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Weekender 10/4/19

October 4, 2019 Weekender 2 Comments

weekender


Weekly News Recap

  • Northwell Health (NY) will work with Allscripts to develop a cloud-based EHR incorporating voice recognition and artificial intelligence.
  • Walmart will pilot several programs across the country to connect its employees to healthcare services that it hopes will offer quality care at more affordable prices.
  • Private equity firm Francisco Partners will acquire laboratory information systems vendor Orchard Software.
  • Beginning next year, the VA will automatically share health data with community providers using the Veterans Health Information Exchange.
  • Siemens Healthineers subsidiary Siemens Medical USA will acquire ECG Management Consultants from Gryphon Investors.
  • FDA issues an alert about Urgent/11, a cybersecurity vulnerability found in IPnet third-party software that attackers may exploit to take over medical devices and hospital networks.
  • After laying off half its staff this summer and filing for Chapter 11 earlier this month, UBiome will cease operations and liquidate assets.
  • Canada’s New Brunswick Medical Society will close Velante, the for-profit company it created in 2012 as the sole EHR provider for the province’s doctors.

Best Reader Comments

Re: Walmart connecting employees to health services around the country. I like the concept. I would love to be able to go to the best of the best for treatment of a very serious illness if my insurance allowed. The travel, the hotel, etc., to be arranged and paid for through my insurance. I would welcome that. If I had serious heart problems, I would want to go to the Cleveland Clinic; if I had a rare form of cancer, I would want to go to MD Anderson; if I had kidney disease, I would want to go to Johns Hopkins. Will the next generation of Healthcare define Centers of Excellence around the country for various diseases and allow the insured to pick? I gotta say, it is a concept that I am slowly warming up to as I watch what Walmart and Amazon are up to. (X-Tream Geek)

I think naughty lists based on reports generated from the EHR are the way to go. It’s also easy to automate with the IT team. First time you mess up, automated email at the end of the week with quick note about what not to do. Second time, note+policy with manager cc’ed. Third time someone calls you. Fourth time … (Santa)

RE: Your comment: “I can’t recall an EHR vendor in recent memory putting boots on the ground at a single client site to design, develop, and implement a product before releasing it to the market. ” GE Healthcare attempted to do the same thing (well…kinda) with Intermountain Healthcare 2007-2013. GE invested approx $500M and the final product wound up being a meager ‘white board’. The project essentially killed the careers of numerous execs as well as what was left of IDX/GE. (leftcoaster)

Re: HealthTech “Influencers” — I agree on all shared above, and I know Mr.HISTalk has well documented his concerns over the years (as well as created a brilliant suggested scoring system), so I won’t elaborate on the lunacy of such lists. EXCEPT to comment that the most glaring concern are those named whose role is marketing on behalf of an organization/group/client. Marketing Brand experts should be invisible, not found on these lists. Especially considering the fact that they likely have a very warm fuzzy relationship with a publisher as they are the go between for the client. That does not make them an “influencer”. Their sole job is making money off of media placements and brand recognition, NOT to revolutionize technology for improved health delivery or outcomes like some on the list. I find it VERY poor form for the publisher to do a favor to recognize the man who brands himself and actually believed he is changing healthcare. Worst part….said man inspires countless others like himself, and is creating a small army of brand promoters. I kind of feel like John Legend in the R.Kelly documentary…..no one else in music would speak up. Often times when I do, I receive countless IMs from people telling me they agree with me, but refusing to go on record. Folks….can we change this, or is this social media world such that we just have to roll with it? (BehindtheScenes)


Watercooler Talk Tidbits

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In Florida, AdventHealth and Philips commit to becoming anchor partners of Metro Development Group’s third Connected City. The mixed-use development will offer residents concierge telemedicine services, a wellness park, and on-site Advent services including a standalone ER.

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Healthcare fraudster Jesse Lopez will spend more time behind bars after attempting from jail to hire a hit-man to kill her husband, a witness in her court case. Lopez was previously found guilty of posing as a nurse and performing unlicensed medical procedures at the Drop It Like It’s Hot Weight Loss Clinic and Jesse’s Gym in Florida.

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Saratoga Hospital (NY) will move some of its non-clinical operations to an anchor space in nearby Wilton Mall in order to free up space on its campus for more patient care. Information systems employees will be among the first to transition to the former Sears space.

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Micron Technology has developed a toilet that uses artificial intelligence to analyze a user’s waste to diagnose potential health issues. CEO Sanjay Mehrotra urges skeptics to “[I]magine smart toilets in the future that will be analyzing human waste in real-time every day. You don’t need to be going to visit a physician every six months. If any sign of disease starts showing up, you’ll be able to catch it much faster because of urine analysis and stool analysis.”

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Kaiser Health News profiles the secretive world of Instagram dolls, a community of women who have taken to the social media platform to share their cosmetic surgery journeys. 

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In Virginia, Joel Smithers, MD is sentenced to 40 years for prescribing over a half million doses of opioids – at least one prescription per patient – since opening his practice in 2015.

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Weird News Andy asks, “Perhaps they should start a new one and put up the names of those responsible?” St. Mary’s Regional Medical Center (ME) officials apologize for a “Wall of Shame” kept by employees that mockingly showcased pictures and details of patients with disabilities. Kept on the inside of a cabinet door, the collage was discovered and reported on in 2016 by an employee who told administrators about it. Citing a toxic work environment, she later quit after colleagues retaliated against her by looking up her medical records and discriminating against her because of her own disability. St. Mary’s has been quick to assure the media that no identifying patient details were kept on the wall.


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Morning Headlines 10/4/19

October 3, 2019 Headlines No Comments

New Associate Benefits Aim to Simplify Health Care and Focus on Appropriate Care

Walmart will pilot several programs across the country to connect its employees to healthcare services that it hopes will offer quality care at more affordable prices.

Epic Systems gearing up for yet another expansion in Verona

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.

abeo Acquires Computer-Assisted Coding Platform, Trusted i10, LLC

Practice management and billing vendor Abeo acquires AI-powered coding company Trusted i10 for an undisclosed sum.

News 10/4/19

October 3, 2019 News 7 Comments

Top News

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Not to be outdone by Amazon, Walmart announces it will pilot several programs across the country to connect its employees to healthcare services that it hopes will offer quality care at more affordable prices.

Featured Provider programs in Arkansas, Florida, and Texas will incentivize employees to use physicians in their areas that provide appropriate, high-quality care. Health data aggregator and analysis vendor Embold Health (the brainchild of former Walmart Care Clinics CMO Daniel Stein, MD) will provide Walmart with data it will use to create lists of physicians that the company will share with employees. Those who wind up seeing a provider not on the list will pay more for their benefits.

The company will try out a Personal Healthcare Assistant concierge service that will help employees in the Carolinas find providers, deal with billing, understand diagnoses, and find transportation and childcare.

Walmart has tapped Doctor on Demand, Grand Rounds, and HealthScope Benefits to offer employees in Colorado, Wisconsin, and Maryland expanded telemedicine visits at $4 a pop, as well as the option to access care coordination services.


Reader Comments

From PizzaSlinger: “Re: Adventist’s Cerner contract. Adventist Health West Coast is ending the contract with Cerner RevWorks after only 2 years on 11/4. Work will revert back to Adventist and employees have option to convert to Adventist at same pay rate. If employees do not convert they will lose employment on 12/1. Huron is taking over management functions as well. Around 300 employees are affected.” PizzaSlinger’s numbers line up with those of the Kansas City Business Journal, which reports that 360 Cerner staffers will be impacted by Adventist’s decision. At least half of those probably came over from Adventist when the health system started outsourcing jobs last year.

From SoftwareSavvyShrink: “Re: Appriss Health’s acquisition of OpenBeds. I found it interesting that you highlighted the Appriss Health acquisition of OpenBeds software aimed at helping connect behavioral health patients with inpatient and outpatient care. This is a prime example of a technological workaround to a system defect. No matter how good the software is, it’s unlikely to solve the underlying problems, which are:

  • Insufficient numbers and erratic geographic distributions of beds for inpatient psychiatric and substance use disorder treatment.
  • Insufficient supply (and erratic geographic distribution) of psychiatrists and other mental health professionals to provide outpatient care and even smaller numbers of treatment programs for substance use disorder treatment.
  • Insurance reimbursements and utilization review practices that cause many of the existing mental health professionals to avoid taking insurance altogether (including Medicare and Medicaid, so don’t hold out hope for single payer).
  • Fragmentation of mental health services and no mandated accountability so that no one is interested in treating individuals with the most severe disorders or the most complex comorbidities (and value-based care and other performance measures make challenging patients even more challenging to treat without losing money).

Even the best software won’t solve issues of inaccurate information on bed availability and a lack of ability to predict discharges.

Hospitals tend to keep a bed open for their own services (ED or transfers from medicine) and are more reluctant to accept transfers from other hospitals because you often don’t get the full story on the patient from the referring hospital. (The person who’s ‘totally straightforward, has great insurance and their own house’ has multiple medical issues, doesn’t want to take medications, has been filing false complaints to the police, has already reached the coverage limits of their great insurance, and has a home but it’s in foreclosure.)

We had a software system almost 30 years ago to track available inpatient beds in our county but it was never very helpful because we couldn’t get accurate data on bed availability. And getting data on outpatient appointment availability was even more challenging.

The best system that I’ve ever seen for mental health referrals was the one we used 35+ years ago. Our region was divided into catchment areas and every catchment area had a designated community mental health center, an affiliated primary psychiatric hospital, a backup hospital, and a corresponding state hospital. We didn’t need any complicated processes or insurance authorizations. The psych resident on call carried a 1/4 inch bound volume known as ‘the magic book.’ If a patient needed referral, you looked up their address in ‘the magic book’ and learned their catchment area. You either gave them the number of the outpatient service for that catchment area, which was obligated to provide mental health or substance use treatment. Or you called the hospitals in sequence. It was never more than three calls and if they had a bed, they took the patient. If the other one (or two) hospitals had no beds, the patient was automatically accepted at the state hospital.

Unrelated to OpenBeds but related to substance use treatment, the Google Doodle on October 1 honored Dr. Herb Kleber, a pioneer of evidenced-based treatment of substance use disorders and an all-around-incredible person.”

