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Morning Headlines 10/31/18

October 30, 2018 Headlines No Comments

Healthcare tech startup 98point6 raises $50M, led by Goldman Sachs, to expand its ‘virtual clinic’

Seattle-based 98point6 raises $50 million to expand its chat-powered “virtual primary care” unlimited service that costs a flat $20 per year for the first year, then $120 in following years.

Secret report raises questions about Queensland’s medical records system

In Australia, a report blames Cerner for May 2017 outages at seven Queensland Health hospitals, refuting the health system’s initial claim that the downtime was caused by ransomware.

EXCLUSIVE: Cincinnati executive launches tech firm to prevent suicide

Mason, OH-based Clarigent Health will commercialize technology developed by Cincinnati Children’s Hospital that assesses suicide risk by analyzing conversations between patients and their therapists or doctors.

LabCorp Enables Health Records on iPhone

LabCorp adds support for Apple Health Records, which will allow patients to send their lab results to their IPhones.

News 10/31/18

October 30, 2018 News 3 Comments

Top News

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Seattle-based 98point6 raises $50 million to expand its chat-powered “virtual primary care” unlimited service that costs a flat $20 per year for the first year, then $120 in following years.

The company’s 15 doctors serve patients in 38 states.

Millennials and others for whom convenience is paramount will probably love turning a doctor visit into a text chat, but calling it “primary care” seems like a stretch since it’s just responding in kneejerk fashion to user-reported symptoms, with no effort made to provide continuity of care or chronic condition management. Anyone want to spend $20 to give it a test drive and let me know how it turns out? I bet the $20 deal doesn’t last long. 

I’m interested that the company’s terms of use include a binding arbitration clause, leading me to question (a) does that clause really prevent malpractice lawsuits and instead force plaintiffs into arbitration with no class action option? (legal precedents suggest yes), and if so, (b) why don’t more doctors include binding arbitration clauses in their “new patient” forms with hopes of getting more reasonable judgments than are often awarded by juries made up of mostly retirees, students, and the unemployed?


Reader Comments

From Doyenne: “Re: Cerner share price. It’s dropping due to ‘Cernover,’ in which whole metropolitan areas like Seattle, Chicago, and the Bay Area are switching. Contracting: Seattle Children’s and University Washington. Implementing: University Illinois Chicago, Northwestern. Implemented: Dallas Children’s, Packard Children’s, Royal Children’s (Melbourne), University of Utah, Loma Linda, John Muir.” Unverified, and I agree only somewhat. Certainly Epic’s focus on academic medical centers has given it high-profile customers that created regional momentum, but Cerner is still turning in good numbers due to diversification even as Epic has inflicted obvious pain. Cerner talks less these days about big hospital wins, ambulatory, revenue cycle, and CommonWell and instead reassures investors about population health, IT services, non-US sales, sales outside the Millennium base, and its perfectly timed contracts with the DoD and VA (all of which conveniently avoid butting heads with Epic). The biggest questions are how the company will perform given the questionably credentialed replacements it chose for Neal Patterson and Zane Burke; the good or bad PR that will result from whatever happens with DoD and VA; and diversifying its business to meet Wall Street growth expectations while avoiding becoming a GE-like unfocused conglomerate that behaves like a dull mutual fund. Quite a few companies stumble after they lose a fire-breathing visionary leader, but like Apple, Cerner can always keep booking add-on sales of services, accessories, and questionably improved new models to an existing client base that is reluctant to shop elsewhere. My bottom line: while Epic’s business is solely focused on EHR customers and it’s hard to beat (and getting harder) in that market, Cerner is not limited to EHR sales, and investors price its shares accordingly even though we hospital-centric insiders see Epic as the unstoppable juggernaut.

From Splainin’ to Do: “Re: startups. This health IT site is charging startups to have their updates and company profiles published as fake news. Do it!” No thanks. That site didn’t even register in the Reaction Data survey of C-level health system executives and charging vendors to run their biased content seems to be yet another way to send readers fleeing. You can sell your integrity only once and you can’t buy it back afterward. I take an infrequent look at the content, advertisers, and overall excellence of sites similar to mine and I don’t see many ideas I’d want to emulate.


Webinars

November 7 (Wednesday) 3:00 ET. “Opioid Crisis: What One Health Plan is Doing About It.” Presenter: Samuel DiCapua, DO, chief medical director, New Hampshire Health Families; and chief medical officer, Casenet. Sponsor: Casenet. This webinar will describe how managed care organization NH Health Families is using innovative programs to manage patients who are struggling with addiction and to help prevent opioid abuse.

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


Acquisitions, Funding, Business, and Stock

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IBM will acquire Red Hat for $34 billion, apparently hoping to reverse years of declining revenue by trying to compete with entrenched cloud computing competitors such as Amazon and Microsoft. IBM’s bet-the-farm investment in Watson Health may well become the Previous Shiny Object as the company moves to its more familiar roots in enterprise software in hopes of placating impatient shareholders. I’m pretty sure Red Hat customers aren’t thrilled.


People

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Cantata Health promotes Krista Endsley to CEO. NTT Data sold its healthcare software business to GPB Capital to create Cantata Health in April 2017, which tapped former NTT Data SVP/GM Mike Jones as CEO through April 2018 when Endsley joined Cantata as president.

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Oncology analytics vendor Cota Healthcare hires industry long-timer Mike Doyle (QPID Health) as president and CEO.

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PatientSafe Solutions hires Tim Needham (Burwood Group) as chief commercial officer.


Announcements and Implementations

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A KLAS report on secure communication finds that while ambulatory providers are focusing on simply exchanging messages securely, health systems are moving toward broader, enterprise-level platforms that include interfacing and support for multiple workflows (Voalte and Vocera are furthest along in offering a true communication platform, KLAS concludes). The top vendors (in terms of market consideration, customer retention, and performance) are TigerConnect, Voalte, and Epic. Potential disruptors are Telmediq and PatientSafe Solutions, which have high win rates and quality scores, while KLAS says Spok and Imprivata are losing business due to lagging development.

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Mason, OH-based startup Clarigent Health will commercialize technology developed by Cincinnati Children’s Hospital that assesses suicide risk by analyzing conversations between patients and their therapists or doctors.

Dimensional Insight launches Measure Factory, an automation engine that extends its Diver Platform to support data governance and data integrity.

LabCorp adds support for Apple Health Records, which will allow patients to send their lab results to their IPhones. Some Twitterati were puzzled why it only supports IPhones, with the obvious answer being that while Apple is #2 in mobile phone OS behind Android, there’s no Apple Health Records counterpart in Android (Google Fit is mostly just activity tracking).

Partners HealthCare and Lifespan end their merger talks, with Partners forging ahead with plans to acquire Lifespan competitor Care New England Health System. 


Other

In Australia, a report blames Cerner for May 2017 outages at seven Queensland Health hospitals, refuting the health system’s initial claim that the downtime was caused by ransomware. Investigators say Cerner has refused to provide system logs covering the incident. Cerner is the leading candidate to win a new bid for a patient administration system and insiders report executive pressure to avoid putting the company in a bad light.

Fascinating: a Utah insurer rolls out a “pharmacy tourism” option in which patients who take expensive drugs will be given plane tickets to San Diego, a ride across the border to Tijuana, and $500 as a cash bonus to buy their drugs in Mexico, where they are so much cheaper that the insurer still saves money. Hopefully Mexico won’t build a big, beautiful wall to keep medical tourism invaders out. 

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Weird News Andy comes up with a seasonally appropriate thriller that leads him to conclude, “Always go for the $5 teeth; the $3 teeth will get you every time.” An Alabama woman completes her Halloween ensemble with $3 fake teeth, only to find that the included temporary glue was (at least in her case) permanent. The emergency dentist, in true Halloween fashion, debated whether to saw or drill away the plastic with the risk of making her permanently scary, but as the woman describes, he eventually “picked and pulled and I squealed like a baby.”

And in a WNA Halloween Two-fer, a surgery professor says students have spent so much time in virtual worlds that they fare poorly at hands-on surgical work that requires thinking in three dimensions and “actually doing things.” The instructor recommends pumpkin-carving as good training because it is “one example of using sharp instruments with great delicacy and precision on a hard surface with a soft inside to create something that you have got in your mind and then you have to make it happen.”


Sponsor Updates

  • Glytec publishes an ebook titled “Hypoglycemia in the Hospital: Why Is It Costing You Millions and What Can You Do?”
  • EClinicalWorks posts a podcast titled “Tools and Training to Target Physician Burnout.”
  • Vocera will resell QGenda’s provider scheduling system in the federal healthcare market and the companies will integrate their systems.
  • CarePort Health expands its product, analytics, and customer success teams.
  • Impact Advisors is named to Modern Healthcare’s list of largest revenue cycle management firms.
  • AdvancedMD will exhibit at APTA PPS November 7-10 in Colorado Springs.
  • Waterloo MedTech awards Agfa Healthcare with its 2018 Award of Distinction.
  • Aprima will exhibit at the AAP National Conference & Exhibition November 3-5 in Orlando.
  • CarePort Health will exhibit at the ACMA 2018 Leadership Conference November 5-7 in Huntington Beach, CA.
  • CompuGroup Medical will exhibit at the AMP 2018 Annual Meeting & Expo November 1-2 in San Antonio.
  • CoverMyMeds will make its RxBenefit Clarity real-time benefit check tool available to Allscripts users.
  • CTG, Cumberland Consulting Group, and Dimensional Insight will exhibit at the CHIME Fall CIO Forum October 30-November 2 in San Diego.
  • Diameter Health will present at the AMIA 2018 Annual Symposium November 3-7 in San Francisco.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
Contact us.

