Recent Articles:

Morning Headlines 7/10/19

July 9, 2019 Headlines No Comments

HGP Client Omnisys Acquires STRAND Clinical Technologies

Pharmacy technology vendor OmniSys acquires Strand Clinical Technologies, which offers a clinical services documentation platform for pharmacists.

GNS Healthcare Raises $23 Million Led by Cigna Ventures

Precision medicine technology vendor GNS Healthcare raises $23 million in a Series D funding round.

IBM closes Red Hat acquisition for $34 billion

First announced last October, IBM wraps up its acquisition of cloud software company Red Hat for $34 billion.

Providence St. Joseph Health Collaboration With Blue Shield of California and Gemini Health Delivers Immediate Drug Cost Savings for Patients

Providence St. Joseph Health providers use the EHR-integrated prescription cost transparency service of Gemini Health to offer Blue Shield of California patients lower-cost drug alternatives.

News 7/10/19

July 9, 2019 News 5 Comments

Top News

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Providence St. Joseph Health will convert a Seattle-area hospital to a “hospital of the future” in partnership with Microsoft. The organizations hope to improve the EHR, use technology such as natural language processing and machine learning, and help big employers lower their healthcare costs.

PSJH will make Microsoft products its standard for cloud (Azure), productivity (Office 365), patient engagement (Dynamics 365), and collaboration (Teams).

PSJH hired Microsoft enterprise commerce executive B.J. Moore as EVP/CIO in January 2019.


Reader Comments

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From Back Up the Truck: “Re: stocks. Which of the IPO shares on your poll would you buy?” I don’t buy, recommend, or own health IT stocks since I wouldn’t feel good about being both a financial and a journalistic participant. I’m scrupulous about conflicts of interest – sponsors (whose ads are clearly identified) get no editorial privilege and I don’t advise companies, accept paid speaking gigs, sell “sponsored articles,” or run any other business. I hope I’m never desperate for cash or ego strokes to the point that I have to turn shill or shameless self-promoter since we’re already loaded with those.


HIStalk Announcements and Requests

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Just a reminder – I turned Vince’s HIS-tory series of 1,300 slides into a single, searchable PDF. Download it, open it in your favorite PDF reader, and look back on decades of health IT history. You’ll enjoy reminiscing if you worked in the industry pre-2000, and if you didn’t, you’ll benefit from reading about company successes and stumbles that hold lessons for today.

Listening: The Pretty Reckless, New York City-based hard rockers led by former actress Taylor Momsen. It’s more than a vanity project – Momsen colors her decent but unspectacular vocal range with a lot of inflection, which is interesting in the mellower and acoustic tracks, much better when they rock it out.


Webinars

July 18 (Thursday) 2:00 ET. “Healthcare’s Digital Front Door: Modernizing Medicine’s Mobile-First Strategies That Are Winning Patient Engagement.” Sponsor: Relatient. Presenters: Michele Perry, CEO, Relatient; Michael Rivers, MD, director of EMA Ophthalmology, Modernizing Medicine. Providers are understandably focused on how to make the most of the 5-8 minutes they have on average with a patient during an exam, but what happens between appointments also plays a significant role in the overall health of patients. Modernizing Medicine is driving high patient engagement with best practice, mobile-first strategies. This webinar will describe patient engagement and the challenges in delivering it, how consumerism is changing healthcare, and how to get started and navigate the patient engagement marketplace.

July 25 (Thursday) 2:00 ET. “Meeting patient needs across the continuum of care.” Sponsor: Philips Population Health Management. Presenters: Cindy Gaines, chief nursing officer, Philips Population Health Management; Cynthia Burghard, research director of value-based healthcare IT transformation strategies, IDC. Traditional care management approaches are not sufficient to deliver value-based healthcare. Supplementing EHRs with advanced PHM technology and a scalable care management approach gives health systems proactive and longitudinal insights that optimize scarce resources in meeting the needs of multiple types of patients. This webinar will address the key characteristics of a digital platform for value-based care management, cover the planning and deployment of a scalable care management strategy, and review patient experience scenarios for CHF and diabetes.

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


Acquisitions, Funding, Business, and Stock

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Pharmacy technology vendor OmniSys acquires Strand Clinical Technologies, which offers a clinical services documentation platform for pharmacists.

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Precision medicine technology vendor GNS Healthcare raises $23 million in a Series D funding round led by Cigna Ventures, increasing its total to $77 million.


Sales

  • CPSI subsidiary TruBridge signs the first two clients for its Chronic Care Management service, in which the company enrolls the patients, coordinates their care, and issues bills.  

People

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ONC’s Deputy National Coordinator Jon White, MD will leave the agency to take a research job at the Salt Lake City VA. Replacing him is ONC Executive Director Steve Posnack, MS, MHS.

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Cerner hires Tracy Platt, MS (Medtronic) as EVP/chief human resources officer.

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Revenue cycle technology vendor ESolutions hires Chris Hart, MBA (Experian) as VP of product and strategy.

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Perot Systems founder and two-time presidential candidate Ross Perot dies at 89.


Announcements and Implementations

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Patient payments platform vendor Patientco adds apps to Epic’s App Orchard to support self-service payments via MyChart for patients and Epic-integrated payment processing for provider staff.

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Solutionreach announces GA of SR Intake for mobile and web-based patient registration.

Providers at Providence St. Joseph Health are using the EHR-integrated prescription cost transparency service of Gemini Health to offer their Blue Shield of California patients lower-cost drug alternatives when appropriate. Sausalito, CA-based Gemini Health was founded in 2014 by former PDR Network CEO Edward Fotsch, MD. Other industry long-timers on the executive team are Mickey McGlynn, Andrew Gelman, and Roger Pinsonneault. 

A Black Book survey finds that health system CFOs are increasingly taking responsibility for cybersecurity and related purchasing decisions.

Allscripts offers users of the retired Microsoft HealthVault a data export to its FollowMyHealth app.

Medsphere adds CloudMedx-powered AI capabilities to its EHR.

TriHealth goes live on Kyruus Provider Match for Consumers to provide visibility to its network. 


Other

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Two family medicine doctors at University of Missouri Health Care convene monthly “EMR Happy Hours,” where they provide Cerner documentation efficiency tips for a handful of attendees.

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Fast Company profiles hospitals that are testing the Moxi nurse helper robot, which can run errands, deliver lab specimens, and fetch supplies. EHR integration allows rules-based behavior, such as delivering cleaning supplies to a newly vacated patient room. Its inventors programmed in hourly hallway walks after patients kept asking for selfies. Moxi is sold by Austin, TX-based Diligent Robotics, which was started by two robotics PhDs. One of them is an expert on “social intelligence,” in which robots are programmed to behave in ways that make humans comfortable, such as making eye contact when roaming hallways. 

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An electronic musician being seen in the ED is stunned by the racket emitted by call buttons, IV pumps, elevators, carts, and, most notably, medical equipment alarms. She has joined a group that is working on creating medical alarm sounds that are quieter and more easily differentiated, quoting Florence Nightingale: “Unnecessary noise is the cruelest absence of care.” An anesthesiologist / musician who served on the committee that developed the standard for medical device alarms in 2006 – categorized into “the six ways people die” – has publicly apologized for the “terrible” sounds the group chose but is working on new ones. Another expert is working on CareTunes, which translates patient vital signs into an electronic dance music-type melody that becomes dissonant as their condition worsens.


Sponsor Updates

  • Gartner names Clearsense as a “2019 Cool Vendor in Digital Business Transformation in Healthcare.”
  • Georgia Hospital Health Services endorses CarePort’s care coordination solution.
  • AdvancedMD publishes a new e-guide, “Untangling Large Group Techno-Spaghetti.”
  • Artifact Health will exhibit at the AHIMA CDI Summit July 14-15 in Chicago.
  • Frost & Sullivan recognizes Avaya with its 2019 Contact Center Vendor the Year award.
  • Bluetree will exhibit at CultureCon July 17-18 in Madison, WI.
  • CoverMyMeds Account Coordinator Michael Ward sings the national anthem at the Cleveland Indians game.
  • Diameter Health will exhibit at the NCQA Digital Quality Summit 2019 July 16-18 in Boston.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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Contact us.


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Morning Headlines 7/9/19

July 8, 2019 Headlines No Comments

Deputy National Coordinator Transition

ONC Executive Director Steve Posnack will become deputy national coordinator when Jon White leaves in mid-August to become the associate chief of staff of research at the VA Salt Lake City Health Care System.

iMedX Launches Industry Leading Analytics and Business Intelligence with Acquisition of Prevalent, Inc. and Axcension, Inc.

RCM and HIS vendor IMedX introduces analytics capabilities culled from newly-acquired companies Prevalent and Axcension.

Microsoft and Providence St. Joseph Health announce strategic alliance to accelerate the future of care delivery

Providence St. Joseph Health will work with Microsoft to develop new technologies it will then deploy at its hospital in Seattle.

Curbside Consult with Dr. Jayne 7/8/19

July 8, 2019 Dr. Jayne 2 Comments

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I was off the grid this week doing some volunteer work. Since I sent Mr. H my posts in advance, I failed to notice that Independence Day in the US fell on Thursday, so Happy Belated Birthday, USA.

