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Curbside Consult with Dr. Jayne 1/9/23

January 9, 2023 Dr. Jayne 3 Comments


I read a number of articles this week that addressed various hot topics about how people spend their time and how employees should be treated.

It was quite ironic that the best thing I saw on Facebook this week was a link to a piece in The Atlantic titled “The Age of Social Media Is Ending.” I have a love/hate relationship with social media depending on how much I feel like I’m being forced to use it versus how much I’m electively using it to keep up with things I care about. I despise it when community organizations (including our local schools) decide that Facebook is the best way to communicate important information. They don’t seem to understand that Facebook isn’t a static place you go to view things, like a bulletin board. The algorithm serves up different things to different people at different times and depending on your settings it’s possible to miss information unless you’re stalking a particular group or page on the daily.

I also dislike the fact that social media posts from individuals have become newsworthy. Outlets like MSN are constantly posting stories about things that people share on TikTok. Often, these stories are about happenings that we’re supposed to find outrageous, but I can’t take any more earnest-appearing people complaining about things that aren’t really that outrageous. I enjoy social media when I see updates from friends I don’t often see or use various groups or forums to get advice about my hobbies. Rather than broadcast to the entire universe on Twitter or Facebook or Instagram, I prefer to be part of smaller platforms that let me connect in a deeper way with my actual friends, like private workspaces on Slack or chats on GroupMe. I still can’t figure out why Twitter thinks I want to see most of the tweets it recommends for me, or what behaviors to exhibit to see content I would actually read.

The piece from The Atlantic talks about the evolution of social media from the early days of collecting friends to the recent explosion of its use as a “latent broadcast channel” where “all at once, billions of people saw themselves as celebrities, pundits, and tastemakers.” Social media has certainly made it more difficult for primary care physicians to do our jobs, with the constant barrage of headlines touting so-called “things your doctor doesn’t want you to know about” and the proliferation of people trying to make a buck with pseudo-medical “wellness” offerings that physicians have to spend time debunking.

The author notes that “as the original name suggested, social networking involved connecting, not publishing.” The evolution to “social media” happened around 2009, according to the article, “between the introduction of the smartphone and the launch of Instagram. Instead of connection – forging latent ties to people and organizations we would mostly ignore – social media offered platforms through with people could publish content as widely as possible, well beyond their networks of immediate contacts.”

The piece notes that the 2006 introduction of Twitter “amounted to a giant, asynchronous chat room for the world.” It goes on to discuss “the data-driven advertising profits that the attention-driven content economy created,” including the influencer economy, where people are essentially paid for sharing marketing messages or for product placements, creating the idea that becoming an influencer “became an aspirational role, especially for young people for whom Instagram fame seemed more achievable than traditional celebrity – or perhaps employment of any kind.”

It talks about the potential decline of social media given the current state of things, and what a remodeling might look like – drawing an analogy from the cultural changes needed to drive a decline in smoking across several decades. The idea that social media could play a smaller role in our lives is an interesting one. Many people check their accounts, feeds, and streams compulsively and I wonder what they would do with all the time they might get back.

Speaking of time, I also enjoyed this read from Forbes: “Companies Fret About Time Theft – But Who’s Taking From Whom?” Time theft has traditionally been defined as the hours when employees do things like managing personal business while on the company clock, or otherwise wasting time that is seen as belonging to their employers. With the rise of remote work, employers have taken to doing things like monitoring laptop use, the time spent in various applications, or the calendars of employees.

The article looks at the idea that time theft can go both ways. It talks about employers who demand work outside of normal working hours, but who don’t provide additional compensation or mandating unpaid training. It notes that “this kind of time theft more often affects marginalized people who are asked to go the extra mile and work harder than others to be considered for advancement opportunities.”

The author describes the pathway by which people who are constantly battling additional demands “grow weary of their work time encroaching so insidiously on their personal time…They lose their desire to shine and they focus on self-preservation instead.” I’ve worked in plenty of organizations like this, including one health system where the IT team was constantly expected to deliver the impossible. The teams sacrificed themselves on the altar of this principal and what resulted was global burnout and the departure of key leaders and high performers from the organization.

The author notes that “Workers shouldn’t feel that their private time can be snatched from them at a moment’s notice for questionable reasons, and that if they balk at putting in those additional hours their chances of advancing in the organization will be compromised.” In my experience, healthcare IT organizations are particularly at risk for this due to the 24×7 nature of our work. When someone has to be on call, it’s easy to reach out to them as opposed to thinking carefully about whether the situation needs to be addressed immediately or whether it can wait until the next business day.

Also in my reading, I came across a number of articles about the proposed end to non-compete clauses. Companies seem to love them, workers hate them, and states have done variable jobs regulating them. Most physicians are subject to non-compete clauses.

When I left the medical practice that I had built from the ground up (literally it was a slab when I started), one of the things the health system used to sweeten the deal was voiding my non-compete clause. I’m not a fan of them, especially in medicine, because they jeopardize the patient-physician relationship. They force employees to decide between uprooting their families and preserving their livelihoods and I’ve seen them hasten the demise of numerous relationships. Employees who feel handcuffed aren’t going to be as productive or successful as those who feel they’re remaining at their employer by choice. The best way to keep an employee from leaving to go work for the competition is to treat them with respect, pay them fairly, and support them.

Those concepts were among the topics at the most recent session of my leadership intensive. The theme of one of the presentations was “What fills your bucket?” We were asked to visualize our psychological bucket and the things that fill or drain it. Your bucket might be filled by support from co-workers, knowledge of a job well done, or completion of a difficult task. It might be drained by an overly demanding boss, stressful working conditions, or a chaotic environment. When people feel forced to remain in situations where they can’t fill their bucket, letting them leave might be the best option for all parties. There are plenty of other things that can fill or drain our buckets, including our own habits. When thinking about social media or time theft or a number of different things, it’s useful to determine the impact they have on our buckets.

What has filled your bucket lately, and what has drained it? Leave a comment or email me.


Email Dr. Jayne.

Morning Headlines 1/9/23

January 8, 2023 Headlines No Comments

Carbon Health to cut more than 200 jobs, narrow focus

Primary and urgent care company Carbon Health lays off 200 employees and will end its initiatives in public health, remote patient monitoring, and chronic care.