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Morning Headlines 10/30/18

October 29, 2018 Headlines No Comments

Carrot Inc. Raises $25 Million to Commercialize Pivot, the Company’s Digital Health Solution for Smoking Cessation

Carrot secures $25 million to develop a digital smoking cessation program that will incorporate a breath sensor, app, coaching, and drug therapy.

New mobile assessment saves brain cells during stroke

Mayo Clinic’s Center for Connected Care in Jacksonville, FL launches a telemedicine project that will give physicians access to stroke patients en route to the hospital.

Forget Watson, the Red Hat acquisition may be the thing that saves IBM

Analysts speculate that IBM’s $34 billion acquisition of Red Hat may signal a Watson wind-down and a return to enterprise software and services.

HIStalk Interviews Kurt Garbe, CEO, IMAT Solutions

October 29, 2018 Interviews No Comments

Kurt Garbe is CEO of IMAT Solutions of Orem, UT.

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Tell me about yourself and the company.

IMAT Solutions solves the core data problems of healthcare companies. We focus on how to improve data quality, data currency, the amount of data, and the type of data that companies can look at.

How do you position the company among competitors?

Many companies look at different parts of data — analysis, cleanup, or integration. We take a more comprehensive approach. This is a data platform. What are the requirements for the different types of data you’re trying to bring in, the comprehensive data? How do you look at cleaning up the data that’s coming in? How do you look at the currency? How do you make sure you can quickly access that data in a comprehensive way? We look at all of those components, not just some individual pieces and parts.

How would you assess healthcare in terms of your C3 framework of data that is clean, comprehensive, and current?

Healthcare is still, unfortunately, at the early stage. We know this from talking to our customers. It’s across the board. Different companies have different strengths and focus on different things, but we haven’t found a lot of evidence that people have taken the full picture and made a lot of progress.

Are healthcare organizations making decisions using data that is either bad or incomplete?

Absolutely. The core question is, what data are we even talking about? The data related to healthcare and the health of an individual includes a lot of free-text data, unstructured data from lab reports, notes, and so forth. When we talk to people through surveys and discussions, 80 percent aren’t looking at that data yet. They don’t apply natural language processing to figure out what insights they could get from that data.

It’s the old story about the elephant. We look at data as this big elephant. Some people look at data as just the foot or the trunk. They’re only looking at the pieces and parts. They don’t usually say their data is good — they admit it’s a challenge, something they’re looking at, or the subject of some new initiatives. We don’t find a lot of complacency and satisfaction.

It gets more complicated where a health system has several groups. Each says they have clean data, and they probably do to a great extent, but the data is not coordinated. How they describe their data and how this other group describes their data are not consistent. It’s therefore not particularly useful in having a real impact.

What due diligence is required before accepting a new source of data to understand its semantics rather than just finding matching columns that can be joined to create a bigger database?

I wish we identified some rules of the road out there. This is a major effort and a major problem. Like everyone in data and healthcare, they’re doing the best they can. Often they’re just prioritizing. They are saying, we can’t absorb all the data, but can you give us the following type of data so we can work on that first? Let’s cut the problem into small pieces.

That’s a practical approach that works, but it takes a long time. They are often disappointed with the impact of those efforts. You get the greatest impact when you’re using the largest amount of data to make decisions.

Will artificial intelligence and machine learning help solve the problem?

We’re in an unfortunate race. People talk a lot about AI and machine learning. But with these systems, as much as they’re making great progress in AI and machine learning, the inputs — unstructured and free-form data — are still weak. An AI engine or machine learning algorithm can’t necessarily turn it into something meaningful and useful.

Years ago, everyone was talking about predictive analytics. We have these great models, but the source data isn’t very good. You’re trying to do more analytics and use more of these advanced tools on poor data to get to that answer faster, as opposed to getting a better answer. People still have to spend a lot of effort to to turn unstructured data into something useful and meaningful that a predictive analytics engine, AI algorithm, or machine learning can do something with.

The challenge, and it’s a big one, is that the unstructured data multiplies the amount of data you have by a factor of five or 10. It’s 10 times more than you used to have, so how do you get meaningful results from it in a meaningful time frame? If it takes a week to process through all that data every time you run a report, create a model, or do some analytics, you’re not going to do it often. That’s why we talk about the currency, meaning how quickly you can get insight out of all of this data that you have.

That’s why we talk about the C3. It’s not just the fact that you have comprehensive data. You’ve got all of your data in an unstructured form, and through an NLP process or even manually, you’ve cleaned it up. It’s consistent, it works well. But now, how do you get results out of that in some meaningful time frame, where you can run reports, look at the reports, and say what works, what doesn’t work, or look at these fields instead? You’re now interacting with the data. That’s where this third C of currency comes in. That’s the only way you get high impact from whatever tools you have, whether it is predictive analytics, AI algorithms, or machine learning.

What lessons did you learn from connecting the aggregated datasets of two HIEs together after Hurricane Florence and validating that the result was accurate at a patient level?

The historical approach to interoperability or interconnecting data is to tell Company A, “Here is how we want you to give us output.” That’s historically a huge problem. Company A doesn’t have the time or they don’t see the value of doing that. Our approach is, just give us what you have. We won’t ask you to change your formats, your fields, or anything else. You give us what you have, this other organization does the same, and we’ll re-index that data and provide one comprehensive view.

The major lesson that we’ve learned in integrating new clinics and new hospital groups into these data pools is that we have to lower the bar of what they have to do. We’re not asking them to change their format, because those IT discussions are often where interoperability gets bogged down, where you ask people to change what they do. We don’t do that. Just provide us what you have and we will make it work for you.

How do you see the company and the general areas of data interchange, quality, and interoperability changing in the next five years?

Our aspiration, and the hope that we have for healthcare, is that tools such as AI, machine learning, and predictive analytics can help deliver real results now. We need to raise a bar on the baseline of getting comprehensive data, making it current so it can be analyzed in real time, and making sure it’s clean, consistent, and makes sense.

If we can get to that baseline, those other tools will get you what you want in healthcare — bending the cost curve, improving outcomes. Without that, we’re still in some ways guessing. If we can address the core data issues, those tools, as well as others that we can’t envision today, can help us make decisions on what it actually happening instead of guessing, which is what’s happening now in healthcare.

Do you have any final thoughts?

The topic of improving healthcare through data is not new. It has been envisioned, talked about, and hoped for for 20-plus years, if not longer. What is exciting now is that the technology, the ability to actually get there, has caught up to that vision. We look forward to helping make this vision come true.

Curbside Consult with Dr. Jayne 10/29/18

October 29, 2018 Dr. Jayne 1 Comment

I happened to be in New York this week during the pipe bomb scare, close enough to the CNN offices to receive an emergency alert on my phone advising me to “shelter in place.” The presenter in the continuing education seminar I was attending must have seen everyone checking their phones even though they were supposed to be silenced, so she stopped the presentation to find out what was drawing everyone’s interest.

People were texting friends and family members to let them know that they were OK or were looking for news on what was happening in the neighboring building. It was clear that with everything going on there wasn’t going to be much learning happening, so the conference organizers wisely instituted an unplanned break.

Although most of us were from out of town, several physicians at the table in front of me were residents of the city who had been in practice there during the World Trade Center attacks in 2001. They began talking about what it was like that day, being put on alert by their hospitals that they should prepare for a mass casualty event. They talked about the preparations to receive hundreds of patients, including possible air transports to hospitals outside the city, as the events began to unfold. They also talked about the horrible experience of waiting for patients who never arrived and how that affected them as clinicians. It was clear that even after so many years, they are still profoundly impacted by the events of that day.

The conversation moved into one around disaster preparedness and what is different for them now compared to what was in place then. As we talked, they were checking in with their hospitals to let them know their location and status should there be an actual bomb detonation. By that point, we were informed that our building was on a modified lockdown procedure, with guests and employees being encouraged not to leave and no one allowed to come in. I assume they would have allowed physicians to leave in the event they were needed emergently, but I’m glad the incident was resolved relatively quick and we never had to find out how the lockdown really worked in the lobby.

There was a side conversation about the fears that clinicians and others that work in hospitals carry with them. People are afraid of how they might react to a disaster or mass casualty situation, whether they would be able to stay the course and care for patients or whether they would want to focus on making sure family and other loved ones are safe. A few mentioned episodes of violence they had experienced in their own hospital workplaces, including assaults on patients and staff and even an active shooter event. Nearly everyone mentioned a higher frequency of drills and discussions of potential dangers, with several in the conversation noting that the ongoing drills and reviews are likely contributing to the anxiety.

The fear of violence has influenced technology purchasing decisions. Hospitals are installing advanced security systems and some require visitors to present identification so they can be credentialed to enter the facility. Visitors are wearing stickers with their names, pictures, and sometimes their destination, such as a room number or office suite. It’s different from back in my Candy Striper days when we looked up the patient’s name on a printout, told the visitor the room number, and pointed them towards the elevators without a second glance. I don’t think there are too many facilities that would leave a lone 13-year-old girl manning the front desk any more.

We talk a lot about EHRs, revenue cycle platforms, clinical and financial analytics, telehealth platforms, and the numerous systems that support our hospitals and practices. Although I’ve seen the booths for security vendors at HIMSS, I’ve not had the chance until recently to reflect on those additional systems that CIOs might be called on to select and support in order to ensure business continuity for the facility. One vendor’s website notes their commitment to using big data to analyze incidents and predict patterns in order to better protect patients and staff. That’s a tall order to consider for those of us who are more used to contemplating PHI breaches than we are to thinking about breaches of the physical perimeter.

