Monday Morning Update 8/12/19

Top News

From Thursday’s Allscripts earnings call:

• Two Paragon accounts added ambulatory as part of their contract extension in the quarter, with 20 clients having signed long-term agreements since the Paragon business was acquired from McKesson in late 2017.
• Two clients bought Sunrise, 61-bed San Gorgonio Memorial (CA) and an 1,100-bed hospital in the Philippines.
• The company is negotiating a contract extension with its biggest customer, Northwell, and expects a decision to made by the end of the year.
• Allscripts says it knew that the Department of Justice was investigating Practice Fusion pre-acquisition, and while the $145 million settlement amount “is not insignificant,” it is in line with settlements made by other EHR vendors that were under similar investigation and paying a settlement will allow Allscripts to put that history behind it.
• Allscripts expects that “recoveries from a variety of third parties” will “help offset a portion of the amounts” of the $145 million DoJ settlement that is being negotiated.
• Paul Black says that the company’s expansion into the high-growth payer and life sciences markets distinguishes it from its EHR peers.
• The company continues to seek “strategically priced M&A” to drive growth.
• Allscripts says its ZappRx and HealthGrid acquisitions haven’t made a significant impact on revenue so far.
• The company is happy with its retention of the former Practice Fusion customers.

Allscripts shares dropped 4% Friday after the report.

The all-time high for MDRX was in early 2000, with shares since having shed 88% of their value. A $10,000 investment in Allscripts five years ago would be worth $6,456, while putting the same money into Cerner shares then would be worth $12,000 today.

Reader Comments

From Imbued Dignity: “Re: patients participating in vendor product design and conferences. Aren’t all of us patients?” We are at one time or another, so “patient” in terms of industry involvement should probably mean “not working in health-related job.” So-called patient advocates (perhaps better labeled as “patient-advocates”) may add some value in hailing from outside the industry  — at least until they make a fill-time job from vendor payments — and may have gained more exposure to our system since they have chronic conditions. We all have our personal expectations and aspirations for healthcare and can obviously see (and say) when they aren’t being met, but we sometimes respond better to heart-tugging or indignation-raising stories about the frequent occurrences of where the system fails. Absent that aspect, we wouldn’t need patient advocates any more than we need advocates for using Facebook or paying the electric bill. The fact that healthcare and health IT executives are shocked, saddened, or motivated by the personal stories of patient advocates means that they are hidden away in their ivory tower. They just need to talk to real people, including their own employees. They also need to retain empathy after the heart-tugging speech is over, which may be their biggest challenge. Healthcare organizations and their executives may express support for a well-told patient story pointing out how the organization failed them, but I’m not too sure they go back home and actually fix the problems.

From Craniotomy: “Re: physician assistant buying a closed hospital. What’s your guess as to why?” He got a big-footprint commercial building for just $200,000 in the form of closed Cumberland Regional Hospital, most likely wildly underpriced because it’s located in a rural area where specialized real estate demand and investment money is limited, so he has a lot of options for expanding his own clinic business and bringing in other healthcare tenants. He can also cherry-pick the most profitable parts of the unprofitable hospital’s business – probably the ED, which was also the service most valued by the community – without trying run run acute care or skilled nursing beds. PA Johnny Presley also just offered $1 million for the closed Jamestown Regional Medical Center, which is next door to a clinic he owns. Tennessee is a certificate-of-need state, so he says he will apply to reinstate some JRMC services, such as a freestanding ED, outpatient diagnostic center, and surgery center. It seems that he’s just interested in the real estate and not the hospital or home health license, so hopefully he won’t follow the steps of others elsewhere who made big promises about saving a rural hospital and then used it purely as a billing machine for lab claims that are paid at higher hospital rates. Local politicians are in a tough spot when a hospital closes and thus displaces a bunch of employees who vote, given them obvious urgency to get it re-opened under whatever terms and/or vague promises they can get. 

From Exec Checker: “Re: Athenahealth. How much of the executive team remains from its days as a publicly traded company?” Not much. Veritas acquired the company in February 2019 and the eight-member executive team is mostly new – only one member joined the company before 2016. A couple of the execs have some healthcare experience, but the rest (including Chairman and CEO Bob Segert) do not. Here’s your “where are they now” moment looking back a few years vs. LinkedIn now:

• Jonathan Bush, chairman and CEO – no current job listed.
• Kyle Ambrester, SVP and chief product officer – CEO of Signify Health (clinical and social care coordination).
• Dan Haley, SVP /general counsel – no current job listed.
• Diane Holman, SVP/chief people officer – no current job listed.
• Stephen Kahane, MD, president – no current job listed.
• Prakash Khot, EVP/CTO – co-founder and CTO of Prekari Labs (privacy software).
• Timothy O’Brien, chief marketing officer – CEO of Groups Recover Together (addiction treatment).
• Jonathan Porter, SVP of network services – no current job listed.
• Todd Rothenhaus, MD, chief medical officer – CEO of Cohealo (health system capital equipment software).
• Karl Stubelis, SVP/CFO – CFO of Data Intensity (managed cloud services).

From The Usual Usury: “Re: Meditech. You didn’t offer your opinion when the reader asked about what they should do to grow.” That’s a tough one. Their sweet spot is small to mid-sized hospitals that want a proven, functional, full-hospital system whose upfront and annual maintenance costs are a lot less than those of Cerner and Epic. That’s Meditech, but the problem is that those prospects  are either (a) being acquired by large health systems, or (b) are also prospects for running Cerner or Epic as either a remote-hosted or client-hosted service offering, which also gives them easy connectivity to the larger health systems that almost always run Cerner or Epic. That leaves few prospects for vendors like Meditech, CPSI, Medhost, and others no matter what advantages they offer. Meditech is finally moving toward product the market wants – with integrated ambulatory, cloud hosting, and good support for web and mobile – but I don’t have a good feel on how many prospects remain. The other challenge is that while cash-strapped hospitals might save a fortune in maintenance costs switching off Epic or Cerner to Meditech, few of the hospitals that bought and implemented those systems recently are likely to want to start over with another round of disruption, not to mention that hospitals in cost-cutting mode are probably targets for being acquired or marginalized anyway.

From Green Machine: “Re: Cornerstone Advisors. Managing Principal Keith Ryan is no longer with the company.” Keith’s LinkedIn profile says he left Cornerstone in June 2019 after selling the company to cloud managed services vendor 8K Miles in December 2016. He has since turned his 500-acre farm in Tennessee into a hemp and CBD business. 

HIStalk Announcements and Requests

Only a small percentage of poll respondents expect the Cerner-Amazon Web Services agreement to produce much in the way of healthcare innovation. Dan agrees that “Cerner in the cloud” isn’t all that innovative, but believes it may increase CIO confidence that the cloud is viable, provide easier access to data onto which innovation can be layered, and give Amazon direct experience in supporting health IT and HIPAA.

New poll to your right or here: What technologies did you find personally useful in your most recent provider encounter? Click the Comments link after voting and add anything I missed.

A CIO asked me years ago to create the Consulting RFI Blaster, which provides an efficient, low-friction way to contact multiple firms by completing a single, simple form in which most fields are optional (like if you would rather be contacted by email instead of by telephone).

Listening: angry, dramatic music from Meg Myers, way too dark for one-time spin but loaded with nuance that grows on you.

Webinars

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

Acquisitions, Funding, Business, and Stock

Nuance reports Q3 results: revenue down 9%, EPS $0.31 vs. $0.28, beating analyst expectations for both. Healthcare revenue increased 2%, although the company’s HIM and EHR implementation businesses underperformed.

CPSI reports Q2 results: revenue down 3%, EPS $0.50 vs. $0.34, missing analyst expectations for both. The company said in the earnings call that customers are taking longer to make decisions and aren’t driven by urgency. It adds that it’s tough selling TruBridge because small-hospital personal connections and community image make it hard for those hospitals to outsource their business offices, while larger hospital prospects are outside CPSI’s client base. CPSI shares are down 12.5% in the past year, valuing the company at $332 million.

Apple healthcare expert and radiation oncologist Andrew Trister, MD, PhD leaves the company after three years to join the Gates Foundation, where he will help US digital health entrepreneurs take their products to the developing world.

Sales

• Quorum Health signs an EHR deal with Medhost to continue using its EHR in transitioning off a previous agreement with Community Health Systems, from which Quorum was spun off in early 2016.

People

Jacob Brauer (NextGen Healthcare) joins SymphonyRM as VP of engineering.

Announcements and Implementations

Two senior facilities operators go live on Netsmart’s Referral Manager, which they say has decreased their processing time by 73%. The system can be used standalone or integrated with EHRs such as Netsmart MyUnity.

Privacy and Security

Cybersecurity vendor UpGuard finds an Internet-accessible MongoDB database containing the health records of 37,000 people who had signed up with Neoclinical, an Australia-based clinical trials matching company. Neoclinical did not respond to emails or telephone calls, so public access to the information wasn’t removed until 25 days later. The psychology involved with helpfully telling a company that they are exposing sensitive information is complex, often leading to messenger-shooting.

Lehigh Valley Health Network (PA) admits that an admitted patient’s business partner – a plastic surgeon with whom he was feuding – inappropriately accessed his medical records in Epic. The patient, who is suing the health system, says it ignored his privacy complaints and did nothing for months. Investigation by the health system and the state health department corroborated the patient’s claim. The doctor insists that he had an active patient relationship with the patient, which the health department says wasn’t the case. 

Other

In Canada, Nova Scotia closes registration to the MyHealthNS patient portal after McKesson Canada declines to renew its contract due to low registrations under the contract’s pay-per-user pricing model. The government says it will replace the system, which was rolled out in 2017. Less than 10% of doctors have enrolled despite the province’s offer to pay them up to $12,000 per year if they encourage their patients to sign up, respond to electronic messages from patients, and share their test results via the portal.

The president and CEO of Centra Health (VA) apologizes to the community for billing problems that followed its September 2018 rollout of Cerner, which it also blames for recent operating losses. The health system says it spent $65 million on its first implementation phase vs. the $33 million that it originally budgeted under Cerner’s direction, much of that apparently related to the unexpected hiring of hundreds of consultants to train staff. Andy Mueller, MD, who took the top job in May 2019, says in an op-ed piece in the local paper:

I want to talk about one thing many of us in this community have struggled with, and that is Centra’s billing. Transitioning to a new electronic medical record last year seemed to compound an already weak process. From late bills, to incorrect bills to long wait times on hold for customer service — it has not gone unnoticed.  We must do everything in our power to help reduce the stress and anxiety of having to deal with health care bills. Plain and simple, we must do better, and we will. Period. We did not get here overnight, and correcting the system will also not be an overnight achievement. My ask for this community is to bear with us as we get our system corrected. We are working to review each account to ensure we have processes in place to make our billing accurate and more efficient. We’ve also embarked on additional system training and education for our staff. It’s all hands on deck here.

In Australia, Queensland Health Minister Steven Miles says the crash of its behind-schedule, over-budget SAP S/4HANA ERP system right after go-live was caused by user error. He says in response to media reports that it’s not unusual for employees to stockpile inventory or to buy items with their credit cards.

Research by Johns Hopkins Bloomberg School of Public Health finds that independent charities that offer drug co-pay assistance – most of which get their tax-exempted funding from drug companies — usually cover only expensive, brand-name drugs and exclude those patients who don’t have insurance, with the end result most likely being that they increase overall healthcare costs.

Six Philadelphia-area health systems bid a surprising $55 million for the 550 medical residency positions being auctioned off by bankrupt Hahnemann University Hospital. A notable legal objection comes from CMS, which pays more than $100,000 per year for each resident and says it will be precluded from recouping any cost-based overpayments once control is transferred to a different owner.

