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HIStalk Interviews Jeremy Pierotti, CEO, Datica

September 16, 2019 Interviews 2 Comments

Jeremy Pierotti is co-founder and CEO of Datica of Minneapolis, MN.


Tell me about yourself and the company.

I’ve been working in healthcare IT for about 20 years. I started off working at Allina Health in Minneapolis and ended up doing consulting. Then I co-founded Sansoro Health. Sansoro and Datica merged in June 2019, with the go-forward company name being Datica. We help healthcare move to the cloud by addressing compliance and data integration challenges.

What can the merged companies do more effectively than they could have done as separate organizations?

We knew that healthcare is moving to the cloud at an accelerating pace. As Travis Good and I started talking, we recognized that we had a complementary set of products, technologies, and team talent, and that if we put the companies together, we could help digital health engineering teams address the two challenges that they have to solve. Those are cloud compliance — which increasingly means meeting the HITRUST CSF requirements — and data integration, being able to exchange data bi-directionally between lots of different digital health applications. Electronic health records, but also all the different supporting systems that every health system runs.

How far along is healthcare in its seemingly inevitable move to the cloud?

It is toward the beginning of its journey, and it’s going to move fairly quickly. We’ve read lots of reports that show anywhere from 10 to 20% CAGR growth over the next five to seven years, and we’re experiencing that ourselves.

Like every other industry, healthcare is recognizing that what the cloud brings is not just running your software on somebody else’s computer in a data center that they manage, but providing access to a whole new set of tools for data analytics, supporting mobility, and integrating lots of types of data from lots of sources. You just can’t develop software with those features using an on-premise architecture. You are increasingly seeing large companies develop their new applications on a public cloud framework because it gives them the flexibility and the power of the toolset to leverage the capabilities of engineers and development teams all across the world.

How does the work of Cerner, Epic, and Meditech fit into a strategy of making their data available for use by cloud-based services?

They are moving deliberately and cautiously, understanding that they can’t make dramatic changes overnight. Their customers are big, complicated provider organizations for whom stability is enormously important. They are all looking for the right balance of making new capabilities available and taking advantage of cloud functionality that will give customers the features that they want, while at the same time, keeping their core systems stable. That means something a little bit different to each of those vendors, but they are all trying to find and strike that balance.

Would a move to the cloud change the exclusive relationship between a health system and their primary EHR vendor?

In the short term, I don’t think it changes anything significantly. I certainly don’t think it makes it more exclusive. In the long term, I think it makes it less exclusive.

I was listening to a podcast from Andreessen Horowitz, where Mark Andreessen was talking about how in Silicon Valley, you have this rich ecosystem of API-driven data exchange and whole companies that have been developed just to facilitate the development and management of APIs within industries. What we see in other industries will come to healthcare, too. When you have increasing adoption of cloud-based application development, you end up stitching those pieces together with API-driven data exchange. We’re seeing that same thing in healthcare as you look at the emergence of FHIR and other API toolsets for patient data exchange.

A move to the cloud by Cerner, for example, is not going to tie the hands of Cerner’s clients and make them any more dependent on Cerner. It is just part of the the slow, steady move toward health systems being able to choose from a variety of tools and integrate the tools that work for them best.

What is creating the demand for cloud-based services?

My colleague and our chief medical officer, Dave Levin — who used to be CMIO of at the Cleveland Clinic – says he spends all day working in healthcare and then he goes home to the 21st century. The reality is that it’s consumers. It’s our everyday experience with smart phones, tablets, and advanced software that we run on whatever device we choose and that allows us to move from one device to another almost seamlessly.

Those experiences that we who work in healthcare have every day in every other part of our lives make us realize that we need that same type of functionality when we’re delivering healthcare services to patients. When we’re managing populations of patients or health plan members, we need those same capabilities, those same toolsets.

To take the simplest of examples, there’s no reason that if I’ve been to the same doctor’s office six times in the last year, that I should have to fill out the same piece of paper on the same clipboard the seventh time. When when I walk into all sorts of other businesses, they know who I am. They have read my license plate or I’ve agreed to have my smartphone notify them when I walk in, so they know from the beacon  at the front door that I’ve arrived and they’re ready for me. It’s those kinds of experiences — the scalability, the mobility — that is driving healthcare organizations to create software with those same capabilities.

Will it be hard for healthcare IT vendors to move their systems to the cloud?

Vendors are looking to do that module by module. I don’t have deep insight into the Cerner-AWS announcement that came last month, but the way I understand it, Cerner is not saying that all of a sudden they’re going to move all of their clients who use Cerner Millennium onto AWS servers or AWS services. But they will be increasingly developing new software capabilities on the public cloud. On AWS specifically, for Cerner.

Going back to what I said earlier about the need for stability and reliability by providers and payers, but especially providers, our expectation is that you’ll see vendors developing their new software, their new modules, in the public cloud, taking advantage of those capabilities. They will work deliberately over time to figure out what makes sense in terms of potentially migrating their legacy products to a cloud infrastructure. I’m not sure I have any unique or special insight into that, but that’s the trend I’m seeing, health IT companies developing their new stuff in the cloud and migrating their customers who want those new features to that new platform.

Health IT vendors seem obligated to name-drop AI and analytics in their cloud announcements. What kind of learning curve will they and their cloud services vendor encounter as they modernize healthcare applications?

I wish I knew the answer to that. There clearly are some tremendously exciting applications of artificial intelligence and machine learning in healthcare. I’ve also read many pieces recently about the need to approach it carefully. Any time you’re going to train a machine to learn something, you need to make sure that you’re training it in the right way, otherwise you can create more problems than you’re solving.

But the cloud is a big part of that, because there are so many AI and ML services that are available through a public cloud infrastructure. AWS announced Comprehend, their natural language processing service, a couple of years ago. It allows users to train it and it comes at a competitive price point. That’s an example of how cloud service providers and application developers in AI and NL are looking to leverage the cloud — making those services available, allowing lots and lots and lots of engineers and creators to experiment with those services, test them, and determine what can have a real, positive impact on patient outcomes.

Big provider organizations are announcing their own cloud partnerships, such as Mayo Clinic and Google Cloud. How will those organizations work directly with cloud providers?

It speaks to the amount of data that providers are accumulating. They need to find ways to support the efficient storage and analysis of that data so that they can learn from it as quickly as possible and apply that to better operations and better patient care. It’s not surprising to me at all and I think we will see more of it. It’s understandable, because in other industries, you have big players, big companies that are on a daily basis using cloud platforms and the analytics capabilities of cloud platforms. To improve their products, to improve their customer service, and to improve their deployment of personnel.

Healthcare has the same needs and the same demands of end users to capture those capabilities without having to invest in standing up a new data center full of physical hosts and a big huge team of devops engineers, DBAs, and others to manage all of that traditional infrastructure. You’ve got all of that data and you need somewhere to quickly and efficiently store it and analyze it.

What impact do you expect to see from the federal government’s implementation of the interoperability and data blocking implications of the 21st Century Cures Act?

We’re waiting just like everybody. Our sense is that when the final rule is released, it will raise the floor, but it won’t necessarily raise the ceiling. We are looking to continue to push the ceiling with innovative solutions for integration.

We recognize that even when ONC and CMS release those new rules, it’s likely to be several years before they’re enforced. It’s going to take the vendors time to develop the technology and capabilities that those rules may require. We’re not waiting. We are working every day with health systems and innovative health IT companies to figure out how they can make the most of the data exchange capabilities that exist today.

The bottom line is that we’re eager to see what comes out. Industry discussion of those rules has been robust and the public itself is highly interested in it. Every person has a personal investment in being able to get access to and make portable their health information. So it’s fascinating, but we recognize that it will be years before anything is actually required and implemented. Our goal is to help our customers, providers, and payers take advantage of what they’re capable of right now.

Is the federal government at risk of oversimplifying the interoperability challenge in declaring mission accomplished just because the use of APIs and FHIR has widened?

As I listened to the debate over the last several months, and certainly after the draft rule was released, I was struck by how thoughtful and mature the discussion was across the board on these rules. There is a broad recognition within health IT that if this were easy, we would have solved it.

I’m not saying that it’s challenging mostly from a technology standpoint. It’s challenging mostly because there are lots of competing interests that have to be resolved, and they’re not necessarily easy to resolve. There are ways to do it, and our company and I personally have our own views on how to address some of those challenges. But it’s been a robust, mature discussion about how we balance the interests of different players, always keeping in mind that the goal here is the delivery of better patient care at lower cost and having better outcomes.

Do you have any final thoughts?

My colleagues and I are excited about the pace of innovation in health IT. If we weren’t, we would go find something else to do, since goodness knows the world has plenty of other problems to solve. I look forward going to work every day because of the opportunity to partner with people who feel emotionally compelled to bring positive change to something that impacts every single person — the delivery of quality healthcare.

Morning Headlines 9/16/19

September 15, 2019 Headlines No Comments

Livongo Reports Second Quarter Financial Results

Livongo says it will lose $40 million on the year after reporting Q2 results: revenue up 156%, adjusted EPS –$0.46 vs. -$0.31.

Varian and Oncora Partner to Accelerate Precision Medicine in Radiation Oncology

Cancer powerhouse Varian will invest an unspecified amount in Philadelphia-based Oncora Medical, which offers precision radiation oncology software.

Tyler & Company Seeks CIO for Penn State Health

Penn State Health system (PA) enlists an executive recruitment firm to help it find a Cerner-savvy SVP/CIO.

Monday Morning Update 9/16/19

September 15, 2019 News 1 Comment

Top News


A report from the American Hospital Association and consulting firm EY says that participatory health, or “healthcare with no address,” is coming. It predicts that health systems will respond to consumers who want on-demand, connected, and data-driven services.

The report says a participatory health framework will require health systems to offer:

  • Health and wellbeing support.
  • A personal health cloud containing the patient’s own data, including biometrics.
  • AI analysis of the data to create new insights and solutions.
  • A demand-driven global marketplace.

The report predicts that physicians will become “data-driven conductors” who will take responsibility for managing the lifestyle and wellness of patients.

The authors observe that while the future is more patient-centric and participative, health systems must move toward value while continuing to earn most of their revenue for volume. They will also have deliver anywhere, anytime care even though they have spent a lot of money on brick-and-mortar locations.

Nontraditional players such as entrepreneurs, retailers, and technology companies are ahead of health systems in offering consumer-oriented health services. Value-based payments favor non-hospital locations such as retail clinics and consumers prefer those anyway, with the next step for those retail locations being to offer chronic care management via telehealth.

Time zone differences also encourage global approaches, such as ICU monitoring virtual second opinions.

The article also calls out successes in which health systems have applied their quality improvement and relationship-building expertise to partner with their communities to address social determinants of health. 

Reader Comments

From Set in Code: “Re: CPT codes. I work in a large Medicaid health plan. CMS requires use of AMA-copyrighted CPT codes. We are now being charged per member for each instance of the CPT code set that is used in any of our systems, meaning that we’re paying AMA multiple times for the same member. It also seems that organizations pay radically different per-member rates. AMA has created a monopoly and I believe that CPT licensing revenue is its largest revenue source, but I would like to see leverage applied to keep the cost reasonable as AMA seems to be offsetting shrinking membership by forcing health plans and providers to make up the gap.” AMA’s most recent tax filings show a profit of $26.4 million (up from $9.4 million last year) on revenue of $317 million, of which only $38 million came from membership dues. Royalties generated $148 million of the “other revenue” total of $191 million. AMA paid its EVP/CEO $2.2 million, its COO $1.2 million, and the former Allscripts executive who heads up the CPT group $900,000. About 80% of US doctors are not AMA members. AMA made $1.5 million in political contributions last year and spent $20 million on lobbying, just in case you want to launch a grassroots effort to get politicians to rein in its CPT fees. Like a lot of member organizations (including HIMSS), the organization’s most significant revenue comes from selling access to members and running businesses that actually compete with the work of some of those members (as I always say, that’s the “ladies drink free” business model). 

