Morning Headlines 1/3/20

Changes in Quality of Care after Hospital Mergers and Acquisitions

NEJM-published research finds that not only does hospital quality usually not improve after a merger, it sometimes gets worse as lower-rated hospitals acquire those with better quality scores.

Liberty IT Solutions Awarded $95M Management Consulting Services and Healthcare Revenue Workflow Management and Business Information Technology Tools Task Order

The government consulting firm expands its VA contract portfolio to over $800 million with more Cerner-related work.  

It Looks Like Health Insurance, but It’s Not. ‘Just Trust God,’ Buyers Are Told.

One million Americans have chosen unregulated cost-sharing health ministry plans to save money over traditional insurance, even though the companies issuing them are not obligated to pay claims, they don’t cover pre-existing conditions, they have a fixed limit on payouts, and they require adherence to a Christian lifestyle.

News 1/3/20

Top News

Professors of nursing and medicine write in a New York Times opinion piece that the professions should overcome their traditional hostility toward each other and unite in protesting the excessive documentation required by billing and regulatory requirements that are enforced via the EHR.

The authors recommend that hospitals regularly review their EHR setup to strip away requirements that are not related to patient care.

They also observe that while doctors make more money and are often dismissive of nurses, the latter have done a better job of supporting unions.

The piece concludes by saying that doctors and nurses want the best for patients, but are prevented from delivering it because of “profiteering and gross inefficiency.”

Reader Comments

From Moon Shot: “Re: sponsors. I used Internet Wayback to compare your sponsor list three years ago to today. I’m surprised at those that have disappeared for reasons other than being acquired.” I never though of using Internet Wayback for that, but it does indeed work. The end of the Meaningful Use-fueled buying frenzy has caused quite a few companies to scale back in various ways that I assume aren’t limited to HIStalk sponsorship. Several sponsors tell us they are cutting back or don’t have any senior people remaining in marketing or other departments. I expect that trend to continue and I predict that the HIMSS conference exhibit hall will be more Spartan than in the gold rush years. We will find out if companies can downsize their way to competitive success, but in any case, I appreciate those companies that keep HIStalk running and the readers who keep coming back in numbers that haven’t diminished.

From Corporate Brand Expert: “Re: our company name. You omitted our trademark designation – please fix.” Companies use trademark symbols in their own communications. Third parties and journalists, except for the clueless ones, do not. 

From Robert D. Lafsky, MD: “Re: New York Times opinion piece on EHRs. How did paperless systems become ‘paperwork?’” Dr. Lafsky — the only grammarian I know who is even less forgiving than I – correctly notes that the Times article’s headline refers to performing low-value EHR activities as “paperwork.” I blame the headline writer of the “paper” (pun intended) since the authors don’t use that term in the actual article. I’m not appalled because I don’t know any word that conveys the concept better, although I am annoyed at its omission of the Oxford comma that makes the headline harder to read (no one is ever confused by its inclusion, but some are confused by its omission).   

From Going Commando: “Re: Calvary Hospital (NY). Sacked the CIO and the analysts they hired after a successful Meditech Expanse rollout. Navin Haffty is now ruling the roost.” Unverified, although Kathleen Parker’s bio has been removed from the hospital’s web page. Either way, it’s always interesting to me how frequently CIOs are deposed by the vendors they manage.

From Please Provide a Correction: “Re: Health Catalyst share price. Up 30% from its IPO price, not down 8%.” Share performance is based on price at the market’s close. Health Catalyst shares were priced at $26 for its first day of trading on July 25, 2019, but opened for trading at $37.37 and closed at $39.17. They are now at $34.76, down nearly 12% from that first-day close in valuing the company at $1.3 billion. Their all-time high was $48.47 on August 12, while the all-time low of $26.44 occurred on October 9. HCAT shares are traded on the Nasdaq, which is up close to 10% since July 25.

From Health Tech Stocks: “Re: hospital patient survey vendor NRC Health. Shares were up 74% in 2019, valuing the company at over $1.5 billion.” Shares of NRC – headquartered in Lincoln, NE — are up nearly 400% in five years. The company was founded in 1981 by Mike Hays, who remains CEO. He holds $10 million worth after selling $300 million worth from the trust fund of his grandchildren last year.

From COBOL Been Berry Good to Me: “Re: Y2K. Thanks for that look back, which as someone involved in the remediation, made me smile.” People forget that Y2K was the ransomware of its day, a non-event only because programmers who were forced to dig into ugly, old code made it so. Anyone who thinks the issue was a made-up problem is ignorant of the facts, conveniently benefitting – as do people who refuse to be vaccinated – by the more responsible behavior of others. I think we’ll do better in fixing well in advance the Year 2038 problem, the “Unix Y2K’ in which systems that represent time as the number of seconds elapsed since January 1, 1970 will stop working when the storage variable runs out of space on January 19, 2038.

From Get Thee to Conferences: “Re: health IT conferences. I see other sites attend dozens of conferences each year. Why don’t you?” I think the lack of return is obvious given the continuingly inexpert content of those sites. Racking up exhibit hall miles is no substitute for running a hospital IT department, practicing as a clinician, performing informatics research, or all those other activities that go beneath self-important conference meet-ups and selfies. I admit that I sometimes develop useful perceptions about vendors and trends at the HIMSS conference since it covers just about everything important, but I’m not too tempted beyond that. Technology education requires cross-country flights and overpriced hotels only because that’s where the exhibit hall cash register is ringing. I always savor the irony of the American Telemedicine Association holding an-person conference in New Orleans to pitch seeing a doctor by video with the argument that those sessions are cheaper, more efficient, and more convenient.

HIStalk Announcements and Requests

Welcome to the new year, when the high deductibles and out-of-pocket maximum costs of many expensive health insurance plans reset, most likely giving providers a break as the patients who need their services can’t afford them.

Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.

Announcements and Implementations

The World Health Organization designates 2020 as the “Year of the Nurse and the Midwife” in calling for 9 million more nurses and midwives that are needed to achieve universal health coverage by 2030.

Government and Politics

The VA awards Liberty IT Solutions a three-year, $95 million task order to integrate the VA’s Consolidated Patient Account Centers with its Cerner system, adding to the $434 million contract Liberty won in November to modernize the VA’s systems under Cerner. The company had previously won $700 million in VA IT contracts in a single quarter of 2019.

Other

Hospital mergers and acquisitions haven’t improved quality and in some cases have made it worse, researchers find. While prices nearly always increase after a merger, quality rarely does. Sometimes the acquired hospital saw its quality scores dragged down by the lower ones of its acquirer.

An Australian insurer says doctors there appear to be choosing medical device implants based on their personal profit rather than medical evidence, to the point that sales reps are scrubbed in to advise surgeons during procedures (it’s exactly the same in the US, in case you haven’t worked in a hospital). The company recommends creating an independent organization that reviews prices and clinical efficacy similar to a program that reviews drugs, also noting that the federal government sets medical device payments for public hospitals but private hospitals pay a lot more. The medical device trade group says the campaign is a smokescreen for increasing health insurance premiums and that it’s not the government’s job to decide which products provide the most value.

In England, politicians call for the resignation of the Imperial College Healthcare Trust Chair Paula Vennells after the country’s Post Office – which she headed as CEO from 2012 through 2019 – agrees to pay $75 million in lawsuit damages to sub-postmasters who were blamed for accounting shortfalls that were actually caused by the Post Office’s Horizon computer system. Some of the sub-postmasters had been fired, fined, or imprisoned while the Post Office was spending millions defending Horizon, which the presiding lawsuit judge called “institutional obstinacy.”

Contacts

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

EPtalk by Dr. Jayne 1/2/20

Regardless of what holidays you celebrate, everyone is impacted by medical offices that are closed and healthcare facilities that are running on modified schedules this time of year.