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HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor StayWell. The Yardley, PA-based health empowerment company enables providers everywhere to improve health outcomes using the science of behavior change. Its patient education and marketing solutions inspire change, improve outcomes, and create loyalty. Providers use its digital, video, and print educational materials for 80 million patients each year, with outcomes that have been proven in 120 peer-reviewed studies. Its Krames On FHIR solution — available in Epic App Orchard and Cerner App Gallery – delivers personalizable patient education directly into the clinician’s EHR workflow for the specific patient’s profile and encounter, allowing users to tag their favorite tools, organize folders, search by keyword, and filter by age and gender. Thanks to StayWell for supporting HIStalk.


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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22C Capital joins Advent International and Spectrum Equity as an investor in health data marketing and research firm Definitive Healthcare’s recapitalization, first announced in June.

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Defense lawyers for former Theranos CEO Elizabeth Holmes and former president and COO Sunny Balwani insist the prosecution is refusing to turn over documents that would clear the pair of any wrongdoing. The attorneys contend that documents from the FDA and CMS are vital to refuting allegations that the pair knew Theranos blood tests were inaccurate and that they lied to investors, partners, physicians, and patients. The Theranos saga will continue on November 4, when all parties are expected back in court.


Sales

  • The Texas Health Services Authority selects Audacious Inquiry’s Emergency Department Encounter Notifications and Encounter Notification Service care coordination technology.

People

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Mathew Gaug (Lima Memorial Hospital) joins Memorial Hospital and Health Care Center (IN) as VP and CIO.

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Diameter Health names Terry Boch (Machinify) chief commercial officer.


Announcements and Implementations

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In New Hampshire, GraniteOne Health system will leverage Dartmouth-Hitchcock Health’s Epic software and telemedicine expertise once their merger is approved.

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The George Washington University Hospital in Washington, DC implements new software that combines care coordination and communication software from TransformativeMed with clinical decision support from Crossings Healthcare Solutions.

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Meditech will offer EHR software on Google Public Cloud, starting with its Meditech-as-a-Service subscription model. Google Cloud will also work with the company to develop native cloud products and corresponding APIs.

North Memorial Health (MN) will connect its Epic system to the state’s AWARxE PDMP, developed and managed by Appriss Health, next month.

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Porter Medical Center, part of the University of Vermont Health Network, will go live on Epic November 1.


Other

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ProPublica digs into the steps Newark Beth Israel Medical Center (NJ) took to keep a heart transplant patient alive for one year in order to avoid being penalized by federal regulators who could potentially shut the transplant program down. A leaked recording of a meeting of hospital administrators found that some found the situation unethical given the patient’s vegetative state and a lack of communication about palliative care with his family; but most ended up agreeing that the patient would “take one for the team” to help the transplant program survive.


Sponsor Updates

  • Engage and Gevity Consulting partner to expand their services across Canada.
  • Elsevier Clinical Solutions, Ensocare, Healthwise, and Imprivata will exhibit at CHC 2019 October 7-9 in Kansas City, MO.
  • EClinicalWorks will exhibit at the Georgia Primary Care Association conference October 9-11 in Alpharetta.
  • Glytec congratulates customer Sentara Healthcare for achieving Magnet status at its Virginia Beach General Hospital.
  • Phynd becomes a member of the CHIME Foundation.
  • CoverMyMeds will sponsor and exhibit at the IPatientCare National User Conference October 18-19 in Cincinnati.
  • CB Insights includes Kyruus, Redox, MDLive, PatientPing, and TriNetX on its list of 150 digital health startups redefining the healthcare industry.
  • Experity launches a new website to serve as the one-stop-shop for urgent care businesses.
  • Meditech announces its support for Health Records on iPhone.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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Contact us.


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EPtalk by Dr. Jayne 10/3/19

October 3, 2019 Dr. Jayne 2 Comments

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Fall is finally here in my part of the world, although areas of the US are still near broiling. October 3 marks the start of the last 90-day EHR reporting period for those of you playing the Promoting Interoperability home game, hospital edition. Those not reporting for a continuous 90 days in the calendar year will receive a downward payment adjustment. Hospitals must also respond in the affirmative for the Prevention of Information Blocking and ONC Direct Review Attestations.

Speaking of reporting, I somehow wound up on an email list for Greenway Health customers. Apparently, there is an issue with the Greenway Patient Portal and settings that allow providers to block sending laboratory data through the portal. Originally designed to keep sensitive information from being sent, if the setting is enabled then the entire site is unable to attest to certain MIPS and Medicaid measures. Providers were advised to adjust their settings prior to October 1 so that they would have data for the 90-day collection period ending December 31. Seems like something that should have been found earlier in the year, and I’m still puzzled how I wound up on their mailing list.

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For anyone who has worked with hospitalized patients, we know how challenging it can be when patients are disoriented or at risk for falls. I was excited to read this case study about virtual sitters in the hospital environment. Mission Hospital in Asheville, NC piloted virtual sitters in its neuroscience unit. They noted a 23% reduction in falls and a 12% reduction in fall-related injuries during the 12-month pilot. Mission Health worked with Cerner to develop the virtual sitter system, using Microsoft Kinect technology to monitor patient movement. The solution included two-way audio, voice recognition, and customizable alerts. Technicians could monitor six patients at a time, and if patient movement occurred, the technician would be alerted to the specific feed. Similar to when an in-person sitter is used, the technician could use voice instructions to try to redirect the patient if needed. If the intervention isn’t successful, the technician can alert nursing staff to intervene in person. Large hospitals can spend millions of dollars on sitters, so this technology has the ability to significantly impact the bottom line.

Despite what the folks at Apple may have us believe, the iPhone isn’t the be-all, end-all of smart phones. I always cringe when a vendor launches a solution that is only available for the iPhone, as if those of us who use Android are some kind of second-class citizens despite Android having a slim majority of market share. I ran across a press release about a non-profit industry group that is working to create an open-source version of the Apple Health tool kit that can be used by Android users. Members of the CommonHealth project team include Cornell Tech, UC San Francisco, Sage Bionetworks, Open mHealth, and The Commons Project. The plans include robust governance to review partners and apps requesting to connect through the platform. UCSF is piloting along with other academic medical centers and health systems. I’d be interested to hear from anyone who is involved in the project.

From Incognito: “Dr. J – You are on to something when you note that switching back and forth between scribes and flying solo is a bit of a thing. I am convinced that EMRs bring a very different and intense kind of cognitive load than the analog world did, even without accounting for all the ‘little things’ that have been added to the physician’s thought process (because now, ‘they’ can). Adding a scribe is really just another piece of that cognitive load, even if it does reduce some bits. Switching back and forth flies in the face of ‘standard work’ in good processes. I’m sure that there are industrial design and psychology/perception experts who can tell us what we are doing to ourselves. They see it in fighter pilots and in air traffic controllers – and in Facebook ads.” Fortunately, I had a scribe all day today so things ran smoothly. Unfortunately, it’s probably the last time I’ll work with him since he’s getting ready to travel to residency interviews. Today’s scribe is a fully qualified physician, trained and licensed in another country. He’s been a delight to work with, even though his employment is a direct result of our broken health system that doesn’t always allow international medical graduates to perform the functions they might otherwise be able to. He plans to complete a residency in internal medicine so he can practice in the US, since he’s a dual national also holding US citizenship.

There was an article in my local paper about the explosive growth of urgent care facilities in the US, and not surprisingly several local physicians wrote scathing editorial letters claiming that urgent care providers are guilty of rampant overprescribing of antibiotics. The same claims are often made of telehealth providers, even though some have better data on others on how well they avoid unnecessary antibiotic prescriptions. It can be difficult to get data out of EHRs to run those types of reports, and even more difficult to try to use technology to limit prescribing, as one reader recently wrote:

“At my facility, we get fairly regular reports on antibiotic stewardship. Oddly enough the EHR is one of the roadblocks for doing what we want and need to do in this area. Tracking antibiotic use requires substantial pharmacist and infectious disease physician time where a well-designed EHR should have easy-to-use canned modules for tracking use as compared to the latest local microbiology profile. More importantly, there is no straightforward/easy way to restrict specific drugs to be ordered only by certain specialists, on certain floors or services, or with co-signatories or approvals by another service. Oddly enough, it seemed easier to implement such restrictions in the pre-EHR era. One issue is that we don’t want to block all direct prescribing of specific antibiotics since we are very mindful of not restricting initiation of a potentially life-saving antibiotic in an emergency situation such as impending sepsis. The issue of drug-specific prescribing restrictions is not just a problem with antibiotics – we have the same issues in trying to restrict rampant prescribing of other costly drugs.”

There’s no perfect system out there that can prevent all imperfect human behavior from happening. I know providers who consistently do sketchy things regardless of the education they receive, and probably the only thing that would block those folks would either be a hard stop in the EHR or a disciplinary action. Even though the organizations I’ve worked for take a dim view of such behaviors, there’s a delicate balance between admitting volumes, revenue generation, and tolerance for those who know where their bread is buttered.

Has your organization figured out how to effectively transform physician prescribing behaviors? Was it high-tech or high-touch? Leave a comment or email me.

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Morning Headlines 10/3/19

October 3, 2019 Headlines No Comments

22C Capital Announces Investment in Definitive Healthcare

22C Capital joins health data marketing and research firm Definitive Healthcare’s recapitalization with an undisclosed investment.

MEDITECH Announces Collaboration with Google Cloud to Bring EHRs to the Public Cloud

Meditech will offer select EHR software on Google Public Cloud, and will work with Google Cloud to develop native cloud products and APIs.

GraniteOne Health moves forward with Dartmouth-Hitchcock collaboration

In New Hampshire, GraniteOne Health system will leverage Dartmouth-Hitchcock Health’s Epic software and telemedicine expertise once their merger agreement is approved.

Elizabeth Holmes’ attorneys blast prosecution over withholding government documents

Defense lawyers for former Theranos CEO Elizabeth Holmes and former president and COO Sunny Balwani insist the prosecution is refusing to turn over documents that would clear the pair of any wrongdoing.

