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Morning Headlines 10/16/19

October 15, 2019 Headlines No Comments

Northwell Health extends partnership with comprehensive Allscripts Sunrise™ platform through 2027

Northwell Health extends its Allscripts Sunrise contract through December 2027.

Cerner workers to become Adventist Health employees

Cerner will lay off 350 California employees following Adventist Health’s decision to bring its revenue cycle operation back in house from Cerner RevWorks.

Introducing AncestryHealth®: Actionable Health Insights for You and Your Family

Family history vendor Ancestry launches AncestryHealth, which will sell a $149 profile of genetic screening results that are matched to specific medical health conditions, plus a costlier membership-based service that provides deeper screening and quarterly screening updates.

Queensland Health’s IT problems can be overcome, new eHealth head says

In Australia, the new head of EHealth Queensland says its struggling Cerner implementation can be turned into a showcase project, but urges all of the state’s health bodies to help in getting new sites live while optimizing existing ones.

News 10/16/19

October 15, 2019 News 7 Comments

Top News

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Northwell Health extends its Allscripts Sunrise contract through December 2027.

Northwell’s 19 hospitals have been live on Sunrise since 2005, making it the largest customer of Allscripts.

Northwell extended its Allscripts TouchWorks agreement in 2018. 

MDRX shares rose 1.4% Tuesday after the announcement, performing slightly better than the Nasdaq Composite index for the day.  


Reader Comments

From Grim Sleeper: “Re: Allscripts and Northwell. What are the odds that their collaboration will result in a commercially viable inpatient product that can compete with Epic or Cerner” Zero, my reasoning being thusly even though all of us should be wishing for new inpatient EHR competitors:

  • Allscripts says the new product will be based on Avenel, which is targeted to ambulatory practices but hasn’t sold well in its 18-month history. The company has admitted to stock analysts that it misjudged market interest in a cloud-based EHR that doesn’t offer a paired practice management product, which is a significant oversight for an EHR/PM company.
  • Northwell said in the Allscripts press release that Avenel is immature and its usability needs help from Northwell’s experts, a comment that I’m surprised Allscripts approved.
  • Allscripts has a low-and-dropping inpatient market share in which Sunrise has been replaced with broader, integrated offerings from Cerner and Epic. Northwell will continue using Sunrise for inpatient.
  • Custom developing a product around a key customer’s specifications is a strategy that usually fails miserably except for that one customer, who gets their quirks and petulant demands baked into code that someone has to try to sell to the next hospital. Coding to spec as a follower than a leader is not the best way to create an innovative product that the broad market wants.
  • My conclusion is that Northwell took advantage of knowing it had Allscripts over a barrel as its largest client. I obviously haven’t seen the contract, but I would bet that Northwell is the big financial winner, Allscripts saves face and slings a Hail Mary about a new product (created by improving a not-new product), and we will see in future Allscripts earnings reports whether the new R&D costs and possibly lower revenue contributions from Northwell can be offset by increased additional revenue.
  • The key metrics to watch are overall EHR market share and Allscripts stock price. MDRX shares are up 10% since Paul Black took over as CEO in late 2012, vs. the Nasdaq’s 167% gain and Cerner’s 75% rise, and have shed 23% in the past year.

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From Market Watcher: “Re: Epic contracts. They’re usually a source of mystery, but a moderately redacted copy of one popped up on SEC’s Edgar. I don’t see anything that looks like a gag clause, although there’s a lot of concern about protecting Epic’s IP.” The contract between Epic and Ardent Health Services doesn’t contain anything shocking:

  • Clients pay higher Epic fees as their usage increases.
  • Clients must be current on all Epic payments before bringing a new module live.
  • Disclosure of Epic confidential information is prohibited, and if required by law (such as Freedom of Information Act requests for contract details), the client must notify Epic beforehand and cooperate with Epic to get the legally required disclosure stopped.
  • No non-disparagement clause is present in the redacted version, but the customer is required to make each user sign an agreement to keep Epic’s confidential information confidential. That information includes functionality descriptions, source code, data structures, and implementation methods. Screen shots, which are the most contentious items in that arise in sharing information about system problems among users, aren’t mentioned specifically but probably fall within functionality descriptions (as does documentation, which Epic protects vigorously). 
  • Use of third parties for implementation, staff augmentation, training, support, and hosting is limited to those companies that have signed an agreement with Epic and that have agreed not to hire employees of clients or of Epic.
  • Use of source code, data structures, and APIs can’t be used to develop a product that competes with anything Epic offers or that is “reasonably anticipated Epic software.”
  • The customer is not allowed to solicit or hire (as either an employee or contractor) anyone who has worked on an Epic implementation within the past 12 months without the previous employer’s permission and Epic won’t “work with or provide training” for those exceptions.

From NH: “Re: Novant Health. Creating an innovative electronic patient and family advisory council.” Novant will survey volunteer council members about patient room decor, food quality, and nicer waiting rooms. I’m all for those things, but what I really want from a hospital is for them to put my interests ahead of their profits, develop and follow sound clinical protocols, give me access to caring and highly skilled providers, and send me home vertically and better than when I entered. I might enjoy having better coffee or softer chairs at the oil change place, but that’s not much consolation if the tech uses the wrong filter, doubles my cost by acquiring competitors, or claims to be concerned about my car’s overall health when what they really want is to sell me more services. Consumers can see only the most superficial aspects of healthcare and they assume that they don’t need to worry about the rest, which is not true at all.

From Billing Boy: “Re: patient estimates. They are often wrong, this study finds.” It’s easy to get worked up about patients being charged more than they were told to expect (which would be shocking in any business except healthcare), but portraying those hospitals as dastardly rather than incompetent misses the point. Healthcare billing is so arbitrary and complex that even the hospital itself has no idea what will be billed until after the fact, when all the revenue-obsessed hospital departments have picked the insurance bones clean. Here’s an easy test – give a hospital an anonymized copy of the clinical records from someone’s inpatient stay at their own facility and ask them what they think the itemized bill would look like (no dollar amounts, just which line items the patient would be billed for). It would have little correlation to the bill they actually sent to the patient. Hospitals are right that they don’t know what a given patient needs until they have already provided it, but it’s a mistake to ensure that the variability between estimates and actual bills is strictly due to clinical uncertainty or insurance surprises.


HIStalk Announcements and Requests

Thanks to Jenn for covering my absence of a few days for vacation. I kept up with what she was writing and sent her items that looked interesting, but otherwise spent close to zero time using any computing form factor. Other than the many “circling back” and “pinging you again” re-sent emails from PR people who can’t grasp that not everyone stays online 24×7 or finds their self-serving announcements to be of top importance, I saw no evidence that anyone even noticed my absence, which is how it should be.

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I rarely think of Forbes as an objective, insightful news publication and this doesn’t change my mind – the company has launched a vanity publishing press and is paid-spamming LinkedIn with boilerplate invitations to “business leaders” who are willing to rent the Forbes nameplate to repackage themselves as quote-worthy experts a la “The Art of the Deal.” Its partner company touts that lazy executives can create an industry-captivating book in under 24 hours. Healthcare clients include former CMS Deputy CIO Henry Chao and about a zillion attention-seeking dentists. 


Webinars

October 24 (Thursday) 1:00 ET. “The power of voice: Will AI-drive virtual bedside assistants become mainstream?” Sponsor: Orbita. Presenters: Nick White, co-creator of DeloitteAssist and principal in Deloitte’s Smart Healthcare Solutions practice; Bill Rogers, CEO and co-founder, Orbita. Conversational AI and virtual health assistants are bringing new opportunities to care facilities to improve patient journeys and yield radical workflow efficiencies. Will the hospital rooms of the future continue to provide traditional bedside call buttons? Or will these be replaced with digitally reimagined, AI-driven, voice-powered agents? Learn from the expert who created today’s industry-leading, market-proven, virtual bedside assistant.

Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

Cerner will lay off 350 California employees following Adventist Health’s decision to bring its revenue cycle operation back in house from Cerner RevWorks. Cerner says Adventist Health has offered to hire all of the laid-off employees, while another 1,000 Cerner employees will swap their badges for those of Adventist Health.


Sales

  • Bozeman Health (MT) chooses Kyruus ProviderMatch to integrate patient access in its website and access center.

People

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Per-diem clinician hiring app vendor ConnectedRN hires Matthew Levesque (Athenahealth) as CEO.

