of diagnosis patterns and volumes to estimate how long we can stretch our supplies. It’s still baffling that we have shortages of key medications in the US, including antibiotics and especially generics. We’re also low on influenza vaccine, so I worked on a strategy to predict demand and redistribute what we had. Not exactly high-powered informatics or big data analysis, but the run-of-the-mill data needs that are common for practices.

I also spent some time with one of our training scribes to talk about proposed changes to our scribe program since we have had to ramp up quickly to prepare for the opening of several new locations. We don’t want to shortchange any of the training, but want to make it as efficient as possible since scribes are the lifeblood of our high-volume days during flu season.

I had some time to play around with data around influenza and was glad to see that our influenza activity is paralleling the CDCs data at around 2 percent of the visit volume. It’s days like today that I’m glad to have an EHR and can extract data for useful purposes. In the coming weeks I’ll be extracting data for more challenging purposes, including our annual analysis of whether we should continue to opt out of the federal incentive programs. That’s a much bigger project, including analysis of provider workflow, documentation time, and click counts on top of the analysis of payer mix, CPT codes, quality measures, and more. It’s not exactly something I look forward to every year, but it’s rewarding to be able to analyze, interpret, and package the data so that informed decisions can be made.

We also had a tornado warning issued while seeing patients, which put our disaster planning skills to the test. There’s not a lot of patient privacy when you have people huddled in the central core of the office, away from the windows that are present in all the exam rooms. People seemed to take it in stride, though, especially since we’re looking at high winds through the evening and snow into the morning. I may be grumbling during the commute, but at least I’m not in Chicago at RSNA where there is still a blizzard warning in effect. Wherever you may be, I hope your weather allows you to stay safe.

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A Machine Learning Primer for Clinicians–Part 6

Alexander Scarlat, MD is a physician and data scientist, board-certified in anesthesiology with a degree in computer sciences. He has a keen interest in machine learning applications in healthcare. He welcomes feedback on this series at drscarlat@gmail.com.

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Previous articles:

  1. An Introduction to Machine Learning
  2. Supervised Learning
  3. Unsupervised Learning
  4. How to Properly Feed Data to a ML Model
  5. How Does a Machine Actually Learn?

Artificial Neural Networks Exposed

Before detailing what is a NN, let’s define what it is not. 

As there is much popular debate around the question whether a NN is mimicking or simulating the human brain, I’ll quote Francois Chollet, one of the luminaries in the AI field. It may help you separate at this early stage between science fiction and real science and forget any myths or preconceptions you may have had about NN:

Nowadays the name neural network exists purely for historical reasons—it’s an extremely misleading name because they’re neither neural nor networks. In particular, neural networks have hardly anything to do with the brain. A more appropriate name would have been layered representations learning or hierarchical representations learning, or maybe even deep differentiable models or chained geometric transforms, to emphasize the fact that continuous geometric space manipulation is at their core. NN are chains of differentiable, parameterized geometric functions, trained with gradient descent.” (From “Deep Learning with Python” by Francois Chollet)

You’ve met already an artificial neural network (NN) in the last article. It predicted the LOS based on age and BMI, using a cost function and trained with gradient descent as part of its optimizer.

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ANN Main Components

  • A model has many layers: one input layer, one or more hidden layers, and one output layer.
  • A layer has many units (aka neurons). Some ML models have hundreds of layers and tens of millions of units.
  • Layers are interconnected in a specific architecture (dense, recurrent, convoluted, pooling, etc.)
  • The output of one layer is the input of the next layer.
  • Each layer has an activation function that applies to all its units (not to be confused with the loss / cost function).
  • Different layers may have different activation functions.
  • Each unit has its own weight.
  • The overall arrangement and values of the model weights comprise the model knowledge.
  • Training is done in epochs. Each epoch deals with a batch of samples from input.
  • Each epoch has two steps: forward propagation of input and back propagation of errors (see above diagrams).
  • A metric is calculated as the difference between the model prediction and the true value if it is a supervised learning ML model.
  • An optimizer algorithm will update the weights of the model using the loss / cost function.
  • The optimizer helps the model navigate the hyperspace of possibilities while minimizing the loss function and searching for its global minimum.
  • After model is trained and it makes a prediction, the model uses the final values of the weights learned.

In the following example, a ML model tries to predict the type of animal in an image as a supervised classification task.

  • An input layer on the left side accepts as input the image tensors as many small numbers.
  • Only one hidden layer (usually there are many layers). It is fully connected to both the input and the output layers.
  • An output layer on the right that predicts an animal from an image. It has the same number of output units as the number of animal types we’d like to predict. The probabilities of all the predicted animals should sum up to one or 100 percent.

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From giphy.

What Is the Difference Between a NN and a Non-NN ML Model?

Non NN Models:

  • One set of weights for the whole model.
  • Model has one function (e.g. linear regression).
  • No control over model internal model architecture
  • Usually do not have local minima in their loss function
  • Limited hyperspace of possibilities and expressivity

NN Models:

  • One to usually many layers, each layer with its own units and weights.
  • Each layer has a function, not necessarily linear.
  • Full control over model architecture.
  • May have multiple minima as the loss function is more complex.
  • Can represent a more complex hypothesis hyperspace.

Remember the clustering exercise from a previous article?

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  • Task: given the X and Y coordinate of a dot, predict the dot color.
  • Input: X and Y coordinates.
  • Output: color of dot.
  • Performance: accuracy of prediction.

How would a NN model approach the above supervised learning problem ?

Note that no centroids are defined, nor the number of classes (two in the above case) are given.

The loss function that the model tries to optimize results from the accuracy metric defined: predicted vs. real values (blue or orange). Below there are five units (neurons) in the hidden layer and two units in the output layer (actually one unit to decide if yes / no blue for example, would suffice as the decision is binary, either blue or orange.)

The model is exposed to the input in batches. Each unit makes its own calculation and the result is a probability of blue or orange. After summarizing all the layers, the model predicts a dot color. If wrong, the weights are modified in one direction. If right, in the opposite direction (notice the neurons modifying their weights during training). Eventually, the model learns to predict the dot color by a given pair of X and Y (X1 and X2 in the animation below)

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From “My First Weekend of Deep Learning at Floyd Hub.”

Advantages of a NN Over a Non-NN ML Model

  • Having activation functions, most of them non-linear, increases the model capability to deal with more complex, non-linear problems.
  • Chaining units in a NN is analogous to chaining functions and the result is a definitely more complex, composite model function.
  • NN can represent more complex hypothesis hyperspace than non-NN model. NN is more expressive.
  • NN offers full control over the architecture: number of layers, number of units in a layer, their activation functions, etc.
  • The densely connected model introduced above is only one of the many NN architectures used.
  • Deep learning, for example, uses other NN architectures: convoluted, recurrent, pooling, etc. (to be explained later in this series). Model may have a combination of several basic architectures (e.g. dense on top of a convoluted and pooling).
  • Transfer learning. A trained NN model can be transferred with all its weights, architecture, etc. and used for other than the original intended purpose of the model.

The last point of transfer learning, which I’ll detail in future articles, is one of the most exciting developments in the field of AI. It allows a model to apply previously learned knowledge and skills (a.k.a. model weights and architecture) with only minor modifications to new situations. A model trained to identify animals, slightly modified, can be used to identify flowers. 

Next Article

Controlling the Machine Learning Process

Morning Headlines 11/26/18

November 25, 2018 Headlines No Comments

Intelerad Medical Systems Acquires Clario Medical

Intelerad acquires radiologist worklist technology vendor Clario Medical.

Naval Hospital Bremerton’s new medical records system making ‘significant strides’

Fourteen months after going live on MHS Genesis, Naval Hospital Bremerton CMIO Lt. Cmdr. Bryan Wooldrige reports that pharmacy wait times are back to normal, care standards are once again being met, and initial workflow glitches have been ironed out.

Nuance Introduces New PowerScribe One Radiology Reporting Platform Powered by AI and the Cloud

Nuance launches PowerScribe One, a radiology reporting platform that includes AI-powered diagnostic and decision support tools.