One of my volunteer partners is a US history teacher, who asked some very pointed questions that provoked discussion on how treasonous the revolutionaries were, Not just the so-called Founding Fathers, but the Founding Mothers who stood behind them. Cokie Roberts wrote a book using their correspondence as source material. I read it a few years ago and was glad to learn of women like Deborah Read Franklin, who held things together on the home front so their husbands, sons, and brothers could help shape a nation.

After being away, the first place I stopped on the internet was of course HIStalk, where I was ecstatic to learn that Samuel Shem is at it again with “Man’s 4th Best Hospital.” I still recommend “The House of God” to all of my clinical scribes who aspire to attend medical school or physician assistant school. Although many things have changed since 1978, there are still a number that are the same.

Clinicians are still faced with rampant absurdity on a daily basis and often develop some off-the-wall coping skills in an effort to not descend into madness themselves. I thought about it yesterday when multiple patients had issues where I was forced to offer less-effective care just because of their insurance coverage. Of course, it’s always the patient’s decision to pay out of pocket for the more effective option, but seeing that choice made is a rarity. I can’t wait to see his treatment of the topic of electronic health records and the crazy world in which we are forced to operate.

I’m glad Mr. H mentioned it. Even as a HIStalk insider, I still marvel at his ability to distill the news of the day and help us keep up even after we’ve deliberately avoided the internet.

As is usual after I’ve been away, my inbox was full of messages clamoring for my attention. It’s increasingly difficult to sort the wheat from the chaff. Although I have all kinds of rules in operation, I still struggle to find the important items at times.

An educational activity on “Managing Common Summer Health Conditions” from the American Medical Association caught my attention, although I was somewhat surprised that they grouped tick-borne illnesses and sexually transmitted syphilis in the same educational session. I was shaking my head, but then I came up with a couple of snarky “Summer of Love” jokes, so maybe they do indeed belong together.

I’m working with a client right now who is trying to optimize their EHR to help them improve a variety of clinical quality metrics. Despite efforts for federal organizations to corral these measures into a meaningful cohort that is supported across multiple groups of payers, they are tracking subtly different metrics for different audiences. They’ve worked with various payer medical directors and others trying to find a resolution, but everyone seems entrenched in their own specific benchmarks. They use the excuse that they need to keep the metrics the same across all their providers, but since most of the providers in this particular metropolitan statistical area are contracted with the same payers, it just means that everyone has to suffer with a hodgepodge of requirements.

I understand where the subtle differences come from. Perhaps they see particular trends in their patient populations, or perhaps they’re chasing outcomes noted in recent literature. If it’s the latter, I was excited to see a recent article in the Journal of Internal Medicine that looks at one of the healthcare cost kings – diabetes – and how it develops in older adults, which are going to be a large segment of our patients moving forward. The Swedish National Study on Aging and Care looked at nearly 5,000 patients, following them for 12 years. Most of the older adults with pre-diabetes either remained stable or returned to a normal blood sugar range, with blood pressure and weight management contributing to the latter.

It’s unclear whether these results from Swedish patients can be translated to other populations and racial / ethnic groups. If they can, it may support a change in how we think about these patients. If the results aren’t generalizable to different populations, it may argue for a more precision approach to disease management that current EHRs haven’t even thought of. I’m pretty sure that the addition of clinical guidelines that are based on sub-populations would make many physicians’ heads explode. On the other hand, that’s right where we’re headed with precision medicine, although we don’t yet have all the systems and financial support in place to support that type of approach.

As a physician, I’d like nothing more than to be able to input factors about my patient, their family history, their genetic makeup, etc. into my EHR and have it tell me exactly what screenings they need and when they need them. As issues arise, it could also advise on whether they need aggressive treatment or conservative treatment. Right now we spend money treating some diseases that from a statistical standpoint aren’t necessarily fatal and/or don’t cause a lot of disability; but since they’re there, we feel obligated to beat them into submission. What if we could pick and choose the patients who would most benefit from treatment?

Delivering those kinds of recommendations requires a tremendous amount of data. I’m not apologizing for the patient safety issues or workflow horrors found in many EHRs. However, it does improve one’s mood to remember the reasons (other than facilitating billing and keeping up with government regulations) why EHRs might be a good thing. I’m looking forward to the day I can have a system capture my spoken office visit through a console on the wall (come on, Nuance, refine that technology for primary care already) and adaptively learn what I’m going to recommend for a patient based on my past practices. I’m eager for the arrival of seamless data interchange so that clinicians can have all of a patient’s data at their fingertips. Until then, I’ll keep plugging away with the EHR and working from the sidelines to make the technology better for providers.

What benefits of technology are most exciting to you? Leave a comment or email me.

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Email Dr. Jayne.

Neal Patterson’s Final CHC Speech – November 16, 2016

July 8, 2019 News 1 Comment

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Cerner Chairman, CEO, and co-founder Neal Patterson made a surprise appearance – one that would would turn out to be his last — at the Cerner Health Conference on November 16, 2016. Patterson had been diagnosed with cancer in January 2016. He died less than eight months after his CHC talk on July 9, 2017 of cancer complications. He was 67 years old. His wife Jeanne – who was Cerner’s seventh employee and who suggested the company’s name – died of longstanding metastatic breast cancer less than two months later at 59.

I recently received a recording of Patterson’s remarks and am running them on this second anniversary of his death.


This time last year, I gave this talk on this stage. At that time, I knew something was going on. I think it was New Year’s Eve when I got the call about the biopsy that said I had cancer. For me standing here, the previous talk [by David Feinberg, MD, then CEO of Geisinger Health System] was incredibly relevant to me as the patient.  

I think about caring and the inherent trust you have with your provider. You are at their mercy. You’re there because you trust their competency, but the caring is not always there. You can tell when people are in a hurry or when they are behind schedule. 

Dr. Feinberg is the leader of possibly one of the most important parts of healthcare in the next decade. A lot of other things are going to happen in the next decade. Data is going to be there. We are going to be right at the center of it. What we do collectively is going to change fundamental platforms. Cognitive computing — or whatever the term ends up being — systems are going to make good physicians, good nurses, and good technicians better. But most importantly, they will change the experience that we have as patients.  

I have quite a few stories that I could tell about my cancer treatment experience. It wasn’t exactly that I was bored, but I did pretty much spend eight months in a rabbit hole, going through a series of treatments that had brutal effects. You have a lot of time to be a patient inside the facility getting the treatments, and then you have quite a bit of time to reflect on the consequences of those treatments. 

I have figured out that God has a sense of humor because he put me at a place where the provider was going through an EMR conversion. [note: Patterson didn’t name the institution, but it was almost certainly MD Anderson, which was undergoing a conversion to Epic at the time]. I know he did it on purpose. Only one or two of us really deserve to go through one, and I have done mine, OK? [laughs, clearly joking about Epic CEO Judy Faulkner] It wasn’t a Cerner conversion, but I’m sure anything I say has also happened in a Cerner environment. Here’s a couple of stories from that. 

This was a high-quality, high-prestige organization. It was one you would pick from the list if you had cancer. I went for my chemo treatment one day and they sent me to the big transfusion room. I hated that room because it was always going to take a lot longer.

I had been in the waiting room for four hours waiting to get assigned a room to get a transfusion. Few who know me well would believe this statement, but I had patience, because there was a lot of complexity and a lot of stuff floating around. But after four hours, I went through the door that I wasn’t supposed to go through, into the triage room. 

They said, “We can’t get you a room because we haven’t got this lab test done yet. Your doctor didn’t order it.” I said, “I am most certain that he did.” They said they hadn’t received the results. 

I said, “Here’s what I’m going to do. I going to stand here until you get the results. The only way I’ll leave is if you send me to a stat lab, which will get the results in 10 minutes, and I’ll be back with those results. This doesn’t need to happen.”

Sure enough, they got somebody in the laboratory who promised they would stay on the line until they got the result. Then I got a room assigned and started the process of transfusions that can last four hours.

I forgot to tell you. Many of you have heard me speak before. I was always a terrible speaker, but one of the negative outcomes of my treatments was my speech. My assistant Elaine whispers in my ear, “Talk slow. Try to finish the words.” I don’t know If I’m talking slowly or finishing anything. 

Anyway, I got to my room. A lady who was there I first arrived was still there. I asked her how she was doing. She said it had been a terrible day. I asked how long she had been there. She said seven hours. [Patterson stopped speaking for several seconds to compose himself after an emotional reaction]. There’s no caring in that.  

The message for us, and what I think is the reason that God sent me here, is that most of that was probably due to the system conversion and changing procedures. We in the room need to anticipate those things to minimize the impacts, because they are big impacts.

Let me do one more quick story. I could tell that the cancer center was quite proud of their laboratory. They have a big lab. I was impressed, but the big lab waiting room was just cram-packed full. Always full. I went back to get my test and they were doing positive ID, running your patient ID, and confirming that the test order is in the lab system. It was taking 10 minutes for this handshake to work. 

I knew which third-party system was on the other side. While I was waiting through my 10-minute turnaround, I asked the tech, “How long does it usually take? It should only take like 10 seconds, but it has been taking 10 minutes.” I picked up the phone while I was waiting, since I was stuck anyway, and I called. I got it fixed pretty fast. I don’t think anybody in the whole place even knew they had the problem. They had enough problems they were chasing and they weren’t chasing that one. I fixed that one overnight, so I was proud of that.

There are two stages of being a patient. I took it as a project. Once I got the diagnosis, there was a problem and I was going to solve it. You have to make a series of decisions, such as where to get treatment. Then you get your strategy of how you’re going to approach it. Finally, you get a plan and go execute it. I was familiar and comfortable with that part. 

