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Morning Headlines 4/11/19

April 10, 2019 Headlines No Comments

Partners HealthCare Embraces the Democratization of AI to Accelerate Innovation in Medicine

Partners HealthCare (MA) will equip its clinicians and researchers with the tools necessary to develop their own AI algorithms through its MGH & BWH Center for Clinical Data Science.

InTouch Health Unveils the First Fully Integrated Virtual Care Platform

InTouch Health develops telemedicine software that can be used in any type of healthcare setting.

Feds Charge 24 In Alleged $1.2 Billion Medicare Fraud Scheme

Federal prosecutors charge 24 people, including executives at five telemedicine companies, with $1.2 billion in Medicare fraud.

Concerto HealthAI Enters Precision Oncology Collaboration with Pfizer

Concerto HealthAI will work with Pfizer to advance AI capabilities for oncology using its proprietary AI technology, EHR software, and claims data.

HIStalk Interviews Luis Castillo, CEO, Ensocare

April 10, 2019 Interviews 1 Comment

Luis Castillo is president and CEO of Ensocare of Omaha, NE.

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Tell me about yourself and the company.

Ensocare is a care coordination platform that helps move patients to the right level of care along the care continuum. We’ve been doing this for about 10 or 11 years and I’ve been there five years.

I’ve been in healthcare IT for a long time. I don’t think I’ll ever go back to big company. I’m having the time of my life running this small company.

What are the benefits and challenges for hospitals in getting discharged patients placed and coordinating their care afterward?

The big EMR push, Meaningful Use, and even ICD-10 took people’s attention away from the post-acute care side. What happens once you leave the hospital? I lost my brother about two years ago and I remember trying to get him placed into hospice. I had to go to our network and ask my team. Who is available Des Moines area? What are their CMS scores? Because the hospital handed me what looked like the cardboard filler that comes in a shirt. It was laminated and had a bunch of numbers on it. Some were scratched out, some were written over.

They said, here you go, it’s up to you. Make some calls and figure out where to put him. There was no automation and no ability to tell me which facilities were better or which ones weren’t. That discharge and placement process is highly fragmented and not very process driven.

We put automation and technology behind this very manual place. Nurses typically stand in front of a fax machine for 5-6 hours a day getting this done, so we let them go back to working at top of license and get them back in front of the patient — case managers, social workers, and so forth. But we also impact length of stay, so if I can decrease it by a quarter-day for patient population, that’s big money over the year.

Hospitals sometimes leave placement decisions to the patient and family to make sure they aren’t accused of playing favorites or being held accountable for placements that don’t work out. Is their challenge in advising patients and families due to lack of knowledge or a reluctance to exert undue influence?

That’s a really tricky question. I still remember when health providers and payers couldn’t even be in the same room together. There was this hatred for each other. But now health plans own hospitals and hospitals create their own health plans. With some of the Medicare Advantage plans, people who are taking on risk can manage and direct patients to places if it’s their own population.

But you bring up a great point. The IMPACT Act says you have to give a patient choice. You have to disclose any financial relationship you have with that home care agency or that behavioral health provider that is affiliated with your IDN.

Our system lets you put all the choices in front of the patient and give them an unbiased score, such as the CMS scores for quality. They can flip through almost a Hotels.com interface on the tablet and look at the places that have a bed available. They can see if they are pet friendly, check which churches are nearby, see a picture of the area.

Hospitals aren’t supposed to direct people or to steer them. They have to manage that closely. Our application helps document that they gave the patient choices.

In the absence of something like a Tripadvisor that includes detailed reviews and scores from individuals, should I as a patient or family member trust the CMS star ratings?

We’ve been asked by our customers to do some kind of independent rating score for post-acute care facilities based on the data that we have, such as readmit ratios and quality scores. But I’ve been hesitant to do that. We offer the post-acute care network a free portal. We don’t charge them to belong to this, although some of our competitors do. We try to get them to be engaged, to answer inquiries within 30 minutes, and to keep their engagement level up.

We have something that is more on the predictive side on our roadmap. Predictive analytics that say, based on what we know of this patient and the performance of organizations in our network, here’s where we think this patient will do best. They need DME, infusion, dialysis, and these levels of care, and these places do really well with that. I don’t want to become a Class II device and make a clinical recommendation, but I will start scoring and show them a predictive model.

How important is it to have access to actual empathetic humans and not just technology and information when making what could be one of the most important decisions in someone’s life?

I remember when Gateway and Dell came into the PC market. Nobody thought they would ever pick a laptop or desktop off a pick list since technology was intimate in some ways. You wanted to see it and touch it. You would never buy it sight unseen. But the paradigm has shifted. We buy online, even for major purchases like cars, and just have it delivered.

You probably won’t pick a provider via technology, but you’ll get a list of 10-12 places that have a place for Aunt Betty. You take a look on the tablet at their quality scores and decide which three to visit because they meet the criteria. You’ll physically go and take a tour to see if it’s the right place.

The predictive modeling will make it more interesting in being able to show outcomes and recommendations. I’m not sure if I’m going to develop a Yelp-like thing, but people want to know what other people felt about their visit there and what it was like.

It’s also true that everybody is not in the same financial situation. We are looking at working with payers to provide an estimated out-of-pocket expense. That is powerful because you may not be able to afford the five-star rated place.

Given that not everyone is willing or able to pay for a Ritz Carlton, can someone with a Motel 6 budget at least look up how satisfied others like them with similar expectations were with a particular facility instead of just comparing absolute satisfaction numbers?

Not today. The closest thing involves discharges, although it’s hard to quantify with so many variables and I can’t say for sure if I’m impacting it. But we’ve seen a big change in HCAHPS scores. On discharge, people afterwards didn’t understand the discharge because it was in the wrong language, she spoke very quickly, they were pushing me out the door, the ambulance was late. They list all these things, but an HCAHPS-type measure does not exist for the post-acute care visit right now. But as you start managing populations, I think it’s coming.

What does a hospital need to do to get started with your program?

They start by listing their favorite facilities in the area, the ones they use frequently and discharge to most often. We build that into a quick list in the system. We reach out to all those post-acute care providers, train them on our portal, and get them to understand that there’s an engagement value here that says you have to answer referrals within 30 minutes. Seventy percent of Ensocare calls are outgoing as we are managing the network. That’s different from some of other solutions that just buy a CMS database, import it into their system, and call it done.

I build my database organically. Every time I do these outbound calls, I know which facilities aren’t responding. Our customer support people and customer experience people call them proactively to say, we notice that you aren’t responding to the referrals we’ve been sending you. Is there a problem? Many times it’s, oh, the lady that had the app on her phone left and we don’t know how to answer any more.

We deal with post-acute care facilities that are very technically advanced and are part of large national chains. But we also work with home care mom-and-pop organizations in rural parts of the country, so it can be challenging. But we actively engage and manage the network to make sure they are responding.

You wrote after HIMSS19 about how smart speakers like those powered by Alexa might be used in healthcare. What do you predict?

The interface is becoming more reliable. Nine times out of 10, Siri or Alexa gets it right. One of the biggest potential uses I see is managing the population after discharge. Once you get a risk score through LACE or some other technology, you know that this patient has two co-morbidities, is high risk, and has a lot of social determinants. The nurse wants to follow up, but they’re going to call you, ask you to enter information into a mobile device on an app. Many patients aren’t all that technology savvy. But if you send them home with a smart speaker, it could automatically populate population health platforms with vital signs. The nurse is now calling only the people who need intervention as opposed to calling everybody every day. That model is unsustainable.

I recently was at a hospital that had a warehouse full of 75 nurse navigators. All they do, all day long, is call people. I’m following up on your primary care visit. Did you pick up your prescriptions? Did you do these things? Tools like the smart speakers are going to begin to invade that space.

Do you have any final thoughts?

I worked for two large companies. Shared Medical Systems taught us how to be close to the customer. Siemens, true to its German engineering background, taught us all about process and engineering. A healthy combination of both of those things is appropriate.

But the one thing that can’t be supplanted, the one thing that you always have to keep at the top of your radar, is high-touch customer service. We have a person at the end of the phone each time. You don’t get routed and automated and have to press two and three to talk to a representative. We have a high-touch customer service that our customers appreciate.

Vendor Alternatives to Exhibiting at the HIMSS Conference

April 10, 2019 News 1 Comment

The HIMSS conference exhibitor roster turns over every year as a significant portion of companies either sign up for the first time or previous exhibitors decide not to return. I’ve heard from more of that latter group after HIMSS19 who are questioning the return on investment, which for most of them means generating sales leads.

Most vendors have no plans to stop exhibiting. Some are happy with the value they receive in having a lot of people they need to see who are in a single place at a single time. Others worry that their absence will be exploited by competitors as a sign of weakness or that customers will question their commitment. The exhibit hall is likely safe from mass defection, especially for long-established and large vendor players.