From Jonas Sister: “Re: Epic’s employee testing. Some of your readers have spoken, but you haven’t.” My position is that: (a) Epic can use whatever methods it wants to hire employees and it’s nobody else’s business; (b) you can argue theoretically why Epic’s tests shouldn’t be good predictors of job performance, but you can’t argue with the success Epic has had for decades in using those tests virtually unchanged to hire thousands of employees; (c) people who complain about Epic’s tests as being irrelevant or unfair are usually folks who weren’t hired, either by Epic itself or its health system customers who administer the same tests to their own prospective Epic team members; and (d) while we might personally believe that our experience should be valued over test scores, that’s not the case with Epic, who sees greater long-term promise in a blank canvas. Also note that Epic has an endless supply of applicants, the company is an efficient machine in onboarding new hires and either moving them up the ladder or out the door, and its processes are apparently so well laid out that it doesn’t need people who have learned bad habits from crappy health IT companies. I will give more credence to passionate arguments about how Epic’s hiring and retention practices are wrong once I see the company struggling because of them. It hurts to be passed over purely based on the results of a “lions, tigers, and cages” type question or a MUMPS-like programming logic quiz, but the most important logic question is why anyone would expect Epic to ditch practices that made it the industry leader.

HIStalk Announcements and Requests


Two-thirds of the employers of poll respondents have laid people off recently, and of those, about half say that older or sicker employees seemed to have been targeted. Not Exactly says his EHR vendor laid off to hit a payroll dollar target, so that raised the risk for experienced, higher-paid employees. Cosmos says their vendor employer reduces headcount by running long hiring freezes instead of layoffs, but the folks who leave are often younger ones with better options and who don’t need the health insurance instead of those who might be laid off otherwise.

New poll to your right or here: Which factor do you think was most important in being hired by your current employer?


Welcome to new HIStalk Platinum Sponsor Zynx Health. The Los Angeles-based company, which is part of the Hearst Health Network, offers ZynxOrder (evidence-based order sets and clinical decision support rules); ZynxCare (evidence-based plans of care); specialty content packages (home health, pediatrics, skilled nursing, chronic conditions); Knowledge Analyzer (evaluation and optimization of clinical content and processes); and the recently introduced Lumynz (analytics that looks at orders vs. evidence, including the financial impact). Its Vital Interventions has identified high-impact interventions (mortality, cost, length of stay, admissions and readmissions, and hospital-acquired conditions) that align with performance measures and quality and cost objectives. The company just announced new Knowledge Analyzer reporting capability that allows hospitals to map clinical decision support to best outcomes and to prioritize the potentially most impactful interventions. Thanks to Zynx Health for supporting HIStalk. 

I was playing some country music on the Sonos for a visitor who, unlike me, enjoys it. Just about every song featured cartoonishly cowboy-hatted, testosterone-swaggering male singers with questionable Southern accents. I looked up how many of the 20 or so songs that we heard were actually written by the throaty twangers themselves. Answer: zero, although a couple of them shared a songwriting credit with an actual songwriter in what I imagine was a pay-to-play deal to get the tune recorded in the first place. Country and pop were about the same on Billboard’s current top 10 charts – lots of co-writing credits, but no singer actually wrote their hit solo. Conclusion: as in acting, comedy, politics, and maybe most other areas, music stars are usually just reading someone else’s thoughts since they are entirely separate forms of craftsmanship, although (a) those with star power in TV and music can command inflated billing as executive producers or co-writers, respectively; and (b) in music, at least the less-recognizable people who actually create the songs are earning publishing royalties in perpetuity instead of swigging vodka from an onstage water bottle while unenthusiastically shouting “How you doing tonight, Omaha?” from their gig in Kansas City.


September 19 (Thursday) 2:00 ET. “ICD-10-CM 2020 Code Updates.” Sponsor: Intelligent Medical Objects. Presenters: June Bronnert, MSHI, RHIA, director of terminology mapping, IMO; Theresa Rihanek, MHA, RHIA, classification and intervention mapping lead, IMO; and Julie Glasgow, MD, senior clinical terminologist, IMO. The 2020 regulatory release is right around the corner. Join IMO’s top coding professionals and thought leaders as they discuss new, revised, and deleted codes; highlight revisions to ICD-10-CM index and tabular; discuss changes within Official Coding Guidelines; share potential impacts of the code set update; and review ICD-10-CM modifier changes.

September 26 (Thursday) 2 ET. “Patient Education Data: A Key Ingredient for Improving Quality and Patient Experience.” Sponsor: Healthwise. Presenters: Victoria L. Maisonneuve, MSN, RN, director of the Nursing Center for Excellence and Magnet program, Parkview Health; Marta Sylvia, MPH, senior manager of quality improvement and outcomes research, Healthwise. Healthcare data is everywhere! It’s scattered across various systems and in countless formats, making it difficult to collect and glean actionable information. Knowing where to start depends on what your organization wants to accomplish.  By focusing on your patient education data, you can drive quality improvement across your organization. Vicki Maisonneuve will share how her team analyzes data around the use of patient education. By combining different data sets, she can easily identify trends, gaps, and opportunities to improve quality and patient experience across Parkview Health.

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

Acquisitions, Funding, Business, and Stock


I missed this last week. Livongo reports Q2 results: revenue up 156%, adjusted EPS –$0.46 vs. -$0.31. The company says it will lose $40 million on the year. Shares dropped 17% on news of widening losses, with LVGO shares now trading at under $25 versus their first-day offering price of $28 and first-day close of $38.10 on July 25, meaning that someone who spent $10,000 jumping on the IPO now has less than $6,500 worth of shares. The company is valued at $2.4 billion. From the earnings call:

  • The company says it met all of its financial and operational objectives in the quarter, with increased enrollment and 720 clients signed.
  • Livongo touted its increasing total contract value, which it calculates using percentage enrollment assumptions that are applied to company headcount. Contracts runs 1-3 years.
  • The company didn’t directly answer an analyst’s question about how many users drop out, but later said it lost about 2% of users during the year and three-fourths of that was due to employees leaving their companies that provided the platform.
  • Livongo is cross-selling among its products – hypertension, weight management, diabetes management, and behavioral health – but its diabetes offering is generating almost all its revenue so far.


Cancer powerhouse Varian will invest an unspecified amount in Philadelphia-based Oncora Medical, which offers precision radiation oncology software.


  • Thomas Health (WV) outsources its Level 1 help desk to CereCore.
  • England’s East Lancashire Hospitals NHS Trust joins the global health research network of TriNetX for searching patient cohorts, querying study-related data, and adding study visibility to pharmacy and contract research organizations.

Announcements and Implementations

Nordic creates Registry Direct, which offers automated, FHIR-powered abstraction for sending EHR data to the American Heart Association’s Get With The Guidelines online registry.

Government and Politics

An article in Foreign Affairs says that China is following the economic growth script of Germany, France, and Japan in moving up the food chain from manufacturing cheap global goods to creating an innovation powerhouse that is being driven by a world-leading economy and government-led investment in research. It predicts that China will soon end the US’s 70-year run as the world’s leader in science and technology. The authors cite JAMA, which predicts that China will become the world’s leader in drug development in the next five years. The well-credentialed authors recommend that the US government spend more on scientific research, push efforts to translate the results into marketable products and services, and create jobs outside of the usual hub cities like Seattle, San Francisco, and Boston and instead focus on cities where land is cheaper and people can be more productive.  

Privacy and Security


Facebook warns users that new privacy protections are enabled by default in IOS13 and Android 10 that prevent the app from tracking its users in real time, which Facebook insists (without irony) is a problem because users will thus be deprived of valuable services such as location-targeted ads. The new features mimic privacy options that are already available in Facebook, but Facebook knows that few users modify its defaults and in any case will struggle to find the option within its complex privacy settings menu.


The Chicago business paper looks at the highest-paid executives of Lurie Children’s Hospital, including the CEO ($2.2 million) and the CIO ($460,000).

Britain’s health secretary Matt Hancock declares that he won’t let his country’s drug usage “escalate to the level seen in the United States,” following release of a new government report that says 25% of people in Britain are taking meds for pain, anxiety, depression, and insomnia, with half of those being long-term users of at least a year. More than 10% of Britain’s population take antidepressants and nearly that many are taking opioids, with women and people in poorer parts of the country having higher rates. England and Wales have a long way to go to hit US-class opioid death rates, as just 2,200 people there died of opioid overdoses last year vs. 47,600 in the US.


The 33-year-old investor co-founder of Hims – which peddles erection and baldness treatment drugs following an “online assessment” that is reviewed by “our network of doctors” – publicly announces his expectation of being a billionaire “by my mid to late 30s” in a Quora post he later deleted in a late-onset attack of faux humility. If you want to upend US healthcare and save billions of dollars, make all drugs available without a prescription since consumers who want them will get them at any cost regardless.


@DrJenGunter explains why she became a patient advocate in answering the call of Bernie Sanders to describe “the most absurd medical bill you have ever received.”

Sponsor Updates

  • Health Catalyst will exhibit at the 2019 MHA Fall Convention & Trade Show September 18-20 in Billings, MT.
  • Mobile Heartbeat will exhibit at the Chief Nursing Officer Summit September 16-17 in Scottsdale, AZ.
  • Waystar will exhibit at CareVoyant UGM September 18-20 in Schaumburg, IL.
  • Netsmart will exhibit at the Ohio Council for Home Care and Hospice Annual Conference and Tradeshow September 17-18 in Columbus.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the Perinatal Partnership Conference September 22 in Concord, NC.
  • OmniSys will exhibit at the Pennsylvania Pharmacists Association’s Annual Conference September 19-22 in Seven Springs.
  • PatientKeeper will exhibit at AHIMA through September 18 in Chicago.
  • Health Catalyst shares insights from its annual Healthcare Analytics Summit.
  • Wolters Kluwer Health announces efforts to promote Sepsis Awareness Month, including a new blog series and its Sepsis Resource Center.

Blog Posts



Mr. H, Lorre, Jenn, Dr. Jayne.
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Weekender 9/13/19

September 13, 2019 Weekender No Comments


Weekly News Recap

  • Surescripts cuts off prescription data access to Amazon’s PillPack mail order pharmacy.
  • The premier of Queensland, Australia promises to investigate a 14-hospital downtime of several hours that was caused by a Cerner upgrade.
  • Apple announces that it will partner with several high-profile healthcare institutions to conduct studies related to hearing, women’s health, and heart health using its new Research app.
  • Mayo Clinic signs a 10-year partnership with Google in which Google Cloud will provide Mayo with data hosting, cloud computing, analytics, and machine learning and AI.
  • Bayfront Health St. Petersburg (FL) pays $85,000 to settle HHS OCR’s first case under the Right of Access requirement to give patients complete copies of their medical record within 30 days.
  • Hackers breach DDS Safe, a cloud-based records retention and backup solution that is sold to dental practices, and use it to install ransomware on the computers of hundreds of dental practices.

Best Reader Comments

Private equity can jump in the line of who all are screwing the consumer –bloated organizations, vendors charging five times what it would cost out of healthcare, solutions bought not needed, physicians making a fortune off their patients’ problems, and hospital execs stuffing pockets while driving up costs. Next up: pediatric offices charging based on parent fear level. (Overcharged)

I use PillPack and one of the things that appealed to me was that it took five minutes to sign up and they had my insurance information and prescription information without my needing to supply it. If this had been manual, I would have never signed up. (To be or not to be)

Is a really high deductible and co-pay actually “coverage” or just the illusion of coverage? (Brian Dale)

I’m honestly thrilled that a hospital / health system got nailed for obstructing access to patient records. It’s overdue. As a hospital, I owe it to my patients to assure that they can get to their records in a timely manner. I don’t always know why they need it, and it isn’t my problem. It is their information. They should have a right to it. (MEDITECH Customer)

In effect, Epic aptitude testing tries to determine if you are a smart person. The assumption is, if you are a smart person, you can be a good IT analyst. Good grief! Only your job history proves that and I already have that. (Brian Too)

Epic doesn’t tell you how you do on the exams, but you can assume you did well if you’re offered the job. Carl Dvorak, in a new hire class, told us that the aptitude and personality tests were better predictors of how well Epic employees would perform than their college major, job history, college, etc. (Publius)

Worked in a border city in a prior life — we had hospitals in both states. One state required a physician signature on every individual script, the other allowed batch signing. EMR workflow was a nightmare, as was physician adoption for the physicians that worked in both hospitals. (Was A Community CIO)

Burnout is a real condition, but for most of organized and academic medicine, it has provided a handy new topic to generate more content for sale and consultation fees. (Kevin M. Hepler)

If the AMA was fighting for us, they would be loudly demanding truly radical restructuring of US health care rather than tweaking the existing one with apps, conferences, wimpy comments on CMS rule-making, etc. The solution to our problem isn’t going to come from the AMA until they recognize that they helped to create the problem. (Joe Schneider)

That’s the nature of implementation in general. People who have previously done the exact same thing as you need command a premium salary. Most of the work isn’t really that complicated and is just grunt work. Therefore vendors provide the grunts and let the high-powered implementation people go become consultants that the customer can pay high salaries if that’s what the customer wants to do with their money. (Grunt)

I like where you are going with a basic skepticism of feedback you receive from folks who have not yet bought your product. In the startup world, a little book called “The Mom Test” has become the standard for the “customer discovery” process, in which you learn that people desperately want to tell you what they think you want to hear – and it’s usually not helpful. (Michael Burke)

Watercooler Talk Tidbits


The Seattle newspaper recites yet another example of The Joint Commission giving a hospital a glowing review while state inspectors were nearly simultaneously threatening to shut it down for safety problems, highlighting the Commission’s self-proclaimed role as being the non-punitive advisor to hospitals that want to improve.

