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News 5/10/19

May 9, 2019 News No Comments

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Harris Healthcare acquires clinical communication and collaboration software company Uniphy Health for an undisclosed sum.

Uniphy Health merged with PracticeUnite in 2016.


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

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

Acquisitions, Funding, Business, and Stock


The private equity arm of Audax Group acquires The Chartis Group, a Chicago-based health IT advisory firm, from RLH Equity Partners.


TransformativeMed will use a Series A funding round of $6 million to expand sales and marketing efforts for its Cores clinical workflow apps for Cerner Mpages.


Home health testing company LetsGetChecked raises $30 million in a Series B round led by LTP. The New York City-based company has raised $42 million since launching five years ago. It also offers a companion app to help consumers track and analyze their health, lab, and wearables data.

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Novant Health (NC) launches a digital health and engagement division to enhance its ability to virtually connect with patients from anywhere at any time. SVP and Chief Digital Health and Engagement Officer Hank Capps, MD and Senior Director of Digital Health and Engagement Stephanie Landry will head up the new division.



Capsule Technologies names Hemant Goel (Spok) CEO.


Howard Wilson, MD (Castlight Health) joins Zynx Health as SVP of customer success.


Medhost promotes CFO Ken Misch to the additional role of president.


  • The Connecticut Dept. of Social Services selects analytics software from HBI Solutions.
  • Quorom Health will implement RCM technology and services from R1 RCM across 26 hospitals.
  • St. Joseph’s/Candler (GA) selects wayfinding technology from Connexient.

Announcements and Implementations


Hardin Memorial Health (KY) becomes the first hospital to go live on IBM Watson Imaging Patient Synopsis, which provides radiologists with a summary of relevant patient data from a variety of contextual sources.


Appalachian Regional Healthcare implements tele-ICU capabilities from Advanced ICU Care at its 12 hospitals in Kentucky and West Virginia.


A new KLAS report on global EHR market share finds that:

  • Epic added more beds in 2018 (11,666) than any other vendor, most of them coming from its regional wins in Singapore, but otherwise Epic signed fewer than its average number of new contracts at just four.
  • Cerner signed two counties in Sweden as its first Millennium deployment in the Nordics, but otherwise sold no Millennium deals outside of Europe.
  • Agfa Healthcare, Dedalus, and InterSystems won eight or more decisions each.
  • Latin America saw a large number of EHR purchases, with MV leading all vendors.
  • Few deals were signed in the Middle East and Africa, with Health Insights winning two deals and InterSystems one.
  • InterSystems signed three hospitals in China.
  • No new contracts were signed by hospitals in Canada, although four legacy Meditech customers contracted for an upgrade to Expanse.



The American Medical Association’s annual physician practice survey finds that for the first time, employed physicians outnumber those who have ownership in their practices. Physicians are shifting to larger practices (mostly in abandoning solo ones) and more are working for hospitals.


Cedars-Sinai (CA) equips its post-op patients with Fitbits to encourage them to walk 1,000 steps around the hospital per day after a study led by Timothy Daskivich, MD found an increased step count led to a reduction in length of stay. The hospital has also created an app that ties step counts in to tours of artwork found throughout the hospital.

Sponsor Updates


  • Hyland team members spend time helping out at St. Mary’s Food Bank as part of the company’s Volunteer Time Off program.
  • Access announces that its EForms user interface now integrates with Meditech Expanse.
  • Elsevier Clinical Solutions will exhibit at the American Association of Immunologists conference May 9-13 in San Diego.
  • EClinicalWorks will exhibit at ASCA 2019 May 15-17 in Nashville.
  • HGP publishes its “Health IT April Insights.”
  • Ambient Clinical Analytics and Iatric Systems partner to deliver point-of-care FDA Class II-cleared solutions to health systems utilizing Meditech EHRs.
  • Imprivata and InterSystems will exhibit at the Healthcare Providers Transformation Assembly Millenium Event May 14-15 in Nashville.
  • OnPartners profiles Information Builders CEO Frank Vella.
  • Intelligent Medical Objects will exhibit at the Netsmart Connections 2019 User Group Meeting May 12-15 in Washington, DC.
  • Halifax Health (FL) expands its use of Access e-forms management to include Meditech-integrated and tablet-enabled informed consent solutions in its Cardiac Catheterization Lab and Anesthesiology Department.
  • DrFirst will work with enterprise pharmacy system vendor PDX to offer pharmacies technology that will help them increase the fill rate of new prescriptions.
  • OptimizeRx will present at the Oppenheimer Emerging Growth Conference May 14 in New York City.
  • FDB unveils new global branding.

Blog Posts



Mr. H, Lorre, Jenn, Dr. Jayne.
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Readers Write: The Big Fib

The Big Fib
By Weary Healthcare Traveler

On Tuesday, May 7, Don Rucker appeared before the Senate to garner support for ONC’s new rule relating to 21st Century Cures. Although he used complex language and invoked incantations of magic like JASON, Restful Services, APIs, AI, ML, and OAuth2 to US Senators who all just nodded and went back to their scripted questions, this is my summary of what he was really championing in that hearing.

The Baseless Promise that Apps and APIs will revolutionize health and healthcare records. There is no evidence to suggest this at all after almost a decade of patients having the ability to download their own medical records, billions of dollars of venture capital spent on startups, and a wide range of APIs available across all the major healthcare vendors. This includes both standard FHIR and proprietary APIs available through agreements with third parties.

The Big Stick of severe penalties for the new vague crime of data blocking of patients and venture capitalists seeking data perpetrated by doctors, health systems, or technology developers who submit to ONC in support of their ever more ridiculous programs which continue to torture doctors in the name of CMS quality management and payment programs.

Of course, given the lack of any traditional enforcement for such a nebulous crime, ONC’s plan is to invoke False Claims Act laws to create a Sword of Damocles over any vendor or steward of patient data who does not submit fully to the Baseless Promise and the new rule.

The False Flag of claiming patient data rights as the primary rationale for their new rules, as ONC has fully submitted to the venture capitalists of Silicon Valley and other special interests who wish to exploit patient data on a massive scale. The Big Stick is big, but of course specifically designed by ONC to not be big enough to reach the new bread of app developers mentioned in The Baseless Promise who would abuse patient data through complex and intentionally deceitful terms and conditions (they are not covered by HIPAA or ONC Certification.

Rucker misleads the Senate by claiming that OAuth 2, a beautiful standard that works in other industries, will provide protections for patients when in fact he simply means that the patient would retype their passwords and afterwards the same rules that apply to Facebook, Google, Cambridge Analytica and the like would magically protect our most sensitive and personal data. It won’t.

The Big Hero as ONC tries to claim the high ground defending all that is right and just. And,but for the evil forces of vendors, health systems, and wicked data blockers would be able to fix up healthcare in a matter of months if everyone just got behind their new rule. Per Rucker previously, to wait even a month for additional input would have dire consequences to patients.

The Big Villains are said to be EHR vendors, who through their mandated support of ONC, CMS, and other payer requirements, try to help doctors and health systems cope with a fundamentally polluted reimbursement and regulatory system and are cited as the cause of burnout as thanks for their efforts. These vendors will inevitably stand accused under these new regulations for not fully supporting the data broker industry and be subjected to The Big Stick.

And, oh, gag me – this notion that EHR vendors have gag clauses is ridiculous. Asking customers not to publish trade secret intellectual property is not a gag clause. Health systems and provider contracts almost always tip the other way, restricting vendors from sharing any confidential information they may have. That would include basics like fee schedules, business expansion, and acquisition plans, but also observable medical errors that providers and pharmacists make on a routine basis even after overriding a warning to stop and reconsider. That’s where the real gag clauses exist.

If EHR vendors actually had gag clauses, I doubt you’d have the level of ONC- and AMA-sponsored EHR bashing you have today. Let EHR vendors protect their intellectual property and use well-established methods through Patient Safety Organizations for any real EHR safety problems.

The Evil Empire is healthcare providers and systems who themselves hoard data with a fearful eye toward outsiders who seek to exploit it. Fearful because HIPAA will crush them if they make even an innocent mistake in their stewardship of patient data. And now fearful that patients won’t understand how their data, their family history, and their genetic information was permanently released to the Internet and sold many times over when the terms and conditions of an app seemed to assure patients it wouldn’t do so when the patient connected the app to their doctor’s EHR.

All this in spite of health systems now offering online portals and apps that rival any travel, banking, or self-serve app found in any other industry. Going back to the Baseless Promise, only about 35% of patients even sign up to use their apps and portals at the urging of their doctors and health systems which, like airlines, also benefit from patient self service.

So, finally, The Big Fib. Through this new rule and under the flags of innovation and healthcare reform, our government (this administration as well as the previous) is on a path to sell out American patients to a data broker industry that has spent over a decade and countless millions of dollars lobbying for unwitting and uninformed patients to allow their data to be used in ways they can’t even imagine. This False Flag above is in large part sponsored by the a data broker industry worth hundreds of billions of dollars seeking hundreds of more billions.

What should we be focused on instead of ONC’s “Game of Thrones” heroes and villains narrative?

The healthcare industry is largely built on a model of cost shifting from patients without coverage or covered by government-subsidized programs to patients with employer-sponsored commercially insurance. That worked out in a world with more commercial than government subsidized patients. With the Medicaid expansion, there are now more people on subsidized plans and fewer on commercial plans, and thus we have run out of the ability to shift costs. Prices and deductibles are rising fast because neither insurance companies nor healthcare providers want to take a hit to revenue or their bottom lines.

There is not a quick solution here because it is more beneficial for politicians to campaign on the issue of healthcare coverage than to come together to create a bipartisan solution. We need more than a Baseless Promise to fix healthcare. We need to press Washington to unwind this hairball of a reimbursement system.