Sponsor Updates

• Waystar publishes the results of a new study, “The Patient Financial Experience: Consumer Attitudes and Behavior.”
• CloudWave launches a new website for multi-cloud healthcare IT solutions.
• Wisconsin Women’s Health Foundation implements Redox’s health IT integration capabilities through the Redox Gives program.

Blog Posts

• Reduce Physician Burnout by Becoming a “Dot Connecting” Organization (Lightbeam Health Solutions)
• 5 blogs to improve your cybersecurity strategy (Meditech)
• Accurately Improving Accessibility of Patient Data with a Single File (NextGate)
• Q&A with Experian Health Patient Access leader on MyHealthDirect Acquisition and enhancing the patient experience (Experian Health)
• Leveraging AI to Improve Health Outcomes (PatientBond)
• Patient Payment Processing: A Checklist for Your New Solution (Patientco)
• Improve Well-Child Schedule Adherence with Patient Engagement (PerfectServe)
• Care Traffic Control: 6 Steps to Launch a Value-Based Care Model (PreparedHealth)
• How We Onboard Clients for Lasting IT Security Success (Fortified Health Security)
• Feet on the Street: Black Hat 2019 (SailPoint)
• Complete Guide to HL7 Standards (Datica)
• Experts share best practices in clinical communications. (Voalte)
• 3 Times When You Absolutely Must Issue a Patient Refund (WebPT)
• ZeOmega Contributes Expertise to HHS-CODE Roundtable on Privacy and Data Access (ZeOmega)

Contacts

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

Weekender 8/9/19

Weekly News Recap

• Allscripts announces mixed Q2 results, which include a $145 million charge toward settling any liability that results from the Department of Justice’s Meaningful Use investigation against its acquired Practice Fusion.
• CVS beats Wall Street’s quarterly expectations and announces plans to expand its HealthHubs concept and to implement “next best action” programs for chronic care management.
• England’s NHS announces plans to form an $300 million artificial intelligence lab.
• Truman Medical Center pays ransomware hackers to regain access to its systems.
• Duke Clinical Research Institute and Cerner announce a pilot project to study patient data from non-Duke sites as the initial step in forming Cerner’s Learning Health Network.
• The DefCon cybersecurity conference creates a mocked-up hospital full of medical devices for hackers to play with.
• A new funding round values London-based AI health services vendor Babylon Health at over $2 billion.
• Guidehouse will acquire Navigant for $1.1 billion.
• Beaumont Health responds to reports of IT-heavy layoffs and the recent departure of its CIO and CMIO.

Best Reader Comments

Are you getting your license in other states for telemedicine purposes?? It always interests me how you have to have to be credentialed in the state of the patient even though you are providing the service from a different state, right?. Then I think of weird examples, like if you are on the phone with a patient who is riding in a car and they drive across state lines. One second you are having a legal conversation with a person and the next second you might be breaking the law! (Creds)

Even the most tech-awarded CHIME and HIMSS hospital systems are relying on their insurance to protect the corporation (not patients’ privacy) from hackers, Shamefully, most hospital CIOs have maintained very small budgets for cyber protection solutions and put basic security on auto pilot. [Ransomware victim] Truman Medical Center is “Most Wired” since 2010, Stage 7 HIMSS Analytics since 2013, a 2015 Davies Enterprise winner, and a Cerner model show site in its home town. (Are CIOS Ignoring or Ignorant?)

We need a law that says that they can’t play around with “re-identifiable data.” At this point we’re all aware that de-identified really means “not immediately identified”, or “you have to put in some work to make identifiable again.” De-identified should become un-identifiable. Of course in order to do that, you’ll probably be destroying whatever value they’re getting out of it. But they shouldn’t get to call it de-identified, it’s still PHI/PII unless mathematically provable that you can’t use that data to get to the identity of the people. (AC)

Why is Eric Topol not brave enough to say it? If you are in hospital administration, the group that collectively lobbies for you is called the AHA. If you are a small business owner – physician, the group that collectively lobbies for you is the AMA. If you are an employee of either of those two, the group that collectively lobbies for you is called a union. Ask a nurse to explain it to you. (SelfInflictedWound)

Meditech’s sales revenue is declining again. The company’s progress seems to be one step forward, two steps back. Saying the company is profitable and the balance sheet looks good, as was heard at the shareholder’s meeting, is another way of saying they are surviving. Meditech has yet to explain to its shareholders why it suffered such a large contraction during the period of greatest expansion the market has ever experienced, placing it a very distant third behind Cerner and Epic. (Running on MT)

I’ve talked to 5+ doctors about the thought process that they use to diagnose patients. I would characterize it as being a “satisficing” approach and I don’t think that computers are going to help make it better. I’m curious, though, about the percentage of diagnoses people think are incorrect. It really depends on how you define a misdiagnosis. 10% seems reasonable. (IANAL)

What’s [tackling problems with more impact than misdiagnosis] worth in real dollars that real physicians or medical organizations are going to spend? Unless I can convince enough physicians to pay for that service, what good does that do? I have to pay for my rent and groceries, too. We can have as many clever ideas for improving outcomes and patient health as we like, but we can’t do it for free. (HIT Girl)

Watercooler Talk Tidbits

A doctor from University of Calgary’s medical school mines Alberta’s EHR to find 60 ED visits that contain the word “scooter” to determine the extend of e-scooter injuries, although he admits that word usage might compromise accuracy. He urges those using the scooters to wear a helmet, which few riders of the newly introduced rental e-scooters do. The city requires helmets for bicyclists but not scooter-riders and allows only scooters to be ridden on sidewalks. 

Doctors eventually find that a Michigan woman who had choked on the first bite of a grilled hot dog and then experienced repeated problems afterward with breathing, talking, and swallowing had a wire embedded in her throat, which turned out to be a bristle from a grill brush. Doctors removed it and she’s fine. She urges people to use plastic grill cleaning brushes, explaining that her husband later passed a magnet over the grill and picked up 30-40 more bristles.

A  man who was sentenced 20 years ago to jail and six months of psychiatric counseling for impersonating a doctor over a six-month period at UCLA Medical Center graduates from a Caribbean medical school at 47, admitting that it’s tough to get licensed and accepted into a US residency when his past includes forging prescriptions. His education probably isn’t helping his quest – a current student of the for-profit Saint James Medical School says the school has a minimum GPA of 2.0, an MCAT-optional admissions process, an attrition rate of 86%, an 8% first-pass NBME pass rate, and a low residency match rate. 

Physician assistant Johnny Presley buys the recently closed Cumberland River Hospital (TN), pledging to open his fourth outpatient clinic there within four weeks and then possibly eventually adding a standalone ED. He paid $200,000 for the hospital, which had been bought for $6 million by a local hospital in 2012 that closed it after ongoing financial losses. He explains, “I might not be hardly as smart as some people or have as much money as some people, but I’ll outwork anybody. I just apply a lot of commonsense approaches. It’s a one-man show … I spent my life working in rural hospitals and rural communities and it’s a needed service in these areas. Unfortunately, it’s like time left those places, and it’s very sad. Growing up and working in them, seeing them all start to close is very sad.”

The for-profit hospital operator that bought two Wheeling, WV-area hospitals two years ago announces plans to close them both. One started as a city hospital in 1890, while the other opened its doors in 1906.

A jailed, 77-year-old pain management doctor in Detroit who is accused by the federal government of bilking insurers out of $500 million in a scheme involving opioid prescribing and spinal injections offers to turn his lakefront estate into a privately guarded prison if authorities will release him. Raj Bothra, MD’s most prolific prescriber, Eric Backos, MD – who “specializes” in “pain management, medication management, opioid detoxification, EMG/NCS testing to identify specific location of nerve injury, Botox therapy, and acupuncture” – prescribed 5.9 million pills from 2013 to 2018, with 86% of them being opioids and with at least two patients dying of overdoses following their visit.

In Case You Missed It

• News 8/9/19
• EPtalk by Dr. Jayne 8/8/19
• HIStalk Interviews Peter Smith, CEO, Impact Advisors
• News 8/7/19
• Curbside Consult with Dr. Jayne 8/5/19
• Monday Morning Update 8/5/19

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 8/9/19

Allscripts Announces Second Quarter 2019 Results

Allscripts announces Q2 results that include a $145 million charge to settle all criminal and civil liability related to the Department of Justice’s Meaningful Use investigations into its Practice Fusion unit.

Experian acquires MyHealthDirect, strengthening leadership position in patient access and engagement

Experian Health acquires care coordination and appointment scheduling software vendor MyHealthDirect.

NHS to set up national artificial intelligence lab

In England, Prime Minister Boris Johnson allocates $303 million for the development of a National Artificial Intelligence Lab that will operate within the national health service’s digital innovation unit.

Castlight Health Announces New Customer Center of Excellence in Utah

Castlight Health will open a new Customer Center of Excellence in Salt Lake City next year, and hire up to 200 new staff by 2022.

News 8/9/19

Top News

Allscripts announces Q2 results: revenue up 1%, adjusted EPS $0.17 vs. $0.19, beating earnings expectations but falling short on revenue.

GAAP earnings swung from a $65 million gain to a $150 million loss quarter over quarter.

The company announced that it has recorded a $145 million Q2 charge to settle all criminal and civil liability related to the Department of Justice’s Meaningful Use investigations into its Practice Fusion unit.

Allscripts had offered to buy Practice Fusion for up to $250 million in mid-2017, but pulled its bid when the federal government opened a review of Practice Fusion’s compliance with Meaningful Use requirements right after EClinicalWorks paid $155 million to settle similar charges. Allscripts eventually bought Practice Fusion for $100 million in January 2018.

Reader Comments

From Considering MaaS: “Re: Meditech as a Service. Now that the first wave of sites has been brought live, I’m curious about feedback. I understand that they are now offering it to community hospitals, so I suspect that the trial run with critical access hospitals must have been successful.” I’m happy to report any firsthand experience reports that are sent my way.

HIStalk Announcements and Requests

Vince Ciotti surprised me with a spiral-bound version of his HIS-tory series, which while highly useful in its bookmarked, searchable PDF form, is truly impressive as a thick book that makes you realize how much work he put into it.

A Google PR person responded to the reader’s question about the “Google Health advisory board” to which some industry folks list membership. They said Alphabet has a number of groups, but this particular Healthcare Advisory Board was created in 2013 and isn’t tied to a particular product, team, or strategy. They said the group is convened “from time to time,” which I interpret as being rarely since the link provided was some guy’s announcement of being chosen in 2015. I don’t know if this group is connected to the Google Health Advisory Council that was announced in 2007.

Webinars

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

Acquisitions, Funding, Business, and Stocks

Experian Health acquires care coordination and appointment scheduling software vendor MyHealthDirect.

CNBC reports that CVS and Walgreens pharmacists are denying prescription transfer requests from PillPack, claiming patients haven’t given their permission to make the change, perhaps after signing up for PillPack’s service accidentally or forgetting they had done so. CVS has told its pharmacists to make sure that people who ask about PillPack are told about similar CVS offerings, while some pharmacists have admitted to throwing away PillPack’s faxed (!) requests. Walgreens, meanwhile, will close 200 stores in the US as part of previously announced restructuring plans.

CPSI announces Q2 results: revenue down 3%, EPS $0.12 vs. $0.02, missing expectations for both.