With the kind of stuff I had, you don’t have “a doctor.” You have four major doctors.  

  • You have the doctor who will cut a bunch of stuff out. I was in surgery for 15 hours, so they were working on something pretty hard. 
  • Then you have the surgeon who tries to make you look something like you looked before. He’s a pretty important factor to you. He’s trying to put you back together. 
  • Then you have the radiation oncologist, who is going to basically fry you by putting you in the oven and cooking you every day. I had proton-beam radiation, although I never did understand whether it’s actually better.
  • Then you end up with your medical oncologist, who is a really important doc, too. 

That’s a team, but it is very hard to be part of that team. I would score my team pretty high on the team list, but it wasn’t hard to find things where they did not work together as a team. They are busy as all get-out and you are in one space at a time.

You’ve built the team and the plan and you’re going to go execute the plan. But there’s that other side, where you are actually having it done to you. That’s where you can feel the caring. 

What’s really cool about healthcare is that the people you encounter are almost always caring. It’s usually the way systems are designed, leadership, or other factors such as workload that create the distractions that reduce that feeling of caring on our side.

With that, there are a couple of elephants in the room. One is, what is my plan?

This is a great diet. I lost 70 pounds. Thirty of that I enjoyed taking off, maybe even 40 of it, but the last 30 pounds was basically strength. I’m kind of in shock now. I look like I’ve come out of a prisoner-of-war camp. You lose a lot of strength.  

At this stage, I’m at the end of the treatments. I received very good news. The surgeon who was going to do the voodoo stuff said to me at the beginning, “I’m going to cure you.” The first thing I asked him when I woke up was, “Did you cure me?” 

He got an A. That team got an A. But I think all of you know that with a disease like this, it’s five years before you feel good about what the next checkup is going to find. 

With all the treatments I had, I have issues. If I’m out eating with somebody, they’ll say, “Neal has a few issues we’ll have to accommodate here.” But I’m in a mode of getting stronger and getting better daily, which is a great place to be.  

I will be back at Cerner in basically my capacity probably in January. But the reality is that I’m going to make some changes. Before we had the last board meeting, I had my assistant look at my time over the last three years. I spent almost a full day in the air flying each week, that is, in the airplane and off the ground. That doesn’t count the time getting and from to the airport. So one of the things I’m going to have to adjust is that I’m not going to be everywhere I have been. You’re going to see me less at your site, and the converse is that Cerner will see me more.

My last comment is about our industry. We’ve been through the digitization phase of healthcare, and most of it was automating processes. Many times, the automation of processes could have been done better. Too many times, we were automating the old process.

What we are going to do as a company is to double the productivity of physicians. The EMR is central to their work and it will increase their productivity. We’re going to do the same thing with nurses and many technologists.

But one thing that I’m saying here today that I wouldn’t have said a year ago is that we’re going to make being a patient a different experience, too. It’s just not the freaking portal, if you don’t mind my language. The patient portal was a nice step, but for the patient to be part of the team, it has to be part of the team. The portal cannot just be a source of information. We’re going to be part of a team, we’re going to make us part of the team, and then we’re going to make it easier to care for us.

Thank you for being here. Thanks for the opportunity. What I have gotten to do over the last 35-40 years has been a privilege. There’s an awful lot left to be done and we are going to go do it. Thank you very much.

Morning Headlines 7/8/19

July 7, 2019 Headlines No Comments

Q&A: Providence Exec on Bluetree Acquisition, Trends in Health Tech

Providence St. Joseph Health will create a billion-dollar company from its non-clinical projects, including the acquired Engage and Bluetree businesses and its Epic Community Connect hosting business.

Sale of Bain’s Waystar may wrap by end of July: sources

Sources report that Bain Capital may close on its sale of Waystar, which some value at as much as $3 billion, within the next several weeks.

Despite millions spent, ‘crucial’ DSHS electronic records system years behind schedule

A State of Washington project to implement Cerner at Western State Hospital is running several years behind schedule with no completion date established.

32 workers at Conifer Health Solutions to be laid off

Citing a change in a significant client relationship, RCM vendor Conifer Health Solutions announces it will lay off 32 employees in mid-August.

KKR, Baring Asia lead race for CitiusTech

India-based private equity firms KKR and Baring Asia become frontrunners to acquire CitiusTech, with a final sale decision expected by the end of July.

Monday Morning Update 7/8/19

July 7, 2019 News 12 Comments

Top News

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Providence St. Joseph Health plans to create a billion-dollar company from its non-clinical projects, which include the acquired Engage and Bluetree businesses (which offer Meditech and consulting services, respectively) and its Epic Community Connect hosting business.

The health system expects the company to produce 20% EBITDA by 2023. Annual revenue so far is $44 million for Engage and $15 million for the Community Connect business.

PSJH says it will replace Meditech with Epic at its acquired sites that are still using it. It also sees a business opportunity now that Epic is selling its system to health plans such as Humana. 


Reader Comments

From Gaggled Goose: “Re: gag clauses. I haven’t seen our vendor contract, but we as doctors have always been granted permission when we’ve asked to display screenshots about what we’ve done. On the other hand, I was horrified by the software-related safety risks in our CPOE rollout, and when I posted comments on an AMIA discussion board without naming the vendor, someone at the vendor became upset and I was called to the office of the hospital’s chief medical officer. I was told that if I didn’t stop making negative comments about the software that I would be viewed as a ‘disruptive physician’ under hospital bylaws and Joint Commission rules and that disciplinary action would proceed against me.” This amplifies my point that it’s nearly always health system executives rather than vendors who directly threaten clinicians who bring software problems to light. Signing a big vendor contract puts those health system executives in cahoots with their vendor counterparts in spinning every aspect of the project positively, making a contractual gag clause superfluous. Preventing harm to another health system’s patients is not a priority.

From Auspicious Date: “Re: gag clauses. Our vendor’s contract called on us to manage comments made by any and all ‘authorized users.’ Not all of those users are under our direct employ and we don’t enter into agreements that we can’t reasonably enforce or control. Further, academic medical centers deal with all walks of like with all sorts of opinions.” It’s surprising how many health systems accept vendor contract boilerplate as presented in the draft agreement, but in their defense, they don’t have much leverage when only 2-3 vendors are in play and they’ve already named their favorite. You can’t really play tough guy with Epic or Cerner in beating them up over T&C when you’ve already chosen them.

From Rama Lama: “Re: workflow automation. I’m interested in which HIStalk sponsors offer it. I’m thinking about companies like Healthfinch that offer clinician-focused automation. I’m also interested in companies that work on clinical laboratory automation (like automated reflex testing) and pharmacy robotic fill systems.” I’ll invite my sponsors that offer products in this real to add a comment to this post with your contact information.

From Aggrieved Partygoer: “Re: physician inbox. Why are automated messages sent to it?” Because non-doctors don’t trust doctors, firmly believing that everybody from lab techs to pharmacists to IT analysts need to get involved in their patient care decisions to prevent the grievous harm they think will otherwise result. It’s not doctors asking for those automated messages. I’m being slightly facetious, but the argument has two sides: (a) medical practice is too complex for a lone practitioner to always do the right thing without having an ever-prodding team of people, insurance companies, and electronic systems to provide reminders and to prevent suboptimal therapy, not to mention that processing required actions is easier for the doctor when presented as an inbox message; or (b) doctors really are careless and undereducated in some areas and will harm patients without non-physician oversight, making patient care a team sport despite doctors being trained as the star player and feeling resentment when that role is diminished. I always ponder the role of the doctor when many hospital people roll their eyes at their perceived incompetence or impure motivation. Do we want insurers and faceless hospital committees creating evidence-based guidelines that result in our doctor being constantly chided for non-conformance, or would we better off sticking with the one person who has actually spoken to us and reviewed our situation with us? The science vs. art debate is far from over.

From Yellow Submarine: “Re: Jacobus Consulting. Has closed its doors – its website gives an error.” Unverified, although the web page is indeed down. Owner Sandra Jacobs hasn’t changed her LinkedIn and the company’s LinkedIn page shows 51-200 employees. I feel bad for people who have to write grand, self-congratulatory statements about healthcare consulting firms, like this one about Jacobus: “Providing real, actionable solutions that optimize patient care and provide true value.”

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From Rocket Man: “Re: HIMSS. Check this email subject line out. What do you think?” I laughed when I received my copy of the email. I doubt many people (at least those who aren’t HIMSS employees) have seen their careers rocket because of HIMSS. It’s not exactly an exclusive club.


HIStalk Announcements and Requests

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Poll respondents would be drawn to potential new job that offers more interesting challenges and/or more money. Mario says I should have included a “I’m content to stay put option,” but I disagree – you can’t tell me that you wouldn’t bolt if someone offered you $10 million, however unlikely that may be. As the old joke goes, we’ve already established what sort of people we are, now we’re just haggling over price.

New poll to your right or here: which company’s IPO shares would you buy with your own $10,000 if forced to pick one?

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I tried something new today – I deposited a check to my bank account by taking a picture of its front and back via the bank’s app and received the deposit confirmation a few minutes later. Technology had already eliminated the need to actually visit the bank branch (other than to get something notarized or to obtain a cashier’s check) and now this deposit option eliminates most of my ATM visits since I just get cash back from stores for the rare times I need it. The possible fraudulent downside of “remote deposit capture” is that the recipient keeps the physical check and could theoretically deposit it more than once either accidentally or intentionally, which is probably why one of the checks I deposited has a checkbox to mark to prevent multiple deposits.

