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Readers Write: Three Reasons to Look Beyond the SNF Five-Star Rating When Assessing Potential Hospital Partners

May 15, 2019 Readers Write No Comments

Three Reasons to Look Beyond the SNF Five-Star Rating When Assessing Potential Hospital Partners
By Tom Martin

Tom Martin is director of post-acute analytics for CarePort Health of Boston, MA.


Last month, the SNF Five-Star Rating program underwent major changes in all three domains. As a result, many SNFs saw their ratings drop on Nursing Home Compare, and many hospitals and health systems questioned whether these facilities could continue to meet their high standards for quality.

A close look at the program’s methodology revealed that CMS’s changes in measurement were the root cause of the decline in ratings, as opposed to a true dip in quality. As tempting as it is to use the star ratings as the primary criteria for adding or keeping SNFs in a preferred post-acute network, there are a few compelling reasons for hospitals to look beyond these general statistics and consider alternative strategies.

The first reason is that the quality domain carries the least weight though it includes some of the most important measures.  The survey domain is the most heavily weighted in the calculation of a facility’s overall star rating.

While surveys are certainly an important indicator of quality, they’re not the most relevant or timely markers for hospitals that are assessing SNFs as potential partners. The results are subjective, standard surveys only happen once a year, and the forced distribution of ratings in this domain makes it difficult to know if a provider is truly improving or if other SNFs in their state are just getting worse.

In contrast, CMS is constantly adding new measures to the quality domain, some of which are highly relevant to hospitals. In fact, for a few key measures such as 30-day readmissions, ER visits, and successful discharge to the community that really matter to hospitals, the period of time that patients are followed has been extended beyond discharge from the SNF. These longer measurement windows are especially helpful to hospitals that are part of an ACO or involved in other value-based programming that holds them accountable for patient outcomes across the entire care continuum.

Unfortunately, with a total of 17 quality measures currently included in the quality domain, a SNF’s performance on these critical measures has a limited impact on its quality star rating and minimal impact on its overall star rating.

The second reason to look beyond the star ratings is that the claims-based quality measures are limited to the Medicare fee-for-service population. Even if a hospital or other acute entity such as an ACO focuses on the measures that are most relevant to them, as mentioned above, and ignores the composite star ratings, the data on these measures are confined to a facility’s Medicare fee-for-service population, which may or may not make up a significant portion of its current population. And looking ahead, the percentage of Medicare beneficiaries choosing to receive their benefits under a Medicare Advantage plan will only continue to rise, making these fee-for-service claims-based measures even less representative of the quality of care provided at a SNF—ironic given that they would otherwise have the potential to provide the most valuable information in the program.

The third reason to look beyond the star rating system is that changes in measurements, such as those made this April, have occurred many times over the 10 years the program has been in place and will likely continue to occur. But as we saw in April, they skew the data and can mask true trends in quality, making it hard for hospitals to get a complete and accurate picture of the performance of participating SNFs. What hospitals really need are objective means of measuring performance, and that’s not a given with the Five-Star Rating program. For example, in April CMS changed the cut points for the various star levels in the staffing domain, so even though a provider may have actually increased staffing levels in April, that provider may still have received a lower rating due to these new higher thresholds.

Selecting a few measures from the Five-Star Rating program to focus on when assessing potential SNF partners is a reasonable strategy, but one that doesn’t quite go far enough in the era of value-based care. In today’s climate, where hospitals and health systems are being held responsible for patients long after their inpatient stays are over, these acute entities need to be much more closely connected to their downstream partners. They need access to real-time patient data from SNFs, and not just on their Medicare FFS patients, but on their entire population.

All stakeholders—acutes, post-acutes, and most importantly, patients—benefit when providers break down data siloes and exchange healthcare information freely. Simple alerts stemming from ADT (admissions, discharge, and transfer) data can go a long way toward helping providers stay on top of what’s going on with their patients. The star ratings have their place, but to truly understand the quality of care that is being provided by their post-acute partners and ensure patients are receiving high-quality care at every point in the continuum, hospitals need to get proactive and start collecting their own data.

HIStalk Interviews Ashish Shah, CEO, Prepared Health

May 15, 2019 Interviews 2 Comments

Ashish Shah is co-founder and CEO of Prepared Health of Chicago, IL.


Tell me about yourself and the company.

I was previously the chief technology officer for Medicity, where I worked for about eight years leading up to the acquisition by Aetna. I stayed for three and a half years post-acquisition. Prepared Health is a Chicago-based company that is a little over four years old. Our platform connects hospitals and health plans to post-discharge providers such as post-acute care facilities, home care, and social determinants of health partners.

Your new customer Jefferson Health said in the announcement that they want to offer “healthcare with no address.” How are hospitals motivated financially to coordinate post-discharge care?

What’s been happening in healthcare over the last 20 years is a physical re-engineering. For a long time, care was organized around the institution, the community, the beacon, the hospital. Everyone could point to it. But there’s been an overwhelming amount of merger and acquisition activity as pressure increases over cost and improving the access in the community. Sometimes that’s care in the home, sometimes it’s rehab facilities or ambulatory sites. We’re starting to see significant re-engineering of physical assets and communities.

Jefferson is thinking about care not only in those care settings, but also virtually and on demand. You never know when you’ll have a moment that requires a healthcare encounter, so make it easier. President and CEO Dr. Stephen Klasko is a pretty special guy. He reminds me a little bit of Mark Bertolini at Aetna when he talked about quality equaling convenience. Trying to make life easier in healthcare, which is a mess, unfortunately. That’s why I started this company.

Who pays for your system? Do hospitals convince their local post-acute care providers to use it to manage their shared patients?

Like all early companies, we’re not immune to having to figure it out. But in our model today, everyone pays a modest subscription for the platform. We don’t have a limitation on the number of users, the number of patients who are managed, or the number of coordination moments that are managed through our network. That was by design. Part of the challenge is simplifying the entire go-to-market model.

Hospitals pay, but it is our ultimate responsibility to bring post-acute care sites — home health, other home-based providers, and community-based providers – online. That’s part of the value. It’s a difficult job, not only for hospitals, but for health plans, too.

Were hospitals already in regular contact with those post-acute care providers, or is it a new new relationship for the two groups to be at least talking, if not actually working together?

It’s starting to change. A lot of those relationships have been at the social work level. If you had a transitional care nurse or a licensed social worker who was managing that transition out of the hospital, they were the ones who knew the facilities and the home-based providers. It was a personal relationship. That’s how decisions were made on who goes where and for how long.

Cost and quality are bigger topics. You’re starting to see health systems start to invest in new roles, directors or VPs of preferred provider networks or post-acute care in addition to population health roles. There’s more of an effort to try to understand your partners outside of the hospital. The reality is that you can’t acquire enough providers. There will always be a capacity issue. These groups are trying to get a handle on who the very best partners are to invite into their preferred network.

The product screenshots on your site look a lot like Facebook. How important is the user interface when users work for post-acute care organizations that may not use much technology and who may perform all their work on a mobile device?

This is the principal design challenge. It’s extremely important.

If you don’t mind, I’m going to back up for a minute to talk about why I started the company. My father suddenly passed away six months after Medicity was acquired by Aetna. He was way too young. It was unfortunate. We felt unprepared. I was an executive inside of a healthcare business, but over the ensuing months after his passing, we spent time with people who were around him from a caring perspective. He was visited by home health aides. He spent time in senior centers. The toughest thing to understand was that many of these people knew what was happening with him, but there was no mechanism to share that information.

That was the most humbling moment for me. At Medicity, we had connected thousands of hospitals to many ambulatory care sites, yet nothing we we were working on was going to change our family situation with my dad. As I dug into the problem, there are 100,000-plus sites of post-acute home and community-based care. That’s being conservative. The challenge is a design challenge. How do you quickly organize a large ecosystem that the majority of the market says has no money? Why would you focus on that? Yet we know it is super critical.

When I left Aetna and Medicity, we looked at models like Facebook and LinkedIn. Although we had made nice progress, Facebook and LinkedIn had organized billions of users. Although our business model is not the same as theirs, there’s something to be learned from their design approach.

Sometimes technology just makes a process more efficient or transparent, but your platform does something that can’t be accomplished otherwise. You can’t get everyone from all these provider organizations and family members together at the same time in a conference room or conference call.

We are in a crisis right now as a country. Ten thousand people are turning 65 years old every day. People talk about the silver tsunami. It’s going to tax the healthcare ecosystem in a significant way, but 47 million people in the US are unpaid family caregivers. These are people who care and who are willing to do whatever it takes to take care of their loved one, but they have no coaching, no training, no access, no connectivity.

As much as I love many of the great healthcare IT companies that are out there, no one is really focused on this part of the space. What health systems and health plans are starting to talk to us about is that personal caregivers, family caregivers, somebody in the community, or post-acute care providers make up an important group of teammates that they need to get connected and coached.

What kind of interaction do family members typically have with the platform and the provider care team?

Our first version was full transparency, just the way I wanted it when I started the company. It’s not uncommon to see home health staff and all the different workers connected to the family members around an individual. Or maybe a skilled nursing facility is also involved. Everyone is in together.

The types of things that people are doing are escalations and managing interventions. If somebody has a fall in the home or if there’s a sudden change in mood or weight gains, those are prompted by the professional care team to the family members and communication around those moments is being managed. These are difficult moments for families and there’s a lot of emotion in these conversations. What we’re most proud of is that through our implementation, we’ve seen these two groups turn into one team versus two teams that sometimes let emotions get the best of them.

As we think about scaling that experience, our provider organizations have coached us to think about how to keep the convenience and access in place, but to think about this as two modes of communication — a back office communication channel where things are communicated in shorthand and then a front office communication channel where you have buttoned up or polished communication with the patient and family. The concern is always that somebody will say something that makes the organization look bad. We’re working through that with some of our earlier customers.

It would seem beneficial to allow caregivers who work for different organizations and who may rotate assignments to have a closed channel that allows them to take a conversation offline.

We’ve paired group-based communication with individual communication. We’re trying to attack any mode of communication. That could be an assessment, an electronic check-in on how you’re progressing, a referral, or a transition. We incorporate group and secure texting and chat into the product. Interestingly, we see high utilization of all of these across the board.

The magic is communicating with somebody outside your organization. That’s the biggest challenge. I spent 10 years working on data interoperability in healthcare and God bless everyone who is trying to push all that stuff forward, but I think we have skipped over the fact that a number of these types of things will never happen through an EMR. People don’t talk through EMRs. They don’t manage interventions in real time through EMRs.

What kinds of things does your virtual care coordinator recommend?