I’m in the middle of a streak of clinical shifts that have at times reduced me to a mound of quivering jelly. Influenza is definitely on the rise and I’m starting to feel like my mask is permanently attached to my face. Our urgent care group saw nearly 2,000 patients on December 26, breaking our city-wide record. Many patients reported trying to get in touch with their primary care physician only to find the office closed, with some offices being closed until after the new year.

Seeing a 20% bump in volumes, the IT side of my brain always wonders about scalability of the solutions we use. I’m happy to report that the EHR held up like a champ, but viewing radiology images in the PACS was another story entirely. Load times were running up to two minutes, which seems like an eternity when you’ve got a full house and need to know what’s going on with your patients’ films.

One of my patients happened to be an imaging rep, who asked how we were holding up this time of year. It was nice to see someone who understands that there are many factors behind keeping an office running, although he was less than amused that we couldn’t send his records to his primary physician.

As an independent organization, the large health systems in town aren’t too keen on sharing data with us even though it would mean they receive our work product as well. Just another example of information blocking that isn’t a vendor’s fault. In the meantime, I take full advantage of the features within Epic that allow me to access patients’ charts for a short time with their permission.

My operations brain is always challenged by these high-volume days. They make me wonder what “the system” could do differently to better manage these patients. Although many of those we saw had acute conditions that needed urgent treatment, like influenza or pneumonia or lacerations, many of them could have been handled by a nurse triage line or other lower-acuity situation.

Quite a few patients hadn’t tried any self-care, not so much as a decongestant or an over-the-counter cough medication, even though they were relatively young and healthy and didn’t have any reason to be concerned about medication interactions or worsening of chronic conditions. Several had been sick for less than a day. My favorite presenting issue of the day was, “My throat started with a tickle a couple of hours ago and I just wanted to see what it was.” This shows a lack of health literacy, even in the relatively affluent area in which I was working. What could we as a healthcare system do to serve these patients better?

I’ve also been able to put my telehealth hat on this week, due to a spike in volumes in my state. I only do telehealth visits sporadically since I don’t hold a lot of different state licenses. I was pleasantly surprised by the number of patients who weren’t specifically seeking antibiotics – who just wanted to make sure they were doing everything possible to treat their condition, or wanted validation of their treatment plan because they were making slower than expected improvement.

Back in the clinic the next day, I also saw the dark side of some virtual visit care as patients came in for face-to-face visits after having been prescribed medications that seemed unrelated to their symptoms. I saw three patients from the same physician who were each a bit concerning. It sounds like her practice has recently started using functionality within Epic that allows for patients to have billable asynchronous visits, and perhaps she isn’t in the swing with the fact that just because a visit is virtual doesn’t mean you don’t have to follow the standard of care. Maybe she doesn’t know the antibiotics she is prescribing aren’t indicated for the condition being treated, but there’s no good way to try to address that professionally when we see it.

Our volumes continued throughout the weekend, with record-breaking numbers of visits at several of our locations. I encountered a couple of primary physicians and one psychiatrist whose offices were not only closed during the holiday weekend, but also who had no after-hours coverage. Even other physicians received no response when trying to reach them. In my state, that’s tantamount to patient abandonment, and I hope those patients have some difficult conversations with their physicians (or perhaps soon-to-be-former physicians) about being left hanging.

I also heard some complaints from patients who just don’t feel like their physicians listen to them. It’s not only complaints about looking at the computer instead of the patient, but also complaints about physicians pushing additional procedures that are unrelated to their care plans. One patient showed me the brochure from her pulmonologist who was offering cosmetic Botox injections. These are just a small sample of the patients who wind up in the urgent care, where they’re trying to make up for whatever they’re not receiving in their usual setting of care, if they have one.

Santa must have been very good to a couple of patients, who presented with ICD codes in the F12 series: cannabis-related disorders. Cannabis-induced palpitations was one of the conditions, and I would have loved to have simply typed “lay off the weed” in my care plan. Somehow “reduce or eliminate cannabis use until cleared by cardiology” just doesn’t seem as festive. Nor does “your risk of recurrent vomiting would be lower if you stopped using marijuana.” These are the things they don’t tell you about in medical school, that one day you might find yourself dealing with in an exam room.

On days like these, I long for the relative lack of excitement found in a good lab interface build or some of the other work I do in my informatics practice.

For those of you who worked around the holidays, what kinds of adventures did you have? Any great stories? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 1/2/20

Doctors, Nurses and the Paperwork Crisis That Could Unite Them

Professors of nursing and medicine urge the professions to come together to reduce the documentation requirements enforced by the “bureaucratic nightmare” of EHRs.  

Using AI to improve breast cancer screening

A study in UK hospitals with the participation of Google Health finds that an AI model that supports radiologists in detecting breast cancer produced a modest reduction in false negatives and positives even though the model did not have access to patient histories and prior mammograms.  

The Family Wanted a Do Not Resuscitate Order. The Doctors Didn’t.

A ProPublica report finds that transplant doctors sometimes talk families out of asking for DNR or withdrawing life support within 30 days to avoid skewing the survival statistics of their programs. 

Social media hosted a lot of fake health news this year. Here’s what went most viral.

The most widely shared health misinformation on social media in 2019, much of it originating with anti-vaccination groups, include the US government conspiring with drug companies to hide cancer cures, herbs and homeopathy that cure cancer and chronic conditions more effectively than medical treatments, and the injuries and deaths caused by vaccines.

Woman wrongly told she had cancer when software misheard doctor

A hospital in England apologizes to an endoscopy patient for telling her doctor that her exam revealed “cancer,” which it says was an unnoticed mistake made by its speech recognition software that misunderstood the word “candida” that relates to the patient’s yeast infection.

Morning Headlines 12/31/19

FDA Failed to Ensure Safe Prescribing of Opioids, Documents Show

Johns Hopkins Bloomberg School of Public Health researchers find that FDA was lax in failing to require opioid manufacturers to collect data to prove that their physician prescribing training was effective in reducing addiction, overdoses, and deaths and instead allowed those companies, in the absence of such data, to regulate themselves.

I tracked my sleep with an Oura ring — here’s what I learned

CNBC’s Chrissy Farr says Oura’s sleep tracking ring provided a lot of sleep quality data over a two-week period, but the 15 minutes she spent with a sleep coach – which the company does not offer – provided more value.

What’s Next for Health: Leading Through Change with a Strategic Direction

HIMSS touts its “new strategic direction and brand re-alignment” that includes a reorganization to remove silos, an emphasis on its value beyond the annual conference, and its intention to become “a catalyzer to transform the global health ecosystem through the power of information and technology.”

The Big Change Coming to Just About Every Website on New Year’s Day

The California Consumer Privacy Act, which takes effect January 1, requires the websites of large companies to provide ways – including web buttons saying “Do Not Sell My Personal Information” – to their websites, which will be available to all US citizens since the sites can’t target Californians specifically.

Morning Headlines 12/30/19

DCH Health System patients file federal suit over ransomware attack

Four patients of the Alabama-based health system claim their care was disrupted by an October ransomware attack.

Verily Partners with Emory Healthcare to Analyze Medication and Lab Ordering Patterns for Improved Cost-Effectiveness and Operational Efficiency

The health system hires Alphabet-owned Verily to use analytics to find value opportunities.

Just what the doctor ordered: How AI will change medicine in the 2020s

Eric Topol, MD again calls for technology to give doctors “the gift of time” that will allow them to develop deeper relationships with their patients.

New York doctor sues Apple over irregular heartbeat detection

NYU Langone Health cardiologist Joseph Wiesel, MD says Apple violated his patented method for detecting atrial fibrillation after he shared details with the company in September 2017.