Hospitals: Patient information safe in EORH, OVMC computer attack

East Ohio Regional Hospital and Ohio Valley Medical Center go on ED diversion after their systems are attacked by ransomware.

Monday Morning Update 11/26/18

November 25, 2018 News 3 Comments

Top News

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RSNA 2018 kicks off in Chicago’s McCormick Place, running through Friday.

A big focus of the conference is artificial intelligence and machine learning.

RSNA 2017 drew nearly 53,000 registrants, half of them imaging professionals.

Chicago was under a blizzard warning Sunday evening, with up to 13 inches of snow expected, driven by wind gusts of up to 45 mph. Highs Tuesday and Wednesday will be in the mid-20s.


Reader Comments

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From Participle Dangler: “Re: your mention of Papa Roach. Lead singer Jacoby Shaddix remains active in hometown causes and supports NorthBay HealthCare’s hospice program.” The Vacaville, CA-born singer – who turned his life around from substance abuse and depression – also supports causes related to hunger and homelessness, having been raised with both.


HIStalk Announcements and Requests

I tossed out last week’s poll due to obvious technological attempts to stuff the ballot box (nearly nobody believes that Allscripts legitimately earned Black Book’s “best integrated EHR/PM” survey finding). I added CAPTCHA protection this week, although I have little doubt that a script kiddie without much else going on in life can crack that as well.

New poll to your right or here: for those who attend both the HIMSS and RSNA conferences, which provides more value? Vote and click the poll’s “comments” link to explain or to suggest another conference that is better than those two.


Webinars

December 5 (Wednesday) 1 ET. “Tapping Into the Potential of Natural Language Processing in Healthcare.” Sponsor: Health Catalyst. Presenters: Wendy Chapman, PhD, chair of the department of biomedical informatics, University of Utah School of Medicine; Mike Dow, senior director of product development, Health Catalyst. This webinar will provide an NLP primer, sharing principle-driven stories so you can get going with NLP whether you are just beginning or considering processes, tools, or how to build support with key leadership. Dr. Chapman’s teams have demonstrated phenotyping for precision medicine, quality improvement, and decision support, while Mr. Dow’s group helps organizations realize statistical insight by incorporating text notes along with discrete data analysis. Join us to better understand the potential of NLP through existing applications, the challenges of making NLP a real and scalable solution, and the concrete actions you can take to use NLP for the good of your organization.

December 6 (Thursday) 11 ET. “Make the Most of Azure DevOps in Healthcare.” Sponsor: CitiusTech. Presenter: Harshal Sawant, practice lead for DevOps and mobile, CitiusTech. Enterprise IT teams are moving from large-scale, project-based system implementations to a continuously evolving and collaborative process that includes both development and business teams. This webinar will review healthcare DevOps trends and customer stories, describe key factors in implementing a DevOps practice, describe how to assess Azure DevOps, and lay out the steps needed to create an Azure DevOps execution plan.

Previous webinars are on our YouTube channel. Contact Lorre for information.


Acquisitions, Funding, Business, and Stock

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Intelerad acquires radiologist worklist technology vendor Clario Medical.


Announcements and Implementations

Nuance launch PowerScribe One, a radiology reporting platform that includes AI-powered diagnostic and decision support tools. 


Other

Two Ohio hospitals go on ED diversion after their systems are attacked by ransomware.

An Indiana doctor says his lawsuit against EHR/RCM vendor SSIMED (now Meridian Medical Management) for losing 70 percent of his practice’s claims for more than nine years triggered a 2014 DEA raid of his offices for overprescribing narcotics, as accused by former employees of his practice.

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Spectrum Health’s transplant clinic tells a patient that they won’t perform a heart transplant because she can’t afford the post-surgical immunosuppressant drugs, suggesting that she undertake “a fundraising effort of $10,000,” after which a newspaper columnist concludes that it’s not a healthcare system if “you can’t have a heart unless you do GoFundMe for $10K.”

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In Australia, a conspiracy theorist with no medical background charges $4,000 to serve as an expert witness for estranged parents who disagree on vaccinating their children. She has threatened to sue the newspaper for reporting about her services, defending her “support for the public’s right to vaccination choice.” The doctor – she earned a PhD in humanities — claims that a secret WHO committee orchestrates pandemic hysteria under the direction of the World Bank.

In England, a woman sues a hospital for not telling her about her father’s Huntington’s disease, saying she would have aborted her child (now eight years old) if she had known that the girl has a 50 percent chance of being afflicted by the neurological disease. The woman’s father – who had killed his wife – refused to give doctors permission to tell his daughter about his condition, fearing that she would abort the baby. The legal precedent could be significant – do doctors and hospitals have the legal duty to perform genetic due diligence and to override privacy requirements in telling those who may be affected by an identified genetic disorder? A genetic ethics expert observes:

How much effort should a clinician make in chasing up relatives? And those relatives might be unhappy to be tracked down and given unwelcome information – for example, that they possess a gene that predisposes them to breast cancer. You cannot take back that information once you have given it.

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ProPublica finds that CPAP machines used for sleep apnea often are programmed to report usage data back to the patient’s insurance company, the device’s manufacturer, the medical equipment distributor, and the ordering doctor. Insurers say too many patients who are prescribed the costly machines don’t use them regularly. The article notes that an industry has been created around the potentially serious but often undiagnosed condition, with sleep studies, the CPAP machine, and the required ongoing use of supplies raising the financial concerns of insurers. Medicare requires physicians to document that their patients use CPAP for at least four hours per night in at least 21 of each 30 days, a policy quickly adopted by private insurers, and the manufacturers say their surveillance meets those documentation requirements. 

I saw this commercial watching Thanksgiving parade lip-syncing – UPMC is running $3 million worth of national ads for its living-donor liver donor program as it fights with the dominant local health plan. The KHN article notes that hospitals are trying to lure well-insured patients into their hospitals – and to diminish the impact of insurers trying to control costs despite the health system’s market clout — by creating a national and international brand based on high-priced procedures that few people need. Hospital for Special Surgery and Yale New Haven Hospital are also running national TV ad campaigns that, unlike direct-to-consumer drug company ads, are not regulated by FDA for accuracy. Some Internet wags claim that UPMC’s ad is voiced over by Benedict Cumberbatch of “Sherlock” and it does indeed sound like his highly compensated voice.

Weird News Andy’s turkey day must have caused him to miss this story. A Paris hospital that is recruiting participants for a fecal implant study is overwhelmed with calls, emails, and visits after someone takes a photo of the offer and posts it to social media, claiming that anyone who shows up with a fecal sample will be given $57.


Sponsor Updates

  • Healthwise will exhibit at the NextGen Patient Experience November 27-29 in San Diego.
  • Imat Solutions will sponsor the SHIEC reception at ONC’s 2018 Annual Meeting November 29 in Washington, DC.
  • Influence Health customers UCLA Health, Advocate Health Care, Virginia Mason, and Texas Health Resources win seven EHealthcare Leadership Awards.
  • InterSystems will exhibit at RSNA November 25-30 in Chicago.

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 11/21/18

November 20, 2018 Headlines No Comments

Apple in Talks to Give Veterans Access to Electronic Medical Records

Apple and the VA discuss developing software that would enable veterans to transfer medical records to their iPhones.

Jump Technologies Receives $2M in Follow-on Series B Funding, Bringing Total Round to $5.5M

Hospital supply chain management software vendor Jump Technologies raises $2 million with help from Mount Sinai Ventures.

Office 365, Azure users are locked out after a global multi-factor authentication outage

Microsoft brings its cloud-based, multi-factor authentication services for Office 365 back online after a global outage Monday morning.

How Geisinger Health System Reduced Opioid Prescriptions

Geisinger Health (PA) attributes a 30-percent decline in opioid prescriptions to a multi-pronged approach that includes EHR-based interventions, e-prescribing, and access to the state’s PDMP.

News 11/21/18

November 20, 2018 News 2 Comments

Top News

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The VA is talking with Apple about connecting IPhone-using veterans to their EHR information, The Wall Street Journal reports.

