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Morning Headlines 11/5/19

November 4, 2019 Headlines No Comments

Allscripts Announces Third Quarter 2019 Results

Allscripts reports Q3 results: revenue up 3%, with adjusted EPS of $0.17.

JPMorgan Tests Its Amazon-Berkshire Health Venture on Bank Employees

JPMorgan and Amazon will offer employees in select states access to deductible-free health plans administered by their Haven healthcare business.

Google Health is finally opening up about its plans, and they’re all about search

Google Health VP David Feinberg says the company hopes to develop a search bar that will assist doctors in pulling relevant content from their EHRs, as well as to improve healthcare search results for consumers.

Curbside Consult with Dr. Jayne 11/4/19

November 4, 2019 Dr. Jayne 2 Comments

I had the privilege of attending a prestigious medical school, so I’m always on the lookout for articles about our “rivals” doing something that my alma mater’s institutions aren’t. Johns Hopkins recently launched what may be a first: the Center for Psychedelic and Consciousness Research. They received a $17 million donation from a private foundation and four philanthropists, one of whom is Tim Ferriss, author of “The 4-Hour Workweek.”

The center’s director is interested in studying drugs such as LSD and their potential to treat depression, anorexia, substance abuse, and possibly early Alzheimer’s disease. Apparently Hopkins isn’t the only place who wants to be on this cutting edge. Research is also being done at institutions including New York University, Yale University, University of Wisconsin-Madison, University of California, and the University of Alabama at Birmingham. The center’s director expects that federal funding for psychedelics will increase.

In the article, he speaks at length about a typical psilocybin treatment session. It’s about as far from eating magic mushrooms at a party as one can get. Prior to the session, patients spend up to eight hours with the clinical team reviewing their personal and family histories as well as “life circumstances” to build rapport since the drug can make patients feel vulnerable. On the treatment day, patients receive the medication, lie on a couch, wear eye shades, and use headphones to listen to music. They are encouraged to focus their attention inward while two clinical guides monitor them for six to eight hours. Drug effects typically begin after about 30 minutes and peak a few hours later, then gradually resolve. Patients report sensations that range from love and joy to anxiety or panic. Test subjects often feel that they have a redefined sense of self, which can lead to ongoing positive changes in mood and behavior.

The team has studied the compound in patients with cancer who report decreased depression and anxiety. Patients have reported a positive impact on tobacco cessation efforts. I was surprised to hear that a couple of pharmaceutical companies have shown interest in the drug. I suppose it’s not much different from other drug agents where we don’t entirely understand the mechanism of action or how effective it might be, but companies smell profit potential and so they dive in. Psilocybin has been decriminalized in Denver and Oakland, but those cities aren’t entirely representative of the rest of the US as far as potential for future use.

Of course, this topic has little bearing on the world of healthcare IT, other than use of platforms for research and data aggregation, but it was a good diversion from reading about CMS releasing the Final Rule for the 2020 Quality Payment Program.

CMS continues to tweak the recipes for the Merit-based Incentive Payment System (MIPS) along with the Advanced Alternative Payment Models (APMs) under the guise of reducing burden, responding to stakeholder feedback, and better aligning with various legal requirements. I’ve honestly given on up trying to follow all the MIPS details since my practice remains opted out, and most of my clients have hired full-time people to keep up on everything rather than relying on consultants.

Long story short, various performance categories have been re-weighted, thresholds have been increased, and the finish line keeps being moved. CMS is also finalizing its proposal for MIPS Value Pathways, which of course carry the MVP moniker. I’m sure anyone who participates in the program, which starts in 2021, won’t consider themselves most valuable players in the eyes of CMS.

In other random web surfing this weekend, I saw that Amazon and JPMorgan plan to roll out new health insurance plans for their employees for the 2020 year. The new Haven Healthcare plan will include wellness incentives and will be deductible free. Berkshire Hathaway apparently has a similar pilot. The plans will be offered through traditional insurance providers, including Cigna and Aetna, and may vary slightly depending on the state. The plans are supposed to be more clear than other plans as far as what patients have to pay and how co-pays are applied. Patients will receive rewards for meeting health-related goals.

I had the unique opportunity this weekend to deliver an impromptu education session (which I fear may have turned into a little bit of a sermon) about the state of healthcare delivery in the US. We had some unexpected downtime at my clinical gig, so I was doing some reading on value-based care and my staff asked me what it was all about. Since most of them were in high school when Meaningful Use came about, we did a brief tour through the history of US healthcare, the rise of electronic health records, and what life was like back in the dinosaur days before the internet came into being.

