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Morning Headlines 5/23/19

May 22, 2019 Headlines No Comments

Zipline, which delivers lifesaving medical supplies by drone, now valued at $1.2 billion

California-based drone-delivery company Zipline announces a $190 million investment and plans to expand its healthcare-focused service to the US.

DGMC to go live with new electronic health record in September

Travis Air Force Base’s David Grant USAF Medical Center (CA) will go live on the DoD’s Cerner-based MHS Genesis in September.

Scoop: Former FDA head Scott Gottlieb rejoins VC firm

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

DNA-Test Startup Helix Cuts Staff, Closes Offices After Shift

Helix lays off employees and closes two of its four offices after announcing earlier this month that it will pivot from a direct-to-consumer DNA testing company to a provider-focused population health management business.

Morning Headlines 5/22/19

May 21, 2019 Headlines No Comments

Interoperability among Office-Based Physicians in 2015 and 2017

ONC finds that interoperability among office-based physicians didn’t improve from 2015 to 2017 even though more doctors used information from outside sources.

Google says the new Google Glass gives workers ‘superpowers’

With help from development partner Sutter Health, Google releases an updated $999 enterprise edition of Glass, promoting the product from its Google X skunkworks division to mainstream Google.

Comcast is working on an in-home device to track people’s health

Comcast will begin piloting an in-home health monitoring device later this year in hopes of bringing it to market in 2020.

News 5/22/19

May 21, 2019 News 8 Comments

Top News

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ONC finds that interoperability among office-based physicians didn’t improve a bit from 2015 to 2017 even though more doctors used information from outside sources. The percentage who sent, received, and integrated the information didn’t change and only 10% of doctors participated in all four domains.

Only 30% of doctors received an electronic summary of care record, 20% were sent ED notifications, and hospitals provided electronic patient discharge summaries to just 25% of PCPs.

Here’s a tip for ONC. Just about every hospital uses Cerner, Epic, or Meditech. The fact that some hospitals are able to do the right thing using those systems means the challenge is not a vendor or technology problem – it’s that some providers just don’t want to do it, no matter how much their patients might benefit. Think about this when you anoint these foot-dragging health systems as the official steward of everybody’s overall health. The jammed interoperability floodgates would magically open by Labor Day if their payments depended on it.

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In an accompanying report, ONC also finds that only about half of people were offered access to their online medical record in 2018, unchanged from 2017. About 60% of those looked at their information at least once. Most people said they have no need to view their online record.


Reader Comments

From AC: “Re: EHR internal timers and event log monitoring. Epic measures this. Customers should make sure they are getting an Executive Packet (Physician Well-Being section) and request access to Epic Signal. You should see if you can get Epic to interview with you on this topic or to share an overview. It might benefit their customers since not all of them take advantage of the tools available or even know about them.” I would like to hear more if someone from Epic or a client site is willing to share details. The study I cited suggests that tools like this can highlight EHR areas that could be streamlined and to quantitatively measure the impact of making system changes. It would also be interesting for an EHR vendor or its clients to compare the time and clicks required for specific functions across multiple health systems to identify best practices.

From Jack Ripa: “Re: HIMSS. Says investors are attending its conferences to follow trends.” MobiHealthNews (which is owned by HIMSS) runs a commercial from HIMSS TV (which is owned by HIMSS) that was recorded at HIMSS19 (which is owned by HIMSS) that says investors are finding value in attending conferences (that are owned by HIMSS). You, too have been (owned by HIMSS). Investors are there, of course, but I would assume everybody already knows that. Pro tip: despite appearances, the people wearing snappy suits are lightweights – the folks with real money (to whom the nattily attired genuflect) show up wearing clothes that are more commonly seen on golf courses and Applebee’s happy hour because they don’t need to impress anyone.

From Interview Analyzer: “Re: interviews. CEOs on occasion seem to get fresh ideas from your questions that I wonder, do they follow up with you afterward to pick your brain?” I’m pretty sure that my questions, while sometimes refreshingly off the wall or embarrassingly uninformed, have minimal business utility to someone who lives and breathes their particular niche. I attribute what you’ve read to: (a) interviewees who are being nice because they are HIStalk fans or who aren’t but hope to score flattery points; or (b) the interviewee being surprised at hearing thoughts from someone who lacks a verbal filter and who understands the race but has no horse in it. Neither party would have reason to continue the conversation offline and indeed that has never happened.


HIStalk Announcements and Requests

Readers recommended several folks for me to interview and that’s been fun. Let me know if you have suggestions of others who are interesting, doing good work, and confident enough to speak boldly about their area of interest.


Webinars

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

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


Acquisitions, Funding, Business, and Stock

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Private equity firm TPG sells its chain of cancer hospitals in India to oncology device and software vendor Varian Medical Systems for $283 million, proving that healthcare as a profit-driven industry isn’t just an American concept.

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Inova Personalized Health Accelerator invests an unspecified amount in Ireland-based Deciphex, which develops AI-powered digital pathology triaging applications such as Patholytix Preclinical.

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A Signify Research report finds that the EHR market in EMEA (Europe, Middle East, and Africa) is highly fragmented, with Cerner being the only vendor that holds a double-digit percentage of the region’s estimated $3.7 billion in annual spending.

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Google parent Alphabet’s Verily signs deals with several drug companies to display study recruitment ads to people who search for certain symptoms. Verily’s Project Baseline, launched in 2017, invites people to sign up (it’s a 12-minute online process) to contribute their research data, participate in surveys and focus groups, and test new technologies in working with partners Stanford Medicine, Duke University School of Medicine, and the American Heart Association.

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PatientsLikeMe founder Jamie Heywood expresses frustration that the federal government’s Committee on Foreign Investment is forcing the company to sell itself because its key investor is China-based genomics company ICarbonX. PatientsLikeMe is expanding beyond offering people a platform for discussing their conditions and symptoms with others with the same condition, now collecting their blood samples for AI analysis to understood more about human disease. Heywood says the government was concerned about exposing de-identified patient data to Chinese investors and insisted that the company prove that its work presented no national security risks.


Sales

  • Camden Coalition of Healthcare Partners chooses ACT.md’s social determinants of health collaboration system, which will support its care model identifying high-utilization patients and visiting their homes to help with medications, transportation, and connecting with social services.
  • In England, Gloucestershire Hospitals NHS Foundation Trust will implement Allscripts Sunrise.
  • Baystate Health (MA) selects Artifact Health’s mobile physician query platform to give physicians a faster way to review records in its clinical documentation improvement program.
  • Central Ohio Primary Care will use Updox for document management and communications services.

People

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Greg Miller (Health Catalyst) joins TransformativeMed as chief growth officer.

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Hackensack Meridian Health hires Pam Landis (Atrium Health) as VP of strategic digital programs.


Announcements and Implementations

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Google releases an updated enterprise edition of its much-maligned Glass, promoting the product from its Google X skunkworks division to mainstream Google. The $999 Glass won’t be sold directly to consumers – its audience is companies that want to sell their productivity-enhancing industrial software. The new version has a beefed-up processor and runs on Android with easier API integration. Google’s blog post says that Sutter Health is a development partner, which probably relates to its use of (and investment in) the Augmedix remote scribe service.

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A new KLAS report on practice management systems for practices of 11 or more doctors finds considerable variation in performance even those systems have been around forever. Epic continues to lead in satisfaction by far as customers report lower A/R days and better cash flow, while NextGen Healthcare is steadily improving. Practices of 76+ doctors report growing dissatisfaction with Cerner, mostly due to the product itself, and only 40% of them expect to see improvement in the next year. Satisfaction with Athenahealth has also declined significantly as customers say the company’s changing culture has impacted product support. They also express uncertainty about the company’s merger with Virence Health. Greenway Health performed well in mid-sized practices and is improving.


Government and Politics

The TL;DR version of why Missouri is the only state that can’t figure out how to launch a prescription drug monitoring database: (a) politics; (b) a family doctor-state senator who keeps squashing legislative efforts over privacy concerns that he somehow links to federal meddling in gun ownership; and (c) proposed bills that would have made physician use of the system mandatory.


Other

A Harvard Business Review article describes how New York City Health + Hospitals uses data science to identify homeless patients and match them to community services. They look for patient records that contain:

  • A home address of a homeless shelter or hospital
  • The words “homeless” or “shelter” in the home address
  • 10 or more ZIP code changes in one year
  • Registration-collected “homeless” flags from those few facilities that record it
  • ICD-10 codes for homelessness in the problem list, diagnostic assessment, or billing record

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I’m a big fan of giving patients a way to communicate their self-assessed health status to clinicians via an electronic form. Patient-reported outcomes for early chemotherapy side effect detection is one example, where patients report how they’re feeling or problems they are having that can then trigger EHR alerts for quick follow-up. An oncology researcher found that cancer patients who were provided that method of feedback lived an average of five months longer than those who weren’t, which doesn’t sound all that impressive until you remember that chemo drugs that cost hundreds of thousands of dollars often can’t deliver even that modest life extension. This concept should be applied to routine encounters – why must doctors swoop into the exam room and immediately start reading an electronic or paper form for the first time to see why you are there and then ask you all over again, wasting a couple of the few minutes patients get? I can’t figure out why the SF-36 form with additional specific data collection isn’t used widely, other than (a) clinicians aren’t paid to review it; (b) providers aren’t really interested in a patient deep dive as much as cranking out billable work; and (c) providers are afraid of being sued for missing something that turned out to be important. I have never personally seen this form, or anything like it, used out there in the Wild West of healthcare’s front lines, suggesting that my providers don’t really want to open up a can of medical worms by asking how I’m doing overall except as the rhetorical question part of exam room small talk.

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Analysis by US News & World Report finds that Washington, New Hampshire, and Minnesota are the best states overall when taking into account everything from healthcare to the economy. Dead last at #50 is Louisiana, which beat out fellow cellar-dwellers Alabama, Mississippi, West Virginia, and New Mexico. The public health implications are significant given the key role of states in driving public health, setting spending levels on social services, and creating and enforcing healthcare-related laws. You might also assume that telemedicine could be important if skilled clinicians agree with the conclusions and elect to live elsewhere.

