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Readers Write: ASCs Have a Chance to Get Ahead of Physician Burnout

July 22, 2019 Readers Write No Comments

ASCs Have a Chance to Get Ahead of Physician Burnout
By David Howerton

David Howerton is CEO of Simplify ASC of Brentwood, TN.

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Not long ago, two retired physicians gathered to reflect on their careers (an OB/GYN and an internist) from roughly 1965 to 2010. Both were in private practices they owned and later sold for a healthy profit. Their careers saw all the benefits of new, lifesaving drugs and medical procedures. The largely hierarchical workplaces they inhabited supported the “buck stops here” identity of the physician as having the final say in patient care. Paperwork was practically nonexistent. A prescription pad, a few notes in a patient’s file, and they were on their way to the next patient.

Both doctors agreed their retirement came at just the right time. While this golden era had its flaws — most notably high rates of medical error and social and racial disparities — the physician felt valued and supported. Today, the healthcare landscape is dramatically different. The headlines proclaim it, from trade media to news magazines, and from research university to family medical clinic: physician burnout is a thing. Harvard’s School of Public Health calls it a public health crisis.

According to Medscape’s 2018 report on “Physician Burnout and Depression,” more than half of the report’s 15,543 respondents, or 56%, cited “too many bureaucratic tasks (e.g. charting, paperwork)” as contributing to physician burnout.

The Annals of Family Medicine found that physicians spent more time working in the EMR than they did spending face-to-face time with patients. An emergency room doctor notes the average ER physician will make 4,000 mouse clicks in the course of a single shift.

To cope with all these stresses, half will exercise, 46% will talk with family members or close friends, and 42% will try to get some sleep, according to the Medscape survey. The Harvard School of Public Health report recognized the positive impacts of these wellness-driven solutions, as well as recommending improved physician access to mental health treatment. Others advocate for the appointment of a chief wellness officer to focus C-suite attention on the remedy.

But the research clearly points to the elephant in the room. Charting and other bureaucratic tasks remain the biggest driver of physician burnout.

Adding to the tension: over 30% of physicians are older than 60 years and began practicing medicine well before computers elbowed their way into healthcare. The story is the same for perioperative nurses: 66% are over 50 years old and 20% of that group are over 60. These digital immigrants, while conversant in digital “language,” aren’t always fluent, and the transition raises stress levels.

While no one is advocating a return to a paper-based system, current technology needs a serious overhaul. Rather than conform to way they practice medicine, clunky, off-the-shelf software leaves physicians at the mercy of the way the software wants them to treat patients.

While ASCs have, for now, been spared from the same burdensome EMR certification requirements as hospitals and health systems, they haven’t been spared from digital tools that leave the average user wishing for something more relevant to their ASC experience in the OR, supply closet or at the front desk.

Now is the time to develop digital tools that respect the time and talents of every clinician and work the way they do. As ASC volumes increase and compliance standards climb, those who work to help ASCs navigate technology transformation have a chance to get it right. But they should be mindful of the words from self-described tech humanist Kate O’Neill: “The meaningful design of experiences in physical space now regularly overlaps with the meaningful design of experiences in digital space.”

Curbside Consult with Dr. Jayne 7/22/19

July 22, 2019 Dr. Jayne 4 Comments

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Around the World with Dr. Jayne

This week, I embarked upon the adventure of a lifetime, as I had the opportunity to serve on the medical staff at the 24th World Scout Jamboree.

With somewhere upwards of 43,000 Scouts and leaders from around the world converging on West Virginia, there is a definite need for medical staff. I applied to serve way back in November 2017 and was selected in January 2018, so the anticipation has been building. Although the event is being held on a Boy Scouts of America property, the US is co-hosting with scout organizations from Canada and Mexico. The last time a World Scout Jamboree was held in the US was in 1967, so it’s truly a once-in a lifetime opportunity.

There are scouts from over 150 countries attending, so it will be a patient base like I’ve never cared for. Talk about not knowing what might walk through the door! In addition to caring for illness and injury that occurs as a result of the Jamboree itself (heat exhaustion, sunburn, blisters, insect bites, sprains, strains, cuts, dehydration, and more) there’s the need to provide care for all manner of chronic conditions in both young people and their adult leaders as well as the thousands of staffers that are there to support them.

I’ve never practiced in a tent before. And speaking of tents, I’ll be spending the next two and a half weeks living in one. Everything I need had to be packed in a single duffel, which was an adventure in itself.

There are 500 volunteers assigned to the Jamboree Medical Services team, including physicians, nurses, paramedics, EMTs, behavioral health personnel, dentists, optometrists, and more. A full-service Jamboree Health Center has diagnostics including x-ray, but I will be embedded with the participants in one of the “base camp” medical centers that runs 24 hours a day.

Because the World Jamboree is being held at the site of the two most recent US National Scout Jamborees, the State of West Virginia had the licensure and credentialing process down to a fine science. It was just like completing a hospital credentialing process (minus the letters of recommendation) and each of us receives a temporary “Summit Health Services Permit” allowing us to practice only at the Summit Bechtel Family National Scout Reserve and only during the specified Jamboree Dates.

The health services team isn’t just made of US volunteers. On my bus from the Charlotte airport, I met up with several international medical volunteers as well as those from other disciplines that are more “scouty” than healthcare – shooting sports, aquatics, aerial sports, climbing, and mountain biking. There is also an entire logistics team, including food service (thank goodness they’re already on site, ready to feed a horde of hungry scouters) including registration, transportation (routine and emergency), security, communications, and pretty much any other services you can think of for a small city. In fact, for 12 days, we’ll be the second largest city in West Virginia.

In addition to preparing for somewhere in the vicinity of 10 miles of walking each day, not to mention heat and humidity, the health services team has also been preparing for the challenges of delivering thousands of “new patient” visits each day. Other than a brief health history that may or not be available electronically, we’ll be starting most of our visits from scratch.

The EHR is from Cerner, and many of us have been through training (including super user training in Kansas City) as well as running drills in a sandbox environment prior to arrival. We are on site for several days prior to the arrival of the participants, completing training, setting up the medical facilities, and conducting drills. West Virginia is very concerned about the potential for a measles outbreak in this environment, with volunteers assigned to measles response plans based on their personal immunity status.

As clinicians, our EHR training focused entirely around the actual patient care piece. However, my clinical informatics brain had numerous questions about the potential for interoperability, sending records back to participants’ home care teams, caring for an international population, and more. I reached out to Cerner for an interview a couple of months ago, but they declined to make anyone available. There will be Cerner employees on site, so if you’re one of them and want to talk anonymously off the record, drop me an email. They say The Summit is going to be the most wired camp in the world for the next couple of weeks, so I won’t have to be off the grid. And to Cerner proper – if you change your mind, I’m still interested in chatting.

I’m actually looking forward to the EHR experience. Not only does the Cerner version we are using have content embedded from Intelligent Medical Objects (IMO),  we’re not worried about coding or billing, so we can actually focus on taking care of patients. Although patient privacy will be upheld consistent with the dictates of professionalism, there are no covered entities involved, so no HIPAA.

I’m also looking forward to the clinical experience. Since most of the patients are Scouts or their leaders, we might be able to assume that some level of personal first aid or home care has been applied prior to their arrival on our tent’s doorstep. I’m sure the folks staffing the “Thrasher Mountain” program area might see a little different case mix than I’ll see at the base camp, but you never know.

I’m excited to work with health professionals from different countries and different models of care, and of course to meet young movers and shakers from around the world. This is a time for people to learn that they are more alike than they are different, and to come together as citizens of the world rather than of their own nations. We’ll be living under the principles of Scouting as established more than 100 years ago and hopefully returning home with a renewed desire to make the world a better place.

I’ll be filling our readers in on the challenges of practicing in this unique environment as well as my experiences with healthcare IT in the field. And if you happen to be here, I’ll be the blonde in the khaki shirt.

Have you been on a medical volunteer trip? Was it high or low tech? Leave a comment or email me.

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Email Dr. Jayne.

Morning Headlines 7/22/19

July 21, 2019 Headlines No Comments

Tech IPOs Keep Popping as Phreesia Surges 53% in Debut

Phreesia shares rose as much as 53% from their opening price of $18 on their first day of trading on the NYSE Thursday, closing at $26.75.

Amazon threatens to sue major pharmacy player if it prevents PillPack from accessing patient drug data

Amazon threatens to sue Surescripts, which is partially owned by Amazon competitors CVS and Express Scripts, over threats to revoke its mail-order pharmacy’s access to patient medication lists.

Marshfield Clinic Health System outsourcing some jobs

Marshfield Clinic Health System (WI) lays off 46 employees as it transitions its release-of-information jobs to Ciox.