Walgreens Boots Alliance (WBA) Q1 2023 Earnings Call Transcript

Walgreens says during its most recent earnings call that it will pause M&A activities short term and will eventually consider smaller acquisitions that advance its core business, stressing that it won’t “go out and do a $2 billion or $3 billion acquisition on a health tech company.”

Codex IT Acquires Utah Managed Services Provider

Healthcare IT consulting and managed services company Codex IT acquires competitor Intranet Consulting.

Morning Headlines 1/6/23

January 6, 2023 Headlines No Comments

KeyCare Completes $27M Series A Investment Round to Expand Adoption and Grow Capabilities of its Epic-based Virtual Care Platform

Epic-integrated virtual care platform vendor KeyCare completes its $27 million Series A funding round.

Onc.AI Raises $25 Million Series A Financing Co-Led by MassMutual and Action Potential Venture Capital

Onc.AI, which offers a medical oncologist clinical decision-making platform, raises $25 million in Series A funding.

Porter Raises $5.4M in Seed Funding

Porter, a Miami-based software and services startup specializing in care coordination and quality optimization, raises $5 million in seed funding.

Careficient Acquires Home Health, Hospice, Home Care, Palliative and RCM Solutions and Services from Net Health

Home health, hospice, and home care management company Careficient acquires Net Health’s HealthWyse, Hospicesoft, and RCM division.

News 1/6/23

January 6, 2023 News 6 Comments

Top News


Allscripts changes its company name to Veradigm.

The company sold many of its health IT assets in the past two years. It says it has now consolidated its remaining portfolio of EHR, PM, and patient communication systems into the Veradigm Network.

Shares will continue to trade under the MDRX ticker symbol. They are down 8% in the past 12 months versus the Nasdaq’s 34% drop.

Reader Comments


From Publius: “Re: non-competes. This would significantly impact Epic, which would have a mass exodus of employees. I assume they would fight it in court.” The Federal Trade Commission proposes banning the use of non-compete clauses that prevent employees from taking jobs with competitors or starting their own businesses. FTC says the clauses are exploitative, affect one in five American workers, and are sometimes imposed by companies on low-earning employees who don’t have significant company knowledge. Previous studies have shown that non-compete agreements protect established companies from startups, reduce competition, and limit the ability of companies to hire the best-suited workers. FTC says the change would provide new opportunities for 30 million Americans and raise wages by $300 billion per year. The proposed change would not affect non-disclosure agreements, but those could be subject to FTC review if they interfere with workers changing jobs. Among the companies named in FTC’s complaints are two Michigan-based security companies that prevented low-wage security guards from working within a 100-mile radius for two years after leaving.

From Pure Energy: “Re: M&A in a down market. Predictions?” Previously overvalued but cash-burning startups that have no obvious path to profitability will find themselves selling out to larger competitors – assuming any are interested in attaching new weights to their corporate ankles – at barely more than asset value as being ‘disruptive” and “innovative” without making money causes newly focused eyes to roll. Modestly or selectively successful companies will shed non-core business in hopes of generating quick cash from carve-outs. Companies that went public during the recent boom, especially those that took the sketchy SPAC route, will have to figure out how to continue operating (or not) based on trashed share price with zero chance of obtaining favorable funding. This is healthy and necessary, just like thinning and pruning deadwood, and survivors will emerge stronger. Also important is that the profitable aspects of the entire hospital and health system market may be consolidated into a couple of dozen big provider and provider-insurer players over the next 10 years, so it will be feast or famine for companies who sell into that market whose participants are focused on decreasing their vendor count.

HIStalk Announcements and Requests

I’ll be migrating HIStalk to a new server shortly, which includes a lot of changes to the underlying programming and databases, so expect the usual (hopefully minor and short-lived) glitches.


January 19 (Thursday) 2 ET. “Supercharge Your Clinical Data Searches.” Sponsor: Particle Health. Presenter: Paul Robbins, MSMBA, VP of product, Particle. Particle’s team will preview the exciting results of Specialty Search, a new condition-specific record locator service. This webinar will review how to collect patient records from top Centers of Excellence across the entire country; how healthcare organizations of all types are benefiting from Specialty Search capabilities, using Particle’s simple API; and why a focused search of chronic condition data — in oncology, cardiology, endocrinology, orthopedics, and more — has an outsized impact on care outcomes.

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

Acquisitions, Funding, Business, and Stock

Salesforce will reduce its workforce by 10%, about 7,000 jobs, and will close offices in some markets, reductions the company blames on reduced customer spending and its own excessive hiring during the pandemic’s boom times. It not break out how many of the job cuts were related to healthcare. The company’s market value has dropped more than half to $134 billion from its late-2021 high.


Shares of GE spinoff GE HealthCare begin trading on the Nasdaq under the GEHC ticker. Shares closed their first day of trading Wednesday up 8%.

Epic-integrated virtual care platform vendor KeyCare completes its $27 million Series A funding round.

Onc.AI, which offers a medical oncologist clinical decision-making platform, raises $25 million in Series A funding.


  • East Tennessee HIN chooses 4medica’s patient matching system.



Ardent Health Services hires Brad Hoyt, MD (Utica Park Clinic) as CMIO.


Acadia Healthcare Company hires Laura Groschen (Medtronic) as CIO.


Experity promotes Brian Berning, MS to CFO.


Curve Health hires Matt Michela, MBA (Life Image) as CEO.


Nicholas Anderson (G2o) joins Olah Healthcare Technology as VP of product management.

Announcements and Implementations

EHNAC publishes new versions of its program criteria for its accreditation programs.

The new quarterly market report of Pivot Point Consulting, A Vaco Company makes these points:

  • Amazon’s acquisition of One Medical gives the company partnerships with big health systems and a business that has off-the-charts member satisfaction, 90% retention, and 300% member growth over five years, plus a growing Medicare and Medicare Advantage business via its Iora Health.
  • Amazon’s relaunched virtual service of Amazon Clinic will be challenged to attract both consumers and providers to its platform, with modest synergies with its pharmacy business but little impact on expensive chronic condition spending.
  • CVS Health gained 10,000 contracted clinicians with its September 2022 acquisition of Signify Health, which also gives it a Medicare presence with its Caravan marketplace.
  • The acquisition of Summit Health by Walgreens-controlled VillageMD, which closed Thursday will double the company’s PCP count to 2,800 working in 680 locations.
  • Walmart made no healthcare acquisitions in 2022, but expanded its telehealth and Medicare preventive care markets using its 4,000-stores footprint.
  • Pivot Point recommends that providers start with the digital front door to enhance patient and staff experience, use data to innovate, and build partnerships with payers since the big retailers have shown little interest in hospital care.