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I missed this story that illustrates how healthcare price competition should work if you buy the idea that care is a commodity. SSM Health will charge just a flat $25 for a questionnaire-based, call-back virtual physician visit. It appears to be a white-labeled service from Zipnosis. I wondered where the country would get enough pharmacists when chain drug stores were popping up on every corner, so with that fear proven to be unfounded, I can now wonder whether we have enough doctors to staff telemedicine services. Probably so given puzzlingly modest adoption, although being a telemedicine doctor must be like working as an Uber driver except the money is good, you can work from home in your pajamas, and your car stays clean (note to self: patent the idea of telemedicine surge pricing). It sounds potentially dehumanizing as a doctor, however, since the only important outcomes involve volume, patient satisfaction, and not getting sued since the patients have low-acuity needs that are being addressed episodically. Maybe it will devolve into those 1980s 1-900 telephone services for sex and psychics, although the objective there was to keep callers on the line with the meter running (there’s another note to self in maximizing profit from chatty patients). 

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An interesting study finds that the overconfidence of wealthy people makes everybody think they are more competent than they really are, proving that “fake it until you make it” and some level of snobbishness works, especially in one-off situations such as job interviews. I’ll add an unresearched postulate – executives often think they are smarter and more insightful than everyone else just because someone put them in charge, causing them to overvalue lone-wolf instinct instead of underling-assembled facts and analysis (I wrote about this way back in 2006 in describing what I called “Man of Action Syndrome.”)


Sponsor Updates

  • Dimensional Insight will exhibit at the 2019 MUSE Inspire Conference May 28-31 in Nashville.
  • Bluetree will exhibit at the HIMSS Southern California 2019 Annual Healthcare IT Conference May 23 in Los Angeles.
  • CarePort Health will exhibit at ACMA Northern California May 28-29 in Napa.
  • The Chartis Group publishes a paper titled “EHR Benefits: Unlocking the Secrets of Successful Organizations.”
  • Authority Magazine profiles Collective Medical CEO Chris Klomp.
  • CoverMyMeds will exhibit at the 2019 CMSC Annual Meeting May 28-June 1 in Seattle.
  • Hunt Scanlon highlights Direct Recruiters’ integration with sister company Direct Consulting Associates.

Blog Posts


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Morning Headlines 5/21/19

May 20, 2019 Headlines No Comments

Facebook is mapping demographics, human movement, and network coverage to combat diseases

Facebook combines its data and AI capabilities with public and commercially available datasets to create maps that will aid public health workers in preventing the spread of disease.

After forced sale, PatientsLikeMe founder frets that U.S. policy could chill collaboration in biotech

PatientsLikeMe founder Jamie Heywood believes the federal government’s demand that the company extricate itself from its China-based investor will have a detrimental effect on future, potentially life-saving, healthcare collaborations.

Why Missouri’s The Last Holdout On A Statewide Rx Monitoring Program

Lack of action during Missouri’s latest legislative session helps the state continue its seven-year streak as the only one without a PDMP.

Nashville health-tech firm lands $7.3M in funding, with help from Jumpstart

Clinical decision-support startup EvidenceCare raises $7.3 million in a funding round led by JumpStart.

HIStalk Interviews Erine Gray, CEO, Aunt Bertha

May 20, 2019 Interviews No Comments

Erine Gray, MPA is founder and CEO of Aunt Bertha of Austin, TX.

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Tell me about yourself and the company.

Aunt Bertha focuses on the easiest way to connect people to health and human services programs through a simple interface. I experienced the need for this personally. My mom is permanently disabled. I have been her guardian for the last 17 years. Throughout this journey, I would find out about social programs after the fact. It was confusing to navigate.

I started the company nine years ago to offer an easier way to find programs and to connect to them directly and electronically. Some people call them referrals. We have 73 employees.

The concept of social determinants of health is suddenly popular, but for hospitals, it often just means having a place to record the patient’s self-reported information. Are they getting better at using that information to better transition their inpatients or ED patients to social organizations?

You’re right, there is a lot of talk about social determinants. It used to be called poverty and poverty alleviation. These are difficult problems to solve. The hospital system can do some things in many cases, but in a lot of them, they don’t have much control.

We have 175 customers, of which a good chunk are hospital systems. Many of them are just starting to record the assessments so they can at least uncover problems related to social care. Finding out if they need food or housing is a great place to start. They either turn on assessments in their EHR or they use our assessments.

That’s a great start, but some hospital systems that we’ve worked with have gone really deep. They have staffed social workers and teams who go the next mile and follow up with patients. In some cases, they actually buy wheelchair ramps, groceries, and other things if they find there’s a need.

I would say that the movement is still pretty early. It has been really neat to see how these hospital systems are experimenting.

Is it hard for hospitals to make a quick, clean handoff to community-based organizations that aren’t necessarily equipped to respond quickly?

Absolutely. You still have the issue of non-profit financing. A community-based organization, or CBO, could be a government program or a social service program. Many of them are dealing with long waiting lists and a lack of funding, Some can’t serve their existing population. It is a challenge.

The question then becomes, what is the health system willing to do to engage them further, and, in some cases, to allow for reimbursement for some of these services? We are starting to see the sector think about it. CMS is starting to think about allowing for reimbursement for non-medical services beginning in 2020 for certain situations, if that service is deemed by a doctor to be medically necessary.

The short answer is that it depends. Organizations that sit down with the community-based organizations, get to know them, and build a partnership with them have seen higher levels of success under that model versus just hoping that an underfunded social care network can handle even more demand for services.

These are hard problems. Healthcare should assume longer-term commitments to these financing issues. I don’t think software is going to fix it, to be honest. Even though we’re a software company, I think the broader conversation is, how are the health systems and the local community-based organizations working together?

It’s interesting that 50 years ago, hospitals weren’t very much different from other community non-profits. Somehow their paths diverged and hospitals became monolithic and highly profitable, while most of the rest struggled for funding and hospitals quit talking to them in focusing on delivering episodic services.

You’re reminding me of the book “The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry” by Paul Starr. It’s about how in the early days, people helped each other and how specialization within healthcare then happened. Your analogy is spot on. People did use to look after their neighbors a little bit more and there was tighter coordination. We’ve gotten away from that.

I entered the name of a remote, tiny town on your web page and it returned a list of 800 programs. It was nicely divided by the type of service and offered many simple but powerful ways to filter the list, mark favorites, make notes, and contact the organization. Your website says you have a large team manually maintaining that database versus other vendors who either unethically scrape your data or use a software bot to harvest information from the web. Why is it important to have humans doing the work?

It is incredibly important to us. If you put yourself in the shoes of a social worker or a doctor, they are sitting down with a patient and hearing about things that are happening in their lives. Maybe they need counseling, drug addiction help, or whatever the case may be. You learn very early on that the credibility of our users is on the line. The social worker is sitting down with a patient who is being vulnerable about their situation, which is hard enough. Referring to a program that doesn’t exist or that hasn’t been updated hurts the credibility of the social workers who are out there doing important work. We don’t always get it right, but we try really hard.

We determined early on that we wanted to build an operation of people for two reasons. One, because we think the product and the data will be better. That doesn’t mean we can’t automate some things along the way, and we’ve done some things to make those employees more efficient. But every listing is approved. We try hard to do this across the country, but we focus on states where we have customers and usage because we don’t have unlimited resources. That focus has allowed us to grow.

The team is 25 people and growing. That line item is one of the most expensive aspects of running the business. However, we’ve never spent any money on marketing or public relations. We’ve been able to get to know health systems, health plans, schools, foundations like AARP, and others just by providing a free search. We’ve started to get users that way. It has ended up being a good investment in the business in the long run.

Secondly, it’s a great way to find people in a growing organization. We’ve had many employees graduate from what we call the data fellows program, where they spend a year or two curating the data and verifying information. They become programmers, data analysts, and supervisors. We grow folks and get to know them. It’s a mutually trusted source. They end up doing great things with the rest of the organization.

It’s a win-win, the way we see it. There might be other approaches to maintaining a reliable database, but I don’t think they will win in the long run.

What is your revenue model and how does the community connection work?

We’re doing something different in healthcare. We try to make it simple. Smaller organizations can become a customer at a basic level, a professional level, or an enterprise level. We’ve learned that our customers don’t like seat licenses, per-user per-month models, or other models. We look at it differently than in classic health IT. We’re successful when we have thousands of customers out there paying us a modest amount. That de-risks us. If you are a health system, you can buy our enterprise version with a couple of add-ons at a set amount that is open, transparent, and explained on the website. That allows us to build trust with our prospects.

Once they become customers, we want lots of users. We don’t want to put anything in the way of that. The more users who are on the system, the more people who will get help and the more we’ll get our name out there. Our pricing follows models from outside health IT and it has worked well for us.

It’s also a lot more fun. We only have three salespeople and myself. When a sales team is getting 15 to 20 customers per quarter, they’re having fun. It’s an approach we feel really good about and our customers like that we keep it simple and transparent. This approach to pricing subsidizes the data operations team. We have been able to provide a free service at AuntBertha.com because we have enough customers to cover our costs.

Why is it important that you don’t require people to register before using your online service?

It’s understanding our users. We need to earn the trust of people who are in need, patients in the healthcare setting. We use the term “seeker,” which is basically anybody who is seeking services. Most people are not ready to identify themselves when they’re searching for help for their most intimate needs. Think of a breadwinner who loses their job. Maybe they’re not ready to identify themselves.

It’s an important principle that we allow people to look for things. We see what people are searching for. They are searching for sensitive situations, such as childhood trauma. They have the courage to at least search for help. We want to leave it as an opt-in situation because we build trust. Social workers who work in hospitals or community-based organizations also don’t like creating accounts, so we get their loyalty as users as well.

