Curbside Consult with Dr. Jayne 11/25/19

Clinician burnout continues to be a hot topic, so this American Academy of Family Physicians article caught my eye. It looks at the possibility that being able to better address the social needs of patients might reduce the possibility of burnout. I’m not surprised by this – physicians and other clinicians are trained to do their best to address all their patients’ issues, whether they are purely biological, psychosocial, or somewhere in between.

In many residency programs, we have all kinds of ancillary providers that help us do these things. My training program had PhD pharmacists, social workers, diabetic educators, dieticians, and psychologists to which we could refer our patients for a variety of services. Need a patient to receive education on anticoagulant drugs, their long-term monitoring, and the need for dietary changes? Check. Want to enroll a patient in smoking cessation clinic? Check. Newly diabetic patient who needs supplies and training? You got it. Patient who needs help navigating Medicaid enrollment or applying for supplemental nutrition assistance? Done.

When I headed out into practice, however, I was on my own to try to deliver many of these services. Even referring to subspecialists often became a battle that was made worse depending on the patient’s insurance coverage, ultimately resulting in the patient not receiving needed services.

At one point in time early in my career, only one of the city’s practices was taking new neurology patients who had Medicaid, which made the wait to see a consultant nearly a year long. This led to primary care physicians trying to do what they could to manage complex neurological issues that they weren’t trained to handle. You don’t have to ponder to hard to see where that could cause stress and burnout.

Not much has changed in the last couple of decades, although at times it’s a little easier to get patients in to see subspecialists, or maybe I’ve just built up enough friendships to be able to call in more favors. There are other more complex issues that we can’t solve through a phone call to a friend or classmate. Maybe it’s housing issues, transportation issues, or food insecurity. These are the types of issues that the study mentioned was looking at, along with whether inability to address patients’ social needs was a contributing factor to primary care clinician burnout. The authors went on to note that increasing services in the practice to address social needs tended to reduce burnout and improve clinician morale.

The study noted that participating physicians were concerned about how addressing social needs would impact their workflow. I’m curious about how those physicians went about adding services or training staff to address social needs and how that impacted not only the workflow, but the practice bottom line. Theoretically, some of the new care models, such as Comprehensive Primary Care Plus or Primary Care First, should provide additional funds to cover these additional services. However, it’s still not going to be enough.

A friend’s EHR has the ability to link out to transportation resources for patients, such as Uber. However, the practice has to pay for the transportation, leading to an ongoing internal conflict about which patients should receive those services. Independent physicians can make these decisions locally, but employed physicians are often subject to the whims of their owners, and productivity and case mix determines which physicians (and therefore patients) receive additional support and which don’t.

On the technology side of healthcare, we face similar difficult decisions. We have limited budgets and requests for more projects than we could possibly fund or staff. At one of my large health system clients, decisions often impact broad swaths of patients. Are we going to focus on systems to improve labor and delivery workflows this year, or fund the initiatives that the heart failure program has requested? How many patients would benefit from either approach? What about the community diabetes screening initiative, or the dental care mobile van? Should we look just at patient count, or go further to see how interventions would impact people over time?

At one point, money earmarked for optimization of frontline nursing workflows was diverted to cover consulting services needed to complete a required regulatory upgrade. This led to a relative revolt by some of the staff involved in advocating for projects that didn’t get the nod.

The emotions felt by some of the IT staff were no different than what was probably felt by the physicians in the study. In particular, those whose projects weren’t taken forward felt disenfranchised and often had a profound sense of loss. Some of those whose projects succeeded had something akin to survivor’s guilt as they watched other worthy initiatives wither. It also engendered a sense of fear and concern, with people wondering whether their project would be the next one to be defunded or otherwise not fully implemented. Sure, projects get canceled in every industry, but I think my colleagues in healthcare IT feel it more acutely because they know their work has the direct ability to impact patients’ lives.

The emotions become even more acute when you are working for organizations that are sitting on billions of dollars of resources, but may not be spending as much on patient care as they should. The marble lobby of the tertiary referral hospital is particularly luxurious (and the fountain is pretty darned impressive), but neither of those see patients. They don’t make up for the negative emotions felt by the clinical staff that empties the exam room trash cans every other day because the housekeeping budget was cut and services are only provided on even days. The luxury boxes at the ballpark and the over-the-top billboards are also a visible reminder of the money the health system is willing to spend on non-patient-care activities.

As the old adage goes, you have to spend money to make money, but somehow that spending is becoming less palatable when healthcare is on the line and patients are literally dying due to lack of basic interventions.

It’s easy to see why people in healthcare are burned out, no matter where you work or what your role is. Our inability to meet our patients’ needs is only a proximal cause, with many root causes beneath. I’m cautiously optimistic about new models of care that might help alleviate suffering or reduce gaps in care, but it may take years to determine how successful they really are. In the meantime, we need to support each other and continue to try to come up with innovative ideas to solve some of the most difficult problems humanity faces.

What would make you feel less burned out? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 11/25/19

110 Nursing Homes Cut Off from Health Records in Ransomware Attack

Nursing home IT vendor Virtual Care Provider is hit by ransomware, taking down electronic patient records, Internet service, email, billing, and phone systems across 80,000 PCs and servers running hundreds of nursing homes in 45 states.

Google-linked fund seeds Berkeley medical AI startup

Google’s venture fund invests $4 million in radiology workflow optimization software company Rad AI.

Hospital Computer Firm Insists – We Did Our Job

Allscripts defends its work on an $18 million software implementation in the Bahamas that has resulted in no applications live after three years and $8 million in payments.

USDA Invests in the Expansion of Rural Education and Health Care Access

The USDA announces $42.5 million in grants for 133 distance learning and telemedicine projects in 37 states and two territories.

Monday Morning Update 11/25/19

Top News

Wisconsin-based nursing home IT vendor Virtual Care Provider, Inc. is hit by ransomware, taking down electronic patient records, Internet service, email, billing, and phone systems across 80,000 PCs and servers running hundreds of nursing homes in 45 states.

The hacker is demanding $14 million to provide the encryption key, which the company says it can’t afford.

VCPI says some of its client facilities may be forced to shut down due to their inability to order drugs, generate bills, and pay employees.

Ironically, VCPI sells IT security and HIPAA risk analysis services.

HIStalk Announcements and Requests

Over 80% of poll respondents think that Ascension’s data analysis agreement with Google is legal, but two-thirds also think the relationship is unethical.

New poll to your right or here: Have you ever been laid off or otherwise lost a job other than for performance issues? Click the poll’s Comments link after voting to share your experience.

I regularly worry that my 2.5-year-old, inexpensive Acer laptop will fail and leave me without a backup other than my Chromebook, which works great but doesn’t run some niche Windows apps that I need. I’ve been watching for a deal on something similar and saw a pre-Black Friday offer on an HP Pavilion 15z with AMD Ryzen 5, 16 GB of memory, 256 GB SSD storage, and a 15.6” touch display. I wanted 16 GB (which isn’t as common or cheap as it was a couple of years ago for some reason) and SSD since I’ve become spoiled by both, so my $480 order is in. I’ll report back after it arrives early next month.

Webinars

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

Acquisitions, Funding, Business, and Stock

Google’s venture fund provides $4 million in seed funding to Rad AI, a radiology workflow optimization software company that was started in 2018 by a radiologist who entered medical school at 16 and now practices in North Carolina.

Sales

• SCL Health will offer virtual services using Bright.md’s SmartExam asynchronous virtual care platform.
• Steward Health Care chooses Health Catalyst’s Data Operating System and Rapid Response Analytics. 
• Humber River Hospital chooses CloudWave to support Meditech and its infrastructure.

People

Cooper University Health Care promotes interim CIO Dustin Hufford, MBA to SVP/CIO

Government and Politics

The VA says that it hasn’t worked out jurisdictional issues with the Department of Defense over patient information that will be stored in their respective Cerner systems, admitting that nobody really thought about data sharing issues when the projects were conceived. Existing laws may require veterans to make separate requests to the VA and DoD to obtain their health records despite the goal of a single record for each patient. The VA also acknowledges that its March go-live at Mann-Grandstaff VA Medical Center (WA) will involve a limited implementation that will require employees to toggle between Cerner and VistA. 

Privacy and Security

Medical researchers observe that European Union’s General Data Protection Regulation has caused problems for their studies that cross national borders outside the EU. NIH Director Francis Collins says his study of diabetics in Finland ground to a halt when NIH could not meet the privacy requirements of its national equivalent in Finland. Neither the US nor Canada are recognized by the European Union as providing adequate data protection, so researchers must sign contracts to accept Europe-based audits or to cede legal jurisdiction to the originating country’s courts. GDPR isn’t an issue when patient information is anonymized, but countries haven’t agreed on how that anonymization can be performed and some studies include sample data that cannot be stripped of identifying characteristics.

Other

Bloomberg notes that Inovalon Chairman and CEO Keith Dunleavy, MD is a billionaire once again following a 60% run-up in the analytics platform vendor’s stock price in the past year. Timing is everything, though — the company went public in early 2015 at $27 per share and is down 36% since, while the Nasdaq rose 74% in the same period.

Allscripts defends its work on an $18 million software implementation in the Bahamas that has resulted in no applications live after three years and $8 million in payments. The company responded to a newspaper’s request for comment that it is in full compliance with the contract and is waiting on approval from the government, which says it is looking for a replacement system. Allscripts misidentified its client in the response as the “Public Housing Authority” rather than the “Public Hospitals Authority.”

Medical residents in South Korea complain that while their weekly work hours are newly capped at 80, they are seeing more patients without much help from specialists in learning new procedures. They also claim that hospitals shut off after-hours EHR access to make it look like they are complying with the hours cap, but give them other work to perform instead.

In Australia, a government review of misused private data looks at Queensland Health’s Cerner IEMR, which allows employees and staff at any of its 14 hospitals to view the records of all patients. The government worries that the hospitals don’t fully understand how to configure the system’s privacy controls, such as flagging high-profile records to warn users that any inappropriate access will be investigated. However, one hospital’s HR director says its P2Sentinel access monitoring system issues reports that aren’t that useful, leading to a huge backlog of potential inappropriate viewing incidents that the hospital doesn’t have time to investigate. 

Two Colorado state agencies announce that a bug in their tracking system allowed several batches of contaminated medical and recreational marijuana to be sold, triggering a recall of such products as Ghost Cake Killah and Grape Ape.