Monday Morning Update 7/22/19

July 21, 2019 News 2 Comments

Top News

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Phreesia shares rose as much as 53% from their opening price of $18 on their first day of trading on the NYSE Thursday, closing at $26.75.

PHR shares closed Friday at $24, valuing the patient intake software company at $844 million.

CEO Chaim Indig holds shares worth $70 million.


HIStalk Announcements and Requests

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Most of the 280 respondents to last week’s poll saw at least some aspects of their lives improve compared to five years ago, most commonly wealth (around 60% of the total respondents), happiness, and level of relaxation. Few of them, however, are healthier or more optimistic.

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New poll to your right or here: for those who’ve had an in-person visit for a minor condition within a year, what’s the #1 reason you didn’t use telehealth instead? I’ve never had a virtual visit, partly because I haven’t needed one, but also because I can call or text the cell number of my $70 per month concierge MD at any time. I’ve called a couple of times for issues other than prescriptions (which he sells at his low cost) – once for a sudden allergic reaction to something and another for a one-and-done toe swelling, both of which were managed well with a short course of prednisone after I texted him a photo.

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I added bookmarks to Vince’s HIS-tory series, allowing the reader to click on each chapter’s title to jump directly there. That gives three ways to use the PDF document – page through it like a book, use the bookmarks as a clickable table of contents, or perform a full-text search of the entire 1,438-page file (it works best to download the file, then open in a PDF reader rather than working directly in your browser). I also appended the history of HIMSS as created by the HIMSS Legacy Workgroup in 2012 and not updated since, just to make sure that document isn’t lost forever. I haven’t used a PDF writer tool for a long time, so I was happy to find PDF Architect, which worked flawlessly for this little project with zero learning curve. It contains many options I didn’t need (direct PDF editing, document conversion, inserting images and links, rearranging pages, etc.) but it’s still a good deal —  I paid $36 for a one-year personal subscription versus the $156 per year for Adobe’s product.

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Welcome to new HIStalk Platinum Sponsor Get-To-Market Health. The Malvern, PA-based consulting firm helps health technology businesses accelerate their sales and drive their revenue growth by coaching them through this market’s rapidly changing complexity and unique buying patterns. The company’s experts have redesigned sales organizations, developed market entry plans for big companies, created partner channel strategies, and coached and supported chief commercial officers. They will also help potential investors perform due diligence and craft plans for rapidly growing the business. The principals are industry long-timers Steve Shihadeh, M.P. Brock Zimmerman, and Paul Mattes. They bring deep connections in health systems and vendor organizations when specialized expertise is needed. I read through some of the company’s excellent blog posts and call to your attention this information-packed and highly relevant one: “Surviving and Thriving in an Epic and Cerner-Dominated Health Information Technology World.” Thanks to Get-To-Market Health for supporting HIStalk.


Webinars

July 25 (Thursday) 2:00 ET. “Meeting patient needs across the continuum of care.” Sponsor: Philips Population Health Management. Presenters: Cindy Gaines, chief nursing officer, Philips Population Health Management; Cynthia Burghard, research director of value-based healthcare IT transformation strategies, IDC. Traditional care management approaches are not sufficient to deliver value-based healthcare. Supplementing EHRs with advanced PHM technology and a scalable care management approach gives health systems proactive and longitudinal insights that optimize scarce resources in meeting the needs of multiple types of patients. This webinar will address the key characteristics of a digital platform for value-based care management, cover the planning and deployment of a scalable care management strategy, and review patient experience scenarios for CHF and diabetes.

July 31 (Wednesday) 1:00 ET. “Modern Imaging Technology for the Enterprise: Mercy’s Approach That Improved Imaging Cost, Speed, Capacity, and Care Quality.” Sponsor: Mercy Technology Services. Presenter: Jim Best, executive health IT consultant, Mercy Technology Services. Enterprise imaging has become as critical as EHRs for transforming patient care, but many health systems are struggling with the limitations and costs of dated, disconnected PACS even as imaging volumes grow and radiologists report increasing levels of burnout. Radiologists at Mercy were frustrated by its nine disparate PACS, which required them to toggle between workstations, deal with slowdowns and poor reliability, and work around the inability to see the complete set of a patient’s prior images, even as demands for quick turnaround increased. In this webinar, MTS — the technical backbone of Mercy — will describe the lessons they learned in moving to a new best-of-breed PACS platform that increased radiology efficiency by 30%, with the next phase being to take advantage of new capabilities by eliminating third-party reading services and distributing workload across radiology departments to improve efficiency, capacity, and timely patient care.

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


Acquisitions, Funding, Business, and Stock

Amazon threatens to sue Surescripts over threats to revoke its mail-order pharmacy’s access to patient medication lists. Prescription integration automation vendor ReMy Health – which provides API access to modified Surescripts data – says it will no longer work with Amazon-owned PillPack. Surescripts, which is partially owned by Amazon competitors CVS and Express Scripts, says it has no signed patient privacy agreement with PillPack. Without access to Surescripts data, PillPack’s pharmacists would have to call each patient to ask about conditions and medications before dispensing their medications. The management team of ReMy Health, which was founded in 2013, is made up mostly of former Allscripts executives.


Decisions

  • Kennedy Krieger Institute (MD) went live on Epic on July 1.
  • Regional Mental Health Strawhun Center for Mental Center (IN) replaced Netsmart with Harris Healthcare in June.
  • Gibson General Hospital (IN) will replace Evident (A CPSI Company) with Epic this year.
  • Ferrell Hospital (IL) will go live on Epic in August.

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


Announcements and Implementations

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The Patterson Health Center – mostly funded by a $35 million donation by The Patterson Family Foundation – opens (Monday) in Harper County, KS, the birthplace of the late Cerner co-founder and CEO Neal Patterson. The 62,000-square-foot hospital sits midway between two small towns whose struggling hospitals were consolidated into the new one. The facility includes a 16-bed critical access hospital, a clinic, a physical therapy and rehab center, and a wellness center. Technologies include electronic registration, digital patient tracking, telemedicine for remote specialist consultations, automated medication dispensing cabinets, and modern imaging systems. Health Center Chairwoman Martha Hadsell says, “Neal gave us a voice, and when you’re in rural America, sometimes you don’t have a voice. He gave us a facility to really experiment and try out new ways to deliver healthcare in rural America.”


Government and Politics

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A Tennessee Senate task force will review EHR use in the state, with its new chair promising to find ways that hospitals can use them more effectively in contrast with the false promises that were made when they “were first introduced by the Obama Administration 10 years ago.” Sen. Todd Gardenhire – a 71-year-old wealth manager who, like all five task state Senate force members, is a Republican – says he will study hospital EHR vendor contracts and determine whether EHRs enable Medicaid fraud.


Other

A US psychiatry resident writes in Scientific American that China’s overloaded psychiatric services may provide the incentive for virtual reality-powered psychiatry to leapfrog into mainstream acceptance, citing as an example VR applications that could take people through fear-inducing situations to condition them. China has too few mental health professionals and the people who seek them out are sometimes subject to humiliation or even treatment as criminals.

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Athenahealth and Epic are named as being among the companies who had information from their systems found to have been exposed by spyware that is contained in several browser extensions. Experts found that companies that rely on unpublished URLs to hide sensitive data are vulnerable to Dataspii, which developer Nacho Analytics calls “God mode for the Internet.” The original researcher found home security system videos, Intuit-hosted tax returns, vehicle buying information, patient information from DrChrono and other health IT vendors, itineraries on travel sites, and Facebook Messenger attachments and Facebook photos. I would be surprised if any health IT vendor relies purely on a complex URL to hide patient information, so I’m interested in learning more.

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ProPublica finds that the federal government doesn’t check applications for National Provider Identifier (NPI) numbers for accuracy, making it easy for just about anyone to obtain one and then file false non-Medicare claims with insurance companies. A personal trainer called “Dr. Dave” flooded insurers with out-of-network claims for personal training sessions labeled as medical services under the assumption that the companies would blindly pay some of them and he was right – he billed $25 million and pocketed $4 million in cash, much of that after he had been caught multiple times. Experts use the phrase “pigs get fat, hogs get slaughtered” in recognizing that insurers don’t really care about most fraud since they simply pass those costs along to employers and policyholders, going after only the most obvious claims data outliers.

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Court documents spell out what FBI agents found in their 2014 raid of an Arizona body donation business — piles of unlabeled body parts, a large torso with a smaller head “sewn together in a Frankenstein manner,” and a bucket filled with male genitalia. The state doesn’t license donation centers, although the high-school educated owner (whose last name is, remarkably, Gore) says he should have told families that while their donation provided free body transportation and cremation, the deceased person’s body would not be used for educational purposes but would instead be broken down into parts that would be sold to anyone willing to pay prices ranging from $375 for a knee to $2,900 for a headless body. The civil lawsuit that has been brought by 33 plaintiffs against the former owner Mr. Gore, who walked away with probation in his criminal case, kicks off in October.