Google adds naloxone-finding tools and addiction recovery meeting locations to Maps.


An 86-year-old Georgia doctor who operates a weight loss clinic is arrested for illegal drug distribution and money laundering, charged with taking cash from former NFL linebacker Sedrick Hodge for providing him with prescription medications to sell on the street.


San Diego physician Murray Alsip, DO discovers that he can continue practicing medicine even after a heart transplant left him unable to see patients in an office by signing on as a telemedicine doctor with MDLive. Alsip previously met with the former girlfriend of 20-year-old man whose heart he received so she could hear it beating in his chest.

In Case You Missed It

Get Involved



Morning Headlines 9/13/19

September 12, 2019 Headlines No Comments Raises $60 Million in Series C Funding and Receives FDA Clearance for Smartphone-Based Test to Diagnose Chronic Kidney Disease raises $60 million and receives FDA clearance for the use of its smartphone-based ACR test to be used in diagnosing chronic kidney disease.

TrialCard Announces Acquisition of Mango Health

Digital prescription savings company TrialCard will acquire medication management app Mango Health.

GE’s health unit wins first FDA clearance for A.I.-powered X-ray system

GE Healthcare receives FDA clearance for its Critical Care Suite, an AI-powered X-ray device that can reduce the time between diagnosis and treatment for a collapsed lung to as few as 15 minutes.

Google and others ‘not interested in electronic patient record market’

Google Cloud Executive Advisor Toby Cosgrove, MD says that health systems have spent so much on Cerner and Epic that Google, IBM, and other companies aren’t interested in trying to launch competing EHR products.

News 9/13/19

September 12, 2019 News 4 Comments

Top News


Surescripts finally severs ties with ReMy Health, which supplied Amazon-owned mail order pharmacy PillPack with patient prescription data collected by Surescripts.

Surescripts CEO Tom Skelton told customers the move was made to ensure the “integrity of its network.” It came after Surescripts allegedly discovered that ReMy had requested patient insurance information and prescription pricing data that it then passed on to drug marketing websites without permission. ReMy has denied any wrongdoing.

The tit-for-tat amongst the trio has been going on for several months, with Surescripts claiming it would take its complaints to the FBI and Amazon retaliating with threats of a lawsuit.

The FTC filed an antitrust lawsuit against Surescripts in April for allegedly monopolizing the e-prescribing market, specifically in the areas of routing and eligibility.

Reader Comments


From MIPS Maven: “Re: MIPS. More than a dozen major EHRs have not released full 2019 MIPS functionality. Practice Fusion just released their dashboard yesterday after months of customer complaints. MIPS is a FULL YEAR program that began on January 1, 2019. How are EHR vendors not being fined for failing to offer MIPS functionality when they are ONC certified?”

From Attendance Mandatory: “Re: conferences. Don’t you find it ironic that telemedicine conferences require in-person attendance?” I find it ironic that any technology-related conference requires in-person attendance, but I also know that the cash register rings hardest from vendor booths, hotel room bookings, and endless venue advertising. You could easily live-stream every conference education session or just put the video on YouTube as we do webinars. However, attendees are most interested in socializing, making personal connections, or cruising the show room floor, so just watching podium presentations – which are often not very good or very timely anyway – won’t cut it. Conferences provide the supply of whatever it is that the market demands. I’m interested in how the heavily investor-funded HLTH conference will fare in October, having sat out 18 months after making the disastrously stupid decision to launch its initial conference immediately following HIMSS and in the same city of Las Vegas. I haven’t heard any buzz about the 2019 version of HLTH despite its many “media partners” (although quite a few of those are lame).

From Dr. Doctor Please: “Re: surprise medical bills. This is one of the most depressing stories about my profession that I have ever read. Goes well with your recent remarks about how we doctors brought a lot of the burnout-causing conditions on ourselves and how medicine is just another business.” Kaiser Health New says that physician groups are among the biggest and well-funded opponents of laws that would prohibit balance billing, but the real force behind the media blitz is private equity and venture capital firms that have bought physician staffing companies. That earns them fortunes as they intentionally remain out of insurance networks so they can charge whatever they want and leave the patient owing the difference. A snip:

In some areas, doctors have few options but to contract with a staffing service, which hires them out and helps with the billing and other administrative headaches that occupy much of a doctor’s time. Staffing companies often have profit-sharing agreements with hospitals, so some of the money from billing patients is passed back to the hospitals. The two largest staffing firms, EmCare and TeamHealth, together make up about 30% of the physician-staffing market. That’s where private equity comes in. A private equity firm buys companies and passes on the profits they squeeze out of them to the firm’s investors. Private equity deals in health care have doubled in the past 10 years. TeamHealth is owned by Blackstone, a private equity firm. Envision and EmCare are owned by KKR, another private equity firm.

With affiliates in every state, these privately owned, profit-driven companies staff emergency rooms, own dialysis facilities, and operate physician practices. Research from 2017 shows that when EmCare entered a market, out-of-network billing rates went up between 81 and 90 percentage points. When TeamHealth began working with a hospital, its rates increased by 33 percentage points.


September 19 (Thursday) 2:00 ET. “ICD-10-CM 2020 Code Updates.” Sponsor: Intelligent Medical Objects. Presenters: June Bronnert, MSHI, RHIA, director of terminology mapping, IMO; Theresa Rihanek, MHA, RHIA, classification and intervention mapping lead, IMO; and Julie Glasgow, MD, senior clinical terminologist, IMO. The 2020 regulatory release is right around the corner. Join IMO’s top coding professionals and thought leaders as they discuss new, revised, and deleted codes; highlight revisions to ICD-10-CM index and tabular; discuss changes within Official Coding Guidelines; share potential impacts of the code set update; and review ICD-10-CM modifier changes.

September 26 (Thursday) 2 ET. “Patient Education Data: A Key Ingredient for Improving Quality and Patient Experience.” Sponsor: Healthwise. Presenters: Victoria L. Maisonneuve, MSN, RN, director of the Nursing Center for Excellence and Magnet program, Parkview Health; Marta Sylvia, MPH, senior manager of quality improvement and outcomes research, Healthwise. Healthcare data is everywhere! It’s scattered across various systems and in countless formats, making it difficult to collect and glean actionable information. Knowing where to start depends on what your organization wants to accomplish. Vicki Maisonneuve will share how her team analyzes data around the use of patient education. By combining different data sets, she can easily identify trends, gaps, and opportunities to improve quality and patient experience across Parkview Health.

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

Acquisitions, Funding, Business, and Stock

image raises $60 million in a Series C funding round and receives FDA clearance for the use of its smartphone-based ACR test to be used in diagnosing chronic kidney disease. The company released a smartphone-based urinalysis app last year.


Digital prescription savings company TrialCard will acquire medication management app Mango Health. Co-founder and CEO Jason Oberfest left Mango Health to join Apple’s health team late last year.


Health IT consulting firm HCTec will invest $500,000 in expanding its workforce by 100 employees over the next five years in Tennessee.


GE Healthcare receives FDA clearance for its Critical Care Suite, an AI-powered X-ray device that can reduce the time between diagnosis and treatment for a collapsed lung to as few as 15 minutes. The company is working with scientists at the University of California to develop screening capabilities for additional conditions.


  • Provincial Health Services Authority in British Columbia signs a three-year contract with Vocera for its care team communication technology.
  • WellStar Health System expands its use of Glytec’s EGlycemic Management System two eight additional Atlanta-area facilities.



University of California promotes Tom Andriola to the newly created position of vice chancellor of IT and data at the University of California, Irvine, which includes UCI Health.

Announcements and Implementations


Christie Clinic (IL) will implement Epic through a Community Connect arrangement with neighboring Carle Health System.


A new KLAS report on EHR implementations outside the US finds that Epic has the highest satisfaction and its customers implement the widest variety of software modules. Allscripts customers report budget overruns and worry that the company is more focused on sales than implementation; InterSystems overpromises on scope and timelines; and Meditech customers are most likely to report budget overruns due to unexpected third-party and infrastructure costs. However, Meditech finished first on hitting the timelines that are under its control. Epic takes the highest amount by far of EHR project budget at up to $164 million, while Meditech, Philips, and MV had narrower cost ranges that were in the single-digit millions.

Redox posts the agenda for its Healthcare Interoperability Summit, convening in Boston on October 15.

Government and Politics


In Australia, Queensland Premier Annastacia Palaszczuk promises to investigate the IEMR crash that occurred Tuesday afternoon across 14 hospitals. The $1.2 billion system was down for several hours after a routine Cerner software patch caused a “system degradation.”

Privacy and Security

Healthcare technologist Fred Trotter says Facebook still hasn’t fixed some privacy-compromising features of its Groups function, potentially exposing the medical information of people who sign up for health groups. Facebook did a partial fix: (a) you can no longer download the information of group members unless  you yourself are a member; (b) Facebook users can no longer add other users to a group without their consent; and (c) groups are set to be “private” by default. Fred says Facebook needs to add name privacy, so that members are listed by only their first names and are not linked to their full Facebook account, which means the user can interact with the group but nobody can find out more information about them. This is similar to how Facebook set up its “dating” feature” to facilitate privacy. 



A cardiologist’s New York Times opinion piece says that doctors are always outraged and surprised at onerous or ineffective regulations that are forced upon them, but have done little to offer their own solutions to problems such as inappropriate imaging. He notes interestingly that Medicare created a physician golden goose in 1965 in virtually guaranteeing that medical services would be paid for, but doctors cashed in while ignoring waste and fraud that was eventually addressed by insurers and lawmakers in the form of managed care. He concludes that doctors can retain their independence only if they become more active in addressing healthcare’s problems, some of they they themselves created.  

Google Cloud Executive Advisor Toby Cosgrove, MD – formerly CEO of Cleveland Clinic – says that health systems have spent so much on Cerner and Epic that Google, IBM, and other companies aren’t interested in trying to launch competing EHR products. He said in a conference this week that IBM and Google both considered developing ad EHR, but it’s probably too late.

University of Oxford researchers have designed an algorithm that can detect potential signs of heart attacks years before traditional methods. The technology can flag indicators like inflammation, scarring, and changes in blood vessels that supply blood to the heart. When combined with traditional scans, researchers hope that the software will assist providers in early intervention and treatment strategies.


Orig3n CEO Robin Smith pushes back against the accusations of 17 former employees who claim the genetic testing company manipulated results to cover up testing errors that led to radically different results when the same genes were tested separately for fitness and nutrition profiles. They claim to have logged 407 such errors in a sample of 2,000 tests over a three-month period, and say that marketing, rather than science, was the priority. Smith says the claims are inaccurate and that “former employees are former employees for a reason.” This is the same at-home testing company that made news last summer for failing to recognize that one customer’s DNA sample was actually from a dog.

Sponsor Updates

  • EClinicalWorks will exhibit at Health 2.0 September 16-18 in Santa Clara, CA.
  • Ensocare will exhibit at the ACMA Illinois Chapter Conference September 17 in Rosemont.
  • FormFast will exhibit at AHIMA September 14-18 in Chicago.
  • Greenway Health will exhibit at the NIHB Annual Tribal Health Conference September 16-20 in Temecula, CA.
  • Hayes hires Jessica Kender (PrismHR) as senior implementation project manager, and Julie Anne Bonee (Change Healthcare) as client success manager.
  • HealthCrowd will exhibit at the MHPA 2019 Annual Conference September 18-20 in Washington, DC.
  • Hyland will host CommunityLive September 15-19 in Chicago.
  • InterSystems will exhibit at the CIO Summit September 19 in Boston.
  • Intelligent Medical Objects will exhibit at AHIMA September 14-18 in Chicago.
  • Pivot Point Consulting names Jeff Maris (Cerner) head of its Cerner Strategic Implementation and Partnerships team.
  • PatientSafe Solutions adds enhanced security and mobile features to its PatientTouch Clinical Communication platform.
  • Prepared Health will lead a roundtable, “Becoming a Preferred Provider: Home Health’s Role in Hospital and Skilled Nursing Transitions,” at the at the Home Health Care News Summit September 18 in Chicago.
  • Vocera announces that Metro Health – University of Michigan Health has improved its stroke time to treatment from 53 to 29 minutes, in part through Vocera communication technology.

