News 10/18/19

Top News

Nuance and Microsoft will co-develop ambient sensing and conversational AI software to enable physicians to pay more attention to their patients instead of on administrative tasks.

Building upon Nuance’s ambient clinical intelligence software (on display at HIMSS earlier this year) and Microsoft’s intelligent scribe service, the new technologies will be rolled out to select end users early next year.

Initial capabilities will include ambient listening, wake-up word, voice biometrics, signal enhancement, document summarization, natural language understanding, clinical intelligence, and text-to-speech. 

Reader Comments

From Henry W. Jones, III: “Re: Epic’s redacted contract that appeared in the SEC filings of Ardent Health Services. Any assessment that the redaction is moderate and the contents are not worrisome (such as the absence of a gag clause) are overconfident. The redaction leaves holes and many provisions that could be contained but not shown (such as IP claims, liability shifting, unique terms and conditions). We know that Epic demands more redactions and secrecy than other EHR vendors and than vendors in non-medical industries. For example, the contract omits in its litigations listing the Epic vs. Tata saga, which involves over 1,000 court pleadings and an initial Epic jury verdict of $900 million (later reduced to $400 million per state statutes). Latency also yields uncertainty and this was a contract signed eight months ago and posted on the SEC seven months ago, so we don’t know what might have changed. The long-term, non-obvious industry impacts of locking customers into EHR contracts merits serious, granular analysis; the devil is likely to be in the many details that are missing here.” Hank is an IT lawyer and consultant. I interviewed him in 2016.

From Skimmer: “Re: HIStalk. How does anyone find the time to read it all?” Many readers think reading everything here provides positive ROI, and I certainly hope that’s the case. I’ve already surfaced the most important or interesting items among the junk, so it’s up to them to pick the parts of what I run that will be most impactful to their careers as professionals who should be taking the time for continuing (and continuous) education. But if they don’t have the time, the news posts run just three times per week (which is a minimal time investment since it’s broken out into easily skippable sections), the Weekender summarizes the week’s biggest news each Friday morning, and the absolutely most important stories appear in my daily headlines. I hope the 90% of readers who say reading HIStalk helps them do their jobs better are finding it worth their time and thus mine.

Webinars

October 24 (Thursday) 1:00 ET. “The power of voice: Will AI-drive virtual bedside assistants become mainstream?” Sponsor: Orbita. Presenters: Nick White, co-creator of DeloitteAssist and principal in Deloitte’s Smart Healthcare Solutions practice; Bill Rogers, CEO and co-founder, Orbita. Conversational AI and virtual health assistants are bringing new opportunities to care facilities to improve patient journeys and yield radical workflow efficiencies. Will the hospital rooms of the future continue to provide traditional bedside call buttons? Or will these be replaced with digitally reimagined, AI-driven, voice-powered agents? Learn from the expert who created today’s industry-leading, market-proven, virtual bedside assistant.

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

Sales

• Novant Health (NC) will implement telemedicine services from TytoCare.
• SwipeSense selects health data integration capabilities from Redox to ensure that its RTLS applications are interoperable with any EHR.

People

Goliath Technologies names Stacy Leidwinger (Nuance) as chief marketing officer.

Heather Trafton (Steward Health Care Network) joins Arcadia as COO.

Announcements and Implementations

Champlain Valley Physician Hospital transitions to Epic as part of a $152 million system-wide deployment within the University of Vermont Health Network.

Mid-Valley Hospital and Clinic (WA) goes live on Cerner Millennium.

Lightbeam Health Solutions reports that ACOs that attained a positive savings rate using its population health management technology achieved $602 million in shared savings over the five-year Medicare Shared Savings Program.

A new KLAS report finds that the HIE technology market is moving to broader use of aggregated data, with advanced users of Allscripts and InterSystems most likely to be using those systems for advanced use cases. KLAS notes, however, that less-advanced users of the Allscripts DBMotion product report dissatisfaction with getting the system up and running, Health Catalyst is consistent in its support but behind in keeping technology promises, Orion Health users say the platform is too rigid to support innovative use cases, and InterSystems customers are strongly satisfied across the board, giving it the highest purchasing energy among the four companies.

WVU Medicine (WV) begins enrolling patients in the National Cancer Institute’s Cancer Moonshot program, one of six organizations funded to use technology to enable patients to report and manage their cancer treatment symptoms.  WVU will use its Epic MyChart to answer patient questions (which can include images or files) and to send out routine surveys, with the patient-entered information flowing back into Epic. 

Philips adds the new Sentry Score predictive algorithm to its ECareManager telehealth software, giving clinicians the ability to prepare for patient ICU interventions in under an hour.

Government and Politics

The VA launches a multi-site pilot program that will give veterans access to telemedicine services at local VFW or American Legion posts using Internet-connected healthcare pods developed and donated by Philips.

Former VA Secretary David Shulkin, MD authors “It Shouldn’t be This Hard to Serve Your Country,” a book about his 13 months working in the Trump Administration.

Other

The NFL is rolling out a prescription drug monitoring program as part of its more focused efforts on monitoring pain management and opioids. First announced in May, the league’s PDMP will also be used by unaffiliated physicians.

A Nor’easter takes down the EHR and other systems Thursday morning at hospitals that are part of Northern Light Health in Maine.

The Colorado Sun profiles the ways state-based hospitals are using AI and machine learning, with innovations ranging from “digital sitter” remote patient-monitoring efforts, to algorithms that predict and cut treatment time for patients at risk for sepsis, to algorithms that can help radiologists identify areas for concern more quickly and accurately. HealthOne CIO Andy Draper says, “We’re right in the very beginning of it. There are a lot of tools that will pop up and we should embrace and love them all and then over time we’ll see what their real potential is.”

Sponsor Updates

• EClinicalWorks will exhibit at the TACHC Annual Conference October 21-22 in The Woodlands, TX.
• Healthfinch will exhibit at the Group Practice Improvement Network Semi-Annual Conference October 23-25 in Portland, OR.
• The Chartis Group names Aaron Bujnowski (Texas Health Resources) director and leader of the company’s integrated delivery network segment.
• Healthwise will exhibit at Allscripts ACE HHS October 21-23 in Dallas.
• Glytec forms a Quality Team to help health systems adopt best practices in glycemic management.
• InterSystems will exhibit at the Gartner Symposium/ITxpo October 20-24 in Orlando.
• Yukon Health and Social Services in Canada will upgrade its Meditech system next year.
• Black Book names Nuance the top vendor for end-to-end healthcare coding, clinical documentation improvement, transcription, and speech-recognition technology.

Blog Posts

• Patient Transport Delays? Technology Holds the Answer (Ensocare)
• Best practices for password management, 2019 edition (Google Cloud)
• Pause to Consider: Leveraging Technology (Fortified Health Security)
• How to optimize practice revenue while improving patient care (Greenway Health)
• HGP’s Target Metrics for Emerging Growth Health IT Software (Healthcare Growth Partners)
• Showcasing End-to-End Visibility Across Cerner RHO and Health IT Infrastructure at 2019 Cerner Health Conference (Goliath Technologies)
• Creating new efficiencies with referral and medical records management (Hyland)
• Building an Electronically Integrated Hospital from Scratch (Impact Advisors)
• How AI and Machine Learning are Transforming the Way Discoveries are Made (InterSystems)
• 3 ways communication technology can help prevent workplace violence in healthcare (Spok)

Contacts

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

Book Review: HIT or Miss

Reading the third edition of “HIT or Miss” is like trying to reconcile memories of someone’s previously vibrant life with their coldly objective obituary. It contains dozens of examples in which the exuberance, high-fiving (especially by the vendor’s salesperson), and lofty goals of improving patient care via IT somehow ended up as flaming wreckage whose major contribution is to serve as a cautionary tale for the rest of us.

You may well chuckle at the naiveté and hubris of each (unnamed) hospital’s executive and IT teams for making some really bad decisions, but deep down you know your own organization isn’t any better even though its gaffes aren’t included. Hindsight is 20-20.

You also might question why this sort of HIT autopsy holds value and I see your point. The organizations that have yet to make such plus-sized IT mistakes aren’t likely to read the book like the Bible and declare themselves reborn. Every IT project is different and maybe the lessons belatedly learned by other hospitals either aren’t relevant or must be relearned by others.

Still, it’s made clear that the enthusiasm to “do this project right” – implicitly outperforming lesser-skilled peers whose cloak of invincible destiny turned out to be full of holes – can be crushed by a single, cancerous-like cell that metastasizes. Its genesis isn’t notable – a low-level decision made in an overcrowded conference room that smells of stale bagels, Type A executives who insist pushing on to recoup their eye-popping software investment by bringing it live at all costs so they can be photographed at the ribbon cutting, and leaders who allow the scope to creep to appease an influential department head or foot-stomping doctor. Any one of thousands of ever-moving parts can cause the whole machine to blow up once the big switch is pulled.

The biggest takeaway here – not surprising that AMIA was involved – is that hospitals should  listen to their CMIO, clinical IT folks, and patient care front-liners. I had “your vendor” on the list, but I’ll asterisk that – some vendors are determined to make their clients successful and possess the competence to do so, while others peak at getting the contract signed and may do more harm than good.