Monday Morning Update 12/30/19

Top News

Four patients of DCH Health System file a class action lawsuit that claims their medical care was disrupted because of a ransomware attack in October.

One of the plaintiffs says she couldn’t get post-op meds, another complains that she was told her daughter would have to wait 4-5 hours to be seen for an allergic reaction, a third says her orthopedist couldn’t see her in a scheduled follow-up, and a fourth patient makes no specific claim except to say that her care was disrupted.

Reader Comments

From Gilligan’s Paragon Island: “Re: Allscripts. Its Atlanta Paragon hosting center suffered an outage at 6 a.m. on December 21 and didn’t come back up until 30 hours later. They were not forthcoming about what caused the outage or what they were doing to fix the issue. How can hospitals provide quality patient care without access to their EMR and core ancillary systems for more than a day?” Unverified.

From Oneida Platter: “Re: CoverMyMeds. It’s actually a phishing attack. If you search in a browser, it advertises a CoverMyMeds link that actually takes the user to a rogue site.” That’s what I assumed since the “contact Microsoft immediately at this number” scam is always delivered via browser. It has nothing to do with the systems of CoverMyMeds.

From Joey Cheesesteak: “Re: Optum layoffs. You reported the rumor of a January 3 layoff – I’m one of 24 consultants (of 90) in Optum Advisory Services who was laid off effective January 2. HIStalk is still a daily read – thanks and keep up the great reporting with a humorous spin.” I’m sorry to hear that and angry with Optum in laying people off over the holidays. Optum generates more half of the $260 billion in annual revenue of parent company UnitedHealth Group, which is tracking at $20 billion in annual earnings. I’m trying to decide which is most despicable: (a) laying off employees over Christmas; (b) laying off employees at all from a division that brings in $112 billion per year; or (c) having a parent company in UnitedHealth Group that is making $20 billion in annual profit on $260 billion in annual revenue, all of it coming from people who are either sick or who are trying to fund the future cost of becoming sick. Your $10,000 investment in UHG 10 years ago would be worth more than $100,000 today, and the CEO (who has been around only a couple of years) holds something like $300 million worth. Buying shares of healthcare’s profiteers might have been the best hedge against rising healthcare costs, but you need money to make money.

HIStalk Announcements and Requests

Christmas is the most commonly celebrated winter holiday among poll respondents, but I’m interested that 18% don’t really care about any of them. Cosmos suggests that employers provide “religious vacation” instead of limiting paid holidays to those that are Christian-centered. That’s why I love the paid time off system, although even then some employers mandate using PTO for holidays like Christmas where there’s not much work to get done.

New poll to your right or here: Where did you buy your most recently purchased technology item? I subscribe to the New York Times, of which reader comments are the most interesting part, and today it featured a furious debate over Amazon’s role as both a supporter and competitor to small businesses and whether having a huge company fulfillment center in your town is good for business and residents. We heard the same thing about shopping malls and Walmart before Amazon, of course, and regular retail disruption is pretty much a given unless Amazon’s size, analytics capabilities, and political influence have made it immune. I noticed that some NYT commenters also called out Amazon’s possible Achilles heel being its tolerance of scammy sellers offering counterfeit goods backed by fake reviews.

Today I learned that all Chromebooks are shipped with a hard-coded expiration date, after which they will no longer receive Chrome OS updates. That education was delivered to me via a pop-up message on my four-year-old Asus that gives June 2020 as its final connection to the Google mother ship. The hardware manufacturer sets the date based on when the configuration is first locked down, not when the Chromebook is manufactured or sold, so even a new copy of an older model could be short dated. I’ll have to decide whether to replace mine or just use it without updates, but at least I paid only $200 for it and it’s still my favorite computing device. Most important to me is the 11.6” screen that makes it barely bigger than a tablet, but with a good keyboard.

Happy 20th birthday, Y2K. Thank a remediation programmer — quite possibly a paunchy, gray-haired COBOL coder who was dragged out of retirement — for making it a non-event and thus rendering Y2K survival kits worthless when humankind survived after all. The nail-biting Y2K teams were sitting in war rooms listening to “Smooth,” “Back At One,” “Hot Boyz,” and “Blue,” or more likely, watching TV news to see what was happening in countries whose rollover midnight came hours before ours.

Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.

Acquisitions, Funding, Business, and Stock

I checked 2019 share price performance of the publicly traded health IT companies I could think of, of which just four beat the Nasdaq composite index percentage increase:

1. NantHealth (up 91%)
2. Teladoc (up 68%)
3. Nuance (up 56%)
4. Cerner (up 40%)
5. Nasdaq composite (up 36%)
6. Change Healthcare (up 34% from mid-2019 IPO)
7. Inovalon (up 32%)
8. S&P 500 (up 29%)
9. McKesson (up 26%)
10. Dow Jones Industrial Average (up 23%)
11. CPSI (up 8%)
12. NextGen Healthcare (up 8%)
13. Premier (up 3%)
14. Allscripts (up 3%)
15. Health Catalyst (down 8% from mid-2019 IPO)
16. Livongo (down 33% from mid-2019 IPO)
17. Castlight Health (down 40%)
18. Vocera (down 47%)
19. Evolent Health (down 56%)

Announcements and Implementations

Emory Healthcare (GA) engages Alphabet’s Verily for medication and lab ordering analytics to identify value opportunities.

RSNA and Carequality publish “Imaging Data Exchange Implementation Guide Supplement,” expanding Carequality’s medical image exchange capabilities. It was presented at RSNA on December 2.

Other

The New York Times cites a study that proves what we all know – healthcare services in the US cost way, way more than any other country (basically double), with one example being an angioplasty that runs around $7,000 elsewhere costs $32,000 here. The employer survey looked only at private insurance, meaning that the spread is probably even larger since public health programs pay less elsewhere. The Times concludes that those high prices finance a politically powerful healthcare industry that is likely to repel any efforts to reduce prices.

Experts warn that terrorists could create “dirty bombs” that could contaminate several square miles by extracting Caesium-137 from blood irradiators used in hospitals and blood banks. A 2008 government panel wanted the devices withdrawn in favor of equally effective but safer alternatives, but hospitals complained that the panel was “regulating the practice of medicine” and the number of devices in use has grown since. A GAO report noted that a hospital left an irradiator on an unsecured cart on its loading dock, while another stored the device behind a combination-locked door upon which someone had helpfully written the combination.

Contacts

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

Morning Headlines 12/27/19

The Watch Is Smart, but It Can’t Replace Your Doctor

A physician author says in a New York Times article that the public health value of the Apple Watch’s atrial fibrillation detection capability is overhyped and that even study participants mostly ignored its guidance.

Artificial Intelligence Is Rushing Into Patient Care – And Could Raise Risks

AI systems have already made significant healthcare mistakes as technology companies their rush products to market without the benefit of peer-reviewed studies and with minimal FDA oversight.

Mayo Clinic names chief digital officer to lead transformative digital strategy, create Center for Digital Health

Mayo Clinic hires Rita Khan (United HealthCare, Best Buy, Macy’s) as chief digital officer.

Augmedics Announces FDA 510K Clearance and U.S. Launch of xvision, the First Augmented Reality Guidance System for Surgery

Chicago-based Augmedics earns FDA’s F10(k) clearance for its augmented reality system that allows surgeons to visualize 3D spinal anatomy and track instruments and implants while looking directly at the patient.

News 12/27/19

Top News

An atrial fibrillation detection study of 420,000 Apple Watch users finds that just over 2,000 of them received irregular pulse warnings, but only 450 followed up with the offer of a free telemedicine visit and verification via an EKG sensor patch. Of those 450, atrial fibrillation was confirmed in 153, with the actual outcome and health benefit to the population as a whole remaining unknown.

The physician author of the New York Times article concludes, “While there may be reasons to own an Apple Watch, using it as a widespread screen for atrial fibrillation probably isn’t one.”