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EPtalk by Dr. Jayne 9/12/19

September 12, 2019 Dr. Jayne 3 Comments

My attorney friends are always asking me about the sheer volume of information in medical records that they see for personal injury cases. It’s staggering – what used to be a manila folder full of records now might be a copy paper box when printed.

Many of the notes incorporate (or simply regurgitate) other data, which just adds to the overall length – whether it’s a copy-and-paste situation or whether it’s embedding diagnostic results such as CT scans or laboratories. Either way, it’s difficult to sift through the information.

So-called “note bloat” is a problem, and some EHRs are better than others as far as helping providers visualize key patient information. It’s not surprising that the EHR is cited in medical malpractice suits. EHR-related claims have increased from 0.35% in 2010 to 1.29% in 2018. EHR adoption has jumped from 15% to 90% across that same time period.

According to recent data from The Doctors Company, this trend continues. Issues frequently cited include system design and usability problems, which are typically cited as contributing factors to a claim rather than as a primary cause. Issues around alerts were cited in 7% of claims, while fragmented records were cited in 6%. User-related issues are an issue, from problems with copy/paste to entering incorrect information.

The Doctors Company, a medical liability insurance carrier, offers some tips for avoiding EHR-related claims: avoid copy/paste except with past medical history; contact IT if data is being inappropriately auto-populated; review entries selected from drop-down menus; and review information thoroughly before treating patients. The latter is easier said than done.


I’m always interested in new apps, so was excited to hear about Foodvisor, which claims to use photo recognition and AI algorithms to identify the food on your plate and offer personalized coaching around your eating habits. Many of my patients who have tried to use food journals get frustrated with the tracking part, even using an app which they often find tedious. If the photos can accurately be translated to discrete data, this would be a leap forward for patients who have been unable to track their eating habits.

Patients can also use the app to track their activities, either keying them in or by syncing them from the IOS Health app. (I guess Android users are out of luck in that regard.) The company launched in 2018 in France and this month in the US after the system learned how to recognize foods that are popular here. I like their avocado mascot and am looking forward to seeing how they do in the marketplace.

Perhaps the app might be of use to medical students, whose rates of hypertension are more than twice that of the general public, according to a recent presentation at the American Heart Association’s Hypertension 2019 Scientific Sessions. The student rate of Stage 2 hypertension was 18%, compared to 8% for comparable members of the general public. The study looked at over 200 first- and second-year students at the DeBusk College of Osteopathic Medicine. Participants completed a survey on tobacco, alcohol, diet, exercise, mental health, social support, and past medical history. The real surprise was that only 36% of students had normal blood pressures – the rest were either elevated, Stage 1, or Stage 2.

They might also want to take advantage of recent data from the journal Heart was published last month and indicated that daytime naps may be linked to a lower risk of heart attack or stroke. Researchers looked at 3,500 people living in Switzerland and found that those napping once or twice a week were better off than those not napping at all. Participants ranged in age from 35 to 75 years and were healthy prior to the five-year study. The study was observational, meaning it doesn’t show cause and effect; but I’m certainly going to take those results to heart.

Each year in September, EHR/PM vendors and clients scramble to make sure they have updated CPT codes since the new codes typically go into effect on October 1. This year’s 248 new codes include six for online services, three for physicians and other qualified professionals and three for communications with non-physicians. Two additional codes cover self-reported blood pressure monitoring. Just because the codes exist is no guarantee that they’ll actually be paid for if used, so providers should check their payer contracts to see how new codes are handled before they get too excited. There are also 71 codes being retired and 75 being revised.

Providers typically look to their specialty societies for information on how they’ll be impacted by the changes. They also look to their IT teams to make sure the codes are loaded and mapped appropriately anywhere they might be embedded within technology, so good luck to those of you responsible for the changes.


HIMSS launched registration this week for the flagship annual conference, with the coming year’s theme of “Be the change.” There’s also apparently a rebranding effort going on, with insiders being excited by their kicky new font and expanded color palette. I guess they’ll have to commission a new set of giant letters to adorn the grassy slope outside the Orange County Convention Center. The conference itself even got a rename – it’s now the HIMSS Global Health Conference & Exhibition. According to the marketing staffer who gave me the scoop, this complements their new vision and mission of being focused on the health and wellness ecosystem. The good news is that no one really used the full name of the conference anyway, so the rest of us can still call it HIMSS20 and be good. I booked my hotel a few months ago to make sure it was affordable so now I just have to book the flight.

Speaking of HIMSS, they’re hosting their annual US National Health IT Week event later this month. Its theme of “Supporting Healthy Communities” is designed to promote transformational activities to drive better health outcomes and health equity. Points of engagement include public health, population health, workforce development, expanding access to broadband and telehealth, and addressing social determinants of health. Several governors are expected to issue proclamations in recognition of the event, but it doesn’t look like there’s much going on in my neck of the woods.

How to you plan to celebrate Health IT Week? Leave a comment or email me.


Email Dr. Jayne.

Morning Headlines 9/12/19

September 11, 2019 Headlines 1 Comment

It just got very hard for Amazon’s online pharmacy to access patient medication data

Surescripts ends its relationship with ReMy Health, which supplied Amazon-owned PillPack with patient prescription data collected by Surescripts.

A.I. technology could identify those at risk of fatal heart attacks, research claims

University of Oxford researchers have designed an algorithm that can detect potential signs of heart attacks years before traditional methods.

Kindbody Unveils New York City Flagship at 102 Fifth Avenue

Women’s health and technology company Kindbody opens its fourth clinic in Flatiron, NY, and announces plans to open three more by year’s end.

HIStalk Interviews Steve Shihadeh, Founder, Get-to-Market Health

September 11, 2019 Interviews No Comments

Steve Shihadeh is founder of Get-to-Market Health of Malvern, PA.


Tell me about yourself and the company.

I’m the founder of Get-to-Market Health, a consultancy that helps healthcare technology companies accelerate their growth and revenue. I got my start in healthcare IT as a sales trainee with Shared Medical Systems, and through a series of growth experiences, ended up being their leader for commercial activities. I then had that same role at Siemens Medical after they acquired SMS, at Microsoft Health Solutions Group, and then finally at Caradigm, a population health company.

About two years ago, I formed Get-to-Market Health. I have a passion about the business and what technology can do. I also have a strong belief that high-quality commercial activities are an important part of any successful healthcare technology business.

What advice do you give a startup or a company that is getting into healthcare for the first time?

A big part of what we do is help people understand the market, but equally, help them understand how the market looks at them. Healthcare buyers are different. We will often have clients who want to enter a new space and it’s just not the right fit, or they need to make some adjustments. Lead generation, building a pipeline, qualifying — all those things are important, but the most important thing is figuring out where their product fits.

What help do companies need in deciding what product to bring to market or how to get it in front of the right people?

The healthcare market is incredibly complicated, in a good way. It’s not just hospitals and doctors any more. Trying to figure out who the real buyer is, who has the authority to buy, who has the budget to buy, and how to present a product in its best light is an important issue for any company, but especially smaller companies that are trying to grow.

How should companies approach a market in which Cerner and Epic have become dominant and may become even more so as providers consolidate to create a customer base that has fewer, larger players?

It’s funny how the market has swung. It used to be that everything was interfaced and people bought best-of-breed. Now the pendulum has swung the other way, where a few large companies dominate the space. But I don’t think you can keep innovation or innovators down. 

A lot of the work we do is coaching and helping innovators figure out whether they should have a relationship with one of those big companies. If they are going to compete, how? And if they are going to get out of the way of the big vendors, how do they do that and still be successful? It’s a tricky landscape.

I think of the relationship between newspapers and companies like Facebook or Google that send them much of their traffic, but also take a lot of their revenue. How can companies figure out how to cooperate with those big EHR vendors while remaining aware that they also compete with them?

We see that every day. There is coopetition, where companies are OK that you compete or you partner. But I think vendors and also providers are trying to watch the way the landscape is moving because hospitals and health systems have that same issue around digital traffic as well. It’s a pretty interesting time to be in this space.

Will big health systems succeed in their for-profit efforts to create IT companies, invest in startups, or run accelerators and incubators?

That’s the multi-million dollar question. The organizations you’ve written about, which I know well, have invested hundreds of millions of dollars to incubate businesses. They are  becoming the investor. 

I understand the argument. To have a strategic investor behind a product like that is a big deal and will clearly help with other providers deciding to do business with them. 

It’s early to declare success. You can certainly point to some great examples – UPMC, Providence, and Northwell  have made some  good investments. It’s a clear trend because they aren’t able to make the margin they want on the core business and they have valuable intellectual property that they want to leverage.

How do companies that bring in new investment money meet the accompanying heightened expectations for growth?

It may be a little overused term, but it’s clearly an inflection point. The investor is betting on a multiple and a growth that wasn’t there before the investor showed up. Often the company that has taken an investment hasn’t really thought through how they’re going to make that growth happen. It is a point in time where the business evolves. Sometimes the players stay the same but just change what they’re doing, sometimes there are new players, sometimes there are new markets. But generally when an investor writes a big check, something’s going to happen.

What catch-up work do small companies need to do once they’ve hit a higher revenue level and have to start behaving like a bigger company?

We generally get called in when there’s a realization by the leadership team or the investor that they want to do more in terms of marketplace growth. What got them to that point isn’t going to get them ahead, so they want to try something different. It could be new markets. We have one client that is bringing in an AI machine learning platform from Europe to the US. People are taking products up into the enterprise space where they just used to work in community hospitals. It’s a realization that they want to do something different and they’d like an outside point of view as they do that.

How does a company formalize its sales process?

That stereotypical sales guy or sales gal from the past still exists, I guess, but they are a dying breed. One of the biggest changes I’ve seen in my career is how much more capable providers are getting as organizations and as buyers. They are pushing and demanding more from their salespeople than just buying lunch and overseeing a good demo. It’s clearly gotten better. Often we get called in to help them improve the deliverable that their sales team provides to the buyer.

How much of a company’s success is based on the skill, personality, or perseverance of a superstar salesperson whose traits can’t be easily replicated or obtained elsewhere?

It’s an interesting point. I suspect that the head of engineering has a few people he or she really relies on. The head of services has a few key people they rely on. I can’t argue against salespeople who are stars.

However, it’s more of the whole commercial mechanism —  how the company presents the product to the marketplace, how it prices it, how it creates product awareness, how it names and positions the product, and how it approaches buyers. You have to approach the CIO IT shop with your act together. You have to be able to answer the security questionnaire. You have to answer how it integrates with the EMR platform. You have to be pretty buttoned up in order to be successful today. It takes more than just a great salesperson. Although they are good to have and everybody wants them, it’s far bigger than that.

How do you advise companies to fit user surveys from companies like KLAS and Black Book into their marketing plan?

Really small companies don’t have to worry about KLAS, but they have other activities. Big companies have to invest in KLAS, Black Book, and various awards. Folks on the buying side really do use it. You may not be number one, but you had better not be off the list. It’s an acquired skill to be great at both delivering customer satisfaction and managing your relationships with those companies.

Do vendors call you because they haven’t done a good job at developing relationships with their existing customers?

One of the cool things we’ve been doing a fair amount of lately is running focus groups with clients and potential clients, to help them understand how they are perceived and how their product comes through. It gives them a safe zone to test ideas and get honest feedback. We facilitate that and help them hear what the potential buyers say.

Cerner hired KLAS to convene some of its big customers to tell the company how to improve its revenue cycle product and to ensure accountability as they did so. Will other companies do something similar instead of just talking to those customers themselves?

I’m not sure I fully understand the Cerner-KLAS thing. I was reading something about it this morning, in fact. One of the most important things a healthcare technology company can do is to get honest feedback about what’s working and what isn’t working. However you do it, I think it’s great. We seem to be getting more and more requests to help with it.

How do you see your business changing over the next few years?

It’s an exciting business. I have learned over the years that I don’t know as much as I think I know. It’s going to change in different ways. You look at some of the big companies that are spending money and hiring people and doing things and clearly there will be some shakeout from that. I hope they have the staying power and don’t get exhausted before they deliver some real products and capabilities. With the IPO activity and the buyouts that have happened, there will be more investor appetite for innovation. That guy or gal with a great idea won’t have any problem finding investors. It will be interesting to see where the products have an impact.

What goes through your mind when you walk the HIMSS exhibit hall?

