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Readers Write: Why the Interoperability and Patient Access Proposed Rules Matter for the Future of Healthcare

June 3, 2019 Readers Write 2 Comments

Why the Interoperability and Patient Access Proposed Rules Matter for the Future of Healthcare
By Russ Thomas

Russ Thomas is CEO of Availity of Jacksonville, FL.

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The Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC) have proposed new rules designed to give patients greater control over their own data and advance interoperability across the healthcare industry. Should the rule be finalized in its current form, millions of patients will have unprecedented access to and control over their own health information by 2020.

With some limited exceptions, including several related to privacy and security, the Interoperability and Patient Access Proposed Rule would make patient data exponentially more accessible and portable through open data-sharing technology and patient-facing apps.

Ideally, this would not only provide patients greater ownership of information related to their diagnoses, procedures, and tests, but also would mandate the seamless transfer of information from one healthcare organization to another as patients transition from physician to physician – enabling the promise of coordinated care within a complex healthcare system.

HL7 FHIR will be required as the standard for supporting all APIs under the proposal. Nearly 90% of hospitals and 70% of MIPS-eligible clinicians are using FHIR-enabled EHRs, according to ONC.

On paper, the rules are a logical extension of the Triple Aim—delivering better quality, better population health, and lower costs. Our industry has long advocated for the migration of patients to the center of the healthcare ecosystem.

However, empowering patients as consumers is only as effective as the tools they have to make more informed choices about their care. In this regard, healthcare is woefully behind the curve. Consumers can easily and securely access banking transactions and retail purchases over their smartphones, but not, say, their own clinical information, which is often tangled in a web of data silos, privacy rules, and vendor competition. Implementing and standardizing these rules will not be an easy lift.

In the real world of healthcare, the free flow of data and determining how, where, and when it is routed to the appropriate person is a daunting task with the highest of stakes. Although applying the proposed rules industry-wide will be time-consuming and resource-intensive, I believe the effort is both worth it and long overdue.

These proposed rules are a critical tap on the shoulder, a reminder that achieving healthcare’s future is impossible without first solving the foundational problems rooted in our present moment.

Healthcare technology companies should be at the forefront of supporting industry standards that drive efficiencies and interoperability and reduce costs and administrative burdens for their customers. Tools like FHIR enable healthcare organizations to efficiently exchange well-defined information.

I believe that this standardization is essential to the shift to value-based models of care, where payers and providers are seeking secure ways to better communicate and exchange information.

Standards, however, are only one part of the solution. Creating a more solid foundation for healthcare’s building blocks requires several key ingredients: widespread adoption of automation; more efficient channels for sharing and maintaining healthcare information; and modernization of laws governing healthcare data access and sharing, like HIPAA. It also requires evolution of business models to reward transparency and information sharing and penalize data duplicity.

On the payer side, many health plans still store provider data on legacy systems in multiple disconnected databases. As business requirements have evolved, insurance organizations have implemented incremental stopgap measures to address data limitations, but these don’t address the core challenge, the lack of a single source of truth.

It’s important to hear from all concerned stakeholders in order to get these rules right. However, I believe that at the core of these rules lies an essential truth. Unlocking and harnessing the power of data and providing patients the ability to access it is the truest course to a more sustainable and patient-centric healthcare system.

We have been presented an opportunity to fundamentally transform the American healthcare system for the better. It would be a mistake to miss it.

Morning Headlines 6/3/19

June 2, 2019 Headlines No Comments

EHR Developers are Aligned with Goals of Cures NPRM, Hope ONC will Remove Ambiguity and Reassess Timeline

The vendor members of the HIMSS Electronic Health Record Association raise “significant concerns” in draft comments about proposed federal rules covering interoperability.

Troubled microbiome startup uBiome to lay off some employees, refund payments from federal insurers

Microbiome testing vendor UBiome’s interim CEO warns employees of pending layoffs in the wake of federal investigations that have also prompted the company to refund government payments for its tests.

Kan. Hospital Agrees to Pay $250K To Settle False Claims Act Allegations

Coffey Health System (KS) will pay HHS $250,000 to settle claims that it falsely attested to conducting security risk analyses as required by the Meaningful Use incentive program.

Monday Morning Update 6/3/19

June 2, 2019 News 11 Comments

Top News

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The vendor members of the HIMSS Electronic Health Record Association raise “significant concerns” about proposed federal rules covering interoperability. Their draft comments note that:

  • The rule limits EHR vendor profits and thus discourages innovation because it requires them to share their intellectual property. The proposed rule would require vendors to offer interoperability elements with “reasonable and non-discriminatory terms.”
  • The compulsory licensing rule would require developing documentation, APIs, and patents, creating a regulatory burden that might “outweigh the opportunity that remains.”
  • ONC’s definition of “interoperability elements” and “electronic health information” are overly broad and unreasonable, while some of the defined exceptions would be nearly impossible to enforce.
  • EHR vendors can’t deliver the programming necessary in the proposed 24-month timeline, especially when they are dealing with other CMS and ONC regulatory requirements.
  • The proposed rule includes ambiguous definitions such as “reasonable,” “as soon as possible,” and “near real-time,” which is risky when penalties can be issued of up to $1 million per infraction.
  • EHRA recommends publishing an Interim Final Rule this year to allow continuing clarification and feedback and to create a way that vendors can get quick answers to their questions.

The Health Innovation Alliance this week said the rule is too vague and contains too many loopholes, recommending that ONC and CMS “go back to the drawing board.”


HIStalk Announcements and Requests

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More than half of poll respondents say vendor and hospital burnout in health IT is caused by excessive workload and time pressure rather than organizational, management, and compensation issues. Furydelabongo says that work overload could be a symptom of having incompetent or overly ambitious managers, while Drex cites the nearly universal absence of good IT governance in hospitals that encourages employees work at whatever tasks they believe are important or that executives complain the loudest about.

New poll to your right or here: What method did you use the last time you communicated directly with a doctor who was providing care to you? I’m looking for your most recent exchange, the final one in your most recent encounter.

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Happy 16th birthday this week to HIStalk, which I started writing in June 2003. I think it was June 6, but I’m not certain since I sometimes think it was June 3. Back then:

  • Some big healthcare names were George W. Bush, Tommy Thompson, Tom Scully, Dennis O’Leary, Erich Reinhardt, Linda Kloss, Anthony Principi, and Neal Patterson.
  • Hospitals were struggling with early CPOE implementations.
  • Kaiser Permanente had just chosen Epic.
  • Cerner had just made its first UK sales and opened its new headquarters.
  • HIMSS offered HIMSS03 in San Diego (with keynotes from Jeff Immelt, Rudy Giuliani, and Patch Adams) following Summer HIMSS in Chicago and also launched Solutions Toolkit, the predecessor to HIMSS Analytics.
  • Computers ran Windows XP while users licked their wounds caused by Windows ME and awaited / dreaded the promised magic of Windows Vista as the effects of the “every other Windows release sucks” rule were about to be felt.
  • People sent messages on BlackBerry devices and talked on the Nokia cell phones that dominated the market.
  • Companies such as MercuryMD, Misys, First Consulting Group, Per-Se, IDX, Healthlink, Quovadx, Alaris, and Sentillion were making a few sales.
  • Health IT news came slowly and with little critical review other than from expensive, influential newsletters such as “Inside Healthcare Computing” and “HIS Insider.”

Listening: new from NF (Nate Feuerstein), a 28-year-old, Michigan-based, Eminem-influenced rapper whose lyrics are emotional but commendably free of profanity (a change he made in 2010, saying that he’s Christian even though his music is not) and misogyny. His vocal rhythms immediately embed themselves in your head even if the lyrics don’t. The link is for “Let You Down,” which is not only a dramatic video, but also a powerful song about the strained relationship between a disappointed father and his son who has bitterly decided that their superficial relationship is over.

Thanks to the following companies that recently supported HIStalk. Click a logo for more information.

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Webinars

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


Decisions

  • Bayhealth (DE) switched from Avaya To Cisco Systems for call center technology in April 2019.
  • Highpoint Health (IN) will replace Meditech with Allscripts in July 2019.
  • ProMedica Coldwater Regional Hospital (MI) replaced Meditech with Epic on May 1, 2019.
  • Chestnut Hill Hospital (PA) will go live on Epic in August 2019.
  • Baptist Health Floyd (IN) will replace Allscripts with Epic In June 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

SailPoint earns a US patent for its application of AI/ML to identify peers among system users to detect those whose access profile is unusual enough to warrant review for potential security concerns.