However, small and medium-sized vendors who rack up significant booth, travel, and staffing costs for just three frantic days may wonder if they should be spending the money elsewhere. That’s especially true as the industry has settled down into less of a land-grab mentality now that Meaningful Use money has been spent, major software decisions have been locked in at health system corporate levels, and health systems worry about margins as their core business faces unknown changes.

I asked vendor readers for ideas of how they might reallocate some or all of their HIMSS exhibition costs into efforts that would yield more tangible business results. Thanks to those who took the time to share their thoughts.


We don’t exhibit, but we send more than 10 people to HIMSS and get a meeting room instead. We set up meeting room appointments prior to the conference so we can use our time efficiently. We’ve gotten a lot out of this and plan to keep it up.


We use our budget to attend the shows where we already have a big client presence. We go as attendees, offering a dinner with our strategic client advisory board. We don’t get leads, but the partnerships lend to better product strategies and focus areas for the business. HIMSS isn’t a big lead generator for us, so the rest of the budget I would diversify into PR activities and a solid PR agency. We also do sponsored blog content and attend smaller conferences.


We go every year because we want our name on there and it’s an opportunity to meet with customers and partners. But we absolutely do not recover the cost of attendance in ROI. HIMSS is where vendors show off to each other, not where customers come away having made purchasing decisions.


We exhibited at one HIMSS conference 15 years ago as a startup selling a small departmental system and decided never again. Every year a few of us attend the show (we can always rustle up some guests-of-vendors badges), and we set ~20 meetings with current and potential partners. Every year we’re grateful we don’t exhibit. We’re still spending money attending the shows, so we’re not saving as much as we could be, but our expenses are less and we get good value out of the face-to-face meetings. We’ve never specifically allocated the funds we would have spent at HIMSS to other efforts, but the remainder has gone toward our general marketing budget.


We stopped exhibiting at HIMSS following the 2018 show. Even though we booked a booth for 2019 during the 2018 show, we forfeited our deposit because it was cheaper than following through and burning the hundreds of thousands we’d have to shell out to be present as we originally planned. Instead, we found smaller, more regional shows that offered more engagement with our specific target audience. We carried out some branding campaigns, spent more on content development and distribution, and sponsored some webinars that again allowed us to better target our outreach and drive the right people to our event.

We also invested in some technologies to help us connect with our target audience, including ZoomInfo and Definitive Healthcare. That way we could identify the accounts (health systems and hospitals) we wanted to contact and find out exactly who the people were who should be our target buyers. A quarter of a million to half a million dollars can go a long way when you spread it out to different activities and you identify those that will support your marketing and sales efforts. And we’re just a former 20×20 vendor. Think about the major players and all the floor space and investment they burn.


We will continue to exhibit, but an alternative would be to do a roadshow. We would evaluate which cities would be the best locations for existing and targeted prospects. Select an event marketing team to pick venues. Then use the money for team, rent venues, catering, AV, travel, swag, etc. A key component would be to pay to have featured customers and internal team members travel to and speak at event.


An alternative to paying for a large booth is to simply downsize and pay for a 10×20 or even a 10×10 booth. Your company will save a ton on expenses and will benefit from reduced staffing and reduced equipment, etc. But you still maintain a listing in the HIMSS guide so that customers and partners can find you. This will also force you to choose the most impactful people that need to attend and forces a decision on what products you really need to showcase. Sort of like downsizing when you move — it forces some tough decisions.


We stopped three years ago. We spent about $300,000 on a booth, had 90 leads (most were students) and only 12 actual decision makers. Twelve leads for $300,000 is a bad investment. Now we hold an industry breakfast and it has been a great event – CIOs, CTOs, and CMIOs only. We had 30-40 people for about $20,000, a much better investment. The attendees are the ones driving this and frankly we’ll spend our dollars elsewhere. This convention has become nothing but a money grab for HIMSS and the value is long gone.


I would invest those resources in organic PR, meaning I would take the time and effort to document client success stories, translate them to meaningful, educational information to prospects, and pitch that content to trade press, national media, etc. (not sponsored content). I would also consider investing in good, well-produced, reusable video content.


As a small company, we stopped having a physical booth at HIMSS a few years ago for many of the reasons you described — cost, being lost in caverns and hinterlands of the exhibit hall, very few real leads, etc. We still have what we believe is a strong presence for our size by doing other things — working with partner companies in their booths, leveraging healthcare ecosystem areas like the Intelligent Health Pavilion, and partnering with our customers to have educational sessions on the agenda. We also promote our attendance at HIMSS before the conference with customers and on our website / social media so we can make sure to connect with those who we need to see during the show. A few weeks prior, we do a press release about the various ways we will be participating at HIMSS, and during the show we are posting / tweeting “Live from HIMSS”. I guess you could say we have virtualized our booth for HIMSS!


Register as a participant, attend be at all the social events and relevant educational sessions, keep the elevator speech short (2-3 sentences), arrange for a Wednesday or Thursday evening offsite event that can be promoted over the week. Don’t try to cram so much in up front. Create some mystery and intrigue. Useful or unique bling (or chocolate) may help.


This actually occurred at my last company. We opted to host an event at HIMSS, a one-night, blowout event that was half the cost of the booth for the week. We spent months prospecting and getting folks to the event, while setting up meetings outside of the exhibit area (restaurants, hospitality suite, etc.) for 1:1 meetings. This works much better in Las Vegas than it does Orlando.


Is HIMSS a huge financial commitment? It sure is. And if all you’re going to measure is lead generation, then it won’t be worth it. The cost per qualified lead at HIMSS in my experience is north of $10K or even $15K. And clearly there are cheaper ways to get to leads if that is your only measure of success.

But HIMSS is also a place to get stuff done. Strategic partnerships, briefings with current and potential partners, window shopping for possible M&A, early look at emerging trends and competitor positioning, and … gasp … customer engagement (which shouldn’t be confused with lead generation.) A well-planned and executed HIMSS with proper organizational support yields far more benefits than simple leads.

Having said all that, if HIMSS were to disappear as an expo, I would not be all that disappointed. It’s become more of a place to be seen. The nuclear arms race of HIT marketing, if you will. Unfortunately denuclearization only works if everyone disarms. And we know that won’t happen. So we make the most of it with planning and outreach months in advance.

Finally let’s not forget the HIMSS points system. If you have years spent supporting HIMSS, pulling out for even one year knocks you back to zero. And suddenly you’re at the back of the bus in terms of booth selection, making it an even harder ROI to justify.


Have a party right across the street with free alcohol and food. Has that been done before?


Invest in breakfast briefings and lunch and learns as a way to drive targeted executives interested in your solutions and offerings.


As a provider, I don’t care if vendors exhibit, especially if I’m told in advance the reason for not having an actual booth. Having some company representation at the conference to meet with, even if not at a booth, is generally sufficient for my needs.


Exhibit at AHIMA and select state HIMA conferences.


No customers come to HIMSS,  just other vendors. I would rather invite customers and prospects to a smaller, more intimate event and invest in interesting thought leadership or education for that base. For example, physician roundtables with an industry thought leader.


Work with Becker’s and CHIME more closely.


Drive a subject matter interest thought leadership 1.5 day summit for 50 persons


Morning Headlines 4/10/19

April 9, 2019 Headlines No Comments

Cerner Announces Agreement with Starboard Value Regarding Board Refreshment, Operational Improvement Initiatives and Expanded Capital Return Program to Drive Next Phase of Profitable Growth and Value Creation

Cerner bows to pressure applied by an activist investor by appointing four new board members as nominated by hedge fund operator Starboard Value, which owns 1.2 percent of outstanding CERN shares.

Diameter Health Announces $9.6 Million in Series A-1 Funding Round

Clinical data integration vendor Diameter Health raises a $9.6 million Series A-1 funding round led by new investor Optum Ventures.

Microsoft is shutting down its HealthVault patient record service

Microsoft will shut down its HealthVault service on November 20, 2019.

Ontellus Acquires B2B Health Information Exchange ChartSwap

Multi-vertical records retrieval company Ontellus acquires medical records request vendor ChartSwap.

News 4/10/19

April 9, 2019 News 5 Comments

Top News

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Cerner bows to pressure applied by an activist investor — and perhaps as a result of its own self-examination led by Chairman and CEO Brent Shafer, who was hired in January 2018 — by appointing four new board members. Hedge fund operator Starboard Value owns 1.2% of outstanding CERN shares.

Starboard was less adversarial in this case than with previous targets, steering clear of public criticism of the company and not delving into operating minutiae with a public call for changes.

In a previous example, Starboard took control of Darden Restaurants despite owning just 10% of the company by observing that its Olive Garden restaurants are too generous with breadsticks, use non-standard sized drink straws, and over-salt the pasta. Starboard managed to get every member of Darden’s well-qualified board replaced in October 2014, since which DRI shares have since risen 169% vs. the Dow’s 60%.

The new, well-credentialed Cerner directors — former top executives of Hill-Rom Holdings, MedAssets, Jawbone, and Cloudmark, two of them nominated by Cerner and two by Starboard – now represent 40 percent of the board. Another board member will be retiring.