The program was conceived by top VA officials who worked with President Trump’s so-called “Mar-a-Lago group” of campaign supporters who were later accused of meddling in VA affairs.

Android-using veterans will be out of luck, just like the 40 percent of patients who are seen by health systems that launch an IPhone-only records-sharing project.


Reader Comments

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From No Mas: “Re: University of Toledo. Any response back on the progress of their partnership with Athenahealth to develop an inpatient EHR for UTMC?” University of Toledo Medical Center CMIO Bryan Hinch, MD did not respond. It might be best if the project stumbled early since it probably won’t be a priority of Athenahealth’s new private equity owners.

From 98765: “Re: Cerner’s MIPS module. We spend a significant amount of our time assisting clients with MIPS. Every single Cerner client we’ve assisted has informed us that Cerner has no MIPS module. Cerner is apparently makes clients request custom reports if they want their MIPS information, with the ability to submit via their registry.” Unverified. I’m wary of users stating that a vendor is missing capabilities since they often just aren’t aware of it. Cerner users, feel free to weigh in.

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From NashVegas: “Re: LifePoint. Layoffs Monday, including some heavy-hitting executives.” Unverified, but that would not surprise me – LifePoint Health just completed its merger with RCCH HealthCare Partners, approved by LifePoint’s shareholders in October. Shareholders also rejected a proposed $120 million golden parachute for LifePoint’s top four executives. The company had already announced that Chairman and CEO William Carpenter would retire after the merger, replaced as CEO by COO David Dill. Most of the RCCH executives weren’t listed in the new executive org chart. The company’s performance makes it a given that well-coiffed heads will roll.

From Retired Number: “Re: CHIME Speakers Bureau. Says you have to be actively employed as a healthcare CIO. Several of those listed do not qualify.” Quite a few folks on the list don’t meet that qualification (including CHIME President and CEO Russ Branzell, who obviously doesn’t still work as a health system CIO). I count two retired CIOs, two CMIOs, three consulting firm employees, and a CISO, looking only at the job titles listed on the CHIME page.


HIStalk Announcements and Requests

I suspect that Thanksgiving-proximate readership, as well as health IT news, will be sparse, so we will take a holiday break. I’ll probably return to the nasal grindstone with the Monday Morning Update. Travel, eat, and shop safely, especially you radiology folks who have been convinced to illogically leave your families and postprandial warmth to head off for freezing Chicago and RSNA (as a health IT pundit, my crystal ball tells me you’ll hear the term “AI” a time or two).


Webinars

December 5 (Wednesday) 1 ET. “Tapping Into the Potential of Natural Language Processing in Healthcare.” Sponsor: Health Catalyst. Presenters: Wendy Chapman, PhD, chair of the department of biomedical informatics, University of Utah School of Medicine; Mike Dow, senior director of product development, Health Catalyst. This webinar will provide an NLP primer, sharing principle-driven stories so you can get going with NLP whether you are just beginning or considering processes, tools, or how to build support with key leadership. Dr. Chapman’s teams have demonstrated phenotyping for precision medicine, quality improvement, and decision support, while Mr. Dow’s group helps organizations realize statistical insight by incorporating text notes along with discrete data analysis. Join us to better understand the potential of NLP through existing applications, the challenges of making NLP a real and scalable solution, and the concrete actions you can take to use NLP for the good of your organization.

December 6 (Thursday) 11 ET. “Make the Most of Azure DevOps in Healthcare.” Sponsora few organizations across the country are demonstrating success using advanced technology tied to intuitive processes and procedures.: CitiusTech. Presenter: Harshal Sawant, practice lead for DevOps and mobile, CitiusTech. Enterprise IT teams are moving from large-scale, project-based system implementations to a continuously evolving and collaborative process that includes both development and business teams. This webinar will review healthcare DevOps trends and customer stories, describe key factors in implementing a DevOps practice, describe how to assess Azure DevOps, and lay out the steps needed to create an Azure DevOps execution plan.

Previous webinars are on our YouTube channel. Contact Lorre for information.


Acquisitions, Funding, Business, and Stock

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The still-unnamed Amazon-and-others health venture hires an analytics and quality improvement officer from BCBS Massachusetts. Dana Safran, ScD will hold the title of head of measurement.

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The Wall Street Journal says insurer Humana and Walgreens are discussing taking equity in each other’s companies.

Healthcare cloud vendor ClearData raises $26 million.


Sales

  • Curahealth Hospitals (TX) chooses Evident Thrive EHR.

Announcements and Implementations

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MModal announces a cloud-based version of its Fluency for Imaging radiology reporting solution.

The AI-powered algorithm of Cardiologs performed better than a traditional algorithm in identifying EKG abnormalities in ED patients, a study finds. 

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Nicklaus Children’s Hospital (FL) goes live on an IOS-only mobile image collaboration platform powered by Dicom Systems and WinguMD.

ECRI Institute launches ECRI Guidelines Trust, a replacement for AHRQ’s ECRI-managed National Guideline Clearinghouse website that was taken offline on July due to HHS budget cuts.


Government and Politics

A doctor is charged with prescribing medications for patients he had not examined, writing prescriptions on pre-printed pads provided by telemedicine companies that orchestrated a compounding pharmacy scheme that cost insurers $20 million. Hopefully the Nigerian-trained doctor’s “Leader in Medicine” award from a scammy awards company won’t be compromised so he can realize his goal to “improve and evolve his practice,” which sounds like a good idea.


Other

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In England, a doctor apologizes for ordering a tenfold morphine overdose for an 81-year-old woman who died afterward of pneumonia. The patient was transferred to the hospital from an infirmary without paperwork, so the doctor had to look up each of her meds on the computer to order them for her. He typed in a partial name without noticing that the intended 20 mg dose of sustained action morphine was actually being entered as 200 mg and the pharmacy dispensed the completed order without question.  The doctor has quit working for the hospital trust, saying that it doesn’t allow doctors to use the systems with which they could audit their own clinical work.

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Weird News Andy says this is a terrible way to lose a Thanksgiving dinner. A North Carolina man’s family lost their chance to gobble the holiday meal he was preparing last year when his always-draining nose contributed an unwanted ingredient. Various doctors who had diagnosed him with allergies, pneumonia, and bronchitis turned out to be wrong – he had a cerebrospinal fluid leak that was repaired via surgery. A doctor offers a smart diagnostic idea – test clear rhinorrhea with a glucose test strip since cerebrospinal fluid contains glucose but nasal discharge does not. 


Sponsor Updates

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  • Attendees at Bluetree’s fifth Annual Brinner Fundraiser donate 387 pounds of food for the Badger Prairie Needs Network.
  • Datica will sponsor AWS re:Invent 2018 November 26-30 in Las Vegas.
  • Elsevier will exhibit at RSNA November 25-30 in Chicago.
  • Cedar County Memorial Hospital (MO) completes its Meditech Expanse implementation, assisted by Engage.
  • Glytec congratulates customer Mission Health (NC) on being recognized on IBM Watson Health’s list of top 50 cardiovascular hospitals for 2019.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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Morning Headlines 11/20/18

November 19, 2018 Headlines No Comments

The health care venture from Amazon, Berkshire and JP Morgan just hired its first female exec, and she comes from a big insurance company

The ABJ health initiative hires Dana Safran (BCBS of Massachusetts) as head of measurement, leading analysts to surmise the still-unnamed joint venture will focus heavily on health data analytics.

Update on our Smart Lens program with Alcon

Citing insufficient consistency in measurements, Verily shuts down its four-year smart contact lens project with the eye-care division of Novartis, which sought to help diabetics manage their disease through tear-based glucose measurement.

Information on Medicare Telehealth

CMS reports that telemedicine utilization by Medicare beneficiaries increased 50 percent between 2014 and 2016, with members in rural areas making up the bulk of visits for mostly mental health and chronic conditions.

Readers Write: Our Experience with Epic’s App Orchard

November 19, 2018 Readers Write 2 Comments

Our Experience with Epic’s App Orchard
By Chinmay Singh

Chinmay Singh, MBA, MSE is co-founder and CEO of SimplifiMed of San Francisco, CA.