Other

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Eric Topol notes the nearly identical, relentless price increases for competing best-selling injectable arthritis drugs Humira and Enbrel, which generated a combined $28 billion in 2018 sales. Today’s price is more than double that of 2012, with cash-paying patients paying more than $5,000 per month even with the best coupon offered by GoodRx. The cost is much less in the UK, which doesn’t allow endless drug company patent filings and lawsuits that block competition for biologic drugs.

CDC reports that the number of US measles cases has broken the 25-year-old record even though we’re only halfway through the year. Measles is classified as “eliminated” in the US, but that achievement is at risk for the first time in a generation.

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I’m fascinated that Cincinnati-based Bon Secours Mercy Health will sell its majority stake of an RCM company it bought for $60 million in 2016 for $1.2 billion. The Catholic health system, former in September 2018 with the merger of Mercy Health and Bon Secours Health System, had just announced its merger with Ireland’s largest healthcare provider, a five-hospital system in Dublin, with intentions I don’t quite understand (unless they’re using Ireland’s favorable tax status to benefit their for-profit ventures).


Sponsor Updates

  • Sansoro Health announces an integration partnership with OpiSafe, which provides clinical decision support for opioid prescribers.
  • TriNetX will exhibit at Academy Health June 2-4 in Washington, DC.
  • A study finds that hospitals using Meditech Expanse outperformed Cerner and Epic clients in CMS quality and value measures.
  • Wolters Kluwer Health promotes Greg Samio to president and CEO of health learning, research, and practice.
  • The SSI Group will exhibit at the Alabama HFMA Annual Institute June 2-4 in Destin, FL

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Weekender 5/31/19

May 31, 2019 Weekender No Comments

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Weekly News Recap

  • The latest funding round of precision medicine platform vendor Tempus values the company at $3.1 billion
  • Cerner initiates a $0.18 quarterly dividend for shareholders, its first
  • Cincinnati-based Bon Secours Mercy Health announces plans to sell its majority share in a revenue cycle management subsidiary, netting $1.2 billion on its 2016 investment of $60 million
  • Cardinal Health makes a $10 million investment in home medical monitoring technology and monitoring services vendor Medically Home Group
  • Change Healthcare files an amended prospectus for a $200 million IPO that doubles the value indicated in its mid-March filing
  • The VA opposes a Senate bill that would create an independent advisory committee to oversee its $10 billion Cerner implementation

Best Reader Comments

Tempus got a $3.1 billion valuation without any peer-reviewed data on the veracity of its precision medicine claims? Without any randomized clinical trials? Oh, well. We live in a world where a company putting out green color scooters on city sidewalks can get valuation in billions of dollars, so why not? (TempusInATeapot)

I’m still trying to get my head around why people insist that privately held companies that are still very profitable are “struggling” because revenues are down. The key being the slight decline in overall revenues was clearly predicted in advance. Maybe the major shareholders have a little heartburn because of unreasonable expectations borne out of the MU honey pot days, but the companies still are very healthy. (Smartfood99)

I had an interesting interaction with an insurance pre-auth department. They claimed that they needed my knee MRI report faxed to them because of HIPAA. I told them I didn’t have a fax machine, and why didn’t they have a secure portal for these? They again claimed HIPAA, but said there were several third party websites I could use to upload a PDF to and they would fax on my behalf, and better yet, some had free trial periods. (Bob Smith)

I did consulting about a decade ago for a teaching hospital that was being built to advise on how to make sure the layout promoted it being “EHR ready.” I was handed the outlines of the medical ICU floors and they had left so little space that they were either going to have to choose call rooms or tiny conference / charting rooms on the same floor. When I pointed that out, I was told that they couldn’t change any of that, and the space was going to be offices for the ICU leadership, so no call rooms or conference rooms. Turns out a committee had put together their high-level requirements and handed it to the architects who had returned these designs, and at that point, it was too late to make any changes. (DrM)

The brand new multi-million dollar building at our medical center eliminated conference rooms and working areas for clinicians. This means there is no place to sit at a desktop computer and actually do work or make phone calls. The computers in the patient rooms are ergonomic disasters. Plus, it’s difficult to concentrate and write efficiently when patients or families are asking questions. Patient privacy will be infinitely more challenging without any available private areas to discuss clinical issues. They did, however, install a faux fireplace in the oncology infusion center to make it seem more welcoming and homey. (Anonymous)

Is Epic still growing? Not if you read between the lines. Last year they said they hired 400 new employees. Now they say turnover is 10%, others say 20,% maybe it’s 15%. Either way that’s means replacing at least 900 employees per year. Looks like they may be cutting back or at best be in a holding position. Makes sense since Judy said a few months ago in a news article they are done building, and with the end of HITECH money, that juggernaut is over. The hospital market is clearly saturated, and a month or so ago, an Epic VP stated they want to move into other levels of care, like LTC, rehab, etc. But those markets are also saturated with some very well established vendors and Epic does not buy other companies. Is the writing on the wall? (HISJunkie)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. A in Washington, DC, who asked for math manipulatives for her pre-K class. She reports, “The math manipulatives you have provided will help to develop math skills during our center time and small group instruction. My kids are using the math manipulatives to practice counting, measurement and sorting. They are so excited to practice math now! Each student has a favorite manipulative they like to use. They like to make groups of five and 10, find out how many items are needed to make the scale go up or down and mix up all of the manipulatives and sort them according to shape, size, or feature. Thank you again for your donation and for making math accessible and fun!”

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Security experts warn that hackers can modify the USB ports of airport phone charging stations, allowing them to access user data or install malware. The fix is obvious – use your wall charger instead.

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A startup is developing software that can be used to deploy a drone in response to reported incidents or 911 calls, allowing first responders a live look at a fire or accident scene within 30-90 seconds even though they won’t arrive for 8-15 minutes. 

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An orthopedic surgeon opens a coffee shop in the lobby of Lake Health Beachwood Medical Center (OH), with 100% of the proceeds being donated to a local charity that helps single mothers buy homes. The Ethiopia-born doctor is one of the highest-volume shoulder surgeons in the US.

The Chinese scientist who was widely condemned by his peers for creating the world’s first genome-edited babies says he’s getting inquiries from shady fertility clinics offering to pay him to show how he did it so they sell those services .

The Chicago Tribune profiles a practicing 100-year-old optometrist who says he has no plans to retire. “I work because I feel I’m doing some good … I enjoy it. It’s not work as far as I’m concerned.”

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Fascinating: the doctor behind those ubiquitous online ads in which he begs us to “throw out this vegetable now” is found to be an integrative health MD who runs a variety of questionable websites that sell expensive herbal products and books for weight loss and constipation. He never says what vegetable everyone should throw it is and the ad uses photos of different ones, but it’s likely corn. The article also notes that the ads are known as “chumboxes,” sponsored pay-per-click content that baits people into clicking ads featuring miracle cures, ads triggered by the viewer’s IP address to offer what appear to be local services, and those that tease about something that is “weird.” Keep in mind that they exist only because people are stupid enough to click on them.


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Morning Headlines 5/31/19

May 30, 2019 Headlines No Comments

Tempus raises $200M at a $3.1B valuation

Precision medicine platform vendor Tempus raises $200 million in a Series F funding round that values the Chicago-based company at $3.1 billion.

Cerner’s initial quarterly dividend exceeds original estimate

Cerner initiates a $0.18 quarterly dividend, its first and $0.03 greater than it originally mentioned in February.

Apprio Announces New Commercial Health Division, ApprioHealth, to Meet the Specialized Needs of Hospitals and Health Systems

Government health IT contractor Apprio creates a new commercial healthcare division to market its RCM services to hospitals and health systems.

Welkin Health Raises $17.5 Million in Series B Funding from Altos Ventures

Patient relationship management vendor Welkin Health raises $17.5 million in a Series B round, bringing its total funding to $30 million.

News 5/31/19

May 30, 2019 News 3 Comments

Top News

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Precision medicine platform vendor Tempus raises $200 million in a Series F funding round that values the Chicago-based company at $3.1 billion.

CEO Eric Lefkosky, JD founded the company in 2015 after launching two marketing companies, a logistics technology company, and a venture capital firm. He is also chairman and co-founder of Groupon and formerly served as that company’s CEO. 


