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News 9/11/19

September 10, 2019 News 10 Comments

Top News

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Bayfront Health St. Petersburg (FL) pays $85,000 to settle Office for Civil Rights charges that it failed to provide a woman with the fetal heart monitor records of her unborn child within HIPAA’s 30-day window. This is HHS OCR’s first case brought under HHS’s Right of Access Initiative that was announced earlier this year.

The mom didn’t get the information until nine months later, and then only after she filed an OCR complaint.

The hospital is part of Bayfront Health, which is owned by for-profit Community Health Systems.

The hospital also agreed to a corrective action plan that includes revising PHI-related policies and procedures if necessary, validating its Designated Record Set Policy, training its employees who manage information requests, and providing HHS with a list of its business associates.

The settlement is important since it signals OCR’s belated interest in going after health systems that have been widely ignoring the requirement that they give patients copies of their records promptly and at a reasonable cost.


Reader Comments

From Banga Gong: “Re: physician burnout. What about other people who are burned out? You don’t read much about them.” Agreed. Many Americans are experiencing the cultural phenomenon of burnout that is caused by excessive workload, too much time wasted in conference rooms and on email, an always-on expectation of answering work messages around the clock, jobs that discourage creativity or individualism, a disconnect between accomplishment and rewards, general executive cluelessness and indifference, and employers whose social mission and human connection are coincidental at best. They make it worse by wasting endless time staring at their phones and anguishing second by second over political nonsense instead of cultivating in-person relationships, breathing fresh air, and stepping out of their consumptive role as never-rest shoppers. Therefore, I’ll take the harsh point of view that doctors who have decided to become employees are belatedly finding out that it’s not so great being an employee in the US these days, no matter how much you’re paid. Thousands of lower-earning people name email or Slack as the corporate villain for every doctor who blames the EHR for their unhappy work life. Forming a union isn’t likely to help, so the choices are to (a) find a more suitable physician job; (b) leave the profession and do something else; or (c) become self-employed. Complaining while remaining isn’t a good look, but I can understand why doctors are especially unhappy because their entire post-high school lives were structured around being gunners who earned rewards by beating others.

From Mensch: “Re: layoffs. How would readers know if a layoff seems to unfairly target more expensive workers?” They can easily go down a self-made list of newly vacant cubicles and tally the dearly departed by age group, position level, known health problems or frequent absences, etc. I’ve been involved in health system layoffs, and while HR ran our proposed IT layoff list through a discrimination testing program to make sure we wouldn’t get sued, the end result was that we just took the first run of the program to see if we had the prescribed mix of ages and males-female, then chose more younger people or females or whatever we needed to get the spreadsheet’s green light. In other words, some people were cut loose purely to balance our desire to get rid of some of their peers. I’m saying “we,” but the decision was made above my level by an executive who was new and therefore naive enough to think that his gung-ho team play would benefit him as a man of decisive action.

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From Alan: “Re: Netflix documentary ‘Diagnosis.’ See attached screen grabs. S1-E6  shows a Johns Hopkins neurologist writing a paper note in front of his Epic screen. Seems like he could have more room to write if it weren’t for that annoying keyboard.” The patient is probably happier to have the doctor at least looking him most of the time since the room arrangement doesn’t readily support showing the patient the screen while entering information. Large monitors and even projectors are super cheap and small these days, so it would be nice to have both participants looking at the same screen image as a teaching point. My tax guy has a large monitor behind his desk that we look at together when he is explaining stuff and it works great, especially since his wireless keyboard keeps him untethered.  


HIStalk Announcements and Requests

A relative of mine is a family doctor who has worked for years (not all that happily) for a multi-specialty clinic whose foreign-trained physician-owner pushes the medical staff hard to increase patient volume and keeps elevating the bonus targets. The relative says working conditions suddenly got worse recently as the clinic “got a new investor” (which I take to mean that it was sold to a big investment group), a new practice manager was installed who chews out the doctors over administrivia, and the whip is being cracked harder to make new number targets. Sometimes you forget that even modest private medical offices can be the storefront for big business.

I was also talking to a doctor friend who gets insurance from his academic medical center employer. He found when his kids went to college that his employer’s family plan offers basically no coverage outside its immediate area. I wonder how many of us know what would happen financially if we’re taken to an ED unexpectedly while on vacation several states away from home?


Webinars

September 19 (Thursday) 2:00 ET. “ICD-10-CM 2020 Code Updates.” Sponsor: Intelligent Medical Objects. Presenters: June Bronnert, MSHI, RHIA, director of terminology mapping, IMO; Theresa Rihanek, MHA, RHIA, classification and intervention mapping lead, IMO; and Julie Glasgow, MD, senior clinical terminologist, IMO. The 2020 regulatory release is right around the corner. Join IMO’s top coding professionals and thought leaders as they discuss new, revised, and deleted codes; highlight revisions to ICD-10-CM index and tabular; discuss changes within Official Coding Guidelines; share potential impacts of the code set update; and review ICD-10-CM modifier changes.

September 26 (Thursday) 2 ET. “Patient Education Data: A Key Ingredient for Improving Quality and Patient Experience.” Sponsor: Healthwise. Presenters: Victoria L. Maisonneuve, MSN, RN, director of the Nursing Center for Excellence and Magnet program, Parkview Health; Marta Sylvia, MPH, senior manager of quality improvement and outcomes research, Healthwise. Healthcare data is everywhere! It’s scattered across various systems and in countless formats, making it difficult to collect and glean actionable information. Knowing where to start depends on what your organization wants to accomplish. Vicki Maisonneuve will share how her team analyzes data around the use of patient education. By combining different data sets, she can easily identify trends, gaps, and opportunities to improve quality and patient experience across Parkview Health.

Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

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A ProPublica report finds that private health insurance companies, unlike Medicare and Medicaid, don’t pursue widespread and sometimes obvious examples of healthcare fraud because they can simply pass its cost on to consumers in the form of higher premiums.


Sales

  • Mayo Clinic signs a 10-year partnership with Google in which Google Cloud will provide Mayo with data hosting, cloud computing, analytics, and machine learning and AI.
  • Cerner signs three new CommunityWorks clients: Eastland Memorial Hospital (TX), Pawhuska Hospital (OK), and Schoolcraft Memorial Hospital (MI).

People

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BioBright, whose technology extracts medical device information for research, hires industry long-timer Edward Chung, MD (Covenant Health) as chief medical officer.

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Michael Keyes, MBA, PT (3M Health Care) joins Collective Medical as VP of health plan business development.

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Patient engagement technology vendor Conversa hires Cameron Ough, MSc (Cigna) as CTO.

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Healthcare talent management software vendor HealthcareSource names Michael Grossi (Ipswitch) as CEO. He is also a former Air Force captain in Intelligence Command.

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Cerner EVP / Chief of Innovation Jeff Townsend will retire this year after 30 years with the company.


Announcements and Implementations

A Spok survey of hospital employees on mobile strategies finds that poor wi-fi and cellular coverage remain the biggest problems, although improving. More than half of non-clinical staff still use pagers, which respondents say provide better coverage than any other communications device.

Carolina EHealth Alliance reports expanded adoption among state EDs after it switches vendors to Health Catalyst.

Apixio announces Quality Identifier, which uses AI to extract quality data elements from patient notes, scanned charts, and other documents that are then presented to abstractors for review.

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Leidos Partnership for Defense Health announces go-live of the Department of Defense’s MHS Genesis project at Mountain Home Air Force Base (ID), Travis Air Force Base (CA), Naval Health Clinic Lemoore (CA), and the Presidio of Monterey, US Army Health Clinic (CA). The project remains on track for 2023 completion, with 23 go-live waves of around three hospitals each.


Government and Politics

The Census Bureau reports that for the first time since 2014, the percentage of uninsured Americans rose in 2018 even with a strong economy.


Privacy and Security

In Canada, British Columbia’s privacy watchdog opens an investigation into Vancouver Coastal Health’s use of paging systems to broadcast patient movement data, which it says can be easily intercepted by anyone with enough technical proficiency to run software-defined radio since the information is not encrypted. 


Other

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A Washington Post article decries the lawsuits brought against patients who have unpaid bills by University of Virginia Health System, which over six years filed 36,000 lawsuits in an effort to collect $106 million. The article notes that UVA has sued 100 of its own employees, garnishes paychecks from lower-pay employers such as Walmart, and has seized $22 million in state income tax refunds as Virginia law allows. Perhaps the moral outrage could be redirected from UVA – which has broken no laws and is doing exactly what any business would do – to a national health non-system in which exorbitant provider prices collide with a patchwork insurance program in leaving some patients with medical bills – at full list price that only cash patients are expected to pay — that bankrupt them through no fault of their own. Shaming UVA publicly won’t resolve a whole lot since the problem is far greater than defining just how far that specific hospital should go in its collection practices. There’s also the issue that giving those who can’t or won’t pay a free ride just means the health system will milk the rest of us harder to compensate and help hide the real problem. It’s cute that people are still surprised that it’s not the pre-Medicare 1960s in healthcare, or that they beam at  the massive employment and architectural splendor of their local health system without questioning who’s paying for it.

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Speaking of billing practices, nephrology social worker Teri Browne, PhD describes her experience after Lexington Medical Center (SC) notifies her that it has asked the state to place a lien on her future tax refunds for the $286 she owes, with these details:

  • MyChart showed no balance due and she had received no statement.
  • She was told in her 26-minute phone call with the hospital’s billing department that the hospital’s billing company is “infamous for not sending out statements.”
  • She paid the $286, then spent another 16 minutes on the phone with the billing department, who said they didn’t see bills for the dates of service. They also told her that charge display isn’t supported by MyChart.
  • She made another call to complain formally, noting that unlike some people, she knows healthcare, she could afford to take an hour out of her workday to get the problem resolved, and she had the money to settle up what she finally found that she owed.

A Health Affairs article finds that nearly all of the highest-charging air ambulance companies are owned by private equity firms.

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From the Apple Event 2019:

  • The company announced the IPhone 11, 11 Pro, and 11 Pro Max, which mostly involve a better camera (actually three cameras on the back) and a new design, starting at $699. Unlike its competitors, the new IPhone will not offer 5G support.
  • The sixth-generation IPad was introduced, with a 10.2” display.
  • The Apple Watch Series 5 was announced, offering an always-on display, power-saving features, and a compass. The company highlighted health research projects related to hearing, women’s health, and the heart.

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Apple provides more details about the three studies being launched on the new version of its Research app:

  • Looking at menstrual cycles and gynecological conditions, performed by Harvard’s public health school and the NIH.
  • Seeing if heart rate and mobility signals can be correlated with health events, performed by Brigham and Women’s Hospital and the American Heart Association.
  • Measuring sound exposure and its effect on hearing, performed by University of Michigan.

Sponsor Updates

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  • The CoverMyMeds team helps Gladden Community House prep for its annual fundraising dinner.
  • Arcadia will partner with Cigna to present “Will Physicians Ever Welcome a Health Plan into the Exam Room” at Rise West September 11 in San Diego.
  • Artifact Health will exhibit at AHIMA September 14-18 in Chicago.
  • Clinical Architecture debuts “The Informonster Podcast.”
  • CompuGroup Medical releases version 19.9 of its LABDAQ laboratory information system.
  • Charlyn Slade joins the advisory board of Prepared Health.
  • John Halamka, MD, MS joins the advisory board of PatientPing.

Blog Posts


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Contacts

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


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Morning Headlines 9/10/19

September 9, 2019 Headlines 1 Comment

Vim, a Healthcare Platform for Health Plan-provider Collaboration, Raises $24 Million in Series B Financing Led by Optum Ventures and Premera Blue Cross

Appointment scheduling optimization and care collaboration technology vendor Vim raises $24 million.

OCR Settles First Case in HIPAA Right of Access Initiative

Bayfront Health St. Petersburg (FL) pays $85,000 to HHS to settle a potential HIPAA violation related to its failure to provide medical records to a patient in a timely manner.

Pentagon’s New Electronic Health Records System Deployed To Second Wave of Bases

The DoD rolls out the Cerner-developed MHS Genesis system at three facilities in California and one in Idaho.