An EpicShare article describes how University of Michigan Health – West uses Nuance’s DAX to reduce physician time spent writing notes, with some doctors reporting a total daily effort of 10 minutes to review the results. The organization says the cost can be high and DAX works better in primary care than with specialties, but notes got better and faster over time, more prior authorization requests were approved on the first try, and patients say they enjoy seeing their own words in the doctor’s notes in MyChart.


Withings announces U-Scan, a toilet bowl device that takes daily biomarker readings. The device, which is pending US FDA clearance, will debut in Europe with consumer health cartridges for women’s cycle tracking and hydration.

Government and Politics

A JAMA Network opinion piece warns that clinical algorithms may be found to violate antidiscrimination laws under the Affordable Care Act or may be regulated by FDA as medical devices, both of which the authors urge the federal government to avoid for lower-risk algorithms and until discrimination aspects are better defined. 



Amy Abernethy, MD, PhD, who runs Verily’s life sciences clinical studies platforms, discusses the state of clinical trials in a brief Politico interview:

  • Clinical trials will move to using existing data from EHRs and claims, along with sensor data, although data quality mismatches need to be resolved.
  • Clinical trials need to involve a low burden for participants to generate representative participation.
  • Clinical trials recruitment needs to include digital marketing, call centers, and extra service.
  • Future clinical trials will involve long-term following of participants, which will require new ways of thinking about keeping people enrolled.


This is an interesting observation by Will Weider, although perhaps less relevant than it seems to healthcare since ordering is the focus at Amazon and most of us have done it many times. I don’t mind a chat bot as long as it doesn’t hog the screen, make sounds, or pop up on every new page after I’ve already dismissed it. I always renew my car registration online and DMV’s chat bot is like a nicer, field-prompting version of an online form. At least even the dumbest chat bot is smarter than the smartest telephone auto attendant.

Sponsor Updates


  • Availity associates volunteer at the 24th annual Make-a-Wish Request-a-Thon.
  • Medicomp Systems releases a new Tell Me Where IT Hurts Podcast featuring National Coordinator Micky Tripathi.
  • Wolters Kluwer Health marks the 30th anniversary of its UpToDate clinical decision support solution by announcing that it has donated over 100,000 subscriptions to UpToDate to caregivers and organizations in 159 countries.
  • EClinicalWorks publishes a new customer success story featuring Orthopaedic Institute of Ohio, “Prisma: How Better Data Improves Care and Reduces Costs.”
  • Everbridge appoints RSA CEO Rohit Gai and Blackbaud EVP David Benjamin to its Board of Directors.
  • Nordic launches a new podcast series titled “In Network.”
  • The Empowered Patient Podcast features First Databank VP of Product Management Virginia Halsey, “Improving Access for Pharmacists to Appropriate Drug Interaction and Dosing Data.”
  • Get Well offers a digital inclusivity toolkit to help healthcare teams address workplace violence.
  • InterSystems announces it has been positioned in the Visionaries Quadrant of the recently published Gartner Magic Quadrant for Cloud Database Management Systems.
  • Juniper Networks announces it has been named a leader in the 2022 Gartner Magic Quadrant for Enterprise Wired and Wireless LAN Infrastructure for the third consecutive year.
  • Meditech publishes a new case study, “Frederick Health Aligns Workflows Across Care Settings with Meditech Professional Services.”

Blog Posts


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


EPtalk by Dr. Jayne 1/5/23

January 6, 2023 Dr. Jayne No Comments

I’m a big fan of my Withings blood pressure cuff, which captures readings wirelessly and syncs them with health management software. It is useful to show my physicians what my blood pressure actually runs at home, as opposed to the elevated values I have when I walk into a healthcare facility and start having anxiety symptoms related to the last few years I spent working in emergency department and urgent care facilities.

Withings has announced U-Scan, which it claims is “the first hands-free connected home urine lab.” The device is 90 mm in diameter and is placed in the toilet bowl to provide “an immediate snapshot of the body’s balance by monitoring and detecting a large variety of biomarkers found in urine.” It also promises to offer “actionable advice for health improvements.” The unit contains a cartridge that holds “test pods” and chemical reagents, along with a reader that transmits data by Bluetooth or Wi-Fi. The cartridge and its battery are designed to last for three months and the website notes that it is “designed to be compatible with most Western-style toilets” and can be mounted with an included fixation arm. The battery can be charged via USB-C during periodic cleaning and maintenance.

Other language on the website notes it can follow menstrual cycle-related monthly hormonal fluctuations and deliver “key hydration and nutrition biomarker analysis, recommended actions based on cycle phases, and data correlation for an optimized menstrual cycle.” Since none of this data is protected by HIPAA, as a woman of reproductive age, I would be leery of giving a private company access to this data, but I’m sure a number of potential users won’t even think of that as a problem.

It also promises to give information on hydration status, but I was surprised to see that the smartphone app featured on the website recommended the “eight glasses of water” each day that has been widely debunked. As someone who has medically managed cohorts of people doing strenuous activities in the backcountry, I know that people can also learn a lot about their hydration status by following the collective wisdom to keep urine “clear and copious,” and that advice is free to boot.

Withings makes it clear that the Nutri Balance and Cycle Sync cartridges are not considered medical devices and are intended to encourage a “healthy lifestyle,” which is the same advertising speak used by a lot of quasi-medical items including nutritional supplements and non-regulated devices. Nutri Balance will measure specific gravity, pH, ketones, and vitamin C, but to be honest, I’m not sure how useful those markers are to the average person. The site doesn’t make it clear how often it will be testing which components, but states that each cartridge includes “more than 100 biomarker results” which should be a three-month supply “when following the recommended measurement plan in the Withings App.”

