London-based Babylon Health confirms the close of a $550 million Series C funding round, calling it the largest-ever digital health investment of its kind in Europe or the US.
Ambulatory health IT company DAS Health acquires the WRT collection of companies, which includes WRT Specialties, Easy PC Solutions, EasyMed Billing, and Systech Solutions.
Presbyterian Healthcare Services (NM) begins alerting 183,000 patients of a June phishing scam that exposed the personal information of patients and health plan members.
The Detroit business paper covers this year’s layoffs by Beaumont Health, the most significant of which involved IT and revenue cycle employees.
EVP, Chief Transformation Officer, and CIO Subra Sripada left in April (he’s now with Navigant), as did VP/CIO Matthew Zimmie, MD (who’s doing independent consulting). The organization’s SVP of human resources is serving as interim CIO.
Those employees who were let go probably won’t appreciate executive comments that all healthcare systems “are reorganizing their operational platforms” and that while 175 people lost their jobs this year, 4,235 were hired.
The health system is spending tons of money on the acquisition of Summa Health, hospital construction, and the opening of 30 urgent care centers.
Beaumont Health’s most recent year’s tax filings show a loss of $3.9 million on revenue of $4.4 billion. The CEO was paid $5.6 million, while the departed CIO made $1.3 million.
Reader Comments
From Google Pyle: “Re: Google Health. LinkedIn has people listed as being on its advisory board. I thought it Google Health was dead.” I’m not sure what Google Health even means now that the failed personal health record of that name was retired in 2011 and much the company’s healthcare projects placed under Verily. It may be that “Google – Health Advisory Board “ was the intention rather than “Google Health – Advisory Board.” I emailed a Google press contact hoping to clarify what Google Health is these days and who serves on its advisory board, if it still exists. I’m not holding my breath for a response. I don’t get too excited about advisory boards (as opposed to actual boards of directors) since companies often choose high-profile people just to pick their brains and maybe try to sell them something instead of relying on them to provide actual sound advice in return for compensation.
From AngryMD: “Re: Epic. Rebrands its anesthesia product ‘Flo’ and its infection control product ‘Bugsy.’ Can you stop wasting our time with these inane name changes and work on improving the software we’re spending millions on?” I’m a fan of Epic’s product names, which like the company’s campus, are clever, whimsical, and integral to the culture you’re paying for as a customer whether you like it or not. Judy Faulkner still picks the product names herself as far as I know, so I doubt any developers were harmed in the making of this movie. I don’t hear many complaints about Epic lagging on support responsiveness or development timelines, but I’m always interested in the physician user perspective. What would you say the company’s top priorities should be?
From Sue Schadenfreude: “Re: Meditech. As you noted, newly named Meditech President Michelle O’Connor has only ever worked at Meditech, and unlike most of the company’s execs who have only undergrad degrees but several from MIT, hers is from a state college. Hoda Sayed-Friel has been moved off to the side to start a professional services division. Always interesting things happening there.” Meditech is starting to hand off to the next generation of executive leadership (O’Connor is second-youngest of all directors and officers at 52), although its youngest board member is 65. This might serve as a preview of how Epic’s next generation will be installed since the companies are similar. Meditech values tenure, with its most recent annual report listing these executives and their start date (imagine still being the rookie suit after nearly 30 years with the company):
Michelle O’Connor – 1988
Hoda Sayed-Friel – 1986
Helen Waters – 1990
Christopher Anschuetz – 1975
Steven Koretz – 1982
Leah Farina – 1989
Scott Radner – 1990
James Merlin – 1986
Geoffrey Smith – 1989
From Cohesive Summary: “Re: AI in medicine. Why do technologists persist, decade after decade, in focusing on diagnosis rather than solving problems that people actually want help on? What springs to mind is finding ways that billing could be at least partially automated.” Startups, investors, and consumers grossly overestimate the incidence of misdiagnosis, maybe because it’s always been an easy programmer’s target to match up a set of symptoms with possible diagnoses even when the result changes nothing. They could probably save 100,000 times more lives by tackling problems that directly influence outcomes, although that’s a much fuzzier area than a computer-generated a-ha moment of dramatically announcing some weird but correct diagnosis. Precision medicine might be a good compromise, but even that isn’t likely to move the public health needle much. Perhaps the biggest reason for missing the point is that technologists are mostly young, can’t fathom death or disability, and have the money to bribe their way around healthcare’s velvet rope, so they may be oblivious to the concept of public health and the societal cost our inferior version of it creates. I also speculate that those same companies are overly focused on population health and patient engagement as the nail their technology hammer can easily pound, failing to understand that even cleverly designed and customized automated messages aren’t likely to improve the outcomes of those among us with the greatest healthcare needs. The idea that patients always do fine once properly diagnosed is dangerously naive, as is trusting providers to first do no harm even with the best of intentions. Also naive is the idea that companies and healthcare organizations will value the consumer’s interest over their own.
HIStalk Announcements and Requests
I belatedly realized that I omitted the most obvious option in last week’s poll – leaving the patient data-selling situation as-is. Otherwise, respondents most often chose requiring the patient’s explicit permission, paying them, or not allowing their information to be sold at all.
New poll to your right or here: how much healthcare innovation will result from Cerner’s partnership with Amazon Web Services? Click the Comments link after voting to explain yourself.
A chance radio encounter with Deep Purple’s magnificent 1972 “Machine Head” deep track “Pictures of Home” led me to mount a Spotify exploration of their contemporaries, which sent me to the catalog of Iron Butterfly. They put out quite a bit of awful, unfocused dreck after their label rushed them into non-psychedelic follow-ups to “In-A-Gadda-Da-Vida,” but some gems shine through and their influence on future metal and hard rock bands is obvious. Fun fact: guitarist and former child prodigy violinist Erik Braunn – part of the classic 1968 Butterfly lineup along with Doug Ingle, Ron Bushy, and Lee Dorman – was only 17 when he played on “In-A-Gadda-Da-Vida” and concerns about his age cost the band their chance to land Jeff Beck and Neil Young as members. Dorman later co-founded another band I like, Captain Beyond, which is still around albeit carrying only a trace of its DNA with drummer Bobby Caldwell as the only original member. Iron Butterfly keyboardist and vocalist Ingle, in my mind the band’s key member, is long retired at 73, but is still on the preferred side of the dirt.
I just realized today that Microsoft Windows has properly faded into the background of my daily routine, finally outgrowing its maddening stage as an exuberant puppy that chews shoes and pees on the floor into a contented companion that never lets me down. I can’t recall the last something about Windows frustrated me.
I was thinking today that the most successful technologies either (a) help you do something you want to do, such as stream movies or play games; or (b) make it easier to do something you’re required to do, such as fill out tax forms or prepare presentations. Most apps that fall under the “digital health” category do neither.
Webinars
None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.
Acquisitions, Funding, Business, and Stock
Here’s a look at how the recent health IT IPOs are doing:
Health Catalyst (July 25) – listed at $26, opened at $37.17, now at $40.54, valuing the company at $1.4 billion.
Livongo Health (July 25) – listed at $28, opened at $40.51, now at $37.49, valuing the company at $3.4 billion.
Phreesia (July 18) – listed at $18, opened at $26.75, now at $26.86, valuing the company at $953 million.
Change Healthcare (June 27) – listed at $13, opened at $14.01, now at $13.16, valuing the company at $1.6 billion.
People
Jamison Callins (Cloudticity) joins Prepared Health as RVP of sales.
Privacy and Security
Security firm ExtraHop warns that an unnamed medical device management product – intended to protect privacy over hospital WiFi – was actually phoning home to its vendor in connecting to its cloud storage system, which the security firm says is a strict HIPAA violation.
Other
I saw a tweet about Simple, an open source Android app and web dashboard for providers to manage blood pressure measurements and meds, created by the philanthropically supported Resolve to Save Lives.
Vendors might want to take a look at this developer productivity booster, an AI-powered auto-complete add-in that supports 22 programming languages.
Sponsor Updates
CereCore staff volunteer at Hope Lodge in Nashville.
Meditech makes its antibacterial stewardship toolkit available to customers in the US and Canada.
Nexus Primary Health in Australia migrates its InterSystems TrakCare HIS to an InterSystems cloud-based managed service.
Waystar will exhibit at EClinicalWorks Day August 7 in Atlanta.
Nordic will exhibit at the CORE Conference August 5-7 in Salt Lake City.
Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the Arizona Perinatal Trust Conference August 8-9 in Flagstaff, AZ.
Recondo Technology will host a networking event during the CORE Conference August 7 in Salt Lake City.
Unlimited Technology Systems integrates Relatient’s automated patient engagement solutions with its G4 Studio RCM platform.
ROI Healthcare Solutions names Sara Wallace (Oracle) director of business development for the Midwest region.
The VA opens director and deputy director positions to oversee its Cerner implementation.
Meditech reports lower quarterly revenue and earnings.
Cerner signs a partnership deal with Amazon Web Services.
The country’s biggest technology companies reaffirm their commitment to healthcare interoperability.
CMS announces a pilot project to display a patient’s claims data to Medicare fee-for-service providers.
Surescripts says Amazon-owned mail order pharmacy PillPack accessed its patient prescription records without authorization and will turn the issue over to the FBI.