Morning Headlines 10/2/19

October 1, 2019 Headlines 2 Comments

Northwell, Allscripts to jointly develop next-gen electronic health record

Northwell Health (NY) will work with Allscripts to develop a cloud-based EHR incorporating voice recognition and artificial intelligence.

VA shares electronic health records

Beginning next year, the VA will automatically share health data with community providers using the Veterans Health Information Exchange.

FDA informs patients, providers and manufacturers about potential cybersecurity vulnerabilities for connected medical devices and health care networks that use certain communication software

FDA issues an alert about Urgent/11, a cybersecurity vulnerability found in IPnet third-party software that attackers may exploit to take over medical devices and hospital networks.

All 3 DCH Health System Hospitals Closed to New Patients Due to Ransomware Attack

An early-morning ransomware attack forces DCH Health System (AL) to divert patients from its hospitals.

BREAKING: Bankrupt microbiome-testing startup uBiome is shutting down

After laying off half its staff this summer and filing for Chapter 11 earlier this month, UBiome will cease operations and liquidate assets.

News 10/2/19

October 1, 2019 News 10 Comments

Top News

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Northwell Health (NY) physicians and IT and operations staff will work with Allscripts to develop a cloud-based EHR incorporating voice recognition and artificial intelligence. Northwell has been an Allscripts customer (Sunrise and TouchWorks) since 2009, when the health system was known as the North Shore-Long Island Jewish Health System. It plans to implement the new software systemwide.

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SVP and CIO John Bosco, who has been with the organization since 2004, will likely have a hand in product development.

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I can’t recall an EHR vendor in recent memory putting boots on the ground at a single client site to design, develop, and implement a product before releasing it to the market. Perhaps that end-user accountability will result in something more tangible than the ambulatory-focused Avenel software Allscripts launched at HIMSS18, only to cease mentioning it almost immediately afterwards.

Allscripts shares seem largely unaffected, dipping slightly from $11.11 to $10.58 during Tuesday’s trading.


HIStalk Announcements and Requests

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Welcome to new HIStalk Gold Sponsor Summit Healthcare. The Braintree, MA-based company has helped 1,000 healthcare systems take control of their integration and automation needs over its 20-year history while maintaining a 98% customer retention rate. Product suites include Exchange (interoperability platform), All Access (document distribution and display), EMPI (patient identity and demographics management), Scripting Toolkit (robotic process automation), Scheduler (schedule- and parameter-based task launching), and InSync (synchronization for data management). The company’s integration technology and professional services can help health systems lower costs, increase speed to results, improve care, and enhance compliance and control. Its EMPI Analysis Check can help hospitals that have merged, changed systems, or maintain best-of-breed ancillary systems assess the impact of duplicate records, inaccurately billed claims, and reconciliation costs. Thanks to Summit Healthcare for supporting HIStalk.


Webinars

October 2 (Wednesday) 1:00 ET. “Conversational AI in Healthcare: What About ROI?” Sponsors: Orbita, Cognizant. Presenters: Kristi Ebong, SVP of strategy and GM of healthcare providers, Orbita; Matthew Smith, AVP and conversational AI practice leader, Cognizant. Conversational AI holds great promise to drive new opportunities for engaging consumers and customers across all industries. In healthcare, the stakes are high, especially as organizations explore opportunities to leverage this new digital channel to improve care while also reducing costs. The presenter experts offer a thought-provoking discussion around conversational AI’s timeline in healthcare, the factors that organizations should consider when thinking about virtual assistants through chatbots or voice, and the blind spots to avoid in investing in those technologies.

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


Acquisitions, Funding, Business, and Stock

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PDMP-focused technology company Appriss Health acquires OpenBeds, software developed by Johns Hopkins faculty member Nishi Rawat, MD that helps providers and social workers connect behavioral health patients with inpatient and outpatient care.

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Athenahealth puts its Arsenal-on-the-Charles headquarters outside of Boston up for sale. It purchased the historic property from Harvard University in 2013 for $168 million. The company still maintains five offices in the US and two in India, and intends to remain in the area as a long-term tenant.

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Siemens Healthineers subsidiary Siemens Medical USA will acquire Seattle-based ECG Management Consultants from Gryphon Investors.

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Francisco Partners will buy LIS vendor Orchard Software. Billie Whitehurst (Netsmart) will become CEO of the newly acquired company. The Francisco Partners portfolio already includes Capsule Technologies, CoverMyMeds, GoodRx, T-System, QuadraMed, and ZocDoc.


Sales

  • Inspira Health (NJ) will offer telemedicine services from MDLive.

People

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Alphabet names Robert Califf, MD (Duke Health) to head of strategy and policy for its Google Health and Verily Life Sciences Divisions. The former FDA commissioner has been a Verily advisor since 2017.


Announcements and Implementations

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WakeMed Health & Hospitals (NC) implements PeraHealth’s Rothman Index predictive analytics software.

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Boulder Community Health (CO) goes live on Epic.

Boston Software Systems announces GA of productivity-focused analytics.


Government and Politics

Beginning next year, the VA will automatically share health data with community providers using the Veterans Health Information Exchange.

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ONC is looking to hire a Washington, DC-based executive director and economist.

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FDA proactively issues an alert about Urgent/11, a cybersecurity vulnerability found in IPnet third-party software that attackers may exploit to hack into medical devices and hospital networks.


Privacy and Security

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A ransomware attack forces several hospitals in the Australian state of Victoria to take their computer systems offline. Impacted organizations include Allscripts customer Gippsland Health Alliance and the South West Alliance of Rural Health, which seems to be an InterSystems customer. The hack coincided with an upgrade to the nationwide My Health Record PHR connecting diagnostic imaging and pathology providers to the system.

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DCH Health System in Alabama diverts patients from all three of its hospitals after their computer systems were taken down by an early-morning ransomware attack. The system announced it was implementing Meditech Expanse just over a year ago.


Other

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Northern Light Health administrators say they will work harder to get physicians on board with the Maine-based health system’s rebrand, which kicked off last year. Staff have questioned the value of an expensive project that has no direct impact on patient care. The undisclosed cost of the marketing project, which typically runs into the millions of dollars, has eaten into earnings as the system attempts to pay off $391 million in debt and borrow another $34 million for construction.

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Stanford University’s Machine Learning Group works with Intermountain Healthcare (UT) to develop software that can accurately identify the presence of pneumonia from chest X-rays in as little as 10 seconds. Intermountain expects to roll out the CheXpert technology in select emergency departments this fall.

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A small Definitive Healthcare survey of healthcare stakeholders finds that a lack of resources including health IT, gaps in interoperability, and trouble with collecting and reporting patient data are some of the biggest barriers to moving to value-based care models. Those who’ve already made the transition cited reduced medial errors as the biggest benefit.


Sponsor Updates

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  • Dimensional Insight team members sponsor the registration table at the St. Jude run/walk.
  • AdvancedMD publishes a new e-guide, “4 Ways to Tell if Your EHR is an Adult or Teen.”
  • Bluetree names Deb May (Renown Health) and Carmen Wolf (Nuance) executive partners.
  • Burwood Group Cloud Services President Chris Pond joins the board of the Boys & Girls Club of Greater San Diego.
  • CoverMyMeds publishes a new case study, “End-to-End Support Improves Patient Access for Specialty Medications.”
  • The One Million by One Million blog features Diameter Health CEO Eric Rosow.
  • Hyland Healthcare assists in the development of NIST’s new practice guide, “Securing Picture Archiving and Communication System.”
  • Zynx Health’s new Import Manager gives customers the ability to import PowerPlans from their Cerner EHRs to Zynx Health’s Knowledge Analyzer.

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Contacts

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


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Morning Headlines 10/1/19

September 30, 2019 Headlines No Comments

Francisco Partners to Acquire Orchard Software

Private equity firm Francisco Partners will acquire laboratory information systems vendor Orchard Software.

ECG Reinforces Client Focus, Joining Siemens Healthineers

Siemens Healthineers subsidiary Siemens Medical USA will acquire ECG Management Consultants from Gryphon Investors.

Alphabet taps former FDA commissioner to oversee health strategy and policy

Alphabet names Robert Califf, MD (Duke Health) to head of strategy and policy for its Google Health and Verily Life Sciences Divisions.

Athenahealth campus is for sale, but it aims to stay put in Watertown – as a tenant

Athenahealth decides to sell its Arsenal-on-the-Charles headquarters outside of Boston, but intends to remain in the area as a long-term tenant.

HIStalk Interviews Karly Rowe, VP, Experian Health

September 30, 2019 Interviews No Comments

Karly Rowe, MBA is VP of new product development, care and identity products, at Experian Health of Franklin, TN.

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Tell me about yourself and the company.

I’ve been with Experian for eight years. I oversee all of our new product development, the processes, the teams, as well as our identity and care management portfolio. Our Experian Health business is represented by the areas of revenue cycle management, identity management, care management, and analytics. We started in the market serving a group of providers.

What are the chances of the US implementing a unique patient identifier?

Now more than ever, there’s an openness to consider a national patient identifier, especially as topics of interoperability are getting more and more advanced through things like TEFCA. There’s a new acknowledgement within the public sector, the private sector, and the healthcare industry as a whole that a lot of the things that we want to achieve — in terms of true interoperability and improvement of care for patients and care coordination – all foundationally stem from having a national patient identifier in place.

I don’t have a crystal ball to predict whether that time will be tomorrow, next week, or a year or two years from now. But I do think that there’s been a significant shift and an openness, to where we are closer now than we ever have been to getting to a point to embrace the national patient identifier.

How would that change the company’s business?

I don’t see a large pivot. Our position is that there isn’t one key-holder to this identifier. It’s more likely and more beneficial that it’s a handful of vendors, of organizations, working together to provide it. 

We collaborate with vendors across many other lines of business. Our core business is as a credit bureau. If you look at that model, Equifax, TransUnion, and Experian work together, collaborate, and share information as it pertains to individual’s credit to ensure that the information is the most accurate when going out to consumers.

For us in a healthcare setting, do we provide identity services? For sure. Would we be open and accepting to collaborate with other key leaders within the industry to make this something that could truly help transform the healthcare industry? 100%. There’s precedent that has been set across multiple aspects of our business. That credit example is just one of many.