They do mention that they have a U-Scan for Professionals cartridge for monitoring of urinalysis data, which is likely where the real utility of this device might lie. The website notes that remote patient monitoring will be subject to “appropriate regulatory clearances.” They’ll be unveiling the device at the Consumer Electronics Show (CES) this week, with a plan to move to a public launch in Europe during the second half of the year. The consumer-grade starter kit contains one cartridge and a reader for 500 Euros ($526), with a 30 Euro monthly subscription. Pricing for the professional model is by request only. I’m sure plenty of people will be lining up to purchase one, though if nothing else than to have something that’s latest and greatest, especially if they are deeply into analyzing their quantified selves.

The New Year always brings out plenty of articles for predictions about the coming year, and I got a chuckle out of one that surveyed a few dozen investors, founders, and other startup and corporate folks for their take on 2023. The best question in my book: If Elon Musk were to buy and operate one healthcare company (for better or worse), what company would you suggest he buy? Oscar Health came in first, with Epic and Bright Health tied for second place. UnitedHealth Group ranked third, with the next cohort being a tie between Cerebral, Athena, and “Will not happen/please stay away from healthcare.” Based on recent events I don’t think Mr. Musk will be buying any companies soon, so we are safe at least from that kind of drama.

My second favorite question was “Where will VBC be on the Gartner hype cycle curve at the end of 2023?” with 55% of respondents saying it will be in the “trough of disillusionment.” Let’s face it – preventive care and the kinds of routine chronic care that are the hallmark of value-based care are not sexy and they are not big moneymakers, and many primary care providers agree that short of something miraculous or stemming from massive government regulations and a complete realignment of incentives, we are never going to be at the forefront as we’d need to be to really drive change. Needless to say, I won’t be leaving clinical informatics for the primary care trenches any time soon.

The New Year came in with a bang in my area with spring-like temperatures and the chance to take care of some yard cleanup tasks that didn’t happen before the holidays. It was good to get outside and do something that created a visible change. Sometimes in healthcare IT, we work on large projects for a significant amount of time, but since the work is largely behind the scenes, it doesn’t feel as productive as it might be if it were more visible. Still, we create tangible changes that benefit users and patients regardless of whether they see them or not.

Sometimes we work on projects that don’t even see the light of day. I’ve had entire upgrade projects that were shelved when organizational priorities shifted. During my career I’ve helped build two complete EHRs that never saw broad adoption. The work helped me get where I am today, and some experiences can only be learned through the school of hard knocks.

Here’s to hoping the new year brings us projects that are complete successes, upgrades that are smooth, and projects that run on time and on budget. What are you most excited to work on in 2023? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 1/5/23

January 4, 2023 Headlines No Comments

HealthStream Acquires Electronic Education Documentation System, LLC (d/b/a “eeds”)

Healthcare workforce management company HealthStream acquires continuing education management vendor Electronic Education Documentation System for $7 million.

CommonSpirit Health sued over data breach involving 600,000 patients

Multistate CommonSpirit Health faces a proposed class action lawsuit over its alleged negligence in protecting the private data of 600,000 patients during an October ransomware attack.

Salesforce to cut workforce by 10% after hiring ‘too many people’ during the pandemic

CRM software vendor Salesforce, which includes healthcare among its verticals, will lay off 7,000 employees and close offices in certain markets.

Morning Headlines 1/4/23

January 3, 2023 Headlines No Comments

Allscripts Announces Corporate Name Change to Veradigm Inc.

Allscripts rebrands to Veradigm after transitioning many of its products over the last year to the Veradigm name.

Ransomware gang gives decryptor to Toronto’s SickKids Hospital

The LockBit ransomware group apologizes for a cyberattack on Toronto’s Hospital for Sick Children and gives the hospital a free decryptor to release their files.

EHNAC Announces Finalized 2023 Accreditation Criteria Versions for All Accreditation Programs

The Electronic Healthcare Network Accreditation Commission finalizes and publishes criteria for its accreditation programs focused on the electronic exchange of healthcare data.

News 1/4/23

January 3, 2023 News No Comments

Top News


Congress approves an omnibus spending bill that includes $300 billion in 2023 funding for the VA, with $1.8 billion of that earmarked to continue to support the rollout of the department’s Oracle Cerner-based EHR across 25 facilities beginning in June.

Implementations were paused last summer after numerous reports of system outages, patient safety concerns, and cost increases.

Oracle’s progress dashboard shows that it has resolved eight high-priority software issues identified by the VA, and a dozen more in various stages of progress.

The VA purchased the Oracle Cerner system in 2018 for $10 billion. More recent estimates of total project cost exceed $50 billion over 28 years.


January 19 (Thursday) 2 ET. “Supercharge Your Clinical Data Searches.” Sponsor: Particle Health. Presenter: Paul Robbins, MSMBA, VP of product, Particle. Particle’s team will preview the exciting results of Specialty Search, a new condition-specific record locator service. This webinar will review how to collect patient records from top Centers of Excellence across the entire country; how healthcare organizations of all types are benefiting from Specialty Search capabilities, using Particle’s simple API; and why a focused search of chronic condition data — in oncology, cardiology, endocrinology, orthopedics, and more — has an outsized impact on care outcomes.

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


  • Outpatient radiology service provider Akumin will implement cloud-based enterprise imaging and informatics software from Mach7 Technologies.
  • Virtual consultation software vendor SmileSnap subscribes to Clearwater’s managed cybersecurity and compliance services program.



Fuse Oncology promotes James Bauler, MA to CEO.


Jessica Hadley (CHIME) joins Divurgent as associate VP of client engagement.


Direct Recruiters promotes Trevor Yasinow to partner.


Carl Bertrams, MBA (Collateral Opportunities) joins Prevounce Health as VP of sales.


Atrium Health promotes Dawn Ross, RN, DNP, MS to chief clinical informatics officer.

Announcements and Implementations


San Juan Regional Medical Center (NM) acquires an Amwell telemedicine cart that it will use as part of its new telehealth partnership with Presbyterian Hospital’s NICU team.


Tampa General Hospital (FL) launches a remote monitoring pilot program for patients with chronic conditions using technology from Stel Life and remote care management services from Signalamp Health.

Government and Politics


Staff at Walter Reed National Military Medical Center (MD) prepare for the spring transition to MHS Genesis.

Hawaii’s prison and jail medical records system has not been working since June, leaving staff unable to determine inmate COVID-19 vaccination status. The department apparently purchased EClinicalWorks in 2008 but failed to budget software maintenance and has not applied updates since. It  launched a replacement project in 2021 with a 2025 implementation deadline, but hasn’t signed a contract.