These examples, provided by and recounted by a stunning roster of industry luminaries and edited by Jonathan Leviss, MD, are representative:

• A hospital whose voluntary CPOE usage dropped from 60% during the pilot to 15% immediately afterward (and zero shortly after that) as the project team called it mission accomplished, took vacations, and shifted their attention to other priorities.
• Another (Hospital B) whose patient satisfaction dropped from the 70th percentile to the 5th as its health system parent tried to copy the successful ED implementation in its larger, newer, and more sophisticated Hospital B without involving Hospital B’s clinicians in the build and testing.
• A hospital that rolled out a legacy data viewer as it implemented a new EHR, but continued to send the viewer new data until its forced retirement three years later, at which time it was discovered that 40% of clinical users were still using it (instead of the new EHR) to look up lab results and clinical notes, after which staff complaints (mostly from surgeons) forced the hospital to reconfigure the new EHR’s screens to look like those of the legacy system.
• A decision to issue all drug interaction alerts to clinicians, with the intrusive pop-ups being overridden 95% of the time for drug-drug interactions and 87% of allergy warnings, wasting an estimated 12-18% of clinician time.
• A hospital that decided to implement a new medication reconciliation system and process across four hospitals without performing a pilot project, which had to be shut down two weeks later when the executive-estimated few seconds of pharmacist time required for each patient turned out to be 20-30 minutes.
• A barcode medication program that failed because IT and facilities engineering weren’t involved in choosing laptops, batteries, and carts and nobody had time to work the trouble tickets.
• A community hospital that slowly migrated from one ICU vital signs capture system to another as rooms were renovated, but each system interpreted and displayed information differently to the clinicians making decisions.
• The discovery that a newly implemented fetal monitoring system displayed information for the wrong patient because of a cable plug-in mix-up.

Each of the 48 case studies is interesting, even those that may now be mostly a historical curiosity now that integrated, single-vendor EHRs have eliminated some of the risk points of integration, upgrade timing, and multiple device use.

“HIT or Miss” was a lot more interesting and detailed than I expected. It recounts millions of dollars worth of bad decisions, unfortunate events, and vendor shortcomings that we wouldn’t have heard about otherwise. I’d like to think that no patients were harmed in the making of this book, but I’m certain that isn’t the case. And while IT sophistication grows linearly as health systems get bigger, complexity and thus the potential damage grow exponentially.

This is not my usual book review since it would be missing the point to focus on writing style or entertainment value (although both are excellent). Its value is to show what can go wrong when a project transitions from executive self-congratulation for choosing a bold IT path forward to their underlings trying to make it all work in an ever-changing environment full of self-interest landmines, competing pressures from all sides, and products whose shortcomings aren’t discovered until  analyst sleeves are rolled up.

Perhaps the takeaway is that it’s really tough to implement process change and ever-changing technology in meeting timeline and budget expectations while preserving the originally envisioned benefit to patients without harming them in the process. For that reason, IT leaders might want to stock up on copies to hand out to overconfident C-suiters and board members who feel that their executive insight justifies overriding the advice of those pessimistic, business-naive clinicians who won’t quite yapping about their “concerns” or the potential harm to patients that they can’t say with certainty will actually happen in standing in the way of lighting the candle. Worst is that they are right – you won’t know what you don’t know until you bring the system live and there’s never a perfect time to do that, so at some point you might was well just turn it on and be ready to fix what’s broken.

Thanks to attorney Henry W. “Hank” Jones, III, JD for sending me a copy of the book (he wrote Chapter 48 – “Explore HIT Contract Cadavers to Avoid HIT Managerial Malpractice.”) It’s $60 on Amazon.

EPtalk by Dr. Jayne 10/17/19

I had occasion recently to talk with a personal liability attorney, fortunately just socially and not professionally. He had some questions for me about the role of artificial intelligence in healthcare. Fortunately, I was able to point him towards a recent editorial in the Journal of the American Medical Association.

The article has a nice summary of the concerns that many in practice have about AI: communicating recommendations without the underlying rationale; poor training data sets used in the development process; and failure to reach an accurate result or recommendation. The JAMA article notes that case law on AI-related liability is lacking, but existing law can be extrapolated to cover these situations.

The authors’ examples support the use of AI as an adjunct to the existing decision-making process in order to prevent additional liability. However, as AI becomes engrained as part of the standard of care, this approach may necessitate more trust in AI systems at the point of care, in order to prevent the physician from making the error of underutilizing technology that could be of benefit. It’s a complicated equation, for sure.

The VA recently announced planned steps to increase data sharing with non-VA providers using the Veterans Health Information Exchange. They’re going to shift the current opt-in protocol to one where opt-out is the norm, so patients no longer have to provide a written release for the VA to share their data electronically. A quote from the VA in one of the articles I read about it states that community providers and organizations must have partnership agreements and be part of the VA’s trusted network to receive VA health information. I hope they meant to say that you have to be part of the network to receive information electronically, unless the VA isn’t covered by HIPAA, which allows providers to share information for Treatment, Payment, and Operations without a specific release.

The HIE plans to share information including: problem list, allergies, medications, vital signs, immunizations, laboratory reports, discharge summaries, medical history, records of physicals, procedure results such as radiology reports, and progress notes. Veterans who don’t want their data shared can still opt out, but they will have to be either all in or all out – previous mechanisms which allowed some data to be shared but not others will no longer be permitted.

Speaking of veterans, telehealth middleware provider Medici has launched “Operation 11/11” to provide no-cost virtual consults to all US veterans on Veterans Day, November 11. Proof of military service is required and participants can pre-register for services from 8 a.m. to 8 p.m. in their time zone on November 11.

Medici is welcoming four military advisors for the initiative and has also partnered with 2nd.MD to provide virtual second opinions for veterans with complex patients. Medici has an interesting model where providers pay to be on the platform and set their own rates for virtual visits. I can imagine it might be compelling for independent physicians, but struggle to see how it plays for the majority of physicians who are in employed situations.

I was intrigued to hear about Black + Decker’s new automated medication management and home health care assistant device, Pria (first covered on HIStalk nearly a year ago). It’s the first foray into healthcare from the people who brought us the Dustbuster. The voice-activated device tracks and schedules up to 28 medication doses along with reminders and timely dispensing. It also allows patients to have access to family members or caregivers using a built-in camera for video calls. It can also enable reminders for drinking water or other key health-related activities. The product is pricey at $600 plus a $10 monthly subscription.

I recently became aware of a club I have no desire to be a member of: telehealth providers who have licenses in all 50 states. Becoming licensed in a handful of states is enough work, so I can’t imagine wanting to have dozens of applications in process. The CNBC piece profiles a couple of telehealth providers who advocate for the approach as a way to treat patients more effectively particularly patients in underserved areas.

Data from the Federation of State Medical Boards indicates the club is pretty small, with only 14 physicians licensed everywhere as of 2018 data, up from six in 2016. The number will likely be higher for 2020 given the overall growth in telehealth. One interviewee notes the cost of procuring 50 licenses is around $90,000. In addition, there are annual fees to maintain them. If providers ever surrender a license, there’s also a process to explain that in future license renewals in other states, so if you’re going to do it, you had better be ready to maintain it. I’ve found telehealth compensation for physicians to be lower than pay rates in brick-and mortar situations. Unless you have the temperament to conduct, complete, and document visits every couple of minutes, I don’t see a lot of physicians opting for this type of practice.

An interesting potential use of artificial intelligence was detailed this week in The Wall Street Journal: prediction of marital arguments. Engineers and psychologists are using speech patterns, physiological data, and acoustic / linguistic information to detect potential conflict. One described use case is sending a text message to a highly stressed individual, warning them of an imminent conflict so they can take action.

The original 2017 study followed 19 Los Angeles couples and tracked data such as heart rate, perspiration, and activity levels. A phone app prompted them to document hourly reports on their feelings and also recorded speech content, pitch, and frequency in taking a three-minute recording every 12 minutes. Researchers were able to detect conflict with nearly 80% accuracy. The original data was gathered during a one-day period, which is a significant limitation along with the size of the sample.

A more recent investigation by the same researchers looked at 87 couples, using speed of speech and intonation to detect conflict. The research sounds promising. I hope they consider the next logical investigation, which would be parent-teenager interactions. I’m sure that would be a target-rich environment for conflict identification. Or, we could install such systems in healthcare IT conference rooms across the country – certainly there’s some conflict there!

What do you think about AI identification of conflict? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 10/17/19

NFL, players taking strides to address pain management

The NFL is rolling out a prescription drug monitoring program as part of its more focused efforts on monitoring pain management and medications.

I Ran the VA Under President Trump Until He Fired Me. Our First Trump Tower Meeting Was a Job Interview Unlike Any Other

Former VA Secretary David Shulkin, MD releases “It Shouldn’t be This Hard to Serve Your Country,” a book about his 13 months working in the Trump Administration.

VFW Post 6786 First Site in Innovative Initiative Giving Veterans Access to VA Health Services Close to Home

The VA launches a multi-site pilot program that will give veterans access to telemedicine services using Philips technology at local VFW Posts.

Readers Write: It’s More than the EHR That Is Causing Physician Burnout

It’s More than the EHR That Is Causing Physician Burnout
By Julie Mann

Julie Mann is chief commercial officer of Holon Solutions of Alpharetta, GA.

The cause of physician burnout is a frequent topic on this site and many healthcare sites. The culprit in these posts and articles – as well as those written in major publications such as the New Yorker and Fortune – is inevitably the EHR.

The story is familiar by now. Doctors hate EHRs, doctors spend too much time on them, they interfere with patient care, they take away from the coveted doctor-patient relationship, etc.

What many of these articles don’t discuss, however, is that it’s not just the EHR – or even EHRs from many different providers – that are causing inefficiency, frustration, and burnout.

The broader problem is the non-EHR-stored data in payer portals, analytics platforms, HIEs, and elsewhere. Physicians have to log-in and log-out of all these different places for almost every patient, 30 or more times a day, and then search and scan through irrelevant screens of data to find the specific information they want to know. If the important, contextual data were available in their workflow immediately at the point of care, then it would drastically speed up their workflows.