Reader Comments

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From Food for Chewing: “Re: KLAS’s new report on Cerner revenue cycle management. I’m curious to know if Cerner paid for or commissioned the report.” KLAS responded to me by saying that it was initially creating the report without Cerner’s involvement, but Cerner asked KLAS to convene a big-client summit that was hosted by Intermountain. The Cerner clients then asked KLAS to provide quarterly updates about Cerner’s progress. Cerner will engage around those results, and while KLAS tell me specifically that Cerner is paying, it’s not unreasonable since Cerner commissioned the follow-up. Cerner won’t get much immediate mileage from this initial report – the client feedback (at least as reported in the “Key Findings” summary, which is all I can see) is nearly universally negative, not surprising given the meeting’s genesis (no pun intended for you Cerner DoD MHS types).

From Crowdfunding Not for the Weak at Heart: “Re: HEAL Diabetes Clinic. Received an email indicating that after its StartEngine funding campaign, CEO Richard Koffler ‘surprised us by announcing his resignation from the company.’ The company decided that it couldn’t move forward without home, so it is shutting down and returning any leftover money to investors.” The company’s webpage says it has closed and Koffler’s LinkedIn indicates that he has resigned. It offered a ketogenic diet program.

From Non-Corporate Man: “Re: your experience with an HIT vendor owned by a large company. My experience was the opposite. I did just about every job you could think of in corporate HIT, did an MBA and law degree while working full time, and got the CEO job because I knew all the pieces.” My only for-profit experience was with this vendor, but it was eye-opening to see what happens when a Fortune 500 company acquires a failing software vendor that quickly disappears into the murk of the corporate balance sheet once it fails to meet overly optimistic expectations. They only bought us with the questionable hope that our sexy-sounding business would jumpstart their anemic growth rate, apparently actually believing our financials that must have been quite the work of fiction ( (I speculate our executives offered them the “Promises & Lies” version of our P&L).

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From Union Rep: “Re: HIT headlines. This one is surely among the worst.” I agree. As health IT wit goes, this is half. The story itself is basically a rewritten press release, so someone was anxious to show some poorly executed creativity in the headline in desperately punning “Sunrise.” I can only imagine the damage they would do in trying to work “Millennial” into a Cerner sales announcement.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Multi-state Bon Secours Mercy Health will sell a majority stake in its Ensemble Health Partners RCM and Epic optimization business to Golden Gate Capital for $1.2 billion.

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Cerner initiates a $0.18 quarterly dividend, its first-ever such payment and $0.03 greater than it originally mentioned in February. Opinions vary on whether companies that initiate dividend payments are showing signs of strength (making so much money that they might as well share it with investors) or weakness (management can’t entice people to buy the stock otherwise). I generally side with the latter. Companies that are doing well and expect strong future performance would be better off investing the money in their own business and let the success-driven share price increase reward its shareholders. But that’s just me, and if CERN shareholders love the stock, they can just reinvest the dividends themselves. CERN shares are down 3% vs. the Nasdaq’s 3% rise since Brent Shafer took over on January 10, 2018.

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Government health IT contractor Apprio creates a new commercial healthcare division to market its RCM services to hospitals and health systems.

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Talkspace raises $50 million in a Series D round led by Revolution Growth, bringing its total funding to $107 million. Optum’s behavioral health business has signed on for the company’s online therapy service.

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Pillo Health raises $11 million to complete its Series A round. Lead investor Stanley Black & Decker will work with Pillo to launch a direct-to-consumer version of its digital home health companion later this year.

Patient relationship management vendor Welkin Health raises $17.5 million in a Series B round, bringing its total funding to $30 million.


Sales

  • UCLA Health (CA) selects Microsoft’s Azure cloud computing services to speed up data analysis for researchers and precision medicine efforts.
  • The Louisiana Dept. of Health will implement provider credentialing software from Verisys.
  • Allegheny Health Network (PA) selects Vynca’s end-of-life care planning technology.

People

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Mount Sinai Health System (NY) names Andrew Kasarskis, PhD (Icahn School of Medicine) as EVP and chief data officer.

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Roni Zeiger, MD (Smart Patients) joins Facebook as head of health strategy.


Announcements and Implementations

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Woman’s Hospital (LA) goes live on Meditech Expanse.

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OHSU Doernbecher Children’s Hospital (OR) offers parents Locus Health’s app-based remote monitoring software for use post-discharge.

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PerfectServe announces GA of embedded messaging within Cerner.


Privacy and Security

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In Australia, auditors warn Victoria’s public health system officials that weak cybersecurity practices have left facilities vulnerable to attacks. A review of security measures at several hospitals within the state found similar weaknesses, including weak passwords, poor system and network monitoring, inadequate user access controls, and lack of appropriate governance and policy frameworks. Barriers to implementing all 72 of the recommended cybersecurity measures include lack of budget and staff, plus a lack of awareness around third-party vendor security protocols.

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Allegheny Health Network brings its Epic system back online after an unspecified network issue caused it to go down Wednesday morning. The outage affected all seven of its Western Pennsylvania hospitals.

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Indiana-based Medical Informatics Engineering and its subsidiary NoMoreClipboard will pay $900,000 to settle a multistate lawsuit brought against it last year by 16 state attorneys general over a 2015 breach that compromised the data of 4 million patients. Meanwhile, nobody is planning a PHI heist of 4 million clipboards.


Other

Canada’s Sunnybrook Health Sciences Centre will integrate its self-developed SunnyCare clinical workflow solution with CPSI Evident’s Thrive EHR. The organizations will also establish an outcomes innovation center in Toronto.

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A New York Times investigation finds that pediatric cardiologists at UNC Children’s Hospital (NC) were so alarmed at high death rates that they questioned — in secretly recorded department meetings obtained by the newspaper — whether they would send their own children there for surgery. From the Times article:

  • The hospital’s death rate was among the worst among the 82 institutions that publicly report it.
  • Cardiologists and hospital executives were all worried about the hospital’s high death rate, but didn’t know what to do about it.
  • Since 2015, the hospital had lost two of its pediatric cardiac intensivists and some experienced nurses, closed its CIC unit, and didn’t have a dedicated cardiac intensive care unit.
  • A transplant surgeon failed to show up to perform a heart transplant when a donor heart became available on a weekend, leading one cardiologist to say, “This is what you signed up for. Who is he to play God with some kid’s life?”
  • UNC said it has since replaced leadership that hospital administrators called “a dysfunctional group.”
  • So many hospitals offer complex pediatric heart surgeries that some hospitals, including UNC, perform few cases and thus have limited resources and experience. Several hospitals have shut down similar programs or merged with others in hopes that higher volumes would drive better outcomes.
  • UNC says mortality data alone isn’t a good measure and termed it “critically important” to instead look at risk-adjusted data, but then refused to release that data because it says the data doesn’t adequately reflect that its patients are sicker.
  • The since-retired head of the children’s hospital told cardiologists to follow their conscience if that included referring patients to other hospitals, but warned them that reduced surgery volume would hurt hospital revenue and possibly cost them their jobs.

Sponsor Updates

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  • HCTec employees volunteer with the Gentlemen’s Quest of Tampa and the United Way.
  • Elsevier Clinical Solutions will exhibit at ASCO June 1 in Chicago.
  • EClinicalWorks will exhibit at the SCPHA Association Annual Clinical Network Retreat June 7-9 in Myrtle Beach, SC.
  • Glytec publishes a new case study, “Paul Chidester, MD: How Sentara Healthcare Achieved the Standard of Care in Glycemic Management, and Your Organization Can, Too.”
  • Google Cloud releases a new video, “American Cancer Society: Powering cancer research using Google Cloud machine learning.”
  • Hayes Management Consulting will host a reception during the AAMC Compliance Officers’ Symposium June 6 in Washington, DC.
  • Audacious Inquiry celebrates 15 years in business by reflecting on 15 significant company milestones.
  • Nordic releases a new podcast, “How to build an effective hub-and-spoke relationship.”
  • NextGate publishes a new case study, “Enterprise Patient Matching Helps KeyHIE Establish Integrated Network of Accurate, Accessible Health Records and Drive Down Duplicate Record Rate to Less than 1%.”

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EPtalk by Dr. Jayne 5/30/19

May 30, 2019 Dr. Jayne 1 Comment

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I’ve been following Diasyst for some time and was happy to see their recent win at the Webit.Foundation Founders Games in Sofia, Bulgaria. Diasyst was recognized as a finalist and was selected by Microsoft for Startups for $120K in awards to support growth, including assistance with investments and partnership development. Diasyst has an elegant solution that assists clinicians with diabetes management and currently partners with Emory University, the US Department of Veterans Affairs, and Georgia Tech.

