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Monday Morning Update 10/15/18

October 14, 2018 News No Comments

Top News

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Pathology image detection support system vendor Deep Lens announces $3.2 million in seed funding and availability of its free VIPER service for pathologists.

Co-founders of the Columbus, OH-based company are CEO Dave Billiter, MBA (Cardinal Health) and President Simon Arkell, MBA (Predixion Systems).

The company is based on work first performed at Nationwide Children’s Hospital in Columbus.

I like an uncredited quote in a company blog post that says you can’t rely too much on company experts whose user experience still makes them “FORMER experts in the field.” It also notes that product feedback from anyone other than a customer should be politely answered with, “Your opinion, although interesting, is irrelevant.”


Reader Comments

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From Biometric Believer: “Re: biometric ID. Would you mind asking your readers why, with advances in technology and increased fraud, hospitals aren’t deploying more iris scanning to patient care locations?” Good question, although I would expand your question to include palm vein scanning, facial recognition, voice recognition, and other less-used forms of biometric ID that hold equally promising potential without the need to approach someone’s eyeball with a scanner. There’s no question that all of these technologies work, only that consumer perception isn’t always great and healthcare and other industries (even banking) have resisted accordingly despite its obvious utility in fraud prevention. Some problems I see:

  • Cost. Although technology costs are going down, deploying biometric readers broadly is a big expense and requires a coordination effort that you don’t want repeat often as those technologies change.
  • Workflow integration, which has been mostly solved, I expect.
  • The creep factor. Years ago I got the job of convincing nurses that our newly implemented fingerprint scanning for drug dispensing machines did not mean we were storing their fingerprints or checking them for criminal history.
  • If hackers breach your system or someone grabs a patient’s fingerprints or takes a picture of their face, your patient is screwed because unlike passwords, they can’t change their biometrics.

My conclusion is that perhaps all of these problems could be solved by using the patient’s own phone as the biometric reader. People are happily using fingerprint recognition, voice recognition, and in some cases with higher-end phones, facial recognition to identify themselves for their own security. You would think that the hospital’s reader could connect via Bluetooth, although that’s a minor patient setup issue as well. Or, to address that issue as well as the fact that not everyone has a cell phone, maybe the hospital could use its own cell phones, handing one over temporarily to the patient to provide a less-threatening biometric ID process using a familiar consumer device.

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For Biometric Believer, I created a poll for providers to say if they’re using biometric patient ID or why they don’t. Vote and then add a comment to elaborate.

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From Arthur Allen: “Re: HIStalk. I spotted a rare error in Friday’s update. The VA’s assignment of Paul Tibbits to executive director for the Office of Electronic Health Record Modernization is not a direct replacement of Genevieve Morris. Title-wise at least, Tibbits and Morris differ. She was CHIO, but was also ostensibly in charge of OEHRM. Tibbits is the exec director and they described his job a little differently as well,  more of a liaison with OIT, leaving Captain Windom in charge of OEHRM.” Good point, thanks. John Windom, III led the Cerner selection and rollout by the DoD. Arthur is Politico’s e-health editor who made me beam with his “rare” adjective.

From Kermit: “Re: pre-existing conditions. NPR has a good analysis of the nuances.” The article notes that Republican leaders recognize that it’s politically unwise to take a stand against pre-existing conditions since at least 25 percent of us have them, yet their continued efforts to dismantle the Affordable Care Act and to encourage junk insurance plans as an alternative are making them legal once again after several years. Medicare and Medicaid don’t have pre-existing condition limitations, so claims by Democrats that everyone would be impacted by ACA changes isn’t accurate. HIPAA is a factor since most Americans get health insurance through their employer and HIPAA doesn’t allow those insurers to deny coverage or price premiums based on medical history, but even that’s complicated since some HIPAA protections were moved into the ACA and might die along with it if ACA doesn’t survive legal challenges given the White House’s strategy of not defending it vigorously. TL; DR: everybody hates pre-existing conditions except politicians, who will throw those who have them under the bus if it helps their party.


HIStalk Announcements and Requests

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I ran this poll to encourage folks who are struggling with an involuntary career change. Respondents who were fired, laid off, or relocated a few years back overwhelmingly say it turned out to be a positive development.

Marketing Guy was let go the same week he and his newly pregnant wife bought a new house, but he eventually got two job offers, took one that allowed him to move his family to Europe, and rose within that company’s ranks over 10 years. His advice is to keep working hard (even if that work involves job-hunting), keep learning, and stay positive. Hermanator was fired due to office politics from a company he had helped start, but he says it was the best thing that could have happened because he then started an even better company. He advises that folks take a break, reflect, learn from any mistakes they made, focus on their strengths, and find a new opportunity they can get passionate about.

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New poll to your right or here: which would you value most highly in your personal doctor? You don’t get an “other” or intellectually lazy “all of the above” option because it’s my poll and I know what I’m trying to assess, but those who feel deprived that they weren’t given an essay question can click the “Comments” link after voting and opine away.

Old friend of HIStalk Alex Scarlat, MD (we first corresponded sometime before 2011, I found by searching my old emails) is doing fun work on his own with machine learning. Check out his DogBreed.io, which can identify a dog breed from a photo with 97 percent accuracy (giving you some idea of the excitement behind using ML for diagnostic imaging analysis). He says he wrote it in under 50 lines of Python code. Alex has also done some work with weather prediction that is showing high accuracy. I have suggested that he consider writing a primer series on machine learning for clinicians for HIStalk, a non-technical review of what’s inside the black box and where it might be good (or not so good) for healthcare applications.

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I realized that my ancient Yahoo Mail account is a treasure trove of 80,000 emails going back to August 2004, 14 months after I started HIStalk (I don’t recall which email provider I used before then). Reading the names of defunct companies, seeing email from now-retired or deceased industry people, and marveling at my energy and exuberance in my emails way back then made me nostalgic. Yahoo Mail is still the best service I’ve used and its search is excellent, so let me know if there’s something fun I should search for (people, companies, unflattering terms, etc.) I found my first-ever interview from late 2004 that I thought was lost forever (with Meditech’s Howard Messing); planning emails from the first HIStalkapalooza in 2008; and threats from an industry magazine’s publisher who was unhappy that I ridiculed a newly assigned health IT reporter who was hired from a pastry magazine.


Webinars

October 30 (Tuesday) 2:00 ET. “How One Pediatric CIN Aligned Culture, Technology and the Community to Transform Care.” Presenters: Lisa Henderson, executive director, Dayton Children’s Health Partners; Shehzad Saeed, MD, associate chief medical officer, Dayton Children’s Health Partners; Mason Beard, solutions strategy leader, Philips PHM; Gabe Orthous, value-based care consultant, Himformatics. Sponsor: Philips PHM. Dayton Children’s Health Partners, a pediatric clinically integrated network, will describe how it aligned its internal culture, technology partners, and the community around its goal of streamlining care delivery and improving outcomes. Presenters will describe how it recruited network members, negotiated value-based contracts, and implemented a data-driven care management process.

Previous webinars are on our YouTube channel. Contact Lorre for information.


Acquisitions, Funding, Business, and Stock

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Four private equity firms and activist investor Elliott Management are considering placing a bid to acquire Athenahealth, sources suggest. Pamplona Capital, which was previously rumored to be interested in acquiring the company and merging it with its NThrive holding, is not listed in the latest round of rumored potential acquirers but is presumably still in the hunt. ATHN will announce earnings on Thursday. Somehow you get the feeling that Elliott’s malicious manipulation isn’t going to be good for Athenahealth, its customers, or the health IT industry, but I’m sure some money guys will figure out how to enrich themselves while creating nothing more than mayhem.

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Valley Presbyterian Hospital (CA) tries to ride the coattails of the new Neil Armstrong movie “First Man” by reminding everyone that it was the first hospital to use telemetry-based patient monitoring back in 1966, when Spacelabs took NASA’s astronaut monitoring product into healthcare.


Sales

  • Drug maker Allergan joins TriNetX’s global health research network to analyze patient cohorts, choose study sites, and determine drug study protocol feasibility.
  • The Kentucky Hospital Association joins Collective Medical’s care collaboration network to allow state hospitals to identify patients with a history of substance abuse or treats to ED staff safety as well as to identify and support complex patients.

Decisions

  • Select Specialty Hospital-Johnstown (PA) will replace Medhost with Epic in 2019.
  • Maury Regional Health System (TN) will implement Cerner in November 2018, replacing Meditech.
  • Mercy Medical Center (MA) went live with Epic in September 2018.
  • Washington County Regional Medical Center (GA) will go live with Evident financial management on November 1, 2018.

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


People

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Wayne, PA-based behavioral health solution vendor Tridiuum hireshttps://tridiuum.com/tridiuum-expands-executive-team-with-cro/ Chris Salvatore, MBA (Halo Communications) as chief revenue officer.

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Intelligent Medical Objects promotes Eric Rose, MD to VP of clinical informatics.


Announcements and Implementations

Mayo Clinic has been going live with the Visage 7 Enterprise Imaging Platform along with its Epic go-lives, finishing up last week at its Jacksonville and Scottsdale campuses. Mayo now has a single enterprise imaging platform and diagnostic viewer along with Epic-driven interpretation workflow across its national network.

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Maitland, FL-based Therigy, which sells specialty pharmacy software for therapy support and patient assessment, says it has reached 100 million patient engagement activity and assessment responses. The company offers care plans and assessments for 20 conditions, with 900 assessments covering 400 medications.


Government and Politics

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A tweet by CMS Administrator Seema Verma implies that EHR vendors are responsible for the lack of interoperability adoption (which I’m wording intentionally as a combined technical and business problem as opposed to “lack of interoperability capability” as a purely technical issue). She says “doctors should be able to seamlessly exchange data between EHRs,” failing to note that many of them who are properly motivated already do in proving the product’s capability, while those using the very same EHR often remain as information silos.

The government of China expands its e-healthcare regulations:

  • Commercial companies can collaborate with providers to offer electronic diagnosis, telemedicine, or e-hospitals, but they can’t provide those services on their own.
  • Only licensed professionals with at least three years of clinical practice experience can offer online diagnostic services.
  • Patients can use online clinical services only for follow-up visits. Physicians must refer patients to traditional channels otherwise.
  • Remote consultation and prescribing is allowed as an adjunct to a hospital visit.
  • Controlled substances may not be prescribed as part of a telemedicine visit.

Other

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You won’t like this if you think HIMSS already has too much influence by running its own conference, media, and advertising empire and absorbing competitors by acquisition. HIMSS will help health services research organization AcademyHealth run Health Datapalooza 2019, which used to be a rather quiet conference targeting mostly federal government leaders and data wonks. You may take it to the bank (and HIMSS will) that the exhibit hall is going to get a lot bigger.

HIMSS haters might not like this, either. HHS will work with Healthbox (acquired by HIMSS a few months ago) to convene quarterly Deputy Secretary’s Innovation and Investment Summit meetings to ask investors which policies are standing in the way of innovation. Healthbox is a business accelerator that HIMSS acquired to expand its consulting, investment fund management, and startup assistance programs in uncovering yet another way to compete with its paying members.