Although we have a panic button under the front desk of each of our clinic locations, I’ve been fortunate in not being at work in a situation where the staff had to use it. The staff has activated it on accident and based on the anxiety level while they worked to get it resolved, I can’t imagine what they would feel like in a live-use scenario.

In past clinical positions, I’ve worked at facilities where I had to park my car in a chain link enclosure inside the parking garage. I have staffed emergency departments where metal detectors and armed guards were just part of the daily scenery. We performed “fit for confinement” examinations on prisoners being transported by law enforcement, so on any given shift, there might be a patient handcuffed to the gurney. In those situations the potential risk was visible and fairly obvious and we grew to accept it as part of the job, but we didn’t think much about some of the other dangers that might come our way.

I would be interested to hear from readers on the state of security in their facilities and whether their organizations are using technology to help mitigate threats to patient and staff safety. In the times we live in, there is more to think about then tornadoes, fires, floods, and hurricanes.

What keeps you up at night about safety or potential disasters that might impact your organization? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 10/29/18

October 28, 2018 Headlines 1 Comment

Epic chops down App Orchard fees

Epic will reduce its fees for listing third-party software in its App Orchard.

Individuals Charged With Defrauding Non-Profit Health-Care System

A federal grand jury indicts a former IT employee of Catholic Health Initiatives for allegedly issuing $72 million in phony purchase orders to a co-conspirator’s IT consulting firm for integration services, then splitting the take.

Cerner (CERN) Q3 2018 Results – Earnings Call Transcript

The company expects its DoD and VA business to drive growth as financially-challenged providers and lack of regulatory incentives reduce private sector market urgency.

HHS CTO’s office to support Indian Health Service IT modernization study

The CTO’s office at HHS will support consulting firm Emerging Sun in a research project focused on updating the Indian Health Service’s Resource and Patient Management System.

Monday Morning Update 10/29/18

October 28, 2018 News 8 Comments

Top News

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From the Cerner earnings call following a small revenue miss that sent shares down 11 percent on Friday: (CERN shares are down 19 percent so far in 2018 vs. the Nasdaq’s 2 percent gain):

  • Q3 bookings were up 43 percent over last year, although revenue was up just 5 percent due to lower-than-expected software and technology sales.
  • The company expects its DoD and VA business to drive growth as financially-challenged providers and lack of regulatory incentives reduce private sector market urgency (“there isn’t anything that’s forcing clients to get deals done.”)
  • The company expects the federal government business, along with the replacement market, to carry the company until HealtheIntent revenue grows. It notes that its population health business has grown slower than projected.
  • Chairman and CEO Brent Shafer says Cerner will be the partner of choice for healthcare innovation.
  • Chief Client Officer John Peterzalek says Cerner is a leader in interoperability and expects to benefit if the government issues interoperability mandates.
  • The company expects its $10 billion VA contract to deliver $1 billion in annual revenue by 2022, although task order timing makes the growth irregular.
  • CFO Marc Naughton says that selling population health tools can deliver $3-4 per member per month, but adding services such as those enabled by its deal with Lumeris could increase that PMPM amount to $15.
  • The company’s ITWorks outsourcing business generates single-digit margins, but selling software and services into that client base can yield 40 percent margins.
  • Naughton, responding to a question about monetizing the data Cerner holds, says he sees eventual opportunity, but regulatory limitations make it a non-focus area for now.
  • Four more DoD sites will go live in early 2020.
  • The company hasn’t decided how the VA work will be divided among Cerner and its partners even though the company originally mentioned a 50-50 split as a placeholder.
  • Cerner will continue with its R&D spend and will focus on business segments that can deliver $100 million in revenue.

Reader Comments

From Jules Verne: “Re: webinars. What advice do you have for getting more registrations?” I get insight from the webinars we do since I see the stats for clicks, registrations, and attendance. My conclusions:

  • Make the goal to educate, not to sell something (we struggle endlessly trying to make this point with the junior marketing people of vendors). Potential audience members won’t sign up for what promises to be a sales pitch and they won’t sit through a webinar that turns into one.
  • Get customers or outside experts as presenters. Nobody will give up an hour of their day to hear a company marketing person’s perspective on population health or analytics.
  • Make sure the presenter is prepared. It’s shocking when during rehearsal the presenter (usually enlisted from a health system) has never seen the slides, doesn’t know what they’re supposed to talk about, or delivers a presentation that doesn’t match the abstract.
  • A product overview or demonstration is not a broadly educational topic and won’t generate many signups. On the other hand, even a handful of attendees is fine if they become prospects. Evaluate success accordingly. We did one super-specialized webinar that drew only five attendees, but they were good leads for the niche product and the vendor was smart to realize that a couple of self-qualified prospects was much better than 100 uninterested attendees (but a marketing person might have, from their perspective, seen it as a failure).
  • Include on the registration page a descriptive abstract and an honest description of the target audience. Sometimes companies get only a small percentage of those who looked at the registration page to actually register, which means something on that page made most of them bail (most likely the webinar description, speaker bio, or asking for too much information to register).

HIStalk Announcements and Requests

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Previous polls found that most of us health IT people don’t really care whether our doctors use EHRs and we prefer old-fashioned doctor-patient relationships over evidence-based medicine and technology. Last week’s poll demonstrated more of the puzzling “do as I say, not as I do” dichotomy between our jobs vs. what we want for ourselves and our families as patients, as nearly none of us (me included) keep their own medical information in electronic form.

New poll to your right or here: are you proud of the products or services your employer offers?

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Mrs. H bribed me to see “A Star Is Born” with her, and while the movie was good and the acting was terrific (actor-director Bradley Cooper admirably mimicked a singer and singer Lady Gaga excelled as an actor), the key moment for me occurred early in the movie, when I excitedly elbowed a startled Mrs. H to point out that Gaga’s character Ally was wearing a Yes tee shirt (although from their forgettable 1978 “Tormato” tour, I later found by Googling).

Listening: Rebelution, a California-based, highly literate reggae band whose UC Santa Barbara-graduated members are described in articles decrying cultural appropriation as “fratty white guys” (apparently those magazines believe that reggae is the exclusive domain of dreadlocked, spliff-brandishing Rastafarians who refer to everyone as “mon” and whose rainbow-colored clothing and revolution-inciting musical messages are obscured by ganja clouds). At least the bass player’s first name is Marley. Sample lyrics: “Whether you want love or money, good fortune or fame, you want a brand new car, you want the world to change. You better take some action right now, because there’s nothing in the world that you can’t get, so don’t fill your life with confusion and regret, you better take some chances right now.” I’m listening to more reggae these days because it’s one of few genres that haven’t been overproduced into unlistenable vacuity. I’m also enjoying refreshingly non-explicit hip-hop from Common, who I also liked in AMC’s western series “Hell on Wheels.”


Webinars

October 30 (Tuesday) 2:00 ET. “How One Pediatric CIN Aligned Culture, Technology and the Community to Transform Care.” Presenters: Lisa Henderson, executive director, Dayton Children’s Health Partners; Shehzad Saeed, MD, associate chief medical officer, Dayton Children’s Health Partners; Mason Beard, solutions strategy leader, Philips PHM; Gabe Orthous, value-based care consultant, Himformatics. Sponsor: Philips PHM. Dayton Children’s Health Partners, a pediatric clinically integrated network, will describe how it aligned its internal culture, technology partners, and the community around its goal of streamlining care delivery and improving outcomes. Presenters will describe how it recruited network members, negotiated value-based contracts, and implemented a data-driven care management process.

November 7 (Wednesday) 3:00 ET. “Opioid Crisis: What One Health Plan is Doing About It.” Presenter: Samuel DiCapua, DO, chief medical director, New Hampshire Health Families; and chief medical officer, Casenet. Sponsor: Casenet. This webinar will describe how managed care organization NH Health Families is using innovative programs to manage patients who are struggling with addiction and to help prevent opioid abuse.

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


Acquisitions, Funding, Business, and Stock

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Politico reports that Epic announced at its annual developer meeting that it will reduce its fees for listing third-party software in its App Orchard. One software company’s CEO had previously said that listing a simple HHS family planning questionnaire on the the app stores of Epic and Cerner would cost $750,000 per year. With the change, early-stage startups will pay just $100 per year to gain access to Epic’s API documentation and testing sandbox, then will pay an unstated higher amount once their product is released.

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From the Roper Technologies earnings call, following a Q3 report in which it beat both revenue and earnings expectations (the diversified company owns Sunquest, Strata Decision, Atlas Medical, SoftWriters, CBORD, and several other health IT vendors):

  • The company promoted COO Neil Hunn to president and CEO in late August, moving Brian Jellison to executive chairman due to health problems. Hunn came from MedAssets
  • The company’s Medical and Scientific Imaging segment, which represents 29 percent of Roper’s revenue, increased quarterly revenue 11 percent to $380 million.
  • Sunquest’s US business declined in “mid-single digits” while expanding globally, with 2019 expectations for Sunquest continuing to trend down due to competitive pressure. Roper says it will be “rebasing the North American business” of Sunquest. It also notes that it paid only 10 times EBITDA to acquire Sunquest for $1.42 billion in cash in 2012. 

Decisions

  • Crossing Rivers Health (WI) replaced Evident with Epic in June 2018.
  • Ferrell Hospital (IL) will switch from Medhost to Epic in fall 2019.
  • Chatuge Regional Hospital (GA) will replace Allscripts with Cerner in October 2019.