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Industry long-timer Kim LaFontana, MBA (Medically Home) joins Livongo as VP.

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BHM Healthcare Solutions promotes Jean Neiner to president and CEO.

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Ajay Kapare (Ellkay) is appointed to the CHIME Foundation Board and its board of trustees.


Announcements and Implementations

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A new KLAS report looks at strategic mergers and acquisitions in healthcare IT, observing that about 40% of customers are happier afterward, 40% are less happy, and 20% see no impact. The percentage of customers anxious to bolt to a new vendor doubles after M&A when long-term customers resent the imposition of intentional nickel-and-diming, crappy support, and R&D slowdowns. Customers are better off if the acquirer is privately held and thus not desperate to pander to shareholders in chasing short-term profits at the expense of long-term strategy. KLAS concludes that M&A fails when the acquirer saddles the former company with layers of bureaucracy and sales-focused goals; fails to get its executives interested in the acquired company; makes grand promises that aren’t kept; and cuts back on support so that the resulting financial numbers make the acquirer’s executives look smart.

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Family history vendor Ancestry launches AncestryHealth, which will sell a $149 profile of genetic screening results that are matched to specific medical health conditions, as well as a more expensive, membership-based service that provides deeper screening and quarterly screening updates. The company has contracted with an independent physician group to order the tests. Stat notes that the tests of competitor 23andMe are regulated by the FDA since consumers order them themselves, while AncestryHealth won’t get FDA oversight because the tests are ordered by doctors but instead will be under CMS’s physician-ordered diagnostic testing rules. Experts note that only 2% of patients who don’t have a family history of a disease will learn something new from such tests, while others say that genetics accounts for less than 10% of longevity, but lack of rigorous science doesn’t usually stand in the way of companies making big money from irrational health concerns (see: Goop). 

A Black Book provider survey of vendors of software and services for coding, clinical documentation improvement, and HIM finds Nuance topping most categories, but Optum360, MModal, Dolbey, Adadyne, Qventus, and Fujitsu also finished first in some areas.

Nvidia and King’s College London create a platform that allows organizations to contribute their imaging data for machine learning-powered brain tumor research without copying it offsite or sharing it directly, with the federated learning system keeping patient data confidential.

Canada-based EHR vendor Premier Health Group will add AI from IBM Watson to its telemedicine app to use a chatbot to reduce clinician time on each call.


Other

In Australia, the new head of EHealth Queensland says its struggling Cerner implementation can be turned into a showcase project, but urges all of the state’s health bodies to help in getting new sites live while optimizing existing ones.

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A reader sent this article about Shots Heard Round the World, a “rapid-response digital cavalry” that helps providers whose vaccine-related social media messages – such as “flu vaccine has arrived – get your shot today” — trigger an electronically mobilized torrent of negative comments, scathing Yelp and Google reviews, and threats from anti-vaxxers from around the world. The group was founded by two employees of Kids Plus Pediatrics, a Pittsburgh area practice that was attacked relentlessly after it published a video explaining the value of HPV vaccine in preventing cancer. They offer the highly detailed and excellent Kids Plus Anti-Anti-Vaxx Toolkit to help practices defend themselves online harassment. Fascinating to me is their analysis of who created the 10,000 negative anti-vaxx comments on their site:

  • 95% were female, most of them either of age 18-24 or over 50.
  • The vast majority were uneducated and either unemployed or underemployed.
  • Attackers were mostly extremist in their politics, both to the left and the right.
  • Every single person who visited the practice’s Facebook page during the eight-day siege whose profile photo featured one of those dopey filters was an anti-vaxx attacker.

In England, a hospital won’t be fined the prescribed $190,000 for 600 incidents in which it placed male and female patients in the same room. The hospital says it has a zero-tolerance approach for mixed-sex rooms, but then stretches the definition of “zero tolerance” by adding that it sometimes does it anyway when all beds are full. NHS England says mixed-sex rooms are detrimental to safety, privacy, and dignity, which it fails to note are already endlessly compromised throughout all aspects of hospital care, but especially when any patient is forced to room with another. Imagine if a hotel did this, even without all employees running in and out, awkward moments involving specimen collection and bedpan usage, receiving visitors, and being separated by just a thin curtain from a dying, moaning, or loudly delusional roommate.

Odd: the elected part-time coroner of an opioid-ravaged Ohio county is charged with illegally prescribing 1.5 million opioid doses over two years and fraudulently billing Medicaid and Medicare in his day job as a pain management doctor. On the other hand, he donated to the county’s Staying Clean Club and its drug task force, so there you go.

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Even odder: Tampa General Hospital opens an OnMed telemedicine consult and drug dispensing booth in its food court so that its employees — who are inside its walls — can seek medical care from clinicians who aren’t. Maybe this is a Halloween-appropriate “the call is coming from inside the house” type situation. It’s not really an admission that employees don’t have time to deal with their own hospital employer’s bureaucracy as patients – the hospital is in business with the vendor and this first booth is a pilot for a broader rollout. The hospital CEO says millennials won’t wait to see a doctor in person, which if you’re a doctor who actually wants to care for patients, is depressingly accurate. The oldest millennials are now in their late 30s, so it would be interesting to see how those who are doctors run their practices and patient encounters.

Georgia lawmakers will require the state’s rural hospital CEOs, CFOs, and board members to complete eight hours of classes in financial management and strategic planning (in an apparent lack of irony).


Sponsor Updates

  • Netsmart processes a record 300 million secure transactions through its CareFabric solution suite in a single month, triple the number of a year ago.
  • AdvancedMD will exhibit at ASDS October 24-27 in Chicago.
  • Apixio will exhibit at the RISE HEDIS & Quality Improvement Summit October 23-25 in Miami.
  • Culbert Healthcare Solutions will exhibit at the Association of Administrators in Academic Pediatrics meeting October 17-18 in Miami.
  • Cumberland partners with Chronicled’s MediLedger Project to advance blockchain supply chain networks for pharma manufacturers.
  • Dimensional Insight will exhibit at the Massachusetts Health & Hospital Association event October 18 in Burlington.
  • ONC names Surescripts as an ONC Program Partner for Electronic Prescribing, proving EHR vendors an alternative test method to ONC-ATL.
  • Netsmart will present and exhibit at the American Health Care Association/National Center for Assisted Living 2019 Convention and Expo through October 16 in Orlando.
  • Prepared Health will exhibit at HLTH, October 27-30 in Las Vegas, as part of the Matter Showcase Pavilion.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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Morning Headlines 10/15/19

October 14, 2019 Headlines No Comments

Parsley Health Launches New Digital Services on Tail of $26M in Series B Raise

Membership-based primary care company Parsley Health raises $26 million and launches an online version of its brick-and-mortar practice.

Claus Torp Jensen Has Been Appointed First Chief Digital Officer and Head of Technology for Memorial Sloan Kettering Cancer Center

Former CVS Health CTO Claus Jensen joins Memorial Sloan Kettering Cancer Center (NY) as its first chief digital officer and head of technology.

Prairieville pediatrics clinic working with FBI, notifying patients after computer attack

Magnolia Pediatrics (LA) alerts patients to an August ransomware attack that infiltrated the practice through its unnamed IT vendor, which wound up paying the ransom.

Curbside Consult with Dr. Jayne 10/14/19

October 14, 2019 Dr. Jayne 2 Comments

Most of the scribes I work with are either applying to or have been admitted to medical school and are trying to save up money as well as learn about clinical practice. It’s fun to work with them because they’re eager to learn. I enjoy teaching but haven’t been on faculty anywhere in years. Most of them know I have another job besides seeing patients, and are often interested in what I’m working on from a CMIO standpoint. We talk a lot about EHRs and what’s different about using our niche system versus what they will encounter when they go to medical school.

A recent article in the Journal of the American Medical Informatics Association looked at the existing literature to assess the current state of EHR training for medical students and residents. The authors looked specifically at “educational interventions designed to equip medical students or residents with knowledge or skills related to various uses of electronic health records” and to “compare the aims of these initiatives with the prescribed EHR-specific competencies for undergraduate and postgraduate medical education.” There wasn’t a tremendous amount of literature for them to sift through in their analysis – only 11 studies. Of those, seven covered medical students, three included residents, and one included both groups. All of the interventions they identified covered data entry, but none involved manipulating the resulting data at a panel or population level.