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Speaking of HIMSS, they’ve yet to respond to my October 2 request for their non-profit Form 990 federal filing, which they are required by law to provide (but maybe not promptly), even though I notice that I fawningly and mistakenly said “please” twice in the same sentence. I’m always interested in its salaries, revenue by segment, and the occasional buried information about its acquisitions.

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The American Nurses Association’s journal celebrates National Health Information Technology Week with observations about EHR nurse documentation:

  • Data models do not accurately capture nurse assessment and interventions, focusing instead on patient demographics, diagnoses, and procedures instead of the actions that nurses take.
  • All care team members should be able to add to the electronic care plan documentation, including non-clinical information such as social determinants of health, and that documentation should be supported by health IT standards.
  • A study has found that the EHR requires 593 clicks for a nurse to complete the nursing admission assessment and that 31 percent of the required items were already documented elsewhere, motivating Vanderbilt University Medical Center to create a “click gatekeeper” team that must approve requests to add items to the nurse documentation record.

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Several prominent Memorial Sloan Kettering Cancer Center researchers update their conflict-of-interest disclosures in previously published journal articles, adding previously undisclosed financial ties to drug companies. One doctor added 31 company affiliations, while another’s updated long list of company ties includes being paid consulting fees, owning stock options, and co-founding a company. MSKCC says each journal has its own disclosure requirements and some require authors to disclose relationships unrelated to the study being published, complicating the issue.

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Weird News Andy titles this story as “CO and Old Lace.” In China, an anesthesiologist who was having an affair with the tutor of his children is sentenced to life in prison for killing his wife who refused to divorce him (his 16-year-old daughter also died as unintended collateral damage) by filling a yoga ball with carbon monoxide, removing the stopper, and placing it the trunk of his wife’s car. The deflated ball raised the suspicions of police, who then found that the doctor had ordered the carbon monoxide from his university employer claiming he needed it to perform animal tests.


Sponsor Updates

  • Intelligent Medical Objects chairman, chief innovator, and co-founder Frank Naeymi-Rad, PhD, MS, MBA will be inducted into the American College of Medical Informatics at AMIA’s annual symposium in San Francisco November 3-7.
  • InterSystems makes its IRIS Data Platform available in the Microsoft Azure Marketplace.
  • Waystar will exhibit at HFMA Region 2 Conference October 17-19 in Verona, NY.
  • Nordic will exhibit at the Georgia HIMSS Annual Conference October 16 in Atlanta.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the AWHONN Iowa Section Conference October 16 in Des Moines.
  • Recondo Technology will present at the Health Management Academy’s CFO Forum 2018 Meeting October 17-21 in Deer Valley, UT.
  • Experian Health will host its 2018 Financial Performance Summit October 22-24 in Dallas.
  • Redox partners with Smart Health Innovation Lab to help innovative healthcare startups accelerate time to integration.
  • Sunquest will exhibit at ASHG 2018 October 16-20 in San Diego.
  • Surescripts CEO Tom Skelton will keynote the Value-Based Care Summit October 17-19 in Boston.
  • T-System offers disaster relief sheets free of charge to hospitals in the path of Hurricane Michael.
  • Voalte will exhibit at the 2018 Michigan Nursing Summit October 18-19 in Lansing.
  • FormFast joins the Zen Healthcare IT Interoperability Community.
  • ZeOmega will exhibit at the 2018 CAHP Annual Conference October 22-24 in San Diego.

Blog Posts


Contacts

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

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Weekender 10/12/18

October 12, 2018 Weekender No Comments

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Weekly News Recap

  • Athenahealth is reportedly choosing from its options to accept acquisition bids from previously rejected suitors, sell out to NThrive, or continue as a going concern
  • Several hospitals evacuate patients and suffer damage from Hurricane Michael
  • The VA promotes Paul Tibbits to executive director for the Office of Electronic Health Record Modernization
  • The DoJ clears CVS Health to proceed with its $69 billion merger with Aetna
  • GE Healthcare’s former Value-Based Care Solutions Group, now owned by Veritas Capital, renames itself Virence Health Technologies
  • Mayo Clinic completes the final go-lives of its $1.5 billion Epic implementation
  • A study of 83 mostly top-rated hospitals finds that patients still struggle to get copies of their medical records

Best Reader Comments

Many states have information blocking (!) from their PDMPs. In fact, many state laws prohibit PDMP data from being exported outside the system to EHRs (it can only be seen in view-only mode on their web browser interface), making use in clinical decision support problematic. It’s not an issue of EHR vendor unwillingness, but rather that they can’t do an implementation if they can’t consistently get the data. (Harry Solomon)

Alerts seem like a perfect opportunity for an AI system rather than manual configuration files that will drive everyone crazy. (rxsdsu)

Tailoring every alert to each clinician requires work and maintenance far beyond the capacity, much less interest, of most IT departments. And, even people who rarely make mistakes still do make mistakes. Having a system that helps prevent that as a safety net is still relevant and helpful. I agree with you that too often a “one size fits all” policy is applied, which is inappropriate.  How much “tuning” can actually be accomplished is a yet to be seen outcome, but I’m not sure it is as much the hospital’s view of physicians as it is the financial and WorkStream reality we currently have. (Michael J. McCoy, MD)

As Warren Buffet has said, “When the tide goes out, it is easy to see who is swimming naked.” Jack Welch was really running a hedge fund within the GE Capital division. It accounted for over 50 percent of corporate profits many years. Everybody thought he was a management genius based on his PR announcements. Turns out he was nothing more than a hedge manager and the tide went out in 2009. He jumped ship and left the ruins to Jeff Immelt, who couldn’t turn it around for whatever reason. Now it looks like GE will follow many other firms like Xerox, Eastman, Alcoa, etc. Many years ago, I worked for GE and the inbreeding was smothering. (HISJunkie)

Totally agree with Mr. H about careers. Each time I was shown the door (boss conflict, downsizing, and failed salesmanship), I fell up to a better job, better pay, and more interesting work. Keep the resume ready, network all the time (it’s fun finding out who is where and what they are doing), keep records of your contacts, and keep reading HIStalk! (Laid Off)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. J-J, who asked for tablets and a printer for her Georgia class (whose 18 students, she notes, include six English language learners and three who are homeless). She reports, “The tablets we received allow students to work independently in small groups on lessons and activities that help to increase learning and comprehension. The printer has also been a huge help because now we can send information about school and additional practice work home to parents without hassle. I am beyond thankful that my class was chosen and was able to benefit from the generous donation that you sent.”

Here’s a summary of how my DonorsChoose project works:

  • I accept donations from individuals, but mostly companies willing to donate a significant sum in return for being included in my HIMSS-related activities, such as CIO/CMIO lunches.
  • Donors place their donation directly with DonorsChoose and thus receive charitable donation documentation directly from that organization for tax purposes. I never touch their money directly.
  • Their donation is matched by an anonymous vendor executive (who pretty much every HIStalk reader knows), doubling the original donation. That will continue until those matching funds are exhausted.
  • I choose STEM-related DonorsChoose projects that resonate strongest with me, most of those involving additional matching money from foundations.
  • I immediately describe on HIStalk the projects I chose, and when I receive updates and photos from the teacher involved, I post a summary. You don’t see them all right away since I run just one update each week, but I include all of them eventually.
  • As an example of the buying power of a donation, the project above totaled $735, which includes $30 to DonorsChoose for doing all the labor and an additional 20 percent general donation to DonorsChoose that I always select. Of that, the matching offer from Arthur M. Blank Family Foundation covered $368, and of the remaining $368, half of that was provided by my anonymous vendor executive. The original donor’s $184 donation thus provided this classroom with six Kids Edition Kindle Fire tablets and a Xerox wireless printer.

A researcher says high-profile cases, such as the Golden State Killer, that were solved through DNA forensics prove that just about every American could be genetically identified if just 2 percent of us have our DNA tested through consumer sites such as MyHeritage and Ancestry.com. Such matching requires only a third-cousin or higher relationship and the authors say that “such database scale is foreseeable for some third-party websites in the near future.” 

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Baylor St. Luke’s Medical Center (TX) threatened to punish an internist in “an assassination” in retaliation for his complaining about unnecessary services his patients received in the ICU. A private practice physician who serves on the hospital’s medical executive committee warned Tomas Rios, MD that “you’ve got to get the guy you’re going after and none of the people who were involved get implicated” and suggested that he resign instead. A hospital committee found Rios in violation of patient care standards just weeks later. The hospital says in response to his lawsuit that Rios is not a board-certified intensivist and opposes the closed ICU process that would place them in charge of all ICU patients, while legal experts have noted that hospitals have in some cases used peer review threats to silence doctors from speaking out about patient care issues.

Five New York City doctors are called “drug dealers in white coats” by the US attorney who has charged them with writing prescriptions for 5 million oxycodone pills to patients with no documented medical need who paid them $5 million. Neighbors called police several times to complain about lines of people at all hours outside of the office of one doctor who had two of his own employees, along with several patients, die of overdoses. Another doctor took in so much cash that he had to count it using one of those bill counters that banks use, after which he would hand out wads of cash to his employees. Another doctor prescribed 12,000 tablets for a single patient over five years. A pharmacist who received free lunches and a trip from a customer observed, “I guess you could call us licensed drug dealers. Oxy pays the bills around here.”

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A Chinese tech site finds that fitness trackers will display a heart rate when wrapped around anything cylindrical, most impressively a roll of toilet paper or the arm of a stuffed animal. Apparently the light sensors that attempt to detect a pulse rate are easily confused by reflections, although they still read a human pulse accurately.

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It’s all in the fine print: a small research study concluding that paper towels are better than air dryers in hospital handwashing was funded by the paper towel lobbying group.


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Morning Headlines 10/12/18

October 11, 2018 Headlines No Comments

Athenahealth is reaching out to previously rejected suitors

The New York Post reports that Athenahealth is waffling between accepting acquisition bids from companies it previously rejected, merging with NThrive, or remaining as is.

2 Florida hospitals in wake of Hurricane Michael evacuating all of their 330 patients

Bay Medical Sacred Heart and Gulf Coast Regional Medical Center evacuate 330 patients after suffering extensive damage, including downed computer systems, during Hurricane Michael’s destructive trek through Panama City, FL.

Penn Medicine Launches Initiative to Transform Electronic Health Record Systems

Penn Medicine launches an internal EHR campaign that it hopes will get its Epic end users thinking about how to use the software more for care delivery than documentation.

News 10/12/18

October 11, 2018 News No Comments

Top News

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Bay Medical Sacred Heart and Gulf Coast Regional Medical Center evacuate a combined 330 patients after suffering extensive damage during Hurricane Michael’s destructive trek through Panama City in the Florida panhandle. Damage to the facilities included a collapsed roof, cracked walls, blown-out windows, and in the case of Bay Medical, cooling and plumbing issues and loss of its information systems.

Bay Medical cardiologist Sam Patel, MD told the local news Michael’s winds were, in his experience, worse than Katrina’s: “The wind damage was pretty phenomenal. Windows were being blown in and water was coming in. Luckily, none of our patients had any injuries due to the storm. It was about two to three hours of pure hell.”

The category 4 storm, which achieved wind speeds of up to 155 mph, caused the closure of four hospitals and 11 nursing homes in Florida.