The current federal proposal (now closed for public comment) to solve the interoperability problem may make data easier to share across EHR platforms, but it doesn’t solve the context or workflow problem. What the proposal amounts to is not much different than the early days of HIE and sharing CCDs, which no physician has the time or interest to read because they’re too long and filled with information a physician at the point of care already knows, doesn’t care about at that moment, or doesn’t care about at all.

While the quantity of information shared between different parties may improve if the current interoperability proposal moves forward, it’s unlikely the quality or relevance of the data will change at all. That is because this proposal doesn’t seem to consider workflow or context, which means physicians will spend more time searching and scanning through pages of digital data, resulting in greater frustration levels and experience even more administrative burden.

New or augmented automated workflows can be triggered at the point of care, in concert with patient-relevant context, to make the overall healthcare delivery more meaningful, efficient, and robust to reduce physician frustration.

Patented sensor-based software technology in use at health systems and practices delivers actionable patient data to providers within any EHR system, and from any third-party source, without the need for interfaces. These aren’t APIs that just pass blobs of data back and forth without regard for context or what the physician actually wants to know. Rather the sensors recognize when a provider is in a patient’s chart and automatically surface relevant care gaps and other information within the provider’s workflow immediately when they open the chart.

The information is visually integrated into the workflow (think of it as right next to the chart on the screen), allowing the physician to quickly review information he or she actually cares about instead of logging in , searching, and scanning only to find nothing.

Instead of searching, providers have all the care and coding gap information curated from analytics platforms and other physicians’ charts, but also from population health management companies, a laboratory or radiology testing company, or a SMART on FHIR-enabled application hosted by a third-party system.

The sensors, however, aren’t mind readers. The health system would define which data from which EHRs, applications, portals, and elsewhere their physicians would want to know. Because the sensor technology and supporting application are independent of any EHR or other HIT companies, third-party vendors do not need to get involved. That saves months of waiting and untold dollars for the health system because no vendor needs to create or implement an expensive point-to-point interface.

The final interoperability rule may look exactly like the proposal, but it may not. Instead of waiting to see whatever solution comes from the legislation, if any, health systems can reduce their physicians’ burnout through simple, effective, plug-and-play solutions now.

Healthcare data is expected to grow by more than 36% from last year to 2025, which is the largest trajectory of any of the industries studied. Physicians are already buried in data. More data will only add to health systems’ physician burnout problem if they don’t get a handle on this tsunami of information.

Putting contextual insights in front of physicians immediately in their workflow won’t solve all burnout issues, but it is an important step forward in a crucial patient care quality and financial issue for health systems. Liberating the data will liberate the care.

HIStalk Interviews Kavita Bhavan, MD, Chief Innovation Officer, Parkland Health & Hospital System

Kavita Bhavan, MD, MHS is associate professor of infectious diseases at the University of Texas Southwestern Medical Center and chief innovation officer at Parkland Health & Hospital System in Dallas, TX.

This interview was conducted by Vikas Chowdhry, MS, MBA, chief analytics and information officer of Parkland Center for Clinical Innovations in Dallas, TX.

Describe how your career led you to become a chief innovation officer.

I started out as a graduate student in public health at Johns Hopkins and then pursued my MD at Penn State. After completing my residency training in Internal Medicine at Ochsner, I chose infectious diseases, at Washington University, as a subspecialty because it is an area where public health and medicine naturally interface. I joined the faculty at UTSW in 2009, working in an HIV clinic at Parkland.

Shortly after joining the faculty here, I was asked to work in a smaller capacity with a great team of pharmacists on ways in which we could improve delivery of care for uninsured patients that require long courses of IV antibiotics in the outpatient setting. The existing disparity between this group of patients and those with adequate insurance was that they could not access standard forms of outpatient therapy, such as infusion centers, home health services, or skilled nursing facilities.

Prolonged inpatient care is difficult for an individual patient since it limits their ability to return to work or care for family at home. It also impacts the safety net system, where many patients may be waiting to be admitted in the ER. We innovate in this kind of an environment out of necessity and can only succeed when we are given space to rethink care delivery with support from leadership and key input from frontline providers.

What does innovation in healthcare space mean to you?

Innovation in healthcare can present itself in a various forms. While many people associate technology with innovation, I’ve been increasingly interested in thinking about another aspect — low-tech, low-cost approaches to patient-centered innovation to address disparities and improve health equity. The most natural place to start seems to be effectively engaging patients in care processes to reconfigure existing resources to improve high-value care.

What does that mean? In healthcare, we often talk about empowering nurses, social workers, and physicians to practice at the top of their license. What does top of the license for patients look like? Innovation in healthcare includes co-designing care with patients to improve access and address other existing problems. Better clinical outcomes can be achieved with such co-production of care.

There is a shift that occurs when a patient is providing care for themselves at home, as in our home IV antibiotic program. They move from being a passive recipient of care in the hospital to being an active participant in their care at home. We have observed better clinical outcomes over the years while also seeing enhanced engagement and management of one’s health, including other chronic diseases such as diabetes.

Innovation is usually thought of as synonymous with technology. While technology is important, we need to make room for another model of innovation that is even cheaper and easier – recognizing human potential.

How does engagement that goes deeper than “use this app to check your lab results” or “use this device to report your steps” work in practice?

Our self-administered outpatient antimicrobial program at Parkland has become a new standard of care for our patient population and is an example of effective patient engagement. Typically, patients with infections that require long-term antibiotics receive intensive diagnostic and therapeutic services in the first several hospital days. Afterward, they remain in the hospital only to receive antimicrobial infusions.

Insured patients may be discharged early to complete their antimicrobial courses at home with contracted nursing assistance or in lower-cost nursing facilities, but uninsured patients usually remain in the hospital because they cannot afford a healthcare-administered outpatient parenteral antimicrobial therapy (H-OPAT, overseen by the healthcare system).

Those uninsured patients have limited options and may be confined to the hospital, which prevents them from resuming work or other activities of daily living or caring for family members at home. In the safety net hospital setting, this can be a challenge in terms of capacity and the ability to care for other patients, in the ER for example, as a sub-optimal use of resources such as beds.

We approached this problem by piloting our program with a few patients in 2009 with the goal to teach and train the method of self-administrated IV antibiotic therapy by gravity at home. We started the program with minimal resources as patients did not have a home visit or access to home health nurse, infusion center, or devices such as pumps / elastomeric balls (S-OPAT, overseen by the patient themselves).

We began with four patients as a proof of concept and have now cared for more than 4,000 patients through this program. Along the way, our multidisciplinary team listened and learned from our patients what works and what doesn’t work to further refine the process.

We translated education material to appropriate levels of health literacy for our population, achieving a fourth-grade literacy level in English and Spanish and including pictures. After a few years, we moved to an audiovisual process where patients can scan a QR code on the back of an IV bag and be sent to a teaching video on their smart phone where they can watch the process and review all of the steps for infusion at their own pace. This has been effective not only for patients who speak other languages, but also for those who prefer visual learning.

We developed a competency checklist, and using the teach-back method, had patients demonstrate all of the steps of infusion and PICC line care needed to ensure safe discharge from hospital to home.

After the first four years of operation, we tracked clinical outcomes for our S-OPAT patients compared to patients with insurance who left our hospital for healthcare-associated OPAT such as home health or skilled nursing facilities. We were surprised to find that our S-OPAT patients had a 47% lower 30-day readmission rate along with higher patient satisfaction.

How is that possible? When we talked to our patients on return visits, we found they mastered all of the steps and took ownership of the process. It was clear they were more invested with effective engagement. One patient actually said she thought she did better because “it is my own body” versus a nurse coming out to the home to perform a job. We began to appreciate the positive impact of patient engagement with meaningful results.

How do you scale the program?

One of the interesting aspects of this program was that after learning about the success of self-administration, other patients who were insured with access to healthcare-administered therapy wanted to participate in our self-administration process. I have since learned from others that this may fit a model of disruptive innovation. You create something that is useful for a small section, usually a bottom tier of your consumers, that eventually becomes attractive to the broader market. However, unlike a consumer market, adoption by the broader market is determined by a lot of other factors, including existing health policy, reimbursements, etc.

There has been other interest in promoting patient engagement as seen by the recent CMS position on encouraging at-home dialysis. The proposed ESRD Treatment Choices model will give patients an ability to choose at-home dialysis, which may potentially improve satisfaction, lower costs, and improve outcomes.

Could your work have been done at other institutions?

UTSW and Parkland’s partnership is unique because we are committed to caring for a large population of uninsured or underinsured patients with health disparities. Innovation centers attached to larger health systems may have greater investment in technology-based innovation. Our approach has been more patient centered. Our CEO, Fred Cerise, MD, MPH, described another way of looking at innovation that does not need to be driven by profit in his Harvard Business Review article a few years ago

We are likely in the minority coming from a safety net hospital in the larger healthcare innovation space, but there is a need to grow across the country since safety net settings innovate out of necessity.

What’s the most impactful book you have read in the last 12 months?

“The Moment of Lift” by Melinda Gates. She articulates the value of inclusiveness and educating and empowering women to fully recognize our collective potential as a society. There are examples of how impactful this can be around the world and here in the United States.

How do you remain optimistic as a physician when working with a population whose inequities and social disparities are root causes that you can’t address?

The problems are far reaching and there is no simple solution. We are increasingly aware that social determinants affect health and outcomes. Just because we cannot do everything to solve these problems does not mean we cannot do something, to do some small part to help address a given problem to improve the status quo.