Once you start making referrals, you can identify yourself and make an account. But we are perfectly fine with users of AuntBertha.com and social workers who are using our platform to pick up the phone and call a non-profit directly instead. It’s perfectly their right to do so and we would not get in the way of that. But from a business perspective, that wins out in the long run and we get customers who want to opt in later.

How do you balance the company’s social mission as a public benefit corporation and your own advocacy work with running a business?

I don’t think they are conflicting. The trade-off in allowing for free users and that social mission side comes across during a deal cycle when we’re talking to hospital systems. Laying out what we’re about and what we’re trying to accomplish is a differentiator in that process. People can quickly tell the difference between an alternate approach that is on price maximization.

We are pretty close to break-even. Our growth and the number of potential prospects allow us to charge less, get lots of users, and still make a difference. We would not be getting into the doors that we’re getting into without the goodwill that we’ve built over the years by providing a free service.

Do you have any final thoughts?

I’m excited about the way healthcare finance is going. I’m certainly not an expert. I was a programmer by training. I worked in public policy with some state health programs. But what I see happening is that health plans and hospitals are starting to become interested in getting the basic needs of people met in non-healthcare or social care ways. They feel like it’s a win-win in the long run, for their government contracts if you’re a health plan, or under alternative payment models if you are a health system.

It’s an exciting time to watch this transformation happen. You’re starting to see teams being formed with the goal of, how can I interact with somebody in need at their moment of need? Could we as a health system or health plan solve that need by building a wheelchair ramp or getting them some groceries? It’s an amazing win-win. I don’t know what’s going to happen with government policy, but watching that is exciting.

Curbside Consult with Dr. Jayne 5/20/19

May 20, 2019 News 2 Comments

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In a recent issue of Applied Clinical Informatics, researchers from the Arch Collaborative detailed their examination of the relationship of EHR user satisfaction to the investment in training made by the users’ organizations.

This comes as no surprise to those of us who have spent time in the EHR implementation trenches. Those who have more effective training tend to be better users of a given system. Being a better user often leads to less frustration compared to those who are struggling with the system. In general, people who experience less frustration might tend to be happier with their workday, or at least with the tasks that have to be completed in the EHR.

The data was compiled from a survey of 72,000 clinicians across 156 provider organizations to identify which elements determine whether a user reports higher levels of user satisfaction. The authors noted, “If healthcare organizations offered higher-quality educational opportunities for their care providers – and if providers were expected to develop greater mastery of EHR functionality – many of the current EHR challenges would be ameliorated.”

I’ve seen health systems that would allow physicians to go live on a system with only a couple of hours of classroom training with no hands-on experience and no ability to personalize or configure the system even though the system had those capabilities. In my experience, users trained in this manner have a greater tendency to turn into raging EHR haters than those who receive training that includes laboratory scenarios and the ability to create favorites and defaults.

I’ve also seen plenty of go-lives at organizations that didn’t hold physicians accountable for mastering the EHR. “Difficult” individuals might be allowed to opt out of training altogether after putting up barriers to participation in scheduled sessions.

I watched one hospital bend over backwards to schedule training at the time and place demanded by each subspecialty department, only to have a large number of physicians no-show their scheduled sessions. Conversely, I’ve worked with hospitals that demanded their providers attend training sessions and complete practice scenarios before being allowed access to the production system. Of course the latter group of providers seemed happier with the changes in workflow brought by the EHR than those who fought the process. In the study, physicians who reported poor training were “over 3.5 times more likely to report that their EHR does not enable them to deliver quality care.”

The researchers looked at multiple organizations across a subset of EHR systems and noted that a smaller portion (20%) of variation in user experience can be attributed to the actual software, but a larger portion (50%) of variation resulted from differences in how users acted on the system. They were able to identify both successful and unsuccessful provider organizations using the same systems. They also noted nearly 500 examples where two physicians of the same subspecialty at the same organization used the EHR and cited markedly different user experiences. In almost 90% of those situations, the more satisfied physicians said they had better training or more effort spent on personalizing the EHR.

Ultimately, the authors recommend that organizations require at least four hours of EHR training if they want to avoid frustrating their users. I would suggest that four hours doesn’t scratch the surface of what it takes to be an EHR power user. Physicians often argue that systems aren’t intuitive and it shouldn’t take them that long to learn how to do it since paper is “a no brainer,” but I point them back at the countless hours that they spent as medical students, interns, and residents learning to write a good note. Only through time and practice are the 10-page history and physical documents generated by third-year medical students whittled down into a two-page admission note done by a resident and a one-pager dictated by an attending physician.

The authors use the example of the scalpel, which “is a tool that has a very simple interface and use, but using it with confidence and safety requires knowledge of anatomy and surgical techniques coupled with practice to use it skillfully. In other industries, it is well recognized that education and training are of paramount importance to the successful use of professional-grade software. We need to recognize that this also holds true for EHRs and the practice of medicine.”

The authors recommend standardizing EHR training paradigms, although they were not able to identify a single methodology that performed better than the rest. They did note that more training needs to be focused on user-level configuration or personalization. However, they also noted that improved user training “needs to be balanced with a parallel focus on better designed and smarter software that can better meet nuanced needs of healthcare.” They also note that “these findings do not negate the need for EHR developers to continue to improve their user interfaces to be more intuitive, nor do they negate the critical need to reexamine the current regulatory and billing requirements that drive so much of the clinical documentation burden faced by providers today …”

They look to the future in considering the growing role of decision support within EHRs and how it might impact patient care. “For this vision to become a reality, physicians will need to know the limits of their technology’s advice in the same way that pilots know the limits of a plane’s autopilot. Without clearly understanding the EHR’s limits or how to use the technology, care providers will not trust the technology they work with.”

I like the airplane analogy. One of the EHRs I’ve worked with is an extremely robust system and some users complain it’s too complicated. I used to say that it is like a fighter plane – you want a system that is completely capable in case you wind up in a dogfight, even though most of the time you are just going to be on patrol. Users need to understand how to efficiently and effectively use the features that make up 80% of their day, but they also need to know how to access the next level of features for when the one-off situations arrive in the office.

The authors made some forceful comments that made my attention, one being that “caregivers who do not understand EHR technology are a threat to quality care and will likely not realize an efficiency gains in using the EHR nor be able to use the technology fully to advance care quality.” They go on to “advocate for caregivers to adopt EHR technology expertise as a core competency of their profession.”

I’m sure some physicians reading the study might be up in arms over its conclusions. I’ve been known to say that if some physicians would spend the same amount of time actually learning the EHR that they do complaining about it, they’d find themselves in a different place. This piece seems to reinforce that sentiment.

What do you think about the impact of training on EHR user satisfaction? Leave a comment or email me.

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Email Dr. Jayne.

Morning Headlines 5/20/19

May 19, 2019 Headlines No Comments

JP Morgan buys health-care payments firm InstaMed in the bank’s biggest acquisition since the financial crisis

JP Morgan Chase will acquire medical payments platform vendor InstaMed for more than $500 million.

Patient Hurt by Do-It-Yourself Artificial Pancreas Prompts FDA Warning

FDA warns users of do-it-yourself artificial pancreas systems that the individual components, including software, don’t necessarily work together to accurately control blood glucose levels.

UPMC Starts Telemedicine Company to Fight Infectious Disease

UPMC (PA) commercializes the infectious disease telemedicine services it has provided to patients over the last five years with the formation of Infectious Disease Connect.

Health at Scale lands $16M Series A to bring machine learning to healthcare

Optum invests $16 million in San Jose, CA-based precision care delivery startup Health at Scale.

Monday Morning Update 5/20/19

May 19, 2019 News 7 Comments

Top News

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JP Morgan Chase will acquire medical payments platform vendor InstaMed for more than $500 million. It’s the bank’s largest acquisition since the 2008 financial collapse, when it took over the failing Bear Stearns and Washington Mutual.

The bank’s head of wholesale payments says that 90% of providers still bill on paper. He says an acquisition makes more sense than starting from scratch since InstaMed has already created both the platform and its extensive network.

InstaMed, founded in 2004, had raised $134 million in funding. Co-founders Bill Marvin and Chris Seib were previously with Accenture. The 300-employee, Philadelphia-based company processed $94 billion in transactions last year.


Reader Comments

From Malted Milk Ball: “Re: ‘most powerful’ and ‘most influential’ lists. What is their methodology?” You’ve seen those click-baity “Best Hamburger in All 50 States” and “The Best Dog Breeds for Families” lists, compiled by some social media-savvy kid who has zero first-hand experience but who knows how Google and steal data from online sites. As far as I can tell given minimal transparency on the process, this is the same. Either someone is nominated (most likely by themselves) or aforesaid Googler simply heads over to LinkedIn. At least HIMSS is honest in accepting nominees for its “Most Influential Women in Health IT Awards,” although a committee of unstated membership makes the final decisions, gives preference to HIMSS members, and obligates nominees to contribute two HIMSS fluff pieces. It’s also good to remember that HIT fame is fleeting – Modern Healthcare’s 2008 “Most Influential in Healthcare” list was topped by Steve Case (Revolution Health Group) and Eric Schmidt (Google), then rounded out by some folks who have since passed away as well as those who are mostly forgotten, are now viewed less favorably, or who held a powerful role for a short time (former Hackensack CEO John Ferguson, short-term National Coordinator Rob Kolodner, and former FDA Commissioner Andrew von Eschenbach caught my eye among faded politicians and lots of people I’ve never heard of).


HIStalk Announcements and Requests

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A combined 53% of poll respondents take the federal government at its word in pushing interoperability to give patients more control and to save money, although a significant number believe its motivation is to benefit data brokers or to discredit previous administrations.

New poll to your right or here: If you’ve coordinated post-acute care for someone in the past five years, how hard was it? The bonus question, which you can answer by clicking the poll’s Comments link after voting, is how technology might have made the process easier or better.