Webinars

October 30 (Tuesday) 2:00 ET. “How One Pediatric CIN Aligned Culture, Technology and the Community to Transform Care.” Presenters: Lisa Henderson, executive director, Dayton Children’s Health Partners; Shehzad Saeed, MD, associate chief medical officer, Dayton Children’s Health Partners; Mason Beard, solutions strategy leader, Philips PHM; Gabe Orthous, value-based care consultant, Himformatics. Sponsor: Philips PHM. Dayton Children’s Health Partners, a pediatric clinically integrated network, will describe how it aligned its internal culture, technology partners, and the community around its goal of streamlining care delivery and improving outcomes. Presenters will describe how it recruited network members, negotiated value-based contracts, and implemented a data-driven care management process.

Previous webinars are on our YouTube channel. Contact Lorre for information.


Acquisitions, Funding, Business, and Stock

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TransUnion acquires revenue cycle vendor Rubixis in an effort to strengthen its post-discharge revenue recovery services.

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Amazon patents speech analysis technology that may give Alexa the ability to detect illness and mood in a user’s voice, and then recommend and order products from Amazon’s marketplace. The patent filing also suggests that products and services from advertisers would be the first of Alexa’s suggestions.

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The DoJ clears CVS Health to proceed with its $69 billion merger with Aetna, which will operate as a standalone business once the deal closes at the end of Q4. First proposed late last year, the deal gained steam after Aetna sold off Medicity in May, and is now contingent on the payer selling off its Medicare prescription drug Part D plans. It has gotten pushback from trade associations like the AMA, which believes the merger will negatively affect patients by offering them fewer choices and, ultimately, higher prices.


Government and Politics

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The VA promotes financial management exec Paul Tibbits to executive director for the Office of Electronic Health Record Modernization. Tibbits takes over the role from Genevieve Morris, who resigned in August over differences with leadership in project direction.

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NASA pilots Wolters Kluwer Health’s UpToDate clinical decision support software aboard the International Space Station. To work around spotty Internet connectivity, astronauts are using the MobileComplete version, which gives them the ability to download content for offline access.


Sales

  • Sovah Health (VA) will implement lung cancer screening software from Eon at its Martinsville and Danville campuses.
  • Cornerstone Hospice and Palliative Care selects Netsmart’s MyUnity EHR for post-acute providers.

People

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AMIA will honor National Library of Medicine Director Patricia Brennan, RN with the 2018 Morris F. Collen Award of Excellence at its annual symposium next month.

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William Turner (GovernmentCIO) joins Healthcare Management Solutions as chief strategy officer.


Announcements and Implementations

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Penn Highlands DuBois (PA) goes live with tele-ICU capabilities from Advanced ICU Care that will connect its providers with specialists at UPMC.

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Avera Health will use an $8 million grant to develop a behavioral health team at its ECare telemedicine hub in South Dakota. Virtual services will initially cater to ED and psychiatric hospital patients, then expand to first responders.

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Urgent Care Group implements DocuTap’s EHR and practice management software at its MedCare Urgent Care facilities in South Carolina.

Surescripts sees utilization of its Record Locator & Exchange service jump 40 percent since launching last year thanks to increased adoption amongst Epic, NextGen, and EClinicalWorks users.

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Northern Light Health’s A.R. Gould Hospital (ME) transitions to Cerner as part of what seems to be a nearly system-wide roll out that coincides with a rebranding from Eastern Maine Health System.

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Good Shepherd Health Care System (OR) will go live on Epic next month through a $3 million sharing agreement with Legacy Health.


Other

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Penn Medicine launches an internal EHR campaign that it hopes will get its Epic end users thinking about how to use the software more for care delivery than documentation. The transformation project will include an innovation tournament that will pair IT staff, data scientists, and clinical educators with clinicians to create software improvements.

Public hospitals in Melbourne, Australia rake in $45 million in car parking fees thanks to daily rates as high as $35, and government officials who don’t mind turning a blind eye despite promising to lower prices. The public’s outrage has also extended to Sydney, where its Eye Hospital has earned the dubious honor of charging the highest parking rate in the country – $64 for six hours.

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Children’s Hospital of Philadelphia researchers use EHR data from its Epic system to develop an automated malnutrition screening tool that alerts providers to at-risk patients.

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Cerner CEO Brent Shafer shows off his musical chops at the company’s closing night conference bash.

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Military Makeover host Montel Williams credits the use of telemedicine by NYC paramedics with helping to save his life after suffering a rare type of stroke while working out in a hotel gym.


Sponsor Updates

  • Primus Capital’s growth investment in Hayes will support continued development of its MDaudit Enterprise revenue integrity software.
  • Elsevier provides point-of-care tools to NHS Wales in the UK.
  • The EClinicalWorks National Conference attracts over 5,000 attendees.
  • FormFast will exhibit at Health Connect Partners Hospital & Healthcare IT Conference October 15-17 in Chicago.
  • Glytec publishes a new e-book, “Hypoglycemia in the hospital: Why is it costing you millions and what can you do?”
  • Hayes will exhibit at the 2018 Revenue Integrity Symposium October 16-18 in Phoenix, AZ.
  • Iatric Systems will exhibit at the HIMSS Healthcare Security Forum October 15-16 in Boston.
  • InterSystems will exhibit at Healthcare Providers Transformation October 16-17 in Denver.
  • The American Medical Informatics Association will induct Intelligent Medical Objects CEO Frank Naeymi-Rad, PhD, MBA into the American College of Medical Informatics.
  • Kyruus will host the Annual Thought Leadership on Access Symposium October 15-17 in Boston.
  • Meditech will host the 2018 Physician and CIO Forum October 17-18 in Foxborough, MA.
  • AxialHealthcare will incorporate medication history from Surescripts into its analytics-based pain management software.
  • Diameter Health earns ONC 2015 Edition Health IT Module Certification from the Drummond Group.
  • PatientPing congratulates its national network of ACOs on generating shared savings of $270 million.

Blog Posts


Contacts

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

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EPtalk by Dr. Jayne 10/11/18

October 11, 2018 Dr. Jayne 2 Comments

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I was excited to hear that Atul Gawande, MD has been booked as the opening keynote speaker for HIMSS19. Many of us were initially enthusiastic about the efforts by Amazon, Berkshire Hathaway, and JP Morgan Chase to revolutionize healthcare delivery. That enthusiasm was somewhat tempered by the clarification that they’re really focused on solving the issue for themselves as employers, although it may eventually be extrapolated to the world at large. Regardless, Dr. Gawande has significant street cred in the healthcare trenches, and as a practicing physician, I’d much rather hear from him than from some of the other recent HIMSS headliners.

I was also excited to hear some information coming out of the American Academy of Family Physicians annual meeting this week. The American Board of Family Medicine used the meeting to announce a pilot program starting in January that will “assess the value and feasibility of a longitudinal assessment option to the 10-year secure examination.” Completing educational opportunities on an ongoing basis rather than cramming for an exam every 10 years is much closer to what we do every day in practice and was the preferred choice for recent exam-takers who were surveyed by the University of Florida in conjunction with ABFM’s assessment of the role of the exam. The questions will be administered quarterly and providers can use resources to find the answers, which better demonstrates our ability to manage knowledge rather than memorize.

I’m doubly excited since I have to recertify in 2019, although I already spent nearly $1,000 on a self-study board review course. The proposal still has to be approved by the American Board of Medical Specialties Committee on Continuing Certification in November. There aren’t any details on how large the pilot will be or whether everyone who wants to participate can actually take part, so I might still have to take the exam. I’ll be crossing my fingers, though.

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The use of ride-sharing services as an alternative to ambulances for transportation to the hospital is getting some coverage in mainstream media. Data from 2011 shows that the US spent $14 billion on ambulance services, more than a third of which was paid for by Medicare. Inappropriate use is estimated at approximately 30 percent.

Although it sounds like a good idea from a cost perspective, I’ve found that in practice, patients don’t do the best job of determining whether an ambulance is necessary or not. We’ve had patients in the midst of active heart attacks at our urgent care who want to argue with us about an ambulance transport because of the cost. I’d hate to see someone in that situation summoning an Uber to their home because they’re worried about the money.

In order for this lower-cost transportation to be appropriate, patients are going to need education on whether it’s the right option for them. Maybe the ride sharing services need to add some screening questions to the app to not only help patients, but also to protect drivers from unwittingly picking someone up who needs serious medical attention. So far, what I have heard about Uber Health is that it will allow providers to order transportation, but doesn’t necessarily address the issue of patients trying to get rides on their own. I’m still up for some screening questions in the apps themselves.

Last week, the US Senate sent for presidential signature a bipartisan package fighting the opioid epidemic. The bill passed the Senate by a vote of 98 to 1, showing that political adversaries can and actually will cooperate when the circumstances are right. The only opposition was from Senator Mike Lee of Utah. The 600-plus page bill includes relaxation on Medicaid payments for inpatient treatment, increased surveillance on opioids being imported by mail, and allows certain midlevel providers to prescribe buprenorphine treatment. It doesn’t appear to have been signed yet, but I’m keeping my eye out.

The opioid bill is timed nicely with the release of the Surgeon General’s report on “Facing Addiction in America.” Assisting in management of opioid use (not only prescription, but illicit versions) is an area where EHR technology can be expanded for better support of clinicians. It’s not just about making it easy to link the EHR to the state prescription drug monitoring program (assuming the state has one, which one state does not) but in getting those links into the right part in the prescribing workflows and making the connections fast enough that they don’t impede provider workflow. It’s also about providing clinical decision support including morphine equivalents for drugs patients are already taking as well as those providers are considering for a new prescription. These should be relatively simple things to code, but don’t seem to be given much bandwidth on the development calendars of vendors.

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It’s National Health IT Week, but I didn’t see a celebration in the physician lounge. Most of my local physician colleagues still see healthcare IT as a threat, not necessarily because of what it offers at face value, but because it’s a proxy for the perceived decline of medical practice as they used to know it. National Coordinator for Health Information Technology Don Rucker, MD blogged on the HIMSS site about how automation in healthcare is transforming medicine. Rucker talks a fair amount about the 21st Century Cures Act and its prohibition on information blocking.

Despite being signed into law in December 2016, it hasn’t done anything to improve information blocking in my region, which is largely due to competing health systems that refuse to share data even though they could do it fairly easily if they wanted to, especially now that all of them are on the same vendor platform. As an urgent care physician, I can’t even get their physician-owned practices to give me a medication list over the phone (despite the fact that it’s permissible under HIPAA for treatment, payment, and operations), let alone gain access to their clinical data repositories to find out what testing has already been done for patients before they arrive in my exam room.

Speaking of automation (or lack thereof), I’m still battling a billing issue with the hospital where I had emergency surgery over a year and a half ago. They sent me a bill last month for which I had no explanation of benefits document, which is unusual since I save every scrap of documentation around my healthcare. I hadn’t yet had time to call my insurance and see what the story was, but in the mean time, the hospital sent me to collections less than 30 days from the date of the statement.

