News 11/1/19

Top News

Point-of-care patient education and marketing company Outcome Health avoids prosecution by the DoJ for the fraudulent acts of former executives by agreeing to pay $70 million in restitution to customers and to continue with its remediation efforts.

The Chicago-based company was once valued at $5 billion. Its founders came under fire in 2017 for overcharging drug company advertisers by intentionally inflating the number of waiting room screens running their ads, manipulating third-party ad performance analyses, and creating phony ad campaign screen shots.

Reader Comments

From Rolling it Back: “Re: Walmart Health. Any idea what they are using for an EHR in their new clinic?” I posed that question to Walmart’s PR team, but haven’t heard back so far. Jenn did a a couple of visits to the clinic since the pilot site is in her home town. They told her they’re using Athenahealth, Orchard for labs, and a third system whose name the tech couldn’t recall. They’re also using Zotec for patient self-scheduling. You can read her first-person experience as a patient here.

From Barred Roller: “Re: surveys. Have you done a survey of hospital C-suite leadership about how they use KLAS in making decisions?” I’ve done various KLAS-related poll questions, but respondents are anonymous and thus not limited to verified hospital executives. My experience is that health systems use KLAS more for vendors outside the inpatient EHR realm, since for those, most hospitals will have just two logical choices (not always Epic and Cerner, I should add) and can pick one without help, using factors that go beyond simple user scores. It’s also good to sneak a peek before naming your frontrunner since your executive peers and board members may do that (at the urging of one of the companies that is in the hunt, sometimes) and you need to be ready to explain why you’re buying the #3 product. Lastly you read the comments to make sure you aren’t surprised by a subtle trend, a user-reported issue that hits home, or any good or bad results that were caused by switching to or from your chosen product. All that aside, a health system that is competent and earnest should be able to make their own decision based on references, site visits, and the vendor’s willingness to pay penalties for failing to deliver. That last item is a big one – while health systems sometimes choose a product unwisely, more aggressive contract T&C instead of just signing lawyer-approved boilerplate would flush out a pretender vendor who knows their own weaknesses, but hopes you don’t. List your biggest fears and account for them with required penalties.

From Stock Picker: “Re: health IT stocks. I don’t understand why people buy shares of second-rate product and service vendors. Can’t they read financial reports?” While share price will eventually reflect company performance — even as shifty executives try to keep the shell moving with slick financial transactions and market-confusing acquisitions – a share of stock is ultimately worth exactly what someone else will pay you to take it. Shareowners don’t necessarily have any more confidence in the long-term performance of a company than skeptics, but rather hope that company news, irrational stock market exuberance, or the possibility of an acquisition will reward their patience. TL; DR: share price is a reflection of many factors, of which hard performance numbers play a minor role (until they don’t).

HIStalk Announcements and Requests

The folks at Definitive Healthcare confirmed a reader’s question about the Meditech replacement at Christus Good Shepherd Medical Center – Longview (TX) as I mentioned Monday. Definitive rechecked and they are indeed  moving to Epic, not Cerner. Thanks for the correction.

Webinars

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

Acquisitions, Funding, Business, and Stock

Meditech reports Q1 results: revenue up 2%, EPS $2.44 vs. $0.52, although the net income increase was due to selling a building for $120 million that booked a gain of $89 million. Product and service revenue both increased slightly

Huron joins virtual hospital company Medically Home Group’s Series B round of funding and becomes the exclusive implementation partner for its hospital-to-home care services.

Optum acquires remote patient monitoring startup Vivify Health. Founder and CEO Eric Rock also founded EDIS vendor Medhost.

Falconer Pharmacy in New York files a class-action lawsuit against Surescripts, alleging that the company has forced the pharmacy to use its e-prescribing network to avoid higher transaction rates as a “non-loyal customer.” The suit names Allscripts and RelayHealth as co-conspirators.

Group purchasing organization and consulting firm Premier Inc. acquires Medpricer, a developer of purchased services management technology, for $35 million.

Sales

• In England, Alder Hey Children’s Hospital in Liverpool will implement Meditech Expanse.

People

Cardiologist David Tsay, MD (Columbia University Medical Center) joins Apple’s health team.

Announcements and Implementations

Audacious Inquiry will work with The Sequoia Project to expand availability of the Patient Unified Lookup System for Emergencies (PULSE) during disaster response efforts. The system was initially used by the California Emergency Management Services Authority during wildfires in 2017.

Livongo adds telemedicine services from MDLive and Doctor on Demand to its digital solutions for patients suffering from chronic conditions.

Geisinger (PA) implements Life Image’s Mammosphere software, giving women the ability to request, store, and share breast health records through its system-wide KeyHIE.

USF Health Morsani College of Medicine (MCOM) at the University of South Florida will partner with Microsoft to create a Medical School of Innovation in the school’s new building that will open soon. Microsoft will provide Teams, Power BI, curriculum-monitoring analytics, and Surface Studios and Hubs. 

Government and Politics

Finger-pointing ensues after Australian media outlets report that senior Queensland Health officials emailed staff at the region’s hospitals ordering them to avoid performing upgrades to digital systems – including Cerner’s problematic IEMR software – while parliament is in session so as to avoid embarrassing scrutiny from politicians. A Queensland Health representative has since labeled the email inappropriate, adding that planned upgrades will take place with at least a week’s notice and at times that are least inconvenient to patient care.

Beckman Coulter Diagnostics will use a $2.5 million grant from HHS to develop and commercialize a sepsis-detection algorithm for hospitals.

Other

Popular Science profiles the progress Facebook and the NYU School of Medicine’s Department of Radiology are making with their FastMRI project. Announced a little over a year ago, the knee-focused project aims to develop AI that can generate MRI scans up to 10 times faster than traditional methods. Researchers are preparing to submit their study for academic review. Once submitted, they’ll then study whether AI-created images match what surgeons see when they perform knee surgeries.

Wolters Kluwer will use a $1 million grant from Ancestry to develop ways providers can interpret and act on the results of genetic testing using its UpToDate evidence-based clinical resource. Ancestry began offering genetic testing alongside its family heritage services earlier this month.

Astria Health (WA) lays off staff and implements a shared services agreement in hopes of emerging from the Chapter 11 bankruptcy it filed in May 2019. It said an unnamed vendor was unable to collect $75 million in patient revenue. The health system implemented Cerner in mid-2018. Its new revenue cycle outsourcer is Gaffey Healthcare.

Medical residents and fellows at Yale New Haven Hospital crash a graduate medical education committee meeting to unfurl a banner reading “Doctors are Humans Too” and to present a Bill of Rights in which they demand working conditions that are safe for patients, elimination of workplace discrimination, adequate supervision, fair evaluations, treating patients the same regardless of their ability to pay, comprehensive health insurance with mental health coverage, and being paid a living wage.

Wags speculate that the suddenly widespread shortage of black turtlenecks in San Francisco is being caused by their repurposing for Halloween costumes by people who are dressing up as disgraced Theranos CEO Elizabeth Holmes.

Weird News Andy says this patient can no longer count to 24, but will save on pedicures. Surgeons in China remove the four extra toes on a 21-year-old man’s left foot. He had stopped wearing sandals and has never had a girlfriend because of his insecurity, but his parents had refused to let him have the surgery because the extra digits were a “gift from the heavens” that could always be covered up with shoes (unless they are Vibrams).

Sponsor Updates

• EClinicalWorks will exhibit at APHA 2019 November 3-5 in Philadelphia.
• Ellkay and InterSystems will exhibit at the CHIME CIO Fall Forum November 3-6 in Phoenix.
• Ensocare will exhibit at the ACMA Greater Houston Chapter Annual Conference November 2 in Houston.
• TriNetX will report its findings about using EHR data for research at ISPOR Europe 2019 November 2-6 in Copenhagen, Denmark.
• Healthwise and Kyruus will exhibit at the Healthcare Internet Conference November 4-6 in Orlando.
• Meditech publishes a new case study, “Summit Pacific Increases Reimbursement, Clinic Volumes with Meditech Analytics.”
• The Chartis Group names Roger Ray, MD (Atrium Health) physician consulting director.
• Black Book names Nuance the top vendor for end-to-end coding, CDI, transcription, and speech recognition technologies for the seventh consecutive year.
• Prepared Health CEO Ashish Shah will speak on a panel at the PointClickCare Summit: “Using Data to Build a Bridge to Better Care,” November 5 at 1:45 in Dallas.
• Google Cloud adds digital clinical assistant startup Suki to its Partner Advantage Program.

Blog Posts

• A Look Back at the 2019 National Conference (EClinicalWorks)
• Updates make Cloud AI platform faster and more flexible (Google Cloud)
• Harnessing Transparency to Achieve Revenue Integrity (Hayes Management Consulting)
• Manage Citrix & VMware Horizon Deployments (Goliath Technologies)
• Lessons Learned in Obtaining Financial Data for Archival Applications (Impact Advisors)
• Pause to Consider: Workforce Targets (Fortified Health Security)

Contacts

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

EPtalk by Dr. Jayne 10/31/19

From Policy Wonk: “Re: Primary Care First. Great job on your review of this disaster of a program. Thanks for going deep on the 100-plus pages!” I attended the PCF application webinar on Wednesday. Although I shouldn’t be surprised, I’m continually baffled by some of the things that happen with these programs. The most recent highlight is that the application requires the applying practice to list the NPI for every provider who has worked in the practice since 2013, even if they are no longer there, are no longer practicing, or are deceased. No concrete reason was given for this despite several people asking about it. I was also surprised by the continued inability of CMS to release slides for its webinars on a real-time basis. The slides had to be done to deliver the webinar, so why not make them available for immediate audience download? Telling interested parties that they’ll just have to keep checking back on the Primary Care First website is a tremendous waste of people’s time. I’d be interested to hear from anyone who actually plans to apply for this program.