Sponsor Updates

  • Lightbeam Health Solutions publishes a new patient impact story featuring Mohawk Industries, “Breast Cancer Early Detection: Improving Quality Outcomes with Population Health Technology.”
  • Meditech publishes a new case study, “Meditech’s Expanse Point of Care Mobilizes Nurses at KDMC.”
  • Waystar publishes a case study featuring Bayada Home Healthcare.
  • Netsmart and Vocera will exhibit at the LeadingAge Florida Annual Convention and Exposition July 22-24 in Orlando.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the AWHONN Florida Section Conference July 25-26 in Lake Buena Vista, FL.
  • MedStar Health (MD) renews its contract for TransformativeMed’s Core Workflow Suite and becomes an innovation partner with the company.
  • Concordia University alumnus profiles T-System CTO Hank Hikspoors.
  • TriNetX announces the agenda for its third annual user conference September 24-25 in Boston.

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 7/19/19

July 19, 2019 Weekender 1 Comment

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Weekly News Recap

  • Ellkay acquires X-Link.
  • John Muir Health outsources IT-related functions to Optum and transfers 540 employees to the company.
  • A study finds that follow-up is often not performed for patients with poor kidney function, with EHR configuration changes recommended to close care gaps.
  • Livongo Health’s updated IPO filing values the company at up to $2.4 billion.
  • SPH Analytics acquires SA Ignite.
  • Baring Private Equity Asia is reported to have edged out other bidders to acquire CitiusTech for $1 billion.
  • PeaceHealth lays off 50 IT employees as it centralizes tech support.

Best Reader Comments

John Muir outsources its IT and analytical functions while Providence bought an entire consulting company to go deeper into that area. Just goes to prove that nobody knows anything! People are just throwing stuff on the wall to see what will stick. (Nobody Knows Anything)

John Mui, is looking for operational efficiencies (again in theory), so outsourcing IT and business process can make sense for them. Providence, on the other hand, is looking to increase revenue, so they bought those consulting firms to accomplish a couple of goals. For starters, they are doing custom Epic development, so once they make certain changes in the system, they will then market those changes and sell them to other customers through this new acquisition (similar to what UHS did with Crossings Health Solutions via Cerner mPages). Providence also has an innovation team that is thinking up new healthcare technologies and then will most likely uses these new firms to sell/push those to other systems. This is something we are seeing more and more with the larger IDN’s like Providence, Ascension, UHS, etc. building their own business lines and are selling those solutions to the masses. (Associate CIO)

I hope the outsource deals works out for John Muir and goes better than most outsourcing. Typically the client never REALLY gets improved operations. Keeping in mind the outsource company is for profit and has to do the same and more with less people and it typically ends up being less than desired results. You sure can’t keep people on the payroll making 500K plus. (Robert Smith)

The accuracy published of 75% is only slightly better than guessing. “Metastatic carcinoma is present in 36 whole slides”…” The dataset consists of 130 de-identified WSIs of axillary lymph node specimens.” Thus, 36/130 = 27% has carcinoma, and 73% no carcinoma. Without AI, I could guess all slides are “no carcinoma” and I’ll have an accuracy of 73%. Always perform a sanity check of the baseline accuracy of “no AI.” (AI lover)

[Virtual visit versus office visit] is more comparing Netflix to going to a theater release. You won’t experience professional sights, sounds, and touch, on the other hand, you won’t have screaming kids, catch something from someone coughing on top of you, or get your feet sticky walking through the place. (AC)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. W in South Carolina, whose asked for art supplies for her high school classroom that closed for several weeks after flooding from two hurricanes. She reports, “It has been an unbelievable challenge recovering from the devastation due to the hurricanes and floods. Students were so excited when we received the materials, it was as if they were opening presents on Christmas morning. They have really taken an interest in demonstrating their learning through hands-on, creative projects and the materials have allowed us to easily differentiate learning and assessments. Furthermore, decorating the classroom and hallways with students’ work gives a sense of ownership and comfort to the space.”

The New York Times covers hospitals hiring “secret shoppers,” consultants who pose as patients in reporting vague symptoms to see how well employees follow procedures and practice empathy. The shoppers even have blood drawn and have some tests performed, but are trained to leave for a claimed family emergency if treatment would put them at risk. One shopper who went to the ED wearing old clothes and claimed to have no insurance found that employees didn’t introduce themselves, make eye contact, or apologize or even acknowledge issues such as blood on her arm following a draw. She returned professionally dressed and presented an insurance card and received better treatment.

A Pennsylvania hospital locks down its ED when two rival groups continue their earlier all-day fighting in what the hospital called a “riot” at 4:30 in the afternoon. Apparently those involved were not otherwise occupied with gainful employment or academic pursuits. 

Drexel University will lay off 40% of its physician group because of the impending shutdown of Hahnemann Hospital. Politics aside, presidential candidate Bernie Sanders summarized it well: “It’s insane. If you look at this thing objectively and you say that in the midst of a healthcare crisis, a hospital is being converted into a real estate opportunity in order to make some wealthy guy even more money, ignoring the healthcare needs of thousands of people, that is pretty crazy.” Although I’ll offer a more realistic assessment — the investor is just doing what investors are highly paid to do, and relying on his moral rather than his legal obligations is naive. Repeat with me in observing the obvious: people and companies do exactly whatever benefits them the most.

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A man breaks his leg minutes after renting a Bird electronic scooter, racking up a $100,000 bill from Tampa General Hospital, which says it has treated 50 such injuries in the past two months. The guy’s hipster beard was probably more appropriate for the e-scooter than his brand new walker. 

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Huntsville Hospital brings in Asteroid, a certified service dog that can accompany patients to their procedures and comfort families in bereavement. My first thought was whether the hospital has figured out a canine billing code.


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Morning Headlines 7/19/19

July 18, 2019 Headlines No Comments

Healthcare Interoperability Leader ELLKAY Acquires X-Link

Interoperability solutions vendor Ellkay acquires the assets of Legal Easy, which includes the X-Link interfacing software that connects EHRs, practice management systems, and other healthcare technologies.

Health System Boards Lack Sufficient Oversight Over Technology, Black Book Survey Reveals

A Black Book poll finds that 4% of health system boards include members with health IT experience, with 91% of boards relying on consultants to develop IT strategy.

ECG and Oncology Resource Consultants Merge to Establish the Industry’s Leading Oncology Consulting Practice

ECG Management Consultants merges with oncology consulting practice Oncology Resource Consultants.

News 7/19/19

July 18, 2019 News 15 Comments

Top News

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John Muir Health outsources its IT, RCM, analytics, purchasing, and claims processing operations to Optum and will  transfer 540 employees to the company.

I’m wondering – have other health systems turned over this much of their non-clinical work to Optum? This deal represents nearly 10% of the health system’s total headcount.

John Muir’s just-filed financial report shows a $59 million profit on $1.5 billion in revenue, a CEO who was paid $3 million, and several million-dollar executives. The CIO made $825K.


Reader Comments

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From Jade Warrior: “Re: Surescripts. Shouldn’t they have to change their name since we are no longer sure about these scripts? Don’t they do testing?” Surescripts warns users in a Patient Safety Alert that medication histories may contain incorrect patient instructions if they include a slash symbol, which it removes in erroneously converting instructions such as “take 1 and 1/2 tablets” to “take 1 and 12 tablets,” which it estimates has happened in 0.3% of Medication History dispensing records. I don’t fully understand the problem description, but it sounds as though the error is limited to storing the incorrect patient instructions in its medication history – the prescriptions it sends are fine.


HIStalk Announcements and Requests

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Welcome to new HIStalk Gold Sponsor MWTherapy. The Wellesley, MA-based company’s web-based physical therapy software platform serves outpatient practices everywhere. PTs and staff can work anytime, anywhere, and from any device, including both Windows and Mac. The software, which was built from scratch for the rehab market without cobbling together acquired products, can be set up for any practice, budget, or need. Modules include EMR, billing, scheduling, appointment reminders, home exercise program, outcomes, reporting, secure messaging, and patient email. The “Amazing Value” EMR package starts at $1.65 per day per therapist, while the affordable Build-A-System offers a customized solution with exactly what a practice needs with no long-term contracts and with the backing of a company that has been around for 15 years. Thanks to MWTherapy for supporting HIStalk.