A new policy on advertising for speculative and experimental medical treatments

Google announces that it will prohibit ads for unproven or experimental medical techniques like stem cell therapy, cellular therapy, and gene therapy.

Curbside Consult with Dr. Jayne 9/9/19

September 9, 2019 Dr. Jayne 4 Comments

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Lots of companies are talking about gamification as it relates to patient engagement and management of chronic conditions, but I never thought I would see an app designed to gamify strategies to reduce physician burnout.

The folks at the American Medical Association have released an app that tries to make a game of dealing with this serious issue. Titled “HealthBytes,” the app is designed to teach strategies to help physicians optimize their practice’s operations in an attempt to reduce physician burnout. The app can be played on a PC or smartphone. The AMA states “no matter how many times you play the game, you are bound to learn something new each time.” I’m not sure what kind of research they did to drive the creation of this game, but in my experience the last thing that burned out physicians want to do is experience anything office related if they don’t have to.

The AMA admits there is a time pressure element to the “Practice Master” game within the app. Players have four minutes to play through a physician scenario, including meeting the team, designing “my dream team,” optimizing documentation, conducting a patient visit, and creating a well-being plan for the physician and the team. Following that exercise, providers can share their score, play again, or consult AMA content designed to “offer innovative strategies to allow physicians and their staff to thrive in the new health care environment.”

After finishing my recent read of “Code Blue” by Mike Magee, which names the AMA as one of the principals behind the dysfunction of the US health care system, I find it only mildly amusing (but significantly distasteful) that they’re positioning themselves as experts ready to help solve the problem. One of my colleagues refers to the AMA (along with payer executives and federal regulators) as part of the Medical Axis of Evil.

The AMA is trying to be all over the issue of burnout, including offering the trademarked “American Conference on Physician Health” that will be held September 19-21 in Charlotte, NC. The organization is co-hosting with Stanford Medicine’s WellMD Center and the Mayo Clinic Department of Medicine Program on Physician Well-Being. The conference website lists of statement of need that “Physicians’ professional wellness is increasingly recognized as being critically important to the delivery of high quality health care.” It also notes that the meeting “is designed to inspire organizations throughout the country to seek ways to bring back the joy in medicine and achieve professional fulfillment for all our physicians.”

The sheer fact that presentations will include more than 70 wellness projects and programs illustrates the significance of the issue of burnout. I was surprised to see that the two-day conference costs $825 for AMA members ($925 for non-members), with a whopping $25 discount given to presenters who only have to pony up $800 to attend.

AMA is also offering a practice transformation boot camp immediately prior to the conference, at the bargain price of $279 for the day (although you do get a $100 discount if you register for both). Tack on an additional $214 per night for hotel accommodations plus meals and travel. Frankly, if I was going to spend that kind of money, I’d be heading to the beach since that is my proven strategy for improving my own physician well-being. I noted on the website that AMA recently extended the registration and now it closes a mere nine days before the conference, perhaps an indicator of what potential attendees think of the conference.

I frequently read articles about burnout, physician wellness, resilience, etc. and they often portray clinicians in the trenches (not just physicians – it’s all of us) as somehow being lacking, therefore we are subject to burnout. If we could just be more resilient, if we could just explore mindfulness, if we could just tweak every fiber of our practice’s operations, we would be OK. If we could just embrace the therapy dogs, take a walk in a grassy meadow at lunch time, or build the ideal care team, we’d be able to dodge the flaming arrows we encounter on a daily basis.

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In the spirit of fairness, I gave the game a try. I found it simplistic and revealing only of the information that most of us already know. I made the leaderboard on the first try even despite being penalized for answers that were situationally correct but not what the game was looking for. It suggested hiring a scribe, which it refers to as a CDA (clinical documentation assistant – always great to add more acronyms), along with getting the IT team to restructure my EHR inbox. Good luck with that latter suggestion in a large health system environment where any changes to the EHR require the approval of three committees, a resource analysis, and endorsement by the person behind the curtain.

I admit I played it at work with the sound turned off, so maybe I missed out on some kicky soundtrack that might have made it more enjoyable, but mostly it just made me more aggravated than I already was about the situation.

An increasing body of research and commentary is describing “burnout” as the wrong word for the situation. Instead, they’re labeling this phenomenon as moral injury, the damage that occurs to an individual’s moral conscience as a result to the trauma we face in practicing medicine. The original definition of moral injury as coined by professor Jonathan Shay included three components: 1) when there has been a betrayal of what is morally right; 2) by someone who holds legitimate authority; and 3) in a high-stakes situation.

Although other definitions have evolved, I think this still holds for a large number of situations that healthcare providers face daily. One more recent definition from Brett Litz and colleagues describes that “perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations may be deleterious in the long term, emotionally, psychologically, behaviorally, spiritually, and socially.”

Tweaking the process for the office’s morning huddle isn’t going to do much to address the more deep-seated issues at play here. It is insulting for the AMA to put this in front of its physician constituents.

People often ask me how I cope with the craziness of healthcare, especially when you add the craziness of information technology on top of it. On some days, the answer is “barely.” Fortunately, I have a support system with friends and colleagues who understand what it’s like to work in this environment. I try not to take it too seriously and have modified my clinical career to one that is healthy for me. Being in traditional primary care was not, but providing episodic care is better. Doing clinical informatics work helps me feel like I’m doing something to help my fellow clinicians, regardless of the muck in which we operate on a daily basis. I also spend quality time on my treadmill watching utterly mindless shows on Netflix and there’s a smattering of time leftover for music, as well as my arts and crafts hobby. It’s a lot of work to stay sane in this environment.

What do you think of the response of the AMA and other professional organizations to the problem of burnout in healthcare? What would be a better answer? Leave a comment or email me.

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Email Dr. Jayne.

HIStalk Interviews Ken Misch, President, Medhost

September 9, 2019 Interviews 3 Comments

Ken Misch is president and CFO of Medhost of Franklin, TN.

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Tell me about yourself and the company.

I began my career on a traditional finance and accounting track with Price Waterhouse in Cleveland in the late 1980s. After going back for my MBA in the early 1990s, I determined that I wanted to do something other than just auditing.

For the last 20 years, I’ve worked with smaller, growth-oriented, private equity-backed companies, either in the technology or the healthcare space. After a personal health issue surfaced about 15 years ago, I decided I wanted to spend the rest of my career in the healthcare industry. Obviously since Medhost is a healthcare IT company, I’m fortunate that I can combine my interest in tech with my passion for healthcare.

Medhost serves over 1,000 facilities. We provide these facilities with inpatient electronic health record systems, related implementation, revenue cycle, patient engagement, and hosting and other managed services as well.

How would you characterize the market that you serve?

Medhost mainly serves what we would consider to be the community or the rural healthcare market, which is a different market than the traditional tertiary care market. The urban academic, large research healthcare facilities that you find in very large cities, is a different space than the healthcare facilities that we’re serving, those out in rural America. Those facilities are really challenged. Maybe all of healthcare is challenged to some degree right now, but rural healthcare probably more than others. Rural America is shrinking, but there’s still a need for providing healthcare in those communities.

Al the IT vendors that serve the healthcare space have been challenged recently by the increased regulation that’s been coming out of DC with respect to Meaningful Use, interoperability, et cetera. All of us have had to spend and invest significant dollars in upgrading the systems. Not only to comply with increased regulation, but hopefully provide better optimization and efficiency for our customers.

How has the move of Epic and Cerner into smaller facilities as well as Meditech’s efforts to rejuvenate its business changed the dynamic?

Certainly competition is increasing and is getting more intense every day. Epic and Cerner have tried to provide offerings to come downstream. They’ve had different degrees of success with that. We’ve had customers that have tried both and have come back to Medhost. We’ve had customers that have been forced to do one or the other through a health system connection. We typically get feedback on how that’s going. 

We think we provide the right solution with the right level of functionality at the right price point for these community facilities.It’s hard for these larger systems to come downstream to de-feature those systems at a price point that makes sense for these community hospitals without cannibalizing their existing base. It’s challenging for those facilities to come downstream.

Meditech is is trying to do more with some of their current offerings, but they still have three basic platforms out there that they’re supporting. Their SaaS offering might add a fourth to that mix.

The marketplace is competitive. We recently announced a large win with Quorum Health. Quorum was spun out of CHS. They needed to find their own standalone platform. They went out in a competitive and rigorous bid process and eventually selected Medhost to be their system of the future.

Why do investor-owned health systems almost never choose Epic or Cerner when their large, non-profit counterparts almost always do?

You’re touching on the basic point — it’s about who you answer to. The investor-owned facilities or the investor-owned providers are answering to a group of shareholders and stakeholders. A lot of their systems and their choices are being run by processes that look at return on investment or cost.

It’s hard to justify a return on investment in any IT space in healthcare right now, but looking at it from a cost perspective, those other systems are at a price point that might not make sense for an investor-owned provider organization, whereas the not-for-profits don’t exactly have that same mission. They both have a mission of taking care of patients, but the investor-owned providers probably have a little bit more of a financial hurdle, as they need to answer to their investor group.

Do hospitals worry more about their image in buying Epic or Cerner because their large competitors did instead of looking hard at return on investment?

In the urban communities, the bigger metropolitan areas across the US, that might be more relevant than in some of the spaces that we’re serving. We’re serving communities that probably only have one hospital and the next hospital is 50, 75, 100, or 150 miles away. There isn’t a lot of true provider competition in the markets that we’re serving.

I could certainly see when facilities are competing for talent in a large city that they might want to recognize that physicians seem to have a preference for one or the other. Physicians don’t like really any system from everything I can read and gather. They have more of a tolerance than a preference. Perhaps they have a tolerance for one more than another, and perhaps they’re getting training on one versus another as they come out of med school. That could be a decision for competing hospitals.

We have a large, investor-owned company here in Nashville that we talk to on a regular basis. A lot of what they talk about is providing the physicians with some tools. They may not need to invest in the largest system that’s out there, that may be run by some of large health systems in the country. They may choose to go a different route, but provide their physicians with robust tools that they need to do their job. But the back-end engine might be something a little bit different.

What are small health systems that are too successful to close yet aren’t being considered for acquisition doing to remain in business?

It’s tough for them. They’re facing a lot of challenges. A lot of those facilities are going to be more heavily Medicare and Medicaid versus commercial reimbursement. That’s been getting squeezed. There is more competition and some of their higher-value procedures are being siphoned off by the urban centers. They’re still being forced to comply with the same regulations as the large facilities. They still have to chin the bar on all the various regulatory items with respect to Meaningful Use and the other items that have come out of DC.

We’re seeing innovation starting to happen with some of our customers. How can they innovate their business model? How can they come up with strategies to help their communities? How can they engage a little bit more with those communities to help offset some of those challenges? It’s tough in the rural space right now.

We are seeing rural aggregators that are popping up and buying some of these facilities. They’re not going to be as big as a CHS or even a Quorum, which has about 25 facilities currently, but they’re acquiring maybe a handful to 10-12 facilities. They are realizing they can run those with scale. They can leverage some of the infrastructure and spread that investment across numerous facilities. We’re seeing some degree of private equity money coming into that, although most of that is an individual investors or small partnerships.

What vendor service offerings can help small hospitals gain some level of scaling?

We’ve been investing heavily in our service offerings. It started with the IT and hosting side and other managed services. As facilities were forced to upgrade their IT platforms, they were staring at either investing in hardware to put on-premise and then they would have to have the resources, both from a human and a capital perspective, to support those and maintain those technology resources. These small facilities realized that they would prefer to have somebody else do that, so we started to invest heavily in our hosting services about six or seven years ago. Now we’ve built a world-class hosting operation here at Medhost. Most of our standalone facilities have now elected to move into our hosting environment. In fact, we’ve had some of our recent corporate customers make that same decision.

More recently, we’ve started to expand our revenue cycle services, our back office services, and business office services. The smaller rural aggregators want us to do that for them because they don’t have the skillset that they need in the facilities. They don’t want to make the investment at the corporate location, so they are outsourcing that to companies like Medhost.

Is technology, specifically maintaining IT infrastructure or supporting regional interoperability, a big driver of small hospitals affiliating with larger ones?