DINA is our digital nursing assistant. She was an accidental invention. It started with how we could create this rapidly growing ecosystem or community for communication. In our first implementation, we met Amie Martinelli from Bayada Home Health Care. I’ll never forget her. She did an amazing job of coordinating care for complex CHF patients. When we looked back at the implementation, we thought, how will we ever scale Amie? Is this what everyone in healthcare is doing? As we studied more, it is what everyone is doing.

Every great outcome is an exception. Someone has to put forth a heroic effort to make sure all the right things happen. That’s hard in a market where there’s 40-50% turnover. We thought that a combination of advanced analytics, AI, and all the other buzzwords could be an answer. Today, DINA is present in our network and she is aware of all the communication. When people integrate their data with our solution, we get our hands on rich functional, behavioral, and other types of assessments. She can recommend people who perhaps should have a particular type of service, who could be seen at a more optimal care site, or whose situation should be escalated.

One that stands out is hospice. Sometimes people are on home health for a long time. They are re-certified over and over and over again. A lot of that is because of the personality of a nurse. They never want to quit on a patient. We’ve taught DINA to identify that moment where perhaps it’s time to have a more difficult conversation around palliative care options or hospice. One of the things that you’ll never find in a hospice eligibility guideline is the inability to use the telephone, but our predictive models found that to be a huge predictive factor.

DINA is aware of a lot of the communication. She can recommend people for conversations around hospice or perhaps a readmission back into skilled nursing versus a hospital. She’ll notify people when they are crossing certain care guidelines. If somebody should have been in a skilled nursing facility for 10 days but they are on their 15th day, she will identify that and communicate it upstream. She can do a lot of things, but much of it involves intervention management.

The Jefferson Health contract gave the company a lot of visibility given its relatively modest amount of funding. Where do you see the business going?

We have been humble and quiet by design. We bootstrapped the company for two years because David Coyle and I were focused on understanding the market, solving a problem, and generating some revenue along the way. We raised a modest amount of money, $4 million, to build a team and enter a new region. We’re active in three states — Illinois, Pennsylvania, and New Jersey. We’re proud of the work in that greater Philadelphia market, which is a top eight metro market. We working not only with Jefferson, but also Holy Redeemer. Almost every major home health provider in that region is on our network and soon we’ll be adding many of the leading skilled nursing providers as well.

As we scale the business, we’re looking to take this national. We just added a new senior vice president of sales and marketing, which is a brand new role for us. But we feel like we’ve been doing this the right way. We didn’t oversell. We didn’t over-promise. We did the hard work of trying to understand the space and create a great product experience. We’re maniacal inside the company around Net Promoter Scores and engagement of the product. We stand on a solid foundation. That’s what we care about first and foremost. Do we create value, and do we create it at a faster rate than anything else that’s out there?

With a few wins under our belt, it’s time to pick up the pace on building the business. We have identified hot spots across the country where there’s a greater need, where Medicare Advantage and managed Medicaid in the aging population is growing faster than other places. We will zoom in on those as a starting point. We’re in a good spot to start to scale. We see a lot of companies that try to scale too fast. We’re in the right place at the right time, but we have to do the work like everyone else.

Do you have any final thoughts?

There have been a lot of competing incentives and sites of care. Nobody is trying to do the wrong thing. But the next major wave is Dr. Klasko’s “healthcare with no address.” Internally, we call that a never-discharge mindset. How do we care for an individual when they’re healthy, they have an acute need, or they move into the post-acute ecosystem? With the amount of M&A that’s taking place and the amount of change that is required, we need more people to adopt this never-discharge mindset. The caring never stops for the family or the individual, so it shouldn’t stop for the institution.

Morning Headlines 5/15/19

May 14, 2019 Headlines No Comments

Cerner to Work With DrFirst to Connect to State Prescription Drug Monitoring Programs

Cerner will connect its systems to state prescription drug monitoring program databases using DrFirst.

Erlanger working with tech companies to launch new era of artificial intelligence to identify, treat strokes

Erlanger Health System (TN) works with AI-focused health IT startups and Neural Analytics to develop and pilot software and apps capable of detecting blood clots in the brain.

Seattle Children’s spin-out MDMetrix raises $3M to unlock data from medical records

Seattle Children’s Hospital analytics and data visualization spin-off MDMetrix raises $3 million.

News 5/15/19

May 14, 2019 News 8 Comments

Top News


AliveCor extends its ECG lead (no pun intended) over Apple with KardiaMobile 6L, which offers a six-lead ECG and expanded detection of arrhythmias including atrial fibrillation, bradycardia, and tachycardia.

The $150 consumer device has earned FDA clearance, works on both Apple and Android devices, and will reach the market in June.

Reader Comments


From Unconjoined Twin: “Re: Medi-Span. Hit by malware. We can’t do our monthly medical loads to Epic.” Verified, although I missed this when it first came up a week ago. Netherlands-based Wolters Kluwer released a statement Monday saying that it has restored most systems – which include CCH cloud-based tax systems and other applications in addition to healthcare — after it took them offline after discovering “the installation of malware.” Discussion on Reddit says the company’s website was down, along with its Internet access, email, and phones, with one person indicating that two of their employees received emails from a Wolters Kluwer email address that contained malicious links. A Krebs on Security report says file directories that are used to store new versions of its software were found to be writable by anonymous users, at least one of whom apparently uploaded suspicious files.

HIStalk Announcements and Requests

I’m increasingly annoyed by big health systems that suddenly claim they’re passionate about empathy, post-discharge care coordination, patient engagement, innovation, social determinants of health, and patient experience. Why now? They could have done those things at any time and didn’t. They were fat and happy until threatened by disruption and possible payment changes that threaten their massive bottom lines, so now they are suddenly the self-proclaimed experts and advocates. At least they are providing a good reminder that health systems do only what someone pays them to do, which isn’t necessarily the right thing. Maybe we need a tech innovation that dispenses dollar bills every time a doctor washes their hands or doesn’t prescribe an unnecessary antibiotic.


May 21 (Tuesday) 2:00 ET. “Cloud-Based Data Management: Solving Healthcare’s Provider Data Challenge.” Sponsor: Information Builders. Presenters: Jeremy Kahle, manager of planning and business development, St. Luke’s University Health Network; Shawn Sutherland, patient and member outcomes, Information Builders; Bill Kotraba, VP of healthcare solutions and strategies, Information Builders. Inaccurate provider data negatively impacts revenue cycle, care coordination, customer experience, and keeping information synchronized across systems and functions. SLUHN will describe how it created a single version of provider data from 17 sources, followed by a demonstration of how that data can be used in reports and geospatial analysis. Learn how Omni-HealthData Provider Master Edition provides rapid ROI in overcoming healthcare organization provider data issues.

May 30 (Thursday) 2:00 ET. “ONC Data Blocking Proposed Rule: What Health Systems Need to Know.” Sponsor: Philips PHM. Presenter: Greg Fulton, industry and public policy lead, Philips. Proposed data-blocking regulations could specify fines, disincentives, and de-certification of providers who don’t provide an API for patients to extract all of their data. This webinar will describe who is deploying APIs, the scope of data and third-party apps that can be used, the seven costs that do not count as a data-blocking exception, and the health system protections that don’t involve using a vendor. It will also provide examples of data blocking and further exceptions.

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

Acquisitions, Funding, Business, and Stock


Business Insider looks at startup Sempre Health, which texts patients to offer them cash savings if they fill their new prescription quickly. The discounts are funded by drug companies as an alternative to drug coupon programs. Co-founder and CEO Anurati Mathur was a data scientist at Propeller Health and before that at Practice Fusion.



Greenway Health hires Geeta Nayyar, MD, MBA (Femwell Group Health) as chief medical officer, where she will help guide development of the company’s next-generation, cloud-based EHR/PM known as Project Polaris, which the company says will incorporate the best features of  Intergy, Prime Suite, and SuccessEHS.

Announcements and Implementations

Collective Medical enhances its platform to enhance collaboration among physical and behavioral providers by adding a consent feature that complies with CFR 42 Part 2. The combined efforts of a physician group and community providers in using the system reduced 911 calls by 44%, EMS transport by 47%, ED visits by 36%, and hospital admissions by 42%.

Cerner will connect its systems to state prescription drug monitoring program databases using DrFirst.


Definitive Healthcare adds prescription drug claims to its all-payer commercial claims platform, allowing users to analyze prescribing patterns, diagnoses, procedures, and referrals.

Storage array vendor Infinidat, whose systems use disk-based storage with memory caching, creates a software-defined flash array called Epic Compatibility Mode that it hopes will allow it to earn Epic certification since Epic does not allow disk-based storage for performance reasons.


Relatient announces GA of an electronic registration and check-in solution that expands its Digital Front Door strategy and patient engagement platform.

Appriss Health announces a dynamic patient matching solution for its prescription drug monitoring program connectivity system.

CHIME and Sheba Medical Center at Tel Hashomer – Israel’s largest hospital – will create a health innovation lab within the hospital’s innovation center.

Government and Politics

A medical laboratory sales rep receives a 50-month prison sentence for Medicare fraud after he used a sham non-profit group to convince seniors living in low-income housing to submit to genetic testing. He recruited two healthcare providers via Craigslist to provide phony documentation, netting the three co-conspirators $100,000 in commissions from two clinical labs.


A doctor who followed the suggestion of a conference speaker on social media to Google herself is shocked to find 100 negative reviews and comments that had been left on Vitals, Healthgrades, and Google, with none of the reviewers being actual patients but rather anti-vaccine activists who targeted her because of a social media comment she made in support of a colleague who was undergoing vaccine-related cyberbullying. None of the three sites removed the ratings until she got her lawyer involved. I notice that Healthgrades has removed the fake reviews, but the nut jobs have now just thumbs-downed them, while WebMD still has nearly all one-star reviews. A pediatric practice that posted a video recommending the HPV vaccine had its webpage as well as outside ratings websites flooded with 10,000 negative reviews and comments, while the Facebook of an internist who simply mentioned that his office had received its flu vaccine shipment was bombarded with hundreds of comments accusing him of poisoning children. We live in a shaky society when people can muster up so much ignorance and anger over a flu shot.


Well said. It’s not the job of a business to tell customers how to reconfigure their lives for the convenience of the business. The “problem” isn’t that of patients.


The Department of Defense profiles eight senior Army nurses who worked together early in their careers at William Beaumont Army Medical Center. Among them is WBAMC CIO/CMIO Lt. Col. Rich Clark (fourth from left in the photo above), who says, “Even though I work in IT, being a nurse helps bridge the gap between the physicians and IT. We look at IT from a clinical perspective now, to support the clinicians. I love coming to work every day, no day is ever the same. For us it feels like yesterday that we were in the operating room and medical ward. It’s not just the camaraderie, but it’s the mission, too. We’re taking care of America’s sons and daughters. It’s not about the money, it’s about the role and the impact that you can make.”