CVS Health reports Q2 results: revenue up 35%, adjusted EPS $1.89 vs. $1.69, beating expectations for both and valuing the company – including its $70 billion acquisition of Aetna late last year – at $82 billion. CVS shares are down 13% in the past year vs. the Nasdaq’s 2% gain. The company said in the earnings call that it will convert 1,500 locations to HealthHubs in the first half of 2020 after seeing the uptick in Net Promoter Scores and increased store traffic that is driving sales. It is piloting “next best action” programs at its HealthHubs and MinuteClinics to close care gaps and improve chronic care management. CVS will also roll out CarePass nationally, for which members pay $5 per month to get free shipping, access to a 24/7 live pharmacist helpline, and a 20% discount on CVS Health branded products.

Sales

• Plumas District Hospital (CA) will go live on Cerner Millenium through its CommunityWorks offering by the end of the year.
• Missouri River Medical Center (MT) selects Evident’s EHR and TruBridge’s RCM services. Both are CPSI companies.

People

CommonSpirit Health hires Suja Chandrasekaran (Kimberly-Clark) to be its first senior EVP /chief information and digital officer.

Rick Schooler (Practical Advisory, LLC) joins Lee Health (FL) as CIO.

Announcements and Implementations

HL7 CEO Charles Jaffe, MD announces the 23 organizations that will participate in real-world testing of its FHIR Bulk Data Implementation Guide. Developed with help from ONC and Boston Children’s Hospital/Harvard Medical School, the guide will also be used by CMS as part of its new Data at the Point of Care pilot set to launch next month.

Advocare implements EClinicalWorks across its 200 practices in New Jersey and Pennsylvania.

UCHealth (CO) works with AI company Avaamo to develop a virtual assistant skill for Amazon’s Alexa that can help patients find UCHealth providers, facilities, and content. It will soon integrate “Livi” with its Epic EHR and patient app.

Government and Politics

In England, Prime Minister Boris Johnson allocates $303 million for the development of a National Artificial Intelligence Lab that will operate within NHSX, the national health service’s digital innovation unit. Initial projects will focus on treatments for cancer, dementia, and heart disease.

Reuters reports that Merck has received a series of subpoenas related to a federal investigation into an unnamed EHR vendor – presumably Practice Fusion – acquired by Allscripts last year. Practice Fusion teamed up with the drug maker in 2014 to conduct a population health management study on the effectiveness of vaccine alerts within its EHR.

Other

Pittsburgh Health Data Alliance researchers will use machine learning technology from AWS in eight projects related to cancer diagnostics, precision medicine, voice-enabled technologies, and medical imaging.

Nashville Public Radio looks at the progress Vanderbilt University Medical Center is making with the development of its VEVA EHR voice assistant. Built on Nuance technology and integrated with the hospital’s Epic system, VEVA is set to go live with a handful of physicians later this month. They’ll initially use it to familiarize themselves with patients before appointments.

It’s early days for hospital interest and investment in AI technologies, according to a survey of 115 hospital executives. Respondents were nearly evenly split with regard to awareness of available solutions and vendors. Twenty-three percent of survey takers plan to invest in AI today, while 50% plan to do so within the next two years. Executives believe supply chain and revenue cycle management, finance, and human resources will benefit the most from automation.

Lawmakers in Australia accuse appointment scheduling app HealthEngine of misleading and deceptive conduct after a news investigation last summer revealed that the company sold or passed user information to insurance brokers and law firms. HealthEngine has also been accused of manipulating patient reviews, and promising its advertisers that ads could be targeted based on user symptoms and conditions. Co-founder and CEO Marcus Tan has assured customers that the company has shut down its third-party referral service and overhauled its practice recognition system: “We are working hard to rebuild the trust we’ve lost with our users.”

Apple, Eli Lilly, and data collection company Evidation Health have conducted a study to determine if information from Apple’s devices can be used to detect early signs of dementia. The 12-week study equipped participants with an Iphone, Watch, and Beddit sleep tracker. Those already diagnosed with cognitive decline typed more slowly and infrequently, sent fewer text messages, filled out fewer surveys, and relied more on support apps.

Sponsor Updates

• HCTec staff volunteer with the Nashville Food Project.
• FormFast will exhibit at the Florida Society for Healthcare Risk Management & Patient Safety annual meeting August 15-16 in Orlando.
• Hayes Management Consulting will sponsor the Epic East Coast CORE Summer/Fall 2019 event August 14-16 in Boston.
• VentureFizz.com’s CxO Briefing interviews Imprivata President and CEO Gus Malezis.
• InterSystems adds API management to its IRIS Data Platform.
• PointClickCare adds Collective Medical’s care transition technology to its post-acute care EHR.
• DrFirst uses Imprivata’s Mobile Device Access to develop single sign-on access to its HIPAA-compliant Backline messaging software.
• Elsevier and LogicStream Health will align their respective Care Planning and Clinical Process Improvement and Control Software Solutions to help improve nursing documentation.
• Norton Healthcare (KY) adds ProviderMatch for Consumers from Kyruus to its website to help patients find providers more easily.

Blog Posts

• National Health Center Week: Continuing the Legacy (EClinicalWorks)
• Venmo for Health Data? What You Need to Know About PHI Portability (Ensocare)
• Top 5 Reasons to Attend the 2019 FormFast User Group Summit (FormFast)
• 5 habits that are killing your collections (Greenway Health)
• 4 Questions with Jonathan Goldberg, Chief Information Officer, Arkansas Children’s Hospital (Optimum Healthare IT)
• 5 Ways to Spot a Weak Link on Your EHR Implementation Project Team (The HCI Group)
• HGP Health IT July Insights (Healthcare Growth Partners)
• Why Working with an MSSP Is Smarter Than Building Your Own Cybersecurity Team (Fortified Health Security)
• The Interoperability Directive: What the Proposed ONC & CMS Regulations Mean – Part 2 (InterSystems)
• The Importance of Clinical Engagement in Access Initiatives: A Provider’s Perspective (Kyruus)
• Meet Mary Pat Fralick: Nordic’s executive advisor of Cerner Solutions (Nordic)

Contacts

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

EPtalk by Dr. Jayne 8/8/19

I’m once again in the middle of a billing dispute with Big Medical Center, so I was excited to see this article about tech giants teaming up with healthcare companies to share claims data. One of the proposed applications is helping consumers avoid paying erroneous bills, which would apply in my situation. The group is using CARIN Alliance specifications and testing should begin first with Apple, which appears to be farther along in the process.

The goal is for patients to have broad access to their data rather than having to look at how they use health services across providers. This may enable patients to better understand how they utilize services before having to select health coverage each year. The same thing can be done using the paper Explanation of Benefits statements that most of us receive, although a fair number of people don’t seem to read them or keep them.

It’s been a week now since I called to complain about my erroneous bill and was bounced from the faculty practice billing service to the hospital billing service to the office, which doesn’t understand how I have two receipts for my payment even though one is from Epic and the other is a credit card slip. They declined my offer to scan copies to them, claiming they can only interact through the patient portal and patients can’t add attachments.

I have no hope of getting this straightened out anytime soon. The last time I had a billing dispute with them, they sent me to collections even though the aging on my patient balance was less than a week old. Apparently the fact that it took them more than a year to actually generate a bill during their Epic transition wasn’t a mitigating factor, since the system just saw it as way overdue.

Up until I studied for the Clinical Informatics board certification in 2013, public health informatics wasn’t something I knew much about, let alone practiced. A lot has changed since then given the availability of rich data sets and the ongoing commitment by health organizations to try to reduce costs. Healthcare delivery organizations are also looking at outbreaks in an expanded way, from influenza to measles.

I was glad that we didn’t have to put the measles containment protocol into place during my recent gig at the World Scout Jamboree. The only suspected case turned out to be the relatively harmless Pityriasis rosea rash. Still, we were ready. Recent data from the Centers for Disease Control show more than 1,170 cases of measles this year with no end in sight.

One of my clients recently asked me to create a measles reporting package for them, looking not only at vaccination status among patients, but also to prepare to gather data for measles-related complications such as pneumonia and encephalitis. I spent entirely too much time immersed in ICD-10 finding all the right codes to look for, but hopefully it will help them be prepared if and when the time comes for them to need to do regular reporting. Kudos to them for being proactive even though they’re in one of the 20 states that hasn’t yet experienced a measles case.

Speaking of cost reductions, I was intrigued by this New England Journal of Medicine article that looked at ACO model participation with respect to levels of Medicare spending. Specifically, the authors found that ACO providers in rural or underserved areas had lower spending compared to non-ACO providers, at least during the first performance year. It’s important to note that the primary outcome of the study was spending – secondary outcomes were utilization-focused, including inpatient admissions, emergency visits, days in skilled nursing facilities, and inpatient readmissions. Key outcomes measures, such as mortality, were missing from the study.

I don’t disagree with the need to reduce Medicare spending so that there is some money left when the rest of us reach that age, but I think patients and physicians would be more likely to adopt new payment and care models if they are shown to make a difference in patients’ lives, either through quality of life or quantity of life. Medicare spending is seen by many patients as “someone else’s money,” so there isn’t as much incentive to go along with changes as if the money was their own.

Another article about cost savings also caught my eye, primarily because it was talking about blockchain’s ability to save the healthcare industry $100 billion over the next half decade. Areas of potential cost savings include IT operations, personnel, and health data breaches. Other potential areas of savings are for drug companies using the technology to track medications and reduce counterfeiting.

I love some of the general statements in the associated report, including that blockchain can help solve widespread interoperability problems and non-standardization along with “overcoming the shortcomings and challenges associated with legacy systems.” The devil is always in the details when any technology is positioned as the ultimate solution to a multitude of ills.

Another proposed area for blockchain in healthcare is in physician credentialing, with an estimated 80% savings over the time it currently takes to complete the process. We could save some money without adding additional technology just by making physician credentialing rational. There’s no reason why I should have to provide my high school transcript to credential as a physician, even though I was recently told by someone that the state of Illinois requires it. I hope the requestor enjoyed reading the legitimate but decidedly sketchy document from the 1990s that I provided following a quick phone call to my high school registrar. The finished product looked like it could have been drawn up by anyone who owned a dot matrix printer and a photocopier.

I’m an avid reader, so of course have to mark the passing of Nobel-winning author Toni Morrison. Morrison also received numerous other awards, including the Presidential Medal of Freedom and major awards from France. I didn’t really appreciate her work until some parents in my local school district tried to ban it, and I wish I had found it earlier. I leave you with her comments from a graduation speech in 2005:

Of course I am a storyteller and therefore an optimist, a firm believer in the ethical bend of the human heart, a believer in the mind’s appetite for truth and its disgust with fraud… I’m a believer in the power of knowledge and the ferocity of beauty, so from my point of view your life is already artful – waiting, just waiting, for you to make it art.

May each of us find the art within.

Email Dr. Jayne.

HIStalk Interviews Peter Smith, CEO, Impact Advisors

Peter Smith is CEO and co-founder of Impact Advisors of Naperville, IL.

Tell me about yourself and the company.

I’m the CEO and one of the two co-founders of Impact Advisors. We are a consultancy that is dedicated to healthcare and we are a technology-enabled process improvement firm. We focus on what your readers would consider to be the HIT market, as well as helping our clients optimize their processes across the organization.

Our clients are pretty much all flavors of healthcare providers — IDNs, all kinds of hospitals, physician clinics, and almost any entity in healthcare. We also do a little health plan work as well, but predominantly it’s the provider-based segment that we work in.

It seems like most big health systems are playing around with digital health, innovation projects, and consumer-focused initiatives, to the point that they’re creating C-level positions to oversee them. Is this a fad or are health systems really changing the way they do business in response to changing demand?