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The state of Missouri closed its legislative session last week and remains the lone holdout in the US without a statewide prescription drug monitoring program. St. Louis County provides the leading workaround with its federally-funded voluntary PDMP; more than 70 additional jurisdictions including Illinois, Kansas, and Oklahoma share data with the system and it now covers 84% of the state’s population. Missouri legislators continue to cite privacy concerns as preventing Missouri from enacting PDMP legislations despite the support of new governor Mike Parsons. A Kaiser Health News piece covering the issue is worth reading. One of the main legislators who had opposed a statewide PDMP is a family physician, although he was finally term-limited. PDMP legislation has also been inexplicably tied up with gun rights issues. It should be noted that Missouri was also last to implement a statewide immunization registry. My favorite quote of the piece: “But if 49 other legislatures are saying ‘This is important, we need to save lives,’ I don’t understand why Missouri can’t find a way to compromise and do what’s best for its citizens.”

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It’s already been mentioned in HIStalk, but I’m intrigued by Amazon’s foray into wearables that can read the emotion of the wearer. It’s a step up from a mood ring, but I wonder how well Amazon is really doing with understanding user emotions and experiences at present. The company needs to do a better job selling its data in a way that I don’t keep seeing ads for products I’ve already bought. The device would supposedly analyze user voice patterns to determine their emotional state. I’m just trying to get my Echo to recognize my commands when I’m moving across the room or when there is background noise.

Artificial intelligence continues to be a headliner for buzzword bingo and the US government continues to expand spending. Early adopter agencies such as the Defense Department, the General Services Administration, NASA, and the Department of Health and Human Services are using AI to reduce backlogs or increase productivity of existing workers. Additional departments looking to leverage AI include the Departments of Agriculture and Veterans Affairs, along with the National Institute of Standards and Technology. Additionally, the Patent and Trademark Office wants to use AI to screen patent applications against more than ten million patents already on the books.

A recent report on federal AI adoption highlights the need to make sure agencies have solid business cases for AI and that they’re not building solutions in search of a problem. It also notes that government needs to get “beyond the belief that AI is magic. It’s not – it’s something that’s evidence-based that uses data.” The report also calls for a unified ethics framework that addresses difficult issues around AI transparency and accountability. Previous projects involving analysis of drone footage have been controversial.

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The US Food and Drug Administration (FDA) is fast-tracking an Apple Watch app to help individuals who experience nightmares from post-traumatic stress disorder (PTSD). The NightWare app uses biometric data collected during sleep and processes them with machine learning algorithms to identify the onset of nightmares. Vibrations are triggered to interrupt the nightmare without waking the user or interrupting sleep rhythms. The FDA granted “breakthrough status,” which is typically granted for life-threatening conditions with no approved treatments. Nightmares and nightmare disorder are linked to increased risk of suicide, heart disease, diabetes, memory loss, anxiety, and depression. An estimated 5 million Americans suffer from nightmare disorder. NightWare is conducting randomized clinical trials prior to applying for FDA priority review.

I’ve noticed an increase in the number of elderly patients who don’t have family nearby. They may continue to drive past the point where it is safe because they don’t want to be dependent on taxis or ride share services. As the Baby Boomers age, self-driving cars may be an appealing way to stay independent. IBM and British startup Cera Care are taking a deeper look at using the technology off the road to help elderly patients navigate within their homes. They plan to use lidar laser sensors from self-driving cars to monitor patient movements and daily routines. A change in movement patterns may indicate physical deterioration, psychological changes, or a fall. Lidar sensors are expensive at approximately $1K per room, but developers expect costs to fall over time.

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The University of Michigan finds that the DNA of new doctors ages six times faster than normal DNA during the critical internship year. Researchers looked at segments of DNA called telomeres, which keep the ends of chromosomes intact. The interns were compared against a control group of college students. The study showed that telomeres in stressed subjects shrank in an accelerated way. The data could be applicable to other populations exposed to prolonged stress such as military trainees, new parents, and those working for startup companies.

I had the chance to connect with an old friend and industry vet this week. It was great to catch up and to commiserate about the problems we’re trying to solve out in the client community. Some of the issues we continue to run across include clients who want to do the wrong thing despite our best advice, such as failing to flag deceased patients in the system. Nothing says “patient engagement” like a family receiving a colonoscopy reminder after their loved one has died of colorectal cancer. As we use increasing amounts of information across numerous applications and data streams, the need to ask “is this the right thing for the patient” becomes more important.

Does your organization constantly keep patients at the forefront? What are your pitfalls or a-ha moments? Leave a comment or email me.

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Email Dr. Jayne.

Morning Headlines 5/30/19

May 29, 2019 Headlines No Comments

Allegheny Health Network’s computers go down, delaying some procedures

Allegheny Health Network’s Epic system goes down Wednesday morning due to an unspecified network issue that has affected all seven of its Western Pennsylvania hospitals.

Talkspace announces $50M Series D, expands services to over 5M lives

App-based therapy company Talkspace raises $50 million in a Series D round.

Tennessee, 15 Other States Reach $900,000 Data Breach Settlement

Indiana-based Medical Informatics Engineering will pay $900,000 to settle a multistate lawsuit brought against it last year by 16 state attorneys general over lax security practices that led to a 2015 breach that compromised the data of 4 million patients.

Golden Gate Capital to Buy Stake in Billing-Services Firm

Bon Secours Mercy Health will sell its Ensemble Health Partners RCM business to Golden Gate Capital for $1.2 billion.

Morning Headlines 5/29/19

May 28, 2019 Headlines No Comments

Medically Home® Group Raises $10 Million Towards Its Virtual Hospital Series B Funding

Cardinal Health makes a $10 million investment in home medical monitoring technology and monitoring services vendor Medically Home Group.

Banner Health launches Banner Innovation Group

Banner Health (AZ) launches an Innovation Group, bringing together its incubators and innovation and digital business leadership team to support and commercialize homegrown technologies and services that benefit the patient experience.

MISSION Act’s new community care program ready for prime time, VA says

After three years and $7 million, the VA continues to struggle with the development, implementation, and certification of a new IT system that will manage the MISSION Act’s caregiver program.

NextGen Healthcare, Inc. Reports Fiscal 2019 Fourth Quarter and Year-End Results

NextGen Healthcare CEO Rusty Frantz says the company’s Q4 results exceeded revenue expectations thanks to growth in bookings and deal size, and the launch of integrated ambulatory care software.

News 5/29/19

May 28, 2019 News 3 Comments

Top News

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Cardinal Health makes a $10 million investment in home medical monitoring technology and monitoring services vendor Medically Home Group.

The company says that its remotely monitored “virtual hospital room” that it sets up in the patient’s home saves the 60% of the expense of hospitalization that is related to fixed costs, such as buildings.


Reader Comments

From Hospital Digital Marketer: “Re: Google. Did they ban healthcare systems from posting star ratings for doctors in search results? We pay a lot to our survey vendor to post these on our website, but the stars disappeared after Google updated its search engine results pages.” I’ll invite marketing folks to weigh in since this isn’t something I follow.

From Pendulous Appendages: “Re: management. What eventually happened to your software vendor employer manager who refused to alert customers to a problem that put patients in harm’s way?” I Googled him and turned up nothing, leaving me free to speculate hopefully that karma found him despite his apparent corporate fast track back then. I did locate his boss, the corporate suit who was parachuted into our office as a 20-something newly minted executive assigned to lend his vast knowledge to our failing operation – he later became CEO of several large healthcare companies (one of which he took public, another of which was sold to an especially scummy drug company) and is now an investment company partner. My takeaways from this:

  • The people who end up in charge have the drive, ambition, and personality quirks that set their direction early. They never spent time as programmers, clinicians, or cube-dwellers, having been chosen early on for internships and consulting assignments that skipped the hands-on layer. It doesn’t hurt to be a family friend or relative of a company bigwig.
  • Some of the anointed ones are screaming, petulant psychopaths (the CEO I mentioned above was the poster child for that), while others are generally amiable since they aren’t really emotionally invested in the assignment that they know is just a brief stop on their ascent to the summit. I didn’t mind working for the later-career ones who took the top job as a favor for our investors and therefore were more often bemused than tyrannical in realistically assessing their ability to do anything more than delay the inevitable.
  • They took every job with the next one in mind. Those of us rowing the boat saw a lot of captains come and go. We were happy to see most of them leave, apprehensive about which company man would be sent to our corporate hinterlands to replace them, and full of conflicting thoughts about their jobs and lives versus ours as we passed around the newspaper reports of their opulent home purchases and saw them wheeling their testosterone-boosting sports cars (all but one were male) into their reserved parking spots each day.
  • The rise to the top can be achieved even while running failing, doomed companies as long as you can make their corporate budget contribution look temporarily better than when you arrived (i.e., laying people off, cutting R&D, sunsetting products, increasing maintenance and services fees). This is not a good thing for customers, but then again, having a perpetually money-losing software vendor isn’t sustainable anyway.  
  • The victory lap for circuit-riding CEOs is in venture capital and other investment activity, which lines their pockets even more than running companies.

