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Morning Headlines 4/23/19

April 22, 2019 Headlines No Comments

Kindbody Raises $15M Series A To Reinvent Modern Women’s Health Care

Women’s healthcare company Kindbody raises $15 million in a Series A round that brings its total funding to $22 million.

ESO Takes Over Emergency Medical Services Performance Improvement Center (EMSPIC) from the University of North Carolina

Emergency medical services software company ESO takes over North Carolina, South Carolina, and West Virginia state EMS data systems from the EMS Performance Improvement Center at the University of North Carolina.

Artificial intelligence can diagnose PTSD by analyzing voices

An NYU School of Medicine study finds that an AI tool can differentiate between the voices of veterans with our without PTSD with 89% accuracy.

Global public health expert and primary care physician to lead Ariadne Labs

Harvard professor and Brigham and Women’s Hospital primary care physician Asaf Bitton, MD succeeds Atul Gawande, MD as executive director of the university and hospital’s joint innovation center in Boston.

Curbside Consult with Dr. Jayne 4/22/19

April 22, 2019 Dr. Jayne 3 Comments

I’ve been working with a large provider group and recently spent some time with them in a retreat format. Although the group bills itself as a topnotch organization from a clinical quality perspective, there is a great deal of physician dissatisfaction. The EHR is a major target of complaints, so I was brought in to do some workflow mapping and to help facilitate the sections of the retreat where workflow topics were discussed.

It no longer surprises me, but I’m still baffled by physicians who refuse to delegate or to use their support teams to actually support them. My workflow mapping revealed the usual operational failures: 

  • Physicians doing staff-level work because they either don’t trust the staff or don’t want to spend the time educating staff on how they want it done
  • Physicians who refuse to give a year of refills to stable, compliant patients
  • Physicians who refuse to allow clinical staff to assist with refill management
  • Lack of proactive management of lab and imaging results
  • Overbooked schedules far beyond any chance of ever running on time

These are all paper problems that I suspect existed before the EHR, yet providers insist that the EHR is the reason they are working on charts at home. One physician I shadowed has his schedule blocked for 15-minute appointments, yet he consistently spends 20 to 25 minutes seeing each patient. He has a highly capable scribe and they work well together. However, he is always behind. Just doing the math, there is no way he is ever going to be able to get out of the office on time (nor will his staff) and he’s always going to have to do some work after hours. It wouldn’t matter what system he has. Until he can either figure out a way to see patients faster or is willing to adjust his schedule to match his actual cycle times, he’s always going to feel like he is under the gun.

(I suggested reducing the sports-related small talk that he engages in with every patient whether they seem interested or not, but that was met with a frosty stare from the physician, although the scribe seemed grateful for the suggestion.)

Physicians were frustrated by “missing results in the EHR” but failed to realize that it wasn’t that the results were misfiled, it was that the patient never had the tests performed. This is an issue that can be caught prior to the visit, either through pre-visit planning or an orders management process. Most of this frustration occurred when physicians were processing medication refills, which I would argue they shouldn’t be processing in the first place. They would be looking for cholesterol or diabetes labs so they could decide on whether to grant a refill or not, and were unwilling to task staff to do the hunting for them.

One physician is handling refills on his patients constantly since he won’t give them more than 90 days’ worth of refills at a time. That might be a necessary strategy for a patient whose conditions are not well controlled or who has issues with follow up, but the majority of patients can receive refills for a year without risk.

I discussed the number of organizations that successfully use refill protocols and the tools available to assist with ensuring patients are at goal before granting refills, but they felt that allowing anyone to approve refills other than the physicians themselves was “negligent.” We arrived at this conclusion halfway through the first day of the retreat, and it was all I could do to keep a straight face while I tried to figure out how I was going to get through another 12 hours with people that are not living in the real world.

We did identify a number of true EHR issues, mostly around lack of use of shortcut techniques and provider-level configurations. More than 50% of the providers I had shadowed didn’t even have favorites lists in their prescribing profiles, so they were manually searching for every single medication rather than selecting from a short list of medications that they commonly prescribe. Although providers agreed it would be beneficial to have such a favorites list, most of them said they were unwilling to create them on the fly, but instead wanted someone to build them for them either after a chart audit or through shadowing. We discussed how that could be a self-defeating strategy, because as they begin prescribing new agents or if their prescribing habits change, they wouldn’t be able to add those drugs without spending the time to explain them to a staff member or spending the time to log a help desk ticket.

We also found some issues with their CPOE system, including some confusing test names, and they were willing to come to a consensus to streamline that feature.

There were a number of issues on which we never reached resolution, but I did get to sit in on some of the sessions on non-operational topics so I could get a better feel for the culture of the group. There was an extensive review of their clinical quality metrics. Providers had previously received their reports only twice a year, but with the addition of the EHR, they began to receive them quarterly. At a previous retreat, they had asked for monthly reporting and were quite happy with it. However, it didn’t seem like anyone was willing to admit that it was only because of the “soul-sucking” EHR that they could ever have that level of transparency into their practice without spending a considerable amount of money on chart audits.

I also sat in on a financial workshop where expenses and provider compensation were reviewed. The providers weren’t terribly receptive to the CFO’s explanation that they had higher-than-market physician salaries with lower-than-average staffing costs as a possible explanation for why the physicians felt they were overworked. Unless they’re willing to shift work to team members, they’re going to be doing it at home in the evening or at times they’d otherwise prefer not to be working.

As an outside observer, it felt like the physicians were happier to spend the afternoon complaining about it rather than rolling up their sleeves and trying to find solutions since none of them were willing to take a lower salary for any reason. Although I do feel like we made some progress on a subset of quick-fix issues, I’m not sure this group is going to find its happy place anytime soon. I’m glad my role with them is limited and the engagement a short one although it was fun to be in the field after a long stretch at home.

Do you have persistent “paper problems” at your organization? Are providers willing to help address them? Leave a comment or email me.


Email Dr. Jayne.

Readers Write: AI and Machine Learning Only Work if You Do

April 22, 2019 Readers Write No Comments

AI and Machine Learning Only Work if You Do
By Brian Robertson

Brian Robertson is CEO of VisiQuate of Santa Rosa, CA.


Do AI and ML represent a game-changing opportunity for revenue cycle management? Absolutely. An annual research report by EMC and IDC indicates that the digital universe will contain 44 trillion gigabytes of data next year, with nearly a third of that data collected and stored by the healthcare industry, according to a Ponemon Institute study.

Within this vast ocean of data, AI and machine learning are well equipped to act as the precision sonar to detect and solve business problems using advanced data-driven methods. Indeed, AI and ML are part of today’s buzzwords du jour, but few now question that it will play a role. We must now advance the conversation: how to get going and laser in on value.

Let’s rewind to a time not long ago when we couldn’t blink without seeing a plethora of white papers on big data. They seemed to all contain the same message: “Big data has the potential to be a game-changer.” As the CEO of a company in the data analytics arena, we sometimes struggled with how to best communicate the power of big data to our clients. Our ultimate answer was to focus less on the intelligentsia and more on “get stuff done” (GSD) thinking.

Using AI and ML as an accelerator

First on deck? Don’t get too caught up in the hype cycle. From a pure technology standpoint, it’s just not that hard. One of the benefits of back-office operations, as opposed to clinical departments, is easy access and availability of structured data.

The harder part? Prioritizing business problems where a return on analytics (ROA) could deliver big value. Back to the ocean. Don’t boil it! Invest more time with your team thinking through what you’re trying to accomplish and what can deliver ROA/ROI.

Let’s take something like denial management. AI and ML can help speed up the discovery of problems that are both acute and systemic.

First, resolve what’s in front of you. Then go upstream where the real potential is. If you’re fixing the same problems repeatedly, solve that problem at its core.

Consider a physician dictation issue where some dictate with great attention to detail the complete services and care provided during a complex surgical case. Coders love that because they rely on substantive information to correctly code. That’s in contrast to physicians with less attention to detail, where denials and/or lost revenue is impacted a la the old adage, “If it wasn’t documented, it wasn’t done.”

Automating variability by physician can help you better solve problems upstream. Maybe it’s a system glitch where a bill editor is not set up correctly. Inaccurate or incomplete payer edits often repeat month after month. Deeper trending insights can automate the illustration of consistent anomalies.

This is where AI and ML become a competitive advantage, particularly when you stay focused on business value vs. the glitter of new tech. Start narrow and allow the algorithms do some of the heavy lifting.

  1. Purely repetitive process automation. Take a binary process and drive automation via robotic process automation (RPA) tools and methods.
  2. Enhance user or consumer experience. Chatbots can deliver an exceptional user experience. Why not leverage voice automation and have your chatbot send you the daily cash report for your commute home? Or a report showing slow-paying payers? Or the bad debt forecast?
  3. Deep data mining. Use anomaly detection on historical claim data to empower upstream decision-making. Leverage ML to see what’s going on with the patterns. Let the decision-making power get smarter every day.

Done right, AI and ML will improve yield, increase velocity, and optimize FTE impact.