Reader Comments

From Juneau Boy: “Re: CoverMyMeds. Hacked, maybe? Their prior authorization system gives users a warning that their computer has been compromised and they need to call a telephone number to get it resolved.” Unverified. I don’t know how their system is accessed, but if it’s via browser, it may be the user’s computer that has been compromised and not theirs since malware-produced scammer pop-ups are common.

From OptumOrange: “Re: Optum. Laid off many in behavioral health on 12/23. Merry Christmas.” Unverified, but widely reported on TheLayoff.com and not too shocking given that the healthcare-milking company has 175,000 employees who are collectively insignificant compared to investors. Another round of layoffs is rumored to be on the books for January 3. The warning signs from my experience (other than working for a huge, publicly traded company, which is the most relevant layoff tell of all) are: (a) managers start disappearing for lengthy meetings, possibly offsite, to prevent leaks; (b) their assistants look dejected because they have to do the dismissal paperwork and deploy security guards and boxes of tissue to the impromptu departure lounge from which their colleagues will be forcefully bidden adieu; and (c) the managers stop looking employees in the eye, especially the ones they have chosen for the executioner, because even the microscopic, situationally malleable conscience of managers feels a tiny bit of shame at being involved in the door-showing of people who got them where they are.

HIStalk Announcements and Requests

I hope you had a memorable Christmas, whether you specifically celebrated that holiday or not. It’s always interesting to see how infrequently-seen relatives handle family get-togethers – the inevitable personal drama and political arguments, toddlers and some adults who are too preoccupied by shiny objects like toys and phones to interact socially, and the important ritual of telling family stories and collectively rekindling memories for the next generations. It’s also a time of despair for those who can’t be with family, those whose life circumstances present few reasons to celebrate, and those who actually believe the self-stroking fiction people post on Facebook and conclude that their less-photogenic lives must indicate some degree of personal failure in falling short of Hallmark Channel expectations. In any case, the National Suicide Prevention Hotline is 800.273.8255. We all struggle, just differently.

Here’s why you shouldn’t trust Amazon reviews for products made by companies you’ve never heard of, most of them being in China. I bought a junky flash drive that was DOA and immediately returned it to Amazon in a great customer service moment (fast and easy). When it first arrived, the company offered a second drive for free if I would post a positive Amazon review, but instead I wrote an appropriately scathing one. This week, the company offered me a $50 Amazon gift card to take the review down (which of course I did not). I immoderately love most things Amazon and Prime, but even I’m getting fed up with its lack of control over third-party sellers, counterfeit products, and the artful gaming of its review system to scam Amazon customers. Mark my words – Amazon will be the next EBay if it can’t protect one set of customers (consumers) from the other set (the third-party sellers that contributed $43 billion in Amazon revenue in 2018).

I received lots of nice emails, even several on Christmas Day, from teachers whose Donors Choose projects were fully funded by donations from HIStalk readers and my Anonymous Vendor Executive (AVE). Ms. M said the Chromebook we provided to her class is a “true blessing” since she can’t afford to buy one for her class given her $46,000 salary after 20 years of teaching. Anyway, AVE has replenished the matching funds that reader donations thankfully depleted, so we’re back on for funding more projects.

I’m pondering the past tense of “intake,” as in the “patient intake process.” When it’s over, have they been intaken, intaked, or intook? It’s a fair question when people start using made-up words and phrases, sort of like “executive producer” that begat the awkward “executive produced.” It’s also not the best reflection of the noble nature of healing the sick to impersonalize the process as “patient intake” like they are birds being sucked into a jet engine.

Listening: Shudder to Think, a long-defunct DC indie hardcore band whose album was tracking in the vinyl store / bar I was in today as I was looking over an album by Lothar and the Hand People, which I would bet nobody in the place ever heard of except me.

Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.

People

House call provider Landmark Health hires Rod Jardine (DST Systems) as CIO.

Other

Scientific American says the rush of artificial intelligence systems into patient care has significant potential, but those systems are overhyped, they are often created by technology companies whose rush to market may endanger patients, they sometime deliver illogical results after being trained on illogical data, and companies haven’t proven their effectiveness via peer-reviewed journal articles. An industry expert says AI developers aren’t interested in spending the time and money on clinical trials, noting that, “It’s not the main concern of these firms to submit themselves to rigorous evaluation that would be published in a peer-reviewed journal. That’s not how the US economy works.”

An outcomes expert questions a study claiming that Livongo for Diabetes reduced medical spending by 22%, noting:

• The article was written by Livongo employees and employees of drug manufacturer and Livongo partner Eli Lilly.
• Journal of Medical Economics, in which the article appeared, fast-tracks such articles for cash.
• The journal’s measured influence is low and the article has been cited few times since it ran.
• The authors were asked to disclose that they couldn’t prove that Livongo users had lower medical spending, so they said the results “imply” it.
• The “participants versus non-participants” study design is known to be invalid, with the difference in outcomes always attributable to study design rather than the intervention itself.
• The author called the author of website HIT Consultant “the dumbest member of the media” after it “swooned over Livongo’s outcomes” without understanding the study’s many flaws.

The Pentagon urges service members ignore their 23andMe and Ancestry Christmas gifts, warning that sending off their DNA samples could compromise security and place their military career at risk if their information is exposed and suggests risks to military readiness. They also note that the tests are unreliable anyway.

A Kaiser Health News article says EHRs are creating a “new era” of healthcare fraud, but it’s all over the place, trying to connect the dots from previous new stories, some of them involving accusations that haven’t yet been proven:

• EHR vendors are concealing software problems that endanger patients.
• EHR vendors gamed the Meaningful Use payout system by falsifying certification test results even though it was an “open book test” where their systems had to perform a limited, published set of tasks.
• Hospitals and practices falsely attested to having met MU requirements to earn their chunk of the $38 billion in federal payouts.

A fascinating set of tweets addresses the admirable American phenomenon of “aging in place” that conflicts with our suburban sprawl of cul-de-sac neighborhoods where public transportation can’t effectively reach. The result: aging people remain in their homes but are unable to drive, so they assume their transportation needs will be met by unpaid family and caregivers, but the reality is that they rarely leave. I suppose ridesharing services are the answer for those seniors who are comfortable using smartphone apps and who can afford the fare. 

Penn Medicine Listening Lab invites people to share their stories about experiencing real communication as a form of care during their illness. One submission was from a doctor who noticed that his new patient was clutching a large envelope, and when he looked up from EHR data entry long enough to ask about it, the man explained that his son had died of cancer at 32 and “he was looking for a chance to tell his son’s story before he told his own.” That reminded me of project my health system ran years ago in which employees were coached to go beyond the rote performance of their duties to ask patients, “Can I help you with anything else? I have the time.” The “I have the time” part is the secret sauce, because we healthcare people are always rushing around in front of our current patient / widget. Our IT field support techs had already learned this – they knew that once they went out to a nursing station to work on a printer or something, they could make themselves and the rest of us heroes by simply looking up from the paper jam to ask the folks around them how it was going. It was initially surprising how many problems our clinical employees asked them for help with email, browsers, Wi-Fi, etc. and we could have fixed them easily had they opened a support ticket. We got even smarter and started rotating our support center people out on the floors, which dramatically increased empathy on both sides of the IT fence.

Charities, including hospitals, are fundraising by running telethon-like pitches to the live streams of online gamers and other streamers. St. Jude’s Children’s Research Hospital has raised $20 million from 20,000 participants since 2014, while Children’s Miracle Network Hospitals has taken in $70 million.

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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Morning Headlines 12/26/19

Artificial Intelligence Is Rushing Into Patient Care – And Could Raise Risks

Experts say AI could have a big healthcare impact, but worry about excessive hype, the tech industry’s mantra to “fail fast and fix it later,” systems whose training allows them to base predictions on meaningless data points, and the absence of any randomized clinical trials proving that such systems actually work.

