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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.


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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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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.

Blog Posts


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Morning Headlines 5/14/19

May 13, 2019 Headlines No Comments

AliveCor’s FDA-cleared 6-lead ECG aims to detect more than the Apple Watch

AliveCor gains FDA clearance for a new ECG device that, when it debuts in June, will be the first consumer-grade product to monitor heart activity on six different leads. 

MiraMed and Medac Join to Create Leading Revenue Cycle Management Platform in Anesthesia Market

Business process outsourcing company MiraMed merges its Anesthesia Business Consultants subsidiary with anesthesia practice management and billing vendor Medac.

Dr. Geeta Nayyar to bridge medicine, business, and health information technology as chief medical officer for Greenway Health

Greenway Health names Geeta Nayyar, MD (Femwell Group Health) CMO.

Curbside Consult with Dr. Jayne 5/13/19

May 13, 2019 Dr. Jayne 4 Comments

We as CMIOs are often called upon to try to use data, information, and knowledge to try to solve complex problems that are caused by specific factors within the US healthcare system. They might be tied to low health literacy, funding barriers, or the high cost of care. I’ve worked with people to try to strategize around school-based health centers, community outreach programs, healthcare for the homeless, and more.

Since I often see situations where health insurance coverage (or lack of coverage) becomes part of the care equation, I was interested to see this piece in the Journal of the American Medical Association. It asks the question: “Does Employment-Based Insurance Make the US Medical Care System Unfair and Inefficient?”

On the surface, it seems like the answer to the question is yes. I often see people trapped in jobs they don’t like or aren’t suited for because they are afraid of losing their insurance coverage. I see people staying in dysfunctional marriages or domestic partnerships because of the insurance issue. Insurance in general adds inefficiencies to our practice, as we have to hire a fleet of people to handle claims creation, management, denials, appeals, and other billing functions. The complexity of insurance rules and differences in coverage are significant and it’s nearly impossible for the average clinician to try to make sense of it without significant assistance.

The coverage offered by employers can differ in striking ways. I was privileged to grow up in a family that had excellent coverage that was tied to my father’s membership in a union, insurance that was independent of the contractor for whom he worked and which could be continued in the event of a job loss through credits that workers could bank over time. I didn’t realize until medical school how amazing it was that my parents still had a $5 co-pay and that they didn’t need a referral to go see a specialist. (Of course that was in the bad old days when you were kicked off your insurance when you finished college, so I didn’t think the coverage was that great when I had to pay out-of-pocket to have my wisdom teeth extracted after they caused issues during my first semester.)

This was during the time when HMOs were growing in the US and many patients were having to get used to the ideas of working through a primary care gatekeeper and of being restricted to certain groups of physicians or particular hospitals. Now that we’ve seen that approach wax and wane and morph into what we’re working with now in the realm of value-based care, people are still complaining about their insurance. Employers may limit the plans available to employees due to cost. Changes in coverage can lead to frequent switching of physicians that can cause fragmented care for patients with chronic conditions.

Having heard about those factors over the years, I was interested to see an academic’s impression of the situation. The author notes that in the US, “the interests of high-income individuals dominate decisions about what medical care is offered and how it is financed. The result is a less efficient and less equitable medical care system than in other high-income countries.” He offers a review of the history of employer-based insurance, which initially started as a benefit to recruit employees during World War II. Other factors fueled its growth, including group insurance and tax advantages for employer contributions to the cost of coverage.

Employer-based coverage is cited as a contributor to rising costs when it includes wide networks, fee-for-service payments, and self-referral to specialists. The author notes other cost factors, including a focus on specialty / subspecialty care, high-cost technologies, relatively low hospital occupancy rates, and better hospital amenities, including space and privacy. He goes on to note that higher-income patients might be likely to pay for those amenities, but that “many low- and middle-income households would be better off if medical care was less costly and they had more money for other public and private goods and services.” He likens the high-cost product of the US medical system compared to other high-income countries as the difference between Whole Foods and Walmart.