Bain sells a majority stake in Waystar.
Meditech celebrates the 50th anniversary of its founding this week.
Kaiser Permanente hires its first chief digital officer.
Best Reader Comments
I’ve seen [inaccurate hospital patient records] more times than I can count. However the more the information gets used and the more visibility it has, you start to see incentives to clean up the problem. One of the strongest forces is when you see automation or analytical reporting, or any type of financial incentive. My standard line is, “no one cares about data quality so long as no one is using the data”. Also, we are very forgiving about data errors so long as only human beings are consuming that data and the data usage is transactional and episodic (e.g. a patient chart during treatment). As soon as you start comparing one patient chart to a bunch of other patient charts, in any systematic way, that changes. Eventually the Data Quality department gets involved, the line managers can’t justify or defend the bad documentation, nor can the clinicians, and some procedures to clean things up are put in place.It takes time but it’s a real thing. (Brian Too)
I’d like to understand how Cerner moving to AWS is innovative and “pretty disruptive.” (ellemennopee)
I’m not seeing the real value in the “Data at the Point of Care” project for any one provider. It appears that it only gives them data for Medicare FFS patients. Only about 60% of Medicare patients are still in FFS, and think about how any one provider’s patients come from a variety of commercial and public payers. Does it help provide better care overall if they can only use that data for a small percentage of their patient panel? Care is already delivered differently based on who the payer is due to network restrictions, coverage levels, and the payer’s unique quality measure requirements, does this just further that divide? Would be interested in providers’ thought. (SEH)
Interesting combo of news this week. Cerner encourages investors with their plans to boost earnings by selling patient data. Amazon’s PillPack and Surescripts scrap over access to patient medication data. Cerner announces partnership with Amazon’s AWS for hosting their customers’ systems. Hmmm, I wonder where my patient data is going to end up when I entrust it to a Cerner hospital? (YourRxAdsHere)
[Epic’s] implementation staff is green, inexperienced, and taught to walk the Epic Foundation line. They in no way have experience in a hospital, or in any sort of maintenance of the systems they implement … On the other hand, if I had to hire staff, I would hire any Epic employee in a heartbeat. They are hard workers, bright, and great presenters, I have nothing bad to say about any I have encountered. It’s their lack of true experience that bothers me. (IMPlement)
One of the reasons IT and hospital administration favor systems like Epic and Cerner is that they want to standardize across the health system. They don’t want an app to be able to come in and override their configuration. They want everyone in their system to be on the same software and they want one throat to choke for getting software to do what they want. This is especially true for the particulars of this period of time in healthcare, in which ensuring quality while reducing cost is on everyone’s mind. We aren’t designing aircraft or cruise ships or other innovative developments. We need good execution of the good ideas already out there at an attainable price. (WhoIsBuyingThat)
Watercooler Talk Tidbits
Readers supported the teacher grant request of Ms. D in Texas, who asked for math manipulatives for her elementary school class following the devastation of Hurricane Harvey. She reports, “Thank you so much for all you gave to my class. The games and activities you helped bring into my class has already made such an amazing impact. We love to use them in centers and the students love to play with them, but most importantly, learn with them. Words cannot describe how much these items mean to us. We recently used the fraction cards and power pen to help compare fractions! The students loved being able to hear the sound it made when they got it correct. We will continue to use these amazing materials and games to help further their learning.”
An analysis of the Democratic presidential debates by the executive editor of the liberal magazine “The American Prospect” says the candidates are ignoring and misrepresenting the top issue of voters, which is healthcare:
It’s a very strange situation for the leaders of reforming healthcare in America are too cowardly to talk about what’s wrong with healthcare in America. We know from experience that trying to play a savvy game and keeping the hospital industry on the sidelines won’t work. The hospital industry cut a deal with President Obama to eliminate the public option last time around. They’re already funding the effort to destroy reform this time. Why won’t anyone say this out loud?
Healthcare in America costs too much. We’re having a debate over how to fix it that renders invisible the very actors who charge the prices. That’s a recipe for disaster. Someone must show a modicum of guts and describe this system as it is, before it consumes us all. So far, guts are not in evidence.
A retired doctor in Ohio gets the attention of the President when his daughter’s back surgery results in an $18,000 bill for urine drug screening that had been sent to an out-of-network lab, the same test that would have cost $100 if performed in-network. He says he is “ashamed of my profession” and notes that “almost all medical bills are paid with someone else’s money.” A Houston pain management doctor owns both the surgery center and the lab.
Missouri’s medical board places Russell Imboden, DO on probation for prescribing drugs to himself, ordering unnecessary lab tests, and treating patients with serious medical conditions with chicken bouillon, protein shakes, and controlled substances from his “cell-based regenerative medicine” clinic that focuses on “metabolic and age management medicine.” He was previously fired from a similar clinic operated by another DO that sells energy drinks, medical weight loss, homeopathic remedies, and libido enhancement.
An oral surgeon sues an anesthesiologist who supervised his Brooklyn Hospital residency for sexual harassment, claiming that the woman groped him during surgery, threatened to kill him and his mother, waved a syringe at him, and sent him messages that included text such as “How would you like my dead body on your doorstep?” and “How long do you think it takes someone to bleed out?” Pik Lee was served with a protection order and arrested, but Francisco Sebastiani says she caused his firing after he complained and then gave him a bad recommendation that lost him a residency bid.
The new Miss England starts her NHS medical residency hours after winning the pageant. India-born Bhasha Mukherjee, MBBS, age 23 – whose family moved to the UK when she was nine — will move on to the Miss World competition. She says,
Some people might think pageant girls are airheads, but we all stand for a cause. We’re all trying to showcase to the world that actually just because we’re pretty, it doesn’t end there. We’re actually trying to use our reach and influence to do something good … I couldn’t tell if I was more nervous about the competition or about starting my job as a junior doctor.
An East Cleveland, OH car mechanic whose high school GPA was under 2.0 and whose family includes two young children at home graduates from medical school this year at age 47 and is doing an emergency medicine residency at Cleveland Clinic Akron General Hospital. The ED chair says of Carl Allamby, MD, “He’s got people skills most doctors don’t start out with, that customer relations mentality from his years in business. We were blown away by him.”
Babylon Health will soon reach unicorn status thanks to a forthcoming $100 million to $500 million investment from Saudi investors, allowing it to move forward with previously announced US expansion plans.
The VA posts a help-wanted notice for a director and deputy director to oversee the $10 billion Federal Electronic Health Record Modernization Program.
Salary details haven’t yet been released, though the new hires will receive a sign-on bonus and 49 days of paid vacation.
Meanwhile, the DoD announces that the next wave of MHS Genesis rollouts will occur in September at three bases in California and one in Idaho. Another seven bases will go live next June.
Implementation changes made since the initial, somewhat bumpy rollout at four sites in Washington include improved training, change management, and infrastructure.
All military medical facilities are expected to be live on Cerner by 2023.
Reader Comments
From Kermit: “Re: Meditech. Howard Messing has passed the title of president to Michelle O’Connor. He’s keeping the CEO title.” I don’t recall seeing an official announcement, but the company’s executive page and Michelle O’Connor’s LinkedIn show that “president” has been added to her COO title, apparently in April 2019. She joined the company as a programmer in 1988, having never worked anywhere else.
From Rxcellent: “Re: NCPDP’s 2017071 SCRIPT standard. I have a question for HIStalk readers. RxFill workflows provide for RxFillIndicator and subsequent RxFillIndicatorChange messaging. This allows prescribers to indicate that they only want to see partially-dispensed and not-dispensed prescriptions, but not the dispensed messages. Why would a doctor want anything other than ‘all fill statuses?’ If you use RxFill to monitor adherence or to determine whether the requested renewal is appropriate, why wouldn’t you want to see all statuses? Why does NCPCP include this as an option?” I invite readers to comment on this particular clinical use case.
From Pliny the Younger: “Re: reproducibility of AI/ML. Will the concerns offset the enthusiasm for healthcare disruption?” A couple of recent articles question whether AI/ML should be trusted to make medical decisions when its results can’t be compared to previous work (think about the FDA’s point of view here). A Google researcher observes that AI is like alchemy, which produced innovations such as glass along with false cures such as bloodletting. My favorite quote from this article:
Another problem is that AI experiments often involve humans repeatedly running AI models until they find patterns in data, like the conspiracy theorist who makes spurious correlations between unrelated phenomena because that is what he is looking for. This causes AI experiments to make false inferences from data because machines cannot distinguish correlation from causation, and the more a machine searches for patterns, the more it will find them … Market incentives can also impede reproducibility. AI labs are often encouraged by parent companies to get newsworthy results by any means and make them difficult to copy. This encourages researchers to prioritize research outputs over methods and to conceal crucial aspects of their workings.
HIStalk Announcements and Requests
I don’t like to compare the quality and usefulness of the webinars that we produce — it’s like asking someone which child is their favorite — but this week’s one from Mercy Technology Services titled “Modern Imaging Technology for the Enterprise: Improve Imaging Cost, Speed, Capacity and Care Quality” is among the best ever, with my review panel and I offering zero suggestions for improvement after watching the rehearsal and Thursday’s live presentation delivering the goods. Jim Best is a great speaker, the history and overview of exactly what Mercy Technology Services does is highly informative, and the recap of their imaging project is admirably concise and useful.