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


Announcements and Implementations

Vanderbilt University Medical Center gets a federal grant to mine its 20-year EHR database and biological samples to look for biologic and genetic markers of Down syndrome.


Government and Politics

The Spokane newspaper interviewed just three veterans for its story on implementing Cerner in the VA, but those they chose were perceptive:

  • Army vet Charles Bourg, 64, questioned why Cerner got a no-bid $10 billion deal, adding that while it’s nice that the VA and DoD are trying to integrate their respective Cerner systems, it’s more important that Cerner connect to outside doctors.  He adds, “You have to go in the basement of the VA to get the records … and it can take weeks. I did get electronic records from the VA to take to the [private practice] doctor, but he couldn’t even open them up.”
  • Former Navy Seabee Charlie Monroe says he’s skeptical about the new system and fears it will take away from the time doctors spend with patients.
  • Air Force veteran Bob Brodie says the VA never paid the bill for his VA-approved stay at a private hospital, which then turned his account over to collections.

Other

A federal grand jury indicts a former IT employee of Catholic Health Initiatives for allegedly issuing $72 million in phony purchase orders to a co-conspirator’s IT consulting firm for integration services, then splitting the take.

AMIA publishes core competencies for master’s-level applied health informatics programs that can be tested after graduation.

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The Journal of the American Academy of Dermatology takes down a research paper that analyzed the effect of private equity firms buying up dermatology practices after it receives complaints from several dermatologists who have PE ties. One of them is the Academy’s incoming president, who sold his own practice to a private equity-owned management company on whose board he sits. The peer-reviewed article observed that PE firms selectively acquire practices that perform high volumes of procedures covered by private insurance and Medicare, also noting that quite a few of those practices also run profitable pathology labs.

In Russia, a woman shows up a hospital with an ultrasound order she had changed to a different procedure, then attacks the hospital doctor who refused to perform the test, throwing the order’s clipboard at him and then beating him over the head with his computer keyboard.


Sponsor Updates

  • LiveProcess will exhibit at the Delaware Healthcare Forum October 30 in Dover.
  • Meditech will exhibit at the 2018 AMIA Annual Symposium November 3-7 in San Francisco.
  • Netsmart will exhibit at the NHPCO Fall Conference November 5 in New Orleans.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the Annual Perinatal Partnership Conference October 28-30 in Myrtle Beach, SC.
  • OmniSys will add ScriptPro’s SP Central Pharmacy Management System to its Fusion-Rx interactive voice response solution for pharmacies.
  • PatientSafe Solutions, Pivot Point Consulting, Redox, and Surescripts will exhibit at the CHIME18 Fall CIO Forum October 30-November 4 in San Diego.
  • Patientco publishes a new white paper, “Improving Patient Financial Experience Through Smart Payment Technology.”
  • Voalte will exhibit at the OONE Fall Conference November 1-2 in Columbus, OH.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
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Weekender 10/26/18

October 26, 2018 Weekender No Comments

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Weekly News Recap

  • Nova Scotia’s province-wide EHR selection nears completion, with all vendors except Allscripts and Cerner failing to make the cut in a process that has raised questions about possible bias
  • Clearlake Capital Group will acquire provider management, credentialing, and payer enrollment technology vendor Symplr
  • VC-backed Naya Health, which developed a $1,000 smart breast pump, apparently shuts down after user complaints that its product does not work
  • Vatica Health makes a $1 million bid to acquire the assets of chronic care management company CareSync, which abruptly closed its doors in June
  • Politico reports that Pentagon investigators have found Madigan Army Medical Center’s new Cerner-based MHS Genesis software lacking in effectiveness, suitability, and interoperability
  • Deborah DiSanzo, general manager of IBM Watson Health for the past three years, will step down

Best Reader Comments

What the US has now is elements of several [healthcare] systems, As T.R. Reid described in “The Healing of America; A Global Quest for Better, Cheaper, and Fairer Health Care,” for veterans and their families, we’re Britain or Cuba. For those who receive health insurance through their employer, we’re Germany or France. For people over 65 on Medicare, we’re Canada. For the percent of the population who have no health insurance, the United States is Cambodia. (Wadiego)

Very nice of IBM to allow Deb DeSanzo to keep her job and take a demotion despite her lack of success in turning the corner. I wonder how the thousands of IBM’ers who were laid off at the end of each quarter the past three years when the numbers weren’t good feel about this? (The More Things Change)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Mrs. H in Alabama, who asked for STEM maker kits for her fifth grade class. She reports, “This project has been a lifesaver. My students were so surprised when we received the kits. They were so excited to know they had something that they could actually build by themselves without my instruction. My students are using the K’NEX STEM Education Kits during our science intervention.”

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The US Military Academy uses a robot to co-teach an ethics philosophy course, feeding Bina48 data about wars and philosophy as well as an instructor’s lesson plan to allow it (her?) to deliver a lecture and answer student questions. The AI developers blocked her access to the Internet fearing that, like many students, she would take the lazy way out and simply regurgitate Wikipedia. She has her own Facebook page and completed a “Philosophy of Love” college class a year ago. Developers patched her rather stern countenance into a smile a couple of months ago.

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23andMe CEO Anne Wojcicki says one of the company’s biggest competitors is Gwyneth Paltrow’s Goop — which specializes in wacky products that have zero scientific basis — and fake, clickbait news about health that draws in naive eyeballs. She summarizes Goop’s “faux science,” such as anti-vaccine advocacy, as benefitting from Paltrow’s celebrity in a way that the CDC can’t counter with actual facts. Goop paid civil penalties and offered customer refunds to settle a lawsuit over the company’s promotion of a floral blend to prevent depression and jade vaginal eggs to regulate menstrual cycles.

Analysis finds that eliminating the requirement that all Americans carry health insurance and allowing the sale of policies that don’t cover pre-existing conditions have caused a 16 percent jump in premium cost for exchange-based silver plans. 

Wired takes a contrarian view of Silicon Valley’s obsession with disruption in reviewing three books, noting:

  • Technology’s promise to lead us into the future turned out to be all about those companies – taking our personal data, eating up our time and creativity, and invading our homes and cities
  • They promised an open web and individual liberty while trampling on both
  • They created rising inequality, not because it was inevitable, but because they used old-school capitalism in dodging regulation and squashing competition
  • They squeezed labor markets by hiring obedient, flexible, and poorly paid subcontractors and unofficial workers – many of them immigrants – who are not covered by wage and safety protection
  • Venture capitalists make massive profits by arriving late to the party after companies have already taken risks and developed something innovative
  • Much of the hard work of innovation is accomplished using government grants and research for which taxpayers receive nothing
  • Science-based philanthropy rewards causes favored by tech donors who prefer life-extending technologies for themselves rather than a better healthcare system for all

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A report by Truth in Advertising titled “Cancer Care: The Deceptive Marketing of Hope” finds that cancer centers have exponentially ramped up their advertising in competing for patients, with 90 percent of them using emotion-tugging but deceptive stories in which outliers who survived high-mortality cancer (at least in the short term) imply that the specific cancer center saved them despite poor odds (example: “statistics mean nothing to believers.”) For-profit chain Cancer Treatment Centers of America leads the advertising pack. Following CTCA’s lead are mostly non-profits, which unlike CTCA, are not subject to Federal Trade Commission actions for deceptive advertising. All advertise clinical trials, immunotherapy, and genomic testing that aren’t always effective and carry their own risks.

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Doylestown Hospital (PA) installs a free short story dispenser in its ED, which gives visitors a short read printed on non-toxic, recycled paper that can help them pass the time. It’s a nice thought, although convincing Americans to look away from their phones or ad-filled TV junk shows to actually read something is a tough sell.


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Morning Headlines 10/26/18

October 25, 2018 Headlines No Comments

Bid process ‘stunning’: Management of multimillion-dollar Nova Scotia health records contract questioned

In Canada, the 16-month bidding process for Nova Scotia’s province-wide EHR project comes down to the wire, with Meditech, Epic, Evident, and Harris Healthcare Group failing to make the final cut.

Cerner (CERN) Q3 Earnings Match Estimates

Cerner reports Q3 results: revenue up 5 percent, adjusted EPS $0.63 vs. $0.61, meeting earnings expectations but falling slightly short on revenue.

AWS Opioid Crisis Council Committed to Help Solve the Opioid Epidemic

Shortly after the passage of the SUPPORT for Patients and Communities Act, Amazon stresses its commitment to combatting the opioid epidemic via new Alexa capabilities and AWS endeavors.

Black Book™ Announces Eighth Annual Revenue Cycle Management Technology and Outsourcing Solutions Top Client-Rated Honors

Optum360, Waystar, and TruBridge take top spots for customer satisfaction and client experience across multiple categories in Black Book’s latest RCM survey.

News 10/26/18

October 25, 2018 News 1 Comment

Top News

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In Canada, the 16-month bidding process for Nova Scotia’s province-wide EHR project called OPOR (One Person One Record) comes down to the wire, with Meditech, Epic, Evident, and Harris Healthcare Group failing to make the final cut.

Only Cerner and Allscripts were allowed to bid based on results from a qualification round that was apparently based entirely on their Request for Supplier Qualification submissions, a document of around 50 pages describing each company’s qualifications. Vendors were not allowed to provide detailed documents or to demonstrate their systems. 

Evident, a smaller vendor that was an original contender, has become vociferous in its allegations of what boils down to cronyism and an unfair procurement process.

Even Epic, which wasn’t even approached by the government for a proposal, seems to have suffered from mysterious postal mishaps in not being made aware that Nova Scotia was considering its project until someone let them know in late 2016, then having its documents package delivered in time but not internally routed to the correct office by the deadline.