At times. But technology replacement is a disruptive activity. A lot of the facilities, especially the inpatient facilities, have a system that they’ve chosen here over the last three to five years, maybe even longer than that. They have  decided who their partner is going to be. They are looking for that partner to help optimize the system.

The government, with the 21st Century Cures Act and a lot of the regs that are coming out with respect to interoperability, are requiring vendors like Medhost and others to make their systems more open and to begin to share data. That it isn’t going to require significant investment on the facility side to just link up a similar system. The systems will be able to communicate with each other, so that they can get the largest return that they can on the existing investment that they’ve made.

Typically there has to be some type of triggering event for a customer to make a change with an EHR. Maybe they see an end-of-life coming at some point and they will need to make a different choice, so they may go out to bid. It could be through a merger and acquisition, where they’re becoming part of another entity that wants to consolidate on a single platform. It could be dissatisfaction. Certainly not all customers are always happy, and so they may just get fed up with the existing system. But it takes a lot to get to that point because of the disruption that rip-and-replace causes.

What is the demand for interoperability in your market?

We’re not seeing a lot of proactive demand. A lot of it will be reactive to what regulations comes out  to make sure that they can comply.

As these community facilities evolve, being able to capture some information from other providers, other avenues, and other platforms will be helpful for them. They’re going to have to evolve from the traditional episodic care center that they’ve been in the past. The community hospital of the past will certainly change into the future and will need to provide different kind of tools and services for the residents of that community. Opening up the systems to enable them to capture patient data — or resident data, let’s call it — from other systems will be helpful for them. In the mean time, what they’re thinking about right now is just, how are we going to be able to comply with this?

Do you have any final thoughts?

I mentioned that I had a personal health issue surface about 15 years ago. It presented again about three and a half years ago. I have an extreme case of coronary artery disease. After receiving all the best possible surgeries and treatments from the best possible physicians and facilities, my symptoms continued to present, even with the smallest exertion, so I was forced to look for alternatives and to think differently.

I was fortunate to get connected to thought leaders and researchers who suggested a significant lifestyle modification. It involved a complete overhaul of how I thought about nutrition, fitness, and stress management. After three years of adopting this lifestyle, I’m off all medications. I have no symptoms, and I have a vigorous daily exercise routine that serves as a stress test for me.

It might be a stretch, but I look at the challenges that are facing rural healthcare today in a similar fashion. Traditional strategies, business operations, and the wonderful clinicians at these facilities are being stressed every day. It will take innovation led by the residents and employers within these communities, in partnership with local civic and government leaders, to identify business models that can help these organizations not only survive, but hopefully to evolve and thrive in the future.

Morning Headlines 9/9/19

September 8, 2019 Headlines No Comments

Ransomware hits hundreds of dentist offices in the US

Hackers breach DDS Safe, a cloud-based records retention and backup solution that is sold to dental practices, and use it to install ransomware on the computers of hundreds of dental practices.

Mountaineer docs going high tech to meet patient needs

In an effort to reduce ER visits and hospital readmissions, a team from the West Virginia University School of Public Health is preparing to launch a pilot program through WVU Medicine that will offer telemedicine services to certain Medicaid patients transitioning from long-term care to the home.

Automated deep learning design for medical image classification by health-care professionals with no coding experience: a feasibility study

Researchers find that clinicians with no experience in medical coding or deep learning can create clinical classification algorithms that perform well at diagnosis.

Monday Morning Update 9/9/19

September 8, 2019 News 15 Comments

Top News

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Hackers breach DDS Safe, a cloud-based records retention and backup solution that is sold to dental practices, and use it to install ransomware on the computers of hundreds of dental practices.

The two companies that created the software elected to pay the ransom and then share the unlock codes with their affected customers.

Some practices complained on Facebook that the decryption either didn’t work or didn’t restore all their data.

DDS Safe, ironically, pitches its product as protecting clients from ransomware.


Reader Comments

From Gaping Wound: “Re: AI snake oil. You’ve heard of his healthcare companies.” The founder, chairman, and CEO of Crown Sterling, which sells AI-powered encryption software, is ripped for his “sponsored presentation” at the Black Hat security conference that attendees quickly called out as incorrect, imitative, and lacking rigor. It was so bad that Black Hat pulled it from its website, admitting that its vetting process for sponsored sessions was basically nonexistent, after which Crown Sterling sued the conference for breach of its $115,000 sponsorship contract in claiming that the organizers colluded with attendees to interrupt him. The presenter was amateur mathematician Robert Grant, former president of Allergan Medical and Bausch and Lomb Surgical. He runs a growth equity firm that focuses on “the lifestyle sector of healthcare technology” such as its Alphaeon credit card for financing plastic surgery.

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From Magma: “Re: new technology. When do we need to assemble a focus group?” Focus group type activity never ends, but its membership, method, and purpose should always be changing. When developing a product, figure out who would need to be your likely internal customer advocate to get a deal signed, then randomly choose 10 people who hold that position, get them to sign an NDA and pay them if necessary, and ask them after a brief overview if they would risk their jobs to recommend spending budget money on your offering. Liking a product (or being polite in falsely claiming to) is not the same as putting your employee reputation on the line to push its purchase, so ask the right question. Early in a product’s existence, listen to the users, but don’t assume that their worldview is representative enough to simply give you a list of design features – it’s your job as a vendor to create a broadly useful product instead of letting notoriously process-challenged users take you down a rabbit hole. The easiest focus group for a mature product is the market, which is either buying it or not, and those who look but take a pass will hopefully offer feedback. The bottom line here is listen to your users when considering minor product tweaking, but show some bold leadership in doing more than just coding their self-serving feature requests.

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From Charlie Covin: “Re: Vince Ciotti interview. It brought a smile to my face since I was one of the installation directors who botched a couple of installs in the 1970s before getting it right. On the other hand, thanks to Vince and the many SMS alums for getting me started in a 40-year healthcare IT career.” Charlie’s work history includes SMS, HBO, IDX, HMA, Superior Consultant, and finally Eastern Connecticut Health Network, where he retired in 2013 after 11 years as VP/CIO. Vince has heard from quite a few industry long-timers and copies me on his replies to them. The lesson for relative industry noobs is that (a) quite a few people illogically find their way into health IT and then stick with it for life; (b) the career turns are circuitous as the industry evolves; and (c) those in the industry should create themselves a health IT network of folks and avoid being a jackass since it’s a small, close-knit community where reputations, both good and bad, travel quickly.

From Is Greed Really Good?: “Re: EHR vendors. They are finally getting called out for creating physician burnout.” EHR vendors created the product that the market demanded of them. You’ve missed the point that it’s that market that is greedy, not the software companies who operationalize its physician-unfriendly rules. In fact, I will posit that the most-responsible greed is that of physicians themselves, who happily signed up as the widget of production of insurers, lapped thirstily at the government’s Meaningful Use cash trough, and sold their practices to hospitals and private equity firms to become lackeys, all in their naive pursuit of the almighty dollar (there’s nothing wrong with that, but there’s also no reason to whine afterward). Their gates were stormed with no casualties other than the loss of a few invader dollars spent bribing their way in. Some doctors are incredibly naive despite being enrobed in professional arrogance, allowing themselves to be played like a fiddle by everyone from cute opioid drug company reps to online pharmacies that milk their obedient prescribing authority as a key business concept. They chose their bosses, their bosses chose their tools, and thus we have doctors who think EHRs missed their intended target when in fact they hit a bulls eye, just not the one they want. Hang out a shingle, stop taking insurance, use whatever EHR you want or paper charts if that makes you happy, don’t worry about federal carrots and sticks, get to know your patients even if your potential panel is only those who are willing to pay you out of their pockets, and watch the burnout dissipate.


David Meyers, MD Answers a Reader’s Question About Misdiagnosis

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A reader asked a question of David Meyers, MD following his HIStalk interview, wondering how much misdiagnosis is caused by the provider not having adequate information vs. not following clinical guidelines. Also, whether how much of the needed information could come from the EHR vs. from further tests or surgery. David provides this response:

There are no simple answers to the questions, because there is no single diagnostic approach that describes the entirety of identifying the cause of a patient’s illness. Identifying a lesion on an X-ray or CT scan, or a rash on a patient’s skin or cancerous cells on a pathology slide are different from the process of collecting information from a patient about her symptoms and signs via the history of the illness, the physical exam and diagnostic tests, and synthesizing a diagnosis from that information. But all are forms of diagnosis subject to error.

The diagnostic process can be viewed as having two broad elements – individual / human factors and system factors – which interact to lead a clinician to a name for the patient’s illness. While data on the frequency of misdiagnosis is uncertain and dependent on the setting and source of the information (hospital, clinic, autopsy reports, self reports, malpractice data, etc.) the range of frequency of misdiagnosis is thought to be somewhere between 5 and 30%.

In an attempt to identify the causes of diagnostic errors and their frequency, Schiff and colleagues published an analysis of 583 diagnostic errors (mis-, missed, and delayed diagnosis) self-reported by physicians in response to a questionnaire (Diagnostic Errors in Medicine, ARCH INTERN MED, 169:1881-87 (2009). Using a tool to specify where in the diagnostic process an error occurred, they found that test-related factors (delay in testing, wrong tests and dealing with the results accounted for 44% of the diagnostic errors; ~30% were related to assessment and synthesis of the data obtained. The most common process failure was failure or delay in considering the diagnosis. These are largely on the individual / human factor side, although system factors such as lack of time to spend with the patient, distractions, fatigue, flawed results reporting processes, lack of access to old medical records, etc. also play significant roles.

Most EHRs currently in use are seen as inadequate to the needs of the doctors, nurses, and others who use them. Created primarily to be tools for billing, they are not yet clinician-friendly and usable enough to allow for easy navigation to find information, nor are they sophisticated enough to synthesize the data and help the doctor craft a list of important diagnostic possibilities. There are, however, several apps called differential diagnosis generators which can give a list of possible diagnoses when information on symptoms and physical findings is put in by the physician. There are also versions of these apps available to patients. 

And in terms of powerful forces to reduce diagnostic errors, an engaged and informed patient is thought to be one of the strongest. Asking “what else could this be?” and other questions can be a very useful way for patients to influence the doctor’s thinking. See the “Resources for – Patients” link on the web site of the Society to Improve Diagnosis in Medicine for a toolkit to use at the visit with the doctor.


HIStalk Announcements and Requests

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An encouraging one-fourth of poll respondents credit their mobile device with life-changing health improvements. Folks called out MyFitnessPal and Fitbit for tracking nutrition and heart rate, smart watch integration with continuous glucose monitoring, drug management, patient portal communication, Kardia for monitoring atrial fibrillation, the 7-minute workout, and Pokemon Go and 5K training apps.

New poll to your right or here: Has your employer conducted a layoff in which older or sicker employees seemed disproportionately represented?

I’m amused at hospitals that brag that they chose their new executive after a “nationwide” search, like they sent teams out to scour every backwater town for candidates. Are the locals impressed that they didn’t just run a Craigslist ad or hang a flyer on the town lamppost?

Virtual show of hands – who knew that GroupWise email is still being sold and maybe even being used by some hospitals?


Webinars

September 19 (Thursday) 2:00 ET. “ICD-10-CM 2020 Code Updates.” Sponsor: Intelligent Medical Objects. Presenters: June Bronnert, MSHI, RHIA, director of terminology mapping, IMO; Theresa Rihanek, MHA, RHIA, classification and intervention mapping lead, IMO; and Julie Glasgow, MD, senior clinical terminologist, IMO. The 2020 regulatory release is right around the corner. Join IMO’s top coding professionals and thought leaders as they discuss new, revised, and deleted codes; highlight revisions to ICD-10-CM index and tabular; discuss changes within Official Coding Guidelines; share potential impacts of the code set update; and review ICD-10-CM modifier changes.