Pentagon Warns Military Personnel Against At-Home DNA Tests

The military urges service members to decline to take consumer DNA tests because they create security risks, their results are unreliable, and they could lead to unintentional discovery of genetic information that could jeopardize their military career.

CoverMyMeds about to grow to 1,500 jobs – as outgoing CEO Matt Scantland charts what comes next

CoverMyMeds will grow to 1,500 employees by the end of March, triple its headcount since McKesson acquired the medication prior authorization company three years ago.

Morning Headlines 12/24/19

Electronic Health Records Creating A ‘New Era’ Of Health Care Fraud

Kaiser Health News covers fraud by hospitals and medical practices in receiving Meaningful Use payments, by vendors that overstated their MU compliance, and in false claims settlements by Greenway Health and EClinical Works, with experts concluding that the MU program was poorly conceived and that most of the money was handed out too early in the program when providers were paid for doing little beyond agreeing to participate.

Health documents reveal patient harm linked to Queensland’s new medical record system

In Australia, a TV news department’s Right to Information request finds that 95 cases of patient harm have been attributed to Queensland Health’s Cerner IEMR system in just over a year, with 45 incidents being caused by user error and 32 by poor usability.

Sunnybrook Health Sciences Centre and Evident Partner to Improve Patient Outcomes in Canada

CPSI’s Evident business unit and Sunnybrook Health Sciences Centre announce plans to develop a Canada-specific hospital information system that will combine the health center’s Sunnycare system with the Evident EHR.

Besler acquires majority ownership in Panacea Healthcare Solutions Inc.

Reimbursement solutions vendor Besler acquires a majority ownership position in Panacea Healthcare Solutions, which offers physician revenue cycle services and technology. 

For Her Head Cold, Insurer Coughed Up $25,865

A woman’s insurer pays $26,000 for a PCP visit in which she received only a throat swab and blood test, with much of the expense being the exotic DNA tests – all of which were negative – the doctor sent off to an out-of-network lab whose price was 20 times higher than average in her area. The lab is apparently owned by the doctor. 

New FDA Commissioner Takes Over Predecessor’s Twitter, Deletes All Previous Tweets

New FDA Commissioner Stephen Hahn, MD converts the @SGottliebFDA twitter account to @SteveFDA to keep his predecessor’s 44,000 followers for “maximum exposure,” but also deletes all of Gottlieb’s tweets and public comments, which some some experts say raises ethical concerns.

Curbside Consult with Dr. Jayne 12/23/19

A student reached out to me recently, looking for a primary care physician willing to host him for a four-week clinical clerkship. I used to be a preceptor for both of the local medical schools but haven’t hosted anyone since I stopped practicing traditional primary care more than a decade ago. A call to the primary care clerkship office revealed that a computer glitch brought me back from the virtual dead, along with a number of physicians who are no longer able to host, and we were able to get it straightened out pretty quickly.

Still, I enjoyed chatting with the student, who had never heard of clinical informatics and had no idea what a physician might do besides conducting research or seeing patients clinically.

I was a little shocked by this since the medical school he attends is affiliated with a health system that just spent nearly half a billion dollars on an EHR overhaul. He’s already in the middle of his first clinical clerkship year, so theoretically he has been exposed to the hospital and countless resident and attending physicians complaining about the EHR or how it works. I would have hoped that the orientation to the EHR might have included an outline of how to request changes in the system, which would theoretically include mention of physicians serving on committees or in leadership roles who would have input into any requested changes. Apparently none of these things happened or were ever discussed, or my potential student missed the mention.

In hindsight, I think it’s more likely the former, since the hospital (and health system) in question still does not have a functional CMIO role. They have a number of clinical VPs and other titled people who are supposed to play a role in the governance of clinical informatics, but the reality is they have a number of other things on their plates that takes them away from actual informatics work. From what I understand from my peers, they don’t have functional governance structures and part of the IT team is devoted to just building what is needed to silence the squeaky wheels. The community physicians are up in arms about changes that are put in place for the academic faculty, and there’s a lot of duplicate work going on as they build different work streams without a unified approach.

I think the student enjoyed hearing about alternative careers for primary care physicians, especially once we talked a little about healthcare finance in the US and the high level of burnout among primary care physicians. His school isn’t doing a good job educating him on that topic either, since he had little understanding of Medicare or Medicaid or commercial insurance and the pressures felt by physicians as they try to navigate our healthcare non-system on behalf of their patients.

I suppose this might be one of the key goals of the primary care clinical clerkship, to expose students to such things since they’re probably not seeing it in the halls of the ivory tower. On the other hand, especially with the new push for premedical students to already have clinical experience before they apply to medical school, I was surprised by how little he knew.

He was also unaware of the salary limitations for primary care physicians. When I asked him if he had a ballpark idea what he might make in practice, he quoted a starting salary that was more than one and a half times that of an independent primary care physician with a well-established practice and an excellent payer mix with minimal Medicare and no Medicaid.

In my heart, I don’t want students to choose their specialties based on earnings potential, but I don’t want them to be surprised, especially when they’ll be leaving school with nearly half a million dollars in student loan debt. Granted, physicians still make a very good living, but many of us now in practice didn’t graduate with anywhere near that kind of debt. I was lucky with no undergrad debt, but still had to borrow the entire amount for medical school over and above what I had saved from jobs at the golf course, the donut shop, editing people’s term papers, and substitute teaching.

We talked a lot about how I came to be in clinical informatics and how I see the role. Usually I summarize it as being a translator or mediator – being able to work with clinical teams, operations teams, and the technology teams to identify ways that we can better the mission of patient care. Sometimes it’s process improvement work, sometimes it’s deep technology design work, and sometimes it’s just handholding for providers who are at their wit’s end. There are days when it’s sheer boredom (lab interface crosswalk build – if you’ve never tried it, you’re missing out) and some days are exhilarating (go-lives gone well). The rest of the time can be a roller coaster, but I wouldn’t trade what I do for a more traditional medical career.

I’m sorry I wasn’t able to teach him how to be a family physician, or to share how enjoyable it can be to take care of patients over time and to get to know them and their families. I like to think that he did learn something over the course of our conversations, though, even if it was just that he needs to do a little more investigation before he decides on a specialty. He has a few months left before he has to start applying for residency positions, when seems relatively short when you’re deciding how you want to spend the rest of your life.

I also gave him my standard advice: learn about the business of healthcare; learn about personal finances; don’t spend “like a doctor” when you get out of school; and find some non-work-related activities that will keep you company for the rest of your life. I was lucky to have learned many of those lessons along the way, but some of my peers, and many non-physicians as well, learned those topics the hard way.

I wonder how the medical school would receive the idea of a class covering these topics. Healthcare has certainly changed in the time I’ve been out of school, and not always for the better. There are driving forces that many in the industry don’t understand, whether they’re clinical or not.

On the other hand, isolating students from the reality of what they’re getting into might be useful to maintain the physician pipeline. I know quite a few of us who wouldn’t have done it had we known then what we know now. I see some of those former colleagues in hospital administration roles, industry roles, etc. You can always tell the people who really enjoy patient care because they often fight for the ability to keep their toes in the water, even if it’s only a couple of days a month. Of course, not all employers are sympathetic, and many more are forced to give up their clinical aspirations.

What does this have to do with the larger topic of healthcare IT? It’s food for thought to help us understand the force that shape clinicians and why they might act the way they do when faced with uncomfortable or unwanted change, or when some bit of technology puts them over the edge. Maybe if they were better integrated into the healthcare IT ecosystem earlier in their training, we would be fighting fewer (or at least different) battles. Maybe they wouldd feel more empowered to demand better usability and not just go along with what their hospital says they are going to use. Maybe they would see “the IT people” as less of a threat and more of a team working towards common goals.