Meditech, which is the incumbent vendor for many of Nova Scotia’s hospitals, did not make the short list despite no particular complaints from existing users.

Vendors were told that the authority was not meeting with vendors, but Evident claims to have evidence that people involved with Cerner and Allscripts gained unfair access in social and educational settings, with Allscripts in particular having had executives participate in health authority’s “Let’s Talk Informatics” education events.

A final decision is expected by the end of the year on the project, which could cost several hundred million dollars.


Reader Comments

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From Spanker: “Re: HIMSS. Did you get this email?” HIMSS now claims that it is not only a “partner in the creation of transformative change,” but is also a leading “health and wellness association.” Any claims of health and wellness expertise or accomplishment by HIMSS or its members should be taken with a truckload of salt. It sounds good on a vision statement, but it’s insured sick people who make it rain for all of them.

From Leading Indicator: “Re: IT advice. Links here.” LI calls out three recent examples in which people who have never worked in a health system IT department – much less run one – apparently feel qualified to tell CIOs how to manage their IT organizations, dispensing painfully obvious, simplistic recommendations that usually involve soft subjects like management style or consumerism. I’m all for pontification based on experience and accomplishments (and have seen plenty of it), but possessing a TV, armchair, and beer does not make one a coach.


Webinars

October 30 (Tuesday) 2:00 ET. “How One Pediatric CIN Aligned Culture, Technology and the Community to Transform Care.” Presenters: Lisa Henderson, executive director, Dayton Children’s Health Partners; Shehzad Saeed, MD, associate chief medical officer, Dayton Children’s Health Partners; Mason Beard, solutions strategy leader, Philips PHM; Gabe Orthous, value-based care consultant, Himformatics. Sponsor: Philips PHM. Dayton Children’s Health Partners, a pediatric clinically integrated network, will describe how it aligned its internal culture, technology partners, and the community around its goal of streamlining care delivery and improving outcomes. Presenters will describe how it recruited network members, negotiated value-based contracts, and implemented a data-driven care management process.

November 7 (Wednesday) 3:00 ET. “Opioid Crisis: What One Health Plan is Doing About It.” Presenter: Samuel DiCapua, DO, chief medical director, New Hampshire Health Families; and chief medical officer, Casenet. Sponsor: Casenet. This webinar will describe how managed care organization NH Health Families is using innovative programs to manage patients who are struggling with addiction and to help prevent opioid abuse.

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


Acquisitions, Funding, Business, and Stock

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Cerner reports Q3 results: revenue up 5 percent, adjusted EPS $0.63 vs. $0.61, meeting earnings expectations but falling slightly short on revenue.

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Tesla CEO Elon Musk mentions during an earnings call that the company offers onsite clinics, a relatively new employee perk at its Fremont, CA facility that has helped the high-end auto manufacturer decrease its lost work days and days missed by 10 percent. A job posting on the company’s website hints at the need to find someone who can assist with the “development, implementation, and management of Tesla’s electronic medical record (EMR) system by developing standardized processes for on-site medical staff.”

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Medicare quality reporting company Mingle Analytics merges with care management software company SilverVue to form Mingle Health.


Announcements and Implementations

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Optum360, Waystar, and TruBridge take top spots for customer satisfaction and client experience across multiple categories in Black Book’s latest RCM technology and outsourcing solutions survey.

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EClinicalWorks adds an opioid risk smart form to its EHR, giving providers the ability to assess a patient’s risk for drug abuse and offer alternatives that align with CDC recommendations.

Philips releases IntelliVue Guardian, an mobile app that allows clinicians to view patient vital signs and early warning scores on their Android mobile devices.

Medication safety technology vendor Tabula Rasa HealthCare creates a technology and consulting division called CareVention HealthCare. 


People

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Peter Pronovost, MD, PhD joins University Hospitals (OH) as chief clinical transformation officer, where he will oversee population health, high-reliability medicine, the ACO, and digital health initiatives. Thanks to the reader who forwarded the internal announcement. Pronovost left Hopkins Medicine after seven years in February 2018 to join UnitedHealthcare as SVP of clinical strategy, was promoted to chief medical officer in June 2018, then resigned three months later.

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Healthwise appoints CMO Adam Husney, MD to the additional role of CEO.

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Health Catalyst brings on Ryan Smith (Banner Health) as SVP of client engagement; Will Caldwell, MD (Novant Health) as SVP of physician and market development; and Cathy Menkiena, RN (Encore Health Resources) and Steven Vance (Intermountain Healthcare) as VPs of professional services.

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ClearData promotes Chad Coder to VP of strategic alliances.


Sales

  • Managed care organization Virginia Premier selects ZeOmega’s Jiva population health management software.

Government and Politics

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Amazon announces that Alexa is now able to answer questions about opioids and the opioid epidemic shortly after President Trump signed the opioids-focused SUPPORT for Patients and Communities Act into law. The company’s AWS Opioid Crisis Council has also pledged to use the cloud to improve first responder access to medical records, and identify fraud using PDMP data and analytics.


Other

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A two-year OCHIN study on the feasibility of documenting social determinants of health in EHRs finds that end users need more training to ensure relevant data is entered and acted upon, especially in the area of referrals for community services. Screenings for community service referrals ended up creating unmanageable workloads.

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The New York Times looks at the ways smart thermometer maker Kinsa licenses its “illness data” – temperatures submitted by users based on ZIP codes – to help companies like Clorox better target ads. The cleaning wipes company saw interaction with its digital ads spike 22 percent with Kinsa’s help, allowing it to target markets suffering from the flu in nearly real time. While Kinsa founder and CEO Inder Singh says he’s likely to sell or share the de-identified data only with companies whose services could help Kinsa’s users, others aren’t so sure public health benevolence will win out over profit and privacy concerns. Christine Bannan of the Electronic Privacy Information Center is one such skeptic: “It’s less of a privacy question and more of an ethical question on what we think is acceptable for targeting people who are ill and what safeguards we want to have around that. I can just think of how cigarette and alcohol companies could use strategies like this, or other industries that could really have more harmful effects on people.”

Weird News Andy’s clickbait headline for this story is, “Physician, Steal Thyself.” A 79-year-old doctor borrows $300,000 from a patient to keep her struggling practice afloat, then when asked to repay the money, diagnoses the patient with dementia without any supporting evidence. The doctor says the accusation is “all lies” and that she’s been making loan payments since she borrowed the money 20 years ago, but she nonetheless voluntarily surrendered her medical license in assuming that her case is unwinnable.


Sponsor Updates

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  • The Imprivata Cares team participates in the Technology Underwriting Greater Good’s annual Tech Gives Back event by hosting a Shark Tank-style event for local middle schoolers and volunteering at a homeless shelter for young adults.
  • EClinicalWorks publishes a podcast titled “Long Distance Relationships Made Easy With TeleVisits.”
  • HCTec publishes a new case study, “Successful Training Optimization Reduces Costs While Improving Learner Experience.”
  • InterSystems will exhibit at the CHIME Fall CIO Forum October 30-November 2 in San Diego.
  • ScriptPro will offer OmniSys’s Fusion-Rx interactive voice response system for prescription refills with its pharmacy management solutions.
  • Meditech posts a video describing how Med Center Health uses quality metrics to reduce sepsis mortality and readmission rates.
  • Formativ Health adds XpertDox data to its patient engagement technology, giving providers the ability to match up patients with best-fit providers and clinical trials.
  • Strata Decision Technology recaps its Lift18 user conference, which drew 650 attendees and offered Paul DePodesta from the movie “Moneyball” (played by Jonah Hill) as a keynote presenter. The company announced Time-Driven Costing that allows health systems to understand operational costs beyond traditional cost accounting.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
Contact us.

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EPtalk by Dr. Jayne 10/25/18

October 25, 2018 Dr. Jayne 2 Comments

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ONC has posted the agenda for its annual meeting to be held November 29-30 in Washington, DC. Day One begins with a welcome from Jared Kushner, director of the White House Office of Innovation, followed by a heynote from HHS Secretary Alex Azar. Breakout sessions will cover international health IT efforts, disaster response, HIEs, APIs, FHIR, and an “Ask the ONC Clinical Team” session. Day Two includes a fireside chat with National Coordinator Don Rucker, MD along with Senators Lamar Alexander and Tammy Baldwin.

Value-based care is the chief buzzword for many healthcare organizations and the Comprehensive Primary Care Plus (CPC+) initiative was touted as a way to end the chicken-or-egg struggle faced by ambulatory organizations as they try to figure out how to pay for better care coordination that will lead to incentives that can help them pay for better care coordination and more comprehensive care. The American Academy of Family Physicians has called on CMS to modify the window between when practices have access to their Performance-Based Incentive Payment reports and when they have to repay incentives plus interest.

The reports were to be available around September 26 with interest starting to accrue on October 18. There’s a 19-month gap between performance and reporting, but the CMS piper expects to be paid within a month. The Medicare Shared Savings Program gives Accountable Care Organizations 90 days to repay shared losses. If the current timeline holds, it’s yet another barrier to practice participation in what is supposed to be a driver towards value-based care.

It’s clear that the focus on quality and value isn’t changing any time soon. CMS is hosting a National Provider Call on October 30 to talk about Physician Compare and the upcoming release of publicly available Quality Payment Program data for 2017. A 30-day preview period will allow providers to review their information before it is posted for all to see. The session will include time for question and answer, so if you’re not sure how to navigate the release of information or what to do if you feel it’s not accurate, I’d recommend attending.