He agrees with rank-and-file physicians about the high cost of administering the US system and its “mix of employment-based insurance, other private insurance, numerous government programs, including Medicaid and Medicare, each with its own eligibility rules and payment schemes and out-of-pocket payments.” Because of that hodgepodge, it’s impossible to understand the true cost of care, either to the patient or to the overall healthcare system, because of financing across patients, employers, and government entities. Ultimately in the US, patients bear the cost as employers lower wages to cover insurance premium payments and as the federal government collects money for Medicare through payroll taxes.

He notes that the US could save a significant amount of money if administration were simpler or if the healthcare “products” offered could be tailored to create a lower-cost alternative. However, government regulations would need to change for this to occur. He concludes that additional exploration is needed, although it appears that the way our system is financed causes inefficiencies and unfairness.

Trying to move from this hypothetical state to one that actually has an impact on our medical system is a tall order. People aren’t going to be lining up for narrow networks, stripped-down experiences, or a return to general ward care. Hospitals are in a veritable arms race as they compete to put heads in beds by offering in-room services that rival some of the nice hotels I’ve stayed in. However, those services don’t change the rate of handwashing or operative complications regardless of how much they appeal to patients.

We’re also addicted to technology and that raises costs. I was working with a medical student last week who trained in China. He’s seeking residency training in the US and was asking for strategies and feedback to improve his chances of being offered a training slot. We had an extensive discussion about physical diagnosis skills and how in the US we often jump to technology rather than using our ears and eyes and brains when we order CT scans and echocardiograms. I suggested that his ability to manage complex patients in a low-tech environment might be appealing to residency training programs given the alignment of those skills with what is desired in value-based care. It’s not going to change the fact that patients want an MRI, CT, X-ray, or lab test because they trust it more than physician skill, but it creates interesting food for thought.

The JAMA piece only had one comment. I would be interested to hear what readers think about the role of employer-based insurance in our complex healthcare system. Is it a blessing or a curse? Leave a comment or email me.

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Email Dr. Jayne.

Morning Headlines 5/13/19

May 12, 2019 Headlines No Comments

Patient health information needs to be readily accessible

David Brailer, MD, PhD – the country’s first National Coordinator – urges support for HHS’s proposed interoperability rules.

$6 million billing loss leads to another internal investigation in Escambia County EMS

Escambia County, Florida launches an investigation into its emergency medical services to figure out who authorized the purchase of billing software from ESO Solutions, glitches from which forced the county to write off $6 million before it was turned off for good.

Littlejohn to take majority stake in Outcome Health

Private investment firm Littlejohn acquires a majority stake in point-of-care patient education and marketing company Outcome Health, which is continuing to recover after investor lawsuits, layoffs, and media scrutiny over its sales tactics.

After burning through $1 billion, Jawbone’s Hosain Rahman has raised $65 million more

Failed wearables company Jawbone rises from the ashes as Jawbone Health with a $65 million investment that will propel its subscription-based, clinical-grade wearables offering.

Monday Morning Update 5/13/19

May 12, 2019 News 3 Comments

Top News

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David Brailer, MD, PhD – the country’s first National Coordinator going back to 2004 – urges support for HHS’s proposed interoperability rules. He says that $35 billion worth of incentive payments have made EHRs almost universal, but those systems “have failed miserably in bringing information to patients and consumers.”

Brailer notes that the federal government failed to make sure those EHRs could share information. He thinks it should have defined patient information as belonging to “the people whose bodies it comes from.”

Brailer concludes, “These rules, if implemented as proposed, will transform the experience of consumers. We will finally be able to gather all of our health information in one place and make sense of it. If we want to switch physicians, hospitals, or health plans, our data will move with us and we won’t have to fear retaliation. When we arrive at an emergency room, our information will be there. We will be able to use our personal information to pick the physician or health system that matches our needs. We can discover what new genetic therapies or advanced clinical trials might hold unique promise for us. These proposed rules are fundamentally necessary if we want to improve our health.”