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

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Webinars

July 18 (Thursday) 2:00 ET. “Healthcare’s Digital Front Door: Modernizing Medicine’s Mobile-First Strategies That Are Winning Patient Engagement.” Sponsor: Relatient. Presenters: Michele Perry, CEO, Relatient; Michael Rivers, MD, director of EMA Ophthalmology, Modernizing Medicine. Providers are understandably focused on how to make the most of the 5-8 minutes they have on average with a patient during an exam, but what happens between appointments also plays a significant role in the overall health of patients. Modernizing Medicine is driving high patient engagement with best practice, mobile-first strategies. This webinar will describe patient engagement and the challenges in delivering it, how consumerism is changing healthcare, and how to get started and navigate the patient engagement marketplace.

July 25 (Thursday) 2:00 ET. “Meeting patient needs across the continuum of care.” Sponsor: Philips Population Health Management. Presenters: Cindy Gaines, chief nursing officer, Philips Population Health Management; Cynthia Burghard, research director of value-based healthcare IT transformation strategies, IDC. Traditional care management approaches are not sufficient to deliver value-based healthcare. Supplementing EHRs with advanced PHM technology and a scalable care management approach gives health systems proactive and longitudinal insights that optimize scarce resources in meeting the needs of multiple types of patients. This webinar will address the key characteristics of a digital platform for value-based care management, cover the planning and deployment of a scalable care management strategy, and review patient experience scenarios for CHF and diabetes.

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


Other

A State of Washington project to implement Cerner at Western State Hospital is running several years behind schedule with no completion date established. The Department of Social and Health Services has spent $21.8 million so far and has signed two Cerner contracts valued at $32 million. It is embroiled in a contract dispute with the vendor.

Berkeley Lab researchers find that running out-of-the-box machine learning algorithms on old materials science research papers “discovered” new thermoelectric materials years in advance, as the algorithm learned concepts on its own, such as the periodic table and the crystal structure of metals. The authors conclude that such analysis can establish new scientific knowledge from existing literature.

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Samuel Shem will publish a sequel to his seminal 1978 book “House of God” titled “Man’s 4th Best Hospital” on November 12, 2019, focusing on EHRs and healthcare profits. Legendary character The Fat Man, now the operator of an anti-establishment clinic, summarizes, “Money kills care. Screens make money. Screens kill care.” The book’s promo material, which calls the book “the novel of resistance,” quotes Shem as saying, “Say the name of the most dominant brand – Epic – and doctors start screaming. Literally screaming.” Shem – the pen name for 74-year-old Boston psychiatrist Steve Bergman, MD, PhD – makes thinly veiled references to Partners Healthcare (“Buddies Healthcare”) and Massachusetts General Hospital (“Man’s 4th Best Hospital.”) Here’s an example from “House of God” of the kind of prose I’m anxiously awaiting: 

The House of God found it difficult to let some young terminal guy die without pain, in peace. Even though Putzel and the Runt had agreed to let the Man With Agonal Respirations die that night, his kidney consult, a House red-hot Slurper named Mickey who’d been a football star in college, came along, went to see the Agonal Man, roared back to us and paged the Runt STAT. Mickey was foaming at the mouth, mad as hell that his “case” was dying. I mentioned the end-stage bone cancer, and Mickey said, “Yeah, but we’ve got an eight-grand dialysis shunt in his arm and every three days the dialysis team gets all his blood numbers smack back into line perfect.” Knowing there was going to be a mess, I left. The Runt came out of the elevator, fuming, and ran down the long corridor his stethoscope swinging side to side like an elephant’s trunk. I thought of the bones in multiple myeloma: eaten away by the cancer until they’re as brittle as Rice Krispies. In a few minutes the Man With Agonal Respirations would have a cardiac arrest. If Mickey tried to pump his chest, his bones would crunch into little bitty bits. Not even Mickey, seduced into the Leggo’s philosophy of doing everything always for every patient forever, would dare call a cardiac arrest.

Mickey called a cardiac arrest. From all over the House, terns and residents stormed into the room to save the Man With Agonal Respirations from a painless peaceful death. I entered the room and saw an even bigger mess than I’d imagined: Mickey was pumping up and down on the chest and you could hear the brittle bones snap, crackle, and pop under his meaty hands: a Hindu anesthesiologist pumped oxygen at the head of the bed, looking over the mess with a compassionate disdain, perhaps thinking back to the dead beggars littering dawn in Bombay; Molly was in tears, trying to follow orders, with the Runt shouting, “Stop! Don’t resuscitate him!” and Mickey cracking and crunching and shouting, “Go all-out! Every three days his blood numbers are perfect!” 

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The Philadelphia paper notes the plight of the 570 medical residents of Philadelphia’s Hahnemann University Hospital, which will close in the next couple of months. The residents, some of whom just started their training last week, will have to scramble hoping to be hired on elsewhere. ACGME has invoked its Extraordinary Circumstances Policy to allow hospitals to hire Hahnemann’s residents or to increase their own resident count, but CMS pays their salaries and is the ultimate authority. Investment banker Joel Freedman bought the money-losing hospital and St. Christopher’s Hospital for Children from Tenet for $170 million in January 2018. I believe the hospitals use Cerner inpatient and Allscripts Touchworks outpatient.

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Two families sue Chicago Police Department and Mercy Hospital for misidentifying a disfigured, unresponsive ICU patient who was taken off life support as authorized by two women who were were assured that the man was their brother. The patient died, but the sisters were shocked a few days later when their brother showed up for a family cookout. The brother is not happy since his disability and Social Security payments were stopped and the hospital charged his Medicaid account $1 million for the other guy’s hospitalization.

A hospital in China suspends a doctor whose wife had bragged on social media about the gifts patients give him, her family’s ability to skip the hospital line, and his “excessive medical treatment” of a taxi driver who had annoyed him.


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Morning Headlines 7/5/19

July 4, 2019 Headlines No Comments

Q&A: Providence Exec on Bluetree Acquisition, Trends in Health Tech

Providence St. Joseph Health says it will roll its non-clinical projects — Bluetree’s consulting, Engage’s Meditech services, and Epic Community Connect hosting — into a billion-dollar company that will generate a 20% return.

OpenNotes: More Than 40 Million Patients Can Access Their Clinicians’ Visit Notes Via Secure Portals at 200 Health Systems

OpenNotes says that 40 million Americans who are served by 200 health systems can access their clinician-entered notes.

MVHS launches new system-wide electronic health record

Mohawk Valley Health System (NY) goes live with Epic at its two hospitals and physician practices.

EPtalk by Dr. Jayne 7/4/19

July 4, 2019 Dr. Jayne No Comments

It’s that time of year when CMS releases updates to ICD-10 codes for the coming fiscal year. The files are now available and go into effect starting October 1. For those of you used to receiving a General Equivalence Mapping update along with your new codes, you’re out of luck. CMS previously announced that they would only update the GEMs files for three years after the implementation of ICD-10. It’s hard to believe it’s been that long since we kissed ICD-9 goodbye. I wonder how many clinicians are hoping they’ll be long-retired before ICD-11 comes around? Most World Health Organization member states are slated to start using it in 2022, but I’m betting it will be a long time before it makes it to the US.

Kaiser Health News reports some interesting data from the Food and Drug Administration database containing medical device malfunctions and injuries. Manufacturers sent data to this “hidden” database via Alternative Summary Reports rather than to the public FDA database used by researchers and patients. Top tidbits include: blood glucose meters had more incident reports (2.4 million) than any other device, with the majority of them being manufactured by a former subsidiary of Johnson & Johnson; dental implants comprised 2.1 million reports; 176 deaths were reported through the non-public workflow, including those related to insulin pumps, pacemakers, and ventilators; surgical stapler malfunctions numbered 66,000 in the hidden database vs. 84 in the public database; and breast implants accounted for nearly half a million reports. Despite the visibility of this issue, the FDA has replaced the alternative “hidden” reporting process with a new Voluntary Summary Reporting Program that may be just as hard to track as the previous Alternative Summary reports.

In the Virtual Assistant arms race, CNBC reports that Google Assistant does a better job than Alexa or Siri in helping patients with medications, although studies still indicate that voice assistants aren’t ready for prime time where health or medical data is at stake. The study looked at queries regarding the 50 most commonly prescribed medications and whether users received accurate information when asking a device to “Tell me about” a particular drug. Google Assistant identified 92% of brand name drugs and 84% of generics, with Siri scoring 58% and 51%, respectively. Alexa trailed at 55% and 46%.

It’s time to cut the cat videos. Nearly all of us have fallen down the rabbit hole that is YouTube and found ourselves minutes (or hours) later having watched video after video. (My personal favorite begins with the “Nope Ropes, Sneks, & Danger Noodles” offering  from Lucidchart and devolves from there.) New data shows that the number of people spending two hours a day or more watching TV or videos is high – 62% of children, 59% of teens, 59% of non-retired adults, and 84% of seniors. This inactivity places us at risk for obesity, chronic disease, and overall mortality. I made a pact with myself to only watch Netflix while I’m on the treadmill, so thanks to “Halt and Catch Fire” for helping me meet this month’s fitness goals.