I hopped on the phone to the payer, who had no record of a claim for that date of service, then had to call back to the hospital’s outsourced collections company, which provided me a supposed claim number. I called back to the payer to learn that the provided claim number didn’t even fit the standard format. They dug a bit deeper and found a charge for the same amount, but on a different date of service. It turns out it was paid, no one knows why I didn’t receive an explanation of benefits, and no one can explain why I was billed more than 18 months after the fact or why I was sent to collections less than 30 days after the bill was mailed. I paid my co-insurance online after sorting it all out, so hopefully this adventure is at an end.

What’s the longest running medical bill saga you’ve ever seen or experienced? What are you doing to celebrate National Health IT Week? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 10/11/18

October 10, 2018 Headlines No Comments

CVS Health and Aetna $69 Billion Merger Is Approved With Conditions

The DoJ clears CVS Health to proceed with its $69 billion merger with Aetna, which will operate as a standalone business once the deal closes at the end of Q4.

Amazon patents new Alexa feature that knows when you’re ill and offers you medicine

A new patent suggests that Amazon’s virtual assistant will soon be able to detect when someone is ill through speech analysis, and then propose Amazon products to treat their illness.

VA Appoints IT Vet Paul Tibbits as Electronic Health Record Program Executive Director

The VA promotes Paul Tibbits from program executive officer for financial management business transformation to executive director for the Office of Electronic Health Record Modernization.

TransUnion Expands Healthcare Solutions with Agreement to Acquire Rubixis

TransUnion acquires revenue cycle vendor Rubixis for an undisclosed amount.

Morning Headlines 10/10/18

October 9, 2018 Headlines No Comments

Former GE Healthcare Value-Based Care Solutions Group Rebrands as Virence Health Technologies

GE Healthcare’s former Value-Based Care Solutions Group, sold to private equity firm Veritas Capital in April 2018 for $1.05 billion in cash, renames itself Virence Health Technologies.

Share Your DNA, Get Shares: Startup Files an Unusual Offering

Startup LunaDNA, backed by a DNA sequencing company, seeks SEC approval for its business plan to pay consumers for the right to sell their genetic information.

Roche Turns to App in Fight Against Multiple Sclerosis

Roche develops a symptom-tracking for MS patients in hopes of using aggregated, de-identified data to improve its treatments for the disease.

News 10/10/18

October 9, 2018 News 6 Comments

Top News

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GE Healthcare’s former Value-Based Care Solutions Group, sold to private equity firm Veritas Capital in April 2018 for $1.05 billion in cash, renames itself Virence Health Technologies.

The GE Healthcare products that were included in the acquisition are revenue cycle, ambulatory, and workforce management systems previously sold under the Centricity and API Healthcare brands.

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Virence Chairman and CEO Bob Segert, appointed in mid-September, has zero healthcare experience. Former GE VP/GM and industry long-timer Jon Zimmerman will report to Segert as president.


Reader Comments

From Red Red Wine: “Re: careers. Why would you say that co-workers aren’t your friends? I socialize quite a bit with my work family at [vendor name omitted].” The people who might give you a ride to work from your oil change since they might need you to return the favor won’t be nearly as willing to serve as emergency overnight dog-sitters, listen patiently as you tearily describe your mother’s dementia, or know when and how to reach out supportively when you miss a few work days without explanation. I should probably take my own “work is not life” advice by not holding a grudge against former co-workers who I think wronged me in some way – it probably wasn’t personal that they were back-stabbing opportunists who were forged in an ugly corporate health system crucible that resembled one of those psychology experiments where a test subject will apply deadly electric shocks to an innocent victim when an authority figure insists. I guarantee that within minutes of your also-friendly employer marching you off their property in a layoff, your “work family” members are going to be unemotionally circling like vultures to get first dibs on your cubicle stuff.

From Conference Liner: “Re: Cerner naming social media influencers for CHC. Is that a thing now that HIMSS has been doing it?” Beats me. I don’t really get the point of naming “social media influencers” unless it’s to give them free registration in return for the free advertising they theoretically offer in return. It’s not as though tweeting is so hard that only Twitter experts can figure it out, or that those folks possess industry influence that correlates to their Twitter stats (since those stats don’t indicate exactly who they are influencing beyond each other). At least the Cerner-named influencers are mostly accomplished people who hold responsible jobs as recognizable subject matter experts.


Webinars

October 30 (Tuesday) 2:00 ET. “How One Pediatric CIN Aligned Culture, Technology and the Community to Transform Care.” Presenters: Lisa Henderson, executive director, Dayton Children’s Health Partners; Shehzad Saeed, MD, associate chief medical officer, Dayton Children’s Health Partners; Mason Beard, solutions strategy leader, Philips PHM; Gabe Orthous, value-based care consultant, Himformatics. Sponsor: Philips PHM. Dayton Children’s Health Partners, a pediatric clinically integrated network, will describe how it aligned its internal culture, technology partners, and the community around its goal of streamlining care delivery and improving outcomes. Presenters will describe how it recruited network members, negotiated value-based contracts, and implemented a data-driven care management process.

Previous webinars are on our YouTube channel. Contact Lorre for information.


Acquisitions, Funding, Business, and Stock

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Odd: the soon-to-be-renamed Adventist Health System / Florida Hospital signs up as a multi-year sponsor of Nascar’s Speedweeks, heretofore to be reverently referred to as “Daytona Speedweeks Presented by AdventHealth.” Nascar, which must be happy to have signed a new sponsor as its attendance, TV ratings, and sponsorships continue their sharp slide, declares that “the Daytona Speedweeks brand will provide another platform for Florida Hospital to amplify their new name.” Hopefully the terms did not include requiring Florida Hospital’s doctors to wear ads on their scrubs or surgical teams to swoop in with their instruments like a pit crew to complete an appendectomy in less than 20 minutes.


People

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The National Library of Medicine promotes Clem McDonald, MD, MS to the newly created position of chief health data standards officer.


Announcements and Implementations

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China-based Tencent – which developed the globally popular (except in the US) WeChat app — will work with England-based Medopad to assess the condition of Parkinson’s disease patients by analyzing video of their movements and to alert their doctors of any deterioration. Tencent is working on other AI-related healthcare projects.

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Office Depot-owned CompuCom launches Self Healing Healthcare, a service that monitors end user devices for problems, outages, and failures.

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Blockchain-focused, UK-based health data rights organization Hu-manity.co launches in Europe to push for patients to control and manage their own healthcare data under the #My31 movement that advocates making such ownership the 31st Human Right. They’re also launching a US-only app to allow users to specify such control.


Privacy and Security

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Startup LunaDNA, backed by a DNA sequencing company, seeks SEC approval for its business plan to pay consumers for the right to sell their genetic information, the opposite of companies like 23andMe that charge people to sequence their DNA and then profitably sell their information on the sly. Donors earn shares in the “biobroker” company and post their de-identified information up for bid on its marketplace to keep a share of the proceeds.

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Google shuts down its spectacularly failed would-be Facebook competitor Google+ after deciding not to alert users that a security hole allowed their data to be hacked over several years. A Google committee advised executives that owning up to the breach would damage the company’s reputation and trigger a regulatory response a la Facebook’s Cambridge Analytica scandal, so it decided to close Google+ instead. A splendid Twitter review by former US Digital Service Administrator (and former Google employee) Mikey Dickerson says Google+’s self-proclaimed “social spine” infected the company’s other products, such as YouTube’s shared log-in and the termination of Google Reader. He concluded with a brilliant observation above. We science types appreciate Mikey’s LinkedIn tagline of “Free Radical.”

DataBreaches.net reports that virtual visit vendor MedCall Advisors has, for the second time in a month, been caught storing patient data in an unsecured Amazon S3 bucket. CEO Randy Baker did not acknowledge the courtesy notifications that were sent to him or ask those who alerted him about the exposure to delete any PHI they accessed.


Other

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Researchers advocate that EHR-powered electronic trigger tools be used to detect possible diagnostic errors and to identify patients who are at high risk of adverse events. The most obvious immediate benefit would seem to be to identify gaps in care cause by poor coordination, such as when nobody seems to have followed up on critical diagnostic results. The most limiting factor is the extent of clinical information stored as free text.

A BMJ opinion piece says the industry needs to do a better job of reducing the number of unwanted EHR alerts that consume physician time. Here’s the dilemma – we don’t let doctors individually decide based on their own practice which alerts to turn off because those “unwanted” alerts are often important, at least in the opinion of the non-doctors who maintain them. That brings up the never-ending dilemma of the purpose of the EHR – is it intended to help doctors, or instead to force administrative policies and concerns on them? I’ve worked a lot on those alerts and found these challenges:

  • Alerts are not always personalized (or cannot be personalized). A warning about a specific drug for a patient with kidney disease might be useful to a surgeon, but not a nephrologist.
  • An overridden alert, where the intended action is completed as an order, means the user, rightly or wrongly, didn’t find that alert useful.
  • On the other hand, doctors routinely fail to read EHR screens (due to alert overload, poor UI, or sloppy behavior) and will happily override a warning that prescribing 1,000 Tylenol tablets might be unwise and leave their error for someone else to catch.
  • My most important conclusion is that the quest to apply alerts universally is an illogical reflection of the collective nature of how hospitals see doctors. They know which ones have marginal skills or a record of causing patient mayhem, but they punish all doctors instead of just those who clearly need more than an average amount of electronic help to avoid screw-ups. Doctors should be regularly graded on their clinical track record, experience levels, malpractice and discipline history, and history of alert compliance, with the sensitivity of clinical alerts tuned to prevent them from making mistakes while not hindering those who rarely do so.

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A review of virtual online consultation platforms, aka virtual second opinions – specifically Medscape Consult – concludes that medical crowdsourcing can reduce diagnostic errors and increase global reach. The most valuable takeaway is that most of the doctors presenting cases were young, but most of the expert responses came from doctors over 60 years of age, suggesting that: (a) younger doctors can benefit from asking more experienced ones to weigh in; and (b) older doctors are technically comfortable enough to provide such wisdom. The authors note that they don’t have any way to determine whether those second opinions improved diagnostic accuracy, but it doesn’t matter – even if the original doctor’s conclusion was correct, having experienced peer validation provides confidence and perhaps reduces further expensive diagnostic work. Having face-to-face contact with patients is important, but this is an example of where armchair quarterbacking can provide real patient value and an opportunity for older doctors to contribute purely as an intellectual challenge without dealing with reimbursement, the limitations of a 15-minute encounter, practicing defensive medicine, or managing a patient’s entire medical life instead of just recognizing what’s wrong with them and then moving on.

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A fascinating New York Times article covers the MD-PhD co-founder of drug maker Regeneron, whose cholesterol-lowering drug is so widely useful yet so expensive ($14,000 per year) that insurers often won’t pay for it. The kicker: that co-founder is the guy who invented the drug and yet he pays full list price for his own prescription (so he claims, anyway) since the company’s insurance doesn’t cover it. He says Regeneron spent $2.6 billion to get the drug on the market and annual sales are less than $200 million.

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Pediatrics professor and New York Times contributor Aaron Carroll says the Apple Watch’s new EKG capability has quite a few negatives – few people have undiagnosed arrhythmias that don’t have symptoms, false positives and negatives can be worrisome and expensive, a Stanford study found that most of the Watch’s EKG warnings were wrong, previous large-scale studies found little value in mass population EKG screening, and that the device’s cost (which isn’t covered by insurance) means that people who would benefit most from it won’t get it. He advises, “But I’m under no illusion [Apple Watch’s activity monitoring] will help me lose weight or exercise more or improve my heart health. I own one because I want it, not because I need it.”

