Former FDA Commissioner Scott Gottlieb, MD says in a JAMA Forum article that at-home diagnostic tests may be the most enduring technological innovation of the pandemic, so it will be critical to connect those tests with telemedicine to reduce office visits and increase access to care.
Medical software vendor CompuGroup Medical was hit by a ransomware attack on Saturday that has affected its network and telephone support systems. The company is setting up emergency telephone numbers and email addresses for customers.
Reader Comments
From Historian: “Re: Oracle acquiring Cerner. Acquisitions like this don’t usually work out well for health IT customers.” Very true, especially if the acquirer is new to healthcare and states upfront that its primary motivation of the acquisition is to increase growth. Extra negative points since Oracle seems to think that what Cerner needs to finisher higher than #2 in a three-horse race is bolted-on, market-lagging technologies such as its voice assistant. Oracle also may underestimate the challenges that lurk underneath its glib statement that it will magically increase non-US sales of Cerner products. The clinking of milkshake toasts must be echoing throughout the Verona cornfields, with the only other delighted parties being Cerner shareholders and the heirs of Neal Patterson, who are stacking their cash with fingers stuck in ears to avoid hearing him rolling over in his grave.
Webinars
None schedule soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.
Acquisitions, Funding, Business, and Stock
The EU’s regulator approves Microsoft’s acquisition of Nuance, which it says raises no anti-competitive concerns.
Sales
MUSC Health will implement Sectra’s enterprise imaging solution in a subscription model that covers its main campus, several satellite locations, and all affiliated regional hospitals in South Carolina.
Announcements and Implementations
Vyne Dental announces enhancements to its Trellis revenue cycle and communications platform.
Government and Politics
FDA issues draft guidance on using digital health technologies for remote data acquisition in clinical studies.
Other
The co-founder of the COVID Tracking Project says in The Atlantic that the US is about go temporarily blind in the Omicron variant fight because the folks who collect and report testing results take holiday periods off. Cases will appear to be dropping sharply over the next several days due to underreporting, then will skyrocket in the first several weeks of 2022 as the data backlog is cleared (or as infection rages, or both – it won’t be possible to tell). The only data that is likely to be accurate is HHS’s hospitalization figures, which are more of a record of interventions gone wrong than an early warning system. I think hospital admissions and deaths will become the only relevant numbers since case counts and positivity mean little when nearly everybody is going to become infected and the tools that can blunt the infection’s damage become more important.
An interesting aspect of the ransomware downtime of Ultimate Kronos Group’s cloud-based payroll system. Health systems that can’t access hourly pay records are being forced to issue employee paychecks in the same amount as a weeks-ago pay period. That means that not only will they have to claw back any overpayment right after Christmas (assuming the system is restored soon); they have to deal with newly hired employees, people who received bonuses or overtime in the pay period that is used; and W-2s will potentially be affected by paycheck adjustments.
The New York Times says Pediatrix and its parent company Mednax are earning millions of dollars each year by showing up at the bedside of a newborn’s mother and offering to administer expensive hearing tests, which the mother assumes is covered by the hospital stay. Pediatrix – which also offers pediatric intensive care, pediatric surgery, and obstetric services – is administering the hearing tests to nearly 1 million babies per year. Aetna sued the companies three years ago for inflating charges by more than $50 million but eventually settled, although Mednax admitted in court that it destroyed emails in which it pestered its doctors to upcode procedures. Pediatrix sponsored a successful campaign to pass state laws requiring hearing tests for newborns, then started doing a test that costs several hundred dollars instead of the previous $50. Patients have complained about the surprise bills, with at least one hospital warning expectant parents that the company may not be an approved provider under their insurance and that the company balance-bills patients for what insurance doesn’t cover.
I haven’t been anywhere near the physician water cooler this week, but around the healthcare IT water cooler, the hot news (as expected) is the Oracle acquisition of Cerner.
I haven’t heard any optimism around it. Most of the comments are of the “lots of organizations have tried to succeed in healthcare and they all fail” variety. Many see it simply as a way for Oracle to increase its customer base as well as it being a win for Epic since customers who might have debated between it and Cerner choose the path that isn’t about to undergo changes to leadership and strategy.
I’ve been involved in a couple of EHR replacement evaluations where Cerner was a contender, but failed to win the deal despite being less costly than the alternative. Primary care physicians tend to find it underwhelming for high-volume ambulatory practices. It will be interesting to see if Oracle does any better at winning those hearts and minds with their promises of voice recognition-based workflows and automation of care delivery.
As far as the virtual hospital hallways are concerned, I’ve been in contact with several friends who are nurses, one of whom is currently infected with COVID-19. They’re irate at suggestions that infected healthcare workers should be subject to shorter isolation periods to avoid straining the US healthcare system. Especially with many healthcare organizations continuing to fail at providing adequate personal protective equipment, including N95 masks, asking those who have shouldered the burden of care to put themselves at additional risk working alongside COVID-positive colleagues is something we never imagined would be suggested at this stage of the game.
My COVID-positive friend, who happens to be an ICU nurse, commented on how beneficial it has been for her to actually sleep for as long as her body needs. She has found her isolation to be somewhat restorative even though she is having mild coronavirus-related symptoms. Asking for additional sacrifice from those workers to care for what truly has become a pandemic of the unvaccinated just rubs salt on existing wounds and will not bolster the morale of healthcare workers. I would propose that if anything, it makes them feel that people think they are expendable.
Another hot topic among healthcare policy friends is the jump in US health spending. The number topped $4.1 trillion for 2020 as we attempted to fight COVID-19 in our dysfunctional and misaligned way. Case in point: COVID testing. My county testing with no direct cost to patients through multiple drive-through clinics. Results are generally delivered same day via email. Appointments are readily available on its website, with dozens of unclaimed appointments each day. Despite this, I see dozens of posts every week in various community-focused Facebook groups and other forums where patients are looking for open slots at CVS, Walgreens, and other pharmacies because they are booked solid.
My former clinical employer is running four testing sites that do several hundred visits each day, but with a twist – they require each patient to be seen by a licensed provider (MD, DO, NP, PA), which results in a full visit billed to the insurance company. Since patients don’t incur that cost up front, they don’t understand that what could have been a relatively cost-effective testing visit has been inflated by a factor of 10. Even if they don’t pay the cost out of pocket, they’re going to pay it down the road through increased insurance premiums and shifts to cost sharing.
These processes are why spending has jumped nearly 10%, double its usual rate, with no corresponding improvement in outcomes. I don’t think people realize that $1 of every $5 in the economy is going to healthcare. Even if people did, I’m not sure it would have much meaning to them.
Other interesting tidbits in the report, since it’s hiding behind a paywall:
Health spending works out to approximately $12,500 per person.