Mr. H covered this earlier in the week, but I wanted to put in my two cents about the Walgreens plan to close 40% of its in-store clinics while adding Jenny Craig weight loss services at more than 100 locations in an attempt to boost sales. The Jenny Craig services will include individual consultations along with customized menu planning and meal delivery. As a clinician, I’m not a fan of Jenny Craig. My patients who have tried it have found the weight loss to be unsustainable when they stop purchasing food from the program. The company also hit a nerve with me last year when it announced its intent to add DNA testing to its weight loss plans because “customizing nutrition plans to an individual’s genetic makeup can offer members even greater personalization for weight loss and overall wellness.” 

The reality is that most people who need to manage their weight don’t need super-sexy-sounding gene-driven remedies. They need basic nutrition advice, including how to prepare their own food rather than using higher-cost commercially packaged options. I love the way that the C-suite folks describe these moves, with the Walgreens CEO saying they are focused on creating healthcare destinations around a modern pharmacy. The reality of most Walgreens stores is that the actual pharmacy space is a tiny fraction of the store, with the rest of it being little more than a glorified convenience store.

I’m always on the lookout for cool healthcare tech, so was intrigued to hear about the Hyperfine portable MRI. The device, which is in the prototype state, is small compared to a traditional MRI, about the size of a large wheeled curbside trash can. Although the images aren’t quite the same quality of a standard MRI, there’s no need to magnetically isolate the patient. Hyperfine’s founder Jonathan Rothberg cites the ability to image patients without moving them as another benefit. The unit is slated to be significantly cheaper than existing machines, with a cost of close to $50,000 rather than the millions needed to buy a standard machine and set up a dedicated imaging suite. Rothberg’s previous entrepreneurial experience includes Butterfly Network, a handheld ultrasound that connects to the iPhone. The MRI device is under study in the neurological intensive care unit at Yale University. The company has applied for FDA clearance for brain imaging in adults and children.

St. Louis-based clinical genomics company PierianDx closed a $27M series B funding round this week. The round included ATW Partners and SJF Ventures, with participation from existing investors including Health Catalyst Capital, Inova Health Systems, RTI International, and ARUP Laboratories. The company was founded in 2014 from Washington University in St. Louis and focuses on advancing cancer diagnostics and enabling clinical genomics as the standard of care. The company plans to use the funds to expand current operations and further develop its solutions. For those of you whose memory of Greek mythology is fuzzy, the Pierian Spring was sacred to the muses, and was regarded as a fountain of knowledge that would inspire anyone who drank from it.

From Gong Show Afficionado: “Re: earnings calls. The 10/21 article is phenomenal and I wanted to thank you for taking the time to share it! I used to think a lot about earnings transcripts and coming up with % allocations of speaker (i.e. if CFO is speaking less % of the time or answering less % of the questions quarter over quarter, I would assume a bad thing?) but not tone or word choice, so you got me thinking about it. I’ve bee on the sales side and now that I’m on the other side of sales pitches I have that inescapable feeling of you are lying to me and I know it because I’ve been on your side of the table. It makes decision-making difficult. It would be incredibly powerful to have a sales pitch BS evaluator hooked up to an LED scoreboard that you could have hanging above the conference table during the pitch so the buyer could provide real-time feedback to the seller on how they’re doing. Every time someone mentions their use of a data lake, the scoreboard goes straight to zero.” I’d go further to suggest a trap door that dumps onto a funhouse slide that takes the rep directly to the door and could be triggered by either an overall buzzword count or by a “whammy” button that we could hit when we the sales effort goes off the rails.

Hopefully your Halloween night will be ghoulish but not dangerous. The Journal of the American Medical Association came through this week with a host of Halloween-themed articles sent via email:

• “Spook House Sporotrichosis.” This piece from 1997 highlights the risks of hay bales used as props in haunted houses. Outbreaks of the condition are rare, and the article highlights an outbreak noted in a dermatology practice. Four of the patients had handled hay bales in a haunted house and one visited the house. The causative organism, Sporothrix schenckii, is one of my favorite things to say, so the article caught my eye.
• A more recent piece  focuses on “Pedestrian Fatalities Associated with Halloween in the United States.” It highlights that the relative risk of a fatal pedestrian accident was 43% higher on Halloween compared to control evenings, with the average Halloween leading to four more pedestrian fatalities. That’s a good reminder to wear reflective clothing, use flashlights, and make sure your vision isn’t obscured.

Personally, I plan to spend the evening pairing the occasional Reese’s Peanut Butter Cup with a nice glass of cab.

What’s your favorite Halloween candy? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 10/31/19

Surescripts hit with another e-prescribing monopoly lawsuit

Falconer Pharmacy in New York files a class-action lawsuit against Surescripts, alleging that the company, along with co-conspirators McKesson and Allscripts, has forced the pharmacy to use its e-prescribing network to avoid higher rates as a “non-loyal customer.”

Premier Inc. Acquires Medpricer to Optimize Savings in Purchased Services

Group purchasing organization and consulting firm Premier Inc. acquires Medpricer, a developer of purchased services management technology, for $35 million.

Parthenon invests in MRO

Private equity firm Parthenon acquires an ownership stake in release-of-information vendor MRO.

Huron Announces Partnership with Medically Home Group, Inc.

Huron joins virtual hospital company Medically Home Group’s Series B round of funding, and becomes the exclusive implementation partner for its hospital-to-home care services.

Outcome Health Reaches Favorable Resolution with the DOJ Related to Past Misconduct by Former Employees

Digital patient education tech vendor Outcome Health avoids prosecution by the DoJ for the past misconduct of former employees by agreeing to pay $70 million in restitution to customers.

Readers Write: Connected Communities and Social Care in the US

Connected Communities and Social Care in the US
By Jaffer Traish

Jaffer Traish is VP of partnerships at Aunt Bertha of Austin, TX.

I’ve been on the road for more than 100 days this year. I’ve been visiting with payers, healthcare systems, colleges, housing organizations, nonprofits, students, patients, and seniors. I’ve also visited EHR companies, population health vendors, and data scientists. The discussion has been focused on learning how to strengthen communities and reduce poverty through connections to social care programs, leveraging collaborative investment and integrated technology.

There is significant alignment among the broad stakeholders in the principles to govern solutions.

People

• We describe all people in need as seekers. The entry point where we express needs may be in healthcare, at college, after corrections release, or when we’ve become widowed. The seeker is always at the center — not the referring hospital, payer, or other business interests.
• Seekers may receive help, though they deserve and desire the dignity of self-navigation. Make it possible to self-refer, and never hide available resources in the long tail of programs nationwide.
• Seekers own their social care data. This is a tough one, though we have the chance to get it right in social care. Seekers should control how their self-referrals are shared among the network.

Community Organizations

• Community organizations are able to maintain an unbiased ability to serve people. Do not subject them to industry specific contracts, forced services, or quid pro quo funding.
• Community organizations should have tools that facilitate relevant intake data and processes respecting privacy rules, whether FERPA, HIPAA, HUD, or others.
• Community organizations should be more easily able to align with philanthropy in demonstrating service success.
• Each community is unique. Conversations about solutions should take place in the community, with the community.

Helpers

1. Helpers or navigators, the folks who facilitate referrals, go beyond industry (or clinical) staff. Librarians, guidance counselors, and family members are all part of the helper community. This reach of helpers serves the seekers best.
2. Helpers should be able to act as the legal proxy, with permission.
3. Helper information should be protected in the referral process. It’s not always appropriate to share the referrer’s name to the seeker.

With this perspective, creative developers can better build integrated, interoperable technology to serve seekers.

For those of us who have spent time in healthcare, we remember when electronic orders brought ambulatory EHRs to life in the mid-1990s. Similarly, eligibility-driven social care connections will bring a nationwide network to life. While we absolutely need policy changes to support equity and opportunity, there is much we can do today.

Executives ask for a multi-year framework to be successful with social care connections and referrals. An example is below.

• Stage 1: Electronic resource library with breadth and depth available to helpers and seekers.
• Stage 2: Helper organization promotes self-navigation through their portal.
• Stage 3: Helpers share program resources with seekers electronically.
• Stage 4: Helpers share program resource referrals with seekers and CBOs electronically.
• Stage 5: Helper organization integrates staff workflow within the system of record (EHR, care platform, housing platform, corrections) including data acquisition for business intelligence reporting.
• Stage 6: Helper organization builds partnerships with CBOs to affect supply of help available.
• Stage 7: Helper organization funds CBOs, and helpers directly order solutions for social needs.
• Stage 8: Helper organization participates in interoperability of social care data.
• Stage 9: Helper organization leverages predictive methods for identifying and helping seekers.
• Stage 10: Helper organization completes real-time self-navigation risk intervention.

Organizations like the Winn Corporation in housing, Atrium in healthcare, Red Cross and AARP as networks, Cigna as a payer, State of Colorado in government are all exploring these frameworks to build connected communities.

Community organizations also ask for frameworks, such as the one below.

• Stage 1: Respond to or track assistance.
• Stage 2: Leverage network tools to participate in data sharing.
• Stage 3: Leverage reporting for funders.
• Stage 4: Integrate tracking into preferred case tools
• Stage 5: Leverage funding donations from helper organizations and broader philanthropy.

I am excited to thoughtfully continue to grow the social care network keeping the seeker at the center, bringing dignity and ease to the process of finding help.

HIStalk Interviews Scott Shreeve, MD, CEO, Crossover Health

Scott Shreeve, MD is CEO of Crossover Health of San Clemente, CA.

Tell me about yourself and the company.

I am an emergency medicine physician. I was one of the co-founders of Medsphere, the first open source enterprise electronic health record. It was built and based on the Veteran’s Administration software system that was in the public domain. We had a good experience commercializing that software for hospitals and health systems that couldn’t afford the Epics and Cerners of the world. We had some nice success and early wins. I left the company under some challenging circumstances, but I’m thrilled to see it go on to be successful.