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SimplifiMed went live last month on App Orchard after several months of work. I believe other startups can benefit from our experience as they pursue integration with Epic.

We integrated with many other EHRs before Epic, including Athenahealth, Centricity, and Drchrono. As I review my experience, there may be a whiff of unavoidable comparison.

1. Epic is the most customer-focused EHR vendor

This became clear to me in my first call with Epic’s App Orchard team. I could vividly imagine a customer in the center of anything App Orchard team discussed — workflow, security, or marketing message. For this reason, I would recommend that startups first integrate with other EHRs, learn from that, and then approach Epic.

2. The App Orchard team knows the customer

Your contact at App Orchard is unlikely to be a mere project manager. He or she will be an active participant and will gently prod and challenge you on your workflows and the selection of APIs. If you don’t have an active Epic customer, this is one of the best resources you have to compensate for the lack of information. Use it.

3. Epic listens to App Orchard members

We all have heard about a certain recalcitrant Midwest company. I was surprised at how receptive the App Orchard team was to my suggestions on the program, pricing, and terms. They listened to my concerns and responded to them in a timely fashion, and I assume that the new program terms were partially influenced by the feedback I provided to them. Reach out to them with your feedback.

4. App Orchard documentation is lacking

The API documentation is very basic, and in some cases, unusable. For example, there is no explanation of the different versions of the same APIs. Or that two different APIs appear to be doing the same thing (they are not) without a good explanation. The advice in #1 and #2 above partially compensates for this. If Epic team needs some inspiration, they should look at Athenahealth’s developer suite. Not only does Athenahealth have more robust documentation, all of their APIs can be tried in the sandbox.

5. No Hyperspace

This is the biggest issue with App Orchard. Without access to Hyperspace, it is difficult to test the product. Moreover, Epic periodically resets the back end, forcing you to re-create your test cases. This is a huge time sink. As we are experiencing now, prospects want to see a demo of SimplifiMed working with Epic. But without access to an Epic instance, we are unable to do so. I would love to hear from other App Orchard partners on how they are overcoming this problem.

Curbside Consult with Dr. Jayne 11/19/18

November 19, 2018 Dr. Jayne 2 Comments

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Thanksgiving is upon us, a quintessential US holiday. A friend sent me some seasonally appropriate ICD codes, including the W61.43 category “Pecked by Turkey” and W60 “Contact with Sharp Leaves.” There’s also Z63.1 “Problems in Relationship with In-Laws” for those of you with challenging holiday kinship arrangements.

All kidding aside, in some areas, Thanksgiving marks the beginning of increased healthcare utilization, which stresses the system in a variety of ways. People who have reached their deductibles for the year may be trying to schedule elective procedures at the same time providers and staff are trying to take time off with their families. There tends to be a bit of overeating in the US, which can lead to an increase in gallbladder disease, gout attacks, and elevated blood sugars. Family and personal stress levels increase. Just when things start to settle down, influenza and other viral illnesses will begin to peak.

Just in time for the holiday magic, the United States Preventive Services Task Force released a final recommendation statement regarding screening for unhealthy alcohol use in adolescents and adults. Adults 18 and over should be screened in the primary care setting and in addition to screening and practices should also be providing brief behavioral health counseling interventions to reduce unhealthy alcohol use. However, current information is insufficient to recommend screening in adolescents aged 12 to 17. EHR vendors, get ready to update your clinical guidelines packages.

To further dampen our holiday spirits, the Department of Health and Human Services has released its new Physical Activity Guidelines for Adults that emphasize the fact that roughly 80 percent of US adults and adolescents are not sufficiently active. HHS recommends that adults complete at least 150-300 minutes of moderate intensity activity each week, or 75-150 minutes of vigorous intensity activity each week. We should also be doing muscle-strengthening activities twice weekly. There are other specific recommendations for older adults and pregnant / postpartum women. The bottom line is “sit less, move more,” and even if you’re already moving, you’re probably not moving enough.

As we move toward the end of the calendar year, the healthcare IT space is in the doldrums, with vendors marking time until HIMSS, when they’ll try to make a big splash (among the dozens of other vendors trying to do the same thing) with various product releases and enhancements. The user group season is winding down with hospitals and health systems having exhausted their travel budgets for the year. Even those facilities that have cash to spend might be waiting until the beginning of the calendar year to start dispersing it unless they’ve aligned their fiscal years to the federal calendar and their year started in October. Nothing big usually happens between now and HIMSS unless it’s scandalous or completely revolutionary and unexpected.

It’s a good time to reflect on the year that has been and to think about what we might like to accomplish in the year ahead. I’m encouraging my team to think about their priorities, both professional and personal. Are there new skills that they’d like to learn, or a different area of the healthcare IT world in which they’d like to be more knowledgeable? Are they satisfied with their work-life balance and travel schedule, or do they want opportunities to slow down (or speed up?)

I work with several people who have recently become relatively empty nesters and they’re interested in potentially picking up extra work opportunities to fund things like retirement catch-up savings or creating college savings accounts for grandchildren. I had incorrectly assumed they were interested in slowing down, and without a structured conversation about priorities, I might have missed out on extra capacity with some outstanding resources. Another member of my team will be leaving at the beginning of summer, having decided to purse a public health masters’ program. Sometimes these goals align across personal and professional domains and sometimes they’re at cross purposes, but I appreciate the opportunity to try to help people meet their goals.

I have several good friends who have had it pretty rough this year with layoffs, family illness, natural disasters, and other unexpected surprises. I’m continually impressed by their resilience and their ability to look at the world through a glass-half-full lens (even if it is occasionally tinted with a hint of desperation). It helps put things in perspective and reminds me of how important it is to support the people around you from an emotional standpoint. It has taught me that time is short and success can be fleeting. I’ve made it a point to schedule quarterly meetings with friends and colleagues I had previously lost touch with, even if it’s to meet to walk a couple of miles at the park during a child’s soccer practice rather than sip wine as we might have liked to do in the past. If we don’t make those relationships a priority, it’s too easy to lose touch.

I’d like to challenge our readers to make a list of things they’d like to do in the coming year that will bring them either closer to friends and family or to help them explore a part of themselves that they’ve allowed to be put by the wayside. Maybe it’s a larger commitment such as a new hobby, or maybe it’s something as small as taking yourself to a local museum. I’d love to hear from readers about what they find satisfying and what they’d like to accomplish in the coming year. In the meantime, I’m going to try to find my pre-Thanksgiving bliss with some pastry therapy. Caramel apple pecan pie, in case you’re curious.

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Morning Headlines 11/19/18

November 18, 2018 Headlines 2 Comments

The 25 most valuable US startups that failed this year

Business Insider lists “The 25 Most Valuable US Startups that Failed This Year,” including four health technology companies that raised a combined $1.1 billion.

The Chopraj Group Launches Imperativ, Inc., Delivering Unique Artificial Intelligence For Healthcare

Industry long-timer and neurosurgeon Gopal Chopra, MBBS, MBA launches healthcare AI company Imperativ.

CommonWell Health Alliance Announces General Availability of Carequality Connection

CommonWell announces GA of its connection to Carequality two years after the organizations announced a connectivity agreement.