I’m lucky to work in an environment where I and many others have the opportunity to make some small difference as we strive to improve patient care.

Morning Headlines 10/16/19

Northwell Health extends partnership with comprehensive Allscripts Sunrise™ platform through 2027

Northwell Health extends its Allscripts Sunrise contract through December 2027.

Cerner workers to become Adventist Health employees

Cerner will lay off 350 California employees following Adventist Health’s decision to bring its revenue cycle operation back in house from Cerner RevWorks.

Introducing AncestryHealth®: Actionable Health Insights for You and Your Family

Family history vendor Ancestry launches AncestryHealth, which will sell a $149 profile of genetic screening results that are matched to specific medical health conditions, plus a costlier membership-based service that provides deeper screening and quarterly screening updates.

Queensland Health’s IT problems can be overcome, new eHealth head says

In Australia, the new head of EHealth Queensland says its struggling Cerner implementation can be turned into a showcase project, but urges all of the state’s health bodies to help in getting new sites live while optimizing existing ones.

News 10/16/19

Top News

Northwell Health extends its Allscripts Sunrise contract through December 2027.

Northwell’s 19 hospitals have been live on Sunrise since 2005, making it the largest customer of Allscripts.

Northwell extended its Allscripts TouchWorks agreement in 2018. 

MDRX shares rose 1.4% Tuesday after the announcement, performing slightly better than the Nasdaq Composite index for the day.  

Reader Comments

From Grim Sleeper: “Re: Allscripts and Northwell. What are the odds that their collaboration will result in a commercially viable inpatient product that can compete with Epic or Cerner” Zero, my reasoning being thusly even though all of us should be wishing for new inpatient EHR competitors:

• Allscripts says the new product will be based on Avenel, which is targeted to ambulatory practices but hasn’t sold well in its 18-month history. The company has admitted to stock analysts that it misjudged market interest in a cloud-based EHR that doesn’t offer a paired practice management product, which is a significant oversight for an EHR/PM company.
• Northwell said in the Allscripts press release that Avenel is immature and its usability needs help from Northwell’s experts, a comment that I’m surprised Allscripts approved.
• Allscripts has a low-and-dropping inpatient market share in which Sunrise has been replaced with broader, integrated offerings from Cerner and Epic. Northwell will continue using Sunrise for inpatient.
• Custom developing a product around a key customer’s specifications is a strategy that usually fails miserably except for that one customer, who gets their quirks and petulant demands baked into code that someone has to try to sell to the next hospital. Coding to spec as a follower than a leader is not the best way to create an innovative product that the broad market wants.
• My conclusion is that Northwell took advantage of knowing it had Allscripts over a barrel as its largest client. I obviously haven’t seen the contract, but I would bet that Northwell is the big financial winner, Allscripts saves face and slings a Hail Mary about a new product (created by improving a not-new product), and we will see in future Allscripts earnings reports whether the new R&D costs and possibly lower revenue contributions from Northwell can be offset by increased additional revenue.
• The key metrics to watch are overall EHR market share and Allscripts stock price. MDRX shares are up 10% since Paul Black took over as CEO in late 2012, vs. the Nasdaq’s 167% gain and Cerner’s 75% rise, and have shed 23% in the past year.

From Market Watcher: “Re: Epic contracts. They’re usually a source of mystery, but a moderately redacted copy of one popped up on SEC’s Edgar. I don’t see anything that looks like a gag clause, although there’s a lot of concern about protecting Epic’s IP.” The contract between Epic and Ardent Health Services doesn’t contain anything shocking:

• Clients pay higher Epic fees as their usage increases.
• Clients must be current on all Epic payments before bringing a new module live.
• Disclosure of Epic confidential information is prohibited, and if required by law (such as Freedom of Information Act requests for contract details), the client must notify Epic beforehand and cooperate with Epic to get the legally required disclosure stopped.
• No non-disparagement clause is present in the redacted version, but the customer is required to make each user sign an agreement to keep Epic’s confidential information confidential. That information includes functionality descriptions, source code, data structures, and implementation methods. Screen shots, which are the most contentious items in that arise in sharing information about system problems among users, aren’t mentioned specifically but probably fall within functionality descriptions (as does documentation, which Epic protects vigorously). 
• Use of third parties for implementation, staff augmentation, training, support, and hosting is limited to those companies that have signed an agreement with Epic and that have agreed not to hire employees of clients or of Epic.
• Use of source code, data structures, and APIs can’t be used to develop a product that competes with anything Epic offers or that is “reasonably anticipated Epic software.”
• The customer is not allowed to solicit or hire (as either an employee or contractor) anyone who has worked on an Epic implementation within the past 12 months without the previous employer’s permission and Epic won’t “work with or provide training” for those exceptions.

From NH: “Re: Novant Health. Creating an innovative electronic patient and family advisory council.” Novant will survey volunteer council members about patient room decor, food quality, and nicer waiting rooms. I’m all for those things, but what I really want from a hospital is for them to put my interests ahead of their profits, develop and follow sound clinical protocols, give me access to caring and highly skilled providers, and send me home vertically and better than when I entered. I might enjoy having better coffee or softer chairs at the oil change place, but that’s not much consolation if the tech uses the wrong filter, doubles my cost by acquiring competitors, or claims to be concerned about my car’s overall health when what they really want is to sell me more services. Consumers can see only the most superficial aspects of healthcare and they assume that they don’t need to worry about the rest, which is not true at all.

From Billing Boy: “Re: patient estimates. They are often wrong, this study finds.” It’s easy to get worked up about patients being charged more than they were told to expect (which would be shocking in any business except healthcare), but portraying those hospitals as dastardly rather than incompetent misses the point. Healthcare billing is so arbitrary and complex that even the hospital itself has no idea what will be billed until after the fact, when all the revenue-obsessed hospital departments have picked the insurance bones clean. Here’s an easy test – give a hospital an anonymized copy of the clinical records from someone’s inpatient stay at their own facility and ask them what they think the itemized bill would look like (no dollar amounts, just which line items the patient would be billed for). It would have little correlation to the bill they actually sent to the patient. Hospitals are right that they don’t know what a given patient needs until they have already provided it, but it’s a mistake to ensure that the variability between estimates and actual bills is strictly due to clinical uncertainty or insurance surprises.

HIStalk Announcements and Requests

Thanks to Jenn for covering my absence of a few days for vacation. I kept up with what she was writing and sent her items that looked interesting, but otherwise spent close to zero time using any computing form factor. Other than the many “circling back” and “pinging you again” re-sent emails from PR people who can’t grasp that not everyone stays online 24×7 or finds their self-serving announcements to be of top importance, I saw no evidence that anyone even noticed my absence, which is how it should be.

I rarely think of Forbes as an objective, insightful news publication and this doesn’t change my mind – the company has launched a vanity publishing press and is paid-spamming LinkedIn with boilerplate invitations to “business leaders” who are willing to rent the Forbes nameplate to repackage themselves as quote-worthy experts a la “The Art of the Deal.” Its partner company touts that lazy executives can create an industry-captivating book in under 24 hours. Healthcare clients include former CMS Deputy CIO Henry Chao and about a zillion attention-seeking dentists. 

Webinars

October 24 (Thursday) 1:00 ET. “The power of voice: Will AI-drive virtual bedside assistants become mainstream?” Sponsor: Orbita. Presenters: Nick White, co-creator of DeloitteAssist and principal in Deloitte’s Smart Healthcare Solutions practice; Bill Rogers, CEO and co-founder, Orbita. Conversational AI and virtual health assistants are bringing new opportunities to care facilities to improve patient journeys and yield radical workflow efficiencies. Will the hospital rooms of the future continue to provide traditional bedside call buttons? Or will these be replaced with digitally reimagined, AI-driven, voice-powered agents? Learn from the expert who created today’s industry-leading, market-proven, virtual bedside assistant.

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

Acquisitions, Funding, Business, and Stock

Cerner will lay off 350 California employees following Adventist Health’s decision to bring its revenue cycle operation back in house from Cerner RevWorks. Cerner says Adventist Health has offered to hire all of the laid-off employees, while another 1,000 Cerner employees will swap their badges for those of Adventist Health.

Sales

• Bozeman Health (MT) chooses Kyruus ProviderMatch to integrate patient access in its website and access center.

People

Per-diem clinician hiring app vendor ConnectedRN hires Matthew Levesque (Athenahealth) as CEO.

Industry long-timer Kim LaFontana, MBA (Medically Home) joins Livongo as VP.

BHM Healthcare Solutions promotes Jean Neiner to president and CEO.

Ajay Kapare (Ellkay) is appointed to the CHIME Foundation Board and its board of trustees.

Announcements and Implementations

A new KLAS report looks at strategic mergers and acquisitions in healthcare IT, observing that about 40% of customers are happier afterward, 40% are less happy, and 20% see no impact. The percentage of customers anxious to bolt to a new vendor doubles after M&A when long-term customers resent the imposition of intentional nickel-and-diming, crappy support, and R&D slowdowns. Customers are better off if the acquirer is privately held and thus not desperate to pander to shareholders in chasing short-term profits at the expense of long-term strategy. KLAS concludes that M&A fails when the acquirer saddles the former company with layers of bureaucracy and sales-focused goals; fails to get its executives interested in the acquired company; makes grand promises that aren’t kept; and cuts back on support so that the resulting financial numbers make the acquirer’s executives look smart.