After I left Medsphere, I became interested in healthcare delivery and primary care. I was doing a lot of reading about re-architecting and designing new types of health services. I had read “Crossing the Chasm” and “The Innovator’s Prescription.” Primary care has always been such an important part of the foundation of a good, strong, healthy healthcare system, and if we could design that primary care foundation in a better way, with new payment models and a new care experience, that could be the basis of some great innovation.

After speaking, consulting, writing, and blogging about those topics for several years, I decided to take the plunge in 2010 to start Crossover Health. It began as a direct primary care practice. We had some initial success after opening up our first store in Aliso Viejo, California, but quickly learned that going directly to the consumer was quite challenging. We pivoted our innovative primary care model to address the needs of self-insured employers. Crossover became the medical group that provides services to companies like Apple, Facebook, Microsoft, Comcast, and others. We’ve been on quite a run since then.

Crossover Health describes itself as a digital-first national medical group. How does that work in terms of access, provider licensure, and use of analytics?

Crossover is focused on Fortune 50 companies and Fortune 500 companies that are looking to bend the cost trends in healthcare, that want a different experience, and that want to get more involved in healthcare delivery. They hire us to do that. We’ll come onto their campus or near their campus to build these health services.

What we find, though, is that most of the employers we work with have scattered pockets of employees all over the country. We were addressing only 10% to 40% of their populations by building near their headquarters. That was great for the patients who had access, but it didn’t address the needs or solve the problems of all of their employees. What they’ve asked us to do, and what we were doing on our own, is to extend our care model by adding digital-first as a strategy to capture the rest of the population.

That move is critically important. Telemedicine has been around for years. A remote employee in Georgia might work for Facebook in Menlo Park, but they can pick up their phone to immediately access their dedicated care team for the designated Facebook population and get the care they need right off the bat. We can either address is then or have them follow up locally where they live in Georgia with a curated network of specialists.

We have built a consistent care team that is licensed in all the different states. It is available to the people throughout the country who are covered by the benefits of that particular employer. Because we’re not physically in Georgia, we then have to steer, navigate, and coordinate the care for them when they access care that they may need locally. 

It’s an interesting solution. We either come on your campus or near your campus and provide a set of services, but now we are meeting the patients where they are, and that is digital-first. People are comfortable coming online. It’s  how they work in the rest of their life. Now we’re allowing them to work with their dedicated care team in the same way.

Surveys have shown that Millennials love technology and the immediate gratification it can provide, but don’t have much interest in cultivating an ongoing relationship with a primary care provider. How do you work with those employees?

I love the quote that “nature finds a way.” Everyone finds a way to get care. Millennials are comfortable getting online and asking things. If there’s not a coordinated, organized way in which that happens, they will meet their needs their own way.

What’s fascinating to me is that when you give them the opportunity to interact with a primary care physician and a consistent care team, they love it. It’s simple to them. They want to establish a relationship, but it has to be convenient, accessible, and in the way that they normally live their lives.

Our technology isn’t an electronic health record designed for billing. It’s a more like Slack, asynchronous communication with a consistent care team, where we can have that constant communication as needed. Then guide them in their local geography.

We’re finding that Millennials really do care about their health, but they don’t care for the traditional system that doesn’t provide access and tools. If you can meet them where they are, it’s very effective, very powerful. They are used to picking up their phone, logging into an app, texting their provider with a question, getting a response, and then digging in deeper if needed or being guided and steered to a local, curated specialty group. They are very comfortable with that. That’s not foreign to them, that’s expected. We are having a lot of success with that population.

Each employer has their own fingerprint and demographics. Some have older employees, such as in manufacturing and retail. We’re finding that those people very much want a relationship as well, and they are becoming comfortable with the tools. It’s almost like you are looking at different ends of the spectrum. You have the Millennials, who are very comfortable with the tools, and by the way, the relationship is great. On the other end, you have “I really care about the relationship,” and by the way, the tools are great. It seems like we’re crossing the generations through this type of a care model.

What are the contrasts you’ve seen as a former EHR vendor who now has the luxury as a provider to build the exact systems you need?

We’ve always had an electronic health record undergirding the foundation. But we built our own patient technology. Our patients never see the electronic health record. They see our tools, our patient engagement platform. With Jay Parkinson coming on board and all the work that he’s done at Sherpaa, we are building more tools and capabilities for our team members, our provider groups, to interact in this more asynchronous, structured question way.

Most of the care that we provide is through asynchronous means. Someone says I’m not feeling well, so we get orientation of what that is through this asynchronous communication. Once we’ve narrowed it down to a diagnostic category, we’ll send a structured question set, say, for stomach pain. Patients will take their time to answer that back. Based on that feedback, we’ll take the next step. We may need to see them in person and we ask if we can schedule that right now, or it could be that we suggest waiting for it to declare itself over some period of time.

We look at the electronic health record as the Slack channel. Each episode of care that we open up is its own project. We have tools that are effective at managing projects. Over time, we see replacing bits and parts of the EHR infrastructure with this patient engagement tool set because we are so focused on that. That’s where we see the evolution with Jay and with Sherpaa coming on board. Jay has taken on the roles of our chief designer and is building and extending what he did at Sherpaa, on a platform that has both a digital and now a physical presence. That combination is where he gets to play and innovate now.

Why is there a disconnect between widespread availability of virtual visits and the low percentage of Americans who have used them?

We are finding that it is not in the human experience, certainly not in the cultural experience in America, to get on the phone for 10 minutes with a random physician that you have no relationship with. We see 2% to 5% utilization. There are clearly situations where that is fine and where it works for the 30 set conditions that you can manage. What we’re really talking about here with our model is full-blown primary care that has, as its basis and foundation, a physical visit that’s done a little bit differently. Better, we think. But now purpose-building in the virtual connection as well and delivering it in the same way.

It’s a known care team that now has new capabilities. It can extend to individual patients and interact with them in the way that they do in every other aspect of their lives.

Traditional telemedicine — when it is disconnected, when it’s a random physician that you don’t have a relationship with, and when it’s not endorsed from your provider — is only going to have a certain percentage of pickup. Our thesis has been that you can develop trust in a medical group that is endorsed by your employer; that you have met, touched, and felt; and that now has the ability to extend the technology to you. That is really powerful. The person is at home and can access us. They know us. We get back to them. We’re on call 24/7. They have this connected experience wherever they are in the country. That’s the difference that we are banking and betting on.

How do health systems that make big money selling those questionably necessary visits react when you sign on with a big local employer?

Comcast / NBCUniversal is a huge player in all these different markets. Every health system wants to cater to their business. Our other employers are similar.

A lot of the health systems don’t really know what to make of us. If your business is built on sick care and you’re dependent on me feeding your MRI machine, that business model is doomed. The health systems that we do have a chance to work with are really innovative. They are very much based on value-based healthcare. They are realizing that while having a incredibly full hospital has historically been a big part of their business, I don’t really want that for the overall health of populations and value-based contracting.

We’re somewhat of a nebulous group to interact with. Some know that it’s a great model and a great primary care foundation, but it’s also challenging for them to understand how to work with us. Some innovative health systems know they haven’t been able to change the fundamentals of primary care in their own markets, so let’s do something totally disruptive outside of our system, but in partnership with a primary care group that is value-based and will send us the right referrals. It might initially look like that affects our immediate, short-term bottom line, but over time, given the new financial models that they’re moving towards, this is exactly what needs to happen, and they are embracing and endorsing it.

How much of Crossover Health’s identity do health systems use when announcing those services?

Most health systems have a lot of equity built into their brand from the trust and years and decades of work in that community. We have the option, and we do this with our employers as well, to white label our services, so it is very strong on that particular health system or employer’s brand. We can go all the way to the other end toward Crossover, because there are advantages to being totally separate, new, and different. In different settings, the privacy and the security and having a separate entity provided is useful.

We find that most strike a middle ground, where they want to have their name. but also our name together. It becomes a “powered by” situation. We leverage the good name and goodwill of that institution or brand from the employer, the health system, and then you can also show and highlight that you have this innovative collaborative partnership as well. That’s where we see most people land.

You’ve been out of health IT for a long time, but how do you see that landscape developing, especially with regard to what investors are funding?

This is like a view from 10 years ago since I left the industry when I was following it closely, but a couple of comments, maybe. One is that I’m surprised, but also not surprised, that Epic essentially has eaten the entire medical space. I think Judy’s concept of having a fully-integrated, comprehensive suite and then being able to get ahead of that is amazing. The value of the integration has been greater than any limitations of their underlying technology or otherwise. That’s been impressive to see from the outside.

Conversely, these monolithic kinds of system are incredibly hard to work with from the outside. It’s not that they are so technically hard to work with, it’s that they flat out don’t want to work or integrate with other people outside. That’s the negative side of how big they have scaled.

It’s interesting to see where Cerner has continued to evolve, along with Allscripts and others. I’m still a huge advocate of open source technology and love to see that Medsphere and others are out there still doing it.

Where my perspective has changed is that I see healthcare IT as simply a tool. Whether I have this tool or that tool, it is a tool that enables the information, the sharing of information.

The problem I see with health IT as it is today is that if architecture is destiny, then the way that these systems have been architected is highly concentrated around billing and other things. They have added other clinical components that are important, but that overemphasis and tying it to a fee-for-service system, which I also feel is doomed, impinges on the potential impact of where healthcare IT can go. What we are working toward and building is trying to get things that are more consumer-centric, where consumers can be more involved with their care, the record is really theirs, it is shared with their provider groups, and they have modern tools for interacting with their care teams.

Where IT has always been strong and remains strong is that you can aggregate the data, analyze it, and provide advisory services back to the people who need it, both providers and patients. I am pleased to see where that’s gone and where it hopes to go with machine learning, artificial intelligence, and other ways to introspect the data that has been gathered. That is really promising.