How does your organization onboard medical students? Do they understand what the technology teams do? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 12/23/19

Australians shun My Health Record with only 9 per cent ever logging in

Government health officials in Australia admit that while 23 million people have a My Health Record online health account, 91% of them have never logged in and most of those who did log in have not returned.

Abbott Labs kills free tool that lets you own the blood-sugar data from your glucose monitor, saying it violates copyright law

Drug maker Abbott Labs issues a takedown notice to a diabetes support group that told users how to extract their own blood sugar readings from the company’s continuous glucose monitor and monitor them on a free software tool.

New Software Targets ICU Delirium

Epic works with Vanderbilt University Medical Center (TN) to release workflows that prevent ICU delirium.

Monday Morning Update 12/23/19

Top News

In Australia, government health officials admit that while 23 million people have a My Health Record online health account – most of them only because enrollment was changed from opt-in to opt-out early this year – 91% of them have never logged in and most of those who did log in have not returned.

A large percentage of public hospitals, pharmacies, and medical practices are connected, but only 33% of private hospitals and less than half of medical and diagnostic labs.

The Australian Digital Health Agency has had to pay software vendor, pathology providers, and imaging providers for integration in trying to boost data availability and usage.

The system cost more than $1 billion to develop and annual maintenance costs are estimated at $350 million.

The digital health agency’s CEO is Tim Kelsey, who just resigned to take an SVP job with HIMSS. 

HIStalk Announcements and Requests

About half of poll respondents who had a provider visit in 2019 had to provide the same information to a different provider who didn’t have access to it otherwise, while 9% found that the information their providers shared contained errors and 2% experienced clinical harm from a lack of data sharing. Half-Wit says her 35-year health IT career seemed like a waste of time when a GI specialist remembered only after asking her a long list of questions that she could have simply looked it up in the EHR in front of her. HISJunkie gave an Epic MyChart download on thumb drive to a new, Allscripts-using practice and was told that they can’t use the electronic information, and when he gave the doctor a hard copy printout of the same information, the doctor insisted on asking him questions off his own EHR screen instead of looking at the paper and even then entered only about half the information.

New poll to your right or here: Which winter holiday is most important to you?

Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.

Sales

• Northeast Georgia Health Systems (GA), Salem Health (OR), and Saber Healthcare Group choose Hyland Healthcare’s OnBase enterprise information platform.

People

Beaumont Health hires Hans Keil, MBA, MA (PerkinElmer) as CIO.

Gary Gerber (Hyland) joins Heartbeat by Intelligent Imaging as chief strategy and revenue officer.

Verge Health promotes Connie Moser, MBA to CEO and board member, replacing Mark Crockett.

Announcements and Implementations

Epic works with Vanderbilt University Medical Center to release ICU Liberation Bundle, workflows that prevent ICU delirium by reminding clinicians to discontinue analgesics and sedatives, test the patient’s waking and breathing, perform delirium assessments, and get the patient out of bed to encourage mobility and exercise.

Government and Politics

CHIME expresses its support for Congress’s spending deal, which calls for HHS and ONC to support private sector patient matching initiatives. The spending bill does not lift the government’s ban on funding such a program directly.

Sutter Health will pay $575 million to settle the state of California’s claims that it engaged in non-competitive behavior. Sutter will also be prohibited from using “all or none” terms in requiring insurers to include all of its facilities if they include any of them, and also from charging excessively for providing out-of-network services.

Other

The Madison paper profiles Kiio, a 14-employee startup whose app assesses low back pain, refers the patient to the appropriate resource, and provides a customized exercise program with animated instructions. The company says users report a 50% reduction in pain and 90% of them would recommend the program.

Drug maker Abbott Labs issues a takedown notice to a diabetes support group that told users how to extract their own blood sugar readings from the company’s continuous glucose monitor and monitor them on a free software tool. Abbott says the free tool infringes on its copyrights and claims that a patient’s own blood sugar readings are its copyrighted property.

A Columbus, OH ED doctor ponders the amount of time she spends reassuring healthy patients that despite what they have found in their Internet medical searches, they don’t need emergency treatment. She also wonders how she should close those encounters without triggering low-score patient satisfaction surveys.

Sponsor Updates

• Nordic staff volunteer at The River Food Pantry in Madison, WI.
• PCare publishes a new solutions paper, “Patient Ambassador Program Best Practices.”
• Gartner recognizes PatientSafe Solutions in its “Market Guide for Clinical Communication and Collaboration.”
• KLAS Research recognizes Arcadia’s population health management platform for its ability to support identifying and closing gaps in care.
• Redox releases a new podcast featuring Dr. Bill Hanson, CMIO of Penn Medicine.
• Relatient publishes a new case study, “Kentuckiana Pediatrics Group Finds Patient-Centered Billing is Key to the Patient Journey.”

Blog Posts

• Tried and True Areas of Focus for 2020 (Lightbeam Health Solutions)
• Healthcare Price Transparency: Doctors Need It Too (Loyale Healthcare)
• Meditech Staff Organize Annual Holiday Giving Program (Meditech)
• Three Key Strategies for Healthcare Financial Transformation (Health Catalyst)
• Clinical Communication Etiquette: When Should You Text, Call, Broadcast or Video Chat? (Mobile Heartbeat)
• Physical Therapists, Physical Therapy Assistants, Physical Therapy Aides – Looking at the Core Clinical Workforce of a Practice (MWTherapy)
• EHR Errors Continue to Threaten Patient Safety (Nextgate)
• Enhancing Analytics Using Scrum (Impact Advisors)
• Rethinking Your Routine in 2020 (Netsmart)
• How data can help you solve your care coordination problem (Experian Health)
• How to Increase Your Patient’s Financial Literacy & Improve the Collections Process (PatientBond)
• Leadership Roundtable Series: Social Determinants of Health Community Insights (PatientPing)
• A Decade of Patient Payment Services: Our Greatest Hits (Patientco)
• #GetToThePoint: Best practices to prevent delayed test results (Pivot Point Consulting)
• Balancing Zero Trust with a strong identity strategy and AI (SailPoint)
• Healthcare Organizations Make Major Progress in Transition to New SCRIPT Standard Ahead of January 1, 2020 CMS Deadline (Surescripts)
• Galaxy Brain: Data Science Workflows with Prefect & Dask (SymphonyRM)
• RSNA 2019 Visage’s Top Five (Visage Imaging)
• When new technologies connect, the results are magical. (Voalte)
• Real-Time Healthcare Analytics: Monitor, Predict, Nudge, Act (Vocera)
• FAQ: MIPS and S’more: 2020 Final Rule Highlights (WebPT)
• Youth Suicide and the Technology Puzzle (Medsphere)

Contacts

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

Weekender 12/20/19

Weekly News Recap

• The National Academy of Medicine publishes an overview and recommendations for the use of artificial intelligence in healthcare.
• LifeLabs, Canada’s largest lab testing company, admits that it paid a hacker’s ransom to recover its systems in an October breach that affects 15 million patients.
• Amazon Web Services adds ICD-10 and RXNorm linking to its Amazon Comprehend Medical natural language processing service.
• HIMSS hires Tim Kelsey, CEO of the Australian Digital Health Agency, for an SVP of analytics job.
• Hackensack Meridian Health, New Jersey’s largest health system, admits that it has paid a ransomware hacker to regain access to its systems.
• A Florida pain management chain pays $85,000 to settle HIPAA charges that it ignored a patient’s request to send an electronic copy of their medical records to a third party.
• Partners HealthCare announces a five-year, $100 million digital health initiative.