They concluded that the documented interventions don’t really prepare students to show mastery in the competencies required to be effective physicians. In thinking through this, I’m not sure how many current physicians have EHR skillsets beyond just data entry. Most of the organizations I work with expressly prohibit their physicians from doing anything remotely involving data analysis or population health work. All of those functions are managed at the group level or health system level rather than by physicians. Although physicians may receive various clinical scorecards, they’re not really accessing or addressing the data on their own. This certainly would be different for independent physicians, although many of my peers in those environments don’t have the knowledge or understanding of how to get at that data, either.

In digging deeper into the study and its methods, I was surprised by how much the different training interventions varied. Some were a brief (one hour) self-directed module that reviewed screenshots of different areas of the EHR; others could be as long as a multi-week simulated EHR curriculum. Most of the included workflows were based on data entry or information retrieval. Other activities included retrieving lab results, looking at medication lists, orders, and billing functions such as E&M coding. The interventions had different ways to assess competency. Some included a pre-test followed by a post-test after the intervention. Only three studies included a control group. Nine of the studies involved changing skills and only two looked at changing attitudes. Other assessment methods included quizzes, surveys, self-reported questionnaires, chart review, and structured practice with standardized patients.

The students and residents did well when they were evaluated using quizzes and surveys, and were satisfied with that approach as well as being able to demonstrate competency. Other studies didn’t show a difference between the intervention group and a control group. One study was able to show that learners receiving the intervention performed better on standardized patient examinations while they were being judged on their ability to complete a structured patient visit. Although standardized patients are an important part of learning (particularly as students and residents learn to perform sensitive examinations) they always made me nervous, since they were fully aware of what I was supposed to be doing and what kind of findings were supposed to be present, and I was being compared not only against my own classmates but the dozens of students who had examined them in previous years.

I was curious as to the specific competencies the authors were including when they identified gaps in training interventions. They expected students, prior to beginning their clinical clerkships (usually in the third year of medical school at the latest) to “be able to describe the components, benefits, and limitations of EHRs; the principles of managing and using aggregated electronic health information, including tenets of electronic documentation as well as differences between unstructured and structured data entry; and articulate standards for recording, communicating, sharing, and classifying electronic health information in the context of a medical team.” They also note students should “be able to identify how systems may generate inaccurate data, discuss how data entry affects direct patient care and healthcare policy, gather relevant data from EHRs, and assess the reliability and quality of these data.”

Again, I’m not sure many practicing physicians would be able to enumerate all of these elements. They may also not have a “working knowledge of health informatics through chart audits and research projects.” On the flip side, maybe if the physicians I work with had received better education around the role of EHRs, they’d be more interested in the idea of clinical informatics as well as what they can do with the vast amount of data they’ve been keying into the EHR over the years. The authors did note that “a significant number of trainees have had exposure to the EHR before their medical training as scribes and that inclusion of these individuals in the studies may have affected the results.”

I’d be curious to hear from those of you who are academic institutions on whether your training programs are incorporating these competencies into the curriculum. My medical school recently began undertaking a complete overhaul of the educational curriculum, so you can bet I’ll be asking about it the next time I run into the new associate dean who has been tasked with that effort. We heard a bit about it at my medical school reunion in the spring, but the main points of her address were around providing clinical exposure to students far earlier than we experienced during our training. The only EHRs available when I was a student involved one that used a green screen terminal to access lab results at the flagship hospital, and one that used a light pen to navigate at the community hospital. The academic center was just beginning to build its own clinical data viewer, whose contents were hit or miss, as I entered my fourth year. Now after a decade of best-of-breed construction, they’re all using Epic.

Do you think your current practicing physicians can demonstrate mastery of the skills the authors evaluated? Leave a comment or email me.

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Morning Headlines 10/14/19

October 13, 2019 Headlines No Comments

Centra begins issuing bills after almost three-month hiatus

Centra (VA) resumes billing and collections after a three-month hiatus caused by glitchy Cerner software that hospital officials say led to rejected claims, delayed billing, incorrect bills, and prematurely sending patients to collections for lack of payment.

UCSF Launches Artificial Intelligence Center to Advance Medical Imaging

Researchers at UC San Francisco’s new Center for Intelligent Imaging will work with Nvidia’s AI computing technology to develop new solutions for radiology.

Topcon Healthcare Selected to Ease Transition for IBM® Merge Eye Station and Merge Eye Care PACS Customers

IBM Watson Health Imaging will discontinue support for its Merge Eye Station digital imaging technology and Merge Eye Care PACS by the end of 2020.

Monday Morning Update 10/14/19

October 13, 2019 News 12 Comments

Top News

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Centra (VA) resumes billing and collections after a three-month hiatus caused by glitchy Cerner software that hospital officials say led to rejected claims, delayed billing, incorrect bills, and prematurely sending patients to collections for lack of payment. The $73.5 million Cerner system was installed in 2018, but Centra’s financial team didn’t notice any problems until a few months later. It estimates that 2,200 incorrect billing statements have been sent out.

To rectify the problem, Centra is rebooting its billing cycle, giving impacted patients a 5% discount, and making sure that its customer service reps have had Cerner-specific training so that they can be more empathetic to patients with billing problems.

Centra will continue with the second phase of its Cerner implementation at remaining ambulatory and post-acute care sites next year.


HIStalk Announcements and Requests

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A majority of respondents would have no problem using employer-approved providers if it resulted in a discount on their employer-sponsored health plan. Nevertheless offers the employer perspective: “We have employees who work in at least 5 states today and that will grow. This approach is not at all manageable for a company like ours. I want to be LESS involved in my employees’ healthcare access, not more. I’m ok with paying for healthcare coverage for my employees – but I don’t want to micromanage how they get those services.”

MerryMe offers the employee’s: “Absolutely not. Employers shouldn’t be involved in healthcare – AT ALL. Not insurance. Not in/out of network. Not hey, save $100 if you stop smoking. If my employer or co-worker wants to send around an email saying ‘had great experience at XYZ’ or ‘hey, I found this website and maybe you can save on your Rx like I did,’ fine. Want to do a benefit dinner for a fellow employee who has cancer? Great. Otherwise, keep your nose and ‘help’ out of my business. I don’t trust that costs for types of procedures are not being shared with the employer – and what I’m seeking care for is none of my employer’s business.”

And Sorry that of the too-young-to-need-it: “As a young person who doesn’t use any healthcare right now and expects not to work at a place longer than five years, I’ll take that deal and then continue never going to the doctor. I would be interested to know how much of the cost of health insurance you could knock off this way though. I get the feeling that I’m subsidizing the old people’s healthcare at my company. Eventually we’ll move off employer-tied health insurance (since businesses are starting to hate it) and to something state-funded, at which point the young will still be subsidizing the old but 1. I’ll be old. 2. At least I’ll be able to see what’s going on rather than trying to interrogate my HR rep.”

New poll to your right or here: Would you avoid treatment at a hospital that has a history of suing patients for unpaid bills? Comments (anonymous or not) are welcome, especially if you’ve found yourself on the receiving end of relentless debt collectors.


Webinars

October 15 (Tuesday) 1:00 ET. “Universal Health Services Case Study: How to Improve Network Design and Management with Claims Data.” Sponsor: CareJourney. Presenters: Mallory Cary, regional director of ACO operations, UHS; Abbas Bader, director of product development, CareJourney. Universal Health Services (UHS), one of the nation’s largest hospital management companies, has more than 350 acute care hospitals, behavioral health facilities, and ambulatory centers across the US, Puerto Rico, and the UK. UHS has collaborated closely with CareJourney over the last three years in building high-performing networks in new markets, managing patient populations as they flow through those networks, and targeting areas for performance improvement within the network. Join the expert presenters for deep insights into network design and optimization.

October 24 (Thursday) 1:00 ET. “The power of voice: Will AI-drive virtual bedside assistants become mainstream?” Sponsor: Orbita. Presenters: Nick White, co-creator of DeloitteAssist and principal in Deloitte’s Smart Healthcare Solutions practice; Bill Rogers, CEO and co-founder, Orbita. Conversational AI and virtual health assistants are bringing new opportunities to care facilities to improve patient journeys and yield radical workflow efficiencies. Will the hospital rooms of the future continue to provide traditional bedside call buttons? Or will these be replaced with digitally reimagined, AI-driven, voice-powered agents? Learn from the expert who created today’s industry-leading, market-proven, virtual bedside assistant.

Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Announcements and Implementations

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Alameda Health System (CA) goes live on Epic. AHS staff from what looks like every department put together this great video celebrating the install. The $200 million project was first announced at the beginning of 2018.

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Virtua Health (NJ) implements SymphonyRM’s Next Best Action CRM.

In Illinois, Pivot Point Consulting assists in the implementation of Christie Clinic’s Epic system through a Community Connect affiliation with Carle Foundation Hospital.

IBM Watson Health Imaging will discontinue support for its Merge Eye Station digital imaging technology and Merge Eye Care PACS by the end of 2020. Topcon Healthcare Solutions will offer transition assistance to Merge customers who want to transition to its Harmony data management system. IBM acquired Merge Healthcare in 2015 for $1 billion.

Brigham and Women’s Hospital (MA) will use digital lifestyle tracking and telemedicine tools from Fruit Street Health in a six-month brain health improvement study of patients at risk for cognitive decline and dementia.


Privacy and Security

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A look back at WannaCry’s impact on the NHS finds that the 2017 ransomware attack resulted in a $7.6 million loss due to a decrease in admissions and appointments. Over 600 NHS facilities were affected. The health service spent considerably more – some analysts estimate nearly $90 million – on IT to fix the fall-out.

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Men’s online health and wellness company Ro alerts customers to a potential breach that occurred when hackers attempted to access information on the laptop of an affiliate physician. The physician’s computer, which was the property of the MD’s health system employer, was infected with malware. Ro fired the physician for violating its Physician Code of Conduct by downloading unapproved software. CEO and co-founder Zachariah Reitano brings up a point relevant to telemedicine vendors who hire physicians with other employers: “The challenge Ro and others face is that, in addition to securing our own systems, we need to account for systems outside of our direct control. Ro has taken and will take a number of steps to implement additional security measures to help further protect personal information, including enhancing the security on our physicians’ computers.”


Other

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Stanford Medicine (CA) hosted its second annual EHR National Symposium featuring speakers from its health system, Epic, ONC, UnitedHealthcare, Microsoft, Cleveland Clinic, Cerner, and Livongo, among others. Videos from the event should be on the symposium’s website soon.

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Researchers find that opioid dosages decreased 22% per new prescription after the University of Pennsylvania Health System implemented EHR alerts in New Jersey practices notifying prescribers if prescriptions exceeded the legal five-day limit.

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Researchers at UC San Francisco’s new Center for Intelligent Imaging will work with Nvidia’s AI computing technology to develop new solutions for radiology. Ci2’s initial work will focus on an NIH-directed project using AI and data analysis to evaluate chronic back pain.


Sponsor Updates

  • Elsevier rebrands its Via Oncology cancer care management and clinical decision support tool to ClinicalPath.
  • The Women Tech Council honors Health Catalyst Chief People Officer Linda Llewelyn with its award for culture leadership.
  • Mobile Heartbeat will host an event on Enhancing Clinical Communications October 16 in Dallas.
  • Netsmart will exhibit at the NAHC Annual Meeting October 13-15 in Seattle.
  • PMD adds a two-click Instant Capture option to its Charge Capture software.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at AWHONN WA Fall Meeting October 13-15 in Bremerton.
  • Authority Magazine features “’5 Things I Wish Someone Told Me Before I Became CEO of Experity,’ with David Stern.”
  • Redox will host its Interoperability Summit October 15 in Boston.
  • The Touch Point podcast features StayWell President Pearce Fleming.
  • Surescripts will exhibit at the EClinicalWorks National Conference October 18-20 in Orlando.
  • Vocera will exhibit at the Indiana Organization of Nurse Executives Fall Conference October 16-18 in French Lick.
  • Spok publishes a new e-book, “Why the future of healthcare is in the cloud.”

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
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Weekender 10/11/19

October 11, 2019 Weekender No Comments

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Weekly News Recap

  • Mednax will sell its MedData business to private equity firm Frasier Healthcare Partners for between $250 million and $300 million.
  • DCH Health System (AL) agrees to pay Russian hackers after an October 1 ransomware attack forced it to divert patients and revert to paper processes.
  • Membership-based primary care company One Medical hires several banks to help it prepare for an IPO.
  • Patient engagement vendor Relatient acquires patient self-scheduling and waitlist software developer Everseat.
  • Cerner reveals details about “Project Apollo,” new cloud-based technology that will leverage the company’s previously announced partnership with AWS.
  • Researchers determine that 25% of healthcare spending – between $760 billion and $935 billion per year – is wasteful.

Best Reader Comments

Re: Putting off health care for financial reasons. According to GoFundMe’s CEO, one third of all campaigns are for medical expenses. Folks are literally begging strangers for money to help them pay their medical bills. (Kermit)

My “great expectation” would be that every time someone makes an entry into my medical record, that I would get a notification say that “X just entered something into your medical record. If this is appropriate, do nothing. If this is an error, please call us”. I feel this way because I was a victim of an identity mix-up with inappropriate merging of my record with someone else’s. Patient awareness like what happens with my credit care/bank might go a long way to reducing errors – and maybe it might make patients feel more responsible for their records at the same time. (Joe Schneider)

Sucks about athena but it is a hard market at a hard time. It looks like everybody will be stuck with CPSI until Allscripts buys them out and puts Evident out to pasture. (2Bad)

re: NextGen acquiring Topaz. The ‘agnostic’ market that NextGen has attempted to build (Eagle Dream Analytics, Entrada Mobile etc) continues to struggle with execution, two to three years in for analytics and mobile. If they could fix that problem, NextGen could be a different company. I don’t know if Topaz is another agnostic unicorn attempt but if the company doesn’t figure out how to execute, it will still be the same old NextGen regardless of the shade of lipstick on the pig. (ellemennopee)


Watercooler Talk Tidbits

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Ghanian teenager Mustapha Haqq develops a predictive analytics model that uses AI to diagnose breast cancer. Because of poor Internet access in his area, Haqq walked several miles to an Internet café, where he taught himself to code and develop the model using resources from UC Irvine. “Internet access is expensive,” he says, “but thanks to the generous support of my parents – who made some sacrifices to give me a chance to complete a few online courses – I built sufficient coding skills to start developing solutions to some of the problems affecting our community.” Haqq has gone on to launch several coding clubs for students of all ages.

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CNN profiles Olawale Sulaiman, MD a professor of neurosurgery and spinal surgery at Ochsner (LA) and founder of RNZ Global, which provides spinal surgeries and medical training in the US and his homeland of Nigeria. Sulaiman has taken a 25% pay cut to spend time – up to 12 days every month – caring for patients in Nigeria at little to no cost. “I believe that happiness doesn’t come from what you get, rather, it comes from what you give,” he said. “There is always room to give; you don’t need to be a millionaire to give.”

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National Library of Medicine researchers call for “no-selfie zones” after determining that 259 people died attempting to take death-defying pictures of themselves between 2011 and 2017.

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Restaurant franchise company Chanticleer Holdings decides to spin off its dining assets, which include the Hooters chain, so that it can merge with cancer drug maker Sonnet BioTherapeutics. @VentureValkyrie has started a tweet thread to crowdsource names for the newly combined company.


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Morning Headlines 10/11/19

October 10, 2019 Headlines No Comments

MEDNAX Reaches Agreement to Sell MedData Business to Frazier Healthcare Partners

Mednax will sell its MedData RCM software and services business to private equity firm Frasier Healthcare Partners for between $250 million and $300 million.

Relatient Acquires Everseat, A Leading Patient Self-Scheduling and Waitlist Software Company

Patient engagement vendor Relatient acquires patient self-scheduling and waitlist software developer Everseat.

Persivia Secures $15 Million Growth Financing from Petrichor Healthcare Capital Management

Care coordination, analytics, and value-based care software company Persivia raises $15 million in a Series C funding round.

Harris Healthcare Acquires Connecture, Inc.

Harris Computer’s healthcare group acquires Brookfield, WI-based insurance enrollment technology vendor Connecture.

News 10/11/19

October 10, 2019 News No Comments

Top News

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Mednax will sell its MedData RCM software and services business to private equity firm Frasier Healthcare Partners for up to $300 million.