The count of uninsured individuals held steady, although there was a shift in those covered from workplace-based policies to Medicaid and Affordable Care Act marketplaces.
Medicare beneficiary counts grew more slowly due to significant numbers of deaths in those aged 65 and older.
Individual out-of-pocket spending decreased due to deferred care, such as postponed surgeries and screening procedures.
The latter two are certainly negatives in my book. Where senior citizens accounted for roughly 15% of all COVID-19 cases, they represented 80% of the deaths. The loss of so many family members and loved ones is tragic. I’m fortunate that the elders in our family are extremely healthy and their living situations allowed them to be protected thus far, but plenty of my friends and colleagues have lost an entire generation to the virus.
I’m hearing a lot more this year about people planning to test prior to family gatherings. Hopefully that will help prevent at least a small amount of transmission and reduce the strain on our overwhelmed healthcare workers. I’ve been generally pre-quarantining just to be on the safe side, but not everyone has the luxury of working from home.
I enjoyed attending the Consumer Electronics Show last year, even though it was virtual. There were plenty of products to check out and many of the companies did a great job trying to engage the virtual audience. Obtaining a media registration last year was easy, but they made things trickier this year for me since a photo is required even for digital attendees. My credentials are still pending approval, so there’s no guarantee I’ll be on prowl in the virtual exhibit hall this year. I’ve lived a full year without the $16,000 bathtub I was eyeing last year, so I guess if I can’t attend, I will survive. One of my colleagues is attending in person and I’m a bit jealous, but I’ll be holding down the fort while he’s gone and will have to rely on him for the in-person buzz.
What conferences are you looking forward to attending this year, or do you think COVID-19 will keep us all close to home again? Leave a comment or email me.
FDA issues draft guidance for medical device manufacturers that are selling products approved under EUAs on how to transition to normal approvals once EUAs are discontinued.
Several investment firms and bond ratings organizations downgrade Oracle’s shares and debt due to the cash requirements and possible lack of strategic value in acquiring Cerner for $28 billion in cash.
Several investment firms and bond raters downgraded Oracle’s shares and debt Tuesday following its announced intention to acquire Cerner. They worry that the cash payout is large and Cerner’s offerings aren’t strategic to those areas where Oracle should focus.
Oracle has $23 billion in cash and will likely need financing to complete the Cerner acquisition for its offer of $28 billion in cash.
ORCL shares dropped 5% on the announcement Monday and were flat Tuesday.
Oracle’s biggest previous acquisition was PeopleSoft, which it acquired for $10 billion in 2004.
Reader Comments
From Change of Control: “Re: Cerner. Could CEO David Feinberg really have been key to the Oracle acquisition given that he’s been on the job for less than three months?” That was my immediate question as some seemed to give him credit for the deal. Either way, he’s even more fabulously wealthy than when he started on October 1 – shares in his $35 million compensation package have jumped in price. He is also protected by a change-of-control employment clause if Oracle fires him within 12 months of closing the deal (two years of base salary, 24 months of benefits, immediate vesting of shares, and his initial $1.35 million cash bonus). It seems from the cheap seats that Oracle would have pursued its long-rumored acquisition regardless of who was sitting in the CEO chair, and the fact that it was the new guy Feinberg is very good for him. I doubt Oracle based its plans on his ongoing involvement or found Cerner to be a more attractive target because the CEO spent less than three years working for Google. It may well be that 77-year-old Larry Ellison’s testosterone kicked in (a common tech punch line: “God doesn’t think he’s Larry Ellison”) at the chance to steal an AWS client and to match Microsoft’s acquisition of Nuance by rather wildly claiming that Oracle will make its voice assistant the primary clinician interface to Millennium.
From On-Demand: “Re: Cerner. Oracle is buying into healthcare, not buying into a sexy acquisition.” I agree. CERN revenue and shares haven’t budged much in years, the company lost a lot of its executive talent (to the benefit of other health IT vendors) while Brent Shafer kept the CEO chair warm for his short and generally forgettable three years, and Cerner is #2 and losing ground in its primary business. Oracle’s history involves milking database customers hard while missing trends such as cloud, AI, and voice assistants, but revenue from the former lets them belatedly buy their way in. Tech analysts raised interesting questions: are more Oracle acquisitions imminent since the company historically plays aggressive catch-up, and will Salesforce be pushed into broadening its modest healthcare presence?
From Bob Loblaw Law Blog: “Re: Cerner. Oracle triggers more customer complaints than any software vendor I’ve seen.” A class action suit that was filed in early 2020 claims that Oracle’s shares were tanking because it failed to predict cloud-based competitive threats, so the company boosted its numbers by forcing customers to buy its flawed cloud offerings by using a strategy called “Audit, Bargain, and Close.” The lawsuit claims that Oracle intentionally installed on-premises software that boosted the customer’s license usage without their knowledge, then threatened to impose large license agreement penalties unless the customer accepted a cloud subscription that they didn’t want and wouldn’t use. The lawsuit quotes a company executive who said that up to 95% of the company’s cloud sales involved these “financially engineered deals” that were designed to mislead investors into thinking that Oracle’s cloud strategy was working.
HIStalk Announcements and Requests
I’m curious about what you think about Oracle’s planned acquisition of Cerner. Let me know. I’m thinking of these themes:
How does Oracle perform as a health system vendor (database, HR, ERP, EMPI, etc.)
How well does Oracle’s Voice Digital Assistant work? Could it really be suitable as Millennium’s primary user interface for clinicians?
What is the customer impact of Cerner moving from AWS, which is already complete for some systems and in process for others, to do an about-face move to Oracle’s Gen2 cloud services?
How will Cerner’s VA and DoD business be affected?
How many on-the-fence Cerner customers and prospects will be spooked by uncertainty and will instead make a quick Epic decision?
What will Oracle’s strategy be given that much of healthcare, including Epic, uses InterSystems Cache’ rather than relational databases like Oracle’s?
Speaking of the acquisition, let’s give credit to some HIStalk readers who called it early (July 25, 2021). Eddie T. Head stated confidently that Oracle will be the top general technology firm in healthcare “after they buy Cerner,” which he expected because Cerner is a heavy Oracle user (databases and Java), Oracle is desperately late to the cloud, and Cerner seemed primed for sale. IANAL added that Oracle has acquired other sector-specific application vendors such as NetSuite and predicted accurately that it would be a $30 billion acquisition.
I’m always happy to see December 21 even though it’s the first day of winter (and another COVID one at that) because at least daylight hours start increasing.
An Anonymous Health System CIO’s Initial Thoughts About Oracle Acquiring Cerner
We’ve been a Cerner customer on the acute EHR side for quite a while and have further implemented both ambulatory and rev cycle. On the acute side, we’ve been generally pleased with the product, services, and support. However, we saw Cerner challenges with the ambulatory and rev cycle implementations. From my viewpoint, Cerner’s biggest problems today are:
Revenue cycle functionality. Millennium still has challenges to get it to work well. I’m hoping the RevElate strategy pans out.