Sponsor Updates

  • AdvancedMD will exhibit at the America Psychiatric Association event May 18-22 in San Francisco.
  • Arcadia CMO Rich Parker, MD will speak at the New England HIMSS Conference May 16 in Foxborough, MA.
  • Artifact Health will exhibit at ACDIS 2019 May 20-23 in Orlando.
  • Avaya will exhibit at the E-Health Conference & Tradeshow May 26-29 in Toronto.
  • Dan Mendelson joins the board of Audacious Inquiry.
  • Datica CEO Travis Good, MD will speak at HITRUST 2019 May 21-23 in Grapevine, TX.
  • CompuGroup Medical will exhibit at the McKesson Sales Meeting May 15-16 in Las Vegas.
  • Impact Advisors VP John Stanley is named as one of Consulting magazine’s top 25 consultants.
  • Collective Medical updates software functionality to include a new consent feature to support better care collaboration between mental and physical health providers.
  • A UCONN computer science and engineering team sponsored by Diameter Health prototypes a new clinical user interface at UCONN’s Senior Design Presentation Day.
  • Cumberland Consulting Group will exhibit at the Medicaid and Government Pricing Congress May 20-22 in Orlando.

Blog Posts

Get Involved



Morning Headlines 5/14/19

May 13, 2019 Headlines No Comments

AliveCor’s FDA-cleared 6-lead ECG aims to detect more than the Apple Watch

AliveCor gains FDA clearance for a new ECG device that, when it debuts in June, will be the first consumer-grade product to monitor heart activity on six different leads. 

MiraMed and Medac Join to Create Leading Revenue Cycle Management Platform in Anesthesia Market

Business process outsourcing company MiraMed merges its Anesthesia Business Consultants subsidiary with anesthesia practice management and billing vendor Medac.

Dr. Geeta Nayyar to bridge medicine, business, and health information technology as chief medical officer for Greenway Health

Greenway Health names Geeta Nayyar, MD (Femwell Group Health) CMO.

Curbside Consult with Dr. Jayne 5/13/19

May 13, 2019 Dr. Jayne 4 Comments

We as CMIOs are often called upon to try to use data, information, and knowledge to try to solve complex problems that are caused by specific factors within the US healthcare system. They might be tied to low health literacy, funding barriers, or the high cost of care. I’ve worked with people to try to strategize around school-based health centers, community outreach programs, healthcare for the homeless, and more.

Since I often see situations where health insurance coverage (or lack of coverage) becomes part of the care equation, I was interested to see this piece in the Journal of the American Medical Association. It asks the question: “Does Employment-Based Insurance Make the US Medical Care System Unfair and Inefficient?”

On the surface, it seems like the answer to the question is yes. I often see people trapped in jobs they don’t like or aren’t suited for because they are afraid of losing their insurance coverage. I see people staying in dysfunctional marriages or domestic partnerships because of the insurance issue. Insurance in general adds inefficiencies to our practice, as we have to hire a fleet of people to handle claims creation, management, denials, appeals, and other billing functions. The complexity of insurance rules and differences in coverage are significant and it’s nearly impossible for the average clinician to try to make sense of it without significant assistance.

The coverage offered by employers can differ in striking ways. I was privileged to grow up in a family that had excellent coverage that was tied to my father’s membership in a union, insurance that was independent of the contractor for whom he worked and which could be continued in the event of a job loss through credits that workers could bank over time. I didn’t realize until medical school how amazing it was that my parents still had a $5 co-pay and that they didn’t need a referral to go see a specialist. (Of course that was in the bad old days when you were kicked off your insurance when you finished college, so I didn’t think the coverage was that great when I had to pay out-of-pocket to have my wisdom teeth extracted after they caused issues during my first semester.)

This was during the time when HMOs were growing in the US and many patients were having to get used to the ideas of working through a primary care gatekeeper and of being restricted to certain groups of physicians or particular hospitals. Now that we’ve seen that approach wax and wane and morph into what we’re working with now in the realm of value-based care, people are still complaining about their insurance. Employers may limit the plans available to employees due to cost. Changes in coverage can lead to frequent switching of physicians that can cause fragmented care for patients with chronic conditions.

Having heard about those factors over the years, I was interested to see an academic’s impression of the situation. The author notes that in the US, “the interests of high-income individuals dominate decisions about what medical care is offered and how it is financed. The result is a less efficient and less equitable medical care system than in other high-income countries.” He offers a review of the history of employer-based insurance, which initially started as a benefit to recruit employees during World War II. Other factors fueled its growth, including group insurance and tax advantages for employer contributions to the cost of coverage.

Employer-based coverage is cited as a contributor to rising costs when it includes wide networks, fee-for-service payments, and self-referral to specialists. The author notes other cost factors, including a focus on specialty / subspecialty care, high-cost technologies, relatively low hospital occupancy rates, and better hospital amenities, including space and privacy. He goes on to note that higher-income patients might be likely to pay for those amenities, but that “many low- and middle-income households would be better off if medical care was less costly and they had more money for other public and private goods and services.” He likens the high-cost product of the US medical system compared to other high-income countries as the difference between Whole Foods and Walmart.

He agrees with rank-and-file physicians about the high cost of administering the US system and its “mix of employment-based insurance, other private insurance, numerous government programs, including Medicaid and Medicare, each with its own eligibility rules and payment schemes and out-of-pocket payments.” Because of that hodgepodge, it’s impossible to understand the true cost of care, either to the patient or to the overall healthcare system, because of financing across patients, employers, and government entities. Ultimately in the US, patients bear the cost as employers lower wages to cover insurance premium payments and as the federal government collects money for Medicare through payroll taxes.

He notes that the US could save a significant amount of money if administration were simpler or if the healthcare “products” offered could be tailored to create a lower-cost alternative. However, government regulations would need to change for this to occur. He concludes that additional exploration is needed, although it appears that the way our system is financed causes inefficiencies and unfairness.

Trying to move from this hypothetical state to one that actually has an impact on our medical system is a tall order. People aren’t going to be lining up for narrow networks, stripped-down experiences, or a return to general ward care. Hospitals are in a veritable arms race as they compete to put heads in beds by offering in-room services that rival some of the nice hotels I’ve stayed in. However, those services don’t change the rate of handwashing or operative complications regardless of how much they appeal to patients.

We’re also addicted to technology and that raises costs. I was working with a medical student last week who trained in China. He’s seeking residency training in the US and was asking for strategies and feedback to improve his chances of being offered a training slot. We had an extensive discussion about physical diagnosis skills and how in the US we often jump to technology rather than using our ears and eyes and brains when we order CT scans and echocardiograms. I suggested that his ability to manage complex patients in a low-tech environment might be appealing to residency training programs given the alignment of those skills with what is desired in value-based care. It’s not going to change the fact that patients want an MRI, CT, X-ray, or lab test because they trust it more than physician skill, but it creates interesting food for thought.

The JAMA piece only had one comment. I would be interested to hear what readers think about the role of employer-based insurance in our complex healthcare system. Is it a blessing or a curse? Leave a comment or email me.


Email Dr. Jayne.

Morning Headlines 5/13/19

May 12, 2019 Headlines No Comments

Patient health information needs to be readily accessible

David Brailer, MD, PhD – the country’s first National Coordinator – urges support for HHS’s proposed interoperability rules.

$6 million billing loss leads to another internal investigation in Escambia County EMS

Escambia County, Florida launches an investigation into its emergency medical services to figure out who authorized the purchase of billing software from ESO Solutions, glitches from which forced the county to write off $6 million before it was turned off for good.

Littlejohn to take majority stake in Outcome Health

Private investment firm Littlejohn acquires a majority stake in point-of-care patient education and marketing company Outcome Health, which is continuing to recover after investor lawsuits, layoffs, and media scrutiny over its sales tactics.

After burning through $1 billion, Jawbone’s Hosain Rahman has raised $65 million more

Failed wearables company Jawbone rises from the ashes as Jawbone Health with a $65 million investment that will propel its subscription-based, clinical-grade wearables offering.

Monday Morning Update 5/13/19

May 12, 2019 News 3 Comments

Top News


David Brailer, MD, PhD – the country’s first National Coordinator going back to 2004 – urges support for HHS’s proposed interoperability rules. He says that $35 billion worth of incentive payments have made EHRs almost universal, but those systems “have failed miserably in bringing information to patients and consumers.”

Brailer notes that the federal government failed to make sure those EHRs could share information. He thinks it should have defined patient information as belonging to “the people whose bodies it comes from.”

Brailer concludes, “These rules, if implemented as proposed, will transform the experience of consumers. We will finally be able to gather all of our health information in one place and make sense of it. If we want to switch physicians, hospitals, or health plans, our data will move with us and we won’t have to fear retaliation. When we arrive at an emergency room, our information will be there. We will be able to use our personal information to pick the physician or health system that matches our needs. We can discover what new genetic therapies or advanced clinical trials might hold unique promise for us. These proposed rules are fundamentally necessary if we want to improve our health.”

It’s no surprise, Brailer says, that technology vendors, hospitals, and physician associations that “make a fortune off of the current system” are opposed to the proposed changes, which would “make it easy for hospitals to switch technology vendors.”

Brailer is chairman of Health Evolution, which is apparently the conference-running remnant of Brailer’s investment-focused private equity firm Health Evolution Partners, which  lost its sole limited partner (California’s CalPERS) in 2014 after poor returns.

Reader Comments


From Creaky Joints: “Re: Greenway Health SuccessEHS. I’m hearing that it will be end-of-life in September 2019. Can you confirm?” Greenway Health predecessor Vitera acquired Birmingham-based SuccessEHS in 2013. Its EHR/PM is targeted to community health centers and FQHCs. The company provided this response to my inquiry:

All of us at Greenway Health are committed to the success of our customers and we understand the leading role our support, software, and services play in that success. This week, after extensive analysis of our SuccessEHS platform, we informed customers that we will move up the platform’s end-of-life date and partner with them to transition to our flagship platform, Intergy. (Intergy, which recently was named 2019 Best in KLAS “Most Improved Physician Practice Product,” will evolve into our next-generation platform.) This was not an easy decision to make, but we did so with our customers’ best interest in mind.

The dates customers need to migrate will depend on their reporting needs. All SuccessEHS customers who plan to participate in incentive programs for the 2019 reporting period must migrate to Intergy no later than September 30, 2019. This will allow them to be on Intergy for a 90-day period to meet the reporting requirements. SuccessEHS customers who do not plan to participate in a government incentive program will have until December 31, 2019, to migrate to Intergy.

From AHitDuke: “Re: non-poach agreements. How many have them? Allscripts, Cerner, Epic, and NextGen seem to.” I assume you mean between customer and vendor since vendors agreeing not to hire each other’s employees is illegal unless the organizations have a documented business collaboration. I’ve seen at least a couple of contracts in which customers agree not to hire their vendor’s employees and vice versa. The vendor may also prevent customers from hiring their employees without permission via their employment agreements.