Even though several of them are applying to medical school and have been working in various clinical settings for some time, they had shockingly little understanding of how healthcare is financed here, other than knowing that when patients don’t have insurance, things often get dicey. At least one had experience working in a free clinic and had that frame of reference, but for others, it was eye-opening. Many of the jobs done by aspiring medical students are focused tours through the healthcare system. They might be in the emergency department, at a clinic, or volunteering in a medical office. I can’t imagine that many of them are spending time in the local billing office or following around certified professional coders, although maybe they should be.

They left with some homework assignments. Not only books to read, but also to consider watching “Halt and Catch Fire” on Netflix so they can better appreciate the overwhelming assortment of technology that they can choose from every day. If you haven’t seen it, it’s a fictional tour through the early days of the PC industry and the creation of the internet and search engines. I enjoyed it tremendously during my treadmill sessions earlier in the year. I’m currently watching Charité on Netflix, which depicts the prominent Berlin hospital during the 1800s. The series is in German with English subtitles, and I’m enjoying the depictions of famous physicians of the time.

What random tidbits are you thinking about? Leave a comment or email me.

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Email Dr. Jayne.

Book Review: Lethal Injection

November 4, 2019 Book Review No Comments

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A reader correctly predicted that I would like “Lethal Injection,” which he accurately described as an “informatics murder mystery” that came out in June 2019. That reader is a former colleague of the author and recognized in his book subtle references to the hospital and anesthesiology department in which they worked.

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Author Perry Miller, MD, PhD is an anesthesia professor emeritus at Yale School of Medicine and founder and previous director of the Yale Center for Medical Informatics and its biomedical informatics research training program. He earned his medical degree at University of Miami , an MS at Cal Berkeley in electrical engineering and computer science, and a PhD in computer science from MIT.

It is remarkable that the book is Miller’s first foray into writing anything except research papers. The book is fast paced, flows perfectly, and contains few of the common flaws that often cause me to put a book down for good when the literary awkwardness distracts me from the story.

The book leads off with a flurry of action in which the CEO of academic health system Boston Central Hospital dies while undergoing cardiac surgery at Laurel Hill Community Hospital, which Boston Central is taking over.The anesthesiologist in the CEO’s surgery case is the wife of the protagonist, ED doc Gideon Lowell (the author has a lot of fun with his first name, which isn’t entirely random as he explains in the appendix). She is immediately targeted as a suspect when investigators find that a syringe that was labeled as vecuronium actually contained something else that killed the patient when she injected it. Lowell launches his own investigation, partly because of his patient safety background, but mostly because he wants to prove that his wife wasn’t responsible.

A good page-turning crime mystery starts by introducing several suspects with various motives, then keeps you guessing at who did it until the climactic end. Miller does a great job in weaving a tale of who might have wanted to see the CEO dead. Laurel Hill employees resent having Boston Central know-it-alls running around in preparation for the takeover. Partners in Laurel Hill’s contracted anesthesiology company stand to lose hundreds of thousands of dollars per year via lower academic salaries. Also present are the usual hospital soap opera issues of romantic entanglement, bullying, and doctor back-biting, not to mention hospital greed in performing questionable but lucrative surgeries. In other words, it is realistic.

Miller adds some fun IT flourishes that are vital to the story – spoofed hospital emails, intentional disclosure of EHR patient information, medical records tampering, and the fact that Laurel Hill was ripe for takeover because a botched billing system implementation caused revenue problems (that part of the book isn’t described believably, but it’s not crucial to the story). Then we meet an old friend of Lowell who is a cybersecurity expert who offers to help, a somewhat clueless risk management lawyer, a medical group programmer, a quality assurance manager, anesthesiologists whose character flaws range from laziness to hostility, and an investigative reporter who starts probing into Laurel Hill’s clinical problems.

This book flows really well, contains fun hospital insider knowledge, and probably scares laypeople who will wonder whether hospitals really are greedy and whether doctors could be so vain, insecure, and hostile to employees and to each other. Reading it is a pleasure, not a chore.