I’m one of the people who actually enjoys going to HIMSS. Not because of the environment, but because it’s the business I’ve been in my whole career. I love the energy. You can clearly see who’s doing it right and who’s not doing it right. There’s a bunch to be learned from it. It’s a pretty amazing business, and a fun thing about the business I’m in now is that I can have a broader view of it. The roles I had before, in hindsight, were fairly narrow considering how wide the healthcare space really is and all the ways it is interconnected.

It’s clear that companies need to have their A-game for HIMSS or they shouldn’t go. We’ve helped several clients get ready for HIMSS and to do it right, but we’ve also counseled some clients not to go to HIMSS. They wouldn’t be heard above the noise. Awareness and creating client interest is a key opportunity for any company. They really have to pick their spots, whether it’s HIMSS or HLTH or any of the other regional or local shows. They have to have their act together.

Do you have any final thoughts?

You and I are fortunate to work in a business that’s evolving, growing, and consuming technology. It’s a business that all of us will depend on at some point in our lives. My view is, let’s make it better. We get to work with diverse business leaders to simplify the complexity and buying patterns of the healthcare technology market. That simplified buying process, with a clear understanding of what a product does or doesn’t do, is good for everybody. It’s win-win. No one, especially today’s providers, has time or money to waste. We think effectiveness and efficiency matter. That’s what gets us up and going every day.

Morning Headlines 9/11/19

September 10, 2019 Headlines No Comments

Apple announces three groundbreaking health studies

Apple will partner with several high-profile healthcare institutions to conduct studies related to hearing, women’s health, and heart health using its new Research app.

Google, Mayo Clinic strike sweeping partnership on patient data

Mayo Clinic signs a 10-year partnership with Google in which Google Cloud will provide Mayo with data hosting, cloud computing, analytics, and machine learning and AI.

Health IT firm to add 100 jobs in Lewis County

HCTec will invest over $500,000 to expand its Brentwood, TN-based consulting firm.

More trouble for Queensland hospital software after statewide issues

In Australia, Queensland Health’s $1.2 billion IEMR system goes down for several hours after a routine Cerner software patch causes “system degradation.”

News 9/11/19

September 10, 2019 News 10 Comments

Top News


Bayfront Health St. Petersburg (FL) pays $85,000 to settle Office for Civil Rights charges that it failed to provide a woman with the fetal heart monitor records of her unborn child within HIPAA’s 30-day window. This is HHS OCR’s first case brought under HHS’s Right of Access Initiative that was announced earlier this year.

The mom didn’t get the information until nine months later, and then only after she filed an OCR complaint.

The hospital is part of Bayfront Health, which is owned by for-profit Community Health Systems.

The hospital also agreed to a corrective action plan that includes revising PHI-related policies and procedures if necessary, validating its Designated Record Set Policy, training its employees who manage information requests, and providing HHS with a list of its business associates.

The settlement is important since it signals OCR’s belated interest in going after health systems that have been widely ignoring the requirement that they give patients copies of their records promptly and at a reasonable cost.

Reader Comments

From Banga Gong: “Re: physician burnout. What about other people who are burned out? You don’t read much about them.” Agreed. Many Americans are experiencing the cultural phenomenon of burnout that is caused by excessive workload, too much time wasted in conference rooms and on email, an always-on expectation of answering work messages around the clock, jobs that discourage creativity or individualism, a disconnect between accomplishment and rewards, general executive cluelessness and indifference, and employers whose social mission and human connection are coincidental at best. They make it worse by wasting endless time staring at their phones and anguishing second by second over political nonsense instead of cultivating in-person relationships, breathing fresh air, and stepping out of their consumptive role as never-rest shoppers. Therefore, I’ll take the harsh point of view that doctors who have decided to become employees are belatedly finding out that it’s not so great being an employee in the US these days, no matter how much you’re paid. Thousands of lower-earning people name email or Slack as the corporate villain for every doctor who blames the EHR for their unhappy work life. Forming a union isn’t likely to help, so the choices are to (a) find a more suitable physician job; (b) leave the profession and do something else; or (c) become self-employed. Complaining while remaining isn’t a good look, but I can understand why doctors are especially unhappy because their entire post-high school lives were structured around being gunners who earned rewards by beating others.

From Mensch: “Re: layoffs. How would readers know if a layoff seems to unfairly target more expensive workers?” They can easily go down a self-made list of newly vacant cubicles and tally the dearly departed by age group, position level, known health problems or frequent absences, etc. I’ve been involved in health system layoffs, and while HR ran our proposed IT layoff list through a discrimination testing program to make sure we wouldn’t get sued, the end result was that we just took the first run of the program to see if we had the prescribed mix of ages and males-female, then chose more younger people or females or whatever we needed to get the spreadsheet’s green light. In other words, some people were cut loose purely to balance our desire to get rid of some of their peers. I’m saying “we,” but the decision was made above my level by an executive who was new and therefore naive enough to think that his gung-ho team play would benefit him as a man of decisive action.



From Alan: “Re: Netflix documentary ‘Diagnosis.’ See attached screen grabs. S1-E6  shows a Johns Hopkins neurologist writing a paper note in front of his Epic screen. Seems like he could have more room to write if it weren’t for that annoying keyboard.” The patient is probably happier to have the doctor at least looking him most of the time since the room arrangement doesn’t readily support showing the patient the screen while entering information. Large monitors and even projectors are super cheap and small these days, so it would be nice to have both participants looking at the same screen image as a teaching point. My tax guy has a large monitor behind his desk that we look at together when he is explaining stuff and it works great, especially since his wireless keyboard keeps him untethered.  

HIStalk Announcements and Requests

A relative of mine is a family doctor who has worked for years (not all that happily) for a multi-specialty clinic whose foreign-trained physician-owner pushes the medical staff hard to increase patient volume and keeps elevating the bonus targets. The relative says working conditions suddenly got worse recently as the clinic “got a new investor” (which I take to mean that it was sold to a big investment group), a new practice manager was installed who chews out the doctors over administrivia, and the whip is being cracked harder to make new number targets. Sometimes you forget that even modest private medical offices can be the storefront for big business.

I was also talking to a doctor friend who gets insurance from his academic medical center employer. He found when his kids went to college that his employer’s family plan offers basically no coverage outside its immediate area. I wonder how many of us know what would happen financially if we’re taken to an ED unexpectedly while on vacation several states away from home?


September 19 (Thursday) 2:00 ET. “ICD-10-CM 2020 Code Updates.” Sponsor: Intelligent Medical Objects. Presenters: June Bronnert, MSHI, RHIA, director of terminology mapping, IMO; Theresa Rihanek, MHA, RHIA, classification and intervention mapping lead, IMO; and Julie Glasgow, MD, senior clinical terminologist, IMO. The 2020 regulatory release is right around the corner. Join IMO’s top coding professionals and thought leaders as they discuss new, revised, and deleted codes; highlight revisions to ICD-10-CM index and tabular; discuss changes within Official Coding Guidelines; share potential impacts of the code set update; and review ICD-10-CM modifier changes.

September 26 (Thursday) 2 ET. “Patient Education Data: A Key Ingredient for Improving Quality and Patient Experience.” Sponsor: Healthwise. Presenters: Victoria L. Maisonneuve, MSN, RN, director of the Nursing Center for Excellence and Magnet program, Parkview Health; Marta Sylvia, MPH, senior manager of quality improvement and outcomes research, Healthwise. Healthcare data is everywhere! It’s scattered across various systems and in countless formats, making it difficult to collect and glean actionable information. Knowing where to start depends on what your organization wants to accomplish. Vicki Maisonneuve will share how her team analyzes data around the use of patient education. By combining different data sets, she can easily identify trends, gaps, and opportunities to improve quality and patient experience across Parkview Health.

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

Acquisitions, Funding, Business, and Stock


A ProPublica report finds that private health insurance companies, unlike Medicare and Medicaid, don’t pursue widespread and sometimes obvious examples of healthcare fraud because they can simply pass its cost on to consumers in the form of higher premiums.


  • Mayo Clinic signs a 10-year partnership with Google in which Google Cloud will provide Mayo with data hosting, cloud computing, analytics, and machine learning and AI.
  • Cerner signs three new CommunityWorks clients: Eastland Memorial Hospital (TX), Pawhuska Hospital (OK), and Schoolcraft Memorial Hospital (MI).



BioBright, whose technology extracts medical device information for research, hires industry long-timer Edward Chung, MD (Covenant Health) as chief medical officer.


Michael Keyes, MBA, PT (3M Health Care) joins Collective Medical as VP of health plan business development.


Patient engagement technology vendor Conversa hires Cameron Ough, MSc (Cigna) as CTO.


Healthcare talent management software vendor HealthcareSource names Michael Grossi (Ipswitch) as CEO. He is also a former Air Force captain in Intelligence Command.


Cerner EVP / Chief of Innovation Jeff Townsend will retire this year after 30 years with the company.

Announcements and Implementations

A Spok survey of hospital employees on mobile strategies finds that poor wi-fi and cellular coverage remain the biggest problems, although improving. More than half of non-clinical staff still use pagers, which respondents say provide better coverage than any other communications device.

Carolina EHealth Alliance reports expanded adoption among state EDs after it switches vendors to Health Catalyst.

Apixio announces Quality Identifier, which uses AI to extract quality data elements from patient notes, scanned charts, and other documents that are then presented to abstractors for review.


Leidos Partnership for Defense Health announces go-live of the Department of Defense’s MHS Genesis project at Mountain Home Air Force Base (ID), Travis Air Force Base (CA), Naval Health Clinic Lemoore (CA), and the Presidio of Monterey, US Army Health Clinic (CA). The project remains on track for 2023 completion, with 23 go-live waves of around three hospitals each.

Government and Politics

The Census Bureau reports that for the first time since 2014, the percentage of uninsured Americans rose in 2018 even with a strong economy.

Privacy and Security

In Canada, British Columbia’s privacy watchdog opens an investigation into Vancouver Coastal Health’s use of paging systems to broadcast patient movement data, which it says can be easily intercepted by anyone with enough technical proficiency to run software-defined radio since the information is not encrypted. 



A Washington Post article decries the lawsuits brought against patients who have unpaid bills by University of Virginia Health System, which over six years filed 36,000 lawsuits in an effort to collect $106 million. The article notes that UVA has sued 100 of its own employees, garnishes paychecks from lower-pay employers such as Walmart, and has seized $22 million in state income tax refunds as Virginia law allows. Perhaps the moral outrage could be redirected from UVA – which has broken no laws and is doing exactly what any business would do – to a national health non-system in which exorbitant provider prices collide with a patchwork insurance program in leaving some patients with medical bills – at full list price that only cash patients are expected to pay — that bankrupt them through no fault of their own. Shaming UVA publicly won’t resolve a whole lot since the problem is far greater than defining just how far that specific hospital should go in its collection practices. There’s also the issue that giving those who can’t or won’t pay a free ride just means the health system will milk the rest of us harder to compensate and help hide the real problem. It’s cute that people are still surprised that it’s not the pre-Medicare 1960s in healthcare, or that they beam at  the massive employment and architectural splendor of their local health system without questioning who’s paying for it.


Speaking of billing practices, nephrology social worker Teri Browne, PhD describes her experience after Lexington Medical Center (SC) notifies her that it has asked the state to place a lien on her future tax refunds for the $286 she owes, with these details:

  • MyChart showed no balance due and she had received no statement.
  • She was told in her 26-minute phone call with the hospital’s billing department that the hospital’s billing company is “infamous for not sending out statements.”
  • She paid the $286, then spent another 16 minutes on the phone with the billing department, who said they didn’t see bills for the dates of service. They also told her that charge display isn’t supported by MyChart.
  • She made another call to complain formally, noting that unlike some people, she knows healthcare, she could afford to take an hour out of her workday to get the problem resolved, and she had the money to settle up what she finally found that she owed.

A Health Affairs article finds that nearly all of the highest-charging air ambulance companies are owned by private equity firms.


From the Apple Event 2019:

  • The company announced the IPhone 11, 11 Pro, and 11 Pro Max, which mostly involve a better camera (actually three cameras on the back) and a new design, starting at $699. Unlike its competitors, the new IPhone will not offer 5G support.
  • The sixth-generation IPad was introduced, with a 10.2” display.
  • The Apple Watch Series 5 was announced, offering an always-on display, power-saving features, and a compass. The company highlighted health research projects related to hearing, women’s health, and the heart.