Online services often ask people to verify their identity by choosing their previous address or a car they used to drive from a list of choices, something that they know that others would not. How is that being used in healthcare versus just taking a patient’s driver license or insurance card?

That’s a service that Experian Health has been providing to the healthcare industry for several years. We work with a lot of the patient portal systems and are integrated directly with them. We can help provide the confidence to our healthcare clients that the patient is who they say they are, before you then open up access to all of their personal health information that’s highly sensitive. 

That’s something that we have carried over. Banks and financial institutions probably paved the way and were pioneers of setting that precedent. Healthcare is adopting that, as patient information is no longer on paper and it’s all electronic records. Access to that information needs to be protected and treated with the highest degree of security and sensitivity.

Surveys have shown that consumers, wisely or not, are willing to share their private information with companies that give them something in return. How will that play out in healthcare?

Even speaking for myself as a consumer, there’s a general frustration that we all feel when we say, “I can’t access all of my health information, my historical information, anywhere.” Unlike when I go online to look at my credit card statement and I can see all the transactions and I can look across multiple credit cards. The history, credits, and debits are all there.

It is absurd in healthcare that from a consumer perspective, if I wanted to do that today, I would have to individually reach out to find every doctor, every pharmacy, every lab test that I ever got, and manually go ask for that information. There’s a convenience where I would love to know that the care that I’m getting, the decisions that the doctor who’s standing in front of me is about to make on my health, are the best decisions.

The way for that doctor to make the best decisions is for me to provide the consent to say, you have access to that information, and there’s a way to pull that all together. The only way that that really happens is if you have an understanding of who I am as a patient across all of the different encounters that I’ve had. That stems by speaking the same common language, and the problem that we have today in healthcare is that we’re all speaking different languages. Everybody’s got a different way of identifying a patient and none of them interact. It’s like one health system speaking French, one speaking German, and another speaking Italian, all trying to talk to each other about a patient. It’s impossible.

Are health systems interested in using outside consumer information for patient engagement, marketing, or other communication that doesn’t involve only what the EHR contains?

Some are, but there are clear lines of distinction. This is where the patient plays a role in what information is being shared and for what purposes. There’s that clinical aspect of saying, I just want to be able to provide the history of my health so that that doctor has seen every lab result, every test, every procedure in their hands.

There is another element where, like in many other facets of our lives, we like the customization of the ads that are being sent to us, the coupons that are targeted to services that we enjoy, or the commercials. That transcends every other part of our life. In healthcare, there is an interest in saying, “Maybe there are pieces of who I am as an individual and the likes that I have. I’m OK with you having so that you can tailor my experience when I’m a patient visiting your portal or when I’m interacting with you as a healthcare system.”

That starts to get into things that could improve the patient experience and their overall engagement. A lot of topics stem around overall care management, care coordination, and how that patient is being treated and receiving care. There are broader socioeconomic data factors that can assist in that. But I draw a line of distinction between those. For a lot of consumers and patients, clinical information is different and feels different than your lifestyle, behavioral, and socioeconomic type information. Patients may want to choose to share those things differently for different purposes.

Some of the first uses of commercial consumer information I saw in health systems were as simple as verifying a patient’s identity via the address they provided or to determine their propensity to pay. Is it a big leap from there to using social determinants of health?

We talked about having a patient identifier. Studies done by ONC on patient matching show that having reference data, knowing more about a patient than what’s present within a healthcare system, can help you get a better match. It’s the same in social determinants of health. They say 80% of health outcomes are attributed to non-clinical factors. That means the socioeconomic factors that surround someone.

If you take a step back and say, what am I willing to give to get, it is like what you said about consumers. If a consumer knows that they could receive better care or have better care decisions made for them if they allow the caregivers or the healthcare organization to have a more complete picture of who they are as an individual, I don’t know who wouldn’t sign up for that.

Protections need to be in place to make sure that there isn’t abuse. Organizations like ours take it very seriously — the types of data, how that data is being used, and adhering to all of the regulations that are set forth. One of the things that we stand by very strongly is that we’re an original source compiler, which means all the data that comes into us, we have direct relationships with all those data furnishers. That allows us to ensure the integrity of that data, how it is intended to be used, and the regulations that are involved.

Others are buying data from somebody who buys data from somebody who buys data. The further downstream you get and all those different extensions, the higher the risk goes in terms of that data being used for the wrong purposes and for purposes that wouldn’t make a patient feel good.

What trends are you seeing in the increasing number of uninsured patients and high-deductible health plans that leave them paying more?

Patients have two pain issues – paying a larger percentage of the total and wanting visibility earlier. Sometimes it’s not the total of my bill that bothers me, but rather that I don’t have visibility before I get that bill in the mail. We do a lot of work with many of our clients to put patient estimates in the hands of consumers so that they are not surprised by what a particular procedure will cost or what their bill will look like. That goes a long way in helping them have a dialogue and a conversation with their healthcare provider to understand whether they have options or flexibility. 

That becomes critical, because it ties directly to the overall amount that the patient will ultimately be burdened with. There may be things that are optional within a patient’s care plan, there may be things that aren’t, or maybe there’s a drug that’s getting prescribed where there’s the option for a generic. Having that patient visibility into the cost up front allows that dialogue to happen, and maybe downstream to reduce that total burden and allow the patient to play an active role.

What is the expected outcome of Experian Health acquiring patient scheduling vendor MyHealthDirect?

What MyHealthDirect does is synergistic with what we do. We provide a lot of services that fall into the patient access realm. Bringing in the scheduling component to our suite of solutions, providing that ability to schedule a service, combining that with our matching and the correct identification of that patient, and then being able to facilitate the registration process, which starts to include running eligibility, looking at coverage, and providing those estimates. It’s really just continuing our breadth and advancing the more holistic solution of the patient access services that we can provide to our client base. 

All of this ties around our broader vision of of helping improve the care coordination for patients on behalf of our clients. It’s a natural fit and tie-in with many of the services that we provide today, but it also allows us go back to our clients with a solution that helps them manage that upfront interaction with a patient from the point of scheduling an appointment.

Do  you have any final thoughts?

We at Experian Health are excited about how we can help transform the healthcare industry, providing services and offerings to the market that are unique to our business. How we combine those, how we help solve challenging problems. One of the reasons I got into our healthcare space is that we have unique data and unique capabilities that, when hearing the challenges that our clients are facing, allow us to provide a differentiated solution. We’re excited about where we can help take the industry as we go forward.

Pretzel Logic 9/30/19

September 30, 2019 News 6 Comments

It’s a Dog’s Life

As everyone knows by now, on the Internet, no one knows you’re a dog. In US healthcare, it turns out, you might actually be better off being treated like a dog.

I recently had to manage my 12-year-old dog’s journey through the veterinary care continuum. I found a system that is responsive to provider, patient, and caregiver needs in ways that our human healthcare system is all too often lacking.

Charlie was a mixed breed rescue dog, but he presented as a black lab. Last spring, he developed a fatty lump on his chest that was benign but growing fast, so we consulted with our local veterinarian and decided to have it surgically removed.

Our ensuing veterinary saga took us from the local ambulatory vet to an acute care facility, back to the local vet, back again to a specialist employed by the acute care facility, back to the ambulatory vet, and finally to a palliative care vet. So, we had a “care team” of organizationally and geographically disparate clinicians of varying specialties. Not unlike, say, a typical Medicare patient.

Routine pre-surgery tests showed an abnormally high protein level, possibly indicating kidney disease. Our vet ordered another test with cystocentesis — insertion of a needle into the bladder — to get a sterile sample. Standard practice is to use an ultrasound to accurately place the needle. The surgeon who drew the sample noted in the EHR that while guiding the needle, she saw a peripheral “shadow” that seemed abnormal.

A follow-up abdominal ultrasound revealed a large mass on the spleen, either a non-cancerous hematoma or a malignant tumor (hemangiosarcoma), that needed to come out. Our vet referred us to Angell Medical Center in Boston, pretty much the Mass General of veterinary hospitals.

We got an appointment easily with a couple of emails to the surgical scheduler. The day before our visit to Angell, I got an email with an estimate of how much the visit would cost. That was a surprise. Not the estimated cost itself, but the fact that they did it at all.

We arrived, checked in, and were met immediately by a medical assistant who cheerfully greeted Charlie. After a quick medical history, she stayed on to scribe for the surgeon.

Kneeling to greet Charlie, the surgeon said that he had reviewed the chart from our local vet — which was already in the EHR (!) — and asked to hear my version of the story while he did his physical exam. He also actively communicated with the medical assistant.

Surgeon: “Can you please check the date of Charlie’s lab results from the local vet?”

Scribe: “Five days ago.”

Surgeon: “We also have the ultrasound report from the local vet, correct? Please read it aloud.”

Scribe: “Yes, no images, but we have the interpretation.”

He concluded there was no need for any more labs or imaging, and recommended a splenectomy and removal of the mass. We talked through the various scenarios and the likelihood and pros and cons and risks of each one. I asked about the price, and he said that I would receive a price estimate via email once he had signed off on the chart. Walking back to the lobby, he told me that on the day of surgery, his staff would send me text updates. He asked if I had any other questions.

Me: “I’m pleasantly surprised by your use of the EHR and a scribe. Is that common among vets?”

Surgeon: “Well, pets can’t talk, so I need to 100% focus on the pet’s and owner’s body language and emotional state to really know what’s going on.”

Me: “I’m impressed by the high-touch engagement with owners through mobile technology. That must be quite a recent change. Do you like these changes?”

Surgeon: “It’s not really a question of what I like. It’s what the world wants, so we either keep up or we go do something else.”

We scheduled Charlie’s surgery for a few days later. Our local vet, who had received the consult report from the surgeon, called me to see if I had any other questions and to wish us luck.

Dropping Charlie off on surgery day, I was part of a parade of owners who were tearily watching our pets being escorted through the double doors of their medical fate. Some sensed danger and frantically tried to dig their claws into the unforgiving tile floor, others were cautious but resigned with heads and tails cast downward, and the rest remained blissfully ignorant with tails wagging. Charlie cycled through all three stages, but ended up with tail wagging, choosing trust over anxiety.