Chairman and CEO Brent Shafer stated previously and reiterated today that the company has identified opportunities to “unlock the company’s significant potential” in creating a new operating model and will focus on improving profits and efficiency along with ramping up innovation. He says Cerner has:

  • Replaced the president position with chief client officer
  • Eliminated the strategic business unit structure
  • Reviewed its product portfolio to maximize development resources
  • Centralized operational functions that were previously spread across multiple executives who reported to the COO
  • Announced plans to pay share dividends, repurchase more shares, and add free cash flow generation as an executive bonus metric
  • Expanded margins

Starboard Value was a significant shareholder and an activist investor in MedAssets a few years back. It also triggered the sale of physician services vendor Envision Healthcare to a private equity firm last year.

CERN shares were up 10% at Tuesday’s market close. They’re up 17% over the past five years vs. the Nasdaq’s 93% rise.

Perhaps I missed it, but I wasn’t aware that Cerner was being pressured by Starboard, although in this case the relationship seems more collaborative than Starboard’s history would suggest and Shafer had already implemented changes to reposition the company in ways that Starboard would likely have found aligned with its own areas of focus.


Reader Comments

From Mark: “Re: HealthVault. Why can’t a company that’s worth $700 billion leave something running for probably $10,000 per year? They probably spend that on fancy coffee for management alone.” This is probably good news for Apple and other Microsoft technical competitors since MSFT tends to turn tail and run at spectacularly mistimed points after burning through a ton of cash and partner / customer goodwill with little to show for it as competitors find a way to sell their own versions of the same technology. This is the company that couldn’t figure out how to find success in offering a smartphone (Lumia and Windows Phone), a music player (Zune), a streaming service (Groove), a fitness tracker (Band), a browser (IE/Edge), a search engine (Bing), a smart speaker (Cortana), a tablet (Surface RT), a sophisticated movement tracker (Kinect), and now a personal health record even as Apple gets accolades for its own product and the government begins a hard push on giving patients their data. I’m being nice in not mentioning Microsoft’s healthcare-specific fumbling with Sentilion single sign-on and Azyxxi / Amalga / Caradigm. Keep that history in mind as the company starts playing the soothe-the-cobra music in trying to convince healthcare that this time, in the face of entrenched cloud competition from Google and Amazon, it’s serious about healthcare interoperability and AI.

From Spinal Screw: “Re: HIStalk. I find it hard to believe that anyone has time to read it all.” Not everyone does, but somehow quite a few folks – many of them running big provider and vendor organizations and some of them likely outcompeting you – invest the time in their success. I’m editorially selective and good at summarizing, but even I can’t tell you everything you need to know in a 30-second phone read in the coffee line or on the toilet and you may or may not be good at skipping stuff that you don’t think applies to you. I have no incentive to pad it out with fluff or verbosity. You might be in the wrong business or need a productivity makeover if you don’t have 5-10 minutes per day to follow your field.


HIStalk Announcements and Requests

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A reader commented that opinions expressed on HIStalk – both mine and those of readers – “reek heavily of cynicism of status-quo-ism” in always being skeptical of potentially disruptive developments (such as AI, EHRs, digital health, etc.) without offering alternative solutions, all because we’re protecting our hospital paychecks. This tension between would-be disruptors and those who keep the IT lights on today is important – we’re always going to be defending ourselves to impatient, often naive disruptors whose technology hammer is desperately seeking a healthcare nail to pound as we try to maintain a responsible, enterprise-driven approach. Here’s your chance to respond, perhaps considering these issues in your comments on the survey form I created. I’ll recap our collective thoughts in a few days.

  • Are provider health IT people really averse to investigating and using disruptive technologies or are we just jaded by a long list of previous failures?
  • What are the outsiders missing about what makes healthcare different?
  • What is the potential of technology-powered disruption in a mostly non-profit healthcare system that is heavily regulated and full of entrenched stakeholders ranging from hospitals to insurers to drug and device companies?

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Welcome to new HIStalk Platinum Sponsor Relatient. The Franklin, TN-based company offers a patient-centered approach to patient engagement that recognizes that “it’s not just a phone, it’s healthcare’s digital front door.” Solutions include appointment reminders and rescheduling, on-demand outreach for events such as weather delays, patient self-scheduling and waitlisting, satisfaction surveys, AR balance messaging, MDpay balance collection, and health campaign management (recalls, education, portal promotion). The service requires no app, no portal, and no password (since the service validates directly to the phone) and communicates with patients via their preferred channel (phone, email, or text messaging, the latter preferred by a startling 98% of patients vs. the basically zero who like patient portals). Patients are engaged as comfortably as they would be with friends and families, using behavioral science to meet their wants and needs without having a clumsy app inserting itself. An Epic-using pediatric hospital dropped its clinic no-show rate by 27 percent within six weeks, while a FQHC uses it to help meet the needs of diabetic patients with transportation problems. It’s integrated with a long list of systems that include those of Epic, Cerner, Allscripts, Meditech, EClinicalWorks, and Athenahealth. Thanks to Relatient for supporting HIStalk.

Listening: King Crimson, purely because the reclusive and formerly retired Robert Fripp — the only consistent band member as its 72-year-old guitar player — just did an amazing press conference for the band’s 50th birthday as reported by Rolling Stone. It’s a delightful, wry look at the challenges and rewards of playing in a band whose membership is constantly evolving (Fripp loves blowing it up and starting over to stir his creative juices) and whose epic progressive music plays great live even though each musician must count different time signatures in their heads in front of thousands of audience members in playing songs recorded decades ago by someone else. Their tour goes out in June and has some US dates. Certainly many (including me) enjoy the take-no-prisoners “21st Century Schizoid Man” (original vocals by ELP’s Greg Lake) or the mostly improvised “Asbury Park,” but my favorite will always be “Starless.” How cool it must be to bemusedly explain to your grandchildren that time in 1969 when, as an impossibly young man of 23, Grandpa was rocking half a million people at England’s Hyde Park weeks before Woodstock and the moon landing, and now he’s about to hit the road again.


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information.


Acquisitions, Funding, Business, and Stock

Morgan Stanley predicts that Apple’s healthcare opportunity is $15 to $313 billion in annual revenue within the next eight years, with analysts speculating (with little evidence to back it up) that the company could roll out medical-grade wearables within AirPods, integrate sensor-powered apps into the Watch, get insurers to pay for the Watch, or buy healthcare companies. The prediction seems laughable given its assumption that the company’s 2027 healthcare revenue could exceed today’s total revenue even as Apple scrambles to defend its mature market position. People keep trying to make excuses for Apple’s unpleasant slide into middle-aged corporate mediocrity and often predict healthcare as its savior based on one-off ideas like Apple Health Records and the Watch EKG that are interesting to consumers but don’t have any kind of monetization path (Rule #1 in healthcare – patients do not pay. Rule #2 – neither do doctors.)

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Clinical data integration vendor Diameter Health raises a $9.6 million Series A-1 funding round led by new investor Optum Ventures.

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DocuTAP and Practice Velocity announce that their merged companies will be branded as Experity.


Sales

  • Acuity Healthcare, which owns three long-term acute-care hospitals, chooses HCS Interactant as its enterprise health IT platform. 
  • AdventHealth will implement Par80’s referral management system.
  • McKesson chooses Google Cloud as its preferred cloud provider for infrastructure, platforms, applications, and analytics.
  • Australia’s NSW Health signs a 13-year contract with Sectra for enterprise radiology imaging for its 11 Local Health Districts.
  • Signature Healthcare will implement Meditech Expanse.

People

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OptimizeRx hires Denys Ashby (CaptureRx) as VP of hospital and health systems.

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Jeff Fallon (Oneview Healthcare) joins patient experience technology vendor EVideon as CEO.


Announcements and Implementations

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Google Cloud opens its healthcare API for beta testing, offering an interoperability engine that supports FHIR,  HL7v2, DICOM, patient de-identification, and machine learning.

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Microsoft will shut down its HealthVault service on November 20, 2019. The notice – sent via email to registered users — expands the company’s January 2018 warning that it would retire HealthVault Insights and its December 27, 2018 announcement that Direct messaging would no longer be supported. Now the whole thing has been scrapped.

Fortified Health Security publishes its 2019 Horizon Report on the cybersecurity risks of connected medical devices.

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Montefiore St. Luke’s Cornwall Hospital goes live on Artifact Health’s physician query solution to expedite accurate coding just four weeks after the project began.

Saratoga Hospital goes live on integration of B. Braun Medical’s smart IV pumps with Meditech Magic as delivered by Iatric Systems.

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DirectTrust earns ANSI accreditation to develop interoperability and identity standards and invites industry stakeholders to participate.

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Recondo Technology announces record bookings and growth in Q1.