Dear people who are writing for public consumption: please don’t start sentences with “there,” “so,” and “and.” It would also be nice if you didn’t mismatch a collective subject with a plural verb, as in, “The group of hospital CEOs are attending a conference.” Don’t misspell the possessive “its” as “it’s,” a mistake so prevalent that it seems more the rule than the exception. You can certainly write however you like when your readers are acquaintances — the folks with whom you would be comfortable wearing a ketchup-stained tee shirt or after having one-too-many glasses of wine —  but everybody else is forced to judge you on your thoughts and how well you express them. Most knowledge workers whose writing style is below average will see significant ROI from applying the slight bit of effort that is required to move to above-average (especially since the average is moving down). I’m preachy about this, but only because I want all readers to do everything they can to be successful.

Happy Victoria Day to readers in Canada.

Listening: Brooklyn-based Afrobeat band Ikebe Shakedown, a 1970s-style groove of big horns and wah-wah guitar funk. The Afrobeat genre was created long ago by the legendary Fela Kuti and is carried on by groups like Newen Afrobeat. I’ve seen an Afrobeat band live at an outdoor event and it gets people moving more than just about any other kind of music. I’m also still playing a lot of surf rock ran across the all-female, Canada-based Surfrajettes, which YouTubers compare to a Tarantino movie, what Austin Powers extras do on break, and “one of the best living room bands I’ve seen.”


Webinars

May 21 (Tuesday) 2:00 ET. “Cloud-Based Data Management: Solving Healthcare’s Provider Data Challenge.” Sponsor: Information Builders. Presenters: Jeremy Kahle, manager of planning and business development, St. Luke’s University Health Network; Shawn Sutherland, patient and member outcomes, Information Builders; Bill Kotraba, VP of healthcare solutions and strategies, Information Builders. Inaccurate provider data negatively impacts revenue cycle, care coordination, customer experience, and keeping information synchronized across systems and functions. SLUHN will describe how it created a single version of provider data from 17 sources, followed by a demonstration of how that data can be used in reports and geospatial analysis. Learn how Omni-HealthData Provider Master Edition provides rapid ROI in overcoming healthcare organization provider data issues.

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

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


Acquisitions, Funding, Business, and Stock

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The Alabama Supreme Court rules that purchasers of all software, regardless of whether it is off-the-shelf or customized, must pay state sales tax. Russell County Community Hospital paid the state $18,000 in sales tax for its Medhost software and equipment (as correctly billed separately by the company to comply with state law), but the hospital then petitioned the Department of Revenue for a refund in arguing that what it had actually purchased was non-taxable “custom software programming.” The Supreme Court disagreed, ruling that “all software, including custom software created for a particular user, is ‘tangible personal property’ for purposes of Alabama sales tax.”


Sales

  • University of Rochester Medical Center joins the TriNetX research network to expand access to clinical trials and for cohort discovery.
  • KPMG will offer Waystar’s social determinants of health data to users of its clinical intelligence platform for care continuum optimization. 

Announcements and Implementations

Pivot Point Consulting launches HIM services that it will back with quality guarantees.


Government and Politics

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FDA warns users of do-it-yourself artificial pancreas systems that the individual components, including software, don’t necessarily work together to accurately control blood glucose levels. This follows a report of a patient who received repeated insulin overdoses due to incorrect blood sugar readings issued by their homebrew setup.


Other

A single-hospital review finds that adding internal timer functions to the EHR and monitoring its event log allows the hospital to reliably measure the before-and-after result of software changes. It this determined that streamlining the nurse’s EHR patient history function reduced user clicks and the time required by more than 70%. I like this work for two reasons: (a) it highlights the importance of focusing relentlessly on optimizing clinician EHR time; and (b) it provides an automated way to capture the result that goes beyond (or perhaps hand-in-hand with) user surveys and anecdotal reports from the more IT-friendly clinicians.

Unrelated but interesting: Uber and Lyft drivers who are waiting to pick up fares at Reagan National Airport are logging out of the company driver apps right before big planes land, with the AI of the apps then triggering surge pricing because of the driver shortage. The drivers then log back in a couple of minutes later and are paid at the higher rate. Maybe this is more relevant than I think in illustrating that software-enabled gaming of the system is likely happening all over healthcare.

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This might be the news item needed to convince movie studios to make a Theranos-like movie about microbiome testing company UBiome, which was recently raided by the FBI after complaints of billing fraud. Co-founder and co-CEO Jessica Richman, PhD lied about her age to qualify her for various low-rent “Under 30” awards even though she was 40 at the time. I pulled the photo above with Maria Shriver from her Twitter – the now-45-year-old Richman is on the left. In a Theranos-like poorly kept romantic secret, insiders also say she was in a relationship with her co-founder, Zachary Apte. It’s pretty obvious – online records I checked in the free parts of some people-searching sites show both of them living at the same address in Washington (the article says they have houses in two states) and voter records confirm that Richman is 45 and Apte is 34. Lack of age-checking leads me to ponder how organizations that have separate awards for women verify the nominations – do they go strictly by appearance or name and are slippery slopes inevitable?

Newly filed tax records indicate that UPMC CEO Jeffrey Romoff got a 40% raise in 2018, with $8.5 million in total compensation. Another two dozen of the health system’s executives exceeded $1 million. UPMC reported FY2017 profit of $189 million on revenue of $13.5 billion.

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I’m pretty sure this little guy who had just emerged from tonsil surgery at UPMC Susquehanna was happier to be comforted by Annie Hager, RN than one of UPMC’s million-dollar executives. He even brought her flowers for his follow-up visit, making it her turn to cry.


Sponsor Updates

  • Patient engagement and Next Best Action technology vendor SymphonyRM doubles its client base year over year.
  • Ken Congdon, content marketing manager at Hyland, publishes “EMR Optimization is the Hottest Thing Since … EMRs.” 
  • Lightbeam Health Solutions publishes a new white paper, “Data-Driven Solutions Providers and Payers Need for Value-Based Care Alignment.”
  • Mobile Heartbeat and Voalte will exhibit at NWone May 20 in Stevenson, WA.
  • Waystar will exhibit at the ECW Education Expo May 27-31 in Boston.
  • NextGate will exhibit at Cerner NARUG May 20-22 in Richmond, VA.
  • Netsmart will exhibit at the Leading Age TX Annual Conference May 19-22 in Austin, TX.
  • Flywire Health and The SSI Group will exhibit at HFMA Region 1 May 21-22 in Uncasville, CT.
  • QuadraMed publishes a new case study, “Atlantic Health System Entrusts Patient Identity Leader for MPI Cleanup Before Massive Epic Rollout.”
  • Vocera will exhibit at the Northern Ohio HIMSS Spring Conference May 23 in Cleveland.

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Weekender 5/17/19

May 17, 2019 Weekender No Comments

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Weekly News Recap

  • A large survey of clinicians finds that the #1 predictor of positive EHR experience is training, with EHR personalization also being a major contributor
  • Cerner will connect its systems to state prescription drug monitoring databases via DrFirst
  • AliveCor earns FDA clearance for its consumer device that offers a six-lead ECG and expanded arrhythmia detection
  • Wolters Kluwer’s malware attack takes down its systems, some of them healthcare related
  • Former National Coordinator David Brailer, MD, PhD urges support for HHS’s proposed interoperability rules, saying that the federal incentive program should have made sure that EHRs could share information and defined medical information as belonging to the patient

Best Reader Comments

Re: Anti-poaching clauses. I negotiate them into all of my major agreements, if they’re not already there. Typically the vendor has it one sided that you can’t hire their employees and I make it reciprocal. (Was a Community CIO)

Healthcare data is complex, and while advancing FHIR will help, the fact is healthcare organizations need to invest in an enterprise healthcare data strategy and platform to really leverage the power of data. The EHR is just not that platform. The challenges of healthcare data are too complex for EHR vendors and they do no one a service when then try to position themselves as having more capabilities than they do. (Wow)

There’s a lot of very professional sales people out there selling products designed to help your health system solve problems, to get better, to better care for patients, to improve processes, to drive more revenue. Your industry is being disrupted while you sit in your office not taking phone calls from dreaded vendors trying to help. (Mike Bull)

One person comments on how there is no indication that sharing of data has decreased the cost of care, or increased the quality. I encourage you to please visit ARHQ.gov or HBR.org and review the numerous articles showing positive outcomes. I also dare you to find a single study not published by an EHR vendor that demonstrates that the EHR has done anything to improve the quality or cost of care. (Dissent)

Here are some hard truths: clinical data isn’t shared because it doesn’t profit your doctor and the health system to do so. EHR vendors built their systems to suit their health system masters and use their size anti-competitively, just like health systems do. Existing patient portals are a joke. This rant is indicative of those in this industry that proudly proclaim “I’ve been in healthcare for 30 years” but don’t understand that they are clearly part of the problem and won’t take responsibility for the state it’s in. (Disruption Please)

Rethinking regulations to protect patients by enforcing rational HIPAA-protected interoperability, including both doctor-to-doctor exchange, but also patient to their chosen apps with full awareness, audit abilities, and responsibilities similar or under HIPAA for those app providers. Force apps to protect patient data in a reasonable and accountable manner similar to health providers. (Love Fishin Too)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. K in Wisconsin, who asked for a “Jeopardy”-like game system for her elementary school class. She reports, “This gaming unit is very successful in my class and is especially good with the students that may not be good at paper assessments, whether it be ESL or special education students. This provides a different and motivating way to assess the students rather than a more traditional way. They are always asking to use this technology!”

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The Baltimore paper reports that Johns Hopkins Hospital has filed 2,400 lawsuits against patients with unpaid bills since 2009, many of whom live in economically depressed East Baltimore where its multi-billion campus sits. The lawsuit totals made up less than 0.1% of the hospital’s annual revenue of $2.4 billion.