By the time I got home, texts and pictures started arriving from the surgical staff:

“Charlie is resting comfortably before surgery. Please text us if you have any questions or concerns!”

“Charlie’s hanging out on his bed relaxing after surgery. The surgeon will call you shortly.”

“Charlie is getting ready for bed. He misses you!”

“Charlie is ready to come home whenever you are! Let us know what time you’ll be here, and we’ll have him ready to go!”

The surgeon called with a quick update that all went fine. He said he would call again in the morning after the pathology results came in. He called at 8:00 the next morning and told us that the mass was cancerous, but with no apparent metastases, Charlie should be good to go!

We received a final itemized bill that was 24% lower than the estimate. Our local vet — who received the surgery, discharge, and pathology reports from the hospital — called later that morning to express her relief that all had gone well and to discuss follow up.

I so wish I could report that all was fine after that. But I can’t, because it wasn’t.

A couple of months passed. Charlie still had issues, so back we went to Angell, this time to the internal medicine specialist, who again had all the updated local vet’s records available. Her diagnosis after examination broke my heart: large-cell lymphoma in multiple lymph nodes. Prognosis: grim.

Our local vet received the consult report later that morning and called to express her sadness and to help us sort out options. We ruled out further treatment (e.g., chemotherapy) to err on the side of quality, rather than quantity, of life. She connected us with a palliative care veterinarian, who came to our house to visit Charlie. The home vet had already reviewed Charlie’s records prior to our meeting (with our permission, given over the phone), so we were able to focus our time on next steps rather than on reviewing his medical history.

Our discussion was a best practice out of Atul Gawande’s “Being Mortal.” She guided us through a family discussion of our goals for Charlie, what Charlie’s goals might be for himself and for us if he could express them, and our family’s goals for each other. Then we talked about how these goals would translate into plans and actions that met everyone’s needs.

About a week later, Charlie woke up with respiratory difficulty. Quality-of-life indicators were also gone: he didn’t look up and wag his tail when I walked into the room, and he wouldn’t eat his favorite snack foods. One of our end-stage goals was to protect him from distress or pain or fear, so we consulted with his care team. We then spent the rest of the day talking to him and comforting him and letting him know how much he meant to us.

The home vet came late in the afternoon. I laid down next to him in his favorite bed and said goodbye to Charlie.

[Long pause. Deep breath.] Charlie was a very good boy who gripped my heart and never let go. I really miss him.

Our local vet got the final consult report from the home vet overnight and called me the next morning to console us and assure us that we had given Charlie both a joyful life and a dignified death. The home vet also called the next day to see if we were OK. Hand-written condolence cards arrived in the mail from the home vet and our local vet. The card from the local vet was signed, with short notes, by every member of the veterinary staff.

Our story ended sadly, but Charlie’s care journey was much better than similar human episodes that I’ve been through. How so?

  • Customer service. We didn’t get valet parking or gleaming lobby atriums, but we did get attention not only whenever we needed it, but whenever we asked for it. From convenient communications via email and texting and promptly returned calls, to on-time appointments and regular updates, we always felt like the system was working for us instead of the other way around.
  • Accountability. There is no Accountable Care in veterinary medicine, but we got plenty of accountability nevertheless. We never had to step in to fill obvious gaps. Medical records were shared electronically in the background among the various provider organizations without any intervention or “sneaker-net” transport from us. Doctors called us promptly with new information and called repeatedly when they couldn’t get hold of us. We were given price estimates prior to major visits, and the actual prices were almost always below what was estimated (obviously they’re gaming this a little, but it gave us confidence that we wouldn’t get any surprise bills).
  • Care coordination. Transitions of care were well oiled by the exchange of records and consult notes and by phone calls between primary care and specialist and hospital. Referral loops got closed every time with timely consult reports back to the local vet. The hospital proactively pushed information back to the referring vet for local follow-up. The incidental finding of a tumor – a common gap in human health care – was picked up and followed through on expeditiously.
  • Embracing of modern technology. There was no Meaningful Use for veterinarians, but all of the providers involved in Charlie’s care had invested in EHRs regardless. They were also active users of convenient communication technologies like email and texting. Finally, they integrated technology into the patient experience with well-orchestrated division of labor between physicians and support staff.

Before you deluge me with all the institutional reasons that impede human health care from being this responsive, I’ll beat you to the punch.

  • Privacy and security. There is no animal equivalent of HIPAA or 42 CFR Part 2, which impose rules on information sharing.
  • Payment. There are no claims, prior authorization, coding, documentation, quality measures, or Meaningful Use requirements imposed by health insurers, which occupy too much provider time.
  • Technology. There are no EHR Certification or HIPAA Security Rule requirements, which load EHRs with a lot of administrative overhead and prevent the use of widely adopted off-the-shelf technologies (e.g., non-secure email and SMS) for communication with other providers and patients.

These constraints, and many more, certainly make veterinary care “easier” in some ways than human healthcare. And yet I’m not convinced that this accounts for the whole difference, or even most of the difference.

While it’s routine to complain about the burdens of HIPAA, the reality is that a large fraction of that burden is self-imposed, either for ulterior motives or out of sheer confusion or incompetence. See the recently released Patient Record Scorecard from ciitizen if you don’t believe me.

With respect to payment and technology, I sympathize with providers who understandably lament the hijacking of EHRs for ever-higher claims support documentation and quality reporting requirements. But one need only look at the circular firing squad debate on surprise billing to see that both institutional providers and insurers are complicit in putting their own needs ahead of patients’ needs.

Veterinary care isn’t perfect and has some of the same issues as human care, such as extra-inflationary price growth. But we didn’t have to goad Charlie’s providers to work as a team as if it were some unnatural act. We weren’t left anxiously waiting for important diagnostic results. And the condolence cards and calls we got from Charlie’s doctors after he died had me trying to remember whether that happened after my father and father-in-law passed away. Oh, I remember now – it didn’t.

Our human healthcare system has somehow become way less than the sum of its parts. Our world is divided into those who have already made that discovery and those who are just about to. It comprises brilliant, dedicated, and caring individuals whose efforts somehow often aren’t accretive or synergistic, giving us a “system” that is often indifferent, and all too often, aggressively callous toward patients. The veterinary “system,” by contrast, seems imbued with a certain humanity that is missing from human healthcare. Maybe what we need is an incentive payment tied to a “humanity” quality measure – pretty sure that’ll take care of it.

My profound thanks go to Dr. Alleman and the staff at VCA Rotherwood Animal Hospital in Newton MA, Dr. Schoenberg at Autumn Care & Crossings in Medford MA, and Drs. Trout, Kearns, and Magestro and the staff at Angell Animal Medical Center in Boston. Please please please keep doing what you do.

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Micky Tripathi, PhD, MPP is president and CEO of the Massachusetts eHealth Collaborative. The views expressed are his own.

Curbside Consult with Dr. Jayne 9/30/19

September 30, 2019 Dr. Jayne 5 Comments

I recently wrote about Nuance and their efforts to create the exam room of the future, where charting is performed in real time as speech occurs. Several readers reached out with some detailed questions and discussion about the technology, which spurred me to dig a little deeper.

One reader commented about the concept of meaning as it relates to voice recognition technology and the need for systems to use pattern matching to correctly identify the content of the speech. I have a tremendous time getting my phone to recognize the difference between “pictures” and “pitchers” no matter how clearly I try to articulate, and regardless of context. Getting a system to recognize words when you’re actually trying is one thing, and having them accurately identify speech in an exam room conversation that is all over the place is another.

An article in the Journal of the American Medical Informatics Association looked at the difficulty in detecting conversation topics during primary care office visits. They used transcripts of the visits to look at whether machine learning methods could be effective in automating annotation of visits. The authors recognized the complexity of the average primary care office visit, noting:

Patients present multiple issues during an office visit requiring clinicians to divide time and effort during a visit to address competing demands, such as a patient could be concerned about blood pressure, knee pain, and blurry vision in a single appointment. Moreover, visit content does not solely focus on biomedical issues, but also on psychosocial matters, personal habits, mental health, patient-physician relationship, and small talk.

When looking at the content of visits to determine what material was covered, research raters can label each so-called “talk-turn” using codes intended to capture the visit content. This process can take several hours per visit, making it difficult to scale such an analysis. Being able to automate the extraction of these topics could not only help reduce documentation burden, but could also help identify providers who may not be following up on all the clinically relevant parts of the encounter. The authors wanted to build on previous studies that looked at human-labeled interactions and showed that machine learning systems can create annotations of those conversations.

Using 279 primary care office visits, they found that different models performed better at the visit level vs. the topic level, concluding that there needs to be additional study and larger datasets available to achieve performance that would succeed in the real-world exam room. It doesn’t seem as easy to move from the realm of natural language processing generation of discrete data as people might think. I’ve often thought about what it would be like if you could just record an office visit (both audio and video) as documentation. The pain would be in reviewing it later, unless there was a way to transcribe the information or make it searchable. Various vendors have tried to solve this problem, including leveraging Google Glass to do so.

Remember Google Glass, the tech industry’s darling way back in 2013? It’s been hiding in plain sight, as an “Enterprise Edition” that’s being used in a variety of manufacturing and heavy industrial applications as well as in healthcare. A quick scan of the website shows several big-name healthcare organizations on the client roster.

I recently had a chance to catch up with Ian Shakil, founding chairman of Augmedix, whose client roster shares some of the big names listed by Glass. He confirmed that Glass is far from gone, with around 30% of Augmedix customers using it as part of tech-enabled scribing services. The remaining clients use smartphones, which might be worn or on a stand in the exam room. It sounds like patients have gotten over the concerns that many of us initially had with Glass and privacy – he cites a 98% acceptance rate by patients, which is partly accomplished by education by the front desk or clinical staff.