I added a sidebar menu item for Vince’s magnificent HIS-tory document, which he views (and I would agree) as the high point of his 50-year career in our industry. The information that Vince has preserved for posterity exists nowhere else that I’m aware of.
Webinars
None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information.
Acquisitions, Funding, Business, and Stock
Meditech reports Q2 results: revenue down 4%, EPS $0.44 vs. $0.65. Product revenue slid 15%. The company will sell one of its nine buildings for $120 million, giving it an $88 million profit.
Spok reports Q2 results: revenue down 3%, EPS –$0.03 vs. –$0.06. SPOK shares are down 15% in the past year vs. the Nasdaq’s 6% increase, valuing the company $232 million.
Business Insider reports that Babylon Health will soon reach unicorn status thanks to a forthcoming $100 million to $500 million investment from Saudi investors. Analysts predict the UK-based company will use the funding to make good on its previously announced expansion plans into the US and Saudi Arabia, though it remains to be seen if its services will leave physicians as up in arms as their British counterparts. Many NHS providers contend the company’s GP at Hand virtual primary care service has skewed patient demographics, leaving NHS clinics caring for the most vulnerable while the young, wealthy, and tech-savvy opt for Babylon’s app-based care.
Accolade will use software from recently acquired physician performance data company MD Insider to power its new nurse-led care coordination program for members and employees.
Madison, WI-based Nordic expands beyond its Epic roots to add Cerner consulting services.
Sales
The VA awards Ready Computing a five-year contract to support the transition of health data from VistA to its new Cerner EHR.
CoxHealth (MO) will offer MDLive’s virtual care service across its network of six hospitals and 80 clinics.
People
David Sides (Streamline Health) joins Teladoc Health as COO.
Castlight Health promotes Maeve O’Meara to CEO following the departure of John Doyle. CFO Siobhan Mangini will take on the additional role of president. CSLT shares are down 50% in the past year and have tanked a stunning 95% since its March 2014 IPO.
CommonWell Health Alliance opens a search to replace Executive Director Jitin Asnaani, MBA, who will leave the organization after four years.
Announcements and Implementations
Montefiore Nyack Hospital (NY) implements Aidoc software to help radiologists better identify life-threatening conditions on patient CT scans.
Patient intake and engagement vendor Orca Health selects Redox’s EHR integration software.
In Canada, Holland Bloorview Kids Rehabilitation Hospital goes live on Meditech Expanse.
A new KLAS report finds that three-fourths of the hospitals that are actively seeking to replace their EHRs are running legacy Meditech, Allscripts (especially Paragon), and Cerner. KLAS’s A-list includes Epic and Meditech Expanse, the latter of which draws customer praise for usability, workflow, mobility, company responsiveness, and innovation while offering strong value (and notably beats Epic Community Connect in “would buy again.”) The #1 reason for considering an EHR replacement is integration, where old products such as legacy Meditech, Allscripts Paragon, CPSI, and Medhost lag. Some Cerner prospects are scared away by revenue cycle issues, while Allscripts Paragon lost 16 clients in 2018 and nearly half of the remaining customers say they’re ready to move on to something else, rarely Allscripts Sunrise (zero of the 16 defections). KLAS says Sunrise “receives few considerations, and when considered, is rarely selected” as its customer base is shifting mostly to Epic. Critical access hospitals are anxious to see the inpatient product of EClinicalWorks once it starts bringing sites live.
Privacy and Security
DirectTrust is working to develop a standard for secure instant healthcare messaging. Trusted Instant Messaging+ will enable users to communicate within enterprise messaging software and across different technologies using a common standard.
Other
Google-owned DeepMind announces that its AI software can detect acute kidney disease up to 48 hours before physicians recognize its symptoms. The London-based company developed and tested its algorithm using 700,000 medical records from 100 VA hospitals as part of a project announced at the beginning of the year. DeepMind, which also worked with the Royal Free Hospital in London, plans to also develop and deliver provider alerts in emergency situations.
The Los Angeles County District Attorney’s Office charges Guido Germano, PhD, director of the Division of Artificial Intelligence Medicine at Cedars-Sinai Medical Center (CA), with distributing child pornography.
Cerner COO Mike Nill says the company chose Amazon Web Services as its cloud partner mostly because it wants to tap into Amazon’s consumer and supply chain expertise to create products that the two companies can sell to other organizations. Nill also says that 80% of Cerner clients host their systems in the company’s data centers and AWS can migrate them to the cloud faster than competitors such as Google and Microsoft.
Sponsor Updates
FormFast staff helped to prepare 20,454 meals at the St. Louis Area Foodbank.
Alabama One Health Record relies on InterSystems HealthShare to power its HIE and enhance connectivity between providers and emergency responders during natural disasters.
Wolters Kluwer Health Voice Design Director Freddie Feldman will present at the Voice of Healthcare Summit August 5-6 in Boston.
Spok announces that all 21 hospitals named to the US News & World Report’s 2019-20 Best Hospitals Honor Roll use its clinical communications solutions.
EClinicalWorks will exhibit at GI Outlook 2019 August 2-3 in Los Angeles.
EPSi will exhibit and present at the HFMA Mid-America Summer Institute August 507 in Kansas City, MO.
The Deal interviews Healthcare Growth Partners Managing Director Chris McCord.
A new KLAS report on acute care EHRs gives Meditech Expanse an A-List Honorable Mention for its increased market energy, overall customer satisfaction, and high customer retention.
In Scotland, NHS Forth Valley goes live on InterSystems TrakCare.
The Federal Trade Commission has agreed to a $5 billion settlement with Facebook following allegations that the social media giant misled users about their ability to protect personal data. Privacy advocates argued that Facebook deceived patients about the “Groups” function, encouraging them to share personal health information which was then exposed to the public. Although the settlement also requires Facebook to create an internal privacy oversight board, some say the penalty doesn’t do enough to protect user privacy. The settlement order will be in place for 20 years and sets up multiple compliance channels. The settlement, nearly 20 times larger than any previous settlement, must still be approved by a federal judge.
CMS announces additional Primary Care First Model Payment Office Hours sessions aimed at reviewing the proposed model payment structure and various model components and measures. CMS still hasn’t released the Request for Application for the program, so many of us are waiting for the details before we make decisions on participation. They did update the anticipated timeline for the RFA from “spring” to “summer” on their website, however.
CMS did, however, release the proposed rule for the 2020 Medicare Physician Fee Schedule this week. The Relative Value Unit (RVU) conversion factor went up a whopping $.05. Bundled episode of care codes were added for telehealth treatment of opioid use disorders. There is additional refinement of Evaluation and Management (E&M) codes for outpatient visits, including retention of five levels of coding for established patients and the reduction to four levels for new patients. There are also changes to the time requirements and medical decision making requirements for all of the codes. History and Physical are now required only “as medically appropriate,” which should be interesting when audits start occurring.
Medicare supervision of physician assistants will have increased flexibility for PAs to practice more broadly; requirements for physicians who precept students will be relaxed so that re-documentation is no longer necessary. Payments for Transitional Care Management will be increased along with the development of new HCPCS codes for certain Chronic Care Management services. I’m not sure that this addition of Medicare-specific codes will make things more simple, although it should allow physicians who spend additional time and resources to be able to differentiate that in their billings. A new code for Principal Care Management will also be created to compensate clinicians for providing care management services to patients with a single serious or high-risk condition.
Since they can’t release just one proposed rule, they also released the 2020 proposed rule for the Quality Payment Program. Highlights include:
Increasing the performance threshold from 30 to 45 points.
Decreasing the category weight for Quality and increasing the weight for Cost.
Increasing the data completeness threshold for quality data submission.
Increasing the threshold for Improvement Activities for group reporting.
Updating requirements for Qualified Clinical Data Registry measures.
I’ve long been a follower of CIO Sue Schade and really enjoyed her recent blog post on meeting norms. Sue is currently doing interim IT work at the University of Vermont Health Network and is getting used to their rules regarding meetings. It sounds like they’re walking the walk and talking the talk on the fabled “50-minute meetings” that I always try to get my clients to adopt. People need time to refresh and readjust between meetings and the back-to-back culture I see with most of my clients doesn’t add to a positive working environment. Their “meeting norms” include providing agendas and meeting materials in advance with the invitation, and allowing people to bypass meetings that don’t have an agenda. They’ve also adopted meeting-free Fridays to allow people to focus on work and individual interactions.
It takes time for organizations to move to this kind of structure, but when they do, productivity typically increases and frustration decreases. You no longer see harried people scurrying from meeting to meeting or zoning out because they’re overextended.
I missed this newsy tidbit last week, but AHIMA and CHIME went to Capitol Hill to lobby to eliminate the 20-year prohibition of federal funding for a unique patient identifier. Representatives urged the Senate to support the Foster-Kelly House amendment to the Departments of Labor, Health and Human Services, and Education, and Related Appropriations Act of 2020. Removal of the ban would allow HHS to fund efforts towards a unique identifier. After working with patients from around the world who are used to having to provide a national health card prior to receiving services, it certainly seems like it might be an improvement over the matching algorithms we have that use name, DOB, address, and phone numbers.