Final tips to those looking at AI and ML for back-end optimization

  • Fail fast so you don’t lose precious time over-analyzing.
  • Avoid the technology hype and focus more on business problems the technology can help enhance or catalyze.
  • Train your staff. FTEs in repetitive roles will become obsolete — it’s just the reality of our future. We as leaders have a moral responsibility to train our talent. As Gartner often advocates, create learning pathways to enable your staff to become capable citizen data scientists. Give them a meaningful shot at surviving in the long-term.
  • Lastly, pick three business problems. Go narrow and deep. but as deep as you possibly can. Then it’s time to grab a shovel and get after it.

Morning Headlines 4/22/19

April 21, 2019 Headlines No Comments

HHS Announces Next Steps in Advancing Interoperability of Health Information

HHS opens Draft 2 of its Trusted Exchange Framework and Common Agreement for public comment.

Trusted Exchange Framework and Common Agreement – Recognized Coordinating Entity (RCE)

ONC will open a four-year, $900,000 per year funding opportunity for a non-profit to serve as the Recognized Coordinating Entity to oversee TEFCA’s Common Agreement for qualified Health Information Networks.

Latest phases at Cerner’s Innovations Campus steam ahead

Phase 3-4 construction at Cerner’s $4.5 billion Innovations Campus in Kansas City adds 777,000 square feet.

Health and education start-ups say recruiting has gotten easier in wake of Facebook, Google scandals

Startups in Silicon Valley, particularly those with a social mission, are finding it easier to recruit disenchanted talent from big tech companies like Facebook and Alphabet that have suffered from scandal-induced negative press.

Monday Morning Update 4/22/19

April 21, 2019 News 2 Comments

Top News


HHS opens Draft 2 of its Trusted Exchange Framework and Common Agreement for public comment.

ONC will present a webinar on Draft 2 on April 23.


In related news, ONC announces that it will open a four-year, $900,000 per year (first year) funding opportunity for a non-profit to serve as the Recognized Coordinating Entity to oversee TEFCA’s Common Agreement for qualified Health Information Networks.

Reader Comments

From Looming Clouds: “Re: health IT fire hose. Give me five things I need to know about healthcare as an outsider.”

  • Fix a problem using the most appropriate tools and methods, which may have nothing to do with technology. Companies desperately seeking a nail for their software hammer to pound always end up quietly slinking off in shame.
  • Remember that you, your friends, and your family are all patients at one time or another. You probably wouldn’t want someone like yourself affecting their care with your technology tinkering.
  • It’s tough to automate an industry whose key players (clinicians) don’t really buy into the idea of conveniently computer-amenable concepts such as evidence-based medicine, standardized practices, and reducing practice variation, especially when they are right. Medicine is half business, half science. Even those of us in the industry don’t really care which technology tools our doctors (or our accountants, or our carpenters, etc.) use – we judge them on the factors that, at best, are invisibly influenced by the technology they choose. Clinicians of all types rarely love hospital-mandated software because 80% of its functionality enforces rules set by their many overlords that add nothing to patient care and force them to enter data for someone else’s benefit.
  • People and organizations, even those in healthcare (maybe especially those in healthcare) do whatever rewards them most personally as long as they don’t have to intentionally harm patients. It’s not as ethical and purely motivated as you see on medical TV shows. Don’t be fooled into thinking that medical practices (which are always for-profit) are less nobly motivated than theoretically not-for-profit health systems and insurers. All of them will find the money no matter where Medicare and insurers hide it.
  • The only thing that matters that long-term outcomes are improved, patient access is made easier, or costs are reduced. Everything else is a nice-to-have at best. Do patients and your business a favor and find some other profit opportunity if you can’t address these issues.

HIStalk Announcements and Requests


Two-thirds of poll respondents spend 1-3 hours each week reading healthcare and healthcare IT news, which is plenty of time to catch up on the latest news, rumors, and opinions on HIStalk (maybe 30-45 minutes of skimming per week, tops) plus whatever else is out there.

New poll to your right or here: Will Cerner, Epic, and Meditech face any new health system EHR competition in the next 10 years? If so, from whom? A lot of people (admittedly, most of them clueless) seem to think that EHRs are dinosaurs that are in imminent danger of being felled in their tracks by a Silicon Valley-launched asteroid and are planning an after-party in which a replacement product suddenly sheds all the unpleasant functionality (coding, billing, documentation) in giving clinicians a fun, rewarding system written just for their needs that will free them from the electronic shackles created by the people who provide their incomes. Those whose deep psychological insight allows them read between the lines I write might detect my skepticism.


Thanks to Prepared Health for upgrading its HIStalk sponsorship. The company’s EnTouch Network makes it easier for patients to stay healthy at home by connecting them with providers, caregivers, and payers. Health systems use the platform to stay connected to referral sources, involve the patient’s caregivers in their care, receive real-time alerts of changes in risk or care setting, and monitor for fraud and abuse via GPS-powered visit verification. The co-founders have a long industry history going back to the early days of Medicity, which I should mention was HIStalk’s first-ever sponsor back in 2005 or so. The big company news this week is that Jefferson Health chose Prepared Health its digital technology partner for post-acute and transitional care for its 14 hospitals.


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

Acquisitions, Funding, Business, and Stock


Haven opens a New York City office to attract technology talent, according to a LinkedIn post by its CTO. Open positions — which are described with just a generic job title — include clinical, data and analytics, product, and technology.


The Kansas City business paper provides an update on Phase 3-4 construction at Cerner’s $4.5 billion Innovations Campus, with the latest efforts adding 777,000 square feet. Campus construction will be completed in 2025 with space for 16,000 employees. You have to wonder if this was a bad idea (at least in the absence of a reliable crystal ball when it was announced in 2016) given the company’s subtle retrenchment for what seems likely to be a tougher haul, which might also be true of Epic.

Several Blue Cross Blue Shield plans are sponsoring ACOs and opening their own primary care practices and urgent care centers to reduce the use of expensive hospital care.

I hadn’t checked NantHealth’s share price lately – it is $0.79, valuing the company at just $86 million and no doubt annoying those IPO-day buyers who in mid-2016 paid $21 per share (now sporting a 96% haircut). Shares of the other health IT train wreck Castlight Health are down 91% from their IPO day close in March 2014. It’s always good to remember an inviolate Wall Street rule – buying company shares early means that insiders who know way more than you are happy to dump shares on you at the price they have set.



David Bean (Complete Merchant Solutions) joins Prepared Health as SVP of sales and marketing.

Announcements and Implementations


NYC Health + Hospitals brings Epic live at 19 more locations, increasing its total to 50 and taking the $1 billion project it calls H2O past the halfway point of 45,000 users.

MDLive launches CareLink, a telehealth program that helps health plans and systems improve quality metrics via increased member engagement and lower cost. Optima Health (VA) is a pilot site.


Weird News Andy will love this. An ambulance headed for a hospital ED with a patient whose heart is racing at 200 beats per minute restores normal rhythm when the ambulance hits a pothole.

Sponsor Updates

  • Formativ Health will demonstrate its Patient Engagement Platform at the NAHAM annual conference April 23-26 in Orlando.
  • Lightbeam Health Solutions will exhibit at NAACOS Spring 2019 April 24-26 in Baltimore.
  • Vyne Medical, Experian Health, and Relatient will present and exhibit at NAHAM April 24-26 in Orlando.
  • Mobile Heartbeat will exhibit at the 2019 LONE Spring Conference April 25-26 in New Orleans.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the AWHONN Colorado State Conference April 25-26 in Colorado Springs.
  • CloudWave partners with Nutanix to bring the first certified health information solution to healthcare organizations running Meditech.
  • Redox will exhibit at the AWS Healthcare & Life Sciences Symposium April 24-25 in Boston.
  • Surescripts will exhibit at Matrixcare Directions 2019 April 24-26 in Nashville.
  • T-System will exhibit at the 2019 EDPMA Solutions Summit April 28-May 1 in Scottsdale, AZ.
  • TriNetX CMO Manfred Stapff, MD publishes “First-line treatment of essential hypertension: A real-world analysis across four antihypertensive treatment classes” in the Journal of Clinical Hypertension.
  • Voalte will exhibit at the NC HIMSS Chapter Annual Conference April 23-25 in Raleigh.
  • Vocera will exhibit at the Minnesota Organization of Leaders in Nursing 2019 Spring Conference April 25 in Brooklyn Park, MN.