It’s a combination of both. We’re obviously seeing a shift in healthcare. Whether it’s the concept of moving towards value-based care or more consumer-directed care, there’s a lot of dynamics that are being backed up in terms of reimbursement models. We’re not there yet. I just gave another interview talking about organizations that have one foot in a fee-for-service world versus the new world. I fully recognize that we’re going to be in that state for a while.

But clearly we’re moving there, and that’s driving a lot of organizations to think about some of the things you just mentioned — digital health, patient and consumer access, how to create a digital experience for not only patients, but families. All of that’s coming into play. Organizations are optimizing the existing environment, but also thinking about how to start building technology services and processes in the new world in preparation for a shifting environment.

To answer your question, I think a good organization will not only retain what they’re doing and optimize it, but also think very diligently about how they move forward with things like digital health or optimizing their a future environment.

Health system competition is no longer just the other hospital across town, it’s regional and soon-to-be national health systems, drugstore chains, insurance companies, and research organizations that are coming in late to the health IT party. Do health systems have the level of expertise, both corporately and in the CIO office, to keep up with the new technology demands?

You’ve hit on a couple of major trends. Obviously many organizations are moving towards scale. Five and $10 billion a year organizations are becoming $20 billion because they need to get to a certain scale. Certainly from a managed care standpoint, to drive economies within the managed care world or the impending value- based care world.

I have a little empathy for folks who are running hospital systems right now. It is not an easy world. They’re getting hit from all sides as they have to aggregate and get scale to be competitive in a new marketplace. They have to create relationships with patients in a different way that I just described, and all the investment that’s associated with that.

Another major driver is what’s being carved out of their systems. Profitable services are being carved out by for-profit companies. If you’re running a large hospital system, you’re getting hit competitively from all angles. That’s a very tough place to be.

You asked particularly about leadership. You’re seeing some very progressive leaders in this space. Those are the ones who are going to be successful, who are thinking about their business models in a new and different way and maybe even challenging some of the traditional ways.

As health systems scale into multi-billion dollar revenue, will the people they choose to lead IT and innovation increasingly be hired from outside the industry?

You’ll start to certainly see that. But there’s a premium in terms of understanding healthcare and understanding healthcare technology. You’ll see entrants, some of them very good, from outside of the industry, but they will have a steep learning curve.

I don’t believe you’ll see a major tipping point where organizations are actively bringing people in from the outside of healthcare. But I do think that condition will exist, and in some cases, it will be very successful, while in others, maybe not. It will be predicated on the individual and what previous experiences they have had.

Providence St. Joe’s is in a geographic area where they have a lot of talent around them  — Microsoft, Google, and Amazon — but that access to talent might not exist in places in Nebraska. If you’re in those markets, you exploit the best talent you can. If they also come with healthcare experience, that’s an absolute bonus.

How does having larger but fewer healthcare systems as customers change your business?

We think about that every day. We recognize that in some parts of our business, we have to get to scale. Certainly in some of our implementation practices, we need to ramp up our recruiting to service clients in a much larger way than they have traditionally. When we were working for the mid-sized market — the $1 billion to $3 billion organizations that have IS departments of 100 people — we could serve as the whole team. Now we look at a scaling, not only of our internal resources, but how to partner with others to be a full-service providers.

Providence St. Joseph Health, Mercy, and other big health systems have blurred the line between provider and vendor, with the former hoping to create a billion-dollar annual revenue organization. How do you see that playing out?

I’m very interested in seeing it. I’ll even add a little twist to that, the Optum deal with John Muir that was announced about two weeks ago, a major platform play and potentially extending that platform beyond. This is not a new concept. Many IDNs have created some form of managed services organization over the decades. Some have been successful and some have not.

It’s going to be about leadership, client relationship management, and about how they execute. I think the concept is sound. How do you aggregate services in a better, higher-quality way at a lower price point? Those are sound objectives and the industry needs that. How they execute over the next year or two is going to be critical.

Providence St Joe’s is fascinating. Just in full disclosure, we’re doing work there, so we know a little bit about their designs on Community Connect and beyond. But these models can absolutely be successful. They will probably first be successful on a regional basis and they’ll use those as proof points and qualifications to possible extend beyond.

How do you see the movement toward cloud computing as Cerner announces a deal with Amazon Web Services? Will we see a lot more results of vendors moving to cloud services offered by Amazon, Google, and Microsoft?

We’re just on the tip of it right. In healthcare, most IT processing is on premise. You’re seeing companies that are moving to the cloud very quickly and having a lot of success.

Cerner is probably the best example of having success in their application management services model over the last decade. Epic is now having a lot of success. Workday in the ERP space is using that as a competitive differentiator and people are gravitating towards it because it implies a level of standardization. It makes your maintenance more predictable, your expenses more predictable, and you’re building a support environment that is homogeneous and high quality.

Health systems are increasingly spinning off startups and running incubators and accelerators. How will that change as they start to see the results of their early efforts?

It will absolutely continue. There’s a lot of variability in how people think about, develop, define, and execute innovation. On one hand, it could be just like a tech transfer function, to allow some form of liquidity for inventions or ideas that are coming out of their medical staff. That’s a very traditional look. In other areas, these guys are running shark tanks and small venture capital firms.

You’re seeing this incredible continuum of how they think about innovation and investment and how they want to monetize or get the ROI out of it. I preface my comments that it remains to be seen whether there will be a a common approach in our industry to innovation across the landscape. You’ll see some variability in how organizations think about it, but it will continue to be important part.

We do a lot of digital health planning and it always ends in a plan that is doing a couple of things. It’s leveraging technology that’s already exists in place, foundational systems like the EHR. It’s also buying or developing a series of solutions that might come out of your own innovation area, or you may buy them commercially, and building an ecosystem of digital health. As we get more mature in that space, those solutions will get rationalized and you’ll have greater platform players. But right now, successful organizations are moving in this continuum of knowing that they have to solution a digital world with many different partners and providers.

Are the three significant health system EHR vendors supporting that innovation by opening up their systems to other companies? Is interoperability more of a technical problem or a business problem?

In our business, we joke that the most difficult thing is integration between systems. Why it’s difficult is a combination of factors. One is the competitive factor, where a lot of healthcare organizations don’t want to share with their neighbor across the street because of the competitive advantage. It could also be a cultural, political, or technology reasons that can make it difficult.

It’s drastically improving. You’re seeing integration increase every single day in multi-platform environments, and that will continue. Will it ever be plug-and-play, immediate and easy? I don’t believe it will be, but it absolutely it is improving.

One of the reasons it’s improving relates to that scale we talked about. You’re now talking about $10 billion to $20 billion organizations that have 60, 70, or 80 hospitals across large geographical regions. You’re getting a level of inherent interconnection and integration among data. Things that had been fragmented or in separate organizational structures are now common and are exploiting the technology they have to to break down some of those cultural and political and competitive barriers.

What are the biggest challenges of healthcare IT consulting and staffing firms?

It depends on your entry point. We’ve just gone through a period of time that was the Wild West for consulting firms. We had a lot of entrants into this marketplace. There’s been a lot of work in our environment over the Meaningful Use period and beyond as people considered major platform changes.

You’ve seen a lot of entrants leave this market or have diminished performance because they didn’t have a long-term vision. We call them pop-up consultancies, companies that were taking advantage of a very hot market. God bless them for that, because everyone deserves an opportunity to do that. But we’ve seen a tremendous rationalization. The firms that are left in our space are the ones that had durable business models, paid attention to quality, paid attention to their associates, and most importantly, paid attention to providing value to their clients.

Only a few high-quality consulting firms are left that have weathered that transition. Those will continue to be successful. Our hope is that we’re one of those moving forward.

I guess there’s nothing inherently unhealthy that the industry flexed to meet the short-term demand and now has to flex back. What trends are swinging the pendulum the other way?

We feel really good about the next couple of years. This has been a very difficult or weird environment to manage a consulting firm. We’ve had boom and then site stabilization in this market. We believe that we’re back to a rational market right now, and the next five years will be a rational growth market within our space. Not boom or bust. We’re actually excited about moving forward. We think it will be much easier to run a business in this climate moving forward.

In terms of what we’re investing in as a strategy moving forward, digital health is number one. The concept of planning and solutioning digital health strategies for our clients is a big growth engine for us. The concept of virtual healthcare, whether it’s telemedicine or beyond telemedicine, helping our clients deliver healthcare in a virtual way is another big driver for us.

This market may not all be about our traditional provider space. There are other entrants into this market, these carve-outs. Even employer-based healthcare right now. We are working with employers that have geocentric employee populations, as an example, that are looking to develop internal healthcare systems. How you provide technology within those worlds is another of channel market for us, working outside our traditional marketplace.

ERP, enterprise resource planning, is another hot spot right now that many organizations are now looking at. Those systems have been in place for 20 or 30 years and now they’re replacing them after they’ve done their EMR. That’s another hot area for us.

Lastly, the thing that I think is going to be most important that’s driving a lot of our business is that after clients put in an EMR or have done a lot of their heavy lifting around some of their major systems, about four years after they convert, they take a look around and say, wow, we have an opportunity to kind of fix some of these processes. We maybe haven’t spent a lot of time and attention. We haven’t viewed it in a programmatic way. We had spent so much money on the systems and we’ve let them languish a little bit. So at about the four-year mark, a lot of our clients are popping up and saying, I need a programmatic way to optimize my clinical and revenue cycle solutions. This concept of optimization is going to be really big and we’re investing pretty heavily in that.

Do you have any final thoughts?

We’re excited about the future for a couple of reasons. But the one thing that I’m most excited about is that our industry spends a lot of time putting in foundational systems, while the next generation is about getting maximum value out of these investments. When we move up that continuum, we’re getting closer and closer to moving the needle for the patients, consumers, and families that we all serve.

It used to be that EMRs were going to be the best thing in the world for patients. They are, but they’re used primarily by caregivers. This next generation of conductivity, this next digital world, will have a direct impact on patients and families in a measurable way. Not only better healthcare, but lower cost, with better digital connections and ease of access. All these things that we’ve been working our entire career on. That’s what I’m excited about.

Morning Headlines 8/8/19

Apple and Eli Lilly are studying whether data from iPhones and Apple Watches can detect signs of dementia

Apple, Eli Lilly, and data collection company Evidation Health are working together to determine if information from Apple’s devices can be used to detect early signs of dementia.

Women’s health startup Genneve lands $4M to grow telemedicine service for menopause

Menopause-focused telemedicine and wellness company Genneve raises $4 million in a seed round led by BlueRun Ventures.

IN BRIEF: Merck says U.S. probing ties to electronic health record vendors

Drug maker Merck has received a series of subpoenas related to a federal investigation into an unnamed EHR vendor – presumably Practice Fusion – acquired by Allscripts last year.

Amazon’s AWS will help health researchers diagnose patients and monitor disease

The Pittsburgh Health Data Alliance will use machine learning technology from AWS in its development of diagnostic and disease-monitoring technologies.

Morning Headlines 8/7/19

Cerner, Duke Clinical Research Institute Launch New Solution to Innovate Clinical Research

Cerner will work with Duke Clinical Research Institute to develop the Cerner Learning Health Network, which will aggregate de-identified patient data from both Cerner and non-Cerner EHRs to provide treatment insights to providers and drug and life science companies.

Optimum Healthcare IT Announces Expansion of Staffing Business with OptimumTech

Optimum Healthcare IT launches OptimumTech, a Nashville-based IT staffing division.

Truman Medical Center hit with ransomware, pays to get system access back

Truman Medical Center (MO) pays hackers a “small amount of money” to restore access to operational systems impacted by a ransomware attack early Tuesday morning.