JAMA Network Open confirms what we all already know: US adults are becoming more sedentary. In a cross sectional study looking at more than 27,000 adults, the time spent on sedentary behaviors increased from 5.7 to 6.4 hours per day in 2015 and 2016.
I wish they were here to collect data at the World Scout Jamboree, where I’ve walked 71 miles since I arrived. There’s still a few days to go, so that total will continue to increase. We’re seeing lots of tired feet, a bit of athlete’s foot, and plenty of orthopedic injuries as tens of thousands of scouts try to maximize the time they have left at the Jamboree.
Neckerchief trading is in full swing and I was excited to score one from the UK, but I had to trade away my medical neckerchief to get it. The nations of the world are relatively uninterested in sporting “neckers” from the US. Especially prized are neckerchiefs from Brazil and Belgium. Lots of people are interested in the ones from the Swedish contingent, but from what I’ve been told, they only receive one and don’t typically trade them.
We’ve survived our heat wave here in West Virginia and are having some rain showers that have already brought cooler temperatures. The next milestone is the closing show on Thursday night. I get to attend this one since I was working during the first one, and hope they bring back the fleet of 250 drones that swarmed across a 900 x 400 foot of aerial canvas during the first show. Everyone said the effect was outstanding, with attendees’ wristbands lighting up as the drones formed the shape of their home continents.
It’s only a few days until hundreds of buses roll back in to take the scouts to their next adventures. Some toured the US prior to the Jamboree and others plan to tour after. Either way, they (and the nearly 10,000 staff that have supported them) have had the adventure of a lifetime.
DoD officials assure the next round of MHS Genesis end users that they will receive improved training, change management, and infrastructure during the September roll outs.
Protenus reports that 31,611,235 patient records have been breached in the first six months of 2019 – more than double the number reported for all of the previous year.
Technology leaders Amazon, Google, IBM, Microsoft, Oracle, and Salesforce reaffirm their commitment to interoperability and list their accomplishments toward it over the past year, including releasing open source FHIR tools and new specifications.
Cerner names Amazon Web Services as its preferred cloud provider and will work with AWS to deliver machine learning solutions, analytics, and HealtheDataLab for analyzing patient data.
CMS will pilot its “Data at the Point of Care” project starting in September, which will display Medicare claims data to providers via an API.
The pilot project is part of MyHealthEData, led by the White House’s Office of American Innovation under Senior Advisor Jared Kushner. That office, along with HHS, CMS, ONC, NIH, and the VA, launched MyHealthEData in March 2018, which included Blue Button 2.0.
The API is built to the bulk FHIR standard specification that most EHR vendors have been working on. Providers who sign up for the pilot project will ask their EHR vendor to participate with them.
Providers will be able to view their Medicare patient’s visit history, diagnoses, medications, and procedures.
The project will help prove the value of the data, encourage more widespread use of FHIR, and encourage providers to share data once they see that CMS is doing so. Providers will also publish their endpoints in the NPI database, making them accessible to others.
CMS wants you as a pilot site if:
You are fee-for-service while treating Medicare patients.
You are already receiving claims data from payers and have integrated it into provider workflows.
You have experience working with Blue Button 2.0, the Beneficiary Claims Data API (BCDA), and the bulk FHIR standard.
The project’s FAQ characterizes CMS’s three claim-based programs as follows:
Blue Button 2.0 displays data for a single Medicare beneficiary if the patient authorizes.
BCDA provides FHIR-formatted bulk files to ACOs for all their assigned beneficiaries who have not opted out.
Data at the Point of Care will provide FHIR-formatted bulk files to fee-for-service providers for their active patients as needed for treatment purposes as defined by HIPAA as a covered entity, for those patients who have not opted out.
CMS Administrator Seema Verma announced the pilot at the Blue Button 2.0 Developer’s Conference at the White House.
Also at BBDC
Carin Alliance announces its Blue Button data model and draft implementation guide.
Technology leaders Amazon, Google, IBM, Microsoft, Oracle, and Salesforce reaffirm their commitment to interoperability and list their accomplishments toward it over the past year, including releasing open source FHIR tools and new specifications.
CareMesh announces the first National Provider Directory based on FHIR.
NIH issues two notices to promote the use of FHIR in funded clinical research to promote interoperability of research data.
Reader Comments
From Bill and Larry Duct: “Re: Net Health. Trying to find out the cause of Net Health’s outage that affects users of its wound care systems, which have been down for 48 hours. Wondering if it’s a ransomware attack?” Net Health told customers in a Saturday morning mail that it was hit by ransomware on July 23, which is a week ago today (Tuesday). The company was unusually forthcoming in describing the incident in detail – it was attacked by Readme ransomware, which it says is not likely to have penetrated its encrypted data. We can probably assume given the extent of downtime that the company declined to pay the ransom.
From Screwy Results: “Re: hospital data. Interoperability is only part of the problem. Hospital records are often just plain wrong and allowing other providers to see them would make that fact obvious.” Indeed they are, and that can’t be fixed by technology tweaks alone. I have zero doubt that if you video recorded a patient’s entire multi-day encounter by sticking a GoPro on their head, you would find that probably that at least 20% of what’s in the chart is wrong, mostly because of poor human documentation due to sloppiness, falsifying entries to cover mistakes, or incorrectly recalling something after the fact. We don’t really want patients snooping around in their chart or detailed bill because that would slow down the widget production line and invite ambulance-chasing lawyers. I don’t know of any other industry that is equally complacent about poor internal documentation, but then again, I don’t know of any other industry that requires so many people to document so much information, mostly to help the hospital get paid rather than to help the patient get well. Maybe someone should turn that GoPro idea into a remote monitoring business, except paid for by the patient or insurer to watch for and prevent the inevitable hospital screw-ups.
HIStalk Announcements and Requests
Listening: Gary Clark, Jr., who I mentioned in mid-2016 as a great Hendrix-style blues guitarist (with maybe some David Gilmour mixed in.) I Shazam’ed a cool song playing in an oyster bar kind of place and it was him, then heard another cool song and it was him again. He’s not afraid to get angry about injustice and bigotry, which unfortunately in today’s stridently polarized USA means alienating a big chunk of his potential audience who likes it just fine.
As a word usage curmudgeon, I’m curious why restaurant menus went from “sandwich” to “sammich” and now to “sammy” in ramping up the insufferable cuteness while in the process failing to save even a single syllable.
Speaking of word usage, a Google news search for “HIPPA” turns up 14,000 results, including a telemedicine vendor’s press release, a law firm’s blog post, several stories in a health imaging magazine, and CIO magazine. I can understand when a newspaper or non-healthcare site mangles a sounded-out HIPAA, but a healthcare site should know better. “HIMMS” also makes quite a few appearances on health IT sites (even 28 times on its own HealthcareITNews.com site). It’s not pointless criticism – can you trust a health IT site whose obviously inexperienced folks don’t instantly notice that HIPAA or HIMSS is misspelled?
Webinars
July 31 (Wednesday) 1:00 ET. “Modern Imaging Technology for the Enterprise: Mercy’s Approach That Improved Imaging Cost, Speed, Capacity, and Care Quality.” Sponsor: Mercy Technology Services. Presenter: Jim Best, executive health IT consultant, Mercy Technology Services. Enterprise imaging has become as critical as EHRs for transforming patient care, but many health systems are struggling with the limitations and costs of dated, disconnected PACS even as imaging volumes grow and radiologists report increasing levels of burnout. Radiologists at Mercy were frustrated by its nine disparate PACS, which required them to toggle between workstations, deal with slowdowns and poor reliability, and work around the inability to see the complete set of a patient’s prior images, even as demands for quick turnaround increased. In this webinar, MTS — the technical backbone of Mercy — will describe the lessons they learned in moving to a new best-of-breed PACS platform that increased radiology efficiency by 30%, with the next phase being to take advantage of new capabilities by eliminating third-party reading services and distributing workload across radiology departments to improve efficiency, capacity, and timely patient care.
Surescripts complains to the FBI about data vendor ReMy Health, which it says is sending Surescripts-owned patient prescription histories to Amazon’s mail order pharmacy PillPack without its authorization. Amazon threated last week to sue Surescripts – which is partially owned by PillPack competitors CVS and ExpressScripts and is being sued by the Federal Trade Commission for operating what it says is an e-prescribing monopoly – for revoking access to the patient history data. Surescripts says its contract with ReMy Health allows it to only provide medication histories to doctors who are providing inpatient care. It also claims that ReMy Health and used fraudulent National Provider Identifiers to hide its actual customer. Surescripts says PillPack violated the trust in its network and is threatening patient privacy, while a PillPack spokesperson said in a statement, “Given that Surescripts is, to our knowledge, the sole clearinghouse for medication history in the United States, the core question is whether Surescripts will allow customers to share their medication history with pharmacies. And if not, why not?”
Bain Capital will sell a majority stake in revenue cycle management technology vendor Waystar to a Sweden-based private equity group and Canada Pension Plan in a deal that values the company – formed in 2017 by the merger of Navicure and ZirMed — at $2.7 billion.