Reader Comments

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From RWJBetter Believe It: “Re: RWJBarnabas Health’s rumored conversion to Epic. Looks like the rumblings have been confirmed: “We’ve announced the move to the Epic IT platform, and in 2020 that project will kick off in earnest. We view this move as transformational for our organization; it will allow us to truly connect all of our healthcare assets in a deeper way than they have been connected in the past.”  As Barnabas Rubble first suggested here in June, the New Jersey-based health system – the result of the 2016 merger of Barnabas Health and Robert Wood Johnson Health System – will finally bring all of its facilities onto one platform.

From anon: “Re: PeaceHealth layoffs. PeaceHealth just laid off more IT staff. Unlike their last round of layoffs in July, which was almost only people outside their Vancouver, WA office with the stated intent to centralize services, this round included Epic Analysts in Vancouver. Their upgrade goes live this week, no less.” The local news reports that this round is of 50 centralized support service staffers.

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From Vaporware?: “Re: The Brent Schafer AI story. I totally believe that is real. The head-scratcher is further down in the press release: ‘Stemming from Cerner’s collaborative work in the federal space, the company is soon to roll out “Cerner Seamless Interoperability.’ Questions: Will it be a new contract for Cerner, since they’re just now inventing and releasing it? Will it be based on their current ;federal space’ interoperability model of logging in to side-by-side workstations? How is it different from CommonWell, which has been sold as ‘Seamless Interoperability’ since 2013 (and still is not live in federal space)?

From Insider: “Re: Cantata Health. CEO let go and more layoffs coming. They have moved all support offshore, and clients are not happy. Talk about a sinking ship. The CTO and some finance people are now running the company.” Former CEO Krista Endsley’s LinkedIn profile confirms her departure after 18 months. The company’s sole C-suiter is CTO Rich Zegel.


Webinars

October 15 (Tuesday) 1:00 ET. “Universal Health Services Case Study: How to Improve Network Design and Management with Claims Data.” Sponsor: CareJourney. Presenters: Mallory Cary, regional director of ACO operations, UHS; Abbas Bader, director of product development, CareJourney. Universal Health Services (UHS), one of the nation’s largest hospital management companies, has more than 350 acute care hospitals, behavioral health facilities, and ambulatory centers across the US, Puerto Rico, and the UK. UHS has collaborated closely with CareJourney over the last three years in building high-performing networks in new markets, managing patient populations as they flow through those networks, and targeting areas for performance improvement within the network. Join the expert presenters for deep insights into network design and optimization.

Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

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Patient engagement vendor Relatient acquires patient self-scheduling and waitlist software developer Everseat.

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Care coordination, analytics, and value-based care software company Persivia raises $15 million in a Series C funding round.

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Three months after securing $73 million in funding, Omada Health announces an undisclosed investment from Intermountain Ventures. Intermountain Healthcare (UT) has worked with the digital chronic disease prevention company since 2016. Its diabetes services became a covered benefit for Intermountain employees earlier this year.

Harris Computer’s healthcare group acquires Brookfield, WI-based insurance enrollment technology vendor Connecture.


Sales

  • Greeneville Community Hospital East (TN) selects tele-ICU services from Advanced ICU Care.

People

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Nursing Informatics Boot Camp director Susan Newbold PhD, RN-BC will receive the Virginia K. Saba Nursing Informatics Leadership Award from the Sigma Theta Tau International Honor Society of Nursing at its meeting next month.

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Beth Israel Deaconness Medical Center physician and Society for Participatory Medicine co-founder Danny Sands, MD joins Backpack Health as CMO and VP of medical affairs.


Announcements and Implementations

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The Milford campus of Yale New Haven Health’s Bridgeport Hospital (CT) goes live on Epic. The health system wrapped up its system-wide go live in 2013; it added Milford Hospital several months ago.

The Harvard Pilgrim Health Care Institute will leverage Veradigm Health’s HealthInsights de-identified EHR database in its development of the FDA’s Sentinel drug- and product-safety monitoring system.

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Golden Valley Memorial Healthcare (MO) implements Meditech’s Sepsis Management Toolkit.

NewCrop will integrate OptimizeRx’s digital health messaging with its e-prescribing service.

Arrendale Associates adds NVoq’s speech-recognition capabilities to its Transcript Advantage software.

The Public Hospitals Authority in the Bahamas completes the first phase of its integrated health information management system implementation with help from Santa Rosa Consulting.


Other

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VCU Health (VA) announces it will no longer sue patients for unpaid bills after seeing the uproar caused by revelations that UVA Health filed 36,000 lawsuits over six years in an effort to collect $106 million. VCU’s physician group has filed 56,000 lawsuits to recover $81 million from patients over the last seven. “We don’t want to be a part of that,” says CFO Melinda Hancock. “We feel that taking care of the patient’s financial health is taking care of their holistic health.”


Sponsor Updates

  • Capsa Healthcare adds Imprivata’s identity and access management technologies to its CareLink Nurse Workstations.
  • Elsevier Clinical Solutions will exhibit at the National Association for Home Care & Hospice conference October 13-15 in Seattle.
  • EClinicalWorks, Ellkay, FormFast, and Kyruus will exhibit at MGMA October 13-16 in New Orleans.
  • Ensocare will exhibit at the ACMA Great Lakes Chapter Annual Conference October 11 in Novi, MI.
  • EPSi will host the Visis: 2019 EPSi Summit October 22-24 in Austin, TX.
  • Allscripts names Healthfinch’s prescription renewal delegation solution, Charlie, as its October App of the Month.
  • Healthwise and Intelligent Medical Objects will exhibit at the EClinicalWorks National Conference October 18-20 in Orlando.
  • InterSystems will exhibit at the DoD/VA & Gov Health IT Summit October 16-17 in Alexandria, VA.
  • Nuance expands Clinical Guidance for Dragon Medical Advisor, its AI-powered computer-assisted physician documentation capability available through Dragon Medical One.
  • Imat Solutions integrates Zen Healthcare IT’s Integration-as-a-Service and gateway solutions with its health data management technology.
  • Optimum Healthcare IT publishes a new case study, “Improving Provider Practice Efficiency at Southcoast Health.”
  • Phynd partners with MedTouch to offer health systems one-step appointment search and scheduling capabilities.
  • In a new video series, Wolters Kluwer Health takes a candid look at the nursing profession through the lens of practicing nurses.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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EPtalk by Dr. Jayne 10/10/19

October 10, 2019 Dr. Jayne 1 Comment

The ONC blog this week featured a discussion on Electronic Prescribing of Controlled Substances (EPCS). Among physicians who prescribe controlled substances, those who use electronic systems to transmit those orders remains relatively low at 32%. Although some states have mandated the use of EPCS, others haven’t forced the issue with providers. EPCS requires multifactor authentication, and the reality for those of us who prescribe relatively few controlled substances is that the amount of work (and additional technology needed) doesn’t outweigh the potential for reducing drug diversion or other bad acts.

When I do recommend controlled substances, our practice has in-house dispensing capabilities that prevent the prescription from being diverted since we fill it right there. On the off chance that a patient wants a paper script, we print it on compliant paper. I’ve issued one paper script in the last two weeks, and it was a situation where the patient didn’t really want the medication but since they had a complicated fracture I was concerned about them going through the weekend without a backup plan for something stronger. I don’t think that script for five tablets of Tylenol with codeine has a high likelihood of contributing to the opioid epidemic. Still, mandates are coming including the SUPPORT Act, which requires that certain drugs covered under Medicare Part D must be prescribed electronically beginning in 2021. Depending on the frustrations generated by the clinician’s EHR, I wonder if some providers might just consider no longer prescribing agents that will require additional technology.

Lots of chatter in the physician lounge about the recent New York Times piece regarding wasteful spending in the US healthcare system. The comments are also a good read, especially those that note that although burdensome and wasteful, if we cleaned up these processes a lot of people would wind up unemployed. The piece actually draws on a special communication published in the Journal of the American Medical Association that estimates that 20 to 25% of US health spending is wasteful. In order to truly eliminate waste, a number of solutions would have to be employed, including following principles of evidence-based medicine, which would reduce unnecessary testing and treatments that unfortunately some patients demand. The estimated $760 billion exceeds our spending on education and the military, which is a shocking number. Evidence-based care would shave $200 billion off of that, and trimming administrative costs could reduce it another $226 billion. Better care coordination could reduce another $205 billion in wasteful spending. Another big chunk of spending is related to fraud and abuse, ringing in between $60 billion and $80 billion each year. Lots of food for thought, for sure.