Privacy and Security

The LockBit ransomware group apologizes for a cyberattack on Toronto’s Hospital for Sick Children and gives the hospital a free decryptor to release their files, 13 days after the initial attack. The ransomware group, which sells its technical services to hackers as ransomware-as-a-service, says that its partner that was responsible for the attack violated its rules and has been kicked out of its affiliate program.


Burnout among clinical support staff appears to be on the wane, according to an Artera survey that found a 20% year-over-year decline in staff reporting moderate to severe burnout. A similar decline was found among those reporting high or severe burnout. Of the 300 surveyed, 41% say a patient has noticed their burnout and 33% report that burnout has negatively impacted patient care.

A study of 2,000 consumers by prescription discount card vendor CharityRx finds that two-thirds of Americans Google before they contact their doctors; 37% get health advice from influencers (most commonly for anxiety, weight loss, and depression where clinicians may not have personal experience); and 20% claim they discovered they had a health condition after seeing a drug ad and 25% of those regularly take the advertised product.

Security guards at Beaumont Hospital (MI) threaten to arrest a patient in the ED waiting room for recording a confrontation between a doctor and another patient on her phone, claiming that she was violating HIPAA. The guards told her she could either delete the TikTok video or go to jail, after which they locked her in a room. Local police who were called determined that she had broken no laws, but the hospital refused to hand over her discharge paperwork and prescription. A lawyer who was contacted by the local TV station noted that the patient is not a covered entity and therefore has no obligation under HIPAA.

Sponsor Updates


  • AdvancedMD employees deliver gifts to three local schools and help 14 families and 35 children this holiday season as part of the Sub for Santa program.
  • The Champion Hospital in Kuwait selects Oracle Cerner’s Millenium EHR.
  • Pivot Point Consulting publishes its first quarterly Healthcare IT Market Report for 2023.
  • EClinicalWorks releases a new podcast, “Clinical Testing Hackathon for V12 Release.”
  • Arrive Health employees put together holiday gift bags for residents at WellPower in Denver.
  • Ascom Americas hires Alexandre Gauthier as regional sales director, and Christopher Fant as project manager, professional services group.
  • Nordic publishes a technical paper titled “Healthcare Modernization Through Cloud-Enhanced Application Accessibility.”
  • AvaSure, which specializes in acute virtual care and remote safety monitoring, experiences record-breaking growth in 2022 as its customer base tops 1,000 hospitals.
  • Baker Tilly releases a new Healthy Outcomes Podcast, “The Inflation Reduction Act and its Effect on Healthcare Providers.”
  • CarePort publishes a 2022 Year in Review infographic.
  • Censinet announces new portfolio management capabilities to accelerate cyber risk management and incident response.

Blog Posts


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


Morning Headlines 1/3/23

January 2, 2023 Headlines No Comments

Nectar Raises over $24M in Funding to Scale Personalized Allergy Care Platform Nationally

Web-based allergy care company Nectar will use a $24 million Series A funding round to expand its online business and open its first brick-and-mortar clinic.

Howard Memorial Hospital in Southwest Arkansas says patient and employee data stolen in cybersecurity attack

Howard Memorial Hospital (AR) officials believe data pertaining to patients and current and former employees may have been stolen during an early December cyberattack.

Rapid NHS rollout sees 200,000 diabetes patients get lifechanging devices

NHS England equips 200,000 diabetic patients with glucose monitoring devices and companion apps as part of a program that will eventually offer the technology across all NHS facilities.

Morning Headlines 1/2/23

January 1, 2023 Headlines No Comments

Possible cyberattack at CentraState prompts hospital to divert ambulances

CentraState Medical Center (NJ) suspends outpatient services and diverts ambulances after uncovering a cyberattack on Friday.

Despite Issues, VA’s EHR Deployment Remains Scheduled to Pick Up in Mid-2023

Congress approves an omnibus spending bill that includes $300 billion in 2023 funding for the VA – $1.8 billion of which is earmarked to continue to support the roll out of the department’s Oracle Cerner-based EHR across 25 facilities beginning in June.

GE Healthcare will join S&P 500 as soon as it begins trading

GE Healthcare Technologies, a new company spun out of General Electric focused on patient care solutions, imaging, ultrasound, and pharmaceutical diagnostics, will join the S&P 500 on January 4.

Morning Headlines 12/30/22

December 29, 2022 Headlines No Comments

Data Breach at Louisiana Healthcare Provider Impacts 270,000 Patients

Lake Charles Memorial Health System begins notifying 270,000 patients that their information was compromised in an October 20 ransomware attack.

Rural patients struggle to access expert sexual assault exams. Telehealth services are closing that gap

Sexual assault nurse examiners are using telehealth to help with examinations and evidence collection.

News 12/30/22

December 29, 2022 News No Comments

Top News


A study of 100,000 stroke patients in NHS hospitals finds that the rate of full recovery tripled to 48% when AI software from UK company Brainomax was used to make a quicker diagnosis.

The company was spun out of the University of Oxford.

HIStalk Announcements and Requests

Some healthcare IT websites find themselves with nothing to pontificate about in the slow holiday news weeks, so they pad space with the 2023 digital health predictions of whoever is willing to email a response. All those I’ve seen have been vague and obvious, usually covering overworked territory such as telehealth and wearables. The real problem is that a year is a short time window to snapshot a slow transition, so truly bold predictions would be ill-advised since the Internet doesn’t forget being publicly wrong. I don’t recall any of the 2021 pundits predicting that Oracle would acquire Cerner, that digital health company shares would implode with a special toasting of SPACs, and that widespread scammery in the online ADHD prescription mills would finally draw federal attention.


Welcome to new HIStalk Gold Sponsor Healthjump. The King of Prussia, PA-based company is driving data liquidity and interoperability efforts within the world of healthcare. Healthjump provides a cloud-hosted platform for the collection, standardization, and delivery of EHR data into applications, analytics, clinical research, quality measures reporting, and more without the complex set-up of traditional interface engines. The platform connects to any EHR/PM system to extract over 300 standardized data elements, with delivery options including API, web hooks, flat file, and HL7. The company’s webpage lists, for each EHR vendor, how it access its data, what data is available, and how it is delivered. Thanks to Healthjump for supporting HIStalk.