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In England, University of Cambridge digitizes its 500 favorite examples from the trove of 80,000 handwritten medical records from the 1700s, with the notes of doctors including bizarre references to astrology, witchcraft, and treatment with horse dung. The records, translated into readable English, mention a man who got gonorrhea after “violating another’s wife,” a recommendation of bloodletting for a woman who “will not permit her husband to have the use of her body,” and a man bitten by a rabid dog who followed the prevailing wisdom of the time by eating the dog’s liver.

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French police add 17 new cases to its investigation of an anesthesiologist who is accused of tampering with OR equipment so that surgery patients were overdosed on drugs, then rushing in to revive them to show off his skills. Investigators noted that in the 24 surgeries that are being reviewed, in which nine patients died, the anesthesiologist was “most often found close to the operating room.”

Dietitians in Oregon question why a bill failed that would have required hospitals and long-term care facilities to offer plant-based meals, speculating that the Oregon Dairy Farmers Association influenced the state’s dietitian group. Some hospital nutrition experts said the bill would have limited the choices of patients who don’t eat meat, but who are OK with dairy products.

A Nevada doctor whose Kentucky Derby exacta and trifecta bets both hit is elated to learn that the payoff is $600,000, but he receives only $35,000 because the Reno casino’s fine print notes that it isn’t a pari-mutuel location and thus caps player wins to avoid “taking on unlimited liability, which no one would want to do.” 

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The Massachusetts medical board suspends the license of former Fox News contributor and celebrity psychiatrist Keith Ablow, MD, finding him to be an immediate threat to public health in alleging that he had sex with patients, stole their controlled substances, pointed a gun at employees, and fraudulently renewed his license.

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A man smashes the front window of a Utah medical clinic and makes off with a gumball machine provided for its pediatric patients. Surveillance video shows that the machine’s size prevented the thief from closing his car’s rear door, so he drove off with it hanging open.


In Case You Missed It


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Morning Headlines 5/17/19

May 16, 2019 Headlines 1 Comment

Local Investment in Training Drives Electronic Health Record User Satisfaction

A large clinician survey finds that training is the #1 predictor of positive user EHR experience.

The Joint Commission Enters Next Generation of Quality Measurement, Offers Accredited Hospitals Real-Time Quality Metrics

Joint Commission will give accredited hospitals real-time access to their quality measures that are submitted via its ECQM reporting process.

VA’s Byrne hints at acceleration of health record upgrade

Acting VA Deputy Secretary Jim Byrne tells lawmakers at his confirmation hearing that the possibility of shortening the Cerner implementation timeline will become a strong possibility once its initial operating capabilities are assessed.

Haven, the new health venture led by Amazon, Berkshire Hathaway and JP Morgan, just lost its No. 2 exec

Citing personal reasons, Haven COO Jack Stoddard tenders his resignation.

News 5/17/19

May 16, 2019 News No Comments

Top News

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A large clinician survey finds that training is the #1 predictor of positive user EHR experience. Little correlation was found with the actual EHR product they use.

The report by KLAS’s Arch Collaborative warns that organizations can’t rely on software usability to create physician user success and that poor EHR users are a threat to quality.


Webinars

May 21 (Tuesday) 2:00 ET. “Cloud-Based Data Management: Solving Healthcare’s Provider Data Challenge.” Sponsor: Information Builders. Presenters: Jeremy Kahle, manager of planning and business development, St. Luke’s University Health Network; Shawn Sutherland, patient and member outcomes, Information Builders; Bill Kotraba, VP of healthcare solutions and strategies, Information Builders. Inaccurate provider data negatively impacts revenue cycle, care coordination, customer experience, and keeping information synchronized across systems and functions. SLUHN will describe how it created a single version of provider data from 17 sources, followed by a demonstration of how that data can be used in reports and geospatial analysis. Learn how Omni-HealthData Provider Master Edition provides rapid ROI in overcoming healthcare organization provider data issues.

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

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


Acquisitions, Funding, Business, and Stock

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Glytec receives a patent allowance for interactions between its insulin titration software and connected diabetes technologies like smart insulin pens and pumps and continuous glucose monitoring systems.

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Axios number-crunchers determine that healthcare’s top CEOs made a combined $2.6 billion last year, with nearly half of those leading pharmaceutical companies. Allscripts CEO Paul Black took home $7 million, while Cerner’s Brent Shafer earned nearly $10 million. McKesson’s John Hammergren was paid $18 million, including a $4 million bonus for hitting financial targets even though the company faced several lawsuits. Community Health Systems CEO Wayne Smith, who continues to sell off unprofitable hospitals, received a similar perk for reasons that were unrelated to patient outcomes.


Sales

  • Great Lakes Medical Imaging (NY) will implement NextGate’s enterprise master patient index.

People

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National urgent care provider American Family Care hires Claudius Moore (The South Bend Clinic) as VP of IT.


Announcements and Implementations

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Hospital operator HCA Healthcare will roll out its SPOT algorithm and alert system for the early detection of sepsis to emergency rooms in the coming months. It also plans to expand the technology’s capabilities to include the detection of post-operative complications, early signs of deterioration, and shock in trauma patients.

Baptist Health implements PatientPing’s real-time care alert software for its ACO members in Louisiana, Kentucky, and Indiana.

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The HCI Group will lead Texas-based Val Verge Regional Medical Center’s Meditech Expanse implementation.

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InterSystems releases a new version of its TrakCare EHR – used in 25 countries, but not in the US — that is built on its IRIS for Health data platform that supports FHIR standards.


Privacy and Security

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Hospitals scramble to install a security update from Microsoft after the company discovers a zero-day vulnerability in older systems with Remote Desktop Protocol that make them prime targets for ransomware attacks. “The thing that makes this one so dangerous,” says Allina Health’s threat and vulnerability management expert Jeremy Sneeden, “is that you don’t need any access. A lot of vulnerabilities, you need a username and password, or some sort of access to the machine, to make the vulnerability work. But these — I guess they’re calling them ‘wormable’ now — they don’t need credentials, and that’s why they spread so quickly.”


Other

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A ProPublica investigation of bitcoin transactions finds that at least two US companies that offer ransomware recovery services sometimes simply pay the hacker’s demanded ransom, then bill the client multiples of that amount for technical work and try to sell them ongoing security services. The recovery firms say their clients don’t want to deal directly with the extortion aspects of paying a ransom, don’t want figure out how to buy bitcoin, or want to avoid interacting with the hackers directly. Proven Data’s website says that paying ransom is a last resort since it supports criminal activity and carries no guarantee of recovering data, but its CEO admits that most ransomware is too hard to break so it’s easier just to pay. He says hospitals are among his clients. Legal experts say that serving as a ransomware payment intermediary could be construed as criminal conspiracy.

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The drug company behind a new Botox-like product pays for luxury trips to Cancun for a dozen dermatologists who were coached to talk the product up on social media and post photos of themselves on the supplied model runway and confetti-throwing station, possibly violating FTC’s requirements on disclosures. Evolus, which targets selfie-obsessed millennials who are increasingly undergoing cosmetic surgery, says it isn’t required to report doctor payments to the Open Payments database because it doesn’t sell anything that Medicare or Medicaid pays for, which allows the company’s salespeople to “be very closely involved in high touch and customer-centric and engage with these practices outside of their traditional business hours.” 

Joint Commission will give accredited hospitals real-time access to their quality measures that are submitted via its ECQM reporting process. The system’s cloud-based technology is provided by Apervita.

An article published in NEJM suggests that healthcare adopt analytics techniques that are common in the intelligence community, such as:

  • Using less-structured data storage, such as data lakes, to reduce data modeling
  • Incorporating automated metadata tagging to enhance searching and association of disparate items
  • Using natural language processing
  • Implementing cell-level security to manage data object access
  • Replacing hypothesis-based research with mining for unsuspected correlations

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The Journal of Reproductive Health finally redacts a company-funded study claiming the $330 Daysy thermometer from Swiss company Valley Electronics identifies fertility with 99.4% accuracy. Concerns about the study’s validity had been raised by researchers over a year ago. Reproductive researcher Chelsea Polis spearheaded the redaction efforts, first emailing the company and then the journal to point out the study’s questionable methodology, which included a low participation rate, poorly designed questionnaires, and cherry-picking results for marketing purposes.

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Theranos whistleblower Erika Cheung reflects on her decision to share her misgivings about the company’s business practices with CMS. “I was so paranoid about Theranos and them spying on me, I had a burner phone just to call the Centers for Medicare and Medicaid Services because I was so scared that I was going to get sued or they were going to come after me. Being followed is a very terrifying thing. That was probably the hardest thing: just conquering your own fear and just saying, ‘OK, whatever happens, you’re just going to get through it.” Cheung has since founded the nonprofit Ethics in Entrepreneurship to help startups avoid a Theranos-like fate.


Sponsor Updates

  • EClinicalWorks will exhibit at DDW 2019 May 18-21 in San Diego.
  • KPMG adds Waystar’s social determinants of health data to its Clinical Intelligence platform.
  • Ellkay, Healthfinch, and Healthwise will exhibit at Cerner NARUG May 20-22 in Richmond, VA.
  • Ensocare will exhibit at the ACMA Northern California Chapter meeting May 28-29 in Napa, CA.
  • EPSi will exhibit at HFMA Region One May 21-22 in Uncasville, CT.
  • Healthgrades names the 2019 Patient Safety Excellence Award and Outstanding Patient Experience Award recipients.
  • Imprivata will exhibit at NTI May 21-23 in Orlando.
  • AMIA inducts Intelligent Medical Objects CMO Andrew Kanter, MD and Physician Informaticist Jonathan Gold, MD into the Fellow of the American Medical Informatics Association class of 2019.
  • Kyruus will exhibit at the Healthcare Marketing & Physician Strategies Summit May 21-23 in Chicago.
  • NextGate publishes a new case study, “4 Innovations in Patient Identification.”
  • OptimizeRx will present at the B. Riley FBR Investor Conference May 22-23 in Beverly Hills.
  • Waystar enhances its Agency Manager solution with invoice verification capabilities.
  • The Silicon Valley Business Journal features Vocera CNO Rhona Collins, DNP, RN.
  • Meditech publishes a new case study booklet, “The Innovators: Meditech Customers in Action.”
  • The latest version of TrakCare from InterSystems extends its mobile capabilities to all clinical workflows.