Blog Posts



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


Weekender 4/19/19

April 19, 2019 Weekender No Comments


Weekly News Recap

  • IBM halts sales of Watson for Drug Discovery due to low demand
  • Healthcare data integration vendor Redox raises $33 million
  • The New York Times profiles the Butterfly IQ device that transforms a smartphone into an ultrasound scanner
  • Provider management, credentialing, and payer enrollment technology vendor Symplr acquires competitor IntelliSoft
  • InterSystems adds a provider directory to the newly renamed HealthShare Unified Care Record
  • Vermont HIE struggles with opt-in vs. opt-out participation
  • The number of India-based doctors who support their US counterparts as remote scribes is rapidly increasing
  • China’s WeDoctor provides government-required health checks to villages as a way to collect patient data to train their AI-powered systems
  • Babylon Health ramps up staffing and spending

Best Reader Comments

I think it remains to be seen if physicians and other healthcare leaders are ready to move from anecdotes to numbers, the concept “numbers do not lie.” I have already commented upon the conflation of quantitation, plus emotions, and also enjoyed your reference to one of our (many) limitations. Ultimately, it is my personal opinion modern society is currently seeking too many answers, placing too much hope, in so-called AI/ML. I also believe “magic” AI/ML solutions may produce serious answers, some decade. However, in (current) reality, there is simply limited data granularity access for research, in the context of an increasing number of mixed/blurred physical & electronic “threats” in major news headlines. I think some of these headlines are hype, a form of Security Theater. (Andrew M. Harrison)

We are lousy at the foundational steps, among which is rigor in the process by which we document what we do in a computer-processable way so that we can then extract from large-enough populations accurate data about the best approach to taking care of people. And right now, the EHR is such a PIA that for the foreseeable future, garbage-in is winning. As a tiny example, the average physician is far more concerned (and needs to be concerned, for practical reasons) with getting a term on the chart that gets him paid than getting a term on the chart that reflects what he wanted to say. (James E. Thompson)

Interesting thought experiment: take Epic or Cerner with their current workforce and give them five years and a billion dollars. Starting from scratch, no existing code or documentation, they could either build a new system or try to replicate their current system from their own memory.  Could they build a competing system? My answer would be very unlikely. (AC)

Watercooler Talk Tidbits


Ms. H in Georgia was happy to have her DonorsChoose teacher grant request funded by HIStalk readers, which has allowed her elementary school students to experiment with programmable robots. She says, “Where is Botley? Are we going to play with Botley? These are the questions I get at least twice a week since I introduced Botley to my students three weeks ago! Kindergartners and first graders are so excited to learn and they love how cute Botley is. They are slowly learning not only what Botley can do, but how to code so that Botley can do what they tell him to do. For students who come from economically disadvantaged areas, our students aren’t exposed to all of the things that their more advantaged peers are. Botley is able to bring a much-needed to skill to our students. What I love about Botley is that students are learning that their input can alter what Botley does. This is much like real life, in that individual actions or input can have an impact on what someone else does! Thank you again for believing in our students enough to fund this wonderful project.”


This is my kind of investigative journalism. Business Insider ponders why healthcare startups such as Oscar Health, Flatiron Health, and One Medical use similar fonts in their marketing materials. The first two companies use Tiempos (pictured above), created in 2010 for a Spanish newspaper to be easily readable on newsprint. A company designer says the font is “warm and human, without being overly cute or friendly.” One Medical’s rebrand included retooling the colors closer to British racing green and moving to a customized font called GT Super, which also has print newspaper roots. The company liked that font because sans serif fonts like Helvetica can feel robotic and impersonal. Half of me wants to declare this to be total BS and a job protection act for otherwise marginally employable marketing people, but I have to admit that I subconsciously form feelings about companies based on stuff like this, no different than reacting to a person’s appearance or manner of speaking.


Louisville-based Freedom Medical Labs, which got caught sending employees in unmarked vans to poor neighborhoods where they offered $20 to collect DNA samples along with the person’s health information, shuts down. The company blames negative publicity, but insists that its activities were legal, voluntary, and covered by the insurance of those who were testing. Several companies offer cancer genetic testing when doctors attest that it is medical necessary, and I’m guessing it’s not hard to recruit doctors if you are willing and able to pay them richly. One national company (Medvantage Consulting, above) markets the tests to people with insurance and a family cancer history and pays 15% of the $6,000 to $8,000 to anyone who brings in billable candidates.


This is, unfortunately, medicine in America. DEA agents escort a handcuffed cardiologist Andrew Rudin, MD from the hospital that hired him just three months ago, he being one of the dozens of doctors that were arrested last week for opioid distribution. The charges involve his previous job in Tennessee, where he supervised (or didn’t, according to the DEA) a nurse practitioner who called himself “Rock Doc” in hoping to land a reality TV gig. He paid Rudin to supervise his practice (cosmetics, weight loss, platelet-rich plasma, and anti-aging), from which Rock Doc traded opioid prescriptions for cash and sex. The cardiologist is highly credentialed and accomplished, so it would be interesting to study the psychology that led him from developing ablation procedures to being hauled away in handcuffs.

Vancouver-based opioid specialist Mark Tyndall, MD, ScD – who sets up safe spaces where addicts can shoot up under supervision – is working with a tech company to develop a vending machine that can dispense prescribed opioids with recipients verified by a palm vein scan. He says the US response to the drug epidemic has been to ramp up arrests and border security, while Canada’s goal is harm reduction in keeping users alive instead of trying shut off their access to drugs.

Lime, one of the startups (were all the good ideas taken?) that is trying to push trendy rentable electronic scooters that seem to have high potential for disrupting both vehicular and pedestrian traffic until they are abandoned dysfunctional or broken, will add sensors that will slow the scooter down if the driver seems drunk. I don’t really get the appeal or understand why cities allow the services to operate, but if you care, Lime charges $1 to unlock a scooter via its app and then $0.15 per minute to ride while looking like an insufferable hipster who has freshly graduated from a skateboard and can’t bear to actually put one foot in front of another while staring into a phone.


A 25-year-old woman being discharged from University of New Mexico Hospital steals an ambulance on her way out, crashes it into a pole, and then hops into the gurney in the back to pretend that she is a patient. She explained to the arresting officers that she was just looking for heroin, then claimed that the crash injured her, whereupon she once again became a UNM patient.

In Case You Missed It

Get Involved



Morning Headlines 4/19/19

April 18, 2019 Headlines No Comments

IBM cutting Watson for Drug Discovery

IBM halts sales of Watson for Drug Discovery due to low demand.

Elizabeth Holmes’ Failed Theranos Was Just Granted 5 New Patents In 2019

CB Insights reports failed blood-testing company Theranos was awarded five new patents in March and April, all filed between 2015 and 2016.

Northwell Health opens Emergency Telepsychiatry Hub, reducing ER wait times

Northwell Health (NY) opens an Emergency Telepsychiatry Hub to serve EDs in New York City, Long Island, and Westchester County.

News 4/19/19

April 18, 2019 News 3 Comments

Top News


IBM halts sales of Watson for Drug Discovery due to low demand.

The company says it will intensify its focus on clinical development. 

The Watson for Drug Discovery web page is still active, including testimonials from Barrow Neurological Institute.


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

Acquisitions, Funding, Business, and Stock


Healthcare data integration vendor Redox raises $33 million in a Series C funding round. It has raised $50 million since launching five years ago.


EMV Capital acquires San Francisco-based Wanda, a clinical decision support company focused on preventing adverse events.


After merging last year, healthcare consulting firms HealthInsight and Qualis Health rebrand to Comagine Health. HealthInsight CEO Marc Bennett has assumed leadership of the new company.


The Theranos saga just won’t go away. CB Insights reports the company was awarded five new patents in March and April, all filed between 2015 and 2016. Theranos founder Elizabeth Holmes, meanwhile, is preparing for her day in court. Charged with several counts of wire fraud and conspiracy to commit wire fraud, she has filed a motion in federal court to to force prosecutors to hand over thousands of communication records between the FDA, CMS, and Wall Street Journal reporter John Carreyrou, whose reporting helped bring the company’s fraudulent activities to light. A trial date has not been set, given the 17 million documents federal prosecutors must sift through to build their case.



Tom Niehaus (TJN Advisory) rejoins CTG as EVP of North American operations.


White River Health System (AR) promotes Jeff Reifsteck to AVP/CIO.


EarlySense names Matt Johnson (Sowell & Co.) as CEO.


Robert Fosmire (Kareo) joins Greenway Health as SVP of customer success.


  • Sentara Healthcare (VA) selects PACS software from Mach7 Technologies.
  • Prisma Health (SC) will implement patient access and provider directory technology from Kyruus.

Announcements and Implementations


After more than a year of training led by a core team of 20, Carris Health (MN) will go live on Epic at six facilities next month.


Best Buy begins offering TytoCare’s at-home telemedicine kit online and at select stores in Minnesota. The TytoHome kit retails for $300 plus the cost of a virtual visit with partners that include American Well, LiveHealth Online, and Sanford Health.


In New York, Northwell Health opens an Emergency Telepsychiatry Hub to serve EDs in New York City, Long Island, and Westchester County. The hub’s 35-member team expects to conduct 5,000 consultations this year.


A new KLAS report on enterprise resource planning systems  (HR, finance, and supply chain) finds that cloud-based systems are attractive and organizations are willing to consider them even if it means replacing their incumbent vendor. Workday leads the field despite gaps in supply chain functionality. Infor and Oracle offer newer, lower-rated products; earn client criticism for not taking an active lead during implementation; and have a significant percentage of customers who say they wouldn’t buy those products again. 

Government and Politics


In England, the NHS develops the National Events Management Service, a digital personal health record for children that parents may use in place of the traditional paper version they are expected to bring with them to all pediatric appointments. The new service also features real-time messaging capabilities for birth notifications, address changes, and change-of-practice notifications.