Healthcare providers seek to enhance and protect their relationships with patients and often do so by using data and services in beneficial ways, leveraging their unique relationship with the patient and their stewardship for the patient data under HIPAA. This can be used for good and as well for evil. Rethinking regulations to protect patients by enforcing rational HIPAA-protected interoperability including both doctor to doctor exchange, but also patient to their chosen apps with full awareness, audit abilities, and responsibilities similar or under HIPAA for those app providers. Force apps to protect patient data in a reasonable and accountable manner similar to health providers.

Get over the fixation on EHR vendors as villains. They have done more to dramatically enhance patient outcomes, reduce medical mistakes, and improve convenience, consistency, and compliance in healthcare over the last decade than any other technical innovation. Spend a moment contemplating this array of regulatory and payer requirements and the explosion of medical knowledge unaided by automation. If enough providers hate their EHR when EHRs are being built to deal with the rules providers choose to submit to, then maybe they’ll stop buying certified EHRs and take the penalties as CMS dictates.

If ONC and DOJ continue to abuse vendors who work in good faith to support these complex and ambiguous programs on ridiculous timeframes, maybe those vendors should simply decide to no longer offer certified EHRs. What would happen in this industry if ECW, Greenway, Allscripts, Epic, and Cerner walked away from the ONC certification program?

Maybe most important of all, stop using exaggerated anecdotes and innuendo to “make your case.” As leaders of ONC, CMS, Congress, and industry, it’s time to put some science and integrity to work in crafting a better-functioning health system for Americans. Many billions of API transactions and hundreds of millions of patient records are being transported across health systems and with apps, also made available directly to patients every year. To hear senators read from their scripts that “we still don’t have interoperability” is embarrassing.

Will it be better 10 years from today than it was 10 years ago? Of course it will, but not if we continue to exaggerate and fool ourselves to the benefit of those who continue to seek to exploit patients and their data. This willful campaign of misinformation will likely lead to a backlash by patients when they realize their government has sold them out to data brokers.

EPtalk by Dr. Jayne 5/9/19

May 9, 2019 Dr. Jayne 6 Comments

I hope EHR vendors are busily refining and provider organizations are busily implementing software that allows providers to see relative drug costs at the point of care, because we’re about to start seeing a lot more conversations around it. HHS Secretary Alex Azar announced regulations that will require pharmaceutical manufacturers to modify drug ads to include list prices if medications cost more than $35 for a one-month supply.

Since the list price often bears no resemblance to what patients actually pay for a drug because of pharmaceutical benefit manufacturer and pharmacy kickbacks, this is going to be confusing for patients. On the other hand, the price threshold might deter patients from asking physicians to prescribe everything they see on TV. The administration is apparently considering allowing US residents to import drugs from other countries under certain circumstances.

Although drug makers claim the requirement infringes on their right to free speech, Azar noted that the requirement is similar to requiring auto makers to display a standard sticker price. The top 10 most-advertised drugs have prices ranging from $488 to $16,938, which should give sticker shock to any patient who might be thinking about following the “ask your doctor” instructions. The mandate, which does not cover print or radio ads, applies to all branded (non-generic) drugs that are covered by Medicare and Medicaid.

The pharmaceutical industry spends over $4 billion annually on TV advertising. Interestingly, enforcement of the rule depends on drug makers suing each other for unfair trade practices. The regulations go into effect 60 days after being published in the Federal Register.

This comes right after the announcement that a new drug is coming to market that will sell for $2 million. The drug is for a rare muscle-wasting disease that typically kills affected individuals by the time they turn two years old. The gene therapy is produced by Novartis AG to treat spinal muscular atrophy. The manufacturer felt it could be cost effective at a price tag of between $4 million and $5 million, so the proposed $2 million pricing is a relative bargain. It’s impossible to put a price tag on the value of a child’s life, but the benefit is unachievable if none of the affected patients can afford it. Not to mention that even if insurance covers the drug, patients and families will almost surely go over their lifetime insurance benefit caps.


From Dallas Gal: Re: your recent mentions of Fem Tech. Have you seen the NextGen Jane smart tampon platform?” I hadn’t seen it, but I’m wondering if the software company of the same name is having heart failure over the potential trademark infringement. The startup has raised more than $11 million to date. Users mail in a sample of cells collected during the menstrual cycle (which the company refers to as “a natural biopsy of the female reproductive tract”) so that they can be analyzed to determine if endometrial cells are present. The company’s font and logo color selection even mimics that of the EHR company before its last rebranding maneuver. The non-EHR product is being readied for commercial launch in 2020. I’m betting it gets a rename before that happens.


We’re finally out of the woods as far as flu season, now that it’s May. There are only three states experiencing widespread flu activity and ambulatory visits for flu-like illnesses are down to less than 2%. Even though overall activity is lower, there have been slight increases in hospitalization and an additional five pediatric deaths have been reported. I saw two patients today that I would have sworn would be positive, but they weren’t, so there is still a fair amount of influenza-like illness out there. Hang in there, clinical folks, the end is in sight.

Kaiser Health News reports on proposed regulations that would lead to the ability for patients to compare prices across hospitals and health care facilities using data sent to their smartphones. It could take several years to be able to handle the data in a patient-friendly form and it’s unclear how patients are going to be able to make sense of the craziness that is healthcare pricing.

We had a maddening encounter in the office today with a potential patient who was irate that we could not tell her the exact cost of a hypothetical urgent care visit for a hypothetical diagnoses that she had already arrived at herself. We can tell patients our charge, and we can tell them the price for cash patients without insurance, but we don’t have the ability at the point of care to see what various payers have contracted or where patients stand with regards to their deductibles. Our billing office can figure that out, but of course this patient was in the office after normal billing office hours.

The patient made a scene in the waiting room and my staff was extremely upset after the encounter. Despite doing all the right things, they couldn’t de-escalate the situation. Even the photocopier repair person who was there said the patient was out of control and offered to talk to our management to make sure the staff didn’t get in trouble.

The incident led to an interesting conversation with the staff later in the day about the commoditization of health care. My staff is representative of the average ambulatory practice staff and they have no concept of federal regulations, proposed rules, or comment periods. Since most of them are fairly young, they’ve had few experiences with the healthcare system outside of care in our practice, which waives co-pays and patient responsibility balances for employees as a benefit of employment.

Despite the feds continuing to beat the drum on transparency and portability, we’ve not been able to achieve electronic health records portability in the last decade and a half we’ve been working on it, so it will be interesting to see how long it actually takes. I’m sure at some point in the future I will look back on this post and either wonder where things continued to go wrong or be utterly surprised that we figured out how to solve the challenging problems that stand in the way.

What do you think about true price transparency? Will people really shop around for their healthcare? Leave a comment or email me.


Email Dr. Jayne.

Morning Headlines 5/9/18

May 8, 2019 Headlines No Comments

Harris Healthcare Group Acquires Uniphy Health to Extend Its Suite of Clinical Solutions

Harris Computer Systems acquires clinical communication and collaboration software company Uniphy Health.

Audax Private Equity Announces Recapitalization of the Chartis Group

Audax Private Equity acquires the Chartis Group, a Chicago-based consulting, analytics, and technology firm, from RLH Equity Partners for an undisclosed sum.

Elizabeth Holmes’s Possible Defense in Theranos Case: Put the Government on Trial

Court documents reveal lawyers for Elizabeth Holmes are considering mounting a defense that accuses Wall Street Journal reporter John Carreyrou of exerting undue influence on the regulatory process, leading agencies like CMS to issue biased findings against the company.

HIStalk Interviews Stephen Brown, Director of Preventive Emergency Medicine, UI Health

May 8, 2019 Interviews No Comments

Stephen Brown, MSW, LCSW is director of preventive emergency medicine at University of Illinois Hospital and Health Sciences System.


Tell me about yourself and your job.

I’m director of preventive emergency medicine at University of Illinois Hospital and Health Sciences System. I run the Better Health Through Housing program, which identifies the chronically homeless in our emergency department and transitions them into permanent supportive housing. We’ve been doing this since 2015.

My background is in technology. I worked for Motorola for 13 years in a variety of capacities, starting off as a junior systems engineer and then ending up being a district sales manager. I was also a product development manager and a senior account executive. I transitioned into healthcare in 2005, working in the emergency room at the University of Chicago as a social worker on the South Side of Chicago, surrounded by 10 of the 14 poorest neighborhoods in the state of Illinois. Then I transitioned to University of Illinois in 2011 to start a preventive emergency medicine program.

What motivated you to move from a technology and sales career to becoming a social worker?

I always loved the technology, but being in sales, you’re only as good as your last sale. I just got tired of living under quota. Plus, after doing some career development things, I discovered I was an introvert and that was why sales was so painful for me. [laughs]

It was a career transition, a mid-life transition. By 40, I decided I wanted to do something that was more altruistic. I originally was going to become a psychotherapist and start my own private practice, but I worked for Michelle Obama at one point in my career at the University of Chicago. We had some discussions and I decided that I wanted to do bigger work than just one-on-one counseling. This was an opportunity to do more population health work.

Does simply giving someone who is homeless a place to live help reduce the high healthcare costs they incur, or is the next step to identify and address any underlying behavioral or dependency issues?

This partnership has been with the Center for Housing and Health, a supportive housing agency here in the center of Chicago. They have relationships with 27 agencies scattered around the city.

What we’re learning is that it’s a tiered approach. Many people will just require what we call rapid re-housing. We don’t quite have the answer, but we’re in conversation about tiering the approach based on psychiatric and substance abuse characteristics. They are medical conditions for homeless individuals. We had somewhat of a lower level. It was scattered site housing. It was permanent supportive housing, but it came with a housing case manager, somebody who’s not trained in medicine or in psychiatry. Despite that, we still had good outcomes.

Are views changing on our expensive system of providing healthcare services vs. funding social programs and public health projects that might reduce the need for them?

Some studies have been done on that. We have great sick care in the United States. We wait for you to get sick, and generally you’re going to be sicker because you haven’t had preventive services. We don’t do prevention, nor do we address the social determinants of health.

There have been a number of studies around around the world where the relative spending on healthcare is much lower. I think we spend 2.5 times per capita for healthcare here in the United States compared to other industrialized countries. Healthcare costs are excessive. I think it’s approaching now 17% of our GNP.