It was interesting to talk to someone knowledgeable about a segment of the healthcare industry that I admit I know little about. Other than some excitement around Glass half a decade ago, and some acquisitions of scribe and transcription services by other vendors in the voice recognition and EHR spaces, I hadn’t seen a lot of coverage. We spend some time talking about the way various solutions tackle the problem, from what can be described as “dictation in disguise” to human scribes to remote scribes to attempts to use voice recognition and virtual assistant technology to create a true AI-powered scribe. Some vendors like Augmedix even offer services across the continuum, depending on where their clients are, from a human virtual scribe all the way to tech-augmented scribes who use a variety of tools to enhance their abilities to document visits.

I was surprised to learn that there is variability in what is done with the recordings of patient visits created during the course of visits. Depending on the vendor and the client, some want the recordings and video destroyed and others want it preserved. It may be used for training, quality assurance activities, or even in the future as a multimedia note or for access by the patient as a reminder of the visit. Given the plaintiff’s attorney whose branch is close to mine on the family tree, I wondered about the use of the video feeds in potential litigation. I’ve pored through enough bulky, EHR-generated medical records to know that it certainly would be easier to watch the movie than to read the book in this case.

I use a human scribe in the exam room about half of the time. Our office fully agrees with industry data that shows that such support leads to better notes, timelier patient care, and reduced clinician burnout. The biggest struggle I have though is going back and forth between having a scribe with me or not having one. When I have that support, everything I say is taken down or acted upon in the exam room before we leave, and I can just close that visit in my mind and move to the next exam room. The scribes watch for lab results or radiology tests to return and make sure I don’t miss going back to take care of a patient who is still pending disposition.

When I work a shift without a scribe, I’m pretty good at the follow up piece, but I sometimes forget to put in my orders or flag patients for discharge. I’m just so used to saying, “We’re going to do a flu swab and get a chest x-ray” and having those orders placed, my brain is on autopilot right past the need to enter them myself. It’s enough of an issue that I usually tell the rest of my clinical team that “I had a scribe yesterday and don’t today, so if you see me missing orders or discharges, just grab me” and they usually laugh, because apparently I’m not the only physician who does it.

Shakil shared a great piece with me that ran in The Lancet a couple of weeks ago, one where the author discusses “Empathy in the age of the electronic medical record.” It’s worth a read for folks who might wonder what physicians who struggle with the EHR are thinking as they try to see patients. I’m interested to hear what readers think on the topic. Where are we, and where are we headed? In the meantime, I’m mentally prepping because tomorrow’s schedule does not include a scribe.

What do you think about virtual scribes, natural language processing, and the exam room of the future? Leave a comment or email me.

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Email Dr. Jayne.

Morning Headlines 9/30/19

September 29, 2019 Headlines No Comments

Province gives up on single e-health records provider for doctors’ offices

Canada’s New Brunswick Medical Society will close Velante, the for-profit company it created in 2012 as the sole EHR provider for the province’s doctors, few of whom signed up for the system.

Federal Law Enforcement Action Involving Fraudulent Genetic Testing Results in Charges Against 35 Individuals Responsible for Over $2.1 Billion in Losses in One of the Largest Health Care Fraud Schemes Ever Charged

The Department of Justice charges 35 defendants for fraudulently billing Medicare $2 billion by running phony telemedicine companies whose doctors ordered unnecessary cancer genetic screening tests that were processed by private labs in on the scheme.

March, October Targeted for VA Cerner Implementation

The VA will push back its Cerner go-live date from March to October at several facilities in the Pacific Northwest because of staffing and infrastructure problems.

23andMe, moving beyond consumer DNA tests, is building a clinical trial recruitment business

23andMe will work with clinical trial recruitment startup TrialSpark to offer customers enrollment in clinical trials in their areas.

Baptist Health coding jobs being outsourced to company with locations in US and India

Baptist Health (KY) lays off 37 as it outsources some of its coding jobs to AGS Health.

Monday Morning Update 9/30/19

September 29, 2019 News 1 Comment

Top News

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Canada’s New Brunswick Medical Society will close Velante, the for-profit company it created in 2012 as the sole EHR provider for the province’s doctors.

Few doctors signed up for the system, which was provided via New Zealand-based Intrahealth, despite government subsidies.

The province has since decided to allow doctors to use whatever EHR they want.


Reader Comments

From Jules Verne and Shirley: “Re: must-follow health tech influencers. What do you think of this list?“ Most of the winners have good career accomplishments and job stability that give them credibility to be called an “influencer,” while others have done little beyond promoting themselves loudly. The winners were plucked out of the Twitterverse by the vendor-sponsor’s recently-graduated Twitter manager, whose has zero healthcare and IT experience. I feel that I can critique the list since I’ve appeared on it before, though I wasn’t desperate enough for attention or validation to brag about it. But I do admire any business model that is fueled by ego and insecurity since we adults remain high schoolers in many ways, so perhaps I’ll start my own certification program or “Best Doctors” type list. 


HIStalk Announcements and Requests

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Last week’s poll results are informative even though I regretfully neglected to provide a “no regrets” option. Takeaways from respondent comments: (a) choose wisely in giving up your preferred lifestyle to grind away at a job / career that could go up in smoke because of some unforeseen corporate event; (b) take risks that force you out of your comfort zone; (c) stand up to corporate bullies and bad bosses when patient safety is at risk; (d) spend more time with your kids when they are young since you only get that chance once; (e) build a community outside of work, such as volunteering; and (f) spend time every day learning something new.

New poll to your right or here: have you deferred important medical care for financial reasons?

Listening: new from Temples, which lives somewhere between riffy, chorussy progressive music and 1960s reverb-loaded psychedelia. I’m not sure it’s deep enough to hold my attention, but it was snappy enough to get it in the first place (see: Muse). 


Webinars

October 2 (Wednesday) 1:00 ET. “Conversational AI in Healthcare: What About ROI?” Sponsors: Orbita, Cognizant. Presenters: Kristi Ebong, SVP of strategy and GM of healthcare providers, Orbita; Matthew Smith, AVP and conversational AI practice leader, Cognizant. Conversational AI holds great promise to drive new opportunities for engaging consumers and customers across all industries. In healthcare, the stakes are high, especially as organizations explore opportunities to leverage this new digital channel to improve care while also reducing costs. The presenter experts offer a thought-provoking discussion around conversational AI’s timeline in healthcare, the factors that organizations should consider when thinking about virtual assistants through chatbots or voice, and the blind spots to avoid in investing in those technologies.

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

 

Here’s the video of last week’s well-attended webinar, “Patient Education Data: A Key Ingredient for Improving Quality and Patient Experience.”


People

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Regional Medical Center hires Michelle Edwards (Palmetto Health) as CIO.

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Rohit Madhavarapu, MS (Salesforce) joins SymphonyRM as VP of product.


Government and Politics

The Department of Justice charges 35 defendants, including nine doctors, for fraudulently billing Medicare $2 billion by running phony telemedicine companies whose doctors ordered unnecessary cancer genetic screening tests that were processed by private labs that were in on the scheme. The owner of Atlanta-based molecular testing firm LabSolutions – 40-year-old Minal Patel, who was charged with soliciting Medicare beneficiaries through telemarketing and health fairs and then bribing doctors to order unnecessary tests to the tune of $494 million – had $30 million and his luxury cars seized.


Privacy and Security

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In Canada, the systems of two-hospital Listowel Wingham Hospital Alliance go offline due to a ransomware attack.


Other

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In Canada, the document scanning service of a closed medical practice refuses to give an elderly couple copies of their medical records unless they pay $309. RSRS (Record Storage and Retrieval Services) had a change of heart once they were named in a TV station’s report and says it has a program to help patients who are unable to pay. RSRS offers free services to closing medical practices that include notifying patients, creating a customized web page for inquiries, providing boxes and packing help, extracting data from EMRs, shredding paper, and selling or donating used medical equipment. Nova Scotia’s Personal Health Information Act allows providers to charge $0.20 per page and $12 per hour for copying a patient’s paper records. Only 300 of the province’s 2,400 doctors use EHRs.

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The Detroit paper profiles David Farbman, an entrepreneur who was lured into healthcare revenue cycle management years ago by Meaningful Use-fueled EHR proliferation. He began his career running his dad’s huge commercial real estate firm, developed and sold a hunting and outdoor life media company, and formed a failed competitive hunting tournament in which participants stalked animals to shoot with tranquilizer darts (the concept reminded me of the bizarre movie “The Lobster” that I watched on Netflix recently). His HealthRise has 20 hospital clients and $20 million in annual revenue.

In India, a newspaper claims that “corporate hospitals” are intentionally adding clauses to their patient consent forms in the English language only, hoping that non-English speakers won’t notice that they are giving their permission for the hospital to use their data for research.

In England, hospital volunteers help patients who have motor neuron disease “bank” their voices so that if they lose the ability to speak, they can communicate through a synthetic computer voice that sounds like their own. I Googled and turned up Nemours-created ModelTalker, in which a user records themselves reading 1,600 sentences via a web tool or Windows app, after which  the result is turned into a synthetic voice for $100.


Sponsor Updates

  • MDLive Chief Medical Officer Lyle Berkowitz, MD will present at the Telehealth Secrets Conference October 2-4 in Silicon Valley.
  • Meditech will exhibit at the First Databank User Group Conference October 1-2 in Indianapolis.
  • NextGate responds to CMS on the CY 2020 Physician Fee Schedule Proposed Rule.
  • Netsmart names Dennis Jakubowicz (MatrixCare) VP and GM of its senior living business unit.

Blog Posts

Sponsors named to Modern Healthcare’s “Best Places to Work in Healthcare” for suppliers in 2019 are:

  • Nordic (#4)
  • Burwood Group (#6)
  • Divurgent (#10)
  • PMD (#11)
  • The Chartis Group (#20)
  • Impact Advisors (#25)
  • Santa Rosa Consulting (#41)
  • ROI Healthcare Solutions (#46)
  • Health Catalyst (#53)
  • Imprivata (#56)
  • Redox (#72)

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Weekender 9/27/19

September 27, 2019 Weekender No Comments

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Weekly News Recap

  • FDA releases draft guidance explaining how it will determine if a clinical decision support software product should be regulated as a medical device.
  • Emids is acquired by a private equity firm.
  • Prescription discount service GoodRx adds virtual visits.
  • Amazon launches a virtual medical clinic for its Seattle-area employees.
  • China’s Ping An Good Doctor reaches 300 million registered users of its online healthcare platform.
  • CHIME, AMIA, and other groups ask Congress to address specific information blocking issues and to extend the timeline for enforcement.
  • University of Kentucky HealthCare diverts patients over several days after a registration system update causes a system crash.
  • Campbell County Health (WY) diverts patients following a ransomware attack.