Sponsor Updates

• Chilmark Research highlights Bright.md in its new report, “Primary Care for the 21st Century: Technology-enabled and On Demand.”
• Greenway Health’s Intergy EHR receives five industry accolades in 2019.
• Nextech Systems gives its customers access to Relatient’s patient self-scheduling, automated waitlist, and patient intake capabilities.
• The Chartis Group announces the winners of The Chartis Center for Rural Health 2019 Performance Leadership Awards.
• Hyland Healthcare’s Advisory Councils share insight into top health IT trends including AI, cloud, and optimization.
• LiveProcess will exhibit at the National Healthcare Coalition Preparedness Conference December 2-4 in Houston.
• Gartner recognizes NextGate as a ‘Notable Next-Generation EMPI Vendor.’
• Nordic staff volunteer at The River Food Pantry and donate gifts for 65 local children.
• KLAS Research recognizes PatientPing as a high-performing, emerging healthcare IT company.
• SailPoint will exhibit at AWS re:Invent December 2-6 in Las Vegas.
• Visage Imaging will exhibit at RSNA December 1-5 in Chicago.
• Wolters Kluwer Health publishes a new report, “Mending Healthcare in America 2020: Consumers & Cost.”

Blog Posts

• Diabetes Awareness Month (Lightbeam Health Solutions)
• Medicare’s Price Transparency Rules Alone Don’t Deliver What Patients Need – a Patient-First Approach Does (Loyale Healthcare)
• The future of health IT at CHIME19 (Meditech)
• Five Practical Steps Toward Healthcare Data Governance (Health Catalyst)
• 5 Ways to Measure the Value of Clinical Mobility (Mobile Heartbeat)
• 2020 Hot Topics for Private Physical Therapy Practices (MWTherapy)
• Data Analytics: What Post-Acute Providers Need to Know (Netsmart)
• What’s driving cyber crime in life sciences? (OpenText)
• Will Automation Eliminate Administrative Healthcare Jobs? (Recondo Technology)
• 3 Priorities Impacting the Healthcare IT Workforce (and how Healthcare IT Staffing provides a valuable answer) (CereCore)
• Is your patient access department ready for flu season? (Experian Health)
• How to Encourage Patients to Seek Additional Healthcare Services (PatientBond)
• Simplifying Care Team Assignment Management Means Real Results (PatientSafe Solutions)
• Giving Thanks: Healthcare Payment Processing Edition (Patientco)
• Know on the Go: VP, Revenue Cycle Services, Keith Olenik’s Top 5 Recommendations for Clinical Documentation Improvement (CDI). (Pivot Point Consulting)
• Scrambling to Complete Tedious, Manual Projects Before Year End? Robotic Process Automation Really is All It’s Cracked Up to Be! (Summit Healthcare)
• 50 Days and Counting: Take These Necessary Steps to Meet EPCS Requirements (Surescripts)
• Clean, Actionable Data Critical Success Factor for Population Health (Philips)

Contacts

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

Weekender 11/22/19

Weekly News Recap

• The American Medical Association calls for EHRs to be fully inclusive for transgender patients and expresses its support for government funding to improve public health technology, including EHR integration.
• Government officials in Bahamas scramble to dodge blame for signing an $18 million contract with Allscripts in 2016 that was supposed to transform healthcare, but has yet to result in any installed software.
• HHS expands its price transparency plans by proposing that both hospitals and insurers be required to publicly post their negotiated contract prices.
• The Spokane VA hospital hires more than 100 new employees to cover its expected productivity losses during its Cerner go-live in March.
• Kareo sells its revenue cycle management business.
• Stanford Hospital opens its $2.1 billion, 368-bed hospital that incorporates extensive technology.

Best Reader Comments

Epic did a big enhancement a year or two ago to replace their single “sex” field with an entirely new series of fields to capture sexual orientation, gender identity, sex assigned at birth, legal sex, preferred name, preferred pronoun, etc. It was a big change for healthcare organizations to start using the functionality, but it was the right thing to do. (Anon)

Changing the behavior of core demographic information (like name and sex) is going to be a big task. It’s not a quick and easy update, but being treated with respect (by being called by your real name) from your doctor can help an already at-risk population better engage with their healthcare providers. There are additional benefits to having this be a thing the entire industry focuses on. If your EHR can handles this gracefully but your EKG system doesn’t, then you end up with unnecessary added complexity both on the IT side and on the clinician side. The AMA of course has no teeth on this, but it emphatically is something the industry should be working towards. (TH)

I have learned and I hope some of your readers will learn that you are only as good as the last day you have completed on the job and this can happen at any moment. Tomorrow’s employment is not a promise, unless you have a contract. Layoff, RIF, firing, termination… whatever you call it, the outcome is the same. I would add that career management requires constant networking, having your resume and Linked In account up to date, trusting your intuition – meaning that if if feels or looks like it is going to hit the fan, it probably is and what are YOU doing about that. (Justa CIO)

[The informatics team needs to focus on] the lifecycle of and alert intervention to ensure that the intervention remains current and clinically relevant. This is often lacking in some systems, from my experience, as it is a significant organizational commitment to do this effectively. It require having clinical ownership of the CDS intervention, so it necessitates having clinical subject matter experts and/or a medical literature review process engaged in maintenance in an ongoing fashion. (Luis Saldana)

Seeing that the fine for not being transparent with data is $300 per day, or $109,500 per year, I suspect most organizations will just eat the cost instead of paying for the additional labor that would be required to be in compliance. Or, just look for a way to increase productivity through say, an extra 10 or so MRIs per year. (MoMoney MoProblems)

Read the Mayo Clinic article on usability. Saw that microwave ovens were better, so decided to try it in clinic. It took a while to find enough extension cords, but I managed to set up my 1200-watt Amana microwave on a rolling cart and got ready to see patients. Turns out, it was very easy! I just basically kept hitting the “Add 30 Seconds” button throughout the encounter (it’s the only button I’ve ever used on it). At the end of the encounter, I got a satisfying DING! I can’t believe how much easier it was than my EHR. Amana really gets human factors! Not like those programmers at the EHR companies, with their code and data and functionality. Good riddance, I say! (Andy Spooner)

Watercooler Talk Tidbits

Magee Women’s Hospital (PA) escorts a man whose wife was delivering their baby off its premises, struggling with how to deal with the fact that he is also a registered sex offender. The man is prohibited from having unsupervised visits with his other two children and had alerted hospital security of his conviction before he took his wife to the hospital. The hospital security department offered to escort him to his wife’s room the next day, but he declined, fearing that he would be arrested.

In Indonesia, several motorcycle taxi drivers storm a hospital that had refused to release the body of a deceased six-month-old boy to his family because of his unpaid bill, preventing the Islam requirement of a quick burial. They left with the body, but the hospital director explained afterward that the charges had already been waived, triggering the apology of one of the drivers involved in the “humanitarian mission” who now hopes to “restore the good name of the hospital” because he didn’t know the procedure and thought it was taking too long.

A co-founder of Firefox creator Mozilla develops Brave, a privacy-first browser that blocks the recording of browser history, offers its own password manager, and blocks all ads by default in favor of offering an optional private ad platform that allows users to “tip” their favorite sites. It claims to be three to six times faster than Chrome and Firefox. I tried it on HIStalk and the load time was the same as with Chrome.

The newest faculty member at the Uniformed Services University of the Health Sciences is two years old. Shetland, a Navy lieutenant commander and clinical instructor, is a highly trained military service and therapy dog. Shetland’s job is to accustom students to the therapy dogs they will encounter in clinics, hospitals, and in veterans with PTSD so they can choose them wisely for their patients. 

In Case You Missed It

• News 11/22/19
• EPtalk by Dr. Jayne 11/21/19
• News 11/20/19
• Curbside Consult with Dr. Jayne 11/18/19
• Monday Morning Update 11/18/19

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 11/22/19

Modernize public health surveillance to ease doctors’ reporting burden

The American Medical Association adopts a policy that calls for increased state and local funding to modernize public health IT systems.

VA insists it’s ready for initial EHR deployment at first go-live site in March

The Mann-Grandstaff VA Medical Center in Spokane, WA is hiring 108 more employees to cover anticipated productivity losses during its Cerner go-live on March 28.

Tools to help healthcare providers deliver better care

Google Health lead David Feinberg, MD attempts to clarify the company’s HIPAA-compliant work with Ascension, pointing out that the health system is piloting an interface concept he first mentioned at the HLTH Conference last month.

News 11/22/19

Top News

The American Medical Association adopts a policy that calls for increased state and local funding to modernize public health IT systems. AMA also wants provider EHRs to be capable of automatically sending reportable conditions to public health agencies.

AMA is also encouraging state governments to engage state and national medical specialty societies and public health agencies when considering new mandatory disease reporting requirements.

Reader Comments

From Fatted Calf: “Re: layoffs. Your list of the steps people go through after being laid off should have included advice.” That wasn’t the reader’s question that I was answering via my reality check, but here you go:

1. Don’t be ashamed at being laid off and don’t try to hide the fact that you are involuntarily seeking employment. Layoffs are a failure of executives and only they should feel shame. Develop a one-sentence description of why you no longer work there (general cutbacks, product sunsetted or sold, etc.) and practice succinctly answering the question, “Why did you leave?” because it will be asked often.
2. Set your alarm to get up early every day, dress in real clothes, keep a calendar, make calls, exercise, and treat every day like a workday whose goal is to find a new job. Lack of time is no longer an excuse.
3. Spend a day debriefing yourself in writing. What did you like and dislike about your job and employer? What did you and they do wrong? What good and bad job decisions did you make?The only point of this is to get that crap out of your head so you can move on to more productive pursuits than moping around and second-guessing. It’s amazing sometimes how committing something to writing frees up brain storage and mental CPU cycles.
4. Don’t badmouth your previous employer. You stayed in your rut until the choice wasn’t yours, so there’s no virtue in complaining only afterward how bad it was.
5. Take several days to plan your ideal career and who might hire you to practice it. You have the opportunity, no matter how unwelcome, to change your preconceived notions about yourself and the niche into which your former employer placed you.
6. Polish your LinkedIn, adding your job’s end date, changing your title for “seeking a new opportunity,” and make sure your “About” section is punchy and reflects your abilities. Please don’t use stuffy third-party wording, aka the Godcam view of yourself, such as “Seasoned health system manager” – make it personal, direct, and memorable (and include a decent headshot that isn’t cropped from a phone photo from your last beach trip). Then create one-page, one-sided resume that gets to the point with the most important information listed first. Hiring managers don’t care too much about your personal statements and they already know that you’ll provide references on request. Unless you’re applying for a low-level job, you won’t get hired via an application or resume anyway, with incompetent corporate HR departments being one big reason, so make calls and get out of the house instead of staring at your laptop trying to use IT skills alone to get hired.
7. Attend a local conference such as a HIMSS chapter if you aren’t willing to relocate or a national conference if you are. Those can be target-rich environments for job searches, or at worst, for learning about how the world revolves outside your former company. I also got a couple of good jobs working with a recruiter who I vetted pretty carefully, so while not everyone’s experience is positive, it worked for me.
8. Decide if you are willing to move under any circumstances. If not, then your job search and networking activities will look different than if you’re willing to relocate.
9. Increase your visibility with LinkedIn articles, tweets, or anything else that could catch a potential employer’s eye, assuming that your insight and writing ability match your job expectations.
10. Reach out to everybody you know via email or LinkedIn messaging and keep a worksheet of who you contacted and when. Use the six degrees of separation power of LinkedIn to figure out who might hire you and the email searching ability of Google to get that person’s work email address so you can introduce yourself. You only need to hit one home run to forget the swings and misses.