HIStalk Announcements and Requests


Two-thirds of poll respondents would not be thrilled if their vendor announced a new focus on boosting profits, while one-third wouldn’t care unless any changes affected them negatively. Smartfood99 wonders how anyone could see it as positive (and indeed, few respondents did), while Les V. Fewer says publicly traded and VC-backed vendors will always get to that point and providers might as well assume that to be the eventual case and execute their selecting and contracting accordingly.

New poll to your right or here: What is the #1 driver of HHS’s new interoperability push? This question was precipitated by “The Big Fib” Readers Write article that was polarizing (although it has 43 likes and just five dislikes). Feel free to click the poll’s “comments” link after voting to explain your choice, to complain that I didn’t include an obvious option, or to argue about the very nature of polling that by definition precludes the intellectually lazy “all of the above” option.

Listening: new from Andrew Bird, an indie singer-songwriter and trained, degreed violinist (which he sometimes plays like a guitar on stage) who used to be in the Squirrel Nut Zippers. I was streaming a Spotify indie station on Sonos and a track that caught my ear turned out to be his. The same thing happened again an hour later. His music is smart, introspective, and occasionally soaring and he always surrounds himself with fine backing band members. Play “Manifest” around other people and I’ll wager they’ll ask you what they’re hearing. I’m also streaming the Mermen Pandora station (which includes bands like the Blue Stingrays and the witty, mask-wearing Los Straitjackets) because I just realized I haven’t listened to surf rock in a long time and I really like it, especially the trippy, minor-chords, tremolo arm-bending variety. 

I’m in a constant, low-level state of frustration with Gmail’s Select All, Delete All function for trashing everything in the Promotions tab, which never works. Some Google engineer kludged a macro-like function that you can watch executing as the screens flip by, only to find that when it has finished its ugly work, most of the messages remain. I can repeat this process several times and still not empty that tab. I use Gmail on the IPhone as well and it’s often squirrely in showing messages that I deleted long ago on the web version – at this moment I’ve pruned my inbox to just nine messages, but the IPhone version still shows hundreds of long-deleted ones. I still argue that Yahoo Mail is the best email client I’ve used, especially since I’m not a fan of Outlook or Apple Mail.


May 21 (Tuesday) 2:00 ET. “Cloud-Based Data Management: Solving Healthcare’s Provider Data Challenge.” Sponsor: Information Builders. Presenters: Jeremy Kahle, manager of planning and business development, St. Luke’s University Health Network; Shawn Sutherland, patient and member outcomes, Information Builders; Bill Kotraba, VP of healthcare solutions and strategies, Information Builders. Inaccurate provider data negatively impacts revenue cycle, care coordination, customer experience, and keeping information synchronized across systems and functions. SLUHN will describe how it created a single version of provider data from 17 sources, followed by a demonstration of how that data can be used in reports and geospatial analysis. Learn how Omni-HealthData Provider Master Edition provides rapid ROI in overcoming healthcare organization provider data issues.

May 30 (Thursday) 2:00 ET. “ONC Data Blocking Proposed Rule: What Health Systems Need to Know.” Sponsor: Philips PHM. Presenter: Greg Fulton, industry and public policy lead, Philips. Proposed data-blocking regulations could specify fines, disincentives, and de-certification of providers who don’t provide an API for patients to extract all of their data. This webinar will describe who is deploying APIs, the scope of data and third-party apps that can be used, the seven costs that do not count as a data-blocking exception, and the health system protections that don’t involve using a vendor. It will also provide examples of data blocking and further exceptions.

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

Acquisitions, Funding, Business, and Stock

A fascinating Axios article looks at how entrenched conglomerates squelch competition from startups:

  • Walmart, Amazon, and Apple buy competitors who threaten their market share. It notes that Apple has acquired 20-25 companies in the past six months alone.
  • Razor companies Schick and Gillette, which control 90% of the US market, use their patent portfolios to file lawsuits that take years to expensively resolve.
  • The razor companies also buy startups, which Schick buying upstart Harry’s this week for $1.37 billion and Unilever acquiring Dollar Shave for $1 billion.
  • Direct-to-consumer companies give their acquirer growth and a wealth of customer data.
  • The disruptors aren’t always absorbed into oblivion – the razor startups have retained their management, gained the resources need to scale, and at least in Dollar Shave’s case, haven’t raised prices.



SailPoint Technologies promotes Cam McMartin to COO.



Norway’s new public health minister Sylvi Listhaug says in an interview that “people should be allowed to smoke, drink, and eat as much red meat as they like. The government may provide information, but I think people in general know what is healthy and what is not.” She is a smoker who doesn’t want the country’s anti-smoking laws made more stringent, explaining, “Are they going to have to to into the woods or up on a mountaintop or down to the docks just to take a drag?” She was previously Minister of Agriculture, Minister of Immigration, Minister of Justice, and now Minister for the Elderly and Public Health. These comments came in an interview where she is pictured with a cigarette in one hand and a Pepsi in the other. She’s actually more rational in the full interview than the snippets suggest, explaining that smoking is harmful but that’s no reason to make smokers feel stupid, instead advocating programs that discourage young people from smoking. She also argues that it’s not the government’s job to tell people how to lead their lives.

Escambia County, Florida launches an investigation into its emergency medical services to figure out who authorized the purchase of billing software whose glitches forced the county to write off $6 million before it was turned off for good. The contract was was split into three parts to keep it below the threshold that requires county commission approval. One commissioner said, “This $49,999 deal is going to stop, period. We already sit here all day long, so we might as well approve every purchase order.” The software is from Des Moines-based ESO Solutions.


The Minneapolis paper observes that most of the 1.4 million people who have received breach notice letters from Puerto Rico-based claims clearinghouse Inmediata have never heard of the company and are questioning how it obtained their medical information in the first place, raising the interest of the Minnesota’s attorney general. The letters don’t explain the company’s business and don’t include the names of the recipient’s provider.

Sponsor Updates

  • Meditech will exhibit at the 2019 IHI Patient Safety Congress May 15-17 in Houston.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the HIMSS New England Spring Conference May 16 in Foxborough, MA.
  • Relatient will exhibit at the Cleveland Clinic Patient Experience May 13-15 in Cleveland.
  • The SSI Group will exhibit at the Cerner CommunityWorks Summit May 14-16 in Kansas City, MO.
  • TriNetX will present at ISPOR 2019 May 18-22 in New Orleans.
  • Nordic launches a video series titled “Consultants in Conference Rooms Getting Coffee.”
  • Voalte will exhibit at the Mississippi HIMSS Spring Conference May 16 in Ridgeland.
  • Vocera CFO Justin Spencer will present at the Bank of America Merrill Lynch Healthcare Conference May 15 in Las Vegas.
  • Huron elects Ekta Singh-Bushell to its boards.

Blog Posts



Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
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Weekender 5/10/19

May 10, 2019 Weekender No Comments


Weekly News Recap

  • DocuTAP and Practice Velocity merge
  • Harris Healthcare acquires Uniphy Health
  • The Chartis Group changes private equity owners
  • The Practice Fusion unit of Allscripts is served a criminal grand jury subpoena related to EHR certification and anti-kickback statute issues
  • Astria Health blames its EHR conversion and contracted RCM vendor for its Chapter 11 bankruptcy
  • HHS asks people to share their stories about obtaining copies of their health records or the sharing of them among providers
  • Grahame Grieve is named the winner of the 2019 Glaser Award

Best Reader Comments

If you can’t down load your record, it isn’t due to a lack of regulation. You need to change doctors if they don’t offer it. (A)

Evidence is scant as to all the innovation and data sharing actually reducing the cost of healthcare. CMS and ONC need to face this fact and stop hyping every supposed innovation that comes down the street. (Bill Spooner)

Our industry’s lack of transparency in costs to the patient is inexcusable. It should be a simple question to ask a doctor’s office “how much will this cost me?” Our industry’s answer: It depends on how many topics you bring up and their associated medical complexity, whether the doc prescribes a medication, what associated tests he runs, what unrelated services he adds on (in your and his mutual best interests, of course), and how much time he decides to spend documenting. It also depends on your insurance policy (which neither one of us is knowledgeable about), so it may be fully covered, may just be a co-pay, perhaps co-insurance, or perhaps you will have to pay the full adjusted amount because of your unmet deductible. And there is an off chance that you will be forced to pay the full amount billed if our provider is not on your insurance because he decided that he gets paid more by not contracting. So, in short, today’s visit will be anywhere between $0 and $500 (and we won’t know the final answer until 45 days from now). And, because of this discussion, we just wasted the first 10 minutes of your 15 scheduled minutes with the physician. It’s insanity. (It’s Insanity)

The reality is that a majority of sales professionals aren’t very good at their jobs. If sales professionals are truly making a “cold call,” that means they’re going down a contact list name by name without doing research. I have a tremendous amount of success by calling hospital executives (CEOs, COOs, CNOs), but it takes a considerable amount of planning work. If you’re shooting from the hip and hoping to get lucky, you are making the rest of us look bad. Look at LinkedIn profiles sales professional in HIT space — typically 1.5 to three- year stints. One or two of these short stints over a long career can be explained (acquisition, RIF, etc.), but if it is a pattern, then it’s an obvious tell that they aren’t good at selling. The HIT sales community is super washed up. Lots of old vets who aren’t working too hard. Also many frat bro types who show up to conferences with suit pants altered to show socks and expect to be taken seriously by mostly old hospital execs. (Desperado)

Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. B in Texas, who asked for headphones for her sixth grade class. She reports, “It has made a huge difference. It has helped them gain independence as they are working. We have used them in many ways already! For example, the students were collecting information on South Asia and the headphones enabled them to listen to videos about specific events and people. They were able to take notes and work at their own pace. Another way the headphones have been used is to help students that need to listen to test questions. They can take a test at their own pace and rewind to hear the questions again. They enjoy being independent. We are the only class in the school that has a class set, so other teachers borrow them when we are not using them or if we have extras. Your donation is helping HUNDREDS of students!”

A former technical support contractor pleads guilty to taking down Oregon’s Medicaid management system in 2016 in retaliation for being laid off by Hewlett Packard Enterprise.


Mount Sinai Healthcare System (NY) launches a sports bar-themed prostate education and treatment center in partnership with Man Cave Health, with the waiting room featuring leather couches, ESPN running on a 70-inch TV, framed local sports memorabilia, and a device charging station that looks like a bar. The non-profit Man Cave Health offers a toll-free appointment booking line and says that while it hopes to roll out sports-themed rooms in all NFL cities, it will consider other concepts. I can say that given my lack of interest in sports (actually more like disdain) that I would prefer sitting in a traditional waiting room, although I used to get my hair cut at one of those sports-themed chain barber shops (because they offered free draft beer, snacks, and big leather chairs while waiting) in which the ladies who performed your services while wearing referee shirts were obviously chosen using criteria mostly unrelated to their tonsorial talents.