A few changes could have made the book better:

  • It’s a relatively short read at 232 pages. That isn’t surprising since publishers aren’t going to allow first-time authors to ramble on for 500 pages like Stephen King since they can’t command his high cover price yet. Keeping it short when the book contains mostly dialog – which takes up more page space —  limits what we can learn about characters that can seem one-dimensional at times, and deprive of us what I’m certain would have been some funny details given a few that were included. But if someone wants to make a “Lethal Injection” movie, which isn’t a bad idea, the book already reads like a screenplay that mostly contains characters talking over a linear timeline.
  • An editor should have caught that it’s vocal “cords,” not “chords,” and a data “breach,” not “breech.” Overuse of the term “sub rosa,” meaning done in secret, was a bit grating. Those are the only examples of questionable editing that I saw, and I usually see a ton, even with the books of best-selling authors. 
  • One set of characters was probed in depth, which was good for calling them out as possible perpetrators, but then their seemingly incriminating act was left dangling as the story raced to its conclusion without them.

“Lethal Injection” grabs the reader’s attention in the first couple of paragraphs and doesn’t let it go until the end, demanding furiously fast reading to see how the story unfolds instead of easy savoring of carefully crafted details and back-stories. I can’t imagine that it’s easy for any author to create such a book, much less a first-time author. It’s quick-hit entertainment that won’t leave you thinking about the characters afterward, quoting new facts you learned, or pondering its hidden meaning or the meaning of life.

Perry Miller is an excellent writer and I’m awaiting his next work.

The Kindle version of “Lethal Injection” was a steal at $0.99. It would be the perfect read for traveling health IT folks who need something engrossing to read on planes or in hotel rooms, knowing that they can pick up where they left off easily if interrupted.

Morning Headlines 11/4/19

November 3, 2019 Headlines 2 Comments

Trump Administration Delays Rule Forcing Hospital-Cost Transparency

CMS delays a requirement that Medicare-accepting hospitals share their secretly negotiated insurance rates in machine-readable format and online.

Fitbit to Be Acquired by Google

Google will acquire Fitbit for $2.1 billion in cash, saying it will bring together the best hardware, software, and AI to build wearables.

The Brooklyn Hospital Center Notice of Data Security Incident

The Brooklyn Hospital (NY) says it discovered ransomware in its systems in July 2019 and found that in September 2019 some of its patient data cannot be recovered.

DAS Health Acquires Automated Medical Systems

Health IT reseller DAS Health acquires competitor Automated Medical Systems.

Monday Morning Update 11/4/19

November 3, 2019 News 13 Comments

Top News

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CMS delays a requirement that Medicare-accepting hospitals share their secretly negotiated insurance rates in machine-readable format and online.

CMS Administrator Seema Verma said Friday that the government now wants to make insurers disclose their contracted prices as well. She says the revised plan that includes both hospitals and insurers will be rolled out by the end of the year.

Lawsuits that question the the government’s authority to compel private companies to disclose competitive trade secrets are inevitable.

Hospitals would be fined $300 per day for failing to comply with the disclosure requirement, which would cost a multi-billion dollar health system just $109,500 per year to keep its prices secret.

Verma also credits President Trump for lowering health insurance premium prices on Healthcare.gov via his Executive Orders as open enrollment begins.


Reader Comments

From Built to Spill: ”Re: patient name on labels. We changed our system to use the patient’s preferred name on wristbands and labels. The impact was positive, but now fewer characters print and the names are being truncated. Name length issues are a challenge, and this is an unexpected adverse outcome of trying to do a positive thing.” Label formatting is more maddening than a layperson would appreciate. You have limited space and the nature of most text fields is that, unless you use a fixed-width font, you can neither predict nor highlight truncation (names with I’s and E’s may not truncate, but those with M’s and W’s might). I’ve pored over reams of test data as formatted onto a Crystal Reports label or report, dragging the text box a tiny bit wider or narrower in shooting for the best outcome with critical drug and lab test names. You could do something to trigger an adjacent ellipsis to warn the user that the name has been shortened or perhaps check length and then override the default label font to a smaller one, but that leaves the problem unsolved. I vaguely remember that I once programmed a label to combine all its fields into a single big text box with programmatically-added spacing and line breaks in trying to squeeze it all in without truncating (since the odds of all data elements being oversized was small), but I seem to recall that the result didn’t line up nicely and clinicians accustomed to glancing at predictably formatted information were justifiably less than ecstatic.

From Dogged Determination: “Re: Ed Marx. Hope it’s not true that he has left Cleveland Clinic.” Ed didn’t respond to my inquiry, but I see that he has updated his LinkedIn over the weekend to indicate that he left the Clinic last month after 2 1/2 years as CIO and is now an independent consultant.