An ONC data dive into the ways in which hospitals used their EHR data between 2015 and 2017 finds:

  • A hospital’s use of EHR data varied significantly by vendor; Epic, Meditech, and Cerner users had the highest rates of data utilization to inform clinical practice
  • Small, rural, critical access, state and local government, and non-teaching hospitals had the lowest rates of EHR data utilization
  • Hospitals most frequently use EHR data to support quality improvement efforts, monitor patient safety, and analyze organizational performance
  • Utilization of EHR data slowed significantly (in some cases stalling completely) between 2016 and 2017

Privacy and Security


The communications director at Northern Light’s Acadia Hospital in Maine mistakenly emails a spreadsheet containing the names of 300 patients with Suboxone prescriptions and those of their providers to a reporter at the Bangor Daily News. The spreadsheet was an attachment buried in a chain of emails between the hospital employee and the reporter, who was developing a story on the the availability of Suboxone – a drug given to patients battling opioid addiction – in the Bangor region. The hospital’s privacy lapse has, ironically, made the paper’s pages.



Columbia University (NY) reminds medical staff of the importance of its upcoming transition to Epic, which will encompass converting aging systems to the new or upgraded Epic software across Columbia, Weill Cornell Medicine, and NewYork-Presbyterian facilities. “We knew staying the course was not an option,” said Jack Cioffi, MD, president of ColumbiaDoctors and an executive sponsor of the EpicTogether project. “The pain points we feel now with CROWN and SCM will fade with Epic. That’s not to say we won’t experience new ones these next nine months, but we will be able to better address and fix them. We will have a more efficient, comprehensive system to support us in delivering the best care possible.” Rolling go-lives will take place between 2020 and 2022.

Sponsor Updates

  • Elsevier’s new Transition to Practice platform helps retain newly licensed nurses and build their confidence and satisfaction.
  • EClinicalWorks and Imat Solutions will exhibit at the NAACOS Spring 2019 Conference April 24-26 in Baltimore.
  • Imprivata and Kyruus will exhibit at NAHAM April 23-26 in Orlando.
  • Solutions Review interviews InterSystems Director of Product Management Jeff Fried.
  • Ivenix publishes a new white paper, “Exploring Real-World Performance of IV Pumps.”
  • Vocera receives an Authority to Operate from the DoD, extending the potential purchase and deployment of its Vocera Badge to facilities in the Air Force and Navy.
  • Phynd Technologies migrates its Provider 360° platform to AWS, has partnered with the American Board of Medical Specialties, and joined the Drupal Association.

Blog Posts



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


EPtalk by Dr. Jayne 4/18/19

April 18, 2019 Dr. Jayne No Comments

The largest US health insurer, UnitedHealth Group, has added its critique to the Medicare for All proposals currently being debated in Congress. We’re going to hear about this for the next year and a half, at least through the next presidential election, so I’m not surprised they’re putting their two cents in.

Medicare covers approximately 60 million people and UnitedHealth’s products cover nearly 50 million, so they conclude that Medicare for All would cause “wholesale disruption of American healthcare.” I’d like to remind the CEO making the statement that there’s more to the Americas than the US and we should be looking at many nations’ healthcare systems as we try to find a way out of our own mess. UnitedHealth posted revenues of $226.2 billion last year through insurance, physician practices, consulting, and pharmacy benefits operations. Medicare for All, or any universal coverage, plan would likely take a bite out of those revenues.

In the patient care trenches, I have a bird’s-eye view of the issues caused by employer-based health insurance. Patients staying at jobs they hate where they are abused because they are afraid of losing health coverage, particularly for pre-existing conditions? Check. Patients with complex medical conditions staying in abusive relationships because the spouse holds the coverage and they can’t afford it on their own? Check. Patients suddenly losing coverage due to downsizing, and not being able to afford individual plans? Check.

I saw all three of these this week. A discussion of the cost of care was part of the urgent care visit. Members of Congress need to walk a mile or two in their constituents’ shoes before making decisions on this complicated issue. Even the concept of Medicare for All means many different things depending on whose proposal you are looking at.


Mr. H asked recently for comments on “Health System IT Providers vs. Would-Be Disruptors: Unfairly Dismissive or Appropriately Skeptical of Outsiders” and I wanted to throw in my two cents’ worth based on a recent client project. It’s not only the outside disruptors who that make those of us in the IT trenches skeptical. It’s also the other outsiders that our organizations bring in, because either they feel that input from another industry would be useful, or that as one director told me, “You don’t have to know healthcare to manage IT systems in healthcare.”

That’s how I found myself sitting across a conference table from a “lab interface team” who was supposed to be helping create some custom orders management content for a boutique practice. As we were in the Motor City, it seemed that my team was entirely populated by former auto industry programmers and technicians. Confident in their ability to use algorithms to free the physicians from mundane data management, they had designed a flow for laboratory orders and results management and wanted my sign-off.

Unfortunately, they had no idea of how laboratory flags work or any concept that a lab that is technically abnormal might be perfectly fine for a given patient, or that one that is normal range might be bad for a given patient. The idea that results need to be interpreted in context not just based on normal vs. abnormal was a new one to this team, which appeared hastily thrown together by the hospital, which had acquired said boutique practice without really thinking it through.

Did I mention that they also didn’t know their OBR from their OBX from the proverbial hole in the ground? The look in their eyes at having a physician school them on the nuances of being an actual lab interface team was priceless. I left the meeting suggesting that perhaps they should learn something about HL7 capabilities and scheduled a discussion with their director about the team’s ability to actually get this project done on any kind of useful timeline.

I don’t doubt that non-healthcare people can learn and become healthcare people, but you have to at least understand the problem and the business case before you try to create a technology solution. I’ll be earning my money with these folks, for sure.

From Jimmy the Greek: “RE: Hide the women and their uteri….” Jimmy shared a Washington Post article covering health-monitoring app Ovia, which sells intensely personal (although de-identified) data to employers that include the app in company benefits packages. We all know how easy it is to re-identify that data, so it caught my attention. The app collects information on user mood, bodily functions, sexual activity, and ultimately labor and delivery. The article mentions a woman who was using the app in the delivery room to upload data. Were I not a hypothetically swinging single, perpetually 29-year-old clinical informaticist, using an app when I should have been contemplating the perfectness of my baby and his amazing existence would be appalling.

Employers can see aggregated data on health risks, question searches, finances, and return-to-work plans. Depending on the size of the company it might be easy to figure out exactly what employees are documenting. Users are also exposed to targeted advertising for dubious products, including nutritional supplements and special cleaning products. Privacy experts are worried that employers could modify benefits based on projected costs or that discrimination may occur against women seeking pregnancy. Not to mention that some coercion may be involved when companies pay workers to use the app as mentioned in the article.

As someone who previously provided maternity care and delivered over 150 babies, I’m also concerned at the psychological ramifications of this level of tracking in pregnancy. It’s a scary enough time for mothers without having their every move quantified. There is one popular pregnancy guide out there that I actually recommended the mothers under my care should avoid. It included recommendations that shamed mothers who weren’t baking their own whole-grain muffins and said that pregnant women shouldn’t use microwave ovens because of unknown risks to their babies. The so-called “femtech” market is apparently big business, slated to hit $50 billion by 2025.

The Ovia terms of use give the company a “royalty-free, perpetual, and irrevocable license, throughout the universe” to clearly use information for marketing however they see fit. They can also sell the data to third parties and I doubt many of the users actually review the 6,000-word disclosure.

Ovia also claims reductions in premature births and other outcomes, but the data is from an internal return on investment calculator rather than from appropriately constructed peer-reviewed studies. The company makes no secret that it’s delivering content that helps reduce medical costs and encourages women back to the workplace. While researchers are tempted by the availability of large data sets, they’re concerned about the applicability of the data to actual research.

The article mentioned a number of other women’s health apps, including period trackers and fertility trackers. I must admit I was woefully unaware of the size of that market segment. I’d like to see women be better educated about their bodies, but I hate to see some of these apps positioning themselves as something to help “demystify” normal biological processes.

If you had a daughter, would you encourage or discourage her from using apps like these? Would you use them yourself? Leave a comment or email me.


Email Dr. Jayne.

Morning Headlines 4/18/19

April 17, 2019 Headlines No Comments

Acting as the data integrator between hospitals and digital health apps brings Redox $33 million

Health data integration vendor Redox raises $33 million, bringing its total funding to $50 million since launching five years ago.

Theranos’ Holmes seeks records on reporter’s communications with FDA, CMS

Elizabeth Holmes files a motion in federal court to force prosecutors to hand over thousands of communication records between the FDA, CMS, and Wall Street Journal reporter John Carreyrou.

EMV Capital Completes the Acquisition of Wanda INC, a Leading Telehealth Company in Silicon Valley

EMV Capital acquires San Francisco-based Wanda, a clinical decision support company focused on preventing adverse events.

Health Care Industry Leaders, Qualis Health and HealthInsight, Become Comagine Health

After merging last year, healthcare consulting firms HealthInsight and Qualis Health rebrand to Comagine Health.