Telemedicine is growing and I’ve considered dipping my toe in the waters as an opportunity to deliver patient care without spending 12- to 14-hour shifts in the trenches. Consumer Reports is bringing a recent Annals of Internal Medicine study to the masses regarding increased antibiotic prescriptions issued during telemedicine encounters. The study suggests that there is an association between the length of the visit and the likelihood of an antibiotic prescription. It looked at 13,000 telemedicine visits performed for patients with respiratory complaints. More than 65 percent of phone encounters resulted in an antibiotic prescription. Unfortunately, the research team didn’t have access to the actual encounter documentation so there was not a solid way to determine whether the antibiotic prescriptions were appropriate.

The article offers good information on being an informed telemedicine patient, and notes that “patients often view a telemedicine encounter as more of a consumer transaction than a healthcare visit … here’s an expectation that they get to call a doctor, pay for the visit, and get a prescription.” The author encourages patients to write down their symptoms first including when they started, which is good information for any patient seeking care.

Physician practice management publications such as Medical Economics are encouraging providers to bill telemedicine codes for their own patients. Close to 30 states have so-called telemedicine parity laws, which require commercial payers to reimburse telemedicine services at the same level as face-to-face visits. There are some nuances to coding, though, and physicians are wise to investigate their payer contracts as well as the requirements for proper coding of phone visits.

Many of the scribes in my practice are applying to medical school or physician assistant programs. Those that know I’ve spent time as an administrator often ask about that career path and opportunities in healthcare should they not be admitted to the program of their choice. Money isn’t everything, but I’m happy to share the trend in hospital executive salaries with them. The study looked at CEO and CFO compensation at 22 non-profit medical centers in the US using the “US News & World Report” hospital honor roll list from 2016-17 along with four notable health systems. The authors looked at the growth of clinical worker wages compared to nonclinical workers and management workers.

The rise in value-based care demands administrators with strong financial and quality management backgrounds, which may be driving increased executive salaries. Operational leaders are also in demand as health systems retool their strategic plans. Still, the authors conclude that “there does not appear to be a proportionate increase in healthcare utilization. These findings suggest a growing, substantial burden of non-clinical tasks in healthcare. Methods to reduce non-clinical work in healthcare may result in important cost savings.” I don’t know of too many physicians who would disagree with that sentiment.

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Interesting news for patients who rely on fitness trackers as a tool to assist with their fitness goals. The British Journal of Sports Medicine reports that many trackers aren’t good at measuring energy expenditure. The authors reviewed data from 60 studies looking at 40 trackers worn on the arm or wrist. Devices tended to underestimate energy expenditure, but those that also measured heart rate were more accurate. As an experiment, I used my Garmin watch on the treadmill in “indoor” mode and found that it, too underestimates the mileage my treadmill says I’m logging. The Garmin is accurate in GPS mode when I take it outside for a workout, so it’s still my wearable of choice.

There was quite a bit of buzz in the physician lounge this morning about the FDA approval of Xofluza, which is the first new anti-influenza agent in roughly 20 years. It’s a single dose and can be used to treat patients age 12 and older as long as they’re diagnosed within the first 48 hours of illness, similar to current medications. The wholesale price has been set at $150, but the retail price hasn’t been listed. Genentech makes it and will be offering a coupon for patients with commercial insurance that allows them to purchase it for $30. Now we’ll have to see how quickly EHR teams can get the drug updated for easy prescribing.

How quickly can you get a new drug into your providers’ virtual prescription pad? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 10/25/18

October 24, 2018 Headlines No Comments

Healthcare Leaders Merge to Accelerate the Promise of Value-Based Care

Medicare quality reporting company Mingle Analytics merges with care management software company SilverVue to form Mingle Health.

Health Startup Launches Telemedicine Platform Targeted At Migraine Sufferers

After raising a $15 million Series A, digital health company Thirty Madison will expand to offer telemedicine services for migraine sufferers.

Trump to sign opioid bill today

President Trump signs a bipartisan opioids bill into law that encourages telemedicine utilization for patients suffering from opioid use disorder and the adoption of EHRs among behavioral health providers.

HIStalk Interviews Rachel Marano, Managing Partner, Pivot Point Consulting

October 24, 2018 Interviews No Comments

Rachel Marano is managing partner and co-founder of Pivot Point Consulting of Brentwood, TN.

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Tell me about yourself and the company.

I’ve spent my entire career in healthcare IT, almost 18 years. I’m a computer science graduate. I started my first job at Cerner, where I learned the healthcare IT industry through the Cerner consulting concept. I eventually moved into the hospital side, going to work for Advocate Health Care to get off the road. I did a good bit of implementation and then worked my way into the Epic space and became a certified consultant for a variety of consulting companies. I did everything from build to project management at the project director level.

I launched Pivot Point Consulting in April 2011 with the intent of continuing in the healthcare IT industry, but as a consulting group and a vendor. I’ve seen multiple angles of the industry — software development, the hospital side, the consulting side, and now as an entrepreneur in the healthcare IT space.

What are the most important things you learned from working with Cerner and Epic and their products?

Their products are achieving the same goal, but have different ways of getting there. Both have strong implementation methodologies. Obviously their philosophies and corporate cultures are different. Cerner’s support model is different from Epic’s. Pivot Point Consulting serves both markets.

I’ve worked on both sides and have seen the advantages of both systems, the integration, and how they play in the industry. My roots are Cerner and I spent a good part of my career in Epic, so I think they are equally important in this industry. They create tremendous value for organizations. Many of our consultants have found themselves in both worlds over the years.

Cerner has made a lot of advances in their interoperability and in the international market, which has given them many additional clients. Epic continues to grow domestically and internationally. Epic has a unique way of managing the implementations — giving feedback, doing progress reporting, and ensuring success in install, implementation, and outcomes — which is different from how Cerner manages its clients. They are different animals, with both achieving the same end goal but with different paths to get there. We’ve seen tremendous success with our clients on both products.

How has hospital and health system consolidation affected the consulting business?

It’s certainly a different landscape when there is a lot of merger and acquisition activity. But by definition, that creates opportunity for migration, implementation, and optimization in consolidating older systems to one standard system. It has created a lot of strategy, advisory, and assessment-level work for us and in the entire industry. We’ve done quite a bit of M&A work in the last few years in helping with pre-planning, organizational IT strategic planning, and infrastructure planning for M&A.

We’re doing a large M&A strategy session right now with an organization in downstate Illinois. They didn’t know how to approach the amount of M&A they will be going after in the next 10 years and how that would affect them operationally, strategically, and financially. We put together roadmaps.

Consolidation has, from a consulting perspective, allowed us to look at the industry differently and to see the future state of where these systems will be. Many of them will be unified, integrated, and on similar platforms instead of best-of-breed. We’re going to see a lot more organizations on one platform where they can transfer data more easily.

Are large health systems in less of a hurry than before to rip and replace the systems of the hospitals they acquire in favor of the corporate standard?

One of our larger clients spent probably $200 million on Epic implementation over the years. They were bought by a much larger organization. Things are integrated between the two systems other than the Epic instances. The large organization is maintaining its existing Epic instance and the smaller organization will maintain its Epic instance. They’re both on Epic, but they are running independently by design.

The sheer cost of starting again, redefining workflow, and standardizing all these things between the two systems almost makes the juice not worth the squeeze after these organizations have spent so much money. Things are working, they’re getting the reporting that they need, they’re compliant, and their workflows and operations are efficient with those instances. It makes great sense for some organizations, less for others. Ultimately cost, resourcing, staffing, and other competing projects all come into play into that decision-making. But for some organizations, once they sign on the M&A dotted line, they’re moving forward and starting with the migration.

What projects are floating to the top of health system lists?

We’re seeing a lot of patient engagement, population health, privacy and security, optimization. A lot of managed services, outsourcing the support of these systems. More organizations are shifting energy away from EHR to ERP. The concentration is now that we have the data, what do we do with it? How are we using those measurements to improve performance, clinical outcomes, return on investment, and cash flow? It’s a much more advanced space.

Almost all of our clients are focused heavily on patient engagement initiatives in one way or another. How patients are interacting with their patient portals and what their experience is like from a technology perspective. Systems are in place, we’re live, software is working. Operations, workflow, and clinical and revenue cycle are functional. Where do we go from here in these Phase 2, 3, and 4 post-live scenarios?

Do health systems know what they want to do with population health and patient engagement or are they looking for direction?

Both. More-tenured organizations that have been on these EHR platforms and have software, analytics platforms, or tools are much further ahead in deciding what their initiative looks like or what it should mean. We have small organizations that haven’t even said the word. They’re looking for our guidance and our advisory around the right moves. What tools should we be working with? What vendors are good in this space? Should we be bringing Healthy Planet live? Should we be doing some type of integration?

Most of our large organizations are already underway and have someone leading the charge with population health in some regard. Some of our smaller organizations that might be a little bit further behind are looking for direction and directive. Some don’t know how to approach it, it’s lower on their list, and they’re still trying  to get their technology in order.

What do CIOs tell you is the hardest part of their job?

I haven’t heard as much about CIO turnover. You’ll see it with M&A, but jobs are also evolving into other areas. Some of our CIOs are more focused on innovation and driving revenue into the IT department where before it was more about creating a specific technology infrastructure.

Their challenges continue to be resourcing. I hear this consistently. How do we continue with additional future-state projects with the existing staff? How do we leverage organizations and potentially managed services or outsourced solutions to maximize our organizational resourcing?