January 19 (Thursday) 2 ET. “Supercharge Your Clinical Data Searches.” Sponsor: Particle Health. Presenter: Paul Robbins, MSMBA, VP of product, Particle. Particle’s team will preview the exciting results of Specialty Search, a new condition-specific record locator service. This webinar will review how to collect patient records from top Centers of Excellence across the entire country; how healthcare organizations of all types are benefiting from Specialty Search capabilities, using Particle’s simple API; and why a focused search of chronic condition data — in oncology, cardiology, endocrinology, orthopedics, and more — has an outsized impact on care outcomes.

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

Acquisitions, Funding, Business, and Stock


Seven care homes in Wales win awards for their use of RITA, a touchscreen app that helps patients, particularly those with memory impairments, recall and share events from their past by listening to music and speeches, watching old news reports and movies, and playing games. RITA, which is sold by Cheshire-based My Improvement Network, stands for Reminescence / Rehabilitation and Interactive Therapy activities.

Former Allscripts CEO Paul Black invests in and joins the board of Community CareLink, a Kansas City, MO company that offers software for case management, crisis calls, agency reporting, and social determinants of health referrals.

A group of Apple Watch users sues the company, claiming that pulse oximeters are racially biased because they are less accurate when testing dark skin. The plaintiffs say that the problem is that the Watch’s sensors and algorithms measure blood oxygen at the wrist, unlike medical grade units that measure at the fingertip.




Carteret Health Care (NC) names CIO / VP of General Services Kyle Marek, MS as interim CEO with the retirement of Harvey Case. He has been at the health system since 1998, when he took a network engineer job there right out of college.

Privacy and Security

Scripps Health will pay $3.5 million to settle class action lawsuits over the 1.2 million patients whose information was compromised in a March 2021 ransomware attack. Each plaintiff will receive $100 in cash and credit monitoring services, while those who had their identities stolen will receive up to $7,500 to cover out-of-pocket costs.


Lake Charles Memorial Health System (LA) begins notifiying 270,000 patients that their personal and medical information was compromised in a ransomware attack that occurred in late October, two months before the first letters were mailed.

Toronto’s Hospital for Sick Children says it will take weeks to recover from a December 19 ransomware attack, during which time patients will continue to experience delays.



In England, a surgery practice’s Christmas greeting broadcast text message for patients is mistakenly replaced with one advising the recipient that they had been diagnosed with advanced lung cancer. Panicked patients couldn’t get through on the practice’s telephone, so several lined up at its front door. Said one patient, “If it’s one of their admins that’s sent out a mass text, I wouldn’t be trusting them to empty the bins.”


Mr. H, Lorre, Jenn, Dr. Jayne.
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EPtalk by Dr. Jayne 12/29/22

December 29, 2022 Dr. Jayne No Comments

I’m pleased to report that I made it through the usual family holiday events with a minimum of drama and no outbursts from unruly drunken relatives.

Unfortunately, I just received my first “hey, I’m positive for COVID” text message, so we’ll have to see if there are more on the way. That particular family gathering had way too many people in a small space and too many adolescents who were constantly wrestling around with each other and then going back to the food table, so I’ll be crossing my fingers that everyone else stays healthy. I’ve got a fat stack of COVID tests ready for whatever symptoms make an appearance at my house.

There are a lot of providers ordering expensive respiratory testing panels to try to sort out Influenza from RSV from COVID, but unfortunately in many cases, knowing what specific virus is present doesn’t change the management plan for the patient. Running the test increasees overall healthcare costs and increase the anxiety for patients who “just want to know what virus it is.” There are so many viruses beyond the big three that are running rampant now. Many of us in the trenches refer to them in aggregate as “the crud” and keep advising patients on pushing fluids, rest, and symptomatic treatments.

Apple is being sued over the potential that the Apple Watch’s blood oxygen reader is ineffective on people of color. The class action claim was filed in New York and bases its merit on known issues with pulse oximetry technology, even though it’s unclear whether the Apple devices use the same technology as other devices that are increasingly coming under scrutiny. The suit seeks a jury trial and alleges violation of New York state law as well as a federal law regarding deceptive business practices.

The US Food and Drug Administration (FDA) placed pulse oximetry technology under review back in February of 2021, after studies found that the devices display higher oxygen readings when used on individuals with darker skin tones. Although there were questions about accuracy prior to the pandemic, the pandemic caused rapid expansion in the use of the devices in homes and other settings, which may have magnified the issue. An update by the FDA was issued last month following a virtual public meeting.  When patients have high readings that don’t reflect their actual state of oxygenation, they might not receive oxygen or other treatments that could improve their condition. The problem is believed to affect devices used by medical professionals as well as consumer-facing devices.

Speaking of consumer-focused offerings, many healthcare organizations are seeing the expected surges in requests for on-demand telehealth visits following family gatherings. Based on my experience as a telehealth physician, there are still a number of people who struggle with completing telehealth visits. Sometimes there are glitches with software and video connectivity, sometimes the patient doesn’t answer when the telehealth platform calls the patient to start the appointment, and sometimes patients are multitasking and not paying attention to the visit or the clinician trying to help them. A recent study published in JAMA Network Open looked at whether implementation of a telehealth navigator program would help improve the number of successful video visits.

The program, established at Beth Israel Deaconess Medical Center, was built around scheduled video visits. The navigator was tasked with contacting the patient a day prior to the visit to offer technical support, answer frequently asked questions, and to walk through the steps required for a successful connection. The three-month pilot ran from April 19 to July 9, 2021 in primary care and gerontology clinics. Researchers looked at over 4,000 adult patient visits. Approximately 25% connected with a telehealth navigator prior to the visit. Successful video visits were present in 92% of navigator-enabled visits but only 83% of the non-navigator control group. The cancellation rate was 6% in the navigator group and 9% in the control group. The rate of missed appointments was 2.5% for the navigator group and 8% for the control group. Overall, the navigator group had a 21% increase in successful video visits compared to the control group. In addition to providing greater care for patients, the increased volumes of the navigator group resulted in higher revenues, with a return on investment greater than the navigator’s salary.

