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Morning Headlines 2/22/19

February 21, 2019 Headlines No Comments

Allscripts announces fourth quarter and 2018 full-year results

Allscripts announces Q4 results: revenue up 17 percent, adjusted EPS $0.20 vs. $0.18, falling short of Wall Street expectations for both.

The U.S. government and Facebook are negotiating a record, multibillion-dollar fine for the company’s privacy lapses

The FTC is in negotiations with Facebook over a multi-billion dollar fine that would put a stop to the agency’s nearly year-long investigation into the social media giant’s privacy practices.

China Uses DNA to Track Its People, With the Help of American Expertise

Thermo Fisher will stop selling its DNA testing equipment to China after discovering its government is secretly collecting the DNA of a predominantly Muslim ethic group and adding it to a surveillance database.

“She Never Looks Back”: Inside Elizabeth Holmes’s Chilling Final Months at Theranos

Vanity Fair recounts the icy atmosphere at Theranos during its final months, including the eerily chipper mood and lavish spending habits of CEO Elizabeth Holmes.

News 2/22/19

February 21, 2019 News 2 Comments

Top News

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Allscripts announces Q4 results: revenue up 17 percent, adjusted EPS $0.20 vs. $0.18, falling short of Wall Street expectations for both.

Shares dropped 8 percent in after-hours trading following the announcement.

MDRX shares are down 12 percent in the past year vs. the Nasdaq’s 3 percent gain.


Reader Comments

From Dr Ølsson: “Re: Epic in Denmark. Majority of doctors want to get rid of the Epic platform according to this January 23 article. Heaps of problems with medications and patients harmed. I do not understand how this company is the best of America.” Planned health reform in Denmark pushes the idea of a single IT system for the country instead of five regions making their own decisions, with 62 percent of doctors polled in the Capital Region where Epic is installed saying they are dissatisfied. The Central Denmark region of the Danish health service uses Systematic, and some think it has fewer problems and should therefore become the single hospital system.


HIStalk Announcements and Requests

We’re down to half a full complement of Monkees (aka “the pre-fab four” that were cast as TV actors while leaving the musical work to session players) as bass player Peter Tork has died at 77, presumably of the adenoid cystic carcinoma with which he was diagnosed in 2009.


Webinars

March 6 (Wednesday) 1:00 ET. “Pairing a High-Tech Clinical Logistics Center with a Communication Platform for Quick Patient Response.” Sponsored by Voalte. Presenters: James Schnatterer, MBA, clinical applications manager, Nemours Children’s Health; Mark Chamberlain, clinical applications analyst, Nemours Children’s Health. Medics at Nemours Children’s Health track vital signs of patients in Florida and Delaware from one central hub, acting as eyes and ears when a nurse is away from the bedside. Close monitoring 24 hours a day integrates data from the electronic health record, such as critical lab results, and routes physiological monitor and nurse call alerts directly to the appropriate caregiver’s smartphone. This session explores how the Clinical Logistics Center and more than 1,600 Zebra TC51-HC Touch Computers running Voalte Platform connect care teams at two geographically dispersed sites for better patient safety and the best possible outcomes.

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


Acquisitions, Funding, Business, and Stock

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Inovalon announces Q4 results: revenue up 19 percent, adjusted EPS $0.05 vs. $0.06, missing Wall Street expectations for both. Shares dropped 13 percent Thursday after the midday earnings announcement. They are up 15 percent in the past year vs. the Nasdaq’s 3 percent gain.

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Health IT’s web of vendor consolidation grows more tangled. A week after announcing it was looking for a buyer, Veritas Capital sells workforce management software company API Healthcare it to Symplr. API Healthcare has run through a number of hands, selling to Francisco Partners in 2008, nearly selling to competitor Kronos in 2011, and then to GE Healthcare in 2014. Veritas acquired it last year when GE sold off its Value-Based Care Division for $1 billion.

Stat reports in a paywalled piece that the main goal of the Amazon – Berkshire Hathaway – JPMorgan Chase joint healthcare venture is to make health insurance “more intelligible” and prescription drug prices less opaque. COO Jack Stoddard, testifying at a hearing on trade secrets brought about by Optum, said, “You can imagine our employers are … incredibly allergic to market inefficiencies.”

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Garfield County Hospital District (WA) CEO Julia Leonard says a nearly $1 million shortfall caused by the billing inefficiencies of the hospital’s new EHR has contributed to her decision to drastically cut staff and operating hours. The 25-bed rural hospital – the smallest in the state – seems to have consistently faced financial difficulties over the last several years, including MU penalties. It appears the district uses Athenahealth for inpatient and NextGen for outpatient services.

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Harris Computer Systems acquires long-term and post-acute care health IT vendor Collain Healthcare.


People

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Dan Monahan (Change Healthcare) joins MDLive as COO and CFO.


Sales

  • Mon Health will implement InteliPass RCM software and services from PatientMatters across its facilities in West Virginia and Pennsylvania.

Announcements and Implementations

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Imprivata announces GA of Proximity Aware, a Bluetooth-enabled solution that ensures PHI is protected on shared workstations.

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A new KLAS report on legacy data archiving lists MediQuant, Harmony Healthcare IT, and Legacy Data Access as having broad expertise, with MediQuant scoring highest in customer satisfaction. Ellkay scores high in customer satisfaction as it gains experiencing in moving beyond its initial focus of ambulatory clinical data.

Marshfield Clinic Health System (WI) launches a telehealth program for patients at its Heart Failure Improvement Clinic using software from Health Recovery Solutions.


Government and Politics

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HHS is hiring for a director of its information security and privacy group, who will also act as CMS CISO. The Baltimore-based position pays between $126,000 and $189,000.


Privacy and Security

In Ontario, the Toronto paper notes that an unnamed vendor of a EHR system used there is selling anonymized patient data to IQVIA, which uses it in pharmaceutical marketing.

UW Medicine (WA) notifies 974,000 patients of a data breach that occurred when internal files were inadvertently made public on the Internet via an unprotected server. A patient Googling themselves found the files and notified the health system.

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In Arizona, legal disagreements between the creditors of shuttered Florence Hospital at Anthem and Gilbert Hospital keep medical records wrapped up in red tape, preventing many patients from moving forward with treatment elsewhere. The records have been in limbo since the hospitals, both owned by New Vision Health, declared bankruptcy and closed last summer. Medhost, which repossessed the EHR servers after the hospitals closed, claims it gave patients access to their records six months after terminating its contract. Patients, however, say Medhost is holding the files hostage in lieu of an estimated $100,000 payment. The judge overseeing the legal wrangling says the records can’t be given to patients because of “the estate’s lack of funding, unilateral actions taken by creditors, technological challenges associated with migrating electronically-stored medical records, and other factors.”

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The Washington Post reports that the FTC is in negotiations with Facebook over a multi-billion dollar fine that would put a stop to the agency’s nearly year-long investigation into the social media giant’s privacy practices. The biggest fine the FTC has ever imposed for similar infractions was the $22.5 million Google paid in 2012.


Other

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Kaiser Permanente’s new School of Medicine in California will offer its first five graduating classes free tuition in an effort to attract future professionals who won’t feel financially obligated to opt for higher-paying positions after graduation. NYU’s medical school announced similar plans last fall. Both organizations hope to encourage more students to pursue lower-paying callings like primary care that are facing nationwide staffing shortages.

China is offering “Physicals for All” to a predominantly Muslim ethnic group in one region that involves secretly collecting their DNA and adding it to a surveillance database. The program collected and catalogued DNA samples from 36 million people, some of them told by the government that participation was not optional. Hundreds of thousands of ethnic group members have been held in what the government calls job training camps, where DNA was also taken. Massachusetts-based DNA testing company Thermo Fisher will stop selling its equipment to the part of China that is conducting the tracking campaign. The company was receiving DNA samples in return that were added to a global database, raising consent issues. 


Sponsor Updates

  • EClinicalWorks will exhibit at the American Academy Allergy Asthma & Immunology Annual Meeting February 22-25 in San Francisco.
  • EPSi will exhibit at the Region V Dixie Institute February 24-27 in Mobile, AL.
  • The HCI Group publishes a new white paper, “Designing Smart Hospitals and Patient Rooms with 5G.”
  • Healthgrades announces America’s Best Hospitals.
  • Imat Solutions launches new health data platform Imat 8.0.
  • SyTrue creates an explainer video covering medical record audits for health plans.
  • Imprivata partners with Google Cloud to enable single sign-on access to Chrome devices.
  • The InterSystems Iris for Health Data Platform is now available on the AWS Marketplace, and on all major cloud providers.
  • IMO announces availability of Periop IT content through Epic’s Foundation System.
  • Herb Smaltz (CIO Consult) joins The Chartis Group’s Information & Technology Practice as director.
  • E4 will offer NextGate’s Enterprise Master Patient Index as part of its HIM and data-cleanup services.
  • Humana’s North Carolina Medicare Advantage plan will use PatientPing’s real-time patient alert technology.
  • Cooper University Health Care (NJ) renews its care management contract with CarePort Health and adds CarePort’s Connect and Insight capabilities.
  • Health Catalyst congratulates Thibodaux Regional Medical Center (LA) on being named a Top Innovation winner in its Patient Safety & Quality Healthcare Innovation Award program.
  • Meditech will host its Strategic Leadership Summit April 3-4 in Marina Del Ray, CA.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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Contact us.

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EPtalk by Dr. Jayne 2/21/19

February 21, 2019 Dr. Jayne 9 Comments

We’re officially post-HIMSS, because the emails have started arriving thanking me for my interest in various vendors’ products after I stopped by their booths at the show. Folks have had time to decompress and begin sorting through various business cards that were traded and notes that were made about follow up. 

I have my own stack of cards to go through, following up on new connections and seeing what opportunities might arise from the conference. As summer approaches, I tend to start putting together my strategic plan for the upcoming year. I’ve had some tempting offers to go back into the hospital trenches as well as some interest from the vendor side, so this might be a year full of change.

Normally I don’t spend a lot of time reading things from Healthcare IT News, but their interview with Judy Faulkner caught my eye. Part of the conversation was around physician burnout and relative happiness (or unhappiness) with EHRs. She brought up some good points that many of us in the trenches already know, but that large organizations seem to tune out at times. One of those points is that although EHR use can be associated with physician burnout, it’s not necessarily causal. There are burned out physicians that are happy with their EHRs, and EHR-haters that aren’t burned out. Other factors influence burnout including administrative burden, leadership issues, patient load, and work-life balance issues.

She also notes that clients need to stay current with their EHRs, installing the latest versions so they can benefit from usability enhancements that followed the post-Meaningful Use programming era. I’ve found that to be true with nearly all the vendors I’ve worked with, not just Epic. Once they cleared the certification hurdles, vendors often went back to customer enhancement request lists and started making good on old promises.

Another point she made was around training. Physicians that tend to do better with EHR adoption are likely to have had better training. That doesn’t always mean more hours of training, but it could mean more focused training or role-specific training, using the physicians’ time wisely and training them on the tasks they are most likely to perform in their work.

She calls for physician subspecialists to train their peers. That’s great in theory, but it’s not very easy to find physicians who want to dedicate themselves to learning how to train other physicians how to use the EHR. I’ve worked to mentor multiple CMIOs in this regard and not everyone has the aptitude or personality to be a trainer even if they want to do it, even when the hospital is willing to compensate them appropriately. In too many cases the compensation, isn’t remotely adequate, so it becomes a non-issue.

Faulkner does mention the idea of EHR personalization as a positive factor towards EHR happiness. She notes that it’s a challenge to convince health systems to do that for their physicians. My take on it is that it’s not just an Epic issue, but happens with most vendors and most health systems. It can also vary based on the degree of autonomy held by physicians outside the EHR.

One hospital I work with keeps its employed physicians on what many would consider a short leash. They’re fanatical about quality and reducing unnecessary variation, so physicians are expected to use order sets and standardized workflows. They’re incented on following the rules. Generally, people comply or they leave. The users tend to be satisfied with the EHR because they know what to expect and they know the rules of the game they’re playing.