HIStalk Announcements and Requests

I occupied some of my time over the long weekend with binge-watching: all but the final couple of episodes of ”What/If” and continued progress on “Justified,” both of which I recommend for unchallenging yet engrossing entertainment. Next up is “High Seas.” It’s fun that so many series are available on the streaming services we use (Netflix, Hulu, and Amazon Prime) that when someone asks you what you’re watching or vice versa there’s an 80% chance the other person hasn’t heard of it, unlike the old “three networks” days when everybody talked about the same shows. I didn’t realize until getting engrossed in “Justified” that it’s an old series, having run on FX from 2010 to 2015, magically reborn to feed the streaming beast. 

I was browsing on my Chromebook as I often do (because it’s light and small, just right for a break in the easy chair) when I recalled that Microsoft Office 365 contains fully functional Web versions of the suite (Word, Excel, OneDrive, etc. – everything except Access) that run just fine on it. I could do nearly everything I do on a full Windows desktop on the Chromebook, although “nearly” still prevents a full switch. I suppose I could just get a small, lightweight laptop for these situations, such as a Surface, but I don’t really need one.

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Welcome to new HIStalk Platinum Sponsor Google Cloud. Solutions include unified, HIPAA-compliant and HITRUST CSF-certified data storage with Cloud Healthcare API access; the BigQuery managed, server-less data warehouse; the Cloud Machine Learning Engine and TensorFlow for building and training custom models; collaboration tools such as the G Suite productivity suite and Chromebooks; and Cloud Healthcare API and Apigee Healthcare APIx to bridge systems and applications with FHIR and DICOM support. Customers include Cleveland Clinic (extending its EHR and performing analytics via APIs); Lahey Health (collaboration); Hunterdon Healthcare (collaboration); and Colorado Center for Personalized Medicine (data warehouse for patient and genetic data for personalized diagnoses and treatment as well as research). Rush University Medical Center powers its MyRush app with Google Cloud, improving customer experience and patient outcomes with API-enabled services, use of 250 analytics variables, and management of the access gateway with OAuth, validation policies, and traffic management. Google Cloud offers a free tier that provides everything from storage to development tools, APIs, and analytics. CIOs can connect with the company at CHIME’s Fall CIO Forum in November. Thanks to Google Cloud for supporting HIStalk.

Here’s a panel discussion on “The Future of Health” from Google’s just-concluded Cloud Next 19 developer conference.


Webinars

May 30 (Thursday) 2:00 ET. “ONC Data Blocking Proposed Rule: What Health Systems Need to Know.” Sponsor: Philips PHM. Presenter: Greg Fulton, industry and public policy lead, Philips. Proposed data-blocking regulations could specify fines, disincentives, and de-certification of providers who don’t provide an API for patients to extract all of their data. This webinar will describe who is deploying APIs, the scope of data and third-party apps that can be used, the seven costs that do not count as a data-blocking exception, and the health system protections that don’t involve using a vendor. It will also provide examples of data blocking and further exceptions.

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


Acquisitions, Funding, Business, and Stock

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Change Healthcare files an amended prospectus for a $200 million IPO, double the value of its mid-March filing.

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Apple reportedly acquires Tueo Health, which is developing an app to monitor the nighttime breathing of asthmatic children. The deal was supposedly done in late 2018, but nobody noticed until now.

UCSF ends its plan to affiliate with Dignity Health’s four Bay Area hospitals, citing unresolved issues related to women’s reproductive services, LGBTQ care, and end-of-life options.


Sales

  • Loma Linda University Medical Center chooses QuadraMed for patient identity management.
  • Western Maryland Health System chooses PeraHealth’s Rothman Index for real-time monitoring of patient condition.

People

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Surgical automation and software vendor Caresyntax hires Tim Lantz (Sentry Data Systems) as president.

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Divurgent hires Bill Bottomley (HighPoint Solutions) and Mary Beth Seaman (HighPoint Solutions) as client services VPs.


Announcements and Implementations

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Muhlenberg Community Hospital (KY) replaces Meditech with the Epic system of its corporate parent, Owensboro Health, with the project coming in under budget at $2.3 million. 

Imprivata enables its Confirm ID EPCS solution to run under the Google Chrome browser, making it more accessible to Meditech users.


Government and Politics

A Kaiser Health News analysis reviews whether the reduced cost involved with healthcare overhaul could wipe out “the industry” (meaning providers, insurers, and others) that provides 20% of the country’s employment. The article quotes economists who previously worried that the bloated and growing healthcare sector was being used as a “wildly inefficient jobs program” to drag the country out of the Great Recession. A healthcare economist observes that hospitals make up the top six employers in Boston and two of the top three in Nashville, with the main source of healthcare cost savings being layoffs that he estimates would impact 2 million people, equally split between providers and insurers. Another economist agrees, but says high healthcare costs sap non-healthcare industries in ways that can’t be easily measured.


Other

I missed this earlier: HHS OIG report finds that ACOs (of the six it studied) that run a single EHR are able to to share electronic data in real time, whereas those using multiple EHRs are limited to phone calls and faxes. The report also notes that care coordination outside the network is hard even with HIEs (since they provide limited data) and that most ACOs aren’t using analytics to personalize care. 

A federal lawsuit questions whether hospitals are sidestepping anti-kickback laws by overpaying the salaries and perks of doctors they hire whose test and procedure volume generates hospital profits that exceed their specialty-specific losses. It highlights the aggressive practices of Wheeling Hospital (WV) to increase its market share, which include directly tying physician compensation to the hospital revenue they generate and hiding doctor payments within office lease terms that give some doctors incomes that are multiples of what their private practice counterparts are making. Meanwhile, CMS dropped the hospital’s quality star rating to one, the lowest possible score.

A study estimates the annual cost of physician burnout at $4.6 billion, or $7,600 per doctor per year. Now that WHO has added “burnout” as a rather vaguely defined ICD-11 diagnosis (symptoms: exhaustion, negativity, and reduced productivity), let’s hope we don’t medicalize it by paying for questionable treatment that then creates consumer demand as we’ve done for other newly defined conditions – we don’t want doctors to burn out from treating doctor burnout.


Sponsor Updates

  • Nuance customers in Colorado, Mississippi, and Ohio adopt the company’s CDI solutions.
  • Surescripts expands its White Coat Award to include categories for health systems, pharmacies, and pharmacy technology leaders, as well as EHR vendors.
  • FDB releases MedKnowledge Canada to support bi-lingual medication management app development.
  • The Chartis Group publishes a paper titled “Launching a Revenue Cycle Automation Strategy.”
  • Aprima will exhibit at the NJMGMA Practice Management Conference June 5-7 in Atlantic City.
  • In Argentina, Emergencias deploys Avaya’s IX Contact Center software to help save lives.
  • Bluetree will exhibit at the IPMI Healthcare IT Institute June 2-4 in San Antonio.
  • Burwood Group will exhibit and present at the Southern California CIO Executive Summit June 5 in Universal City.
  • PeriGen publishes a white paper titled “How to Reduce Exposure to Obstetric Megaverdicts with AI-Driven Technology.”
  • CompuGroup Medical will exhibit at the Arizona Medical Association Annual Meeting June 1 in Chandler.
  • CoverMyMeds will exhibit at the NG Healthcare Provider Symposium June 5-7 in Savannah, GA.

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Morning Headlines 5/28/19

May 27, 2019 Headlines No Comments

Physician burnout costs the US health care system approximately $4.6 billion a year

Researchers from the Mayo Clinic (MN), AMA, Stanford University, and the National University of Singapore determine that physician burnout costs the US healthcare system $4.6 billion a year, or $7,600 per employed physician.

WindRose Health Investors Commits $85 Million in Financing to Kidney Health Management Company Healthmap Solutions

Technology-enabled kidney health management business Healthmap Solutions raises $85 million from Windrose Health Investors.