Massachusetts General Hospital pays $5.1 million to settle a malpractice lawsuit with former Boston Red Sox pitcher Bobby Jenks, whose blames his career-ending surgical complications on his surgeon, who he claimed was overseeing another surgery simultaneously. MGH says the surgeon performed the complete surgery, but Jenks failed to follow discharge instructions because he didn’t call immediately to report his complications.

Hospitals struggle to treat John Doe patients who are unable to identify themselves, many of them pedestrians and cyclists who aren’t carrying ID when they are hit by a car. Fingerprints can’t be used unless it’s a criminal matter. The health IT aspects include use of a system that generates a “trauma alias” fake name and the negative impact of HIPAA, where anyone calling to inquire about a missing friend or relative cannot be given information that would help identify a patient as one they know.

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A Texas state representative launches a Twitter attack on Baylor professor, pediatrician, and vaccine expert Peter Hotez, MD, PhD, declaring his work with vaccines to be “sorcery,” accusing him of practicing “self-enriching science,” and being a “typical leftist trying to take credit for something only The Lord God Almighty is in control of.” I checked the background of Rep. Jonathan Stickland, a 35-year-old Republican from Plano (above) — he quit high school but later obtained a GED, studied sales in community college, and worked as a pest control technician. He has previously opined that “rape is non-existent in marriage,” called an online critic “a bratwurst-loving homo,” and declared that “healthcare is not a right.”


A hospital in South Africa brings a lion into the facility (via the back door, to avoid scaring patients) to receive the first of four radiation treatments for cancer.

In Case You Missed It

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Morning Headlines 5/10/19

May 9, 2019 Headlines No Comments

Novant Health launches digital health and engagement business division

Novant Health (NC) forms a digital health and engagement division to enhance its ability to virtually connect with patients from anywhere at any time.

LetsGetChecked Announces $30 Million in Series B Financing

Home health testing and companion app company LetsGetChecked raises $30 million in a Series B round led by LTP.

DocuTAP and Practice Velocity Merge to Form Experity, Establishing a New Market Leader in Urgent Care and On-Demand Healthcare

Practice Velocity and DocuTap name Practice Velocity CEO David Stern head of their newly combined company, Experity.

News 5/10/19

May 9, 2019 News No Comments

Top News


Harris Healthcare acquires clinical communication and collaboration software company Uniphy Health for an undisclosed sum.

Uniphy Health merged with PracticeUnite in 2016.


May 21 (Tuesday) 2:00 ET. “Cloud-Based Data Management: Solving Healthcare’s Provider Data Challenge.” Sponsor: Information Builders. Presenters: Jeremy Kahle, manager of planning and business development, St. Luke’s University Health Network; Shawn Sutherland, patient and member outcomes, Information Builders; Bill Kotraba, VP of healthcare solutions and strategies, Information Builders. Inaccurate provider data negatively impacts revenue cycle, care coordination, customer experience, and keeping information synchronized across systems and functions. SLUHN will describe how it created a single version of provider data from 17 sources, followed by a demonstration of how that data can be used in reports and geospatial analysis. Learn how Omni-HealthData Provider Master Edition provides rapid ROI in overcoming healthcare organization provider data issues.

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

Acquisitions, Funding, Business, and Stock


The private equity arm of Audax Group acquires The Chartis Group, a Chicago-based health IT advisory firm, from RLH Equity Partners.


TransformativeMed will use a Series A funding round of $6 million to expand sales and marketing efforts for its Cores clinical workflow apps for Cerner Mpages.


Home health testing company LetsGetChecked raises $30 million in a Series B round led by LTP. The New York City-based company has raised $42 million since launching five years ago. It also offers a companion app to help consumers track and analyze their health, lab, and wearables data.

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Novant Health (NC) launches a digital health and engagement division to enhance its ability to virtually connect with patients from anywhere at any time. SVP and Chief Digital Health and Engagement Officer Hank Capps, MD and Senior Director of Digital Health and Engagement Stephanie Landry will head up the new division.



Capsule Technologies names Hemant Goel (Spok) CEO.


Howard Wilson, MD (Castlight Health) joins Zynx Health as SVP of customer success.


Medhost promotes CFO Ken Misch to the additional role of president.


  • The Connecticut Dept. of Social Services selects analytics software from HBI Solutions.
  • Quorom Health will implement RCM technology and services from R1 RCM across 26 hospitals.
  • St. Joseph’s/Candler (GA) selects wayfinding technology from Connexient.

Announcements and Implementations


Hardin Memorial Health (KY) becomes the first hospital to go live on IBM Watson Imaging Patient Synopsis, which provides radiologists with a summary of relevant patient data from a variety of contextual sources.


Appalachian Regional Healthcare implements tele-ICU capabilities from Advanced ICU Care at its 12 hospitals in Kentucky and West Virginia.


A new KLAS report on global EHR market share finds that:

  • Epic added more beds in 2018 (11,666) than any other vendor, most of them coming from its regional wins in Singapore, but otherwise Epic signed fewer than its average number of new contracts at just four.
  • Cerner signed two counties in Sweden as its first Millennium deployment in the Nordics, but otherwise sold no Millennium deals outside of Europe.
  • Agfa Healthcare, Dedalus, and InterSystems won eight or more decisions each.
  • Latin America saw a large number of EHR purchases, with MV leading all vendors.
  • Few deals were signed in the Middle East and Africa, with Health Insights winning two deals and InterSystems one.
  • InterSystems signed three hospitals in China.
  • No new contracts were signed by hospitals in Canada, although four legacy Meditech customers contracted for an upgrade to Expanse.



The American Medical Association’s annual physician practice survey finds that for the first time, employed physicians outnumber those who have ownership in their practices. Physicians are shifting to larger practices (mostly in abandoning solo ones) and more are working for hospitals.


Cedars-Sinai (CA) equips its post-op patients with Fitbits to encourage them to walk 1,000 steps around the hospital per day after a study led by Timothy Daskivich, MD found an increased step count led to a reduction in length of stay. The hospital has also created an app that ties step counts in to tours of artwork found throughout the hospital.

Sponsor Updates


  • Hyland team members spend time helping out at St. Mary’s Food Bank as part of the company’s Volunteer Time Off program.
  • Access announces that its EForms user interface now integrates with Meditech Expanse.
  • Elsevier Clinical Solutions will exhibit at the American Association of Immunologists conference May 9-13 in San Diego.
  • EClinicalWorks will exhibit at ASCA 2019 May 15-17 in Nashville.
  • HGP publishes its “Health IT April Insights.”
  • Ambient Clinical Analytics and Iatric Systems partner to deliver point-of-care FDA Class II-cleared solutions to health systems utilizing Meditech EHRs.
  • Imprivata and InterSystems will exhibit at the Healthcare Providers Transformation Assembly Millenium Event May 14-15 in Nashville.
  • OnPartners profiles Information Builders CEO Frank Vella.
  • Intelligent Medical Objects will exhibit at the Netsmart Connections 2019 User Group Meeting May 12-15 in Washington, DC.
  • Halifax Health (FL) expands its use of Access e-forms management to include Meditech-integrated and tablet-enabled informed consent solutions in its Cardiac Catheterization Lab and Anesthesiology Department.
  • DrFirst will work with enterprise pharmacy system vendor PDX to offer pharmacies technology that will help them increase the fill rate of new prescriptions.
  • OptimizeRx will present at the Oppenheimer Emerging Growth Conference May 14 in New York City.
  • FDB unveils new global branding.

Blog Posts



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


Readers Write: The Big Fib

The Big Fib
By Weary Healthcare Traveler

On Tuesday, May 7, Don Rucker appeared before the Senate to garner support for ONC’s new rule relating to 21st Century Cures. Although he used complex language and invoked incantations of magic like JASON, Restful Services, APIs, AI, ML, and OAuth2 to US Senators who all just nodded and went back to their scripted questions, this is my summary of what he was really championing in that hearing.

The Baseless Promise that Apps and APIs will revolutionize health and healthcare records. There is no evidence to suggest this at all after almost a decade of patients having the ability to download their own medical records, billions of dollars of venture capital spent on startups, and a wide range of APIs available across all the major healthcare vendors. This includes both standard FHIR and proprietary APIs available through agreements with third parties.

The Big Stick of severe penalties for the new vague crime of data blocking of patients and venture capitalists seeking data perpetrated by doctors, health systems, or technology developers who submit to ONC in support of their ever more ridiculous programs which continue to torture doctors in the name of CMS quality management and payment programs.

Of course, given the lack of any traditional enforcement for such a nebulous crime, ONC’s plan is to invoke False Claims Act laws to create a Sword of Damocles over any vendor or steward of patient data who does not submit fully to the Baseless Promise and the new rule.

The False Flag of claiming patient data rights as the primary rationale for their new rules, as ONC has fully submitted to the venture capitalists of Silicon Valley and other special interests who wish to exploit patient data on a massive scale. The Big Stick is big, but of course specifically designed by ONC to not be big enough to reach the new bread of app developers mentioned in The Baseless Promise who would abuse patient data through complex and intentionally deceitful terms and conditions (they are not covered by HIPAA or ONC Certification.

Rucker misleads the Senate by claiming that OAuth 2, a beautiful standard that works in other industries, will provide protections for patients when in fact he simply means that the patient would retype their passwords and afterwards the same rules that apply to Facebook, Google, Cambridge Analytica and the like would magically protect our most sensitive and personal data. It won’t.

The Big Hero as ONC tries to claim the high ground defending all that is right and just. And,but for the evil forces of vendors, health systems, and wicked data blockers would be able to fix up healthcare in a matter of months if everyone just got behind their new rule. Per Rucker previously, to wait even a month for additional input would have dire consequences to patients.

The Big Villains are said to be EHR vendors, who through their mandated support of ONC, CMS, and other payer requirements, try to help doctors and health systems cope with a fundamentally polluted reimbursement and regulatory system and are cited as the cause of burnout as thanks for their efforts. These vendors will inevitably stand accused under these new regulations for not fully supporting the data broker industry and be subjected to The Big Stick.

And, oh, gag me – this notion that EHR vendors have gag clauses is ridiculous. Asking customers not to publish trade secret intellectual property is not a gag clause. Health systems and provider contracts almost always tip the other way, restricting vendors from sharing any confidential information they may have. That would include basics like fee schedules, business expansion, and acquisition plans, but also observable medical errors that providers and pharmacists make on a routine basis even after overriding a warning to stop and reconsider. That’s where the real gag clauses exist.