At other organizations where there may be lots of competition for attending physicians’ patient volumes, I’ve seen hospitals bend over backwards to customize the EHR on an individual physician basis for fear that someone will take their surgical business elsewhere. This can lead to redundancy and confusion in order sets and workflows and costs more to maintain, but the organization feels it’s worth it. There’s definitely a need for vendors to make their systems easier to personalize and to allow user-level configuration rather than having to have IT teams involved in making small adjustments.

She goes on to note some data from KLAS that looks at EHR happiness and whether the health system is “agile,” meaning “If a physician wants a change made and talks to an IT person, how many committees does it have to go through? And if the answer is zero, that’s good.”

I understand the sentiment, but for those who haven’t waded into the muck that is EHR or IT governance, it’s an oversimplification. I’ve done hundreds of hours of work for hospitals and health systems “undoing” various changes that were made without any level of approval (and often without any documentation). Oversight isn’t a bad thing, but has to be crafted carefully to support the needs of the user and the goals of the organization. There should be a decision matrix that shows what kind of changes need what kinds of approval, and from whom. Simple things that don’t have downstream ramifications should happen quickly, where more complex issues that might have far-reaching consequences might need multi-level oversight.

Assuming the interview is a relatively straight transcription and didn’t go through much editing, it shows the level of understanding and insight that Judy Faulkner has into some of the issues her clients are facing. I’ve interacted with C-levels at many vendors and some of them don’t seem to have as much understanding of the challenges their clients are facing and how it impacts the end users. Many of them are good at using sound bites, but when it comes to getting into the details, they become quiet.

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I’m approaching a milestone reunion for my medical school class, and one can’t help but think about how much it cost to get here. Some of my classmates are still paying off their loans. A recent planning committee get-together led to some conversation about free tuition being offered at some medical schools. The brand new Kaiser Permanente School of Medicine in California has announced that it will waive tuition for all years for the school’s first five classes of students.

This led to quite a bit of discussion on the fact that Kaiser Permanente is opening its own medical school, unaffiliated with any university. Depending on how much influence Kaiser Permanente has on the students and what facilities they rotate through, there may be significant difference from the educational opportunities received at other schools. The first class will be relatively small (48 students) and the school names three academic pillars: foundational science, clinical science, and health systems science (which they describe as focusing on care delivery including population health, quality improvement, and social inequality). Students will participate in longitudinal clerkships starting in year one, hosted in Kaiser Permanente hospitals and clinics along with community health centers. It will certainly be interesting to see how this plays out.

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I was in the office yesterday treating lots of folks with influenza. At one point, all nine of our exam rooms were occupied by people receiving IV fluids. The flu is hitting people hard. I had a great team working with me. However, at one point, I noticed that probably all of them were young enough to be my children.

This thought came back to me later in the day, when one of them was using the EHR to print a label for a blood draw and asked aloud, “What did we do before we had Dymo printers?” They looked at me like I was from Mars when I started to tell them about the Addressograph machine, with which we used to print headers on patient chart pages and various labels. One of my jobs as a Candy Striper on the mother-baby unit was to stamp new chart pages for all of the patients on the floor. It’s funny the things you forget as technology moves on, but I think I can still smell the ink when I think hard enough.

What’s your favorite piece of extinct technology? Leave a comment or email me.

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Email Dr. Jayne.

Morning Headlines 2/21/19

February 20, 2019 Headlines No Comments

Clearlake Capital-Backed symplr To Acquire API Healthcare

Provider management and credentialing software vendor Symplr will acquire workforce management tech company API Healthcare from Veritas Capital for an unspecified amount of money.

Unsealed testimony reveals a goal of Atul Gawande venture: ‘Make health insurance intelligible’

Jack Stoddard, COO of the Amazon-Berkshire Hathaway-JPMorgan Chase healthcare venture, reveals that one of its main goals is to make health insurance and prescription drug prices easier to understand.

Letter from the CEO: Proposal for Change

Garfield County Hospital District (WA) CEO Julia Leonard says a nearly $1 million shortfall caused by the billing inefficiencies of the hospital’s new EHR has contributed to her decision to drastically cut staff and operating hours.

Data error exposes patient information

UW Medicine (WA) notifies 974,000 patients of a data breach that occurred when internal files were inadvertently made public on the Internet via an unprotected server.

Arizona college student could die because she can’t get copies of her medical records

In Arizona, legal disagreements between bankrupt Florence Hospital at Anthem and Gilbert Hospital keep red tape wrapped around medical records, preventing many patients from moving forward with treatment elsewhere.

Readers Write: EMR Direction Changes in the Post-Growth Era

February 20, 2019 Readers Write 1 Comment

EMR Direction Changes in the Post-Growth Era
By John Kelly

John Kelly is principal business advisor for Edifecs of Bellevue, WA.

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Healthcare acquisitions and mergers tend to give the industry an indication of where investors will go in pursuit of new revenue streams to secure growth in future business. The $5.7 billion sale of Athenahealth is no different. This EMR vendor consolidation represents a significant milestone in what might be a segue toward an end state for the major electronic medical record (EMR) vendor market.

What does this mean for the rest of the EMR market? At the highest level, we may anticipate EMR technology to evolve as a commodity, while the services revenue enabled by the technology will emerge as the primary source of long-term sustainability for EMR vendors. The Athenahealth and Veritas Capital move is an indication that venture investors are thinking just that. This will have long-lasting implications for healthcare technology vendors industry-wide.

The Athenahealth acquisition specifically highlights the fact that the path for growth in software sales in the EMR market continues to narrow, as the vast majority of providers with meaningful spending power have already made the transition to electronic records. The rip-and-replace phase by providers dissatisfied by their first-generation EMRs will continue steadily, but will not compensate for the major decline in new sales opportunities for the industry at large.

With the GE / Athenahealth consolidation of assets, the growth outlook for the five major EMR vendors left in the space (Epic, Allscripts, Athenahealth, Meditech, and Cerner) looks a little different.

Though Athenahealth’s high profile as an EMR vendor provides the primary brand recognition, the revenues associated with its revenue cycle management (RCM) line of business still represents the major portion of its value. The future for EMR vendors will mirror other industries, wherein technology is provided at a small margin in order to capture the high value and healthy profits generated by the information and business processing services tied to the use of that technology.

Early evidence of an emerging trend was seen in the $2.7 billion 2016 acquisition of MedAssets by Pamplona Capital Management. There we witnessed how strategic investors are keenly aware that administrative inefficiencies in healthcare still present big opportunities for gain-sharing on significant cost elimination initiatives. Veritas Capital has doubled down on this opportunity by recognizing the value in merging the RCM book of business at Athenahealth with the clinical software footprint from its GE assets acquisition. Further signaling this industry shift to garner new revenue by the top EHR vendors are the recent announcements by Meditech and Allscripts of their intention to implement consolidated managed services across their EMR and practice management software and services stacks.

The fact is, providers are paying billions of dollars to third-party vendors in outsourcing their RCM activities. Bill-and-chase is costing the providers between 6 percent and 13 percent of receivables (varies by practice setting and size). If the industry can bring those costs closer to the 2-3 percent spread, seen in industries like retail, both vendors and providers would be extremely happy. Outside investors see substantial opportunity here. As a result, EMR vendors left scrambling from the sharp decline in new system sales are beginning to consider a very different view of the future.

While there are many business decisions and regulatory changes that will impact revenue streams for payers, providers, and technology vendors alike, success and growth for EMR vendors in particular will be limited if they don’t embrace creative consolidation. The combination of Athenahealth’s medical records and revenue cycle technology with the existing Virence Health assets is not just a venture firm buying a major revenue cycle company with a great brand, but rather an intentional strategic move to change the nature of the EMR market, one that fosters continued growth and furthers technology stability across the industry.

Readers Write: Measuring to Drive Continuous Improvement in Digital Health Management

February 20, 2019 Readers Write No Comments

Measuring to Drive Continuous Improvement in Digital Health Management
By Mohammad Jouni

Mohammad Jouni, MS is is vice-president of engineering for Wellframe of Boston, MA.

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As health plans implement digital health management solutions to support the comprehensive needs of people outside the four walls, measurement is an increasing priority in order to quantify every aspect of the business and demonstrate tangible value. But measurement can also enable organizations to continuously identify areas for improvement, implement changes, and measure the effect.

The following examples are tangible ways data-driven improvements can take place from the individual patient level up to the executive board room.

Real-time interventions. A care manager noticed one patient’s falling medication adherence and reached out to ask about the issue. The patient explained she didn’t take her pills when she traveled on the weekends. The care manager mailed a new pill box, and her patient’s medication adherence rebounded to normal.

Daily improvements. Population reports indicated low comprehension of safe acetaminophen dosage. This finding, combined with the risk of misunderstanding medications, prompted a change in health education delivered directly after discharge to focus on safe dosing, resulting in an increase in patient-reported level of understanding.

Weekly staffing optimizations. Supervisors reduced the number of care managers focused solely on outreach for gaps in care when they noticed low patient satisfaction compared to a population in which care managers worked with patients more holistically, closed gaps more effectively, and saw higher satisfaction.

Monthly outreach adjustments. Claims and patient self-reports revealed falling attendance at PCP appointments. Care managers addressed this issue by switching to mobile channels to contact members before appointments and increase the frequency of reminders. Attendance rebounded to a higher rate than the baseline.

Quarterly care team reassignments. With newly-implemented technology, supervisors recognized tech-savvy staff early on and embedded them among less adept peers to share their tactics, bringing the whole group up to speed faster and with more camaraderie.

Yearly reinvestment in health management. After showing thousands of dollars in cost savings per member, executives increased the budget for health management to support increased recruitment efforts and extend health management services to more members in order to double down on those results across a broader population.

When your organization measures rigorously to demonstrate effectiveness and to continuously improve, executives will pay attention. Leadership will be able to not only justify increased investment to grow digital health management programs even further, but also apply the same data models to effectively predict the return on additional funding.

Ultimately, measurement allows health plans to make data-driven decisions that elevate the stature of care management from baseline requirement to strategic value center. In doing so, health plans will be able to amplify the effect of their programs and extend services to more members, doing incrementally and continuously better by each member.

Achieving these goals creates new opportunities to focus on member support by strengthening provider partnerships, differentiating to employers on service and outcomes, and driving retention and new sales. Through rigorous measurement and continuous improvement towards these goals, health plans are poised to quantify impact and capture significant value from the powerful data of digital health management.

Readers Write: Why Integrated Behavioral Healthcare is More Important than Ever

February 20, 2019 Readers Write No Comments

Why Integrated Behavioral Healthcare is More Important than Ever
By Christopher Molaro

Christopher Molaro, MBA is co-founder and CEO of NeuroFlow of Philadelphia, PA.

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The pieces are starting to fall into place. Mental health is becoming an integral part of the overall conversation around health. Mental health is discussed in sync with physical health.

It makes sense, too. One affects the outcomes of the other dramatically and the extra costs associated with mental health co-occurrences is staggering.

The question remains: how do we effectively integrate appropriate behavioral healthcare for individual patients when they need it and do so in a cost-effective and time-efficient manner? In other words, how can we align the interests of patients, providers, and payers?

The market is indicating that now is the time to integrate mental and behavioral health into the patient journey. Physical health and mental health are merged into just “health,” patients get the holistic care they need and deserve, and providers are empowered with the tools to improve outcomes and payers save in costs. The triple win is attainable.

Multiple leading commercial payers are reimbursing for certain collaborative care CPT codes released in 2017 and 2018, highlighting the growing awareness around the importance of mental health. As we shift towards a value-based care system, a focus on patient engagement, satisfaction, and outcomes will add visibility to the benefits – and cost savings – of integrated behavioral health.

Also, considering the enormous behavioral health expenses of employees — mental illness costs the US $193.2 billion in lost earnings every year, according the American Journal of Psychiatry — employers are equally willing to find new ways to provide their employees access to tools to address mental health.

The awareness efforts of non-profits, advocacy groups, and healthcare organizations to normalize the conversation around mental health have been invaluable. At the same time, leading athletes and entertainers opening up about their mental health conditions is eroding the historical stigma surrounding those who struggle with behavioral health. Heightened awareness begets healthier, more frequent discussions around treatments and solutions for the one in five Americans experiencing mental illness.