One of our big collaborators is Health Catalyst. Some of these big-iron tools that do deep-dive data analysis for big health systems are getting to the point where smaller providers like us can access them and put them to work. So much of our care is not about reacting to what’s on our schedule that day, but proactively reaching into the population to find those people who we need to be seeing that day. Then using digital-first tools and otherwise to get the people who maybe are less acute, but still have needs. Can we address those another way so that we can reserve the in-person visits or our concentrated efforts on those people who need us most?

How can technology overcome the fact that health system consolidation and the involvement of huge for-profit companies have left patients dealing with ever-bigger and potentially more bureaucratic organizations in their moments of need?

Privacy and the value of healthcare data is incredibly important. How you manage it, and the trust and confidence that people have to have and who’s storing the data, is critical. We work with some of the biggest technology companies with amazing amounts of data on different customers and the lives of all the people who use their platforms. We’ve learned a lot from watching how they do that.

There needs to be a role for a new type of health service that you join that keeps you healthy, that is independent of CVS, Walmart, and the insurance companies. People could join an organization that is purpose-built to manage their health information at their request. Who will be the first health banking service that is a trusted, independent third party that can aggregate your data and that you can assign in a permissioned way to allocate access to your data at certain points in time? Whoever creates that is going to be powerful.

The future health economy will be built on the currency of trust. One of the things that we sell quite a bit to our clients and employers is that Crossover is an independent, tech-enabled, data-enabled, national medical group that is independent of payers and health systems. We are a potential candidate to become that trusted intermediator of your health data. To bank your health data in a way that you trust and to allocate and invest your health information based the permission and rights you have. We are excited to see where that goes.

Morning Headlines 10/30/19

Medecision acquires health delivery system transformation pioneer GSI Health

Medecision acquires population health management technology vendor GSI Health for an undisclosed sum.

eSolutions Acquires Medidal, Solidifying Position in Hospital Revenue Recovery

Revenue cycle technology vendor ESolutions acquires Medidal, which sells systems to help providers identify missed revenue opportunities in the areas of transfer DRGs, payer eligibility, and pharmacy claims.

Twistle Receives $16M Investment to Accelerate Delivery of Personalized Care Guidance Through Care Process Automation

Albuquerque-based patient engagement app vendor Twistle raises $16 million that it will use to expand its office space, increase headcount, and bring on new employees in Seattle.

News 10/30/19

Top News

Facebook will use the demographics of its users to present them with preventive health information and reminders. It will allow them to search for providers, set appointment reminders, and mark the item as completed.

Facebook claims that it won’t use detailed user information, won’t use the data collected to present targeted advertising, and will store the information securely.

The functionality was developed by Freddy Abnousi, MD, MBA, MSC, a Facebook employee who previously designed a system in which de-identified hospital data provided to Facebook would be re-identified against its own user data to alert hospitals of potentially beneficial interventions. That project was killed off following the Cambridge Analytica scandal.

Reader Comments

From Down Low: “Re: GSI Health. Has been acquired by Medecision.” Unverified. DL left a message on my rumor phone line. GSI Health offers population health management technology and was founded by Lee Jones, MS in 2003. UPDATE: Medecision announced the acquisition Tuesday afternoon. GSI’s platform will become part of Medecision’s Aerial.

From Minibar Raider: “Re: HLTH. Received this Dilbert by email, which seems apropos. And Livongo has branded the room keys!” HLTH seems to have attracted a lot of expense account-flush C-level vendor and provider executives. Its glitz and VC-funded excess seems right at home in Las Vegas (it is ironic talking about health behaviors within lavish temples that were built on addictive gambling, smoking, overeating, high alcohol consumption, and most likely some sex-related risk factors). I guess I’m just cynical about wealthy C-level executives trying to sound convincing in proclaiming patients and humanity as their primary motivators, although at least a few presenters fit that description. John Halamka tweeted that HLTH is “a perfect hybrid of JPMorgan and Burning Man,” noting an attendance of 6,000. Bizarre: one HLTH attendee’s exhibit hall photo showed a booth consisting of an oversized barber shop with at least five chairs in which attendees were getting actual haircuts. That’s some original booth thinking. UPDATE: the thinking isn’t that original and its very much not the same as the non-commercial Burning Man – HLTH brought in London’s Pall Mall barbers to offer wet shaves and haircuts during conference breaks, which could be sponsored for $40,000 for each break. The same amount of sponsor money would place signage on the Drybar hair styling booth, or you could spend a little more to sponsor a restroom to “capture our attendees’ attention when and where they least expect it.” This is all amusing until you realize who’s paying.

HIStalk Announcements and Requests

I’m amused that stay-at-home people now report their gossip-focused findings (obtained by all-day peering through their windows or listening to scanners) via the new busybody networks of Nextdoor and Facebook neighborhood groups. I can summarize 90% of their poorly written messages as follows: (a) did anybody hear that big noise just now? (b) my power is out, anyone know why or when it will come back on? (c) where were all those police cars going out on the highway? (d) what’s with the traffic backup? Many posters seem incapable of Googling since they ask easily answered questions about business hours and school calendars. Then we have the paranoid neighborhood alerts that someone black, Hispanic, or under 21 was seen “acting suspiciously” (meaning: daring to exist close by). It’s hard to remember that before social media, you only knew how weird or downright disturbing neighbors are when you saw them in the driver’s license office or the ED.

Webinars

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

Acquisitions, Funding, Business, and Stock

Reuters reports that Google owner Alphabet has made an offer to acquire Fitbit, which has been attempting to turn itself into a healthcare technology business as its wearables market share slides in the face of stiff competition.

Revenue cycle technology vendor ESolutions acquires Medidal (Medical Data Logistics), which sells systems to help providers identify missed revenue opportunities in the areas of transfer DRGs, payer eligibility, and pharmacy claims. ESolutions CEO and industry long-timer Gerry McCarthy joined the company in 2018 after serving in executive roles at McKesson Provider Technologies, HealthMedx, and TransUnion Healthcare.

Walgreens will close 40% of its in-store clinics, but will keep the 200 clinics that it runs with health systems. Analysts say the in-store clinics aren’t profitable and face competition from telemedicine services. Walgreens will add Jenny Craig weight-loss sites to 100 stores.

The HLTH conference’s non-profit foundation acquires CSweetener, a IT executive mentor matching platform for women. The organization’s staff consists of three women named Lisa, with investor and co-founder Lisa Suennen being the most recognizable.

Albuquerque-based patient engagement app vendor Twistle raises $16 million that it will use to expand its office space, increase headcount, and bring on new employees in Seattle. Founder and CEO Kulmeet Singh was formerly VP of strategic planning for Nuance before starting Twistle in 2010.

Sales

• Netsmart signs a 10-year deal with pediatric home care provider Aveanna Healthcare, whose 30,000 clinicians and employees across 200 locations in 23 states will use Netsmart’s MyUnity EHR, analytics, and learning management systems.  
• Adirondack Health Institute chooses Netsmart’s CareManager population health management platform for its New York Health Homes initiative.
• Primary care house call vendor and DaVita subsidiary provider Vively Health will implement Cerner Millennium, HealtheIntent, and HealtheLife.

People

Industry long-timer Michael Lovett, MBA (Formativ Health) joins Northwell Direct, Northwell Health’s new direct-to-employer health services business, as COO. 

Voice- and AI-powered virtual physician assistant vendor Saykara hires Graham Hughes, MBBS (Sutherland Healthcare Solutions) as president.

Rob Anthony (CMS) transitions to director of certification and testing for ONC’s office of technology, where he will oversee health IT certification. He replaces USPHS Captain Alicia Morton, DNP, RN, who will become senior advisor to Deputy National Coordinator Steve Posnack, MS, MHS.

Announcements and Implementations

An InterSystems survey finds that private hospitals in Southeast Asia will dramatically expand their health IT capabilities over the next five years to support value-based care and care coordination. Hospital executives expect to see big gains in the use of analytics and AI as paper records are replaced with their electronic counterparts.

A new KLAS report on global vendor-neutral archive finds that Philips (via its August 2019 acquisition of Carestream HCIS) and Fuifilm deliver scalability and geographic breadth, while Agfa, Sectra, and Hyland run in region-wide deployments with inconsistent delivery. Customers of GE Healthcare report lack of support and partnership, while those of Siemens (deployed mostly in Europe) complain about third-party implementers and inconsistent customization expertise. Mach7 and Intelerad show promise given limited customer data. KLAS notes, however, that it surveyed each vendor’s list of their own best customers, which may not be representative.

Nuance adds The Sullivan Group’s risk mitigation and safety content to a new Dragon Medical Advisor ED solution.

Digital-first national medical group Crossover Health will offer self-insured employers the ability to deliver primary care services, care management, and secondary care coordination in its Connected System of Health  program. Crossover supplies the provider team and a proprietary EHR that includes customer relationship management, secure messaging, and project management. Comcast NBCUniversal is the first customer. CEO Scott Shreeve, MD co-founded the company in 2006 after leaving EHR vendor Medsphere, which he also co-founded, in 2006.

Mastercard announces Healthcare Solutions, extending the capabilities of its healthcare account payment cards to help hospitals offer more effective billing methods for a given patient, for payers to identify potentially fraudulent claims, and to provide biometric mobile access to accounts.

Government and Politics

The Federal Bureau of Prisons issues an RFI for an EHR and patient management system, 

Other

The Verge notes that California’s electricity blackouts are forcing hospitals to decide which equipment – such as refrigerators vs. EHRs – to run on backup generators. That is a real-life example from FQHC Winters Healthcare, which decided to keep some lights on and its EHR running for a planned outage that could last anywhere from one to five days. Hospitals switching to generator risk lengthy system reboots, equipment damage, and potential patient harm caused by drug dispensing cabinet downtime, patients stumbling in the dark, and in influx of patients from homes and skilled nursing facilities without power who use medical equipment such as ventilators and IV pumps. The executive director of Winters Healthcare headed out once power was restored to buy more emergency lighting and another generator since he is worried that power outages could be “the new normal.”