But the other thing that is missed is that other industrialized countries spend more on social services and on prevention services. Having a safety net in place goes a long way toward preventing people from getting a lot sicker. That’s where a lot of the attention is in healthcare now, what we’re calling the social determinants of health. If you don’t have a stable place to live, it’s difficult to manage any of your health affairs, let alone anything else in life.

We’re really good at individual care here in the United States. We focus on the individual. What has been missing in healthcare is hospitals taking responsibility for the health of the communities in which they serve. After all, I think it’s 78% of the hospitals in the United States are non-profit and must demonstrate some type of community benefit to maintain that non-profit status. That shift in focus says that we have to care about the health of the individuals coming from the communities in which we are anchored, and yet that’s been a big disconnect in healthcare.

The technology exists to be able to create community-based report cards. Hospitals should be held accountable for the health of those communities in which they serve. There’s a way to do that through clinical measures, like aggregated hemoglobin A1C in a community, blood pressure, and number of ED visits for asthma exacerbations. Those are all things that are measurable and that health IT could take an active role in bringing forth. That creates accountability for hospitals — perhaps even a collection of hospitals if they serve the same geography — to take ownership of the health of the individuals within those communities.

The alignment is clearer if the health system is also the insurer, such as Kaiser Permanente. Health systems keep getting bigger and spanning state lines. How will those mega-systems work with the many communities in which they operate?

It remains to be seen. We are seeing some activity from Geisinger and from UnitedHealthcare. United Healthcare Is working with the American Hospital Association to develop 20 new ICD-10 codes for social determinants that would be actionable. We can document these things, but unless we take action on those social determinants, they’re really not going to go anywhere. I’m in conversation with a Denver health plan right now about replicating the model that we’ve created and a number of other health systems around the country.

The most interest is coming from those integrated health systems that are both the provider and the payer. It’s in their economic best interest to prevent people from getting very, very sick. We’re beginning to get interest from managed care organizations, too, many of which are represented by larger health insurance companies.

In any state, 5% of the patients in Medicaid account for about half the budget. Generally those budgets can consume about a third of the state budget. Because we’ve been so focused on individual care, we’ve lost the forest through the trees on those. There needs to be some attention on more of a population health model, not only at the state and federal level, but also within some of those large health systems, too. There’s tremendous opportunity to manage the health of these individuals by looking beyond the walls of the hospital and saying, what is it in a community that is driving the exacerbation of disease and poor outcomes?

How you see the pacing of the buzz about social determinants of health being matched by the creation of programs that will make them useful for actually changing something?

What happens with social determinants of health is that we try to do it the old, inefficient way. We hire a bunch of people. We screen in emergency departments. We’ve had some experience doing that. We’ve only been able to hit maybe 2% of the entire ED population because we’ve done it in the manual way. Again, here’s an opportunity for tech to get involved. When you bring big data to bear on this issue, you can find lots of things that you can elevate for risk and make it actionable.

Adverse Childhood Events, or ACE, is being promoted by the CDC. The chronically homeless fit the same profile over and over again, as 60% of the chronically homeless or the homeless in general have what we call high ACE scores. It’s a 10-question questionnaire that predicts poor outcomes, the development of psychiatric illness, and early death, among a variety of things. It’s kind of astounding.

We found that our chronically homeless individuals fit the same profile over and over. You’ll find this is true in criminal justice, too. The higher the ACE score, the higher the probability that person is going to end up on welfare, will have a mental illness, will end up in the criminal justice system, and will die early. One or both of the parents had mental illness or substance abuse and it played itself out on a profile where that person ended up becoming chronically homeless and developed serious mental illness.

You can find those things in a combination of electronic medical records, in public data, and in credit data. A number of emerging companies are looking at data mining to find those folks who have elevated risk. For example, with classical homelessness — somebody who has fallen off the grid because they’ve had some financial catastrophe or income volatility in their lives — you can find those people easily in credit data. You can predict the risk of homelessness eight to 12 months before it actually happens.

The way healthcare responds to that is inefficient, but there are opportunities to find people with a high ACE score and intervene with them early, because you’re going to see it play out in a lot of different things that are going to result in poor outcomes.

I’ll give you a vivid example. When I worked at the University of Chicago, there was a lot of crack cocaine on the South Side of Chicago. We would often get women who had cocaine intoxication. They were hyperkinetic or manic. Once we allowed them to detox on cocaine, I’d go in and interview that woman. The doctors were focusing on whether or not she was going to have a heart attack, so they were looking at elevated troponin and all these medical characteristics. They had a medical course of action. They were treating the symptoms of what is a greater problem.

When I dug into it, I found that the typical scenario was that the woman that had been repeatedly sexually abused when she was eight years old by her stepfather or uncle and had undiagnosed PTSD as a result. She had a very high ACE score and we hadn’t done anything. We got her treatment for her substance abuse, but she probably needed treatment for PTSD, too.

How can technology fit into a program like yours?

The big piece of it is bridging the gap from healthcare into the community. The FHIR standard is a promising technology, but as we found with the CMMI Accountable Health Communities, there is a substantial gap in tech between health IT and community IT. Many people are still dealing with spreadsheets. If the provision of a social service or community-based services is going to be effective, we need to be able to track whether or not that person actually got the service. Then, was there a treatment effect from that service?

What we’re doing here on the West Side of Chicago with the West Side United effort — a collection of five hospitals — includes a lot of economic development. Things like wealth management classes. We’re doing local sourcing for our supply chain. We’re trying to partner with colleges to create a talent pipeline and steer kids in the community into careers in tech and healthcare.

But beyond that, we need somehow to bridge the gap. Some of the things we’ve been talking about is giving out case management solutions, so we have just one platform for the community that can provide data on the receiving end. Those are going to be some of the biggest challenges we’re going to be facing if we are really going to tackle these social determinants of health.

The other thing is that I’m a big believer in microservices and having the ability to have an app store kind of arrangement for human services. Something that is plug-and-play and easy for JavaScript programmers to integrate and exchange data with healthcare organizations. But we’re going to need some enabling technology on that. We have a grant with the JB Pritzker Foundation to do cross-sector data exchange. In order to drive clinical integration of systems, we’re going to need to be able to have some kind of common appliance that can manage the traffic and flow of messaging and interoperability between human services and healthcare. This is a particular issue here in Chicago because we don’t have a healthcare information exchange.

The other piece of is from an evidence-based public policy, to be able to track individuals and their service utilization. In an ideal world — especially with these homeless individuals that we’ve found to be very, very expensive — we’re only looking at the most obvious cases. But as a population, how could we look at their healthcare costs? We know they have elevated healthcare costs, but do we know for the entire homeless population what that looks like? We’re only looking at mostly the chronically homeless, those who have been continually homeless over for a year. We need to have more resources available to do interoperability for both clinical integration purposes and to bring together large public health data sets so we drive evidence-based public policy.

A fair amount of national empathy seems to have been replaced with resentment toward social programs and those they help. Is there a message of hope that these programs work and will be accepted?

You see these bright spots happening around the country. Bexar County, Texas, which includes San Antonio, has a psychiatric stabilization center where they divert people in psychiatric crisis to a center where they are treated. They don’t have to go to the ED or jail. There’s a lot of good work happening. It just doesn’t get publicized because it’s a little bit wonky.

My job is more public policy and aligning systems so that they talk to each other. I think that we’re going to see some tremendous benefits from those things, because no matter what your political affiliations might be, we’re discovering that at least with some of these populations, the solution is cheaper than the problem. We would all feel better about ourselves if we look at how we can care for these people in ways that will extend their lives and keep them from getting sick. It’s also the right thing to do.

Here in Chicago, we’re having extraordinary conversations with the jail, with Cook County Health, the other public hospital here, and with Illinois Department of Corrections. We’re creating a flexible housing pool that will result in more supportive housing, with about 750 new units coming online. We haven’t borne the fruit of it, but I’m optimistic that we’re going to see some major sea change in how we treat the homeless and other marginalized populations. Especially non-violent offenders. Can we offer them alternatives to prison or jail? I’m seeing a lot of work in the opioid crisis right now. The sheriff’s department is creating a diversion unit. Hospitals are learning that if you want to treat the opioid crisis, you have to go out to them. They can’t come to you.

The glass is half full, as far as I’m concerned. We’re doing a lot of great work that will bear fruit very shortly.

Morning Headlines 5/8/19

May 7, 2019 Headlines No Comments

Allscripts electronic health records unit receives grand jury subpoena

The Practice Fusion unit of Allscripts has been served a criminal grand jury subpoena regarding EHR certification and anti-kickback statute compliance, according to company SEC filings.

Providing excellent patient care remains Astria Health’s highest priority

Astria Health (WA) files Chapter 11 bankruptcy, blaming its financial situation on its EHR conversion and hiring of a revenue cycle management company that failed to meet agreed-on accounts receivables collection targets.

UMMS scandal: Medical system board chairman, two others resign as additional contract revealed

The board chair and two board members of University of Maryland Medical System resign over a no-bid software contract with Real Time Medical Systems, whose founder and CEO is former UMMS board member and donor Scott Rifkin, MD.

DispatchHealth Closes On $33 Million in Growth Financing Led by Echo Health Ventures

House call company DispatchHealth raises $33 million to further invest in its mobile app and logistics software, and expand services to more Medicare patients.

Google says its AI can spot early-stage lung cancer, in some cases better than doctors can

Google shares early data from a project with the National Cancer Institute and Northwestern University showing that its AI can detect early-stage lung cancer with equal or better accuracy than radiologists.

News 5/8/19

May 7, 2019 News 4 Comments

Top News


CMS Administrator Seema Verma invites people to tell their stories of their struggles in obtaining copies of their health records or with providers failing to share their information.

My personal experience (and that of others) is that alerting HHS, including filing an OCR complaint, is a waste of time that changes nothing, but it’s a nice thought.