Aetna’s recent “Health Ambitions” study highlights that healthcare consumers recognize the importance of mental health. Over one-third of respondents say digital messaging would make them more likely to communicate with their doctors, and the majority of people ages 18-50 say they would be likely to use a confidential website or app to track health information.

This new narrative around mental health is getting louder, and it will only help to bridge the gap between mental and physical health and the solutions patients need. But numerous studies indicate that we still have a long way to go when it comes to providing digital health technologies that meet the expectations of the modern healthcare consumer.

The digital doctor’s office is no longer a future vision, but a present-day reality. While adoption of these innovative tools can be slow, healthcare providers are rapidly warming up to technologies that can improve patient outcomes while absorbing it into their workflow and existing EMRs.

With behavioral health integration, we’ve arrived at an alignment of incentives and mechanisms among payers, providers, and patients that is rare in the modern healthcare landscape. This is an exciting opportunity for the future of mental health and one that we as a community can’t afford to pass up. The data supports the opportunity as well. Decades of research highlight the effectiveness of collaborative care in psychiatry, and when patients stay engaged with behavioral health treatment, outcomes are improved drastically.

Eighty percent of people with a behavioral health disorder will visit a primary care provider at least once a year, yet we know that treatment and access are still major issues, as nearly 60 percent of adults with a mental illness didn’t receive mental health services in the previous year, according to the National Institute on Mental Illness.

While there is much work ahead, we are encouraged by the progress we’re seeing in hundreds of clinics around the country from pediatric / school settings to geriatric and Medicare populations. Mental health knows no bounds — it can affect anyone. As a health system, our effort in addressing mental health access and engagement should also show no bounds.

Morning Headlines 2/20/19

February 19, 2019 Headlines No Comments

FTC Complaint: Multiple Ongoing Patient Privacy Breaches in the Facebook PHR (Groups Product)

Healthcare data expert Fred Trotter, health lawyer David Harlow, JD, MPH, and several patient advocates file a Federal Trade Commission complaint against Facebook over security problems with its Groups function.

Ochsner Health System and Pfizer Partner to Develop Innovative Models for Clinical Trials

Ochsner Health System (LA) partners with drug company Pfizer to make it easier for patients to participate in clinical trials via the use of digital tools.

China Could Use Medical Data to Blackmail Americans, Report Says

A Congressional report says that Chinese investments in US biotechnology firms potentially gives China’s government access to American patient data that could be used for nefarious purposes.

Collain Healthcare Joins Harris Computer Systems

Harris Computer Systems acquires long-term and post-acute care health IT vendor Collain Healthcare.

NHSX: new joint organisation for digital, data and technology

In England, Health Secretary Matt Hancock announces NHSX, a technology-focused initiative that will work with public and private organizations to help the NHS improve patient access and care through digital tools.

News 2/20/19

February 19, 2019 News 1 Comment

Top News

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Healthcare data expert Fred Trotter, health lawyer David Harlow, JD, MPH, and several patient advocates file a Federal Trade Commission complaint against Facebook over security problems with its Groups function. They say Facebook used AI to encourage users to sign up for private patient support Groups (based on their search history) knowing that their information (including real name, email address, city, employer) could be publicly downloaded.

The complaint also accuses Facebook of allowing its advertisers to target people using their identifiable health information.

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The complaint says Facebook Groups fits the legal definition of a personal health record, so Facebook as a PHR vendor should have notified users and the FTC that their protected health information had been exposed. It offers as evidence CEO Mark Zuckerberg’s endorsement of Groups for patient care collaboration and coordination.

It concludes that Facebook violated the FTC’s 2012 consent order and could face billions of dollars in penalties for failing to notify under FTC’s breach notification rule.

House Committee on Energy and Commerce Chairman Rep. Frank Pallone, Jr. (D-NJ) and ranking member Rep. Greg Walden (R-OR) have asked Zuckerberg to provide a staff briefing by March 1.


Reader Comments

From Sampan: “Re: Jonathan Bush. Did you see him at HIMSS? You should interview him again.” I didn’t see him there, but I would certainly enjoy interviewing him since it’s been awhile.

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From Waiting to Exchange: “Re: Cerner’s HIMSS19 slide bashing Epic over CommonWell. There are only 16 CommonWell sites available to query (see list above), although this is double the number of sites available in December. New sites are coming on board gradually. None of these organizations are in our region, so while our referring sites have an EHR capable of exchanging data, we are still waiting for the ‘marketplace’ to evolve.”

From Dyn Doc Diva: “Re: Cerner. Leadership is constantly undermining things with hype and hoopla versus functionality and usability. Cerner used to have a way for organizations to innovate with custom builds within Cerner and then sell those innovations to other clients, but I don’t think it was very successful. It will be interesting to see if the app experience is any better. Having a bunch of apps is just another fragmented way of getting people to pay more for extra modules instead of incorporating the features that people want and need into the base build. The adoption of Dynamic Documentation would not be languishing if it really did a credible job of reducing burnout – it was touted as revolutionary when still in the widely-promoted vaporware stage, but our organization has it and it’s good for quick dictated notes but requires a lot of upfront provider work to use for complex patients. Our department suggests that people not use it because it doesn’t do everything we need for regulatory and billing purposes, but Cerner isn’t fixing minor things in Powernotes that would go a long way to improve productivity. Cerner is trying to drive adoption of one half-baked solution over another.”

From Engine Brake: “Re: HIMSS. Maybe the demise of HIStalkapalooza had an impact on attendance. I always enjoyed the HISsies voting and pictures, especially shoes.” I doubt many people made their HIMSS conference attendance decision based on HIStalkapalooza, but maybe some did. Had I not also mercy-killed our expensive and ultimately pointless HIMSS19 booth, I could have designated a “shoe day” in which I would invite everyone to wear their finest footwear to the exhibit hall, then proceed to my “selfie station” of a downward-pointing camera that would catalog their feet for posterity and perhaps for online crowdsourced judging afterward.

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From InteropNerd: “Re: Epic App Orchard. Closed to new membership with no timeline on reopening.” A source tells me its open again after Epic updated processes related to safety, privacy, and security policies.

From Unbroken Yolk: “Re: HIMSS19. How were the logistics?” They were invisible, which is the goal. The only gripes I heard involved the convention center’s food vendors, which weren’t particularly inspired (or high value) and unlike in Las Vegas, you can’t easily go elsewhere. That’s not inconsequential since anyone running a conference will tell you that the major factors impacting attendee satisfaction are the quality of the food and having enough networking time built in, but given the scale of HIMSS19, it was mostly a good experience. It’s just a very different environment from Las Vegas, where the convention is just one small part of the Strip, but each city has its fans. Personally I like Orlando better (even without bringing along family members for doing tourist stuff) because costs are reasonable; I don’t end every day smelling like cigarette smoke; I can sleep without hearing drunken screaming and sirens all night; and there are no strippers, panhandlers, or barkers clogging up the walkways. Plus the sun-deprived can spend time at the beaches of either Florida coast before or after the conference. Both convention centers struggle with squeezing too many exhibitors into the hall, however, leaving those with low HIMSS point counts in the basement (Las Vegas) or back past the food court (Orlando).

From A Sheen Warlock: “Re: hospitals losing money after EHR implementations. Why isn’t this bigger news?” The headlines always claim that hospitals “blame” losses on their EHR implementations. However, most of them (the smart ones, anyway) had planned for the obviously higher short-term costs — much of it the labor expense of training employees — and the temporarily lower revenue due to intentionally reducing appointments to give ambulatory users time to get used to the system. It’s not all that different from a big construction project that involves high costs and business interruption, but that hopefully pays for itself for years afterward. Assuming, in both cases, that it is used wisely.

From Confused Parent: “Re: Epic. In MyChart under Health Trends, there’s an option to graph a patient’s vital signs. We clicked the button for our son and here’s what rendered.” I’m not including the screen shot since I know Epic goes crazy over that, but it’s just a bunch of vital signs trended onto a single graph. The reader didn’t say what they were looking at specifically, but I’m guessing that it’s the body surface area trend line, which shows up as close to zero. That’s a graph scaling issue since the child’s BSA would be 1 or less throughout and the single graph’s X axis runs 0-100 (so BSA is always going to be near the Y-axis line). Parents probably don’t care about BSA anyway since its primary purpose is to calculate drug doses, so displaying it is somewhere between pointless and misleading.


HIStalk Announcements and Requests

Here’s one last chance to tell me your thoughts about HIMSS19. I’m also looking to ride the wave of enthusiasm it created by interviewing health system CIOs, CMIOs, CISOs, or caregivers interested in technology. Email me at mrhistalk@gmail.com —  the interview takes only 20 minutes by phone, no prep is required, and you can remain anonymous if you like.

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The reader who was randomly chosen as a $50 Amazon gift card winner for completing my reader survey asked that I instead use the money to fund teacher projects. With some careful application of a couple of layers of matching funds, the prize funded these DonorsChoose teacher grant requests: (a) math and English manipulatives for Ms. H’s kindergarten class in Fresno, TX; and (b) word games for Ms. G’s elementary school class in Denver, CO. Ms. H responded immediately to say, “My students will be so surprised and happy to know that they will receive new learning materials thanks to an awesome donor! I am super excited to see their reactions. We will use the station materials for both reading and math. Thank you again for your kindness!” Ms. G also responded in expressing excitement that she can share the news with her students that they will soon have new resources to use for their sight words.

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I decided to keep my burner phone active for now. Add 818.722.1903 to your phone’s contacts and you can text me stuff quickly and easily. I appreciate the information and photos sent to me at HIMSS19.

Listening: new from Strand of Oaks, a project of Indiana-born Tim Showalter that spans indie rock, Americana, and mainstream pop.

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Welcome to new HIStalk Platinum Sponsor OptimizeRx. The Rochester, MI-based company gives life sciences companies a digital communication channel to healthcare professionals with a single connection point to 500 brands of EHR, allowing them to alert the prescriber within their workflow of available patient prescription financial support, such as co-pay offers and vouchers, that can improve prescription affordability. The EHR user can print or email the information to the patient or send it electronically to the pharmacy, also providing the patient with customized patient education materials. OptimizeRx helps drug companies launch new products by getting them added into e-prescribing and EHR drug data files. It recently announced its acquisition of CareSpeak Communications, which engages patients and families using multimedia text, chatbot, and other platforms to optimize adherence, support dose titration, provide fill and refill reminders, and manage side effects. Case studies found an 83 percent reduction in transplant rejection, a 50 percent decrease in asthma symptoms, and a 15 percent increase in heart drug adherence. Thanks to OptimizeRx for supporting HIStalk.


Webinars

March 6 (Wednesday) 1:00 ET. “Pairing a High-Tech Clinical Logistics Center with a Communication Platform for Quick Patient Response.” Sponsored by Voalte. Presenters: James Schnatterer, MBA, clinical applications manager, Nemours Children’s Health; Mark Chamberlain, clinical applications analyst, Nemours Children’s Health. Medics at Nemours Children’s Health track vital signs of patients in Florida and Delaware from one central hub, acting as eyes and ears when a nurse is away from the bedside. Close monitoring 24 hours a day integrates data from the electronic health record, such as critical lab results, and routes physiological monitor and nurse call alerts directly to the appropriate caregiver’s smartphone. This session explores how the Clinical Logistics Center and more than 1,600 Zebra TC51-HC Touch Computers running Voalte Platform connect care teams at two geographically dispersed sites for better patient safety and the best possible outcomes.

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


Acquisitions, Funding, Business, and Stock

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CPSI announces Q4 results: revenue down 7 percent, adjusted EPS $0.78 vs. $0.63, beating earnings expectations but falling short on revenue. Shares are up 8 percent in the past year vs. the Nasdaq’s 4 percent increase. From the earnings call:

  • 18 Centriq and Classic clients moved to Thrive in 2018.
  • The company added 29 new community hospitals for the year and expects the same for 2019 as “the acute EHR replacement market continues to experience churn.”
  • CPSI says new hospital sales are driven by hospitals that made bad long-term decisions based on Meaningful Use and clinicians aren’t happy with the systems they chose.
  • Quarterly MU3-related revenue dropped $9.2 million year over year.
  • The company expects ONC’s proposed information blocking regulations to benefit the company as those actions usually drive smaller competitors out of the market.
  • President and CEO Boyd Douglas says HIMSS19 was “a typical HIMSS” that provided little traffic from either existing or potential customers, adding that customers in CPSI’s market don’t have a lot of travel money and that they would be better off attending the company’s user conference. He also added that while more international visitors dropped by, you never know if any business will result from that.