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From Sunny Jim: “Re: our industry. It never fails to not deliver! I took this in a health system-sponsored, grocery store-based convenient clinic during daytime hours. I told the receptionist it was down, but she just shrugged her shoulders like it happens all the time. We just can’t get away from the clipboard!” I’m amused that the kiosk’s splash screen helpfully explains that it is “Epic’s Self Service Check In Kiosk” and then someone has helpfully taped on a torn scrap of printed paper in an act of customization that announces “KIOSK.” This self-aware message reminds me of no-hunting signs that needlessly say “POSTED” or the legendary title and theme song of the late-1980s Showtime series “It’s Garry Shandling’s Show,” where the song’s opening lyrics were, “This is the theme to Garry’s show.”


HIStalk Announcements and Requests

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About two-thirds of poll respondents who attended HIMSS19 will be at HIMSS20, while a few folks who didn’t go last year will be in Orlando in March. HIMSS is trying to invoke the bandwagon effect of touting increased C-suite and physician registration compared to HIMSS19, but A-Rod’s keynote aside, I would still put my money on a modest attendance decline.

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New poll to your right or here, since people always say the biggest benefit of the HIMSS conference is the networking opportunities: how much of your conference networking benefits your employer versus you personally? Is it more than just socializing, catching up with old friends, having fun, and connecting for a possible job change?

Speaking of HIMSS, I still have a twinge of both regret and relief that I didn’t buy a tiny booth this year so Lorre could say hi to readers in the one time each year she sees them in person, but it involved a lot of money for minimal ROI.  The map of available booths suggests that 250 of the available 449 10×10 booths (the size I bought in previous years) are unassigned. The exhibit hall floor plan shows 1,126 booths taken, about two-thirds of the number available. It also shows just over 100 first-time exhibitors, although the usual churn (along with consolidation) will likely more than offset that number with non-returning HIMSS19 vendors. Total booth square footage leaders, at least by eyeballing, are Epic (12,064), Allscripts (10,800), IBM (10,110), and Cerner (9,074). HIMSS charges a base rate of $39 per square foot, which puts Epic’s basic rent for the three days at $500K, which must be a fraction of what the company will spend for freight, signage, travel and salary costs, and various forms of conference advertising and sponsorship.

I had some big site upgrades performed over the weekend, just in case you noticed something weird (and if you’re still seeing it, let me know since maybe I missed something, although I still have a couple of punch list items). I moved to PHP 7 (specifically 7.3), a faster and more secure version of the server-side scripting language that has been around since 2015. Newer versions are used by only a small percentage of sites since they breaks a lot of old code that someone has to analyze and fix, which to which I can personally attest. 

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Welcome to new HIStalk Platinum Sponsor Bright.md. The Portland, OR-based, physician-founded company offers SmartExam, an AI-powered, asynchronous virtual care platform that increases provider capacity by a factor of 10 and reduces care costs by up to 90%. Patients with hundreds of conditions can be treated in under two minutes and in just three clicks without the provider touching the EHR. The patient interface doesn’t require appointments, video visits, or a broadband connection. SmartExam serves as the virtual front door for health systems, the first step in a ladder of care that moves the patient along their care journey for more complex issues. It can be brought live in 10 weeks or less, delivering a quick win for physician satisfaction and patient delight. The company just delivered significant improvements that include care escalation to a 911 call when triggered by patient question responses, AI-powered interpretation of patient responses to eliminate dropdowns, configurable formularies, and an all-inclusive design approach that is also ADA compliant and does not require patients to choose a gender. Thanks to Bright.md for supporting HIStalk.

Listening: new from Tacocat, Seattle-based punkish, smart-assy pop rockers (whose name is a palindrome, I just noticed) who sound like high school best girlfriends who decided to form a band. Pitchfork summarized an earlier album as, “It feels like taking a joyride with four bonafide party experts egging you on as you drunk-text an ex.” On a more somber side is “Ghosteen,” a new double release from the always-poetic Nick Cave & the Bad Seeds, Cave’s first album written after the 2015 death of his 15-year old son. Nick Cave is a genius and master of art forms that include performing, writing, film scoring, acting, and screenwriting and the Bad Seeds are underrated in being more than just backing musicians. Their live performances are intense, although unfortunately next year’s tour contains no US dates so far.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Google will acquire Fitbit for $2.1 billion in cash, saying it will bring together the best hardware, software, and AI to build wearables. CNBC notes that Google’s hardware aspirations have mostly failed with Nest, Google Glass, its light-selling Pixel smartphone, and its purchase of IP from smart watch maker Fossil having failed to make much of a dent. Its acquisition of Motorola lasted just three years as it sold the company to Lenovo for less than 25% of the price it paid. Fitbit sales were in big trouble, so perhaps the company was right to recast itself as a healthcare and data collection company in catching Google’s eye in what started as a collaboration in April 2018. Let’s see if Google takes a Facebook-like route in linking up wearables data to the wealth of information it holds, using it for purposes we as users might not like, at least those of us who aren’t in Europe where GDPR offers at least some consumer privacy protection. 