It’s no surprise, Brailer says, that technology vendors, hospitals, and physician associations that “make a fortune off of the current system” are opposed to the proposed changes, which would “make it easy for hospitals to switch technology vendors.”

Brailer is chairman of Health Evolution, which is apparently the conference-running remnant of Brailer’s investment-focused private equity firm Health Evolution Partners, which  lost its sole limited partner (California’s CalPERS) in 2014 after poor returns.


Reader Comments

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From Creaky Joints: “Re: Greenway Health SuccessEHS. I’m hearing that it will be end-of-life in September 2019. Can you confirm?” Greenway Health predecessor Vitera acquired Birmingham-based SuccessEHS in 2013. Its EHR/PM is targeted to community health centers and FQHCs. The company provided this response to my inquiry:

All of us at Greenway Health are committed to the success of our customers and we understand the leading role our support, software, and services play in that success. This week, after extensive analysis of our SuccessEHS platform, we informed customers that we will move up the platform’s end-of-life date and partner with them to transition to our flagship platform, Intergy. (Intergy, which recently was named 2019 Best in KLAS “Most Improved Physician Practice Product,” will evolve into our next-generation platform.) This was not an easy decision to make, but we did so with our customers’ best interest in mind.

The dates customers need to migrate will depend on their reporting needs. All SuccessEHS customers who plan to participate in incentive programs for the 2019 reporting period must migrate to Intergy no later than September 30, 2019. This will allow them to be on Intergy for a 90-day period to meet the reporting requirements. SuccessEHS customers who do not plan to participate in a government incentive program will have until December 31, 2019, to migrate to Intergy.

From AHitDuke: “Re: non-poach agreements. How many have them? Allscripts, Cerner, Epic, and NextGen seem to.” I assume you mean between customer and vendor since vendors agreeing not to hire each other’s employees is illegal unless the organizations have a documented business collaboration. I’ve seen at least a couple of contracts in which customers agree not to hire their vendor’s employees and vice versa. The vendor may also prevent customers from hiring their employees without permission via their employment agreements.


HIStalk Announcements and Requests

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Two-thirds of poll respondents would not be thrilled if their vendor announced a new focus on boosting profits, while one-third wouldn’t care unless any changes affected them negatively. Smartfood99 wonders how anyone could see it as positive (and indeed, few respondents did), while Les V. Fewer says publicly traded and VC-backed vendors will always get to that point and providers might as well assume that to be the eventual case and execute their selecting and contracting accordingly.

New poll to your right or here: What is the #1 driver of HHS’s new interoperability push? This question was precipitated by “The Big Fib” Readers Write article that was polarizing (although it has 43 likes and just five dislikes). Feel free to click the poll’s “comments” link after voting to explain your choice, to complain that I didn’t include an obvious option, or to argue about the very nature of polling that by definition precludes the intellectually lazy “all of the above” option.

Listening: new from Andrew Bird, an indie singer-songwriter and trained, degreed violinist (which he sometimes plays like a guitar on stage) who used to be in the Squirrel Nut Zippers. I was streaming a Spotify indie station on Sonos and a track that caught my ear turned out to be his. The same thing happened again an hour later. His music is smart, introspective, and occasionally soaring and he always surrounds himself with fine backing band members. Play “Manifest” around other people and I’ll wager they’ll ask you what they’re hearing. I’m also streaming the Mermen Pandora station (which includes bands like the Blue Stingrays and the witty, mask-wearing Los Straitjackets) because I just realized I haven’t listened to surf rock in a long time and I really like it, especially the trippy, minor-chords, tremolo arm-bending variety. 