Best Reader Comments

If your organization is resistant to change (like most acute orgs) and not receptive of feedback (like most places with bad politics), you should probably keep your mouth shut. If you can’t, you should quietly leave. If you want to be a hero, volunteer after work or donate some money to a good cause. In general, sacrificing yourself on the molehills of office politics is a bad way to achieve moral goals. (DifferentIndustry)

One thing that always startled me as a someone who entered healthcare from a different field is how low quality healthcare management is. In private practice, you often have MDs trying to be managers. A general manager at McDonald’s has more well- developed management skills than these people. Sometimes they eventually realize that they don’t have what it takes and cede the role to a clinic manager or the practice is small enough that everyone learns how to work around them. The acute side is where you get real pathological relationships due to the scale, low pay for middle managers, and lack of competitive pressure. Every office has politics, but if people are incentivized to backstab, they will backstab. (Diseased)

Re: downloading health data. One more manifestation of the consistent phenomenon (see: open notes, patient portals) that patients are less fascinated by their heath data than we imagine. Most find this information to be either unpleasant, confusing, inaccurate, or some combination of these. A small core of patients find access to be essential, but it is a very small fraction. Assuming that all patients want to see their info makes us think we are failing. But maybe we need a different denominator.(Andy Spooner)

If I may, I’d like to add my two cents about why patients don’t download their data. I, for one, do download my data, especially the visit summary. But it is usually a waste of time and paper/ink because the substance of the discussion I had with my provider(s) is rarely reflected in the note. It’s more of a CYA note so pretty useless to me if I want to go back and try to see what the doc said in past visits. I even had a couple of physicians who dictated their notes AFTER I downloaded the note so the only thing entered in the visit note was PMH, Meds, VS, etc. Very disappointing. (Eyes Wide Open)


Watercooler Talk Tidbits

In England, twins who were mistakenly assigned the same NHS number at birth 37 years ago still have problems booking services, getting the right meds, and following up on appointments whose reminders are sent to the other sibling. NHS says it can’t talk about individual cases, but the problem is most likely to happen when patients share a last name, data of birth, and address.

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A woman receives 500 letters at her home address from UnitedHealthcare that are addressed to “State of Maine DHHS.”

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ProPublica congratulates itself on its story about non-profit Methodist Le Bonheur Healthcare’s aggressive pursuit of unpaid hospital bills in which it sued 6,500 patients, many of them living in poverty. The hospital was shamed by the report into offering more generous financial assistance, eliminating court-ordered interest on medical debt, and eliminating attorney fees. The feel-good story ignores the obvious – patients who didn’t pay their bills now don’t have to (unlike many patients before them), the hospital will surely find other ways to squeeze money out of patients once the headlines fade, and the problem of super-high hospital bills remains. The pea has simply been moved under a less-noticeable shell. Interesting facts from the health system’s tax forms:

  • It paid its current CEO $1.6 million and its “senior advisor” and former CEO $1.3 million in its most recent tax year.
  • The CIO was paid $469,000, the CTO made $337,000, and the chief health information officer earned $370,000.
  • Cerner was among its five highest-paid vendors, with $13.3 million in maintenance costs for the year.

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The stored stem cells of 56 cancer patients at Children’s Hospital Los Angeles are lost when the hospital’s freezer fails. CHLA apologized for the failure and for sending the notification letters addressed to the children instead of their parents. On a positive note, they bought a new freezer.

A Staten Island doctor is arrested for trading opioid prescriptions for sex, with 20 of his patients filling prescriptions for 100,000 oxycodone tablets.

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Former San Diego Chargers team doctor David Chao, MD  — an orthopedist whose history includes DUIs, a DEA investigation, 20 malpractice lawsuits, and a revoked medical licensed that was stayed in a settlement – launches a subscription football injury service called the Injury Index for gamblers under his moniker “Pro Football Doc.”

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A New Zealand woman credits her throat cancer recovery to a retired New Jersey pediatrician and cancer survivor who gave her a second opinion on Facebook. Sajjad Iqbal, MD wrote a 2017 book titled “Swimming Upstream: My Struggle and Triumph Over Cancer and the Medical Establishment: New Hope in Cancer Treatment.”


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Morning Headlines 9/27/19

September 26, 2019 Headlines No Comments

Statement on new steps to advance digital health policies that encourage innovation and enable efficient and modern regulatory oversight

The FDA releases new draft guidance documents that cover the safe and effective use of digital health technologies, using a risk-based framework under its Digital Health Innovation Action Plan that addresses provisions of the 21st Century Cures Act.

emids Announces Investment from New Mountain Capital

New Mountain Capital acquires Nashville-based healthcare technology, services, and consulting company Emids.

GoodRx Expands Healthcare Services With Introduction of GoodRx Care

GoodRx acquires telemedicine vendor HeyDoctor, enabling it to add virtual visits to its prescription drug discount website and app.

VA to Pilot New Scheduling System at Same Ohio Facility that Tested the Last Solution

The Chalmers P. Wylie Ambulatory Care Center in Columbus, OH will become the first VA facility to replace Epic scheduling with Cerner next April.

Trump Administration Puts Patients Over Paperwork by Reducing Healthcare Administrative Costs

CMS releases the Omnibus Burden Reduction Final Rule to scale back regulatory requirements that the agency projects will save providers 4.4 million hours and $8 billion over the next 10 years.

News 9/27/19

September 26, 2019 News 11 Comments

Top News

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The FDA releases new draft guidance documents that cover the safe and effective use of digital health technologies, using a risk-based framework under its Digital Health Innovation Action Plan that addresses provisions of the 21st Century Cures Act. 

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FDA will focus its enforcement on software that hasn’t been approved as a medical device but that offers clinical recommendations to providers without transparency about how it derives those recommendations. Examples are flu detection functions that use EHR data and location; software that identifies patients with potential opioid addiction; and machine learning algorithms that predict postoperative cardiovascular events in diabetic inpatients. These software functions do not allow providers to see the underlying logic that is being used and are therefore considered to be medical devices.

FDA will also review software that analyzes or manipulates medical images; designs custom orthopedic or dental implants; monitors physiological signs to predict heart attack or narcolepsy; measures lesions to predict malignancy; and that analyzes images to differentiate between stroke types.

FDA is also interested in software that issues caregiver alerts when detecting life-threatening situations that require immediate action, such as stroke.

Also on FDA’s list of clinical decision support as a medical device is software that analyzes sleep apnea monitor data; calculates insulin doses; and that analyzes genetic variants to issue patient-specific treatment recommendations.

FDA considers consumer technologies to be medical devices if they recommend lifestyle changes for insulin-dependent type 2 diabetics; recommend treatment options based on questionnaire answers; and advise parents whether to take a child to the ED.

Software will not be considered a medical device it if meets these four conditions:

  • It doesn’t process medical images or signals.
  • It doesn’t display or analyze patient information.
  • It makes recommendations to providers to help them make patient care decisions.
  • It enables a provider to see how and why it made a particular recommendation for a patient’s diagnosis or treatment.

FDA makes it clear that software that matches patient information to reference information is not a medical device, such as displaying practice treatment guidelines; issuing warnings for drug-drug interactions and drug-allergy contraindications; checking drug or device orders to see if they follow FDA labeling; recommending additional tests or interventions; and calculating nutritional needs.

Comments on the proposed clinical decision support-related rules are due by December 26, 2019.


Reader Comments

From Going Epic: “Re: RWJ Barnabas. Has 90+ jobs listed that require Epic experience.” Reader Barnabas Rubble said back in a June rumor that they would be replacing Allscripts and Cerner with Epic, although CIO Robert Irwin ignored my resulting inquiry. You have to wonder what Northwell Health is thinking since they are one of few big US Sunrise sites left and they are supposedly making a keep-or-dump decision in the next few weeks. UPDATE: an equities analyst noted that while Allscripts said in its most recent earnings call in talking about new Sunrise sales that “extending and expanding” at Northwell is being decided soon, he thinks that its Sunrise and TouchWorks agreements were extended last year and run for several more. He’s thinking that it’s the IT outsourcing agreement that is expiring and thus being discussed. I think he is correct as I re-read the Q3 2018 earnings call transcript, in which Rick Poulton says that Northwell extended its TouchWorks agreement for five more years, the managed services  agreement is up for renewal but isn’t a high-margin business anyway, and Sunrise wasn’t specifically mentioned. Readers who know more are welcome to chime in. Thanks for the correction.

From Insider: “Re: Cantata Health. Continues to purge employees who have been around since the Keane days. They have abandoned the acute market, with NetSolutions as their only viable product under new leadership.” Unverified. A private equity firm acquired the health IT assets of NTT Data to form Cantata Health in 2017. The company’s website continues to list Optimum.

From Exec Checking In: “Re: your site. My onboarding with a very large global firm required me to sign up for HIStalk updates. It’s the only email I always click on. I have to be up to date on industry news at all times and your site is my best source.” That comment made my day, thanks. I like being required reading, although having people following me voluntarily is even better.


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor OpenText. The Waterloo, ON-based company’s cloud and on-premise Enterprise Information Management products for healthcare drive interoperability, improve information access, eliminate paper documents, and enable data-driven decisions. Among its solutions are RightFax (paperless, secure faxing that creates an organization’s most-connected device with minimal disruption); MedNX (lab report distribution); EMR-Link (lab and imaging orders and results integration and outreach); Intelligent Forms Automation (transition to digital processing); Documentum (information asset management); TeleForm (document-driven workflows); Covisint MIPS reporting; and Magellan (analytics and AI). Banner Health uses the company’s EnCase EDiscovery and EnCase Endpoint Investigator to assess potential cybersecurity issues and to respond accordingly, while Lahey Health uses Documentum to present outside unstructured clinical data within Epic with a single click. Thanks to OpenText for supporting HIStalk.