Definitely innovation. We have CIOs who are focused on developing programs internally in their IT departments to drive revenue, to create revenue-generating entities within their organization that can align potentially with their IT shop. Potentially consolidating efforts with other local hospitals, leveraging other IT departments and their resources. We’ve seen a lot of unusual approaches to the post-EHR implementation world in CIO roles and evolving how they play in their organizations.

What are the issues most commonly involved when a health system calls you wanting to replace an incumbent consulting firm?

Typically we find that organizations are unhappy with the relationship, the level of consultant talent, or potentially the level of experience and ability. A lot of times, we’re called on because they’re unhappy with the level of service.

But we also find that organizations are looking for a firm that can do more than just one thing and can cast a wider net of service offerings. The group understands their culture, nuances, and their uniqueness and are able to go in other directions, whether it be at an advisory level, a managerial level, legacy, potentially on revenue cycle or clinical, training, and managed services. We’ve seen a good bit of that and we’ve seen organizations that are looking for companies at a certain KLAS level, where they’ve had vendors that have fluctuated in that KLAS standing. Organizations consistently say they’re looking for vendors within the top 10 in their category and that’s who they stick with.

Our focus is relationships, trusted advisory, strategic connections with our clients, and offering value. Being able to identify a challenge and provide a solution. We can do that at more of a strategic level, but also with staffing. We’re trying to approach it differently. We definitely do staffing, but we’ve always been a firm that has been consultant led and consultant driven. We have a different vision on how we work with clients and how we engage with them.

What are the biggest opportunities and threats for health systems, CIOs, and companies in the next 3-5 years?

Merger and acquisitions. We’re going to see in the next 10 years more and more organizations being consolidated, with fewer and fewer independent organizations. The challenges come with combining facilities, the cost of doing that, and technology integration. That will drive the future of the healthcare market. The continued advancement in the technology itself will also change how we are leveraging data.

Do you have any final thoughts?

Our organization is evolving and certainly has changed over the years. When Pivot Point started, we were focused pretty heavily on Epic and Cerner implementation. At that time, that was where the industry was, and that was the main focus of most organizations. We have changed with the times and evolved with the industry and continue to meet the needs of our clients.

We have cast a wider net into some of these divisions, departments, and areas where we see challenge and opportunity. A lot of that is around that managed services space and assisting clients with post-live initiatives. We’re going to continue to see more organizations putting energies in and around that as well as the strategic and more challenged areas around privacy and security, population health, mobility, and even compliance and infrastructure and technology.

A Machine Learning Primer for Clinicians–Part 2

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

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To recap from Part 1, the difference between traditional statistical models and ML models is their approach to a problem:

1

We feed Statistics as an Input and some Rules. It provides an Output.

With a ML model, we have two steps:

  • We feed ML an Input and the Output and the ML model learns the Rules. This learning phase is also called training or model fit.
  • Then ML uses these rule to predict the Output.

In an increasing number of fields, we realize that these rules learned by the machine are much better than the rules we humans can come up with.

Supervised vs. Unsupervised Learning

With the above in mind, the difference between supervised and unsupervised is simple.

  • Supervised learning. We know the labels of each input instance. We have the Output (discharged home, $85,300 cost to patient, 12 days in ICU, 18 percent chance of being readmitted within 30 days). Regression to a continuous variable (number) and Classification to two or more classes are the main subcategories of supervised learning.
  • Unsupervised learning. We do not have the Output. Actually, we may have no idea what the Output even looks like. Note that in this case there’s no teacher (in the form of Output) and no rules around to tell the ML model what’s correct and what’s not correct during learning. Clustering, Anomaly Detection, and Primary Component Analysis are the main subcategories of unsupervised learning.
  • Other. Models working in parallel, one on top of another in ensembles, some models supervising other models which in turn are unsupervised, some of these models getting into a  “generative adversarial relationship” with other models (not my terminology). A veritable zoo, an exciting ecosystem of ML model architectures that is growing fast as people experiment with new ideas and existing tools.

2

Supervised Learning – Regression

With regression problems, the Output is continuous — a number such the LOS (number of hours or days the patient was in hospital) or the number of days in ICU, cost to patient, days until next readmission, etc. It is also called regression to continuous arbitrary values.

Let’s take a quick look at the Input (a thorough discussion about how to properly feed data to a baby ML model will follow in one of the next articles).

At this stage, think about the Input as a table. Rows are samples and columns are features.

If we have a single column or feature called Age and the output label is LOS, then it may be either a linear regression or a  polynomial (non-linear) regression.

Linear Regression

Reusing Tom Mitchell definition of a machine learning algorithm:

” A computer program is said to learn from Experience (E) with respect to some class of tasks (T) and performance (P) – IF its performance at tasks in T, as measure by P, improves with experience (E)”

  • The Task is to find the best straight line between the scatter points below – LOS vs. age – so that, in turn, can be used later for prediction of new instances.
  • The Experience is all the X and Y data points we have.
  • The Performance will be measured as the distance between the model prediction and the real value.

The X axis is age, the Y axis is LOS (disregard the scale for the sake of discussion):

3

Monitoring the model learning process, we can see how it approaches the best line with the given data (X and Y) while going through an iterative process. This process will be detailed later in this series:

1

From “Linear Regression the Easier Way,” by Sagar Sharma.  

Polynomial (Non-Linear) Regression

What happens when the relationship between our (single) variable age and output LOS is not linear?

  • The Task is to find the best line — obviously not a straight line — to describe the (non-linear) polynomial relationship between X (Age) and Y (LOS).
  • Experience and Performance stay the same as in the previous example.

4

As above, monitoring the model learning process as it approximates the data (Experience) during the fit process:

5

From “R-english Freakonometrics” by Arthur Carpentier.

Life is a bit more complicated than one feature (age) when predicting LOS, so we’d like see what happens with two features — age and BMI. How do they contribute to LOS when taken together?

  • The Task is to predict the Z axis (vertical) with a set of X and Y (horizontal plane).
  • The Experience. The model now has two features: age and BMI. The output stays the same: LOS.
  • Performance is measured as above.

Find the following peaks chart — a function — similar to the linear line or the polynomial line we found above.

This time the function defines the input as a plane (age on X and BMI on Y) and the output LOS on Z axis.

Knowing a specific age as X and BMI as Y and using such a function / peaks 3D chart, one can predict LOS as Z:

6

A peaks chart usually has a contour chart accompanying, visualizing the relationships between X, Y, and Z (note that besides X and Y, color is considered a dimension, too, Z on a contour chart). The contour chart of the 3D chart above:

7

From the MathWorks manual

How does a 4D problem look?

If we add the time as another dimension to a 3D like the one above, it becomes a 4D chart (disregard the axes and title):

8

From “Doing Magic and Analyzing Time Series with R,” by Peter Laurinec.

Supervised Learning – Classification

When the output is discrete rather than continuous, the problem is one of classification.

Note: classification problems are also called logistic regression. That’s a misnomer and just causes confusion.

  • Binary classification, such as dead or alive.
  • Multi-class classification, such as discharged home, transferred to another facility, discharged to nursing facility, died, etc.

One can take a regression problem such as LOS and make it a classification problem using several buckets or classes: LOS between zero and four days, LOS between five and eight days, LOS greater than nine days, etc.

Binary Classification with Two Variables

  • The Task is to find the best straight line that separates the blue and red dots, the decision boundary between the two classes.
  • The Experience. Given the input of the X and Y coordinate of each dot,  predict the output as the color of the dot — blue or red.
  • Performance is the accuracy of the prediction. Note that just by chance, with no ML involved, the accuracy of guessing is expected to be around 50 percent in this of type of binary classification, as the blue and the red classes are well balanced.

In visualizing the data, it seems there may be a relatively straight line to separate the dots:

8

The model learning iteratively the best separating straight line. This model is linearly constrained when searching for a decision boundary:

9

From “Classification” by Davi Frossard.

Binary Classification with a Non-Linear Separation

A bit more complex dots separation exercise, when the separation line is obviously non-linear.

The Task, Experience, and Performance remain the same:

10

The ML model learning the best decision boundary, while not being constrained to a linear solution:

11

From gfycat.

Multi-Class Classification

Multi-class classification is actually an extension of the simple binary classification. It’s called the “One vs. All” technique. 

Consider three groups: A, B, and C. If we know how to do a Binary classification (see above), then we can calculate probabilities for:

  • A vs. all the others (B and C)
  • B vs. all the others (A and C)
  • C vs. all the others (A and B)

More about Classification models in the next articles.

Binary Classification with Three Variables

While the last example had two variables (X and Y) with one output (color of the dot), the next one has three input variables (X, Y, and Z) and the same output: color of the dot.

  • The Task is to find the best hyperplane shape (also known as rules / function) to separate the blue and red dots.
  • Experience has now three input variables (X, Y, and Z) and one output label (the dot color).
  • Performance remains the same.

 2018-10-24_5-53-08

From Ammon Washburn, data scientist. Click here to see the animated 3D picture.

How can we visualize a problem with 5,000 dimensions?

Unfortunately, we cannot visualize more than 4-5 dimensions. The above 4D chart (3D plus time) on a map with multiple locations — charts running in parallel, over time — I guess that would be considered a 5D visualization, having the geo location as the fifth dimension. One can imagine how difficult it would be to actually visualize, absorb, and digest the information and just monitor such a (limited) 5D problem for a couple of days.

Alas, if it’s difficult for us to visualize and monitor a 5D problem,  how can we expect to learn from each and every experience of such a complex system and improve our performance, in real time, on a prediction task? 

How about a problem with 10,000 features, the task of predicting one out of 467 DRG classifications for a specific patient with an error less than 8 percent? 