Maybe CMS should require Medicare providers to post a notice on their wall that lists the information rights of patients, including a telephone number and email address to report information blocking offenders. Then fine them for non-compliance rather than just having OCR provide “technical assistance” and closing the incident.

Reader Comments

From Erudite: “Re: Cedars and Medlio. The founder is complaining about the manner in which the ‘no’ was conveyed. Why did Techstars part ways with Cedars? What credentials does the Cedars CIO have to compete with notable early-stage investors? Why is Cedars using their tax-exempt earnings to help folks play VC? They should shut down the accelerator and ask the CIO to focus on his job or go out and raise money from limited partners to run a fund.” The co-founder’s side of the story is that her struggling startup was abused in interviewing with the Cedars CIO and that she as since accumulated “multiple examples of the CIO’s unethical behavior” sent to her after her article. She’s pondering whether to go public with those examples, which I would warn might elevate her diatribe from “unfortunate” to “libelous.” I know little about the Cedars accelerator, but I recall that accepted companies get significant funding, access to internal experts, a good shot at earning a paid pilot, and the involvement of people like the CIO who actually work in frontline healthcare. I think a better view of the Cedars program would come from a company that has completed it. I’m with you on non-profit health systems using their patient-provided profits to do unrelated work, but that horse has long since left the barn and is playing excitedly in fields green with cash.

From Corrective Action: “Re: listing experience as ‘more than 20 years.’ People do that because if they put in the actual number, especially once it is 30 or more, they may not even get an interview despite being highly capable, physically and mentally sound, and ready for another 10-plus years of work ahead of them. It isn’t about math, it’s about age discrimination.” I hadn’t thought of that, although I’ll say that many of the folks who say they have ‘more than 13 years of experience’ when they have 13 years, two months are not old enough to worry about age discrimination. I have noted obvious efforts on LinkedIn to sidestep the ageism issue – lack of a photo, omission of dates for education, and listing only the most recent jobs. I’m interested in the result. Would it be like a dating app, where you can Photoshop your picture but then have your lack of transparency become embarrassingly obvious in the resulting a face-to-face encounter? Or are potential romantic and employment targets willing to waive their biases if the personal encounter goes well and thus it’s worth a shot to underplay age to earn the face-to-face?

From Medical Minion: “Re: making patient care more human. You’ve complained that front desk people are often cold and robotic to patients. Why didn’t you complain to their employer instead?” For the same reason I don’t complain when a Walmart cashier doesn’t try to be my new best friend or an Uber driver fails to provide scintillating chitchat. Healthcare has become a huge, impersonal business and those on the front lines are buried several layers deep in dysfunctional organizations that don’t treat them especially well or reward them for good customer service behaviors. I don’t hold them accountable to sprint to the front lines full of enthusiasm and empathy. Full waiting rooms ensure corporate-wide indifference.

HIStalk Announcements and Requests


Welcome to new HIStalk Platinum Sponsor Omni-HealthData, powered by Information Builders. Omni-HealthData helps health systems make operational decisions and improve the insights needed to improve outcomes and patient care. It’s a complete information management solution that gives providers and payers a 360-degree view of members, patients, workforce, facilities, community care organizations, and other critical domains. The platform, developed with St. Luke’s University Health Network, combines data integration (hospitals, physician practices, nursing home, telemedicine, financial information, etc.), data quality, and master data management that power InfoApps out-of-the-box information applications (hospital patient experience, quality and safety, balanced scorecard, physician practice dashboard, and population care analytics). It is built on the WebFocus BI and analytics platform, which also provides advanced analytics (visualization, location analytics, enterprise search); predictive analytics; and social media analytics. Customers have used its data management platform to develop integrity and integration solutions, analytics dashboards for clinics, a customer-facing portal with analytics, an self-serve reporting with visualization. Instead of learning complex tools and worrying about data preparation, users can serve themselves and quickly get answers and insights from relevant data, right when they need it. It’s easy for non-technical, mainstream users to get and analyze information on both web browsers and mobile devices.Thanks to Omni-HealthData for supporting HIStalk.

A friend who has a terminal illness whose treatment is likely to bankrupt her family (even if her insurance covers part of the cost, which isn’t guaranteed) let me know she’s getting a divorce even though her marriage is fine. Her family’s financial advisor told her to transfer their joint assets to him, divorce him, then sign up for Medicaid to give her a reasonable chance at getting the treatment that could save her life. Divorce laws are unique to each state, so I didn’t ask whether her husband is required to move out or whether his caregiver role will be affected. Our healthcare system is certainly interesting.


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

Acquisitions, Funding, Business, and Stock


The Practice Fusion unit of Allscripts has been served a criminal grand jury subpoena regarding EHR certification and anti-kickback statue compliance, according to company SEC filings. The original US Attorney’s information request came in March 2017, so presumably Allscripts was aware of at least some level of federal interest before its $100 million acquisition of Practice Fusion in January 2018.

UBiome, the high-valuation startup that was recently raided by the FBI after overbilling complaints from insurers, suspends the sale of its prescription-only microbiome tests, leaving it with just one consumer test that doesn’t require a doctor’s order (and that insurers won’t pay for). I think we’re getting enough case studies to prove that the investor-funded Silicon Valley mantras of “move fast and break things” and “ask forgiveness rather than permission” don’t work well when they try to elbow their way to the massive healthcare trough. On the other hand, we’re learning that cash-hungry doctors will prescribe just about any crap those companies sell as long as it doesn’t directly harm patients.



Ciox Health hires Pete McCabe (GE Onshore Wind) as CEO, replacing Paul Roma.

Announcements and Implementations

Post-acute care technology vendor Brightree will connect with CommonWell.

Government and Politics


FDA will hold a five-hour webinar, demo, and technical discussion of its open source, user-configurable MyStudies clinical trials data-gathering framework on Thursday, May 9. 

NIH and the Navajo Nation sign the first tribal data-sharing agreement, which will allow NIH grant recipients to continue a birth cohort study. 



The board chair and two board members of University of Maryland Medical System – whose purchase of hundreds of thousands of dollars worth of children’s health books got its CEO and the author who was also Baltimore’s mayor fired – resign over a no-bid software contract. Real Time Medical Systems, whose founder and CEO is former UMMS board member and donor Scott Rifkin, MD, provided UMMS with predictive analytics software for clinical and financial improvements. Rifkin says the one-year contract involved zero cost and he intended to extend it afterward at no charge.

Astria Health (WA) files Chapter 11 bankruptcy, blaming its financial situation on its EHR conversion and hiring of a revenue cycle management company that failed to meet agreed-on accounts receivables collection targets. The announcement didn’t name either vendor, but it signed with Cerner in January 2018

A small study finds that obese patients who were sent text reminders and provided with remote feedback weighed themselves more often and were more physically active, but 12-month weight loss was exactly the same as in the control group at four pounds.

A nurse whose son died in a car accident obtains video taken by the driver of the other car that shows first responders walking around without doing anything, rolling her son around without protecting his neck, digging through his pockets before starting treatment, and lifting him onto a stretcher by his belt loops without using a backboard. One EMS crew member was fired, another quit to go to fire school, and the EMS chief eventually resigned. 

A man who is transported to an in-network hospital with a facial injury is billed $167,000 by its on-call plastic surgeon, who is among the large percentage of doctors in that specialty who don’t contract with insurers because they don’t have to.


Four University of Arizona journalism students work with the local newspaper on a grant-funded project in which they developed an app to review businesses and tourist destinations for their access to those with physical disabilities. They also created a health site allows users to read health news, search for a clinic, and find health events.

Studies find that the elevated carbon dioxide levels found in conference rooms and classrooms impair cognitive ability, perhaps refuting my theory that meetings are mostly attended by people who aren’t all that bright. 

Sponsor Updates


  • Avaya employees assemble 50,000 meals for those less fortunate in collaboration with Rise Against Hunger.
  • San Diego Woman Magazine features Burwood Group SVP of Technology Joanna Robinson in its Power Women issue.
  • Divurgent is named a Microsoft Gold Partner.
  • Collective Medical adds the capability for users of its platform to identify high-risk infants, including those with neonatal abstinence syndrome.
  • The Tampa Bay Times features Collective Medical’s work with the Florida Hospital Association and the Florida chapter of the American College of Emergency Physicians to combat the opioid epidemic.

Blog Posts



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


Morning Headlines 5/7/19

May 6, 2019 Headlines No Comments

Kaiser Permanente Launches Social Health Network to Address Social Needs on a Broad Scale

Kaiser Permanente will leverage social services coordination software from Unite Us as part of a new Thrive Local network that will connect members with community-based services.

DirectTrust Reports Record First Quarter Results in Direct Secure Messaging as Traffic Migrates into Trust Bundles, Messaging Use Expands Beyond Referrals

DirectTrust reports several Q1 accomplishments, including 49% increases in both participating organizations and messages sent.

Tennessee Diagnostic Medical Imaging Services Company Pays $3,000,000 to Settle Breach Exposing Over 300,000 Patients’ Protected Health Information

OCR fines Touchstone Medical Imaging (TN) $3 million for potential HIPAA violations related to a 2014 incident in which one of its FTP servers was left unsecured, enabling uncontrolled access to PHI even after the server was taken offline.

Arizona changes medical records law after Republic’s story about student’s fight

Inspired by the story of a student who couldn’t move forward with life-saving surgery because of an inability to access her medical records, Arizona Governor Doug Ducey passes a law requiring providers closing up shop to to give patients access to their files or face a $10,000 penalty and the denial of future facility licenses.

Curbside Consult with Dr. Jayne 5/6/19

May 6, 2019 Dr. Jayne No Comments

National Nurses Week is May 6-12 and I want to send a shout-out to all the nurses out there. I’ve worked with some phenomenal nurse informaticists over the years. Their perspective often varies from that of physicians and their input has been invaluable on numerous projects.

I’m also grateful to the clinical nurses who have had my back, whether it was in medical school, residency, or when trying to implement EHRs. Nurses have helped me formulate strategies to get physicians on board because they understand how clinical departments operate in ways that an administrator might not fully grasp.