Beijing-based Lepu Medical — which offers an FDA-approved, $2-per-day heart attack risk warning system that was trained on the publicly available data of 500,000 hospitalized patients in China – says its system isn’t selling well in the US because hospitals that are paid well for visits and surgeries see it as a threat to their profits. He also blames malpractice fears and the expensive, time-consuming process of researchers who conduct studies and wait for the results to be published. The company is basically giving up on US hospital sales and will instead work with an online medical visit provider and an ECG company.

Former college offensive lineman T. J. Abraham, DO was forced to finally retire from his OB-GYN practice when his football-related chronic traumatic encephalopathy left him unable to prescribe drugs or perform surgeries without first covertly checking an app.

A hospital in China suspends several nurses and employees who were captured on video lining up to pose on the bed formerly occupied by a celebrity singer from Singapore. Afterward, someone listed his used IV bag and syringe for sale online.

Sponsor Updates

• OptimizeRx integrates its solutions into a single platform, including those from its recent acquisition of digital therapeutics vendor RMDY Health and its partnership with e-prescribing software vendor NewCrop.
• Pivot Point Consulting, A Vaco Company is named to Consulting Magazine’s 2019 list of fastest-growing firms, rising to #15 in its fifth consecutive appearance.
• Also on Consulting Magazine’s fastest-growing firms list: Impact Advisors.
• Surescripts recognizes a dozen leading health system, pharmacy, and EHR vendors with its White Coat Award for their improvements in e-prescription accuracy.
• Spok’s Connect 19 Conference provides attendees with insights into healthcare communication in the cloud.
• AdvancedMD will exhibit at the APTA PPS event October 30-November 2 in Orlando.
• Divurgent launches an internal department that will focus on expending into new markets and nurturing client and consultant relationships.
• Arcadia publishes a new white paper, “Measuring Care Management: Maximize the Value of Your Care Management Program.”
• Datica releases a new edition of its 4×4 Health podcast, “International Health IT.”
• Cumberland Consulting Group will exhibit at the CHIME19 Fall CIO Forum November 3-6 in Phoenix.
• Dimensional Insight will exhibit at the ACHE Fall Conference November 1 in Needham, MA.

Blog Posts

• Webinar Recap: Investing for the Future:  The ONC and CMS Proposed Rules on Interoperability (Wolters Kluwer Health)
• 3 Benefits to THRIVE After Go-Live (Optimum Healthcare IT)
• 10 Things Healthcare Professionals Must Consider to Ensure a Successful Tablet Initiative (Access)
• An EHR that improves clinical productivity and patient outcomes (AdvancedMD)
• How a hospital sought to reduce strain on staff and improve outcomes using new enterprise imaging technology (Agfa Healthcare)
• For the second time, Atlantic.Net achieved recognition in Gartner’s 2019 Market Guide for Cloud Service Providers to Healthcare Delivery Organizations. (Atlantic.Net)
• Three Reasons Why You Need to Attend Avaya Engage 2020 (Avaya)
• Reducing Noise in Healthcare Data Using Machine Learning (Bluetree)
• Accelerating Healthcare Innovation with DevOps: Upcoming Twitter Chat (Burwood Group)
• 3 Ways to Optimize the ED Work Environment (Collective Medical)
• Technology to Drive the Future of Patient Support (CoverMyMeds)
• How to Improve the Performance of Your Emergency Department (Dimensional Insight)

Contacts

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

Morning Headlines 10/29/19

Exclusive: Google owner Alphabet in bid to buy Fitbit

Fitbit shares rise 27% on the news that Alphabet has made an offer to acquire the company.

Facebook will now remind you to get flu shots and medical checkups

Facebook launches a Preventive Health tool that will remind users to get vaccines, checkups, and tests based on their demographic profiles.

Federal prisons shopping for EHR system

The DoJ’s Federal Bureau of Prisons issues an RFP for an EHR that can handle the physical, mental, and dental care of nearly 200,000 inmates.

Curbside Consult with Dr. Jayne 10/28/19

CMS has finally delivered its Request for Application for the Primary Care First program, which had long been promised to arrive in summer of 2019.

Everyone loves an endless summer, except for the people who have been waiting a really long time for the application for a program that was to start in January 2020. Now, applications are due by January 22, 2020 for a program that won’t begin until January 2021. CMS also promises that “in the coming week” it will release a “Statement of Interest” form for prospective payer partners who want to declare their interest in a non-binding fashion. A formal solicitation process for payer partners will then run from December 9 through March 13, 2020. CMS notes that “this timeline will allow payers to clearly assess where there is likely to be high practice participation in Primary Care First, and make an informed decision about regions in which to develop their own aligned approaches as payer partners.”

Continuing with some vague deadlines, CMS notes that the selection process for practices and payers will take place in “Winter-Spring 2020,” which gives them a fairly long runway since summer apparently stretches to October 24 in their universe.

The CMS FAQ document had some interesting tidbits, for those of you who haven’t had a chance to dive into the documentation yet:

• If more than 3,000 practices apply and meet the eligibility criteria, CMS will use a lottery system to select final participants.
• A second round of applications will occur for practices that are participating in the Comprehensive Primary Care Plus (CPC+) program, to begin participation in Primary Care First starting in January 2022.
• Neither Federally Qualified Health Centers or Rural Health Centers are eligible to participate. CMS states this is because the program is designed to test payment reform for traditional fee-for-service payments, where the excluded centers bill under different but distinct rules.
• Participants will have to comply with interoperability requirements that will be spelled out in the Participation Agreement, which is not yet available for review.
• CMS “anticipates that Primary Care First will qualify as an Advanced APM for all give years of the model test.” I’m not sure why they can’t put their nickel down at this point and declare it. I find the “anticipates” language bothersome.
• CMS will be using a modified CAHPS (Consumer Assessment of Healthcare Providers and Systems) survey “to allow for increased response rate and ease of use among beneficiaries.”
• CMS will allow practices to reduce or waive the applicable co-insurance for the flat primary care visit fee, but practices are responsible for assuming these costs. Practices can determine which patients might benefit most from this, such as patients with frequent emergency department visits or hospital admissions. Practices will have to submit an implementation plan for this at a later date.
• Practices can offer other “beneficiary enhancements,” such as transportation to the primary care provider or other follow-up services. Patients can also receive access to remote monitoring technology or nutrition programs such as Weight Watchers. These will be detailed in the Participation Agreement, which again we haven’t seen.
• Additional guidance regarding telehealth will be provided at a later date.

I began to dig into the 102-page Request for Applications document and immediately began to regret it. There are seven possible levels of performance for regional performance bonuses dependent on the practices’ performance relative to a regional reference group. There are also tiers for the Continuous Improvement bonus.

When I reached the part about “Quality Gateways,” which practices have to meet in Year 1 to receive a bonus in Year 2, my eyes began to cross. My vision cleared up, though, when I saw that participants must agree to participate in CMS efforts to evaluate the model, which may include everything from surveys and interviews to site visits and other unspecified activities. Everyone loves agreeing to more site visits, and the part about “unspecified activities” certainly leaves room for uncertainty.

I was glad to see that the appendix does have all of the application questions listed out, since the application itself requires a login. That at least allows practices to make sure they have all their information gathered before they try to key it all in.

At this point in the game, I doubt any of my current practice clients will want to participate, but if any do, I’ll be referring them out to some consulting colleagues who are more specialized in this area than I will ever be. The devil is definitely going to be in the details for practices that go this route, and only they will be able to truly determine whether the proverbial juice is worth the squeeze. My state isn’t one of the ones that has been selected for the program, so I won’t be hearing about it in the physician lounge, that’s for sure. I do have enough colleagues around the country, though, and I hope at least one of them bites so I can share their experience with our HIStalk readers.

Having to wade through all the Primary Care First documents was enough to make me grateful to have back-to-back clinical shifts scheduled. Unfortunately, I saw my first vaping casualty,  a teenage patient whose lung collapsed after he decided to celebrate a recent academic event with some vaping in the high school parking lot. Luckily, he was in the car with a friend who saw him begin to go into distress and brought him for attention right away. The patient went from being reasonably conversant to beginning to turn blue over the course of a few minutes while we were waiting for EMS to arrive.

It was just another day at the office for our team of in-house paramedics, but based on the level of terror his friend experienced ,I doubt either of them will be vaping much in the near future. Due to the acute timeline of the incident, the patient’s parents didn’t arrive at our office until we had already bundled him into the ambulance and sent him on his way. That’s got to be just about one of the worst feelings a parent can have.

The rest of the weekend was largely uneventful, for which I’m grateful.

How did you spend your weekend? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 10/28/19

VitalHub Corp. Announces Agreement To Acquire Oculys Health Informatics Inc.

Mobile healthcare system VitalHub acquires startup Oculys Health Informatics, which offers a hospital operations dashboard, for $4.2 million.

Cerner Corporation (CERN) CEO Brent Shafer on Q3 2019 Results – Earnings Call Transcript

Cerner says it will no longer offer full revenue outsourcing services after a mutual agreement to end its contract with Adventist Health leads to a $170 million reduction in revenue.

Vocera Announces Third Quarter 2019 Financial Results

Vocera announces Q3 results: revenue up 6%, adjusted EPS $0.23 vs. $0.20.