Cerner names Amazon Web Services as its preferred cloud provider and will work with AWS to deliver machine learning solutions, analytics, and HealtheDataLab for analyzing patient data.
Sales
Northeast Georgia Medical Center will implement Glytec’s Epic-integrated EGlycemic Management System to manage insulin therapy in its hospitals.
Oregon Health & Science University chooses Kyruus ProviderMatch to support its patient access initiative with a comprehensive provider directory.
People
Atlanta-based Streamline Health Solutions names Wyche T. “Tee” Green, III (Greenway Health) as interim president and CEO following the departure of David Sides, who has taken a job with an unnamed company. Green resigned as Greenway’s CEO in April 2016, but remained as executive chairman. STRM shares dropped 8% on the news, valuing the company at just $26 million and making the whole “let’s go public” thing seem uneconomical given the recurring reporting cost involved.
Heather George, MBA (Kaufman Hall) joins Patientco as chief revenue officer.
Healthwise promotes Christy Calhoun, MPH to chief content solutions officer.
AdvancedMD promotes Amanda Hansen to president.
Government and Politics
The White House said Monday that it will force hospitals to publicly disclose their negotiated insurer prices via a proposed federal rule that would take effect in January. The AHA responded by saying, “This is not the information that patients want or need,” while American’s Health Insurance Plans predicted that such action would “push prices and premiums higher.” Hospitals that fail to post their contract prices online could be fined up to $300 per day, a paltry $100K annual cost of business for keeping prices secret. CMS Administrator Seema Verma, questioned about the White House’s authority to issue the requirement without the involvement of Congress, cited a provision in the Affordable Care Act, which the White House has attempted repeatedly to overturn. A recent attempt to force drug companies to include prices in their advertising was shot down quickly as exceeding the President’s authority; the White House killed its own proposal to eliminate drug companies paying rebates to pharmacy benefit managers for fear of increasing Medicare premiums in an election year; and a proposal to eliminate “surprise billing” for out-of-network services seems to be going nowhere. It’s tough to beat deep-pockets industry players who have the country’s best lawyers and influential politicians on speed dial ready to derail any efforts that would threaten their golden goose, especially when trying to do it from the White House instead of the Capitol.
Other
Sunday is Meditech’s 50th birthday, as the company was founded right after the moon landing on August 4, 1969. Learn more on Meditech’s website or from Vince’s HIS-tory series. Celebrating 40th birthdays this year are its competitors Cerner and Epic, which were founded in 1979.
The Tampa newspaper highlights the rapidly increasing number of patient lawsuits being filed by Bayfront Health St. Petersburg after its purchase by a for-profit hospital chain, which is happy to take advantage of Florida’s unique law that allows hospitals to file a lien on the assets of patients if they don’t pay their hospital bills.
Arizona Republic describes how the four IT employees of Wickenburg Community Hospital rebuilt its systems after a ransomware attack last month, restoring them on the Monday morning following the Friday morning attack. Interim CIO Blue Beckham says that every system went down, leaving only “the ability to turn on a computer and get on the Internet,” presumably to pay the demanded ransom (which the hospital didn’t do due to both the principle and the principal). The hospital had just ordered a disk-based replacement for its old tape backup system, which arrived a few days afterward. Beckham says “our response and our recovery would have been 200 times better and faster” had it been installed in time.
Aetna (or more specifically, people who pay Aetna health insurance premiums) changes its mind after negative press reports, announcing that it will now cover the cost of the world’s most expensive drug, which costs $2.1 million per treatment for children who have a rare muscle disease. The drug’s development was funded by NIH and charities. Business Insider ran stories on the patients whose requests had been rejected, with the publication’s editor-in-chief abandoning all pretense of objective journalism in triumphantly tweeting about the “unbelievably good news!” I would be more sympathetic to the “quality journalism isn’t fake news” argument of news sites if they would lay off the editorializing, write stories based on their news value rather than as a personal platform, and stop running clickbait stories that are designed to mindlessly entertain rather than to thoughtfully inform. Our country is screwed if Jefferson was right and its survival requires an educated citizenry. But on the other hand, I admit that I don’t understand how humankind has decided that single-digit aged kids should make double-digit millions each year by posting funny YouTube videos of themselves playing with toys.
In England, NHS may be forced to pay millions of dollars to medical residents after a software bug allowed them to be underpaid them for shifts in which they didn’t take the mandatory 30-minute break every four hours.
The New York Times points out the problems involved with using a newly developed EHR data mining algorithm that can accurately identify men who are at high risk of contracting HIV. It notes that doctors are often clumsy when talking about sex and that patients may resent the intrusion into their sexual practices. It mentions a patient who was told by his doctor to “have less sex” when he asked for a prescription for HIV-preventing drugs, only to test positive for HIV two weeks later.
Sponsor Updates
The Chartis Group publishes a white paper titled “Harnessing Insights from your Data: Nine Key Components of a Dynamic Enterprise Analytics Plan.”
AdvancedMD will exhibit at APA2019 August 8-11 in Chicago.
CompuGroup Medical will exhibit at AACC August 6-8 in Anaheim, CA.
CoverMyMeds will exhibit at the NCSL Legislative Summit August 5-8 in Nashville.
Culbert Healthcare Solutions will exhibit at West Coast CORE August 7-9 in Salt Lake City.
The Home Depot Chief Product and Experience Officer Prat Vemana will become chief digital officer for Kaiser Foundation Health Plan and Hospitals on August 12.
Surescripts terminates its contract with ReMy Health after discovering that it allowed PillPack to access customer prescription data sourced from Surescripts without permission.
It’s another beautiful morning in West Virginia and I was able to see the calm before the storm at the aquatics area.
A fresh team from Cerner has arrived to support us through the end of the Jamboree. Working with physicians and nurses from across the country and around the world has been a great experience. The Cerner team has really gotten into the scouting spirit, with custom Cerner badges and pins to trade with the medical teams.
Since we’re partway through the Jamboree, some of the other EHR realities have come into play, including reports that show that some providers aren’t completing their notes as timely as everyone would like. In that regard, it’s not a lot different from a traditional practice. We also had some new providers arrive to help us finish out the week, and I got to spend some time as a super-user helping a subspecialist through his first shift.
It’s been great interacting with providers from around the world. During a cold snap, we learned about manual massage techniques used in Europe to warm hypothermic patients. We also learned about their method for performing CPR vs. how it’s done in the US. We’ve had some good discussions about single payer and government-based healthcare and how rationing does or does not occur in other countries.
The international providers were fascinated by some of our discussions around Meaningful Use and MIPS, when we were talking about the government requirements for providing printed visit summaries. Fortunately, here the only reason we need to provide written summaries is so that the patients know what to do in follow up. I’m glad the EHR offers instructions in multiple languages as well as easy-to-read versions given the fact that we are dealing with teenagers. It’s good since we are treating patients whose parents aren’t here and who are from other countries. I also learned a little more about how our system interoperates with the local hospital when we have to do transfers for patients who need a higher level of care.
Friends at home have asked me what the biggest challenges are with treating an international population. There are some obvious things like spoken language and medications having slightly different names on the world market. One less-obvious thing is how the EHR handles special characters used in many patients’ names. Attendees completed health history forms when they registered for the Jamboree and much of that information has been imported into our EHR. However, many of those characters have been replaced by placeholder characters, which can make it tricky to search for patients if they’re not wearing their ID badge with their registration number.
For the most part, the data that has been flowing into the EHR has been accurate. I understand from talking to one of the back-end IT personnel that it was a big challenge to merge it in from its native data source, but that they were committed to getting it done right.
AT&T has done a phenomenal job with the WiFi capabilities at The Summit, and we’ve had good coverage not only in the medical areas, but also while we roam thousands of acres of program areas. The Scouts are using a variety of social medial platforms, including a game called Novus that allows them to connect with other attendees using a wristband and then see contact information in their Jamboree app. Participants can get prizes for connecting with attendees from different countries and also for visiting various program areas and clicking their Novus devices.
The highlight of the week was Thursday, when all of the program activities — including the zip lines, scuba pools, paddle boarding, and swimming areas — were closed. Participants were encouraged to cook their traditional foods and wear traditional dress, and walking through the camp was like taking a trip around the world. I sampled spicy chicken from Trinidad and Tobago, fizzies from South Africa, Inca Cola from Peru, a German sausage stew, and some delightful sugared pancakes from The Netherlands (they reminded me a lot of beignets in New Orleans, proving again that that world is perhaps a bit smaller than we think).
We were able to partake of traditional Peruvian dance, a sauna from Finland, salted licorice from Sweden, tea and steamed pudding UK-style, and both Marmite and Vegemite. Then it was back to work to see patients who had a bit too much sun and perhaps more variety of foods than they were used to.
I only have a handful of shifts left before I head home. I have to say it’s been quite an experience. There have been challenges in delivering care in a rugged environment and also in standing up multiple health centers that are only going to run for a couple of weeks. The EHR has performed like a champ, but I suspect I might be a little more tolerant than some of the other users I hear grumbling from time to time. You’d hear that at any healthcare facility, however.