Best Reader Comments

The data quality problems occur because of the vendors, the practices, the clinicians, and external bias generators (Insurance, MU, etc.) These causalities all have an impact to the data at its source. Extracting data and transforming it only makes the data worse. And I find that most people working the data do not consider the source, or the destination of the data,  to understand how it was created and what the requested usage is. Lots of problems to be solved here before we start thinking that AI can create”‘whirled peas.” (HITInteropGuy)

As a parent of a teenager with type 2 diabetes using the Dexcom continuous glucose monitor synced to my iPhone, please alert your readers that this monitor does not sample blood glucose levels. In fact, it is measuring interstitial fluid ( lymphatic fluid) glucose levels and there’s quite a delta in the reading accuracy, especially during large swings. We had to stop using it because of his sports and my obsession watching his glucose levels fluctuate on a minute by minute basis.(El Comandante)

I believe one of the unstated goals of the Meaningful Use program was to reduce the number of EMRs available by creating a certification process that required significant development investment. The ONC was clearly aware that interoperability was hard, and that by reducing the number of EMRs, it becomes less of a burden. The result was a reduction in the total number of ambulatory EMRs as smaller players couldn’t afford to develop the required capabilities.A conspiracy theorist might posit that this also aligns with the fact that smaller EMR companies are not funding campaigns and lobbying efforts. The benefit of MU primarily accrued to the large EMR vendors. (Notmeaningless)

I don’t know how it is in the EMR space; I’m in the imaging space, but there the smaller players sometimes can and do develop the required certification capabilities. The hurdle is often in another place entirely — they can’t afford to invest in the certification process. That being said, not every smaller player is good in terms of capabilities. Some are downright terrible. So certification has its place, if done right. (Clustered)

Interesting that OTTO was headed by ex-Epic Sarah Green. Also another Ex-Epic just became CEO of IDX, an AI diagnostics company. Curious how many other old colleagues are now in C-Suites. (AnotherExEpic)

If this is how data ownership should work, why would this be limited to only healthcare? Credit rating agencies make huge amount of money buying, aggregating, and selling data about your credit worthiness. Online data brokers make even more money collecting and selling data about your online habits. Assuming that our society decides that “data about me” is automatically “data that belongs to me” for healthcare, does it stop there? Why would “data about my body” be more sacred than “data about my habits”? (TH)

Watercooler Talk Tidbits

I received generous Donors Choose donations from Mark, Dana, Friend at Impact, and the IT directors of Atlantic Health System (NJ), which with matching funds from my Anonymous Vendor Executive and other sources fully funded these teacher projects, all of which involve schools in high-poverty areas:

• Math manipulatives for Ms. O’s kindergarten class in Creedmoor, NC
• Math manipulatives for Ms. P’s elmentary school class in Minneapolis, MN
• A learning table for Ms. H’s elementary school class in Philadelphia, PA
• Codable Legos for the coding club of Mr. M’s middle school class in San Diego, CA
• Lego sets for the fourth grade class of Ms. C in Williamsburg, KY
• Flexible seating for Ms. A’s kindergarten class in Cape Coral, FL
• Copy paper, composition books, and cleaning wipes for Ms. C’s elementary school class in Hempstead, NY
• Math tiles for Ms. S’s elementary school class in Woodside, NY
• Learn to Code Ladybug for Ms. P’s kindergarten class in Dallas, TX
• STEM Lego sets for Ms. G’s elementary school class in Baltimore, MD
• Math manipulatives for Ms. M’s elementary school class in Yakima, WA
• A field trip to the Discovery Lab for Ms. M’s elementary school class in Tulsa, OK
• Programmable robotics kits for Ms. D’s elementary school class in Tamarac, FL
• Five tablets and cases for Ms. M’s elementary school class in Magnolia, MS
• Two Chromebooks for Ms. M’s elementary school class in Miami Gardens, FL
• A Viewsonic projector and bluetooth speaker for Ms. P’s elementary school class in Baltimore, MD
• Three laptops for Ms. C’s elementary school class in Washington, DC
• STEAM sensory tiles for the children with disabilities elementary school class of Ms. A in Staten Island, NY
• Video production equipment for Ms. M’s middle school class in New Cumberland, WV
• Accommodations for a field trip to Washington, DC for the fifth grade class of Ms. C in Brooklyn, NY

Surveyed doctors and nurses say that “Scrubs” and “ER” are the most realistic medical TV shows. They note that unlike what other shows portray, doctors don’t really cover everything from surgery to OB, they don’t sprint through the ED doors to meet ambulances, and they don’t usually respond to emergency cases with an insightful diagnosis of some weird problem and instead focus on stabilizing the patient.

The families of people who die at home in France must have a doctor’s signed death certificate before moving the body, but a shortage of GPs willing to travel to the homes of patients they don’t know for a flat rate of $110 means families often must leave the body in their homes for several days. Some towns have passed laws that make dying at home illegal.

A start-up in England invents a toilet with an “inconveniently sloped” seat that intentionally makes users uncomfortable after five minutes, citing the employer productivity benefits from shortening the average 28-minute bathroom break. This if anything proves that it’s time to make “Office Space 2.” Or to launch a startup selling corporate-issued diapers.

Twitter hackers post flashing strobe light GIF images to followers of the Epilepsy Foundation, apparently hoping to induce seizures. I’m beginning to think that humans are too evil to allow anonymous public postings.

A Harvard Medical School analysis of US doctor traffic tickets finds that psychiatrists are the most likely to be caught for “extreme speeding,” while cardiologists are the most common Ferrari-driving specialty.

A teenager who was hospitalized with lupus during Christmas two years continues her annual tradition of creating Christmas tree kits for kids at UC Davis Children’s Hospital. She and her family brought 60 sets of decorated trees to the hospital.

In Case You Missed It

• News 12/20/19
• Donors Choose Updates 12/19/19
• EPtalk by Dr. Jayne 12/19/19
• HIStalk Interviews Laura O’Toole, President, Santa Rosa Consulting
• News 12/18/19
• Curbside Consult with Dr. Jayne 12/16/19
• Readers Write: The Case for Compassion in Healthcare
• HIStalk Interviews Michael J. Alkire, President, Premier
• Monday Morning Update 12/16/19

Get Involved

• Sponsor
• Report a news item or rumor (anonymous or not)
• Sign up for email updates
• Connect on LinkedIn
• Contact Mr. H

Morning Headlines 12/20/19

NCPDP & Experian Health Announce 100% of the U.S. Population Has a Universal Patient Identifier, Powered by Experian Health UIM and NCPDP Standards™

Standards developer NCPDP and Experian Health announce that they have assigned a Universal Patient Identifier to all 328 million Americans.

Hospital execs say they are getting flooded with requests for your health data

Hospitals report that they are being inundated with requests to sell patient information to technology companies, many of them well-funded Silicon Valley startups that need to train their newly developed AI systems.

Mass General team detects Alzheimer’s early using electronic health records

Massachusetts General Hospital scientists say they can predict dementia by scanning their EHR data for a list of cognitive-related terms using natural language processing.

News 12/20/19

Top News

The National Academy of Medicine publishes “Artificial Intelligence in Health Care: The Hope, the Hype, the Promise, the Peril.” Its major points:

• EHR and consumer data are widely available, but wider adoption of common data models and FHIR are needed to support AI projects.
• Inclusion and equity must be incorporated to prevent expanding existing health outcomes inequities as has occurred with other consumer-facing technologies.
• Transparency guidelines need to be developed to create trust.
• Near-term focus should be on supporting what clinicians already do rather than replacing them, such as by providing guidance to non-specialists, filtering low-acuity or normal cases, addressing inattention and fatigue, and automating business processes.
• AI training and education should be incorporated into continuing medical education.
• Health systems should implement AI solutions only if their IT governance process is mature and only if no low- or no-technology solutions already exist. National efforts will be required to support AI deployment in lower-resource environments to support healthcare equity.
• Regulatory challenges will remain for AI developers, but the FDA approach of considering the level of patient risk, the level of AI autonomy, and the level of static or dynamic AI behavior should be taken into account and post-marketing surveillance is needed to evaluate a given model’s ongoing learning. 