Government and Politics

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A jury finds a South Florida nursing home operator guilty of defrauding Medicare and Medicaid of nearly $1 billion via fraudulent billing. The best part of the story is this – he used part of the $37 million he pocketed to bribe a Penn basketball coach to get his son admitted into the Ivy League university. Former Penn basketball coach Jerome Allen, who has pleaded guilty to money laundering in connection with the incident, admits that he accepted $300,000 in bribes to get the son — Morris Esformes — admitted to the Wharton School, after which he never played a single second of Penn hoops. The son’s LinkedIn says he last worked as a summer analyst for merchant bank The Raine Group. Somehow I expected that – state-school guys like me who spent our summers sweating doing dirty, low-paid work outdoors (in my case, coal mines) always knew people with better-connected parents who got them clean, connection-creating jobs working as caddies or perhaps merchant banking. One guy I knew donated his daughter’s way into dental hygiene school (“I’ll buy the damned place if I have to,” he told everyone who would listen, which apparently included the admissions folks) and got his underachieving son into medical school despite the kid’s having been caught breaking into his undergrad college’s administration office to manually improve his grades.


Other

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In Australia, newly opened, 488-bed Northern Beaches Hospital delays its HIE project after it finds “unacceptable errors and omissions.” A sign that the grand opening wasn’t going well – the CEO quit the day after the ribbon-cutting ceremony.

Massachusetts Governor Charlie Baker, speaking at a Partners HealthCare innovation event, says he is skeptical of the promises of AI. He adds that healthcare is rightfully held to a higher standard than other industries and that patient privacy must not be compromised. Baker was the final decision-maker for AI projects in his previous roles in government and provider organizations and says AI was often less useful than its developers thought, it takes longer than expected to make it work, and the choice and formatting of input data complicates the issue.

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Ireland’s state data agency rules that people don’t have an absolute right to have their names spelled correctly, reviewing a TV producer’s complain that the fada (an accent or diacritic mark) in his name was omitted by University Hospital Galway because its software doesn’t support the special character.

Cigna’s PR people shrink from the glare of public spotlight as the insurer suddenly agrees to pay the out-of-network hospital ED bills of a woman’s two daughters who had attempted suicide – one by slashing, one by pills – by reversing its initial decision that neither event was life-threatening. The mother was relieved about the bill, but the story doesn’t provide any insight on what it’s like to have two daughters of unstated age who tried to kill themselves simultaneously.

Weird News Andy codes it as W61.42XA. A Detroit motorcyclist dies when one of several turkeys that were crossing the road take flight and hit him in the chest, causing him to lose control. WNA cautions, however, that we must escalate our coding work to keep up with the stupidity of people, providing as evidence this story in which a 10-year-old boy is critically injured after falling off the car driven by one of his parents as he “surfs” on the roof.


Sponsor Updates

  • Audacious Inquiry joins HL7 and IHE.
  • Spok announces its upcoming conference participation at AONE, the Healthcare IT Institute, and AMDIS PCC Symposium.
  • Impact Advisors is named as one of Modern Healthcare’s largest healthcare IT consulting firms.
  • Digital prescription savings company OptimizeRx announces integration with Cerner and Epic.
  • Aprima will exhibit at the ACP Internal Medicine Meeting April 11-13 in Philadelphia.
  • Audacious Inquiry joins Health Level Seven International and Integrating the Healthcare Enterprise as an organizational member.
  • CompuGroup Medical will exhibit at the Henry Schein National Sales Meeting April 11-13 in Denver.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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Morning Headlines 4/9/19

April 8, 2019 Headlines 2 Comments

Apple’s Health Opportunity Could be Triple Smartphone Market

Morgan Stanley analysts determine that Apple’s piece of the consumer-centered health pie could eventually be between $15 billion and $313 billion.

NVIDIA and American College of Radiology AI-LAB Team to Accelerate Adoption of AI in Diagnostic Radiology Across Thousands of Hospitals

With help from Nuance and GE Healthcare, the American College of Radiology adds Nvidia’s Clara AI Toolkit to free software it will offer radiologists to help them develop and use AI for diagnostic radiology.

Deep Lens raises $14 million to improve clinical trial recruitment with AI

Digital pathology imaging and diagnosis startup Deep Lens secures $14 million in a Series A round led by Northpond Ventures.

Info for wrong patients possibly sent to thousands of West Virginia veterans

The Veterans Health Administration notifies 4,882 patients of a Xerox software and printing problem that resulted in PHI, including lab results, being mailed to the wrong patients.

Curbside Consult with Dr. Jayne 4/8/19

April 8, 2019 Dr. Jayne 4 Comments

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I recently attended my medical school class reunion. It was my first time attending, and since it was a “big year” for our class, I figured I should go. I didn’t know what to expect, but it turned out to be a great experience.

The way our school handles reunions is that it has a major reunion event every year, celebrating the classes every five years starting at the 10-year mark. This year was primarily for the classes of 2009, 2004, 1999, 1994, and so on. Once you hit a certain point (possibly 50 years?) they welcome you at every year. We had about 20% of my class attend, and according to the organizers, that was a pretty good turnout.

The festivities started on the hotel shuttle from the airport, where we got to see members of the class of 1969 figure out that they were sitting next to each other and had no idea they were in the same class. Watching their faces light up as they figured it out was hysterical. They immediately started swapping stories about what it was like to be in school 50 years ago. For us relative youngsters, a lot of it was the same, even though times have certainly changed.

We had a member of the class of 1954 on the bus. In her class were four women, and she was delighted to learn that our class was the first one to have more women than men (even if it was only “more” by one person.) Doing the math, we figured she had to be close to 90 years old, but you couldn’t tell. She had a walker, but was carrying it folded up rather than using it.

From there, it was on to a cocktail reception, where two members of the third-year medical school class plopped down at our table. One of my classmates started probing them on “what is it really like to be a millennial,” which was pretty funny. We learned that most of the class doesn’t actually go to class since all the sessions are preserved on video. Back in our day, we had a “note-taking service” that tape recorded every class. The class then took turns transcribing it and highlighting the key points, leaving you with a great set of notes. Although the new students don’t have to attend class, they miss out on the distillation done by their peers, so I’m not sure they’ve really built a better mousetrap.

We must not have scared them too much since they stuck around for most of the reception, although I think they were relieved to not have to attend any other reunion events after that one.

The next day was full of continuing education sessions and tours of the medical center, parts of which have become unrecognizable in a research grant-fueled construction boom. The medical library has very few actual printed materials any more, with the stacks having been replaced by individual study spaces and administrative offices. A new computer lab allows for computerized administration of the tests that have to be taken during third-year rotations, and student-focused spaces now include lounge areas, video games, and areas for extracurricular groups to meet. It’s definitely more student friendly, although there should be more student-friendly resources given the more than doubling of the tuition since I graduated.

Our tour guide,  a fourth-year student who will be graduating soon, seemed surprised by the state of medical education back in our day. We were thrown out into the world to learn our craft on “real patients,” but they have state-of-the-art simulator labs where they are put through a variety of proctored scenarios so they are better prepared for their internships. The latter half of the fourth year provides opportunities to complete life support and trauma certifications, where we had none of that exposure until we walked in the door at our internships.

I have to say I was a little envious about the preparation they are receiving, I think it will make internship a lot less shocking. Our guide was surprised to learn that as recently as we had graduated, we were not subject to duty hour limitations. Her eyes were wide at learning how often we took call and for how many weeks of the year. On most of her rotations she didn’t take call, and when she did, it was one day a week and the shift was limited to 18 hours.

There were presentations from various medical school leaders, where we learned about upcoming curricular changes that are aimed to better prepare students for the realities of medicine. My school has a strong track record for cranking out researchers and academicians, and I was interested to hear that they’re attacking precision / personalized medicine as a way to reduce costs. I had never really thought about it in the way it was presented, that even with the high cost of some of those treatments, the real savings is in patients you’re actually not treating with standard therapies that might not be effective. It will be interesting to see how that plays out in reality. There were also discussions about whether our school will join the club of schools that are providing full tuition scholarships for the entire student body.

Of course the highlight of the reunion was hanging out with classmates and learning what everyone has been up to in the new century. Some are wholly career-focused and driven, others have dropped out of medicine entirely, and there are several of us in-between. As much as physicians tend to talk about the importance of work-life balance, I was surprised to hear one of my classmates make a negative comment about women who had children during their residency training. Instead of celebrating their ability to juggle that level of complexity, he commented “what a strain that must have been on the residency program.” He backtracked a bit when one of the women mentioned that she only took four weeks off after childbirth, because that was the amount of vacation allotted to all residents each year and she didn’t strain the system any more than her counterparts who went to the beach.

Based on our interactions with current students, I suspect there is going to be a lot more tolerance for work-life balance concerns. There may be a steeper learning curve in residency due to the changes in work hour restrictions as students are exposed to scenarios they haven’t seen before because they simply weren’t in the hospital overnight. On the other hand, they may learn faster or better because their brains won’t be mush from working hellish schedules.

I had the privilege of talking with a 90-year-old urologist and getting his thoughts on how things have changed over time. Based on his family history and state of health, the odds are good that I’ll be seeing him again in five years.