From RansomwareHitsHome: “Re: Casamba LLC. A ransomware attacked has forced some agencies that use its software back to paper records and forms.” The California-based post-acute care EHR vendor hasn’t publicly acknowledged the attack, but this update was provided by one of its customers.

From FlyOnTheWall: “Re: Allscripts layoffs. The highest number I heard was greater than 350, but I’ll stand on my 125-150 let go until I find out more. They are in publicity damage control.” Unverified. I checked WARN notices for Illinois and Pennsylvania for the last several months and didn’t see any Allscripts entries, but WARN applies only to office closures and mass layoffs since they’re intended for giving the state rather than the employees a heads-up.

HIStalk Announcements and Requests

A reader approves of my activation of two-factor authentication to secure my Gmail accounts, but warns that the SMS-based verification option is not secure. He has first-hand experience – he lost $4,000 within minutes of someone using a SIM port hack to steal his cell phone number, which then allowed the hacker to reset the passwords for Gmail, banking, Twitter, etc. I took his advice and switched the authentication method to Google Authenticator, a free app that – like those flashing hardware dongles in the old days – generates authentication codes every few seconds. It’s like SMS messaging, except you open the phone or tablet app to get the current code and the mobile device doesn’t even need to be online at the time (unlike the SMS option). I had a few false starts in trying to figure out how to link the app to multiple email accounts from multiple mobile devices, but I finally figured it out by Googling. Another option is Google Prompt, which allows you to simply touch a phone pop-up acknowledging that it’s really you logging in on the other device, but it only works when the Gmail app is open and I don’t use it.

Webinars

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

People

Jon McAnnis (Providence Health Plans) joins Zoom+Care as CIO.

Regenstrief Institute promotes Indiana University School of Medicine professor Shaun Grannis, MD to VP of data and analytics.

Nick White (Deloitte) joins Orbita as EVP of patient care solutions.

OurHealth promotes Brian Norris, RN, MBA to EVP of population health.

Announcements and Implementations

Orbita announces GA of OrbitaAssist, a bedside virtual health assistant designed to complement nurse call systems. Back-end software routes patient requests to the appropriate member of the care team, while front-end AI assures the patient their request is being fulfilled.

Datica will debut its new cloud compliance technology, including end-to-end cloud managed services, in early December.

Imprivata announces OneSign 7.0, which adds single sign-on for web based applications.

Government and Politics

Kaiser Health News publishes a retrospective look at stalled federal efforts to ensure the safety of EHRs. Ideas have included developing a database to track reports of deaths and injuries related to health IT and establishing an EHR safety center, neither of which have come to fruition due to funding and oversight issues. The issue gets even thornier thanks to a 21st Century Cures Act clause that prohibits the FDA from getting involved. Medical informaticist Dean Sittig, PhD says, “There wasn’t a lot of interest [at ONC] in talking about things that could go wrong. They gave out $36 billion. It’s hard for them to say EHRs aren’t safe.”

The Mann-Grandstaff VA Medical Center in Spokane, WA is hiring 108 more employees to cover anticipated productivity losses during its Cerner go-live on March 28. VA officials insist they are on track to meet that deadline, but will have no qualms about pushing it back should patient safety become an issue.

Privacy and Security

Google Health lead David Feinberg, MD attempts to clarify the company’s HIPAA-compliant work with Ascension, pointing out that the health system is piloting an interface concept he first mentioned at the HLTH Conference last month.

In the wake of Google’s Fitbit acquisition and health data trust debacle with Ascension, Wired offers step-by-step instructions on how to manage the privacy settings of popular health apps like Fitbit, Apple Health, and Google Fit. Some consumers have become so wary of Google and its plans for their health data that they have abandoned their Fitbits. One concerned user explained, “I’m not only afraid of what they can do with the data currently, but what they can do with it once their AI advances in 10 or 20 years.”

Other

A hospital in Bangalore, India will use its patient data to map areas where pothole-related injuries send up to four cyclists each day to its ED.

Kaiser Permanente will name its new medical school after former CEO Bernard Tyson, who passed away earlier this month. The school will open next summer in Pasadena, CA and will offer free tuition to its first five graduating classes.

A former marketing SVP of Novant Health sues the health system for reverse discrimination, claiming that as a white male, he was fired as part of a corporate diversity push and was replaced with two minority hires. David Duvall, MBA, MPH says that at least five other white male executives, including the CIO, were terminated and replaced almost immediately with “either a racial minority and/or female.” He was let go right before his five-year anniversary, when his termination would have entitled him to 18 months of base pay, 1.5 times his previous bonus, $200,000 in retirement benefits, and company-paid health insurance.

Digital health investor, consultant, and author Terri Mead critiques her second annual visit as a participant in Verily’s Project Baseline Health, a four-year study announced in 2017 that aims to create a database of the sequenced genomes of 10,000 volunteers. Study participants like Mead also agree to wear activity trackers that share their sleep patterns, activity, heart rate, and other health metrics with Verily researchers. Her criticisms:

• The “archaic” use of Google Forms to capture patient intake data.
• The risk of inconsistent and unreliable data thanks to manual data entry that does not use drop-downs that are tied to medical terminology.
• The study expressed no interest in her “female parts,” which left her assuming that they consider females “a standard deviation away from males.”
• Lack of follow up on patient adherence to use of wearables, some of which she stopped using months before.
• Abandonment of lung/breathing tests due to budget issues.

Sponsor Updates

• AMIA inducts Intelligent Medical Objects VP of Customer Experience Steven Rube, MD and VP of Clinical Informatics Eric Rose, MD into its 2020 class of fellows.
• Optimum Healthcare IT publishes a new case study, “Cerner Millenium Implementation at Ellis Medicine.”
• The Chartis Group publishes a new paper, “Being a Digital Health System: It’s No Longer a Question of If or When.”
• Pivot Point Consulting releases the first episode of its new Get to the Point podcast, “Flexibility vs. Interoperability. Can Clinical Documentation Do Both?”
• Imprivata updates its OneSign authentication and access software to offer users seamless cloud-based access from any device.

Blog Posts

• How Choosing the Right EHR Helped Our Practice (EClinicalWorks)
• How Google Cloud helps prepare the military’s medical professionals to serve around the globe (Google Cloud)
• The Value of Health Education: Improving Engagement for Members with Diabetes (Healthwise)
• Broadening radiology’s medical imaging horizons (Hyland)
• Optimizing Revenue Cycle Processes: The Technology Factor (Impact Advisors)
• 5 Ways to Measure the Value of Clinical Mobility (Mobile Heartbeat)
• Can Predictive Analytics Cut Patient Care Costs? (Definitive Healthcare)

Contacts

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

EPtalk by Dr. Jayne 11/21/19

I wrote a few weeks ago about my adventures with flu vaccines and how the charges are handled by my insurance. Kaiser Health News dug into the phenomenon this week, going farther in noting the differences in costs among one payer’s own employees. The payments ranged from $32 in Washington, DC to $85 in Sacramento.

This illustrates the results of negotiations between payers and providers, the madness of which leads to the need for entire segments of the healthcare IT industry to keep up with it. Anyone who has worked with practice management or revenue cycle systems has experienced the phenomenon and the layers of code needed to wrangle it, and I salute you. It remains to be seen whether the government will be successful in forcing providers and payers to disclose this information publicly. Efforts to do so will likely be in the courts for some time.

I’ve been doing some behind-the-scenes work on clinical guidelines, and recently tried to track down data on a drug that is supposed to be available as a generic that we couldn’t find. The Wall Street Journal made note of the problem this week as well, observing that multiple factors keep those drugs from making their way into patients’ hands. It’s a disappointing phenomenon, but an interesting read.

In other drug news, a serious outbreak in pigs is likely to cause a shortage of the critically necessary blood-thinning drug heparin. African swine fever is on the march, killing nearly 25% of the world’s pig population, particularly in China, where the majority of heparin is produced. The World Health Organization is recommending that governments stockpile heparin, so be on the lookout for extra alerts and clinical decision support needs in EHRs.

Mr. H already reported on the AMA’s call for inclusive EHRs for transgender patients, but I want to throw in my two cents. Several years ago, I worked on some focus groups with a vendor who was trying to get this done. It can be complex, because there are many variables to document, including legal status, legal name, preferred name, surgical status, hormonal status, anatomical status, genetic status, etc. The vendor was focused and had several physician advocates who would continually explain to business analysts and developers why this was important. They ultimately they got the job done.

I’ve heard rumblings from other sources that this is a big lift for a small number of patients. But without the ability to document key clinical data and use it at the point of care, it results in a subpopulation being treated differently and in ways that might actually be counter to good clinical care.