We walk a lot about physician burnout, but we don’t always talk about nursing burnout as much as we should. Many nurses from my hospital have left traditional nursing and are instead working in fields such as administration, telehealth, case management, or with payers. One of my close friends became an elementary school nurse and another does case review for attorneys. In an anecdotal survey of why they left the patient care trenches, the top reasons include stress, unpredictable hours, and inadequate work-life balance. One who worked with me in the emergency department was mainly afraid of workplace violence, having been involved in several altercations involving patients or upset family members.

I had the opportunity recently to attend a seminar on workplace violence, which is something all of us that spend time in hospitals need to think about. Medical settings are the most common location for workplace violence. According to the Bureau of Labor Statistics, more than 70% of all workplace assaults happen in the healthcare and social services industry. Potential causes include the idea that healthcare has become less patient-focused and less personal; wait times have become longer; patients have unmet expectations; prescription drug abuse; and lack of mental health support services. Even with those facts, organizations tend to provide little education on how to de-escalate tense situations or how to respond when a violent episode occurs.

The seminar recommended that clinical staff receive formal training in spotting behaviors that could lead to violence and in learning how to manage situations so that they don’t escalate. Practices, nursing units, and facility departments should develop detailed procedures for addressing violent situations, including how to protect patients and themselves. They also recommended training in how to best interact with law enforcement should a violent episode occur. Last, they discussed conducting drills to test those procedures, much like an organization would have an EHR downtime drill or a mass-casualty drill. Although we hear a lot about intruder drills in the schools, we don’t hear a lot about them in healthcare settings. The speakers advocated the Run-Hide-Fight response to active shooter incidents, and I could tell these were new concepts for most of the people in the audience.

The majority of the seminar was spent on strategies for preventing violent encounters in the first place. We were encouraged to look for patients or family members with depressed mood, bizarre behavior, and changes in personality. These are readily identifiable by most healthcare professionals, along with findings such as paranoid ideations and delusional statements. Those were fairly subtle, but actual threats of violence also made the list of items that should trigger de-escalation maneuvers.

They went on to recommend that healthcare workplace training programs include situational awareness training during the onboarding process with annual refreshers. I would think that situational awareness would be one of the hardest skills to master in the healthcare setting since we often need to be laser-focused on the patient in front of us. We might not be aware of incidents occurring in adjacent patient rooms or at the clinical workstation.

When the situation is unfolding in front of us, clinical workers are encouraged to allow patients to verbally vent while showing empathy and understanding. If the situation deteriorates, we need to be able to alert others or get help; identify escape routes; and plan for self-defense. Like law enforcement teams, we were reminded to never turn our backs on potentially violent patients or family members.

The seminar also covered strategies for prevention that are fairly straightforward, such as securing doors, limiting non-employee access to critical areas of the facility, installing proper lighting in the parking lot, and changing door codes often if electronic locks are in place. Staff should wear name badges so they can be easily identified as belonging in key areas. The speakers also discussed the practice of “see something, say something” where everyone is empowered to bring attention to situations that might become problematic.

I’ve been in some tense situations and have encountered violent patients, but I’ve never personally experienced the types of violence that was discussed during several of the case studies. We were asked to role play various scenarios, including custody disputes, disgruntled employees, and unstable patients. We were challenged to create a draft emergency operation plan for our facility with ideas for policies and procedures on how to address various types of workplace violence.

Several of us had the most difficulty figuring out how we would protect patients as well as staff members, particularly if patients were immobile or critically ill. We talked about campus lockdowns and how to quickly alert patients and visitors to stay away from the facility if needed. We also talked about how to care for potential victims. Hospitals and emergency departments have different resources than ambulatory practices and we brainstormed ways to use the supplies on hand for different eventualities.

The last part of the course dealt with how to behave in an active shooter situation when law enforcement arrives. Especially if SWAT or other specialized resources are involved, those resources are trained to proceed in ways that might not seem intuitive to healthcare providers. Officers aren’t going to stop and render aid to wounded individuals until they are certain the threat has been stopped. They might treat everyone present as a potential threat while they gain control of the situation.

After the course, I was curious whether any of my friends that work for EHR vendors and routinely assist clients in healthcare locations had received any kind of training on workplace violence. Although my survey sample was small, no one had received any kind of training in workplace violence.

I’d be curious to hear how large technology vendors handle this and whether they provide formal training for staff members. Similarly, for hospitals and provider organizations, what’s your strategy? Leave a comment or email me.


Email Dr. Jayne.

Morning Headlines 5/6/19

May 5, 2019 Headlines 1 Comment

U.S. doctors use medical records to fight measles outbreak

Doctors like those at NYU Langone Health are using EHRs to identify patients in measles outbreak areas who have not received the measles vaccine.

Grahame Grieve Named 2019 Glaser Award Recipient

UTHealth’s School of Biomedical Informatics names interoperability expert Grahame Grieve winner of the 2019 John P. Glaser Health Informatics Innovator Award.

Direct Recruiters and Sister Company Direct Consulting Associates to Integrate

Hospital IT staffing and consulting firm Direct Consulting Associates will roll into sister company Direct Recruiters.

A short thread on the real source of the uBiome fiasco. Hint: it wasn’t venture capital’s pressure for aggressive growth.

The former “citizen-scientist in residence” of UBiome – the microbiome testing vendor raided by the FBI after complaints of insurance overbilling – shares Theranos-like warning signs.

CareCloud raises $33M from inside investors

EHR and practice management vendor CareCloud raises $33 million, bringing its total raised to over $150 million.

Monday Morning Update 5/6/19

May 5, 2019 News 12 Comments

Top News


From the Allscripts earnings call:

  • The company reported record first-quarter bookings despite revenue growth that was less than it had predicted.
  • One Paragon client was committed to switch EHRs until “they experienced the sales implementation by one of our competitors” and extended their Paragon agreement for five years. The hospital was Waverly Health Center, which would suggest that the abandoned replacement vendor was EClinicalWorks, who announced them as a new inpatient customer in April 2018.
  • The company says that recent development of a Paragon ambulatory platform has caused five clients to come back in the past 90 days.
  • CEO Paul Black notes that the company has “the longest-tenured leadership among the top three publicly traded companies in the marketplace,” which he says allows the company to focus on long-term priorities.
  • Black says Veradigm positions the company as a top provider to payer and life sciences markets, to the point that EHR competitor NextGen partnered with Allscripts instead of developing a competing product.
  • Acquisitions over the past five years have added $300 million in annual recurring revenue “at a net cost approaching zero.”
  • Black says Allscripts is the only one of three companies (I assume he’s referring to Epic and Cerner) that is making significant investment in core acute care solutions.
  • In responding to an analyst’s observation that company debt increased due to share buy-back, the company says it is comfortable with its leverage position.

Reader Comments

From Big System CIO: “Re: HIStalk interview. My experience is that going on record encourages the vendor community to overwhelm us in claiming they can assist, regardless of whether we need help or not.” BSC politely declined my interview request for a reason I hadn’t considered – mentioning an initiative in our conversation guarantees that vendors who read it will bug them endlessly to pitch their services. I guess cold-calling it must work at least occasionally or they would stop doing it. I’m interested in both the provider and vendor side of this issue – how do you feel about reps randomly dialing someone up at the hospital hoping for a hit?

From Just Asking: “Re: IT in faith-based health systems. You’ve said you had experience there. What should I look out for if I take the IT executive job offer in front of me?” I can only relate my personal experience, which certainly varies by organization. The top problems that my IT peers had in working for an organization whose faith wasn’t ours (and that was one of the more extreme ones, I suspect) were:

  • The culture was inbred, where everybody went to the same churches, graduated from the same unimpressive church-affiliated universities, and had been chosen since their diaper-wearing years for fast-tracking through various internship and training programs in traveling from one hospital to the next to the way to the top. It’s tough participating constructively in meetings where everybody except you as the IT person has longstanding, trust-based relationships that drive everything instead of knowledge or experience.
  • IT was the dumping ground for underperforming but well-connected junior employees who were untouchable and knew it, so their pathetic job performance demotivated everybody else.
  • IT felt like being an American contractor sent to work in a Middle Eastern hospitals – we were tolerated at best, never respected, and were forced to follow the corporation’s cultural-religious rules while having our own ignored. Be careful taking a job with any health system that declares itself to be a ministry unless you actually want to work for a ministry.
  • Just about every major strategic IT decision was made in meetings to which IT was not leading or even invited because, as one top-ranking executive said in being unaware that he was on a conference line, “Can’t we get one of our own in there?”
  • On the flip side, they paid me well, the benefits were unbelievable, the glass ceiling was obvious but tolerable unless you fancied yourself qualified to be on the executive fast track, and I think they were doing the best they could to integrate us interlopers into the organization in at least a clumsy, superficial way.

From Bewilderment: “Re: succession plan. People joke about that of Judy Faulkner. What’s yours?” I don’t have one. I’ll probably just keep going until I drop dead and then the HIStalk page will be forever frozen on whatever I wrote last (hopefully something decent, unlike good Hollywood actors who died after making an awful last movie as their unplanned swan song). I won’t care at that point. If I quit by choice, I’ll say goodbye.