A Washington Post review finds that millennials often don’t have a primary care provider and don’t want one, favoring the convenience, speed, and upfront pricing of walk-in clinics and urgent care centers to meet their infrequent needs instead of PCP practices that require making appointments well in advance, cover limited hours, and send patients to the ED on evenings and weekends. The dilemma is that patients have to give up the benefits of longitudinal care because they value it less than convenience.

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Cerner Chairman and CEO Brent Shafer provides Monday’s opening keynote at the Cerner Health Conference in Kansas City, MO.

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I enjoyed this recap of the beginnings of Flatiron Health by co-founder Nat Turner, who with his also-under-30 co-founder had previously sold their ad business to Google for $80 million. They  decided to do something about cancer, figuring Flatiron would be a non-profit until they realized that “great engineers don’t work at non-profits. They tend to go to places like Facebook.” Flatiron bought oncology EHR vendor Altos Solutions with Google investment money barely after not even knowing what an EHR is, but quickly figured out how to mine EHR data to assess cancer drug effectiveness. Drug maker Roche bought the company six years after its founding in April 2018 at a $2.1 billion valuation. Cancer has made a lot of people poor, but a few people rich.

Anxious healthcare startups love to compare themselves to Uber or Facebook, but here’s a legal case where Uber can call itself the Epic of ride-sharing services. A court rules that Uber’s driver arbitration agreements are legal based on the US Supreme Court’s ruling in Epic Systems Corp. v. Lewis, which found that such employer-mandated terms preclude employees from undertaking actions as a class to address labor disputes.

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Tuesday was Ada Lovelace Day, honoring the mathematician – and arguably the world’s first computer programmer — who recognized the potential of the Analytical Engine theorized by Charles Babbage. She died at 36 in 1852 after doctors treated her uterine cancer with bloodletting. Her father was Lord Byron, although he bailed on Lady Byron early on and his daughter never knew him.


Sponsor Updates

  • Ellkay is exhibiting this week at the Cerner Health Conference, where it will demonstrate its LKArchive data archiving solution for accessing information from decommissioned legacy systems. 
  • Spok’s Connect 18 annual conference attracts 150 attendees to Scottsdale, AZ this week.
  • Smart Health Innovation Lab will offer Redox’s integration platform to companies that have graduated from its market accelerator program.
  • Howard Medical will offer Imprivata Medical Device Access on some of its medical storage carts.
  • AdvancedMD will exhibit at the American Society of Dermatologic Surgeons Annual Meeting October 11-14 in Phoenix, AZ.
  • Aprima and CompuGroup Medical will exhibit at the AAFP Annual Meeting October 10-12 in New Orleans.
  • Audacious Inquiry hires Christina Caraballo (Get Real Health) as director.
  • Arcadia will exhibit and present at the SRHO 2018 annual conference October 11-12 in Dallas.
  • Bluetree and Direct Consulting Associates will exhibit at the Health Connect Partners Hospital & Healthcare IT Conference October 15-17 in Chicago.
  • Bernoulli Health will present at the Connected Health Conference – Immersion Day October 17 in Boston.
  • Datica will present at the Cloud Native PDX meeting October 12 in Madison, WI.
  • CarePort Health will exhibit at ACMA North Carolina October 12 in Asheville, NC.
  • Diameter Health will speak at the HIMSS NE Health IT Advocacy and HIE Day October 10 in Worcester, MA.

Blog Posts


Contacts

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

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Morning Headlines 10/9/18

October 8, 2018 Headlines No Comments

Mayo Clinic completes installation of Epic electronic health record

Mayo Clinic wraps up its system-wide Epic implementation, dubbed the Plummer Project, with go lives at facilities in Arizona and Florida.

Liberty IT Solutions Awarded $11.4MM Computerized Patient Record System (CPRS) Enhancements Phase 2 (EP2) Task Order

The VA awards government technology contractor Liberty IT Solutions (a partner on the Cerner VA EHR project) an $11 million contract to further enhance the VistA-integrated Computerized Patient Record System.

Ochsner develops new approach to opioid prescribing in primary care

Ochsner Health System (LA) connects its Epic system to the state’s PDMP as part of an effort to help its primary care physicians avoid overprescribing opioids.

Curbside Consult with Dr. Jayne 10/8/18

October 8, 2018 Dr. Jayne 1 Comment

Although the majority of my work is in the CMIO space, I occasionally do some work for vendors. Depending on the vendor and the situation, it could be anything from participating in a focus group to helping design and execute on usability studies.

I’ve worked with vendors who truly get it and are just looking for supplemental input or outside validation for their strategies, but occasionally I work with a vendor that has some significant gaps. This week included successful interactions and one that left me perplexed, so I’ve decided to put together some thoughts for vendors on what to do (or not do) when seeking input from physicians.

First, vendors need to know what they hope to accomplish by interacting with physicians. Do you want an actual practicing physician, and if so, in what specialty or what setting of practice? If not, do you just want someone who “thinks like a physician” and can take you through typical diagnostic or management options? Do you want to work with physicians who understand both the clinical and informatics spheres, so they can provide input on the end user experience but also strategies for solving the problems they may help you identify? Do you want someone who can help with clinical guidelines only and needs no understanding of software and technology?

Working with physicians can be costly since many expect compensation for their time equal to what they would have earned seeing patients during the time they spent with you. It’s important to not only make sure you have the right type of physician, but also that you are prepared to spend your time with him or her wisely.

I worked with a company early in the week that knew exactly what they wanted. They provided a brief synopsis of the project and the assumptions they wanted to test with a physician. They provided that information with enough lead time that I could review it thoughtfully prior to our call. They made sure to let me know that they wanted to interact over video, which let me know that I shouldn’t be in my pajamas or look like I just came off the treadmill, which is occasionally my habit depending on how many calls and meetings I have in a given day.

When I joined the call, it was clear that all internal resources had joined with enough time to be set up and oriented and they were ready to introduce themselves and describe their roles on the project. They also asked me to say a few words about myself and my background, which allowed for adequate level-setting all the way around.

We worked through a product prototype first at a high level, with me giving initial impressions and the team documenting any questions I raised or elements that I didn’t understand. That allowed us to get through the entire workflow without being derailed by details or issues with the mock-ups. Then, we took a second pass through the prototype and addressed the areas where I had questions or didn’t understand where the workflow was going.

I think it was helpful to them that I understood that we were working with some enhanced wireframe designs and not actually software on some of the screens, so that I could phrase my questions around whether what I was seeing was just an artifact of the mock-up or whether it was actually a design element. We then took a third pass through the workflow, with the team allowing me to identify areas where I thought the flow could be enhanced or where functionality could be added to better meet the original design intent.

It was clear that the team was experienced in respecting the time of their audience and also that they had prepped for the call, knowing approximately how much time to allot for the different phases of review. It didn’t feel rushed, we didn’t end with a lot of time left over, and there weren’t too many items that needed additional follow up. They clearly took good notes during the call because they were able to come back to different comments I had given and read them back to me almost verbatim, asking for clarification or expansion on what I was thinking. The whole experience was challenging and fun, and I hope they’ll be interested in my feedback as the project progresses.

The vendor I worked with later in the week provided a polar opposite experience. It was a bit of a different situation to begin with, since the vendor is trying to introduce a new spin on existing workflow and technology rather than moving forward with an innovative product. In my opinion, that makes it challenging since anyone looking at their offering is judging it against their current technology whether consciously or not.

They were asking me to evaluate a new way to do work that I’ve been doing electronically for nearly two decades across half a dozen platforms with numerous upgrades on each. Although one could take the strategy that it would be good to have an experienced clinician who can provide feedback on what other vendors are offering or have tried in the past, the developer kept interrupting the conversation and going on and on about not allowing “the experience” to be hampered by “the technology of today.”

I didn’t realize there were going to be developers on the call. That’s always a tricky one since sometimes when you provide feedback, they can take it personally, and especially since they weren’t introduced when the call began. Having silent parties on a feedback call that suddenly jump in and start a conflict with your research subject usually isn’t an effective strategy.

The product owner tried to calm him down, but it wasn’t working. I tried to explain that unfortunately the workflow they’re trying to address is hampered by a litany of external requirements that they hadn’t addressed, such as governmental and payer regulations. It doesn’t matter what your UI looks like if it is going to force the end user to behave in a way that is going to cause trouble in the case of an audit.

Part of the exercise was for me to work through an alpha version without direction or training to evaluate how intuitive the workflow was. At one point, someone who probably thought he was on mute but wasn’t actually said, “She’s doing it wrong. Why is she clicking there?” When I replied, “I clicked there because every other screen has the ‘save and close’ button in the bottom right corner and that’s where my hand naturally flowed,” there was just a stunned silence. At that point, another member of the team took over the call and we moved forward in the workflow, but I had a hard time thinking of the product vs. whether someone was getting schooled out in the hallway.

The session ended about 30 minutes early. I wasn’t sure whether they were out of material or whether they were just flummoxed. Frankly I was glad for it to be over, because it was stressing me out and my treadmill was calling. I’m happy to help, but there’s a level of dread that they might ask me to work with them again. We’ll have to see how the next sprint cycle unfolds for them. I hope if they’re working with other physicians (they had better be, because when you’ve heard one physician’s opinion, you’ve heard one physician’s opinion) that it’s a more successful experience.

Do you have any advice for software vendors who are seeking physician input? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 10/8/18

October 7, 2018 Headlines 1 Comment

Assessment of US Hospital Compliance With Regulations for Patients’ Requests for Medical Records

A study of 83 mostly top-rated hospitals finds that patients still struggle to get copies of their medical information, with many facilities ignoring a federal requirement that they provide information in the patient-requested format.

These young cardiologists are opening tech-infused health clinics all over New York 

Cardiology practice startup Heartbeat is opening offices in New York City that will offer online tests, virtual care, and treatment plans that include exercise and nutrition components.

DoD rolls out new GENESIS sites, with hopes of fewer complaints about electronic medical records system

The DoD rolls out its Cerner-powered MHS Genesis EHR at a second round of facilities that includes Mountain Home Air Force Base in Idaho and three facilities in California.

Monday Morning Update 10/8/18

October 7, 2018 News 8 Comments

Top News

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An study of 83 mostly top-rated hospitals finds that patients still struggle to get copies of their medical information (matching my appalling experience):

  • 89 percent do not allow patients to request a specific category of information to be released
  • 47 percent don’t offer an option to request the entire medical record even though all of them claim to offer that option
  • Medical records release form instructions often differ from what employees tell patients by telephone
  • Many hospitals ignore the federal requirement that they provide information in whatever format the patient wants
  • More than half of hospitals charge patients more than OCR guidelines and 8 percent say they routinely don’t meet state-mandated release timeframes
  • Trying to get to the right person by telephone is made difficult by complex phone trees and, in the case of two hospitals, no option was offered to speak with a human or to leave a message

Reader Comments

From Kenny Powers: “Re: the all-new Allscripts Avenel EHR. I haven’t heard anything about it since it was announced in March. Is it being sold yet?” I haven’t heard a peep since the buzzword-heavy announcement seven months ago. The product isn’t listed on the company’s EHR page and Googling turns up nothing. It wasn’t mentioned in the company’s August earnings call. Allscripts said it’s being used by Carlinville Area Hospital (IL), which didn’t respond to my inquiry.