The AMA also adopted a policy to promote education on health issues related to sexual orientation and gender identity for medical students and residents. I didn’t know much about the transgender population until medical school, where I had a professor who was public about their transition. It was a tremendous opportunity for learning and understanding and made a great impact on me, ultimately leading to me having a good number of transgender patients in my practice. I’m fully supportive of efforts to make EHRs inclusive for everyone, whether it’s based on differences in gender, age, race, ethnicity, or any other characteristic that may influence health. To be the most effective, we need to be able to meet our patients “where they are” and this is one way to work towards that goal.

Measure-palooza: The American Heart Association (AHA) and the American College of Cardiology (ACC) have released updated Clinical Performance and Quality Measures for adult patients with hypertension. The new report includes 22 new measures and expands focus from blood pressure measurement to care delivery systems and approaches. Their goal is to look beyond individual provider performance.

That’s great in theory, but it’s not how most other clinical quality measures programs work. It may also add workflows to EHRs, resulting in poor usability that will be blamed on the EHR rather than an explosion of guidelines and measures. There are also mismatches in the quality numbers used by AHA/ACC, CMS, and the National Committee for Quality Assurance. I’m sure EHR requirements writers are wringing their hands at this point. The report also includes a focus on digital health, including remote monitoring for hypertensive patients.

Maybe the EHR isn’t so bad: A recent study conducted at the University of Pennsylvania Health System showed an increase in orders for certain cancer screening tests when a “nudge” alerted users from the EHR. The alerts were targeted to medical assistants who created the orders for licensed clinicians to review and hopefully discuss with their patients. Despite the increased orders, there were not significant changes in the number of patients who completed the recommended screenings within a year-long time frame.

I recently worked with a practice that raffled off a big-screen television to patients who completed home colorectal cancer screening kits within a specified time frame. I’m not sure how legal it was, but it was certainly effective at motivating patients to submit a sample.

Kudos to the clinical informatics team at Oregon Health & Sciences University, who recently implemented a drug pricing comparison tool within Epic. It factors in data points such as co-pays, deductibles, and the need for prior authorization. The information has been available to dispensing pharmacists for a long time, but moving it to the point of care is key. It doesn’t matter how effective a drug is when it’s never going to be taken because the patient can’t afford it.

My clinical practice offers cash-only prescriptions at the point of care, which simplifies things for patients who know what their co-pays are (most of our drugs are either $15 or $30). However, many of our patients have no idea what their co-pay might be and are unable to make an informed decision. Having a tool like this at the bedside would be a benefit for the rare cases when we have to prescribe more costly drugs.

Flu season is getting well underway, particularly in the South. My practice is running low on vaccine and expects to be out by the end of the month. If you’re thinking about getting vaccinated but haven’t done it yet, time is of the essence. Three children have already died this season. If you still have plenty of vaccine, maybe an outreach campaign using those expensive population health tools is a good idea.

Email Dr. Jayne.

Morning Headlines 11/21/19

XSOLIS Announces Acquisition of MEDarchon

Nashville-based predictive analytics company Xsolis acquires Medarchon, a messaging and analytics business also based in Nashville, for an undisclosed sum.

Kaiser Permanente’s new medical school to be named after late CEO Bernard Tyson

Kaiser Permanente will name its new medical school, scheduled to open next summer, after late CEO Bernard Tyson.

Mount Sinai Announces Expanded Capability in Medical Research

Mount Sinai Health System (NY) will use a $2 million grant from HHS to double the computing capabilities and speed of its BODE supercomputer, giving researchers enhanced infrastructure for faster results.

Morning Headlines 11/20/19

AMA adopts new policies during first day of voting at Interim Meeting

The American Medical Association adopts a policy that calls for EHRs to be able to collect the preferred name and clinically relevant, sex-specific anatomy of transgender patients.

Kareo Sells Managed Billing Services Business

Health Prime International acquires EHR and practice management vendor Kareo’s RCM services business.

Senator: ‘No Apologies’ For Deal’s Wasted $7m

Government officials in the Bahamas scramble to undo the damage done by an $18 million contract signed with Allscripts in 2016 that has yet to result in any software installations.

Governor Cooper Announces 400 New Jobs in Chapel Hill for Healthcare Technology Operations Center

A week after announcing a $25 million funding round, employee healthcare engagement company Well announces it will bring 400 jobs to a new operations center in Chapel Hill, NC.

News 11/20/19

Top News

The American Medical Association adopts a policy that calls for EHRs to be able to collect the preferred name and clinically relevant, sex-specific anatomy of transgender patients.

AMA’s policy aligns with recommendations that medical documentation contain the patient’s preferred name, gender identity, pronoun preference, and history of medical transition history as well as current anatomy.

Reader Comments

From Creative Juice: “Re: being laid off. I’m thinking about suing. Advice?” Don’t bother. Allow me to list the steps you’ll go through after being laid off, ending with the distant speck of light at the end of the unemployment tunnel:

1. You will experience the ultimate humiliation in coming home early to notify your family that you are no longer employed, threatening your identity in ways you could not have imagined. 
2. For a couple of days after being marched out, you’ll embrace false hope that your former employer will call to explain it was all a big mistake or that they want you to come back in a different role.
3. You will expect an uprising from customers that will never happen, or expect those customers with whom you worked closely to call you cold with job offers, which will also never happen.
4. You will commiserate with former co-workers who also got the axe, convening depressing lunches and not-so-happy hours where the conversation gets louder and faster as you try to convince each other that the company or your former boss will fail without you, which they won’t. 
5. Most of your “work friends” will disappear from your life permanently because (a) they weren’t really your friends, they just shared employer space with you, and (b) nobody wants to hang around former colleagues who were marched out and who are now seeking comforting scuttlebutt about how bad things are at work.
6. You will consider legal action, which is pointless. Even if you are legally right (and you aren’t), it would take years to arrive at a resolution that will not include hiring you back. Not to mention that employment lawyers want their money upfront (they know you won’t win) and it doesn’t really matter anyway because you signed away your right to sue as a condition of receiving severance.
7. You will belatedly update your resume and think about overdue networking as the reality sets in that your income stream is ending. The grim reality of signing up for unemployment will cause endless anguish because you don’t see yourself as one of those pathetic people.
8. Initially you will apply for no positions because of the indignity of the hiring process, then later you will apply for every job in sight because of the indignity of being unemployed.
9. You will struggle with the idea that many of the seemingly good jobs are located in far-away areas where you don’t want to live, requiring uprooting the family with new schools for the kids and a new job for your working spouse (if you have either). You will also rage at the Catch-22 fact that you might get more money later if you move, but you need money now to move.
10. You will eventually find some kind of job, either (a) a short-term one or even a contracting gig that will help pay some bills while you keep looking, or (b) one that is better than your previous one. Then you will rejoice that your incompetent former employer kicked you out of their sorry nest. I’m not one to offer unjustified cheerleading – if you are competent and willing to work, your lot will improve, and if not, then I don’t blame your previous employer for booting you.

From Oingo Bongo: “Re: Allscripts. Heard from a contact that there’s been another round of Paragon staff. Got any info on that?” The company laid people off last week, and while I haven’t heard anything specifically regarding Paragon, I can’t imagine that’s a growth area. Also relevantly not growing is MDRX share price, down 12% in the past year vs. the Nasdaq’s 22% gain.

HIStalk Announcements and Requests

Reader AC made a great suggestion to turn on two-factor authentication for Gmail and other important services that don’t enable it by default, following my story about a hospital employee stealing co-worker logins using a keylogger program. I did it and it was painless. Gmail prompted me to enter a one-time verification code that it sent via SMS message, which it does each time I log in from a new device. Once I did that, it’s business as usual with no further verification unless I (or someone else) logs in from a different device. That means a hacker who has obtained my login credentials still can’t hijack my email account. An extra feature – you can ask Gmail to generate a bank of one-time codes to use when you won’t have your phone. Thanks for that advice. I can’t even imagine the headache and security exposure that would be involved with someone gaining full access to my email account, including all the personal and confidential information it contains.

Listening: the first, eponymous album by The Doors from 1967’s Summer of Love. “The Crystal Ship” alone is worth the ride. Mr. Mojo Risin’ had just turned 23 when the album came out, the beginning of his four-year term as the country’s most dangerous and reckless poet, musician, and performance artist until the unfortunate intersection of drugs and bathwater sent him to “The End” (as it did Whitney Houston and Dolores O’Riordan of the Cranberries). I’m also enjoying new from singer-songwriter JP Saxe, who I think is probably going to be pretty big.

Webinars

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

Sales

• Mary Free Bed Rehabilitation Hospital (MI) will implement Epic in an $8 million, 10-year Community Connect agreement with Covenant HealthCare.
• Cooper University Health Care chooses Phynd for provider management.
• Novant Health will implement KenSci’s AI platform to match workforce demand to capacity and to identify patients who are at risk for longer stays or readmission.
• Visiting Nurse Service of New York selects Netsmart CareManager for care coordination, data reporting, and analytics support for its population health management programs.

People

Ryan Miller (Anthem) joins Change Healthcare as SVP of corporate development.

Medical practice software and services vendor IKS Health hires Kelly Reed, DO (The Iowa Clinic) as SVP of clinical services and outcomes.

Announcements and Implementations

Collective Medical will add HIE CCD data to its care team platform, connected by Kno2.

Virtusa will add EHR data to its VLife life sciences platform from the InterSystems IRIS for Health interoperability solution .

Privacy and Security

National Veterinary Associates, which owns 700 veterinary hospitals and boarding facilities, is struggling to recover from an October 27 ransomware attack that affected 400 of its locations. The company declined to answer questions about the malware or whether it paid a ransom.

Other

American healthcare in a nutshell: the manufacturers of heart stents assure their investors that a widely praised study that proved the less-than-expected value of such procedures won’t hurt their business much. Translation: hospitals, doctors, and device manufacturers aren’t about to let medical evidence get in the way of their profits, meaning your odds of being stented won’t change just because we now know that it doesn’t work any better than a prescription. Meanwhile, a cardiologist whose research helped develop a new drug for a rare type of heart failure criticizes the manufacturer for setting the price of the capsule at $225,000 per year versus the estimated cost-effective price of $17,000.