HIStalk Announcements and Requests


Last week’s reader-requested poll was a good one. Universal interoperability won’t happen until at least 5-10 years (so say 42%) or more than 10 years if ever (46%). Some comments:

  • Until you get into the details of turning a clinical note into something transmittable between two systems, you cannot understand the complexity. I remember spending an hour in a meeting discussing what values should be in the “stool appearance” drop-down. Unless every provider uses the same list, or every interface engine has a translation table, how can one system send to the other? Things like that need to be done with thousands of ideas on what exactly a stool appearance drop-down should look like. Of course you can always transmit entire documents and notes, but if you want to make data interoperable, it needs years and clinical revamping.
  • Everyone everywhere? From legacy systems run by stressed organizations operating at the margin of survival? Patient-generated data, from outside of hospital/ clinic? Genomic data? Third-party analysis of same? Clinically relevant is the touchstone. Truly clinically relevant may be much smaller subset, but, still, you have to get to it. Patient-sovereign software, leveraging API-architecture through consent / authorization / access services and the patient’s right to their data, may be a route, which works because it flips the paradigm.
  • I still vividly remember attending an interoperability conference in 2003, at that time experts were sure that in 5-10 years, all systems would be talking to each other. What year is it now?
  • Data exchange will only move forward once EMR vendors and health systems understand they do not own the data, it belongs to the patient. And to get to that point may take payment penalties for those that do not share.
  • Ask five physicians what “all clinically relevant data” is and you’ll get seven different answers. The reality is that all all of the data you mention in your example can be shared today. Why isn’t it? Because doctors aren’t demanding it and because there remain competitive business reasons to not share data with providers (aka as competitors) outside an IDN. Interoperability remains mostly a business challenge, not a technology challenge.
  • There are aspects that will take longer (e.g., pathology), as today it is not widely digitized. More needs to be done to emphasize the need for the FULL relevant record – too much emphasis still today for making only PAMI (procedures, allergies, medications, and immunizations) data interoperable, as the least common denominator. Finally starting to see more recognition of interoperability needed for clinical reports, which is addressed in the next version of FHIR, but will still take a long time.
  • “All” clinically relevant information is casting a wide net, including all scanned documents, waveforms, diagnostic resolution MRIs and mammos and cine loops, and it also assumes that every internal niche clinical system in a large organization can participate in HIE or at least communicate with the primary system responsible for HIE. If that’s what you mean, it won’t happen in 10 years in this country with our broken fragmented healthcare system, and maybe never.


New poll to your right or here: How would you react to your software vendor announcing a focus on boosting profits, including reorganizing and cutting products and headcount? I thought of the question because of Cerner, but we’ve seen plenty of examples over the years and I’m interested in what you think. Comments are welcome, so just click the poll’s “Comments” link after voting.

Dear everyone on LinkedIn and elsewhere: please stop describing yourself as having “over XX years experience.” It’s not like a toddler’s mom or a former addict who feels the need to proudly account for fractional years, so just round up if you are that insecure. Thank you.

Live Nation is offering $20 lawn seats to some mediocre outdoor concerts (mostly 1980s has-beens and country), but I still bought tickets to three of them. It’s worth $20 to create a summer memory of sprawling on the grass while listening to the B52s supplement their Social Security checks by cautiously frugging yet again through “Rock Lobster.”

Thanks to the following companies that recently supported HIStalk. Click a logo for more information.



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

Acquisitions, Funding, Business, and Stock


The former “citizen-scientist in residence” of UBiome – the microbiome testing vendor that was just raided by the FBI after complaints of insurance overbilling – lists Theranos-like warning signs:

  • The company didn’t hire a CFO until 2017, then fired him shortly afterward.
  • A long list of scientists endorsed the company’s tests, but it’s not clear if any of them ever actually tried them. He says that “too many advisors are really just outsiders with an ego.”
  • The company hasn’t released any clinical data despite listing thousands of partnerships with famous research institutes.
  • VCs lose money when they back what turns out to be a fraud, but the scientific advisors just walk away from the train wreck unnoticed.

Government and Politics

FDA shuts down its “alternative summary reporting” program for breast implants and says it will eventually extend the shutdown to include all medical device problem reporting. The program allowed manufacturers to submit summary reports instead describing safety incidents individually, thus hiding them from the public eye.


Doctors are using EHRs to identify patients in measles outbreak areas who have not received the measles vaccine. It mentions NYU Langone Health, which has created alerts in Epic that notified doctors and nurses that a patient lives in a ZIP code that is experiencing a measles outbreak. Epic collected customer best practices for dealing with measles and published them into a how-to guide.

A woman who counts on getting emotional support from fellow breast cancer patients from a closed Facebook group complains that people like her are “trapped” after not realizing years ago how cavalierly Facebook manages and sells the private data of its users. She says, ‘’Our group cannot simply pick up and leave … how do we keep the same cycle from repeating on a new platform?” I will, as I often do, take the counterpoint. The group absolutely can leave Facebook and move to a platform that they control. Facebook’s most insidious tactic is hooking users on its wide-ranging services to the point that like Pavlov’s dogs, they will obediently waste hours each day in return for a reward treat that was paid for by those companies willing to buy ads and user data. Use an independent technology platform that isn’t funded by invisible, unethical data practices. Consider whatever cost is involved for the platform and its support to be the price of not having your medical information sold like at a Turkish rug bazaar.


Interoperability expert Grahame Grieve is named the winner of the 2019 John P. Glaser Health Informatics Innovator Award. My most recent interview with him (from March 2019) is here. This is a nice summary by Robert Murphy, MD of UTHealth’s School of Biomedical Informatics:

As a physician and an informatician, I am singularly impressed by Grieve’s focus on pragmatic outcomes derived from a comprehensive array of tactics that are steadily moving us toward interoperability—notably, standards development, implementation, and adoption; open source and tool development and devising interoperability toolkits; enterprise architecture and governance; and clinical document and clinical interoperability solutions. He and his colleagues are extraordinary change agents within healthcare


This seems largely pointless: a new hospital in South Korea will be crammed with tech gadgets that would appear to have zero impact on outcomes or cost – hologram images of isolated patients for “visits,” augmented reality-based wayfinding systems, facial recognition biometric access, and voice assistant-powered patient room amenities. A telecom vendor is co-building the hospital, so naturally it is bragging on 5G connectivity that always seems like hype more than anything. I’m picturing patients wandering around in gowns emblazoned with Nascar-like phone company ads. I am amused that one of Yonsei University Health System’s hospitals is named Gangnam Severance Hospital, which makes me picture Psy being marched off the premises with final check in hand following a musical restructuring.


In England, former hospital CIO Richard Corbridge warns in an op-ed piece that NHS’s digital leaders are leaving for jobs in the private sector, frustrated by health secretary Matt Hancock’s unfunded push for a technology revolution such as “axe the fax.” Corbridge, who just left NHS after 23 years to join Boots as director of innovation, says hospitals can afford only 1% of their budget for IT after the cost of dealing with an aging population, historic underfunding, and staff shortages.


In England, Guinness World Records tells a nurse who ran the London Marathon in scrubs to raise money for Barts Charity that her time won’t qualify as a record for “running a marathon while dressed in a nurse costume” because it requires the uniform to include a dress, a pinafore apron, and a white nurse’s cap. They also advised her that wearing scrubs could confuse people into thinking she’s a doctor. She notes, “I’ve certainly never seen a male nurse wearing a dress to work.” I might take the side of GWR, however, since it isn’t looking for occupational accuracy in certifying records of runners dressed as lobsters or telephone booths (why those records even exist is another issue), with its guidelines cautioning costumed record seekers, “No one wants to run 26 miles dressed as a rabbit only to find out their ears weren’t long enough.”

Sponsor Updates

  • Gartner cites Lightbeam Health Solutions in several industry reports.
  • Mobile Heartbeat will exhibit at the Kentucky Hospital Association event May 8-10 in Lexington.
  • Waystar will exhibit at the Office Practicum 2019 User Conference May 9-11 in Orlando.
  • Netsmart will exhibit at LTC 100 May 5-8 in Naples, FL.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the HIMSS CSO Spring Conference May 10 in Dublin, OH.
  • OmniSys will exhibit at the HCP Spring Hospital Pharmacy Conference May 6-8 in Miami.
  • Experian Health will exhibit at the NCPDP 2019 Annual Technology & Business Conference May 6-8 in Scottsdale, AZ.
  • Redox will exhibit at the Prime Health Innovation Summit May 7 in Glendale, CO.
  • Relatient will exhibit at PNW MGMA May 8-10 in Tacoma, WA.
  • The SSI Group will exhibit at the Louisiana HFMA Annual Institute May 5-7 in Lafayette, Louisiana.
  • Surescripts will exhibit at the NCPDP Annual Conference 2019 May 6-8 in Scottsdale, AZ.
  • Hungary’s University of Debrecen joins the TriNetX network to increase collaboration and growth in commercial clinical studies.
  • Voalte will exhibit at the Kentucky Hospital Association Annual Convention May 8-9 in Lexington.

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Mr. H, Lorre, Jenn, Dr. Jayne.
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Weekender 5/3/19

May 3, 2019 Weekender 3 Comments


Weekly News Recap

  • Allscripts announces Q1 results that beat earnings expectations but fell short on revenue
  • Meditech’s Q1 saw reduced revenue, operating income, and net cash from operations although unrealized security gains pushing earnings dramatically higher
  • Capsule Technologies acquires Bernoulli Health
  • Cerner filings indicate that activist investor Starboard Value made its run on the company’s board two days after Brent Shafer announced his new “operating model”
  • A new KLAS report on hospital market share finds that Epic beat Cerner handily in new hospital gains excluding Cerner’s one-time VA deal, with Cerner losing 65 Millennium hospitals vs. Epic losing one
  • HHS announces that it will use its discretion to reduce maximum annual HIPAA fines based on level of culpability

Best Reader Comments

Life in rural America is in a serious long-term decline and has been for decades. De-industrialization has just piled on, especially in smaller towns in the Midwest, Northeast, and the South to a lesser degree especially since 2000. The only area that has avoided this trend is smaller (and relatively newer towns) in the SW and West which never had much, if any, of a manufacturing base to begin with. They have been able to pivot more easily to the current economic model especially if they attract tourists year-round and/or have a higher education institution which has remained competitive. If smaller towns are declining economically and demographically, there is going to be less of a need for community hospitals especially those with aging physical plants which are costly to remain and run. The trend is going to be ASC/outpatient wherever possible and more micro-hospitals/hospital-at-home. There will still be a need for facilities to treat emergency patients but that is going to be a much more complex issue from a political and economic standpoint. Coming back full circle, there is still going to be a market for community hospital IT software but it will be one that is in long-term decline and largely a maintenance market that lives of the 16-20% annual software and maintenance feeds vendors charge (more if they host it). What is likely going to emerge is software to support new models of care and much smaller facilities. It just won’t have the $$$ that an enterprise community hospital system has to it. (Lazlo Hollyfeld)