Webinars

July 25 (Thursday) 2:00 ET. “Meeting patient needs across the continuum of care.” Sponsor: Philips Population Health Management. Presenters: Cindy Gaines, chief nursing officer, Philips Population Health Management; Cynthia Burghard, research director of value-based healthcare IT transformation strategies, IDC. Traditional care management approaches are not sufficient to deliver value-based healthcare. Supplementing EHRs with advanced PHM technology and a scalable care management approach gives health systems proactive and longitudinal insights that optimize scarce resources in meeting the needs of multiple types of patients. This webinar will address the key characteristics of a digital platform for value-based care management, cover the planning and deployment of a scalable care management strategy, and review patient experience scenarios for CHF and diabetes.

July 31 (Wednesday) 1:00 ET. “Modern Imaging Technology for the Enterprise: Mercy’s Approach That Improved Imaging Cost, Speed, Capacity, and Care Quality.” Sponsor: Mercy Technology Services. Presenter: Jim Best, executive health IT consultant, Mercy Technology Services. Enterprise imaging has become as critical as EHRs for transforming patient care, but many health systems are struggling with the limitations and costs of dated, disconnected PACS even as imaging volumes grow and radiologists report increasing levels of burnout. Radiologists at Mercy were frustrated by its nine disparate PACS, which required them to toggle between workstations, deal with slowdowns and poor reliability, and work around the inability to see the complete set of a patient’s prior images, even as demands for quick turnaround increased. In this webinar, MTS — the technical backbone of Mercy — will describe the lessons they learned in moving to a new best-of-breed PACS platform that increased radiology efficiency by 30%, with the next phase being to take advantage of new capabilities by eliminating third-party reading services and distributing workload across radiology departments to improve efficiency, capacity, and timely patient care.

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


Acquisitions, Funding, Business, and Stock

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Interoperability solutions vendor Ellkay acquires the assets of Tampa-based Legal Easy, which includes the X-Link interfacing software that connects EHRs, practice management systems, and other healthcare technologies.

Payments processing technology vendor Edifecs will open an Atlanta office that will house up to 200 new employees.


People

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Patrick Neese (Jefferson Regional Medical Center) joins Lake Regional Health System (MO) as CIO.


Announcements and Implementations

A Black Book poll finds that 4% of health system boards include members with health IT experience, with 91% of boards relying on consultants to develop IT strategy. Eighty percent of health system CFOs say their board members do not remain impartial in their review of system selection and spending approval and are instead influenced by other board members, corporate management, or vendor salespeople. I can’t speak for all, but the health systems I’ve worked for didn’t rely on board members to make IT decisions or set IT strategy – their job as community leaders was to set big-picture strategies and to make sure that the management team — which made its recommendations only after lengthy research and deliberation — hadn’t missed something. I’ve seen bad IT decisions caused by big-ego board members who paid half attention to a 15-minute review of a plan formulated by experts over many months, but who then used their self-perceived insight and wisdom to push an entirely different course of action.

In China, 50 hospitals will use AI technology from Ping An Good Doctor to create Internet hospitals that offer diagnosis, prescription sharing, and health management. The hospitals will share their information in real time.


Privacy and Security

The number of patients whose information was compromised in the breach of American Medical Collection Agency grows to 22 million as Clinical Pathology Laboratories and Penobscot Community Health Care join Quest Diagnostics, LabCorp, and BioReference Laboratories in notifying their affected patients. Quest has complained that AMCA — which filed Chapter 11 bankruptcy after the initial breach reports – didn’t file required HHS breach notification and hasn’t paid $500,000 of Quest receivables it collected from patients. Indiana’s attorney general has filed a motion to convert AMCA’s bankruptcy to Chapter 7, citing the company’s lack of post-event transparency and its food-dragging on getting the reorganization going.


Other

Former Apple CEO John Sculley predicts that the future of healthcare will be in remote patient monitoring and telehealth for chronic condition maintenance, especially as hospital beds are eliminated and high-utilization chronic patients stress the system financially. He predicts that Apple will turn its Health product into a subscription service that will connect Watch users to doctors; says that Google could create a similar health subscription service using medical sensors for its Pixel phone, Assistant voice power, Duplex conversational AI for phone conversations, and its Nest smart home technology; and concludes that Amazon could scale Alexa Health faster than either company. On the other hand, he’s the guy who fired Steve Jobs.

Two physician-venture capitalists who head up Google’s life sciences investment arm warn that technologists “spend on the order of three months before they realize how screwed up [US healthcare] is … you make more money by keeping a patient sicker,” at which point half of them walk away to target more reasonable industries. The investment group has set up crash course rotations and a mini-residency in which technology entrepreneurs can learn what the healthcare system is really like. 

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Kaiser Permanente Southern California researchers find that 58% of patients whose kidney function lab test results are abnormal don’t receive appropriate follow-up. The study authors recommend improving EHR inbox management,flagging abnormal estimated glomerular filtration rates (EGFR), increasing the lab results management role of nurses, and enhancing the use of patient portals. PCPs reported some interesting factors that cause care gaps:

  • Overly large patient panels.
  • EHR inbox message overload.
  • Lack of lab result triage help.
  • Role ambiguity when lab orders are cc’d.
  • Lack of an abnormal result EHR flag for EFGR, which isn’t automatically  is calculated from patient demographics and serum creatinine levels.
  • Lack of follow-up lab draws due to high patient co-pays, limited lab hours, and conflicts with work-life activities.

A Philips-sponsored report finds that while the US is near the top in EHR usage, it is below-average in applying telehealth and artificial intelligence. 

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I checked compensation for Children’s Hospital Los Angeles after its announcement of a $25 million anonymous gift to expand its neurology and interventional radiology services and wasn’t surprised that the CEO makes $1.9 million, but I’m a little bit puzzled at how a Registered Nurse Lead was paid $748K vs. the CIO’s $606K.


Sponsor Updates

  • USPTO awards Medicomp Systems a patent for the intelligent filtering of health-related information in its Quippe solution.
  • EClinicalWorks will exhibit at the 2019 FACHC Annual Conference July 21-24 in Fort Lauderdale, FL.
  • InterSystems will exhibit at Sunquest July 22-25 in Scottsdale, AZ.
  • Imprivata publishes a white paper titled “An Evaluation of the Clinical and Financial Value of Work Station Single Sign-on in 19 Hospitals,” which describes how Christus Health is saving 49,000 clinician hours per year with the company’s OneSign single sign-on and virtual desktop access platform.

Blog Posts


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EPtalk by Dr. Jayne 7/18/19

July 18, 2019 Dr. Jayne No Comments

I took a little break from work and writing this week due to an unexpected illness in the family. As much as hospitals focus on their subspecialty capabilities, imaging, and technology, the one thing that stood out during our stay was the importance of compassion and high-quality nursing care. The care provided by both regular floor nurses and the hospice team contributed more to our patient and family experience than anything else the facility had to offer.

I’m glad we were at a community hospital with a patient-centric focus. The staff was kind enough to allow us to spill over into a conference room for take-out meals after the cafeteria closed and kept us fortified with drinks and snacks. I think we were the only hospice family on the nursing unit and it’s a fairly low-census time of the year for many facilities, but it was good to know they were looking out for ways to make us comfortable.

Being “the doctor in the family” puts you in a unique position. I was grateful that the nurses were willing to let me eyeball the orders so I could help put the rest of the family at ease about the plan of care. It was also an opportunity to think back on the patients in similar situations that I’ve cared for over the years and whether my efforts matched up to their families’ needs. Hospice care delivered in-hospital has come a long way from having the on-call intern make it up as they go along.

I appreciate the work done in the field to ensure patients have maximum comfort and that families have the support they need, especially when things don’t quite go as anticipated. I also appreciate the role of social media in the modern grief process. Although it’s easy to make fun of memes and the silliness we see out there, nothing beats being able to contact dozens of people quickly without having to call each one. Memories can be shared collectively rather than individually and overall it impacted positively on the experience.

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Now I’m back home and back to the healthcare IT grindstone. A reader sent me this article about a skill for Amazon Alexa that allows patients in the UK to receive answers based on information vetted by the National Health Service. The NHS hopes this will reduce backlogs for patients who need advice on uncomplicated conditions. I spent some time learning about care in the NHS firsthand and enjoy the British commentary on issues. The author notes that “maybe, just maybe, this could also save some from going down an online rabbit hole into rubbish health forums.” I had forgotten how much I love the word “rubbish,” especially in that context, and will look for ways to use it going forward.

As expected, privacy and civil liberties groups are against it despite Amazon’s assurances that confidentiality will be maintained. The Health Service has set up a special division, NHSX, tasked with increasing the use of technologies, including electronic prescribing, artificial intelligence applications for radiology, and more. Clinicians want to make sure that research occurs to ensure the quality of the advice, and also that accessibility factors like cost are factored in for new approaches. My experience with Brits and healthcare is that they tend to be quite matter-of-fact and that is borne out in the comments on the piece: “Take paracetamol (basically Tylenol), and if you’re not better or dead in 48 hours, contact your doctor.”