If EHR vendors actually had gag clauses, I doubt you’d have the level of ONC- and AMA-sponsored EHR bashing you have today. Let EHR vendors protect their intellectual property and use well-established methods through Patient Safety Organizations for any real EHR safety problems.

The Evil Empire is healthcare providers and systems who themselves hoard data with a fearful eye toward outsiders who seek to exploit it. Fearful because HIPAA will crush them if they make even an innocent mistake in their stewardship of patient data. And now fearful that patients won’t understand how their data, their family history, and their genetic information was permanently released to the Internet and sold many times over when the terms and conditions of an app seemed to assure patients it wouldn’t do so when the patient connected the app to their doctor’s EHR.

All this in spite of health systems now offering online portals and apps that rival any travel, banking, or self-serve app found in any other industry. Going back to the Baseless Promise, only about 35% of patients even sign up to use their apps and portals at the urging of their doctors and health systems which, like airlines, also benefit from patient self service.

So, finally, The Big Fib. Through this new rule and under the flags of innovation and healthcare reform, our government (this administration as well as the previous) is on a path to sell out American patients to a data broker industry that has spent over a decade and countless millions of dollars lobbying for unwitting and uninformed patients to allow their data to be used in ways they can’t even imagine. This False Flag above is in large part sponsored by the a data broker industry worth hundreds of billions of dollars seeking hundreds of more billions.

What should we be focused on instead of ONC’s “Game of Thrones” heroes and villains narrative?

The healthcare industry is largely built on a model of cost shifting from patients without coverage or covered by government-subsidized programs to patients with employer-sponsored commercially insurance. That worked out in a world with more commercial than government subsidized patients. With the Medicaid expansion, there are now more people on subsidized plans and fewer on commercial plans, and thus we have run out of the ability to shift costs. Prices and deductibles are rising fast because neither insurance companies nor healthcare providers want to take a hit to revenue or their bottom lines.

There is not a quick solution here because it is more beneficial for politicians to campaign on the issue of healthcare coverage than to come together to create a bipartisan solution. We need more than a Baseless Promise to fix healthcare. We need to press Washington to unwind this hairball of a reimbursement system.

Healthcare providers seek to enhance and protect their relationships with patients and often do so by using data and services in beneficial ways, leveraging their unique relationship with the patient and their stewardship for the patient data under HIPAA. This can be used for good and as well for evil. Rethinking regulations to protect patients by enforcing rational HIPAA-protected interoperability including both doctor to doctor exchange, but also patient to their chosen apps with full awareness, audit abilities, and responsibilities similar or under HIPAA for those app providers. Force apps to protect patient data in a reasonable and accountable manner similar to health providers.

Get over the fixation on EHR vendors as villains. They have done more to dramatically enhance patient outcomes, reduce medical mistakes, and improve convenience, consistency, and compliance in healthcare over the last decade than any other technical innovation. Spend a moment contemplating this array of regulatory and payer requirements and the explosion of medical knowledge unaided by automation. If enough providers hate their EHR when EHRs are being built to deal with the rules providers choose to submit to, then maybe they’ll stop buying certified EHRs and take the penalties as CMS dictates.

If ONC and DOJ continue to abuse vendors who work in good faith to support these complex and ambiguous programs on ridiculous timeframes, maybe those vendors should simply decide to no longer offer certified EHRs. What would happen in this industry if ECW, Greenway, Allscripts, Epic, and Cerner walked away from the ONC certification program?

Maybe most important of all, stop using exaggerated anecdotes and innuendo to “make your case.” As leaders of ONC, CMS, Congress, and industry, it’s time to put some science and integrity to work in crafting a better-functioning health system for Americans. Many billions of API transactions and hundreds of millions of patient records are being transported across health systems and with apps, also made available directly to patients every year. To hear senators read from their scripts that “we still don’t have interoperability” is embarrassing.

Will it be better 10 years from today than it was 10 years ago? Of course it will, but not if we continue to exaggerate and fool ourselves to the benefit of those who continue to seek to exploit patients and their data. This willful campaign of misinformation will likely lead to a backlash by patients when they realize their government has sold them out to data brokers.

EPtalk by Dr. Jayne 5/9/19

May 9, 2019 Dr. Jayne 6 Comments

I hope EHR vendors are busily refining and provider organizations are busily implementing software that allows providers to see relative drug costs at the point of care, because we’re about to start seeing a lot more conversations around it. HHS Secretary Alex Azar announced regulations that will require pharmaceutical manufacturers to modify drug ads to include list prices if medications cost more than $35 for a one-month supply.

Since the list price often bears no resemblance to what patients actually pay for a drug because of pharmaceutical benefit manufacturer and pharmacy kickbacks, this is going to be confusing for patients. On the other hand, the price threshold might deter patients from asking physicians to prescribe everything they see on TV. The administration is apparently considering allowing US residents to import drugs from other countries under certain circumstances.

Although drug makers claim the requirement infringes on their right to free speech, Azar noted that the requirement is similar to requiring auto makers to display a standard sticker price. The top 10 most-advertised drugs have prices ranging from $488 to $16,938, which should give sticker shock to any patient who might be thinking about following the “ask your doctor” instructions. The mandate, which does not cover print or radio ads, applies to all branded (non-generic) drugs that are covered by Medicare and Medicaid.

The pharmaceutical industry spends over $4 billion annually on TV advertising. Interestingly, enforcement of the rule depends on drug makers suing each other for unfair trade practices. The regulations go into effect 60 days after being published in the Federal Register.

This comes right after the announcement that a new drug is coming to market that will sell for $2 million. The drug is for a rare muscle-wasting disease that typically kills affected individuals by the time they turn two years old. The gene therapy is produced by Novartis AG to treat spinal muscular atrophy. The manufacturer felt it could be cost effective at a price tag of between $4 million and $5 million, so the proposed $2 million pricing is a relative bargain. It’s impossible to put a price tag on the value of a child’s life, but the benefit is unachievable if none of the affected patients can afford it. Not to mention that even if insurance covers the drug, patients and families will almost surely go over their lifetime insurance benefit caps.


From Dallas Gal: Re: your recent mentions of Fem Tech. Have you seen the NextGen Jane smart tampon platform?” I hadn’t seen it, but I’m wondering if the software company of the same name is having heart failure over the potential trademark infringement. The startup has raised more than $11 million to date. Users mail in a sample of cells collected during the menstrual cycle (which the company refers to as “a natural biopsy of the female reproductive tract”) so that they can be analyzed to determine if endometrial cells are present. The company’s font and logo color selection even mimics that of the EHR company before its last rebranding maneuver. The non-EHR product is being readied for commercial launch in 2020. I’m betting it gets a rename before that happens.


We’re finally out of the woods as far as flu season, now that it’s May. There are only three states experiencing widespread flu activity and ambulatory visits for flu-like illnesses are down to less than 2%. Even though overall activity is lower, there have been slight increases in hospitalization and an additional five pediatric deaths have been reported. I saw two patients today that I would have sworn would be positive, but they weren’t, so there is still a fair amount of influenza-like illness out there. Hang in there, clinical folks, the end is in sight.

Kaiser Health News reports on proposed regulations that would lead to the ability for patients to compare prices across hospitals and health care facilities using data sent to their smartphones. It could take several years to be able to handle the data in a patient-friendly form and it’s unclear how patients are going to be able to make sense of the craziness that is healthcare pricing.

We had a maddening encounter in the office today with a potential patient who was irate that we could not tell her the exact cost of a hypothetical urgent care visit for a hypothetical diagnoses that she had already arrived at herself. We can tell patients our charge, and we can tell them the price for cash patients without insurance, but we don’t have the ability at the point of care to see what various payers have contracted or where patients stand with regards to their deductibles. Our billing office can figure that out, but of course this patient was in the office after normal billing office hours.

The patient made a scene in the waiting room and my staff was extremely upset after the encounter. Despite doing all the right things, they couldn’t de-escalate the situation. Even the photocopier repair person who was there said the patient was out of control and offered to talk to our management to make sure the staff didn’t get in trouble.

The incident led to an interesting conversation with the staff later in the day about the commoditization of health care. My staff is representative of the average ambulatory practice staff and they have no concept of federal regulations, proposed rules, or comment periods. Since most of them are fairly young, they’ve had few experiences with the healthcare system outside of care in our practice, which waives co-pays and patient responsibility balances for employees as a benefit of employment.

Despite the feds continuing to beat the drum on transparency and portability, we’ve not been able to achieve electronic health records portability in the last decade and a half we’ve been working on it, so it will be interesting to see how long it actually takes. I’m sure at some point in the future I will look back on this post and either wonder where things continued to go wrong or be utterly surprised that we figured out how to solve the challenging problems that stand in the way.

What do you think about true price transparency? Will people really shop around for their healthcare? Leave a comment or email me.


Email Dr. Jayne.

Morning Headlines 5/9/18

May 8, 2019 Headlines No Comments

Harris Healthcare Group Acquires Uniphy Health to Extend Its Suite of Clinical Solutions

Harris Computer Systems acquires clinical communication and collaboration software company Uniphy Health.

Audax Private Equity Announces Recapitalization of the Chartis Group

Audax Private Equity acquires the Chartis Group, a Chicago-based consulting, analytics, and technology firm, from RLH Equity Partners for an undisclosed sum.

Elizabeth Holmes’s Possible Defense in Theranos Case: Put the Government on Trial

Court documents reveal lawyers for Elizabeth Holmes are considering mounting a defense that accuses Wall Street Journal reporter John Carreyrou of exerting undue influence on the regulatory process, leading agencies like CMS to issue biased findings against the company.

HIStalk Interviews Stephen Brown, Director of Preventive Emergency Medicine, UI Health

May 8, 2019 Interviews No Comments

Stephen Brown, MSW, LCSW is director of preventive emergency medicine at University of Illinois Hospital and Health Sciences System.


Tell me about yourself and your job.

I’m director of preventive emergency medicine at University of Illinois Hospital and Health Sciences System. I run the Better Health Through Housing program, which identifies the chronically homeless in our emergency department and transitions them into permanent supportive housing. We’ve been doing this since 2015.

My background is in technology. I worked for Motorola for 13 years in a variety of capacities, starting off as a junior systems engineer and then ending up being a district sales manager. I was also a product development manager and a senior account executive. I transitioned into healthcare in 2005, working in the emergency room at the University of Chicago as a social worker on the South Side of Chicago, surrounded by 10 of the 14 poorest neighborhoods in the state of Illinois. Then I transitioned to University of Illinois in 2011 to start a preventive emergency medicine program.

What motivated you to move from a technology and sales career to becoming a social worker?