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Healthstream announces Q4 results: revenue up 8 percent, EPS $0.09 vs. $0.10, beating Wall Street expectations for both. 


People

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Huntzinger Managment Group names John Hendricks (Residual Point Technology) as CTO.

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Computational pathology vendor Paige.AI hires Leo Grady, PhD (Heartflow) as CEO.


Announcements and Implementations

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A new KLAS report on patient engagement technology finds that it’s a “wide but shallow field” in which only CipherHealth, GetWellNetwork, and Press Ganey rise above the fray. Epic leads by far in EHR vendor patient portals and 92 percent of customers say it plays a significant role in their patient engagement strategy. Providers are looking beyond HCAHPS retrospective patient surveys in considering technologies for rounding, patient self-scheduling, care coordination, and targeted educational content delivery.

HFMA and Strata Decision Technology release the free, open-source L7 Cost Accounting Adoption Model, intended to help health systems measure their adoption and use of advanced cost accounting methods.


Privacy and Security

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Authorities in Sweden find that audio recordings of 2.7 million calls made to the country’s 1177 health information line were stored as .WAV files on a Web server that did not use authentication or encryption, allowing anyone to play them back on their browser. The service is operated by Thailand-based, Swede-owned MediCall, which says it will “soon release a statement” following the CEO’s initial denial that the breach occurred. MediCall recruits experienced nurses from Sweden who want to work “in an unusually sunny place.”


Other

HIMSS seeks comments on its proposed update to the definition of “interoperability.” My only observation is that it sees interoperability as a technical capability rather than a provider requirement. Every one of us has examples of our providers not sharing information, but let’s make Phase I simple – look only at hospitals and grade them (maybe in yet another Maturity Model) on how well they provide their patient information to other providers, how they accept and use information sent by other providers, and how well they perform in giving patients their own information quickly and inexpensively. Create the demand for interoperability and the technology will quickly follow.

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Israel’s national EMS service and tech startup MDGo develop a system that uses existing car sensors to analyze the impact of a crash, determining with 92 percent accuracy the extent of occupant injuries and then immediately calling for an ambulance with the accident’s location. The company estimates that non-pedestrian deaths can be reduced by 44 percent because the system eliminates the 5-7 minutes that elapses before a passerby reports an accident and also alerts EMS personnel of its severity so they can deploy the right resources. Co-founder and CEO Itay Bengad recently earned an MD degree and an MS in oncology and cancer biology.

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Connection provides a video update for the children’s bags filled at their booth by HIMSS19 attendees, introducing those who will take them to the children of their respective organizations —  Dan Lim, PhD (VP, AdventHealth University, which offers a children’s summer camp) and Kim Barkman, RN, MSIT, MBA (VP/CIO, Community Health Centers).

The physician humanities editor of Neurology resigns following retraction of an article that the editor-in-chief admits contained “racist characterizations.” The journal will also discontinue the Humanities section; require all articles to be reviewed for diversity; hire a deputy editor for equity, diversity, and inclusion; and offer awareness training. The retracted article by William Campbell, MD, MSHA (cached copy here) described Reggie (“a 60-year-old black man”) and digressed into a side story in which the author wrote, “I once shared a table at a fried chicken fast food establishment with a nice African American lady. Immensely enjoying her fries, she sat with the shaker in one chubby fist and liberally salted each individual fry. I knew the various ways lead could get into moonshine. And I was fluent in the lingo.” The author is a widely published 1970 medical school graduate of Medical College of Georgia and a retired US Army colonel who practiced in a Richmond, VA HCA practice.

Ochsner Health System (LA) partners with drug company Pfizer to make it easier for patients to participate in clinical trials via the use of digital tools. The organizations tested exchanging mock patient information between Ochsner’s Epic system and Pfizer’s clinical trials data capture platform to reconcile gaps and variances. The project will publish a model for using FHIR standards to collect clinical trials data from hospital EHRs.

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Vox runs another example of city-owned Zuckerberg San Francisco General Hospital sticking patients with high bills because it intentionally stays out of all private insurer health networks to maximize its ED revenue. A 19-year-old football player who was hit by a city bus is taken to the city hospital – also its only Level I trauma center — for six stitches and CT scan. Despite having insurance through his father, the hospital billed him for his $28,000 portion of the bill after his insurance paid $2,000. The hospital then turned his bill over debt collectors and placed a lien. He sued the city, finally getting a favorable ruling two years afterward in which San Francisco was ordered to pay his hospital bill (to itself, apparently) along with economic damages. This would be the point where rational people would demand that hospitals offer their lowest accepted prices to everyone, or at least prevent them from chasing private-pay patients for amounts exceeding what they are willing to take from Medicare or other insurers.

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Intel publishes a white paper describing its experience running a five-location, technology-powered employee ACO.  Health outcome improvements were modest, but user retention was high and employees benefited from better choices for appointments and faster responses to their medical advice requests. The company says its key strategies are contracting directly with providers, using health IT and measuring its use, and working with delivery systems to improve quality of care. Technology components vary by state, but include:

  • Data-sharing via EHealth Exchange and Direct messaging, connected to Kaiser’s Epic and Premise Health’s Greenway Health PrimeSuite (which has since been replaced with Epic at Premise).
  • Waiting for the HIE situation to resolve in Arizona and then using the Connected Care to connect with 125 provider EHRs.
  • Connecting to its partner IPA in California, which replaced NextGen Healthcare with Epic.
  • Using Epic’s Care Everywhere and Carequality connectivity in its San Francisco Bay region.
  • Using Direct messaging in Oregon to coordinate referrals with unaffiliated practices, then working with Epic to accelerate functionality development with regard to closing the loop with providers.
  • Using Providence’s Collective Medical’s EDie to obtain patient opioid prescription histories and PreManage ED and to send alerts to providers when their patients are seen in the ED, admitted, or discharged.

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Weird News Andy only wishes this guy lived in the UK to support his fantasy headline “Doctors Remove a Third of a Stone of Stones.” Doctors in South Korea resort to surgery to resolve the stomach pains of a man who had ingested 4.4 pounds of coins and pebbles, which he admitted was his practice when feeling anxious.


Sponsor Updates

  • AdvancedMD will exhibit at the Association of Dermatology Administrators and Managers event February 26-28 in Washington, DC.
  • The Channel Company’s CRN brand names Avaya’s Mark Vella to its list of 2019 Channel Chiefs.
  • Bernoulli Health CNIO Mary Jahrsdoerfer, RN publishes a study on the key attributes of continuous clinical surveillance.
  • CarePort Health will exhibit at the Population Health Management Summit February 21-22 in Miami.
  • The National Cancer Institute awards Carevive with the only Fast-Track Phase I/II contract supporting the development of an innovative symptom management and electronic patient-reported outcome solution.
  • Staffing Industry Analysts names CTG President and CEO Bud Crumlish to its 2019 North American Staffing 100.
  • The VA issues an Authority to Operate for Diameter Health’s health data quality technology.
  • Divurgent publishes a new white paper, “Application Rationalization.”

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 2/19/19

February 18, 2019 Headlines No Comments

Missoula health care execs get $1.2M in venture capital for tech startup to better prepare patients

In Montana, PatientOne attracts $1.2 million in venture capital to hire additional staff and further develop its remote monitoring software for surgical patients.

USDA Prioritizes Investments in Telemedicine to Address Opioid Crisis in Rural America

The USDA will give funding priority to Distance Learning and Telemedicine program applicants who propose projects that provide opioid treatment services to patients in 220 at-risk rural areas.

Third Eye Health raises $7.25M to bring around-the-clock doctor support to nursing homes

Post-acute telemedicine company Third Eye Health secures $7.25 million in a Series A round led by Generator Ventures.

Reader Survey Results 2019

February 18, 2019 News No Comments

I survey HIStalk readers each year right around HIMSS conference time, soliciting feedback and ideas for both the short and long term. I appreciate every comment and find them valuable, especially since as an anonymous spare-bedroom writer I don’t get the chance to receive feedback in other ways.

My readership is diverse, so it’s hard to please everyone, and even if I did, and the result would be so bland that nobody would be reading anyway. I also realize that my readers are self-selected and keep coming back because they get something out of HIStalk, so I favor incremental change that can improve their experience rather than major changes that would be disruptive for readers and for me.

Each year’s survey has many responses that give me a warning of the “if it ain’t broke” variety. In fact, that is always the most common response by far.

Thanks to the 520 readers who responded. One randomly chosen of those readers won a $50 Amazon gift card, which he or she has asked me to donate to DonorsChoose. I’ll report shortly how I spent the money.

I have a few to-do’s from the comments below. I’ve also asked Lorre to review for action items since she can be more objective than I.


The TL;DR Summary of To-Do’s

  1. Investigate creating a subreddit for extending the discussion without having to take on user management myself.
  2. Redesign the bulk email that indicates when I’ve published something new.
  3. Consider summarizing the top news items in the email update like I used to do.
  4. Try to recruit some new contributors, especially from the provider front lines (CIO, CMIO, CISO, etc.)
  5. Consider whether HIStalkapalooza could be restored in a simpler form.
  6. Think about whether I should try harder to get new readers, especially those newer to the industry, via some sort of marketing.
  7. Consider writing longer-form pieces such as editorials.

Respondent Characteristics

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  • 81 percent of readers have worked in the industry for at least 10 years
  • 26 percent work for a provider organization
  • 7 percent are CIOs, 2 percent CMIOs, and 7 percent CEOs
  • 25 percent have provider purchasing influence of at least $10,000
  • 83 percent say they have a higher appreciation for companies that they read about in HIStalk
  • 41 percent say they have a higher appreciation for companies that sponsor HIStalk
  • 89 percent say reading HIStalk helped them perform their job better in 2018 (this is the statistic I care most about)

What Features Readers Like Most

The scored, weighted results give the top items in order as:

  1. News
  2. Humor
  3. Headlines
  4. Rumors

Suggested Changes

I should first say that every year’s survey contains one overwhelmingly prevalent response – don’t change anything. I’m open to ideas, but I also know that most readers who keep coming back like things just as they are. I have to resist the urge every year to change things just because someone suggested it.

Try to say something more productive about companies, especially startups.

I give an honest opinion based on what I see as an industry everyman. It isn’t always analytical, but I always check a company’s website, interviews, leadership, etc. before I comment (assuming I don’t already know that company). I think I say positive things when I like the product or marketing approach.

Parts I like, some I am indifferent to, navigating around them is easy.

You’ve neatly explained how I try to give everyone something they can use. Not everybody cares about sponsor updates, people moves, reader comments, etc. and I make it easy to skip those sections. I run the sponsor updates at the bottom of the page as a courtesy, but everything else on the page is something I thought interesting enough to mention. I have no incentive to pad out a given day’s news post with something I don’t think is useful. I try to earn reader trust that I won’t waste their time.

Explore an alternative website format to keep it fresh and in line with current website formats. A refresh every 2-3 years would be nice.

I’ve always waffled on doing this because it wouldn’t change the content, just the presentation, and I hope readers aren’t fickle enough to read or not based on initial appearance. Politics aside, Drudge Report is the ugliest website in the world, yet one of its busiest, because people want to read the content and have become comforted that the site will always look the exact same.

Write less about start-up financing.

I eliminated announcements involving funding of less than several million dollars, thinking that those companies that receive bigger investments are worthy of mention because they are likely to be up-and-comers, and to skip announcements of companies whose product isn’t purely health IT related.

You are jaded and paint every topic with your negative bias. Sometimes things aren’t as negative as you might think.

I admit that having been in the industry for a long time, I’m skeptical and sometimes cynical and my opinions reflect that. But I’ll also say that one of the reasons I started HIStalk was because the cluelessly cheery publications and websites didn’t reflect reality and I offered an alternative. I should make a sign for my desk reminding me to be more positive.