Readers Write: Uniting the Full Continuum of Care for the Individual: Why Digital Technologies Must Embrace Holistic Patient Engagement

April 17, 2019 Readers Write No Comments

Uniting the Full Continuum of Care for the Individual: Why Digital Technologies Must Embrace Holistic Patient Engagement
By Mary Kay Thalken, RN, MBA


Mary Kay Thalken, RN, MBA is chief clinical officer of Ensocare of Omaha, NE.

More than half of healthcare professionals believe digitization is transforming the healthcare industry. Of adults 55+, 85% believe technology will improve healthcare in the next five years by delivering faster and more accurate diagnoses, curing diseases, and predicting and preventing diseases and conditions before they happen. However, 35% of seniors feel their health plans do not use any technology to improve access, information, or care, and they want more tech-enabled solutions.

Though the first two survey findings from 2017-2018 are encouraging, the third speaks loudly to this need: payer organizations as well as provider organizations must examine what is lagging in their technology offerings to better serve our biggest generation of people spanning the birth years of 1946 to 1964. From politics to fiscal projections, it’s reasonable to predict that Baby Boomers will have an outsized influence on the healthcare technology landscape for years to come.

The projected growth of this population has also caught the eye of Washington. In March, the US Task Force on Research and Development for Technology to Support Aging Adults and the Committee on Technology of the Science & Technology Council released the “Emerging Technologies to Support an Aging Population Report.” It identified six primary functional capabilities as being critical to individuals who wish to maintain their independence as they age and for which technology may have a positive impact:

  • Key activities of independent living
  • Cognition
  • Communication and social connectivity
  • Personal mobility
  • Transportation
  • Access to healthcare

Unquestionably, digitization is penetrating healthcare, including the burgeoning post-acute acute marketplace. In my role, I converse with leaders reshaping the patient’s continuing health recovery, from discharge to home health and hospice centers, skilled nursing facilities, rehab facilities, long-term care hospitals, or home. As a former nurse and provider business executive, it’s an exciting time to work in innovation on behalf of end users and patients who will benefit from enabling technology that unites the full continuum of care.

Why holistic patient engagement matters

Still, national survey results that look at the opinions of the senior population are a serious wake-up call, warning us all that a lot more work must be done – particularly in the critical area of patient engagement.

Granted it seems marginally small that only 35% of seniors think their health plans do not use technology to improve access, information, or care and have a desire for more tech solutions. Now consider this survey result in the context of the aging boomer population and their share of national health expenditures, which is expected to reach $6 trillion in less than 10 years. This powerful moment of clarity challenges the status quo, moving us forward in making tech-enabled patient engagement for adults 55+ a top priority.

Connecting digital technologies to the patient starts with a holistic view of that person’s entire care engagement experience. Subsequently, to unify the patient’s entire care experience through the use of technologies, we must zero in on what’s important to that person in terms of social determinants of health at every touch point. In short, we must create a tech-enabled, personalized experience specific to each patient’s individualized care and other needs, starting from within the hospital to discharge post-acute care facility or home.

The patient’s recovery or chronic care journey doesn’t stop there. Providers can address and integrate comprehensively the needs of patients who are spending more time outside instead of inside the brick-and-mortar walls of the hospital. We can effectively manage those patients — coordinate, personalize, individualize, and enrich their care alias tying all the disparate pieces together — to improve overall their experience, the goal of wellness, and outcomes.

Recommended best practices

On October 2, 2018, 48 health IT leaders from provider and vendor organizations gathered outside of Salt Lake City for one day to collaborate with KLAS Research. Participants developed a framework of key patient engagement initiatives and took part in discussions about best practices either observed or used. The following is those most often cited successful practices focused on the individual that healthcare organizations can use as a planning tool.


  • Create easy-to-use apps
  • Create cloud-based software solutions
  • Adopt telehealth capabilities


  • Gather and analyze social determinants of health
  • Gather and analyze behavioral habits (travel patterns, transportation)

Convenient Care

  • Enable 24/7 access to care team
  • Enable communication with care team (text, email, phone, video)
  • Enable communication with patient (text, email, phone, video)
  • Enable families to communicate with care team (text, email, phone, video)
  • Allow patients to choose how they want to communicate

Right Care Setting

  • Direct patients to the appropriate care setting (nurse practitioner, urgent care, or primary care physician)
  • Let patients go to the care setting at which they will be best served
  • Bring the right care to the patient (24-hour nurse line, telehealth)

Personalized Care

  • Provide patient education and personalized discharge instructions
  • Assign health buddy or care manager to patients as they leave
  • Include patients in the process of setting goals and choosing interventions
  • Enable physicians and nurses to engage with patient during the encounter
  • Incent patients to participate in wellness activities and make healthy lifestyle choices

Provider Organization

  • Develop a patient engagement vision and road map
  • Adopt effective change management when implementing patient engagement strategies

Our industry is facing a colossal transformation over the next 30 years as value-based healthcare solidifies and Baby Boomers dominate the use of healthcare services. Despite their collective differences and perceptions, multi-generations—including the largest groups, the Boomers, Generation X, Millennials and Generation Z—working together creates the potential for creativity, community, coordination, and optimization of enabling technology solutions to enhance quality of life.

No doubt about it, a seismic shift to management and engagement of individuals is underway. To not prepare begets gaps in care that lead to poor outcomes and tremendous waste and spending.

Health System IT Professionals vs. Would-Be Disruptors: Unfairly Dismissive or Appropriately Skeptical of Outsiders?

April 17, 2019 News 2 Comments

I asked provider IT professionals to weigh in on this question, whose genesis was an outsider’s assessment via an HIStalk comment: do we health system IT people automatically dismiss potentially disruptive technologies (such as AI) because we are too entrenched or too well rewarded by the status quo?

The edited responses are below. Thanks to those who offered their excellent insights.

Outsiders have trouble with understanding the speed at which physicians want to move. They are one of few occupations still paid by the piece, not by the hour or a salary. Every second they are waiting for information to populate on a screen, the screen to flip, or the log-in sequence is a lot of money to them. Until you have a database faster than MUMPS, don’t waste my time. For that reason alone, blockchain is a non-starter.

I’ve been involved in minimally transformative ideas and projects that are shot down due to the (over) regulatory environment. A lot of industries are heavily regulated (airlines and nuclear power come to mind), but their regulations are generally around safety. In healthcare, the regulations are around both safety and the prevention of entities over-profiting (Stark). Sometimes these regulations contradict each other and the outsider only understands some of them.

I believe any technology that puts information and decision-making into the hands of the patient has the potential to be disruptive. This will not be a get-rich-quick application, Most people requiring our services are older and even less receptive to change than outsiders would perceive us to be.

They are correct. We actually look to see if incentives are aligned, like everyone else. We rapidly adopted pagers, cell phones, MRIs, and stem cell treatment when we were paid for it or it makes our lives easier. We didn’t rapidly adopt EMRs or other IT solutions when they made our lives harder and cost us money. The issue is not doing something new, it’s doing something reasonable. Make sure incentives are aligned with realistic business models before introducing anything new. One of my favorite quotes: “Incentives matter, whether you think they do or not.”

I think we probably are resistant to AI, but not solely because of incentives. There’s too much vaporware out there and it takes a lot of time to weed through the good and bad, with the good often being no better than the best systems already provide at the added cost of an AI system and/or of nominal value. If they want to blame someone, blame IBM, who taught us that you need to spend a year training your commercial software only to have it continue to provide inaccurate info. To be fair, it is providers that control the data that makes AI training work and our reluctance to share is probably an issue. On the other hand, Google did manage to wrestle millions of records away from the NHS and they still have nothing to show for it.

It’s the pot calling the kettle black. Everyone wants into the healthcare cash cow, but no one wants skin in the game when it comes to actual outcomes, and that includes providers.

Take a look at the technology adoption lifecycle. We’re still in the innovator phase and they’re not yet screaming from the rooftops to get on board. Technology adoption takes 10-20 years, even for consumer products (many of which in recent years had the benefit of being “free”). Why should they be expecting instant results?

We’re dragging our feet on AI when it comes to digital imaging so we don’t tick off providers. We provide a lot of exceptions where it may not work, yet we don’t fire the entire medical community when we have a misdiagnosis rate of 10%.

What disruptors don’t understand is that their solutions are typically unaffordable in the long term for health systems that like to spend more money building buildings than they do to support their existing IT infrastructure. The new shiny object may get some attention and might even get an executive to bite, but at the end of the day, it falls on IT to implement, support, and maintain that disruptive solution over time, all while our budgets shrink due to “cost controls.” The disruptors must demonstrate real-world (not hypothetical) ROI and in reality be at minimum a budget-neutral solution in order for us to take them seriously.

Treating people, while doing no harm, is an art in addition to science. Humans are not machines made to exacting specs that benefit solely from repeatable process. The chance of patient harm or malpractice is real with bleeding edge technology.