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From Pure Prairie: “Re: GE. I can’t figure out how they took such a hard fall.” Chasing business and technology fads; poor strategic and operational performance by Jeff Immelt; a smothering bureaucracy that stifled innovation and encouraged executive backstabbing; unfocused acquisitions under both Jack Welch and Immelt whose interesting aspects were digested away in GE’s sluggish colon; incestuously moving the same old executives around in wildly unrelated divisions per the “GE way;” and a conglomerate strategy that left it vulnerable to big downturns in oil and financial services. GE Healthcare IT was best known for buying vendors with top-ranked products and then diving straight to the bottom as the poster child for “first to worst.”

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From Amatriciana: “Re: careers. I was laid off and could use advice.” I’ve had my share of career missteps (being demoted, boss conflicts, regretting taking a promotion after belatedly realizing that the last thing I wanted was more responsibility) and my general conclusions are these:

  • It doesn’t matter whether the seemingly undesirable change is your fault or the company’s.
  • Your self-worth or identity is not defined by what you do for money and the people you worked for or with are not your real friends. You are a vendor (of your own services) who lost a key account and life goes on.
  • Always be managing your career and your network so you aren’t caught off guard when you need to make a change quickly (OK, I’ve never done that, but I wish I had when the layoff axe began swinging and we were all scrambling simultaneously hoping to find local jobs with similar skill sets).
  • Never stop learning, even if on your own (cue my pitch for reading HIStalk as well as my original incentive for writing it).
  • The dotted lines of your career changes make sense only after the fact, when the pattern becomes clear. You never know where you’ll end up or how to get there. Serendipity is often your friend.

HIStalk Announcements and Requests

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Most poll respondents aren’t heavy users of smart speakers at home. The most common uses are setting hands-free timers, playing music or mood sounds, keeping shopping lists, checking the weather, and controlling smart plugs to turn specific items on and off. There’s apparently also an intercom feature on Echos that I didn’t know about and some folks play games on their devices. 

New poll to your right or here: for those whose company, more than five years ago, terminated you, demoted you, or forced you to move — did that turn out to be positive overall?

Thanks to these companies that recently supported HIStalk. Click a few logos to learn more about companies you don’t know much about and to thank them for making what I do possible.

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I didn’t realize what a mess I’d gotten into when a friend asked for help buying a replacement set of wired earbuds for her Phone 7, a shining example of Apple’s recent cluelessness and crappy accessory quality. That model eliminated the headphone jack for no user-benefitting reason; Apple’s Earpods (as well as the Lightning-to-3.5mm connector) are pure junk that last weeks at best, according to reviews; you can’t listen and charge simultaneously; and because of the market opportunity offered by Apple’s misstep, every product listing on Amazon is obviously fake since the reviews don’t match the product. Bluetooth is an option, but it’s pain having to charge earbuds as well as the phone itself. I finally gave up and spent $30 on the EarPods from Best Buy plus $10 for the converter cable since I was getting free shipping anyway, so at least the option is there to ditch Apple’s earbuds in favor of decent ones, at least for the few days the converter cable is likely to last before falling apart.


Webinars

October 30 (Tuesday) 2:00 ET. “How One Pediatric CIN Aligned Culture, Technology and the Community to Transform Care.” Presenters: Lisa Henderson, executive director, Dayton Children’s Health Partners; Shehzad Saeed, MD, associate chief medical officer, Dayton Children’s Health Partners; Mason Beard, solutions strategy leader, Philips PHM; Gabe Orthous, value-based care consultant, Himformatics. Sponsor: Philips PHM. Dayton Children’s Health Partners, a pediatric clinically integrated network, will describe how it aligned its internal culture, technology partners, and the community around its goal of streamlining care delivery and improving outcomes. Presenters will describe how it recruited network members, negotiated value-based contracts, and implemented a data-driven care management process.

Previous webinars are on our YouTube channel. Contact Lorre for information.


Acquisitions, Funding, Business, and Stock

Gastroenterology EHR vendor GMed, acquired in mid-2015 by Modernizing Medicine, renames itself to Modernizing Medicine Gastroenterology. 


Sales

  • Hackensack Meridian Health (NJ) implements Vocera Rounds at JFK Medical Center, the health system’s 10th deployed hospital.
  • Berkshire Health Systems selects Santa Rosa Consulting to lead its Meditech Expanse implementation.

Decisions

  • Kessler Institution for Rehabilitation (NJ) switched from Medhost to Epic in March 2018
  • University of Mississippi Healthcare (MS) will replace Infor with Workday human resources software by January 2019
  • Yalobusha General Hospital (MS) implement Athenahealth in December 2017, replacing Medhost
  • Memorial Hospital (IL) will replace Evident financial management with Infor
  • Olmstead Medical Center (MN) will implement Epic in September 2018, replacing Cerner

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


People

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Tim Knoll (Healthgrades) joins PatientSafe Solutions as regional VP.


Announcements and Implementations

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A KLAS report on medical device security — created with CHIME and its security group AEHIS — finds that few CIOs and CISOs are confident that those devices are protected, mostly because of poor manufacturer support or due to their own lack of a device inventory. The confident respondents give credit to good policies and procedures, strong technology, and interdepartmental collaboration, although it’s anybody’s guess as to whether they are truly more secure rather than naive. Respondents say it’s tough to protect legacy devices due to outdated operating systems, lack of patching capability due to technology limitations or warranty policy, hardcoded passwords, and lack of encryption. They also say manufacturers use FDA policies as their excuse for not patching their devices, yet FDA rarely holds the device-makers responsible when their systems are breached.

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A new Reaction Data report on clinical decision support finds that 55 percent of mostly hospital-based respondents use multiple CDS solutions, with most of those provided by their EHR vendor. Caveat: I would question the accuracy of the 25 percent of respondents who say their hospital doesn’t use any form of CDS, the non-appearance of Meditech on the list among its EHR competitors, and the inclusion of Allscripts EPSi even though it offers only financial (not clinical) decision support. Non-EHR vendors with the largest presence are Stanson Health and National Decision Support Company. A 2017 study found that the imaging CDS of NDSC, which was acquired by Change Healthcare in January 2018,  holds 70 percent of that market.

EClinicalWorks will integrate its Healow mobile app with the WellWatch smart watch being developed by UK-based Care UK.


Government and Politics

The latest Bureau of Labor Statistics employment report finds that healthcare employment increased by 26,000 in September, nearly evenly split between hospitals and ambulatory services. Healthcare employment has increased by 302,000 in the past year. In other words, we’re turning the entire country into one giant hospital and then complaining that insurance costs too much and our taxes are too high.


Other

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CNBC profiles Heartbeat, a cardiology practice startup that is opening offices in New York City that will offer online tests, virtual care, and treatment plans that include exercise and nutrition components. The “fully digitized boutique cardiology practice” accepts Medicare, commercial insurance, and cash ($200 for a visit or $299 for an annual membership).

Aprima sales executive Lance Allen donates a kidney to allow his peer Mike Alfieri — who he met two years ago at a company sales meeting — to receive a transplant in a 13-person paired exchange.

Just in case watching a single shark jumping isn’t enough, BlackBerry (are they still in business, and if so, why?) announces a blockchain solution for health data storage, an operating system for secure medical devices, and a skin cancer data sharing service for researchers. The company has chased healthcare tech fads before — I haven’t heard a thing about BlackBerry’s work with (and investment in) NantHealth in early 2014.

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The Montivideo, MN paper apparently confused the local hospital’s incumbent vendor (Meditech) with its new one (Epic). I assume it’s a Community Connect implementation at a price of just $1.5 million. It’s also odd that the hospital says its existing system is “outdated” when it was supposed to have upgraded to Meditech 6.1, although maybe that never happened.


Sponsor Updates

  • Liaison Technologies will accept applications for its $5,000 Spring Semester 2019 Data-Inspired Future Scholarship through October 31.
  • LiveProcess will exhibit at the Iowa Hospital Association Annual Meeting 2019 October 9-11 in Des Moines.
  • Vyne Medical, Experian Health, The SSI Group, Surescripts, and National Decision Support Co. will exhibit at the Cerner Health Conference October 8-11 in Kansas City, MO.
  • Netsmart will exhibit at the Michigan Premier Public Health Conference October 10 in Bay City, MI.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the AWHONN conference October 11 in Freeport, ME.
  • TransUnion wins an “Outstanding Company Culture” award from the Illinois Technology Association.
  • TriNetX will exhibit at the MedImmune California Translational Science Forum October 9 in San Francisco.
  • Voalte names Candice Friestad, RN of Avera Health the 2018 Voalte Innovator of the Year.
  • Wellsoft will exhibit at the Urgent Care Association Fall Conference October 12-14 in Houston.

Blog Posts


Contacts

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

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Weekender 10/5/18

October 5, 2018 Weekender 3 Comments

weekender


Weekly News Recap

  • Cerner announces the partner companies that will serve on its VA EHR modernization team
  • Change Healthcare is reportedly preparing for a 2019 IPO that will value the company at up to $12 billion
  • A new Pew Charitable Trusts report on patient matching offers potential approaches that include unique patient identifiers that incorporate biometrics, placing more onus on the patient through verification via text message, and standardizing data elements
  • GE’s board fires Chairman and CEO John Flannery after just over a year on the job, potentially disrupting the company’s plans to spin off GE Healthcare
  • VA OIG is reviewing last year’s manual cancellation of 250,000 radiology orders across eight hospitals during a push to remove duplicate and outdated requests, raising concern that some of the studies might have been medically necessary or had been entered as future orders that had not expired
  • Orion Health shareholders approve the company’s plan to sell its only profitable division, which offers the Rhapsody integration engine, to a private equity firm that will run it as a private company
  • The former CEO of Singapore’s SingHealth’s IT services organization testifies about its massive data breach that she fired an employee who discovered a security vulnerability in Allscripts Sunrise Clinical Manager after he emailed Epic to suggest using his information competitively, but she didn’t take action on the vulnerability because she assumed Allscripts had already fixed it

Best Reader Comments

I, too vividly remember the rapturous articles, books, and memoirs about GE’s Jack Welch back in the day. Creating a durable corporate culture of high performance, customer service, and as a consequence, superior profitability was supposed to be the magic formula for success. The leader doesn’t matter (as much)! The macroeconomic climate doesn’t matter (as much)! The lines of business don’t matter (as much)! The theory being, good people were attracted to such organizations and all obstacles could thereby be overcome. Culture was supposed to “eat strategy for lunch.” I wonder if the Harvard Business Review has ever published a mea culpa on this or any thesis whatsoever? (Brian Too)