A Bahamas senator says he “makes no apologies” for his involvement with the 2016 signing of an $18 million contract with Allscripts and Infor that was supposed to transform healthcare there, even through the Public Hospital Authority warned Allscripts in late 2018 that it wasn’t happy that the company hadn’t installed any software anywhere despite having been paid $7 million. The local newspaper speculates that the government will give Allscripts a 60-day cure notice, then terminate the contract with expectation of a full refund. The government blames Allscripts in “a glaring lack of oversight” for “a staggering increase in implementation costs” beyond agreed-on amounts, with consulting firm Avaap billing the government $1.5 million. The paper also notes that the Allscripts proposal was stamped as received 11 days after the tender’s closing, which had already been extended by 14 days. The country’s minister of health declares the project “a bust.”

A free clinic in Syracuse, NY closes after 12 years when the part-time founding doctor found that she was spending more time maintaining its EHR than seeing patients.

Johns Hopkins Bloomberg School of Public Health profiles Assistant Professor Smisha Agarwal, MPH, MBA, PhD in its magazine, which describes her as “the school’s first faculty for digital health” in a sharp contrast between investor-crazed US digital health and public-focused health projects overseas. Snips:

• She says we don’t know how to integrate digital tools with health system, we don’t know if they are cost effective, and we need to be careful not to amplify existing healthcare inequities, such as improving health only in urban areas or for those people who own a mobile phone.
• She hopes mobile clinical decision support tools can help shift caregivers away from triaging low-severity illnesses and providing preventive services, data from which could then be used to apply machine learning algorithms to predict poor outcomes for intervention.
• She says that a downside of digital health is opportunity cost, where resources are moved from established programs to experimental digital programs.
• She worries about gender inequity in countries where the men are the primary phone owners and the effect on needed pregnancy and newborn care.
• She sees the biggest transformational opportunities for digital health being putting real-time data in front of caregivers, using analytics to target high-risk patients, assisting providers who have limited training with education or remote assistance, and counting births and newborn deaths.

Sponsor Updates

• Avaya announces the availability of Google Cloud contact center AI integration with its IX Contact Center solutions.
• Netsmart takes the top spot for the fifth year in a row for customer satisfaction in Black Book Market Research’s annual look at the post-acute health technology market.
• Dimensional Insight will exhibit at the New England HIMSS Maine Conference November 21 in Portland.
• EClinicalWorks posts a podcast titled “Telluride Medical Center: On the Primary Care Frontier.”
• Collective Medical partners with Kno2 to add enhanced clinical data capabilities including continuity of care documents to its clinical insights and analytics software for HIEs.
• Virtusa enhances the health data integration capabilities of its VLife life sciences platform with the integration of the InterSystems IRIS for Health Data technology.
• Woman’s Hospital (LA) will expand its use of Spok solutions.
• Vocera will resell Spectralink Versity smartphones, which has been certified for use with its clinical communication and workflow system.
• Optimum Healthcare IT completes Epic go-lives at several hospitals under Deaconess Health System’s CareConnect program.
• A five-year study finds that a health literacy incentive program using health education content from Healthwise lowered healthcare costs.

Blog Posts

• Watch: How to pick the right tablet and accessories for your hospital (Access)
• Making Telemedicine Seamless (AdvancedMD)
• Better. Faster. More efficient. At RSNA 2019, Agfa HealthCare showcases the latest release of its Enterprise Imaging platform powered by a smart workflow engine (Agfa Healthcare)
• How Improved Interoperability Can Help Healthcare AI Flourish (Apixio)
• Think Good Customer Experience is Obvious? Think Again. (Avaya)
• 4 ways to ensure your Epic system can facilitate timely (and quality) physician documentation (Bluetree)
• Who is HITRUST CSF Certified? (Datica)
• How Choosing the Right EHR Helped Our Practice (EClinicalWorks)
• Trending at the CHIME19 Fall CIO Forum: Humanizing Healthcare Technology (Burwood Group)
• Transitions of Care: The Biggest Challenge for Value-Based and Senior Care Efforts (Collective Medical)
• Be Yourself: Celebrating Individuality in a Big Way (CoverMyMeds)
• Looking into “The Future of HEDIS” (Diameter Health)

Contacts

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

Morning Headlines 11/19/19

Feds charge 3 former Outcome Health staffers

The US Attorney’s office in Chicago charges three former Outcome Health employees with wire fraud and conspiracy to commit wire fraud, all of which are related to a scheme to defraud customers and investors first uncovered in 2017.

Configo Health Launches with Investment from Texas Children’s Hospital and Children’s National Hospital

Pediatric data and analytics company Configo Health launches with an investment from Texas Children’s Hospital and Children’s National Hospital in Washington, DC.

Deloitte Launches ConvergeHEALTH Connect at Dreamforce 2019

Deloitte announces ConvergeHealth, a set of Salesforce-powered engagement products tailored to patients, providers, public health officials, and payers.

CascadeMD Announces Next Generation of Medical AI-Driven Speech-to-Text Solution

Plantation, FL-based CascadeMD debuts with AI-powered, voice-dictation software that populates a patient’s EHR.

Curbside Consult with Dr. Jayne 11/18/19

A former colleague of mine reached out recently, frustrated by a physician in his organization who is demanding that clinical decision support features in some applications be turned off. He was asking for tips to help counter the argument.

It turns out that the physician in question believes that if the application presents you with guidelines that you ignore, you are liable. Fortunately, it’s a pretty easy counterargument. If a guideline exists and you ignore it, regardless of whether it’s in your application, you are liable. In many cases, if a guideline exists and you don’t know about it but a physician would be reasonably expected to know about it, you are liable.

The whole point of clinical decision support is to bring those guidelines  — which you may or may not be familiar with or incorporating into your practice — to the point of care so you can react to them. Of course, this assumes that the clinical decision support in question is accurate and appropriate.

Since crossing into the realm of clinical informatics more than a decade ago, my clinical activities have been limited. This is partly by choice (realizing that I can’t do justice to the traditional primary care paradigm when practicing on a very limited schedule) and partly due to workforce economics. Unless you’re a physician administrator at an academic institution or your CMIO situation includes a specific carve-out for clinical care, it’s unlikely that someone wants to hire you to see patients one day a week.

Since the scope of my practice is relatively limited, one might think it would be easier to keep up with the knowledge base, but it’s still very challenging. I remember a couple of years ago when one widely-used antibiotic fell out of favor for a particular condition. It was a good six months before one of my go-to journals reviewed the primary article and another three months before I actually read it, meaning that I was prescribing a less-than effective medication for a good nine months before I knew any better. What if there could have been clinical decision support at the point of care, which would have alerted me to the fact that the antibiotic selected was no longer recommended for the diagnosis I had entered?

Conventional wisdom is that medical knowledge doubles approximately every eight years. Physicians graduate from medical school and are then trained in residency by physicians who might have been in practice anywhere between one and 60 years. One would expect great variability in those teaching physicians’ knowledge bases as well, which is another plus for clinical decision support.

There are a number of pros and cons around whether clinical decision support should be regulated and how that might impact shifting liability. Others voice concerns about whether this will lead to so-called cookbook medicine or encourage mental laziness among physicians. Regardless of the strength of decision support or whether it’s regulated, physicians still have a duty to determine whether the recommended course of care makes sense or if there are any concerns about the recommendations.

Physicians need to understand where the recommendations found in clinical decision support systems originate. Are they from well-known guideline producers, such as the US Preventive Services Task Force, the Centers for Disease Control and Prevention, the American Cancer Society, or the American College of Obstetricians and Gynecologists? Are they just automated and exposed guidelines that are doing simple checks against diagnosis codes, SNOMED codes, LOINC codes, and medication codes, or are they using artificial intelligence or machine learning?

Rand Corporation blogged about this issue way back in 2012, and the thoughts around it haven’t changed significantly. Straightforward clinical decision support, such as drug-drug interaction checking is great, but alerts have to be at the right level for a physician to highlight the most critical cases while preventing alert fatigue. Users who click through alerts without reading or digesting them will continue to be at risk for increased liability in the case of a poor outcome.

Oregon Health & Sciences University’s Clinical Informatics Wiki covers this issue as well. It notes that, “As long as 25 years ago it was realized that availability of computerized medical databases would likely erode the local or community standard of care.”

Changes to the community standard of care might not be a bad thing. Many of us believe patients should be treated the same whether they live in the city versus rural areas and regardless of differences in income or demographics. However, there have been pockets of the country where physicians were held to a different standard for a variety of reasons.

Take the PSA test for prostate cancer risk. At a time when the US Preventive Services Task Force was specifically recommending against testing (in part because of the number of false positive tests leading to unnecessary biopsies and other downstream consequences) my community performed them across the board because a leading urology researcher at a local academic institution drove expert opinion that they should be done. If you didn’t do a PSA and a patient turned out to have cancer, you were in for a bumpy ride.

OHSU notes correctly that state laws have lagged behind current technology and that the scope of the legal medical record varies from state to state. I’ve worked in organizations that swear that the final signed chart note in the EHR is the legal record, and others who said, “everything in the database is the legal record.” I’ve worked with attorneys going down SQL rabbit holes trying to figure out what a physician knew and when based on various timestamps, user IDs, and other metadata.

The wiki authors also note the need to better understand how clinical decision support systems influence clinician judgment and how their use might impact those who are “not adept at system-user interfaces.” They also note the relative lack of case law in the area, but go on to say that, “Physicians are likely to be held responsible for the appropriate use and application of clinical decision support systems and should have a working knowledge of the purpose, design, and decision rules of the specific decision support systems they use.”

For some EHRs and related systems, this is easier than others. I’ve seen systems where you can quickly drill down to the specific recommendations and understand why a flag was thrown. I’ve also seen systems where alerts don’t seem to make sense and searches of well-known physician resources fail to shed light on the subject (nor do simple Google searches, so a double dead end). The bottom line remains, however, that regardless of the volume of information out there, physicians are expected to know the answers and do the right thing for their patients.

How does your organization address liability for clinical decisions, whether human-created or prompted by technology? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 11/18/19

Trump Administration Announces Historic Price Transparency Requirements to Increase Competition and Lower Healthcare Costs for All Americans

HHS expands its previous plan to require hospitals to publicly post all of their payer-negotiated charges by also requiring insurers to do the same.

Relatient Secures Growth Capital with New Majority Investor Brighton Park Capital

Brighton Park Capital acquires a majority stake in patient engagement platform vendor Relatient and appoints former Siemens USA President Eric Spiegel as the company’s board chair.

Amazon adds new ‘Amazon Pharmacy’ branding to PillPack and promotes its CEO

PillPack CEO TJ Parker becomes an Amazon VP as the company rebrands the online pharmacy it acquired in June 2018.