Add more commentary.

I’m challenged here because some readers want straight news and no commentary. I also don’t claim to be an expert in everything and therefore hesitate to provide what might be a poorly informed pinion. But I will consider the options.

Put the news bullets in the email update without requiring a click to see it on the website.

My goal isn’t to send out yet another industry newsletter that nobody reads. I can’t squeeze the dozens of items contained in a typical HIStalk post into an email and I’ve already culled out the 95 percent of items that aren’t worth running. I post everything in aggregated form, so all the links are going to take you to the same page anyway – I don’t write separate posts for each news item because that would be a flood of individual stories. I understand the argument that, “Maybe I won’t bother clicking over to the website if nothing sounds interesting,” but I’m willing to lose readers who find that onerous since I’m not doing them a favor by dumbing down the teaser. The thrice-weekly news posts are either worth 15 total minutes of your time each week to skim or they aren’t. 

Seek out more rumors. I started reading HIStalk to find about my competitors. Not all employees can be happy with Epic and Cerner.

Reader rumors are polarizing – most people like them, some hate them, and some like them only until their company is mentioned in a negative light and then suddenly rumors are evil non-journalism. I make it easy to submit rumors anonymously and I never divulge a source anyway, so the opportunity is there for anyone willing to contribute.

Reduce vendor-written Readers Write pieces.

This one is always hard to resolve. Anyone can send me a Readers Write article and I’ll post it if it passes the test of being informational and not a sales pitch, but the only people who send those articles are vendors and their PR firms. My biggest lesson learned from writing HIStalk is that everybody complains that too few people aren’t contributing articles or comments, failing to count themselves among them. I should be thankful because if everyone was wiling and able to write about the industry, I would be made redundant.

I love reading the comments, but wish there was an easier way to see them without clicking the comments link for each article. Maybe a “latest comments” ticker on the side or have them go to a subreddit? I realize you don’t want to have to deal with having readers sign up for accounts.

I’ve tried a lot of things over the years to raise the visibility of comments. There’s already a “latest comments” widget to the right, but it’s one of many things crowded in there. I’ve looked at Disqus and other commenting tools and wasn’t thrilled.

One challenge with comments is understanding how they are displayed on the site. Clicking the email link goes to the specific article (like yesterday’s news post, for example) and you see the comments on that same page and can enter your own. When you just go to the home page (histalk2.com) however, comments are not displayed and you can’t enter them without clicking the specific article’s title. That takes you to the same page as if you had clicked the email link.

I know next to nothing about Reddit, but I’ll check it out.

Emails don’t always include links.

This is a can of worms that I’ve opened and re-opened countless times over the years without being able to fix it. Companies and your own email client use all kinds of tools to block emails, block links, strip images, etc. and those wreak havoc on my emails that always contain links. Not to mention that overly aggressive email filters often categorize anything with an image or link as spam, meaning that (a) it won’t get delivered to your inbox; or (b) it gets delivered, but dropped into your spam folder where you’ll never see it. I don’t really have an answer except that I publish on a predictable schedule (news M-W-F, Dr. Jayne MF, weekender F, and irregular items like interviews or Readers Write usually on M or W) so email or not, you can expect to see something new every day except on the weekends.

Maybe others see value in the Weekender, but I never read it.

I started the Friday morning post because people were complaining about reading DonorsChoose updates and other non-news items in the regular posts, so I thought that was a good place to put them (being clearly labeled) and to put in some fun and sometimes upbeat items. It also contains the week’s best reader comments (which respondents in last year’s reader survey asked for) and a link to all the other items I posted for the week. I’m happy to stop writing it if nobody cares, though, since it’s just extra work for me.

Do away with the morning headlines. Seems duplicative and there are plenty of websites and emails that do this already.

The headlines are by definition duplicative – those who read the full news posts don’t necessarily read the headlines and vice versa. I wanted to give the skimmers a quick way to catch up the most important news items in just a few seconds each weekday, but I also make then invisible to those who don’t care by not sending them out as an email update. No changes here, sorry. Personally I love reading the headlines each morning since Jenn writes them and I never know what she has found.

Start blogging! You already do when you comment on a news piece, but maybe once a month pour out your thoughts on a health IT issue.

I will consider that.

Try not to become a walking advert for KLAS or Chilmark.

I don’t really mention Chilmark at all, but I do think KLAS reports contain some insights worth recapping and their analysis often makes good sense even though I gripe plenty about their methodology and business model. I skip mentioning any of their reports that I don’t find interesting.

Find some new columnists, especially those in the hospital trenches.

I offer regularly, but the folks who have the most to say don’t have the time or interest to say it, and those who have tried didn’t last long. Usually I hear nothing more once I say, “Sounds fun – send me a sample column and let’s see how it fits.” But if you are a provider IT person who is interested in writing (I can even keep you anonymous), then let’s explore.

Add interviews to the YouTube channel, do podcasts, and add commentary and engagement on LinkedIn.

I’m biased since I don’t watch YouTube interviews, listen to podcasts, or use LinkedIn, but maybe you can help me see the broad reader benefit. These might be areas where I need to enlist some help, perhaps some junior person who is good at social media but who wants to gain industry knowledge.

Appreciate the music recommendations.

Thanks. Several people said that, even being nice enough to say which bands they loved after I mentioned them.

Bring back HIStalkapalooza.

I might, but it would have to be in a radically different form that requires less financial risk and work. People told me at HIMSS19 that its biggest feature wasn’t the band or the expensive food and drink, but rather the chance to meet like-minded people – regardless of whether they work for a vendor, provider or other – in a setting where nobody is buying or selling something. Facilitating that networking opportunity without necessarily spending a bunch of money is certainly possible. I will think about how it could work.

Reduce the sponsor mentions.

I think the compromise I’ve reached is a good one in recognizing that they pay the bills. Sponsors gain no editorial advantage except that I include their less-newsy items (which I ordinarily wouldn’t mention at all) in the Sponsor Updates section, where you can easily skip them if you want. They have to earn mentions in the regular news sections like everyone else.

I would love to see a review of health and health IT books.

I do that sometimes if I think it’s worth me buying the book first since I don’t get free copies. The only problem I have is that I appreciate that someone wrote a book in the first place and I struggle with criticizing their effort (probably since I go through that myself).

You should start a conference.

I don’t have the time or expertise to do that alone, although I suppose I could hire someone to do something on a small scale. It seems we have a lot of conferences already, so I would have to find an unserved niche that I’m not envisioning at the moment.

Offer a weekly, high-level news summary for those who can’t keep with the regular emails, like a CEO version.

I could do that, although I kind of already do it in the Weekender, where I list the most important news items of the week with a one-sentence summary. I don’t know what I can add beyond that except maybe to make that a separate email.

Offer more thoughts from the investment community.

I would love to, but I suspect those folks are making too much money to spend time writing articles. The Healthcare Growth Partners folks are very good at it, for example, but they have their own audience.

The email format could be improved.

Good idea. That was on my list of to-do’s. It’s definitely a homebrew format that I threw together in about five minutes when the email service changed its editing tool unexpectedly, so I’ll get someone more artistic to help. I may revisit the idea of including news snips in some form, although the ironic consequence is that I would be convincing some readers not to bother visiting the site that day.

If I were Mr. H, I would retire to the soft sands of a private island knowing my work to expose the real health IT world has been completed in remarkable fashion, then turn over the site to someone else to live behind the lab coat in anonymity. Otherwise, enjoy life more and insert straight comedy, which might just be my warped sense of humor.

This is my favorite comment, although “retiring” suggests doing something I would enjoy more and there is no such thing. Writing HIStalk is still my favorite activity even after 16 years.


Representative Comments

Keep up the great work. And the music references. I spent a good hour catching up on Rival Sons the other week.

Love the snark, but more importantly how you cut through the bs to get to the core of an issue. That coupled with your ability to clearly communicate is priceless.

Gosh do I love this site. I love the people, I love the news, I love the interaction and decade+ learning. I am constantly amazed that there is more to learn, there is so much news, and that someone has the stomach to put it all together on a regular basis. Bravo HIStalk team, you had another marvelous year.

I just want to offer appreciation from a long time reader.  Your commitment to the daily grind of putting out material in a thoughtful, “call it as you see it,” and almost always objective manner is very much appreciated.

Useful and well balanced, I find it a reliable source at a time where stories are either too curated or not curated enough. It would be interesting to have deep dives on some stories, to help understand where a given story really goes or ends up, especially relative to competing solutions. I often have to go to KLAS or Definitive or other resources to get the context to a given story. I also appreciate that is a difficult task given the time required.

As a vendor person, I’ve always liked understanding who we are competing with and how our solutions are fairing out there in the real world. I wish more of my associates would understand the landscape better by reading HIStalk. I’ve been reading it for a long time, and I’ve been at three different vendors (but haven’t moved from the building ;). BTW, I’m a senior techie person, so I’m not directly selling anything, but understand that we are all really part of making a client / customer happy, which is in a way, sales. And I’ve always liked trying to help healthcare do better, since that affects all of us in the end. I do enjoy my daily fix of your stuff, so thank you.

HIMSS is stale. Pretty clear to all of us, but seems not clear to HIMSS because the org is not doing anything to change itself. Seems to me that your blog and to a lesser degree KLAS (because the data is warped too easily) is doing a lot of the work that HIMSS should be doing. How can that be fixed? Could you have any role in that?

Just curious, given the current M & A craze with health systems, maybe an occasional focus on the displaced CIOs or IT leaders out there. Where are they landing, do they choose retirement? It took me 11 months to land in another healthcare IT role, this time with a vendor.

Website design isn’t sexy, but who cares? (because the news is great)

I greatly appreciate the ruthless efficiency of HIStalk – very high signal-to-noise.

I’m surprised when I ask co-workers/peers if they go to your site and most say “no”. After they go, they tell me they go regularly. I’m not sure how big you want your site to be (unique visitors), but if you want to grow, then some marketing may be needed. I was trying to remember how I found out about you and honestly can’t remember, but you are at the top of my regular reading list!

Much of HIStalk still concentrates on hospitals and providers (inside the walls). Would like to some expansion to consumer engagement, telehealth, etc. Mentioned sometime but would like to see regular news, interviews, articles, etc.

Tone down some of the jaded comments. I always agree w/the sentiments you express, but the editorial comments border on bitter sometimes.

I love the non-news like music suggestions, Donors Choose, etc. News is usually a downer, so having some levity makes life better.

It is harder for the hospital side to buy and much harder for the vendors to sell these days. I would love it if we could get some articles from each (people that you pick that could write in, or volunteers?) on how we could better partner with each other, to help this sales cycle and process. Maybe this could be a regular series, every other month?? Just a thought.

You are my single source of truth and only source I depend on for keeping up to date on US news. That said, I’m continually impressed that you report Australian news before the local guys do. Keep up the good work.

As a healthcare sales rep, I find your website invaluable in staying up to date with industry trends and news. I always feel smarter after working my way through a Monday update and yet feel guilty because clearly, you spent a good portion of your weekend writing it. I would be fine with a Tuesday update if that freed up some of your precious weekend.

Weird News Andy is the best! I can’t wait for your HIMSS coverage. I love how you keep it real each year with your commentary.

Appreciate the fact that you are querying your reader audience.

I have worked for healthcare IT vendors for my entire career. I love your neutrality regarding the vendors, even your sponsors. I read your blog for the focus on healthcare delivery as a goal of healthcare IT. That is refreshing. If you doled out not-so-subtle marketing ads masquerading as news I would stop paying attention, like has been done with anything HIMSS touches (and I’m a HIMSS member).

I have always found your Sunday afternoon / evening news roundup extremely helpful to add some insight heading into the week. I have forwarded many of these news stories over the years to colleagues or followed them up myself. For someone who takes a dim view of healthcare journalists as a whole, you do a great service to them in addition to the rest of your audience. The harsher you are on us journalists, especially when you point out mistakes we have made, the more I respect you. A former editor loved it that you highlighted a colleague’s [multiple] mistakes and used it to remind us to be extra cautious that we double check proper nouns, source material, etc.

Set a time horizon for when HIStalk will end. I honestly wonder where I will go for solid news when you retire. I am afraid you will just power off some day. Or maybe Mrs. HIStalk secretly pulls the plug.