Ambulatory functionality. We’re seeing improvements made, but they lack the product maturity other vendors have. Generally, we are able to make it work.
People and process. This is actually their biggest problem. Cerner has struggled to maintain competent staff that understand healthcare and individual customer workflows. Throughout our implementations, we had major challenges with project management, availability of experienced staff, and the ability to help us make informed decisions.
Here are my thoughts on Oracle acquiring them:
If Oracle is going to help reduce the cost of healthcare, they also need to help find savings for their customers.
One of the things mentioned in their announcement was the use of Oracle’s voice assistant product. Our Physicians use Dragon and are very pleased with it. I don’t believe Oracle understands how difficult it is going to be to get physicians to give up something they like and benefit from.
Oracle should be able to bring more technical resources to bear to help with Cerner’s products. However, I hope Oracle isn’t going to distract Cerner to move from their AWS strategy to an Oracle cloud strategy immediately. While this would be favorable to Oracle, I fail to find any immediate value to customers.
Oracle is not going to be able to help bring additional healthcare resources initially.
I hope Oracle can help improve Cerner’s service delivery through more mature processes. However, not knowing the healthcare space or Cerner products, I’m not sure what they can do initially to bring value for customers.
Webinars
None schedule soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.
Acquisitions, Funding, Business, and Stock
Bloomberg reports that activist investor Elliott Investment Management and Vista Equity Partners are considering making a joint bid for Citrix Systems, whose shares are down 36% this year and the company has been exploring its options.
Huron will acquire healthcare analytics vendor Perception Health.
Patient financial solutions vendor AccessOne acquires CueSquared, which offers a mobile payment platform for patient self-pay balances.
The executive director of the World Privacy Forum is concerned that the acquisition of Cerner will give Oracle – which runs the world’s largest third-party data marketplace – access to Cerner-stored patient data. She says that business associate rules might allow Oracle to use Cerner’s EHR patient data to train AI systems.
People
ZeOmega hires Andy Arends, MBA, MSc (NTT Data) as chief growth officer.
Other
KHN finds that small-town pharmacists are opening independent drugstores to replace big-box chains that pull out and leave those areas without pharmacy services. The article notes that the number of pharmacists employed by big-box stores peaked at 31,800 in 2012, but online and mail-order sales dropped that number to 18,000 by 2019. Experts say that people do less “roaming shopping” now, meaning that running a loss-leading pharmacy in the back of a retail or grocery store is not necessarily the most profitable use of the square footage. Rite Aid announced Tuesday that it will close another 63 stories, which follows CVS Health’s announcement that it will close 900 stores in the next three years.
The BMJ complains to Facebook that its peer-reviewed COVID-19 articles are being flagged as “false information” by Facebook’s fact-checking contractor Lead Stories. Lead Stories responds by saying that BMJ’s article “COVID-19: Researcher blows the whistle on data integrity issues in Pfizer’s vaccine trial” and its “scare headline” were adopted by anti-vaxxers to prove that the clinical trial was fraudulent. Lead Stories says the allegation actually involves just three of 153 research sites, the whistleblower Brook Jackson is an EHR auditor rather than a scientist and had worked in the lab for just two weeks, and her Twitter account shows her support for misinformation spreader Robert F. Kennedy, Jr. It also notes that it flagged the article only as being potentially misleading without additional context. Jackson filed an FDA complaint about the clinical trial and was fired by her research contractor employer the same day.
HIMSS announces featured HIMSS22 speakers, none of whom I’ve heard of other than former Olympic swimmer Michael Phelps — the CEO of a children’s education organization, the guy who ran Disney’s ABC Television group for a short time, a couple of former Air Force pilots turned consultants (they sound pretty interesting), an audit firm’s economist, the CEO of the Society for Human Resource Management, and a “60 Minutes” correspondent (those last three are co-presenting a single session on workforce). Exhibitor count is at 550 and Oracle isn’t among them.
Oracle says it will expand non-US sales of Cerner software. The above from KLAS’s “Global (Non-US) EMR Market Share 2021” report shows where Cerner stands.
Weird News Andy, this is my holiday gift for you. In England, the bomb squad is called to a hospital ED when a patient presents with “munition in his rectum.” The patient showed little originality in claiming that he fell on the World War II-era armor-piercing projectile.
Oracle will acquire Cerner for $28 billion in an all-cash deal, describing the company as a “revenue growth engine” whose business it will expand globally.
Oracle will acquire Cerner for $28.3 billion in equity value in an all-cash deal, the companies announced this morning.
Oracle chairman and CTO Larry Ellison said in a statement, “Working together, Cerner and Oracle have the capacity to transform healthcare delivery by providing medical professionals with better information—enabling them to make better treatment decisions resulting in better patient outcomes. With this acquisition, Oracle’s corporate mission expands to assume the responsibility to provide our overworked medical professionals with a new generation of easier-to-use digital tools that enable access to information via a hands-free voice interface to secure cloud applications. This new generation of medical information systems promises to lower the administrative workload burdening our medical professionals, improve patient privacy and outcomes, and lower overall healthcare costs.”
Oracle vertical industries EVP Mike Sicilia said that Oracle will make Cerner’s systems easier to learn by making Oracle’s hands-free Voice Digital Assistant the primary interface to Millennium.
The transaction is expected to close in 2022. Cerner will operate as an industry business unit within Oracle.
The acquisition, at $95 per Cerner share, represents Oracle’s largest acquisition. Oracle says Cerner will be “a huge additional revenue growth engine for years to come” as Oracle expands its business to additional countries.
December 20, 2021Dr. JayneComments Off on Curbside Consult with Dr. Jayne 12/20/21
The news this week has been dominated by surges in COVID-19 cases across the country. Epidemiologists are predicting a January peak and hospitals in many parts of the country are becoming overwhelmed. Staff members at those hospitals, as well as at urgent cares, community health centers, ambulatory offices, etc. are beyond overwhelmed, as they have been fighting this pandemic for nearly two years.
Most of the colleagues who I talk to regularly are beyond stressed as their organizations try to figure out how they’re going to staff another surge. The nursing shortage continues, with some of that work being shifted to physicians, which is increasing their levels of burnout. The thing that bothers them the most is not the hours or the work, but the feeling that they community no longer supports them but instead takes them for granted, or worse, sees them as expendable.
There’s a tremendous push for people to “live their lives,” but the reality is that we would all be better served by dialing it down a notch and sticking close to home for a while. None of us want to be constrained. We’re all tired of it, but it’s a necessity for many families right now as they struggle to protect vulnerable individuals in their households.