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New data has been added to the Physician Compare website reflecting data for the 2017 Quality Payment Program. We didn’t participate, so I don’t have any data, but a quick glance at several colleagues who did participate shows no data for them either. I’m not sure why they’re not displaying, but it adds to concerns about data validity and whether patients are really going to use the metrics to select their physicians. Most of the Medicare patients in my area select their primary care physicians based on who is accepting new patients and whether they can even get an appointment rather than being concerned about quality data that may or may not be accurate.

Speaking of data, here’s some that might be useful. Research presented at the American Diabetes Association annual meeting looked at whether individualized text messages sent to diabetic patients with recent emergency visits can improve glucose control, medication adherence, and ED utilization. The authors identified the ED as a place where high-risk patients can be engaged when they are in crisis and might be willing to make changes to improve their health. The goal is to use texting to bridge between the urgent issue and stable long-term care. The original intervention was one way and patients received two messages daily for six months. The control group received the same information in a pamphlet. The program has now been commercialized and a second module targeting family and caregiver supports is available. Although small at 166 patients, a study on that approach will be completed later this year.

The beginning of July marks the time when newly-minted physicians begin their careers as hospital interns. Internship and residency has changed quite a bit since I was in those trenches, mostly through the implementation of work hour reforms and the addition of dedicated days off, caps on admissions, and extra layers of supervision. A new study published in BMJ shows that “exposure of physicians to work hour reforms during their residency was not associated with statistically significant differences in 30-day mortality, 30-day readmissions, or inpatient spending.” The authors compared rates during 2000-2006 and 2007-2012 to reach their conclusions. The study looked at 485,000 admissions and compared outcomes for patients cared for by physicians in their first year of independent practice vs. patients cared for by physicians in their tenth year of independent practice during the same-year cohorts. The study is somewhat limited by its observational construction and limitation to internal medicine physicians, but it’s a good start.

For those of you in the EHR implementation trenches, how is your July going? Are the new house officers “getting it” or are you ready to pull your hair out? Leave a comment or email me.

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Morning Headlines 7/18/19

July 17, 2019 Headlines No Comments

Proficient Health Merges with Firm Specializing in Mobile Communication Apps

Referral management software vendor Proficient Health merges with clinical communications company MD Interconnect.

John Muir Health and Optum Launch New, Comprehensive Relationship to Advance Quality Care and Experiences for Patients in Bay Area

Over 500 John Muir Health (CA) employees will transition to Optum as it takes over the health system’s IT, RCM, analytics, purchasing, and claims processing.

Philips acquires Boston start-up Medumo to help hospitals communicate with patients

Philips acquires pre-exam patient engagement startup Medumo for an undisclosed sum.

Software firm, health care provider accuse each other of theft; Houston mayoral candidate working the case

In Pennsylvania, Post Acute Medical files a lawsuit against software vendor Meridian Hospital Systems accusing it of abruptly terminating its software access, refusing to return its patient and business data, and violating HIPAA.

Morning Headlines 7/17/19

July 16, 2019 Headlines No Comments

Intermountain Healthcare Announces New Company to Elevate Value-Based Care Capabilities

Intermountain Healthcare (UT) creates Castell, a company that will help providers, payers, and ACOs transition to value-based care through proven care models, technology, analytics, and digital tools.

Casetabs Raises $3M in Funding

Surgery coordination software vendor Casetabs raises $3 million, bringing its total raised to over $16 million.

Eight California Hospitals Join Manifest MedEx

Eight Prime Healthcare hospitals in California join the non-profit Manifest MedEx HIE, joining the seven Prime hospitals that are already members.

News 7/17/19

July 16, 2019 News 2 Comments

Top News

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Livongo Health’s revised IPO filing values the diabetes management technology company at up to $2.4 billion.

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Livongo shares that are owned by founder Glen Tullman and his venture firm are potentially worth over $200 million. CEO Zane Burke – who joined the company in December 2018 after seven years as president of Cerner – holds shares worth up to $23 million.


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor TransformativeMed. The Seattle-based company offers the interface-free, MPages-embedded, Saas-based Core Workflow Suite that turns Cerner Millennium into a modern, workflow-focused EHR that adapts to the way a doctor practices. The company — which was founded in 2011 and just completed a $6 million Series A funding round — has 120 large-hospital customers, including big names such as Ascension, Dignity Health, Tenet Health, and MedStar Health (which just renewed its contract and signed on as an innovation partner). Apps within the suite include Core Work Manager (automating scheduling of multidisciplinary rounds, results tagging for dynamic documentation, assessment and plan management, “discharge before noon” workflows, and workflow-integrated handoffs); Core Notify (continuous EHR monitoring with real-time notifications, configurable notification rules, and one-click result to task follow-up); and Core Messaging (secure texting with image sharing, convert messages to EHR task, care team messaging directly from the chart, and on-call schedules). It offers workflows for specific conditions like diabetes that include patient lists, flowsheets, advanced ordering, safety alerts, and decision support. A Seattle Children’s doctor says, “This ability to customize is a huge benefit for us. It’s made our handoff processes both faster and safer. As medicine becomes more of a shift-work model, and we don’t have these crazy 36-hour shifts anymore, we have more handoffs. More handoffs mean more opportunities for things to fall through the cracks. You must have a really robust tool to control for that. For us, that’s Cores.” Thanks to TransformativeMed for supporting HIStalk.

The industry lethargy created by the slow summer months (aka “The Doldrums”) motivates me to find new sponsors to replace those that have sold out, gone broke, or assigned an unresponsive marketing person as our only contact. Contact Lorre for a deal on webinars, new sponsorships, and a special offer for success-focused start-ups that are anxious to let the health IT world know they are out there. I like to think of this as my Temporary New Operating Model.

Volunteers help me review the recorded rehearsals of upcoming HIStalk-produced webinars (the videos are usually 30-40 minutes long) to offer the presenters suggestions about content, delivery, etc. I gratefully send them a $50 Amazon gift card in return. Let me know if you work in provider-side IT management and can help out occasionally.

Listening: new angry but melodic punk from Bad Religion, which punches hard for a band whose 40th anniversary is next year and whose 54-year-old, Madison-born singer Greg Graffin has a PhD in the history of science, lectures at UCLA, and wrote a book titled “Population Wars: A New Perspective on Competition and Coexistence.”


Webinars

July 18 (Thursday) 2:00 ET. “Healthcare’s Digital Front Door: Modernizing Medicine’s Mobile-First Strategies That Are Winning Patient Engagement.” Sponsor: Relatient. Presenters: Michele Perry, CEO, Relatient; Michael Rivers, MD, director of EMA Ophthalmology, Modernizing Medicine. Providers are understandably focused on how to make the most of the 5-8 minutes they have on average with a patient during an exam, but what happens between appointments also plays a significant role in the overall health of patients. Modernizing Medicine is driving high patient engagement with best practice, mobile-first strategies. This webinar will describe patient engagement and the challenges in delivering it, how consumerism is changing healthcare, and how to get started and navigate the patient engagement marketplace.

July 25 (Thursday) 2:00 ET. “Meeting patient needs across the continuum of care.” Sponsor: Philips Population Health Management. Presenters: Cindy Gaines, chief nursing officer, Philips Population Health Management; Cynthia Burghard, research director of value-based healthcare IT transformation strategies, IDC. Traditional care management approaches are not sufficient to deliver value-based healthcare. Supplementing EHRs with advanced PHM technology and a scalable care management approach gives health systems proactive and longitudinal insights that optimize scarce resources in meeting the needs of multiple types of patients. This webinar will address the key characteristics of a digital platform for value-based care management, cover the planning and deployment of a scalable care management strategy, and review patient experience scenarios for CHF and diabetes.

July 31 (Wednesday) 1:00 ET. “Modern Imaging Technology for the Enterprise: Mercy’s Approach That Improved Imaging Cost, Speed, Capacity, and Care Quality.” Sponsor: Mercy Technology Services. Presenter: Jim Best, executive health IT consultant, Mercy Technology Services. Enterprise imaging has become as critical as EHRs for transforming patient care, but many health systems are struggling with the limitations and costs of dated, disconnected PACS even as imaging volumes grow and radiologists report increasing levels of burnout. Radiologists at Mercy were frustrated by its nine disparate PACS, which required them to toggle between workstations, deal with slowdowns and poor reliability, and work around the inability to see the complete set of a patient’s prior images, even as demands for quick turnaround increased. In this webinar, MTS — the technical backbone of Mercy — will describe the lessons they learned in moving to a new best-of-breed PACS platform that increased radiology efficiency by 30%, with the next phase being to take advantage of new capabilities by eliminating third-party reading services and distributing workload across radiology departments to improve efficiency, capacity, and timely patient care.