September 26 (Thursday) 2 ET. “Patient Education Data: A Key Ingredient for Improving Quality and Patient Experience.” Sponsor: Healthwise. Presenters: Victoria L. Maisonneuve, MSN, RN, director of the Nursing Center for Excellence and Magnet program, Parkview Health; Marta Sylvia, MPH, senior manager of quality improvement and outcomes research, Healthwise. Healthcare data is everywhere! It’s scattered across various systems and in countless formats, making it difficult to collect and glean actionable information. Knowing where to start depends on what your organization wants to accomplish. Vicki Maisonneuve will share how her team analyzes data around the use of patient education. By combining different data sets, she can easily identify trends, gaps, and opportunities to improve quality and patient experience across Parkview Health.

Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Decisions

  • United Health Services (NY) will go live with Epic in 2020.
  • Big Sandy Medical Center (MT) will go live with Evident in October 2019.
  • Crozer-Keystone Health System (PA) will switch from Cerner Invision to Cerner Millennium in 2020.
  • Missouri River Medical Center will replace MedWorxs with Evident EHR in October 2019.
  • Logansport Memorial Hospital will implement Cerner on May 1, 2020, replacing Meditech.

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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Curt Thornton (Quantros) joins Healthx as chief revenue officer.


Announcements and Implementations

Sioux Lookout Meno Ya Win Health Centre goes live on the new Vocera Smartbadge.


Privacy and Security

AMA describes its ideal privacy framework that places the patient first in supporting their fundamental right to obtain their complete medical record, but they believe those same patients aren’t smart enough to “understand what they are consenting to when they grant permission to an app to access their information.” AMA also wants the federal government to require EHR vendors to vet API data access requests and to give requestors only the information they need, such as insurers that request the entire medical record for unrelated data mining and threatening to file a data blocking complaint if they don’t get it. I’m finding myself sort of agreeing with AMA, although they don’t do a good job convincing patients that their motivation is anything but self-serving.


Other

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A reader alerted me to a new HFMA podcast (#2 in the newly launched series) in which Epic CEO Judy Faulkner is the interviewed guest. I enjoyed it despite the podcast’s imitative “we’re just chatting over coffee” format that puns the host’s name (HFMA CEO Joe Fifer). Fun items from the fairly short and breezy conversation:

  • Judy says it was hard for her husband to see her change from wearing jeans and tee shirts with no makeup to dressing professionally when she started Epic.
  • She had to figure out how to write contracts, policy manuals, and budgets (“we don’t have any”), and whether to accept outside investment or go public (“nope”).
  • She says a visiting HR VP asked her how to maintain the culture, and she said “nothing,” with Judy claiming to be unaware that Epic’s culture is different from that  of other companies. Judy teaches a six-hour course on company culture and each person’s role in it.
  • Skipping a monthly staff meeting requires the employee to get a signoff from their team lead, President Carl Dvorak, and Judy herself.
  • She asks employees to choose the top reason they are there, and while new hires usually chose “money” because they haven’t seen the big picture yet, they need to eventually understand that everybody’s #1 answer should be the same as Judy’s as “the customer.”
  • It’s always a challenge to stay focused on strategic items despite fires that need to be fought. She says it’s the Yellow Brick Road and you just have to keep walking on it. When she has to make a good decision, she looks ahead 25-50 years, decides “what would be good for those folks,” and then works back.
  • She doesn’t think about employees as young – they are hired from tests in which they prove that they are articulate and competent, and once hired and trained, they are treated like everybody else.
  • Epic does not have budgets, instead advocating, “If you need it, buy it. If you don’t need it, don’t buy it.“ She developed that practice when someone told her they needed to spend $2 million of leftover budget and couldn’t return it because they would then get $2 million less the next year. Or they needed to buy something immediately, but didn’t have the budget. “Let’s not go that path,” she said. If someone makes a mistake in spending judgment, she likes to catch it early so the person can learn from it.
  • Judy laughed when asked how she avoids thinking she’s done everything she can do with Epic, asking, “Is this a joke?” She says there are always new areas and new projects, so now Epic is working harder on claims and adjudication, specialty labs, retail clinics, research via the Cosmos program, and new types of customers.
  • “The thing that bugs me is that I haven’t found a test for [curiosity],” since results come from curiosity paired with aptitude.

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Alex Scarlat, MD – who wrote the HIStalk “Machine Learning Primer for Clinicians” series – suggested that I take a look at UMLS.me, a free website that extracts 5.7 million Unified Medical Language System concepts from free text, all from within a browser window (which then also supports voice input). Above is my result from pasting in a medical school’s sample HPI.

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@Farzad_MD and @EricTopol question a study run by JAMA Dermatology that claims an AI model can predict non-melanoma skin cancer by looking at EHR data such as diagnoses and ordered medications, noting that only 1,829 patients were analyzed, the risk prediction covered only one year even though most cancers grow slowly, the control group was chosen in a scandalously unsound manner, and the model was heavily dependent on the medication list even considering that most meds are not relevant to skin cancer. Note to journal editors and investors – hire an expert in statistical analysis and AI to vet claims instead of assuming that the author or founder knows what they’re talking about and is being honest about it, or at least get peer reviewers who can sort it all out. 

A study published in Lancet Digital Heath finds that clinicians with no experience in medical coding or deep learning can create clinical classification algorithms that perform well at diagnosis.

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England’s Daily Mail cooks up a clickbait headline to describe for a rather benign development – EDs will give patients a four-minute, tablet-based questionnaire to answer questions about their complaint to save nurse time. The paper dragged up a professor to make a generic, mostly irrelevant statement decrying computers replacing clinicians. Here’s where newspapers and news websites are guilty of the “fake news” claim – the headline screams that the practice is “controversial” because it goaded one guy into saying so, then later claiming that “NHS bosses were condemned” for recommending the use of Alexa for obtaining health information without saying exactly who condemned them and to what extent. I’m wary of any publication that makes ridiculously unquantified statements in claiming response from “the XXX community” or claiming some broad support or criticism in trying to push their own conscious or subconscious agenda (whether it’s political or simply to force readers to click by misleading them). My guess in this case is that it’s the same questions a nurse would ask but who would add little value in simply writing down the answers.

A nursing instructor and author declares in her New York Times opinion piece that the American medical system is “one giant workaround,” as executives mandate policies and procedures that don’t work or take too much precious time. She calls out the use of scribes to work around EHR design flaws, mentions medication barcode scanning problems that force nurses to cheat, and claims that the Affordable Care Act is a kludge that works around our reluctance to provide healthcare to all citizens.


Sponsor Updates

  • LiveProcess and Mobile Heartbeat will exhibit at Disaster Planning for California Hospitals 2019 September 10-11 in Pasadena.
  • SailPoint names Matt Mills (Oracle) as chief revenue officer.
  • Meditech will host the 2019 Physician and CIO Forum September 18-19 in Foxborough, MA.
  • Waystar will exhibit at the Universal Software Solutions Users Conference 2019 September 10-11 in Grand Rapids, MI.
  • Netsmart will exhibit at the ACMHCK Annual Conference September 11-13 in Wichita, KS.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the AWHONN Ohio 2019 Section Conference September 12 in Cleveland.
  • PatientKeeper will exhibit at AHIMA19 September 14-18 in Chicago.
  • T-System will exhibit at the2019 TORCH Fall Conference & Trade Show September 10-12 in Cedar Creek, TX.
  • Prepared Health will exhibit at Health Catalyst’s HAS19 Digital Innovation Showcase September 10-11 in Salt Lake City.
  • FDB adds Redox’s API to its Meducation app, giving users the ability to transfer patient data from the app into Epic.
  • Surescripts will exhibit at the 2019 Health Care Executive Group Annual Forum September 9-11 in Boston.
  • National Decision Support Corporation Product Manager Ben Gold will co- present “Buy vs. Build in Establishing a PBM Program” September 19 at the Society for the Advancement of Blood Management conference in Baltimore.

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Weekender 9/6/19

September 6, 2019 Weekender 2 Comments

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Weekly News Recap

  • Cerner lays off at least 250 employees as part of a cost reduction effort intended to deliver investor-promised operating margin targets.
  • OptimizeRx acquires RMDY Health.
  • AMA releases 2020 CPT, which includes several new codes to cover digital communications with patients. 
  • The Commons Project Foundation announces plans to work with partners to develop an Android alternative to IOS-only Apple Health Records.
  • ONC chooses The Sequoia Project as Recognized Coordinating Entity for TEFCA.
  • AMA and AHA ask for changes to proposed HHS rules that would force hospitals to share medical records with their patients, expressing concern that patients won’t understand them or that they won’t be aware of the possible exposure of their information to third-party apps.
  • Walmart launches a standalone health clinic pilot that will offer primary care, dental, labs, X-ray, audiology, and mental health counseling.

Best Reader Comments

[Regarding the Vince Ciotti interview] Wow, what a great interview! Also, THANK YOU for compiling his PowerPoint presentations into one PDF document! Vince is right! “You can only learn from the past. You can’t learn from the future. It’s not here yet. The mistakes made in the past will be made in the future unless you learn from them and change them. It’s such a priceless thing.” As a young female millennial in healthcare IT, I am appreciating this wisdom and am determined to go through all 1,438 slides. Thanks for conducting a great interview! Wonderful answers Vince! (Weird_Female_Millennial_JCV)

Thinking about the situation for two seconds, many health IT discussions about burnout make no sense. Has burnout among medical assistants increased a huge amount since EHRs or EHR-heavy requirements were put in? Not really, so the source here is probably not the EHR. What’s the rate of burnout among VA staff, who have an EHR that on the clinical side is hugely unusable? It’s about 1/2 that of elsewhere. So it doesn’t seem like the EHR is a driving factor here. Why does your job suck? Probably management. If management came by with a survey asking why your job sucked, would you check the box that says “management sucks?” Only if you were a baby in the corporate world.(tEHRibble)

M&A is not an eventuality, it’s a deliberate strategy. It is so across all industries, including hospitals. How does any business grow in a zero-growth industry? M&A. Any company’s mission and responsibility lies with its shareholders. Some folks struggle with the realization that healthcare is not an altruistic endeavor, not any more at least. (El Comadante)

The reason that you don’t have to ask “Star Trek” computers three times is that the “Star Trek” computers understand meaning. This is what is missing from all the classic voice recognition systems to date. (Brian Harder)


Watercooler Talk Tidbits

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A survey by the UK’s Royal Society for Public Health finds that the most toxic feature of social media – even more so than the content posted by users — is the “like” button.

An oncologist in Australia admits that she was overly influenced by “the opioid industry” when she entered practice in the early 2000s, where drug company reps casually convinced her that the company’s opioid was safe while paying for her journal subscriptions and lunch, which was a small investment given that her resident’s father was flown by a device manufacturer to a Scottish castle to discuss coronary stents. She recommends that doctors be educated on “the insidious influence of drug companies” that vie for their attention when they have little time to critically evaluate company claims. 

Scammers are using AI-powered voice impersonation software to call company insiders and convince them to transfer money to foreign accounts or to divulge sensitive internal information.

Rennova Health, the publicly traded (but Nasdaq-delisted) lab and software company that bought and closed Jamestown Regional Medical Center (TN) after walking away with employee tax and Social Security withholding, confirms that is behind on employee paychecks at the recently acquired Jellico Community Hospital (TN) and has cancelled the employee health insurance plan while continuing to withhold their premium payments. Rennova Health’s CEO, an Irish citizen who lives in the Bahamas, sued a Tennessee state senator in July 2019 for calling him an “Irish gangster” who came to Tennessee to cheat locals after the company closed JRMC. His primary business interest appears to be a chain of toxicology labs. Several struggling rural hospitals have been acquired and eventually closed by similar lab companies that are anxious to bill at higher hospital rates, which lasts only a short while before insurers stop paying. RNVA shares are trading at $0.0001, valuing the company at basically nothing.

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Just because you can doesn’t mean you should. A 74-year-old rural Indian villager becomes the world’s oldest new mother after delivering IVF-created twin girls. Mom, who was hospitalized for her entire pregnancy, says she was inspired to give birth 30 years after the onset of menopause when a 55-year-old neighbor became pregnant. Dad is 80.


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Morning Headlines 9/6/19

September 5, 2019 Headlines No Comments

OptimizeRx to Acquire Digital Therapeutics SaaS Platform Provider, RMDY Health

Digital prescription savings and patient engagement company OptimizeRx will acquire digital therapeutics vendor RMDY Health for $16 million.