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I’m not sure what to think about Devoted Health and its decision to offer coverage for Apple Watches for members of its private Medicare plans. Many Apple Watch users drive me crazy, with the constant checking of their watches as messages and information flows through to their wrists. It’s every bit as annoying as having someone in front of you checking their phone instead of paying attention – having a smaller form factor doesn’t excuse the behavior. The Devoted Health program will pay up to $150 towards the cost of the device for its members in a move to stand above other Medicare Advantage plans. The jury is still out on whether wearables truly drive improved health outcomes, so this may end up being little more than a gimmick to try to entice members to join the plan. The $150 earmarked for Apple Watches can also be used for health-related classes and other programs, some of which are actually proven to drive outcomes. Devoted Health has roughly four thousand members but hopes to scale to 100,000 members over the next four years as it expands beyond its Florida footprint.

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The workflow at my practices requires me to perform initial readings on plan radiographs while we wait for an overread. Although I’ve had a fair amount of training, some findings can be subtle and are easily missed unless you maximize the contrast and other enhancements available as you view the images on the screen. Despite my accuracy statistics, I’m always relieved when I see the overread and know that the radiologist agrees. I’m eager to see artificial intelligence applied to radiology at the point of care for rank and file physicians, not just in the intensive care units where a lot of the research is being done. Recently, several radiologist’s organizations released a joint statement warning that increased use of AI in radiology can raise the risk of system errors leading to adverse patient events. They call on regulatory boards to monitor AI systems to ensure patient safety, and also call for development of codes of conduct covering the ethics of AI use and warned against using radiology algorithms for financial gain. I can’t wait to see what diagnostic imaging looks like in a decade – it’s one of the areas with the most promise for delivering high-tech solutions to the bedside.

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As the leaves are falling and summer is way behind us, I’m going to continue to call out CMS and its Primary Care First program. Their promised Request for Application was due “summer 2019” since the first performance year starts on January 1, 2020. It’s a little difficult to gear up for a program when you don’t know if you’ve been accepted or even if you want to apply since you don’t know what the details are. CMS hasn’t even done the courtesy of updating its website, which still says it anticipates a summer release. Come on, folks, either release the app or officially delay the program. Don’t leave people hanging – and acting like a practice could realistically target a January 1 start date just makes you look out of touch.

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Since my favorite smart jewelry company Ringly went dark, I’ve been on the look out for other smart jewelry items. I’m still baffled by Amazon’s Echo Loop smart ring. It’s not fashion forward in the least but belongs to a group of devices that may or may not fill a consumer need along with Echo Frames glasses and Echo Buds earbuds. It’s a bit pricey at $130, but has potential for people who want another way to control their smart devices. Amazon refers to the group of devices as “Day 1 Editions,” which are past the beta stage but haven’t been fully proven for consumer purposes. The company describes them as “things that we’ve found delightful internally and we want to get customer feedback on it so we can continue to innovate.” It only comes in black and is only available in ring sizes nine and up, so not exactly dainty. Interested customers have to request an invitation to try the product.

What do you think of Amazon’s new wearables? Leave a comment or email me.

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Morning Headlines 10/10/19

October 9, 2019 Headlines No Comments

This startup just raised $8 million to help busy doctors assess the cognitive health of 50 million seniors

BrainCheck raises $8 million in a Series A funding round that will enable it to further develop its cognitive assessment software for seniors.

Marathon Health and General Atlantic Announce Strategic Partnership

General Atlantic acquires onsite health center and technology company Marathon Health from Goldman Sachs.

Top 10 Health Technology Hazards for 2020

The ECRI Institute includes alert fatigue, cybersecurity risks, and medication errors from dosing discrepancies in EHRs on its list of top HIT hazards for 2020.

Morning Headlines 10/9/19

October 8, 2019 Headlines No Comments

WellSky to Acquire ClearCare, Solidify Position in Personal Care Market

WellSky will acquire ClearCare, a San Francisco-based developer of cloud-based management software for home care agencies.

One Medical, the health clinic chain backed by Alphabet, has hired banks ahead of an IPO

Membership-based primary care company One Medical reportedly hires several banks to help it prepare for an IPO next year.

Cerner CEO Unveils Next-Generation Cognitive Platform in Health Conference Keynote

Cerner CEO Brent Shafer reveals details about “Project Apollo,” new cloud-based technology that will leverage the company’s previously announced partnership with AWS.

News 10/9/19

October 8, 2019 News 3 Comments

Top News

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Researchers from the University of Pittsburgh School of Medicine and Humana determine that 25% of healthcare spending – between $760 billion and $935 billion per year – can be characterized as wasteful. They believe that $191 billion to $282 billion could be saved if interventions were put in place.

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The study looked at waste across six categories:

  • Failure of care delivery.
  • Failure of care coordination.
  • Overtreatment or low-value care.
  • Pricing failure.
  • Fraud and abuse.
  • Administrative complexity.

Administrative complexity was found to be the biggest driver. Researchers couldn’t estimate administrative cost-savings through interventions like more seamless interoperability and value-based care due to a lack of previous studies done on the topic – a sadly laughable, highly ironic state of affairs that those working in healthcare will likely not be surprised by.


Reader Comments

From EHRWhisperer: “Re: Advocate’s conversion. Advocate Aurora Health began it’s Cerner to Epic conversion in the first of four waves today at Advocate Condell Medical Center and Advocate Good Shepherd Medical Center. There were no major issues. The project will extend the existing Aurora Epic license to all twelve Advocate Illinois hospitals over the next twelve months. The merged system will be the largest single Epic database in the world.” The merger of Advocate Health Care and Aurora Health Care was approved in March 2018, resulting in an organization that has 27 hospitals, 3,300 employed physicians, 70,000 employees, and annual revenue of $11 billion. AHC was an Allscripts and Cerner site before the merger. Its conversion from Allscripts to Epic took place last December.


Webinars

None scheduled in the coming weeks. Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

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Filings with the Wisconsin Department of Natural Resources show that Epic intends to expand its Verona campus to accommodate another 1,200 employees over the next five years.

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WellSky acquires ClearCare, a San Francisco-based developer of cloud-based management software for home care agencies.

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One Medical reportedly hires several banks to help it prepare for an IPO next year. Valued at between $1.5 billion and $2 billion, the tech-heavy chain of membership-based primary care clinics has raised over $500 million since launching in 2007.


Sales

  • Lafayette General Health (LA) selects provider search, scheduling, and data management technology from Kyruus.
  • West Virginia University Health System selects IntelliGuide software and services from PatientMatters to connect uninsured patients with available benefits.
  • Salem Health (OR) will install Omnicell XT Automated Dispensing Cabinets at Salem Hospital.
  • The BCBS-managed Federal Employees Health Benefits Program signs a two-year contract with Livongo for its remote diabetes monitoring and coaching program.
  • Marshfield Clinic Health System will implement Sectra’s PACS at seven hospitals and 50 clinics.
  • Geisinger (PA) expands its adoption of Cerner’s HealtheIntent population health management software with a new 10-year agreement.

People

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Niki Buchanan (Philips Wellcentive) joins Jvion as SVP of customer success.

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Streamline Health Solutions names Wyche “Tee” Green president and CEO. He has been serving in those roles on an interim basis since July.

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Jerry Henderson, MD (MD Anderson) joins healthcare analytics company PotentiaMetrics as CMO.


Announcements and Implementations

Change Healthcare adds AI capabilities to its CareSelect Imaging decision-support software.

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InterSystems develops data cleansing and normalization services for use in machine learning and analytics applications.

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Devoted Health becomes the first Medicare Advantage plan to subsidize the Apple Watch purchases of its 4,000 members in Florida. Launched by health IT veterans Ed and Todd Park in 2017, the company has raised over $350 million and plans to expand to Texas.

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The Harvard Pilgrim Health Care Institute will use TriNetX’s EHR data network in its management of the FDA’s Sentinel System, a national program that uses digital health data to monitor the safety of FDA-approved drugs and medical products.

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Patients accessing Meditech’s Expanse or 6.0 EHR can now do so through the Apple Health app. 