I’m in a constant, low-level state of frustration with Gmail’s Select All, Delete All function for trashing everything in the Promotions tab, which never works. Some Google engineer kludged a macro-like function that you can watch executing as the screens flip by, only to find that when it has finished its ugly work, most of the messages remain. I can repeat this process several times and still not empty that tab. I use Gmail on the IPhone as well and it’s often squirrely in showing messages that I deleted long ago on the web version – at this moment I’ve pruned my inbox to just nine messages, but the IPhone version still shows hundreds of long-deleted ones. I still argue that Yahoo Mail is the best email client I’ve used, especially since I’m not a fan of Outlook or Apple Mail.


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

A fascinating Axios article looks at how entrenched conglomerates squelch competition from startups:

  • Walmart, Amazon, and Apple buy competitors who threaten their market share. It notes that Apple has acquired 20-25 companies in the past six months alone.
  • Razor companies Schick and Gillette, which control 90% of the US market, use their patent portfolios to file lawsuits that take years to expensively resolve.
  • The razor companies also buy startups, which Schick buying upstart Harry’s this week for $1.37 billion and Unilever acquiring Dollar Shave for $1 billion.
  • Direct-to-consumer companies give their acquirer growth and a wealth of customer data.
  • The disruptors aren’t always absorbed into oblivion – the razor startups have retained their management, gained the resources need to scale, and at least in Dollar Shave’s case, haven’t raised prices.

People

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SailPoint Technologies promotes Cam McMartin to COO.


Other

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Norway’s new public health minister Sylvi Listhaug says in an interview that “people should be allowed to smoke, drink, and eat as much red meat as they like. The government may provide information, but I think people in general know what is healthy and what is not.” She is a smoker who doesn’t want the country’s anti-smoking laws made more stringent, explaining, “Are they going to have to to into the woods or up on a mountaintop or down to the docks just to take a drag?” She was previously Minister of Agriculture, Minister of Immigration, Minister of Justice, and now Minister for the Elderly and Public Health. These comments came in an interview where she is pictured with a cigarette in one hand and a Pepsi in the other. She’s actually more rational in the full interview than the snippets suggest, explaining that smoking is harmful but that’s no reason to make smokers feel stupid, instead advocating programs that discourage young people from smoking. She also argues that it’s not the government’s job to tell people how to lead their lives.

Escambia County, Florida launches an investigation into its emergency medical services to figure out who authorized the purchase of billing software whose glitches forced the county to write off $6 million before it was turned off for good. The contract was was split into three parts to keep it below the threshold that requires county commission approval. One commissioner said, “This $49,999 deal is going to stop, period. We already sit here all day long, so we might as well approve every purchase order.” The software is from Des Moines-based ESO Solutions.

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The Minneapolis paper observes that most of the 1.4 million people who have received breach notice letters from Puerto Rico-based claims clearinghouse Inmediata have never heard of the company and are questioning how it obtained their medical information in the first place, raising the interest of the Minnesota’s attorney general. The letters don’t explain the company’s business and don’t include the names of the recipient’s provider.


Sponsor Updates

  • Meditech will exhibit at the 2019 IHI Patient Safety Congress May 15-17 in Houston.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the HIMSS New England Spring Conference May 16 in Foxborough, MA.
  • Relatient will exhibit at the Cleveland Clinic Patient Experience May 13-15 in Cleveland.
  • The SSI Group will exhibit at the Cerner CommunityWorks Summit May 14-16 in Kansas City, MO.
  • TriNetX will present at ISPOR 2019 May 18-22 in New Orleans.
  • Nordic launches a video series titled “Consultants in Conference Rooms Getting Coffee.”
  • Voalte will exhibit at the Mississippi HIMSS Spring Conference May 16 in Ridgeland.
  • Vocera CFO Justin Spencer will present at the Bank of America Merrill Lynch Healthcare Conference May 15 in Las Vegas.
  • Huron elects Ekta Singh-Bushell to its boards.