Health Recovery Solutions Closes a $10 Million Growth Investment Led by Edison Partners

Remote patient monitoring company Health Recovery Solutions raises $10 million in a Series B funding round led by Edison Partners.

pCare Acquires TruthPoint to Expand Portfolio, Bolster Rounding Capabilities

PCare, an interactive patient experience software vendor based in Lake Success, NY, acquires digital rounding and real-time patient feedback technology company TruthPoint.

athenahealth Welcomes Paul Brient as Chief Product Officer

Former PatientKeeper CEO Paul Brient joins Athenahealth as chief product officer.

CommonHealth Will Enable Android™ Phone Users to Access and Share their Electronic Health Record Data with Trusted Apps and Partners

The Commons Project, UCSF Health, Open MHealth, and other groups will develop CommonHealth, an Android alternative to IOS-only Apple Health Records.

News 9/6/19

September 5, 2019 News 4 Comments

Top News

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Cerner will lay off 255 workers across roles and offices by November 5 as part of a cost reduction program that is intended to boost the company’s profitability.

Cerner announced a hiring freeze this past April and pledged to achieve operating margin targets of 20% for Q4 2019 and 22.5% for Q4 2020. This came in response to Cerner’s April 2019 “cooperation agreement” with activist investor Starboard Capital, which despite holding just 1.2% of outstanding CERN shares, was given four board seats and promises to improve profits. Starboard has since started selling off some of its CERN shares as their price increased.

Rumors suggest that separated employees will received eight weeks’ salary plus and additional two weeks of pay for each year of service. They will also be paid for unused paid time off.

The company says it will hire hundreds more employees by the end of the year.

Meanwhile, the Kansas City Business Journal reports that the company continues to pay former president Zane Burke $112,000 a month as part of a $2.7 million severance package.


Webinars

September 19 (Thursday) 2:00 ET. “ICD-10-CM 2020 Code Updates.” Sponsor: Intelligent Medical Objects. Presenters: June Bronnert, MSHI, RHIA, director of terminology mapping, IMO; Theresa Rihanek, MHA, RHIA, classification and intervention mapping lead, IMO; and Julie Glasgow, MD, senior clinical terminologist, IMO. The 2020 regulatory release is right around the corner. Join IMO’s top coding professionals and thought leaders as they discuss new, revised, and deleted codes; highlight revisions to ICD-10-CM index and tabular; discuss changes within Official Coding Guidelines; share potential impacts of the code set update; and review ICD-10-CM modifier changes.

September 26 (Thursday) 2 ET. “Patient Education Data: A Key Ingredient for Improving Quality and Patient Experience.” Sponsor: Healthwise. Presenters: Victoria L. Maisonneuve, MSN, RN, director of the Nursing Center for Excellence and Magnet program, Parkview Health; Marta Sylvia, MPH, senior manager of quality improvement and outcomes research, Healthwise. Healthcare data is everywhere! It’s scattered across various systems and in countless formats, making it difficult to collect and glean actionable information. Knowing where to start depends on what your organization wants to accomplish. Vicki Maisonneuve will share how her team analyzes data around the use of patient education. By combining different data sets, she can easily identify trends, gaps, and opportunities to improve quality and patient experience across Parkview Health.

Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

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Digital prescription savings and patient engagement company OptimizeRx will acquire cloud-based digital therapeutics vendor RMDY Health for $16 million.

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PCare, a Lake Success, NY-based interactive patient experience software vendor, acquires digital rounding and real-time patient feedback technology company TruthPoint.

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Health Recovery Solutions raises $10 million in a Series B funding round led by Edison Partners. The Hoboken, NJ-based remote patient monitoring company has grown to 80 employees and raised $16 million since launching seven years ago.

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Lab-testing startup UBiome files for bankruptcy, inspiring a plethora of excrement-inspired jokes and Theranos comparisons on Twitter. The San Francisco-based business — which placed its co-CEOs on administrative leave and  laid off staff earlier this summer amidst an FBI investigation into its billing practices, among other purportedly bad business dealings — will use an $8 million bankruptcy loan to stay afloat until it can find a buyer. CVS has reportedly put a halt to sales of the company’s at-home gut health testing kits.


Sales

  • The AsOne Healthcare Independent Practice Association in New York City selects Netsmart’s CareManager population health management technology and services.
  • Guthrie will implement POC Advisor from Wolters Kluwer Health to better enable the detection and treatment of sepsis at its four hospitals in New York and Pennsylvania.
  • In North Carolina, Cone Health and the Triad Health Network of community physicians will implement advance care planning technology from Vynca.

People

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Former PatientKeeper CEO Paul Brient joins Athenahealth as chief product officer.

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In Australia, EHealth Queensland names hospital executive Damian Green CEO and CIO. Green takes over from Richard Ashby, who resigned eight months ago amidst continued provider pushback against the statewide IEMR rollout and accusations of improper conduct with a staff member. Green will oversee the continued rollout of the Cerner software, a project that has been put on hold until 2021 as the agency sorts out patient safety and budgeting issues.

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Life sciences compliance software vendor MediSpend hires Craig Hauben (Ciox Health) as CEO.


Announcements and Implementations

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WellSky develops predictive analytics for home healthcare providers that combines population health with patient-specific data.

CNBC reports that Verily is working with wearable heart monitoring company IRhythm to develop a wearable for people at risk of atrial fibrillation. Verily Head of Clinical Science and Neurology William Marks, MD has said the device will be developed with physicians – and their aversion to unnecessary data – in mind

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Elsevier will use a rare disease database created by NIH’s National Center for Advancing Translational Sciences in its development of a Web-based diagnostic tool.that will take into account patient symptoms, medical histories, and predilection to certain rare diseases.

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Datica announces GA of Integrate, new API integration software that ensures secure compliance with interoperability standards.

Urgent care clinics within St. Mary’s Health Network (NV) implement Carbon Health’s patient engagement and virtual care software.

Politico reports that the Florida HIE has turned on the state’s Emergency Census Service, developed by Audacious Inquiry, to help public health officials locate people displaced by Hurricane Dorian.

AMA releases 2020 CPT, which includes 248 new codes, 71 deletions, and 75 revisions. Several of the new codes cover digital communications, such as patient portals.


Government and Politics

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Montana Governor Steve Bullock signs an executive order allocating $19 million towards the funding and development of the Big Sky Care Connect HIE. The nonprofit will hire a vendor to manage its data network later this month. While Big Sky is now the state’s official HIE, it’s not its first. HealthShare Montana was established with HITECH funding, but later shut down over governance and technology issues.


Privacy and Security

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European advocacy group Privacy International discovers that Web-based mental health services in the UK, France, and Germany have been selling user data to third parties for ad targeting without permission. Google, Facebook, and, to some extent Amazon Web Services were top purveyors of data.


Other

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The Commons Project, UCSF Health, Open MHealth, and other groups will develop CommonHealth, an Android alternative of IOS-only Apple Health Records. It will be the first project of non-profit Commons Project Foundation, which will build public-benefitting digital projects that are free of third-party financial interests. The organization’s leaders have healthcare experience in companies such as Wellpass, Sapiens Data Science, and Surescripts.

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Healthcare investor Garen Sarafian isn’t impressed with an American Hospital Association-commissioned article that claims hospital mergers decrease costs and increase quality. He notes that the piece was not peer-reviewed, the authors chose which hospitals to study, and data used consisted entirely of responses to interview questions posed to executives of those same hospitals. He summarizes, “Look at the appendix survey questions starting from the title in the full report and you’ll be appalled.” (see above sample).


Sponsor Updates

  • EClinicalWorks and Greenway Health will exhibit at ASCENT 2019 September 8-11 in Austin, TX.
  • Ensocare will exhibit at the ACMA Illinois Chapter Conference September 17 in Rosemont.
  • HealthCrowd will exhibit at the NASP 2019 September 9-11 in Washington, DC.
  • Healthcare Growth Partners publishes its “Health IT August Insights.”
  • Healthfinch publishes a new case study featuring The Guthrie Clinic, “Improving Efficiencies and Reducing Provider Burnout with Refill Technology.”
  • Healthwise will exhibit at the Medicaid Managed Care Summit September 9-10 in Scottsdale, AZ.
  • Kyruus will exhibit at SHSMD Connections September 8-11 in Nashville.
  • Prepared Health will exhibit at Health Catalyst’s Healthcare Analytics Summit September 10-11 in Salt Lake City.
  • Spok publishes a new infographic, “Cloud Computing in Healthcare.”
  • Intermountain Healthcare (UT) expands its use of SymphonyRM’s AI-powered HealthOS Platform to its new kidney services program and clinic.
  • DrChrono adds Relatient’s patient engagement technology to its tablet-based EHR and practice management software.

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EPtalk by Dr. Jayne 9/5/19

September 5, 2019 Dr. Jayne No Comments

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Telehealth technology in the news: Mayo Clinic has rolled out a cancer tele-rehab program, resulting in quality of life improvements for participants. The outcomes studied included pain and daily function, which were linked to reduced hospital length of stay as well as reduced need for post-acute care.

The technology used wasn’t strictly in line with what many of us consider telehealth. The 516 participating patients were assigned to either a control group that reported symptoms by phone or web-based survey, an intervention group that also received phone calls from care managers providing instruction on walking and exercise; and a second intervention group with the same interventions plus the addition of medication-based pain management. The number of hospital admissions was comparable, but the length of stay for the first intervention group was four days shorter than the control group. The second intervention group’s length of stay was about two days shorter. Researchers note that cancer pain is often undertreated and impacts the functional status of patients, so engaging with rehab services can lead to better outcomes.

More than a decade ago, I did some HIE work that we thought was pretty cutting edge, but now doesn’t even begin to scratch the surface for interoperability. Being able to access a patient’s full and complete medical information, whether provided by the patient or obtained from other sources, is the equivalent of the holy grail for some physicians. Having been in the clinical trenches for a fair amount of time, though, I wasn’t surprised by the statistics that nearly half of US patients are omitting significant pieces of their histories provided to their care teams.

Data noted in a recent survey of over 4,500 patients included issues such as domestic violence, sexual assault, depression, and suicidal thoughts. Patients are often uncomfortable addressing these issues with providers, especially during relatively brief medical encounters. They may feel they will be judged or lectured. The rate of information withholding is higher among women and younger patients. If the patient isn’t ready to share that kind of information, it’s unlikely to be available from other sources, but I hope that our efforts with patient engagement and empowerment will ultimately lead to patients who feel comfortable sharing information that will help us be better partners for health.

Flu season is nearly upon us, with recommendations to try to vaccinate all patients six months and up before the end of October. As the flu season becomes nearly year-round, the opportunities continue for patients (and staff) to contract the illness.

I once worked with a practice that did not provide employees any sick days and punished them for calling out sick. Their mantra was, “If you’re going to be sick, you might as well be paid for it.” It’s shocking to hear from a healthcare organization, so I was interested to see a recent study that looked at healthcare workers that continued to deliver care while suffering from acute respiratory illnesses. The authors looked at multiple flu seasons in nine Canadian hospitals from 2010 to 2014. At least 50% of participants reported at least one acute respiratory illness, and nearly 95% of workers reported working at least one day while they had symptoms. The relative risk of working while ill was greater for physicians and lower for nurses.

Study subjects were more likely to work with less-severe symptoms and were more likely to work on the first day of illness rather than as it progressed. Most people working while sick felt their symptoms were mild and 67% felt “well enough to work.” Not surprisingly, those without paid sick leave were more likely to state they could not afford to stay home. The authors conclude that “further data are needed to understand how best to balance the costs and risks of absenteeism versus those associated with working while ill.”

In related news, a recent study concludes that the N95 respirator is no better than a standard medical mask at preventing transmission of influenza to healthcare providers. That’s good news. Anyone who has ever had to wear the N95 knows it’s not much fun, not to mention the need for some people to shave beards to get it to fit correctly.

A related editorial notes that although the study was designed to address limitations of previous studies, the current study was somewhat underpowered and might be impacted by under-reporting of symptoms and delays in specimen collection. It also didn’t address the inpatient setting. It did, however, mimic conditions that are typically seen, including providers who may or may not wear the masks they are supposed to, or who may not wear them correctly. This makes the findings more generalizable.