Family history vendor Ancestry launches AncestryHealth, which will sell a $149 profile of genetic screening results that are matched to specific medical health conditions, as well as a more expensive, membership-based service that provides deeper screening and quarterly screening updates. The company has contracted with an independent physician group to order the tests. Stat notes that the tests of competitor 23andMe are regulated by the FDA since consumers order them themselves, while AncestryHealth won’t get FDA oversight because the tests are ordered by doctors but instead will be under CMS’s physician-ordered diagnostic testing rules. Experts note that only 2% of patients who don’t have a family history of a disease will learn something new from such tests, while others say that genetics accounts for less than 10% of longevity, but lack of rigorous science doesn’t usually stand in the way of companies making big money from irrational health concerns (see: Goop). 

A Black Book provider survey of vendors of software and services for coding, clinical documentation improvement, and HIM finds Nuance topping most categories, but Optum360, MModal, Dolbey, Adadyne, Qventus, and Fujitsu also finished first in some areas.

Nvidia and King’s College London create a platform that allows organizations to contribute their imaging data for machine learning-powered brain tumor research without copying it offsite or sharing it directly, with the federated learning system keeping patient data confidential.

Canada-based EHR vendor Premier Health Group will add AI from IBM Watson to its telemedicine app to use a chatbot to reduce clinician time on each call.

Other

In Australia, the new head of EHealth Queensland says its struggling Cerner implementation can be turned into a showcase project, but urges all of the state’s health bodies to help in getting new sites live while optimizing existing ones.

A reader sent this article about Shots Heard Round the World, a “rapid-response digital cavalry” that helps providers whose vaccine-related social media messages – such as “flu vaccine has arrived – get your shot today” — trigger an electronically mobilized torrent of negative comments, scathing Yelp and Google reviews, and threats from anti-vaxxers from around the world. The group was founded by two employees of Kids Plus Pediatrics, a Pittsburgh area practice that was attacked relentlessly after it published a video explaining the value of HPV vaccine in preventing cancer. They offer the highly detailed and excellent Kids Plus Anti-Anti-Vaxx Toolkit to help practices defend themselves online harassment. Fascinating to me is their analysis of who created the 10,000 negative anti-vaxx comments on their site:

• 95% were female, most of them either of age 18-24 or over 50.
• The vast majority were uneducated and either unemployed or underemployed.
• Attackers were mostly extremist in their politics, both to the left and the right.
• Every single person who visited the practice’s Facebook page during the eight-day siege whose profile photo featured one of those dopey filters was an anti-vaxx attacker.

In England, a hospital won’t be fined the prescribed $190,000 for 600 incidents in which it placed male and female patients in the same room. The hospital says it has a zero-tolerance approach for mixed-sex rooms, but then stretches the definition of “zero tolerance” by adding that it sometimes does it anyway when all beds are full. NHS England says mixed-sex rooms are detrimental to safety, privacy, and dignity, which it fails to note are already endlessly compromised throughout all aspects of hospital care, but especially when any patient is forced to room with another. Imagine if a hotel did this, even without all employees running in and out, awkward moments involving specimen collection and bedpan usage, receiving visitors, and being separated by just a thin curtain from a dying, moaning, or loudly delusional roommate.

Odd: the elected part-time coroner of an opioid-ravaged Ohio county is charged with illegally prescribing 1.5 million opioid doses over two years and fraudulently billing Medicaid and Medicare in his day job as a pain management doctor. On the other hand, he donated to the county’s Staying Clean Club and its drug task force, so there you go.

Even odder: Tampa General Hospital opens an OnMed telemedicine consult and drug dispensing booth in its food court so that its employees — who are inside its walls — can seek medical care from clinicians who aren’t. Maybe this is a Halloween-appropriate “the call is coming from inside the house” type situation. It’s not really an admission that employees don’t have time to deal with their own hospital employer’s bureaucracy as patients – the hospital is in business with the vendor and this first booth is a pilot for a broader rollout. The hospital CEO says millennials won’t wait to see a doctor in person, which if you’re a doctor who actually wants to care for patients, is depressingly accurate. The oldest millennials are now in their late 30s, so it would be interesting to see how those who are doctors run their practices and patient encounters.

Georgia lawmakers will require the state’s rural hospital CEOs, CFOs, and board members to complete eight hours of classes in financial management and strategic planning (in an apparent lack of irony).

Sponsor Updates

• Netsmart processes a record 300 million secure transactions through its CareFabric solution suite in a single month, triple the number of a year ago.
• AdvancedMD will exhibit at ASDS October 24-27 in Chicago.
• Apixio will exhibit at the RISE HEDIS & Quality Improvement Summit October 23-25 in Miami.
• Culbert Healthcare Solutions will exhibit at the Association of Administrators in Academic Pediatrics meeting October 17-18 in Miami.
• Cumberland partners with Chronicled’s MediLedger Project to advance blockchain supply chain networks for pharma manufacturers.
• Dimensional Insight will exhibit at the Massachusetts Health & Hospital Association event October 18 in Burlington.
• ONC names Surescripts as an ONC Program Partner for Electronic Prescribing, proving EHR vendors an alternative test method to ONC-ATL.
• Netsmart will present and exhibit at the American Health Care Association/National Center for Assisted Living 2019 Convention and Expo through October 16 in Orlando.
• Prepared Health will exhibit at HLTH, October 27-30 in Las Vegas, as part of the Matter Showcase Pavilion.

Blog Posts

• Agfa Healthcare’s Francisco Perez elected HL7 Fellow (Agfa Healthcare)histalk2.
• Pause to Consider: Data Loss Prevention (Fortified Health Security)
• Beth Israel Deaconess Care Organization: Leaping Forward in Analytics for Population Health Management (Arcadia)
• How HIPAA Compliance Affects Employees (Atlantic.Net)
• Increasing Physician Engagement with a STS Program (Optimum Healthcare IT)
• Choosing the Optimal Path to Cloud for Unified Communications (Avaya)
• Tree Talk: A “Simple” Way to Big Gains! (Bluetree)
• Support for Amazon S3 and EC2 Now Available in Latest Release of Datica Monitor Cloud Compliance Management System (Datica)
• Coming Soon: ChartLogic to Debut Electronic Faxing Solution (ChartLogic)
• How Collective Can Help D-SNPs with New Information-Sharing Requirements (Collective Medical)
• Pharmacist Spotlight: Utilizing CoverMyMeds’ Technology to Simplify Prior Authorization Requests (CoverMyMeds)
• How to Implement an EHR Change Management Program Using ITIL Practices and Survive to Tell About It (Divurgent)

Contacts

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

Morning Headlines 10/15/19

Parsley Health Launches New Digital Services on Tail of $26M in Series B Raise

Membership-based primary care company Parsley Health raises $26 million and launches an online version of its brick-and-mortar practice.

Claus Torp Jensen Has Been Appointed First Chief Digital Officer and Head of Technology for Memorial Sloan Kettering Cancer Center

Former CVS Health CTO Claus Jensen joins Memorial Sloan Kettering Cancer Center (NY) as its first chief digital officer and head of technology.

Prairieville pediatrics clinic working with FBI, notifying patients after computer attack

Magnolia Pediatrics (LA) alerts patients to an August ransomware attack that infiltrated the practice through its unnamed IT vendor, which wound up paying the ransom.

Curbside Consult with Dr. Jayne 10/14/19

Most of the scribes I work with are either applying to or have been admitted to medical school and are trying to save up money as well as learn about clinical practice. It’s fun to work with them because they’re eager to learn. I enjoy teaching but haven’t been on faculty anywhere in years. Most of them know I have another job besides seeing patients, and are often interested in what I’m working on from a CMIO standpoint. We talk a lot about EHRs and what’s different about using our niche system versus what they will encounter when they go to medical school.

A recent article in the Journal of the American Medical Informatics Association looked at the existing literature to assess the current state of EHR training for medical students and residents. The authors looked specifically at “educational interventions designed to equip medical students or residents with knowledge or skills related to various uses of electronic health records” and to “compare the aims of these initiatives with the prescribed EHR-specific competencies for undergraduate and postgraduate medical education.” There wasn’t a tremendous amount of literature for them to sift through in their analysis – only 11 studies. Of those, seven covered medical students, three included residents, and one included both groups. All of the interventions they identified covered data entry, but none involved manipulating the resulting data at a panel or population level.

They concluded that the documented interventions don’t really prepare students to show mastery in the competencies required to be effective physicians. In thinking through this, I’m not sure how many current physicians have EHR skillsets beyond just data entry. Most of the organizations I work with expressly prohibit their physicians from doing anything remotely involving data analysis or population health work. All of those functions are managed at the group level or health system level rather than by physicians. Although physicians may receive various clinical scorecards, they’re not really accessing or addressing the data on their own. This certainly would be different for independent physicians, although many of my peers in those environments don’t have the knowledge or understanding of how to get at that data, either.

In digging deeper into the study and its methods, I was surprised by how much the different training interventions varied. Some were a brief (one hour) self-directed module that reviewed screenshots of different areas of the EHR; others could be as long as a multi-week simulated EHR curriculum. Most of the included workflows were based on data entry or information retrieval. Other activities included retrieving lab results, looking at medication lists, orders, and billing functions such as E&M coding. The interventions had different ways to assess competency. Some included a pre-test followed by a post-test after the intervention. Only three studies included a control group. Nine of the studies involved changing skills and only two looked at changing attitudes. Other assessment methods included quizzes, surveys, self-reported questionnaires, chart review, and structured practice with standardized patients.