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Cleveland’s Global Center for Health Innovation loses its biggest tenant, BioEnterprise, which was also promoting the taxpayer-funded facility that had previously parted ways with its then-largest tenant HIMSS. The developer is trying to figure out how to use the building, with one option being to convert it to meeting space to expand the attached Huntington Convention Center. Taxpayers paid $465 million to build the Center and the convention center.

The Kansas City paper questions whether residents of the declining neighborhoods of south Kansas City are benefiting from the $1.6 billion incentive package that was given to Cerner to build a $4.3 billion campus there on the site of an abandoned mall. They complain that even though 3,000 Cerner employees work on the campus, the only other new development is a single gas station and most employees go straight from the Interstate to the gated Cerner campus and then leave the area after work. The school district loses $2.7 million in annual revenue because of the tax breaks. Local politicians and Cerner had predicted a rejuvenation of the area through new development, but the Walmart remains closed and a neighborhood survey found that the only retail need being met is liquor stores.


People

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Cerner announces in SEC filings the departure of COO Mike Nill and Chief Strategy Officer Joanne Burns in the first quarter of next year. That leaves four executives who were on board when Neal Patterson died in July 2017 – Chief Client Officer John Peterzalek, CFO Marc Naughton, EVP Jeff Townsend, and EVP Donald Trigg. I also noticed that John Glaser has been removed from the executive page even though his individual page as SVP of population health remains, while his LinkedIn shows him as executive senior advisor.

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Denis Zerr (Catholic Health Initiatives) joins Radiology Partners as CIO.


Announcements and Implementations

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The local paper covers the go-live of Kern Medical (CA) on its $30 million Cerner system, showing pride that the hospital, “which had a well-documented history of financial dysfunction,” now has a modern system that is on par with those of competing local hospitals of Dignity Health and Adventist Health.


Government and Politics

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The administrator of Guam Memorial Hospital tells legislators that support for its Optimum system (formerly Keane, then NTT Data, now Cantata Health) will end December 31 but it doesn’t have the money to even start the search for a replacement that could cost $50 million.

CMS is working on Healthcare.gov errors that users experienced on Friday’s first day of open enrollment.


Privacy and Security

The Brooklyn Hospital (NY) says it discovered ransomware in its systems in July 2019 and found that in September 2019 some of its patient data cannot be recovered. Among the lost information is patient name (!!) and cardiac and dental images. The hospital says that recovery efforts are continuing.


Other

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A Newsweek opinion piece by “House of God” author Samuel Shem (aka psychiatrist Joseph Bergman, MD, DPhil) says that “the EMR is essentially a cash register” that was “developed by technocrats as part of the mandate of the Obama administration in 2008” (which is obviously way wrong, but let’s call it creative license). Shem describes a war being waged on both sides of the screen – the hospital’s billing team trying to maximize payment while the insurer’s team tries to minimize it. Shem thinks EHRs should be redesigned to ignore billing requirements like the VA’s VistA (again, good idea, but apropos only in a fictional world, and the VA is dumping VistA for one of those cash registers besides). He closes strong: when someone falls in a theater, does anyone call, “Is there an insurance executive in the house?” Meanwhile, I’ve pre-ordered Shem’s latest book, a “House of God” follow-up that comes out November 12 titled “Man’s 4th Best Hospital.”