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I literally could not contain my excitement when I stumbled across this option in Office 365 that allows me to display a third time zone. I’ve been wishing for that enhancement for a long time and it will make my life so much easier. Not that I don’t know how to figure out time zones, but it’s a nice check and balance to be able to confirm it on the screen. We’ve all been the victim of wrong time zone meetings and I certainly don’t want to be a perpetrator. Now if they could just come up with a calendar widget for scheduling recurring meetings on different days of the week (a la GroupWise circa 2011) my scheduling desires would be complete.

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A recent Journal of the American Medical Association article introduces the concept of a TACo, or Targeted Automatic e-Consultation. The TACo aims to bridge the gap between traditional sub-specialist consultations, which are time-consuming, and so-called “curbside” or informal consultations. Traditional consults are problematic because they require analysis of the chart, examination of the patient, and detailed documentation; subspecialists who are in short supply at some facilities can run themselves ragged trying to complete all their consultations. Curbsides are informal and might be limited by the information available along with lack of an examination; usually the recommendations aren’t documented in the chart because there isn’t a physician-patient relationship. Unlike other consultations which require a physician or care team member to initiate the consult, the TACo would be automatically triggered by certain laboratory or examination findings as they are documented in the chart. The receiving subspecialist would have access to a “customized view of the pertinent information” for virtual review and could then suggest focused advice, a formal consultation, or neither.

The approach is under evaluation by the diabetes service at the University of California San Francisco. The EHR identifies patients meeting certain criteria and presents key chart elements to the diabetes sub-specialist. Management suggestions are documented and most reviews take less than five minutes. The team published data showing improvement in diabetes management through reduction in both high and low glucose events. The outcomes have allowed the organization to provide continued funding to support the time spent in review by the subspecialists. They plan to expand the TACo concept to other services including hematology, metabolic diseases, and infectious diseases with an eye to common conditions that may be managed incorrectly and can be triggered by objective data mined from the EHR. The authors note that “if TACos prove to be beneficial, a convincing argument could be made for payers to reimburse them, just as care coordination and telemedicine ultimately became eligible for reimbursement.” Even if they were billable, organizations would still need to expend resources in managing the technology required to support the approach.

Is your organization considering something along the lines of a TACo, or is it just lunch food? Leave a comment or email me.

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Morning Headlines 7/3/19

July 2, 2019 Headlines 3 Comments

Government EHR proposals threaten patient privacy

The American Medical Association warns that proposed federal rules allow patient data to be shared with third parties who aren’t bound to keep it private.

Net Health to Acquire Optima Healthcare Solutions, Expanding Its Purpose-Built Electronic Medical Record Platform

Outpatient therapy EHR vendor Net Health acquires Optima Healthcare Solutions, which offers a contract therapy EHR.

Aggression Detectors: The Unproven, Invasive Surveillance Technology Schools Are Using to Monitor Students

A few hospitals are using publicly placed microphones and machine learning-analyzed speech in hopes of detecting aggression before it turns into violence.

Electronic medical record system for all M’sian hospitals, clinics to cost up to RM1.5b, says minister

Malaysia’s government will open a tender this year for an EHR to be implemented in its 145 hospitals and 1,700 clinics at an estimated cost of $360 million.

News 7/3/19

July 2, 2019 News 8 Comments

Top News

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Outpatient therapy EHR vendor Net Health acquires Optima Healthcare Solutions, which offers a contract therapy EHR.

Pittsburgh-based Net Health has quite a few industry long-timers on its management team:  Anthony Sanzo (TeleTracking), Kelley Schudy (Allscripts), Jason Baim (TeleTracking), and Mary Mieure (Vitera).


Reader Comments

From Rude Buoy: “Re: vendor gag clauses. Here’s an example.This is the most extreme example of a supplier looking to put parameters on impressions I’ve seen in decades as a CIO. Please keep confidential as the agreement is specific to our organization.” The agreement requires the health system to keep its “authorized users” from publishing falsehoods that are damaging to the vendor, which the vendor admits is subjective. The interesting aspects to me are:

  • The term doesn’t prohibit publishing negative content as long as it is factual, which should be the case in describing software problems that endanger patients. Therefore, I would argue that this is not a gag clause.
  • Health system users don’t sign the agreement and aren’t bound by it individually (as long as additional language isn’t buried in the system’s user agreement, if one exists). The health system might threaten to discipline an employee, but how would it deal with a community-based doctor (who is still its “authorized user”) who posts something untrue, perhaps without even naming the health system? Can the health system legally demand that the doctor either remove their comment or stop posting them?
  • I’m curious how terms like these have worked out in real-life examples where a vendor pressured a health system or practice over comments made by one of it users. I picture the vendor issuing a vague threat to the health system, who then issues a vague threat to whoever made the comment, who then removes or “corrects” their comment in fear of being fired or sued. Or maybe this has happened so rarely that nobody knows.

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From Legal Beagle: “Re: Texas Health Resources. Here’s what its execs told the US Senate under oath.” I remember writing about this when it came up in 2014. The THR ED nurse didn’t ask the Ebola patient about his travel history because that wasn’t part of the ED triage process. The primary nurse saw him an hour later and documented that he had just traveled from Africa, but the nurse didn’t communicate that information verbally to the doctor. Records show that the ED doctor reviewed the patient’s complete EHR record several times, including the location in which the travel history was documented. The patient was new and thus his record contained only the nurse triage and travel history, so it’s not like that information was buried in a big chart. The doctor discharged the patient with a diagnosis of sinusitis and abdominal pain. THR initially claimed in a press release that Epic didn’t automatically display the travel history to the doctor, also explaining that THR’s IT staff “relocated the travel history to a portion of the EHR that is part of both workflows.” Then THR recanted its original claim by admitting that “there was no flaw in the EHR.” My takeaway is that many hospital EDs would have missed the connection between Africa travel and vague Ebola symptoms, but in this case, the story was muddied because of miscommunication or perhaps intentional obfuscation by THR’s clinicians or executives.


Webinars

July 18 (Thursday) 2:00 ET. “Healthcare’s Digital Front Door: Modernizing Medicine’s Mobile-First Strategies That Are Winning Patient Engagement.” Sponsor: Relatient. Presenters: Michele Perry, CEO, Relatient; Michael Rivers, MD, director of EMA Ophthalmology, Modernizing Medicine. Providers are understandably focused on how to make the most of the 5-8 minutes they have on average with a patient during an exam, but what happens between appointments also plays a significant role in the overall health of patients. Modernizing Medicine is driving high patient engagement with best practice, mobile-first strategies. This webinar will describe patient engagement and the challenges in delivering it, how consumerism is changing healthcare, and how to get started and navigate the patient engagement marketplace.

July 25 (Thursday) 2:00 ET. “Meeting patient needs across the continuum of care.” Sponsor: Philips Population Health Management. Presenters: Cindy Gaines, chief nursing officer, Philips Population Health Management; Cynthia Burghard, research director of value-based healthcare IT transformation strategies, IDC. Traditional care management approaches are not sufficient to deliver value-based healthcare. Supplementing EHRs with advanced PHM technology and a scalable care management approach gives health systems proactive and longitudinal insights that optimize scarce resources in meeting the needs of multiple types of patients. This webinar will address the key characteristics of a digital platform for value-based care management, cover the planning and deployment of a scalable care management strategy, and review patient experience scenarios for CHF and diabetes.

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


Acquisitions, Funding, Business, and Stock

Provider scheduling solutions vendor QGenda acquires OpenTempo, which offers clinical resource optimization tools.


People

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UC Health (one of many, in this case Cincinnati) hires Michael Legg (Yale New Haven Health) to the newly created position of VP/chief data and analytics officer.

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John Passchier (TAVHealth) joins Signify Health as RVP of community network strategy.

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Sean Tuley (LifePoint Health) joins Global Medical Response as SVP/CIO.

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Nat’E Guyton, RN, MSN, DM (Spok) joins University of Maryland Medical Center as VP of patient care services and chief nursing officer.


Announcements and Implementations

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Cedars-Sinai welcomes 11 startups to its latest accelerator class:

  • AMPAworks – surgery inventory tracking.
  • ClinicianNexus – clinical rotation matching.
  • Feedtrail – pre-discharge patient surveys.
  • FocusMotion Health – tracking the activity and recovery of orthopedic surgery patients.
  • Hawthorne Effect – keeping clinical study enrollees engaged.
  • Health Note – pre-visit patient questionnaire that populates the EHR.
  • Lantum – provider scheduling.
  • Notisphere – recall tracking.
  • OMNY – hospital sharing of oncology drug usage and supplies.
  • Parker Isaac Instruments – pathology tissue separation instrument.
  • Virti – virtual clinician training.

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Flexible office space vendor and WeWork competitor Convene will operate primary care clinics in most of its 28 locations, hoping to attract tenants by offering immediate access to health services similar to the onsite clinics offered by big employers. The clinics will be operated by Eden Health.


Other

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Researchers find that automatically generated EHR messages account for half of the 243 such messages the average doctor receives each week, with far fewer of their incoming messages originating with colleagues and patients. The auto-generated messages involved health maintenance reminders, prior authorization requests, and patient reminders. Researchers also found that doctors who say they are burned out are more likely to be receiving a higher number of automated messages. The study involve one health system using Epic, but that’s not the point – it’s yet another reminder that there’s a cost to “Revenge of the Ancillaries” where the desire of non-doctors to push information in the faces of doctors is allowed with the best of intentions but not necessarily the best of outcomes. A previous study found that PCPs spend 23% of their day managing their EHR inbox.