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


Sales

  • Philippines-based, two-hospital St. Luke’s Medical Center chooses Allscripts Sunrise.
  • Eight Prime Healthcare hospitals in California join the non-profit Manifest MedEx HIE, joining the seven Prime hospitals that are already members.
  • The Reliance EHealth Collaborative is deploying the virtual health record of Imat Solutions to enhance provider engagement and to add claims and pharmacy fill data for care coordination.

People

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Clinical decision support vendor EvidenceCare hires Shawn Kircher (Idemia) as CTO and Steve Starkey (Medhost) as CIO.

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Tom Neufelder (Philips) joins MaxQ AI as CTO.


Announcements and Implementations

In England, NHS’s digital service manual team will hold a show-and-tell Thursday on YouTube (and live in London) to describe its work so far in developing design principles, accessibility, content style, user interface style, and prototyping. That’s a 6 a.m. ET start for US YouTube live-streamers, although I expect they will archive the video. 

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Optimum Healthcare IT completes the Epic go-live of North Mississippi Health Services.

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Collective Medical’s care collaboration platform will alert providers when a patient who has a documented history of threatening or assaulting other providers presents at a hospital, ED, or other point of care.

SimplifiMed goes live with its NextGen-integrated chatbot that allows providers to engage patients (appointment reminders, recall, no-show follow-up, reviews) via two-way SMS in over 100 languages.


Government and Politics

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India’s health ministry publishes a draft of its National Digital Health Blueprint for public comment, proposing to use the government’s identifier for healthcare and giving citizens access to their heath data within five clicks. The government also hopes to publish de-identified data from its new health insurance program as it moves toward universal health coverage.


Other

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UCSF researchers post an open protocol describing how they plan to study the effectiveness a particular treatment, which is notable because (a) it uses the Protocols.io open collaboration platform to create and manage the protocol and to solicit feedback; (b) it spells out in detail how UCSF plans to extract information from Epic to perform the study; (c) the study will be performed using EHR data; and (d) the completed protocol can be downloaded and used by any other organization.

Memorial Sloan Kettering Cancer Center researchers find that unsupervised AI that looks only at whole slide pathology images and patient diagnoses can accurately identify the 75% of slides that do not require manual annotations. Recent work on unsupervised AI has delivered fascinating results in simply letting the machine “learn” by figuring out the data thrown at it rather than having a human tell it what to look for.  

In Sweden, a self-guided drone completes its first delivery between two hospitals, choosing its landing spot visually at the end of its three-mile journey since the courtyard is between tall buildings and is thus GPS-denied (not mapped by GPS).

I missed this a couple of weeks ago. A new Florida law that took effect July 1 allows out-of-state doctors to conduct virtual visits with in-state patients for a one-time $150 registration fee. As a result, Humana has launched a telemedicine-heavy health plan for Florida residents that reduces premiums by 20%, provides free video consultations, and raises the co-pay for office visits. MDLive’s Lyle Berkowitz, MD was quoted as saying that virtual visits are like Netflix compared to the Blockbuster-like experience of going to a doctor’s office.


Sponsor Updates

  • Atlanta-based Advanced Technology Development Center will offer startups in its health technology program access to Redox’s integration platform.
  • Health IT reseller Microwize Technology offers Aprima EHR and practice management software from EMDs.
  • CoverMyMeds will exhibit at Integrated 2019 July 22-23 in Philadelphia.
  • Diameter Health will exhibit at the NCQA Digital Quality Summit 2019 July 16-18 in Boston.
  • Docent Health publishes a new report, “Patient Navigation: Leading the New Wave of Healthcare Consumerism.”

Blog Posts


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Morning Headlines 7/16/19

July 15, 2019 Headlines No Comments

Healthcare startup Livongo is gearing up to go public at a valuation of up to $2.4 billion. Here are the execs and investors who stand to benefit the most.

Diabetes monitoring technology vendor Livongo updates its SEC filing, indicating that CEO Zane Burke’s shares could be worth as much as $23 million, while Chairman Glen Tullman holds shares worth $87 million and the venture firm he co-founded with Lee Shapiro holds another $129 million worth at the top of the IPO range.

SPH and SA Ignite Partner to Strengthen Quality Payment Program Offerings for Value-Based Healthcare Organizations

Population health management technology vendor SPH Analytics will acquire SA Ignite, which offers analytics to improve federal value-based care payments.

A Statement from Our CEO

Surescripts files a motion to dismiss the Federal Trade Commission’s allegations of antitrust behavior in the electronic prescribing market.

Morning Headlines 7/15/19

July 14, 2019 Headlines No Comments

Baring Private Equity Asia to buy CitiusTech

Hong Kong-based Baring Private Equity Asia will acquire CitiusTech in a deal that values the healthcare consulting and technology company at $1 billion.

After $60M loss, New England health system plots plan for profitability

Covenant Health blames its fifth straight money-losing year on a prolonged Epic implementation that decreased hospital and practice productivity by 30%.

PeaceHealth confirms 50 layoffs across multiple PeaceHealth locations

PeaceHealth (WA) lays off 50 IT employees as it centralizes tech support following its Epic go-live three years ago.

Siemens Healthineers, University of Missouri System and University of Missouri Health Care announce formation of new strategic alliance

Siemens Healthineers will provide the University of Missouri System and University of Missouri Health Care with laboratory and imaging technology, enterprise services, and digital solutions through their new Alliance for Precision Health.

Monday Morning Update 7/15/19

July 14, 2019 News No Comments

Top News

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Hong Kong-based Baring Private Equity Asia will acquire CitiusTech in a deal that values the healthcare consulting and technology company at $1 billion.

General Atlantic owns 32% of the company and will make more than 3.5 times its 2014 investment of $111 million. The 3,000-employee company has $175 million in annual revenue and EBITDA of $60 million.

CitiusTech executives Rizwan Koita and Jagdish Moorjani, along with employees, own the remainder of the company.

The transaction represents the largest involving an India-based health IT company.

I interviewed CEO Rizwan Koita a few months ago, mostly focusing on artificial intelligence and data science.


Reader Comments

From Unflagging Optimist: “Re: American healthcare as a business. Convince me in 10 words or fewer that it will be worse for me personally in my final days.” Here you go: “Venture capitalists own nursing homes, hospices, and funeral homes.” Imagine Gordon Gekko and those he hires attending to you in your moment of need, vulnerability, and inevitable departure from this mortal coil. I worked for a thankfully short time as a department head of an investor-owned, for-profit hospital chain and I can assure you that our motivation had little to do with patients or families. The interesting conundrum is that we’re all patients, just not simultaneously, so you would think we would demand a better system knowing that we and our families will eventually depend on it. Actually maybe I just answered my own cynicism – what we demand is two healthcare systems, one for those who have no financial recourse and a more exclusive one for those who can afford it. I’m pretty sure health system executives follow a different track than the unwashed masses when they are seen as patients in their own organizations (or use their financial clout to go somewhere better).


HIStalk Announcements and Requests

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Health Catalyst is the IPO stock favored by 42% of poll respondents, beating out Livongo.

New poll to your right or here: what’s better about your life now compared to five years ago?

I’ve been enjoying Pluto TV on the Roku without noticing that it has an app – you can stream 100 live TV channels as well as on-demand moves and series for free and without even signing up first. Example: I’ve recently watched Joel-era episodes of “Mystery Science Theater 3000” (which has its own channel), a Pink Panther movie, live network news, and “No Reservations.” It’s funny how watching live TV rather than choosing on-demand streaming content in solitude has become an exercise in nostalgia, having something to do with the shared experience that went away when newspapers, network TV, and radio stations fell victim to more self-indulgent and asynchronous forms of mindless entertainment that we seek to fill our apparently unlimited leisure hours. Check it out soon because Viacom bought the channel for $340 million this past March, so I’m sure they will do what big acquirers do – screw up what made it interesting in the first place.


Webinars

July 18 (Thursday) 2:00 ET. “Healthcare’s Digital Front Door: Modernizing Medicine’s Mobile-First Strategies That Are Winning Patient Engagement.” Sponsor: Relatient. Presenters: Michele Perry, CEO, Relatient; Michael Rivers, MD, director of EMA Ophthalmology, Modernizing Medicine. Providers are understandably focused on how to make the most of the 5-8 minutes they have on average with a patient during an exam, but what happens between appointments also plays a significant role in the overall health of patients. Modernizing Medicine is driving high patient engagement with best practice, mobile-first strategies. This webinar will describe patient engagement and the challenges in delivering it, how consumerism is changing healthcare, and how to get started and navigate the patient engagement marketplace.