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A New York Times essay by UCSF internist, assistant professor, author, and podcaster Emily Silverman, MD says the hospital’s new Epic system amplifies the insecurities of its physician users. She notes:

  • Her first Epic log-in presented a warning that she had “deficiencies,” which she says made her feel like a middle school student whose name was called out in assembly. In contrast, her friends who work at Facebook says the company talks a lot about “voice” in trying to make users feel cared for, with birthday reminders and display of photo memories.
  • Epic has “unintelligible medical notes, filled with ragged vines of superfluous, robot-generated text” and interruptive, mid-documentation demands to choose a patient’s diagnosis from a drop-down list while she is trying to figure out what’s happening with the patient.
  • Entering the chart of a deceased patient, which is often when the physician finds out their patient has died, provides an empathy-free “Deceased Patient Warning” pop-up.
  • She concludes, “A more humane version of Epic would take a different tone. In the absence of a true emergency, its colors and symbols would be neutral, even tranquil. Deceased-patient warnings would recognize the emotional impact of a life lost. Deficiencies and delinquencies would become incomplete tasks, and pop-ups would float into view as small islands of empathy, like the system’s periodic emails. (“Thank you for all of your hard work.”) But until then, the voice of the program itself — urgent, intimidating, and tinged with allegation — will continue to contribute to the profession’s growing sense of despair.”

Cerner SVP John Gresham says the company’s integration with Uber for patient transportation is just one way that Cerner will address social determinants of health, which could include new services such as appointment and prescription reminders that include transportation options, alternatives to ambulance transport that goes beyond Uber’s capability, and prescription delivery.

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Boston Children’s Hospital celebrates the 25th anniversary of its Computational Health Informatics Program (CHIP), which in addition to providing education, created the first personal health record, developed the SMART interoperability protocol, developed HealthMap for visualizing global disease outbreaks, demonstrated the power of analytics and genomics, and spun out several startups. A September 26 symposium reviewed CHIP’s history, then offered panel discussions on what healthcare will look like 25 years from now, including the role hospitals will serve, who will make clinical decisions, how therapies will be developed, and what R&D should be performed now to prepare for the future.

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UCSF hospitalists say moral distress is a root cause of physician burnout and that hospitals should prioritize ethics and the “inherently unethical” healthcare system should be reformed to prioritize patients over shareholder profits. They also urge education in ethics and for doctors to be encourage to advocate for issues that affect their patients, such as gun control and universal health coverage. They cite these specific problems:

  • Pressure to reduce costs in some areas while increasing them in others through profitable prescribing or referrals.
  • Being forced to provide futile or harmful treatments because the patient hasn’t completed an advance directive or family members can’t agree on end-of-life care.
  • Trying to deliver consistently good care despite economic disparities caused by high costs, high insurance deductibles, and a “gutted social safety net.”

Sponsor Updates

  • Health Catalyst and Nordic will exhibit at the CHIME19 Fall CIO Forum November 3-6 in Phoenix.
  • Mobile Heartbeat will host MHUG 2019 November 6-8 in Phoenix.
  • Waystar will exhibit at the Health Management Academy CFO Forum November 6-10 in Laguna Beach, FL.
  • Netsmart will exhibit at the MHCA Fall Conference November 5-7 in Atlanta.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the HIMSS South Carolina Annual Fall Conference November 1 in Columbia.
  • Experian Health and StayWell will exhibit at the Healthcare Internet Conference November 4-6 in Orlando.
  • PerfectServe will exhibit at the Society of Hospital Medicine Leadership Academy November 4-7 in Nashville.
  • Surescripts will exhibit at the PointClickCare Summit November 3-6 in Dallas.
  • Vocera will exhibit at the Florida Organization of Nurse Executives Fall Conference November 7-8 in Orlando.

Blog Posts


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Contacts

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


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Weekender 11/1/19

November 1, 2019 Weekender 3 Comments

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Weekly News Recap

  • UnitedHealth’s Optum acquires remote patient monitoring startup Vivify Health.
  • Waiting room advertising company Outcome Health pays $70 million in customer restitution to settle Department of Justice advertising fraud charges.
  • Australia’s Queensland Health confirms media reports that it ordered its IT department to perform no software upgrades, including to its problematic Cerner system, while parliament is in session to avoid embarrassment.
  • Premier acquires purchased services management technology vendor Medpricer.
  • Medecision acquires GSI Health.
  • ESolutions acquires Medidal.
  • Facebook launches a program in which user demographics will trigger preventive health information and reminders.
  • Google parent Alphabet is rumored to have made an offer to acquire Fitbit (the companies announced Friday that the acquisition is set for $2.1 billion).  
  • Cerner says in its earnings call that it will no longer offer outsourced revenue cycle management services after Adventist Health terminate its contract, which triggered a $60 million charge and an annual revenue reduction of $170 million.