In this series, we’ll tackle problems with many features and many dimensions while visualizing additional monitors — the ML learning curves — which in my opinion are as beautiful and informative as the charts above, even as they are only 2D.

Other ML Architectures

On an artsy note, as it is related to the third group of ML models (Other) in my chart above, are models that are not purely supervised or unsupervised.

In 2015, Gatys et al. published a paper on a model that separates style from content in a painting. The generative model learns an artist’s style and then predicts the style effects learned on any arbitrary image. The left upper corner is an image in Europe and then each cell is the same image rendered in one of several famous painters’ styles:

12

Scoff you may, but this week, the first piece of art generated by AI goes for sale at Christie’s.

Generative ML models have been trained to generate text in a Shakespearean style or the Bible style by feeding ML models with all Shakespeare or the whole Bible text. There are initiatives I’ll report about where a ML model learns the style of a physician or group of physicians and then creates admission / discharge notes accordingly. This is the ultimate dream come true for any young and tired physician or resident.

In Closing

I’d like to end this article on a philosophical note.

Humans recently started feeding ML models the actual Linux and Python programming languages (the relevant documentation, manuals, Q&A forums, etc.) 

As expected, the machines started writing computer code on their own. 

The computer software written by machines cannot be compiled nor executed and it will not actually run.

Yet …

I’ll leave you with this intriguing, philosophical, recursive thought in mind — computers writing their own software — until the next article in the series: Unsupervised Learning.

Morning Headlines 10/24/18

October 23, 2018 Headlines No Comments

Clearlake Capital to Acquire symplr

Clearlake Capital Group will acquire provider management, credentialing, and payer enrollment technology vendor Symplr.

Kyruus Snags an Extra Investment of $4M from Salesforce Ventures

Kyruus lists its ProviderMatch for Salesforce on the Salesforce AppExchange and announces a $4 million Series D investment by Salesforce Ventures.

Industry Veterans Launch Laudio To Solve Health System Staff Burnout

Laudio releases its staff relationship management platform that allows hospital managers to manage employee recognition, accountability, burnout risk, onboarding and career development, and work issues.

News 10/24/18

October 23, 2018 News 1 Comment

Top News

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Clearlake Capital Group will acquire provider management, credentialing, and payer enrollment technology vendor Symplr. Terms were not disclosed.

Symplr acquired Cactus Software (provider management) in early 2016 and Vistar Technologies (provider management) in mid-2017.


Reader Comments

From Vaporware?: “Re: Cerner at DoD MHS. The system is not operable, much less interoperable, after 20 months of being live overall and Congress should get to the bottom of it. EHR stabilization is usually measured in low single-digit weeks. Any CIOs willing to compare?” Politico says that a preliminary DoD report concludes that MHS Genesis at Madigan Army Medical Center is “not effective and not suitable” – the same conclusion reached after evaluating the three previous test sites – and adds that the system is “not interoperable.”


Webinars

October 30 (Tuesday) 2:00 ET. “How One Pediatric CIN Aligned Culture, Technology and the Community to Transform Care.” Presenters: Lisa Henderson, executive director, Dayton Children’s Health Partners; Shehzad Saeed, MD, associate chief medical officer, Dayton Children’s Health Partners; Mason Beard, solutions strategy leader, Philips PHM; Gabe Orthous, value-based care consultant, Himformatics. Sponsor: Philips PHM. Dayton Children’s Health Partners, a pediatric clinically integrated network, will describe how it aligned its internal culture, technology partners, and the community around its goal of streamlining care delivery and improving outcomes. Presenters will describe how it recruited network members, negotiated value-based contracts, and implemented a data-driven care management process.

November 7 (Wednesday) 3:00 ET. “Opioid Crisis: What One Health Plan is Doing About It.” Presenter: Samuel DiCapua, DO, chief medical director, New Hampshire Health Families; and chief medical officer, Casenet. Sponsor: Casenet. This webinar will describe how managed care organization NH Health Families is using innovative programs to manage patients who are struggling with addiction and to help prevent opioid abuse.

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


Acquisitions, Funding, Business, and Stock

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Kyruus lists its ProviderMatch for Salesforce on the Salesforce AppExchange and announces a $4 million Series D investment by Salesforce Ventures, increasing its total to $76 million.

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CNBC reports that Silicon Valley-based, VC-backed smart breast pump startup Naya Health —  whose CEO had blamed the company’s sluggish start on the male-dominated VC industry despite what she claimed is a $30 billion market opportunity – has apparently shut down and left customers without support for its $1,000 device amidst complaints from some of its users that it does not work.

The company that was hired to auction the assets of the defunct CareSync asks the court to expedite a $1 million sale to risk adjustment technology vendor Vatica Health, requesting via an emergency motion to finalize any and all bids by November 5. CareSync had raised $49 million before closing abruptly in June 2018.


Sales

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Island Hospital (WA) replaces its existing electronic signature product with that of Access, integrated with Meditech. 


People

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Divurgent hires Gary Germaine (Leidos Health) as VP of client services.

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Mordecai Kramer (Baim Institute for Clinical Research) joins Carevive Systems as VP of data generation and outcomes, life sciences.

SNAGHTML108009c2

Medtronic co-founder Earl Bakken, who created the modern medical technology industry with the company’s introduction of the first implantable pacemaker in 1960, died Saturday at 94. The former electronics repairman founded the company with his brother-in-law, working from a Minneapolis garage to offer hospital equipment repair and TV installation.


Announcements and Implementations

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Healthcare Growth Partners looks at the vendor “haves and have-nots” from EHR consolidation brought on by high overall market penetration as well as hospitals employing physicians and acquiring practices (HGP estimates that over 50 percent of doctors now work for hospitals). Cerner and Epic are winning the replacement market; specialty EHR vendors are doing well in specialized practice areas not as well served by Epic and Cerner; but Healthland, the former Siemens, the former McKesson Enterprise, and Allscripts Practice Fusion are losing ground as the “have-nots.”

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Denver Health Epic Data Architect Mark Iannucci publishes Epic UserWeb Search on the Chrome Web Store, which allows search terms prefaced with “uw” to search UserWeb or those starting with “uw sherlock” to find occurrences in Sherlock logs, all while skipping the Galaxy screen (assuming you’re already logged into Epic UserWeb and are using the Chrome browser, of course).

image

Laudio releases its staff relationship management platform that allows hospital managers to manage employee recognition, accountability, burnout risk, onboarding and career development, and work issues. The founder and CEO is industry long-timer Russ Richmond, MD. 


Government and Politics

A White House-proposed rule would not only push “junk” health insurance plans (short-term and association health plans) that potentially contain extensive exclusions, it would also encourage employers to offer healthcare imbursement arrangements that give each employee a fixed dollar amount with which to purchase their own insurance, which the administration acknowledges would reduce the number of insured people. All of the new recommendations would support states offering plans that are not ACA compliant in such areas as pre-existing conditions and lifetime payment limits.


Other

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A New York Times article provides advice from chronically ill people on how to make best use of the US healthcare system (or more precisely, two ways to do that plus two suggestions for bypassing it in favor of getting informal personal advice).

Researched published in JAMA finds that use of medical crowd-funding campaigns is growing, people often ask for money to obtain treatments that are not evidenced-based or that may be harmful, meaning those who donate are helping line the pockets of practitioners who are delivering questionable care.


Sponsor Updates

  • AdvancedMD will exhibit at the American Academy of Ophthalmology event October 27-30 in Chicago.
  • IDC MarketScape names Arcadia a leader in its assessment of US population health analytics vendors.
  • TMC names Atlantic.Net a 2018 Cloud Computing Security Excellence Award winner.
  • Bluetree will exhibit at the CHIME CIO Leadership Academy 2.0 October 29-30 in San Diego.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
Contact us.

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Morning Headlines 10/23/18

October 22, 2018 News No Comments

DSI’s Joseph J. Luzinski Asks Court to Speed Asset Sale of Florida-Based CareSync

Vatica Health makes a $1 million bid to acquire the assets of chronic care management company CareSync, which abruptly closed its doors in June.

MHS Genesis gets a bad review

Politico reports that Pentagon investigators have found Madigan Army Medical Center’s new Cerner-based software lacking in effectiveness, suitability, and interoperability.

Tabula Rasa HealthCare Announces the Launch of CareVention HealthCare

Tabula Rasa HealthCare launches a new division called CareVention Healthcare that will offer consulting services and technology, including its medication risk management software.

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Reader Comments

  • EHR Guy: I enjoyed your comments about Epic and their CEO Judy. In watching and being in the industry over the years as Epic has ...
  • EHR Guy: how so... Pretty straight forward. Please explain if you are going to comment....
  • EHR Gal: This was incoherent. Please edit and try again....
  • EHR Guy: I enjoyed your comments about Epic and their CEO Judy. In watching and being in the industry over the years as Epic has...
  • KP Alum: Re the Kaiser Permanente medical school: I think it makes a lot of sense for them to train physicians in how Permanente ...
  • EHRVendor: Good article, unfortunately, this lost credibility when Athenahealth was considered one of the five major EHR Vendors le...
  • Patient advocate: Hi. I don’t see our organization on the Commonwell slide. We have gotten a lot of value from the tool and have ac...
  • Anonymous: I worked for Cerner at the time of the fire, and Cerner had a few dozen associates at the Feather River facilities. Both...
  • monica: 'Champions of Heath' that is perfect and says more about the whole rebranding strategy in 3 words than I could in a para...
  • Bill Spooner: It would be great to know about healthcare costs and outcomes in China, India and Norway, to learn how the various care ...

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