Tomorrow I have a rare day off and am going to spend it whitewater rafting in the New River Gorge. Rumor has it that the trip we’re going on has a couple of Class 4 and Class 5 rapids. I’m a little nervous about that since I’m used to water that’s a little more flat and navigated in a canoe, but I’m open to the adventure.
If you could visit any country in the world, where would you go and why? Leave a comment or email me.
The Sydney newspaper notes that Queensland’s public health system lost $25 million last year, with the health minister naming as a key factor the cost of its over-budget Cerner EHR implementation.
The American Telemedicine Association elects Joe Kvedar, MD as its next president. Kvedar — who has previously served as ATA president and board member — is vice president of connected health at Partners HealthCare.
HIStalk Announcements and Requests
Last week’s poll results should encourage companies that offer virtual visits. The main reasons that respondents didn’t use their services for recent minor conditions can be overcome via education and marketing – habit, uncertainty about how to obtain a virtual visit, and not being sure whether their issue required an in-person visit. Only around 20% of respondents have an ingrained preference for in-person visits or just don’t trust virtual visits and thus will probably never be convinced.
New poll to your right or here: which should be required before health IT vendors sell the de-identified data of patients who were treated by their provider clients? I’m fascinated that a key element of Cerner’s Wall Street-pandering “new operating model” involves selling patient data stored in its systems to drug companies or other potential buyers, announcement of which was nearly concurrent with publication of a study that found that nearly all de-identified data can be re-identified. The patient, as usual, is the pawn in having their information profitably change hands without their knowledge, much less their permission or benefit, even as they struggle to pay high doctor’s office, hospital, prescription, and insurance premium bills. The “whose data is it, anyway?” question remains unanswered even as the deals get signed.
HIStalk has been drawing 4,000-5,000 page views each weekday even in this slow summer new period, which I mention only to encourage potential sponsors to ask Lorre if she has any “Summer Doldrums” sponsorship and webinar deals left. Companies need to work to get and/or keep their names out there, and if your competitor is already doing that via their HIStalk sponsorship, maybe that’s their not-so-secret weapon for smiting you like a picnic mosquito.
Webinars
July 31 (Wednesday) 1:00 ET. “Modern Imaging Technology for the Enterprise: Mercy’s Approach That Improved Imaging Cost, Speed, Capacity, and Care Quality.” Sponsor: Mercy Technology Services. Presenter: Jim Best, executive health IT consultant, Mercy Technology Services. Enterprise imaging has become as critical as EHRs for transforming patient care, but many health systems are struggling with the limitations and costs of dated, disconnected PACS even as imaging volumes grow and radiologists report increasing levels of burnout. Radiologists at Mercy were frustrated by its nine disparate PACS, which required them to toggle between workstations, deal with slowdowns and poor reliability, and work around the inability to see the complete set of a patient’s prior images, even as demands for quick turnaround increased. In this webinar, MTS — the technical backbone of Mercy — will describe the lessons they learned in moving to a new best-of-breed PACS platform that increased radiology efficiency by 30%, with the next phase being to take advantage of new capabilities by eliminating third-party reading services and distributing workload across radiology departments to improve efficiency, capacity, and timely patient care.
Vocera announces Q2 results: revenue up 5%, adjusted EPS $0.07 vs. $0.09, beating analyst expectations for both. Share price slid 8% on the news, however, and are down 14% in the past year vs. the Dow’s 7% gain.
ResMed announces Q4 results: revenue up 15%, adjusted EPS $0.95 vs. $0.95, beating consensus estimates for both.
Sales
Raleigh Neurology Associates joins the TriNetX global health research network.
People
Dann Lemerand joins Welltok as senior director of product management. He started the 3,700-member LinkedIn HIStalk Fan Club forever ago.
Other
NBC News runs a breezy article whose headline promises to describe how “hospitals are using AI to save their sickest patients.” It falls short, however, with just these questionable examples that beg the question, exactly how do these systems learn on their own?:
Mayo’s ICU work turning EHR information into a simplified clinician display of only the most important information, which has since been commercialized as a rules-based rather than AI-powered system.
Sepsis detectors, journal articles about which do not make it clear how machine language is used even though the term is referenced several times.
Use of machine learning-powered algorithms that decrease the number of unhelpful patient alarms, which in the original research publication suggests that the system is actually a rules package that was created after analyzing real-life data.
In Australia, the Sydney newspaper notes that Queensland’s public health system lost $25 million last year, with the health minister naming as a key factor the cost of its over-budget Cerner EHR implementation and the associated planned temporary reduction in capacity.
Industry long-timer Ross Martin, MD, MHA creates “Miss Isabella Rainsong and Her Traveling Companion: A One-Guitar Show,” with a release party and live performance scheduled for August 2-3 in Baltimore.
Baylor MD-PhD candidate Julia Wang notes that a lack of consistency in lab test names can cause ordering errors.
The New Yorker looks at the dangers of using AI/ML without understanding what it’s doing under the covers, likening it to the many new drugs that earn FDA’s approval because they seem to work even though nobody knows why. The author warns that the “intellectual debt” this creates opens those systems to bias, mistakes, or misuse:
As machines make discovery faster, people may come to see theoreticians as extraneous, superfluous, and hopelessly behind the times. Knowledge about a particular area will be less treasured than expertise in the creation of machine-learning models that produce answers on that subject. Financial debt shifts control—from borrower to lender, and from future to past. Mounting intellectual debt may shift control, too. A world of knowledge without understanding becomes a world without discernible cause and effect, in which we grow dependent on our digital concierges to tell us what to do and when.
Sponsor Updates
Lightbeam Health Solutions staff pack 10,000 meals for Feeding Children Everywhere.
Meditech releases a new video, “The future of care delivery.”
Netsmart will exhibit at HomeCareCon July 29-August 1 in Orlando.
Relatient publishes a new case study, “How US Dermatology Partners Solved the Patient Intake Bottleneck with Mobile Registration.”
Vocera will exhibit at the DHITS Conference July 31-August 1 in Orlando.
Zen Healthcare IT welcomes Redcom Dispatch to its Interoperability Community.
NextGate will exhibit at the DFWHC 12th Annual Patient Safety Summit August 1 in Hurst, TX.
First DataBank will present “Medical Device Data Your Clinicians Need at the Point of Care” covering Unique Device Identifiers at AHRMM19 in San Diego this week.
Shares of Health Catalyst, Livongo, and Phreesia begin trading with significant first-day price jumps.
Cerner announces plans to create a “monetized distribution model” of selling patient data to drug companies and insurers.
Tenet announces that it will spin off its Conifer revenue cycle management and population health business into a publicly traded company and that Conifer CEO Stephen Mooney has resigned.
Cerner’s Q2 earnings meet Wall Street expectations as revenue fell short.
Essence, parent company of Lumeris, faces CMS review for using Lumeris software to identify patients who could be billed as “enhanced encounters.”
AHIMA and CHIME urge the Senate to pass a House bill that would allow HHS to participate in the rollout of a national patient identifier.
Amazon threatens to sue Surescripts over the potential loss of access to patient prescription data for its PillPack mail order pharmacy subsidiary.
Tennessee creates a committee to study state EHR use for efficiency and potential fraud.
Best Reader Comments
Cerner CommunityWorks is a multi-tenant domain for critical access hospitals and community hospitals under 200 beds. I believe that Cerner is now moving this type of model to larger medium-sized hospitals but will have less per domain (CommWx can have 20+ per domain) whereas this model for say a 300-500 bed hospital may have only 3-4 customers in a domain. Also, its not technically already configured. Similar to Epic, its call the Model Experiencer where about 80% of the domain is standard / stock content and then each customer has the ability to customize about 20% of it (some rules, reports, documentation format, etc.) Implementation for CommWx is currently scheduled at 10-12 months. However, it still essentially sits on standard architecture. Now if Cerner would really commit to either AWS/Azure or true cloud, then I think that would be move the needle. (Associate CIO)
Rural broadband (broadband in general) needs to be treated as a public utility. This country should handle this the way we handled electricity in the rural South in the 1950s, take it on a a public works project, and wire everyone up. It has become a fundamental tool in communication and commerce, there is no reason (other than paying some C-level executives millions in salary and stock) why we as a country should not ensure that all of our citizens can participate in civic life. (HIT Girl)
There is no such thing as an “Epic API” whereby third-party developers can craft solutions that developers can go market to Epic clients and generate some form of income along the way. In the Epic space you have two options – share your solution with Epic as a submission for the community sharing site (whereby you explicitly grant Epic rights to ALL of your IP embedded in that solution, even if it is never added to the community site) or craft some sort of app for submission to the App Orchard whereby your application / solution is sending transactions into Epic via some very narrowly defined messages (think HL7 here). There are absolutely, hands down, 100% zero options for what (uninformed and snobby) folks may traditionally consider an API for an application whereby complementary, third-party apps can in some fashion manage or change the behavior of the parent application in the Epic space. (Code Jockey)
In all of the time and locations I’ve done pre-implementation build, I’ve never encountered an Epic resource that fully understood the impact of the build decisions that they were leading their clients to implement. No Epic resources know / realize / are trained on the downstream impacts of their area of build or the upstream build areas that will impact their area of responsibility. Those lessons are learned and that knowledge developed only after go live, as the site implementation matures and are long after Epic has left the site. (Code Jockey)
Do you really think that Epic doesn’t share best practices with organizations during implementation? The Foundation System is more or less a best practice soup. Every organization believes they are different and special so there is no reason to believe that Providence would have any more success convincing implementing customers to change their workflows and adopt best practices. Despite staff turnover, no customer organization has more experience implementing Epic’s software than Epic itself. (But we’re special)
Outsourcing some of the business office and IT makes sense. Yes, I know that it mentions [at John Muir Health] about 500+ people badge flipping, but being someone that has worked on deals like this previously, many of those people don’t make it long term. They are re-evaluated and many are given early departure packages, keeping the cream of the crop and then backfilling virtually with people that living in lower cost of living areas. Usually look at a 30% or more reduction in staff. These resources that are kept also get leveraged across other clients as well, so that needs to be kept in mind too. Sharing resources isn’t the worst thing, its just that you need to be tight with cost, SLA’s (service levels), and customer satisfaction. Plus, by outsourcing, the burden is now on the vendor to produce, they are now the throat to choke. I have seen this model be successful but I have also seen in flop and the hospital takes things back over. Again, its a case by case basis. (Associate CIO)
Watercooler Talk Tidbits
Readers funded the DonorsChoose teacher grant request of Ms. R in Florida, who requested three Chromebooks for her high school class. She reports, “Having computers accessible in a science classroom is a real game changer. The students are digital natives, and being able to translate what they are learning into a language they are familiar with using is awesome! They are able to collaborate, engage in digital simulations, conduct research , create presentations, and more! These are useful to every level I teach. From my freshman physical science students, in my Pre AICE chemistry class, to my Chem 2 honors and AP chemistry class. It is applicable in each one. I also teach theater and then I can use them for the students to do CAD design without having to sign up to go to a computer lab or wait for a computer cart to be available. Thank you!”