Former Employee Of Hospital Charged With Compromising Dozens Of Coworkers’ Email Accounts And Stealing Their Confidential Information

The FBI arrests a former IT employee of an unnamed New York City hospital, charging him with installing a keylogger program on dozens of employee PCs to capture their email login credentials so he could steal their photos and tax records.

Monday Morning Update 11/18/19

Top News

HHS, as promised, expands its previous plan to require hospitals to publicly post all of their payer-negotiated charges by also requiring insurers to do the same.

Hospitals would also be required to post the cash payment they are willing to accept for 300 common, shoppable services.

The rule will take effect on January 1, 2021 in the imaginary world where no lawyers live (the American Hospital Association, Association of American Medical Colleges. Children’s Hospital Association, and Federation of American Hospitals immediately said they’re suing for HHS overstepping its bounds).

President Trump said in announcing his executive order:

First, we are finalizing a rule that will compel hospitals to publish prices publicly online for everyone to see and to compare. So you’re able to go online and compare all of the hospitals and the doctors and the prices, and, I assume, get résumés on doctors and see who you like. And the good doctors — like, I assume these two guys are fantastic doctors, otherwise you wouldn’t be here. (Laughter.) And the bad doctors, I guess they have to go and hide someplace. I don’t know. Maybe they don’t do so well, I don’t know. But if they’re not good, we — we are more interested in the good ones. It’s called rewarding talent.

Second, we’re putting forward a proposed rule to require health insurance providers to disclose their pricing information to consumers. We’re giving American families control of their healthcare decisions. And the freedom to choose that care is right before them on the Internet and elsewhere, but on the Internet. Very, very open. Very transparent. That’s why it’s called transparency.

Reader Comments

From Who Diss?: “Re: Who’s Who. This CIO was recognized as a ‘Top Medical Professional’ by a seedy-looking organization’s press release.” A variety of “who’s who” scammers contact people cold, preying on their vanity by advising them that they have been “chosen” by their admiring peers or the company’s editor to be included as a member in a paid online listing. After that, they are hit with the upsell to buy lifetime memberships or vanity crap like wall plaques and hardcopy books. You CIOs, pharmacists, doctors, and nurses who I see listed on this particular one’s site got taken, I’m sorry to tell you. Please don’t list this laughable accomplishment on your resume, which in some LinkedIn examples shares space with bogus educational credentials. Above is the company’s luxurious office suite in Valley Stream, NY, conveniently located above the dumpster in which visitors can pitch their “award” and possibly their careers right out the window.

From Gobsmacked Compliance Professional: “Re: SCL Health and Providence. I was having dinner adjacent to a restaurant’s ‘private’ dining room and was gobsmacked to overhear a detailed discussion about their plan to merge, including proposed timeline, financials, etc. Annual reports are due in December and will be interesting reading.” Unverified. SCL owns eight hospitals in Colorado, Kansas, and Montana that generate $2.5 billion in annual revenue. Providence operates 51 hospitals with annual revenue in the $23 billion range. Maybe this alleged privacy slip is yet another example of hospital people loudly saying things they shouldn’t within earshot of others.

From Register Ringing: “Re: HIMSS20. Look at this page of well over 1,000 things they’re trying to sell to exhibitors.” Vendors can whip out their checkbook to buy nearly every square inch of the convention center or to have HIMSS push their sales message to attendees, including:

• Sponsor pre- or post-conference supplements to “own the conversation” ($20,000).
• Pay HIMSSTV to record a panel discussion in their booth ($20,000).
• Get the impartial, hard-hitting journalists at Healthcare IT News to tweet out links to “one of your thought leadership content pieces” ($20,000, or $22,500 if you want them to just write the piece themselves).

HIStalk Announcements and Requests

Few poll respondents think the Allscripts-Northwell collaboration will result in a commercially successful EHR any time soon.

New poll to your right or here: How would you characterize Ascension’s data analysis agreement with Google? Click the poll’s Comments link after voting to explain.

Webinars

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

Acquisitions, Funding, Business, and Stock

Brighton Park Capital acquires a majority stake in patient engagement platform vendor Relatient and appoints former Siemens USA President Eric Spiegel as the company’s board chair.

Sales

• Amedisys will deploy NVoq’s cloud-based speech recognition solutions for dictation and automation.
• Thomas Health (WV) will add Meditech’s web-based Ambulatory solution to its Expanse system, implemented by CereCore.
• San Gorgonio Memorial Hospital chooses the Azure-hosted Sunrise Community Care from Allscripts. Googling suggests that they are replacing Allscripts Paragon.
• Beebe Healthcare (DE) will improve workflow efficiency and clinician communication using TransformativeMed’s EHR-embedded work management and notification modules to eliminate printed patient lists.

People

CereCore hires Joe Wurzer (Leidos Health) as RVP of sales and business development.

Privacy and Security

The FBI arrests a former IT employee of an unnamed New York City hospital, charging him with installing a keylogger program on dozens of employee PCs to capture their email login credentials so he could steal their photos and tax records. I was thinking that this sort of information shouldn’t have been stored on a work PC in the first place, but then realized that he probably grabbed their logins to Gmail or other web-based personal email services.

Other

The Washington Post covers “rural America’s busiest emergency room,” Avera Health’s telemedicine center in South Dakota that provides remote ED service for 15,000 emergencies each year covering 179 hospitals in 30 states “where the choice is increasingly to have a doctor on screen or no doctor at all.” Rural ED visits have increased 60% in the past 10 years, but hospitals are closing, doctors aren’t willing to move to small towns, and standalone EDs are going broke. One small hospital signed up at a cost of $70,000 per year after it received four critical automobile accident victims with just an single RN working, with no doctors available within an hour’s drive. Fun fact – the virtual service’s doctors wear scrubs and lab coats to their suburban office park location so they will look like real doctors to their TV patients. The virtual ED clinicians must work patiently with local nurses who may have no experience with intubating patients or who need help running a code blue. Avera ECare’s telemedicine network also offers services for ICU, school health, pharmacy, clinics, behavioral health, correctional health, and hospitalist coverage.

The Pittsfield, MA paper covers the $35 million implementation of Meditech Expanse by Berkshire Health Systems. The article focuses on the hospital’s problems with the Allscripts FollowMyHealth patient portal – the inability to share data, uncertainty over how the company might use its data for marketing, low usage in the 30-40% range, and patients who either can’t sign on to FollowMyHealth or who sign up directly with the service instead of through the hospital-provided link. The health system is a longstanding Meditech customer for inpatient and is apparently replacing Allscripts ambulatory with Meditech.

The Wall Street Journal profiles the technology underpinnings of the new $2.1 billion, 368-bed Stanford Hospital that opened this weekend. It was originally scheduled to be open in early 2018, but was delayed because Apple’s spaceship headquarters project sucked up all the Silicon Valley steelworkers. I was curious about Stanford’s financials, which show $4 billion in annual revenue, a profit of nearly $450 million, several executives in the $1-2 million range, and not-unreasonable IT compensation (the CMIO was paid $770K, while the CIO made $500K). Hospital features include:

• Bedside keypads that allow patients to choose entertainment and control temperature, lighting, and window blinds.
• Swisslog robotic dispensing for pharmacy and medication delivery by robots.
• A fleet of automated guided vehicles for delivering laundry and collecting trash.
• Tracking of staff an inventory in real time.
• Remote patient monitoring.

CIOs are expanding their use of “low-code” drag-and-drop automation tools such as Microsoft PowerApps to quickly create applications that automate business processes, which Gartner says will make up 65% of application development in the next five years. St. Luke’s University Health Network (PA) VP/CIO Chad Brisendine says his team has built 20 applications – none of which took more than 20 hours to create – to extract information from hospital systems. A non-programmer needed just eight hours to develop an app that extracts information from its Workday HR system to issue CME reminders to doctors. A Microsoft case study describes how Northwell Health used Dynamics 365 (and its Healthcare Accelerator) and PowerApps to develop a daily rounding app. I admit that the geek in me is aroused.

Several readers forwarded the full text of a just-published article that tried to correlate physician-perceived EHR usability with burnout, with the big conclusion being that EHRs “received a grade of F by physician users.” My critique:

• The sample size was just 870 doctors surveyed out of 31,456 invited, of which the authors used “a deliberate oversampling of non-primary care specialties.”
• Perceived EHR usability was compared to “everyday items” such as Microsoft Excel (which also earned an F), an ATM, and a microwave oven.
• I’m not clear on how the authors expected respondents to answer usability questions about “my EHR,” which would depend on their practice (one or more clinics, one or more hospitals, both, etc.)
• The authors mentioned an “incentivized secondary survey,” which suggests that they paid people to complete it.
• They note that respondents may have been conflating EHR usability with the burden of documentation it supports, with their pushback being against documentation requirements rather than the tool that captures it. 
• A reader says that while one of the authors is an executive of the notoriously EHR-hating AMA, its own JAMA wouldn’t publishing the findings and it ended up in Mayo Clinic Proceedings, probably because of the low response rate.

Sponsor Updates

• OmniSys employees in Greenville, TX collect hundreds of canned goods for those in need.
• The Wharton School’s “Work of Tomorrow” podcast features MDLive CEO Rich Berner.
• The Salt Lake Tribune features Health Catalyst CEO Dan Burton.
• OpenText and Redox will exhibit at Salesforce’s Dreamforce November 19-22 in San Francisco.
• Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the Perinatal-Neonatal Symposium November 18 in Williamsburg, VA.
• KLAS Research recognizes PatientPing as a high-performing, emerging healthcare IT company.
• Surescripts and TriNetX will exhibit at AMIA’s annual symposium November 17-19 in Washington, DC.
• SymphonyRM publishes a new white paper, “AI Next Best Actions vs. Traditional CRM.”
• T-System adds EvidenceCare’s clinical decision support tool to its emergency department documentation software.