Just don’t turn into an over advertisement funded HIMSS or CHIME like service – you’re our only hope for honest reporting in the industry.

Don’t assume all vendors are ‘the bad guy’ – just because we’re selling something doesn’t mean it isn’t coming from a place of concern for patients or that we can’t offer intelligent solutions by collaborating with hospitals and healthcare systems.

As a former healthcare analyst and investor turned operator (I run a BU at a healthcare technology company), I absolutely respect and admire what you have done and the way you deliver content. Love your thoughtful insight, the way you filter through and interpret inbound content from readers (with the occasional shredding of an ask or perspective) and your wit is right up my dry wry alley. I have enjoyed your site for years and will continue to do so–hopefully for a long time. I also really appreciate your effort to make the world a better place through raising money and donating to kids/schools. Means a lot to me. I have long been meaning to reach out to say thank you, and this is the first time in 10+ years that I have done so. I apologize for the long delay. Seriously, way to go, I’m very happy for you!!!

Thank you for years of what I can only describe as virtual mentoring. You’ve made me a much better health IT professional and maybe even a little better person. I am truly grateful.

Improve the job section HIStalk is big enough in terms of audiences — help others find their dream jobs via your site: connect employers with potential employees.

I know the English language enough to get me to where I am, but I’m regularly in awe of your anal retentive approach to grammar. One of the many reasons I like reading your work! I always learn something. And I very much appreciate your sense of humor.

Thank you for what you do, it’s really appreciated. I most appreciate the various studies that you bring attention to as I don’t normally wade into those waters.

Love what you do and will hear colleagues discussing articles you’ve feature. Most recently that gem on mining system issues through alert comments.

I love the format, it’s very digestible, even on a busy day! I trust you, because you seem to seek balance, pursue the truth when possible, and consider things from many angles. You have a voice of independence, which includes the low budget no frills approach, but also the consistent attention to the charity donations to fund teacher projects. Keep it up!

Thanks for making me smarter about the industry without having to invest a lot of time.

In general it’s still routinely very good and occasionally hits great. Which after 15 years is pretty amazing. No one else does what you do.


Curbside Consult with Dr. Jayne 2/18/19

February 18, 2019 Dr. Jayne 2 Comments

I’m still recovering from HIMSS. What started as a slightly runny nose on Thursday has turned into a full-blown head cold with plenty of sneezing. At least it’s not influenza, however, so I’m grateful.

Any time you get that many people together shaking hands in flu season, it’s always a risk, but hopefully vaccination and lots of hand sanitizer has worked to keep the bad pathogens away. Unfortunately I’m spending the weekend in the clinic, making up for time out of office, and there isn’t much room for rest and recovery.

I mentioned the Arcadia-sponsored lunch I attended that featured John Halamka. I have been thinking about some of the things I learned during that presentation.

He talked about several countries and some of the challenges they are facing with healthcare. There was a lot to process. First, he talked about his experiences with China’s healthcare system and its approach to primary care, or lack thereof. The concept of coordinated care is just starting to take hold as China works to develop its primary care workforce. Until then, patients might self-select to a subspecialist physician based on what they think might be happening to cause their symptoms. He gave the example of someone waking with a headache and choosing to queue to see an academic neurosurgeon rather than seeing a primary care physician first. He is involved in a pilot project looking at care coordination that has one million patients in the cohort. That’s quite a bit larger than the pilot projects we’re used to in the US.

Next, he talked about healthcare in India, where a workforce of 600,000 physicians care for approximately 1.4 billion people. (Google shows the number at a bit closer to 800,000, but either way it’s a relatively small number for the care that needs to be delivered). Halamka has traveled to India multiple times and shared photos of his experience looking at x-rays that patients are carrying around with them as part of their personal medical record. There are significant healthcare disparities by region and the informatics community is starting to look at using clinical decision support to address issues where certain diseases such as tuberculosis might be more common in certain regions of the country.

He shared a story about a post-partum patient with abdominal pain and polled the audience (there were a handful of doctors in the crowd) about their thoughts. Nearly everyone thought about post-partum infection or complications like a retained placenta, but the real answer was abdominal tuberculosis, which isn’t even on the radar for most of us in the US, but is apparently fairly common in some parts of India. It really makes one think about how different healthcare experiences can be around the world.

The third country he talked about was Norway, where patients are expected to contribute their personal health information to the overall dataset of public health records. There’s not an “opt out” per se, which results in much more information being able for research and for investigation of health practices. I did some additional digging on this and found that although the Norwegian national Summary Care Record is in place for all citizens, the tool isn’t used as routinely in practice as it might be. Halamka also touched on the drinking habits in Scotland, which are among the largest per capita across the globe.

He also discussed interoperability in Australia, which is chiefly by PDF. This means there is no drug-drug or drug-interaction checking, no clinical decision support, and no common medication lists. There are, however, probably a great deal of duplicate data entry and wasted resources. He touched on Japan with its aging population and low birth date, where fewer clinicians are tasked with delivering care to a growing population, often with significant quality variation. Apparently in Japan it’s also illegal to host electronic health records on cloud-based services, which is going to need to change for optimal use of digital health resources.

Halamka paused from his round the world tour to address the role of artificial intelligence in healthcare, particularly the need to make sure that training sets used to build AI technologies aren’t full of biased information based on historical challenges such as delivering care to patients whose primary language is something other than English. We also need to take care with the use case for AI in healthcare — he used the lack of progress with Watson as an example. He doubted that the big EHR companies would really be doing much innovation, going on to say that the real innovation will be in a cloud of apps around those legacy systems and that the “24 year olds in the garage are the real innovators.”

He noted some of the challenges with interoperability in the US, namely with data sharing for adolescent patients, which must be controlled by policies and age ranges to meet the changing needs of children who are transitioning through adolescence and into the adult world. He mused on Apple’s partnership with Aetna, where patients will be given Apple watches as tools for health monitoring. It will be challenging for providers to figure out how best to use patient-generated data and for systems to figure out what data is important enough to act on.

He used his own example of a rapid heart beat as a test case. When it happens, it usually goes away in a minute or two. How will the system know not to act on it vs. to act on someone who is having a new onset of rapid heart rate or a more dangerous type? It’s one thing to have data, but another thing entirely to transform that data into information, knowledge, and wisdom.

There were good questions from the audience and Halamka went on to explain how he sees his role as “care traffic controller” for three generations of people in his family. I hadn’t heard that phrase before and I have to say I like it and will be stealing it for future conversations. Overall it was a solid session and I am even more curious about how other countries are handling various healthcare delivery crises and whether we’re really as bad off as we think we are. I’m going to have the opportunity to practice medicine with people from around the world this summer and I hope it will be a great learning experience.

What’s the best session you saw at HIMSS? Leave a comment or email me.

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Email Dr. Jayne.

Morning Headlines 2/18/19

February 17, 2019 Headlines No Comments

Porter Health Care System patients could get up to $5K from cyberattack settlement

Community Health Systems (TN) agrees to pay $3.1 million to settle a class-action lawsuit stemming from a 2014 data breach that impacted 4.5 million patients across the country.

FTMC welcomes new chief info officer

Fisher-Titus Health System (OH) hires Linda Stevenson (Cerner) as CIO.

Fairfield Medical Center posts $22.6M operating loss from medical records overhaul

Fairfield Medical Center in Ohio attributes its nearly $23 million operating loss last year to its Cerner implementation.

Nanaimo hospital says it’s making electronic gains; doctor disagrees

Physicians in several departments at Nanaimo General Regional Hospital in Canada are still using pen and paper to document patient encounters and order medications and labs despite the launch of a new Cerner EHR at Island Health facilities three years ago.

Monday Morning Update 2/18/19

February 17, 2019 News 8 Comments

Top News

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HIMSS gives a preview of the “evolution of the HIMSS Brand” (marketing-speak for “we had a new logo drawn up whose deep meaning requires 10 pages to explain.)” Meanwhile, the HIMSS social media folks are apparently fans of “The Dark Knight” or toffee candy bars.

The explainer video talks a lot about “re-imagining” and “reforming” the ecosystem. It also notes “member-driven impartiality,” which is as interesting as it is vague. It ends with a sinister-sounding call to “join the reformation,” which I think is really just a membership pitch.

I am impressed that the HIMSS marketing VP in charge of this project, Terri Sanders, has a long healthcare background (not all in marketing) and an MPH. Quibbles aside, I expect she will do a good job.

A couple of readers have emailed me to express their frustration that HIMSS ignored my request for their IRS Form 990 financial disclosure (which as a non-profit they are required by law to provide), so I’ve emailed the HIMSS media contact, Karen Groppe, with another request. UPDATE: Karen emailed me almost immediately, which is admirable given that we’ve just come off the most hectic week for HIMSS – my previous inquiry had apparently gone astray in Etherland. She will get me the forms. I pointed out that old versions are on Guidestar, but nothing for the previous two years that should have been filed by now. I appreciate the quick response.


Reader Comments

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From Rounding Error: “Re: Cerner’s HIMSS19 slide bashing Epic over CommonWell. Carequality was exchanging 11.5 million records per month when the CommonWell connection went live in July 2018. It hasn’t changed much since even though a dozen CommonWell sites have gone live in the last seven months. I suspect CommonWell doesn’t have many members live or those members aren’t exchanging much data, while Carequality has 1,250 hospitals, 35,000 clinics, and 600,000 care providers. It’s kind of lame of Cerner to say that Epic is the laggard. No wonder the government is stepping in.” I was surprised that Cerner has become either more aggressive or more desperate in calling out competitors by name, which it has never done.

From Over the Shoulder: “Re: this tweet featuring a selfie of one of the Twitterati. Notice anything unusual? Hint: it was taken by a third person as the tweet-prolific subject pretended not to notice!” I thought that was odd, too, as was his inclusion of the twitter ID of a PR firm that seems to specialize in pushing vendor thought leadership. Digging further, he’s apparently shilling for the PR company, creating video commercials for their customers right in the exhibit hall. Hopefully all those folks who were unashamedly cashing in on their questionable fame at HIMSS19 won’t need their credibility back now that they’ve sold it.

From DrJVan: “Re: HIMSS19. Kudos on your coverage. Did Allscripts use this year’s gathering to introduce the industry to their AI product, Avenel? It has been over a year now since they announced this product. Was it displayed or mentioned?” I didn’t visit the Allscripts booth, I didn’t hear anything about Avenel, and Avenel wasn’t mentioned in the Allscripts tweets. I’ll invite readers to comment.  


HIStalk Announcements and Requests

It’s a typically quiet post-HIMSS conference period since everyone (even the federal government) blasted out their big news last week. I expect a refractory period this week as everybody gets back to their real jobs, after which the news will return at a pre-summer level. It’s nice that we have nearly 13 months before doing last week all over in Orlando again at HIMSS20.

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It’s nearly an even poll respondent split on whether the VA made the right choice in ending its Epic patient scheduling pilot and plan a replacement with the Cerner offering. King Solomon provided a wise comment as a former Epic Cadence application analyst, saying Epic’s product is awesome at scheduling and can handle complex rules, but that the single-system argument should prevail.

New poll to your right or here: What is your impression so far of HHS’s newly proposed interoperability policies? Vote and then click the poll’s Comments link to explain.