Seeing JP Morgan Chase cancel its healthcare conference was bittersweet. Everyone is so desperate for “the old normal,” but cramming people in hotels and restaurants isn’t the right answer. There’s a shortage of home testing kits across the country at the moment and people in some cities are facing long waits for clinic-based testing, so it doesn’t seem right to burden those systems with pre-travel testing. The same goes for people planning to travel out of the country for the holidays, which can generate multiple tests per traveler on their return, depending on workplace and school policies. I’m glad people have the money to travel to the Caribbean, but I feel for the healthcare workers who will grimly trudge through the lines of tanned, happy travelers seeking testing as they wonder when they will be able to take a break. One of my urgent care clients is routinely testing more than 100 patients per day at a single location, which is an unsustainable pace.
Mr. H noted that HIMSS is reviewing its Right of Entry Protocols for HIMSS22 to see how they’ll play in Florida, which has blocked vaccine mandates for workers and won’t allow businesses to require proof of vaccination. I have to say I hadn’t thought of that before registering for the conference, but now it’s giving me pause. We’ll have to see what the case rates look like as the conference is closer. We know that vaccination doesn’t necessarily prevent transmission, but data is good as far as there being less viral shedding and a shorter duration of symptoms. As we get more data about the Omicron variant, that may change, but right now I’m definitely more comfortable being around people who are fully vaccinated as well as masked versus the unmasked people at the supermarket who are talking on the phone as they shop, aerosolizing as they go. Influenza A is starting to rip through our community as well, so if the COVID-19 doesn’t get you, there’s a chance the flu will.
From a healthcare IT standpoint, I’m starting to see hospitals and health systems put projects on hold again as they cite the need to be all hands on deck for patient care issues. Organizations that haven’t already been tuning up their telehealth strategies have probably missed the window of opportunity while utilization was relatively low. Those who have robust telehealth programs are seeing greater demand, and most of the physicians I’ve spoken with are considering retooling their schedules to create dedicated blocks for telehealth visits so that they can minimize disruption to their days. With hospitals canceling elective cases again, patients are left in the lurch, and I feel bad for those who have been waiting for procedures that are again being pushed back.
As we approach the third year of the pandemic, I’m also starting to see physicians look for part-time opportunities due to childcare issues, especially in dual-physician households. As higher wage earners, these couples have historically had greater ability to afford full-time household caregivers such as nannies, but the long hours and unpredictably lengthened days have caused some caregivers to leave their physician employers. There is also some degree of mismatch between COVID-sensitive physician families and caregivers who might not want to be vaccinated or mask at work, just like there is in any other part of the workforce. Parents of young children who were hopeful for a vaccine to be available soon for their children are crushed by the recent Pfizer announcement that they’d be amending the clinical trial for children 6 months to under 5 years of age. This could delay the vaccine by an additional six months as boosters are studied. For those families, it will be a long winter, indeed.
There are so many terrible things that have come with the COVID-19 pandemic that when you come across something good that has come from it, you just have to celebrate it. Partway through the pandemic, I was introduced to what was then called The Covid Cello Project. It started as a group of 17 professional cellists who couldn’t work due to the initial lockdowns and decided to do a virtual collaboration. Since then, it’s grown to over 500 cellists who submit individual recordings that are then compiled and mixed into a group performance. It was rebranded some time ago as The Global Cello Project to reflect its worldwide reach as well as the easing of the pandemic, but now many of us are staying close to home again, so it’s hard not to refer to it by its original name.
The founder challenged us to put our most recent piece together in only nine days (usually we have several weeks) and I spent the first three of those days in the woods, so I’ve really had to work to get my part ready. Tonight was the recording deadline, and with the support of my in-house production crew, I was able to nail it in one take. Now the team gets to work editing all the videos and mixing all the recordings and we all get to be surprised by the finished product. It’s been great to have something to think about and work on that brings people together, even though my fingers have had the most exhausting week of their lives.
What good things have you encountered as a result of the pandemic? Have you taken up a new hobby or found a new passion? Leave a comment or email me.
The EHR is (Still) Dead, But I’m Optimistic By Rob Dreussi
Rob Druessi is chief information officer of HCTec of Brentwood, TN.
In May, HCTec CEO Bill Grana published a company article on the evolution of the EHR entitled, “The EHR Is Dead. Long Live the EHR.” In August, digital health strategy consultant Seth Joseph published a similarly titled article, “Long Live the EHR Platform” on Forbes.com.
The key distinction in the headline encompasses his argument for the future of EHRs. Joseph’s two-part article is both comprehensive and detailed. He provides compelling analysis and research, sourced from industry experts to assert that while the government-backed investment (ARRA, HITECH ACT) into EHR adoption did, in fact, achieve the goal of wider physician and hospital adoption of EHRs based on government Meaningful Use (MU) criteria, EHRs collectively have been a disappointment and have not lived up to the hype.
For the most part, I agree with his points and appreciate his arguments, but drawing on 25 years of healthcare IT leadership as my lens, I politely disagree with a few of them.
To compete in a subsidized marketplace, vendors couldn’t just be best-of-breed for specialized focus areas. They needed robust capabilities to survive. In effect, they grew to be” a mile wide, but an inch short in the most important ways.”
In the short term, EHR vendors certainly focused on becoming certified by the US Department of Health and Human Services (HHS) to be MU-compliant. However, hospitals still had the ability to continue using the best-of-breed approach, as modular certifications allowed systems to be certified using a subset of criteria intended for their specific use. Examples of best-of-breed areas include laboratory, surgical, radiology, pharmacy, decision support, oncology, home health, and revenue cycle.
Many hospitals continue to use specialty systems for all the above. But more frequently, they are looking to decrease the overall complexity of running multiple EHRs. If anything, the MU era accelerated the move from full best-of-breed solutions to a modified hybrid approach, where hospitals use a primary EHR with select departmental solutions as necessary. Then, if and when the EHR vendor can provide a sufficient solution with functionality on par with the independent solution, the supplementary solution is often phased out.
In my experience, best-of-breed systems are difficult to manage and costly to maintain. In instances that my company has seen, many health systems agree with me. To illustrate, a Southeastern-based health system recently migrated one of its markets onto Epic from a combination of Cerner (acute side), a third-party home health system, multiple ambulatory systems, and over 50 related third-party applications. Similarly, we have supported many Epic-based organizations move from their independent departmental solution to Epic’s Beaker module this year.
EHRs went from competing on the value of their product to competing on the breadth of functions they offered. Epic achieved its dominant market share for this reason. It offered hospital CIOs a one-stop shop at a time when the CIO’s job was dependent upon helping the organization achieve Meaningful Use of EHRs, no matter how much physicians detested the actual software.