Regulators approve $21M power line to serve Epic Systems’ growing needs

Utility regulators in Wisconsin approve a $21 million underground power line to accommodate Epic’s needs over the next several years.

Morning Headlines 5/27/19

May 26, 2019 Headlines No Comments

VA tells Senate no on more Cerner EHR oversight

The VA opposes a bill that proposes creating an independent advisory committee to oversee the $10 billion Cerner EHR implementation project.

Why the new HHS CIO is not your usual suspect

New HHS CIO Jose Arrieta, who comes to the role with a contracting and technology background, will make cybersecurity, cloud computing, and emerging technology his initial priorities.

Change Healthcare files for $200M upsized IPO

Change Healthcare increases its planned IPO from $100 million to $200 million.

Apple bought a start-up that was working on monitoring asthma in children

CNBC reports that Apple purchased pediatric asthma monitoring company Tueo Health late last year.

Monday Morning Update 5/27/19

May 26, 2019 News 4 Comments

Top News

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The VA skips a House committee meeting that addressed oversight of its Cerner implementation, but attends a Senate meeting long enough to oppose a bill that proposes creating an independent advisory committee to oversee the $10 billion project.


Reader Comments

From Anon E. Mouse: “Re: EHR timers. Cerner was the vendor that wasn’t directly mentioned in the article, although it’s obvious since Eva Karp works for Cerner. Cerner’s Lights On Network has been freely available with such timers for years and is used by many of their clients daily. Cerner invests a ton of effort in building additional timers as they introduce new software and functionality and then works to attack the problem areas to improve performance and clinical workflow.” Cerner’s write-up of Lights On Network describes its benefits: finding users whose system actions suggest that they could use help, identifying system bottlenecks, flagging unusual system settings, and benchmarking against other Cerner clients.


HIStalk Announcements and Requests

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A convincing 97% of poll respondents who have coordinated post-acute care for someone said it was hard, with the biggest issue being trying to coordinate the activities of the care team and family. Some comments:

  • Vicki says organizations served only their own interests in caring for her family members, such as a SNF that wasn’t interested in helping find a home health provider other than the one it owns.
  • Clark’s experience with transitions from ICU to LTAC, SNF, home care, and therapy providers is that nobody every had current patient information, creating both frustration and danger.
  • Brittany’s experience with hospice care is that medical equipment wasn’t delivered, transportation was delayed, and nurses misunderstood the family’s wishes and kept the family member over-sedated in denying them the chance to have meaningful final moments together.
  • Another reader reports that they experienced excellent coordination at Johns Hopkins, but had a “consistently horrendous” experience at their own hospital, where they are a physician faculty member. HIM dragged their feet on providing an electronic copy of the medical records, obtaining images required two trips and upfront payment of fees, a chaotic discharge process created delays that necessitated rescheduling home health appointments, refrigeration-required antibiotics were delivered early when nobody was home, prescriptions were sent to the wrong pharmacy, hospital nurses argued with the family over the medication list in insisting that their computer must be correct, and the hospital ran out of common medical supplies.
  • Caregiver Informaticist says their family member’s care was never coordinated in several trips between LTAC and the acute care hospital, with no information sharing after being falsely told that the LTAC’s doctors round at the hospital and attend joint care planning meetings.

New poll to your right or here: What is the main cause of burnout among employees of health IT vendors and hospital IT departments? My experience working for a crappy vendor makes “all of the above” attractive, but let’s focus on the most important item on the list. For me, that was incompetent, uncaring managers who interfered with our productivity in trying to add value to processes they would never understand, poring over their MBA textbooks in their spiffy offices with the doors shut before emerging into the cube farm to make a lofty pronouncement that after applying their exemplary insight to our operation, they had figured out the solution to our problems (we had tried it before and failed, but saying so elicited scorn that what we had been missing then was their keen leadership). Worst of all, they had no healthcare background and thus nothing but contempt for our users and the patients who depended on our systems – we were just a widget factory that happened to sell healthcare software. I made an impassioned, stick-figure level plea to one of the suits about a patient-endangering software defect that I had laboriously documented urging him to simply allow us to notify all customers of the problem since we hadn’t yet figured out how to fix it. His answer: “We don’t owe those clients a damned thing.”


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Monday is Memorial Day, created not to serve as a nonchalant kickoff to summer, but rather to set aside time to remember those who died while serving in the armed forces. It’s perfectly fine to pass on attending a ceremony or an increasingly rare Memorial day parade, but perhaps you know someone who lost a family member (especially if it happened within the past handful of years) who was serving and could drop them a quick email or social media acknowledgement of their loss. Here’s another idea – take flowers to a cemetery that has a section set aside for soldiers and leave one on each grave that doesn’t already have some.

In Flanders Fields
By John McCrae

In Flanders Fields the poppies blow
Between the crosses row on row
That mark our place; and in the sky
The larks, still bravely singing, fly
Scarce heard amid the guns below.

We are the Dead. Short days ago
We lived, felt dawn, saw sunset glow,
Loved and were loved, and now we lie
In Flanders fields.

Take up our quarrel with the foe:
To you from failing hands we throw
The torch; be yours to hold it high.
If ye break faith with us who die
We shall not sleep, though poppies grow
In Flanders fields.


Webinars

May 30 (Thursday) 2:00 ET. “ONC Data Blocking Proposed Rule: What Health Systems Need to Know.” Sponsor: Philips PHM. Presenter: Greg Fulton, industry and public policy lead, Philips. Proposed data-blocking regulations could specify fines, disincentives, and de-certification of providers who don’t provide an API for patients to extract all of their data. This webinar will describe who is deploying APIs, the scope of data and third-party apps that can be used, the seven costs that do not count as a data-blocking exception, and the health system protections that don’t involve using a vendor. It will also provide examples of data blocking and further exceptions.

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


People

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HHS promotes Jose Arrieta to CIO.


Announcements and Implementations

Lawrence General Hospital completes its implementation of Meditech Expanse under a fixed-fee implementation agreement with Santa Rosa Consulting.

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A new KLAS report covering opioid prescription intelligence finds that all vendors reviewed performed well. PastRx tops the list in pulling PDMP data into the chart for physician review, while AffirmHealth and Collective Medical were praised in their respective regional pain management clinic and ED environments. Appriss Health and DrFirst were seen as less helpful in developing an opioid stewardship strategy since they work with users only indirectly.

In England, Guy’s and St Thomas’ NHS Foundation Trust issues a 10-year, $225 million tender for a enterprise EHR that will be used by up to 35,000 employees of three London-based trusts.


Government and Politics

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The VA’s self-developed, open source workflow tool Light Electronic Action Framework (LEAF) wins a government health IT magazine’s innovation award. The team used the tool to develop a telehealth provider volunteer site for hurricane relief efforts (pictured above) within 24 hours.


Other

A data study finds that Canadian buyers of marijuana (where it is legal) avoid paying by credit card since they know their data is likely to be stored on servers in the US (where it isn’t legal). Also in play is that some employers enforce zero-tolerance policies for non-medical use. Canada’s own Office of the Privacy Commissioner recommends that buyers pay cash since the US government can access their credit card records without a warrant and could prevent them from entering the US.

I’m fascinated by this: Elon Musk’s SpaceX uses its Falcon 9 rocket to launch the first 60 low-Earth, 500-pound satellites of its $10 billion Starlink broadband service, which will offer inexpensive broadband connectivity to the northern US after six launches, the whole country after 12, and the entire populated world after 30. The company will use the revenue from the broadband service to fund its planned colonization of Mars.

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An interesting op-ed piece by the co-founder of a clinician collaboration platform says that architects ruined healthcare by emphasizing grand, soothing aesthetics for visitors while eliminating the conference rooms and lounges where clinicians can interact with each other. He also opines that the Disney-created concept of hiding the “messy parts” of running a hospital means that the healthcare professionals themselves are the messy parts. He concludes that hospital design is now obsessed with distracting people from thinking about their health rather than making them healthy.

More evidence that Americans are too science-challenged to form rational healthcare opinions: people are OK with the widespread rollout of untested medical treatments, but object to randomized trials in which two equally acceptable treatments are applied to separate groups to determine which is better. Experts can’t explain the results, but think people might worry that consent is required from those who don’t get a particular treatment or that such tests should be unnecessary because experts should already know what works.

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A third-year UTHealth medical school student who has undergone six brain surgeries, survived on artificial nutrition due to gastroparesis, and had a stroke that left her temporarily paralyzed from the waist down says the experience (along with deficits in her hand function from the stroke) has motivated her to consider a career in physical medicine and rehabilitation and neurology.