The students and residents did well when they were evaluated using quizzes and surveys, and were satisfied with that approach as well as being able to demonstrate competency. Other studies didn’t show a difference between the intervention group and a control group. One study was able to show that learners receiving the intervention performed better on standardized patient examinations while they were being judged on their ability to complete a structured patient visit. Although standardized patients are an important part of learning (particularly as students and residents learn to perform sensitive examinations) they always made me nervous, since they were fully aware of what I was supposed to be doing and what kind of findings were supposed to be present, and I was being compared not only against my own classmates but the dozens of students who had examined them in previous years.

I was curious as to the specific competencies the authors were including when they identified gaps in training interventions. They expected students, prior to beginning their clinical clerkships (usually in the third year of medical school at the latest) to “be able to describe the components, benefits, and limitations of EHRs; the principles of managing and using aggregated electronic health information, including tenets of electronic documentation as well as differences between unstructured and structured data entry; and articulate standards for recording, communicating, sharing, and classifying electronic health information in the context of a medical team.” They also note students should “be able to identify how systems may generate inaccurate data, discuss how data entry affects direct patient care and healthcare policy, gather relevant data from EHRs, and assess the reliability and quality of these data.”

Again, I’m not sure many practicing physicians would be able to enumerate all of these elements. They may also not have a “working knowledge of health informatics through chart audits and research projects.” On the flip side, maybe if the physicians I work with had received better education around the role of EHRs, they’d be more interested in the idea of clinical informatics as well as what they can do with the vast amount of data they’ve been keying into the EHR over the years. The authors did note that “a significant number of trainees have had exposure to the EHR before their medical training as scribes and that inclusion of these individuals in the studies may have affected the results.”

I’d be curious to hear from those of you who are academic institutions on whether your training programs are incorporating these competencies into the curriculum. My medical school recently began undertaking a complete overhaul of the educational curriculum, so you can bet I’ll be asking about it the next time I run into the new associate dean who has been tasked with that effort. We heard a bit about it at my medical school reunion in the spring, but the main points of her address were around providing clinical exposure to students far earlier than we experienced during our training. The only EHRs available when I was a student involved one that used a green screen terminal to access lab results at the flagship hospital, and one that used a light pen to navigate at the community hospital. The academic center was just beginning to build its own clinical data viewer, whose contents were hit or miss, as I entered my fourth year. Now after a decade of best-of-breed construction, they’re all using Epic.

Do you think your current practicing physicians can demonstrate mastery of the skills the authors evaluated? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 10/14/19

Centra begins issuing bills after almost three-month hiatus

Centra (VA) resumes billing and collections after a three-month hiatus caused by glitchy Cerner software that hospital officials say led to rejected claims, delayed billing, incorrect bills, and prematurely sending patients to collections for lack of payment.

UCSF Launches Artificial Intelligence Center to Advance Medical Imaging

Researchers at UC San Francisco’s new Center for Intelligent Imaging will work with Nvidia’s AI computing technology to develop new solutions for radiology.

Topcon Healthcare Selected to Ease Transition for IBM® Merge Eye Station and Merge Eye Care PACS Customers

IBM Watson Health Imaging will discontinue support for its Merge Eye Station digital imaging technology and Merge Eye Care PACS by the end of 2020.

Monday Morning Update 10/14/19

Top News

Centra (VA) resumes billing and collections after a three-month hiatus caused by glitchy Cerner software that hospital officials say led to rejected claims, delayed billing, incorrect bills, and prematurely sending patients to collections for lack of payment. The $73.5 million Cerner system was installed in 2018, but Centra’s financial team didn’t notice any problems until a few months later. It estimates that 2,200 incorrect billing statements have been sent out.

To rectify the problem, Centra is rebooting its billing cycle, giving impacted patients a 5% discount, and making sure that its customer service reps have had Cerner-specific training so that they can be more empathetic to patients with billing problems.

Centra will continue with the second phase of its Cerner implementation at remaining ambulatory and post-acute care sites next year.

HIStalk Announcements and Requests

A majority of respondents would have no problem using employer-approved providers if it resulted in a discount on their employer-sponsored health plan. Nevertheless offers the employer perspective: “We have employees who work in at least 5 states today and that will grow. This approach is not at all manageable for a company like ours. I want to be LESS involved in my employees’ healthcare access, not more. I’m ok with paying for healthcare coverage for my employees – but I don’t want to micromanage how they get those services.”

MerryMe offers the employee’s: “Absolutely not. Employers shouldn’t be involved in healthcare – AT ALL. Not insurance. Not in/out of network. Not hey, save $100 if you stop smoking. If my employer or co-worker wants to send around an email saying ‘had great experience at XYZ’ or ‘hey, I found this website and maybe you can save on your Rx like I did,’ fine. Want to do a benefit dinner for a fellow employee who has cancer? Great. Otherwise, keep your nose and ‘help’ out of my business. I don’t trust that costs for types of procedures are not being shared with the employer – and what I’m seeking care for is none of my employer’s business.”

And Sorry that of the too-young-to-need-it: “As a young person who doesn’t use any healthcare right now and expects not to work at a place longer than five years, I’ll take that deal and then continue never going to the doctor. I would be interested to know how much of the cost of health insurance you could knock off this way though. I get the feeling that I’m subsidizing the old people’s healthcare at my company. Eventually we’ll move off employer-tied health insurance (since businesses are starting to hate it) and to something state-funded, at which point the young will still be subsidizing the old but 1. I’ll be old. 2. At least I’ll be able to see what’s going on rather than trying to interrogate my HR rep.”

New poll to your right or here: Would you avoid treatment at a hospital that has a history of suing patients for unpaid bills? Comments (anonymous or not) are welcome, especially if you’ve found yourself on the receiving end of relentless debt collectors.

Webinars

October 15 (Tuesday) 1:00 ET. “Universal Health Services Case Study: How to Improve Network Design and Management with Claims Data.” Sponsor: CareJourney. Presenters: Mallory Cary, regional director of ACO operations, UHS; Abbas Bader, director of product development, CareJourney. Universal Health Services (UHS), one of the nation’s largest hospital management companies, has more than 350 acute care hospitals, behavioral health facilities, and ambulatory centers across the US, Puerto Rico, and the UK. UHS has collaborated closely with CareJourney over the last three years in building high-performing networks in new markets, managing patient populations as they flow through those networks, and targeting areas for performance improvement within the network. Join the expert presenters for deep insights into network design and optimization.

October 24 (Thursday) 1:00 ET. “The power of voice: Will AI-drive virtual bedside assistants become mainstream?” Sponsor: Orbita. Presenters: Nick White, co-creator of DeloitteAssist and principal in Deloitte’s Smart Healthcare Solutions practice; Bill Rogers, CEO and co-founder, Orbita. Conversational AI and virtual health assistants are bringing new opportunities to care facilities to improve patient journeys and yield radical workflow efficiencies. Will the hospital rooms of the future continue to provide traditional bedside call buttons? Or will these be replaced with digitally reimagined, AI-driven, voice-powered agents? Learn from the expert who created today’s industry-leading, market-proven, virtual bedside assistant.

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

Announcements and Implementations

Alameda Health System (CA) goes live on Epic. AHS staff from what looks like every department put together this great video celebrating the install. The $200 million project was first announced at the beginning of 2018.

Virtua Health (NJ) implements SymphonyRM’s Next Best Action CRM.

In Illinois, Pivot Point Consulting assists in the implementation of Christie Clinic’s Epic system through a Community Connect affiliation with Carle Foundation Hospital.

IBM Watson Health Imaging will discontinue support for its Merge Eye Station digital imaging technology and Merge Eye Care PACS by the end of 2020. Topcon Healthcare Solutions will offer transition assistance to Merge customers who want to transition to its Harmony data management system. IBM acquired Merge Healthcare in 2015 for $1 billion.

Brigham and Women’s Hospital (MA) will use digital lifestyle tracking and telemedicine tools from Fruit Street Health in a six-month brain health improvement study of patients at risk for cognitive decline and dementia.

Privacy and Security

A look back at WannaCry’s impact on the NHS finds that the 2017 ransomware attack resulted in a $7.6 million loss due to a decrease in admissions and appointments. Over 600 NHS facilities were affected. The health service spent considerably more – some analysts estimate nearly $90 million – on IT to fix the fall-out.

Men’s online health and wellness company Ro alerts customers to a potential breach that occurred when hackers attempted to access information on the laptop of an affiliate physician. The physician’s computer, which was the property of the MD’s health system employer, was infected with malware. Ro fired the physician for violating its Physician Code of Conduct by downloading unapproved software. CEO and co-founder Zachariah Reitano brings up a point relevant to telemedicine vendors who hire physicians with other employers: “The challenge Ro and others face is that, in addition to securing our own systems, we need to account for systems outside of our direct control. Ro has taken and will take a number of steps to implement additional security measures to help further protect personal information, including enhancing the security on our physicians’ computers.”

Other

Stanford Medicine (CA) hosted its second annual EHR National Symposium featuring speakers from its health system, Epic, ONC, UnitedHealthcare, Microsoft, Cleveland Clinic, Cerner, and Livongo, among others. Videos from the event should be on the symposium’s website soon.

Researchers find that opioid dosages decreased 22% per new prescription after the University of Pennsylvania Health System implemented EHR alerts in New Jersey practices notifying prescribers if prescriptions exceeded the legal five-day limit.

Researchers at UC San Francisco’s new Center for Intelligent Imaging will work with Nvidia’s AI computing technology to develop new solutions for radiology. Ci2’s initial work will focus on an NIH-directed project using AI and data analysis to evaluate chronic back pain.