Best Reader Comments

Deleting your Facebook account does not actually stop any tracking. All your web activity is still tracked via pixels and linked back to your deactivated FB account (example: I still would know you are a 40 year old woman with two kids over 8 who lives in a specific zip code and has certain interests from your old FB activity). I can still target ads to you through websites who publish ads through Facebook, “audience network.” (FB Marketer)

How can the responses of 6-7 customers out of thousands [in KLAS’s global VNA report] be classed as “global” insight and customer feedback? (PluckyBrit)

Why so cynical re: HLTH? I’m here now, and am finding it refreshingly relevant compared to HIMSS or Beckers. For goodness sake, the keynote presentations actually focused on current issues, and didn’t just include big name politicians, sports stars, or actors. Sure, there’s glitz, and the caricatures, etc., but for conferences, I’ve found it to have more of a “finger on the pulse of what’s coming” than any other major conference out there. (CynicAl)

Banner Health bought the University of Arizona’s medical arm and transitioned them from Epic to Cerner. It’s the reason Epic had to change their spiel to “no *voluntary* deinstalls.” (Math)

I don’t think [EHR training driving provider satisfaction and adoption] has been a big secret to those who have gone through the implementation cycle multiple times, yet it’s always the first thing in the budget to get cut. You’d think that the vendors would be more prescriptive (as opposed to “advisory”) when detailing training requirements during planning. Or maybe it’s a failure of CIOs to make the case to CMOs, CFOs and CEOs that they’re being penny wise and pound foolish. Maybe this KLAS survey will help. (Recovering CIO)


Watercooler Talk Tidbits

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ProPublica profiles 27-year-old Nerds on Call computer technician Michael Gillespie (guess which one is him in the photo above, as he receives an FBI award), who has cracked 100 forms of ransomware and provides free decryption tools that have saved hundreds of millions of dollars worth of avoided ransom payments. He receives 2,000 files per day from panicked computer users asking for help and spends his evenings on his couch surrounded by his cats, decrypting new strains and corresponding with people who are seeking his assistance. There’s a healthcare connection – he and his wife are broke because of the after-insurance costs of treating her newly discovered bladder cancer, which forced him to take a 2 a.m. paper route, surrender their car to the bank, and overcome threats of foreclosure of their $116,000 house in Normal, Illinois. Pestered by relatives who can’t understand why he helps people for free, Gillespie says, “There’s a time in every IT person’s career where they think, I’m on the wrong side. You start seeing the dollar amounts that are involved. But nah, I can’t say that I ever have. I just don’t care to go that way.”

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The offshore folk who announce a $3,000 market research report and then write it only after someone pays must know, as experts,  something we don’t – that Athenahealth, Allscripts, Epic and clinical trials platform vendor Medidata are among the sellers of pharmacy robotic dispensing systems. They say it’s a big market that is being energized because “the case of non-infectious diseases also increases.” You could take advantage of the company’s offer to “kindly feel free to grill us with queries” as it has “established the pillars of our flourishing institute on the grounds of Credibility and Reliability.”

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A despondent woman whose friend called 911 fearing for her safety is billed $30,000 by Northwestern Medicine Central DuPage Hospital for a five-night psych stay. She had bought one of the White House-touted “association health plans” (aka ACA-non-compliant junk insurance) that costs less but covers little. She knew her $210 per month plan didn’t cover mental health services, but said she didn’t expect to need them. She asked the hospital what each treatment was going to cost her, but they couldn’t answer, leaving her with a bill for double the average negotiated price (since cash-paying patients are billed higher than everybody else in our non-system). The hospital wrote the bill down to $9,000 and adds that they offered the patient help, but she didn’t return their calls or fill out their financial aid forms. She also admits that she started to buy real insurance through Healthcare.gov, but thought the information was confusing. I’m siding with the hospital on this one (although not the idea of insurer-negotiated pricing) since she blew several opportunities to make a responsible decision. But then again, much of our population seems incapable of making responsible decisions, sticking the rest of us with the bill.  

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A Texas woman live-streams her brain surgery on Facebook in hopes of encouraging others to be optimistic about their outcomes. The stream skipped the graphic parts and instead featuring her speaking to the surgery team while remaining awake as the chief of neurosurgery of  Methodist Dallas Medical Center narrated and answered viewer questions. She went home two days later.

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Police arrest a Louisiana medical practice clerk for selling fake doctor’s notes to high school students for $20, of which two students bought 14. 

The New York Times suggests that patients avoid seeing doctors whose practices are owned by hospitals, whose facility fees can tack on unexpected hundreds to thousands of dollars per visit.