July 25 (Thursday) 2:00 ET. “Meeting patient needs across the continuum of care.” Sponsor: Philips Population Health Management. Presenters: Cindy Gaines, chief nursing officer, Philips Population Health Management; Cynthia Burghard, research director of value-based healthcare IT transformation strategies, IDC. Traditional care management approaches are not sufficient to deliver value-based healthcare. Supplementing EHRs with advanced PHM technology and a scalable care management approach gives health systems proactive and longitudinal insights that optimize scarce resources in meeting the needs of multiple types of patients. This webinar will address the key characteristics of a digital platform for value-based care management, cover the planning and deployment of a scalable care management strategy, and review patient experience scenarios for CHF and diabetes.

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


People

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UPMC Pinnacle promotes Lou Baverso to president of its Cumberland Region. He was VP/CIO of Magee-Women’s Hospital from 1997-2011 after working his way up from IT project manager and then director there. The Cumberland Region includes UPMC Pinnacle West Shore and UPMC Carlisle.


Government and Politics

Shares of drug companies, dialysis chains, and pharmacy benefit management owners surged this week after three White House plans to lower prices stumbled. A judge ruled that the White House does not have the authority to force drug companies to disclose prices in commercials, the President announced his intention to reduce dialysis cost while including no specifics, and the White House’s plan to eliminate drug rebates was scrapped over fears that prices would rise at least temporarily in an election year.


Other

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Kaiser Health News covers EHR-integrated prescription pricing tools, noting that while they can help patients save a lot of money and thus improve their medication adherence, few doctors use them and they don’t work for the many patients whose pharmacy benefit management companies decline to participate.

Researchers successfully apply deep learning to patient demographics and clinical notes to predict the mortality of people with dementia so they can be referred to palliative care.

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Covenant Health blames its fifth straight money-losing year on a prolonged Epic implementation that decreased hospital and practice productivity by 30%. The New England system, which posted a $61 million operating loss for 2018, is spending $83 million to implement Epic. They must have come up with other excuses for the remainder of the five-year string of losses since (a) they have replaced most of the executive team; and (b) Epic only went live in 2018.

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PeaceHealth lays off 50 IT employees as it centralizes tech support following its Epic go-live three years ago.

A Lancet article says the “scarcity loop” – a common belief that society can never deliver or afford enough healthcare services – has encouraged doctors to make “health” synonymous with “consuming more resources.” The authors say this mindset has steered doctors into treating every patient as a simple list of physical complaints in trying to help them live longer instead of supporting their need to lead a more meaningful life. It urges “acts of resistance” in developing relationships with patients, choosing practices in which they make longitudinal rather than transactional commitments, and to stop thinking that people could be healthier if they had unlimited access to medications, surgery, and other interventions. It observes that that people in high-income countries are as consumption-driven in eating and land ownership as they are in healthcare.


Sponsor Updates

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  • Pivot Point Consulting employees pack books for kids in their local Nashville community.
  • OmniSys will exhibit at Cardinal Health RBC July 17-20 in Nashville.
  • EClinicalWorks publishes a podcast titled “Interoperability: The Key to Complete Patient Information.”

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Weekender 7/12/19

July 12, 2019 Weekender 2 Comments

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Weekly News Recap

  • Corepoint Health and Rhapsody merge.
  • Waystar acquires Digitize.AI.
  • OmniSys acquires Strand Clinical Technologies.
  • Provident St. Joseph Health and Microsoft announce plans to turn a Seattle-area hospital into a Microsoft-powered “hospital of the future.”
  • IBM closes its $34 billion acquisition of Red Hat.
  • ONC announces that Executive Director Steve Posnack, MS, MHS will become deputy national coordinator when Jon White, MD steps down in mid-August.
  • Providence St. Joseph Health says it plans to create a billion-dollar business from its Engage, Bluetree, Epic Community Connect, and other non-clinical projects, also noting that it will replace Meditech in its acquired hospitals that are using it.

Best Reader Comments

As a customer, we had contractual requirements to stay at Current or Current-1 versions, 20+ years ago. IIRC, you could still run on even older versions but there was a maintenance fee premium to pay then. I’ve always thought this type of agreement struck a fair balance. It allows customers to keep the doors open and lights on even under difficult conditions. Meanwhile it creates a clear incentive to stay current and shows that the vendor places significant value on doing so. (Brian Too)

Another hospital of the future! Guess we were overdue for another new one. Twenty years from now if someone as industrious as Vince Ciotti wants to write the next history of EMR/HIS, all they will have to do is take Vince’s PowerPoints and put in the new vendor names. I hate too say it, but after 40+ years in the healthcare IT world, information technology can’t reform healthcare. People created this mess and only people (not computers, software, AI, or blockchain) can fix it. (Frank Poggio)

As a physician, I am sure you’d like it much more if someone else input factors about your patient into the EHR. Preferably someone who is not two steps removed from the source of the information. How about the patient? Citing Neal Patterson as Mr. H did just today, make the patient truly part of the team, not just an observer through a read-only portal. (Harry Solomon)

The intense rivalry among EHR venders made Epic, Allscripts, Meditech, and the others to push their limits to give providers the tools save lives, make patients healthier, and standardize processes. The healthcare industry would not been the same if it weren’t for Neal and his life’s work. His legacy reaches beyond Cerner. It’s deep within the clients, competitors, and his many protégés. R.I.P. Mr. Patterson. (King Solomon)

Providence would be far better off buying minority stock in a company and collecting dividends or getting an ROI after an acquisition. Hospitals do not know how to run for-profit tech companies. They do not have the stamina or the unique management acumen. The old adage of “stick to your knitting” really applies here. I guarantee in about 3-5 years they will have either closed it down or sold it off at a loss. (Frank Poggio)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. H in Texas, who asked for math manipulatives for her kindergarten class. She reports, “I want to start off by saying thank you for choosing my project to donate to. The students have really enjoyed the learning materials. I use the new resources during guided math time with my students who need enrichment for adding and subtracting. We use the materials so that the students would be able to add and/or subtract with objects or manipulatives. I have also used the materials in stations. When I told the students that they where getting new materials for stations, they were all super excited. When the students saw the materials, they were shouting with joy.”

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Flatiron Health’s 34-year-old CEO Nat Turner, who sold his oncology tech company to Merck for $1.9 billion in early 2018, buys a $19.5 million New York City penthouse.

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A former developer of theme park ride robots is developing teaching simulators for Boston Children’s Hospital, creating robotic trainers for practicing cleft palate surgery, gunshot wound treatment, and abdominal surgery.  

Dell Medical School researchers develop a scheduling system to accommodate its new clinic model in which patients who need to see multiple doctors remain in one office and the clinicians come to them. The medical school staff used mathematical models of actual patient visits along with clinician interviews to eliminate the multiple visits and extended time required when patients are referred in the Musculoskeletal Institute at UT Health Austin. 

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American Airlines apologizes to Tisha Rowe, MD, MBA and promises to hire a chief inclusion and diversity officer after a flight attendant insisted that she cover herself on a flight from Jamaica to Miami. She founded telemedicine provider The Rowe Network, sells online nutrition consultations, and wrote an inspirational book for girls book titled “B is for Bossy.”

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Another attention-seeking idiot makes a video involving licking something and placing then it back on the shelf, this time a 30-year-old woman who recorded her 10-year-old daughter licking a tongue depressor and then placing it back in the jar in a Florida clinic’s exam room. The pair are shown in the video pointing to the “please do not touch medical supplies” sign, then captioning the resulting Snapchat video, “Don’t tell me how to live my life.” The mother, who explained that “I was just being silly with my kids,” was charged with felony tampering with a consumer product.


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Morning Headlines 7/12/19

July 11, 2019 Headlines No Comments

PerfectServe Names Healthcare and Technology Veteran Guillaume Castel as New CEO, Appoints Terry Edwards as Chairman of the Board

Guillaume Castel (Inova Health System) replaces Terry Edwards as CEO of PerfectServe.

Notification of protected health information breach

Essentia Health (MN) notifies 1,000 patients that their personal data may have been compromised during an email phishing incident at its billing services vendor, Nemadji Research.

WellSky Celebrates Grand Opening of New World Headquarters and Announces Inaugural WellSky Foundation Recipient

WellSky (the former Mediware Information Systems) celebrates the opening of its new headquarters in Kansas with a $50,000 donation to local provider Midland Care Connection.

23andMe is moving into Apple’s territory with a pilot to pull in medical data, not just DNA

23andMe gives a subset of customers the ability to add lab results, medication information, and medical history to their genetic data through the Human API medical data network.

News 7/12/19

July 11, 2019 News 2 Comments

Top News

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Health data integration and exchange companies Corepoint Health and Rhapsody will merge.