Nanowear launches a study of using its sensor-powered underwear that is connected to a closed-loop machine learning system for early detection of heart failure. It monitors cardiac output, heart rate, respiratory rate, thoracic impedance, activity, and posture.
AHA and other hospital groups ask CMS to change its HCAHPS patient survey, suggesting that it reduce the number of questions from the current 27, create a digital version to improve response rates, expand it to cover transitions in care rather than just discharges, and allow patients to enter comments.
Guild members hold a garage sale to help cover the $1 million in uncompensated care provided by Seattle Children’s Hospital, whose most recent tax filings show a profit of $165 million on revenue of $1.5 billion. The hospital is running a $1 billion donation campaign.
Malls that are desperate to fill vacant storefronts are leasing space to medical clinics, hoping against reality that someone who comes in for a flu shot or eye exam will do a bit of shopping and that clinic employees will hit Sbarro or Cinnabon for lunch.
Police arrest a Charleston, SC pulmonologist for voyeurism after an 18-year-old tenant of one of his beach rental properties caught the doctor peering through a hole in the bathroom wall from an adjacent unfinished room. The boy and his father chased the fleeing doctor down the beach, who told them he was just the pest control guy. Investigating officers found bathroom peep holes in both of the doctor’s rental houses. He previously lost but regained his medical license after three complaints that he exposed himself to drive-through restaurant employees.
A new GAO report on expected VistA maintenance costs during the VA’s 10-year transition to Cerner leaves lawmakers uneasy about the true cost of the conversion project.
Health Catalyst and Livongo become the first digital health companies to IPO since 2016.
Health Catalyst (HCAT) shares, initially priced at $26, surged 45% during mid-day Nasdaq trading to end at $39 by the close of market. The company raised $180 million.
Livongo (LVGO) experienced a similar debut, with shares initially priced at $28 climbing to $40 at the start of trading and ending at $38. The company raised over $350 million.
Reader Comments
From Socalgrunt: “Re: Jacobus Consulting closure. As follow up to the Jacobus Consulting talk a few weeks ago, I received the following from my Meditech rep: ‘Jacobus is no longer active in the consulting space for MEDITECH,’ which was used to prompt a discussion around their professional services.”
From Miami@Vice.com: “Re: Executive exodus at Nicklaus Children’s Health System in Miami. From inside … both CEO Narendra Kini, MD and CIO Ed Martinez, plus the head of HR, have been escorted out of the building.” The Miami Herald reports that CEO Narendra Kini, MD has stepped down “to pursue opportunities in innovation.” Board members say his departure has nothing to do with financial troubles that led to mass layoffs earlier this year. Tax filings show that Kini took home $1.5 million in 2017. SVP and CFO Matthew Love has been named interim CEO.
Webinars
July 31 (Wednesday) 1:00 ET. “Modern Imaging Technology for the Enterprise: Mercy’s Approach That Improved Imaging Cost, Speed, Capacity, and Care Quality.” Sponsor: Mercy Technology Services. Presenter: Jim Best, executive health IT consultant, Mercy Technology Services. Enterprise imaging has become as critical as EHRs for transforming patient care, but many health systems are struggling with the limitations and costs of dated, disconnected PACS even as imaging volumes grow and radiologists report increasing levels of burnout. Radiologists at Mercy were frustrated by its nine disparate PACS, which required them to toggle between workstations, deal with slowdowns and poor reliability, and work around the inability to see the complete set of a patient’s prior images, even as demands for quick turnaround increased. In this webinar, MTS — the technical backbone of Mercy — will describe the lessons they learned in moving to a new best-of-breed PACS platform that increased radiology efficiency by 30%, with the next phase being to take advantage of new capabilities by eliminating third-party reading services and distributing workload across radiology departments to improve efficiency, capacity, and timely patient care.
An EY consultant says the data on 55 million patients held by the UK’s NHS could be worth $12 billion if sold to commercial interests, but could also be mined by NHS itself to generate $6 billion per year through operational savings and improved patient outcomes.
Cerner reports Q2 results: revenue up 5%, adjusted EPS $0.66 vs. $0.62, beating earnings expectations but falling short on revenue. From the earnings call:
Chairman and CEO Brent Shafer says the company’s future lies in helping clients deliver benefits from the systems the company has sold them.
The company will offer Millennium via a SaaS platform.
Cerner will develop a “monetized distribution model” of selling patient data to drug companies and insurers as a “curated data services asset.” Part of that is its HealtheHistory business, which sells records retrieval services to insurance companies and law firms.
The company has created a transformation management office of four people, two of whom are from turnaround consulting firm AlixPartners.
Cerner will move MyStation patient engagement product users to a similar product product from new partner GetWellNetwork.
Cerner expects to reduce costs by up to $200 million to achieve its announced margin targets.
Call9 co-founder and CEO Tim Peck, MD says the shuttered nursing home telemedicine company will re-open as Call9 Medical. The company, which embedded paramedics and EMTs at customer sites in New York, closed last month after struggling to stay true to its value-based business model and issues with lead investor Redmile. The new iteration may involve a merger or acquisition, will start off with a larger network of nursing homes, and utilize primary care physicians.
Records release vendor Ciox Health raises $30 million in a funding round led by Merck Global Health Innovation Fund and New Mountain Capital.
Revenue down 1%, adjusted EPS $0.16 vs. $0.19, missing expectations for revenue slightly and for earnings significantly.
The company says one of its new, large clients has run into financial problems and won’t contribute the expected $4 million per year in recurring revenue, potentially affecting NextGen’s top line.
The company’s legacy retention rate was 89% for the year, but it expects further volatility there.
NextGen will expand its offshore work in India and has restructured around headcount reduction in the US, driven by a need to increase capacity rather than to save money.
The Bill & Melinda Gates Foundation invests in Halodoc, Indonesia’s largest telemedicine vendor. The financing, which wraps up the company’s $100 million Series B round, is the foundation’s first digital health investment.
People
AliveCor names former Amazon Alexa lead Priya Abani CEO.
Trisha Swift, DNP, MSN, RN (JPS Health Network) joins ZeOmega as VP for clinical transformation.
Oncology Analytics hires David Fusari (TriNetX) as CTO.
Lafayette General Health (LA) promotes Fallon McManus, MD to CMIO.
Sales
Bayhealth (DE) selects Pivot Point Consulting’s new On-Demand consulting service to support its Epic systems.
Announcements and Implementations
UCI Health (CA) adds MediNav wayfinding technology from Connexient to its Epic-integrated app for patients.
Hardtner Medical Center, a 35-bed hospital in rural Louisiana, uses MobileSmith Health’s Blueprints software to develop its first patient app.
Government and Politics
In Australia, Queensland government officials press pause on allocating $150 million needed for the continued roll out of Cerner Millenium software across Queensland Health facilities. Initially budgeted at $600 million, the software has gone live at 14 out of 20 hospitals. It has ballooned past its budget, and suffered from leadership scandals and numerous end-user reports of patient safety errors.
A Government Accountability Office report on VistA maintenance costs during the VA’s 10-year transition to Cerner shows that the agency can’t provide a reliable estimate because it hasn’t been able to define what the 30 year-old, homegrown system is. The findings have, in turn, left lawmakers on the House Veterans Affairs Subcommittee on Technology Modernization doubtful of overall project costs, which have already risen to $10 billion. Subcommittee Chair Rep. Susie Lee (D-NV) pointed out that, “Money does not grow on trees. At what point do we lay out exactly what the costs are? There are many unknowns in this transition. The fact that this plan is still being formulated is concerning.”