Monday Morning Update 10/28/19

Top News

From the Cerner earnings call:

• Chairman and CEO Brent Shafer says Cerner’s partnership with Amazon Web Services will create “advancement in the overall user experience” and will increase Cerner’s profitability.
• The company blames a lack of growth in managed services and support revenue on former Siemens Health Services customers who had decided to leave years ago and are finally doing so, although the retention rate in that business is still 80%.
• The termination of Adventist Health’s revenue cycle outsourcing agreement, which Cerner says was a joint decision, will reduce Cerner’s annual revenue by $170 million and triggered a $60 million charge this quarter. The company says it will become more selective in future RCM outsourcing deals based on potential margin and probably won’t offer full outsourcing going forward.
• The Coast Guard will begin its Cerner implementation this quarter.
• Cerner’s acquisition of government contractor AbleVets will involve a $75 million cash consideration and will contribute $90 million to 2020 revenue.
• Positive feedback on its attempts to fix its revenue cycle management problems has led several large clients to initiate a move to Cerner revenue cycle.
• An unnamed, previously dissatisfied Cerner academic system customer has become a top Cerner reference site and will convert 125 of its clinics from Epic to Cerner.
• The company believes non-US markets will remain attractive.
• 80% of Cerner’s clients are hosted.
• The first Cerner product to move to AWS will be HealthIntent in the first half of 2020.

Reader Comments

From Daddy Shark: “Re: health system CIOs. We just had a deal killed off by an overly aggressive CIO who I think just wanted to flex their power over the medical staff.” Here’s why CIOs and IT governance committees reject user requests for new software, just like parents often say “no new puppy” to their pleading / demanding children even if they promise to take care of it:

• It’s not in the IT budget. It doesn’t matter that the requesting department “has the money” as they always say – if IT is underfunded and departments have budget surpluses that allow them to make their own IT decisions, then the C-level people aren’t looking at IT strategy and costs correctly.
• Nobody has analyzed how much money and resources the project will consume over a 10-year useful life.
• The product is technologically risky, hard to support, or requires hard-to-find expertise.
• The vendor’s expertise or likely survival is questionable, the proposed contract terms and conditions are unacceptable, or the company has a reputation for under-delivering after the contract is signed.
• The software requires other departments that weren’t involved in the decision to do more work or spend more money.
• The user department has stars in their eyes from a vendor-provided, unrealistic vision of post-implementation bliss, forgetting that their department is resistant to changing processes, has failed to successfully manage previous projects, doesn’t optimally use the systems they already have, or are unlikely to be able to juggle the demands of a new implementation with routine departmental operations.

From Bob: “Re: old LP album. Found this in my mom’s collection. Health IT vendors used to commission albums of smooth background piano music.” Wow, that’s cool. The 1985 album, distributed by then-health IT vendor McDonnell Douglas Physician Systems Company, features space pop composer and pianist Charles Albertine, who died the following year at 57. Copies are available on Amazon and Ebay, but you can stream the whole thing on YouTube. It’s pretty good for what it is.

From Impending Doom: “Re: racial bias in AI. How is that even possible?” It’s the data or the process used to interpret it that is biased. AI simply creates a model that describes the data humans give it, so any bias that is implicit in the data or the process that created it will be faithfully replicated by AI. It’s the job of humans to fully understand the characteristics and limitations of available data before applying AI inappropriately. It’s also the job of AI scientists to watch for bias and to understand how the machine has reached its conclusions, which isn’t easy given the “impenetrable black box” nature of some AI / ML projects, especially the proprietary ones. I hope the technology companies that are pushing AI realize that their clinically focused products won’t get much traction unless they are willing and able to articulate how their algorithm works under the covers, since those who are using it are placing their professional licenses at risk.

From Racing for the Cure: “Re: breast cancer awareness. Lots of pink this time of year.” Working for health systems has jaded me to the gulf between individual human empathy and the corporate interests embedded within every aspect of healthcare, but I’ll at least acknowledge that good people are trying to show their support while having fun. Still, I can’t forget that a lot of companies and people wouldn’t be wallowing in cash if it weren’t for exceptionalistic Americans who think we just need to fight harder and give big corporations more money so we can rule the world and triumph over our own mortality.

HIStalk Announcements and Requests

Poll respondents place KLAS just head of “none of the above” for offering the most meaningful industry award. Next was the HIMSS Davies Award and it got ugly fast, with the HIT 100 (I don’t recall exactly what that is since I copied it over from a years-ago poll I ran) finishing dead last at 0.65%. The list was little changed from mid-2017, including the same top two finishers and the same last-placer.

New poll to your right or here: what are your HIMSS20 plans? I run this every year right about now, trying to get a general handle on how conference attendance is looking.

I finally decided to do something about the drawer full of memory cards that span many years and digital cameras. Solution: a 2-terabyte, USB 3.0 Western Digital Easystore portable hard drive that is nearly as fast as a flash drive and requires only the USB connection with no power cord. I just plugged it in and started copying 25,000 photos from an old Windows 8 laptop that was the temporary home of a bunch of these cards from a similar project that I abandoned previously. I hadn’t done the space calculation in my head, so I was surprised that the space consumed was barely a blip of the 2 terabytes. The next step is to move photos into individual folders for each month and year and then copy over the individual memory cards as I try to decide how to handle duplicate files, which with this much cheap storage may mean that I don’t even try to de-duplicate. I paid $59.99 on sale and shipping was free. The drive includes some seemingly well-designed backup software that I don’t need. The old memory cards will provide a backup since their capacity and speed make them obsolete.

Webinars

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

Acquisitions, Funding, Business, and Stock

Vocera announces Q3 results: revenue up 6%, adjusted EPS $0.23 vs. $0.20.

Canada-based mobile healthcare system VitalHub acquires startup Oculys Health Informatics, which offers a hospital operations dashboard, for $4.2 million.

I notice that NantHealth shares are trading at $0.75, down an eye-popping 96% since the company’s splashy mid-2016 IPO and valuing the company at just $83 million. Related company NantKwest shares are at $1.19, down 97% from their IPO-day spike in July 2015. I also noticed that NantHealth’s 10-member executive team is all male except for the VP of human resources, while six of seven executives of NantKwest are male.

CNBC profiles Heal, which offers on-demand doctor house calls for $159 in nine cities. The company has raised $75 million from backers that include former Florida Governor Jeb Bush and singer Lionel Richie. I’m always fascinated by companies that pay professionals X but bill them out at multiples of X while adding what seems like minimal value.

Sales

• Beaumont Health will implement Mobile Heartbeat’s MH-Cure clinical communications platform in a partnership agreement that includes GE Healthcare.
• Children’s National Research Network will expand its implementation of the TriNetX global health research network to Children’s National Hospital (DC).

Decisions

• Huron Regional Medical Center (SD) will replace CPSI Evident with Cerner in 2020.
• Centra Southside Community Hospital (PA) will replace Omnicell automated dispensing machines with Cerner RxStation.
• Advocate South Suburban Hospital (IL) will implement Epic’s Beaker laboratory information system in November 2019, replacing Sunquest.
• Christus Good Shepherd Medical Center – Longview (TX) will replace Meditech with Cerner in 2020. CORRECTION: Definitive Healthcare rechecked with the client and verified that a reader’s report is correct – Christus is moving to Epic, not Cerner.

These provider-reported updates are supplied by Definitive Healthcare, which offers a free trial of its powerful intelligence on hospitals, physicians, and healthcare providers.

People

Cone Health (NC) promotes Ben Patel, MS, MBA to EVP/CIO.

Lisa Maki (PokitDok) joins Microsoft as GM of health alliance formation.

Other

A hospital in China goes live on blockchain-powered patient billing, in which patients can pay their QR-coded bill using the WeChat app. 

This is depressing. A high school volleyball team’s bake sale raises $1,650 to help Santa Ynez Valley Cottage Hospital (CA) buy a 3D mammography system. Clinical benefit to patients is questionable, but the financial benefit to the hospital is a sure thing. Also depressing is that according to tax filings, the donation would cover about three hours of pay for Cottage Health’s CEO. I wonder how many parents of these kids could afford a visit to the hospital’s ED with a volleyball-caused sprain?

Sponsor Updates

• StayWell partners with the California Department of Human Resources to sponsor 7,695 meals for the California Association of Food Banks.
• Glytec will exhibit at Becker’s CEO + CFO Roundtable November 11-12 in Chicago.
• A UCLA study finds that use of Healthwise’s shared decision-making tools in primary care clinics increased the participation of prediabetic patients in diabetes prevention programs.
• Netsmart and Vocera will exhibit at the LeadingAge Annual Meeting and Expo October 27-30 in San Diego.
• Mobile Heartbeat will exhibit at SC HIMSS November 1 in Columbia.
• Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the Maternal Health & Perinatal Safety Symposium November 1 Tenafly, NJ.
• PracticeSuite selects Relatient to power patient reminders, intake, surveys, secure messaging, and self-scheduling for 57,000 medical professionals.
• T-System and Wellsoft will exhibit at the 2019 ACEP19 Scientific Assembly October 27-30 in Denver.
• Over 100 top US health systems attend the 2019 Strata Decision Technology Summit to help bend healthcare’s cost curve.