Blog Posts


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Weekender 5/10/19

May 10, 2019 Weekender No Comments

weekender 


Weekly News Recap

  • DocuTAP and Practice Velocity merge
  • Harris Healthcare acquires Uniphy Health
  • The Chartis Group changes private equity owners
  • The Practice Fusion unit of Allscripts is served a criminal grand jury subpoena related to EHR certification and anti-kickback statute issues
  • Astria Health blames its EHR conversion and contracted RCM vendor for its Chapter 11 bankruptcy
  • HHS asks people to share their stories about obtaining copies of their health records or the sharing of them among providers
  • Grahame Grieve is named the winner of the 2019 Glaser Award

Best Reader Comments

If you can’t down load your record, it isn’t due to a lack of regulation. You need to change doctors if they don’t offer it. (A)

Evidence is scant as to all the innovation and data sharing actually reducing the cost of healthcare. CMS and ONC need to face this fact and stop hyping every supposed innovation that comes down the street. (Bill Spooner)

Our industry’s lack of transparency in costs to the patient is inexcusable. It should be a simple question to ask a doctor’s office “how much will this cost me?” Our industry’s answer: It depends on how many topics you bring up and their associated medical complexity, whether the doc prescribes a medication, what associated tests he runs, what unrelated services he adds on (in your and his mutual best interests, of course), and how much time he decides to spend documenting. It also depends on your insurance policy (which neither one of us is knowledgeable about), so it may be fully covered, may just be a co-pay, perhaps co-insurance, or perhaps you will have to pay the full adjusted amount because of your unmet deductible. And there is an off chance that you will be forced to pay the full amount billed if our provider is not on your insurance because he decided that he gets paid more by not contracting. So, in short, today’s visit will be anywhere between $0 and $500 (and we won’t know the final answer until 45 days from now). And, because of this discussion, we just wasted the first 10 minutes of your 15 scheduled minutes with the physician. It’s insanity. (It’s Insanity)

The reality is that a majority of sales professionals aren’t very good at their jobs. If sales professionals are truly making a “cold call,” that means they’re going down a contact list name by name without doing research. I have a tremendous amount of success by calling hospital executives (CEOs, COOs, CNOs), but it takes a considerable amount of planning work. If you’re shooting from the hip and hoping to get lucky, you are making the rest of us look bad. Look at LinkedIn profiles sales professional in HIT space — typically 1.5 to three- year stints. One or two of these short stints over a long career can be explained (acquisition, RIF, etc.), but if it is a pattern, then it’s an obvious tell that they aren’t good at selling. The HIT sales community is super washed up. Lots of old vets who aren’t working too hard. Also many frat bro types who show up to conferences with suit pants altered to show socks and expect to be taken seriously by mostly old hospital execs. (Desperado)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. B in Texas, who asked for headphones for her sixth grade class. She reports, “It has made a huge difference. It has helped them gain independence as they are working. We have used them in many ways already! For example, the students were collecting information on South Asia and the headphones enabled them to listen to videos about specific events and people. They were able to take notes and work at their own pace. Another way the headphones have been used is to help students that need to listen to test questions. They can take a test at their own pace and rewind to hear the questions again. They enjoy being independent. We are the only class in the school that has a class set, so other teachers borrow them when we are not using them or if we have extras. Your donation is helping HUNDREDS of students!”

A former technical support contractor pleads guilty to taking down Oregon’s Medicaid management system in 2016 in retaliation for being laid off by Hewlett Packard Enterprise.

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Mount Sinai Healthcare System (NY) launches a sports bar-themed prostate education and treatment center in partnership with Man Cave Health, with the waiting room featuring leather couches, ESPN running on a 70-inch TV, framed local sports memorabilia, and a device charging station that looks like a bar. The non-profit Man Cave Health offers a toll-free appointment booking line and says that while it hopes to roll out sports-themed rooms in all NFL cities, it will consider other concepts. I can say that given my lack of interest in sports (actually more like disdain) that I would prefer sitting in a traditional waiting room, although I used to get my hair cut at one of those sports-themed chain barber shops (because they offered free draft beer, snacks, and big leather chairs while waiting) in which the ladies who performed your services while wearing referee shirts were obviously chosen using criteria mostly unrelated to their tonsorial talents.