Everyone I know on the health IT side is very aware of our limitations and looking for any way we can help out the providers. AI/ML, although promising, so far has limited proven use cases. That, coupled with a very high barrier to entry due to the skills required, means that AI/ML often gets lumped into the “maybe, if we have money left over” part of the budget. Not a lot of healthcare organizations ever get to make it to funding that portion of the budget. Trust me, if you proved your ML model could improve clinical care and/or save lots of money, organizations would adopt it in a heartbeat. If you haven’t proven its value, then why would you expect us to adopt it?

Honestly, it sounds like a comment from someone who runs an ML-centric company and can’t find a partner to provide the training for their model. That’s a risk and investment for the healthcare organization, and typically the vendor gets most of the benefit if it works even though they tapped the provider’s knowledge and training to make the product. If you really want us to do that, show up with a fully-funded project, including our expenses, and we’ll consider it if you give us partial ownership of the successful project. At this stage of the game, that’s the only deal that makes sense.

You can kill people with the wrong tech, bad tech, or badly-implemented tech. As a clinician who supported clinical decision support, it is easy to talk it, but harder to prevent the medical misadventures that may happen to said Heath IT Outsider’s child.

Speaking as a provider who works in the vendor space, we prefer to wait and see what works in other industries before taking a risk and sinking big development dollars into expensive new solutions. Exhibit A: cloud computing, which went mainstream with Amazon Web Services in 2006, but only in the last few years have we seen this model take off in our industry with web-hosted EHRs. That’s why we’re always 15 years behind. None of the established players wants to spend $500m to develop a buzzword concept (remember “big data”?) that will fold or go out of fashion next year.

Next time you are sick, open your AI program get a diagnosis, prescription, and any blood tests. There is a place in healthcare for AI, but it is not replacing trained medical professionals

I’m guessing that comment came from a former Elizabeth Holmes devotee. Health IT outsiders have a long history of declaring the US health system stupid, launching a startup, then quietly giving up a year later. If our outsider had any real ideas, they’d have products in the marketplace making money. Optum, Health Catalyst, Arcadia, and many more aren’t waiting around for provider permission. They are innovating, pushing the quality-cost envelope, and growing. I don’t know if AI will truly move the needle positively in healthcare any time soon, but I’d have to hear a great conspiracy theory to believe provider IT people are protecting their EHR vendor from AI, open APIs, or any other technologies that would make the customers happier and their jobs more fulfilling.

As a health system CIO, Individuals who are flabbergasted by the risk-averse nature of the healthcare industry as a whole do not fully understand nor appreciate the current healthcare system business model. It has a customer (patient) market that is shrinking. It is becoming more segmented, with alternative specialized scope limited services. The net revenue opportunity per patient is shrinking as operating costs (especially labor and regulatory related) continue to increase.

Entrepreneurs by their very nature take financial risks if they see an opportunity for a high financial return when no one else does. There is a ton of cash flow within the healthcare industry, but no new opportunities for significant cash infusion The customers (patients) do not have any opportunity to shift their spending from one source to another. The industry players are protecting their revenue stream as best they can. Most healthcare providers and hospitals do not have an entrepreneurial spirit, nor do they have the financial reserves to take on the financial risks.

It is also important to note that the financial industry and venture capitalists do not invest in healthcare providers nor hospitals. The risk is just too high for no foreseeable reward. Thus, it is not surprising at all to me that “health IT outsiders” looking to be disruptors are disappointed when they are not embraced with open arms. I predict that someday there will be disruptors who will change the business model itself with a better SYSTEM of mousetraps rather than just one highly effective mousetrap.

I don’t see provider IT people as being entrenched or particularly well rewarded. Rather, we insiders are pragmatic. Too often we’ve been sucked in by the breathless exuberance of the purveyor of the next big thing that will revolutionize healthcare, only to realize that it’s not nearly what it’s cracked up to be. Or worse, we take the blame for it not turning out to be what it was purported to be.

Technology is evolutionary, not revolutionary. Incremental advances by potentially disruptive technologies – once field tested – make their way into the mainstream. Let’s not forget that a mere 15 years ago, EHRs seemed revolutionary.

Look at FHIR. The bright shiny object du jour which will solve all problems in the delivery of healthcare. Will this technology magically address every issue? Absolutely not. Or will it even address any of the issues better than some long-existing technology? I’m on the fence. Is FHIR really even disruptive? Nope. Interfaces have been around since there was more than one computer. But by being a pragmatist and viewing FHIR as an incremental improvement, I get painted as a curmudgeon.

I think there is an extreme sense of being jaded from a long list of previous failures. People often don’t understand the complexities of healthcare, the countless variations, the messy data, the fickle users mixed with the extreme regulations of privacy and billing. Add all of that to hospital bureaucracy, understaffed IT departments, and low-salaried (and therefore often mediocre) IT staff and you have more sub-optimal systems than you can count.

Healthcare doesn’t operate financially as other industries. I’ve spent the majority of my career in community hospitals and it is difficult for them to sink money into disruptive technologies when you’re payer mix is 40-60% government. We would love to invest in disruptive technologies, but when replacing an EMR originally installed in the mid-90’s causes a financial burden, what’s a girl to do?

What’s the evidence of benefit to (a) patients and their caregivers first; (b) physicians, nurses, and other bedside technical caregivers second; and (c) then everyone else? As a 40+ year emergency physician and 20+ year medical informaticist, let’s see the evidence that AI and other disruptive technologies deal with the chaos of patient variability and sensitivity to initial conditions better than the competent, compassionate physician.

This is healthcare. Ultimately, people’s live are literally on the line. There is no room for alpha or even beta level products in a production environment. If AI can do my job and help save lives, so be it. But that is not now and it is not anytime soon.

The workplace dynamics of provider-based healthcare are different than any other industry. Who is the customer? Is it the patient, doctor, nurse, CFO, payer, government, or someone else? Or all of the above?  Outsiders have not not been able to solve that riddle yet, although things may be changing with consumerism on the rise.

Also, in my long experience as a CIO (25+ years), it is rarely the CIO who calls the shots. Hospital CEOs are notoriously risk averse with a huge herd mentality when it comes to IT. The history of the industry is littered with multiple failures of so-called IT solutions. In addition, CFOs control the purse strings, and if they do not control IT, are out to hamstring it.

I have seen several outside CIOs try to “fix healthcare” and they have all failed to recognize the unique cultural characteristics.

I’m not worried about protecting my paycheck. There are always positions available in my particular medical specialty and my current income isn’t that great anyway. What I am worried about are the costs and potential negative consequences of inadequately designed and tested “disruptive technology.”

Healthcare technology is not like trying a bunch of free or cheap apps on your personal IPhone to see if any generate major or disruptive improvements. Instead, with healthcare technology, there are significant upfront costs (often with no guarantees of benefit or acceptance), significant personnel costs for installation and training, significant changes to workflow, and potential for unintended consequences, including inefficiencies, lost revenue, and actual harm to patients if it doesn’t work correctly. Indeed, I’d be concerned that anyone who jumps on the bandwagon too quickly is impulsive and reckless.

Add to that all of the half-baked snow jobs that we’ve been sold over the years and it’s no wonder that HIT providers (and users) are cautious and skeptical.

I welcome the challenge, but I am more often than not faced with those who do not want to accept that they don’t know the extent of what they DO NOT KNOW about the unique specifications of the industry. If only the industry was established in the status quo. Most who make such proclamations dismiss the history to the why and how we are where we are. Case in point — the Jim Cramer declaration and folks like Chrissy Farr who just pass along without doing the basic journalistic research on Epic. If they came about it with some sort of due diligence, it might be a different story.


Morning Headlines 4/17/19

April 16, 2019 Headlines No Comments

Activist investor Jeff Smith: There is a ‘huge’ value opportunity in Cerner

Starboard Value CEO Jeff Smith believes Cerner can increase its operating margins by as much as 9% within the next 18 months if it meets unspecified targets.

In African Villages, These Phones Become Ultrasound Scanners

The FDA-approved Butterfly IQ device transforms a smartphone into an ultrasound scanner, a capability that is having a huge impact on pubic health efforts in Africa.

Advocates battle over health record consent change

Politicians struggle with the privacy and legal issues over changing patient participation in the HIE operated by Vermont Information Technology Leaders from opt-in to opt-out, which VITL says is needed because low participation has caused low HIE usage.

Clearlake-Backed symplr Acquires IntelliSoft

Provider management, credentialing, and payer enrollment technology vendor Symplr acquires competitor IntelliSoft.

Ro, a direct-to-consumer online pharmacy, reaches $500M valuation

Direct-to-consumer telemedicine company Ro raises $85 million, prompting VCs to increase its valuation to $500 million.

News 4/17/19

April 16, 2019 News 6 Comments

Top News


The New York Times reviews the use of an IPhone-powered whole-body ultrasound scanner in Uganda and other developing nations. The $2,000, US-made device addresses the issue that two-thirds of the world’s population gets no imaging at all due to cost, geography, and machine availability.

The sign that the device is real – it has earned FDA’s marketing clearance. The sign that it works disruptively for public health – one of the company’s backers is the Bill and Melinda Gates Foundation, which unerringly funds projects that deliver the biggest bang for the global buck.

It’s a beautifully written and photographed article.