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EPtalk by Dr. Jayne 5/16/19

May 16, 2019 Dr. Jayne No Comments

We had some struggles at my clinical office this week. Our soon-to-be fossilized PCs running Windows 7 had a bad interaction with Active Directory and Citrix. The result was that nearly half of the physicians couldn’t access the EHR. When our IT team tried to fix it, they effectively eliminated access for the remainder of the providers.

It wasn’t pretty and caused a great deal of consternation as the staff tried to figure out how to execute downtime procedures when only half of the people were down. Staff continued to document electronically, but providers were on paper, except for the lucky providers at busy locations that had scribes assigned to them. Ultimately the situation was remediated, but it underscored the need for our leadership to get rid of Windows 7 since it is reaching the end of its support cycle.

Thanks to Dr. Nick van Terheyden for his kind mention of my recent Curbside Consult regarding employment-based health insurance and its impact on efficiency and fairness. He mentions one sad consequence of our US healthcare non-system that I didn’t mention — married couples who divorce when one of the spouses becomes seriously ill so that the surviving spouse is not saddled with medical debt. Another similar scenario that I’ve seen includes divorce from a spouse with serious (but non-terminal) health issues so that the ill spouse can apply for Medicaid or try to get Medicare coverage due to disability. People shouldn’t have to try to game the system in order to get the care they need.

A recent article in the Journal of the American Medical Informatics Association covers the evolution of knowledge and competencies needed by the clinical informatics workforce. A lot has changed in the years since board certification in clinical informatics was being designed. Survey participants spent approximately a third of their clinical informatics work time on improving care delivery and outcomes, while another quarter of their time was focused on leadership activities. Other blocks of time were spent working with enterprise information systems and on data analytics and governance. AMIA plans to reassess informatics practice every five to even years to ensure that their understanding of needs in the clinical informatics domain remains current.

I struggle sometimes with the requirements of board certification in clinical informatics, particularly the maintenance of certification ones. For those of us who are not employed by a hospital or health system, finding ways to meet the “Improvement in Medical Practice” MOC Part IV requirement is difficult. I don’t own the data of my clients and they’re generally reluctant to have their information used outside of their own organizations. As a consultant, I can’t steer projects to become something I need for informatics certification – I have to keep them between the lines of the client’s engagement.

I struggled with this is a family physician as well. One of the MOC Part IV requirements was to do a hand hygiene project that involved handing out surveys to patients about whether caregivers washed their hands. Guess what? My then-employer (who was a big health system) wouldn’t let me do the project in the office because they felt it would interfere with patient perceptions. Since I don’t have continuity patients, many of the other options were off the table. I have quite a few friends who are giving up on board certification, although it’s easier for them because they don’t practice clinically.

Whether you’re a clinical person or an IT person, most of us have spent many sleepless nights running upgrades, working on projects, or taking care of patients. A study published this week looked at the metabolic changes associated with sleep deprivation and whether “sleeping in” might help mitigate some of them. Nearly a third of US adults don’t get the seven hours of sleep recommended for us, but trying to make up for that isn’t as easy as we think. Researchers engaged a cohort of healthy adults and assigned them to a control group with sufficient sleep, a restricted (five hours nightly) group, and a restricted group that was allowed unrestricted sleep on weekends. The “makeup sleep” group only slept an additional three hours on the weekend despite missing more than a dozen hours of sleep during the previous nights. Those trying to catch up also experienced disruption to their circadian rhythms resulting in trouble falling asleep at the end of the weekend.

Sleep restriction led to decreased insulin sensitivity that was worse in those engaging in recovery sleep. Restricted individuals also consumed excess calories and gained an average of three pounds over the course of the study.

Given the fact that study participants were healthy, the authors question whether the results might be even more striking in patients who were older or less healthy. Even though it leaves a number of unanswered questions, the study shows that our bodies are negatively impacted by lack of sleep and it’s not easy to try to make up for it.

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I was excited to start receiving the AMIA Daily Download, which includes a roundup of top news along with key issues in clinical informatics, bioinformatics, data science, population health, and social media highlights. They’re also including a link to HIStalk Morning Headlines, making it even easier to get your HIStalk fix.

We talk a lot about health insurance and many of us also deal with professional liability insurance, business continuity insurance, and more. I’ve seen some recent articles about data breach insurance. Most of the physicians I’ve spoken with have never heard of it. Policies typically cover expenses related to a breach as well as recovery services. We know that hackers find physician organizations to be easy targets and independent physician practices may be particularly vulnerable. I still see plenty of users writing down their passwords or using easily hacked passwords such as their children’s names. I see many practices that totally disregard the physical safeguards required under HIPAA as they leave server rooms accessible and allow users to put their own devices on the network without appropriate policies in place.

I’ve not been through the underwriting process for a data breach insurance policy, but I wonder if they look at how tuned-up your organization is to begin with. Do you they ask you if you have appropriate policies in place? Is it like auto insurance where they charge more for inexperienced drivers who are more likely to generate a claim? I’d be interested to hear from organizations that have been through the process and especially interested to hear from an organization (anonymously of course) who had to file a claim against their policy. Was it easy to get the coverage to pay out? Or did you have to fight them all the way? Leave a comment or email me.

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Email Dr. Jayne.

Morning Headlines 5/16/19

May 15, 2019 Headlines 1 Comment

Scientists Say They’ve Created a Smartphone App That Can Hear Ear Infections

Researchers at the University of Washington found Edus Health to commercialize their EarHealth app, which is capable of diagnosing ear infections with accuracy similar to that of an in-person exam.

Hospitals on alert to fix potential security risk

Microsoft issues a security update for all customers, even those using software that is no longer supported, after discovering a zero-day vulnerability in older systems with Remote Desktop Protocol that make them prime targets for ransomware attacks.

The Physicians Foundation Announces Interoperability Fund to Improve Health Information Exchange in Six States

Working with medical societies in six states, the Physicians Foundation announces an interoperability fund to help physicians connect to their local and regional HIEs.

Readers Write: Three Reasons to Look Beyond the SNF Five-Star Rating When Assessing Potential Hospital Partners

May 15, 2019 Readers Write No Comments

Three Reasons to Look Beyond the SNF Five-Star Rating When Assessing Potential Hospital Partners
By Tom Martin

Tom Martin is director of post-acute analytics for CarePort Health of Boston, MA.

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Last month, the SNF Five-Star Rating program underwent major changes in all three domains. As a result, many SNFs saw their ratings drop on Nursing Home Compare, and many hospitals and health systems questioned whether these facilities could continue to meet their high standards for quality.

A close look at the program’s methodology revealed that CMS’s changes in measurement were the root cause of the decline in ratings, as opposed to a true dip in quality. As tempting as it is to use the star ratings as the primary criteria for adding or keeping SNFs in a preferred post-acute network, there are a few compelling reasons for hospitals to look beyond these general statistics and consider alternative strategies.

The first reason is that the quality domain carries the least weight though it includes some of the most important measures.  The survey domain is the most heavily weighted in the calculation of a facility’s overall star rating.

While surveys are certainly an important indicator of quality, they’re not the most relevant or timely markers for hospitals that are assessing SNFs as potential partners. The results are subjective, standard surveys only happen once a year, and the forced distribution of ratings in this domain makes it difficult to know if a provider is truly improving or if other SNFs in their state are just getting worse.

In contrast, CMS is constantly adding new measures to the quality domain, some of which are highly relevant to hospitals. In fact, for a few key measures such as 30-day readmissions, ER visits, and successful discharge to the community that really matter to hospitals, the period of time that patients are followed has been extended beyond discharge from the SNF. These longer measurement windows are especially helpful to hospitals that are part of an ACO or involved in other value-based programming that holds them accountable for patient outcomes across the entire care continuum.

Unfortunately, with a total of 17 quality measures currently included in the quality domain, a SNF’s performance on these critical measures has a limited impact on its quality star rating and minimal impact on its overall star rating.

The second reason to look beyond the star ratings is that the claims-based quality measures are limited to the Medicare fee-for-service population. Even if a hospital or other acute entity such as an ACO focuses on the measures that are most relevant to them, as mentioned above, and ignores the composite star ratings, the data on these measures are confined to a facility’s Medicare fee-for-service population, which may or may not make up a significant portion of its current population. And looking ahead, the percentage of Medicare beneficiaries choosing to receive their benefits under a Medicare Advantage plan will only continue to rise, making these fee-for-service claims-based measures even less representative of the quality of care provided at a SNF—ironic given that they would otherwise have the potential to provide the most valuable information in the program.

The third reason to look beyond the star rating system is that changes in measurements, such as those made this April, have occurred many times over the 10 years the program has been in place and will likely continue to occur. But as we saw in April, they skew the data and can mask true trends in quality, making it hard for hospitals to get a complete and accurate picture of the performance of participating SNFs. What hospitals really need are objective means of measuring performance, and that’s not a given with the Five-Star Rating program. For example, in April CMS changed the cut points for the various star levels in the staffing domain, so even though a provider may have actually increased staffing levels in April, that provider may still have received a lower rating due to these new higher thresholds.

Selecting a few measures from the Five-Star Rating program to focus on when assessing potential SNF partners is a reasonable strategy, but one that doesn’t quite go far enough in the era of value-based care. In today’s climate, where hospitals and health systems are being held responsible for patients long after their inpatient stays are over, these acute entities need to be much more closely connected to their downstream partners. They need access to real-time patient data from SNFs, and not just on their Medicare FFS patients, but on their entire population.