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I’m still struggling to think of something conclusively profound to say about HIMSS19, but I’m beginning to lock into an overview along these lines:

  • We give HIMSS too much credit in thinking that we should draw meaningful industry insights from its conference. Nobody expects to be inspired and educated about imperiled marine life by attending a boat show.
  • HIMSS is a show about selling, not doing, and while the former drives the exhibit hall (and thus the conference itself), the latter improves outcomes and cost.
  • Exhibitors in the hall did a good job in minimizing the hype and the hyperbolic come-ons. Some good conversations took place there.
  • Health systems do whatever benefits them the most. Technology amplifies the effects of both their best and worst practices.
  • Sharks have been jumped. The HIMSS conference probably isn’t one of them since the lower attendance will probably inspire changes, but the signs were there among certain vendors, technologies, and concepts.
  • Some companies and sectors (and maybe even HIMSS itself) seem to be struggling to figure out their post-Meaningful Use futures.
  • The government can talk about information blocking all it wants, but it’s a paper tiger when it won’t even take action when hospitals refuse to give patients copies of their medical records or charge excessively for doing so.
  • Cybersecurity is an increasingly big deal, which unfortunately means that providers will be diverting a big chunk of money sideways just to maintain the status quo.
  • Most health systems remain lemmings in following others at a safe distance, but more of them are forging their own paths without endless hand-wringing fretting whether they should wait for 10 similar organizations to it first. The rise in health system-run incubators was driven by potential profit, but also by being able to influence product direction.
  • Health system consolidation will be a feast for some vendors, but famine for the others, as the big will get bigger on both sides of the fence.
  • We have plenty of digital innovation, but health system indecisiveness and ridiculously long purchasing cycles keep killing it off as startups can’t hang in there for years waiting for their first sale.
  • The only sure way to make money as a health IT startup is to create something that taps into the massive profit stream of drug companies.
  • Big technology companies could become a limited disruptor in healthcare, but their arrogant lack of knowledge about how the industry works and their focus on technology rather than patients will make it hard for them to succeed in an ethical way.
  • Most conference attendees want to do the right thing for patients, but are hampered by a healthcare system and business environment in which those patients aren’t the actual customer. The status quo makes all of us unhappy as patients, but it also creates our paychecks, and we struggle with that.

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I’m interested in your HIMSS19 experience and takeaways. Please complete my anonymous HIMSS19 Impressions form. I’ll summarize the submissions next week.

Along those lines, I would enjoy hearing an exhibitors narrative on the conference – setup day pains, good and bad visitor behavior, company expectations, and shoe tips for the zillion steps per day you took. I’ll keep you anonymous, so you can be honest. Send something my way and don’t worry about polishing it up since I will do that.

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I’ve worked from a 15-inch laptop all week, so my first impression upon re-docking at home is that my desk monitor was the size of a theater screen. I’m also enjoying playing with the Amazon Echo Dot that I won by scoring 10 of 10 on WellSky’s trivia quiz at HIMSS19 – it’s similar to my Google Home Mini with good sound for a small gadget, but the setup was easier with the Dot, it’s easy to find new skills in the Alexa library, it plays Spotify and Pandora well, and it can connect to a Bluetooth speaker. It costs about the same as the Mini at $50. Either device is worth it just for setting cooking timers and reading the weather forecast.

I enjoyed the HIMSS19 write-up of Garen Sarafian, who is surprisingly astute and patient-focused as a money guy. He concludes that HIMSS is out of touch in choosing its dopey “Champions of Health Unite” theme that has little to do with actual health or its champions (who are likely caring for patients episodically instead of juggling Orlando party schedules). Like me, he is struggling to detect any overall HIMSS19 theme, although he notes that population health management didn’t get much airplay and health systems aren’t all that interested in exchanging information outside their walls (and thus forced the need for the federal government to provide a push). 

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Welcome to new HIStalk Platinum Sponsor Practice Velocity. The Machesney Park, IL-based urgent care solutions vendor offers the VelociDoc EMR, just named a KLAS Category Leader for 2019 for urgent care. Urgent care providers can document a visit in under two minutes using its Chartlet one-page urgent care chart. It integrates with online registration, teleradiology, in-clinic dispensing, national labs, and payments, with full integration to its PVM practice management system. The company offers 365-day, US-based support. The company’s 150 urgent care billing specialists can help code, process, and monitor claims as a complete revenue cycle management solution, while its full-time contracting and credentialing team can reduce administrative burden in tapping its longstanding payer relationships to maintain contracts and perform comparative fee analyses. See the company’s top-rated urgent care EMR here. Thanks to Practice Velocity for supporting HIStalk. 


Webinars

March 6 (Wednesday) 1:00 ET. “Pairing a High-Tech Clinical Logistics Center with a Communication Platform for Quick Patient Response.” Sponsored by Voalte. Presenters: James Schnatterer, MBA, clinical applications manager, Nemours Children’s Health; Mark Chamberlain, clinical applications analyst, Nemours Children’s Health. Medics at Nemours Children’s Health track vital signs of patients in Florida and Delaware from one central hub, acting as eyes and ears when a nurse is away from the bedside. Close monitoring 24 hours a day integrates data from the electronic health record, such as critical lab results, and routes physiological monitor and nurse call alerts directly to the appropriate caregiver’s smartphone. This session explores how the Clinical Logistics Center and more than 1,600 Zebra TC51-HC Touch Computers running Voalte Platform connect care teams at two geographically dispersed sites for better patient safety and the best possible outcomes.

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


Acquisitions, Funding, Business, and Stock

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Cerner’s investor presentation from HIMSS19 (worth a look in its entirety if you follow Cerner) included Brent Shafer’s “new operating model,” with these comments standing out:

  • The big themes are (a) making it easier for clients to do business with the company; (b) increasing the speed of innovation; and (c) growing profitably over time.
  • Cerner is “structured in a way to not conducive to productivity” in growing to $10 billion, thus the need for change.
  • A key component is the Greenhouse, an incubator where innovative ideas can be nurtured without competing for operational resources.
  • Client relationships will be a strong focus.
  • Process improvement is important – accountability, shared goals, driving increased collaboration and transparency, common metrics and KPIs, a focus on life cycle, and doing a better job of partnering.
  • A consolidating market is creating bigger client footprints.
  • Examples of getting innovation to market faster and making adoption easier: Dynamic Documentation is well liked and reduces clinician burnout, but six years after launch, only half the client base has it. The company offers a network for sharing air quality information for asthmatics, which shows what is possible with network connections.
  • The company offers 30 third-party apps and expects that number to increase.

Decisions

  • University of Maryland Shore Regional Health (MD) replaced Meditech with Epic on December 1, 2018.
  • Haskell Memorial Hospital (TX) replaced Evident (a CPSI Company) with Athenahealth on October 1, 2018.

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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Fisher-Titus Health System (OH) hires Linda Stevenson (Cerner) as CIO.


Announcements and Implementations

CPSI makes its EHR information available to patients via Apple Health Records on the IPhone. 


Government and Politics

FDA warns McKesson over incidents where the company failed to take action after finding that one of its employees replaced opioid tablets with some other product, with McKesson doing nothing to warn other customers to check packages of the same lot number.


Privacy and Security

A hospital in the Netherlands confirms that students who work part-time there were inadvertently given the ability to view the complete electronic medical records of all patients, caused by incorrect software settings. 


Other

Some Twitter fluke kept recommending #HIMMS19 as a hashtag, creating a ton of tweets going out under a misspelled HIMSS.

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Rapidly improving photo and video manipulation tools capable of “deepfaking” (like the AI-generated portrait above) will threaten democracy, justice, and commerce since you can no longer tell if what you are seeing on Facebook or anywhere else is real. Check out this AI-powered site to see how easily technology can create believable images out of thin air. We need some kind of digital certificate that verifies that photos and videos were taken with unaltered cameras and have not been changed by even one pixel (some kind of hashed signature embedded as a watermark, maybe?) 

Non-profit health system Atrium Health – the former Carolinas HealthCare System – paid its CEO $6.1 million last year.

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The busiest webmaster in the industry must work at for-profit, CHS-owned Bayfront Health St. Petersburg, which keeps removing executives from its leadership page. He or she is behind, however, as the CFO just quit, joining other recent departees. I notice that the guy at the lower right moved to an assistant CEO job after two years as a performance improvement intern, his first job other than marina manager and a football skybox attendant (although to his credit he did earn an MHA).

Beverly Hospital (MA) admits to the state’s Department of Public Health that a former pharmacy technician stole 18,000 pills – most of them opioids – by marking them as outdated in Pyxis and then either using them or selling them. The hospital finally caught her a year after the thefts began, blaming the delay on a former pharmacy operations director who it says wasn’t reviewing the Pyxis reports. 

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A sperm bank sends a cease-and-desist letter to a female customer whose daughter was conceived using sperm the woman bought from the sperm bank. The woman had her five-year-old daughter’s DNA tested by 23andMe, which identified another 23andMe customer as the child’s grandmother. The woman thought it “was a cool thing” to contact the grandmother to say she would be open to contact from her son the donor, forgetting that the the sperm bank’s terms prohibit such contact until the child is 18 and only then through the sperm bank rather than directly. The sperm bank threatened her with a $20,000 penalty and said it could withhold the remaining four vials of sperm it was holding for her, also reminding her that she’s not allowed to seek the identity of the donor through DNA testing or online facial recognition tools.

A woman’s cancer treatment is delayed after the copies of her CT scan she had overnighted to her clinical trials team never made it – the mailbox place’s owner was in foreclosure and took off.


Sponsor Updates

  • Oneview Healthcare publishes a case study describing how University of Iowa Hospitals & Clinics uses a combination of technology and empathy to improve the patient experience.

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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 2/15/19

February 14, 2019 Headlines No Comments

Texas Health System Selects CPSI SaaS Offering, nTrust

Mid Coast Health System selects CPSI’s NTrust program, which combines the vendor’s Thrive EHR, interfaces, and maintenance services with RCM support from TruBridge.

Health tech is so old-fashioned that Google had to adapt its cloud service to work with fax machines

At HIMSS, Google offers attendees a preview of the ability to fax medical information from its Google Drive cloud-storage service.

Hospital: Failure to read reports may have allowed pill thefts to go undetected

A pharmacy tech at Beverly Hospital (MA) alters computer records to cover up her theft of 18,000 pills over 13 months.

From HIMSS 2/14/19

February 14, 2019 News 7 Comments

News Items

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Veritas Capital is seeking a buyer for the API Healthcare workforce management software business it bought in its July 2018 acquisition of GE Healthcare’s software business. Veritas separated out API Healthcare with the acquisition and restored its previous operating name.

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Meanwhile Veritas-owned Virence Health, which merged GE Healthcare’s Centricity business with Athenahealth, confirmed on the HIMSS floor with me today that it will stop using the Virence Health name and instead move forward under the Athenahealth banner. Veritas Capital bought the GE Healthcare assets in July 2018, rebranded the business to Virence Health in October 2018, and then struck a deal to acquire Athenahealth five weeks later. It’s not surprising that the newly formed company couldn’t wait to shed its GE Healthcare albatross with a new name and then found itself owning a far more valuable one in Athenahealth, but a lot of money was wasted rolling out the Virence Health brand for its short run, including printing all those HIMSS19 totes. I told the booth rep that they should sell the trademark since it’s mostly a blank slate at this point anyway. 

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Adventist Health has laid off all 1,300 employees of Feather River Hospital (CA) and may not reopen the facility that was damaged in the November 2018 Camp Fire. That isn’t much of a reward for those employees whose dedication and heroics saved patients and provided shelter for local residents who were fleeing the devastating wildfire.


From the Burner Phone

“HIMSS sent this registration count for HIMSS19 – 42,595, with 39 percent representing provider organizations.” That’s down a bit from HIMSS18 and well short of the “45,000+” that HIMSS has been touting. Other leading stats for HIMSS19 that would be relevant are exhibitor count (and square footage), percentage of first-time attendees, and percentage of international registrations. My perception is that it was slower than in previous years, less focused given the absence of government mandates, and perhaps an expense that some exhibitors wouldn’t have committed to a year ago if they could have foreseen their now-obvious decrease in business.

“DoD, VA, and CMS take center stage with enormous agency-made booths and session after session talking about how they’re collaborating and leading. Maybe stay home and get your #!@$#!$@# EHR working?! A reminder that their ‘single instance’ has been ‘live’ for two years now and has yet to sniff a D- grade after two major tests. Not suitable, not operable, and most-certainly not INTERoperable.”


Observations

Today featured a beautiful, sunny morning that got even better as it warmed up. The cold and damp from yesterday were quickly forgotten on this last day of HIMSS19. I say “last day” because hardly anyone will stick around for the Friday afternoon wrap-up. This year’s schedule was a mess since the conference started on Tuesday instead of Monday, meaning that all those folks who could have been headed home for Valentine’s Day after the exhibit hall closed for the week on Wednesday now had to wait until this evening, most of them missing what should have been a special day at home.