Introduced in 2009, MU can’t take credit for the complete success of EHRs. Epic, for example, was already long thriving as an EHR market leader for hospitals with 400 or more beds by then. Kaiser Permanente became an Epic client in 2003 as part of a $1.8 billion deal, and by 2005, their client base included the likes of Cleveland Clinic Foundation and Sloan-Kettering Cancer Center. This shows that while MU may have accelerated the move to Epic for many health systems, Epic wasn’t just competing on the MU compliance to win deals. They were winning deals due to their ability to not only provide a solution that handled both the inpatient and outpatient areas, but one that was developed 100% in-house, without the need for mergers or acquisitions.
Normally, CIOs selecting Epic were not dealing with physicians who detested the Epic EHR. Epic was even known in the marketplace for “selecting” its clients. Commonly, in my personal experience with many Epic organizations, the deciding factor was Epic’s ability to provide multiple reference sites running their full product suite, whereas competitors struggled to do the same.
“EHRs have been more than a disappointment: they have largely turned into a national nightmare…. Additionally, while EHRs may improve safety in some areas, they also introduce new risks that are systemic in nature.”
There are undoubtedly drawbacks to EHRs, and we certainly have not yet fully realized the potential of these digital systems, but to say they are a sweeping disappointment suggests that they have not offered any societal benefit. Before EHRs, providers struggled to have a clear picture of a patient’s health background, even within the same organization. A patient could go to the ER and later visit a primary care physician, who had no record of that visit or what occurred during it.
Our nation would have had a difficult time shifting to telehealth during the COVID-19 pandemic without the currently deployed EHRs. With EHR systems, we can now better share critical patient data across a healthcare organization and even across other healthcare systems when required. For those populations who spend different seasons in different parts of the country, the ability for their separate health systems to “talk” and share health information is an invaluable component in their health journey. With an EHR, providers can access real-time, up-to-date patient information, regardless of where treatment was provided. This element alone is vital for patient safety and care.
“By virtually every financial and operational metric, the business prospects for EHRs have gone in one direction over the past decade: down.”
Joseph is correct that EHR vendors have seen a downturn in the number of net new EHR implementations. Recent implementations appear to be driven by mergers and acquisitions or the routine replacement life cycle when the current EHR is not meeting organizational needs, with a traditional selection process to identify a new solution. More commonly, smaller, specific modules are being introduced as opposed to the full EHR implementations. While EHR vendors have seen declining revenues post MU, which is not totally unexpected, their futures are ripe with opportunity. They will adapt to the changing environment and will take steps (or have already taken steps) to size their workforce accordingly based on the future demands for maintenance / support and new implementations.
I share Joseph’s curiosity as to the future of EHRs. For now, Meditech is seeing more traction with its Expanse solution, with HCA most recently announcing they are implementing the solution at three HCA hospitals in the New Hampshire market. Meditech will realize tremendous growth with HCA if they are able to move the system’s vast footprint of hospitals running the Meditech Magic EHR onto their Expanse solution. Meditech would also realize a significant loss of business if HCA moved away from Meditech altogether.
Epic has chosen a strategic route in developing a web-based client (Hyperdrive) to generally replace the desktop client (Hyperspace). Hyperdrive clients should experience cost savings from the reduced manpower and related technologies necessary to support a web-based client. These savings could also open the door for new adoption at smaller organizations by finally making the ongoing TCO of running Epic feasible. During the pandemic, Epic was also able to deliver their clients a solution, including the underlying technology, for patient telehealth visits representing an unexpected boost in revenue, which luckily for Epic, is here to stay for the foreseeable future.
Perhaps the next boom for major EHR providers will be international growth as opposed to domestic. Whatever the next big break is, I’m curious to see what Joseph sees in his crystal ball for the future of EHRs.
December 20, 2021Readers WriteComments Off on Readers Write: COVID-19 Drastically Cut Lung Cancer Trial Participation. What Can We Do to Reboot?
COVID-19 Drastically Cut Lung Cancer Trial Participation. What Can We Do to Reboot? By Miruna Sasu
Miruna Sasu, PhD, MBA is chief strategy officer at COTA, Inc. of Boston, MA.
COVID-19 has had a devastating effect on the nation’s health. In addition to hundreds of thousands of deaths directly caused by the virus, millions more patients have been unable to access crucial healthcare services due to lockdown orders, economic stress, and fear of illness.
During the early days of the pandemic, primary care visits declined by nearly 60% before rebounding later in 2020. Screenings for common cancers, including breast, colon, and cervical cancer, dropped by an average of 91%, prompting fears of a wave of advanced cancers in the coming months.
A new study from the University of Memphis shows that the clinical trial ecosystem has not been exempt from this trend. The pandemic has prompted a 43% decline in enrollment for lung cancer trials, forcing researchers to delay, postpone, or cancel their initiatives.
Lung cancer leads to a quarter of all cancer deaths: more than colon, breast, and prostate cancers combined. Clinical trials are essential for helping to save and extend the lives of lung cancer patients.
My own life is a perfect illustration of how important clinical trials can be. After immigrating from Romania as a child, my grandfather helped to raise me in America. Soon after, he was diagnosed with advanced metastatic lung cancer and given three months to live. We did not have the resources for conventional treatment, but he enrolled in a clinical trial that offered experimental care we could afford.
Instead of living for three months, he went into remission and got to spend another 30 years with his family. We were lucky to have access to this life-altering program. We knew that the option existed. We lived close enough to the trial site for regular visits. We were able to provide a strong network of support at home. Not every family is so fortunate.
The care access issues of COVID-19 have compounded existing challenges with clinical trial enrollment, including proximity to centralized trial locations and the ability to completely mold one’s life around the demands of constant clinical visits, treatment side effects, and emotional self-care.
We now have the opportunity to rethink how we approach these problems and restart the momentum that has been lost during COVID-19. I believe that three things could potentially be solutions to care access issues and substantially improve trial recruitment and retention for patients:
Increasing enrollment. We can start by ensuring that patients from all walks of life are aware that clinical trials may be an option for them. Clinical trials perennially fall short when recruiting diverse and representative populations, excluding far too many underserved individuals from medical research. By using emerging data strategies, such as leveraging multifaceted real-world data to identify new research sites serving representative populations, we can educate more providers and patients about the positive potential of clinical trials. Real-world data from electronic health records, claims, and other sources can also help us match individuals with the most appropriate trials to maximize their odds of better outcomes.
Maintaining patients on trials. We also need to make sure that patients have the day-to-day resources they need to stick with the program from start to finish. Non-clinical services, including transportation to appointments, childcare, meal delivery options, and other assistance to mitigate social determinants of health are critical for enabling patients to stay adherent to complex trial protocols.
Patient understanding of trial opportunities. Continued trial interest is important for both healthcare providers and patients. We need to work hard to ensure that everyone within the care ecosystem understands their options for clinical trials. As such, building a community of care around clinical trial participants can improve quality of life while making sure that researchers can keep their enrollment numbers where they need to be. To do this, we have to get very good at things such as being able to showcase trial options and providing educational materials to doctors and patients that are tailored for each of these audiences. We also need ask patients questions about life style and quality of life at the right times and provide a variety of easy ways to not only treat but also connect with clinicians and care teams.