All stakeholders—acutes, post-acutes, and most importantly, patients—benefit when providers break down data siloes and exchange healthcare information freely. Simple alerts stemming from ADT (admissions, discharge, and transfer) data can go a long way toward helping providers stay on top of what’s going on with their patients. The star ratings have their place, but to truly understand the quality of care that is being provided by their post-acute partners and ensure patients are receiving high-quality care at every point in the continuum, hospitals need to get proactive and start collecting their own data.

HIStalk Interviews Ashish Shah, CEO, Prepared Health

May 15, 2019 Interviews 2 Comments

Ashish Shah is co-founder and CEO of Prepared Health of Chicago, IL.

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Tell me about yourself and the company.

I was previously the chief technology officer for Medicity, where I worked for about eight years leading up to the acquisition by Aetna. I stayed for three and a half years post-acquisition. Prepared Health is a Chicago-based company that is a little over four years old. Our platform connects hospitals and health plans to post-discharge providers such as post-acute care facilities, home care, and social determinants of health partners.

Your new customer Jefferson Health said in the announcement that they want to offer “healthcare with no address.” How are hospitals motivated financially to coordinate post-discharge care?

What’s been happening in healthcare over the last 20 years is a physical re-engineering. For a long time, care was organized around the institution, the community, the beacon, the hospital. Everyone could point to it. But there’s been an overwhelming amount of merger and acquisition activity as pressure increases over cost and improving the access in the community. Sometimes that’s care in the home, sometimes it’s rehab facilities or ambulatory sites. We’re starting to see significant re-engineering of physical assets and communities.

Jefferson is thinking about care not only in those care settings, but also virtually and on demand. You never know when you’ll have a moment that requires a healthcare encounter, so make it easier. President and CEO Dr. Stephen Klasko is a pretty special guy. He reminds me a little bit of Mark Bertolini at Aetna when he talked about quality equaling convenience. Trying to make life easier in healthcare, which is a mess, unfortunately. That’s why I started this company.

Who pays for your system? Do hospitals convince their local post-acute care providers to use it to manage their shared patients?

Like all early companies, we’re not immune to having to figure it out. But in our model today, everyone pays a modest subscription for the platform. We don’t have a limitation on the number of users, the number of patients who are managed, or the number of coordination moments that are managed through our network. That was by design. Part of the challenge is simplifying the entire go-to-market model.

Hospitals pay, but it is our ultimate responsibility to bring post-acute care sites — home health, other home-based providers, and community-based providers – online. That’s part of the value. It’s a difficult job, not only for hospitals, but for health plans, too.

Were hospitals already in regular contact with those post-acute care providers, or is it a new new relationship for the two groups to be at least talking, if not actually working together?

It’s starting to change. A lot of those relationships have been at the social work level. If you had a transitional care nurse or a licensed social worker who was managing that transition out of the hospital, they were the ones who knew the facilities and the home-based providers. It was a personal relationship. That’s how decisions were made on who goes where and for how long.

Cost and quality are bigger topics. You’re starting to see health systems start to invest in new roles, directors or VPs of preferred provider networks or post-acute care in addition to population health roles. There’s more of an effort to try to understand your partners outside of the hospital. The reality is that you can’t acquire enough providers. There will always be a capacity issue. These groups are trying to get a handle on who the very best partners are to invite into their preferred network.

The product screenshots on your site look a lot like Facebook. How important is the user interface when users work for post-acute care organizations that may not use much technology and who may perform all their work on a mobile device?

This is the principal design challenge. It’s extremely important.

If you don’t mind, I’m going to back up for a minute to talk about why I started the company. My father suddenly passed away six months after Medicity was acquired by Aetna. He was way too young. It was unfortunate. We felt unprepared. I was an executive inside of a healthcare business, but over the ensuing months after his passing, we spent time with people who were around him from a caring perspective. He was visited by home health aides. He spent time in senior centers. The toughest thing to understand was that many of these people knew what was happening with him, but there was no mechanism to share that information.

That was the most humbling moment for me. At Medicity, we had connected thousands of hospitals to many ambulatory care sites, yet nothing we we were working on was going to change our family situation with my dad. As I dug into the problem, there are 100,000-plus sites of post-acute home and community-based care. That’s being conservative. The challenge is a design challenge. How do you quickly organize a large ecosystem that the majority of the market says has no money? Why would you focus on that? Yet we know it is super critical.

When I left Aetna and Medicity, we looked at models like Facebook and LinkedIn. Although we had made nice progress, Facebook and LinkedIn had organized billions of users. Although our business model is not the same as theirs, there’s something to be learned from their design approach.

Sometimes technology just makes a process more efficient or transparent, but your platform does something that can’t be accomplished otherwise. You can’t get everyone from all these provider organizations and family members together at the same time in a conference room or conference call.

We are in a crisis right now as a country. Ten thousand people are turning 65 years old every day. People talk about the silver tsunami. It’s going to tax the healthcare ecosystem in a significant way, but 47 million people in the US are unpaid family caregivers. These are people who care and who are willing to do whatever it takes to take care of their loved one, but they have no coaching, no training, no access, no connectivity.

As much as I love many of the great healthcare IT companies that are out there, no one is really focused on this part of the space. What health systems and health plans are starting to talk to us about is that personal caregivers, family caregivers, somebody in the community, or post-acute care providers make up an important group of teammates that they need to get connected and coached.

What kind of interaction do family members typically have with the platform and the provider care team?

Our first version was full transparency, just the way I wanted it when I started the company. It’s not uncommon to see home health staff and all the different workers connected to the family members around an individual. Or maybe a skilled nursing facility is also involved. Everyone is in together.

The types of things that people are doing are escalations and managing interventions. If somebody has a fall in the home or if there’s a sudden change in mood or weight gains, those are prompted by the professional care team to the family members and communication around those moments is being managed. These are difficult moments for families and there’s a lot of emotion in these conversations. What we’re most proud of is that through our implementation, we’ve seen these two groups turn into one team versus two teams that sometimes let emotions get the best of them.

As we think about scaling that experience, our provider organizations have coached us to think about how to keep the convenience and access in place, but to think about this as two modes of communication — a back office communication channel where things are communicated in shorthand and then a front office communication channel where you have buttoned up or polished communication with the patient and family. The concern is always that somebody will say something that makes the organization look bad. We’re working through that with some of our earlier customers.

It would seem beneficial to allow caregivers who work for different organizations and who may rotate assignments to have a closed channel that allows them to take a conversation offline.

We’ve paired group-based communication with individual communication. We’re trying to attack any mode of communication. That could be an assessment, an electronic check-in on how you’re progressing, a referral, or a transition. We incorporate group and secure texting and chat into the product. Interestingly, we see high utilization of all of these across the board.

The magic is communicating with somebody outside your organization. That’s the biggest challenge. I spent 10 years working on data interoperability in healthcare and God bless everyone who is trying to push all that stuff forward, but I think we have skipped over the fact that a number of these types of things will never happen through an EMR. People don’t talk through EMRs. They don’t manage interventions in real time through EMRs.

What kinds of things does your virtual care coordinator recommend?

DINA is our digital nursing assistant. She was an accidental invention. It started with how we could create this rapidly growing ecosystem or community for communication. In our first implementation, we met Amie Martinelli from Bayada Home Health Care. I’ll never forget her. She did an amazing job of coordinating care for complex CHF patients. When we looked back at the implementation, we thought, how will we ever scale Amie? Is this what everyone in healthcare is doing? As we studied more, it is what everyone is doing.

Every great outcome is an exception. Someone has to put forth a heroic effort to make sure all the right things happen. That’s hard in a market where there’s 40-50% turnover. We thought that a combination of advanced analytics, AI, and all the other buzzwords could be an answer. Today, DINA is present in our network and she is aware of all the communication. When people integrate their data with our solution, we get our hands on rich functional, behavioral, and other types of assessments. She can recommend people who perhaps should have a particular type of service, who could be seen at a more optimal care site, or whose situation should be escalated.

One that stands out is hospice. Sometimes people are on home health for a long time. They are re-certified over and over and over again. A lot of that is because of the personality of a nurse. They never want to quit on a patient. We’ve taught DINA to identify that moment where perhaps it’s time to have a more difficult conversation around palliative care options or hospice. One of the things that you’ll never find in a hospice eligibility guideline is the inability to use the telephone, but our predictive models found that to be a huge predictive factor.

DINA is aware of a lot of the communication. She can recommend people for conversations around hospice or perhaps a readmission back into skilled nursing versus a hospital. She’ll notify people when they are crossing certain care guidelines. If somebody should have been in a skilled nursing facility for 10 days but they are on their 15th day, she will identify that and communicate it upstream. She can do a lot of things, but much of it involves intervention management.

The Jefferson Health contract gave the company a lot of visibility given its relatively modest amount of funding. Where do you see the business going?

We have been humble and quiet by design. We bootstrapped the company for two years because David Coyle and I were focused on understanding the market, solving a problem, and generating some revenue along the way. We raised a modest amount of money, $4 million, to build a team and enter a new region. We’re active in three states — Illinois, Pennsylvania, and New Jersey. We’re proud of the work in that greater Philadelphia market, which is a top eight metro market. We working not only with Jefferson, but also Holy Redeemer. Almost every major home health provider in that region is on our network and soon we’ll be adding many of the leading skilled nursing providers as well.

As we scale the business, we’re looking to take this national. We just added a new senior vice president of sales and marketing, which is a brand new role for us. But we feel like we’ve been doing this the right way. We didn’t oversell. We didn’t over-promise. We did the hard work of trying to understand the space and create a great product experience. We’re maniacal inside the company around Net Promoter Scores and engagement of the product. We stand on a solid foundation. That’s what we care about first and foremost. Do we create value, and do we create it at a faster rate than anything else that’s out there?

With a few wins under our belt, it’s time to pick up the pace on building the business. We have identified hot spots across the country where there’s a greater need, where Medicare Advantage and managed Medicaid in the aging population is growing faster than other places. We will zoom in on those as a starting point. We’re in a good spot to start to scale. We see a lot of companies that try to scale too fast. We’re in the right place at the right time, but we have to do the work like everyone else.