Other
University of Colorado Health CMIO CT Lin, MD publishes “My Failure Resume” to encourage younger colleagues and highlight that success is not as clear-cut as typical resumes would have us believe. A few excerpts:
1999: Working in Informatics at 0.2 FTE, I trained docs to use the EHR (3M Clinical Workstation). Asked orthopedists to use the EHR to view result, notes, and print prescriptions. I thought: who wouldn’t want more readable data instead of paper charts? I was politely asked to go away: they were busy being doctors. Hospital leaders response? “Go ask other clinicians who might be friendlier to you.”
2007: Introducing APSO notes (inverted SOAP notes) for improved readability of EHR notes. I thought it was a great idea. Convinced 80 interested colleagues to try it. APSO use rate during “opt-in” phase? 16% (almost no one). Years later, I was able to gain leadership acceptance and make it near-mandatory: “You want to use our new Epic EHR? It only comes with APSO notes. Sorry.” APSO use in Epic? 90%.
2017: Eastern European hackers attacked and disabled national Transcription Service computers. Hundreds of surgeons lost a week of dictated Operative Notes. It was 3 weeks before transcription service restored. Vicious Rumor: “I’m pretty sure CT Lin did this, to force us all to type in his … EHR.” Somehow kept my job.
Sponsor Updates
WebPT CEO Nancy Ham joins Blue Cross Blue Shield of Arizona’s Board of Directors.
EClinicalWorks will exhibit at the CHCAMS 32nd Annual Conference July 30-August 2 in Biloxi, MS.
Ensocare names Stephen Wood senior software engineer.
Hayes Management Consulting names Joseph Plouffe (Emerson Hospital) client success manager and Jaenna Babajane (Athenahealth) director of implementation.
Hyland and InterSystems will exhibit at the 2019 Defense Health Information Technology Symposium July 30-August 1 in Orlando.
Imprivata and Security Innovation award 15 Def Con scholarships to women.
Kyruus publishes a new report, “Provider Perspectives on Digital Access.”
NextGen adds OptimizeRx’s point-of-care digital prescription savings software to its Enterprise EHR.
The Chartis Group publishes a new white paper, “Getting Beyond the Hype with Apps and Making it a Reality.”
First announced in April, Jim Costanzo succeeds Bruce Cerullo as Nordic CEO.
FDB SVP Patrick Lupinetti will co-present a session entitled “Medical Device Data Your Clinicians Need at the Point of Care” on July 29 at the AHRMM19 Conference in San Diego.
Ellkay partners with Canadian digital healthcare management company Chronometriq to help expand its services in the US.
The Federal Communications Commission (FCC) approved a proposal creating a $100 million fund for telehealth, targeted to reach low-income and rural Americans. The so-called Connected Care Pilot Program would help providers offset the costs of broadband service to help low-income patients and veterans access telehealth services. The fund is designed to cover a percentage of internet connectivity costs for organizations agreeing to participate in the pilot. The FCC is receiving public comments on the proposal, which is specifically designed to increase use of remote patient monitoring services and virtual care.
Earlier this month, National Public Radio did a story on the role of telehealth in rural communities. Profiled services include California Medicaid’s video counseling sessions, which can dramatically reduce the backlog for behavioral health services. A recent NPR poll showed that 25% of rural Americans have used some kind of telehealth services in the last few years. Although some rural telehealth models include patients visiting a local clinic to confer with a subspecialist hundreds of miles away, others rely on the patient having broadband connectivity at home, which is a limiting factor for up to 20% of rural residents. The piece also illustrates the often undocumented costs of rural patients having to drive hours for care – missed work, hotel stays, and childcare. Payment for certain telehealth services continues to be an issue, so we’ll have to see if the funding can keep up with the demand.
I was disappointed to see that a US judge struck down a recent rule requiring pharmaceutical manufacturers to disclose drug pricing in their TV advertisements. The rule would have required wholesale pricing data to be included for consumers to better understand the relative costs of therapies being promoted. Not surprisingly, drugmakers Merck, Eli Lilly, and Amgen were behind the challenge. Although I agree with the ruling that the Department of Health and Human Services doesn’t have the authority to force manufacturers to disclose pricing, I’d love to see Congress make this a reality. Some of the most commonly advertised medications have prices from $500 to $17,000 per month, which shocks patients when they come in and we have to explain why we’re not going to prescribe them.
After spending time in the hospital with a relative, I was glad to see this article on alarm fatigue in hospitals. Clinicians, psychologists, musicians, and designers are working to make alarms that are less jarring and more helpful. Alarms have been linked to patient confusion and staff anxiety as it is difficult to know whether alarms are legitimate or false alarms. I was surprised by the statistic that from 2005 to 2008, more than 500 US patients had adverse outcomes (including death) from alarms that were ignored, silenced, or otherwise mismanaged. A working group aims to develop an alarm standard with more pleasant alerts than those currently in place from the International Electrotechnical Commission.
Random statistics of the week:
The global EHR market hit $31 billion in 2018.
Growth was up 6% from a market of $29.7 billion the previous year.
First-year medical residents spend 43% of their time interacting with EHRs
There are over 700 companies in the EHR market
EHR mergers and acquisitions have increased 15% over the past year
Allscripts and Microsoft have agreed to team up to promote EHR data sharing. Users of Microsoft HealthVault will be able to use the Allscripts FollowMyHealth patient portal to move EHR data to family and home care teams. HealthVault will be retired on November 20, 2019 and users can move their data any time before then. The FollowMyHealth app is available for both IOS and Android.
If you haven’t completed the transition to the new Medicare Beneficiary Identifier, you’re running out of time. After January 1, 2020, claims with old patient identifiers will be rejected. As of the week ending July 5, providers submitted 76% of all fee-for-service claims with the new MBI.
Since I’m spending the rest of this month with the young people of the world, I was interested to see these statistics on worldwide vaccination rates. The World Health Organization notes that more than one in 10 children – or 20 million worldwide – missed out last year on vaccines against life-threatening but preventable diseases such as measles, tetanus, and diphtheria. Vaccination rates are slowing in poor countries or those with ongoing conflict, resulting in a loss of the herd immunity effect where high vaccination rates provide protection for those who might not be vaccinated. Measles is booming in the US due to under-vaccination and worldwide cases topped 350,000 last year.
For those of you interested about my medical volunteer adventures, there have been some ups and downs with the deployment of the EHR. They broke out a ton of laptops, a forest of extension cords (fire marshal beware), and some clinical scenarios, but 20+ care teams were using the same scenarios and test patients, so we were documenting all over each other. Kudos for drawing those scenarios from real patients at the last National Scout Jamboree in 2017, but they weren’t delivered to us in a facility-specific, way but rather to all the medical people together. My team spent a long time figuring out how to order x-rays only, to be told later in the day by our chief medical officer that we would not be ordering x-rays since only the downstream facilities did that — we just needed to put it in our discharge instructions. In defense of the Cerner team, they were also working with a multicultural, multinational team that hadn’t yet been assigned to care teams, so in some ways we were a little off kilter ourselves.
Still, we made it through, and Cerner was kind enough to come to our facility and offer some refresher training to make sure we are ready for when the world arrived. I am having a great time getting to know my team – nurses from Sweden, Austria, and the Netherlands along with nursing students from West Virginia University. They’ve been teaching me about healthcare in their countries and we’ve all been teaching the student nurses (and the Cerner trainers) about the scouting movement. The latter were especially impressed at our ability to quiet a room full of contentious physicians simply by raising three fingers into the air. I doubt they’ll be able to use that on their next training audience.
Some of the Cerner team members are serious scouters and I had the chance to talk in depth with one of them today. She’s staffed several prior Jamborees and knows how they work and how to talk physicians off the edge, which apparently has happened a couple of times this week. As much as the Scout motto is “Be Prepared,” some of the physicians didn’t do their advance training and are a little behind the eight ball. The trainers are staying in tents and hoofing it to work every day just like we are, so we’re starting to build a bit more camaraderie.
It was impressive to see what had to be more than 1,000 charter busses pour into the Jamboree over a 36-hour period and watching open fields turn into seas of tents. Our patient panel includes more than 7,700 youth from 75 countries. I worked my first night shift last night after the opening ceremony, which brought a sea of 50,000 people scattering back into six basecamps. I rendered some postoperative care to a patient whose visit to the US involved the removal of his appendix on the way to the Jamboree, which although within my scope of practice, was not something I expected to see. We also had a brush with hypothermia this morning as overnight temps dipped into the 40s F. I learned that the M997A3 Tactical Humvee Ambulance is not only rugged but warm and the National Guard was a godsend for my patient at 5:30 a.m.
After my post-call nap, I hit a couple of continuing education sessions on orthopedic trauma and wilderness first aid / evacuation.
Today marks my 900th post for HIStalk and I appreciate all of your support over the years. Thank you for sharing my adventures both inside and outside of the hospital.
Yeah i'm not sure this ruling really moves the needle on Epic's behavior at all, the non-competes were always believed…