I am a physician and worked briefly for a health IT company whose single-minded focus was on patient safety — at least that is what the slick website said. When you got behind closed doors, the single-minded focus was on money. They rolled out products that internal developers said were not ready for the market. The product was unstable and could harm people. Brilliant management wanted to get updates out so they could boast about their latest product. There is plenty of greed out there. The other term for it is capitalism. For better or worse, that is the system we choose to live in. But if we are going to point out the greed and highly questionable ethics amongst doctors and pharmaceutical companies, lets do the same for health IT as well. (Anon)

Cash-strapped hospitals aren’t the reason that Orion Health went over the cliff. They scaled and bloated the company based on the state HIE market that had no sustainable financial model. Add to that they rarely delivered (because it’s big software = complex implementations) customers started to bail. (Iknowaguy)

There’s nothing described here I haven’t seen countless times before. What would be educational from you and/or someone else contributing to this website would be more reporting from the legal front, specifically cases of, or statistics involving the effect in depositions and trials of the sort of autocomplete/ cut and paste / incorrect voice transcription issues that you describe. Are plaintiffs lawyers actually using these sorts of mistakes to discredit defendants in front of juries, i.e. OK, you admit that’s false, where else in the record were you lying, doctor? (Robert D. Lafsky, MD)

The Epic installation appears to have been immensely profitable for Erlanger. Epic has many features which enable and facilitate upcoding. As a psychologist, I received a cover letter describing the enclosure on one of my shared patients as a “brief progress note.” It was eight pages of legible medical jargon which obfuscated what was done by the clinician. It was comprehensive everything, enabling maximal billing. Is it any wonder that costs of the healthcare system have increased? (Karen Kegman, PhD)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. K in Kansas, who asked for a Little Scholar tablet, fabric letters, a sentence building set, and a Ten-Frame Treasures. She reports, “Thank you so much for providing great learning tools to my students. One of their favorites is the Little Scholar Tablet. My lower students really benefit from having the preschool and kindergarten apps to play and learn from. The students have been able to grab the tablet and get on a game without any help from me. This has been awesome because I don’t have to stop helping students with their worksheets and lessons to help those get on an app.”

A woman shot in the Route 91 Harvest Festival leaves the hospital a year after she was admitted. She underwent 12 surgeries to repair damage to her liver, spleen, and stomach.

Police shoot and kill an ED patient at Orlando Regional Medical Center after he threatens staff, falsely claiming that he had a gun.

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The New Yorker questions why FDA approved the marketing of menstrual cycle tracking app Natural Cycles as “digital birth control” despite its high failure rate in Sweden, supporting studies that were small and funded by the company, and effectiveness that is predicated on users entering their temperatures correctly each day and following a program that differs little from old-school rhythm method paper tracking. Title X changes are expected to roll back ACA rules, moving federal dollars to clinics that don’t offer the most effective birth control options of condoms, hormonal contraception, or IUDs and instead recommend abstinence or fertility tracking such as that supported by Natural Cycles.

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The VA rates nine of its hospitals as the worst in its system, earning a one-star score. Five of those have been cellar-dwellers for three straight years. As is the case with hospitals, the potentially most-beneficial technology tool for patients might be the car or jet that takes them away from:

  • Big Spring, TX
  • Decatur, GA
  • El Paso, TX
  • Loma Linda, CA
  • Memphis, TN
  • Montgomery, AL
  • Phoenix, AZ
  • Tucson, AZ
  • Washington, DC

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Nobel Prize winner Leon Lederman, who created the physics concept of a “God particle” later discovered as the Higgs boson, dies at 96 after being forced to sell his Nobel medal at auction in 2015 to pay for medical bills and nursing home care.

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Iowa insurance agents will start selling less-expensive but unregulated health plans from Iowa Farm Bureau, which can exclude people with pre-existing conditions or charge them higher premiums. Lifetime benefits will be capped at $3 million. The plans go on sale November 1, the same day ACA open enrollment begins, leading to concerns about consumer confusion. The plans aren’t technically insurance – they are not regulated and policyholders have no recourse to protest insurer decisions. The plans look great on paper, at least, and use Wellmark Blue’s HMO network and prescription coverage. A big, lightly-noted hole even beyond pre-existing condition coverage, however, is that policyholders are on the hook for ACA-prohibited balance billing by out-of-network providers, which could be just about anyone you see wearing scrubs in an in-network hospital.

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Axios reporter Bob Herman notes that attending the AMA’s RVS Update Committee (RUC) – whose rules are used to set Medicare’s payment policies – as a journalist requires signing a confidentiality agreement that prohibits all attendees from disclosing potential CPT code changes, anything the committee talks about, and the names of committee members. AMA says the requirement prevents market speculation and the protection of its proprietary information.

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The FBI releases a Physical Fitness Test app for aspiring agents that includes a privacy warning that users “are subject to having all of their activities monitored and recorded.”

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Employees of St. Luke’s Hospital (ID) line the halls leading from the ICU to the OR in the hospital’s traditional, silent “Walk of Respect” that honors an organ-donating patient on their way to having their life support system turned off and their organs harvested.


In Case You Missed It


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Morning Headlines 10/5/18

October 4, 2018 Headlines No Comments

Health tech pioneer Deborah Estrin named MacArthur fellow

The MacArthur Foundation awards Deborah Estrin a fellowship for her work on determining how data generated by smartphones, wearables, and online interactions can be used for mobile health while still maintaining user privacy.

Frost & Sullivan Honors Medicomp Systems with the EHR Optimization Technology Leadership Award

Frost & Sullivan names Medicomp Systems the winner of its 2018 North America EHR Optimization Technology Leadership Award for its Quippe productivity enhancement solutions for reducing documentation burden.

A startup’s bold plan for a mood-predicting smartphone app is shadowed by questions over evidence

Mental health tech startup Mindstrong raises $30 million in funding and secures agreements with a dozen California mental health departments, but has yet to publish peer-reviewed data that back up its claims.

News 10/5/18

October 4, 2018 News 4 Comments

Top News

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Cerner announces its VA EHR modernization team, with Leidos, Accenture, and Henry Schein taking on prominent roles as expected.

In announcing the 23 members, the company stressed that it will leverage investments already made by the DoD for its nearly concurrent Cerner-powered EHR revamp. VA Secretary Robert Wilkie and Defense Secretary James Mattis have said their departments will work together to ensure their new EHR systems are implemented on a unified schedule and are capable of seamlessly sharing data with civilian and government providers.

Cerner has promised to unveil a project timeline at its user conference next week.

I reviewed the list of companies Cerner has chosen as partners for its VA implementation. These are also working on the DoD’s Cerner implementation:

  • Accenture
  • Leidos
  • Henry Schein
  • Holland Square Group (Cerner-focused implementation consultants — acquired by Alku in December 2017)
  • MedSys Group (EHR consulting)
  • ProSource360 (government consulting)

These are the VA-only partners just announced:

  • AbleVets (government consulting)
  • ACI Federal  (government IT contractor)
  • B3 Group  (government consulting)
  • Blue Sky Innovative Solutions (government consulting
  • Clarus Group (a Salesforce-focused consulting firm that offers government technology services)
  • Forward Thinking Innovations (government health IT — seems to be a two-person consulting firm)
  • Guidehouse (the former PwC Public Sector consulting group)
  • HCTec (health IT and revenue cycle consulting)
  • HRG Technologies (revenue cycle services)
  • KRM Associates (government contract health IT contractor, a small husband and wife business)
  • Liberty IT Solutions (government technology contractor)
  • MedicaSoft (sells an EHR, PHR, and Direct messaging services with a founder who a lot of VA work with FHIR and is founder and board chair at the Open Source Electronic Health Record Alliance)
  • MicroHealth (government analytics, engineering, integration)
  • PM Solutions (project management)
  • Point Solutions Group (consultant staffing)
  • Sharpe Medical Consulting  (health IT consulting, medical staffing)
  • Signature Performance (revenue cycle consulting)
  • ThomasRiley Strategies (consulting)

Reader Comments

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From Plenary Session: “Re: UMass’s financial struggles. Isn’t this the kind of organization that has no business putting $700 million into Epic? Negative operating margins, historically financially strained … makes no sense.” The health system’s operating income has been all over the place, with capital renovation temporarily eating up some of its capacity. While I will defend my contention that a new EHR will amplify a provider’s existing levels of excellence (rarely moving a poor hospital to good), the mere act of choosing, buying, and implementing such a pervasive system (which requires more consensus and focus than many hospitals can muster) may either signal or create its resolve make overdue improvements. Epic also pushes its customers, steamrolling over incompetent or inertia-crippled hospital middle management with the full support of the hospital’s C-level, so don’t underestimate the motivational impact of your CEO demanding that you deliver $700 million worth of value in a rare example of holding executives accountable for true change and coordination across departments. In that regard, improved operational management and visibility may be a byproduct of implementing Epic, although it’s a shame that a software vendor that really doesn’t offer “management consulting” has to lead the charge against mediocrity. Still, hospitals happily pay to have consulting firms tell them what everybody else is doing, so at least an Epic implementation binds the organization to deliver measurable results. As much as we cheap-seaters might smirk about a health system spending hundreds of millions of dollars on software (and oh, I do), the fact is many of them are happy about their decision afterward and show improved results whether it’s Epic, Cerner, or Meditech.

From Expat Investor: “Re: Cornerstone Advisors. Allegations are that officials of its corporate owner 8K Miles forged auditor documents to move money to a sister company mostly owned by the CFO, who resigned.” The India-listed company’s external auditor also quit over the transfers between the companies, which share a CEO.  8K Miles acquired healthcare IT consulting and implementation vendor Cornerstone Advisors Group in late 2016.

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From Zeke Avarice: “Re: webinars. Why would someone watch a recording, such as on your YouTube channel?” Live webinars have just one advantage, and that’s being able to ask the presenter questions. The disadvantage is that you have to be available at the designated time, you have to pay attention at what might be an inopportune moment, and you can’t fast-forward or rewind. That’s why we archive the recording  — those get more views than the live sessions due to the long tail of people discovering them after the fact. Still, we get a lot of interest in webinars (example click counts above), although the quality of the program and the speakers drive whether people actually sign up after reading the description and not everyone who signs up is able to attend (which is why we send absentees a link to the video and a PDF of the slides).


HIStalk Announcements and Requests

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Welcome to new HIStalk Gold Sponsor Atlantic.net. The Orlando-based secure hosting solutions vendor provides HIPAA-compliant, PCI-ready, and cloud hosting from its state-of-the-art data centers in New York, London, Toronto, San Francisco, Northern Virginia, and Dallas. The company just won a “Best IoT Healthcare Platform” awards. Organizations choose the company – founded in 1994 in Gainesville, FL — for its 100 percent uptime SLA, its emphasis on security and compliance, and its award-winning service backed by support engineers with decades of experience, all at competitive prices. It offers the eight items required to deliver HIPAA-compliant hosting – firewall, encrypted VPN, offsite backups, multi-factor authentication, private hosted environment, SSL certificates, SSAE 18 certification, and a signed business associate agreement. Thanks to Atlantic.net for supporting HIStalk. 