Do you have any final thoughts?

There have been a lot of competing incentives and sites of care. Nobody is trying to do the wrong thing. But the next major wave is Dr. Klasko’s “healthcare with no address.” Internally, we call that a never-discharge mindset. How do we care for an individual when they’re healthy, they have an acute need, or they move into the post-acute ecosystem? With the amount of M&A that’s taking place and the amount of change that is required, we need more people to adopt this never-discharge mindset. The caring never stops for the family or the individual, so it shouldn’t stop for the institution.

Morning Headlines 5/15/19

May 14, 2019 Headlines No Comments

Cerner to Work With DrFirst to Connect to State Prescription Drug Monitoring Programs

Cerner will connect its systems to state prescription drug monitoring program databases using DrFirst.

Erlanger working with tech companies to launch new era of artificial intelligence to identify, treat strokes

Erlanger Health System (TN) works with AI-focused health IT startups Viz.ai and Neural Analytics to develop and pilot software and apps capable of detecting blood clots in the brain.

Seattle Children’s spin-out MDMetrix raises $3M to unlock data from medical records

Seattle Children’s Hospital analytics and data visualization spin-off MDMetrix raises $3 million.

News 5/15/19

May 14, 2019 News 8 Comments

Top News

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AliveCor extends its ECG lead (no pun intended) over Apple with KardiaMobile 6L, which offers a six-lead ECG and expanded detection of arrhythmias including atrial fibrillation, bradycardia, and tachycardia.

The $150 consumer device has earned FDA clearance, works on both Apple and Android devices, and will reach the market in June.


Reader Comments

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From Unconjoined Twin: “Re: Medi-Span. Hit by malware. We can’t do our monthly medical loads to Epic.” Verified, although I missed this when it first came up a week ago. Netherlands-based Wolters Kluwer released a statement Monday saying that it has restored most systems – which include CCH cloud-based tax systems and other applications in addition to healthcare — after it took them offline after discovering “the installation of malware.” Discussion on Reddit says the company’s website was down, along with its Internet access, email, and phones, with one person indicating that two of their employees received emails from a Wolters Kluwer email address that contained malicious links. A Krebs on Security report says file directories that are used to store new versions of its software were found to be writable by anonymous users, at least one of whom apparently uploaded suspicious files.


HIStalk Announcements and Requests

I’m increasingly annoyed by big health systems that suddenly claim they’re passionate about empathy, post-discharge care coordination, patient engagement, innovation, social determinants of health, and patient experience. Why now? They could have done those things at any time and didn’t. They were fat and happy until threatened by disruption and possible payment changes that threaten their massive bottom lines, so now they are suddenly the self-proclaimed experts and advocates. At least they are providing a good reminder that health systems do only what someone pays them to do, which isn’t necessarily the right thing. Maybe we need a tech innovation that dispenses dollar bills every time a doctor washes their hands or doesn’t prescribe an unnecessary antibiotic.


Webinars

May 21 (Tuesday) 2:00 ET. “Cloud-Based Data Management: Solving Healthcare’s Provider Data Challenge.” Sponsor: Information Builders. Presenters: Jeremy Kahle, manager of planning and business development, St. Luke’s University Health Network; Shawn Sutherland, patient and member outcomes, Information Builders; Bill Kotraba, VP of healthcare solutions and strategies, Information Builders. Inaccurate provider data negatively impacts revenue cycle, care coordination, customer experience, and keeping information synchronized across systems and functions. SLUHN will describe how it created a single version of provider data from 17 sources, followed by a demonstration of how that data can be used in reports and geospatial analysis. Learn how Omni-HealthData Provider Master Edition provides rapid ROI in overcoming healthcare organization provider data issues.

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

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


Acquisitions, Funding, Business, and Stock

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Business Insider looks at startup Sempre Health, which texts patients to offer them cash savings if they fill their new prescription quickly. The discounts are funded by drug companies as an alternative to drug coupon programs. Co-founder and CEO Anurati Mathur was a data scientist at Propeller Health and before that at Practice Fusion.


People

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Greenway Health hires Geeta Nayyar, MD, MBA (Femwell Group Health) as chief medical officer, where she will help guide development of the company’s next-generation, cloud-based EHR/PM known as Project Polaris, which the company says will incorporate the best features of  Intergy, Prime Suite, and SuccessEHS.


Announcements and Implementations

Collective Medical enhances its platform to enhance collaboration among physical and behavioral providers by adding a consent feature that complies with CFR 42 Part 2. The combined efforts of a physician group and community providers in using the system reduced 911 calls by 44%, EMS transport by 47%, ED visits by 36%, and hospital admissions by 42%.

Cerner will connect its systems to state prescription drug monitoring program databases using DrFirst.

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Definitive Healthcare adds prescription drug claims to its all-payer commercial claims platform, allowing users to analyze prescribing patterns, diagnoses, procedures, and referrals.

Storage array vendor Infinidat, whose systems use disk-based storage with memory caching, creates a software-defined flash array called Epic Compatibility Mode that it hopes will allow it to earn Epic certification since Epic does not allow disk-based storage for performance reasons.

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Relatient announces GA of an electronic registration and check-in solution that expands its Digital Front Door strategy and patient engagement platform.

Appriss Health announces a dynamic patient matching solution for its prescription drug monitoring program connectivity system.

CHIME and Sheba Medical Center at Tel Hashomer – Israel’s largest hospital – will create a health innovation lab within the hospital’s innovation center.


Government and Politics

A medical laboratory sales rep receives a 50-month prison sentence for Medicare fraud after he used a sham non-profit group to convince seniors living in low-income housing to submit to genetic testing. He recruited two healthcare providers via Craigslist to provide phony documentation, netting the three co-conspirators $100,000 in commissions from two clinical labs.


Other

A doctor who followed the suggestion of a conference speaker on social media to Google herself is shocked to find 100 negative reviews and comments that had been left on Vitals, Healthgrades, and Google, with none of the reviewers being actual patients but rather anti-vaccine activists who targeted her because of a social media comment she made in support of a colleague who was undergoing vaccine-related cyberbullying. None of the three sites removed the ratings until she got her lawyer involved. I notice that Healthgrades has removed the fake reviews, but the nut jobs have now just thumbs-downed them, while WebMD still has nearly all one-star reviews. A pediatric practice that posted a video recommending the HPV vaccine had its webpage as well as outside ratings websites flooded with 10,000 negative reviews and comments, while the Facebook of an internist who simply mentioned that his office had received its flu vaccine shipment was bombarded with hundreds of comments accusing him of poisoning children. We live in a shaky society when people can muster up so much ignorance and anger over a flu shot.

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Well said. It’s not the job of a business to tell customers how to reconfigure their lives for the convenience of the business. The “problem” isn’t that of patients.

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The Department of Defense profiles eight senior Army nurses who worked together early in their careers at William Beaumont Army Medical Center. Among them is WBAMC CIO/CMIO Lt. Col. Rich Clark (fourth from left in the photo above), who says, “Even though I work in IT, being a nurse helps bridge the gap between the physicians and IT. We look at IT from a clinical perspective now, to support the clinicians. I love coming to work every day, no day is ever the same. For us it feels like yesterday that we were in the operating room and medical ward. It’s not just the camaraderie, but it’s the mission, too. We’re taking care of America’s sons and daughters. It’s not about the money, it’s about the role and the impact that you can make.”


Sponsor Updates

  • AdvancedMD will exhibit at the America Psychiatric Association event May 18-22 in San Francisco.
  • Arcadia CMO Rich Parker, MD will speak at the New England HIMSS Conference May 16 in Foxborough, MA.
  • Artifact Health will exhibit at ACDIS 2019 May 20-23 in Orlando.
  • Avaya will exhibit at the E-Health Conference & Tradeshow May 26-29 in Toronto.
  • Dan Mendelson joins the board of Audacious Inquiry.
  • Datica CEO Travis Good, MD will speak at HITRUST 2019 May 21-23 in Grapevine, TX.
  • CompuGroup Medical will exhibit at the McKesson Sales Meeting May 15-16 in Las Vegas.
  • Impact Advisors VP John Stanley is named as one of Consulting magazine’s top 25 consultants.
  • Collective Medical updates software functionality to include a new consent feature to support better care collaboration between mental and physical health providers.
  • A UCONN computer science and engineering team sponsored by Diameter Health prototypes a new clinical user interface at UCONN’s Senior Design Presentation Day.
  • Cumberland Consulting Group will exhibit at the Medicaid and Government Pricing Congress May 20-22 in Orlando.

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Reader Comments

  • Nick: Sadly yet another gap in medical education failing to prepare our future generation of doctors imho The scribe labor fo...
  • RevenueCycleRambo: I have good insurance and significant personal cash reserves. However, my main reason for avoiding hospitals that sue pe...
  • Brian Too: "If it is true that there is no cost too high for life saving healthcare ..." It isn't true though. We say things li...
  • Associate CIO: I believe they will be keeping HealtheIntent in similar fashion to what Geisinger is doing (Epic EMR/Cerner HealtheInten...
  • Chilly Illy: Will Advocate remain a showcase install for HealtheIntent or are they pulling the plug on that too?...
  • Mr. Natural: Only 25%? I thought the waste attributed to Administrative Overhead was found to be way larger in other studies? ...
  • richie: The aligned analogy may be "Factory authorized maintenance" (service) as "water" is an object. As if sizzle (stories) is...
  • Adnan Jamil: Hi, I am working as a virtual scribe with one of the vendors of Augmedix for the past 3 years and would like to throw...
  • ttrsld: It's not that relevant to the situation at hand and sort of wrong. You can say the same things about clean water for exa...
  • Employee341541432: Right, it is pushing you to eat at the company cafeteria, not giving you money for the best steak in town....

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