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At least one hospital is using a company’s questionably accurate “aggression detection” voice analysis software, whose machine learning algorithms constantly monitor the sound patterns from publicly placed microphones in attempting to detect verbal aggression before it turns into violence. Netherlands-based Sound Intelligence also markets its system for hospital patient monitoring

UF Health (FL) adds a gender identity section in its EHR as recommended by a LGBTQ+ employee advisory committee, in which patients will be asked their gender identity and pronouns at registration.

The American Medical Association says the proposed interoperability rules of CMS/ONC “threaten patient privacy” by requiring providers to share their information with third parties that aren’t required to keep it private, potentially creating a market for patient data to be sold. 

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Malaysia’s government hopes to implement EHRs at its 145 hospitals and 1,700 clinics at an estimated cost of $360 million, with an open tender to be posted later this year.

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Non-profit NorthBay Healthcare (CA) explains to bondholders that three big insurers have terminated their contracts because “we’ve been able to maintain very lucrative contracts without the competition” in a startling admission that the health system uses its oligopoly power to charge high prices. The health system has increased revenue by 50% in the past five years due to lack of competition, leading experts to conclude that the benefits of price transparency are minimal when consumers have few hospital choices. I didn’t see anything fun in the health system’s tax records other than four of its highest-paid employees are staff nurses who made $400K each. The CIO was paid $500K.

Piedmont Healthcare (GA) will require patients who don’t have insurance, as well as those who have high-deductible plans, to pre-pay 25% of the estimated cost upfront for non-emergency services, explaining that bad debt represents 8% of the health system’s revenue because patients can’t afford to pay their high deductibles.

The city of Lake City, FL fires its IT director after an employee’s opening of a malware-containing email introduced ransomware into the city’s computer systems, after which its insurer agreed to pay the hacker’s demanded $460,000 ransom. The malware was identified as a Triple Threat attack, which runs an email-contained macro that loads several types of malware, after which it notifies the hackers so they can decide if the organization is worth holding for ransom. Another Florida city that experienced a similar attack recently paid a $600,000 ransom, while Baltimore complied with a law enforcement recommendation to refuse to pay a hacker’s demanded $80,000 and is still attempting to recover after spending $18 million. I’m picturing a teen hacker sitting in a coffee shop in Eastern Europe watching their account bump up by an untraceable, untaxable $460,000.

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I’m thinking this DoD tweet trivializes the integration challenges ahead even as it uses “interoperability” in a bafflingly wrong way. I’m reminded of the absurdity of Allscripts CEO Glen Tullman proclaiming constantly a few years ago that all of the company’s multi-heritage EHRs were integrated by definition because they all used the Microsoft SQL database.


Sponsor Updates

  • Medicomp Systems CEO David Lareau is accepted into the Forbes Technology Council.
  • WebPT offers a report titled “The State of Rehab Therapy 2019.”

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Morning Headlines 7/2/19

July 1, 2019 Headlines 2 Comments

QGenda Announces Acquisition of OpenTempo

Provider scheduling solutions vendor QGenda acquires OpenTempo, which offers clinical resource optimization tools.

Telemedicine apps are thriving because working moms love the convenience of their smartphones

Telemedicine providers say that mothers are their super users and advocates in their role as “chief medical officers of the family.”

Physicians’ Well-Being Linked To In-Basket Messages Generated By Algorithms In Electronic Health Records

Researchers find that EHR-generated messages account for half of the 243 such messages the average doctor receives each week, multiples of the number sent by colleagues and patients.

Curbside Consult with Dr. Jayne 7/1/19

July 1, 2019 Dr. Jayne 1 Comment

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One of the challenges we have in healthcare IT is figuring out whether different technologies bring an adequate return on investment. This can be particularly challenging when the expenditure falls to one team’s budget (such as information technology) but the cost savings occurs elsewhere (such as the central scheduling department).

Organizations use a variety of cost transfer mechanisms to try to sort this out, but often the calculations fail to fully represent the true work needed to deploy a new solution, especially on the part of the end users. This becomes even more complicated when the solution is a combination of technical tools and operational changes, such as might be required for a practice to advance through recognition as a Patient-Centered Medical Home.

As we move into value-based care, it will be more important for practices to understand the costs and benefits of new models of care. To be honest, many independent practices are not well equipped to try to figure this out. I was excited to see that NCQA has engaged with Milliman’s actuarial team to offer guidance on how practices can calculate return on investment for that type of clinical transformation project.

The NCQA white paper is publicly available, and even if you’re not knee-deep in one of these projects, it provides background for greater understanding of what it takes to re-engineer a practice. The hypothetic practice in the paper represents a 10-physician primary care practice with approximately 20,000 commercially-insured patients. The model concluded that there would be an increase in revenue, although it varied from 2% to 20% depending on payment models.

Although 2% still represents a positive return on investment, I’m not sure how many practices would be willing to embark on wholesale modification of how they do business for that small of a gain. Many practices pursuing Patient-Centered Medical Home recognition do so for other reasons, including the belief that it’s the right thing to do and/or that they will be able to provide better or higher quality care for their patients.

As with any calculation of this kind, NCQA points out that this is a hypothetical practice and our mileage may vary based on the actual characteristics of our practices. To further the effort, Milliman helped develop guidance for practices to develop a pro forma to calculate their own return on investment data. The guidance is clear on the fact that the numbers will vary based on:

  • Practice size and location.
  • Payer mix and payer models.
  • Medical complexity of the patient population.
  • Degree of change needed to practice processes, procedures, and reporting to align with PCMH.
  • Ability of the practice to meet quality targets.
  • PCMH program rules.

I frequently work with practices that are considering whether they will pursue recognition as a Patient-Centered Medical Home. Often, they jump straight to trying to figure out whether their EHR supports PCMH or whether their technology vendor has programs that will make it easier. Some vendors support a subset of PCMH standards but not others – a host of organizations have developed recognition programs, including HCQA, The Joint Commission, the Accreditation Association for Ambulatory Health Care, and the Utilization Review Accreditation Committee, not to mention other homegrown programs developed by practice networks, health systems, and payers. I find that educating practices on the differences between the different programs is a good first step beyond asking whether the EHR can support it. Often the burdens of a particular program will be a deal-breaker for a practice.

Practices must next consider whether they have the capacity to change, which often translates to whether the physicians have the capacity to change. If physicians are employed, this might be mandated by the organization, but in physician partnerships, it can be daunting if some partners want to move forward but others don’t. It doesn’t matter what the return on investment might be if you can’t get everyone on board. I’ve worked with physicians who aren’t able to delegate and don’t trust their support staff, so that makes the idea of team-based care a non-starter.

The white paper does a nice job listing out the costs during both the investment phase,  when it is figuring out how to manage the transformation, and during the maintenance phase, when they’re trying to sustain the change. They include the amount attributable to lost physician visits for the clinical champion along with time spent by a PCMH manager, other clinicians who lose time to huddles and quality improvement activities, care coordinators, etc.

In reality, many practices don’t allocate dedicated time for physicians to work on PCMH or other initiatives. Instead, they expect the team to perform these tasks on top of their usual workload, under the guise of “other duties as assigned.” I suppose under that model the return on investment becomes even greater from a purely monetary standpoint, although the job satisfaction element may be on the decline.

It goes on to note that contractual requirements for PCMH recognition are the strongest ways to drive provider behavior. The authors discuss the issue of multiple contracts with differing payers and the need to try to align those requirements in order to work efficiently and to not have to meet multiple PCMH standards. It provides a good list of questions for CEOs and CFOs to consider when contemplating a move to one of these care models.

Overall, I think the white paper provides an excellent tutorial for practices considering a change. There are definitions of key terms and explanations of the process along with the actual guidance for doing the calculations. Whether you’re on the tech side or the patient-facing side, it’s a nice primer to better understand what your organization might be getting into when they start talking about Patient-Centered Medical Home or other care models such as Comprehensive Primary Care Plus (CPC+) or Primary Care First, which are based on PCMH. Knowledge is power and I will definitely be using this tool as a conversation starter when working with practices who want to embark upon clinical transformation.

Has your organization found success under the Patient-Centered Medical Home Model? Leave a comment or email me.

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Readers Write: Five Emerging Imaging AI Workflows

July 1, 2019 Readers Write No Comments

Five Emerging Imaging AI Workflows
By Stephen Fiehler

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Stephen Fiehler is founder and CEO of Interfierce of San Francisco, CA. 

Medical imaging is one area of medicine that could significantly benefit from the implementation of artificial intelligence (AI). Applications that interpret chest x-rays, detect stroke, and identify lung cancer are already available. Many AI solutions have garnered FDA approval for commercial or clinical use.

However, few if any have mastered a “best practice” workflow that seamlessly integrates the application’s output with the hospital’s other clinical applications (i.e. PACS, EHR, dictation system). How should the application’s output be delivered? Who should see it first? The answers to these questions are dependent on the nature of the algorithm (i.e. stroke detection, chest x-ray, pediatric bone age), but five workflows are emerging for imaging AI applications.