News 8/7/19

Top News

Duke Clinical Research Institute will work with Cerner on a pilot project in which de-identified data from University of Missouri Health Care and Ascension Seton will be analyzed to seek insight on the treatment of cardiovascular disease. The resulting Cerner product will be called Cerner Learning Health Network, which will aggregate de-identified patient data from both Cerner and non-Cerner EHRs.

The project’s results  will be published with drug company financial support.

The work will use Cerner HealthDataLab to convert the de-identified patient data into formats that can be analyzed with predictive models and algorithms.

Cerner SVP of Strategic Growth Art Glasgow, who was previously CIO of Duke Health, said in the announcement, “At Cerner, we’re committed to taking four decades of digitized data and transforming it into insights that can help clinicians make more informed treatment decisions. We have an opportunity to use clinical research and data-driven insights to develop an intelligent network of health systems that can truly improve health experiences and outcomes for patients.””

Reader Comments

From John R. Brinkley: “Re: ‘Chasing the Cure.’ Any interest in watching it?” The TBS/TNT 90-minute program, which airs live in its Thursday night premiere, features a small panel of doctors that reviews the records of a patient with “unsolvable” medical issues who has submitted their “case file” (a handful of paragraphs of self-description, kind of a Kickstarter for illness, is what is displayed online) ,after which viewers are invited to weigh in using the program’s online community. My reaction:

• I haven’t watched a non-streaming show in many years (easy for me since I don’t watch sports), so I won’t be tuning in. Netflix has spoiled me for being able to watch whenever I want without the intelligence-insulting commercials that take up a third of any program’s time slot.
• I bet quite of the few advertisers are drug companies.
• This concept goes back to the misconception that a bunch of people looking at minimal patient information can be stuck by a “House”-like moment of diagnostic brilliance in figuring out an obscure condition that has escaped their actual doctor.
• People of unstated credentials are already offering advice to the case studies of individual patients on the show’s site, which shows the problem of having everybody and their brother playing doctor from their couches. A woman with joint weakness and pain has been advised to: (a) “eat clean;” (b) get a lumbar puncture; (c) have a contrast MRI; (d) obtain genetic testing; (e) seek stem cell therapy; (f) take a specific brand-name supplement; (g) take B12 shots; (g) get copper and mercury levels tested; (h) have tooth fillings replaced, and (i) try a gluten-free diet. Imagine the plethora of ideas – some wacky and ill-informed, some likely accurate due to a similar experience – that will be offered once the show actually airs. Then a the patient’s real doctor has to waste time sorting out the mess.
• I would prefer having the patient’s doctor review and/or present the case, show the comments of vetted clinicians after the program airs, but display laypeople comments only after the patient’s doctor has reviewed them to make sure viewers aren’t recommending dangerous actions or wasting everybody’s time with bizarre suggestions that stray into “fake news” territory. People with way too much free time who confidently spout bizarre, ill-informed nonsense about everything from politics to unsolved crimes can now give health advice to people desperate enough to make a public plea on TV (note to malpractice and personal injury lawyers – this could be good for you).
• My biggest question is, then what? Even if the armchair diagnosticians eventually turn out to be correct, how does the patient proceed from the show’s airing to resolution? Who’s paying for all the diagnostic work? Does the doctor who couldn’t figure out the problem originally get to explain why they missed it, allowing everybody else to improve?

HIStalk Announcements and Requests

The dental hygienist told me today that she knew that I had arrived for my cleaning and how long I had been waiting because she gets alerts from YAPI, dental practice software that integrates with their Dentrix practice management system. It includes the tablet-based paperless check-in and records update that I had completed upon arrival, a room and patient dashboard that flags patients who are running over or who have waited excessively, team chat, appointment reminders and confirmations, a portal for communicating with patients and checking their appointments, a text message-based review function that routes negative responses to the practice and positive ones to social media, and pop-up patient information displayed with incoming calls from the patient’s phone number. Now I know why I suddenly feel so engaged with the practice, with “send C to confirm” appointment reminders, a follow-up review text message afterward, and not having to explain who I am when I call.

Webinars

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

Sales

• Delta Regional Medical Center (MS) will implement MEDarchon’s Quarc for secure messaging and collaboration.

People

Cameron Memorial Community Hospital (IN) promotes Scott Hirschy, RN to CIO.

Announcements and Implementations

Epic will host its second day-long unUGM in Verona on October 3, where C-suite executives of non-Epic using provider organizations can learn how to connect with their Epic-using peers. Registration is open and costs $100.

Optimum Healthcare IT announces the opening of OptimumTech, a Nashville-based IT staffing division.

Other

Eric Topol, MD says in a New Yorker op-ed piece says that doctors need to organize to push back against EHRs, HMOs, and RVUs to improve burnout. He says, however, that the medical profession has been balkanized by the AMA’s decreased influence as members drop out in favor of joining specialty-specific member organizations. Topol discloses that he’s not paying his American College of Cardiology dues because the organization ignores patient needs, functioning instead as “a trade guild centered on the finances of doctors.” He’s also unhappy that medical associations pursue business themselves – the AMA has endorsed products, the American Heart Association “rents out its name” to use its logo on food products, and the American Academy of Family Physicians took Coke money to fund consumer education about its sugar water (he would have a field day with HIMSS). His overriding point is that medicine is being increasingly run by the non-physician bosses of doctors, as the number of healthcare administrators has grown by 3,200% in the past 40 years. 

Medical Device Village will open Thursday as part of the Bio Hacking Village of the DefCon cybersecurity conference, expanding from the tableful of medical devices offered in past conferences to a 2,600-square-foot, mocked-up hospital’s radiology, pharmacy lab, and ICU departments full of devices for hackers to attack. A capture-the-flag like competition will be offered and reps from 10 medical device manufacturers will be on hand. The conference also invites attendees to “Bring Your Own Medical Device” for security research.

Psychologists find that while most individuals feel economically threatened when they hear about others losing their jobs to technology, they would actually rather lose their own jobs to impersonal tools like robots and AI instead of having another person take their place.

The Onion weighs in on “Data Dump.”

Sponsor Updates

• The CoverMyMeds team serves meals to families staying at Ronald McDonald House Charities of Central Ohio.
• Artifact Health will exhibit at the 2019 CTHIMA Annual Meeting August 16 in Rocky Hill, CT.
• Burwood Group staff help out at the Boys & Girls Club of San Diego’s annual “Stuff a Bus” back-to-school event.
• Meditech offers its Fall Risk Management Toolkit to users in Canada.
• Fortified Health Security releases its midyear healthcare cybersecurity report.

Blog Posts

• MEDITECH Celebrates 50 Years of Healthcare Technology Innovation (Meditech)
• A Former Nurse Looks Back on the Problems Caused by Paper (Access)
• 5 Overlooked RCM Systems & Processes to Boost Your Bottom Line (AdvancedMD)
• Five Things Your Healthcare Company Should Do After a Data Breach (Fortified Health Security)
• Your top questions on the Radiation Oncology Model, answered (Advisory Board)
• How AI Can Ease the Pressures of MA Risk Adjustment Compliance (Apixio)
• Physician Burnout: A History of the Not-So-Recent Phenomenon Plaguing Clinicians (Spok)
• Quantifying the Value of Contact Center AI (Avaya)
• CarePort Granted Innovator Status by CMS, Creating One of the Nation’s Largest Post-Acute Data Sets (CarePort)
• Recap: American Hospital Association Leadership Summit (Collective Medical)
• Measure Harmonization: Getting in Tune (Diameter Health)
• Remote Work, Is It Right for You? (Divurgent)

Contacts

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

Morning Headlines 8/6/19

DirectTrust Reports Explosive Growth in Number of Secure Transactions During Second Quarter

DirectTrust announces that more than 1 billion messages have been sent and received using Direct messaging since it began tracking transmissions in 2014.

EHNAC Announces Launch of Consulting and Advisory Services

The nonprofit Electronic Healthcare Network Accreditation Commission will offer consulting and advisory services to help healthcare stakeholders prepare for compliance certification, readiness assessments, audits, and accreditations.

Flagler Health+ and Optima Curis Partner to Build Virtual Health Village of the Future

Flagler Health (FL) will use technology from Optima Curis to develop a telemedicine platform that will include virtual care, provider messaging, appointment scheduling, social networking, and the ability to view and update health records.

Curbside Consult with Dr. Jayne 8/5/19

The 24th World Scout Jamboree has come to a close. I’m finally back in the world of hot showers where you don’t have to pull a chain to get the water to run.

The World Organization of the Scout Movement pulled out all the stops on the closing ceremony, including former United Nations Secretary-General Ban Ki-moon as guest speaker. The scouts were challenged to build upon the friendships they created at the Jamboree to work together to tackle major global issues as reflected in the United Nations Sustainable Development Goals: poverty, inequality, climate, environmental issues, peace, and justice. Having now worked with scouts from around the world, it’s clear that on the world stage, scouting is about a great deal more than camping and the outdoors.

The closing ceremony was capped by an outstanding fireworks show that also incorporated lasers and the Novus wristbands I mentioned last week. The wristbands were synchronized to the show, strobing in various colors to match the mood of the music and fireworks. There was music from “Star Wars,” “Pirates of the Caribbean,” “Mario Brothers,” and various world artists.

The only “miss” on the show was the failure of musical guest Pentatonix to deliver a version of “Take Me Home, Country Roads,” which was the unofficial anthem of the West Virginia gathering. It was performed at most of the other shows, including the “basecamp bash” events, which were like going to a nightclub without the alcohol and with the addition of neckerchiefs. It was phenomenal to see young people holding hands and swaying to the music despite the fact that their governments are hostile to each other.

Following the show, many of them pulled all-nighters getting their campsites packed into the three crates that were onsite when they arrived, turning the city of nearly 45,000 campers into a field of pale green squares where tents once were. Then came the parade of nearly 1,000 buses to carry the scouts either back to their homes or to tour the US before returning home.

The Charlotte airport had experienced weather delays the day prior and was quickly overwhelmed by the number of scouts trying to clear through security, particularly at the American Airlines terminal. I was lucky to be on Southwest and had smooth travels, but heard many stories of scouts sleeping on piles of luggage outside the terminals and airline agents who refused to allow scout units to check in as a group, adding to the congestion as they issued baggage tags one by one.

As I waited to board, I received my final email from our medical leadership delivering the tally of medical encounters. More than 13,000 patient visits for issues ranging from sore throats and blisters to fractures to myocardial infarctions and cerebral aneurysms. The Listening Ear mental health providers saw more than 660 visits as well, and we were grateful to have their input on scouts whose stomach aches and headaches were likely a manifestation of homesickness or interpersonal conflict.

I was glad to close the book on the Jamboree’s EHR, which as a clinical informaticist, seemed to me to be over-engineered with simplicity as a goal, but in ways that made it difficult to use if you are technology savvy. One of my colleagues continued to curse it (literally) until the end, even though this was his third jamboree using the system. I suspect he’ll never fall to the adopter side of the equation.

We worked through many technology quirks, including two days with wifi outages that made it unusable and no downtime plan in sight. Not even a printed form we could use. I can’t imagine a modern medical office without even a SOAP note template they could bust out in such an occasion, so that’s an improvement they need to make before doing this again at the US National Jamboree in 2021.

We also ran out of printer ink multiple times, making the required workflow of a discharge document impossible. I quit creating the discharge documents at one point, knowing we couldn’t print them and no one would ever read them, so I wasn’t going to waste the clicks when scouts were queuing for two hours to be seen by a provider.