I noticed that a distant relative is working for a small-town behavioral and substance abuse facility whose website talks about “empowering people” and “putting clinical excellence above all else.” Corporate sleuthing reveals that, like much of healthcare these days, the organization is part of a chain owned by a private equity firm.


Webinars

October 2 (Wednesday) 1:00 ET. “Conversational AI in Healthcare: What About ROI?” Sponsors: Orbita, Cognizant. Presenters: Kristi Ebong, SVP of strategy and GM of healthcare providers, Orbita; Matthew Smith, AVP and conversational AI practice leader, Cognizant. Conversational AI holds great promise to drive new opportunities for engaging consumers and customers across all industries. In healthcare, the stakes are high, especially as organizations explore opportunities to leverage this new digital channel to improve care while also reducing costs. The presenter experts offer a thought-provoking discussion around conversational AI’s timeline in healthcare, the factors that organizations should consider when thinking about virtual assistants through chatbots or voice, and the blind spots to avoid in investing in those technologies.

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


Acquisitions, Funding, Business, and Stock

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Veteran health IT communications executive John Hallock shares insight into the PR run-up to the Athenahealth and Livongo IPOs, stressing that hard data helped craft a narrative that attracted the attention of investors, media, and influencers. Hallock’s comms resume also includes stints at Imprivata, CareCloud, and Change Healthcare.

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Best Buy expects to take in $50 billion in revenue by 2025, a move that will be driven in large part by a more aggressive push into senior-focused home healthcare services. The next five years will see the company scale its remote monitoring devices and services through its Geek Squad unit and partner with additional payers to add care coordination services.

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Digital stethoscope and ECG technology company Eko raises $20 million.

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New Mountain Capital acquires Nashville-based healthcare technology, services, and consulting company Emids for an undisclosed sum. Analysts have speculated that the purchase price is between $200 million and $225 million.

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GoodRx adds virtual visits to its prescription drug discount website and app after acquiring telemedicine company HeyDoctor.

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Sam’s Club partners with Humana to offer Care Accelerator, health-related discount bundles that include free prescriptions for popular generics, unlimited $1 telehealth visits, dental discounts, free lab tests, and prepaid health debit cards.


Sales

  • Tenet Healthcare signs a new multi-year agreement with NTT Data Services for application, infrastructure and security support and development services

People

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Greenway Health names David Cohen (Cerner) SVP of product management, David Millen (R1 RCM) SVP of product development, Sri Rajagopalan VP of architecture (SAP America), and Sagy Mintz (Allscripts) VP of quality assurance.


Announcements and Implementations

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A KLAS report finds that Cerner customers are more satisfied with advisory and implementation consulting services obtained from third-party firms than those provided by Cerner itself. Firms such as PwC, Atos, and Emids — which sometimes are engaged to fix a struggling Cerner implementation — had zero dissatisfied respondents. Customers complained that Cerner sends inexperienced fresh graduates while third-party firms not only decline to hire inexperienced employees, they often bring on former Cerner people. Customers also report that Cerner lacks a prescriptive implementation methodology, its consultants don’t talk to each other, and high costs and estimate overruns leave customers feeling that they aren’t getting their money’s worth.

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CoverMyMeds announces GA of AMP: Access for More Patients, an automated specialty prescription access and adherence support tool for patients developed with parent company McKesson.

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Relatient adds secure two-way messaging between patients and providers to its patient engagement software.

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Wolters Kluwer Health adds clinical natural language processing capabilities to its Health Language data extraction and integration software.


Government and Politics

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The VA’s OIG finds that its providers aren’t checking PDMPs regularly, placing patients who take opioids at risk because they don’t see their non-VA prescriptions.

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The Chalmers P. Wylie Ambulatory Care Center in Columbus, OH will become the first VA facility to replace Epic scheduling with Cerner next April, coinciding with the VA’s rollout of Cerner at facilities in the Pacific Northwest.


Sponsor Updates

  • AdvancedMD will host its global user conference, Evo19, October 2-5 in Orlando.
  • Elsevier Clinical Solutions will exhibit at the Emergency Nursing Association event September 29-October 2 in Austin, TX.
  • EClinicalWorks will exhibit at the APHCA Annual Conference October 1-3 in Gulf Shores, AL.
  • Ellkay and Healthwise will exhibit at AdvancedMD Evo19 October 2-5 in Orlando.
  • Goliath Technologies publishes a new solutions brief, “Goliath Technologies + IGEL: Improving patient care through proactive, fast and secure delivery of clinicians’ digital workspaces and EHR applications.”
  • Redox will host its third annual Healthcare Interoperability Summit October 15 in Boston.
  • Meditech maintains its momentum in the Canadian EHR market with 47% market share and a number of new customers and product expansions.
  • ITether adds access to Healthwise’s evidence-based curriculum to its outpatient care coordination and patient engagement software.
  • GetWellNetwork collaborates with Cerner to improve care coordination and patient engagement before and after hospital admission.
  • The Chartis Group publishes a new paper, “How Does Your Physician Enterprise Measure Up?”
  • StayWell’s My StayWell Platform and Krames on FHIR and Krames On-Demand products achieve ISO 27001:2013 certification for its information security management system.
  • Mobile Heartbeat collaborates with Eisenhower Health (CA) to improve emergency response communication.

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EPtalk by Dr. Jayne 9/26/19

September 26, 2019 Dr. Jayne No Comments

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It’s US National Health IT Week, as promoted by HIMSS. I’m working with several organizations right now and none of them is doing anything to “celebrate” the occasion.

The reality of things is that we’re all exhausted by our health IT endeavors. Back in the early days, and before Meaningful Use gummed up the works, it was exciting to be on the cutting edge (and sometimes bleeding edge) of things. As an early adopter organization, we had some pull with our vendor and could demand improvements in the software. Now that they’re just trying to keep up with federal regulations and satisfy shareholders, there’s no initiative to make the customers happy.

If your organization is actually doing something to mark the occasion, I’d be interested to hear about it.

CMS has updated the Medicare Plan Finder website for the first time in a decade. Medicare beneficiaries can access it on Medicare.gov and use it to compare Medicare Advantage and Medicare Part D plan. The upgrade is supposed to be mobile-friendly with enhanced readability. I asked one of my favorite Medicare beneficiaries to tell me what they think of it and he couldn’t find it, probably because he was looking in Google Play rather than the website. I gave it a peek myself and it was pretty vanilla. Apparently the coverage I’d want costs a pretty penny in today’s dollars, so I better work on my skills for retirement savings. Approximately 10,000 people enroll in Medicare every day, so who knows if there will even be any money left for coverage by the time some of us get there.

Most of us are familiar with the Google influenza tracker that used to be available. Although it has been sunset, it used symptom searches to try to identify flu cases. I was excited to see this article in the Journal of the American Medical Informatics Association that looks at internet search data as a way to predict emergency department volume. The authors looked at whether Google search data can be applied to ED volume forecasting to improve accuracy compared to existing methods. The data was from Boston Children’s Hospital, local public school calendars, National Oceanic and Atmospheric Administration weather data, and Google trends. As they added data sources, the model became more accurate. I wish my facility would get on board with this kind of big data, because right now our staffing model is very, very off.

From CliqBait: “Re: hit man. Definitely a head-turner, if not also a head scratcher.” A former University of Iowa medical student goes to prison for trying to hire hit man. The Gazette details the story of a man who wanted to kill one of the university’s associate deans after he informed the student he could no longer attend. The accused pleaded guilty to a firearms charge, but the murder-for-hire plot increased his prison sentence. Pro tip: Don’t hire people to kill other people, especially when your supposed hit man is an undercover law enforcement agent. And if you do make the mistake of trying to do so, don’t offer illegal machine guns as payment for the deed.

Surprise, surprise: a recent journal article notes that data found in EHR visit notes doesn’t always match the examinations performed by physicians. Reviewers compared real-time observational data to EHR documentation and found that they could only verify the Review of Systems 40% of the time and the physical exam only 50% of the time. Most of the discordant findings were in clinical systems that were less clinically relevant to the patients’ presenting complaints. For example, patients who presented with gastrointestinal or genitourinary issues had a small number (5.4%) of findings in those systems that didn’t match. For the same patients, there were plenty of unsubstantiated ear / nose / throat exams (81.8%). One could surmise this happens because of overly-detailed defaults or copy/paste, but either cause culminates in physicians not proofreading and correcting their own notes. The authors call for additional studies to determine how extensive these findings might be since the physician subjects were residents in training and a small number (180) of patients had their encounters observed. They also encourage payers to remove financial incentives that lead to physicians over-documentation.

New England Journal of Medicine Editor-in-Chief Eric Rubin, MD, PhD is shaking things up by saying that “thought print may not be dead, it might soon need palliative care.” He plans to continue to bring the publication into the current century by making it more interactive with a greater online presence. There’s even talk about relaxing rules regarding authors who post copies of manuscripts on preprint servers, getting information into the hands of other researchers faster than the typical peer-reviewed publication pathway. Times are changing and it’s difficult for traditional media outlets to keep up. Print media continues to struggle. In a neighboring corner of the Midwest, the St. Louis Post-Dispatch just moved out of their historic building in downtown St. Louis. The new tenant: mobile payment technology company Square.

Mr. H mentioned this earlier in the week, but Amazon has moved into the telehealth space with its launch of Amazon Care. According to the public-facing website, the service offers virtual visits, in-person visits at home or office, and “prescriptions delivered to your door.” Services will include both urgent care and preventive scope of practice, including contraception and testing for sexually transmitted infections. Nurses can provide vaccinations and collect laboratory samples at the patient’s location. Eligibility is limited to Amazon employees and their families who are enrolled in an Amazon health insurance plan and who are based in the Seattle area. Employees who are enrolled in Kaiser Permanente plans are ineligible. The service is available Monday through Friday 8 a.m. to 9 p.m. and weekends from 8 a.m. to 6 p.m. Medical services are provided by Oasis Medical Group, which hopefully provides a layer of privacy for employees seeking care. Since this is a pilot program, employees have to request an invitation to participate. It will be interesting to see how this plays out in the coming months.

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