Blog Posts

• OIG Series 6: Addressing Behavioral Needs and Social Determinants of Health (Lightbeam Health Solutions)
• Where’s My Pizza? A Winning New Vision for Transparency in Healthcare (Loyale Healthcare)
• How EHRs can help address patient safety concerns (Meditech)
• APIs, Alerting and Power Users Shine at MHUG 2019 (Mobile Heartbeat)
• Elevating the Role of the Nurse to Support Value-Based Care (PerfectServe)
• 3 Considerations for Choosing a Public Cloud Partner in Healthcare (NextGate)
• Why Hospice Care Matters to Me: April’s Story (Netsmart)
• Health IT leaders answer: What makes a successful Community Connect program? (Nordic)
• 4 real-world examples of how consumer data can transform the patient experience (Experian Health)
• 4 Ways to Engage Baby Boomers Using Healthcare Technology (PatientBond)
• It’s No Secret: The Healthcare Industry Can Improve Lives with Transparent Pricing (Patientco)
• CHIME 2019 Fall CIO Forum: Key Themes and Hot Topics (Pivot Point Consulting)
• 5 big questions still to be answered by the final ONC and CMS healthcare interoperability rules (Redox)
• Balancing Zero Trust with a strong identity strategy and AI (SailPoint)
• Realize Your Potential ROI with an RPA (Robotic Process Automation) Solution (Summit Healthcare)
• Welcome to VUE19 … and the Future of Care Communications! (Voalte)
• Healthcare Safety: The Big Picture (Vocera)
• 5 Strategies for Training Your Clinic Staff on Compliance (WebPT)
• The new healthcare consumer engagement landscape for whole-person health management (ZeOmega)
• How Better Patient Engagement Reduces Avoidable Readmissions (Zynx Health)

Contacts

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

Weekender 11/15/19

Weekly News Recap

• HHS OCR will review the HIPAA compliance of the “Project Nightingale” data-sharing agreement between Ascension and Google.
• NextGen Healthcare announces plans to acquire patient portal vendor Medfusion for $43 million.
• Ontario, Canada announces a Digital First for Health strategy that will give patients more online access.
• Results of the Apple Heart Study find that 0.5% of 400,000 enrolled users received an irregular heartbeat notification, most of whom were found to have atrial fibrillation.
• Premier launches Contigo Health, which will connect participating employers and health systems to optimize employee care using EHR-integrated clinical decision support.
• Kaiser Permanente Chairman and CEO Bernard Tyson dies unexpectedly at 60.
• University of Chicago asks to have its medical center to dismissed from a class action lawsuit that was brought by a patient who says its data-sharing agreement with Google violates his HIPAA rights.

Best Reader Comments

After dozens, maybe hundreds of healthcare organizations have partnered with analytics companies to share data and develop solutions, why are we just now becoming concerned that Google has entered the ring? (SkyNet)

Cerner makes money how? From recent earnings call: “As the acknowledged data source, we plan to develop a monetizable distribution model that provides access to legacy client segments and adjacent market prospects such as biopharma, payers and actuaries, to name a few.” (Vaporware?)

I agree it is patient’s data, but that is not the business model in other industries. What about credit information? Isn’t that consumer’s data, too? But credit agencies hog it and sell it without any explicit approval from the individual to collect / distribute it. (Data Business)

What bothers me is that many hospitals willingly give the data away or sell it to entities such as Google, but when the patient asks for copies of his or her own records, they are charged. (X-Tream Geek)

The letter urges that EHR vendors not create financial burdens for physicians trying to connect to state immunization registries and called on HHS to “hold information technology vendors accountable for creating a national standardized, easily accessible, accurate, robust immunization information system.” That’s a recipe to get some terrible software shoved down physicians throats. (What)

I think Mr. Segert has a surprisingly good handle on the [Athenahealth] business here. He’s right that the ambulatory market is consolidating and that Athena has the best ambulatory-only product. If you accept those facts, it seems that Athena should mop up the rest of the smaller vendors. Athena wasn’t making much progress on that because their focus and execution wasn’t there. They were spending their effort on tiny, low volume/$, rural hospitals who would bail out halfway through implementation and go back to CPSI. That was a great way for Athena to take large piles of investor dollars and set them on fire. Also looks like he has a good grip on the sales channels, which is the hardest and most important thing when selling software to the SMB or smaller enterprise market. (GoodFirstImpression)

Layoffs are almost always painful, but it feels worse during the holidays. As a recruiter, I get to see where the layoff leads. It’s remarkable how often it turns out to be for the best. I’ve seen so many people take layoffs hard, only to look back a few months later with gratitude that it led them to something better. (Jim Gibson)

The best way that most economic development agencies have found to lift families out of generational poverty in under-developed economies is to educate girls and women. Across the board, giving women access to education leads them to start businesses that provide economic stimulus to their entire community. Giving menstrual products to teen girls has proven to do just that. Giving a girl the opportunity to get an education is the fastest method to improving her life and the lives of those who depend on her. It is the same reason that diaper banks have proven to reduce sick baby visits and increase teen mothers’ ability to attend classes and work. A child who is constantly ill due to not being able to have a clean diaper is a drain on their parent. The parent can’t improve their economic situation if they can’t go to school and work. Just because a program is focused at the individual level doesn’t meant that it won’t lift up the community. (MEDITECH Customer)

Watercooler Talk Tidbits

Nike will release the Air Zoom Pulse, a lace-free, protectively coated shoe (“a traditional clog made athletic”) that it designed to combat fatigue in testing at OHSU’s children’s hospital. Six young “patient designers” created their own versions of the shoe, profits from which will be donated to the hospital. I like the above design from 12-year-old Sawyer Miller, whose brain tumor was treated with surgery and 30 rounds of radiation therapy. I bet I could make a HIMSS20 splash walking endless miles in these.

University of Washington students petition the university to prohibit faculty members from requiring a doctor’s note for their absences due to “unavoidable” illnesses, saying that seeing a doctor for that purpose is expensive, requires students to explain their symptoms after the fact, disadvantages low-income and DACA students, and may result in the ordering of risky tests and procedures. The students add that doctors always write the notes anyway, so there’s no impact on their behavior.

Loyola University Medical Center tells a woman who was making inquiries into her mother’s unexpected death that its autopsy camera had been stolen and the photos on it lost. Nine of the 18 cases that had been recorded on the camera hadn’t been uploaded to the electronic files as health department policy requires because the camera didn’t come with a cable and the hospital didn’t have one.

A 26-year-old woman undergoing breast cancer treatment is surprised when her boyfriend proposes to her in front of her Sloan Kettering treatment team on her last scheduled visit, after which they were married in an event donated by a wedding planning company.

The gift shop of Park Nicollet Methodist Hospital (MN) adds a selection of hijabs for patients and employees, saying it’s the first US hospital to do so.

UPMC Magee-Women’s Hospital dresses up newborns for November 13’s World Kindness Day in cardigans like those worn by Mr. Rogers, who spent most of his life and career in Pittsburgh. Other local hospitals and individuals did the same, encouraged by public TV station WQED, which created Cardigan Day in honor of Fred Rogers, who filmed 895 episodes of “Mister Rogers’ Neighborhood” at the station over more than 30 years through 2000. He died of stomach cancer in 2003.

In Case You Missed It

• News 11/15/19
• EPtalk by Dr. Jayne 11/14/19
• News 11/13/19
• Curbside Consult with Dr. Jayne 11/11/19
• HIStalk Interviews Bob Segert, CEO, Athenahealth
• Book Review: It Shouldn’t Be This Hard to Serve Your Country
• Monday Morning Update 11/11/19

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 11/15/19

Tyto Care Launches TytoHome Nationwide at Best Buy Stores

Best Buy ups its digital health offerings with the addition of TytoCare’s at-home telemedicine exam device and companion app.

AWS Announces AWS Data Exchange

Amazon Web Services launches AWS Data Exchange, giving users the ability to find, subscribe to, and use third-party data in the cloud.

Ontario Expanding Digital and Virtual Health Care

Ontario health officials announce a Digital First for Health strategy that will give patients the ability to book appointments online, access their medical records, and take advantage of more telemedicine services within the next three to four years.

ECRI Institute and Institute for Safe Medication Practices Join Forces to Enhance Patient Safety

Patient safety groups ECRI Institute and the Institute for Safe Medication Practices will merge, with ISMP becoming an ECRI Institute subsidiary.

Yale study links electronic health record systems to physician burnout, medical errors

The American Medical Association co-sponsors a study that finds that perceived EHR usability is poor and contributes to physician burnout.

News 11/15/19

Top News

The HHS Office for Civil Rights will look into the HIPAA compliance of Google’s data-sharing arrangement with Ascension.

Google has pledged to cooperate with OCR investigators, stressing that its work with Ascension adheres to HIPAA and “comes with strict guidance on data privacy, security, and usage.”

The company added in an amended damage-control blog post that, “Patient data … is not used for any other purpose than servicing the product on behalf of Ascension. Specifically, any Ascension data under this agreement will not be used to sell ads.”

Google Cloud now knows that its parent company has a consumer image problem that, while not on the magnitude of Facebook’s, could still serve as a roadblock for its technical work that has nothing to do with search engine ads.

Perhaps most puzzling is why Google hasn’t enlisted its new high-profile healthcare hires to explain the project or to describe why it’s likely that patient data is more secure within Google’s systems than in those of any hospital or medical practice.

The odds that this deal violates HIPAA are zero. It only violates the data rights that consumers wish they had. 

Reader Comments

From RumorMonger: “Re: Allscripts. Reducing workforce today to cut costs, with a rumored 25-50 people let go.” Unverified, but reported to me by several readers, some of whom said weeks ago that the cutback was scheduled for November 18. Rumored areas impacted are Sunrise, support, and development.

From PizzaSlinger: “Re: Cerner layoffs. A manager apparently sent the layoff script to the associates he was laying off.” I hate that layoffs have become corporate business as usual, with companies unskillfully using them to (a) dump deadwood and high earners while dodging employment law issues; or (b) to quickly juice their financial numbers to arouse some bean counter. I get really worked up when the company cluelessly acknowledges the announcement with a cheery statement that while the valued (to a point) former associates will be missed, the company is hiring wildly otherwise. Maybe the “overall headcount increase” promise encourages investors and customers, but it throws salt in the layoff wound by clearly indicating that the affected “associates” aren’t worth retraining or reassigning. Still, I commend Cerner for sending its executioners a script – which was forwarded to me — to make the employee’s final contact with the company smooth. My summary of it:

• Schedule the appointment ahead of time using an attached link (I assume using the link automatically alerts campus security to be close by at the designated time since that wasn’t emphasized nearly enough in the script otherwise).
• “Anticipate their reaction so you can prepare.” Having laid people off myself, I don’t think you can do this with any degree of accuracy. Most employees are initially stunned, so the idea is to get them off campus without a working access badge before their Kubler-Ross’s “denial” turns to “anger.” I’m surprised that the instructions advised making the appointment ahead of time since that’s a sure sign of impending trouble, although it’s also awkward to have a layoff when some of those affected are on PTO and thus likely to hear from co-workers or a telephoning manager that they are now unemployed. It’s also a good idea to tell the survivors not to let their former co-workers into the building.
• Coordinate with the co-worker who gets the fun job of marching the employee to the “offboarding support area” and then packing up their pitiful personal effects while they are getting the axe.
• Don’t tell people their job has been eliminated while they are at a client site or driving.
• Keep the conversation short, no more than 20 minutes, but book the room for 30-60 minutes so they can compose themselves without being kicked out of the room to make way for the next execution. 
• Have Kleenex on hand.
• Tell them not to return to the office, but advise them that they will remain an active employee through January 14, 2020.