Monday Morning Update 11/19/18

November 18, 2018 News 4 Comments

Top News

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Business Insider lists “The 25 Most Valuable US Startups that Failed This Year,” including these health technology companies and the amounts they raised:

  • Paieon (medical imaging, $34 million)
  • Candescent Health (radiology software, $94 million)
  • Medical Simulation (training, $55 million)
  • Theranos (lab testing, $910 million)

Reader Comments

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From HCInvestor: “Re: Seeking Alpha article on Cerner. Quality of reporting to guide investors is very poor outside of the industry. It’s as if the author hasn’t looked at Cerner’s financial statements or leadership challenges.” I would question quite a few of the statements by the UAE-based research analyst, some of which are so wooden and uninformed that it’s like a computer generated them from financial reports or web pages:

  • I’m not so sure that healthcare IT has “a massive potential to grow,” at least as compared to the boom years of Meaningful Use. CERN shares have been stuck in an up-and-down trading range since early 2015 after years of nearly straight-line growth, and over the past five years, CERN shares are unchanged vs. the Nasdaq’s 82 percent rise. 
  • I don’t understand why Medicare Advantage gives Cerner a competitive edge.
  • The comparison to McKesson makes no sense since the company is mostly out of health IT other than its stake in Change Healthcare
  • The author mentions the DoD contract (in which Cerner is a subcontractor) but fails to mention the larger VA contract (in which Cerner is the prime contractor and thus will pocket a ton more taxpayer cash). The conclusion is cartoonishly oversimplified: “This contract will help build the company’s credibility further, which would pave the way for Cerner to acquire new business.”
  • Cerner, he says, has a “management with a proven track record of delivering growth” even though Chairman and CEO Brent Shafer has been on the job less than a year (and in his first CEO job) and President Zane Burke resigned earlier this month and his position was eliminated.
  • Here’s a bizarre statement: “A single malfunction of their systems would be enough to wipe Cerner off the healthcare IT industry forever,” with the author apparently unaware that such malfunctions happen with every vendor and Cerner in particular was associated (albeit in a poorly researched study) with increased patient mortality at a children’s hospital, which despite headlines had no discernible impact on the company’s growth.
  • The author claims that despite his proclaimed Cerner “moat” and barrier to entry due to long development cycles, the entry of large-scale competitors could drive down profit margins. Which is it?

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From Bam Margarita: “Re: innovator awards. Pay for play?” Healthcare Informatics flags as breaking news its invitation to vendors to apply for its Innovator Awards winner for a $1,999 submission fee, after which I assume advertising persuasion is then exerted to the “winners” to publicize their “accomplishment.” The magazine’s pitch page humbly accepts its own nomination to facilitate “meaningful conversations” between providers and vendors (in other words, sell ads). I don’t fault anything they do – it seems like quite a few health IT publications and websites have hit hard times and are scrambling to pivot into conferences or running sponsored “news,” which I suspect has created the now-common journalism death spiral as readers find even less motivation to return. Healthcare Informatics was just sold, with the new owner seeming to be most interest in its conferences.

From Cold Gin: “Re: updates. I would like to see you tweet out more frequent HIStalk updates as news develops.” People get crazy stressed out from constantly staring at their glowing screens for political, stock market, and sports updates even as they become oblivious to the real life that is unfolding around them. Sites that provide that information are thrilled that users think such manic behavior is not only normal, but necessary, because the frantic eyeballs earn them advertising dollars even though the nail-biting vigil has zero impact on the outcome. Bottom line: only rarely are health IT events so newsworthy that I would break into your day to relay them. Meanwhile, my thrice-weekly news schedule is nearly perfect for getting the signal without much of the noise.

From Kenyan Jambo: “Re: Allscripts Avenel EHR. What happens at HIMSS19 when a product launched with great fanfare at HIMSS18 hasn’t been heard of since?” In a perfect world, the hope for short memories will be dashed, after which embarrassment ensues. Developing a new product and giving it a high-profile launch is perfectly fine, but the months of radio silence that followed suggests that the public celebration and vendor executive high-fiving was premature.

From Agent Orange: “Re: speech recognition. What’s an easy way to dictate documents without cost or system overhead?” Open a Google Docs document, click Tools / Voice Typing (or Ctrl-Shift-S), click the microphone icon and answer any microphone permission messages, and then simply speak away. Accuracy is good even with only a webcam microphone, system impact is minimal, and cost is zero. Just copy and paste your completed text into whatever app you want. You can also dictate directly into Word, which I often forget about since I basically never use Word.


HIStalk Announcements and Requests

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Poll respondents say EHR vendors and the government are the dirty old dastards who made EHRs unfriendly.

  • Dean Sittig thinks that while everyone is complicit, EHR vendors didn’t do a great job of operationalizing requirements or constraints.
  • Evan Steele says vendors are forced to make guns-or-butter decisions in either cramming in RFP-sweetening functionality (some of it via the government’s prescriptive requirements) vs. addressing usability.
  • EHR Girl wishes physicians had not taken a hands-off approach when vendors were trying to computerize the medical record in the early 2000s and that the federal government hadn’t trotted out the HITECH carrot without first assessing the state of the EHR market that stood to benefit hugely.
  • Frank Poggio says clinicians are most responsible because all of the vendors have them on staff, also adding that the chestnut that EHRs were built as a by-product of billing isn’t true since Cerner and Epic didn’t even have billing systems until long after they had rolled out clinical systems.
  • Ross Martin takes the long view in blaming World War II, after which the US ended up with employer-based health insurance that begat third-party payers, then Meaningful Use which increased adoption of systems that weren’t focused on patients and users.
  • Industry Stalwart blames insurance companies (of which he or she includes CMS), but also notes that doctors could have opted out of HITECH and accepting insurance, but otherwise have to obey the wishes of outsiders who send them checks.
  • Cosmos works for a vendor that spends half its nursing development team’s time addressing regulatory requirements and the other half dealing with patient safety events and customer escalations, with usability always taking the back seat. He or she also ponders whether the government’s regulation of healthcare threatens competition in favor of what they see as patient safety benefits.

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New poll to your right or here, as requested by a reader but modified a bit by me: What was your reaction to Black Book’s survey naming Allscripts the #1 integrated EHR/PM? (my post on Black Book’s methodology provides more information). I’m sure the reader who asked for this poll would also like to hear your thoughts, which you can provide after voting by clicking the poll’s “comments” link.

UPDATE: poll cheating has the #1 option (Allscripts as the best EHR/PM makes sense) as the biggest vote-getter. This is pretty obvious:

  • Voting was far heavier than normal, with several votes per minute making it clear that scripting was being used to stuff the ballot box.
  • 170 of the 274 votes that were cast shortly after I wrote this post (more than 60 percent of the total) came from someone hiding their identity and location via the Tor browser. Every one of those votes chose the #1 option.
  • A bunch of votes came from foreign IP addresses, and every single one of those also chose the #1 option.
  • Just about all of the legitimate-looking votes said it’s fishy that Allscripts did so well in the Black Book survey, while none of the suspicious ones did so.

It’s fun and ironic than most of the genuine respondents are skeptical of Black Book’s poll results (most of them wondering whether Allscripts influenced the outcome), and now someone is trying to support that Black Book poll result by cheating on my poll. I think we can assume that all online polls or surveys that aren’t locked down to a validated identity are likely to be gamed by someone who benefits from a particular result.

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UPDATE 2: I turned off poll voting since the bot-driven cheating is continuing. The results excluding those votes are above. Infer what you will that the “Allscripts being ranked #1 makes sense” option gets 67 percent of the vote when you include the obviously fake voters, but just 9 percent with those omitted. Your “false flag” conspiracy theories are welcome.

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LinkedIn profile padders and social media aficionados beware: a lot of people roll their eyes when you anoint yourself with non-quantifiable honorifics whose purpose seems to be to deflect from a lack of accomplishment. Poll respondents are OK with innovator, keynote speaker, and entrepreneur since they are can at least be reviewed against career accomplishments. Demo Chic says she’s tired of social media influencers and ambassadors who have nothing better to do while the rest of us are trying to get work done. Being Real says if you really are an influencer or thought leader, you wouldn’t need to broadcast it. Title Smitle believes that the idea of social media ambassadors is a “load of BS” consisting of un-unsightful tweets and “a preponderance of selfies.”

Listening: the new EP from the upcoming 10th album of Papa Roach, which reminds me only slightly of their angrier, earlier nu metal with more of a 21 Pilots sort of intimate, melodic rhyming. I like it. I’m also marveling at live Skillet, drawn in fascination to one of rock’s best and most joyously dynamic drummers in Jen Ledger.  And while I loathe holiday-themed albums (I always picture uninspired, drugged-out rockers who are bound by record company contracts to stumble unconvincingly through ancient, lame Christmas songs in a June LA recording session) Sia’s “Everday [sic] is Christmas” is stellar, barely recognizable as Christmas music because it’s all new songs that you could play year around. She is brilliant.