Webinars

October 30 (Tuesday) 2:00 ET. “How One Pediatric CIN Aligned Culture, Technology and the Community to Transform Care.” Presenters: Lisa Henderson, executive director, Dayton Children’s Health Partners; Shehzad Saeed, MD, associate chief medical officer, Dayton Children’s Health Partners; Mason Beard, solutions strategy leader, Philips PHM; Gabe Orthous, value-based care consultant, Himformatics. Sponsor: Philips PHM. Dayton Children’s Health Partners, a pediatric clinically integrated network, will describe how it aligned its internal culture, technology partners, and the community around its goal of streamlining care delivery and improving outcomes. Presenters will describe how it recruited network members, negotiated value-based contracts, and implemented a data-driven care management process.

Previous webinars are on our YouTube channel. Contact Lorre for information.


Acquisitions, Funding, Business, and Stock

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Change Healthcare hires underwriters for an IPO that could value the company at up to $12 billion. The prep work comes nearly a year after McKesson CEO John Hammergren said he wanted to take the company public. McKesson owns a 70 percent stake of Change, which was formed last year through the merger of its IT business and the former Emdeon.


People

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The MacArthur Foundation awards Deborah Estrin a fellowship, including a $625,000 “genius grant,” for her work on determining how data generated by smartphones, wearables, and online interactions can be used for mobile health while still maintaining user privacy. Estrin is a professor of computer science at Cornell Tech and of healthcare policy and research at Weill Cornell Medicine. She directs Cornell Tech’s Small Data Lab; and founded the Health Tech Hub at the Jacobs Technion-Cornell Institute, as well as the nonprofit, open-source software architecture startup Open mHealth.


Announcements and Implementations

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Frost & Sullvan names Medicomp Systems the winner of its 2018 North America EHR Optimization Technology Leadership Award for its Quippe productivity enhancement solutions for reducing documentation burden.

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Datica announces GA of its Cloud Compliance Management System for developers.

Collective Medical will deliver its real-time event notification and care collaboration tools through Appriss Health’s PMP Gateway integration software, used by the prescription drug monitoring programs of 43 states.

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A new KLAS report says behavioral health EHRs are one of the lowest-performing segments it measures due to slow development, vendor over commitment, and state-specific reporting needs. Still, frustrated customers are likely to keep their existing systems due to lack of money and competitive alternatives. Valeant would have topped the list (over Credible and Cerner, which has two offerings in Millennium and its acquired Anasazi) had it generated enough responses. No vendor scored above a 7 in “keeps all promises.”

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Buoy Health, which offers an AI-powered chatbot, wins the Robert Wood Johnson Foundation’s AU Challenge Award for patient education. I’m not really a fan of the many available online symptom checkers and I’d like to see their results validated against a an actual visit with a clinician, but this one seems OK if you like them. Startups obsess over the problem they think exists in misdiagnosis or underdiagnosis, packing PCP offices and EDs with people who need more information, have been given bad information by the computer, or who can’t afford further diagnostic work or treatments anyway. We have endless problems with our healthcare services delivery and social policies, but not diagnosing enough symptom-free problems doesn’t top the list.


Privacy and Security

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Scripps Health patient Danielle Sullivan tells the local news the health system has sent her the medical records of other patients three times in the last seven months. She has filed an HHS complaint but expects no change since Scripps hasn’t apologized and she thinks they just treat mistakes as a cost of doing business.


Other

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Healthcare celebrity Atul Gawande, MD will keynote HIMSS19 on Tuesday, February 12 in Orlando.

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Stat digs into the business case behind Mindstrong, a predictive mental health app that’s high on hype but low on clinically valid results. Founded by Paul Dagum, MD, the Silicon Valley startup has raised $30 million in funding and secured implementation agreements with a dozen California mental health departments, but has yet to publish peer-reviewed data that back up its claims. With the Theranos fallout barely out of the headlines, industry analysts have been quick to pump the brakes on panacea-like expectations and the company itself has said the app will be rolled out with caution.

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Police in San Jose, CA use a combination of video surveillance footage and Fitbit data to charge Anthony Aiello with the murder of his stepdaughter. Investigators say her Fitbit shows her heart rate spiking, rapidly slowing down, and then ceasing at the same time neighbors say Aiello was visiting. After being confronted with the data, Aiello said, “I’m done.”


Sponsor Updates

  • Frost & Sullivan honors Medicomp Systems with the EHR Optimization Technology Leadership Award for its Quippe suite of solutions.
  • FDB and PetIQ develop the industry’s first veterinary medications database that will deliver codified, up-to-date information on pet medications, structured for integration into pharmacy systems.
  • Elsevier Clinical Solutions will exhibit at the College of American Pathologists meeting October 8 in Chicago.
  • EClinicalWorks will host its 2018 National Conference October 5-7 in Nashville.
  • Healthwise and Imprivata will exhibit at the Cerner Health Conference October 8-11 in Kansas City, MO.
  • Lutheran Senior Services (MO) becomes the first Netsmart customer to exchange health data with its local health system through the Carequality framework.
  • EClinicalWorks and Healthfinch will exhibit at the AAFP Family Medicine Experience October 10-12 in New Orleans.
  • EPSi will host its Visis National Summit October 10-12 in Amelia Island, FL.
  • FormFast will exhibit at ASHRM 2018 October 7-10 in Nashville.
  • CHIME interviews The HCI Group CEO Ricky Caplin.
  • Hyland will exhibit at AHCA/NCAL 2018 October 7-10 in San Diego.
  • InterSystems will exhibit at the DoD/VA Gov Health IT Summit October 10-11 in Alexandria, VA.
  • Kyruus will exhibit at SHSMD Connections 2018 October 7-10 in Seattle.
  • Surescripts honors five EHR vendors with its 2018 White Coat Award for improving e-prescribing accuracy.
  • Pivot Point Consulting parent company Vaco hires Phillip Noe (The Adecco Group) as CIO.

Blog Posts


Contacts

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

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EPtalk by Dr. Jayne 10/4/18

October 4, 2018 Dr. Jayne No Comments

ECRI Institute releases its 2019 list of the Top Ten Technology Health Hazards. The list is created each year by assessing various factors around each potential hazard, including severity, frequency, preventability, and breadth of the hazard. Insidiousness is also considered – whether the problem is difficult to recognize and whether it could lead to downstream errors before the problem is identified.

This year’s list contains some hazards that are clearly healthcare IT issues. but also some problems that healthcare has been grappling with for a long time:

  1. Hackers can exploit remote access to systems, disrupting healthcare operations
  2. “Clean” mattresses can ooze body fluids onto patients
  3. Retained sponges persist as a surgical complication despite manual counts
  4. Improperly set ventilator alarms put patients at risk for hypoxic brain injury or death
  5. Mishandling flexible endoscopes after disinfection can lead to patient infections
  6. Confusing dose rate with flow rate can lead to infusion pump medication errors
  7. Improper customization of physiologic monitor alarm settings may result in missed alarms
  8. Injury risk from overhead patient lift systems
  9. Cleaning fluid seeping into electrical components can lead to equipment damage and fires
  10. Flawed battery charging systems and practices can affect device operation.

Most of us are familiar with the need to address cybersecurity concerns, as we see ongoing cases of not only breaches, but ransomware attacks. However, I’m still surprised by the number of organizations that don’t keep their systems current with recommended patches and updates, or that are even on versions of software that are no longer supported by their vendors.

Other items such as alarm settings may be addressed by policy and procedure, which can be harder to institute than technological safeguards unless the organization is truly invested in a culture of safety.

Items 2 and 5 are simply gross and it seems they should be straightforward. Unfortunately, the situation is complicated by some manufactures not providing detailed cleaning recommendations or institutions using harsher cleaners than recommended, which damages the surfaces of equipment and allows absorption or sequestration of contaminants.

Retained surgical sponges are an issue that hospitals and surgery centers have tried to address through technology, including special thread in sponges that shows up on x-rays. Other technologies augment the manual counting process and can be effective if they are used correctly. These vary from special counting racks to radio frequency locator systems.

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The Centers for Disease Control’s National Center for Health Statistics recently updated its guidelines regarding hurricanes. These go into effect October 1. The hurricane piece is located on pages 19-20 of the 120-page document, which I’m sure all physicians, coders, and billers will be lining up to read. It mostly addresses the ICD-10 codes for external causes – although they have been in place for years, the guidelines direct physicians how they should be used. The guidelines also address the use of Z codes, which can explain why patients presented for care, including homelessness, inadequate housing, poverty, and lack of availability or inaccessibility of health care facilities.

Speaking of CMS, a recent blog by administrator Seema Verma addressed the topic of “Better Data Will Serve as the Foundation in Modernizing the Medicaid Program.” Essentially, CMS is seeking to demonstrate how the ever-growing Medicaid budget is driving better health outcomes. CMS is also looking for ways to “improve program integrity, performance, and financial management in Medicaid and CHIP.” CMS has identified core sets of quality measures that will be used to monitor outcomes, although reporting is voluntary at this time. It admits that reporting is burdensome and has tried to mitigate the burden through the Meaningful Measures initiative, noting future intent to “leverage existing and more automated data reporting systems to generate these Medicaid measures on behalf of states, thereby reducing reporting burden while also improving data consistency, comparability, and comprehensiveness.”

That’s a buzzword bingo winner right there. Theoretically, isn’t CMS already receiving the data through individual provider reporting as part of Meaningful Use? Wouldn’t that allow CMS to aggregate the data rather than having states submit it? I’m not in the details on Medicaid MU very much any more, but maybe someone who is can shed a little light on this for me. All I know is that as a practicing clinician, fewer of my peers are accepting Medicaid patients and those who are have generally stopped booking new patient visits, leaving a continuing gap in care delivery and pushing patients to the emergency department.

Flu season is officially upon us, with positive cases being reported even though the 2018-19 season is not yet being named on the CDC website. We’re seeing plenty of cases in my practice, along with a particularly nasty influenza-like illness that walks like the flu and talks like the flu but comes out negative in testing.

Our urgent care volumes during last year’s flu season were largely driven by patients who either couldn’t get in to see their primary care physicians or who didn’t want to go to the emergency department due to potential wait times, overcrowding, and perceived lack of service. We’ve hired several new providers and a small army of paramedics and scribes to help us get through the upcoming season. If you haven’t received your vaccine yet, now is the time.

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We already knew it in our hearts, but I was saddened to see the Journal of the American Medical Association call out the “Southern diet” as deadly. Its main mechanism is thought to be elevated blood pressure. The study looked at nearly 7,000 people who were part of a larger long-term study of diet and lifestyle. It tracked weight, blood pressure, cholesterol levels, alcohol use, income, and exercise habits along with symptoms of stress and depression. The study notes, “The largest statistical mediator of the difference in hypertension incidence between black and white participants was the Southern dietary pattern, accounting for 51.6 percent of the excess risk among black men and 29.2 percent of the excess risk among black women.” Hispanic and Latino individuals were excluded from the study.

I looked in the full-text article as well as in the references for the link to the “Southern diet score” they used but didn’t find it. I’m curious how my own diet stacks up – I do love a good fish fry with cheesy potatoes and apple cobbler.

Email Dr. Jayne.

Morning Headlines 10/4/18

October 3, 2018 Headlines 1 Comment

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Sources report that Change Healthcare has hired underwriters for a 2019 IPO that could be valued at up to $12 billion.

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California doctors now required to check database before prescribing painkillers

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