Our flu vaccines are scheduled to arrive today. Personally, I can’t wait to roll up my sleeve since one of my colleagues has already been diagnosed with influenza.

I missed out on the groovy time that was the Epic User Group Meeting, but was intrigued to hear the announcement that they’re pulling together records of more than 20 million patients for medical research. As Mr. H noted, they’ve made this announcement before, so the real news is that clients are actually signed up. Cosmos is designed to gather de-identified data from Epic customers and make it available for evidence-based medicine research.

I’m sure it was a splashy announcement at the annual UGM gathering, but I question the ability for that data to be truly de-identified and how clean it is. Nine organizations have contributed more than 7 million patient records, with 30 additional customers being in discussions with the company. Participating hospitals and health systems agree to ensure data contributed is standardized enough to support research. Epic plans to dedicate resources to do terminology mapping to allow the platform to work.

The data won’t be available to researchers until there are at least 20 million patients in the data set and already people are salivating at the possibility of using it for rare diseases or difficult-to-treat conditions. Researchers will use existing Epic applications to work with the data, along with potential new applications.

There are certainly privacy concerns at play here, even with de-identified data. We’ve all seen how easy it is to re-identify that information. It’s unclear whether patients intended their data to travel far and wide and whether existing consents cover this kind of an aggregation.

I’ve seen half a dozen Epic builds over the years and frankly the lift needed to standardize some of the data might be the limiting factor. My own Epic patient charts are chock full of errors that I don’t have the time or energy to try to correct, so good luck to those who think this is going to be the answer to all kinds of research problems. There’s also the issue of data that lives in Epic that was converted from legacy EHRs, which after being converted and normalized, might not even resemble the original clinical intent.

I’d be interested to hear from anyone who has been involved in this project or who is closer to the details. What did you think of the announcement at UGM? Is it just one more shiny object for organizations to follow, or is it really a game changer? Leave a comment or email me.

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Email Dr. Jayne.

Morning Headlines 9/5/19

September 4, 2019 Headlines No Comments

VillageMD Announces $100 Million in Series B, Led by Kinnevik

Primary care company VillageMD raises $100 million in a Series B round led by Kinnevik AB.

Cerner laying off more than 250 workers as part of wider cost cutting effort

Cerner announces it will lay off 255 workers across roles and offices by November 5, adding that it plans to hire hundreds more by the end of the year.

Lab-Testing Startup uBiome Files for Bankruptcy

San Francisco-based lab-testing company UBiome files for bankruptcy and will use an $8 million bankruptcy loan to stay afloat until it can find a buyer.

Ginger, an MIT spin-out providing app-based mental health coaching to workers, raises $35 million

Behavioral healthcare app company Ginger raises $35 million in a Series C round that brings its total funding to $63 million.

Readers Write: Physicians: The Ultimate Victims of Unusable EHRs

September 4, 2019 Readers Write 3 Comments

Physicians: The Ultimate Victims of Unusable EHRs
By David Lareau

David Lareau is CEO of Medicomp Systems of Chantilly, VA.

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It’s been a decade and a half since President George W. Bush announced his vision for making EHRs accessible for all Americans by 2014. Since President Bush first shared his plan, overall EHR adoption has skyrocketed. As of 2017, 86% of office-based physicians and 96% of all non-federal acute care hospitals had adopted some sort of EHR system, according to the ONC.

But what has this digital transformation really cost us?

I’m not referring to the billions of dollars that the government has paid providers for their meaningful use of EHR technology. The costs that concern me are the ones incurred by the frontline users of EHRs: the clinicians who have been forced to use inefficient systems that cripple their productivity and are fueling unprecedented levels of physician burnout.

In our rush to digitize medical records, we have failed to design and deploy solutions that work for physicians and enhance clinical decision-making. Instead of creating systems that deliver efficient clinical workflows, EHR vendors have been forced to prioritize R&D projects to satisfy regulatory and reporting requirements. Meanwhile, the regulations mandated by the government and payers have largely failed to include standards that enhance EHR usability.

By failing to adequately address usability, physicians have become the ultimate EHR victims.

EHR usability is a major source of frustration and stress that is contributing to physician burnout. According to a recent Medscape survey, 44% of physicians admit feeling burned out and point to EHR use as one of their leading stressors.

Despite their great promise, EHRs are a source of continued physician frustration because usability has remained an afterthought for developers and regulators. The lack of EHR usability hurts physicians, nurses, and even patients.

We could wait for the government to mandate additional usability standards. Alternatively, health IT stakeholders could commit to making EHR usability a top priority and begin taking immediate steps toward much-needed changes.

A few key areas that could make a big impact on EHR usability include:

  • Support for flexible EHR workflows. Physicians have varying workflow needs, especially across specialties. Rather than forcing clinicians to adapt their workflows to satisfy the requirements of an EHR, EHR vendors must support flexible designs that allow users to filter information in ways that support the individual thought processes of each physician.
  • Better point-of-care information. By making it easier for users to access the specific information they need, when they need it, for the patient in front of them, clinicians can drive better outcomes and increase their productivity.
  • Promoting interoperability. Physicians need access to a patient’s complete medical record to optimize clinical decision-making and ensure patient safety. However, many providers and EHR vendors resist opening systems to share patient data out of fear of losing market share. By putting an end to data-blocking, physicians will feel more confident that they are equipped to deliver the highest quality patient care.
  • Involving physicians. Both EHR vendors and health system leaders have largely failed to incorporate input from clinicians. If we want physicians to embrace EHRs, rather than viewing them as an additional burden, we must involve clinicians in the design process and seek their guidance to modify workflows to enhance patient care and increase productivity.
  • Adopting app-based solutions. Healthcare providers have spent millions over the last decade implementing new EHRs. Few organizations can afford the financial and manpower disruption of starting a new EHR implement from scratch, regardless of how inefficient their legacy system might be. App-based solutions can address some usability issues without the need to rip and replace current EHR systems.

The digitalization of health records has been a painful journey for most physicians because the needs of clinicians have largely been ignored. Instead of being a tool for physicians, EHRs have become a task. By committing to fix EHR usability, we have the opportunity to diminish physician frustrations and give them the chance to stay focused on the delivery of quality patient care.

HIStalk Interviews Vince Ciotti, Retired HIS-torian

September 4, 2019 Interviews 17 Comments

Vince Ciotti retired from a 50-year career in health IT in 2019. He documented the history of the industry’s companies, people, and trends over that time in his HIS-tory series. He can be reached at vciotti@hispros.com.

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A reader of your HIS-tory emailed me to ask that I provide more information about you, which is why we are talking today. Describe your background.

I started in the business 50 years ago, in 1969. I was an English major at Temple University. I couldn’t get a job in any kind of English. There was an ad in the Philadelphia Inquirer for a programmer trainee that said, “see Clyde Hyde.” He  was one of the three founders of Shared Medical Systems. The rhyme caught my eye — Clyde Hyde.

I went up for an interview and Jim Macaleer, the president, was dumb enough to hire me. I didn’t know squat about hospitals, computers, or accounting. I learned it pretty quick and had 10 great years at SMS. Then I left them and went to about half a dozen smaller vendors. The first 15 years of my career were with vendors selling to hospitals, the usual job.

Then I got into consulting, first with Sheldon Dorenfest. I met a guy Bob Pagnotta up in New Jersey who’s a real HIS pro, one of the veterans in the industry. We started our own consulting company in 1989, HIS Professionals. It lasted for 30 years, which is probably a world record for consulting firms. Sadly, we just shut it down this year. Now I’m retired.

What will the future hold for health IT consulting firms?

When we started 30 years ago, there were small firms that gave advice to hospitals who were experts in HIT. Sheldon Dorenfest is a classic example. He started many vendors. He started telling hospitals how not to get snookered so bad. Other guys like Ron Johnson, a whole bunch of individual experts, were consultants. Today, I used the word in quotation marks because consulting firms are merely staffing firms. They’re gigantic, billion-dollar corporations that sell you people to do an implementation or to staff. They charge you roughly twice as much as the salary they pay and they make billions.

I’m a little out of touch with this stuff, but the four biggest, I think, are Computer Sciences Corporation, Xerox, Dell — which used to be NTT Data — and Leidos, which got the big Cerner DoD contract. They’re billion-dollar firms that just sell people. Their services are simply to do the implementation of Cerner, like they’re doing for the DoD. Whatever vendor you have, they’ll claim to have somebody that knows it. It’s probably a junior who you’re going to teach to become a more expert person, who they will then charge you more for in the next engagement.

Consulting has gone downhill in my mind. In the early days, it was wonderful. We gave hospitals good advice, saved them a ton negotiating contracts, and felt good at the end of the day to collect our few thousand dollars, not the few million dollars these guys collect today. A different world.

Is it inevitable that a company, regardless of its principles, will eventually get big enough to sell or perhaps to be managed differently?

Two-thirds of hospitals are not-for-profit, one third are for-profit. The non-for-profit ones just don’t know what life is like in a proprietary company. You start a tiny consulting firm, two or three guys, you barely make a few thousand each per month. You struggle to get into six figures. You start hiring a few people, then a few dozen people, you sell more and more, and you grow to hundreds of thousands of revenue, millions of revenue. The next thing is, let’s try to find a sucker to buy us and we’ll get $10 million for our pension fund.

It’s inevitable that a small firm — be it consulting, HIT, or whatever their business happens to be — grows. If they succeed, they’ll look for a buyer, because the original people are now getting kind of old and approaching retirement, like they have a huge stack of funds. So yeah, I’d say it is inevitable. Small consulting firms sadly grow, become giant consulting firms, and look only for the money, not for the good that they could do for their customers.

Your HIS-tory suggests that the same people repeat their success at making fortunes by selling companies that hire them as executives to do just that. What’s it like for the employees who have to just keep rowing down in the galley?

If you could see a bar graph of salaries, it’s mind-blowing. A typical vendor’s C-suite makes tens of millions a year, the managers make high six figures, and what the employees who do the bulk of the work get either in the five figures or just about $100,000. It’s a staggering variance and proportion of income from the C-suite to middle management down to the rank and file.

Where it’s nicest is the tiny startup firms. I was so lucky. SMS was almost a family, just wonderful people. They really gave a damn about their customers. Made sure they delivered the product. The first five to 10 years were just glorious. Then slowly they went public, became a giant, billion-dollar company, and those standards changed. It was purely the money. How can we cut costs and increase income? I bet that’s the truth of almost any company, be it a vendor, consulting firm, or even a for-profit hospital.

How has it changed as hospitals are seeing dollar signs in innovation and startups?

Not much. Every small firm that started way back then had the intention of making money. The successful ones did and got bought up, or bought up others, and eventually sold out themselves for even larger sums. I don’t think that has changed. That’s part of capitalism. I don’t mean to be critical. Believe me, I’m not a communist. I hated communism and Gorbachev is gone. But capitalism has its flaws, too. If making money is the only goal of everybody on earth, it’s a pretty ugly society. It’s the small firms that really care. That family kind of orientation that I really loved. They were the best years, the early years of a small firm.

Last time we talked, I threw out a few company names for you to react to. Let’s start alphabetically with Allscripts.

I get confused. They have bought so much stuff and have so many products. They’re a confusing company. Cerner, Epic, Meditech keep saying just what they are, just what they have. But Allscripts is a little more complicated. I wouldn’t be too optimistic about their long-term future compared to the monsters, Cerner and Epic. But they’re pretty good capitalists and I’m sure they’ll keep making money. I just don’t get too excited about their product line.

Cerner.

They’re the monster. My god, the VA and DoD will keep making billions for them for decades and it’s our tax money. Very sad.

In the original DoD contract, the majority of the money went to Leidos. Of the $8 billion contract, Leidos is going to get something like $7 billion and Cerner only $1 billion for licensee fees. For the VA, wow, the opposite. I think the last note on your site was something like $15 billion is the latest budget estimate for the first part of the VA to go on Cerner. Most of that money is going to go to Kansas City. So I’m very bullish on Cerner from an economic standpoint.