Making the investment in these and other strategies could save untold lives and give lung cancer patients, like my grandfather, many more happy moments with their family and friends.
As we work through the ongoing challenges of the pandemic and continue to design and implement innovative clinical trials, we must commit to enrolling more diverse and inclusive patient cohorts and supporting them holistically during trials so they live their lives to the fullest for as long as possible.
Comments Off on Readers Write: COVID-19 Drastically Cut Lung Cancer Trial Participation. What Can We Do to Reboot?
The mental health startup, valued at $4.8 billion in a recent investment, is accused of making more than 200 salaried therapists hourly and tying their ability to buy benefits contingent on hitting quotas.
Kaiser Health News call out Yale New Haven Health System, which for telehealth visits sends a separate bill for a $50 to $350 facility fee even though telehealth patients never set foot in any of the health system’s buildings.
The health system, warned by the Connecticut Office of the Healthcare Advocate that the state explicitly bans charging facility fees for telehealth visits, blamed a coding mistake.
Despite attributing an error, the health system still argued that the charges are justifiable because they cover the cost of the telehealth software, adding that “we do still have to keep the lights on.”
HIStalk Announcements and Requests
Hard-to-change company attributes are most important to poll respondents who are seeking new opportunities, but otherwise, throwing down cash doesn’t hurt.
New poll to your right or here: How would an Oracle acquisition of Cerner change healthcare?
Webinars
None schedule soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.
Acquisitions, Funding, Business, and Stock
Online mental healthcare startup Cerebral, which was recently valued at nearly $5 billion after its latest funding round and hired Olympic gymnast Simone Biles as chief impact officer, recently changed hundreds of therapists from salaried workers to hourly and made benefits eligibility contingent on hitting quotas. Patients choose company therapists from its web directory, so the new structure means that therapists have no control over the company’s minimum billed hours threshold.
UK’s business secretary will investigate complaints that Microsoft pushed British companies out of contention for NHS contracts by giving NHS free use of its Teams remote meeting software, which small competitors say is a way to gain overall IT leverage posting as a charitable act. Also complaining is Salesforce, which owns Teams competitor Slack.
Cerner shares closed at Friday $89.77, up 13% on the rumor that Oracle will acquire the company in a $30 billion deal. ORCL shares dropped 6% on the Wall Street Journal report.
Axios reports that the two founders of PillPack, acquired by Amazon in mid-2018 for $1 billion, have been demoted to consultants to the online pharmacy. Employees who reported to T.J. Parker now report to John Love, an Amazon VP who oversees Alexa shopping.
Announcements and Implementations
KLAS finds that Epic had the largest net gain in US hospitals in 2020 with 101, which gave it 19,000 new beds. Cerner lost a net of 19 hospitals and 10,000 beds. KLAS concludes that while Epic’s biggest-gaining year was 2015 when it added 144 new hospitals, “their growth has never so decisively outpaced the competition’s.” The company lost three hospitals in 2020, all due to M&A. Meditech lost 62% of the decisions made by legacy customers in 2020, with all of its new hospitals being under 100 beds. Most of those that decided not to move to forward to Meditech Expanse chose Epic instead. UPDATE: I’ve corrected the dates – KLAS’s “US Hospital Market Share 2021” report reflects data from 2020, not 2021.
Government and Politics
The Massachusetts Supreme Court rules in favor of a former Meditech employee who claims he was fired for exercising his right to file a rebuttal in his personnel file. Terence Meehan says Meditech reorganized its 12-person regional sales department in demoting three sales reps – including Meehan – to the newly created position of “sales specialists,” who sales reps rarely used because they don’t want to share commissions. Meehan says he and the other demoted employees were placed on performance improvement plans in July 2018, and when he sent his supervisor a rebuttal, the president and CEO of Meditech immediately terminated him. He filed a complaint of wrongful discharge and the court agreed with him.
Sponsor Updates
Two member agencies of The Arc New York collaborative will implement Netsmart’s CareFabric platform.
Redox releases a new podcast, “Extracting paternalism from the patient experience with B.well CEO Kristen Valdes.”
The Pharmacy, IT & Me Podcast features RxRevu CEO Carm Huntress.
Talkdesk wins the cloud-based CX solution of the year award at Customer Contact Week.
Vocera releases a new podcast, “The Evidence for Team Member Safety and Well-being – Kedar Mate, MD.”
Well Health has helped providers facilitate nearly 10 million vaccine appointments and send over 63 million messages related to COVID-19.
Ophelia, which connects opioid users in 11 states to moonlighting providers who prescribe Suboxone via video visits for $195 per month, raises $50 million in a Series B funding round.
Behavioral health EHR vendor Qualifacts + Credible acquires InSync Healthcare Solutions, a Florida–based company that offers EHR, practice management, and RCM technologies.
Innovaccer raises $150 million in a Series E funding round that values the company at $3.2 billion.
Reader Comments
From Marc: “Re: Scarborough Heath Network. The first client in the world to put Epic DR on AWS. Great collaboration with Deloitte, AWS, and Epic.”
HIStalk Announcements and Requests
I’m interested in hearing about turnover experience – yours and your employer’s — via this short, anonymous survey, whose results I’ll aggregate in the next few days.
The JP Morgan healthcare conference, which just moved to a virtual-only format because of attendee concerns about COVID-19, will start 55 days before the first-ever ViVE conference and 63 days before HIMSS22. It’s not a great time to be in the conference business, especially when those two upcoming conferences are in Florida, which bans vaccine mandates (such as for workers at the convention center, hotels, and restaurants) and doesn’t allow requiring customers to provide proof of vaccination. HIMSS says it is reviewing its Right of Entry Protocols for HIMSS22 to determine which ones “comply with prevailing local regulations in Florida,” which is basically what ViVE is doing in simply saying that it will let people know later what it will be allowed to require (we’re just 80 days out). Would you be comfortable attending a conference where attendee vaccination cannot be verified under state law? JPM would have required attendees to prove vaccination and to wear masks indoors.
Webinars
None schedule soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.
Here’s the recording of Wednesday’s webinar titled “Improve Efficiency, Reduce Burnout: Leveraging Smart Clinical Communications,” presented by Spok.
Acquisitions, Funding, Business, and Stock
Physician performance analytics vendor Embold Health raises $20 million in a Series B funding round. CEO Daniel Stein, MD, MBA founded the company in 2017 after serving as chief medical officer for Walmart’s Care Clinics.
Ophelia, which connects opioid users in 11 states to moonlighting providers who prescribe Suboxone via video visits for $195 per month, raises $50 million in a Series B funding round.