Being an IT person and a long time athlete who has used FitBits, heart rate monitors, and training logs, I figure that the right way to handle the data stream from personal monitoring devices, logs, etc. is for vendors to develop an integrated approach that uses certified devices, periodically calibrated if necessary, feeding data streams to repositories. For example, this could include a bundle of devices for an elderly person with CHF. These might include a few things. One would be a scale, expecting twice-daily readings to check for rapid weight gain due to non-compliance with diuretic. Another would be a smart pill dispenser to track medication adherence … Between the data stream and the clinician would be carefully tuned algorithms that would decide when to alert a licensed provider like an advice nurse in a call center … Once these packages are matured and the value in preventing admissions / readmissions has been demonstrated, I would envision PCPs ‘prescribing’ the bundles, with all of the associated intelligence and process, to their patients. Kaiser Permanente was doing some futures work on this kind of thing a couple of years ago. (Dr. J Fanboy)

I agree 100% with Vaporware and that Cerner has made a deal with the devil with the DoD contract. That is just an opinion based on my experiences. However what isn’t an opinion is that Cerner is a publicly traded company that has to answer to forces that Meditech and Epic do not. It is not an opinion that Cerner has caved to the pressure of profit-seeking investors and it will fundamentally impact the way the manage and pay their talent as well as their development and support expenditures. Do you honestly think that having to balance a huge contract with a notoriously difficult customer in the most open and public way, while at the same time trying to please shareholders demanding more profit now, is conducive to being a responsible steward for your private and community hospital partners? (You don’t need a weatherman to know …)

Whichever vendor you attach to the feed trough basically becomes the de facto in-house IT / development shop for the federal government. The in-house VistA talent that was swept out was expensive, but at least they made an EHR that worked when you turned it on. (Vaporware?)

Churn rate is of course a concern for all vendors not named Epic, however their entry in to selling directly in to hospitals they used to flat out say no to is indicative they know that the acquisition advantage they have is running out of targets. The cat is out of the bag that selling off to the large chain doesn’t cut costs for the community and it doesn’t improve services. The hospitals that have managed their money and capital commitments have been able to resist having to sell of to rid themselves of debt. Many communities take great pride in having their own independent hospital. In short the assumption that every community hospital will end up being owned by Epic or Cerner running systems isn’t set in stone. (Smartfood99)

I also am on board with you as it pertains to Cerner’s terrible attempts at RCM. I mean really, how hard is it to build a reliable financial system? That is what many of us though when Cerner bought Siemens, that Soarian financials would be the go-forward strategy. But instead, for the first three years post merger, Cerner actually still sold Millennium and Soarian Financials and customers were confused and pissed at the same time: why the option? With Cerner’s cash on hand and number of employees, why the hell can they not figure this out? They are so worried about always being first to market. Screw first to market, just make your product the best product. God rest his soul, but this falls on Neal. This should have been corrected years ago, but like that dog in the movie Up, Neal would pick a direction and then see a squirrel and completely lose focus. (Associate CIO)

I actually am more optimistic about Meditech beating Cerner than you. I think the Neal Patterson Cerner would have swallowed the entire lower part of the market and then there would be a Cerner-Epic duopoly. This private equity firm seems to be trying to move Cerner’s focus from gaining market share to milking their customer base. I doubt the corporate suit they have in charge now has the original vision or an alternative vision that he can articulate to the board and shareholders. That could drive the Cerner offering to a price nearer to Epic’s. With the cash-strapped community hospitals or penny pinching for-profits, that could make the cheaper, good-enough Meditech Expanse more tolerable. (SelfInfllictedWound)

I have come to a general conclusion about a lot of this. The EHR is a proxy for a lot of the irritants for clinicians, even if the EHR isn’t the underlying cause. To oversimplify while getting to the point, most physicians are employees now. As an employee, you do what your employer tells you to do. You can complain, but you’ll do as you are told. Or resign. Or get fired. Ouch. I can appreciate how this means some loss of status and independence for physicians. On the other hand, what do you think working life is like for most people? Medicine is a noble profession, but when you attempt to lean on that in order to support privileged working conditions, I don’t think that will go well. (Brian Too)

Watercooler Talk Tidbits

The local paper says that most dentists in Olean, NY haven’t implemented EHRs, some of them wary after seeing the “billing disaster” of Glens Falls Hospital in implementing Cerner. One local dentist uses digital imaging, but says, “When I need to read what I wrote about a patient, I have a paper record … because there can always be a system failure.” Most of the 48% of US dentists that don’t use EHRs question their value and security even though they agree that it’s easier to read online than on paper.

In England, the family of a 64-year-old woman who died in the hospital says that another patient was annoyed by the woman’s snoring, so she beat the woman on the head with a cup. The hospital expressed condolences, but says “it is clearly not possible for staff to supervise all patients individually round the clock.” It makes you wonder why hospitals can’t work like hotels, where rooms are locked to keep unauthorized people out, but employees use a master key whose activity is tracked. That wouldn’t work in hospitals with the illogical and universally despised “semi-private” (meaning not private at all) rooms.

A Mississippi anesthesiologist says he has spent $30,000 on lawyers and notification letters after someone broke into his practice’s offsite storage unit and stole the paper medical records of 14,000 patients. I had an immediate mental image of the “Storage Wars” gang shining flashlights onto his stacks of cardboard boxes in formulating their bidding strategy.


The former girlfriend of a California radiologist captures security video of him crawling through her back yard and peering into windows. The doctor was already on medical probation for a series of arrests related to domestic issues and was previously fired as a locum tenens radiologist by a hospital for inaccurate reports, inappropriate behavior, and unstated mental issues.

An Idaho man whose wellness multi-level marketing company has given him a $4.5 billion net worth creates a $500,000 legal defense fund for people who are being pressured by medical debt collectors. He provides as an example Medical Recovery Services, which he describes as, “We’ve got an outfit operating in Idaho Falls, a debt collection agency, that’s more interested in running up attorney fees than they are in collecting medical debt,” describing one of his own employees whose unpaid bill of $294 was turned over to collectors who inflated it to $6,000.


Bizarre: in England, a 26-year-old “serial prankster” who enjoyed startling his girlfriend by repeatedly faking his own suicide – by squirting ketchup on himself to look like he’d been stabbed and pretending to have an anaphylactic reaction from eating nuts while driving – dies from brain swelling after tying sweatpants around his neck to make her think he had hanged himself on the stairs. 

In Case You Missed It

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Morning Headlines 5/3/19

May 2, 2019 Headlines 1 Comment

Allscripts announces first quarter 2019 results

Allscripts announces Q1 results: revenue flat, adjusted EPS $0.16 vs. $0.15, beating on earnings but falling short of revenue expectations.

CirrusMD Announces $15 Million in Series B Funding and New Plans to Improve Care Delivery For Veteran Population

CirrusMD raises $15 million in a Series B funding round, and announces that its chat-based telemedicine software will be implemented at three VA medical centers.

Insiders describe aggressive growth tactics at uBiome, the health start-up raided by the FBI last week

UBiome places its co-CEOs on administrative leave as the company deals with fallout from an FBI raid and highly questionable business practices that included pressuring doctors to approve its tests and billing payers multiple times without patient consent.

News 5/3/19

May 2, 2019 News 5 Comments

Top News


Allscripts announces Q1 results: revenue flat, adjusted EPS $0.16 vs. $0.15, beating on earnings but falling short of revenue expectations. 

HIStalk Announcements and Requests


Welcome to new HIStalk Platinum Sponsor SailPoint Technologies. The Austin, TX-based company’s platform manages digital identities, allowing organizations to see and control access to apps (on-premise, cloud, web), devices, infrastructure, and structured and unstructured data. Deployment options include SaaS, AWS or Azure cloud, data center, or via a managed service provider. Specific functionality includes provisioning, self-service access requests, access certifications, separation of duties, user-managed password resets, file access management including Microsoft Office, and AI-driven reporting. Specific platforms supported include Epic, Cerner, SAP, Workday, Box, Dropbox, and SharePoint. PeaceHealth dropped its 28-day turnaround time for providing access to two days, is able to run yearly employee access certification campaigns, and has reduced provisioning contractor headcount by 25. Thanks to SailPoint Technologies for supporting HIStalk.

Listening: the new, final album from The Cranberries, completed by the band from demo tracks found on the hard drive of singer Dolores O’Riordan, who died in January 2018 at 46 of accidental drowning. The Cranberries have made recordings in that manner before — she poured so much emotion into the demos that her studio versions couldn’t match them, so they sometimes went with the first draft. She had been through a lot, so the new album is more wistful, reflective, and less angry than “Zombie,” of which I would say her 1995 performance on SNL is still one of the rawest and best in that show’s history from long ago when singers wrote their own songs, performed them with emotion, and used minimal stage equipment with no computers, Auto-Tune corrected vocals, or sequiny dancers. My expectation of just listening to the new album without emotion turned out to be unrealistic as I spent the afternoon looping the achingly perfect title track “In The End.”


It’s a big holiday weekend, so happy Cinco de Cuatro to all.


None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information.

Acquisitions, Funding, Business, and Stocks


CirrusMD raises $15 million in a Series B funding round. Its chat-based telemedicine software will be implemented at three VA medical centers.


Medical device integration and patient monitoring company Capsule Technologies acquires clinical surveillance software vendor Bernoulli Health. Capsule Technologies was acquired by Francisco Partners from Qualcomm just before HIMSS, where it re-emerged from its Qualcomm Life brand as Capsule Technologies (before Qualcomm, it was Capsule Technologie).


CBNC reports why the FBI raided venture-funded microbiome startup UBiome: the company was billing insurers multiple times without patient consent and pressuring its doctors to approve its tests (which it should be noted have zero proven clinical value). The company has placed its two co-founders – who are also its co-CEOs – on administrative leave.  

Medhost adds hospital business office outsourcing services.