The tap-and-swipe Butterfly IQ device offers 18 presets for images such as cardiac and deep abdomen. It stores data in Butterfly Cloud to offer HIPAA-compliant image sharing with patients and peers.


The inventor is DNA sequencing pioneer and Yale School of Medicine genetics professor Jonathan Rothberg, PhD, who I hereby elevate to the top of my “most interesting people in health IT” list (and that’s a short list).

Reader Comments

From OOB?: “Re: Epic and Cerner. This article says they’ll be out of business within 10 years because their EHR technology is outdated.” That’s just attention-seeking silliness since surely nobody who has any connection to health IT could be that uninformed. I’ll offer just three of the many dozens of counterpoints that come immediately to mind:

  • Seeing Epic and Cerner as offering just “EHRs” – which is an awful and misleading term in the first place – is marking yourself as a clueless technology fanboy who has never worked a day in hospital IT. Their systems run every hospital department and service, including non-clinical ones, and then roll the vast amount of information up into a single database for operational management, reporting, patient access, etc. With what, exactly, would they replace all those systems, which are integrated with every kind of clinical device made?
  • It would take even a tech giant probably five years and $1 billion to develop a competing system assuming they could recruit the right subject matter experts, and given the maze of governmental, regulatory, financial, and clinical minefields to be navigated, no publicly traded company would devote the resources to get Version 0.1 into testing, much less find buyers among conservative health systems who have little interest in bearing the beta testing pain. Even Microsoft and Google couldn’t give away their crappy consumer-targeted personal health records and ended up shutting them down, so don’t expect them run off and responsibly build a laboratory information system or IV barcode scanning.
  • No tech company is working on anything at this scale. They might try to cherry-pick a few seemingly easy targets, but they aren’t hiring armies of people who know how healthcare works to help them design a system that would actually function beyond offering sexy screens. You cannot build healthcare software with 23-year-olds sitting in a Silicon Valley and slinging rad code in between company-provided foosball and beer pong.

From Dignity Defined: “Re: Cerner. Do you you see them cutting back?” All vendors whose sales were goosed by Meaningful Use (note to self – that would be a fun song title) are already cutting back in various ways and will continue to do so. I asked the question publicly when Meaningful Use first came into play of how vendors who geared up for a competitive battle of a fixed duration would gracefully downsize once the feed trough had been licked dry. Nobody could look past the boom years. Hospitals and practices will continue to buy products that provide ROI (why wouldn’t they?) but now that government’s contribution to the equation has been eliminated, software and services will have to pay their own way, which will likely involve lower prices, more tangible short-term benefits, and recurring costs that align with the benefits delivered. Cerner, Epic, and Meditech have won the hospital core IT system wars and the independent ambulatory market seems to be consolidating pretty quickly, so the ripple effects will be seen every aspect of health IT, especially consulting. Cerner is particularly vulnerable because it is publicly traded and has underperformed despite winning billions in federal government business, so in the absence of a fiery, singularly-focused co-founder at the helm, it must now redirect its attention to Wall Street type (although it’s been doing that for years, just to a lesser degree). Note that Cerner Millennium and maybe Cerner itself would not exist today if Neal Patterson hadn’t told 1990s investors that it would take a lot of years and money to create a new hospital IT architecture and they would just have to suck it up until it was done.

From Pistolero: Re: clinical decision support to detect questionably beneficial orders. Why isn’t it more widely used?” I would say:

  • Some and maybe most doctors don’t necessarily think minimum-necessary when ordering – they think more along the lines of, it can’t hurt to get more information while we’re drawing blood anyway
  • But it can hurt – the descent into the medical misadventure maelstrom often starts with a pointless test whose value must be conformed to normal range by aggressive therapy that is unlikely to improve and may in fact worsen a patient’s outcomes as armies of uncoordinated niche experts ply their trade aggressively
  • Doctors are trained around the paradigm of every patient being unique, and given that they see only their own small number of patients, they don’t always see the big health picture in which their patient is one data point in a see of historical information that, along with the N-of-one experience, will determine likely outcomes
  • Even questionably beneficial orders are profitable as long as insurers continue paying for them

HIStalk Announcements and Requests

I use AP Stylebook standards about 99% of the time when writing HIStalk (big exceptions – I always use an Oxford comma and I use post office state abbreviations, in both cases feeling as though AP is way off base in mandating a less-readable form). You probably didn’t notice that I started writing “99%” this week instead of “99 percent” because they just changed their standard. Today I learned from them that “farther” refers to physical distance, while “further” is an extension of time, so now I can obsess about that. Thank goodness they don’t use “everyday” incorrectly (as “I brush my teeth everyday,” which drives me crazy) or incorrectly capitalize a noun that isn’t used as a title (“I sent my Mom a present,” which is wrong). I admit that I’m sadly out of touch in believing that you show respect to those who listen or read what you have to say by following the grammatical rules of the road as best you can, although I’m offended only by obvious indifference usually encouraged by text messaging and posting Facebook nonsense.


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

Acquisitions, Funding, Business, and Stock

Interoperability platform vendor Bridge Connector raises $10 million, increasing its total to $20 million.

HM Health Solutions, a 3,200-employee insurance-focused IT vendor owned by Pennsylvania-based insurer Highmark, lays off 239 employees. 

London-based Medbelle raises $7 million to create what it calls a “digital hospital” that sounds more like an online marketplace for cosmetic and weight loss surgery practices that also includes a care coordination platform.


  • Jefferson Health chooses Prepared Health as its digital technology partner for connecting its 14 hospitals to post-acute, home care, and social determinants of health providers for coordination of hospital-to-home care transitions.
  • Fullerton Health, which owns 500 medical facilities in the Asia Pacific region, hires Health Catalyst to assess its data analytics potential. 



Denis Zerr (Catholic Health Initiatives) joins Radiology Partners as CIO.


Change Healthcare promotes Dan Mowery to VP of channel partner and customer marketing.

Announcements and Implementations


PMD adds video chat capability to PMD Secure Messaging application, extending support for telehealth charge codes for interprofessional teleconsults and virtual check-ins.


InterSystems adds HealthShare Provider Directory to the 2019.1 release of HealthShare, providing a single source of truth for provider demographics and relationships. The release also includes a renaming of HealthShare Information Exchange to HealthShare Unified Care Record.

NPR observes that rural areas whose local hospital closes take an economic hit — retirees move out or look elsewhere, heavy industry bails because there’s no ED, and medical practices close because doctors don’t want to drive 30 minutes to see their hospitalized patients.

Meditech announces Expanse Labor and Delivery, which includes status boards, mother-baby recall, flowsheets, and fetal monitoring integration.

A Solutionreach survey of healthcare providers finds that patient relationship software that includes text messaging improves outcomes through reminders, reduces no-shows, and decreases phone time while increasing revenue.

Government and Politics

Vermont politicians struggle with the privacy and legal issues over changing patient participation in the HIE operated by Vermont Information Technology Leaders from opt-in to opt-out, which VITL says is needed because low participation has caused low HIE usage. Only in maple syrup-producing areas (Vermont contributes half the US total) would a politician describe the maturation of a policy “as it sugars off.”

The VA issues a $1.5 million, no-bid contract to Minburn Technology Group for HPE Synergy server modules and frames that will be used to convert 131 instances of VistA data to Cerner.

Privacy and Security


India-based IT outsourcing giant Wipro admits that its systems have been breached in a phishing campaign, with hackers using the company’s own systems to attack its customers. Wipro, which sells cybersecurity services, has hired another firm to investigate. Wipro has 170,000 employees and annual revenue of $8 billion.

Facebook actively planned to provide user data to companies willing to buy it or to advertise with Facebook while denying the data to companies that it saw as competitive, all while putting on a public face of protecting user data, an NBC News investigative report finds. Reporters found few examples where Facebook executives expressed any interest in user privacy except as a PR strategy or in profitably selling data access to app vendors.


The DC business paper confirms Dudevorce’s reader rumor that I ran Monday – Inova Health System will stop offering its MediMap genetic testing for medication response after FDA warns it that the test is being marketing illegally. Inova says it was told it by someone unstated that didn’t need FDA’s approval, but FDA made it clear that patients were potentially being put at risk because the unproven tests could lead to bad medical decisions. 


Clinicians at Bagram Airfield, Afghanistan are trialing a trauma digital documentation system from T6 Health Systems, which the company says can integrate with Epic, Cerner, Meditech, and Allscripts. USAF trauma surgeon Lt. Col.Valerie Sams, MD  of the 455th Expeditionary Medical Group (on the right above) is leading the trial.


Zuckerberg San Francisco General Hospital changes its billing policy to eliminate balance billing and to set an income-adjusted maximum on patient payments, courtesy of some fine investigative reporting by Sarah Kliff at Vox. Let’s give her the credit instead of the hospital – until the expose ran, they were perfectly happy picking the pockets of patients by intentionally remaining out of network with EVERY private insurer so they could tap ED patients – many of whom didn’t have a choice because it’s San Francisco’s only a trauma center – with high bills that were quickly sent to collectors. One might reasonably expect that hospital heads should roll for creating and enforcing this policy in the first place, but that won’t happen. The hospital recently toyed with the idea of ditching the Zuckerberg part of its name (bought with a $75 million donation) over Facebook privacy shame, but at this point they’ve soiled their own name worse than Facebook.