You may remember the history of why we’re in Orlando this year and again next before returning to Las Vegas for HIMSS21. HIMSS got into a snit with Chicago Tourism in 2014 after finding out that RSNA was given lower hotel room rates and quickly lined up Orlando as a replacement for Chicago for HIMSS19, presumably with less flexibility on dates due to the relatively short notice. HIMSS17 was last in Orlando February 19–23, 2017, with the opening reception on the usual Sunday and the exhibit hall open Monday through Wednesday, a far better and more familiar schedule (I’ve been behind a day every single day this week, including Tuesday, when I was confidently telling everyone it was Monday). Las Vegas will probably always start later in the week because the casinos aren’t about to lose weekend gambling revenue for a conference. HIMSS20 is March 9-13, nearly a full month later than this round (yay – we have a 13-month break), but apparently still on the Tuesday through Friday schedule as this year. Maybe HIMSS has decided to try to synchronize Orlando and Las Vegas in avoiding the Sunday opening reception.

I was quite wrong about how this last day in the exhibit hall played out. I saw few pieces of luggage in booths, companies stuck it out, and reps were reasonably well focused. It was actually a really good day, where booth traffic was down a little and food lines were non-existent. It was quieter and I suspect the quality of the conversations was better. I think some vendors had already written today off and were happy to see fewer swag-seekers and more folks anxious to talk specifics and see demos. Good job not wasting the last day, everyone.

I continue to be amazed at how many men who are employed in healthcare leave the restroom without washing their hands. By the way, you are shaking those same unwashed hands when you visit a booth.

MedData scone trivia – the company brings their own ovens to conventions to bake and then ice the scones, which are made from frozen dough, and it’s all done with their own employees, not convention center catering people. They can do in-booth baking in every convention city except Boston and Las Vegas, where the trade unions are too strong and won’t allow it even if union members man the ovens.

I sat through a dull HIMSS Analytics presentation today, with the only slightly interesting takeaway being that 347 hospitals in 12 countries have achieved EMRAM Stage 7. And that HIMSS is starting yet another adoption model, this one for clinically integrated supply chain like medical devices and implants (H-SIMM). HIMSS sold off its data business to Definitive Healthcare recently, but is keeping the adoption model business, which includes consulting. I haven’t heard why it wanted out of the data business it so desperately wanted in when it bought a data company years ago.

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Good job, everyone (including me) who filled a bag with toys and supplies for hospitalized children at the Connection booth. Coincidentally I ran across an old friend today and found that she is CIO at an area facility – she had just learned that kids at her place will be getting a bunch of the bags. It felt good giving and I hope it feels good receiving.

I did get a memory blast from the past from the HIMSS Analytics presentation since the presenter referred to it – old school hospital wiring closets that, when you sent your network tech to reset a router, always required moving the mop and bucket the nurses had stashed there.

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Cerner previously never referred to its competitors by name, hoping to diminish them by leaving them anonymous. I was therefore surprised to see two slides from a very long deck playing on a huge monitor at Cerner’s main booth podium, the first of which called out Epic as being late to the interoperability party by not joining CommonWell, the second slamming Meditech with a headline of “Rebranding is not re-engineering” in claiming that Expanse is just a new name for an old product that wasn’t selling. I was surprised that they used the logos of both companies.

I heard from vendors all week that exhibit hall Internet connectivity was too slow to present demos. That’s surprising given what they pay for connectivity.

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I wondered if they made the consultants pedal?

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I don’t know why I find boxed water amusing, but here it is.

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I thought my photo included the name of the vendor that put out this very nice spread at the end of the last exhibit hall day, including some nice chocolate-dipped strawberries. Alas, I did not, but I appreciate whoever it was that sprung for impressive closing-day afternoon treats (the red velvet cookies were great).

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Optum made sure that every bench and table were labeled to discourage anyone from sitting on them without permission. They are owned by an insurance company, so they’re good at denials.

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I’m not sure what IBM was thinking in buying up the biggest floor space in the exhibit hall, then leaving it largely vacant. Either they over-estimated customer interest or Watson lost its mind trying to recommend a booth size.

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I was afraid of this door in the IBM Watson Health booth since I figured it might have been the last thing seen by all those older employees who IBM unceremoniously laid off in its attempt to “correct seniority mix.” Or maybe this is where the “Man Behind the Curtain” is sequestered.

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The line to have a custom t-shirt made by DSS stayed long even as the last afternoon of the conference wound down.

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A fun giveaway in the form of George Clooney’s tequila Casamigos. Life isn’t fair that someone with George Clooney’s looks and acting career then sells his tequila brand for $1 billion. At least I won one of the little bottles of it.

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I wouldn’t want to sit next to a stranger on seats like these.

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I admit that while I feel justified in questioning the credentials and intentions of some of the HIMSS Social Media Ambassadors, I’m casting the net too wide because some of them rise above the rest. Case in point is Dr. Nick van Terheyden (you can easily assess my respect because I follow only 133 Twitter accounts and his is one of them). Dr. Nick read that I was shut out from the cool helicopter socks being issued by Intermountain Ventures, and not only did he score me a pair and leave them with Lorre, he also included a pair of pink socks with a beautiful handwritten note that not only describes how he sees the Pink Socks movement, but also his own philosophy. I’m not ashamed to say that it choked me up a little – he was brimming with the positivity that isn’t my long suit. Thank you, Dr. Nick, for sending me not only a giveaway, but a takeaway.  

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The last view of the convention center from the shuttle bus. Taxis were loading up with people anxious to get to the airport and then home.

I’m too tired to keep working tonight, but this weekend I’ll try to arrive at some kind of conclusions about HIMSS19 and ask you for yours.

Dr. Jayne at HIMSS 2/14/19

February 14, 2019 News No Comments

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There was a shuttle immediately available at my hotel today, so I took it, figuring I’d give my feet a rest before hitting the show floor. It delivered me a bit before the doors opened but when I looked to find a place to sit, all the tables were covered with food and trash that based, on its content, was from yesterday. For as much as this conference costs, the tables could be wiped off overnight.

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People always ask me what is the best thing I saw in the hall on any given day, and this is the one. A good friend clued me in to WEconnect Health Management, which was over in the 888 booths. They’re using smartphones to engage patients along the addiction recovery process, delivering positive reinforcement in the palm of your hand. Families and providers can track compliance with care plans and patients who engage with their treatment plan can earn loyalty rewards. Founder and former professional tennis player Murphy Jensen was in the booth. Their content is evidence-based and they use a risk score algorithm to identify risk of relapse before it happens, so the care team and supporters can intervene. This is one of those solutions that I’m excited enough about to actually go home and try to get some of my colleagues to engage with it. My practice provides medical coverage for a residential treatment center and I think they’re going to be really excited about this company. A lot of people don’t spend any time in the small booth areas, but there are some gems for sure.

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Elsevier prominently displayed their sponsor sign.

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So did Santa Rosa Consulting.

I continued my quest to learn more about telehealth with a stop by InTouch Health. They’ve got a slick platform that’s geared to hospitals and health systems with offerings that span from stroke management to cardiology to ICU monitoring and beyond. The booth reps were friendly and knowledgeable and worked to get me the demo I wanted without making me feel like I was waiting. They have some impressive data on their network and connectivity stats that I hadn’t heard from other vendors I visited with this week.

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Intermountain Healthcare had awesome socks with air ambulances on them and were happy to give me a pair just for the asking.

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I was looking for 3D printing at the Hewlett Packard booth and spent some time talking to their team about Fitstation. It’s a device that performs a volumetric scan of the feet and collects data to enable 3D printing of custom orthotics at a fraction of the cost of traditional devices. The team was engaging and very enthusiastic about their product even though this isn’t a high-traffic show for them. They also happily added to my sock collection, supplying both running socks and fashion socks.

I ran into an old friend at Optum – reconnecting with people is really my favorite part of HIMSS (other than getting the required LLSA Continuing Education hours for my Clinical Informatics board certification). Some of the folks I happened across were people that I’ve walked through fire with (at least as far as EHR implementations go) and even though we hadn’t seen each other in years, it was as if had just seen each other yesterday. Several of them were job hunting, and knowing the caliber of people they are, it’s a loss for the employers they’re trying to leave. People are tired of being at risk for being reorganized, downsized, or streamlined and the good ones jump when they can.

Some of the reps were getting more aggressive today. One vendor’s team was halfway across the main aisle soliciting people to come to their booth. I’m pretty sure that’s some kind of violation of the HIMSS rules of engagement, and this particular rep wouldn’t take no for an answer. Once someone indicates they’re not interested, you’re not likely to convert them. Perhaps some additional sales education is in order.

Orchestrate Healthcare had their “booth babes” in short skirts again today. The putting green is such an overdone booth attraction and frankly I would take the company more seriously if they put the green attendants in funky golf pants or even just khakis. The skirts they were wearing were too short to pass the dress code at the last course I played and at least four inches shorter than the one golf skirt I own.

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I attended a lunch that featured FirstNet, powered by AT&T. Having spent some time in the emergency room trenches as well as volunteering with a rural fire department, I was interested to hear about their efforts to build an ultra-reliable wireless network for first responders. The lead presenter had one of their hardened smartphones and literally threw it across the room for attendees to see how rugged it was. It has an insane amount of battery life and can survive submersion and a drop from a seven-story building. One of the company’s goals is to deploy the network to 99 percent of the US population within five years and they’re running a year ahead of schedule, which is impressive. They’re creating a public safety app store where downloads will be fully vetted and guaranteed to have no back-end data capture. The network is used not only for disasters, but to enable ambulance teams to communicate reliably with emergency department medical control officers. They had a great use case of having a physician look at an EKG from the field and reroute the patient from the emergency department directly to the cardiac cath lab. The Orange County Convention Center butter pats were a nice touch.

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There were plenty of good shoes to be seen, although I wasn’t able to capture all of them. Props to the woman in the blue embroidered gaucho boots — they were amazing. There were also some memorable thigh-high boots on the floor today along with these numbers. I feel like a creeper taking the pictures at times, so I apologize if anyone was offended.

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The Colorado HIMSS contingent was ready for action. I spotted them at the Intelligent Medical Objects (IMO) booth where champagne and prosecco were being served in honor of Valentine’s Day.

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As was Dr. Nick van Terhyden. My own Valentine’s Day socks paled in comparison.

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The Allscripts booth had the tagline “Open up your possibilities,” but I found the booth oddly claustrophobic with its lowered illuminated ceiling.

A CIO friend told me about Nuance’s new offering that promises “clinical documentation that writes itself.” I am excited about what they have to offer – it’s Dragon-powered virtual scribe technology that links up with EHR documentation. The demo was slick and well prepared, although it’s hard for me to enjoy demos because my brain always gets sidelined by the super-simplified clinical content. They’re going to begin deploying to a subset of specialties soon, although I suspect it might be a while before they get to primary care. If they’re looking for a physician to continue to kick its tires and see if she can stump the dragon, I know where they can find someone.

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I mentioned this empty booth the other day. HIMSS filled it with tables and chairs, providing a much-needed place for weary travelers to rest their feet.

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The Howard Med Technology Solutions booth featured a diner offering ice cream, sodas, and Moon Pies. The staff was welcoming and happy to give refreshments to anyone who asked.

I’ve heard a lot of negative feedback about other vendors this week who weren’t willing to give out their swag, even when asked nicely. I experienced it myself, when one booth’s staff handed me off to three separate people before someone would finally agree to negotiate with me about some socks. Another vendor was only giving out their socks to people who fit a specific sales profile. If that’s your situation, then don’t put them out on the counter and instead keep them hidden for the right person to stop by.

If you have stuffed animals and someone specifically asks you for one to take home to a child, humor them. If you’re in a booth, you’re likely a road warrior yourself, and someday you might know what it’s like to surprise a kiddo with a cool animal that will be meaningful to them during a week where mom or dad was away. Typically on the last day of HIMSS people are a bit more free with their swag because they don’t want to send it home, but apparently not everyone thinks that way.

That’s a wrap on HIMSS19. I’m hanging out at the airport enjoying the free MCO Wi-Fi. Safe travels to everyone who is still at the show. I’ve never attended a closing keynote, so if you want to share your impressions, leave a comment or email me.

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