Have you ever attended a class reunion? Would you do it again? Leave a comment or email me.

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Morning Headlines 4/8/19

April 7, 2019 Headlines 1 Comment

DocuTap merging with a competitor based in Illinois

Urgent care EHR/PM vendor DocuTAP will merge with urgent care solutions vendor Practice Velocity.

Data payday slow in coming for electronic medical records specialist

Crain’s Chicago Business says the attempt by Allscripts to diversify itself away from smothering competitors Epic and Cerner in a slowing EHR market hasn’t paid off for investors, as disappointing financial reports have sent shares down.

Hardin Memorial Hospital issues statement on ‘information technology disturbance’

Hardin Memorial Hospital (KY) is working to restore systems taken offline by a reported cyberattack of an unstated nature.

Monday Morning Update 4/8/19

April 7, 2019 News 13 Comments

Top News

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Urgent care EHR/PM vendor DocuTAP will merge with urgent care solutions vendor Practice Velocity, the companies said in a teaser announcement that promises further details later. 


Reader Comments

From Not From Monterey: “Re: Cerner Rev Cycle. Can any site that has converted, including billing, say that claims are going out the door speedily, bills are being sent out, A/R is doing well, etc.? We have Cerner clinicals and a third-party reg/sched system. We need to either go all-Cerner or all-Epic and we’re not making any progress because of fear of Cerner Rev Cycle.” I’ll open the floor to readers.

From Weekend Warrior: “Re: Politico’s Morning EHealth. Cutting back to three days per week. Cue sound of bubble bursting?” Politico launched its free weekday newsletter in mid-2014 under the umbrella of “EHealth.” Healthcare technology has lost some of its luster due to the end of federal incentives, market saturation, the domination of a few broad-line vendors, and technology’s lack of success in improving outcomes, cost, or public health in general. As a result, HIMSS, other conferences, and low-value websites have had to trade their long-term credibility for short-term vendor cash where never is heard a discouraging word. Unlike those organizations, while I don’t find a lot I need to know from Politico and maybe 10% of any given issue at most seems relevant, they are good at bird-dogging government stories and that’s important. I think the toilet bowl water is already swirling around some poorly run sites and “curators” that can’t deliver decision-making eyeballs – the Reaction Data survey from a couple of years ago exposed the difference between having a enthusiasm-powered but expertise-light website, newsletter, or social media account that no C-level reader would ever follow.


HIStalk Announcements and Requests

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Poll respondents are skeptical about any near-term benefits of artificial intelligence in healthcare. As they should be.

New poll to your right or here: Hospital software vendor employees: how are business conditions now compared to two years ago?

Thanks to the following companies that recently supported HIStalk (without gaining any editorial control for doing so, I should add). Click a logo for more information.

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Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information.


Acquisitions, Funding, Business, and Stock

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Crain’s Chicago Business says the attempt by Allscripts to diversify itself away from smothering competitors Epic and Cerner in a slowing EHR market hasn’t paid off for investors, as disappointing financial reports have sent shares down. It expresses some hope that selling patient data – through its Veradigm (the former Allscripts Payer & Life Sciences) and Practice Fusion businesses – will eventually boost financials, although analysts say competitors could easily enter growth markets such as population health with products better than those Allscripts sells. Above is the five-year share performance of MDRX (down 39%) vs. the Nasdaq (up 99%). Shareholders hate watching companies promising but failing to deliver, even with a good excuse such as being deep in a market that is receding and a consolidating customer base that is standardizing solutions from competing vendors.

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I expected Inc.’s pretend letter to Apple CEO Tim Cook from Steve Jobs to be lame, but it was actually pretty brilliant in defining what Apple should be doing beyond sitting on a pile of cash, announcing late market entries in video streaming and credit cards, and allowing the Mac to age ungracefully. This is a great idea:

Google is our new nemesis, remember? They attacked our core business model with that Android PoC. But, Tim, c’mon… Google is weak. They can’t innovate worth beans and most of their revenue still comes from online ads, which are only valuable because they constantly violate user privacy. You could cut their revenues in half if you added a default 100% secure Internet search app to iOS and Mac OS. Spend a few billion and make it faster and better than Google’s ad-laden wide-open nightmare. This isn’t brain surgery.


People

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Google Cloud healthcare vertical leader Greg Moore, MD, MS, PhD joins Microsoft as corporate VP, health technology and alliances. He was at Geisinger from 2010-2016.


Announcements and Implementations

Medsphere announces GA of its cloud-based Wellsoft Urgent Care, which includes the top-rated Wellsoft EDIS – which it acquired in late February 2019 — along with practice management and patient engagement applications.


Privacy and Security

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Hardin Memorial Hospital (KY) is working to restore systems taken offline by a reported cyberattack of an unstated nature.

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Dropbox pays a bounty of $319,000 for being made aware of 254 product security flaws that were documented by hackers who participated in a one-day security vulnerability bug hunt. The CEO of the hacker challenge company HackerOne suggests that companies not necessarily use the bounty programs to find their biggest vulnerabilities, but rather those with the most value at stake, such as systems that hold medical or customer data.


Other

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The Madison paper belatedly notes the 40th birthday of Human Services Computing, launched March 22, 1979 in an apartment building basement by its only full-time employee, a computer science instructor named Judy Faulkner. She later renamed the company to Epic Systems, which now has nearly 10,000 employees, $3 billion in annual revenue, and a billion-dollar campus. The company still insists on the personal touch – incoming calls are answered by a human rather than a machine and outbound mail always bears old-fashioned postage stamps rather than electronic postage.

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A breathless Google-Harvard Medical School NEJM article sees a time in which AI reviews every medical decision for appropriateness, catches provider mistakes, and refers tough cases to experts for diagnosis. Sounds good, but I’m puzzled at what the future of medical practice will be when on one hand you have frightful deviation in diagnosis and treatment (use of outdated data, refusal to follow evidence-based medicine, hurried decision that are often wrong, and a tendency to over-treat rather than to wait patiently) versus having AI simply calling the shots by looking deeply and broadly at what has worked on similar patients. Or, embedded the practices of the best doctors for the benefit of the majority. Do you allow those poorly-performing doctors to keep their involvement, just as we did in anointing hospitals as the overseer of population health even though they showed zero interest and aptitude in it when nobody was paying? We should just admit science doesn’t always drive medical decisions and the practice of medicine can be inconsistent, illogical, expensive, dangerous to patients, and not necessarily a positive influence on patient outcomes. My conclusion – do everything you can to avoid becoming enmeshed in the rabbit hole of diagnostic and treatment Whac-A-Mole – a well-intentioned medical system can cause more harm than good in unsuccessfully chasing one problem after another in an uncoordinated manner, especially when they’re getting paid either way. 

The New York Times notes the frightening but seldom-reported spread of drug-resistant fungal infections, likely caused by rampant antimicrobial overprescribing and use in feed crops. Government agencies and hospitals don’t usually publicly acknowledge outbreaks because of fears of negative publicity and the fact that patients can’t do much about it anyway. You have to admire those bugs – while humanity is divided into whether it’s us or the cockroaches that run out the clock, the ever-transforming bacteria, viruses, and fungi just keep adapting to whatever we throw at them and may eventually kill us all off (if we don’t do it to ourselves first). 

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A 39-year-old Villanova adjunct professor should probably have questioned why the health insurance she bought over the Internet cost her just $250 per month. The answer: it wasn’t real insurance, but instead was a short-term junk insurance plans like the White House is pitching that does not cover pre-existing conditions and pays only a fixed price for a short list of services. She says the agent for the publicly traded insurance broker lied to her about the Chubb-provided coverage even though the acceptance letter she signed made it clear that the non-ACA compliant plan doesn’t cover emergency services, either. The plan offered to pay a grand total of exactly $0 for her $22,500 worth of emergency sepsis treatment, with the hospital demanding to be paid upfront for the resulting foot amputation.