HIStalk Announcements and Requests

The best lesson we can learn from the Ascension-Google controversy is that Americans are naive in thinking that HIPAA gives them broad privacy protection, so perhaps the shock – justified or not – that a company that most Americans know only for searching and serving ads is holding their medical data will open much-needed consumer privacy law discussion. Many people, even media types, seem shocked that HIPAA addresses only providers, or that they get a free pass under “treatment, payment, and operations.” I don’t question the data-sharing deal since it’s really not all that unusual other than consumers react more quickly when it’s Facebook or Google than if they found out that many, many other companies are sifting through their medical information, sometimes paying some other organization for the privilege. Bottom line – Ascension did nothing intentionally wrong, patient data is almost certainly safe, and both Ascension and Google now know they have a public trust issue that isn’t limited to just this tiny aspect of their businesses. I’m waiting to see if Ascension’s interest really is related to clinical outcomes rather than their own financial ones and whether anyone raises the issue of whether Ascension really has 50 million signed Notice of Privacy Practices forms on file (and whether those are valid if they were signed before Ascension acquired the original hospital). All this aside, the issue goes well beyond these two organizations.

Webinars

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

Acquisitions, Funding, Business, and Stock

NextGen will acquire patient intake, scheduling, and payment software company Medfusion for $43 million. Medfusion will spin off its data services business into a separate entity named Greenlight Health. Steven Malik sold Medfusion in 2010 to Intuit for $91 million, then reacquired it in 2013. He owns the North Carolina FC of United Soccer League and North Carolina Courage of National Women’s Soccer League and is working to build a $2 billion entertainment complex in Raleigh.

The planned merger of Sanford Health (SD) and UnityPoint Health (IA) to form one of the country’s largest health systems is called off, with Sanford’s CEO saying that UnityPoint Health’s executives “failed to embrace the vision.”

Sales

• St. Joseph’s/Candler will implement Tabula Rasa Healthcare’s DoseMeRx precision dosing software across its facilities in Savannah, GA.
• Willis-Knighton Health System (LA) selects Meditech Expanse.
• Humana, GuideWell, and Trusted Health Plan will use Healow Insights integrated services from EClinicalWorks for interoperability among their networks.

People

Surgical software vendor Provation Medical hires Daniel Hamburger, MBA, MS (Renaissance Learning) as CEO. He replaces Dave Del Toro, who will join the company’s executive board.

Jamie Trigg (Seattle Children’s) joins Virginia Mason Health System (WA) as CTO.

Announcements and Implementations

The St. Louis Children’s Hospital and Washington University Heart Center (MO) sends high-risk infant cardiac patients home with Locus Health’s remote monitoring app.

Best Buy ups its digital health offerings with the addition of TytoCare’s at-home medical exam device and companion app. The $300 device comes equipped with attachments that can be used during a telemedicine visit with partners from several health systems and telemedicine companies.

CHI Memorial Hospital (TN) implements Epic.

WellSky develops the WellSky IO interoperability framework to help post-acute and community providers connect to patient data exchanges.

The Michiana Health Information Network, Indiana Health Information Exchange, and HealthLinc will merge operations under the IHIE brand in January. IHIE executives believe the consolidation will create new value propositions and help scale services. IHIE has played around with several business models since launching in 2004, including its ThriveHDS clinical data repository services offshoot, which shut down after just nine months. The HIE’s CEO and COO presented “Said the HIE: ‘Reports of Our Death Are Greatly Exaggerated” at HIMSS earlier this year.

Amazon Web Services launches AWS Data Exchange, giving users the ability to find, subscribe to, and use third-party data in the cloud. Healthcare use cases include subscribing to aggregated data from historical clinical trials to accelerate research activities, and subscribing to aggregated and de-identified healthcare claims and transaction data to improve care delivery.

In Canada, Ontario health officials announce a Digital First for Health strategy that will aim to give patients the ability to book appointments online, access their medical records, and take advantage of more telemedicine services within the next three to four years. Providers will be given access to interoperable records, and enhanced data integration and predictive analytics.

A KLAS report on remote patient monitoring finds that nearly all users get measurable outcomes, but the market is changing to demand products that are patient-centric, that engage patients, and that offer patient-provider interaction, all using consumer-based rather than proprietary medical devices. Health Recovery Solutions and Vivify Health are leading the evolution, but the report’s conclusions are incomplete because several vendors refused to participate (Resideo, Care Innovations, Medtronic, and Philips).

Patient safety groups ECRI Institute and the Institute for Safe Medication Practices will merge, with ISMP becoming an ECRI Institute subsidiary.

Privacy and Security

I can’t tell if this is satire or serious: Google’s alleged whistleblower takes to The Guardian to outline why he or she felt compelled to share concerns about “the Nightingale Project” with, presumably, the Wall Street Journal: “After a while I reached a point that I suspect is familiar to most whistleblowers, where what I was witnessing was too important for me to remain silent. Two simple questions kept hounding me: did patients know about the transfer of their data to the tech giant? Should they be informed and given a chance to opt in or out? In short, patients and the public have a right to know what’s happening to their personal health information at every step along the way. To quote one of my role models, Luke Skywalker: ‘May the force be with you.’”

Health Care Cost Institute CEO and former CMS Chief Data Officer Niall Brennan tries to calm the masses.

Other

The American Medical Association co-sponsors a study that finds that perceived EHR usability is poor and contributes to physician burnout. The article is paywalled so I can see only the highlights (except for the graphic above, tweeted out by one of the authors), although I notice that response rates weren’t good. The authors conclude that EHRs scored an F with self-reported doctor scores in the bottom 9% across all industries and then correlated those scores to burnout. The correlation versus causation issue would lead me to question, do EHRs burn doctors out, or do burned-out doctors hate EHRs as a tangible manifestation of their unhappiness? Also, I’m not sure that it’s fair to compare an EHR to Amazon, a Google search, or a microwave oven, especially since those tools are voluntarily chosen for personal benefit. Doctors are frustrated with their EHR, but they’re also frustrated with nearly everything else about their jobs (and many of them must be frustrated with the AMA itself as well, given that only a fraction of US doctors are members, so maybe the EHR vendors should study that phenomenon).

STAT looks at the integral role remote healthcare coaches play in the success of headline-grabbing digital health companies like Omada Health, Livongo, and Fitbit. Omada Health CEO Sean Duffy admits that though he’s a big fan of tech, “It’s hard to recreate human accountability.”

Results of the Apple Heart Study are in, leaving researchers with several solid takeaways regarding the Apple Watch’s ability to alert users to abnormalities. The eight month study of 400,000 users – one of the largest of its kind – found that the device notified two thousand of an irregular pulse; 84% of which were found to have atrial fibrillation. Researchers concluded that passive monitoring can be beneficial, but more work needs to be done for the Watch to be truly useful in helping at-risk, rather than young and healthy, populations. Apple just launched a separate Research app to study heart, movement and hearing issues, and women’s health.

Sponsor Updates

• Apixio celebrates several milestones including its 10^th anniversary, adding 17 new provider and payer customers in 2019, and making Deloitte’s 2019 Technology Fast 500 list of fastest-growing companies in North America.
• Ellkay will exhibit at Momentum 2019 November 22-24 in Orlando.
• Ensocare will exhibit at the 2019 Leadership and Physician Advisor Conference November 15-17 in Miami.
• CarePort Health’s post-acute provider database and patient choice application, CarePort Guide, is now available in the Epic App Orchard marketplace.
• HealthCrowd will present at the Florida Association of Health Plans 2019 Connect Conference November 19 in Orlando.
• In Australia, Hyland integrates Medrefer’s referral technology with its OnBase enterprise information technology.
• InterSystems will exhibit at Healthcare Providers Transformation November 18-20 in Denver.
• Intelligent Medical Objects will exhibit at the AMIA 2019 Annual Symposium November 16-20 in Washington, DC.
• Kyruus CTO Chris Gervais will present at Salesforce’s DreamForce November 20 in San Francisco.
• AMIA inducts Clinical Architecture CIO Shaun Shakib into the 2020 Class of AMIA Fellows.
• Recondo Technology announces that bookings for its automation solution for prior authorization transactions has accelerated in 2019 to 60 health systems, most of them Epic users.
• ZDNet profiles Nuance.
• Health Catalyst appoints Julie Larson-Green (Qualtrics) and S. Dawn Smith (Cologix) to its Board of Directors.
• The Chartis Group publishes a new white paper, “Creating a Successful Physician Enterprise in Academic Health Systems.”

Blog Posts

• How to Improve Your Ob/Gyn with Your EHR (EClinicalWorks)
• How to Narrow Your Post-Acute Care Network – And Why It’s So Important (Ensocare)
• Honoring – and learning from – Google Cloud Veterans (Google Cloud)
• Health IT leaders answer: What makes a successful Community Connect program? (Nordic)
• Harnessing the Power of Chronic Care Management (Greenway Health)
• Anatomy of a Great Prescription Renewal Protocol (Healthfinch)
• 10 ways Hyland Healthcare shined at #CommunityLive (Hyland)
• Interoperability Proposals Push HIEs to Focus on Data Quality (Imat Solutions)
• Meditech Celebrates Digital Health Week in Canada (Meditech)
• Post-Acute Providers Predict Probable Insolvencies Under Value-Based Care Without Basic IT, Data Sharing, and Care Coordination (Black Book Market Research)

Contacts

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