Reader Comments

Randy Bak, MD, JD added a comment — in response to my observation that doctors aren’t good at practicing evidence-based medicine – that is worth running here (with my edits):

Not all patients fit the target of a care guideline. They become care guidelines when most patients should be treated that way. You could call the result art rather than science, but some hardheadedness still applies. If you treat most patients as exceptions to the guideline, then you are out of bounds, just as you are if you treat all patients by the guideline. The key is understanding what makes an exception, and even then realizing that sometime you will be wrong.

Managers looking at how clinicians respond to guidelines need to look at actual practice, but they also need to apply the same kind of hardheadedness about measurement and its conclusions.

Small sample sizes don’t tell you a lot about a practice pattern. They say it takes about 30 samples to get a reasonable approximation of the normal curve of a phenomenon, so if you start judging physician practice based on 10-20 cases, you’re looking for trouble. Even when you get decent sample sizes, they remain just that– samples. Regression to the mean is a real phenomenon. Worse is that, especially in low sample-size settings, last year’s champion can be next year’s black sheep. Sampling must be repeated over time get to the “truth.”

Use case exists where real measurement can be applied, such as surgical procedures. Just about every practice has something that occurs frequently enough to allow reliable measurement. There is not infrequently a halo effect or inference that can be made from what is measurable to what is not, which can drive management of that clinician. Still, caution is due.

As in sports, individual measures may not tell the whole story.  I am fascinated at how pro sports geeks have gone “moneyball” on metrics, trying to find measurements that tell them how to spend their team budget. Is there a way to get to “outcomes above replacement” or such things that tell you this clinician improves the care all around them?

HIStalk Announcements and Requests

Unrelated, other than seasonally: Rev, the transcription company I use for interviews, sent a holiday email that contains the perfect mix of humor, holiday cheer, and sly self-promotion.

Thanks for the cool holiday swag from Ellkay, which included several flavors of honey from the company’s rooftop beehives. I don’t usually get vendor marketing stuff other than at the HIMSS conference, but Ellkay’s is the best, and the honeybee connection is the most memorable, feel-good tie-in that I can think of.

Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.

Acquisitions, Funding, Business, and Stock

RCM vendor Streamline Health will sell its legacy enterprise content management business to Hyland.

Sales

• Baptist First Health (KY) will integrate ActX’s genomic decision support software with its Epic EHR.

People

Aspire Health co-founder Brad Smith will become the new head of the Center for Medicare & Medicaid Innovation.

Augmedix names Davin Lundquist, MD (CommonSpirit) as chief medical officer.

Announcements and Implementations

OhioHealth implements KitCheck’s Bluesight for Controlled Substances across 10 hospitals.

Rush University System for Health (IL) integrates Mytonomy’s Patient Experience Cloud care education software with Epic’s MyChart.

Online health and wellness company Hims & Hers will offer customers in Florida access to telemedicine for chronic conditions through Ochsner Health System (LA) beginning next year.

Employer-sponsored provider QuadMed implements Epic.

KLAS is apparently branching out from purely technology coverage given its new reports on worksite health services and value-based care consulting. I’m not all that interested in either, but the first report gives Cerner a B- and QuadMed – announced above as having implemented Epic – a D+, while the second puts Deloitte at the top as a transformational partner.

Government and Politics

CMS temporarily shuts down the Blue Button 2.0 system after a developer notifies the agency of a bug that may have exposed Medicare beneficiary data. CMS will restore service after it finishes a quality and validation review.

Privacy and Security

LifeLabs, Canada’s largest laboratory testing company, notifies patients of an October ransomware attack that compromised a server used for online appointment bookings. The company, which admits that it paid the hacker’s demanded ransom, says 15 million customers were affected and the lab results of 85,000 of them were exposed.

Other

Standards developer NCPDP and Experian Health announce that they have assigned a Universal Patient Identifier to all 328 million Americans. Experian Health creates the UPI when a a provider, pharmacy, or lab sends it patient demographic information, then sends back specific identity information. The assigned UPI itself is not disclosed to the patient or provider to prevent its misuse.

Hospitals report that they are being inundated with requests to sell patient information to technology companies, many of them well-funded Silicon Valley startups that need to train their newly developed AI systems. Jefferson Health says companies that get a firm “no” from its executives then try to twist the arms of individual doctors and researchers. Jefferson Health’s cancer center director Karen Knudsen, MBA, PhD drily observes, “We often find, once we look deeper into the pitch, that it starts as a joint development project and ends up somehow with us being both the product and the customer that pays for the product.”

The CEO, a director, and four researchers of H. Lee Moffitt Cancer Center & Research Institute (FL) resign after its compliance department finds conflict of interest violations in their ties with research organizations in China. The cancer center’s founder says the group was found to be “secretly accepting money from China.”

Massachusetts General Hospital scientists say they can predict dementia by scanning their EHR data for a list of cognitive-related terms using natural language processing.

MIT researchers say their Gates Foundation-funded, patch-based vaccine delivery system would not only eliminate the need for syringes, it wouldn’t require an EHR for documentation either since the patch leaves a skin pattern that can be detected by smartphone.

Sponsor Updates

• PatientPing makes Vynca’s advance care planning data available to providers within its real-time care collaboration network.
• Meditech releases a new video, “Meditech Expanse Delivers the Power of Mobility to Androscoggin Valley Hospital.”
• Pivot Point Consulting names Kyle McAllister (Nordic) director of strategic implementation.
• Greenway Health makes the Carequality Interoperability Framework available to its Prime Suite and Intergy EHR customers via the CommonWell Network.
• CHIME interviews The HCI Group’s VP of Operations and Strategy, Chris Belmont.
• PatientSafe Solutions is recognized in Gartner’s “Market Guide for Clinical Communication and Collaboration.”
• The New Pittsburgh Courier honors ConnectiveRx Director of Pharmacy Operations Natalie Tyler with a Women of Excellence Award.
• LaTonya O’Neal (Change Healthcare) joins The Chartis Group as principal.
• Vyne Medical and its Trace interaction capture solution are featured in KLAS’s “2019 Revenue Cycle Unicorns Report.”
• Cigna expands its relationship with MDLive to include virtual visits for behavioral healthcare.

Blog Posts

• Three tips for maintaining an effective Master Training Environment (Nordic)
• How to Better Understand the Benefits of Health Data Standards (EClinicalWorks)
• 4 C’s of Millenial Healthcare (Optimum Healthcare IT)
• Clinical Communication Etiquette: When Should You Text, Call, Broadcast or Video Chat? (Mobile Heartbeat)
• Ensocare Product Showcase Creates Wow Factor for Team Members (Ensocare)
• How do you measure your return on analytics? (EPSi)
• What is a healthcare clearing house in medical billing? (Greenway Health)
• Using Data Analytics to Ensure Case Mix Index Accuracy (Hayes Management Consulting)
• Troubleshooting Slow Logons when User Profiles are Root Cause (Goliath Technologies)
• Healthfinch Resources: The Best of 2019 (Healthfinch)
• Has UCLA’s New PRIDE Study Perfected Shared Decision Making for Diabetes Patients? (Healthwise)
• Social Determinants of Health Data Analytics Top Disruptor in 2020 (Imat Solutions)
• Three tips to Jumpstart your Distressed IGA Deployment (Imprivata)
• How Providence St. Joseph Health is Digitizing the Consumer Healthcare Journey (Kyruus)

Contacts

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