Blog Posts

• Maximizing the Value of Integrated Test Automation Scripts (Santa Rosa Consulting)
• Why Treating Depression Under PDPM is More Important Than Ever (Netsmart)
• Integrating Breast Cancer Detection with Value-Based Care: An Interview with Lightbeam’s Jessica Scruton (Lightbeam Health Solutions)
• Hospital Billing Practices are Under a Microscope and Providers are Responding to the Public and Political Scrutiny (Loyale Healthcare)
• When the Promise of Prehabilitation Meets the Power of Healthcare Analytics (Health Catalyst)
• 5 Technology Trends for Physical Therapy Practices (MWTherapy)
• Blockchain for the Future of the Healthcare Enterprise (NextGate)
• Are you ready for the Medicare Beneficiary Identifier? (Experian Health)
• What Does Medical Crowdfunding Mean for Patient Financial Responsibility? (PatientBond)
• Measuring Patient Engagement with … PEAs? (Patientco)
• How to Build Outcome-Based Partnerships? Start with Communication (Prepared Health)
• Can shadow IT work in healthcare? (Redox)
• 2019 Market Pulse Survey: If Time is Money, Then Identity Pays (SailPoint)
• Maximizing the Value of Integrated Test Automation Scripts (Santa Rosa Consulting)
• Surescripts is Helping Independent Pharmacists Spend More Time with Patients – and Less Time with Paperwork. (Surescripts)
• A HIPAA Risk Assessment is a Learning Experience (WebPT)
• ZeOmega Experts Join HHS-CODE Roundtable on Social Determinants of Health (ZeOmega)
• Gold Key Interventions Provide Road Map for Improving Quality Outcomes (Zynx Health)

Contacts

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

Weekender 10/25/19

Weekly News Recap

• Cerner’s Q3 revenue and earnings meet Wall Street expectations.
• Amazon will use the symptom checker and triage chatbox of just-acquired Health Navigator in its virtual clinic pilot.
• KLAS emphasizes physician EHR training to improve satisfaction.
• Viz.ai will use a new $50 million investment to expand the availability of its AI-powered stroke detection software.
• Recruitment and consulting firm Ettain Group acquires Leidos Health.
• Cleveland Clinic will expand its relationship with American Well to include a new digital health company, The Clinic, that will offer patients access to Cleveland Clinic providers through American Well’s technology.
• Cerner acquires healthcare security-focused government IT contractor AbleVets.
• England’s NHS gives Google access to five years’ of patient data from several hospitals despite the privacy concerns of critics.
• Google hires former National Coordinator Karen DeSalvo, MD, MPH (Dell Medical School) to the newly created position of chief health officer.

Best Reader Comments

I’m boycotting HIMSS. Not interested in attending when the keynotes get less and less relevant or even offensive. (Garrnut)

Re: 3D mammograms. I’ve also heard that more “stuff” shows up on 3D imaging, requiring more follow ups and six-month instead of one-year cycles, adding even more to the bottom line than the $50 bump in the initial fee. (Bob)

Discerning the financial health of an IT vendor in healthcare doesn’t require AI nor Machine Learning algorithms. Basic common sense is all that’s needed. The more cryptic the language, the more creative language used by executives to describe basic economics and forecasts , the more you know you’re listening to BS. It’s all in the numbers. (El Jefe)

Ancestryhealth. Interesting. People won’t willingly share a Social Ssecurity number with anyone, yet will gladly send off DNA to organizations who have no obligation to tell you exactly who / what they’re sharing with their partners. “You are not the customer, you are the product” – Pernille Tranberg. (ellemennopee)

Watercooler Talk Tidbits

Researchers find that an Optum-developed population health management algorithm introduced racial bias in ranking healthy white patients the same as sicker black patients. They found that adjusting the algorithm to predict the number of chronic illnesses a patient will likely experience in a year – rather than the cost of treating those illnesses – reduced the racial disparity by 84%, emphasizing the importance of understanding the data that was used to train the algorithm.

The Iowa Hospital Association fires its VP of communications for his criticism of the governor’s healthcare track record on Facebook, which he he claimed was supposed to be funny as it was “kind of in a Donald Trump language, kind of an over-the-top, hyberbole thing” that went wrong when a “small but powerful” group of hospital association members objected.

Investigation of patient abuse allegations at Laguna Honda Hospital yields 130 pieces of privacy-compromising evidence from photos and videos shared by six employees who have since been fired.

A National Academy of Medicine report finds that half of the country’s doctors and nurses are experiencing significant symptoms of burnout that increase patient risk, malpractice claims, absenteeism, and turnover at a cost of billions. They conclude that clinicians are bearing the brunt of a dysfunctional healthcare system that forces them to work long hours, mires them in bureaucratic record-keeping, keeps them worried about malpractice lawsuits, and forces them to work around a lack of resources. A co-author observes that laws are turned into regulations that are made into policies that take the most conservative path for legal protection, such as requiring clinicians to log in several times each day because of privacy concerns.  They also note that hospitals force doctors to complete long checklists full of often-irrelevant items so they can bill the maximum amount.

The Washington Post reports that President Trump will nominate MD Anderson radiation oncologist and chief medical executive Stephen Hahn, MD as FDA commissioner.

New York Jets guard Kelechi Osemele, apparently worried that his employer doubts his claims of a shoulder injury because they’re fining him for not showing up for practice, posts his doctor’s surgery recommendation to his Instagram.

In Case You Missed It

• News 10/25/19
• EPtalk by Dr. Jayne 10/24/19
• News 10/23/19
• Curbside Consult with Dr. Jayne 10/21/19
• Monday Morning Update 10/21/19

Get Involved

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

Morning Headlines 10/25/19

Cerner Reports Third Quarter 2019 Results

Cerner reports Q3 results: revenue up 7%, adjusted EPS $0.66 vs. $0.63, meeting analyst expectations for both.

Northwell Health launches LabFly in Manhattan, Queens, first health system app to facilitate blood draws at home or work

Northwell Health works with health IT vendor MphRx to develop an app that lets patients schedule blood draws from their home or office.

Ransomware and data breaches linked to uptick in fatal heart attacks

A study finds that mortality rates among heart attack patients increase at hospitals that have experienced a data breach, with as many as 36 additional deaths per 10,000 heart attacks occurring annually at the hundreds of hospitals studied.

Augmedix Announces Additional $19 Million in Series B Funding

Tech-enabled remote documentation company Augmedix raises $19 million in a funding round that brings its total raised to $82 million.

News 10/25/19

Top News

Cerner reports Q3 results: revenue up 7%, adjusted EPS $0.66 vs. $0.63, meeting analyst expectations for both.

The company issued mixed Q4 guidance.

Cerner shares dropped a few percentage points in after-hours trading following the earnings announcement.

Reader Comments

From AZ: “Re: Care Innovations, the Intel and GE joint venture. Heard they are in trouble and almost closed their doors a couple of months ago.” Unverified. The joint venture, formed in 2011 if I recall correctly, hasn’t had much to say beyond touting a remote patient monitoring system.

Webinars

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

Acquisitions, Funding, Business, and Stock

NextGen Healthcare reports Q2 results: revenue up 3%. adjusted EPS $0.24 vs. $0.24, beating earnings estimates but falling short on revenue.

InterSystems will expand its work with partners in China after seeing revenue there increasing 18-20% annually as that country’s economy grows and its healthcare sector undergoes digital transformation. 

Viz.ai will use a new $50 million Series B investment to expand the availability of its AI-powered stroke detection software.

Amazon will offer newly acquired Health Navigator’s symptom-checker and triage chatbot service to its employees as part of its Amazon Cares virtual clinic pilot. Health Navigator founder and CEO David Thompson, MD is also know for his co-development of a set of globally-used telephone triage protocols.

Belgium-based digital imaging company Agfa is reportedly accepting bids for its health IT business. The company announced its intent to divest the enterprise imaging and integrated care business in 2017.

People

Pivot Point Consulting (The Christ Hospital Health Network) names Mauraan Schultz VP of delivery.

TriCore Reference Laboratories gives CIO James Brown the additional role of CEO of its Rhodes Group LIS and consulting subsidiary.

Announcements and Implementations

Northwell Health works with health IT vendor MphRx to develop an app that lets patients schedule blood draws from their home or office. The LabFly app comes with a $20 convenience fee and adds payment processing, lab-tech tracking, and access to lab results.

Verily will work with the VA health system in Palo Alto, CA and Atrius Health in Massachusetts on population health projects that will focus on improving care and outcomes for patients undergoing knee replacements, going through alcohol withdrawal, and recovering from heart attacks.

Nordic completes its move to a new Madison, WI office, doubling its square footage to 50,000 and giving employees views of the University of Wisconsin Arboretum through 12-foot-tall windows. 

Strata Decision Technology announces StrataJazz OnePlan, an advanced planning platform that streamlines budgeting and planning.

A new KLAS survey of 30,000 physicians via its Arch Collaborative finds that while physicians in some specialties (hospital medicine, pathology, pediatrics) are more satisfied with their EHR than others (plastic surgery, cardiology, orthopedics), it is not consistent and may be driven more by the quality of their initial training. Still, physicians in some specialties say the EHR is too bulky for their limited needs, while others report its inability to accept their drawings or images. More Epic-using specialists say they have the functionality they need vs. Cerner users, but users of both products report deficiencies in their ophthalmology and dermatology capabilities. The report concludes that the quality of initial training, availability of follow-up training, and assistance with personalization can improve satisfaction across all specialties. It would be interesting to see how physician personality type, age, and employment status drove the individual specialty scores.

Government and Politics

The HHS Office for Civil Rights fines Jackson Health (FL) $2 million for a three-year string of HIPAA violations related to losing paper records, failing to notify authorities in a timely manner about the loss, staff improperly accessing patient medical records and then posting PHI on social media, and a separate incident in which an employee attempted to sell PHI, among other privacy failures. Jackson Health is the same organization linked to an ESPN reporter’s posting of NFL player Jason Pierre-Paul’s medical chart on Twitter, with the report that he had blown off his finger with fireworks on July 4, 2015 derailing his $60 million contract negotiations with the New York Giants.

Texas Health Resources reports that 82,000 people have been impacted by a billing system error that led to it accidentally mail patient information to the wrong recipients.

Privacy and Security

A Health Services Research study finds that mortality rates among heart attack patients increase at hospitals that have experienced a data breach, with as many as 36 additional deaths per 10,000 heart attacks occurring annually at the hundreds of hospitals studied. The study’s authors found that it took an extra 2.7 minutes for a patient to receive an ECG at a hospital that had experienced a breach, with the lag time remaining as high as 2 minutes up to four years after the hack. Though the researchers didn’t analyze what, if any, additional cybersecurity controls were installed at the hospitals, they have surmised that increased software log-in and access times at these facilities have had a direct impact on heart attack mortality rates.

Other

An AP article questions the role stethoscopes have left to play in healthcare in light of their higher-tech counterparts. The advent of app-based, handheld devices that use ultrasound and artificial intelligence seem to slowly be edging out the traditional instrument invented by French physician Rene Laennec in 1816. While celebrity MDs like Eric Topol consider it to be obsolete, others working in the trenches of daily care have yet to be fully swayed by shiny new objects that come with considerably higher price tags.