ResMed announces Q3 results: revenue up 12%, adjusted EPS $0.89 vs. $0.92. 

Inovalon reports Q1 results: revenue up 57%, adjusted EPS $0.10 vs. –$0.04.


  • Oklahoma Spine Hospital selects Evident’s Thrive EHR.



Netsmart promotes Kevin Kaufman to CFO.


Mindy Heintskill (Walgreens) joins MDLive as chief marketing officer.

image image

Medhost promotes Jason Myers to CIO and Rick Brown to chief development officer.


Cerner Chief People Officer Julie Wilson will retire on June 30 after 16 years in that position and 24 with the company.

Announcements and Implementations


Cantata Health adds a resident referral portal to its NetSolutions EHR for skilled nursing facilities.

In Massachusetts, Lahey Health System and Tufts Medical Center implement secure communications and notification capabilities from Secure Exchange Solutions as part of the ELINC HIE.

Woman’s Hospital (LA) goes live on Meditech Expanse Point of Care.


North York General Hospital in Toronto goes live on Spok’s Care Connect contact center technology.



AMIA announces its first group of Fellows (FAMIA) in applied informatics. 


DirectTrust seeks members to serve on its Direct Standards Consensus Body.

Medlio co-founder Lori Mehen recounts her negative experience in applying for the Cedars-Sinai Accelerator, saying that the CIO (presumably Darren Dworkin) told her seven minutes into her 15-minute scheduled meeting with him that not only would he vote no, but that he would also “veto anyone who says yes,” describing his tone as “belligerent and hateful” in telling her, “We don’t need your help getting our patients to find our doctors.” (It should be noted that this is one side of the story and other companies, especially those who were actually accepted into the program, have spoken positively about their experience and Darren’s involvement). She concludes:

We’re certain that we’re not going to be accepted. Nevertheless, it was imperative that I write this before they make their final decision. I’ve discussed this with my partners and they both agree, in the off chance we would have been accepted, we want to go on record as saying Cedars can go f%&k themselves. I’m not supposed to say this because doing so will almost certainly cost me, but that’s exactly why I must. Not just for me, or for my co-founders, but for all the other startups he has abused and will continue to abuse.


The University of Maryland works with local officials to deliver a kidney via drone to the University of Maryland School of Medicine three miles away, where it was successfully transplanted into a 44 year-old woman who had been on dialysis for eight years. Baltimore traffic must be awful to risk having a kidney-bearing drone come crashing to earth for such a short trip.


I’m not sure if this is an example of social engineering hacking, incredibly bad security practice, or incredibly good cybersecurity humor.

Sponsor Updates

  • Securance Consulting gives Engage a five-star for the fourth year in a row for being a Best Practice Meditech Hosting Provider.
  • Elsevier will work with PhactMI to develop a new semantic search portal that will offer providers scientifically accurate, current, and unbiased information.
  • EClinicalWorks will exhibit at the 2019 AAOE Annual Conference May 4-7 in Nashville.
  • EPSi extends early-bird pricing for the Visis EPSi Summit, taking place October 22-24 in Austin, TX, through May 31.
  • HCTec publishes a new case study featuring St. Luke’s University Health Network.
  • Iatric Systems will exhibit at the NCHiMA Quad-State event May 5-8 in Myrtle Beach, SC.
  • InterSystems will exhibit at the DoD/VA & Gov Health IT Summit May 8-9 in Alexandria, VA.
  • Kyruus announces the availability of ProviderMatch DirectBook in the Cerner App Gallery for direct scheduling into Cerner Millenium.
  • OptimizeRx will integrate Eversana’s patient support and specialty distribution models into its real-time EHR network.
  • Artifact Health partners with HCPro to provide compliant, time-saving CDI templates for provider queries.
  • The Customer Relationship Management Institute awards Wolters Kluwer customer support teams the NorthFace ScoreBoard Award for exceeding customer service expectations.
  • Henry Ford Health System (MI) expands its use of CarePort software with the implementation of Guide, Connect, and Insight solutions.
  • ROI Healthcare Solutions launches a new “day-in-the-life” content series focusing on its project managers.
  • Dimensional Insight publishes a new white paper, “How Successful Are Healthcare Organizations with Clinical Analytics?”

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Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
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EPtalk by Dr. Jayne 5/2/19

May 2, 2019 Dr. Jayne 3 Comments


I’m continually surprised by the inability of EHR vendors to add fairly straightforward safety features to their systems. A reader sent in this screenshot that shows a patient’s pulse documented as 12,224 beats per minute. They also shared screenshots of other parts of the EHR with similar issues. The blood pressure field isn’t divided for systolic or diastolic entries, but rather requires the user to type a “/” between the values, leading to potential errors.

Since I’ve been on the vendor side of the house, I understand that it’s not as simple as it seems to make these kinds of corrections since they may require changes to the database. However, it’s not as difficult to make changes to the screens where data is entered. In this situation, they could limit the entered data to three characters. Frankly, if you need to enter a fourth digit, your patient has probably just died of rampant tachycardia.

When reporting these types of issues to vendors, we are often told that it’s not on the development roadmap, that it would be too technically difficult, or that it would require more development hours than are available. When we’re talking about data entry errors and patient safety, however, how much time is too much time to spend on something like this? Not to mention that if you’re trying to exchange data and want to be truly interoperable, this kind of bad data is going to be an issue for practices trying to consume data from flawed sources.

With all the certification requirements, why haven’t we mandated management of basic patient safety issues like this? As much as we’re told that paper kills, I doubt there were too many instances where a technician would have documented a pulse of 12,000 in a paper chart.


You know people are desperate when felony colonoscope theft becomes an issue. Two men and a woman burglarized a Philadelphia-area hospital and made off with tools from the colonoscopy suite. Police fear the devices may be sold on the black market. If that’s the case, I hope they go through a thorough cleaning cycle first.

I had a conference call today with a potential employee who dialed into the meeting from a shared work space with little privacy. There were people walking back and forth in the background during the entire call, and in a couple of instances, the interviewee even turned around to see what was going on behind him. If this is the best environment he could come up with for a job interview, I wonder what his daily work environment might look like. He mentioned that he likes to work away from home because “it’s less boring,” but failed to elaborate. That’s a trip directly to the round file for this candidate.

Other occupants of the round file include people who try to conduct their entire lives from their phones, leading to emails saying they can’t open attachments on their phones or have trouble accessing various resources on their phones. Mobile is a great extender, but if you’re going to do a serious job in IT, you have to understand when it’s appropriate to use a more traditional laptop, tablet PC, desktop, etc.

In response to my recent piece about Ovia and other fertility apps, a reader shared this Washington Post follow-up that discusses ways women protect their privacy on these apps. One woman drew the line at providing the name and date of birth of her baby – she was willing to share her own personal information, but not that of her newborn.

Over 100 women responded to a request from the Post. Respondents “often said they felt trapped by an unfair choice: They cared about privacy, but they also found the digital trackers too valuable to give up.” Women used pseudonyms, logged only a minimum of information, and modified some data to preserve anonymity. Others noted that the apps weren’t that helpful. One commented that they “led to micromanaging my body and habits, which led to stress.” Another noted deliberate gaming of systems used by employers who are trying to get data on staffers: “If my employer was offering money for pregnancy tracking, I would probably do the same thing I already do with the fitness tracking and just input false content.”


The reality is that personal health information is everywhere, whether people are providing it willingly with the understanding that they can’t control it once it’s out of their hands, or whether they want to use it for specific purposes. There is a great deal of discussion about the role of patient-generated health data in clinical care. Many clinicians are uncertain about its role in driving outcomes and contributing to clinical quality. There are also concerns about how to handle the data. Clinicians find the idea of receiving hundreds if not thousands of data points into their EHRs to be particularly daunting. Some of these physicians were concerned in the paper days about patients bringing in blood pressure or blood sugar logs, so it’s not surprising that they are uncertain about the data in the electronic world.

There are also concerns by both patients and providers about data security, but it’s hard to quantify the pros and cons. An article in the Journal of the American Medical Informatics Association notes that patients are open to various methods for data collection, whether it is through a medical history, patient questionnaires and surveys, or biometric and activity data. Researchers interviewed health system leaders, EHR vendor leaders, and leaders of third parties providing patient-generated health data tools to health systems. They also interviewed patients with chronic conditions, with half of those patients having experience with generating data. The number of survey participants was small, but the authors conclude that patient-generated health data really isn’t being pursued at broad scale, largely due to concerns about its value.

What do your providers think about patient-generated health data? Are you using it? Does it add more confusion? Leave a comment or email me.


Email Dr. Jayne.

Morning Headlines 5/2/19

May 1, 2019 Headlines No Comments

Capsule Technologies Acquires Bernoulli Health

Medical device integration and patient monitoring company Capsule Technologies acquires clinical surveillance software vendor Bernoulli Health.

Teladoc Health Reports First Quarter 2019 Results

Teladoc exceeds analyst expectations, posting $129 million in revenue for the quarter, 4 million new members, and a 75% increase in visits.

AMN Healthcare to Acquire Advanced Medical

AMN Healthcare Services will acquire Advanced Medical Personnel, which offers healthcare staffing services that include telemedicine positions, for $200 million.

VA, DoD Electronic Health Records Still Aren’t Compatible, and Lawmakers Are Angry

Despite a decade’s worth of promises and billion-dollar expenditures, lawmakers continue to express outrage over the combined inabilities of the DoD and VA to merge EHR systems.

Morning Headlines 5/1/19

April 30, 2019 Headlines 1 Comment

Health Catalyst Aims to Raise $150 Million to $200 Million in IPO

The Wall Street Journal reports that Health Catalyst expects to raise up to $200 million in its IPO.

MEDITECH Announces Professional Services

Meditech launches a professional services division that will include quality initiatives, physician consulting, performing interoperability assessments, and lending expertise to analytics and population health projects.

Philips’ Q1 core profit misses estimates on bleak sales

Philips announces poor Q1 revenue and earnings that strong growth in China could not offset.

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Reader Comments

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

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