Although this specific approach is best applied to scheduled visits, I’ve seen navigators used during on-demand visits too. Some organizations are using medical assistants to virtually “room” patients, gathering and entering the patient’s chief complaint, vital signs, and medical history data elements. One system I worked with that employed this approach reported greater patient satisfaction but some frustration on the physicians’ part if they had downtime between visits while the patient was still working with the medical assistant. Keeping a physician on schedule and reducing patient wait times is challenging whether you’re seeing patients in person or virtually. I’m looking forward to seeing more studies that help identify the best practice approach and whether organizations will adopt flows that have been successful elsewhere or whether they will continue to reinvent the wheel.


Although most of my clinical reading revolves around surging viruses, preventive care, and strategies for better conducting telehealth visits, sometimes it’s nice to come across an article that covers a completely different aspect of medicine. A recent study published in JAMA Internal Medicine illustrates the relationship between major motorcycle rallies and organ donation. The authors estimated 21% more organ donors and 26% more transplant recipients per rally day compared with the four weeks before and after rallies. An accompanying editorial calls on organizations that are associated with high-risk sports to encourage members to consider organ donation.

Looking at the donor demographics, 71% were male and the mean age was 33 years. Recipients were 64% male with a mean age of 49. The most common organ transplants were kidney, liver, heart, and lungs. The authors looked at data from seven major rallies, including the Atlantic Beach Bikefest (SC), the Bikes, Blues, & BBQ (AR), Daytona Bike Week (FL), Laconia Motorcycle Week (NH), Myrtle Beach Bike Week Spring Rally (SC), the Republic of Texas Biker Rally, and the Sturgis Motorcycle Rally (SD). Needless to say, they did not include data from the Cushman Club of America’s 2018 rally in Sturgis, where the riders were generally low speed as well as low key. Here’s a shout-out to my favorite Cushman rider for teaching me what I know about having fun on two wheels.

Are you an organ donor? Have you discussed your wishes with your family? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 12/29/22

December 28, 2022 Headlines No Comments

Settlement: Scripps Health agrees to pay $3.5 million to patients affected in 2021 data breach

The health system settles with the 1 million patients who were affected by a May 2021 ransomware attack.

Stroke victims up to 48 PER CENT more likely to make full recovery when diagnosed using AI technology, trials suggest

Analysis of the data of 100,000 stroke patients suggests that 48% made a full recovery when AI was used to diagnose and treat them faster, versus 16% without the technology.

Ohio Supreme Court says insurance policy does not cover ransomware attack on software

The Ohio Supreme Court overrules a previous ruling that the property insurer of medical billing software vendor EMOI should cover a ransomware attack.

Morning Headlines 12/28/22

December 27, 2022 Headlines No Comments

Spokane VA has reduced staff despite ongoing effects of troubled computer system as veterans wait longer for care

The local paper reports that the cost of extra staff who have been hired to offset a loss of productivity with Oracle-Cerner has delayed care and pushed veterans into the private healthcare system.

CapVest’s GLO Healthcare completes acquisition of Calyx, a Global leader in the delivery of improved outcomes from clinical trials

A private equity firm acquires Calyx, which offers medical imaging, interactive response, and clinical trials management software.

Patient access to full general practice health records

An editorial in BMJ calls for NHS England to move head with its delayed program to give patients access to their records, saying that patients will need to become more self-reliant as access to care in the UK continues to worsen.

News 12/28/22

December 27, 2022 News 4 Comments

Top News


The Spokane VA is losing clinical staff over its Oracle Cerner implementation, the local paper finds. The hospital is projecting a budget deficit of $30 million in the fiscal year that ends in September 2023, with $10.5 million of the shortfall being caused by adding jobs to offset the loss of productivity with Oracle Cerner.

Employees complain that Oracle Cerner requires extra steps and irrelevant drop-down entries because it shares the DoD’s design, such as a lab prompt that requires selecting the patient’s species (since DoD documents the care of service animals).

The hospital’s decreased capacity has led more veterans to seek care in the private sector, which involves longer waits and higher cost to taxpayers.

Nearly three-fourths of the employees of Mann-Grandstaff VA Medical Center said in a September survey that their morale had decreased because of Oracle Cerner, with the vast majority complaining about less-efficient work processes, increased documentation time, and concerns about patient safety. More than 80% of respondents said they have seen little or no improvement in the system went live.

An OB-GYN  resigned “mainly because of the Cerner EMR,” saying that she is “mystified by and beyond disappointed in the Cerner product.”

HIStalk Announcements and Requests


Two-thirds of poll respondents say that the kind of healthcare that most of us want can’t be delivered in the US because of our free market health system. AT says that individuals prefer to be healthy, but that is a worst-case scenario for providers who are paid under a sick care model. Cosmos says healthcare should be regulated like a utility. Adam Smith (probably not the one who comes to mind since he’s been dead for a couple of centuries) notes that people don’t actually want healthcare, they want to feel and look better, so a true free-market system would focus on services that consumers will pay for, such as Lasik and cosmetic surgery, at the expense of public health and emergency services that support the common good.

New poll to your right or here: Is it acceptable for a non-profit health system to provide donors and VIPs with a higher level of non-clinical service than everybody else gets? I’ve mentioned before that I worked right out of school for a dump of a for-profit hospital, and when the mother of the eye surgeon who was our biggest revenue generator was scheduled to be admitted, it was like the President had collapsed on the sidewalk outside. I still maintain that we weren’t doing her any favors on the clinical side – nurses and other staff were forced to work outside their usual routines to cater to her in her room in a mostly isolated hallway (because our fawning administrators had her neighbors transferred further away) and the last thing you want as a patient is for clinicians to be winging it.


January 19 (Thursday) 2 ET. “Supercharge Your Clinical Data Searches.” Sponsor: Particle Health. Presenter: Paul Robbins, MSMBA, VP of product, Particle. Particle’s team will preview the exciting results of Specialty Search, a new condition-specific record locator service. This webinar will review how to collect patient records from top Centers of Excellence across the entire country; how healthcare organizations of all types are benefiting from Specialty Search capabilities, using Particle’s simple API; and why a focused search of chronic condition data — in oncology, cardiology, endocrinology, orthopedics, and more — has an outsized impact on care outcomes.

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

Acquisitions, Funding, Business, and Stock

A private equity firm acquires clinical research technology vendor Calyx, which it will fold into its GLO Healthcare.

Oracle Cerner has offered 4.1 million square feet of Kansas City-area office space for sale in the past 22 months.


  • Luminis Health will replace its legacy PACS with Visage 7 from Visage Imaging in a transactional licensing model for the cloud-engineered system.