Jenn has to miss HIMSS19 due to fun family events, so that leaves Lorre to cover our booth solo for three long days with no chance to scurry quickly away for intake and output. Let her know if you would like to stand in for a few minutes or an hour, posing with visitors anxious to take a picture with The Smokin’ Doc or representing me without doing something scandalous (or if it is scandalous, at least making sure it’s fun, yet not legally actionable). I’m also up for hearing about things we might do in our tiny booth that would be fun since we don’t have anything to sell or do except say hello to puzzled passersby.


Webinars

December 6 (Thursday) 11 ET. “Make the Most of Azure DevOps in Healthcare.” Sponsor: CitiusTech. Presenter: Harshal Sawant, practice lead for DevOps and mobile, CitiusTech. Enterprise IT teams are moving from large-scale, project-based system implementations to a continuously evolving and collaborative process that includes both development and business teams. This webinar will review healthcare DevOps trends and customer stories, describe key factors in implementing a DevOps practice, describe how to assess Azure DevOps, and lay out the steps needed to create an Azure DevOps execution plan.

Previous webinars are on our YouTube channel. Contact Lorre for information.


Acquisitions, Funding, Business, and Stock

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I missed this item previously. VC-backed, Philadelphia-based health cloud vendor CloudMine files for Chapter 7 bankruptcy after defaulting on a $1.8 million bank loan and laying off its 11 remaining employees. The company had raised $16.5 million, most recently in an undersubscribed Series A round in early 2017.  Companies that built applications using CloudMine’s platform were warned that it would be shut down with data deleted per HIPAA requirements.

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Industry long-timer and neurosurgeon Gopal Chopra, MBBS, MBA launches healthcare AI company Imperativ.


Sales

  • Australia’s Perth Children’s Hospital selects Vocera Collaboration Suite.
  • Signature Healthcare (MA) chooses Santa Rosa Consulting to lead its upgrade to Meditech Expanse and implementation at its multi-specialty physician group.

Decisions

  • Franklin County Medical Center (ID) replaced Evident with Athenahealth in October 2018.
  • Pana Community Hospital (IL) will switch from Allscripts to Cerner in 2019.
  • San Juan Regional Medical Center (NM) will implement Workday for financial management software in July 2019, replacing Meditech.

These provider-reported updates are supplied by Definitive Healthcare, which offers a free trial of its powerful intelligence on hospitals, physicians, and healthcare providers.


People

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DocuTAP hires Ron Curtis (Cardlytics) as SVP of product and Kerri Tietgen (KT Consulting) as EVP of people and culture.


Announcements and Implementations

Research network provider TriNetX adds ambulatory care, medical claims, and pharmacy claims from 190 million patients to its network. It also adds propensity score matching to address potential cohort bias.

Catholic Health Initiatives and Dignity Health name their merger-created organization CommonSpirit Health, with the press release brimming with the usual marketing mumbo-jumbo explaining the “positive resonance” that the made-up word (called “one powerful word” despite the fact it’s two words with a trendily omitted space) will create in unifying every single person who is involved in the sprawling endeavor. There’s something unsettling about a ministry preaching the prosperity gospel in “serving the common good” while simultaneously bragging about annual revenue of $28 billion.

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Ciox Health announces HealthSource Vault, a member-centric data repository that creates a longitudinal patient record from medical records, health assessments, clinical data feeds, and other information sources using OCR and NLP extraction.

CommonWell announces GA of its connection to Carequality two years after the organizations announced a connectivity agreement in December 2016.


Privacy and Security

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Japan’s newly appointed minister of cybersecurity admits to Parliament that he has never actually used a computer because “I order my employees or secretaries to do it.” He’s also in charge of the 2020 Tokyo Olympics.


Other

The former CTO of Cleveland Clinic spinoff Interactive Visual Health Records, which offered a system that presented a physician-friendly view of Epic data (the company appears to be defunct), pleads guilty to defrauding the Clinic of $2.7 million by skimming payments made to a foreign company. He agreed to being deported following sentencing. The former CEO of Cleveland Clinic Innovations, who prosecutors said was involved in the scheme, was sentenced to federal prison for fraud last year.

Two China-based Google AI researchers return to Stanford University’s medical school to work on healthcare projects.

HIMSS Media says that providing expert news and analysis isn’t really important since “decision-based content” is what drives vendor sales leads and thus pays the bills. The guy who runs the HIMSS media lab explains that “we provide deeper insight for HIT vendors seeking sales prospects” and that he “specializes in the neuroscience of HIT buyers.” In other words, it’s all about ads posing as news and collecting reader information for advertisers, which is in itself hardly news to anyone. Healthcare really pushes the boundaries of “non-profit.”

Daily Mail provides some gruesome photos and videos to show the sad results of fame-hungry teens taking the “Fire Challenge” that involves pouring flammable liquid on themselves and then igniting it while recording on video. It’s not technology’s crowning achievement that kids who are the age of those who died on Normandy’s beaches are now seeking their place in history by eating Tide Pods.

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Local TV covers how AnMed Health Medical Center (SC) honors veterans who die in the hospital. The hospital announces their passing (with the family’s permission) along with their name and rank, their body is covered with the American flag and escorted to a hearse by available doctors and nurses, and employees line up with hands over hearts to honor the deceased.


Sponsor Updates

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  • PatientSafe Solutions employees in San Diego relocate to larger office space.
  • Meditech releases a new video, “How the Meditech mobile app transformed home care for Kalispell Regional.”
  • PatientPing moves to expanded office space in Boston.
  • PreparedHealth wins several awards at the inaugural Matter Accenture Digital Health & Life Sciences Pitch Competition.
  • Philips Wellcentive publishes a new white paper, “Embracing Disruption.”
  • Access releases version 8.17 of its Passport web-based electronic forms hospital solution.
  • ZappRx founder and CEO Zoe Barry joins the Life Sciences Cares Board of Advisors.

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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Weekender 11/16/18

November 16, 2018 Weekender 1 Comment

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Weekly News Recap

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

Best Reader Comments

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

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

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

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

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


Watercooler Talk Tidbits

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

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

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

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

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

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


In Case You Missed It


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Morning Headlines 11/16/18

November 15, 2018 Headlines No Comments

Lawmakers balk at $350M addition to VA’s health record deal

John Windom, director of the VA’s EHR modernization efforts, says during a congressional hearing that an additional $350 million in personnel costs will be part of the Cerner project’s already $16 billion budget.

Surescripts Prescription Price Transparency Tool Realizes Massive Provider Adoption, Achieves Breakthrough In Healthcare Market

Surescripts announces that its Real-Time Prescription Benefit tool has increased prescriber count 40-fold, and has been used 30 million times within EHRs to look up patient-specific drug price and alternative information.

HIPAA Privacy: Request for Information on Changes to Support, and Remove Barriers to, Coordinated Care

HHS OCR issues an RFI to solicit the public’s views on whether HIPAA rules prevent or discourage providers, payers, and patients from sharing information for care coordination and case management.

News 11/16/18

November 15, 2018 News 2 Comments

Top News

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Pointed fingers fly at a House Veterans’ Affairs EHR subcommittee meeting, with most aiming towards VA program director John Windom once he let it be known an additional $350 million in personnel costs would be part of the Cerner project’s already $16 billion budget.

Windom attributed the hiring costs (part of the “fuzzy math” some committee members have complained about) to EHRM office downsizing and the need to have “highly qualified subject matter experts to grade the implementation efforts of Cerner. Those people cost money.”

Other items of interest from the oversight meeting:

  • Computers – most of them at least five years old – will be replaced six months ahead of the Cerner implementation at most VA facilities.
  • The DoD and VA will use the same web address to access the online system.
  • The agencies will share a patient identity management system.
  • Progress checks should be made every 90 days over the life of the 10-year project, a recommendation in line with Cerner President of Government Services Travis Dalton’s promise that the VA project won’t suffer from a lack of frequent engagement with implementation sites – a problem that has plagued initial DoD sites in the Pacific Northwest.
  • Leadership over the joint DoD-VA project is still in doubt. VA Secretary Robert Wilkie has said he will take the lead, while Windom told the committee that acting Deputy VA Secretary Jim Byrne is in charge.