Sponsor Updates

  • Meditech; NextGate; Clinical Computer Systems, developer of the Obix perinatal data system; CereCore; CloudWave; Experian Health; PatientKeeper will exhibit at the 2019 MUSE Inspire Conference May 28-31 in Nashville.
  • Waystar will exhibit at the EClinicalWorks Education Expo May 27-31 in Boston.
  • The Chartis Group publishes a white paper titled “Bridging the Digital Divide in the Healthcare C-Suite: Positioning IT for Success in the New Health Economy.”
  • OmniSys and Surescripts will exhibit at the PioneerRx Connect 2019 May 31-June 2 in Orlando.
  • Relatient welcomes its 100th employee.
  • Sansoro Health releases a new 4×4 Health Podcast, “Intellectual Property for Entrepreneurs and Investors.”
  • The SSI Group will exhibit at the South Carolina HFMA Annual Institute May 28-31 in Myrtle Beach, SC.
  • PatientKeeper will demonstrate its EHR optimization solutions this week at E-Health in Toronto and MUSE Inspire in Nashville.
  • Community First Health Plans goes live with ZeOmega’s Jiva LTSS for long-term care.

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Weekender 5/24/19

May 24, 2019 Weekender No Comments

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Weekly News Recap

  • Agfa is reportedly considering the sale of its health IT business
  • Medical drone delivery company Zipline’s latest investment round values it at $1.2 billion
  • ONC finds little interoperability improvement among office-based physicians since 2015
  • Google promotes Glass from its skunkworks division in releasing a new enterprise version aimed at software developers
  • JP Morgan buys medical payments processor InstaMed for more than $500 million

Best Reader Comments

Any complex software that you spend a lot of time in, you’d better learn it well. Most people do that but if you invest your time in resentment instead, you get nowhere. For highly skilled software users, they memorize key application pathways. It becomes second nature to them, to the point they don’t even think about it. Then for every work task, the only application questions that arise are: 1). Do I already know how to do this? 2). If I don’t, do I think my application can do it and I just need a nudge to get there? (Brian Too)

Cerner has this as well, it is called the Lights On Network. A current customer can log into LON (Lights On Network) and look at all of their timers, usability metrics, playbook scores as well as compare themselves to other like-sized Cerner Customers. It is a very useful tool if you choose to use it. You can see how many clicks it takes to fill out documentation, the amount of time a physician takes for a particular process and you can drill down into the individual users to determine who may be struggling or not even using the system. It is a very underrated tool. (Associate CIO)

Patients want to know who is grabbing their info. Follow-up: that part of the law got specifically wiped away. It’s also noted in the first comment of the proposed rule (long document, but it’s in there). (Richie)

As a former EHR implementer, specifically into physician practices, your article is honestly depressing. These are the EXACT same physician complaints that I heard when I was implementing over 15 years ago! NOTHING HAS CHANGED. You hit the nail on the head. Many docs are all too eager to blame the EHR for problems that have always been there (overscheduling, refill management issues, unwillingness to change habits). I worked with those groups for years and honestly gave up on it because I felt we couldn’t ever really win, as the EHR vendor. (Kallie)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. H in North Carolina, who asked for five laptops for her first grade class (they were out of school for six weeks following school damage from Hurricane Florence). She reports, “We absolutely love our new laptops. We use them every day. We are so very thankful for you kind generosity to our classroom. It has helped our learning in. So many different ways. Our new laptops have sparked so much new learning for all of my students.”

Journal of Hospital Medicine publishes a fun, informative article titled “I, EHR” that is written from the EHR’s perspective to its physician users. It includes tips for integrating an EHR into practice – explain to the patient what you’re doing in the EHR, stop typing and listen when the patients starts to tell a relevant story, use the EHR’s data and images to illustrate medical talking points, and add a photo of the patient and personal information about them to add richness to notes. It concludes,

I know I am annoying. I am over-programmed, leading to novella-length notes, “pop-up fatigue,” and overloaded in-baskets. Clearly, I am not the brains of the partnership (that will always be you). But talented medical informatics specialists are working hard to improve me. I dream of the day when I will create a truly seamless experience for you and your patients. In the meantime, I can foster a continuous integration of workflow, where all you have to do is talk to your patient. I take care of the rest … The future holds even more promising ways in which we may work together. My computer-aided image analysis could help you to improve the accuracy of your diagnoses. Perhaps telemedicine will further increase access to specialists in rural areas, so that we can continue to serve the most vulnerable populations. Machine learning algorithms may continue to enhance our ability to determine which patients require urgent hospitalization.The possibilities to put me to work are endless.

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CNBC describes the 34,000-square-foot Bel Air mansion built by a celebrity nose job plastic surgeon who expected to flip the $70 million property into a $180 million sale. His mistiming was spectacular – the luxury market was glutted and foreign buyers became scarce, so now he’s hoping to unload at $120 million, which would still net him $60 million in cash. The house next door that was listed at $250 million has been cut to $150 million. The doctor says he’ll just live in the house if he can’t sell it – he would just need to sell his existing $20 million home first. It’s hard to fathom that all of this excess is funded solely by people who don’t like how their noses look.

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Henry Ford Hospital says that someone stuffed an ED patient’s lice-infested clothes under the pad of a gurney, leading to a PR nightmare incident in which a patient who was the next gurney’s occupant was found covered in the bugs.


In Case You Missed It


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Morning Headlines 5/24/19

May 23, 2019 Headlines No Comments

Agfa to Consider Selling Hospital IT and Integrated Care Business

Global imaging and IT company Agfa considers selling off the health IT and integrated care parts of its European healthcare business.

Indiana Medical Records Service Pays $100,000 to Settle HIPAA Breach

Medical Informatics Engineering will pay OCR $100,000 to settle HIPAA violations stemming from a 2015 data breach that impacted nearly 4 million patients.

Amazon Is Working on a Device That Can Read Human Emotions

Amazon is reportedly developing a voice-activated wearable capable of detecting emotion that may also offer users advice on how to interact with others.

News 5/24/19

May 23, 2019 News 18 Comments

Top News

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California-based drone-delivery company Zipline announces $190 million in funding and plans to expand its healthcare-focused service to the US, starting in North Carolina.

Founded in 2011, the company initially focused on delivering vaccines, blood products, and medications to remote clinics in Rwanda and Ghana. CEO Keller Rinaudo says Zipline is now ready to provide similar services to remote areas in the US: “People think what we do is solving a developing economies problem. But critical-access hospitals are closing at an alarming rate in the US, too, especially if you live in the rural US.”


Webinars

May 30 (Thursday) 2:00 ET. “ONC Data Blocking Proposed Rule: What Health Systems Need to Know.” Sponsor: Philips PHM. Presenter: Greg Fulton, industry and public policy lead, Philips. Proposed data-blocking regulations could specify fines, disincentives, and de-certification of providers who don’t provide an API for patients to extract all of their data. This webinar will describe who is deploying APIs, the scope of data and third-party apps that can be used, the seven costs that do not count as a data-blocking exception, and the health system protections that don’t involve using a vendor. It will also provide examples of data blocking and further exceptions.

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


Acquisitions, Funding, Business, and Stock

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Helix lays off employees and closes two of its four offices after announcing earlier this month that it will pivot from direct-to-consumer DNA testing to a provider-focused population health management business. The company has raised $300 million over the last four years. Its most high-profile contract seems to have been with organizers of the Healthy Nevada Project, which had promised last spring to hand out Helix testing kits to 40,000 of its public health data project participants.

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Global imaging and IT company Agfa considers selling off the health IT and integrated care parts of its European healthcare business, the most high-profile part of which is its Orbis EHR. Analysts believe potential acquirers could include Cerner, Philips, or CompuGroup Medical, which made a purchase offer in 2016.


People

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Diabetes management software vendor Glooko names Mark Clements, MD (Children’s Mercy Kansas City) CMO.

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Russell Siebert (ZirMed) joins analytics company VisiQuate as EVP of growth.

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MDLive appoints Kristen Lalowski (N-of-One) chief product officer.

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MD Anderson Cancer Center (TX) hires David Jaffray (University Health Network/Princess Margaret Cancer Centre) as its first chief technology and digital officer.

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Former FDA Commissioner Scott Gottlieb, MD returns to venture capital firm New Enterprise Associates as a special partner on its healthcare investment team.