From a product standpoint, they still have a terribly weak revenue cycle. You seem to get a headline every couple of months of a hospital with a catastrophe. Great EMR, solid clinicals, but they still haven’t fixed what used to be called ProFit that’s now called Cerner Revenue Cycle. It still seems to be their weak link.

How will the company’s culture change now that Neal Patterson isn’t involved in running the company his way as the passionate founder?

Brent Shafer was an odd choice. You would think Zane Burke as president would have been the perfect person to be the CEO. He knew Neal real well, knew the culture and all that stuff. Then for some reason they go with this outside search and bring in an outsider. He’s going to be a pure revenue guy who will just want to make money. He doesn’t know much about hospitals or Cerner’s product line. That’s the classic capitalism problem, pure dollars. I don’t think they’ll sell many hospitals, but they’ll make a fortune out of the taxpayers on the DoD and the VA. They’ll stay at the top for a long time.

Epic.

Oh, Judy. Such a miracle. No sales and marketing. She’s so different. It’s just staggering that she’s made such a success and I think it’s going to continue. You know, the large hospital sales are all going to Epic. Many from Cerner, many from Allscripts as the old Siemens customers buy a new system.

Judy has a stunning future. Staggering success. It’s true hospital businesses, not taxpayers and DoD and VA. It’s really hospitals. She refuses to buy another vendor. Has had the same product now for almost 40 years, but the only vendor that has never acquired another vendor. I can think of no other that has been just their own system, period.

They have their weaknesses, too. They’re human. The kids, the young youngsters that they hire that don’t have much experience. The partner consulting firms that rip you off to give a lot of staffing for an Epic conversion. They have no homegrown ERP. Just like Cerner, you have to go buy another ERP and build interfaces. But boy, overall Epic … if I were a large hospital, that’s where I’d go.

Meditech.

Neil Pappalardo gave Judy a lot of advice when she formed Epic. She has followed his rules, which was never acquire anything, just build your own product. In those days, Meditech hired their own people fairly young like Judy did. Built all their own products, no interfaced partners, and they’ve got a complete set of applications.

Meditech probably has the most comprehensive set of apps of any vendor out there. With Expanse, they finally came out with a physician practice system. The last piece they were missing was an integrated doctor piece. So I’m very bullish on Meditech. Their sales were slow for a couple of years. I think for four years in a row, their sales declined, their revenue declined. Last two years, its finally come up. So hats off to Ms. Waters. 

I’m fairly bullish on their future. It’s just, darn, there’s not a lot a hospitals that are going to change EMRs. They stick with what they have. They spent so much money on it, they’re reluctant to go to the board and ask for a couple of million dollars for a new system. It’s just hard to get sales.

How much weight do you give technology when you choose your own doctor or hospital?

None. I go for the personality of the doctor. Do you like the guy or the gal? Does she like you? Can you get along with them? Can you smile? Can you talk?

I’ve got a family physician here in Santa Fe who’s so good that I’ll fly here from Florida 2,000 miles just to see him if I’m sick and then fly back. The ones I have in Florida suck. I just can’t stand them. To me, for a doctor, it’s the human side, the personality. Can you talk and you trust them? Do you think they really care about you?

For the hospital side, I had no choice. You may remember that I had a grand mal seizure in January. It’s kind of ironic. After 50 years in hospital computers, I retire and I go to my doctor’s office for a checkup and I have a seizure and they put me in a hospital and stick a computer in me. I got a pacemaker inserted in me and it saved my life. I’d have probably died. Still don’t know the cause, some kind of micro-stroke, but the pacemaker has been a damn miracle. Doctor’s say the battery’s good for 14 years. I told him I may not be good for 14 years. I’m thrilled to have it and it’s working like a charm.

The technology for the patient, when it’s interfacing with you personally, is priceless. Boy, the advances are glorious. You know, my father or grandfather would have dead with this seizure, and I’ll probably get 10, maybe 15 more years. So I love technology on a personal standpoint. But as far as the hospital’s computer system, I couldn’t care less.

I went to UCLA Medical Center and they have Epic. It was phenomenal to be able to see my whole chart on the screen with the security code and all that stuff. That was nice. And if I go to other Epic hospitals, they’ll know all about me. But a fourth of hospitals are are Epic, a fourth are Cerner, a fourth are Meditech, and a fourth are CPSI. If you’re admitted because of an emergency, you have no choice. If I had the choice, I would probably go with Epic now that I’m on that with my UCLA record, but again, when there’s an emergency, you have no choice. You go where ambulance takes you.

How do you see the dynamic among health IT vendors, salespeople, and health system executives?

In the early days at SMS, I was an early education manager. I had to train the new installers, as we called them then. Today they’re consultants, I guess, but then they were IDs, installation directors. I had a two- or three-week class to go through every single report, every single profile option, every master file, every transaction, whew. Took two to three weeks to train them and then they could still go out and botch up their first install. Took a couple of installs before they knew what the heck they were doing.

We hired salesman at SMS and they spent one day walking around all the offices, saying hello, shaking hands. Who are you? What do you do? Oh, OK. Then boom, after one day, they were out there selling. They had no idea what they were selling. It doesn’t matter. Sales is commissions. If you sell a lot of systems, you make a lot of money and you get promoted and you become a big cheese. If you don’t sell any systems, you get fired. You’re going to go to another company and try again.

You don’t learn the product. You haven’t been an installer or a customer service rep. You haven’t worked with the system. You have no idea how the system works. What you know how to do is smile, be pleasant, buy lunch, buy dinner, shake hands, be charming, have people trust you, get them to sign the contract, and then run like hell because you’ve got to make some more sales. 

That hasn’t changed to this day and never will. It’s capitalism. There’s nothing wrong with it. It’s just what life is like. Think of a used car salesman. What does he or she know about the engine, the transmission, or the differential of a car you’re buying? They know that they want you to sign quick before the end of the day. It’s not immoral. It’s not nasty. It’s just the truth.

Hospital, it’s so sad, they just spend time talking to salesmen. Hospitals should ask to talk to their installer. Who’s going to put the system in? I want to see him or her, have them walk around my hospital and tell me what good or bad things are going to happen. No hospitals do that, but that would be the dream, to see your installers before you sign that contract. Salesmen again are not immoral. They’re not liars or nasty people. It’s just their job. The job of used car salesman is to get you to sign that contract and HIT is not much different.

What do you think about the recent health IT IPOs?

It’s part of capitalism. Initial public offering is inevitable. The reason you form a firm is to get that stock on the market. Get double, triple, quadruple and away you go.

I joined in SMS in 1969. I got the 200 shares that Jim Macaleer gave to every new employee. I went to my boss and said, what’s a share? He explained it to me, and I said, what’s it worth? He showed me that it said 1 cent per share, so my 200 shares were $2. I was going rip it up, but he said wait five years, you’ll  be very glad. Sure enough, we went public around 1975. I think it was $14 a share. The stock had split several times before then, so my 200 shares were now like 800 or 1,600 shares. I was suddenly a very rich man. That’s the goal of capitalism, money, and it’s going to be the future as well as the past. That’s the American way. Nothing wrong with it, nothing immoral, it’s just the truth, it’s what our economy does. Nothing but money.

The only time I’ve sensed that you were star-struck was when you visited Judy Faulkner at Epic’s campus as you described in your HIS-tory. What surprised you about that visit?

She’s a very humble person. I walked into the lobby. There’s nothing massive, it’s just a lobby. Usually what you get is that the executive secretary comes over, asks if you want coffee, takes you into some big, glamorous conference room, and then after five minutes — there’s always a delay — in comes the executive. Shakes your hand, has two or three assistants on either side of them because they don’t know all the answers to your questions you’re going to ask.

I walked into Epic. I’m sitting in the lobby, you know, handsome couch. I look in the bathroom over there. There’s only a toilet, there’s no urinal. It’s a very female-oriented company. It’s kind of cute. All of a sudden, across the lobby, here comes this lady walking towards me. I suddenly recognize that it’s Judy Faulkner. No executive secretary, no setting me up in a big conference room.

She walks over, shakes my hand, takes me into her fairly small office, sits down, and says, “What are you here for? What do you want to do?” She’s such an open, humble, honest person. If you went to visit Brent Shafer at Cerner, you would probably get 45 minutes of introductory talk from other people before he finally came in the room, with seven assistants to answer all your questions. Boy, she just sat down and talked and said such honest comments. It was amazing. So yeah, she’s unique in our industry. Very a wonderful lady.

The one sad thing about her and Epic is that she is the company. I think she’s as old as me, 74, 75, something like that. At some point… she won’t retire. She’s not that kind of person. Epic has been her life and she’s very proud of it. I don’t blame her. But at some point, she’s human. She’s going to die, she’s going to retire, she’s going to have a heart attack. Who knows? Her successor can be nothing as good as she is. The company cannot have as bright a future once Judy is gone. She is the company. The company is her.

Sort of like Cerner and Neal Patterson, maybe Meditech and Neil Pappalardo. Neal and Neil slowly started to give the power of the company to their subordinates. I think Judy still runs Epic completely. I just can’t see a replacement for her. She is the company, personally.

Who are your heroes of our industry?

The folks at SMS, just because it’s the company I knew. Jim Macaleer and Harvey Wilson were the two bosses. Jim was just an incredible guy. He could be a mean son of a gun at times. A real Theory X manager. He was tough, but then the other half of the time he was funny, he was charming, he was pleasant. He just died, I think it was last year, 18 months ago. I’m really sad that we had to lose him. Harvey’s still around and doing wonderfully well. He not only helped form SMS, he was the number two at SMS, but then he formed Eclipsys and sold out to Allscripts.

We’re having our SMS reunion in a few days, the 50th reunion of SMS. One hundred and fifty people are showing up in King of Prussia and Harvey’s giving an introductory speech. To me, that’s a wonderful life, to have such a success and so many people coming to see you again and such a family feeling.

I can’t think of too many others that I really respect, that is until you get to the current vendors, and Judy would be at the top of that one.

How has retirement been versus what you thought it would be like?

Well, that’s an interesting point, because frankly I’m bored to tears. I’ve always been into motorcycles, Honda motorcycles. I started as a kid and that’s become my full-time occupation. I have six of them. I just sold one. I used to have seven, one to ride every day. 

I literally do ride a motorcycle every day. I get home about 1:00 or 2:00 from lunch and then wonder, what the heck am I going to do? I usually take a nap on the couch and I’m bored to tears. So I’m looking into some hobbies, other hobbies, maybe learn the piano, some other stuff. I love to look your site every morning, five minutes to get an update on what’s going on. Still keep up with a lot of good old CIO friends and consulting friends and even some people from vendors and we get together often.

Retirement is a bit of a shock. I had no idea what I was going to do and I still don’t. I work one day a year. I teach a class at Brown University, in their MHA program. I’m going out there two weeks and I probably spend about a week updating my vendor review and present it to the students. I should say “students” in quotes because they are CFOs, CMOs, CNOs, very sharp people. I probably learn as much from them as I teach them. But that two-hour class is the only thing I do all year.

When you meet someone and they ask what you do, they expect you to describe your job as your primary identity. How do you introduce yourself now?

I’m usually on a motorcycle when I meet somebody. We start talking about Hondas. I don’t meet professional business people any more, but if I sit next to someone on an airplane who wants to know what I’ve done, I tell them that for 30 years, I was a hospital computer consultant, and then for 20 years, I used to work for vendors in hospital computers, and now I ride motorcycles. That kind of sums it up.

You’ve got to think ahead of retirement. I didn’t and I’m sorry for it. I didn’t have any plans at all and I’m struggling with it now. If I didn’t have the Hondas, I’d go crazy.

Do you feel any springtime pull toward the HIMSS conference?

I live down in Orlando right next to HIMSS. I used to go every year, and the thing got so big. I started to get totally bored to tears with 40,000 people in one hall and hundreds of vendor booths. At the booths, the few old guys or ladies I knew were just not there any more. Dozens of young sales reps. So no, I have lost my affection for HIMSS. When it was small and you knew everybody, it was wonderful. It was glorious. It was a family kind of thing. As it has grown to the gigantic size of today, I haven’t gone for the past two or three years.