This has Weird News Andy written all over it. Entrepreneur David Hachuel, MSc, MPH, who hopes to commercialize an AI-powered stool analyzer, seeks 100,000 photos of bowel movements for training the system. Experts say a poop tracking app is sort of a good idea, but worry that it will send tons of healthy people to doctors unnecessarily and that a better approach would be to actually analyze a sample only when medically indicated. I read this and ponder, has any doctor ever actually asked a patient to bring in a photo of their bowel movement, and if not, how does an app add value? And also, are we so short on good uses of IT in health that poop photo analysis will lure investors? (cue Sally Field in the 1965 “Gidget” episode titled “All the Best Diseases are Taken,” which I just found by Googling in thinking instead of an “Arrested Development” reference). I would swear that Auggi’s video (above) and its rather foul call for photos were actually clever spoofs from The Onion.


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Morning Headlines 11/1/19

October 31, 2019 Headlines 1 Comment

UnitedHealth, an insurance giant, just scooped up patient monitoring start-up Vivify Health

Optum acquires remote patient monitoring startup Vivify Health.

Exclusive: ‘Inappropriate’ email reveals Queensland Health’s ploy to avoid political scrutiny of hospital IT outages

Australian media outlets report that senior Queensland Health officials ordered staff at the region’s hospitals to avoid performing upgrades to digital systems – including Cerner’s problematic IEMR software – while parliament is in session so as to avoid embarrassing scrutiny from politicians.

Audacious Inquiry and The Sequoia Project Announce National Collaboration to Support States in Disaster Response Through the Patient Unified Lookup System for Emergencies (PULSE)

Audacious Inquiry will work with The Sequoia Project to expand availability of the Patient Unified Lookup System for Emergencies (PULSE) during disaster response efforts.

WMH announces 35 layoffs, reduction of services

Williamson Memorial Hospital in rural West Virginia attributes layoffs and the closure of several clinics to extreme delays in collections and an absence of cash flow stemming from its Meditech implementation several months ago.

News 11/1/19

October 31, 2019 News 1 Comment

Top News

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

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


Reader Comments

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

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

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


HIStalk Announcements and Requests

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


Webinars

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


Acquisitions, Funding, Business, and Stock

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

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

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

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

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


Sales

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

People

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


Announcements and Implementations

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

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

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

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


Government and Politics

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

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


Other

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

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

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

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

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

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


Sponsor Updates

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

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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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EPtalk by Dr. Jayne 10/31/19

October 31, 2019 Dr. Jayne 2 Comments

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

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

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

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

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

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

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

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

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

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

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Morning Headlines 10/31/19

October 30, 2019 Headlines No Comments

Surescripts hit with another e-prescribing monopoly lawsuit

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

Premier Inc. Acquires Medpricer to Optimize Savings in Purchased Services

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

Parthenon invests in MRO

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

Huron Announces Partnership with Medically Home Group, Inc.

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

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

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

Readers Write: Connected Communities and Social Care in the US

October 30, 2019 Readers Write No Comments

Connected Communities and Social Care in the US
By Jaffer Traish

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

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

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

People

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

Community Organizations

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

Helpers

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

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

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

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

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

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

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

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

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

HIStalk Interviews Scott Shreeve, MD, CEO, Crossover Health

October 30, 2019 Interviews No Comments

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

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Tell me about yourself and the company.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Morning Headlines 10/30/19

October 29, 2019 Headlines 2 Comments

Medecision acquires health delivery system transformation pioneer GSI Health

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

eSolutions Acquires Medidal, Solidifying Position in Hospital Revenue Recovery

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

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

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

News 10/30/19

October 29, 2019 News 16 Comments

Top News

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

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

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


Reader Comments

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

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


HIStalk Announcements and Requests

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


Webinars

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


Acquisitions, Funding, Business, and Stock

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

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

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

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

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


Sales

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

People

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

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

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


Announcements and Implementations

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

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

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

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

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


Government and Politics

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


Other

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

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

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

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


Sponsor Updates

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

Blog Posts


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Morning Headlines 10/29/19

October 28, 2019 Headlines No Comments

Exclusive: Google owner Alphabet in bid to buy Fitbit

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

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

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

Federal prisons shopping for EHR system

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

Curbside Consult with Dr. Jayne 10/28/19

October 28, 2019 Dr. Jayne 3 Comments

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

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

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

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

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

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

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

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

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

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

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

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

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

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Email Dr. Jayne.

Morning Headlines 10/28/19

October 27, 2019 Headlines No Comments

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

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

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

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

Vocera Announces Third Quarter 2019 Financial Results

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

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