Other

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Roadblocks to digital health market entry include a lack of expertise and rigid business and reimbursement models that make getting to market difficult, according to a recent survey of 284 healthcare professionals. Digital health clinician end users say poor reimbursement, lack of expertise, and privacy/security concerns hinder their decisions to purchase new products.

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Kaiser Health News looks at the small but growing trend of health systems getting into the housing business. Denver Health, for example, is converting a 10-story building near its campus to senior housing and transitional living for homeless patients who otherwise could occupy a hospital bed at a cost of up to $2,700 a night. The hospital estimates it could house a patient at its new facility for $10,000 a year, though transitional patients will be given help in finding more permanent housing within 90 days.

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The Cerner Health Conference gets into full swing today in Kansas City, MO. During his keynote, CEO Brent Shafer touched on interoperability improvements; new cloud-based technology dubbed “Project Apollo” that will leverage the company’s previously announced partnership with AWS; AI and analytics enhancements to its opioid toolkit; and free online training tools.


Sponsor Updates

  • Cambridge University Hospitals NHS Foundation Trust saves $3.15 million in equivalent staff time and reduce turnaround time after implementing medical device integration technology from Capsule Technologies.
  • AdvancedMD will exhibit at the AAO meeting October 12-15 in San Francisco.
  • Clinical Architecture will exhibit at Epic’s App Orchard Conference October 16-18 in Verona, WI.
  • CoverMyMeds and Culbert Healthcare Solutions will exhibit at MGMA October 13-16 in New Orleans.
  • Dimensional Insight will exhibit at the New England HIMSS HIE event October 10 in Worcester, MA.
  • Goliath Technologies exhibits at the Cerner Health Conference with new partner Igel through October 9 in Kansas City, MO.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
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Morning Headlines 10/8/19

October 7, 2019 Headlines No Comments

Private Medicare plan Devoted Health says it is the first to cover Apple Watch as a benefit

Devoted Health becomes the first Medicare Advantage plan to subsidize the Apple Watch purchases of its 4,000 members.

Livongo Awarded Diabetes Contract for Eligible Population for Approximately 5.3 Million Beneficiaries Through the Federal Employees Health Benefits Program

Livongo’s stock jumps 18% on the news that it has signed a two-year contract with the Federal Employees Health Benefits Program to offer its remote diabetes monitoring and coaching program to eligible beneficiaries.

Journal of the American Medical Association (JAMA) Publishes Humana Study on Health Care Spending

Researchers from the University of Pittsburgh School of Medicine and Humana determine that 25% of healthcare spending – between $760 billion and $935 billion per year – can be characterized as wasteful.

Curbside Consult with Dr. Jayne 10/7/19

October 7, 2019 Dr. Jayne 1 Comment

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Normally my issue of Health Data Management goes straight into the recycle bag, since it’s usually a regurgitation of material I’ve already seen or even written about. The fall issue’s headline caught my eye, since “Great Expectations” is one of the novels I had to suffer through several times during my high school and undergraduate years. I’m sure they didn’t intend to evoke Charles Dickens, but maybe they did considering the major characters include a naïve youngster, a convict, and an eccentric who wants everything to be just like it did at a singular time in their youth. That sounds a bit like healthcare IT, especially when you add in the themes of rich versus poor, love versus rejection, and the ongoing struggle of good versus evil.

All literary parallels aside, I’m not sure what kind of expectations I have for what is to come in healthcare IT in the next decade. I think we all have enormous wish lists, but whether those items are brought to fruition or continue to dwell in the world of pipe dreams will remain to be seen. I think about some of the things I dreamed of as a child that currently exist. What if you could have a soundtrack for your daily life, that could play whatever song you were in the mood for? If the iPod and numerous MP3 players were close but not quite, now we have Spotify to satisfy most of our music cravings. What if you could talk to your computer and get information without even typing? Siri, Alexa, and Cortana can continue to duke it out, but I’m happy to be able to see what the weather is like while I’m scrambling around in the morning doing three things at once.

On the other hand, we see an industry that continues to remain somewhat hobbled by regulatory requirements, where many vendors have had to cast aside true innovation in lieu of checking a host of boxes for functionality that their users not only don’t want but find tedious or annoying. It doesn’t matter how good they might be for patient care, if no one uses them it’s a fairly moot point. Unless there’s a carrot or stick involved, organizations and their users aren’t going to just adopt things for the sake of adopting new features. There’s too much else at stake and too many other things that demand (and deserve our attention).

With that in mind, I’m not sure what I think about the upcoming requirements to (finally) institute Medicare’s Appropriate Use Criteria Program, which has been in the wings for years. Health Data Management happened to cover it in the issue that caught my eye, and I have to admit I had kind of forgotten about it, since it’s been coming at us in fits and starts for so long.

Essentially, on January 2, physicians who order advanced imaging tests (such as MRI, CT, and PET scans) for Medicare patients have to consult qualified clinical decision support systems before ordering those tests. The software is supposed to incorporate evidence-based guidelines and Appropriate Use Criteria (AUC) to make sure people aren’t just ordering expensive tests for every little thing, or because patients demand them. Commercial payers have already tackled this issue by requiring prior authorization for these kinds of tests, which Medicare is trying to avoid by instituting the AUC requirement. There are eight conditions that are being targeted, including low back pain and headaches.

The problem with the proposal is that the penalty occurs in the wrong place. If ordering physicians don’t do the right thing, then radiology providers won’t be paid for the test. This puts them in the position of having to make sure their referral base is doing the right thing, with some even offering access to clinical decision support systems for their referring physicians, who might also have that support within their EHRs. The prior authorization requirements used by commercial insurers put the burden squarely where it belongs – on the ordering physician who needs to be ordering tests that are needed and that will provide useful diagnostic information.

The first year of the program is designed to be an educational and testing opportunity for all involved, with the nonpayment penalty being applied starting January 1, 2021. Ultimately, CMS plans to force providers who don’t follow requirements for clinical decision support to seek a prior authorization. With all the work that organizations have put in during the last several years for this requirement (during its on again, off again progression), one could wonder whether it just would have been easier to institute a prior authorization requirement in the first place. Ordering physicians already have those workflows in place in their practices and the lion’s share of work is done by non-provider staff members. Medicare could have been the leader here, standardizing the requirements and drawing commercial payers into line to create a single set of prior authorization rules across all payers. Instead, it has created an additional burden that no one in the process (other than CMS apparently) wants to deal with.

I’ve been in the clinical trenches for a long time, and frankly I can only remember one time a prior authorization was denied for one of my patients. It was a scenario I can only describe as a goat rodeo. The CT scan was ordered urgently, as the patient was in my urgent care with severe abdominal pain and a host of abnormal blood tests. Since no one is sitting at the insurance company at 7pm on a Friday night to handle a prior auth, we proceeded with the test and tried to get the auth retroactively on Monday morning. The reviewer was demanding more information, because in my note I described one of the areas of abdominal tenderness as “mild” rather than using a more serious-sounding word or even omitting a qualifier altogether. It didn’t matter that the patient had guarding and rebound tenderness in another area of the abdomen, which are ominous findings on their own; the reviewer had the word “mild” stuck in her craw.

I had to admit I became rather hot around the collar, and might have asked her if she gave a damn about the fact that the patient had a 6cm tumor in their pancreas that was causing obstruction and mayhem. She certainly hadn’t bothered to look at the test result itself, which more than showed the study was warranted. By the time we were trying to get the prior auth, the patient had already been admitted to the hospital, undergone a number of invasive tests, and was coping with a cancer diagnosis and the high likelihood that he’d never see his children graduate high school. Eventually the reviewer relented and approved the test, but it was silly that we even had to go through the exercise.

Maybe that should be my “great expectation” for the 2020s, that some day physicians who are spot-on with their test ordering won’t have to jump through hoops on behalf of their patients. I don’t have a lot of hope for it, though. What’s your great expectation for healthcare IT in the next decade? Leave a comment or email me.

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Morning Headlines 10/7/19

October 6, 2019 Headlines No Comments

DCH Hospital System pays Russian hackers in ransomware attack

DCH Health System in Alabama agrees to pay Russian hackers after an October 1 ransomware attack forced it to divert patients and revert to paper processes.

3 lawyers defending Theranos founder Elizabeth Holmes say they haven’t been paid in over a year and would like to quit

Court documents reveal that attorneys defending ex-Theranos CEO Elizabeth Holmes in a civil suit filed by former Theranos patients have asked to withdraw from the case because they haven’t been paid in over a year.