Sponsor Updates

• Elsevier rebrands its Via Oncology cancer care management and clinical decision support tool to ClinicalPath.
• The Women Tech Council honors Health Catalyst Chief People Officer Linda Llewelyn with its award for culture leadership.
• Mobile Heartbeat will host an event on Enhancing Clinical Communications October 16 in Dallas.
• Netsmart will exhibit at the NAHC Annual Meeting October 13-15 in Seattle.
• PMD adds a two-click Instant Capture option to its Charge Capture software.
• Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at AWHONN WA Fall Meeting October 13-15 in Bremerton.
• Authority Magazine features “’5 Things I Wish Someone Told Me Before I Became CEO of Experity,’ with David Stern.”
• Redox will host its Interoperability Summit October 15 in Boston.
• The Touch Point podcast features StayWell President Pearce Fleming.
• Surescripts will exhibit at the EClinicalWorks National Conference October 18-20 in Orlando.
• Vocera will exhibit at the Indiana Organization of Nurse Executives Fall Conference October 16-18 in French Lick.
• Spok publishes a new e-book, “Why the future of healthcare is in the cloud.”

Blog Posts

• Part 2 of Our Breakdown of the CMS Primary Care Initiatives: Direct Contracting (Lightbeam Health Solutions)
• Tackling Rampant Waste in Healthcare – A Guide for Healthcare Providers in the New Consumer-Driven Marketplace (Loyale Healthcare)
• MHUG 2019 is Approaching! (Mobile Heartbeat)
• An Inside Look into IT Support from our Support Services Director: Rhonda Mech (CereCore)
• Why Patient Experience Should Play a Bigger Role in Your Collections Process (PatientBond)
• The New Discharge Planning Rule: What You Need to Know (PatientPing)
• Expert Tips for a Better Patient Payment UX (Patientco)
• Identity & Access Management: The Cornerstone of Enterprise Security (SailPoint)
• Top 3 Lessons Learned from Meditech Training (Santa Rosa Consulting)
• #EndNurseAbuse: When Protocols Are Not Enough (Vocera)
• Protecting Patient Data: Lessons Learned from the Anthem and Equifax Data Breach Settlements (WebPT)
• How Leaders Establish Organization Success (EClinicalWorks)
• Meet Terri LeFort: President of Healthtech, Nordic’s Canadian partner (Nordic)
• Pause to Consider: Managing Connected Medical Device Security Program (Fortified Health Security)

Contacts

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

Weekender 10/11/19

Weekly News Recap

• Mednax will sell its MedData business to private equity firm Frasier Healthcare Partners for between $250 million and $300 million.
• DCH Health System (AL) agrees to pay Russian hackers after an October 1 ransomware attack forced it to divert patients and revert to paper processes.
• Membership-based primary care company One Medical hires several banks to help it prepare for an IPO.
• Patient engagement vendor Relatient acquires patient self-scheduling and waitlist software developer Everseat.
• Cerner reveals details about “Project Apollo,” new cloud-based technology that will leverage the company’s previously announced partnership with AWS.
• Researchers determine that 25% of healthcare spending – between $760 billion and $935 billion per year – is wasteful.

Best Reader Comments

Re: Putting off health care for financial reasons. According to GoFundMe’s CEO, one third of all campaigns are for medical expenses. Folks are literally begging strangers for money to help them pay their medical bills. (Kermit)

My “great expectation” would be that every time someone makes an entry into my medical record, that I would get a notification say that “X just entered something into your medical record. If this is appropriate, do nothing. If this is an error, please call us”. I feel this way because I was a victim of an identity mix-up with inappropriate merging of my record with someone else’s. Patient awareness like what happens with my credit care/bank might go a long way to reducing errors – and maybe it might make patients feel more responsible for their records at the same time. (Joe Schneider)

Sucks about athena but it is a hard market at a hard time. It looks like everybody will be stuck with CPSI until Allscripts buys them out and puts Evident out to pasture. (2Bad)

re: NextGen acquiring Topaz. The ‘agnostic’ market that NextGen has attempted to build (Eagle Dream Analytics, Entrada Mobile etc) continues to struggle with execution, two to three years in for analytics and mobile. If they could fix that problem, NextGen could be a different company. I don’t know if Topaz is another agnostic unicorn attempt but if the company doesn’t figure out how to execute, it will still be the same old NextGen regardless of the shade of lipstick on the pig. (ellemennopee)

Watercooler Talk Tidbits

Ghanian teenager Mustapha Haqq develops a predictive analytics model that uses AI to diagnose breast cancer. Because of poor Internet access in his area, Haqq walked several miles to an Internet café, where he taught himself to code and develop the model using resources from UC Irvine. “Internet access is expensive,” he says, “but thanks to the generous support of my parents – who made some sacrifices to give me a chance to complete a few online courses – I built sufficient coding skills to start developing solutions to some of the problems affecting our community.” Haqq has gone on to launch several coding clubs for students of all ages.

CNN profiles Olawale Sulaiman, MD a professor of neurosurgery and spinal surgery at Ochsner (LA) and founder of RNZ Global, which provides spinal surgeries and medical training in the US and his homeland of Nigeria. Sulaiman has taken a 25% pay cut to spend time – up to 12 days every month – caring for patients in Nigeria at little to no cost. “I believe that happiness doesn’t come from what you get, rather, it comes from what you give,” he said. “There is always room to give; you don’t need to be a millionaire to give.”

National Library of Medicine researchers call for “no-selfie zones” after determining that 259 people died attempting to take death-defying pictures of themselves between 2011 and 2017.

Restaurant franchise company Chanticleer Holdings decides to spin off its dining assets, which include the Hooters chain, so that it can merge with cancer drug maker Sonnet BioTherapeutics. @VentureValkyrie has started a tweet thread to crowdsource names for the newly combined company.

In Case You Missed It

• News 10/11/19
• EPtalk by Dr. Jayne 10/10/19
• News 10/9/19
• Curbside Consul with Dr. Jayne 10/7/19
• Monday Morning Update 10/7/19

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Morning Headlines 10/11/19

MEDNAX Reaches Agreement to Sell MedData Business to Frazier Healthcare Partners

Mednax will sell its MedData RCM software and services business to private equity firm Frasier Healthcare Partners for between $250 million and $300 million.

Relatient Acquires Everseat, A Leading Patient Self-Scheduling and Waitlist Software Company

Patient engagement vendor Relatient acquires patient self-scheduling and waitlist software developer Everseat.

Persivia Secures $15 Million Growth Financing from Petrichor Healthcare Capital Management

Care coordination, analytics, and value-based care software company Persivia raises $15 million in a Series C funding round.

Harris Healthcare Acquires Connecture, Inc.

Harris Computer’s healthcare group acquires Brookfield, WI-based insurance enrollment technology vendor Connecture.

News 10/11/19

Top News

Mednax will sell its MedData RCM software and services business to private equity firm Frasier Healthcare Partners for up to $300 million.

Reader Comments

From RWJBetter Believe It: “Re: RWJBarnabas Health’s rumored conversion to Epic. Looks like the rumblings have been confirmed: “We’ve announced the move to the Epic IT platform, and in 2020 that project will kick off in earnest. We view this move as transformational for our organization; it will allow us to truly connect all of our healthcare assets in a deeper way than they have been connected in the past.”  As Barnabas Rubble first suggested here in June, the New Jersey-based health system – the result of the 2016 merger of Barnabas Health and Robert Wood Johnson Health System – will finally bring all of its facilities onto one platform.

From anon: “Re: PeaceHealth layoffs. PeaceHealth just laid off more IT staff. Unlike their last round of layoffs in July, which was almost only people outside their Vancouver, WA office with the stated intent to centralize services, this round included Epic Analysts in Vancouver. Their upgrade goes live this week, no less.” The local news reports that this round is of 50 centralized support service staffers.

From Vaporware?: “Re: The Brent Schafer AI story. I totally believe that is real. The head-scratcher is further down in the press release: ‘Stemming from Cerner’s collaborative work in the federal space, the company is soon to roll out “Cerner Seamless Interoperability.’ Questions: Will it be a new contract for Cerner, since they’re just now inventing and releasing it? Will it be based on their current ;federal space’ interoperability model of logging in to side-by-side workstations? How is it different from CommonWell, which has been sold as ‘Seamless Interoperability’ since 2013 (and still is not live in federal space)?”

From Insider: “Re: Cantata Health. CEO let go and more layoffs coming. They have moved all support offshore, and clients are not happy. Talk about a sinking ship. The CTO and some finance people are now running the company.” Former CEO Krista Endsley’s LinkedIn profile confirms her departure after 18 months. The company’s sole C-suiter is CTO Rich Zegel.

Webinars

October 15 (Tuesday) 1:00 ET. “Universal Health Services Case Study: How to Improve Network Design and Management with Claims Data.” Sponsor: CareJourney. Presenters: Mallory Cary, regional director of ACO operations, UHS; Abbas Bader, director of product development, CareJourney. Universal Health Services (UHS), one of the nation’s largest hospital management companies, has more than 350 acute care hospitals, behavioral health facilities, and ambulatory centers across the US, Puerto Rico, and the UK. UHS has collaborated closely with CareJourney over the last three years in building high-performing networks in new markets, managing patient populations as they flow through those networks, and targeting areas for performance improvement within the network. Join the expert presenters for deep insights into network design and optimization.

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

Acquisitions, Funding, Business, and Stock

Patient engagement vendor Relatient acquires patient self-scheduling and waitlist software developer Everseat.

Care coordination, analytics, and value-based care software company Persivia raises $15 million in a Series C funding round.

Three months after securing $73 million in funding, Omada Health announces an undisclosed investment from Intermountain Ventures. Intermountain Healthcare (UT) has worked with the digital chronic disease prevention company since 2016. Its diabetes services became a covered benefit for Intermountain employees earlier this year.