I always loved the technology, but being in sales, you’re only as good as your last sale. I just got tired of living under quota. Plus, after doing some career development things, I discovered I was an introvert and that was why sales was so painful for me. [laughs]

It was a career transition, a mid-life transition. By 40, I decided I wanted to do something that was more altruistic. I originally was going to become a psychotherapist and start my own private practice, but I worked for Michelle Obama at one point in my career at the University of Chicago. We had some discussions and I decided that I wanted to do bigger work than just one-on-one counseling. This was an opportunity to do more population health work.

Does simply giving someone who is homeless a place to live help reduce the high healthcare costs they incur, or is the next step to identify and address any underlying behavioral or dependency issues?

This partnership has been with the Center for Housing and Health, a supportive housing agency here in the center of Chicago. They have relationships with 27 agencies scattered around the city.

What we’re learning is that it’s a tiered approach. Many people will just require what we call rapid re-housing. We don’t quite have the answer, but we’re in conversation about tiering the approach based on psychiatric and substance abuse characteristics. They are medical conditions for homeless individuals. We had somewhat of a lower level. It was scattered site housing. It was permanent supportive housing, but it came with a housing case manager, somebody who’s not trained in medicine or in psychiatry. Despite that, we still had good outcomes.

Are views changing on our expensive system of providing healthcare services vs. funding social programs and public health projects that might reduce the need for them?

Some studies have been done on that. We have great sick care in the United States. We wait for you to get sick, and generally you’re going to be sicker because you haven’t had preventive services. We don’t do prevention, nor do we address the social determinants of health.

There have been a number of studies around around the world where the relative spending on healthcare is much lower. I think we spend 2.5 times per capita for healthcare here in the United States compared to other industrialized countries. Healthcare costs are excessive. I think it’s approaching now 17% of our GNP.

But the other thing that is missed is that other industrialized countries spend more on social services and on prevention services. Having a safety net in place goes a long way toward preventing people from getting a lot sicker. That’s where a lot of the attention is in healthcare now, what we’re calling the social determinants of health. If you don’t have a stable place to live, it’s difficult to manage any of your health affairs, let alone anything else in life.

We’re really good at individual care here in the United States. We focus on the individual. What has been missing in healthcare is hospitals taking responsibility for the health of the communities in which they serve. After all, I think it’s 78% of the hospitals in the United States are non-profit and must demonstrate some type of community benefit to maintain that non-profit status. That shift in focus says that we have to care about the health of the individuals coming from the communities in which we are anchored, and yet that’s been a big disconnect in healthcare.

The technology exists to be able to create community-based report cards. Hospitals should be held accountable for the health of those communities in which they serve. There’s a way to do that through clinical measures, like aggregated hemoglobin A1C in a community, blood pressure, and number of ED visits for asthma exacerbations. Those are all things that are measurable and that health IT could take an active role in bringing forth. That creates accountability for hospitals — perhaps even a collection of hospitals if they serve the same geography — to take ownership of the health of the individuals within those communities.

The alignment is clearer if the health system is also the insurer, such as Kaiser Permanente. Health systems keep getting bigger and spanning state lines. How will those mega-systems work with the many communities in which they operate?

It remains to be seen. We are seeing some activity from Geisinger and from UnitedHealthcare. United Healthcare Is working with the American Hospital Association to develop 20 new ICD-10 codes for social determinants that would be actionable. We can document these things, but unless we take action on those social determinants, they’re really not going to go anywhere. I’m in conversation with a Denver health plan right now about replicating the model that we’ve created and a number of other health systems around the country.

The most interest is coming from those integrated health systems that are both the provider and the payer. It’s in their economic best interest to prevent people from getting very, very sick. We’re beginning to get interest from managed care organizations, too, many of which are represented by larger health insurance companies.

In any state, 5% of the patients in Medicaid account for about half the budget. Generally those budgets can consume about a third of the state budget. Because we’ve been so focused on individual care, we’ve lost the forest through the trees on those. There needs to be some attention on more of a population health model, not only at the state and federal level, but also within some of those large health systems, too. There’s tremendous opportunity to manage the health of these individuals by looking beyond the walls of the hospital and saying, what is it in a community that is driving the exacerbation of disease and poor outcomes?

How you see the pacing of the buzz about social determinants of health being matched by the creation of programs that will make them useful for actually changing something?

What happens with social determinants of health is that we try to do it the old, inefficient way. We hire a bunch of people. We screen in emergency departments. We’ve had some experience doing that. We’ve only been able to hit maybe 2% of the entire ED population because we’ve done it in the manual way. Again, here’s an opportunity for tech to get involved. When you bring big data to bear on this issue, you can find lots of things that you can elevate for risk and make it actionable.

Adverse Childhood Events, or ACE, is being promoted by the CDC. The chronically homeless fit the same profile over and over again, as 60% of the chronically homeless or the homeless in general have what we call high ACE scores. It’s a 10-question questionnaire that predicts poor outcomes, the development of psychiatric illness, and early death, among a variety of things. It’s kind of astounding.

We found that our chronically homeless individuals fit the same profile over and over. You’ll find this is true in criminal justice, too. The higher the ACE score, the higher the probability that person is going to end up on welfare, will have a mental illness, will end up in the criminal justice system, and will die early. One or both of the parents had mental illness or substance abuse and it played itself out on a profile where that person ended up becoming chronically homeless and developed serious mental illness.

You can find those things in a combination of electronic medical records, in public data, and in credit data. A number of emerging companies are looking at data mining to find those folks who have elevated risk. For example, with classical homelessness — somebody who has fallen off the grid because they’ve had some financial catastrophe or income volatility in their lives — you can find those people easily in credit data. You can predict the risk of homelessness eight to 12 months before it actually happens.

The way healthcare responds to that is inefficient, but there are opportunities to find people with a high ACE score and intervene with them early, because you’re going to see it play out in a lot of different things that are going to result in poor outcomes.

I’ll give you a vivid example. When I worked at the University of Chicago, there was a lot of crack cocaine on the South Side of Chicago. We would often get women who had cocaine intoxication. They were hyperkinetic or manic. Once we allowed them to detox on cocaine, I’d go in and interview that woman. The doctors were focusing on whether or not she was going to have a heart attack, so they were looking at elevated troponin and all these medical characteristics. They had a medical course of action. They were treating the symptoms of what is a greater problem.

When I dug into it, I found that the typical scenario was that the woman that had been repeatedly sexually abused when she was eight years old by her stepfather or uncle and had undiagnosed PTSD as a result. She had a very high ACE score and we hadn’t done anything. We got her treatment for her substance abuse, but she probably needed treatment for PTSD, too.

How can technology fit into a program like yours?

The big piece of it is bridging the gap from healthcare into the community. The FHIR standard is a promising technology, but as we found with the CMMI Accountable Health Communities, there is a substantial gap in tech between health IT and community IT. Many people are still dealing with spreadsheets. If the provision of a social service or community-based services is going to be effective, we need to be able to track whether or not that person actually got the service. Then, was there a treatment effect from that service?

What we’re doing here on the West Side of Chicago with the West Side United effort — a collection of five hospitals — includes a lot of economic development. Things like wealth management classes. We’re doing local sourcing for our supply chain. We’re trying to partner with colleges to create a talent pipeline and steer kids in the community into careers in tech and healthcare.

But beyond that, we need somehow to bridge the gap. Some of the things we’ve been talking about is giving out case management solutions, so we have just one platform for the community that can provide data on the receiving end. Those are going to be some of the biggest challenges we’re going to be facing if we are really going to tackle these social determinants of health.

The other thing is that I’m a big believer in microservices and having the ability to have an app store kind of arrangement for human services. Something that is plug-and-play and easy for JavaScript programmers to integrate and exchange data with healthcare organizations. But we’re going to need some enabling technology on that. We have a grant with the JB Pritzker Foundation to do cross-sector data exchange. In order to drive clinical integration of systems, we’re going to need to be able to have some kind of common appliance that can manage the traffic and flow of messaging and interoperability between human services and healthcare. This is a particular issue here in Chicago because we don’t have a healthcare information exchange.

The other piece of is from an evidence-based public policy, to be able to track individuals and their service utilization. In an ideal world — especially with these homeless individuals that we’ve found to be very, very expensive — we’re only looking at the most obvious cases. But as a population, how could we look at their healthcare costs? We know they have elevated healthcare costs, but do we know for the entire homeless population what that looks like? We’re only looking at mostly the chronically homeless, those who have been continually homeless over for a year. We need to have more resources available to do interoperability for both clinical integration purposes and to bring together large public health data sets so we drive evidence-based public policy.

A fair amount of national empathy seems to have been replaced with resentment toward social programs and those they help. Is there a message of hope that these programs work and will be accepted?

You see these bright spots happening around the country. Bexar County, Texas, which includes San Antonio, has a psychiatric stabilization center where they divert people in psychiatric crisis to a center where they are treated. They don’t have to go to the ED or jail. There’s a lot of good work happening. It just doesn’t get publicized because it’s a little bit wonky.

My job is more public policy and aligning systems so that they talk to each other. I think that we’re going to see some tremendous benefits from those things, because no matter what your political affiliations might be, we’re discovering that at least with some of these populations, the solution is cheaper than the problem. We would all feel better about ourselves if we look at how we can care for these people in ways that will extend their lives and keep them from getting sick. It’s also the right thing to do.

Here in Chicago, we’re having extraordinary conversations with the jail, with Cook County Health, the other public hospital here, and with Illinois Department of Corrections. We’re creating a flexible housing pool that will result in more supportive housing, with about 750 new units coming online. We haven’t borne the fruit of it, but I’m optimistic that we’re going to see some major sea change in how we treat the homeless and other marginalized populations. Especially non-violent offenders. Can we offer them alternatives to prison or jail? I’m seeing a lot of work in the opioid crisis right now. The sheriff’s department is creating a diversion unit. Hospitals are learning that if you want to treat the opioid crisis, you have to go out to them. They can’t come to you.

The glass is half full, as far as I’m concerned. We’re doing a lot of great work that will bear fruit very shortly.

Morning Headlines 5/8/19

May 7, 2019 Headlines No Comments

Allscripts electronic health records unit receives grand jury subpoena

The Practice Fusion unit of Allscripts has been served a criminal grand jury subpoena regarding EHR certification and anti-kickback statute compliance, according to company SEC filings.

Providing excellent patient care remains Astria Health’s highest priority

Astria Health (WA) files Chapter 11 bankruptcy, blaming its financial situation on its EHR conversion and hiring of a revenue cycle management company that failed to meet agreed-on accounts receivables collection targets.

UMMS scandal: Medical system board chairman, two others resign as additional contract revealed

The board chair and two board members of University of Maryland Medical System resign over a no-bid software contract with Real Time Medical Systems, whose founder and CEO is former UMMS board member and donor Scott Rifkin, MD.