MUHC computer crash caused by two successive malfunctions

Hardware malfunctions in the sub-basement data center of $1.3 billion “superhospital” McGill University Health Centre in Montreal cause its computers and back-up system to crash.

A hospital’s ‘Wall of Shame’ used private records to mock disabled patients. Now officials are apologizing.

St. Mary’s Regional Medical Center (ME) officials apologize for a semi-secret collage kept by employees that mockingly showcased pictures and details of patients with disabilities.

Monday Morning Update 10/7/19

October 6, 2019 News 9 Comments

Top News

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DCH Health System in Alabama agrees to pay Russian hackers after an October 1 ransomware attack forced it to divert patients and revert to paper processes. Officials haven’t been able to pinpoint when systems will be back up and running normally: “We have been using our own DCH backup files to rebuild certain system components, and we have obtained a decryption key from the attacker to restore access to locked systems. We have successfully completed a test decryption of multiple servers, and we are now executing a sequential plan to decrypt, test, and bring systems online one-by-one. This will be a deliberate progression that will prioritize primary operating systems and essential functions for emergency care. DCH has thousands of computer devices in its network, so this process will take time.”

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DCH, plus hospitals in Ontario and Australia, attribute their recent ransomware attacks to Ryuk malware, named for a Japanese comic book character who can’t be destroyed by conventional human weapons. A total of 13 facilities were impacted, with all still in various states of recovery.


Reader Comments

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From concerned: “Re: Athenahealth. Athenahealth will be leaving the hospital market in the next few months.” A company marketing exec responded with this statement: “We continue to be active in the hospital market through our support and investment in the experience of our existing athenahealth hospital customers. We are also committed to our customers who use the Centricity Business product, and are actively building that customer base, investing in that product, and are focused on our relationships with hospital and IDN revenue cycle clients.”


HIStalk Announcements and Requests

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Responses are nearly evenly split, which isn’t surprising given the schismatic nature of healthcare these days. A deeper dive might look into insurance status, health savings accounts, employer contributions, and the like. The one thing I’m sure most respondents have in common is feeling an increasing squeeze on their wallets for healthcare services that may be hard to access and are priced so that they’ll never truly understand what they’re paying for until the debt collectors come calling. Mr. T says American patients fear the cost of a diagnosis more than the diagnosis itself, while North American attic laughs at the thought of a Canadian being in such a situation: “Deferred or declined recommended medical care for financial reasons? Canadians would not even comprehend the question.”

Nick van Terheyden paints a bleak but realistic picture for many: “Yes. At one end of my personal extreme I broke my ankle (or at least as best as I could tell clinically) but refused to visit any doctor or facility for an X-ray and treated myself with a boot that I had already been charged a huge sum of money for for a pervious fracture. I have told my family and any friends that I do not want an ambulance called under any circumstances – get me to a hospital if you must but by taxi or car. I don’t want my family lumbered with crushing medical debt from me. I buy my drugs overseas to save money – in bulk and at double strength, and use a pill cutter to save money. Were I to get cancer, I highly doubt I would take treatment given the debilitating nature of medical debt that accompanies this and the thought of leaving my family to lose what little we have to some large healthcare billing corporation. I’ll manage any chronic disease I have the misfortune of getting under any and all circumstances – again rather than be a burden to my family leaving them with debt they will struggle to pay. What a sorry commentary on a system that works precisely as designed.”

New poll to your right or here: For those with employer-sponsored health plans, would you be willing to use employer-approved providers if given a financial incentive to do so? As Walmart pilots a program that will do just that, and Amazon offers virtual employee care, I wonder how many of us would go that route to save a few bucks.


Webinars

None scheduled in the coming weeks. Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

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NextGen Healthcare acquires Topaz Information Solutions, a NextGen reseller that works with behavioral health providers and social services organizations.

Court documents reveal that attorneys defending ex-Theranos CEO Elizabeth Holmes in a civil suit filed by former Theranos patients have asked to withdraw from the case because they haven’t been paid in over a year. The Cooley LLP lawyers believe they’ll never be paid given the “dire financial situation” of Holmes, whose blood-testing startup was once valued at $4.5 billion.


Decisions

  • Fayette County Memorial Hospital (OH) will switch from Medhost to Cerner in February.
  • Butler County Health Care Center (NE) will switch from Meditech to Cerner In November.
  • St. Francis Medical Center (NJ) will switch from Sunquest To an Epic Beaker laboratory information system in 2021.
  • Franciscan Health Rensselaer (IN) will switch from Omnicell to BD Pyxis automated dispensing machines next year.

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


People

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Retail pharmacy tech vendor OmniSys names David Pope chief innovation officer. Pope co-founded Strand Clinical Technologies, which OmniSys acquired in July.

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Peyman Zand (Community Health Systems) joins CereCore as VP of advisory services.


Announcements and Implementations

Banner Health (AZ)  implements online scheduling using Kyruus ProviderMatch for Consumers.

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Health Catalyst announces GA of Closed-Loop Analytics to offer providers deeper clinical insights within workflows at the point of care.


Privacy and Security

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UAB Medicine (AL) notifies nearly 20,000 patients of an August email phishing scheme in which hackers tried without success to divert automatic employee payroll deposits to an account they controlled.


Other

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Iris Kulbatski petitions the government of Ontario to enforce fee regulations related to accessing medical records after University Health Network charged her $1,100 to retrieve her late father’s medical records. She appealed the charges for the 3,000-page file, saying that the health system backdated its policy so that it could charge her – and other patients requesting digital copies – more. UHN eventually honored the newer policy, charging Kulbatski the $40 she originally anticipated.

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Hardware malfunctions in the sub-basement data center of $1.3 billion “superhospital” McGill University Health Centre in Montreal cause its computers and back-up system to crash. MUHC suffered a similar event last year when back-up generators failed during a blackout, and in 2013 when a goose got into the electrical system at an off-site vendor, starting a fire that eventually caused similar downtime.

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The local paper commemorates the centennial of South County Health with a look at how computers have impacted provider workflows (and lab hygiene) at the Wakefield, RI hospital. While SCH physicians acknowledge the game-changing benefits of electronic records, they bemoan the lack of interoperability when logging into five different EHRs every day. Cost is a big barrier to getting all systems on the same page. Hospital officials say it would cost $12 million to integrate its inpatient and outpatient systems. It pays $30,000 to $40,000 per year per physician to keep systems updated.


Sponsor Updates

  • Meditech will host its 2019 Revenue Cycle Summit October 8-9 in Foxborough, MA.
  • Mobile Heartbeat will exhibit at the ANCC Magnet Conference October 10-12 in Orlando.
  • Waystar, Experian Health, and Relatient will exhibit; and SymphonyRM will present at MGMA October 13-16 in New Orleans.
  • Netsmart will exhibit at the NAHC Annual Meeting October 13-15 in Seattle.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the AWHONN 3rd Annual Fall Conference October 11 in Traverse City, MI.
  • PatientPing congratulates customer Bane Care Management on its silver ribbon in the McKnight’s Excellence in Technology Quality Awards.
  • Pivot Point Consulting, StayWell, Summit Healthcare, Surescripts, TransformativeMed, and Zynx Health will exhibit at the Cerner Health Conference October 7-10 in Kansas City, MO.
  • Redox will host its Interoperability Summit October 15-16 in Boston.
  • Vocera will exhibit at the ANCC National Magnet Conference October 10-12 in Orlando.
  • Wolters Kluwer Health releases an enhanced version of its Lipincott CoursePoint+ digital education solution for nursing education programs.

Blog Posts


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Reader Comments

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  • Mr. HIStalk: Thanks. Looks like it was a shorter than expected stay -- I can't find when he actually reported to prison, but he was s...
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  • David Pomerance: Talking about Healthcare Informatics, does anyone know what happened to Bill Childs?...
  • fedlocator: Charlie McCall was released from federal custody in 2016. Look up 93071-011 at https://www.bop.gov/inmateloc/....
  • Larry Kaiser: I was SHOCKED to see Chicago back in the mix a few months ago. It really is a horrible location for the show. Only one h...
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  • Mark Weisman: What the authors get wrong is trying to compare the pharmaceutical industry to the EHR industry. With Pharma, there’s...

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