Reader Comments

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From Ginsu Sharpener: “Re: CommonWell. Launching a search for a technology vendor.” The company will issue an RFP in December 2018 for “interoperability infrastructure and services.” I assume these are the services that RelayHealth has provided since CommonWell’s founding in 2013. They’ will explain more in the RFP Bidder Call on Friday, November 16 at 4:00 p.m ET.

From Watcher: “Re: ONC proposed rule from Tuesday. #3 supports a safe harbor for care coordination, which would significantly benefit social determinant and social care workflows.” HHS OCR issues an RFI to solicit the public’s views on whether HIPAA rules prevent or discourage providers, payors, and patients from sharing information for care coordination and case management. One item specifically addresses creating a safe harbor for good-faith PHI disclosure for coordinating or managing care. The change is being considered under HHS’s “Regulatory Sprint to Coordinated Care,” which hopes to remove regulatory barriers that impede coordinated, value-based care. 

From Hanzi: “Re: Centra Health. Blames its Cerner implementation for its loss.” The health systems nine-month report says Cerner went live on September 1, increasing staffing costs while reducing clinic volumes. It spent $65 million on Phase I. Year-over-year operating income dropped from a $18.8 million to –$2.7 million.

From Curved Air: “Re: 3M. We were notified that one of their administrator accounts was compromised. We’re in the midst of our investigation. I figured it’s the same issue as the anonymous report you posted early.” That is correct. Two C-level readers say they received a communication from the company, but haven’t seen public reports otherwise.


HIStalk Announcements and Requests

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I’ll report the results of this poll over the weekend, so it’s last call to vote (exit polls suggest a possible upset in that “disruptor” is even more loathed as a self-assigned adjective than “thought leader.”)


Webinars

December 6 (Thursday) 11 ET. “Make the Most of Azure DevOps in Healthcare.” Sponsor: CitiusTech. Presenter: Harshal Sawant, practice lead for DevOps and mobile, CitiusTech. Enterprise IT teams are moving from large-scale, project-based system implementations to a continuously evolving and collaborative process that includes both development and business teams. This webinar will review healthcare DevOps trends and customer stories, describe key factors in implementing a DevOps practice, describe how to assess Azure DevOps, and lay out the steps needed to create an Azure DevOps execution plan.

Previous webinars are on our YouTube channel. Contact Lorre for information.


Acquisitions, Funding, Business, and Stock

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In the UK, RenalytixAI raises $29 million in an IPO that will be used to fund the launch of AI-enabled applications for the early detection of kidney disease and transplant management. The company was spun out of Mount Sinai Health System’s New York-based commercialization arm, and will use de-identified data from the health system’s Epic EHR in its product development.

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Allscripts rebrands its Payer & Life Sciences Division to the far more confusing moniker of Veradigm, offering clinical workflow, research, and analytics software and services to providers, payers, and health IT and life sciences companies.


People

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Loyale Healthcare names Timothy Sykes (Regroup) as VP of sales.

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Health Catalyst appoints Jason Jones (Kaiser Permanente) chief data scientist and Elia Stupka (Dana-Farber Cancer Institute) chief analytics officer / SVP of life science.


Sales

  • Dartmouth-Hitchcock Health (NH) will use technology from Philips to develop a tele-ICU program at Dartmouth-Hitchcock Medical Center and Cheshire Medical Center.

Announcements and Implementations

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Casenet announces GA of its TruCare 7.0 population health management software, including chronic care guidelines from MCG Health.

Wake Forest Baptist Health (NC) implements tele-ICU services from Advanced ICU Care at three hospitals.

LogicStream Health releases a drug shortage app to help hospital pharmacies identify and manage drug shortages, noting that manual process require up to 10 hours to evaluate each shortage as organizations experience 3-4 per week, basically a full-time pharmacy department position. 

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A new KLAS report on healthcare management consulting finds that health systems are seeking help with value-based care transformation (top choices: Premier, Optum / Advisory Board, McKinsey); financial improvement (Huron, Deloitte, Navigant); strategy (McKinsey, The Chartis Group, Deloitte); and consumer experience (Press Ganey, Huron, Optum / Advisory Board). The high-mindshare, cross-industry firms are Deloitte, McKinsey, and Huron, although KLAS notes that McKinsey and Huron are also the two lowest-performing firms.  

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Surescripts announces that its Real-Time Prescription Benefit tool, launched last year, has increased prescriber count 40-fold and has been used 30 million times within EHRs to look up patient-specific drug price and alternative information. CVS Health says prescribers switch non-formulary prescriptions 75 percent of the time and higher-cost meds 40 percent of the time, saving patients an average of $130 per prescription.


Other

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A New York Times analysis of hospital mergers in 25 markets reveals what most of us already know from Econ 101 – less competition has resulted in higher prices, despite hospital PR efforts touting the contrary. Admission prices have gone up between 11 and 54 percent in the years following mergers in the analyzed areas; they tick up even further once acquired physician groups are taken into account. The cost of replacing or integrating the health IT systems of acquired organizations isn’t mentioned as part of the price increases, but I’m willing to bet it has a strong downstream effect on patient pocketbooks.

The New York Times also looks at the incredible wealth made by the family-related owners of Wall Street-backed private hospital chains in China that control 8,000 facilities, 80 percent of the private hospital total. The hospitals, overseen mostly by overwhelmed local governments, have been caught fabricating patient testimonials, claiming 100 percent cure rates, falsifying doctor credentials, and using outdated or dangerous treatment protocols. The original founder made his money selling a homemade remedy for scabies door to door, overcoming his lack of medical background in recognizing that the country’s medical system was a mess. His company grew quickly as the government realized public hospitals could not handle a rapidly growing population.

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AI celebrity Andrew Ng launches a Coursera program aimed at non-technical business leaders called “AI For Everyone.” The three-week course requires 2-3 hours of work per week and opens in early 2019. 


Sponsor Updates

  • EClinicalWorks will exhibit at the Annual Pain Care for Primary Care event November 16-17 in Bayside, San Diego.
  • Healthfinch launches the first of a four-part e-book series, “Introduction to Prescription Refills Requests.”
  • IDC MarketScape names Lightbeam Health Solutions a leader in its US Population Health 2018 Vendor Assessment.
  • Visage Imaging will preview its new Visage 7 technology with AI capabilities at RSNA November 25-29 in Chicago.
  • Surescripts reports a fortyfold increase in adoption of its Real-Time Prescription Benefit tool since it launched last year.
  • Meditech publishes a new case study, “Union Hospital’s Journey To Stage 7.”
  • Nordic releases a new podcast, “Expert advice on preparing your MSSP submission.”

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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Black Book’s Vendor Report Methodology

November 15, 2018 News 7 Comments

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Readers asked how Black Book performs its survey-driven health IT vendor reports, apparently surprised that Allscripts finished in the #1 spot for integrated EHR/PM/RCM vendors.

Doug Brown is president and CEO of Black Book Market Research, LLC. He has a long background in hospital administration and a master’s degree in hospital and healthcare administration. He provided quite a bit of information and the full detail behind this particular report, responding nearly instantly to my email. He says the company received a dozen calls in one day about this report, which is just one of 140 it publishes each year.

My questions and Doug’s answers (paraphrased for conciseness by me except when in quotes) are below.

How do you choose the people you survey?

The company sends survey invitations – usually during the big conference season – to those who have volunteered. That includes 90,000 past participants; 330,000 website signups; contact lists obtained from membership groups, journal subscribers, conference attendees; and for private physician practices, contact information from third-party lists. Participants are required to provide a verified company email address for validation.

Are vendors involved, either in providing a client list or publicizing the survey?

Never, Doug says, and he invites anyone to ask any highly-ranked vendors if they’ve ever been in contact with Black Book. Black Book discourages vendor and public relations company involvement and doesn’t communicate with them as surveys are underway (and doesn’t ask them for client lists). He also adds that plenty of vendors publicize their #1 rankings without even buying the detailed report, which he says is just fine.