Optum sets the date for completing its $13 billion acquisition of Change Healthcare as April 5, 2022.
UK-based secure communications platform vendor Hospify will shut down its flagship service on January 31, 2022. The app, which was launched in February 2018, was the first to be approved for general provider and patient use by the NHS Apps Library. The company blames its demise on the government’s early-pandemic waiver of the Data Protection Act, which continues in allowing providers to use non-GDPR compliant consumer messaging apps such as WhatsApp. The company also questions the post-Brexit uncertainties around the UK-EU data agreements. Hospify’s movingly honest and sometimes humorous explanation of its circumstances says that the company will remain in business at it seeks new markets where “data protection is taken more seriously by the relevant governments.”
Sales
Low-code app development vendor Appian will use Redox for healthcare data integration.
Sage Memorial Hospital goes live on Meditech-as-a-Service with the assistance of Healthcare Triangle.
Community Care Cooperative will implement Epic at 12 of its FQHCs.
Medicare primary care center operator Oak Street Health will expand its use of real-time patient event notifications from Bamboo Health.
People
Optimum Healthcare IT promotes Larry Kaiser to chief marketing officer.
Commure hires Abhijit Mitra, MS, MBA (ServiceNow) as chief product and engineering officer, Manisha Shetty Gulati, MPA, MBA (Clarify Health Solutions) as chief growth officer, and Christine Tibbits, MA (Google Health) as chief people officer.
St. Luke’s (MN) names Chris Sorenson, MBA (Ascension) to the newly created position of CIO.
Integris Health hires industry long-timer Bill Hudson, MBA (John Muir Health) as VP/CIO.
NextGen Healthcare promotes Bob Murry, PhD, MD to chief medical officer. He replaces Betty Rabinowitz, MD, who is retiring.
Personalized care solutions vendor Happify Health hires Megan Callahan, MPH (Lyft Healthcare) as COO.
K Health, which offers “people like me” compiled health insights and telehealth, hires Jennifer Pena, MD (Nurx) to the newly created position of chief medical officer. She previously served as White House physician and spent 10 years as a US Army doctor.
Industry long-timer Thomas “TR” Rush – VP of business development at MedAssist and veteran of a long career at Siemens Healthcare — died unexpectedly last week, two days before the birth of his first grandchild. He was 51.
Announcements and Implementations
A study of Arcadia’s de-identified health history of 150 million patients finds that unvaccinated people were six times less likely to report multiple symptoms of long COVID if they were given their first COVID-19 vaccination in the four weeks after becoming infected. Even those who didn’t get the shot until 4-8 weeks after diagnosis were three times less likely to report multiple long COVID symptoms.
KONZA, the Kansas Health Information Network, releases Translate, which automatically sends ambulatory COVID-19 test results to public health departments without manual entry.
Epic will add mapping, navigation, and location-aware analytics via System1’s MapQuest Business-to-Business service.
Midwest grocery chain Hy-Vee launches RedBox Rx, a national, low-cost telehealth and online pharmacy service that includes free prescription shipping. The service, which offers telehealth visits for prices ranging from zero to $39, does not accept insurance. It is offered by partner MDBox, the telehealth business of Reliant Immune Diagnostics that also offers testing and monitoring.
Cigna-owned health services vendor Evernorth chooses Omada Health as its preferred vendor for digital chronic care programs for diabetes, hypertension, and prevention. It apparently displaces Livongo, which was acquired in October 2020 for $18.5 billion by Teladoc Health, whose shares dropped on the latest news in valuing the company at $14 billion. TDOC’s market cap has dropped by two-thirds – $28 billion — since February 2021.
A new KLAS report that covers EHR vendors that offer a wide range of comprehensive solutions for ambulatory practices finds that Epic, NextGen Healthcare, and Cerner earn high user satisfaction with offering technologies that meet most or all of an ambulatory practice’s needs, although the virtual care offerings of those vendors are sometimes passed over in favor of best-of-breed tools. Cerner customers remain concerned about Cerner’s revenue cycle track record and don’t always choose its practice management solution, while all interviewed customers of NextGen Healthcare and Epic report lowered costs and/or increased revenue after implementation.
Government and Politics
Two Republication US senators introduce a bipartisan bill that requires the VA secretary to report the cost, performance metrics, and outcomes of its Cerner project quarterly to Congress.
The Tampa paper notes that while Tampa General Hospital can’t legally donate money to political candidates, its for-profit, outsourced coffee shops have contributed $226,000 to mostly Republican state candidates. The coffee shop corporation’s three directors are Tampa General executives, including EVP/CIO Scott Arnold.
Privacy and Security
AMA calls for app developers to practice “privacy by design” to gain the trust of physicians who have involvement in patient app use. It notes that many people mistakenly believe that direct-to-consumer health apps are regulated by HIPAA. It also notes that developers who use software development kits from companies such as Facebook, Zoom, and Google may knowingly or unknowingly be exposing user data to third party advertisers and data aggregators, including apps that address addiction and recovery. AMA calls for apps to identify the data they are accessing, using, disclosing, and processing before collecting it and to give users control over how their information is used. AMA also calls for apps to get user approval before their data is used to develop and/or train machines or algorithms and to allow them to opt out.
Other
Among the health systems that have said publicly that they are being affected by the Ultimate Kronos Group ransomware attack are Shannon Medical Center (TX), Ascension, Baptist Health (FL), UF Health (FL), Allegheny Health Network (PA), and Franciscan Missionaries of Our Lady Health System (LA). Some UKG time clocks can store punches locally until their memory is full, but the data can’t be collected since Workforce Central connectivity is unavailable. The company recommends re-posting the previous payroll, then working with UKG to reconcile differences after systems are restored (because it’s always fun to ask overpaid employees to give the extra money back right after Christmas). UKG says the attack has left it unable to access customer environments or to provide historical reports or files.
The president and CEO of Stamford Health (CT) says that virtual health plans “should worry us all” as insurers are using them like 1990s HMO gatekeepers in their virtual-first plans to limit access to physicians, tests, and in-person visits. Kathleen Silard, RN, MS also notes that the virtual health plans often involve third-party companies whose doctors don’t know their patients and whose EHRs make data-sharing harder. She also worries about equity issues due to digital illiteracy and lack of access to computing devices and broadband. She concludes, “I know that technology is a tremendous clinical tool for lowering barriers to care. I hope it becomes a regular site of care for many patients. But don’t confuse virtual care with a virtual health insurance plan. Technology builds walls as easily as it tears them down.”