DispatchHealth Closes On $33 Million in Growth Financing Led by Echo Health Ventures

House call company DispatchHealth raises $33 million to further invest in its mobile app and logistics software, and expand services to more Medicare patients.

Google says its AI can spot early-stage lung cancer, in some cases better than doctors can

Google shares early data from a project with the National Cancer Institute and Northwestern University showing that its AI can detect early-stage lung cancer with equal or better accuracy than radiologists.

News 5/8/19

May 7, 2019 News 4 Comments

Top News


CMS Administrator Seema Verma invites people to tell their stories of their struggles in obtaining copies of their health records or with providers failing to share their information.

My personal experience (and that of others) is that alerting HHS, including filing an OCR complaint, is a waste of time that changes nothing, but it’s a nice thought.

Maybe CMS should require Medicare providers to post a notice on their wall that lists the information rights of patients, including a telephone number and email address to report information blocking offenders. Then fine them for non-compliance rather than just having OCR provide “technical assistance” and closing the incident.

Reader Comments

From Erudite: “Re: Cedars and Medlio. The founder is complaining about the manner in which the ‘no’ was conveyed. Why did Techstars part ways with Cedars? What credentials does the Cedars CIO have to compete with notable early-stage investors? Why is Cedars using their tax-exempt earnings to help folks play VC? They should shut down the accelerator and ask the CIO to focus on his job or go out and raise money from limited partners to run a fund.” The co-founder’s side of the story is that her struggling startup was abused in interviewing with the Cedars CIO and that she as since accumulated “multiple examples of the CIO’s unethical behavior” sent to her after her article. She’s pondering whether to go public with those examples, which I would warn might elevate her diatribe from “unfortunate” to “libelous.” I know little about the Cedars accelerator, but I recall that accepted companies get significant funding, access to internal experts, a good shot at earning a paid pilot, and the involvement of people like the CIO who actually work in frontline healthcare. I think a better view of the Cedars program would come from a company that has completed it. I’m with you on non-profit health systems using their patient-provided profits to do unrelated work, but that horse has long since left the barn and is playing excitedly in fields green with cash.

From Corrective Action: “Re: listing experience as ‘more than 20 years.’ People do that because if they put in the actual number, especially once it is 30 or more, they may not even get an interview despite being highly capable, physically and mentally sound, and ready for another 10-plus years of work ahead of them. It isn’t about math, it’s about age discrimination.” I hadn’t thought of that, although I’ll say that many of the folks who say they have ‘more than 13 years of experience’ when they have 13 years, two months are not old enough to worry about age discrimination. I have noted obvious efforts on LinkedIn to sidestep the ageism issue – lack of a photo, omission of dates for education, and listing only the most recent jobs. I’m interested in the result. Would it be like a dating app, where you can Photoshop your picture but then have your lack of transparency become embarrassingly obvious in the resulting a face-to-face encounter? Or are potential romantic and employment targets willing to waive their biases if the personal encounter goes well and thus it’s worth a shot to underplay age to earn the face-to-face?

From Medical Minion: “Re: making patient care more human. You’ve complained that front desk people are often cold and robotic to patients. Why didn’t you complain to their employer instead?” For the same reason I don’t complain when a Walmart cashier doesn’t try to be my new best friend or an Uber driver fails to provide scintillating chitchat. Healthcare has become a huge, impersonal business and those on the front lines are buried several layers deep in dysfunctional organizations that don’t treat them especially well or reward them for good customer service behaviors. I don’t hold them accountable to sprint to the front lines full of enthusiasm and empathy. Full waiting rooms ensure corporate-wide indifference.

HIStalk Announcements and Requests


Welcome to new HIStalk Platinum Sponsor Omni-HealthData, powered by Information Builders. Omni-HealthData helps health systems make operational decisions and improve the insights needed to improve outcomes and patient care. It’s a complete information management solution that gives providers and payers a 360-degree view of members, patients, workforce, facilities, community care organizations, and other critical domains. The platform, developed with St. Luke’s University Health Network, combines data integration (hospitals, physician practices, nursing home, telemedicine, financial information, etc.), data quality, and master data management that power InfoApps out-of-the-box information applications (hospital patient experience, quality and safety, balanced scorecard, physician practice dashboard, and population care analytics). It is built on the WebFocus BI and analytics platform, which also provides advanced analytics (visualization, location analytics, enterprise search); predictive analytics; and social media analytics. Customers have used its data management platform to develop integrity and integration solutions, analytics dashboards for clinics, a customer-facing portal with analytics, an self-serve reporting with visualization. Instead of learning complex tools and worrying about data preparation, users can serve themselves and quickly get answers and insights from relevant data, right when they need it. It’s easy for non-technical, mainstream users to get and analyze information on both web browsers and mobile devices.Thanks to Omni-HealthData for supporting HIStalk.

A friend who has a terminal illness whose treatment is likely to bankrupt her family (even if her insurance covers part of the cost, which isn’t guaranteed) let me know she’s getting a divorce even though her marriage is fine. Her family’s financial advisor told her to transfer their joint assets to him, divorce him, then sign up for Medicaid to give her a reasonable chance at getting the treatment that could save her life. Divorce laws are unique to each state, so I didn’t ask whether her husband is required to move out or whether his caregiver role will be affected. Our healthcare system is certainly interesting.


May 21 (Tuesday) 2:00 ET. “Cloud-Based Data Management: Solving Healthcare’s Provider Data Challenge.” Sponsor: Information Builders. Presenters: Jeremy Kahle, manager of planning and business development, St. Luke’s University Health Network; Shawn Sutherland, patient and member outcomes, Information Builders; Bill Kotraba, VP of healthcare solutions and strategies, Information Builders. Inaccurate provider data negatively impacts revenue cycle, care coordination, customer experience, and keeping information synchronized across systems and functions. SLUHN will describe how it created a single version of provider data from 17 sources, followed by a demonstration of how that data can be used in reports and geospatial analysis. Learn how Omni-HealthData Provider Master Edition provides rapid ROI in overcoming healthcare organization provider data issues.

Acquisitions, Funding, Business, and Stock


The Practice Fusion unit of Allscripts has been served a criminal grand jury subpoena regarding EHR certification and anti-kickback statue compliance, according to company SEC filings. The original US Attorney’s information request came in March 2017, so presumably Allscripts was aware of at least some level of federal interest before its $100 million acquisition of Practice Fusion in January 2018.

UBiome, the high-valuation startup that was recently raided by the FBI after overbilling complaints from insurers, suspends the sale of its prescription-only microbiome tests, leaving it with just one consumer test that doesn’t require a doctor’s order (and that insurers won’t pay for). I think we’re getting enough case studies to prove that the investor-funded Silicon Valley mantras of “move fast and break things” and “ask forgiveness rather than permission” don’t work well when they try to elbow their way to the massive healthcare trough. On the other hand, we’re learning that cash-hungry doctors will prescribe just about any crap those companies sell as long as it doesn’t directly harm patients.



Ciox Health hires Pete McCabe (GE Onshore Wind) as CEO, replacing Paul Roma.

Announcements and Implementations

Post-acute care technology vendor Brightree will connect with CommonWell.

Government and Politics


FDA will hold a five-hour webinar, demo, and technical discussion of its open source, user-configurable MyStudies clinical trials data-gathering framework on Thursday, May 9. 

NIH and the Navajo Nation sign the first tribal data-sharing agreement, which will allow NIH grant recipients to continue a birth cohort study. 



The board chair and two board members of University of Maryland Medical System – whose purchase of hundreds of thousands of dollars worth of children’s health books got its CEO and the author who was also Baltimore’s mayor fired – resign over a no-bid software contract. Real Time Medical Systems, whose founder and CEO is former UMMS board member and donor Scott Rifkin, MD, provided UMMS with predictive analytics software for clinical and financial improvements. Rifkin says the one-year contract involved zero cost and he intended to extend it afterward at no charge.

Astria Health (WA) files Chapter 11 bankruptcy, blaming its financial situation on its EHR conversion and hiring of a revenue cycle management company that failed to meet agreed-on accounts receivables collection targets. The announcement didn’t name either vendor, but it signed with Cerner in January 2018

A small study finds that obese patients who were sent text reminders and provided with remote feedback weighed themselves more often and were more physically active, but 12-month weight loss was exactly the same as in the control group at four pounds.

A nurse whose son died in a car accident obtains video taken by the driver of the other car that shows first responders walking around without doing anything, rolling her son around without protecting his neck, digging through his pockets before starting treatment, and lifting him onto a stretcher by his belt loops without using a backboard. One EMS crew member was fired, another quit to go to fire school, and the EMS chief eventually resigned. 

A man who is transported to an in-network hospital with a facial injury is billed $167,000 by its on-call plastic surgeon, who is among the large percentage of doctors in that specialty who don’t contract with insurers because they don’t have to.


Four University of Arizona journalism students work with the local newspaper on a grant-funded project in which they developed an app to review businesses and tourist destinations for their access to those with physical disabilities. They also created a health site allows users to read health news, search for a clinic, and find health events.

Studies find that the elevated carbon dioxide levels found in conference rooms and classrooms impair cognitive ability, perhaps refuting my theory that meetings are mostly attended by people who aren’t all that bright. 

Sponsor Updates


  • Avaya employees assemble 50,000 meals for those less fortunate in collaboration with Rise Against Hunger.
  • San Diego Woman Magazine features Burwood Group SVP of Technology Joanna Robinson in its Power Women issue.
  • Divurgent is named a Microsoft Gold Partner.
  • Collective Medical adds the capability for users of its platform to identify high-risk infants, including those with neonatal abstinence syndrome.
  • The Tampa Bay Times features Collective Medical’s work with the Florida Hospital Association and the Florida chapter of the American College of Emergency Physicians to combat the opioid epidemic.

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Reader Comments

  • Vaporware?: Mr. H, you can add this little propaganda gem to your file of Top 10 Euphemisms (emphasis mine). You have one of those f...
  • Fred: Epic's response to burnout is precious. Yes, everyone is happy and challenged, excluding of course the thousands who hav...
  • Brian Too: Any complex software that you spend a lot of time in, you'd better learn it well. Most people do that but if you invest...
  • AC: I don't believe they give you raw click numbers yet (only PEP/NEAT score), although I think Feb 2019 release is bringing...
  • Dodele: We use Cerner's Lights On and Advance data extensively. There is a wealth of valuable information and it is continuousl...
  • Epic User: As someone that actually tried to dig into the details of Epic's signal data, I quickly became underwhelmed. No click co...
  • Frustrated Patient: " suggesting that my providers don’t really want to open up a can of medical worms by asking how I’m doing overall e...
  • AC: That's good to hear. So the major vendors have worked on this and provided tools. The question now becomes are organizat...
  • Associate CIO: Re: EHR internal timers and event log monitoring Cerner has this as well, it is called the Lights On Network. A curr...
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