Harris Computer’s healthcare group acquires Brookfield, WI-based insurance enrollment technology vendor Connecture.

Sales

• Greeneville Community Hospital East (TN) selects tele-ICU services from Advanced ICU Care.

People

Nursing Informatics Boot Camp director Susan Newbold PhD, RN-BC will receive the Virginia K. Saba Nursing Informatics Leadership Award from the Sigma Theta Tau International Honor Society of Nursing at its meeting next month.

Beth Israel Deaconness Medical Center physician and Society for Participatory Medicine co-founder Danny Sands, MD joins Backpack Health as CMO and VP of medical affairs.

Announcements and Implementations

The Milford campus of Yale New Haven Health’s Bridgeport Hospital (CT) goes live on Epic. The health system wrapped up its system-wide go live in 2013; it added Milford Hospital several months ago.

The Harvard Pilgrim Health Care Institute will leverage Veradigm Health’s HealthInsights de-identified EHR database in its development of the FDA’s Sentinel drug- and product-safety monitoring system.

Golden Valley Memorial Healthcare (MO) implements Meditech’s Sepsis Management Toolkit.

NewCrop will integrate OptimizeRx’s digital health messaging with its e-prescribing service.

Arrendale Associates adds NVoq’s speech-recognition capabilities to its Transcript Advantage software.

The Public Hospitals Authority in the Bahamas completes the first phase of its integrated health information management system implementation with help from Santa Rosa Consulting.

Other

VCU Health (VA) announces it will no longer sue patients for unpaid bills after seeing the uproar caused by revelations that UVA Health filed 36,000 lawsuits over six years in an effort to collect $106 million. VCU’s physician group has filed 56,000 lawsuits to recover $81 million from patients over the last seven. “We don’t want to be a part of that,” says CFO Melinda Hancock. “We feel that taking care of the patient’s financial health is taking care of their holistic health.”

Sponsor Updates

• Capsa Healthcare adds Imprivata’s identity and access management technologies to its CareLink Nurse Workstations.
• Elsevier Clinical Solutions will exhibit at the National Association for Home Care & Hospice conference October 13-15 in Seattle.
• EClinicalWorks, Ellkay, FormFast, and Kyruus will exhibit at MGMA October 13-16 in New Orleans.
• Ensocare will exhibit at the ACMA Great Lakes Chapter Annual Conference October 11 in Novi, MI.
• EPSi will host the Visis: 2019 EPSi Summit October 22-24 in Austin, TX.
• Allscripts names Healthfinch’s prescription renewal delegation solution, Charlie, as its October App of the Month.
• Healthwise and Intelligent Medical Objects will exhibit at the EClinicalWorks National Conference October 18-20 in Orlando.
• InterSystems will exhibit at the DoD/VA & Gov Health IT Summit October 16-17 in Alexandria, VA.
• Nuance expands Clinical Guidance for Dragon Medical Advisor, its AI-powered computer-assisted physician documentation capability available through Dragon Medical One.
• Imat Solutions integrates Zen Healthcare IT’s Integration-as-a-Service and gateway solutions with its health data management technology.
• Optimum Healthcare IT publishes a new case study, “Improving Provider Practice Efficiency at Southcoast Health.”
• Phynd partners with MedTouch to offer health systems one-step appointment search and scheduling capabilities.
• In a new video series, Wolters Kluwer Health takes a candid look at the nursing profession through the lens of practicing nurses.

Blog Posts

• Take time for discover and assessment – and consider a partner – for a successful cloud migration (Google Cloud
• Effective Habits, Courtesy of Impact Advisors Winners (Impact Advisors)
• How Health Systems Can Optimize Demand Conversion Online (Kyruus)
• Pause to Consider: Managed Security Service Provider (Fortified Health Security)
• Connect and Go Forward: Highlights from Meditech’s 2019 Physician and CIO Forum (Meditech)

Contacts

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

EPtalk by Dr. Jayne 10/10/19

The ONC blog this week featured a discussion on Electronic Prescribing of Controlled Substances (EPCS). Among physicians who prescribe controlled substances, those who use electronic systems to transmit those orders remains relatively low at 32%. Although some states have mandated the use of EPCS, others haven’t forced the issue with providers. EPCS requires multifactor authentication, and the reality for those of us who prescribe relatively few controlled substances is that the amount of work (and additional technology needed) doesn’t outweigh the potential for reducing drug diversion or other bad acts.

When I do recommend controlled substances, our practice has in-house dispensing capabilities that prevent the prescription from being diverted since we fill it right there. On the off chance that a patient wants a paper script, we print it on compliant paper. I’ve issued one paper script in the last two weeks, and it was a situation where the patient didn’t really want the medication but since they had a complicated fracture I was concerned about them going through the weekend without a backup plan for something stronger. I don’t think that script for five tablets of Tylenol with codeine has a high likelihood of contributing to the opioid epidemic. Still, mandates are coming including the SUPPORT Act, which requires that certain drugs covered under Medicare Part D must be prescribed electronically beginning in 2021. Depending on the frustrations generated by the clinician’s EHR, I wonder if some providers might just consider no longer prescribing agents that will require additional technology.

Lots of chatter in the physician lounge about the recent New York Times piece regarding wasteful spending in the US healthcare system. The comments are also a good read, especially those that note that although burdensome and wasteful, if we cleaned up these processes a lot of people would wind up unemployed. The piece actually draws on a special communication published in the Journal of the American Medical Association that estimates that 20 to 25% of US health spending is wasteful. In order to truly eliminate waste, a number of solutions would have to be employed, including following principles of evidence-based medicine, which would reduce unnecessary testing and treatments that unfortunately some patients demand. The estimated $760 billion exceeds our spending on education and the military, which is a shocking number. Evidence-based care would shave $200 billion off of that, and trimming administrative costs could reduce it another $226 billion. Better care coordination could reduce another $205 billion in wasteful spending. Another big chunk of spending is related to fraud and abuse, ringing in between $60 billion and $80 billion each year. Lots of food for thought, for sure.

I’m not sure what to think about Devoted Health and its decision to offer coverage for Apple Watches for members of its private Medicare plans. Many Apple Watch users drive me crazy, with the constant checking of their watches as messages and information flows through to their wrists. It’s every bit as annoying as having someone in front of you checking their phone instead of paying attention – having a smaller form factor doesn’t excuse the behavior. The Devoted Health program will pay up to $150 towards the cost of the device for its members in a move to stand above other Medicare Advantage plans. The jury is still out on whether wearables truly drive improved health outcomes, so this may end up being little more than a gimmick to try to entice members to join the plan. The $150 earmarked for Apple Watches can also be used for health-related classes and other programs, some of which are actually proven to drive outcomes. Devoted Health has roughly four thousand members but hopes to scale to 100,000 members over the next four years as it expands beyond its Florida footprint.

The workflow at my practices requires me to perform initial readings on plan radiographs while we wait for an overread. Although I’ve had a fair amount of training, some findings can be subtle and are easily missed unless you maximize the contrast and other enhancements available as you view the images on the screen. Despite my accuracy statistics, I’m always relieved when I see the overread and know that the radiologist agrees. I’m eager to see artificial intelligence applied to radiology at the point of care for rank and file physicians, not just in the intensive care units where a lot of the research is being done. Recently, several radiologist’s organizations released a joint statement warning that increased use of AI in radiology can raise the risk of system errors leading to adverse patient events. They call on regulatory boards to monitor AI systems to ensure patient safety, and also call for development of codes of conduct covering the ethics of AI use and warned against using radiology algorithms for financial gain. I can’t wait to see what diagnostic imaging looks like in a decade – it’s one of the areas with the most promise for delivering high-tech solutions to the bedside.

As the leaves are falling and summer is way behind us, I’m going to continue to call out CMS and its Primary Care First program. Their promised Request for Application was due “summer 2019” since the first performance year starts on January 1, 2020. It’s a little difficult to gear up for a program when you don’t know if you’ve been accepted or even if you want to apply since you don’t know what the details are. CMS hasn’t even done the courtesy of updating its website, which still says it anticipates a summer release. Come on, folks, either release the app or officially delay the program. Don’t leave people hanging – and acting like a practice could realistically target a January 1 start date just makes you look out of touch.

Since my favorite smart jewelry company Ringly went dark, I’ve been on the look out for other smart jewelry items. I’m still baffled by Amazon’s Echo Loop smart ring. It’s not fashion forward in the least but belongs to a group of devices that may or may not fill a consumer need along with Echo Frames glasses and Echo Buds earbuds. It’s a bit pricey at $130, but has potential for people who want another way to control their smart devices. Amazon refers to the group of devices as “Day 1 Editions,” which are past the beta stage but haven’t been fully proven for consumer purposes. The company describes them as “things that we’ve found delightful internally and we want to get customer feedback on it so we can continue to innovate.” It only comes in black and is only available in ring sizes nine and up, so not exactly dainty. Interested customers have to request an invitation to try the product.

What do you think of Amazon’s new wearables? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 10/10/19

This startup just raised $8 million to help busy doctors assess the cognitive health of 50 million seniors

BrainCheck raises $8 million in a Series A funding round that will enable it to further develop its cognitive assessment software for seniors.

Marathon Health and General Atlantic Announce Strategic Partnership

General Atlantic acquires onsite health center and technology company Marathon Health from Goldman Sachs.

Top 10 Health Technology Hazards for 2020

The ECRI Institute includes alert fatigue, cybersecurity risks, and medication errors from dosing discrepancies in EHRs on its list of top HIT hazards for 2020.