We also worked through a variety of operational quirks that I hope are addressed in the future. The most major problem at my particular facility was lack of attention to creating the care teams. One of my colleagues even asked, “What’s a care team?” which was not an auspicious beginning. The providers were assigned to teams randomly without regard to their specialties or to their skills or abilities, which were not assessed in advance.

As you can imagine, the pool of providers willing to take off work for nearly three weeks is small and results in a large proportion of clinicians who are either retired or who have been out of practice for some time. Our facility was no exception. I had to teach a neurosurgeon how to treat strep throat as well as how to order meds in the EHR even after he attended more than eight hours of training. I had to remind 18-year-old medical volunteers that they were not licensed in the state of West Virginia to dispense meds or administer IV therapy. As a busy emergency doc who works in facilities that are optimized to the extreme with a staff that is topnotch, it was a struggle.

The Cerner team assisted the medical leadership with analytics, and hopefully they will look at the data for the types of visits seen and supplies used to better provision the medical facilities for the next US Jamboree on this site in 2021 as well as for the next World Jamboree in Korea in 2023.

They are already soliciting medical volunteers for both. Based on some of the challenges as well as the cost (volunteers paid more than $1,700 for the experience, plus travel and lost work time, and the event in Korea is going to be upwards of $6,000) I don’t think I’ll be signing up anytime soon. It truly was a once-in-a lifetime experience and working with the scouts from other countries was priceless. I had return patients from Sweden, Portugal, and Nepal that made sure to follow up when I was on shift so that I could deliver their care, and that was truly an honor. I enjoyed learning about other cultures, scouting around the world, and various healthcare systems in both developed and developing nations.

I am appreciative to my consulting clients who humored me during this hiatus and took my brief and infrequent emails for what they were (exhaustion, lack of connectivity, and being in the middle of treating roughly 1,000 scouts a day at my medical tent). Thanks also to my HIStalk family and to our readers for sharing this adventure.

Email Dr. Jayne.

Morning Headlines 8/5/19

Babylon Health confirms $550M raise at $2B+ valuation to expand its AI-based health services

London-based Babylon Health confirms the close of a $550 million Series C funding round, calling it the largest-ever digital health investment of its kind in Europe or the US.

DAS Health Announces Fifth Acquisition in 12 Months

Ambulatory health IT company DAS Health acquires the WRT collection of companies, which includes WRT Specialties, Easy PC Solutions, EasyMed Billing, and Systech Solutions.

Chicago-based Navigant to be acquired by Washington, D.C., firm in $1.1 billion deal

Public sector consulting company Guidehouse acquires multi-vertical consulting firm Navigant for $1.1 billion.

Presbyterian data breach affects some 183,000 patients

Presbyterian Healthcare Services (NM) begins alerting 183,000 patients of a June phishing scam that exposed the personal information of patients and health plan members.

Monday Morning Update 8/5/19

Top News

The Detroit business paper covers this year’s layoffs by Beaumont Health, the most significant of which involved IT and revenue cycle employees.

EVP, Chief Transformation Officer, and CIO Subra Sripada left in April (he’s now with Navigant), as did VP/CIO Matthew Zimmie, MD (who’s doing independent consulting). The organization’s SVP of human resources is serving as interim CIO.

Those employees who were let go probably won’t appreciate executive comments that all healthcare systems “are reorganizing their operational platforms” and that while 175 people lost their jobs this year, 4,235 were hired.

The health system is spending tons of money on the acquisition of Summa Health, hospital construction, and the opening of 30 urgent care centers.

Beaumont Health’s most recent year’s tax filings show a loss of $3.9 million on revenue of $4.4 billion. The CEO was paid $5.6 million, while the departed CIO made $1.3 million.

Reader Comments

From Google Pyle: “Re: Google Health. LinkedIn has people listed as being on its advisory board. I thought it Google Health was dead.” I’m not sure what Google Health even means now that the failed personal health record of that name was retired in 2011 and much the company’s healthcare projects placed under Verily. It may be that “Google – Health Advisory Board “ was the intention rather than “Google Health – Advisory Board.” I emailed a Google press contact hoping to clarify what Google Health is these days and who serves on its advisory board, if it still exists. I’m not holding my breath for a response. I don’t get too excited about advisory boards (as opposed to actual boards of directors) since companies often choose high-profile people just to pick their brains and maybe try to sell them something instead of relying on them to provide actual sound advice in return for compensation.

From AngryMD: “Re: Epic. Rebrands its anesthesia product ‘Flo’ and its infection control product ‘Bugsy.’ Can you stop wasting our time with these inane name changes and work on improving the software we’re spending millions on?” I’m a fan of Epic’s product names, which like the company’s campus, are clever, whimsical, and integral to the culture you’re paying for as a customer whether you like it or not. Judy Faulkner still picks the product names herself as far as I know, so I doubt any developers were harmed in the making of this movie. I don’t hear many complaints about Epic lagging on support responsiveness or development timelines, but I’m always interested in the physician user perspective. What would you say the company’s top priorities should be?

In an unrelated note, I just discovered that Epic has some great-sounding cafeteria recipes on its site, including a chocolate espresso mousse that is similar to the five-minute Bailey’s Irish Cream pots de crème that is my go-to dessert when I’m cooking.

From Sue Schadenfreude: “Re: Meditech. As you noted, newly named Meditech President Michelle O’Connor has only ever worked at Meditech, and unlike most of the company’s execs who have only undergrad degrees but several from MIT, hers is from a state college. Hoda Sayed-Friel has been moved off to the side to start a professional services division. Always interesting things happening there.” Meditech is starting to hand off to the next generation of executive leadership (O’Connor is second-youngest of all directors and officers at 52), although its youngest board member is 65. This might serve as a preview of how Epic’s next generation will be installed since the companies are similar. Meditech values tenure, with its most recent annual report listing these executives and their start date (imagine still being the rookie suit after nearly 30 years with the company):

• Michelle O’Connor – 1988
• Hoda Sayed-Friel – 1986
• Helen Waters – 1990
• Christopher Anschuetz – 1975
• Steven Koretz – 1982
• Leah Farina – 1989
• Scott Radner – 1990
• James Merlin – 1986
• Geoffrey Smith – 1989

From Cohesive Summary: “Re: AI in medicine. Why do technologists persist, decade after decade, in focusing on diagnosis rather than solving problems that people actually want help on? What springs to mind is finding ways that billing could be at least partially automated.” Startups, investors, and consumers grossly overestimate the incidence of misdiagnosis, maybe because it’s always been an easy programmer’s target to match up a set of symptoms with possible diagnoses even when the result changes nothing. They could probably save 100,000 times more lives by tackling problems that directly influence outcomes, although that’s a much fuzzier area than a computer-generated a-ha moment of dramatically announcing some weird but correct diagnosis. Precision medicine might be a good compromise, but even that isn’t likely to move the public health needle much. Perhaps the biggest reason for missing the point is that technologists are mostly young, can’t fathom death or disability, and have the money to bribe their way around healthcare’s velvet rope, so they may be oblivious to the concept of public health and the societal cost our inferior version of it creates. I also speculate that those same companies are overly focused on population health and patient engagement as the nail their technology hammer can easily pound, failing to understand that even cleverly designed and customized automated messages aren’t likely to improve the outcomes of those among us with the greatest healthcare needs. The idea that patients always do fine once properly diagnosed is dangerously naive, as is trusting providers to first do no harm even with the best of intentions. Also naive is the idea that companies and healthcare organizations will value the consumer’s interest over their own. 

HIStalk Announcements and Requests

I belatedly realized that I omitted the most obvious option in last week’s poll – leaving the patient data-selling situation as-is. Otherwise, respondents most often chose requiring the patient’s explicit permission, paying them, or not allowing their information to be sold at all.

New poll to your right or here: how much healthcare innovation will result from Cerner’s partnership with Amazon Web Services? Click the Comments link after voting to explain yourself.

A chance radio encounter with Deep Purple’s magnificent 1972 “Machine Head” deep track “Pictures of Home” led me to mount a Spotify exploration of their contemporaries, which sent me to the catalog of Iron Butterfly. They put out quite a bit of awful, unfocused dreck after their label rushed them into non-psychedelic follow-ups to “In-A-Gadda-Da-Vida,” but some gems shine through and their influence on future metal and hard rock bands is obvious. Fun fact: guitarist and former child prodigy violinist Erik Braunn – part of the classic 1968 Butterfly lineup along with Doug Ingle, Ron Bushy, and Lee Dorman – was only 17 when he played on “In-A-Gadda-Da-Vida” and concerns about his age cost the band their chance to land Jeff Beck and Neil Young as members. Dorman later co-founded another band I like, Captain Beyond, which is still around albeit carrying only a trace of its DNA with drummer Bobby Caldwell as the only original member. Iron Butterfly keyboardist and vocalist Ingle, in my mind the band’s key member, is long retired at 73, but is still on the preferred side of the dirt.

I just realized today that Microsoft Windows has properly faded into the background of my daily routine, finally outgrowing its maddening stage as an exuberant puppy that chews shoes and pees on the floor into a contented companion that never lets me down. I can’t recall the last something about Windows frustrated me.

I was thinking today that the most successful technologies either (a) help you do something you want to do, such as stream movies or play games; or (b) make it easier to do something you’re required to do, such as fill out tax forms or prepare presentations. Most apps that fall under the “digital health” category do neither.

Webinars

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

Acquisitions, Funding, Business, and Stock

Here’s a look at how the recent health IT IPOs are doing:

• Health Catalyst (July 25) – listed at $26, opened at $37.17, now at $40.54, valuing the company at $1.4 billion.
• Livongo Health (July 25) – listed at $28, opened at $40.51, now at $37.49, valuing the company at $3.4 billion.
• Phreesia (July 18) – listed at $18, opened at $26.75, now at $26.86, valuing the company at $953 million.
• Change Healthcare (June 27) – listed at $13, opened at $14.01, now at $13.16, valuing the company at $1.6 billion.

People

Jamison Callins (Cloudticity) joins Prepared Health as RVP of sales.

Privacy and Security

Security firm ExtraHop warns that an unnamed medical device management product – intended to protect privacy over hospital WiFi – was actually phoning home to its vendor in connecting to its cloud storage system, which the security firm says is a strict HIPAA violation.

Other

I saw a tweet about Simple, an open source Android app and web dashboard for providers to manage blood pressure measurements and meds, created by the philanthropically supported Resolve to Save Lives.

Vendors might want to take a look at this developer productivity booster, an AI-powered auto-complete add-in that supports 22 programming languages.

Sponsor Updates

• CereCore staff volunteer at Hope Lodge in Nashville.
• Meditech makes its antibacterial stewardship toolkit available to customers in the US and Canada.
• Nexus Primary Health in Australia migrates its InterSystems TrakCare HIS to an InterSystems cloud-based managed service.
• Waystar will exhibit at EClinicalWorks Day August 7 in Atlanta.
• Nordic will exhibit at the CORE Conference August 5-7 in Salt Lake City.
• Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the Arizona Perinatal Trust Conference August 8-9 in Flagstaff, AZ.
• Recondo Technology will host a networking event during the CORE Conference August 7 in Salt Lake City.
• Unlimited Technology Systems integrates Relatient’s automated patient engagement solutions with its G4 Studio RCM platform.
• ROI Healthcare Solutions names Sara Wallace (Oracle) director of business development for the Midwest region.