Sponsor Updates

  • MDLive and Redox will exhibit at ATA 2019 April 14-16 in New Orleans.
  • Meditech, Mobile Heartbeat, PatientSafe Solutions, and Clinical Computer Systems, developer of the Obix perinatal data system, will exhibit at AONE April 10-13 in San Diego.
  • NextGate and ROI Healthcare Solutions will exhibit at Cerner SERUG April 9-12 in St. Pete Beach, FL.
  • The local paper covers PatientPing’s partnership with the Lewis and Clark Information Exchange.
  • PerfectServe, Voalte, and Vocera will exhibit at ANIA April 10-13 in Las Vegas.
  • PreparedHealth will exhibit at ACMA April 13-17 in Seattle.
  • Optimum Healthcare IT announces a refreshed brand identity.
  • Sansoro Health releases a new podcast, “Pigs, Pain Management & Palliative Care.”
  • Surescripts will exhibit at the EClinicalWorks Health Center Summit April 9-11 in Boston.
  • TriNetX acquires Custodix NV’s InSite network, establishing the world’s largest clinical research network.
  • Wellsoft will exhibit at the Texas Organization of Rural and Community Hospitals event April 10-12 in Dallas.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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Weekender 4/5/19

April 5, 2019 Weekender No Comments

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Weekly News Recap

  • PatientsLikeMe seeks a a buyer after the federal government’s foreign investment review committee demands that its majority investor, a China-base firm, divest its holdings
  • Amazon announces the availability of six new HIPAA-compliant Alexa healthcare skills
  • GAO officials tell the House Veterans Affairs Committee that the VA’s poor track record of CIO leadership has harmed its IT modernization projects and will continue to do so
  • FDA names Principal Deputy Commissioner Amy Abernethy, MD, PhD to the additional role of CIO
  • Walgreens says it will accelerate digitalization of the company, make executive team changes, cut costs, and redesign stores following poor quarterly results that sent shares down sharply
  • A two-doctor ENT practice in Michigan closes for good and its partners retire after they refuse to pay a hacker $6,500 to restore their ransomware-encrypted systems

Best Reader Comments

AI is about six different things, with different methods and different targets. The fact that it gets rolled up into an undifferentiated mass screams that these are merely magic words meant to attract… well, suckers. Second, I would agree that resources could be spent better on other fronts. You mention lifestyle and similar social determinant factors. This reminds me that serious thinkers wonder whether diverting the last trillion or so marginal dollars from health care to education might actually improve public health outcomes more effectively. (Randy Bak)

Regarding the inability of financial incentives to change patient health behaviors, are the folks designing these studies basing them on any established health behavior change theories? If not, then there are good reasons that these interventions fail. (Mark Hochhauser)

Going to be really interesting when an AI says that we need to address behavioral health issues in a good portion of the population, only for us to realize that 1) there’s a huge shortage of workers; and 2) the reimbursement is not there to operationally break even. (NotTheDataYoureLookingFor)

Transfer of patient information results in decreased use of the healthcare system. Why? Because having those records available results in earlier intervention and in fewer repeated diagnostic tests. Decreased utilization of the healthcare system is important to the survival of only two parties I can think of: (1) the patient (obvious benefit), and (2) the payor (cuts costs). Therefore, we should be looking at the patients to pay, or the payors to pay [for data exchange]. No one else seems to have a dog in this fight. I realize it sounds quite callous to put it this way, but I feel it is realistic. There are indeed providers who act for the greater good and act in support of transfer of patient records. However, hoping that all providers will support timely transfer of patient info – without some inducement to do so – may be misguided. (Clustered)

The patient does not own the data. The data are about them and they have a right to see and distribute. Can they modify their record? Do they pay a record storage fee to the HC org to hold their data? If not, it’s not owned by the patient. (Data owner)

Initially or always for a percentage of tests, it might be a better idea to only give the AI verdict after the radiologist has given their opinion. You don’t want the radiologist to start being lazy/biased and lose their diagnostics chops either. (AC)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. Z in Texas, who asked for STEM activities for her pre-K class. She reports, “They were so excited to see their new center materials. I enjoyed watching their creativity come to life and coming up with new things they could make. One of the lessons we did was using the 3 Little Pigs story and how they could come up with a house that was strong. They started coming up with so many different ways to use the materials and build houses. They were even coming up with things we adults didn’t even think of! I can’t tell you how happy and eager they were to go to their new STEM center and build their own creations! From the bottom of our hearts. we appreciate you giving these children the opportunity to expand their little growing minds!”

Conspiracy-obsessed Internetters are spreading rumors that rapper Nipsey Hussle was killed because he was working on a documentary about an alternative health guru who died in 2016 after claiming he could cure AIDS. The rumored conspirators behind both deaths are the always-collegial drug companies, medical societies, and regulatory agencies. Leading the charge with a list of 90 doctors who were mysteriously killed (by people such as their spouses or by auto accidents) is a “health nut” with no stated educational credentials whose website is full of anti-GMO conspiracy theories; vaccine theories; a recipe for a garlic soup that can cure flu and norovirus and a flatbread that “fights cancer with every bite;” and an online store that sells CBD skin serum and some seriously wacky products (all carefully disclaimed in the footnotes as not being a substitute for professional medical advice, diagnosis, or treatment). Her husband, a DO, runs a similar site, which she promotes in videos in which she languishes on a bed with little evidence of clothing.

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An Arkansas man who is being treated at a hospital for bruises caused by bullets striking his bullet-proof vest tells staff and police officers that he and a friend were involved in a gunfight while protecting a mysterious man called “The Asset” who had hired them as bodyguards. His wife then arrived and set the record straight – the men were drinking on the back porch and dared each other to be shot while wearing a bullet-proof vest. The first man admitted that he was annoyed at being shot, so he emptied five .22 rounds into the second man’s back. Both are fine other than being charged with aggravated assault.

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US Navy corpsmen are working at trauma units in Chicago, Cleveland, and Jacksonville to gain experience with gunshot wounds, burns, and hypothermia that are likely to occur in traditional warfare but that are seen less in the military’s terrorism-related activities in countries like Afghanistan. 

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Johnston-Willis Hospital (VA) arranges for a dying mother to see her daughter graduate from high school in her hospital room, with the school principal delivering a brief commencement address followed by a  vocal performance by the college music fraternity of the graduate’s brother. The mother died the next day.

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A baby who was born in drug withdrawal and who endured a five-month hospital stay without having a single visitor is adopted by the hospital’s nursing director.


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Morning Headlines 4/5/19

April 4, 2019 Headlines 1 Comment

The Trump administration is forcing this health start-up that took Chinese money into a fire sale

PatientsLikeMe looks for a buyer after the Committee on Foreign Investment in the United States demands that its majority owner, a Chinese investment firm, divest its holdings in the company.

Introducing New Alexa Healthcare Skills

Amazon announces the availability of new HIPAA-compliant Alexa healthcare skills from organizations like Livongo, Cigna, and Boston Children’s Hospital.

Memorial Sloan Kettering Leaders Violated Conflict-of-Interest Rules, Report Finds

Memorial Sloan Kettering Cancer Center’s relationship with AI startup Paige.AI and other vendors triggers an outside review that finds the organization violated conflict-of-interest policies and fostered a culture that valued profits over research and patient care.

News 4/5/19

April 4, 2019 News 5 Comments

Top News

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PatientsLikeMe looks for a buyer after the Committee on Foreign Investment in the United States demands that its majority owner, a Chinese investment firm, divest its holdings in the company. The personalized health network has raised $127 million in several venture rounds.

The Trump administration expanded the committee’s oversight last year as concerns heightened around national security and trade secrets, a move that caused Chinese investments in US companies to plunge from $46 billion to just under $5 billion over the last two years.


Reader Comments

From Sagebrush Sister: “Re: CIO vendor entertainment violations. Looking for examples, as my organization is hosting a Pebble Beach outing for key clients. They didn’t consider the healthcare folks and I’m trying to get them to add CEs, even if just for damage control.”

From John R. Public: “Re: America’s Health Insurance Plans whining. It’s funny that they are crying wolf after they’ve harassed providers forever for information while providing them with dated stacks of papers or confusing web pages that are not actionable.” AHIP says 2020 implementation of mandatory data sharing under CMS’s proposed interoperability rules is unrealistic given the effort required to comply with standards that aren’t yet defined.

From HIT OG: “Re: CareCloud. Laid off 40 employees yesterday via a conference call.” Unverified.


HIStalk Announcements and Requests

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Readers have sent some great alternatives to buying a big swath of HIMSS conference exhibit hall space, which I’ll run shortly, Meanwhile, your suggestions are welcome.


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information.


People

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Spok names Timothy Tindle (Harris Health System) as CIO.

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Quil, the joint digital health venture of Comcast and Independence Health Group, names former Imprivata executive Carina Edwards as CEO.

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Ascend Innovations hires Marty Larson (Greater Dayton Area Hospital Association) as president and CEO.

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Michelle Blackmer (CareEvolution) joins Verato as VP of marketing.

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Jim Costanzo (Ernst & Young) will succeed Bruce Cerullo as Nordic’s CEO on July 1. Cerullo will become chairman of the board.

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Sonifi Health hires Cheryl Cruver (Aetna) as chief revenue officer.


Sales

  • The Heights Hospital will implement RCM and health IT software and services from MTBC when it opens in Houston later this year.

Announcements and Implementations

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UMass Memorial Health System will roll out video-based substance use disorder evaluation software at three of its EDs over the next three months. The technology, developed by four physicians from within its Memorial Medical Group, was the winning submission in the annual UMass Prize for Academic Collaboration and Excellence.

Innovaccer launches social determinants of health surveys that feed into its community resources referral program.

The Consumer Technology Association, organizer of CES, forms a working group with nearly 30 healthcare and tech companies to develop standards and best practices for AI in healthcare.

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Healthgrades develops a customer data platform to help providers better aggregate and manage health data and power CRM systems.