Orion Health sold off a 75% share of its Rhapsody business last year for $137 million to private equity firm Hg, which also has a stake in Corepoint. Orion Health has since repositioned itself as a population health management technology vendor.


Webinars

July 18 (Thursday) 2:00 ET. “Healthcare’s Digital Front Door: Modernizing Medicine’s Mobile-First Strategies That Are Winning Patient Engagement.” Sponsor: Relatient. Presenters: Michele Perry, CEO, Relatient; Michael Rivers, MD, director of EMA Ophthalmology, Modernizing Medicine. Providers are understandably focused on how to make the most of the 5-8 minutes they have on average with a patient during an exam, but what happens between appointments also plays a significant role in the overall health of patients. Modernizing Medicine is driving high patient engagement with best practice, mobile-first strategies. This webinar will describe patient engagement and the challenges in delivering it, how consumerism is changing healthcare, and how to get started and navigate the patient engagement marketplace.

July 25 (Thursday) 2:00 ET. “Meeting patient needs across the continuum of care.” Sponsor: Philips Population Health Management. Presenters: Cindy Gaines, chief nursing officer, Philips Population Health Management; Cynthia Burghard, research director of value-based healthcare IT transformation strategies, IDC. Traditional care management approaches are not sufficient to deliver value-based healthcare. Supplementing EHRs with advanced PHM technology and a scalable care management approach gives health systems proactive and longitudinal insights that optimize scarce resources in meeting the needs of multiple types of patients. This webinar will address the key characteristics of a digital platform for value-based care management, cover the planning and deployment of a scalable care management strategy, and review patient experience scenarios for CHF and diabetes.

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


Acquisitions, Funding, Business, and Stock

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Waystar acquires prior authorization automation startup Digitize.AI.

Nashville-based healthcare data analytics business Stratasan raises $26 million.

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Some nuggets from the always-fascinating and sometimes poetic midyear market report from Healthcare Growth Partners:

  • More companies are for sale than we hear about, as they discretely and sometimes informally test the waters to see what price they might attract. Sometimes this results in a quick company sale without the usual auction process, which also allows the selling company to complete a deal without admitting publicly that their own valuation was a stretch. 
  • Deals that close at a high price introduce “survivorship bias,” where potential sellers think their companies are worth more because a higher-quality company attracted a high selling price. This encourages them to pass up reasonable deals that don’t match their fantasy number.
  • A 20-year backlog exists of health companies that are backed by private equity and haven’t yet reached a liquidity event.
  • A startling 82% of health IT transactions involved bootstrapped sellers, while PE-backed companies must hit a higher valuation because investment valuations are higher than M&A valuations.
  • HGP concludes that the rising supply of available health IT companies will be resolved only if sellers hit performance levels that are in line with their valuation expectations or more potential buyers enter the market.
  • Health IT companies that earn high valuations have these characteristics: (a) they use SaaS architecture that creates scale and recurring revenue; (b) their business model involves making money only when customers achieve ROI; (c) they can acquire customers efficiently; (d) they retain data rights; (e) they sell healthcare reform-centric products; and (f) they seek a selling price that aligns with the company’s market leadership and profit.
  • Big publicly traded winners (in terms of share price) in the first half of 2019 are EHealth, Invitae, Streamline Health Solutions, while the big losers are Evolent Health, Care.com, and Benefitfocus.
  • Four companies plan to IPO this year (Health Catalyst, Peloton, Phreesia, and Livingo Health) and Change Healthcare has already done so, ending the 2017-2018 drought in which no health IT companies went public.

Sales

  • Emory Healthcare selects MedCurrent’s OrderWise clinical decision support software for medical imaging orders.
  • Mercyhealth will implement EndoTool insulin dosing software from Monarch Medical Technologies at its facilities in Illinois and Wisconsin.
  • Cerner will take over revenue cycle management at its IT outsourcing client Medical Center Hospital (TX).
  • Dana-Farber Cancer Institute (MA), San Antonio Regional Hospital (CA), and Summit Medical Group select release-of-information software and services from Ciox Health.
  • Choctaw Nation Health Services Authority (OK) will deploy Wellsoft’s EDIS technology.

People

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Guillaume Castel (Inova Health System) replaces Terry Edwards as CEO of PerfectServe. Edwards will transition to chairman of the board.

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James Wellman (Comanche County Memorial Hospital) joins Blanchard Valley Health System (OH) as CIO.

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Redox names Elif Eracar (American Well) chief customer officer and Ben Waugh (Twilio) chief security officer.


Announcements and Implementations

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Geisinger Health System (PA) will implement Medial EarlySign’s LGI-Flag software to help providers more quickly identify patients at risk for lower gastrointestinal disorders. Geisinger’s Steele Institute for Health Innovation will work with the company to develop and deploy similar technology for other diseases.

The State of Louisiana goes live on an end-of-life care planning registry developed with the Louisiana Health Care Quality Forum using software from Vynca. The company announced a $10 million Series B funding round last month.

Novant Health (NC) moves its Epic system to Virtustream’s hosting service.

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Tanner Health System goes live on Epic in its ambulatory locations, with its five hospitals to follow in November.


Government and Politics

Amazon’s Alexa serves up information from the NHS website when patients in the UK ask it health-related questions.


Privacy and Security

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Wickenburg Community Hospital (AZ) reveals that it was the victim of a Ryuk ransomware attack on June 28 that impacted its phone system and shared files. Rather than pay the ransom, it worked with its technical team and vendors to restore functionality.


Other

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A Spok survey of 470 clinical hospital staff finds that an overwhelming majority believe increased or ineffective technology contributes to burnout. Sixty-five percent say their organization doesn’t focus on or offer resources to address burnout. While 95% believe that addressing EHR usability will alleviate burnout, only 30% work at organizations that are attempting to do so.

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Healthcare executives cite improved quality and satisfaction, reduced costs, and growth and higher revenue as top benefits of patient navigation programs, according to a Docent Health survey. Top patient navigation technologies include phone calls, EHRs, and portals. Text messaging and CRM software seem underused, with slightly more than a third of respondents using each.

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Experts question whether private equity firm Paladin Healthcare bought Hahnemann University Hospital last year with lip service about patient care, but with every intention of closing the money-losing facility and selling off its prime real estate to the highest bidder, a strategy that PE firms have used in taking positions in dying businesses such as Marsh Supermarkets and Sears. Paladin also bought hospitals in Los Angeles, Philadelphia, and Washington, DC that mostly serve public assistance patients. It has made few capital improvements and has not rounded out its portfolio with profitable hospitals. Hahnemann’s bankruptcy filing does not include real estate, so the PE company is free offer the property to developers once the hospital closes in September, just 18 months after it paid Tenet $170 million for Hahnemann and St. Christopher’s Hospital for Children. A private equity expert summarizes:

This is an industry where once somebody does this successfully, lots of other private equity firms will follow. You just have to think to yourself how many hospitals are in gentrifying neighborhoods in urban America, where the property is worth a lot more than the hospital itself.


Sponsor Updates

  • EclinicalWorks will exhibit at the 2019 FSASC Annual Conference & Trade Show July 17-18 in Orlando.
  • Penn National Insurance selects Goliath Technologies for its virtual workspace initiative.
  • Vocera President and CEO Brent Lang joins the Forbes Technology Council.
  • Wolters Kluwer Health reports that 700 hospitals in 25 countries now use its UpToDate Advanced interactive clinical pathways.

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Reader Comments

  • Scot Silverstein MD: I can say, unfortunately, with an exceptional degree of confidence that patients are harmed by events such as we describ...
  • Clinton Phillips: Thank you Dr. Jayne for the Veterans Operation 11/11 shout out. Medici is excited to see how many veterans we can help a...
  • @henryjones: Again what evidence do you have here that you "know that Epic demands more redactions and secrecy than other EHR vendor"...
  • Mr. HIStalk: Vikas Chowdhry gets all the credit for interviewing Dr. Bhavan. He volunteered to conduct interviews, of which this is h...
  • Expressyourself: I think the sensor part is referring to sending when you open or are in a patient's chart. Then they probably use that t...
  • Matt Ethington: This is inspiring and has so much more potential for healthcare. So many new reimbursements focus on patient engagement...
  • Eddy T. Head: "Patented sensor-based software technology in use at health systems and practices delivers actionable patient data to pr...
  • Code Jockey: Mr. HIS - you, once again, do this world a great service. For me personally I'll say thanks for posting to a document th...
  • Vaporware?: re: Queensland's Cerner project * Delayed ... check * Over budget ... check * "Not fit for purpose" ... check * Buye...
  • E!: Agreed. Epic is just generally anti-worker with their regular labor violations, over aggressive non-compete, etc....

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