Black Book can’t restrict vendors from suggesting that their clients complete surveys, but it discourages the practice.

Do you have a sample questionnaire?

The company provided its standard list of 18 KPIs for software or services, which have remain unchanged since they were developed in 2010 with help from academics with relevant software and services experience. It may explain a given item differently based on the audience, such as an infection control nurse vs. a business office manager.

In the 18 principles under “support and customer care,” it is stated that “External analysts, press/media and other clients reference this vendor as a services leader and top vendor correctly.” Does that mean customers provide a response, or that this element isn’t provided by customers?

“The content under the 18 key performance indicators is meant to only be a guide and are modified occasionally to suggest ways that that KPI can be interpreted. For instance, if the analysts or other clients are highly satisfied in terms of support and customer care, so may you. They are suggestive ways to consider the KPI theme – such as reliability or trust. Our goal was to find aspects of the client experience that a prospective buyer could not find in vendor RFP responses or get from tainted vendor-provided client reference calls. We aim to find the user level experience from a wide response pool perceptions, -not the input of a couple dozen financial decision makers or CIOs on advisory boards.”

Was additional information used for the report on integrated ambulatory systems?

“After we are in the audit stages, we often go back to the survey respondents with some additional questions on trends and strategies to give the vendor results some additional color. You will find that in the report before the vendor rankings (much is in the press release) and feel free to share that info.”


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The survey responses are reviewed immediately by both internal and external auditors for completeness, accuracy, and respondent validity. Responses from at least 10 unique clients are required to be named in the top 10. Sample sizes that fall below required limits are asterisked.

Overall vendor rank is based on the mean score of the 18 criteria. Each company’s rank in each of the 18 criteria is provided as well.

Some categories had interesting responses of the “wonder what they were thinking here?” types. You’ll have to obtain the full report for details, but I’m flabbergasted that four companies that finished well in the “viability and competent financial management and leadership” category either replaced top executives or sold themselves recently; the top finisher in data security was the only company to have gone offline due to a ransomware attack; and Epic failed to crack the top 10 in surprising categories, finishing behind some questionable players.

However, these are the responses of customers, so their impressions and willingness to remain customers is what counts most.

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Here’s a sample category result. I removed the vendor information since that’s in the report that Black Book sells (and that they sent me).

Note that this particular survey really didn’t address EHR functionality, just the practice management capability of EHR-integrated systems. Also, it does not appear that vendors selling multiple product lines (Allscripts would top this category, as well) have their individual products broken out, so mixing Practice Fusion with TouchWorks may not yield a sound product-specific result.

Another potentially weak point is one that KLAS struggles with – can a given respondent answer all the questions accurately, such as IT people scoring training or a nurse opining on security?

I’m interested in your opinions.


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EPtalk by Dr. Jayne 11/15/18

November 15, 2018 Dr. Jayne No Comments

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I’m always on the lookout for interesting startups and young vendors and have been following Diasyst for a while. Looks like they’re hitting their stride as Piedmont Healthcare plans to implement their solution in both diabetes specialty and primary care clinics along with independent Piedmont-affiliated practices and the residency programs at Piedmont Columbus Regional.

Diasyst uses a patient-facing app to gather blood glucose readings and other information, then analyzes the data against best practices and current clinical guidelines. Clinicians can use an intuitive dashboard to make adjustments to patient treatment regimens and communicate those treatment plans directly to the patients, who can review them and indicate acceptance.

I had a chance to see a demo a while ago. The screens are intuitive and the data is backed by research collaboration with institutions like Emory University, Georgia Tech, Grady Memorial Hospital, and the Atlanta VA Medical Center. It’s a great way for physicians to leverage other members of the care team in managing diabetes. I also like that they’re not just engaging with physicians – they’re looking to work with employer-based clinics and payers as well.

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Although Mr. H and Jenn have weighed in on the Athenahealth acquisition, I haven’t had a chance to put in my two cents. I agree with the sentiment that it seems like the end of an era, especially since the company has been highly visible in its campaigns for disruption, although at times it feels like they were leading what surely had to be a bubble.

It’s definitely causing some anxiety for clients. I had drinks with my favorite OB this week and they just switched to Athenahealth after some disastrous interactions with a previous vendor. They were hoping for stability, but now feel uncertain about what the changes might mean. Athenahealth has been doing a nice job transitioning from the “more disruption please” era to continue looking at important factors, such as physician burnout.

They just released some new data from their research that showed that physicians feel well supported when they have effective communication and strong communication. Isolation is a predictor of burnout and is exacerbated by administrative burdens, time pressure, and limited referral options.

As industry watchers, we miss Jonathan Bush and his antics (wrestling at MGMA and HIStalkapalooza at the New Orleans Rock’n’Bowl are two of my favorite memories), but seeing what happens next will surely hold our interest.

Back to the story of the demise of my OB colleague’s relationship with her EHR vendor. They had been in negotiations for some time around some serious customer service and financial issues. The discussions stalled and the vendor issued an ultimatum that sounded like it was going to block access to their charts, leading to the decision to make a hasty switch. They’re still sorting through some data migration issues, but are at least up and running.

I’ve seen the emails and notices from the vendor and the best way I can describe them is a cross between a high-pressure timeshare pitch and a blackmail letter, with a side note of pleading. Several emails conflicted each other and different company reps threatened different termination dates and processes while begging them to stay. I was embarrassed for our industry as I read them. We can do better, folks.

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Speaking of doing better, NextGen Healthcare hosted its annual User Group Meeting in Nashville this week with the theme “Better Never Stops.” A reader shared this photo of CEO Rusty Frantz on the dance floor.

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I always joke that some year I’d like to hit the EHR vendor user group circuit, attending all the major get-togethers as part of a road trip to end all road trips. The budget for that adventure is beyond my reach, but I was more than happy to attend a regional summit hosted by Slalom in St. Louis along with partners AWS, Salesforce, and Tableau. For those of you who haven’t had the pleasure of visiting that Midwest city, you’re missing out on a delightful intersection of barbecue, hot chicken, and Italian food (including something called a toasted ravioli, which is a wonder by itself). Crashing with a med school colleague definitely left more room in the budget for culinary delights, along with the fact that the registration fee for the meeting was a requested donation to the United Way.

It was a different kind of conference, focused on the goal of “reimagining healthcare for the local community” with afternoon breakout sessions where participants worked together to design solutions to problems like price transparency, managing complex care, and battling healthcare inequality. I enjoyed the hands-on approach and hearing directly from people in the trenches rather than being a passive listener. A white-board artist captured comments from a panel discussion as well as from keynote speaker Allison Massari, who spoke about an intense personal trauma and the value of compassion and connection as part of healthcare. My favorite quote was from a speaker who asked, “Is there a way to not essentially make the patient a victim in their own care?” Those are powerful words.

The Slalom team did an excellent job pulling everything together and facilitating the breakouts. I may have to start checking out more regional conferences, especially those in cities where I can find a sofa to sleep on.

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At the conference, I also got to prep for HIMSS with some shoe watching. The AWS rep had snazzy trainers and company socks. One of the panelists had some seriously kicky boots, but I couldn’t figure out how to get a picture of them without being too obvious. I’ll have to practice my covert shoe capture skills before February rolls around.

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One of my intrepid readers noticed that I didn’t make my usual mention of Veterans Day in Monday’s Curbside Consult. It wasn’t an intentional slight, but rather an issue with my writing timeline ahead of some other commitments, including celebrating a family milestone with my favorite veterans. Many of my physician co-workers trained in the military and their wealth of experience is an ongoing reflection of the years they dedicated to protecting our nation.

The one hundredth anniversary of the armistice ending WWI was an historic event, but also shows that history continues to repeat itself because the “war to end all wars” has been followed by conflict after conflict. I’m angry when I see people lacking respect for our veterans, but I am heartened by images such as this one of Cub Scouts presenting a wreath at the Tomb of the Unknowns in Arlington National Cemetery. For those who don’t recognize the yellow neckerchief, it means these girls are second graders. Thank you to our youngest generation and let’s hope they Never Forget. (Photo credit: National Capital Area Council, BSA)

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