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Mona Hanna-Attisha, MD receives the inaugural Vilcek-Gold Award for Humanism in Healthcare from the Vilcek Foundation and The Arnold P. Gold Foundation. The pediatrician discovered Flint, Michigan’s lead poisoning crisis by analyzing patient data in Hurley Medical Center’s Epic system. She has donated the $10,000 prize to the Flint Kids Fund.

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Provation names Rick Jennings (Teammate) CTO and Erin Surprise (Hoonuit) SVP of professional services. Wolters Kluwer Health sold Provation to Clearlake Capital last year for $180 million.


Sales

  • Consulate Health Care (FL) will leverage Collective Medical’s network for better insight into senior care transitions.

Announcements and Implementations

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Innovaccer announces GA of patient outreach management software.

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Reports surface that Amazon is developing a voice-activated wearable capable of detecting emotion that may also offer users advice on how to interact with others.


Government and Politics

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Travis Air Force Base’s David Grant USAF Medical Center (CA) will go live on MHS Genesis, the DoD’s new Cerner-based system, in September. Other facilities in the initial wave of implementations will include Naval Air Station Lemoore and US Army Health Clinic Presidio of Monterey in California, and Mountain Home Air Force Base in Idaho.


Privacy and Security

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Indiana-based Medical Informatics Engineering will pay OCR $100,000 to settle HIPAA violations stemming from a 2015 data breach that impacted nearly 4 million patients. OCR’s investigation determined that the EHR vendor hadn’t performed a thorough risk analysis before hackers broke into the system using a compromised user ID and password. Other sources have said the company ignored the recommendations of a cybersecurity firm hired at the beginning of 2015, which included strengthening weak login credentials created so that end users didn’t need individual user names and passwords. The company was named in a multi-state December 2018 lawsuit brought by 12 attorney generals over its lack of health data protection.


Other

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Burnout exists in the IT trenches, too, according to a local Madison, WI news outlet. It dedicates a good chunk of copy to the complaints of former Epic employees who have moved on to greener, less grueling pastures. Rachel Neill, CEO of health IT staffing company Carex Consulting, says Epic experiences a 20-30% churn in employees each year, with the majority of replacements coming straight out of college. “They’re looking for someone who can keep on going, going, going until they can’t any more,” she adds. Epic disputes that claim, saying that its actual voluntary turnover is about 10% per year, which is below average for companies in health IT specifically and in the Midwest in general, and that employees work about the same hours per week as salaried US employees overall. Epic Director of Human Resources Allison Stroud believes that most employees feel “happy and challenged, which ends up being one of the best ways to prevent burnout.”


Sponsor Updates

  • Elsevier Clinical Solutions, FormFast, Imprivata, and Intelligent Medical Objects will exhibit at the 2019 MUSE Inspire Conference May 28-29 in Nashville.
  • EPSi shares the updated features of its EPSi 19.1 financial decision support and budgeting software.
  • Hayes Management Consulting hires Yara Hentz (Monster) as client success manager.
  • Goliath Technologies releases an updated version of its Performance Monitor software.
  • Kyruus will host the Sixth Annual Thought Leadership on Access Symposium (ATLAS) September 23-24 in Boston featuring a keynote by Toby Cosgrove, MD.
  • Matter will feature Intelligent Medical Objects co-founder Frank Naeymi-Rad at a networking event on May 29 in Chicago.
  • HBI Solutions joins the Iatric Systems AI Solutions Center.
  • NextGate responds to requests for information by CMS and ONC on strategies to improve patient matching, underscoring the importance of standards, proven technology, and data governance.
  • Glytec receives patent allowances from regulatory bodies in Australia, Japan, and Israel related to systems and methods for insulin titration and glycemic management.

Blog Posts


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EPtalk by Dr. Jayne 5/23/19

May 23, 2019 Dr. Jayne 2 Comments

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Tech pet peeve of the week: time zones. I am working with some folks who don’t know their EST from their EDT, let alone how to work with people in localities that don’t participate in Daylight Saving Time. I’m thinking maybe we just need to all go GMT so we can get along. Either that or Microsoft needs to give us additional time zone display options in Outlook. Two is just not enough for those of us who work coast to coast or sometimes trans-Pacific.

Non-tech pet peeve of the week: recruiters who don’t know their audience. I was contacted by a recruiter from a payer (whose name I will keep anonymous to protect the guilty) who apparently had me confused with someone in another generation. “We believe that you, as a rising star, will use your unparalleled talents… fulfill your dream.” Last time I checked, most physicians don’t dream of working for a payer (although some people are really into it) but the flowery language screamed insincerity. That’s not how I’d approach a seasoned physician exec, but it made for a fun conversation when I decided to just mess with him.

EHR pet peeve of the week: having to respond to laboratory “Ask at Order Entry Questions” that should be hard-coded. How many times have I had to free text “throat” as the source for “culture – throat” in the CPOE screens of my EHR? Seriously, folks.

Clinical pet peeve of the week: my mammogram visit at Big Medical Center. I was greeted by a volunteer, then sent to waiting room purgatory for 25 minutes despite being on time. The registrar who called me over had a coffee-stained desk (right where I was supposed to lean over and fill out paperwork) and the base of her monitor hadn’t been dusted since the Bush administration. There were rubber bands everywhere on the desk and I can’t for the life of me imagine where rubber bands would belong in the workflow. I was asked to fill out a paper clinical history, including all my demographic information, by hand, and then she peppered me with registration questions while I was trying to fill out the clinical history. Perhaps my time in the waiting room would have been a better time to fill that out?

The registration system popped up a phone number that I’ve been trying to have removed from the system for almost 15 years. She had to find someone else to find out how to try to remove it. I asked why I had to put my contact numbers on the paper history and was told “if the techs have to call you, they never look at the computers.” That’s reassuring in this age of interoperability.

The worst part was being informed that I would receive my results “by mail in 7-10 days.” Despite Big Medical Center’s high-risk breast cancer program, I think I’ll be having my next study at Independent Imaging, where I used to go and where results were real time and in person. Independent Imaging at least used their EHR to pre-populate the clinical history form and have patients just update it, which is exactly what I would have expected at Big Medical Center since they just spent half a billion dollars (literally) going up on Epic. Let’s see if they contact me after I gave them free consulting on their comment card.

That’s certainly a greater number of peeves than I should be allowed this week, so let’s talk about what went well.

I’m part of a pilot project with the American Board of Family Medicine to see if doing quarterly board exam questions can be substituted for the in-person, high-stakes exam. I did my second batch of questions and think I finally have my strategy figured out on which references to use and how to approach the questions. The system is pretty streamlined and they did make a few tweaks between the first and second quarters, so I’m looking forward to see if they make any additional enhancements for Quarter 3. Those of us who have hitched our wagons to this paradigm are likely in it for the next three to four years, so hopefully the improvements will continue.

From a mental standpoint, I definitely prefer it to the testing center, where you have to turn your pockets inside out and are practically frisked if you take your allotted breaks. Let’s hope the American Board of Preventive Medicine considers a similar approach before I have to sit for informatics recertification in 2024.

I also caught up on some of my journals, including Applied Clinical Informatics, which published a study validating what most of us already knew – that physicians don’t always document key components of a visit in the EHR. The authors looked at the documentation compared to recorded office visits and concluded that for some clinicians, EHR documentation is more challenging than paper notes. Other factors influencing curated documentation include overbooked schedules and patients with complex medical conditions. Social and emotional health issues were often left out of the EHR, and while primary care physicians may be aware of these details, there are other clinicians who would not be able to access that information in a different setting of care. These omissions may prevent hospital or consulting physicians from creating a workable care plan because they don’t know about patient-specific constraints.

The study is relatively small, looking at 10 unique patient encounters from 2016. All were from the same medical center and documented on the same EHR. Patients had an average of 14 chronic conditions and were on an average of a dozen medications. Chronic conditions were documented 90% of the time, preventive 89%, acute problems 84%, and social/emotional conditions just 30% of the time. Looking at the breakdown of the recorded visits, physicians were having the conversations real time, but just not documenting them.

This is a great place where technology could help. What if we could actually accomplish what virtual scribes are doing, but actually do it real time in the exam room? What if voice recognition was as good as we need it to be? Of course, clinicians would still need to review notes for accuracy after processing, but it would be more valuable use of a computer than we are currently doing. I know Nuance is working on the exam room of the future that would be able to collect some of this information, but last I heard, they were going to pilot it with subspecialists rather than tackle the tangled world of primary care. How long will it take until we finally make it there? Only time will tell, and perhaps it will tell us in GMT.

What is your pet peeve of the week? Leave a comment or email me.

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