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ProMedica’s Coldwater Regional Hospital (MI) will go live on Epic next month. The Toledo, OH-based provider began a system-wide implementation in 2015.

InstaMed launches a blockchain-powered platform for payments.


Government and Politics

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The FTC wins a $50 million court judgment against Omics International, an India-based scientific research publishing company that has for years been accused of deceptive business practices. A judge in Nevada, where the company has a mailing address, has also ordered the company to stop misleading authors about the legitimacy of its publications, marketing conferences with unconfirmed speakers, and failing to disclose fees.

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Departing FDA Commissioner Scott Gottlieb, MD will return to the American Enterprise Institute to work on drug pricing. He joined the think tank as a resident fellow in 2002.


Privacy and Security

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Amazon announces the availability of six new HIPAA-compliant Alexa healthcare skills. Organizations participating in the invite-only, HIPAA-eligible program include Express Scripts, Cigna, Livongo, Boston Children’s Hospital, multi-state Providence St. Joseph Health, and Atrium Health (NC).


Other

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The New York Times highlights the popular trend of “restaurant-style” medicine offered by prescription-on-demand companies like Roman, Kick Health, and Nurx. Medical experts point out these startups give consumers the power to choose their drugs and then have their choices validated by a remote physician, a service that typically omits any type of counseling about potential side effects. Detractors warn that despite their buzzy marketing, convenience, and multimillion-dollar fundraising rounds, consumers should approach these services with caution. The big question I always have – why would a doctor agree to practice in this type of arrangement that violates just about everything in the Hippocratic Oath? (answer: easy work for $$$). It’s too bad that our culture sees prescribing as just a minor speedbump to getting what we think we should have, regardless whether it’s likely to be beneficial or safe.

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Bloomberg looks at the lengths hospital chain Narayana Health will need to go to in order to care for India’s poorest patients under the country’s new national health insurance plan. The company, which already offers assembly-style procedures at rock-bottom prices, was launched by cardiac surgeon Devi Shetty in 2000 with a $20 million loan from his father-in-law. Shetty has tapped his son to lead a software startup dedicated to analyzing and trimming costs from Narayana’s operations, which are already operating on razor-thin margins that, when all is said and done, result in outcomes equal to or better than those of US hospitals. Shetty says, “I would like in my lifetime for every citizen of this planet to get health care at a price they can afford to pay without having to beg or sell something.”

Meanwhile in the US, a West Health-Gallup survey finds that one in eight Americans borrowed a total of $88 billion last year to pay for healthcare services. Sixty-five million people deferred care altogether because of cost.

An outside review of Memorial Sloan Kettering Cancer Center finds that the organization violated conflict-of-interest policies and fostered a culture that valued profits over research and patient care. MSKCC’s relationship with AI startup Paige.AI was one of the issues that triggered the review, as reports noted that it shared pathology slides with the startup as some of MSKCC’s top executives were given lucrative participation arrangements.

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This is bizarre: People claiming to work for Passport Health Plan are showing up in an unmarked van around poor neighborhoods in Louisville, KY offering members $20 for DNA samples. Those who underwent a cheek swab were told they were being tested for cancer.

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This is how obituaries should be written, as the family of 63-year-old Iowan Tim “Lynyrd” Schrandt describes him in a way that makes you wonder how he interacted with his doctors and nurses. The big finish is this:

Tim led a good life and had a peaceful death, but the transition was a bitch. And for the record, he did not lose his battle with cancer. When he died, the cancer died, so technically it was a tie! He was ready to meet his Maker, we’re just not sure the Maker is ready to meet Tim. Good luck, God! We are considering establishing a GoFundMe account for G. Heileman Brewing Co., the brewers of Old Style beer, as we anticipate they are about to experience significant hardship as a result of the loss of Tim’s business. Keep them in your thoughts.


Sponsor Updates

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EPtalk by Dr. Jayne 4/4/19

April 4, 2019 Dr. Jayne 4 Comments

CMS has launched an Artificial Intelligence Health Outcomes Challenge. The three-state competition is planned to “accelerate artificial intelligence solutions to better predict health outcomes such as unplanned hospital and skilled nursing facility admissions and adverse events.” The CMS Innovation Center plans to use the data “in testing innovative payment and service delivery models.” Partnering with the American Academy of Family Physicians and the Laura and John Arnold Foundation, CMS will award up to $1.65 million during the three stages.

CMS has decided to be confusing by naming the three stages “Launch,” “Stage 1,” and “Stage 2” rather than just numbering them. Launch is essentially an application phase, with 20 participants selected to advance to Stage 1, where challengers will design and test their solutions using Medicare claims data. Up to five participants will move to Stage 2 where they can refine their solutions using additional Medicare data sets. The grand prize winner will receive up to $1M with a $250,000 award to the runner up. Launch is already underway and the program will run through April 2020.

If you’re wondering how to further translate the CMS-speak, the goal is to build “explainable artificial intelligence solutions to help front-line clinicians understand and trust artificial intelligence-driven data feedback to target scarce resources and improve the quality of care.” CMS Administrator Seema Verma explained this further: “For artificial intelligence to be successful in healthcare, it must not only enhance the predictive ability of illnesses and diseases, but also enable providers to focus more time with patients. The power of artificial intelligence will truly be unleashed when providers understand and trust the data and predictions.”

I was talking about this with a colleague, particularly the focus on diseases rather than health and prevention. There are so many factors that could immediately impact both individual and population health parameters that don’t require a challenge or competition. We already know what needs to be done, but lack funding to do it. These not-so-sexy solutions involve things like public health education, social workers, and strategies to eliminate food deserts and improve healthy behaviors. AI is a pretty distraction from the difficult work that could (and should) be happening.

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Speaking of the challenges found in trying to improve healthy behaviors, there is much speculation on whether financial incentives make a difference. Many organizations including my own hospital have done this by increasing insurance rates for smokers or offering discounts for non-smokers or those who complete a biometric profile. Discounts for non-smokers seem to make sense because we know smokers have more illnesses thus higher healthcare costs; the benefits of a biometric screening, however, have not been proven. I know that for me personally, going for the biometric screening did nothing to change my behavior, but cost me a half day out of office.

A recent article in the Journal of the American Medical Association looks further at the effect of financial incentives on improving healthy behaviors. In a recent US-based randomized trial, lottery-based incentives tied to medication compliance didn’t lead to a significant reduction in cholesterol levels. Another study found lack of reduction of cardiac events or hospitalization even though patients could earn more than $1,000 for being compliant. Other studies including those looking at smoking cessation in pregnant patients do show some benefit for financial incentives.

The article looks at reasons why studies might not show successful incentive use, including bias created when patients self-select for a study, since those who self-select are more likely to be motivated to change behavior whether there is an incentive involved or not. These motivated patients “rarely represent the population most in need of support, yet they are most often targeted by trials.” There are also issues creating control groups and in timing study enrollment based on patients transitioning through “hot and cold states in which their motivation varies, potentially determining their response to incentives.” Another issue is offering an incentive that is too small for the desired behavior change, which can be a negative motivator when higher incentives may actually drive change.

The authors conclude that when incentive-based interventions are being designed, subtle factors need to be considered, including the size / frequency of the incentive, how it’s positioned, and whether the target population fully understands the incentive and the desired behavior.

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From Midwest Afficionado: “Re: pastry therapy. Here’s some for you, Dr. Jayne, in the form of an edible book festival.” Apparently, this is the third annual edible book festival at Washington University School of Medicine in St. Louis. Although submissions were welcome from any genre, there was a special award category for “Most Edible Medical Book.” Submissions will be eaten promptly at 2:30 p.m. Previous entries included a “Checklist Manifesto” Rice Krispy Treat and a tribute to “Grapes Anatomy.”

Data from a recent Kaiser Family Foundation tracking poll indicates that patients aged 18-29 believe EHR technology has led to increased quality of care and has improved provider communication. The age bracket caught my eye since if you consider the pre-MU era (pre-2009) to be solidly pre-EHR, most of these patients weren’t even adults, so it might be a difficult comparison. General public perception of the benefits of EHR has decreased – in 2009, 67% of patients believed EHR would improve care, but a decade later, only 45% believe it has actually happened.

Still, only 6% of respondents said they felt EHR has worsened quality of care and 7% felt communication has worsened. More than 20% of patients said they or a family member has found an error in their chart. More than half of respondents voiced concerns about unauthorized access to the medical record, although younger adults (that 18-29 year age group) are less likely to be concerned than other age groups. I suspect that group is used to having their data used or mined by third parties, or that perhaps they’re just so used to hearing about data breaches that it is less concerning.

The American Medical Association shares sound advice on the use of wearable health devices in practice. They note four main possible issues that should be considered when adding devices to the care plan. Patients might disengage before the benefit can be realized, either due to convenience or perceived lack of benefits. They might also ignore symptoms and rely too much on devices. Others may obsess over the data, resulting in anxiety. Last, they might try to interpret the data without physician help, leading to false-positives and additional intervention. It was a nice little review of what to think about, and should be helpful for physicians who don’t have a lot of experience with wearables.