JP Morgan Chase cancels its in-person 2022 healthcare conference, bowing to pressure to hold the event online instead of in San Francisco January 10-13. The company says it is concerned about COVID-19, which had already resulted in the pullout of vaccine makers Moderna and Amgen, but big-company attendees had already called for the conference to be cancelled due to their safety concerns related to San Francisco crime and homelessness around the conference site. Some experts predict that JPM will resume in a different city in 2023 to skirt San Francisco’s overcharging vendors, but others say those who are buying $1,000 hotel rooms and $200 hourly coffee shop table rental are often conference hangers-on who don’t join the small number of invited attendees inside the Westin St. Francis anyway.
Sponsor Updates
Availity team members decorate 18 Christmas trees at Sulzbacher’s campuses in Jacksonville, FL.
Medicomp Systems releases a new “Tell Me Where It Hurts Podcast” featuring National Coordinator Micky Tripathi.
Bamboo Health expands its care coordination partnership with Oak Street Health for real-time patient event notifications.
IT Central Station has ranked Everbridge’s Digital Operations Platform the top IT alerting and incident management solution.
Get Well publishes a new white paper, “How CIOs can lead strategic patient engagement.”
According to KLAS, early data on the performance of Meditech’s Professional Services indicate the company is performing above average for its EHR implementation support.
Nordic Consulting is ranked #69 of 100 US companies with the best cultures by Comparably. It also ranked #74 of the top 100 companies that are best for women.
Healthcare IT Leaders will integrate the IBM Digital Health Pass with its Health Returns enterprise COVID-19 services.
The healthcare IT world seems to be going into hibernation for the winter. I don’t expect too many big news stories between here and HIMSS. I’ve started to see some buzz around the Consumer Electronics Show and plan to attend virtually if they ever approve my request for press credentials. I enjoyed the virtual approach last year, although some day I’d like to go in person – they say the atmosphere of the show is really something, although I’ll be interested to see what in-person attendees think of it this year compared to its pre-COVID-19 vibe.
There’s minimal buzz around HIMSS, but I’ve gotten a lot of questions about ViVE. Everyone loves an excuse to go to Miami Beach in March, but the price tag is steep and requesting media credentials would require me to reveal my true identity, so I guess I’ll have to take a pass.
Regardless of the lack of vendor or industry news, academic channels continue to put out good articles. I enjoyed this recent item in the Journal of the American Medical Informatics Association. Titled “Assessing the impact of the COVID-19 pandemic on clinician ambulatory electronic health record use,” it does just that, by looking at data from ambulatory care physicians in over 360 health systems in the US that use the Epic EHR. They looked at data from December 2019 to December 2020, capturing the full timeline of the onset of the pandemic. They used data for active use of the EHR, after-hours use, and messaging. I wasn’t surprised that they saw a decrease in EHR use at the beginning of the pandemic. However, utilization not only ramped back up to baseline but increased by July 2020. This was consistent for both in-office and after-hours use.
In-Basket messages increased, largely due to the category of patient messages, which grew to 157% of its pre-pandemic average. Most of my colleagues hate the inbox regardless of the EHR platform. It usually contains not only messages from patients but also refill requests, correspondence from other providers, requests for referrals, preauthorization paperwork, lab results, diagnostic study results, and reminders to complete documentation in a timely fashion.
Some organizations do well at allowing physicians to delegate a large amount of this work to appropriately trained staff members, which allows team-based handling of many patient messages, refill requests, and referral / authorization requests. However, others refuse to let anyone other than the physician do this work, which not only leads to burnout, but can delay care. The savviest organizations report on their inbox workload and monitor how much work is being done by which members of the staff and adjust coverage accordingly. I wish this approach would be more commonly adopted, but as long as physicians continue to do the work without pushing back, there’s not a significant incentive for those organizations to change.
I wrote recently about challenges faced by the US Food and Drug Administration’s Risk Evaluation and Mitigation Strategies (REMS) programs to help mitigate the risks of serious side effects with certain medications. I used the program for the drug Accutane as an example. Little did I know that the IPLEDGE program for Accutane and its generics would implode this week. A colleague wrote in response to a patient complaint about refill delays: “Since Monday, there has been a nationwide issue regarding IPLEDGE and the FDA’s system for controlling isotretinoin prescriptions. They decided to change several things with the system and use a new website without first ensuring the website actually works. It is *literally* a sh*tshow with the nationwide program being shut down, hold times more than six hours for their tech support, and no one able to renew their prescriptions. I would give the office a break as currently no dermatologist in the country can send isotretinoin prescriptions until the FDA fixes the website.”
Sounds like the FDA didn’t learn much from the clozapine website debacle. These are exactly the kind of technology nightmares that physician offices fear, and which can bring even a well-oiled refill process to a screeching halt. Unfortunately, there’s no mitigation for the losses and frustration caused by this type of systems failure for either the providers or the patients. There are enough experienced healthcare IT people out there who know how to plan a project and how to run a go live that this should not be happening. Sounds like there were gaps in end-user testing, help desk support, and a potential reversion plan. Now that this has happened twice, I’d be interested to hear from anyone with FDA connections on what they plan to do to keep it from happening again.
Despite the news we’ve heard in the past that chocolate is good for you, new information shows that boring old multivitamins are more likely to slow brain aging. Preliminary information from the COcoa Supplement and Multivitamin Outcomes Study for the Mind (COSMOS-Mind) showed that taking a multivitamin each day for three years was associated with a 60% slowing of cognitive aging, most notably in patients with pre-existing cardiovascular disease. The findings were presented at the 14th Clinical Trials on Alzheimer’s Disease conference. The impact of vitamin use peaked after two years then remained stable; the reported 60% slowing is equivalent to 1.8 years. I usually treat myself to some dark chocolate around the holidays, and despite the evidence, I won’t be changing that habit.
I was commiserating with a friend recently about the American Medical Association’s monopoly on Current Procedural Terminology codes. Most of the provider-side organizations I have worked with dread the AMA’s license process, which is challenging for smaller organizations that have a lot of part-time users. Some EHR vendors include AMA licensure in their own license fees, but others make you work directly with the AMA to arrange licenses. My friend must know someone with some good AMA connections, because he later sent me a picture of this AMA-branded cheese board set. I’m not sure what exactly it’s trying to convey, since it’s somewhat evocative of what you see in movies when the character who is going to torture someone opens a case with various knives and picks. From a cheese board standpoint, the recessed AMA logo looks like a great place to harbor bacteria.
The holidays always bring out some interesting corporate gifts, although lately I’ve seen more companies making donations on behalf of their workers rather than sending gifts. What’s the most unusual corporate gift you’ve seen? Leave a comment or email me.
We’ve been a Cerner customer on the acute EHR side for quite a while and have further implemented both ambulatory and rev cycle. On the acute side, we’ve been generally pleased with the product, services, and support. However, we saw Cerner challenges with the ambulatory and rev cycle implementations. From my viewpoint, Cerner’s biggest problems today are:
I hear, and personally experience instances where the insurance company does not understand (or at least can explain to us…