Apple provides more details about the three studies being launched on the new version of its Research app:

  • Looking at menstrual cycles and gynecological conditions, performed by Harvard’s public health school and the NIH.
  • Seeing if heart rate and mobility signals can be correlated with health events, performed by Brigham and Women’s Hospital and the American Heart Association.
  • Measuring sound exposure and its effect on hearing, performed by University of Michigan.

Sponsor Updates


  • The CoverMyMeds team helps Gladden Community House prep for its annual fundraising dinner.
  • Arcadia will partner with Cigna to present “Will Physicians Ever Welcome a Health Plan into the Exam Room” at Rise West September 11 in San Diego.
  • Artifact Health will exhibit at AHIMA September 14-18 in Chicago.
  • Clinical Architecture debuts “The Informonster Podcast.”
  • CompuGroup Medical releases version 19.9 of its LABDAQ laboratory information system.
  • Charlyn Slade joins the advisory board of Prepared Health.
  • John Halamka, MD, MS joins the advisory board of PatientPing.

Blog Posts



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


Morning Headlines 9/10/19

September 9, 2019 Headlines 1 Comment

Vim, a Healthcare Platform for Health Plan-provider Collaboration, Raises $24 Million in Series B Financing Led by Optum Ventures and Premera Blue Cross

Appointment scheduling optimization and care collaboration technology vendor Vim raises $24 million.

OCR Settles First Case in HIPAA Right of Access Initiative

Bayfront Health St. Petersburg (FL) pays $85,000 to HHS to settle a potential HIPAA violation related to its failure to provide medical records to a patient in a timely manner.

Pentagon’s New Electronic Health Records System Deployed To Second Wave of Bases

The DoD rolls out the Cerner-developed MHS Genesis system at three facilities in California and one in Idaho.

A new policy on advertising for speculative and experimental medical treatments

Google announces that it will prohibit ads for unproven or experimental medical techniques like stem cell therapy, cellular therapy, and gene therapy.

Curbside Consult with Dr. Jayne 9/9/19

September 9, 2019 Dr. Jayne 4 Comments


Lots of companies are talking about gamification as it relates to patient engagement and management of chronic conditions, but I never thought I would see an app designed to gamify strategies to reduce physician burnout.

The folks at the American Medical Association have released an app that tries to make a game of dealing with this serious issue. Titled “HealthBytes,” the app is designed to teach strategies to help physicians optimize their practice’s operations in an attempt to reduce physician burnout. The app can be played on a PC or smartphone. The AMA states “no matter how many times you play the game, you are bound to learn something new each time.” I’m not sure what kind of research they did to drive the creation of this game, but in my experience the last thing that burned out physicians want to do is experience anything office related if they don’t have to.

The AMA admits there is a time pressure element to the “Practice Master” game within the app. Players have four minutes to play through a physician scenario, including meeting the team, designing “my dream team,” optimizing documentation, conducting a patient visit, and creating a well-being plan for the physician and the team. Following that exercise, providers can share their score, play again, or consult AMA content designed to “offer innovative strategies to allow physicians and their staff to thrive in the new health care environment.”

After finishing my recent read of “Code Blue” by Mike Magee, which names the AMA as one of the principals behind the dysfunction of the US health care system, I find it only mildly amusing (but significantly distasteful) that they’re positioning themselves as experts ready to help solve the problem. One of my colleagues refers to the AMA (along with payer executives and federal regulators) as part of the Medical Axis of Evil.

The AMA is trying to be all over the issue of burnout, including offering the trademarked “American Conference on Physician Health” that will be held September 19-21 in Charlotte, NC. The organization is co-hosting with Stanford Medicine’s WellMD Center and the Mayo Clinic Department of Medicine Program on Physician Well-Being. The conference website lists of statement of need that “Physicians’ professional wellness is increasingly recognized as being critically important to the delivery of high quality health care.” It also notes that the meeting “is designed to inspire organizations throughout the country to seek ways to bring back the joy in medicine and achieve professional fulfillment for all our physicians.”

The sheer fact that presentations will include more than 70 wellness projects and programs illustrates the significance of the issue of burnout. I was surprised to see that the two-day conference costs $825 for AMA members ($925 for non-members), with a whopping $25 discount given to presenters who only have to pony up $800 to attend.

AMA is also offering a practice transformation boot camp immediately prior to the conference, at the bargain price of $279 for the day (although you do get a $100 discount if you register for both). Tack on an additional $214 per night for hotel accommodations plus meals and travel. Frankly, if I was going to spend that kind of money, I’d be heading to the beach since that is my proven strategy for improving my own physician well-being. I noted on the website that AMA recently extended the registration and now it closes a mere nine days before the conference, perhaps an indicator of what potential attendees think of the conference.

I frequently read articles about burnout, physician wellness, resilience, etc. and they often portray clinicians in the trenches (not just physicians – it’s all of us) as somehow being lacking, therefore we are subject to burnout. If we could just be more resilient, if we could just explore mindfulness, if we could just tweak every fiber of our practice’s operations, we would be OK. If we could just embrace the therapy dogs, take a walk in a grassy meadow at lunch time, or build the ideal care team, we’d be able to dodge the flaming arrows we encounter on a daily basis.


In the spirit of fairness, I gave the game a try. I found it simplistic and revealing only of the information that most of us already know. I made the leaderboard on the first try even despite being penalized for answers that were situationally correct but not what the game was looking for. It suggested hiring a scribe, which it refers to as a CDA (clinical documentation assistant – always great to add more acronyms), along with getting the IT team to restructure my EHR inbox. Good luck with that latter suggestion in a large health system environment where any changes to the EHR require the approval of three committees, a resource analysis, and endorsement by the person behind the curtain.

I admit I played it at work with the sound turned off, so maybe I missed out on some kicky soundtrack that might have made it more enjoyable, but mostly it just made me more aggravated than I already was about the situation.

An increasing body of research and commentary is describing “burnout” as the wrong word for the situation. Instead, they’re labeling this phenomenon as moral injury, the damage that occurs to an individual’s moral conscience as a result to the trauma we face in practicing medicine. The original definition of moral injury as coined by professor Jonathan Shay included three components: 1) when there has been a betrayal of what is morally right; 2) by someone who holds legitimate authority; and 3) in a high-stakes situation.

Although other definitions have evolved, I think this still holds for a large number of situations that healthcare providers face daily. One more recent definition from Brett Litz and colleagues describes that “perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations may be deleterious in the long term, emotionally, psychologically, behaviorally, spiritually, and socially.”

Tweaking the process for the office’s morning huddle isn’t going to do much to address the more deep-seated issues at play here. It is insulting for the AMA to put this in front of its physician constituents.

People often ask me how I cope with the craziness of healthcare, especially when you add the craziness of information technology on top of it. On some days, the answer is “barely.” Fortunately, I have a support system with friends and colleagues who understand what it’s like to work in this environment. I try not to take it too seriously and have modified my clinical career to one that is healthy for me. Being in traditional primary care was not, but providing episodic care is better. Doing clinical informatics work helps me feel like I’m doing something to help my fellow clinicians, regardless of the muck in which we operate on a daily basis. I also spend quality time on my treadmill watching utterly mindless shows on Netflix and there’s a smattering of time leftover for music, as well as my arts and crafts hobby. It’s a lot of work to stay sane in this environment.

What do you think of the response of the AMA and other professional organizations to the problem of burnout in healthcare? What would be a better answer? Leave a comment or email me.


Email Dr. Jayne.

HIStalk Interviews Ken Misch, President, Medhost

September 9, 2019 Interviews 3 Comments

Ken Misch is president and CFO of Medhost of Franklin, TN.


Tell me about yourself and the company.

I began my career on a traditional finance and accounting track with Price Waterhouse in Cleveland in the late 1980s. After going back for my MBA in the early 1990s, I determined that I wanted to do something other than just auditing.

For the last 20 years, I’ve worked with smaller, growth-oriented, private equity-backed companies, either in the technology or the healthcare space. After a personal health issue surfaced about 15 years ago, I decided I wanted to spend the rest of my career in the healthcare industry. Obviously since Medhost is a healthcare IT company, I’m fortunate that I can combine my interest in tech with my passion for healthcare.

Medhost serves over 1,000 facilities. We provide these facilities with inpatient electronic health record systems, related implementation, revenue cycle, patient engagement, and hosting and other managed services as well.

How would you characterize the market that you serve?

Medhost mainly serves what we would consider to be the community or the rural healthcare market, which is a different market than the traditional tertiary care market. The urban academic, large research healthcare facilities that you find in very large cities, is a different space than the healthcare facilities that we’re serving, those out in rural America. Those facilities are really challenged. Maybe all of healthcare is challenged to some degree right now, but rural healthcare probably more than others. Rural America is shrinking, but there’s still a need for providing healthcare in those communities.

Al the IT vendors that serve the healthcare space have been challenged recently by the increased regulation that’s been coming out of DC with respect to Meaningful Use, interoperability, et cetera. All of us have had to spend and invest significant dollars in upgrading the systems. Not only to comply with increased regulation, but hopefully provide better optimization and efficiency for our customers.

How has the move of Epic and Cerner into smaller facilities as well as Meditech’s efforts to rejuvenate its business changed the dynamic?

Certainly competition is increasing and is getting more intense every day. Epic and Cerner have tried to provide offerings to come downstream. They’ve had different degrees of success with that. We’ve had customers that have tried both and have come back to Medhost. We’ve had customers that have been forced to do one or the other through a health system connection. We typically get feedback on how that’s going. 

We think we provide the right solution with the right level of functionality at the right price point for these community facilities.It’s hard for these larger systems to come downstream to de-feature those systems at a price point that makes sense for these community hospitals without cannibalizing their existing base. It’s challenging for those facilities to come downstream.

Meditech is is trying to do more with some of their current offerings, but they still have three basic platforms out there that they’re supporting. Their SaaS offering might add a fourth to that mix.

The marketplace is competitive. We recently announced a large win with Quorum Health. Quorum was spun out of CHS. They needed to find their own standalone platform. They went out in a competitive and rigorous bid process and eventually selected Medhost to be their system of the future.

Why do investor-owned health systems almost never choose Epic or Cerner when their large, non-profit counterparts almost always do?

You’re touching on the basic point — it’s about who you answer to. The investor-owned facilities or the investor-owned providers are answering to a group of shareholders and stakeholders. A lot of their systems and their choices are being run by processes that look at return on investment or cost.

It’s hard to justify a return on investment in any IT space in healthcare right now, but looking at it from a cost perspective, those other systems are at a price point that might not make sense for an investor-owned provider organization, whereas the not-for-profits don’t exactly have that same mission. They both have a mission of taking care of patients, but the investor-owned providers probably have a little bit more of a financial hurdle, as they need to answer to their investor group.

Do hospitals worry more about their image in buying Epic or Cerner because their large competitors did instead of looking hard at return on investment?

In the urban communities, the bigger metropolitan areas across the US, that might be more relevant than in some of the spaces that we’re serving. We’re serving communities that probably only have one hospital and the next hospital is 50, 75, 100, or 150 miles away. There isn’t a lot of true provider competition in the markets that we’re serving.

I could certainly see when facilities are competing for talent in a large city that they might want to recognize that physicians seem to have a preference for one or the other. Physicians don’t like really any system from everything I can read and gather. They have more of a tolerance than a preference. Perhaps they have a tolerance for one more than another, and perhaps they’re getting training on one versus another as they come out of med school. That could be a decision for competing hospitals.

We have a large, investor-owned company here in Nashville that we talk to on a regular basis. A lot of what they talk about is providing the physicians with some tools. They may not need to invest in the largest system that’s out there, that may be run by some of large health systems in the country. They may choose to go a different route, but provide their physicians with robust tools that they need to do their job. But the back-end engine might be something a little bit different.

What are small health systems that are too successful to close yet aren’t being considered for acquisition doing to remain in business?

It’s tough for them. They’re facing a lot of challenges. A lot of those facilities are going to be more heavily Medicare and Medicaid versus commercial reimbursement. That’s been getting squeezed. There is more competition and some of their higher-value procedures are being siphoned off by the urban centers. They’re still being forced to comply with the same regulations as the large facilities. They still have to chin the bar on all the various regulatory items with respect to Meaningful Use and the other items that have come out of DC.

We’re seeing innovation starting to happen with some of our customers. How can they innovate their business model? How can they come up with strategies to help their communities? How can they engage a little bit more with those communities to help offset some of those challenges? It’s tough in the rural space right now.

We are seeing rural aggregators that are popping up and buying some of these facilities. They’re not going to be as big as a CHS or even a Quorum, which has about 25 facilities currently, but they’re acquiring maybe a handful to 10-12 facilities. They are realizing they can run those with scale. They can leverage some of the infrastructure and spread that investment across numerous facilities. We’re seeing some degree of private equity money coming into that, although most of that is an individual investors or small partnerships.