Advanced Visualization

Many imaging AI applications are delivering their output to an interpreting radiologist within a separate application. The radiologist is commonly working out of PACS, the dictation system, and the EHR. The Advanced Visualization (or post-processing) workflow introduces an additional application to the radiologist’s workflow. Sending the study to the AI application, launching it, and running the images through the algorithm can add significant time to the interpretation process. The Advanced Visualization workflow sets a high bar for the value of the AI application’s output. If the application does not save the radiologist ample time or provide substantial value, the Advanced Visualization workflow is not viable.

Dictation System Integration

Some imaging AI applications are opting to integrate with the radiologist’s dictation system (i.e. Nuance PowerScribe 360). If an AI application has a discrete output that is independent of the images, it can send that value to the dictation system via Digital Imaging and Communications in Medicine (DICOM) structured reporting (SR). DICOM is the standard way of exchanging images and image related data in healthcare, and DICOM SR is discrete data associated with the imaging (i.e. left ventricle dimension in centimeters).

An example use case is an AI application that analyzes pediatric hand x-rays to determine the patient’s skeletal age can leverage DICOM SR to send its output to the radiologist’s report. The patient’s “Z-score” is conveniently embedded in the radiologist’s report as soon as she opens the study. She can then confirm the value or edit it before finalizing the result. Dictation system integration adds no time to the radiologist’s interpretation process.

PACS Integration

Computer aided detection (CAD) applications have been integrating with PACS for over a decade. CAD applications are designed to annotate images to improve the detection of disease, like breast cancer, and reduce false negative rates. These applications commonly integrate with PACS via DICOM secondary capture (SC), which adds additional annotated images to the study in PACS. Some AI applications use this same type of integration to send annotated images back to PACS to assist with the radiologist’s interpretation. DICOM SC requires the radiologist to navigate to the annotated images within the study, which can be cumbersome depending on the size of the study.

Worklist Prioritization

A popular type of AI integration is worklist prioritization. Many AI applications integrate with a reading worklist to prioritize studies that present signs of time-critical conditions, like stroke, spinal fractures, or pulmonary embolism. Rather than producing a complicated output like annotated imaging or DICOM SR, worklist prioritization simply elevates the priority of the study or flags it as a particular abnormality. This can help radiologists identify time critical studies more quickly in an effort to expedite patient care.

EHR Integration

To my knowledge, no imaging AI applications are sending results directly to the EHR. Yet direct-to-EHR may become the best practice workflow in the future for mature imaging AI applications.

Sending the output of the AI application directly to the patient’s chart in the EHR has many advantages and risks. The information would be immediately visible by other care team members who have the security to view preliminary results. Therefore, the report should adequately warn the viewing user that “THIS IS A PRELMINARY RESULT” and it has not yet been reviewed by a radiologist.

Careful consideration and planning should take place before implementing direct-to-EHR integration, but as AI applications mature in competency, it will become more common. Many hospitals opt to send an EKG machine’s automated interpretation directly to the EHR today. The result is clearly labeled “preliminary” and the inpatient or emergency room providers know it has not been confirmed by a cardiologist. However, the immediate availability of an imperfect result is valuable. I believe many imaging AI applications will eventually send their output directly to the EHR.

Morning Headlines 7/1/19

June 30, 2019 Headlines No Comments

Form S-1 Registration Statement – Livongo Health, Inc.

Diabetes management technology startup Livongo files for a $100 million IPO.

Public Comments on the Trusted Exchange Framework and Common Agreement Draft 2

ONC publishes the 100 comments it received for TEFCA Draft 2.

Demonstrating the Value of Nursing Care Through Use of a Unique Nurse Identifier

Authors recommend assigning nurses a unique identifier for use in EHRs and other systems that can help measure nursing contributions, improve nursing practice, and support research.

SA Health hunts for inaugural e-health chief

South Australia Health creates a new position for a top-level executive who will be tasked with salvaging its Allscripts implementation and developing a new digital health strategy.

Craneware shares plummet 34% as sales in US stall

Scotland-based revenue, cost, and financial decision support software vendor Craneware says sales volume and timing were off in the second half of the year, but it remains focused on being used by every US hospital.

Monday Morning Update 7/1/19

June 30, 2019 News 9 Comments

Top News

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Diabetes management technology startup Livongo files for a $100 million IPO.

The company’s SEC filing indicates that the company’s revenue doubled from 2017 to 2018 to $68 million, but losses also doubled to $33 million.

The company’s standard boilerplate warnings note that it would have a real problem if Executive Chairman Glen Tullman were to leave. He and the 7WireVentures firm he manages with Lee Shapiro – they were CEO and president of Allscripts, respectively, until the company fired them in late 2012 — hold 9.4 million shares of the company, or 11.7%.

CEO Zane Burke was given nearly 1 million shares, 1.2% of the total, when he was hired in December 2018, two months after resigning as president of Cerner.

Livongo reports having 413 clients representing 114,000 diabetes members whose contracts are worth $155 million. 


Reader Comments

From Dippity-don’t: “Re: NextGen Healthcare. Laid of 100 employees Wednesday. All business analysts, developers, and QA for practice management’s financial, real-time transaction, and patient portal are now offshore. The Milledgeville office was also closed.” Unverified. I didn’t see anything on Georgia’s WARN site.

From I CIO J: “Re: contract gag clauses. Our Epic contract had no such clause and no one from Epic ever raised this concept.” I remain convinced that “gag clauses” are as mythical as the Loch Ness Monster, the subject of rumors spread by people who have never held a position of significant health system IT authority and have never seen an actual vendor contract. A vendor executive asking you nicely (or not so nicely) to remove the extensively detailed screen shots or product documentation that you posted widely for whatever reason isn’t a gag clause, it’s intellectual property protection, which is always part of an IT contract. You can’t assume that a gag clause exists just because your health system boss blames your vendor for shushing you – health system executives often bend too far in hoping to remain in good vendor graces, but that’s not a gag clause. Neither are general non-disparagement terms. It’s true that, this being America and all, companies are free to threaten and sue anyone they feel threatens them, but that’s outside the scope of enforcing a contract term. 

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From Clause or it Didn’t Happen: “Re: contract gag clauses. I wish you could ask Eric Topol directly what evidence he has – he has mentioned gag clauses, specifically calling out Epic, in his book and tweets.” I’ve emailed Eric Topol and will let you know what (if any) response I get.

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From HITPurist: “Re: Epic’s power over a health system. Remember how Texas Health Resources issued a press release about Epic not allowing the MD to see the Ebola patient’s travel history? THR retracted the statement, which implied that Epic’s attorneys forced them to. Can anyone share insight?” I talked to a couple of THR insiders right after the October 2014 event. My conclusion from those conversations was that THR was so anxious to shift the unfavorable PR spotlight elsewhere that its executives quickly threw Epic under the bus after performing little due diligence, not even asking its own IT folks to assess the EHR setup before proclaiming that as the problem. I’m sure that Epic complained vigorously upon being called out in a press release, as would any vendor who was publicly blamed for a high-profile error. In fact, THR’s press release in which it blamed Epic even included this wording: “Texas Health Dallas has relocated the travel history documentation to a portion of the EHR that is part of both workflows.” That suggests that THR corrected its own faulty Epic setup without requiring Epic’s help. THR’s handling of the Ebola patient was inept, to the point that one of its ICU nurses who was exposed to the patient sued the health for poor training and for disclosing her name and medical condition without her permission. A good post-mortem research analysis is here. The bottom line is that THR was no different than most US hospitals in being prepared to treat, but not diagnose, Ebola.


HIStalk Announcements and Requests

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The top reason that poll respondents don’t work for themselves instead of someone else is their concern about stable income and employment.

New poll to your right or here: What is the #1 factor that would motivate you to take a new job?

I have to work harder in the slow summer months (aka “The Doldrums”) to find new sponsors to replace those that have been acquired, run out of money, or made as our unresponsive contact a clueless marketing newbie who knows nothing about the industry. Contact Lorre to learn about:

  • A special deal on webinars
  • A bonus for new sponsors
  • A money-saving package for startups

Vince Ciotti’s HIS-tory Series

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Industry long-timer, iconoclast, and raconteur Vince Ciotti penned (PowerPointed, actually) the remarkable HIS-tory series that I ran on HIStalk over several years starting in 2011. Vince recently closed his firm of 30 years, H.I.S. Professionals and retired. He wanted to make sure that the HIS-tory series remained accessible, so I’ve combined all of the 125+ entries into a single downloadable, searchable PDF document. It works best if you download it, then open it in Acrobat Reader instead of directly in your browser.

This document of nearly 1,300 pages covers the history of our industry from the mid-1960s through 2000 or so. Vince captured information that might have been otherwise forgotten as health IT’s pioneers have changed industries, retired, or passed away.

I asked Vince if he might be up for adding new reader-contributed material, clarifications, corrections, etc. Vince jumped at the chance because, in his words, “I’m so bored with retirement that you wouldn’t believe it.”

Vince and I would be interested in your pre-2000 contributions as follows:

  • A “where are they now” update on the folks Vince mentioned who he has lost track of.
  • Scans of your interesting old magazine articles, ads, etc. like those he included.
  • Your anecdotes about the companies, products, and people that he mentioned.
  • Anything else that you think is fascinating or important about that health IT era through 2000. This might be the last chance to archive what you have or know for future readers.

I won’t update the original slides, but instead will invite Vince to create new ones that update the series with the new information you send. I’ll probably run those on HIStalk as he finishes them, hopefully generate additional reminisces, and then roll those into the PDF file above.