Internist and health polity researcher Dhruv Khullar, MD, MPP writes a brilliant Stat editorial titled “Healthcare needs less #innovation,” making these points:

  • The US healthcare system can’t even provide basic care safely and consistently, performing worse than almost all peer nations.
  • As others have suggested, we need more “chief imitation officers” who bring home best practices from elsewhere rather than chief innovation officers.
  • We have “a dissemination and implementation problem” in failing to consistently use medical developments for an average of 17 years after they have been proven.
  • It’s nice to be in a swanky single hospital room hooked up to monitoring and Alexa-powered nurse call systems, but even nicer to know you won’t die of a catheter infection because someone failed to follow a checklist or use antiseptics improperly.
  • Today’s culture favors using the latest shiny technical object as a solution instead of addressing problems the best way.
  • Today’s tech startups follow the Theranos model of making grand claims while studiously avoiding publishing peer-reviewed studies.

A randomized clinical trial finds no evidence that workplace wellness programs work, as a large US company’s employees who participated said they they exercised more and watched their weight, but data analysis found no measurable improvement in their health, their healthcare expenditures, or their employment outcomes in the following 18 months.

In England, NHS Director of Digital Development Sam Shah says that hot technologies from other industries such as AI, virtual reality, and quantum computing should be placed on healthcare’s back burner in favor of building the less-exciting but vital underpinnings that can give consumers easier access, incorporate technology into care delivery, and to integrate data across IT systems and hospitals.


An India-based paper says that the number of India-based doctors serving as scribes for US hospitals is growing quickly, noting that US-based, $6 billion IKS Health employs 450 doctors in Mumbai and Hyderabad to support customers such as Massachusetts General Hospital and plans to increase doctor headcount to more than 1,000 this year. One doctor says it’s a good deal for young doctors who not only earn money, but prepare to advance their careers by learning medical best practices and documenting care in sophisticated EHRs.


InstaMed publishes its ninth annual report on healthcare payment trends, noting:

  • 90% of providers still bill and collect using manual, paper-based processes
  • 77% of providers say they rarely get payments within the first month of billing
  • 91% of providers get paid by paper check by at least one payer even though almost all of them would rather have money sent by EFT

Sponsor Updates

  • Mumms Software adds DrFirst’s e-prescribing and medication management capabilities to its hospice EHR.
  • CarePort will exhibit at the NAACOS Spring Conference April 24-26 in Baltimore.
  • The Texas Hospital Association features Collective Medical in its latest podcast.
  • CoverMyMeds will host a block party instead of a groundbreaking as construction starts on its $240 million headquarters.

Blog Posts



Mr. H, Lorre, Jenn, Dr. Jayne.
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Morning Headlines 4/16/19

April 15, 2019 Headlines No Comments

You can do a vision test from home in 34 states and go buy glasses, but not in Indiana. Here’s why.

Visibly (fka Opternative) takes several Indiana state agencies to court to overturn a law that prohibits the use of online vision tests.

Medusind Has Secured Investment From H.I.G. Capital

EHR and practice management vendor Medusind secures an undisclosed amount of financing from H.I.G. Capital.

AMA, Sling Health expand engagement with physicians and entrepreneurs

AMA and student-run biotech incubator Sling Health develop the Clinical Problem Database to give physicians the opportunity to share their experiences with health IT and clinical services, and entrepreneurs the opportunity to develop solutions that improve those experiences.

Curbside Consult with Dr. Jayne 4/15/19

April 15, 2019 Dr. Jayne 3 Comments

I was out with a friend on Saturday, at least until he had to leave to go to a planned downtime event at work. He mentioned that in all the years he had been with his company, it was rare for a downtime or disaster-recovery prep event to go as planned.

Maybe his industry has less tolerance than we do in healthcare, but it got me thinking about the impact of downtime in the patient care environment. The Journal of the American Medical Informatics Association published an article on this recently: “Clinical impact of intraoperative electronic health record downtime on surgical patients.”

Many of us just read the abstracts, and a quick pass yielded some interesting information. Researchers looked at the impact of EHR downtime events lasting more than an hour over a six-year study window. Specifically, they looked at adult patients undergoing surgeries more than 60 minutes in length during an inpatient stay lasting longer than 24 hours. Since it’s hard to do certain kinds of controlled studies on events like this, they matched more than 4,000 patients exposed to one of 176 downtime episodes with 4,000 patients who weren’t similarly exposed.

Looking at the math superficially, this means that the facility was averaging more than 29 downtime episodes a year, each lasting more than an hour. That’s pretty striking – approximately one every 12 days. I’ve never worked in a facility that had that kind of downtime and I can’t imagine the anxiety that clinicians might feel in that situation.

The authors found that although the patients exposed to a downtime event had operating room times and postoperative length of stay that were slightly more than unexposed patients, the 30-day mortality rates weren’t any different. In short, there wasn’t an appreciable link between the length of the downtime event and significant adverse events.

I wondered whether the sheer volume of downtime episodes might have been protective in this facility and decided to dig deeper than the abstract to find out more about the study site. The devil is in the details in this scenario, especially since the data was gathered at the Mayo Clinic. The identified downtimes could have occurred in any of the seven applications considered core clinical systems in support of the operating room. These included the anesthesia information management system, PACS, CPOE, clinical documentation, an integrated clinical viewer, the surgical information recording system, and the surgical coordination system.

Researchers categorized the length of the downtime as well as its impact, whether limited functionality was available or whether it was a complete outage. Scheduled downtime events were excluded as were those less than 60 minutes long. When matching exposed and unexposed patients, the team looked at day of the week as well as time of day to control for any variation in staffing, facilities, and EHR load. The patients were also paired according to surgical specialty, emergency / non-emergent status, and physical status.

The typical downtime was on a weekday between 7 a.m. and noon and was not a complete outage. The most commonly impacted systems were the integrated clinical information viewer, PACS, and CPOE. Surgical subspecialties most commonly impacted included general surgery, orthopedic surgery, and cardiac surgery. The median age of patients was 61 years, with a range of 49 to 71.

Although 30-day mortality wasn’t impacted by downtimes, interoperative duration was about 10% longer for the procedures where there were outages or interruptions. Longer operative times have been linked to greater risks of complications and also can lead to higher costs to the facility. In my experience, this also impacts physician morale, with surgeons who feel their schedules have been delayed becoming irritated and at times agitated. The operating suite is one of the parts of the hospital where the adage about time being money is truly applicable. They also noted a 4% increase in length of stay, which also has cost implications. Both increases underscore the need to have strong plans in place to help staff contend with unplanned downtime.

The authors further conclude that there is a need for future studies looking at scheduled vs. unscheduled downtime and parsing it down to specific systems to determine impacts at a more granular level. They also note the need to look at data from different facilities and healthcare settings. They also identified a limitation in the matching, namely that procedures weren’t matched year by year. Since there are constant changes in surgical technique and significant changes in some procedures, the year could have been a confounder. They also noted that, “In this context, it is not possible to generalize the results of this study at our institution to the potential impact of resilience and specific contingency planning to other hospitals.”

I don’t see other facilities planning to line up to bare their downtime data. Additionally, investigators at other institutions may not have the robust longitudinal downtime data that these authors had access to and they may not have the full cooperation of information technology staffers. I still see hospitals where the culture of fear is alive and well and efforts to study incidents in order to improve processes may still be met with suspicion. There are also those where downtime processes are fairly disorganized and they wouldn’t be suitable candidates for study.

I got a surprise Saturday evening when my friend reappeared unexpectedly from his downtime event. His comment about his company’s events not going as planned was prophetic because they actually canceled the downtime before it even started. It was good for a chuckle, although the theoretical risk of downtime events in the patient care environment is no laughing matter.

I’d be interested to hear what readers think about this EHR downtime study and whether they believe their institutions would be willing to undertake that type of analysis of their own data.

Got downtime? Leave a comment or email me.


Email Dr. Jayne.

Morning Headlines 4/15/19

April 14, 2019 Headlines No Comments

How elderly, sickly farmers are quenching China’s thirst for data

Private healthcare company WeDoctor sends medical vans to rural areas to perform mandatory exams on behalf of the Chinese government, enabling it to collect enormous amounts of patient data that it uses to train its AI-powered diagnostic engine.

Highmark IT solutions company sheds 239 workers

After adding over 1,000 employees in the last five years, Highmark’s HM Health Solutions IT company lays off 239 workers.

Amazon Alexa is luring health developers, but it will be a while before we use it to call a doctor

Despite Amazon Alexa’s newly announced HIPAA compliance, privacy concerns will compel it to take baby steps in developing skills that will enable patients to connect directly with physicians.

British doctor-on-demand app Babylon bulks up US team to seize slice of projected $400bn market

After announcing last fall that it would spend $100 million to ramp up its hiring for its London-based operations, telemedicine company Babylon Health plans to more than double staffing for its US and Canadian operations.

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