What vendor service offerings can help small hospitals gain some level of scaling?

We’ve been investing heavily in our service offerings. It started with the IT and hosting side and other managed services. As facilities were forced to upgrade their IT platforms, they were staring at either investing in hardware to put on-premise and then they would have to have the resources, both from a human and a capital perspective, to support those and maintain those technology resources. These small facilities realized that they would prefer to have somebody else do that, so we started to invest heavily in our hosting services about six or seven years ago. Now we’ve built a world-class hosting operation here at Medhost. Most of our standalone facilities have now elected to move into our hosting environment. In fact, we’ve had some of our recent corporate customers make that same decision.

More recently, we’ve started to expand our revenue cycle services, our back office services, and business office services. The smaller rural aggregators want us to do that for them because they don’t have the skillset that they need in the facilities. They don’t want to make the investment at the corporate location, so they are outsourcing that to companies like Medhost.

Is technology, specifically maintaining IT infrastructure or supporting regional interoperability, a big driver of small hospitals affiliating with larger ones?

At times. But technology replacement is a disruptive activity. A lot of the facilities, especially the inpatient facilities, have a system that they’ve chosen here over the last three to five years, maybe even longer than that. They have  decided who their partner is going to be. They are looking for that partner to help optimize the system.

The government, with the 21st Century Cures Act and a lot of the regs that are coming out with respect to interoperability, are requiring vendors like Medhost and others to make their systems more open and to begin to share data. That it isn’t going to require significant investment on the facility side to just link up a similar system. The systems will be able to communicate with each other, so that they can get the largest return that they can on the existing investment that they’ve made.

Typically there has to be some type of triggering event for a customer to make a change with an EHR. Maybe they see an end-of-life coming at some point and they will need to make a different choice, so they may go out to bid. It could be through a merger and acquisition, where they’re becoming part of another entity that wants to consolidate on a single platform. It could be dissatisfaction. Certainly not all customers are always happy, and so they may just get fed up with the existing system. But it takes a lot to get to that point because of the disruption that rip-and-replace causes.

What is the demand for interoperability in your market?

We’re not seeing a lot of proactive demand. A lot of it will be reactive to what regulations comes out  to make sure that they can comply.

As these community facilities evolve, being able to capture some information from other providers, other avenues, and other platforms will be helpful for them. They’re going to have to evolve from the traditional episodic care center that they’ve been in the past. The community hospital of the past will certainly change into the future and will need to provide different kind of tools and services for the residents of that community. Opening up the systems to enable them to capture patient data — or resident data, let’s call it — from other systems will be helpful for them. In the mean time, what they’re thinking about right now is just, how are we going to be able to comply with this?

Do you have any final thoughts?

I mentioned that I had a personal health issue surface about 15 years ago. It presented again about three and a half years ago. I have an extreme case of coronary artery disease. After receiving all the best possible surgeries and treatments from the best possible physicians and facilities, my symptoms continued to present, even with the smallest exertion, so I was forced to look for alternatives and to think differently.

I was fortunate to get connected to thought leaders and researchers who suggested a significant lifestyle modification. It involved a complete overhaul of how I thought about nutrition, fitness, and stress management. After three years of adopting this lifestyle, I’m off all medications. I have no symptoms, and I have a vigorous daily exercise routine that serves as a stress test for me.

It might be a stretch, but I look at the challenges that are facing rural healthcare today in a similar fashion. Traditional strategies, business operations, and the wonderful clinicians at these facilities are being stressed every day. It will take innovation led by the residents and employers within these communities, in partnership with local civic and government leaders, to identify business models that can help these organizations not only survive, but hopefully to evolve and thrive in the future.

Morning Headlines 9/9/19

September 8, 2019 Headlines No Comments

Ransomware hits hundreds of dentist offices in the US

Hackers breach DDS Safe, a cloud-based records retention and backup solution that is sold to dental practices, and use it to install ransomware on the computers of hundreds of dental practices.

Mountaineer docs going high tech to meet patient needs

In an effort to reduce ER visits and hospital readmissions, a team from the West Virginia University School of Public Health is preparing to launch a pilot program through WVU Medicine that will offer telemedicine services to certain Medicaid patients transitioning from long-term care to the home.

Automated deep learning design for medical image classification by health-care professionals with no coding experience: a feasibility study

Researchers find that clinicians with no experience in medical coding or deep learning can create clinical classification algorithms that perform well at diagnosis.

Monday Morning Update 9/9/19

September 8, 2019 News 15 Comments

Top News


Hackers breach DDS Safe, a cloud-based records retention and backup solution that is sold to dental practices, and use it to install ransomware on the computers of hundreds of dental practices.

The two companies that created the software elected to pay the ransom and then share the unlock codes with their affected customers.

Some practices complained on Facebook that the decryption either didn’t work or didn’t restore all their data.

DDS Safe, ironically, pitches its product as protecting clients from ransomware.

Reader Comments

From Gaping Wound: “Re: AI snake oil. You’ve heard of his healthcare companies.” The founder, chairman, and CEO of Crown Sterling, which sells AI-powered encryption software, is ripped for his “sponsored presentation” at the Black Hat security conference that attendees quickly called out as incorrect, imitative, and lacking rigor. It was so bad that Black Hat pulled it from its website, admitting that its vetting process for sponsored sessions was basically nonexistent, after which Crown Sterling sued the conference for breach of its $115,000 sponsorship contract in claiming that the organizers colluded with attendees to interrupt him. The presenter was amateur mathematician Robert Grant, former president of Allergan Medical and Bausch and Lomb Surgical. He runs a growth equity firm that focuses on “the lifestyle sector of healthcare technology” such as its Alphaeon credit card for financing plastic surgery.


From Magma: “Re: new technology. When do we need to assemble a focus group?” Focus group type activity never ends, but its membership, method, and purpose should always be changing. When developing a product, figure out who would need to be your likely internal customer advocate to get a deal signed, then randomly choose 10 people who hold that position, get them to sign an NDA and pay them if necessary, and ask them after a brief overview if they would risk their jobs to recommend spending budget money on your offering. Liking a product (or being polite in falsely claiming to) is not the same as putting your employee reputation on the line to push its purchase, so ask the right question. Early in a product’s existence, listen to the users, but don’t assume that their worldview is representative enough to simply give you a list of design features – it’s your job as a vendor to create a broadly useful product instead of letting notoriously process-challenged users take you down a rabbit hole. The easiest focus group for a mature product is the market, which is either buying it or not, and those who look but take a pass will hopefully offer feedback. The bottom line here is listen to your users when considering minor product tweaking, but show some bold leadership in doing more than just coding their self-serving feature requests.


From Charlie Covin: “Re: Vince Ciotti interview. It brought a smile to my face since I was one of the installation directors who botched a couple of installs in the 1970s before getting it right. On the other hand, thanks to Vince and the many SMS alums for getting me started in a 40-year healthcare IT career.” Charlie’s work history includes SMS, HBO, IDX, HMA, Superior Consultant, and finally Eastern Connecticut Health Network, where he retired in 2013 after 11 years as VP/CIO. Vince has heard from quite a few industry long-timers and copies me on his replies to them. The lesson for relative industry noobs is that (a) quite a few people illogically find their way into health IT and then stick with it for life; (b) the career turns are circuitous as the industry evolves; and (c) those in the industry should create themselves a health IT network of folks and avoid being a jackass since it’s a small, close-knit community where reputations, both good and bad, travel quickly.

From Is Greed Really Good?: “Re: EHR vendors. They are finally getting called out for creating physician burnout.” EHR vendors created the product that the market demanded of them. You’ve missed the point that it’s that market that is greedy, not the software companies who operationalize its physician-unfriendly rules. In fact, I will posit that the most-responsible greed is that of physicians themselves, who happily signed up as the widget of production of insurers, lapped thirstily at the government’s Meaningful Use cash trough, and sold their practices to hospitals and private equity firms to become lackeys, all in their naive pursuit of the almighty dollar (there’s nothing wrong with that, but there’s also no reason to whine afterward). Their gates were stormed with no casualties other than the loss of a few invader dollars spent bribing their way in. Some doctors are incredibly naive despite being enrobed in professional arrogance, allowing themselves to be played like a fiddle by everyone from cute opioid drug company reps to online pharmacies that milk their obedient prescribing authority as a key business concept. They chose their bosses, their bosses chose their tools, and thus we have doctors who think EHRs missed their intended target when in fact they hit a bulls eye, just not the one they want. Hang out a shingle, stop taking insurance, use whatever EHR you want or paper charts if that makes you happy, don’t worry about federal carrots and sticks, get to know your patients even if your potential panel is only those who are willing to pay you out of their pockets, and watch the burnout dissipate.

David Meyers, MD Answers a Reader’s Question About Misdiagnosis


A reader asked a question of David Meyers, MD following his HIStalk interview, wondering how much misdiagnosis is caused by the provider not having adequate information vs. not following clinical guidelines. Also, whether how much of the needed information could come from the EHR vs. from further tests or surgery. David provides this response:

There are no simple answers to the questions, because there is no single diagnostic approach that describes the entirety of identifying the cause of a patient’s illness. Identifying a lesion on an X-ray or CT scan, or a rash on a patient’s skin or cancerous cells on a pathology slide are different from the process of collecting information from a patient about her symptoms and signs via the history of the illness, the physical exam and diagnostic tests, and synthesizing a diagnosis from that information. But all are forms of diagnosis subject to error.

The diagnostic process can be viewed as having two broad elements – individual / human factors and system factors – which interact to lead a clinician to a name for the patient’s illness. While data on the frequency of misdiagnosis is uncertain and dependent on the setting and source of the information (hospital, clinic, autopsy reports, self reports, malpractice data, etc.) the range of frequency of misdiagnosis is thought to be somewhere between 5 and 30%.

In an attempt to identify the causes of diagnostic errors and their frequency, Schiff and colleagues published an analysis of 583 diagnostic errors (mis-, missed, and delayed diagnosis) self-reported by physicians in response to a questionnaire (Diagnostic Errors in Medicine, ARCH INTERN MED, 169:1881-87 (2009). Using a tool to specify where in the diagnostic process an error occurred, they found that test-related factors (delay in testing, wrong tests and dealing with the results accounted for 44% of the diagnostic errors; ~30% were related to assessment and synthesis of the data obtained. The most common process failure was failure or delay in considering the diagnosis. These are largely on the individual / human factor side, although system factors such as lack of time to spend with the patient, distractions, fatigue, flawed results reporting processes, lack of access to old medical records, etc. also play significant roles.

Most EHRs currently in use are seen as inadequate to the needs of the doctors, nurses, and others who use them. Created primarily to be tools for billing, they are not yet clinician-friendly and usable enough to allow for easy navigation to find information, nor are they sophisticated enough to synthesize the data and help the doctor craft a list of important diagnostic possibilities. There are, however, several apps called differential diagnosis generators which can give a list of possible diagnoses when information on symptoms and physical findings is put in by the physician. There are also versions of these apps available to patients. 

And in terms of powerful forces to reduce diagnostic errors, an engaged and informed patient is thought to be one of the strongest. Asking “what else could this be?” and other questions can be a very useful way for patients to influence the doctor’s thinking. See the “Resources for – Patients” link on the web site of the Society to Improve Diagnosis in Medicine for a toolkit to use at the visit with the doctor.

HIStalk Announcements and Requests


An encouraging one-fourth of poll respondents credit their mobile device with life-changing health improvements. Folks called out MyFitnessPal and Fitbit for tracking nutrition and heart rate, smart watch integration with continuous glucose monitoring, drug management, patient portal communication, Kardia for monitoring atrial fibrillation, the 7-minute workout, and Pokemon Go and 5K training apps.

New poll to your right or here: Has your employer conducted a layoff in which older or sicker employees seemed disproportionately represented?

I’m amused at hospitals that brag that they chose their new executive after a “nationwide” search, like they sent teams out to scour every backwater town for candidates. Are the locals impressed that they didn’t just run a Craigslist ad or hang a flyer on the town lamppost?

Virtual show of hands – who knew that GroupWise email is still being sold and maybe even being used by some hospitals?