Thanks for your contributions. Email Vince at vciotti@hispros.com or me.


Webinars

July 18 (Thursday) 2:00 ET. “Healthcare’s Digital Front Door: Modernizing Medicine’s Mobile-First Strategies That Are Winning Patient Engagement.” Sponsor: Relatient. Presenters: Michele Perry, CEO, Relatient; Michael Rivers, MD, director of EMA Ophthalmology, Modernizing Medicine. Providers are understandably focused on how to make the most of the 5-8 minutes they have on average with a patient during an exam, but what happens between appointments also plays a significant role in the overall health of patients. Modernizing Medicine is driving high patient engagement with best practice, mobile-first strategies. This webinar will describe patient engagement and the challenges in delivering it, how consumerism is changing healthcare, and how to get started and navigate the patient engagement marketplace.

July 25 (Thursday) 2:00 ET. “Meeting patient needs across the continuum of care.” Sponsor: Philips Population Health Management. Presenters: Cindy Gaines, chief nursing officer, Philips Population Health Management; Cynthia Burghard, research director of value-based healthcare IT transformation strategies, IDC. Traditional care management approaches are not sufficient to deliver value-based healthcare. Supplementing EHRs with advanced PHM technology and a scalable care management approach gives health systems proactive and longitudinal insights that optimize scarce resources in meeting the needs of multiple types of patients. This webinar will address the key characteristics of a digital platform for value-based care management, cover the planning and deployment of a scalable care management strategy, and review patient experience scenarios for CHF and diabetes.

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


Acquisitions, Funding, Business, and Stock

Shares of Scotland-based Craneware drop 35% after the company reports disappointing second-half sales.


Decisions

  • Ascension Seton Smithville Regional Hospital (TX) will go live with Cerner in 2019.
  • Abbeville Area Medical Center (SC) replaced Evident (A CPSI Company) with Athenahealth in September 2018.
  • Kennedy Krieger Institute (MD) will go live on Epic on July 1, 2019.
  • Dupont Hospital (IN) went live on Cerner on March 1, 2019.

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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Andy Crowder (Scripps Health) joins Atrium Health as SVP/CIO and chief analytics officer.

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CI Security hires Drex DeFord (Drexio Digital Health) as healthcare executive strategist.


Government and Politics

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ONC posts the 100+ comments it received about TEFCA Draft 2.


Other

England’s NHS will develop an app that allows patients to anonymously register any concerns they have about their treatment.

Lawyers for former Theranos CEO Elizabeth Holmes blame Wall Street Journal reporter John Carreyrou for unduly influencing FDA and CMS to shut the company down, claiming that he was “eager to break a story, and portray the story as a work of investigative journalism.” Holmes says the reporter prodded his sources to file government complaints about Theranos, then pressed those agencies to investigate them.

South Australia’s SA Health creates a new chief digital health officer position to lead the overhaul of its Allscripts-powered EPAS system that has struggled with project delays, cost overruns, and usability problems. The EPAS concept has been retired in favor of a change in direction as evidenced by the new position’s job description as described by SA Health’s CEO: “We’re looking for somebody to take us from that centrally controlled, large monolithic systems across SA Health to protecting our core data, protecting our single patient view, but capitalizing on an interoperability, best of breed, switch-in switch-out wave of innovation from small new technologies.” The new hire will serve as the government’s top executive for e-health and will develop its digital health strategy.

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Medtronic recalls an older model insulin pump because of theoretical cybersecurity issues that it says can’t be fixed with an update, although skeptics question whether the company is using the flaw as a way to force users to buy newer models such as the 670G, with was found in a small study to have been abandoned by 40% of users because of usability issues.


Sponsor Updates

  • Loyale Healthcare will offer the CareCredit credit card as part of its Affordability Workbench patient financial solutions.
  • MHK integrates the prior authorization functionality of Surescripts into its member care platform.
  • The South Florida Business Journal profiles MDlive.
  • NextGate’s identity-matching solutions are now available in the Microsoft Azure Marketplace.
  • Thrive Global profiles PatientKeeper CMO Christopher Maiona, MD.
  • Relatient publishes a new case study, “How US Dermatology Partners Solved the Patient Intake Bottleneck with Mobile Registration.”
  • The American Academy of Nursing inducts Vocera CNO Rhonda Collins, DNP, RN into its 2019 Class of Fellows.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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Weekender 6/28/19

June 28, 2019 Weekender No Comments

weekender 


Weekly News Recap

  • Change Healthcare goes public on the Nasdaq exchange.
  • Providence St. Joseph Health acquires Bluetree Network.
  • Sansoro Health and Datica announce plans to merge.
  • Vyne is acquired by PE firm The Jordan Company.
  • The director-general of Australia’s Queensland Health announces plans to resign following problems with its Cerner implementation.
  • UnitedHealth Group acquires PatientsLikeMe in a government-ordered fire sale.
  • The White House issues an executive order requiring providers to disclose pricing information.
  • Phreesia files for an IPO.

Best Reader Comments

From my reading of Change Healthcare’s filing, they mostly make their money from EDI and sending people bills in the mail. Is that correct? Their actual software revenue seems to be smaller and lower margin. That doesn’t seem good as software is supposed to be high margin and they will have a lot of future competition from EHR vendors on the provider side and payers’ own IT staff / Optum et al on the financial side. (WhatAreTheyCha(n)(r)ging?)

Many of our newer contracts for software require that we stay relatively current with upgrades, such as the being no more than one full release behind the current production release. These ‘N-1’ provisions seem to be good for our business and also for the vendor. The vendor doesn’t have to provide backward compatibility for five releases in use so they can put more effort into current fixes and future enhancements. They also work harder on the testing of new releases because if they don’t, half of their clients are going to be really mad because they’re taking that version. N-1 contracts also set an expectation internally with our departments. We tell them they’re getting on a treadmill and they don’t get to jump off without paying a hefty software maintenance premium for supplemental support. Upgrading also puts downward pressure on customization and shifts the emphasis to configuration, which is where it should be. (IT Vendor Mgmt)

Would be interesting to see the gap, perhaps chasm, between what Mark Roche thought the CMS chief health informatics job was going to be and what it actually turned out to be. (JeanneC)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose grant request of first-year teacher Ms. K in Washington, DC, who asked for math manipulatives for her kindergarten class. She reports, “We have been in the full swing of our addition and subtraction unit. These hands on math manipulatives have been AMAZING to help us learn! We’ve been practicing using the unifix cubes, counters, and various other objects. Having manipulatives to use has helped us to better understand the concept and to get accurate answers. Thank you so much for your support!”

A study of crowdfunding campaigns for cancer-related expenses in Canada finds that high-income, highly-educated homeowners in urban areas make up the majority of people who ask others to pay for their cancer treatments. The authors conclude that crowdfunding does little to solve problems with the healthcare system.

A Lyft driver says VCU Medical Center should have warned him that the discharged patient he was called to pick up there was delusional and talking to himself in a loud voice. Lyft says that medical facilities that are scheduling a patient’s ride should indicate whether the rider is a patient who might pose a risk to others. The hospital says it can only do so much since patient rides can be arranged by the patient themselves, their insurance company, or an outside transportation company.

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A Philadelphia pain management doctor is arrested for handing out “goodie bags” of oxycodone and muscle relaxers to patients, for which he then billed insurers more than $4,000 each.

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Wired magazine covers a University of Colorado ED doctor’s simulation class that addresses the medical realities that will be faced by astronauts on Mars. The program, held at the Mars Desert Research Station in Utah, emphasizes that the medical issues of astronauts will need to be addressed with the people and resources at hand. NASA is running risk assessments to determine which medical problems are most likely, also considering whether crew members could use videos to guide them through performing medical procedures and use 3D printers to create medical equipment.

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A newspaper fact-checking a candidate for the Florida House of Representatives who claimed to have to have — as an Orlando Health cardiologist and ED doctor — “removed 77 bullets from 32 people” after the Pulse nightclub shootings finds that she is neither a doctor nor an Orlando Health employee. State records indicate that Elizabeth McCarthy was a certified nursing assistant until 2005. She claims to have been an RN who went back to medical school who also played college basketball for both the University of Florida and Florida State University, which both schools say isn’t true.


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Reader Comments

  • Mr. HIStalk: I was going for the $49 deal, but I got a popup on the company's site for the $36 price. Maybe because I had download th...
  • Layni: Thanks for pointing out PDF Architect - it seems like a good product from what you say & the website's description. ...
  • Code Jockey: "For starters, they are doing custom Epic development so once they make certain changes in the system, they will then ma...
  • Associate CIO: I can only give my opinion and I say that because people love to shred opinions without ever giving a solid opposing arg...
  • SIW: Good analysis. Do you think Providence or John Muir's strategy will work?...
  • Cherry Garcia: Trust me, you were never cool....
  • Associate CIO: While you can make a legitimate argument that no one knows anything in healthcare, these to situations are quite differe...
  • Nobody Knows Anything: John Muir outsources its IT and analytical functions while Providence bought an entire consulting company to go deeper i...
  • Robert Smith: I hope the outsource deals works out for John Muir and goes better than most outsourcing. Typically the client never ...
  • AI lover: Re: Memorial Sloan Kettering Cancer Center AI paper: 1. It is not unsupervised as you've mention and it is not "weakl...

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