Blog Posts

• How to Improve the Patient Experience: Establishing a Strong Online Presence (EClinicalWorks)
• CMS Home Health Emergency Preparedness (LiveProcess)
• Why You Should Care About the High Cost of Healthcare Collections (Loyale Healthcare)
• Overcoming rural hospital challenges through community engagement at Comanche County (Meditech)
• 4 Key Ways to Boost Physician Engagement in Health IT (Mobile Heartbeat)
• The Medicare 8 Minute Rule Explained for Physical Therapy (MWTherapy)
• 7 ways to prevent costly claim denials (Experian Health)
• How Physician Empathy Increases Patient Loyalty (PatientBond)
• Flossing for Dollars (Impact Advisors)
• Powering Better Payment Experiences with Patientco’s New CRO (Patientco)
• Identity is Security: Recipe for Disaster (SailPoint)
• Lessons Learned: How Connecticut Implemented an EPCS Requirement That Was Effective and Embraced by the Medical Community (Surescripts)
• What Hospitals Can Learn about Incident Detection from the Notre Dame Disaster (Vocera)
• The Difference Between Medicare and Medicaid Billing and Reimbursement (WebPT)

Contacts

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

Weekender 8/2/19

Weekly News Recap

• The VA opens director and deputy director positions to oversee its Cerner implementation.
• Meditech reports lower quarterly revenue and earnings.
• Cerner signs a partnership deal with Amazon Web Services.
• The country’s biggest technology companies reaffirm their commitment to healthcare interoperability.
• CMS announces a pilot project to display a patient’s claims data to Medicare fee-for-service providers.
• Surescripts says Amazon-owned mail order pharmacy PillPack accessed its patient prescription records without authorization and will turn the issue over to the FBI.
• Bain sells a majority stake in Waystar.
• Meditech celebrates the 50th anniversary of its founding this week.
• Kaiser Permanente hires its first chief digital officer.

Best Reader Comments

I’ve seen [inaccurate hospital patient records] more times than I can count. However the more the information gets used and the more visibility it has, you start to see incentives to clean up the problem. One of the strongest forces is when you see automation or analytical reporting, or any type of financial incentive. My standard line is, “no one cares about data quality so long as no one is using the data”. Also, we are very forgiving about data errors so long as only human beings are consuming that data and the data usage is transactional and episodic (e.g. a patient chart during treatment). As soon as you start comparing one patient chart to a bunch of other patient charts, in any systematic way, that changes. Eventually the Data Quality department gets involved, the line managers can’t justify or defend the bad documentation, nor can the clinicians, and some procedures to clean things up are put in place.It takes time but it’s a real thing. (Brian Too)

I’d like to understand how Cerner moving to AWS is innovative and “pretty disruptive.” (ellemennopee)

I’m not seeing the real value in the “Data at the Point of Care” project for any one provider. It appears that it only gives them data for Medicare FFS patients. Only about 60% of Medicare patients are still in FFS, and think about how any one provider’s patients come from a variety of commercial and public payers. Does it help provide better care overall if they can only use that data for a small percentage of their patient panel? Care is already delivered differently based on who the payer is due to network restrictions, coverage levels, and the payer’s unique quality measure requirements, does this just further that divide? Would be interested in providers’ thought. (SEH)

Interesting combo of news this week. Cerner encourages investors with their plans to boost earnings by selling patient data. Amazon’s PillPack and Surescripts scrap over access to patient medication data. Cerner announces partnership with Amazon’s AWS for hosting their customers’ systems. Hmmm, I wonder where my patient data is going to end up when I entrust it to a Cerner hospital? (YourRxAdsHere)

[Epic’s] implementation staff is green, inexperienced, and taught to walk the Epic Foundation line. They in no way have experience in a hospital, or in any sort of maintenance of the systems they implement … On the other hand, if I had to hire staff, I would hire any Epic employee in a heartbeat. They are hard workers, bright, and great presenters, I have nothing bad to say about any I have encountered. It’s their lack of true experience that bothers me. (IMPlement)

One of the reasons IT and hospital administration favor systems like Epic and Cerner is that they want to standardize across the health system. They don’t want an app to be able to come in and override their configuration. They want everyone in their system to be on the same software and they want one throat to choke for getting software to do what they want. This is especially true for the particulars of this period of time in healthcare, in which ensuring quality while reducing cost is on everyone’s mind. We aren’t designing aircraft or cruise ships or other innovative developments. We need good execution of the good ideas already out there at an attainable price. (WhoIsBuyingThat)

Watercooler Talk Tidbits

Readers supported the teacher grant request of Ms. D in Texas, who asked for math manipulatives  for her elementary school class following the devastation of Hurricane Harvey. She reports, “Thank you so much for all you gave to my class. The games and activities you helped bring into my class has already made such an amazing impact. We love to use them in centers and the students love to play with them, but most importantly, learn with them. Words cannot describe how much these items mean to us. We recently used the fraction cards and power pen to help compare fractions! The students loved being able to hear the sound it made when they got it correct. We will continue to use these amazing materials and games to help further their learning.”

An analysis of the Democratic presidential debates by the executive editor of the liberal magazine “The American Prospect” says the candidates are ignoring and misrepresenting the top issue of voters, which is healthcare:

It’s a very strange situation for the leaders of reforming healthcare in America are too cowardly to talk about what’s wrong with healthcare in America. We know from experience that trying to play a savvy game and keeping the hospital industry on the sidelines won’t work. The hospital industry cut a deal with President Obama to eliminate the public option last time around. They’re already funding the effort to destroy reform this time. Why won’t anyone say this out loud?

Healthcare in America costs too much. We’re having a debate over how to fix it that renders invisible the very actors who charge the prices. That’s a recipe for disaster. Someone must show a modicum of guts and describe this system as it is, before it consumes us all. So far, guts are not in evidence.

A retired doctor in Ohio gets the attention of the President when his daughter’s back surgery results in an $18,000 bill for urine drug screening that had been sent to an out-of-network lab, the same test that would have cost $100 if performed in-network. He says he is “ashamed of my profession” and notes that “almost all medical bills are paid with someone else’s money.” A Houston pain management doctor owns both the surgery center and the lab.

Missouri’s medical board places Russell Imboden, DO on probation for prescribing drugs to himself, ordering unnecessary lab tests, and treating patients with serious medical conditions with chicken bouillon, protein shakes, and controlled substances from his “cell-based regenerative medicine” clinic that focuses on “metabolic and age management medicine.” He was previously fired from a similar clinic operated by another DO that sells energy drinks, medical weight loss, homeopathic remedies, and libido enhancement.

An oral surgeon sues an anesthesiologist who supervised his Brooklyn Hospital residency for sexual harassment, claiming that the woman groped him during surgery, threatened to kill him and his mother, waved a syringe at him, and sent him messages that included text such as “How would you like my dead body on your doorstep?” and “How long do you think it takes someone to bleed out?” Pik Lee was served with a protection order and arrested, but Francisco Sebastiani says she caused his firing after he complained and then gave him a bad recommendation that lost him a residency bid.

The new Miss England starts her NHS medical residency hours after winning the pageant. India-born Bhasha Mukherjee, MBBS, age 23 – whose family moved to the UK when she was nine — will move on to the Miss World competition. She says,

Some people might think pageant girls are airheads, but we all stand for a cause. We’re all trying to showcase to the world that actually just because we’re pretty, it doesn’t end there. We’re actually trying to use our reach and influence to do something good … I couldn’t tell if I was more nervous about the competition or about starting my job as a junior doctor.

An East Cleveland, OH car mechanic whose high school GPA was under 2.0 and whose family includes two young children at home graduates from medical school this year at age 47 and is doing an emergency medicine residency at Cleveland Clinic Akron General Hospital. The ED chair says of Carl Allamby, MD, “He’s got people skills most doctors don’t start out with, that customer relations mentality from his years in business. We were blown away by him.”

In Case You Missed It

• News 8/2/19
• EPtalk by Dr. Jayne 8/1/19
• News 7/31/19
• Curbside Consult with Dr. Jayne 7/29/19
• Monday Morning Update 7/29/19

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 8/2/19

Nordic launches Cerner Solutions

Nordic expands beyond its Epic roots to add Cerner consulting services.

Babylon Health will achieve unicorn status thanks to Saudi-backed funding round

Babylon Health will soon reach unicorn status thanks to a forthcoming $100 million to $500 million investment from Saudi investors, allowing it to move forward with previously announced US expansion plans.

Comcast-backed Accolade buys healthcare data firm

Personalized health and benefits solution vendor Accolade acquires physician performance data company MD Insider.

COTA, Inc. Announces Headquarter Relocation to Boston for Continued Growth

Oncology analytics vendor Cota will relocate its headquarters from New York City to Boston.

News 8/2/19

Top News

The VA posts a help-wanted notice for a director and deputy director to oversee the $10 billion Federal Electronic Health Record Modernization Program.

Salary details haven’t yet been released, though the new hires will receive a sign-on bonus and 49 days of paid vacation.

Meanwhile, the DoD announces that the next wave of MHS Genesis rollouts will occur in September at three bases in California and one in Idaho. Another seven bases will go live next June.

Implementation changes made since the initial, somewhat bumpy rollout at four sites in Washington include improved training, change management, and infrastructure.

All military medical facilities are expected to be live on Cerner by 2023.

Reader Comments

From Kermit: “Re: Meditech. Howard Messing has passed the title of president to Michelle O’Connor. He’s keeping the CEO title.” I don’t recall seeing an official announcement, but the company’s executive page and Michelle O’Connor’s LinkedIn show that “president” has been added to her COO title, apparently in April 2019. She joined the company as a programmer in 1988, having never worked anywhere else.

From Rxcellent: “Re: NCPDP’s 2017071 SCRIPT standard. I have a question for HIStalk readers. RxFill workflows provide for RxFillIndicator and subsequent RxFillIndicatorChange messaging. This allows prescribers to indicate that they only want to see partially-dispensed and not-dispensed prescriptions, but not the dispensed messages. Why would a doctor want anything other than ‘all fill statuses?’ If you use RxFill to monitor adherence or to determine whether the requested renewal is appropriate, why wouldn’t you want to see all statuses? Why does NCPCP include this as an option?” I invite readers to comment on this particular clinical use case.

From Pliny the Younger: “Re: reproducibility of AI/ML. Will the concerns offset the enthusiasm for healthcare disruption?” A couple of recent articles question whether AI/ML should be trusted to make medical decisions when its results can’t be compared to previous work (think about the FDA’s point of view here). A Google researcher observes that AI is like alchemy, which produced innovations such as glass along with false cures such as bloodletting. My favorite quote from this article:

Another problem is that AI experiments often involve humans repeatedly running AI models until they find patterns in data, like the conspiracy theorist who makes spurious correlations between unrelated phenomena because that is what he is looking for. This causes AI experiments to make false inferences from data because machines cannot distinguish correlation from causation, and the more a machine searches for patterns, the more it will find them … Market incentives can also impede reproducibility. AI labs are often encouraged by parent companies to get newsworthy results by any means and make them difficult to copy. This encourages researchers to prioritize research outputs over methods and to conceal crucial aspects of their workings.

HIStalk Announcements and Requests

I don’t like to compare the quality and usefulness of the webinars that we produce — it’s like asking someone which child is their favorite — but this week’s one from Mercy Technology Services titled “Modern Imaging Technology for the Enterprise: Improve Imaging Cost, Speed, Capacity and Care Quality” is among the best ever, with my review panel and I offering zero suggestions for improvement after watching the rehearsal and Thursday’s live presentation delivering the goods. Jim Best is a great speaker, the history and overview of exactly what Mercy Technology Services does is highly informative, and the recap of their imaging project is admirably concise and useful. 

I added a sidebar menu item for Vince’s magnificent HIS-tory document, which he views (and I would agree) as the high point of his 50-year career in our industry. The information that Vince has preserved for posterity exists nowhere else that I’m aware of. 

Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information.