September 19 (Thursday) 2:00 ET. “ICD-10-CM 2020 Code Updates.” Sponsor: Intelligent Medical Objects. Presenters: June Bronnert, MSHI, RHIA, director of terminology mapping, IMO; Theresa Rihanek, MHA, RHIA, classification and intervention mapping lead, IMO; and Julie Glasgow, MD, senior clinical terminologist, IMO. The 2020 regulatory release is right around the corner. Join IMO’s top coding professionals and thought leaders as they discuss new, revised, and deleted codes; highlight revisions to ICD-10-CM index and tabular; discuss changes within Official Coding Guidelines; share potential impacts of the code set update; and review ICD-10-CM modifier changes.

September 26 (Thursday) 2 ET. “Patient Education Data: A Key Ingredient for Improving Quality and Patient Experience.” Sponsor: Healthwise. Presenters: Victoria L. Maisonneuve, MSN, RN, director of the Nursing Center for Excellence and Magnet program, Parkview Health; Marta Sylvia, MPH, senior manager of quality improvement and outcomes research, Healthwise. Healthcare data is everywhere! It’s scattered across various systems and in countless formats, making it difficult to collect and glean actionable information. Knowing where to start depends on what your organization wants to accomplish. Vicki Maisonneuve will share how her team analyzes data around the use of patient education. By combining different data sets, she can easily identify trends, gaps, and opportunities to improve quality and patient experience across Parkview Health.

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


  • United Health Services (NY) will go live with Epic in 2020.
  • Big Sandy Medical Center (MT) will go live with Evident in October 2019.
  • Crozer-Keystone Health System (PA) will switch from Cerner Invision to Cerner Millennium in 2020.
  • Missouri River Medical Center will replace MedWorxs with Evident EHR in October 2019.
  • Logansport Memorial Hospital will implement Cerner on May 1, 2020, replacing Meditech.

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



Curt Thornton (Quantros) joins Healthx as chief revenue officer.

Announcements and Implementations

Sioux Lookout Meno Ya Win Health Centre goes live on the new Vocera Smartbadge.

Privacy and Security

AMA describes its ideal privacy framework that places the patient first in supporting their fundamental right to obtain their complete medical record, but they believe those same patients aren’t smart enough to “understand what they are consenting to when they grant permission to an app to access their information.” AMA also wants the federal government to require EHR vendors to vet API data access requests and to give requestors only the information they need, such as insurers that request the entire medical record for unrelated data mining and threatening to file a data blocking complaint if they don’t get it. I’m finding myself sort of agreeing with AMA, although they don’t do a good job convincing patients that their motivation is anything but self-serving.



A reader alerted me to a new HFMA podcast (#2 in the newly launched series) in which Epic CEO Judy Faulkner is the interviewed guest. I enjoyed it despite the podcast’s imitative “we’re just chatting over coffee” format that puns the host’s name (HFMA CEO Joe Fifer). Fun items from the fairly short and breezy conversation:

  • Judy says it was hard for her husband to see her change from wearing jeans and tee shirts with no makeup to dressing professionally when she started Epic.
  • She had to figure out how to write contracts, policy manuals, and budgets (“we don’t have any”), and whether to accept outside investment or go public (“nope”).
  • She says a visiting HR VP asked her how to maintain the culture, and she said “nothing,” with Judy claiming to be unaware that Epic’s culture is different from that  of other companies. Judy teaches a six-hour course on company culture and each person’s role in it.
  • Skipping a monthly staff meeting requires the employee to get a signoff from their team lead, President Carl Dvorak, and Judy herself.
  • She asks employees to choose the top reason they are there, and while new hires usually chose “money” because they haven’t seen the big picture yet, they need to eventually understand that everybody’s #1 answer should be the same as Judy’s as “the customer.”
  • It’s always a challenge to stay focused on strategic items despite fires that need to be fought. She says it’s the Yellow Brick Road and you just have to keep walking on it. When she has to make a good decision, she looks ahead 25-50 years, decides “what would be good for those folks,” and then works back.
  • She doesn’t think about employees as young – they are hired from tests in which they prove that they are articulate and competent, and once hired and trained, they are treated like everybody else.
  • Epic does not have budgets, instead advocating, “If you need it, buy it. If you don’t need it, don’t buy it.“ She developed that practice when someone told her they needed to spend $2 million of leftover budget and couldn’t return it because they would then get $2 million less the next year. Or they needed to buy something immediately, but didn’t have the budget. “Let’s not go that path,” she said. If someone makes a mistake in spending judgment, she likes to catch it early so the person can learn from it.
  • Judy laughed when asked how she avoids thinking she’s done everything she can do with Epic, asking, “Is this a joke?” She says there are always new areas and new projects, so now Epic is working harder on claims and adjudication, specialty labs, retail clinics, research via the Cosmos program, and new types of customers.
  • “The thing that bugs me is that I haven’t found a test for [curiosity],” since results come from curiosity paired with aptitude.


Alex Scarlat, MD – who wrote the HIStalk “Machine Learning Primer for Clinicians” series – suggested that I take a look at, a free website that extracts 5.7 million Unified Medical Language System concepts from free text, all from within a browser window (which then also supports voice input). Above is my result from pasting in a medical school’s sample HPI.


@Farzad_MD and @EricTopol question a study run by JAMA Dermatology that claims an AI model can predict non-melanoma skin cancer by looking at EHR data such as diagnoses and ordered medications, noting that only 1,829 patients were analyzed, the risk prediction covered only one year even though most cancers grow slowly, the control group was chosen in a scandalously unsound manner, and the model was heavily dependent on the medication list even considering that most meds are not relevant to skin cancer. Note to journal editors and investors – hire an expert in statistical analysis and AI to vet claims instead of assuming that the author or founder knows what they’re talking about and is being honest about it, or at least get peer reviewers who can sort it all out. 

A study published in Lancet Digital Heath finds that clinicians with no experience in medical coding or deep learning can create clinical classification algorithms that perform well at diagnosis.


England’s Daily Mail cooks up a clickbait headline to describe for a rather benign development – EDs will give patients a four-minute, tablet-based questionnaire to answer questions about their complaint to save nurse time. The paper dragged up a professor to make a generic, mostly irrelevant statement decrying computers replacing clinicians. Here’s where newspapers and news websites are guilty of the “fake news” claim – the headline screams that the practice is “controversial” because it goaded one guy into saying so, then later claiming that “NHS bosses were condemned” for recommending the use of Alexa for obtaining health information without saying exactly who condemned them and to what extent. I’m wary of any publication that makes ridiculously unquantified statements in claiming response from “the XXX community” or claiming some broad support or criticism in trying to push their own conscious or subconscious agenda (whether it’s political or simply to force readers to click by misleading them). My guess in this case is that it’s the same questions a nurse would ask but who would add little value in simply writing down the answers.

A nursing instructor and author declares in her New York Times opinion piece that the American medical system is “one giant workaround,” as executives mandate policies and procedures that don’t work or take too much precious time. She calls out the use of scribes to work around EHR design flaws, mentions medication barcode scanning problems that force nurses to cheat, and claims that the Affordable Care Act is a kludge that works around our reluctance to provide healthcare to all citizens.

Sponsor Updates

  • LiveProcess and Mobile Heartbeat will exhibit at Disaster Planning for California Hospitals 2019 September 10-11 in Pasadena.
  • SailPoint names Matt Mills (Oracle) as chief revenue officer.
  • Meditech will host the 2019 Physician and CIO Forum September 18-19 in Foxborough, MA.
  • Waystar will exhibit at the Universal Software Solutions Users Conference 2019 September 10-11 in Grand Rapids, MI.
  • Netsmart will exhibit at the ACMHCK Annual Conference September 11-13 in Wichita, KS.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the AWHONN Ohio 2019 Section Conference September 12 in Cleveland.
  • PatientKeeper will exhibit at AHIMA19 September 14-18 in Chicago.
  • T-System will exhibit at the2019 TORCH Fall Conference & Trade Show September 10-12 in Cedar Creek, TX.
  • Prepared Health will exhibit at Health Catalyst’s HAS19 Digital Innovation Showcase September 10-11 in Salt Lake City.
  • FDB adds Redox’s API to its Meducation app, giving users the ability to transfer patient data from the app into Epic.
  • Surescripts will exhibit at the 2019 Health Care Executive Group Annual Forum September 9-11 in Boston.
  • National Decision Support Corporation Product Manager Ben Gold will co- present “Buy vs. Build in Establishing a PBM Program” September 19 at the Society for the Advancement of Blood Management conference in Baltimore.

Blog Posts



Mr. H, Lorre, Jenn, Dr. Jayne.
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Weekender 9/6/19

September 6, 2019 Weekender 2 Comments


Weekly News Recap

  • Cerner lays off at least 250 employees as part of a cost reduction effort intended to deliver investor-promised operating margin targets.
  • OptimizeRx acquires RMDY Health.
  • AMA releases 2020 CPT, which includes several new codes to cover digital communications with patients. 
  • The Commons Project Foundation announces plans to work with partners to develop an Android alternative to IOS-only Apple Health Records.
  • ONC chooses The Sequoia Project as Recognized Coordinating Entity for TEFCA.
  • AMA and AHA ask for changes to proposed HHS rules that would force hospitals to share medical records with their patients, expressing concern that patients won’t understand them or that they won’t be aware of the possible exposure of their information to third-party apps.
  • Walmart launches a standalone health clinic pilot that will offer primary care, dental, labs, X-ray, audiology, and mental health counseling.

Best Reader Comments

[Regarding the Vince Ciotti interview] Wow, what a great interview! Also, THANK YOU for compiling his PowerPoint presentations into one PDF document! Vince is right! “You can only learn from the past. You can’t learn from the future. It’s not here yet. The mistakes made in the past will be made in the future unless you learn from them and change them. It’s such a priceless thing.” As a young female millennial in healthcare IT, I am appreciating this wisdom and am determined to go through all 1,438 slides. Thanks for conducting a great interview! Wonderful answers Vince! (Weird_Female_Millennial_JCV)

Thinking about the situation for two seconds, many health IT discussions about burnout make no sense. Has burnout among medical assistants increased a huge amount since EHRs or EHR-heavy requirements were put in? Not really, so the source here is probably not the EHR. What’s the rate of burnout among VA staff, who have an EHR that on the clinical side is hugely unusable? It’s about 1/2 that of elsewhere. So it doesn’t seem like the EHR is a driving factor here. Why does your job suck? Probably management. If management came by with a survey asking why your job sucked, would you check the box that says “management sucks?” Only if you were a baby in the corporate world.(tEHRibble)

M&A is not an eventuality, it’s a deliberate strategy. It is so across all industries, including hospitals. How does any business grow in a zero-growth industry? M&A. Any company’s mission and responsibility lies with its shareholders. Some folks struggle with the realization that healthcare is not an altruistic endeavor, not any more at least. (El Comadante)

The reason that you don’t have to ask “Star Trek” computers three times is that the “Star Trek” computers understand meaning. This is what is missing from all the classic voice recognition systems to date. (Brian Harder)

Watercooler Talk Tidbits


A survey by the UK’s Royal Society for Public Health finds that the most toxic feature of social media – even more so than the content posted by users — is the “like” button.

An oncologist in Australia admits that she was overly influenced by “the opioid industry” when she entered practice in the early 2000s, where drug company reps casually convinced her that the company’s opioid was safe while paying for her journal subscriptions and lunch, which was a small investment given that her resident’s father was flown by a device manufacturer to a Scottish castle to discuss coronary stents. She recommends that doctors be educated on “the insidious influence of drug companies” that vie for their attention when they have little time to critically evaluate company claims. 

Scammers are using AI-powered voice impersonation software to call company insiders and convince them to transfer money to foreign accounts or to divulge sensitive internal information.

Rennova Health, the publicly traded (but Nasdaq-delisted) lab and software company that bought and closed Jamestown Regional Medical Center (TN) after walking away with employee tax and Social Security withholding, confirms that is behind on employee paychecks at the recently acquired Jellico Community Hospital (TN) and has cancelled the employee health insurance plan while continuing to withhold their premium payments. Rennova Health’s CEO, an Irish citizen who lives in the Bahamas, sued a Tennessee state senator in July 2019 for calling him an “Irish gangster” who came to Tennessee to cheat locals after the company closed JRMC. His primary business interest appears to be a chain of toxicology labs. Several struggling rural hospitals have been acquired and eventually closed by similar lab companies that are anxious to bill at higher hospital rates, which lasts only a short while before insurers stop paying. RNVA shares are trading at $0.0001, valuing the company at basically nothing.


Just because you can doesn’t mean you should. A 74-year-old rural Indian villager becomes the world’s oldest new mother after delivering IVF-created twin girls. Mom, who was hospitalized for her entire pregnancy, says she was inspired to give birth 30 years after the onset of menopause when a 55-year-old neighbor became pregnant. Dad is 80.

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