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Morning Headlines 4/4/19

April 3, 2019 Headlines No Comments

UMass prize will fund telemedicine initiative

UMass will roll out video-based substance use disorder evaluation software developed by prize-winning physicians within its Memorial Medical Group at three of its EDs over the next three months.

VA’s IT leadership problem has infected modernization efforts

Officials at a House Veterans Affairs Committee Hearing say the VA’s abysmal CIO track record has hampered – and will continue to hamper – the success of its extremely expensive IT modernization efforts.

Quil, The Joint Venture Between Independence Health Group And Comcast, Names Carina Edwards Chief Executive Officer

Digital health company Quil names former Imprivata executive Carina Edwards CEO.

HealthVerity Announces $25 Million in Series C Funding

Patient data retrieval and management company HealthVerity raises $25 million.

Readers Write: Systems Integration with SMART on FHIR ─ We’ve Come So Far, Yet …

April 3, 2019 Readers Write No Comments

Systems Integration with SMART on FHIR ─ We’ve Come So Far, Yet …
By Dan Fritsch, PhD

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Dan Fritsch, PhD is chief applications architect at First Databank of South San Francisco, CA.

When we first launched Meducation in 2009, we realized that we would have to integrate the application with electronic health records if we wanted clinicians to use it with their patients. The good news? Through our efforts, we’ve become industry leaders in such integration. The burst-our-bubble reality? Despite our success, even after 10 years, many integration challenges remain.

Because electronic health record (EHR) systems were not originally designed to accommodate third-party apps, we have found ourselves taking up the integration cause ever since we initially developed our cloud-based solution that enables healthcare providers to dynamically create fully personalized patient medication instructions in more than 20 languages.

While the integration nut is difficult to crack, we’ve experienced quite a bit of success. Case in point: In 2011 we won an Office of the National Coordinator for Health IT contest for our use of Substitutable Medical Apps and Reusable Technology (SMART) – an open, standards-based technology platform – to integrate our product with other systems.

Yet we weren’t able to fully utilize what we had developed. This SMART integration didn’t allow us to leverage real-time data, but instead required data to be transformed and stored in an alternative format. While we had established ourselves as a systems integration trailblazer, we still didn’t experience the live integration needed.

To make integration work, we had to custom-code the product for each EHR, to accommodate each unique data access framework and each underlying data model. This meant starting from scratch with each new integration. Because of this complexity, we often found ourselves relying on outside systems integration specialists for assistance, which is a costly proposition.

When Health Level Seven International (HL7) introduced the Fast Health Interoperability Resources (FHIR) standard, SMART developed code to support it. As such, we were able to run the product in this new SMART on FHIR architecture environment. This integration model made it possible to use the same FHIR resources to implement our product on various EHR platforms without having to significantly modify code. So, if we wanted to integrate our app into 10 EHRs, we didn’t have to reinvent the wheel with each one.

At the most recent American Medical Informatics Association (AMIA) conference in San Francisco, we demonstrated how a mature SMART on FHIR integration enables us to run an app on various EHR systems, something that many other app developers are still striving to accomplish. AMIA members ranked our demonstration as the top presentation at the conference and recognized us with the AMIA/HL7 FHIR App Showcase Award.

Yet, like all app developers, we are still struggling with a variety of integration challenges, such as:

  • Optimal workflow placement within the EHR. While some vendors allow our app to be launched in an optimal place – such as at the top of the discharge screen – others bury the app launch in the user interface menu, making it burdensome for an end user to find and use at the right time in workflow. We are constantly working to align with our EHR partners to realize that our application is valuable, not a threat to their autonomy.
  • Juggling multiple versions of FHIR. FHIR is a young and rapidly evolving standard. Since its introduction, three versions have been adopted and implemented by various EHR vendors. Each of these standards uses a slightly different data model. As an app developer, we have to know which version each EHR vendor is using so we can modify our code to support that particular iteration.
  • Coping with vendors’ interpretations of resources. To function optimally, our app needs to know the patient’s medication list at the point of discharge, which requires specific resources (specific pieces of information). This information is represented in FHIR by either the “Medication Order” resource or the “Medication Request” resource, or sometimes by a combination of both. As such, we often need to query both of those resources and run an algorithm that gives us the discharge medication list that we need. As FHIR becomes more mature, there will be more agreement among the vendors on what the resources mean, but for now, we need to continue to find ways to deal with each vendors’ interpretation.
  • Dealing with costs. As a developer, we have to cope with fees to enter developer programs; certification costs; legal fees associated with intellectual property protection; costs that sometimes arise when developers need additional integration assistance from vendors; and royalties paid to EHR vendors. These fees are costly and are prohibitive to many smaller companies.

So while we have been able to establish ourselves as integration leaders, especially around SMART on FHIR, we still, like all other app developers, have our work cut out for us. We look for forward to continuing to pave the way and challenging the status quo.

Readers Write: File-Sharing And HIPAA – How You Can Keep Health Data Secure in an Era of Collaboration

April 3, 2019 Readers Write No Comments

File-Sharing And HIPAA – How You Can Keep Health Data Secure in an Era of Collaboration
By Tim Mullahy

Tim Mullahy is executive vice-president and managing director at Liberty Center One of Royal Oak, MI.

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Collaboration is at the heart of modern workflows, and file sharing is at the core of collaboration. That’s as true in the health industry as it is anywhere else. The difference with healthcare, of course, is that the risks of doing file sharing improperly — of distributing files without due attention to security — are higher.

File-sharing and collaboration are necessary for effective patient care. Medical and support staff alike need to be able to openly and readily share patient data with one another, communicating seamlessly both within hospital environments and without. The problem, of course, is enabling such collaboration without violating HIPAA.

After all, Protected Health Information (PHI) is some of the most sensitive data in the world. The penalties, should it fall into the wrong hands, are rightly strict. That isn’t to say that enabling file-sharing is impossible,  just that it needs to be done while keeping a few things in mind.

Encrypt all files

Although HIPAA doesn’t mandate file encryption (it’s recommended, not required), encrypting all data both in-motion and at rest is critical if you’re going to ensure that your files can be shared securely. In the event that a device containing HIPAA is in some way compromised, encryption will ensure that the data it contains remains safe.

I’d advise that you use SSL encryption and use some form of VPN or secure tunnel to keep your files protected when they’re shared across external networks.

Assign unique IDs to all staff

Every user with access to your file-sharing and collaboration platform needs a unique identifier. In addition to being useful for the purposes of authentication, these IDs will allow you to track data access and usage. The idea is that you need to know what data each of them have accessed and what they’ve done with that data at any point in time.

Implement multi-factor authentication

Usernames and passwords are an important component of access control, but they represent only a partial solution. To keep both your files and the platforms through which staff collaborate secure, you’re going to want multiple means of ensuring people are who they say they are. These could include:

  • Biometric (fingerprint scanners, facial recognition, voice identification, retinal scanners)
  • Behavioral (common login locations, common access and browsing habits, etc.)
  • Hardware-based (device recognition, hardware tokens)

Implement auto-logoff

Here’s one directly from the HIPAA guidelines. Any file-sharing or collaboration solution you use needs to have a timeout process built in. After a set period of inactivity (10 to 15 minutes is probably a safe bet), an employee account should be automatically logged out. This protects against unauthorized access via unattended devices.

Ensure that all software is HIPAA-compliant

Last but certainly not least, for each collaboration solution you implement, check with the vendor to ensure that it complies with HIPAA’s regulatory guidelines. Most vendors that support HIPAA compliance will be open about it. Moreover, their solutions will provide full logging and auditing functionality, alongside all the other security controls necessary to stick to HIPAA.

HIPAA need not represent an obstacle to effective collaboration. Provided you incorporate a compliant solution and take all the necessary measures to keep your data safe, you can enable your clinicians, support staff, and everyone else who needs access to collaborate for better, faster patient care.

Morning Headlines 4/3/19

April 2, 2019 Headlines No Comments

Walgreens Boots Alliance Reports Fiscal 2019 Second Quarter Results

Walgreens announces executive changes, store layout redesign, and cost-cutting measures following its announcement of disappointing quarterly results.

U.S. Department of Veterans Affairs Joins DirectTrust’s Accredited Trust Anchor Bundle

The VA joins DirectTrust’s anchor bundle, which will allow its employees to use Direct messaging and information exchange to communicate with 1.8 million providers.

Abernethy tapped as FDA’s CIO

Politico reports that FDA Principal Deputy Commissioner and former Flatiron Health executive Amy Abernethy, MD will become the agency’s CIO, taking over from CISO and interim CIO Craig Taylor.

Theranos Whistleblowers To Launch Tech Ethics Venture

Theranos whistleblowers Erika Cheung and Tyler Shultz will launch the nonprofit Ethics in Entrepreneurship to help connect startups with ethicists, more experienced entrepreneurs, and resources that will help them avoid the fate of the disgraced blood-testing company.

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