When I presented there, that was a lot of fun. Thank you for having me to do that HIS-tory presentation there and dress in the wacko hippie suit. Got me into the whole HIS-tory file, those 120 episodes you ran on your website, but I had never presented at HIMSS. If they wanted me to present the HIS-tory thing again, I would do it. That I love. But to just walk around the halls and meet all those green salesmen who I never knew and they never knew me bores me to tears. I can’t stand it.

Not many people seem to be interested in health IT’s past. How would you convince someone to read your HIS-tory, either now or 25 years from now?

It’s the same as reading the history of the human race, history of America, history of Europe, history of homo sapiens. You can only learn from the past. You can’t learn from the future. It’s not here yet. The mistakes made in the past will be made in the future unless you learn from them and change them. It’s such a priceless thing.

I just bought a book on the history of warfare. I’m a reader, I own thousands of books. And the first page has an incredible statistic. Of the past 5,000 years of human history, roughly back to 3000 BC, only in about 300 years have we not had a war. If you haven’t read history and learned that, you’re not going to appreciate the risk that we’re going into World War III with nuclear weapons and all this horrible strife between small countries around the world. You have to learn from the past to be able to avoid those mistakes in the future.

In HIT, what vendors did back in the sixties, seventies, and eighties, they’re doing today in the 2010s into the 2020s. Only when you read it and learn what they’ve done will you know what they’re going to do in the future and how you can avoid it. You avoid being a victim and help your hospital get a little bit of its money’s worth. I think it’s priceless in any industry — automobiles, transportation, education, automation, you name it. You learn from the past to do better in the future. If you just go into the future blind, you’re going to make the same mistakes.

What will your epitaph say?

If I could be remembered for anything, it would probably be my HIS-tory files, which I thank you for posting over such a long time, two and a half years. I hope some of the future CIOs read them and learn from them. I hope that’s what they remember me by, the guy that warned them about not repeating these mistakes of the past.

Morning Headlines 9/4/19

September 3, 2019 Headlines No Comments

ONC Awards The Sequoia Project a Cooperative Agreement for the Trusted Exchange Framework and Common Agreement to Support Advancing Nationwide Interoperability of Electronic Health Information

ONC chooses The Sequoia Project as Recognized Coordinating Entity for TEFCA, where it will manage the Common Agreement component of the Trusted Exchange Framework and Common Agreement.

Black Book’s Annual State of Global EHR Research Reveals Adoption Trends and Top-Rated Vendors Across World Regions

A Black Book review of global EHR usage finds that Allscripts outperforms other vendors in the UK, Australia, and Canada in getting implementations finished on time and budget.

Cerner grows its UK presence through first-of-type partnership with leading private provider

Mayo Clinic prepares to open its first clinic in the UK in collaboration with Cerner customer Oxford University Clinic.

When Apps Get Your Medical Data, Your Privacy May Go With It

Citing a lack of transparent privacy protections, the AMA, AHA, and other healthcare groups request changes to proposed HHS rules that would require hospitals to share medical records with patients via their smartphone apps.

News 9/4/19

September 3, 2019 News 3 Comments

Top News

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ONC chooses The Sequoia Project as Recognized Coordinating Entity for TEFCA, where it will manage the Common Agreement component of the Trusted Exchange Framework and Common Agreement. It will also work with ONC to manage Qualified Health Information Networks. 


HIStalk Announcements and Requests

I’ve enjoyed doing some recent interviews whose subjects were iconoclasts, rogue thinkers, or just all-around troublemakers. I need more of those to supplement my usual roster of vendor executives, so if you are one or can recommend one, let me know.

Thanks to the following companies that recently supported HIStalk. Click a logo for more information.

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Webinars

September 5 (Thursday) 2:00 ET. “Driving 90% Patient Adoption Across Your Network: How US Dermatology Partners is Showing Us The Way.” Sponsor: Relatient. Presenters: Michele Perry, CEO, Relatient; Sara Nguyen, VP of applications and integrations, US Dermatology Partners. US Dermatology Partners is helping its physicians reclaim time they can spend with patients and is turning patient engagement strategies into business results across its 90 locations in eight states. Attendees will learn how US Dermatology Partners defined its patient engagement objectives and physician-optimized strategies. They presenters will provide advice on starting or accelerating  patient engagement goals.

September 19 (Thursday) 2:00 ET. “ICD-10-CM 2020 Code Updates.” Sponsor: Intelligent Medical Objects. Presenters: June Bronnert, MSHI, RHIA, director of terminology mapping, IMO; Theresa Rihanek, MHA, RHIA, classification and intervention mapping lead, IMO; and Julie Glasgow, MD, senior clinical terminologist, IMO. The 2020 regulatory release is right around the corner. Join IMO’s top coding professionals and thought leaders as they discuss new, revised, and deleted codes; highlight revisions to ICD-10-CM index and tabular; discuss changes within Official Coding Guidelines; share potential impacts of the code set update; and review ICD-10-CM modifier changes.

September 26 (Thursday) 2 ET. “Patient Education Data: A Key Ingredient for Improving Quality and Patient Experience.” Sponsor: Healthwise. Presenters: Victoria L. Maisonneuve, MSN, RN, director of the Nursing Center for Excellence and Magnet program, Parkview Health; Marta Sylvia, MPH, senior manager of quality improvement and outcomes research, Healthwise. Healthcare data is everywhere! It’s scattered across various systems and in countless formats, making it difficult to collect and glean actionable information. Knowing where to start depends on what your organization wants to accomplish. Vicki Maisonneuve will share how her team analyzes data around the use of patient education. By combining different data sets, she can easily identify trends, gaps, and opportunities to improve quality and patient experience across Parkview Health.

Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

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“Teledentistry” vendor SmileDirectClub, which sells $1,900 clear teeth aligners that cost a fraction of traditional braces – prescribed remotely by contracted dentists who review photos and self-made bite impressions — files for an IPO that values the company at $8 billion. Shares owned by the co-founders, who are aged 29 and 30 and who met at summer camp, will be worth $1.5 billion and $1.4 billion, respectively.

A Black Book review of global EHR usage finds that Allscripts outperforms other vendors in the UK, Australia, and Canada in getting implementations finished on time and budget, while Epic is first in Southeast Asia and the Middle East. Cerner’s only #1 finish was in Africa.


Announcements and Implementations

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Mayo Clinic prepares to open its first UK clinic in collaboration with Oxford University Clinic, first announced in late 2017. The London clinic will use Oxford’s Cerner Millennium EHR rather than Mayo’s Epic.

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Vocera announces Vina, a smartphone app that prioritizes patient-centric calls in an inbox that also includes secure messages and alerts.

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Ellis Medicine (NY) goes live on Cerner Millennium, assisted by Optimum Healthcare IT.


Privacy and Security

Temple University Health System restores its systems following a cyberattack last week.


Other

The American Medical Association, American Hospital Association, and other healthcare groups request changes to proposed HHS rules that would require hospitals to share medical records with patients via their smartphone apps such as Apple Health Records. The groups think patients won’t understand that their downloaded information could be accessed by other apps, insurers, or employers since privacy protections would no longer apply. Taking the opposing viewpoint is National Coordinator Don Rucker, MD, who says it is self-serving for hospitals and practices who might benefit from holding patients and their data hostage to play up privacy concerns.

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The New York Times runs an obituary of Donald A.B. Lindberg, MD, who died of fall-related complications on August 17 at 85. It notes that his medical informatics career included heading the National Library of Medicine, where he gave users access to research and genomic information and launched its website, one of the federal government’s first, in 1993. He helped create the National Center for Biotechnology Information; launched the “Visible Human Male” and “Visible Human Female” series of cadaver images; opened up NLM resources to online and API access through services such as PubMed and ClinicalTrials.gov; and served as AMIA’s first president.   

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Carlsbad Medical Center (NM) has sued 3,000 patients over unpaid medical bills, earning the 115-bed hospital an unflattering profile in The New York Times. The hospital, which is owned by for-profit Community Health Systems, is the only hospital in town, with one big local employer running numbers proving that it would be cheaper for them to send a gall bladder patient and their guest to Hawaii for surgery — including airfare and a seven-day cruise for two — than to send them to CMC. Private insurers pay the hospital five times the Medicare price, double the state average.

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I receive an email pitch today for discounted HIMSS20 hotels from Conventioneers US, apparently one of several companies that obtain conference registration lists without authorization to offer prices lower than the conference’s own housing bureau. I found a bunch of conference sites claiming that such organizations are “housing poachers and data scammers,” but all of those came from the conference organizers (who lock up all the rooms to sell themselves) instead of from individuals who were defrauded. Still, the HIMSS site has the Westgate Palace at $186 vs. the email’s claimed $175 rate, so I’m not seeing the reward to be sufficient for the risk of showing up in Orlando with no room at the inn. Years ago you could beat HIMSS prices pretty easily, at least for those hotels that HIMSS didn’t buy out completely, but I don’t think that has been the case for a long time.

A physician’s editorial says that high hospital bills are the biggest driver of out-of-control US healthcare spending, but hospitals are politically untouchable because: (a) they donate a lot of money to politicians; (b) they have become the biggest employers in some cities, especially in the rust belt; and (c) voters don’t see them as villains as they do drug companies and insurers. She notes big medical centers make high profits that they use to build more cancer clinics, boost CEO pay, buy unneeded medical gadgets, and “install spas and Zen gardens,” but they don’t deliver any better outcomes than their less-expensive counterparts in other countries.

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The only-in-Texas phenomenon of high schools building football stadiums that cost dozens of millions of dollars and then selling expensive naming rights includes one whose new $53 million stadium bears the name of Children’s Health in a $2.5 million, 10-year deal, as another high school charged Mansfield Methodist Hospital $575,000 for 10-year naming rights. Another district’s $60 million, 18,000-seat high school stadium includes among its sponsors an unnamed hospital system in a Nascar-like (or HIMSS-like) branding program in which sponsors can plaster their names just about anywhere for the right price. 


Sponsor Updates

  • Boston Software Systems announces intelligent automation for hospital laboratories and their externally linked facilities.
  • Datica will exhibit and present at Health 2.0 September 16-18 in Santa Clara, CA.
  • CoverMyMeds will exhibit at Future Pharma September 9-10 in Boston.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
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Morning Headlines 9/3/19

September 2, 2019 Headlines No Comments

It’s time to talk about James Mattis’s involvement with the Theranos scandal

A new book from former Defense Secretary and Theranos board member James Mattis prompts some to question when his role in scandal-ridden Theranos will finally come to light.

Heart checks while you shop: NHS announces plan to have pharmacies check shoppers’ heart health in bid to cut deaths

Beginning next month, pharmacists in England will offer customers heart checks and health screenings, the results of which they’ll share with local physicians.

DHA to update electronic patient medical records system in Q1 2020

Dubai Health Authority will update Epic in Q1 2020 to allow MyChart users to video chat with their doctor, ask questions, hail ride-sharing services, self-register for appointments, and manage prescriptions, among other features.

Morning Headlines 9/2/19

September 1, 2019 Headlines No Comments

Walmart tests dentistry and mental care as it moves deeper into primary health

Walmart will open a Walmart Health clinic adjacent to one of its stores in Georgia that will offer primary care, dental, labs, X-ray, audiology, and mental health counseling in a pilot project.

NextGen Healthcare in Green closing; 82 to lose jobs

Irvine, CA-based NextGen Healthcare will close its Canton office in Ohio by early next year.

AdventHealth unveils largest-of-its-kind command center

AdventHealth opens its GE-powered $20 million Mission Control command center that will keep a real-time eye on its 2,900 beds and 2 million annual patient visits in Central Florida.

Girish Kumar Navani Announces His Support Of The Campaign For Boston University

An unspecified donation from EClinicalWorks CEO Girish Kumar Navani to his alma mater will result in the creation of the EClinicalWorks Digital & Precision Medicine Design Suite at Boston University.

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Reader Comments

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  • A Gunter Fan: Total fan of Jen Gunter, M.D. She is one of the docs using social media well to spread truth, debunk myths and take on t...
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  • Robert D. Lafsky: The term "copy/paste" is used excessively in a way that obscures problems with current EMR use. Plagiarizing someone el...
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