Acquisitions, Funding, Business, and Stock

Meditech reports Q2 results: revenue down 4%, EPS $0.44 vs. $0.65. Product revenue slid 15%. The company will sell one of its nine buildings for $120 million, giving it an $88 million profit.

Spok reports Q2 results: revenue down 3%, EPS –$0.03 vs. –$0.06. SPOK shares are down 15% in the past year vs. the Nasdaq’s 6% increase, valuing the company $232 million.

Business Insider reports that Babylon Health will soon reach unicorn status thanks to a forthcoming $100 million to $500 million investment from Saudi investors. Analysts predict the UK-based company will use the funding to make good on its previously announced expansion plans into the US and Saudi Arabia, though it remains to be seen if its services will leave physicians as up in arms as their British counterparts. Many NHS providers contend the company’s GP at Hand virtual primary care service has skewed patient demographics, leaving NHS clinics caring for the most vulnerable while the young, wealthy, and tech-savvy opt for Babylon’s app-based care.

Accolade will use software from recently acquired physician performance data company MD Insider to power its new nurse-led care coordination program for members and employees.

Madison, WI-based Nordic expands beyond its Epic roots to add Cerner consulting services.

Sales

• The VA awards Ready Computing a five-year contract to support the transition of health data from VistA to its new Cerner EHR.
• CoxHealth (MO) will offer MDLive’s virtual care service across its network of six hospitals and 80 clinics.

People

David Sides (Streamline Health) joins Teladoc Health as COO.

Castlight Health promotes Maeve O’Meara to CEO following the departure of John Doyle. CFO Siobhan Mangini will take on the additional role of president. CSLT shares are down 50% in the past year and have tanked a stunning 95% since its March 2014 IPO.

CommonWell Health Alliance opens a search to replace Executive Director Jitin Asnaani, MBA, who will leave the organization after four years.

Announcements and Implementations

Montefiore Nyack Hospital (NY) implements Aidoc software to help radiologists better identify life-threatening conditions on patient CT scans.

Patient intake and engagement vendor Orca Health selects Redox’s EHR integration software.

In Canada, Holland Bloorview Kids Rehabilitation Hospital goes live on Meditech Expanse.

A new KLAS report finds that three-fourths of the hospitals that are actively seeking to replace their EHRs are running legacy Meditech, Allscripts (especially Paragon), and Cerner. KLAS’s A-list includes Epic and Meditech Expanse, the latter of which draws customer praise for usability, workflow, mobility, company responsiveness, and innovation while offering strong value (and notably beats Epic Community Connect in “would buy again.”) The #1 reason for considering an EHR replacement is integration, where old products such as legacy Meditech, Allscripts Paragon, CPSI, and Medhost lag. Some Cerner prospects are scared away by revenue cycle issues, while Allscripts Paragon lost 16 clients in 2018 and nearly half of the remaining customers say they’re ready to move on to something else, rarely Allscripts Sunrise (zero of the 16 defections). KLAS says Sunrise “receives few considerations, and when considered, is rarely selected” as its customer base is shifting mostly to Epic. Critical access hospitals are anxious to see the inpatient product of EClinicalWorks once it starts bringing sites live.

Privacy and Security

DirectTrust is working to develop a standard for secure instant healthcare messaging. Trusted Instant Messaging+ will enable users to communicate within enterprise messaging software and across different technologies using a common standard.

Other

Google-owned DeepMind announces that its AI software can detect acute kidney disease up to 48 hours before physicians recognize its symptoms. The London-based company developed and tested its algorithm using 700,000 medical records from 100 VA hospitals as part of a project announced at the beginning of the year. DeepMind, which also worked with the Royal Free Hospital in London, plans to also develop and deliver provider alerts in emergency situations.

The Los Angeles County District Attorney’s Office charges Guido Germano, PhD, director of the Division of Artificial Intelligence Medicine at Cedars-Sinai Medical Center (CA), with distributing child pornography.

Cerner COO Mike Nill says the company chose Amazon Web Services as its cloud partner mostly because it wants to tap into Amazon’s consumer and supply chain expertise to create products that the two companies can sell to other organizations. Nill also says that 80% of Cerner clients host their systems in the company’s data centers and AWS can migrate them to the cloud faster than competitors such as Google and Microsoft.

Sponsor Updates

• FormFast staff helped to prepare 20,454 meals at the St. Louis Area Foodbank.
• Alabama One Health Record relies on InterSystems HealthShare to power its HIE and enhance connectivity between providers and emergency responders during natural disasters.
• Wolters Kluwer Health Voice Design Director Freddie Feldman will present at the Voice of Healthcare Summit August 5-6 in Boston.
• Spok announces that all 21 hospitals named to the US News & World Report’s 2019-20 Best Hospitals Honor Roll use its clinical communications solutions.
• EClinicalWorks will exhibit at GI Outlook 2019 August 2-3 in Los Angeles.
• EPSi will exhibit and present at the HFMA Mid-America Summer Institute August 507 in Kansas City, MO.
• The Deal interviews Healthcare Growth Partners Managing Director Chris McCord.
• A new KLAS report on acute care EHRs gives Meditech Expanse an A-List Honorable Mention for its increased market energy, overall customer satisfaction, and high customer retention.
• In Scotland, NHS Forth Valley goes live on InterSystems TrakCare.

Blog Posts

• Quarterly upgrades one year later: 6 takeaways for a smoother transition (Nordic)
• The Promise of a New EHR: Why Practices Switch (EClinicalWorks)
• How to Prevent (and Handle) a Healthcare Cybersecurity Incident (Ensocare)
• Virtual Training in Today’s Healthcare System (Optimum Healthcare IT)
• 3 questions to ask before moving your organization’s content to the cloud (Google Cloud)
• An Academic Approach – What’s That Mean? (HBI Solutions)
• Why Workflow Assessment is Vital for Delivering Revenue Cycle Optimization That Sticks (The HCI Group)
• How UHS uses availability and performance monitors to ensure Cerner is optimal for its physicians (Goliath Technologies)
• 11 Prescription Renewal Workflows to Standardize Today (Healthfinch)
• Enhancing the patient experience, together (Hyland)
• SHIEC 2019: Providing Health Data Clarity and Confidence for HIEs (Imat Solutions)
• The ‘People’ Side of Implementations: Change vs. Readiness vs. Culture (Impact Advisors)
• The Interoperability Directive: What the Proposed ONC & CMS Regulations Mean – Part 1 (InterSystems)

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EPtalk by Dr. Jayne 8/1/19

The Federal Trade Commission has agreed to a $5 billion settlement with Facebook following allegations that the social media giant misled users about their ability to protect personal data. Privacy advocates argued that Facebook deceived patients about the “Groups” function, encouraging them to share personal health information which was then exposed to the public. Although the settlement also requires Facebook to create an internal privacy oversight board, some say the penalty doesn’t do enough to protect user privacy. The settlement order will be in place for 20 years and sets up multiple compliance channels. The settlement, nearly 20 times larger than any previous settlement, must still be approved by a federal judge.

CMS announces additional Primary Care First Model Payment Office Hours sessions aimed at reviewing the proposed model payment structure and various model components and measures. CMS still hasn’t released the Request for Application for the program, so many of us are waiting for the details before we make decisions on participation. They did update the anticipated timeline for the RFA from “spring” to “summer” on their website, however.

CMS did, however, release the proposed rule for the 2020 Medicare Physician Fee Schedule this week. The Relative Value Unit (RVU) conversion factor went up a whopping $.05. Bundled episode of care codes were added for telehealth treatment of opioid use disorders. There is additional refinement of Evaluation and Management (E&M) codes for outpatient visits, including retention of five levels of coding for established patients and the reduction to four levels for new patients. There are also changes to the time requirements and medical decision making requirements for all of the codes. History and Physical are now required only “as medically appropriate,” which should be interesting when audits start occurring.

Medicare supervision of physician assistants will have increased flexibility for PAs to practice more broadly; requirements for physicians who precept students will be relaxed so that re-documentation is no longer necessary. Payments for Transitional Care Management will be increased along with the development of new HCPCS codes for certain Chronic Care Management services. I’m not sure that this addition of Medicare-specific codes will make things more simple, although it should allow physicians who spend additional time and resources to be able to differentiate that in their billings. A new code for Principal Care Management will also be created to compensate clinicians for providing care management services to patients with a single serious or high-risk condition.

Since they can’t release just one proposed rule, they also released the 2020 proposed rule for the Quality Payment Program. Highlights include:

• Increasing the performance threshold from 30 to 45 points.
• Decreasing the category weight for Quality and increasing the weight for Cost.
• Increasing the data completeness threshold for quality data submission.
• Increasing the threshold for Improvement Activities for group reporting.
• Updating requirements for Qualified Clinical Data Registry measures.

I’ve long been a follower of CIO Sue Schade and really enjoyed her recent blog post on meeting norms. Sue is currently doing interim IT work at the University of Vermont Health Network and is getting used to their rules regarding meetings. It sounds like they’re walking the walk and talking the talk on the fabled “50-minute meetings” that I always try to get my clients to adopt. People need time to refresh and readjust between meetings and the back-to-back culture I see with most of my clients doesn’t add to a positive working environment. Their “meeting norms” include providing agendas and meeting materials in advance with the invitation, and allowing people to bypass meetings that don’t have an agenda. They’ve also adopted meeting-free Fridays to allow people to focus on work and individual interactions.

It takes time for organizations to move to this kind of structure, but when they do, productivity typically increases and frustration decreases. You no longer see harried people scurrying from meeting to meeting or zoning out because they’re overextended.

I missed this newsy tidbit last week, but AHIMA and CHIME went to Capitol Hill to lobby to eliminate the 20-year prohibition of federal funding for a unique patient identifier. Representatives urged the Senate to support the Foster-Kelly House amendment to the Departments of Labor, Health and Human Services, and Education, and Related Appropriations Act of 2020. Removal of the ban would allow HHS to fund efforts towards a unique identifier. After working with patients from around the world who are used to having to provide a national health card prior to receiving services, it certainly seems like it might be an improvement over the matching algorithms we have that use name, DOB, address, and phone numbers.

JAMA Network Open confirms what we all already know: US adults are becoming more sedentary. In a cross sectional study looking at more than 27,000 adults, the time spent on sedentary behaviors increased from 5.7 to 6.4 hours per day in 2015 and 2016.

I wish they were here to collect data at the World Scout Jamboree, where I’ve walked 71 miles since I arrived. There’s still a few days to go, so that total will continue to increase. We’re seeing lots of tired feet, a bit of athlete’s foot, and plenty of orthopedic injuries as tens of thousands of scouts try to maximize the time they have left at the Jamboree.

Neckerchief trading is in full swing and I was excited to score one from the UK, but I had to trade away my medical neckerchief to get it. The nations of the world are relatively uninterested in sporting “neckers” from the US. Especially prized are neckerchiefs from Brazil and Belgium. Lots of people are interested in the ones from the Swedish contingent, but from what I’ve been told, they only receive one and don’t typically trade them.

We’ve survived our heat wave here in West Virginia and are having some rain showers that have already brought cooler temperatures. The next milestone is the closing show on Thursday night. I get to attend this one since I was working during the first one, and hope they bring back the fleet of 250 drones that swarmed across a 900 x 400 foot of aerial canvas during the first show. Everyone said the effect was outstanding, with attendees’ wristbands lighting up as the drones formed the shape of their home continents.

It’s only a few days until hundreds of buses roll back in to take the scouts to their next adventures. Some toured the US prior to the Jamboree and others plan to tour after. Either way, they (and the nearly 10,000 staff that have supported them) have had the adventure of a lifetime.

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