Massachusetts General Hospital pays $5.1 million to settle a malpractice lawsuit with former Boston Red Sox pitcher Bobby Jenks, whose blames his career-ending surgical complications on his surgeon, who he claimed was overseeing another surgery simultaneously. MGH says the surgeon performed the complete surgery, but Jenks failed to follow discharge instructions because he didn’t call immediately to report his complications.

Hospitals struggle to treat John Doe patients who are unable to identify themselves, many of them pedestrians and cyclists who aren’t carrying ID when they are hit by a car. Fingerprints can’t be used unless it’s a criminal matter. The health IT aspects include use of a system that generates a “trauma alias” fake name and the negative impact of HIPAA, where anyone calling to inquire about a missing friend or relative cannot be given information that would help identify a patient as one they know.

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A Texas state representative launches a Twitter attack on Baylor professor, pediatrician, and vaccine expert Peter Hotez, MD, PhD, declaring his work with vaccines to be “sorcery,” accusing him of practicing “self-enriching science,” and being a “typical leftist trying to take credit for something only The Lord God Almighty is in control of.” I checked the background of Rep. Jonathan Stickland, a 35-year-old Republican from Plano (above) — he quit high school but later obtained a GED, studied sales in community college, and worked as a pest control technician. He has previously opined that “rape is non-existent in marriage,” called an online critic “a bratwurst-loving homo,” and declared that “healthcare is not a right.”

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A hospital in South Africa brings a lion into the facility (via the back door, to avoid scaring patients) to receive the first of four radiation treatments for cancer.


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Morning Headlines 5/10/19

May 9, 2019 Headlines No Comments

Novant Health launches digital health and engagement business division

Novant Health (NC) forms a digital health and engagement division to enhance its ability to virtually connect with patients from anywhere at any time.

LetsGetChecked Announces $30 Million in Series B Financing

Home health testing and companion app company LetsGetChecked raises $30 million in a Series B round led by LTP.

DocuTAP and Practice Velocity Merge to Form Experity, Establishing a New Market Leader in Urgent Care and On-Demand Healthcare

Practice Velocity and DocuTap name Practice Velocity CEO David Stern head of their newly combined company, Experity.

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Reader Comments

  • Scot Silverstein MD: I can say, unfortunately, with an exceptional degree of confidence that patients are harmed by events such as we describ...
  • Clinton Phillips: Thank you Dr. Jayne for the Veterans Operation 11/11 shout out. Medici is excited to see how many veterans we can help a...
  • @henryjones: Again what evidence do you have here that you "know that Epic demands more redactions and secrecy than other EHR vendor"...
  • Mr. HIStalk: Vikas Chowdhry gets all the credit for interviewing Dr. Bhavan. He volunteered to conduct interviews, of which this is h...
  • Expressyourself: I think the sensor part is referring to sending when you open or are in a patient's chart. Then they probably use that t...
  • Matt Ethington: This is inspiring and has so much more potential for healthcare. So many new reimbursements focus on patient engagement...
  • Eddy T. Head: "Patented sensor-based software technology in use at health systems and practices delivers actionable patient data to pr...
  • Code Jockey: Mr. HIS - you, once again, do this world a great service. For me personally I'll say thanks for posting to a document th...
  • Vaporware?: re: Queensland's Cerner project * Delayed ... check * Over budget ... check * "Not fit for purpose" ... check * Buye...
  • E!: Agreed. Epic is just generally anti-worker with their regular labor violations, over aggressive non-compete, etc....

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