And speaking of Eric Topol, he responds to Time’s latest cover story on the robot-ization of healthcare.

Sponsor Updates

• Glytec becomes the third largest corporate fundraiser for the American Diabetes Association’s Step Out Walk to Stop Diabetes – Boston.
• Healthcare Growth Partners advises hospital laboratory consulting firm Accumen during its acquisition of 3DR Laboratories.
• EClinicalWorks will exhibit at the 2019 AAP National Conference & Exhibition October 25-29 in New Orleans.
• Ensocare will exhibit at the ACMA Oregon Chapter Annual Conference October 26 in Welches, OR.
• The Tampa Bay Business Journal names Greenway Health Senior Director of Organizational Effectiveness and Transformation Kirsten Schreiter a 2019 People First honoree.
• Hayes Management Consulting will exhibit at the HCCA Clinical Practice Compliance Conference October 25-27 in Nashville.
• KLAS Research ranks InterSystems among the top interoperability vendors of 2019.
• Kyruus and Prepared Health will exhibit at the HLTH Conference October 27-30 in Las Vegas.
• Redox publishes the results of its “Mobile Health Survey.”
• ZeOmega names five healthcare leaders to its Advisory Board.
• Pivot Point Consulting names Joe Clemons (Vancouver Clinic) director of advisory services.
• Spok publishes a new e-book, “Contact centers in healthcare.”
• Meditech publishes a new case study, “Physicians at Halifax Health Go Mobile with Meditech Expanse.”
• Optimum Healthcare IT publishes a white paper titled “ERP System Selection – Evaluating Options and Building Consensus.”

Blog Posts

• Overnight Transformations are Possible! (EClinicalWorks)
• Hunterdon Healthcare teams work more easily and securely using Chrome Enterprise and G Suite (Google Cloud)
• FDA Scrutinizing Predictive Analytics Software (HBI Solutions)
• Leading Thoughts: What Will You Be Famous For? (HCTec)
• Is Your EHR on Citrix Ready for the Workday? (Goliath Technologies)
• 4 Quick Tips to Achieving Prescription Renewal Protocol Consensus (Healthfinch)
• Connecting people by connecting systems (Hyland)
• PwC Study: Data Analytics Critical for Advancing Social Determinants of Health Efforts for Payers (Imat Solutions)
• Improve Your Coaching Skills by Listening and Learning (Impact Advisors)
• Pause to Consider: Vulnerability Threat Management (Fortified Health Security)
• How to Build Outcome-Based Partnerships? Start with Communication (Prepared Health)

Contacts

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

EPtalk by Dr. Jayne 10/24/19

I enjoy mentoring students and I am always excited when one of them is admitted to medical school. There is a lot of buzz around the schools that are offering free tuition or that are subsidizing a large amount of tuition, but most people in medicine don’t realize the financial barriers that occur upstream.

My student has to pay a $1,500 deposit in the next two weeks. Although he’s working full time in our office as a clinical tech, that’s a hefty amount of money after he’s already paid for the application process, travel and lodging for interviews, the MCAT exam, test preparation, and of course an undergraduate degree.

This is a timely topic that was recently covered in the New England Journal of Medicine. The article looked beyond the shocking costs to explore how they impact the types of people that apply. Not surprisingly, few applicants come from lower-income households and minorities continue to be underrepresented in the applicant pool.

Some schools are trying to reduce application costs by having students host applicants. Other programs may reduce the cost of the MCAT and applications or offer guaranteed admissions for students at a certain level of performance at affiliated undergraduate institutions. Schools are starting to look at virtual interviews as a way of lowering costs. It’s been suggested that schools should revisit their supplemental “secondary application” processes as a way of increasing the diversity of the applicant pool while reducing the cost burden.

All of us would benefit from a more diverse physician workforce, rather than having a full quarter of applicants coming from households with greater than $250,000 in annual income as the current statistics demonstrate. Still, it illustrates the pressures that clinicians have already been under before they ever enter practice. For those of us that look closely at clinician burnout, these are contributing factors that have already raised the stress game for those who haven’t even begun to stress around government regulations or burdensome technology.

Score one for AI. A recent study by researchers in NYU School of Medicine shows that an AI tool that uses machine learning can identify breast cancer with 90% accuracy. The tool was trained on over a million images and 14 radiologists reviewing 720 images were included in the study. The tool was able to identify “pixel-level changes” in breast tissue, but radiologists were able to use logical reasoning that the AI could not. The authors conclude that AI can augment radiologists.

It remains to be seen whether this can be extrapolated to other data sets and whether it can be brought into clinical practice, but for those of us in high-risk situations, such AI augmentation is welcome. I don’t personally read mammograms, but for those of us in age brackets where eyeglasses start appearing in our pockets, it’s a nice idea to have a set of extra “digital eyes” on radiology images.

I missed this a couple of weeks ago, but apparently Senator Rand Paul has introduced a bill to overturn what he considers the “dangerous provision” of legislation allowing the US to institute a unique patient identifier. He claims his physician creds make him an expert. Clearly he’s not an informaticist and has never had to disentangle the merged records of premature twin siblings Andrea and Andre, that were combined due to a faulty matching algorithm. He cites breaches as another reason. I’m pretty sure most data breaches that would reveal a universal patient ID would also reveal name, address, DOB, phone number, and often SSN, which are the current keys to your data.

Jenn clued me in on this article answering the question of, “What’s the best shoe for the busy physician?” Physicians were surveyed with 255 responses received, including 172 men and 81 women. The idea that shoe choice is important was nearly unanimous, with 40% expressing a fondness for casual shoes or loafers, 29% choosing dress shoes or heels, 20% wearing sneakers, and 11% wearing clogs or similar.

I was initially surprised to see that more younger physicians are choosing dress shoes since that demographic is often accused of being overly casual. However, it would make sense as they have less overall mileage on their feet compared to the rest of us.

According to the article, physicians suffer from flat feet, plantar fasciitis, pain, and bunions. Physicians are sometimes self-conscious about their shoes. One of my mentees started wearing what she considers “ugly” shoes because she had too many patient comments about her “cute” shoes and felt patients weren’t taking her seriously because of her choice of footwear. My personal favorite shoe, pictured above, is the Medimex Plogs line. They’re vented for breathability, have massaging nubs on the footbed, and are also autoclavable, perfect for whatever might be on the floor of a medical environment.

Speaking of people having opinions on how people dress, I was unsurprised to see this report about women at Ernst & Young being coached on how to dress. Even if a fraction of the allegations in the piece are true, it’s a fairly horrifying read. Unfortunately, I continue to see companies who have different expectations for employees based on sex and/or gender, and also those that have no idea what to do with non-binary employees.

I have been in a position where two executives debated another’s competence while making comments about her lack of artificial hair coloring, including comments on how “all that gray makes her look old.” From that conversation, I learned that apparently men with gray hair are distinguished, but women who go natural look old.

I worked for another client that required female employees to wear at least a two-inch heel and skirts, with no slacks allowed. They didn’t last long on my roster. I’ve seen assertive women labeled as “shrill” when their male counterparts are revered as “go-getters” in the last several months, regardless of publicity around discrimination and lack of equity or parity.

I recently attended a retreat hosted at a facility owned by a traditionally male-dominated company that had a large number of female participants. The company has made many public statements about its deliberate actions to increase female participation and empowerment. Interestingly, a visit to the newly created female showers at the athletic facility revealed a urinal in one of the two stalls. At least they created some individual showers rather than the group / open showers I had heard were in the male locker room area, but it’s hard to believe that organizations still think that group showers are OK for anyone in this day and age, regardless of whether they’re separated by sex or gender.

All the restrooms were clearly marked male or female, with no availability of non-gendered, family-friendly, or separate accommodations for those who might need additional assistance even though the facility is open to families. Nothing rolls out the not-so-welcome mat like inadequate restroom facilities, so I wouldn’t be surprised if they continue to encounter challenges in recruiting women or people outside their historical demographic.

Does your company have a corporate dress policy? Is it equitable regardless of sex or gender? What do you think about the current climate? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 10/24/19

AVIA Raises $22 Million in New Funding Round to Propel Service Expansion

Digital health innovation network and consulting firm Avia raises $22 million in a funding round led by First Trust Capital Partners.

Viz.ai Raises $50 Million Series B Round to Bring AI Powered Synchronized Stroke Care to More Patients

Viz.ai will use a new $50 million investment to expand the availability of its AI-powered, stroke-detection software.

DXC Technology Increases Presence in Conway Creating a Global Center of Excellence in Medicaid Services and Adding 1,200 Tech Jobs

IT and consulting services company DXC Technology will bring 1,200 new jobs to its facility in Conway, AR.

Amazon acquires start-up Health Navigator, its first health-related purchase since PillPack

Amazon will offer newly acquired Health Navigator’s symptom-checker and triage chatbot service to its employees as part of its Amazon Cares virtual clinic pilot.

Morning Headlines 10/23/19

Leading Talent Solutions Provider ettain group Acquires Global Employment Solutions and Leidos’s Commercial EHR Consulting Business

Recruitment and consulting firm Ettain Group acquires Leidos Health, announced in parallel with Ettain parent company NMS Capital’s sale of its Ettain stake to A&M Capital.

Medicomp Systems Secures Patent for its Method of Displaying Clinically Relevant Information Within Physician Workflows

USPTO awards Medicomp Systems a patent for its Quippe platform technology that identifies and filters relevant clinical data for presentation to clinicians at the point of care.

Clinical Trial Technology Startup SignalPath Announces Successful Close of $18M Series B Funding Round

Clinical trials platform vendor SignalPath raises $18 million in a Series B funding round.

Agfa Gevaert expects multiple bids for healthcare IT unit: sources

Reuters reports that digital imaging company Agfa has begun accepting bids for its health IT business.