Medecision hires Jana Barbuto (FluidEdge Consulting) as SVP of business development.


Hunter Bradley (Finvi) joins Atlas Health as VP of implementation.

Privacy and Security

An Associated Press report finds that governments are using COVID-19 contact tracing apps for mass surveillance, to stifle dissent, and to provide police with suspect tracking information. In the US, HHS signed contracts for collecting identifiable patient data and CDC bought the cellphone tracking data of 20 million people for COVID-related purposes.


An op-ed piece in BMJ says that  NHS England needs to move ahead with giving patient access to their own records, both to empower them and to support the self-reliance that is necessary as access to care in the UK has slid to among the worst countries in Europe.

An advocacy group finds that employees at Washington, DC’s public psychiatric hospital didn’t notice one patient killing another earlier this year because they were staring at their phones, chatting, or away from their assigned posts.


An Ontario breast cancer survivor says that a speech recognition program’s omission of the leading word “if” in the second sentence above led her to believe that her cancer had returned.


Mr. H, Lorre, Jenn, Dr. Jayne.
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News 12/23/22

December 22, 2022 News 10 Comments

Top News


HHS publishes ownership data for all 7,000 Medicare-certified hospitals, which it says will help researchers and enforcement agencies identify owners with a history of poor performance, support research related to cost versus ownership, and allow consumers to make better decisions.

HIStalk Announcements and Requests

Today’s post will be short and Monday’s may be entirely absent given the paucity of news. Enjoy whatever holiday that you celebrate, if any. 

Speaking of which, I’m distressed to see companies laying employees off right before Christmas. I can only assume that they are clueless, heartless, or so poorly managed that the best option was to upend the lives of members of their “company family” who now face a bleak holiday season. There’s no good time to be laid off, but a business must be sinking fast if they couldn’t wait until January to jettison their human ballast. Standing in front of holiday decorations to tell your family that your livelihood has been ended while simultaneously dealing with personal shame and a sense of betrayal can’t be fun.

I never look at Google Analytics stats for HIStalk, but I brought it up today to find something. I was surprised to see that while 89% of unique visitors since August 1 (when I installed the new version of GA) were from the US, China was the second-highest country at 3%, followed by Germany, India, Canada, and the UK. I’m curious about what a visitor from China would find interesting about HIStalk.

I think this is the first time that I’m so unenthused at attending a HIMSS conference that I haven’t registered or made travel arrangements by year’s end. The biggest single booths booked so far are Epic (7,200 square feet) and Oracle Cerner (6,400). Other large ones are Microsoft, EClinicalWorks, Athenahealth, InterSystems, and Philips.


January 19 (Thursday) 2 ET. “Supercharge Your Clinical Data Searches.” Sponsor: Particle Health. Presenter: Paul Robbins, MSMBA, VP of product, Particle. Particle’s team will preview the exciting results of Specialty Search, a new condition-specific record locator service. This webinar will review how to collect patient records from top Centers of Excellence across the entire country; how healthcare organizations of all types are benefiting from Specialty Search capabilities, using Particle’s simple API; and why a focused search of chronic condition data — in oncology, cardiology, endocrinology, orthopedics, and more — has an outsized impact on care outcomes.

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

Acquisitions, Funding, Business, and Stock

UK doctors warn that “privatization of the NHS by stealth” is occurring as a subsidiary of US health insurer Centene has quietly acquired 67 GP practices, making it the largest provider of such services. Centene also acquired a 50-hospital private health group. Advocates, some of whom are former NHS executives who took jobs with Centene-related businesses, tout innovation and cost reductions, but prior experience with Centene’s similar operations in Spain suggest that expectations didn’t match reality as cost savings didn’t materialize and the company has started divesting non-core assets to boost profits.

Zus Health founder and CEO Jonathan Bush says that the recession changes the game for digital health vendors:

In 2023, the pudding is that you create rock-solid cash savings for buyers of healthcare. I think that means that many worthwhile point solutions that have excellent offerings will need to work quickly to club up with aggregators or find other means of going to market with guaranteed easy savings math for unsophisticated benefits buyers. It will also mean efficiency will begin to trump effectiveness.



Mallika Edwards (Transaction Data Systems) joins Xsolis as chief product officer.


Bardavon Health Innovations promotes Alex Benson, MPA to COO.

Announcements and Implementations

US life expectancy dropped again in 2021, going back to 1996 levels even as other countries saw their average lifespan rebound. Experts say the US did so much worse because of low COVID-19 vaccination rates, drug overdoses, and the generally poor health of its citizens.


University of North Carolina – Chapel Hill describes how its venture studio launches digital health startups that are quickly ready for investment.

Government and Politics

Omnibus Appropriations legislation, if approved by the Senate and House, would extend Medicare telehealth flexibility and Acute Hospital Care at Home for another two years. Government funding expires at 11:59 p.m. Friday.



The New York State Health Department launches an investigation of ECMC Hospital (NY) after a video goes viral in which its psychiatric nurses confront administrators over staffing levels. The nurses, who say they are caring for an average of 53 patients each, first ask an unidentified administrator about staffing plans for the week, during which the administrator doesn’t look up from her phone. They then knocked on HR’s door, where nobody answered, and then tried to see the director of nurses, who was on vacation. The hospital blamed the issues on its inability to discharge patients to state-supported programs and the low reimbursement rate for Medicaid patients. 


Doctors at NYU Langone’s ED say the hospital gives VIP treatment to wealthy donors, politicians, and celebrities who sometimes cut the triage line when employees see “friends and family” flags in the EHR that the patient should receive preferential treatment. Hospital trustees can use a dedicated phone line to alert staff that they are coming, after which administrators call and text doctors that a high-priority patient is on the way. Two interviewed members of NYU Langone’s board of trustee members told the New York Times that their ED care was fast and excellent, but they assume that all patients are treated similarly. Some doctors have quit or been fired over the hospital’s VIP policies and ACGME has placed the ED on probation. The hospital responded by hiring a defamation law firm that is best known for threatening news organizations with its expertise in “understanding the obstacles that the First Amendment poses for defamation plaintiffs.”


A hospital in France evacuates in a bomb scare that was triggered by the arrival in the ED of an 88-year-old man whose chief complaint was the World War I artillery shell that had mysteriously found its way into his rectum.


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