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EPtalk by Dr. Jayne 2/20/20

February 20, 2020 Dr. Jayne 6 Comments

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I’m all about the data, but I’m not happy to have been faked out by this year’s influenza numbers. We were lulled into a sense of hope by what appeared to be an early peak followed by a decline in flu cases, only to have a second (and higher) peak.

To date, there have been 26 million cases of influenza and 14,000 flu-related deaths, including 92 children. We’ve been seeing a lot of influenza pneumonia in the practice and I’ve just about washed all the skin off my hands. I hope we start to see the end of this soon. Everyone’s keyed up about COVID-19, but few average people are aware of how many people influenza kills each year.

I had a chance to connect with a colleague who lives in Taiwan and who was looking for in the trenches commentary on what people in the US think about COVID-19. He and his family have battened down the hatches for the most part and his children’s school is closed until the end of the month as a precaution. Fortunately, he telecommutes to a job in the continental US, so his livelihood hasn’t been impacted. He’s going to keep me posted from the man on the street perspective as the situation unfolds.

It’s definitely starting to get interesting at work, as we are having difficulty with supplies that typically originate in China, including masks, gowns, and other disposable sterile supplies such as staple remover kits. Fortunately, we have a good stock of standard surgical instruments that can be autoclaved for sterilization, so it’s just a question of shifting to that workflow. Nothing beats a good pair of precision surgical scissors from Germany, so I’m not complaining.

Based on the flu and COVID-19, I expect to see an increase in vendors at HIMSS selling supplies to keep the workplace safe, including washable keyboards, touchscreen covers, sterilization carts, and more. I haven’t received any mailings from them or invitations to any booth events, so if you’re in this part of the industry and you’re not strutting your stuff, you might be missing out. I enjoy touring all the booths that have practical items to promote and aren’t just full of buzzwords and the stuff of pipe dreams. If you have something cool for us to check out, drop us a line and let us know your booth number. We’ll do our best to make it by.

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For a while, I was doing quite a bit of consulting around Patient-Centered Medical Home, so I spent a lot of time on the National Committee for Quality Assurance (NCQA) website. That business kind of died down and I drifted away, so I was happy to be drawn back by their involvement in the pursuit of Natural Language Processing. Their recent blog covers NCQA’s efforts to convene a NLP working group to help them explore how the technology can be used for quality measurement and reporting. The group includes representatives from Apixio, UPMC, and Wave Health Technologies.

The working group is focused on approaches to ensure that data generated from NLP is accurate. It plans to work toward developing a standard for validating NLP data. Since the working group is vendor focused, NCWA will be running parallel meetings with an independent advisory panel that includes NLP experts and researchers who will also weigh in on the potential validation model. I’ll definitely be keeping an eye on their work and how it might impact frontline clinical organizations.

I recently caught up with a vendor friend to talk about their strategy for the new Evaluation & Management coding guidelines that will come into play in 2021. The guidelines are designed to allow physicians to be paid without the onerous documentation they had to do in the past, which theoretically would allow vendors to tailor their clinical documentation to the actual clinical scenario rather than allowing physicians to bill at the highest level possible. I’m looking forward to not having to do more of a Review of Systems than is actually relevant for the visit and to writing notes that are closer to “Strep: Penicillin” than to the multi-page nonsense we generate today. I hope multiple vendors are looking at ways to make documentation easier as well as more coherent.

Time to “Ditch the Disk” in healthcare. Various tech leaders are encouraging the healthcare industry to move beyond CD-ROMs and make sharing images as easy as sending a text message. The task force meets every few months and looks at ways to improve the process. My organization burns an incredible number of discs every month and I’m sure they wind up in piles at patients’ homes, so I’m all for it.

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I’m excited to report that readers are responding to my plea for pre-HIMSS shoe shopping tips. Apparently Jeffrey Campbell boots come highly recommended, with one reader noting “I have three of these…  I can even wear them with a broken toe.” That’s high praise indeed. I’m disappointed they don’t have them in my size in the red and blue snake pattern, because they’d be perfect for my upcoming trip to Washington, DC. A little bird told me you can sometimes find them on third party sites, so I’ll have to check them out. I definitely need something comfortable because I’m going to be hitting all the military memorials with a group of Honor Flight veterans.

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Another reader recommends Irregular Choice, saying, “My artist sister is obsessed, and I am tempted to peruse their men’s section for the show floor.” I was completely blown away by their creations, especially the Muppets and Disney options. If I had an endless shoe budget, I could definitely go crazy there.

Good luck on your HIMSS prep. As usual, I’ll be on the lookout for the best reader footwear (both shoe and sock varieties). Will your shoes make the hall of fame or the hall of shame? What are your other favorite sites for awesome shoes? Leave a comment or email me.

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Morning Headlines 2/20/20

February 19, 2020 Headlines No Comments

Maven Raises $45 Million in Series C, One of the Largest Funding Rounds for Female-led Women’s and Family Health Company

Maven raises a $45 million Series C round of financing led by Icon Ventures, bringing the virtual clinic company’s total raised to nearly $90 million.

Former Chief Technology Officer of U.S. Department of Health and Human Services to Join LifeOmic

Former HHS CTO Ed Simcox joins precision medicine software vendor LifeOmic as chief strategy officer.

Global Interoperability Leader Rebrands as Lyniate

After merging in 2019, healthcare data integration vendors Rhapsody and Corepoint rebrand as Lyniate, and promote Scott Galbari to CTO.

HIStalk Interviews Adam Wright, PhD, Director, Vanderbilt Clinical Informatics Center

February 19, 2020 Interviews 1 Comment

Adam Wright, PhD is professor of biomedical informatics and director of the Vanderbilt Clinical Informatics Center at Vanderbilt University Medical Center in Nashville, TN.

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Tell me about yourself and your new job.

I’m a professor of biomedical informatics at Vanderbilt University Medical Center. I also direct the Vanderbilt Clinical Informatics Center, or VCLIC. As a professor, the main part of my job is research. I get grants, write papers, and teach. I teach a lot of the students in our biomedical informatics and medical school courses. Then I also do some service. I help direct the decision support activities here at Vanderbilt, trying to make sure that we have good alerts and other decision support tools and that we’re not unnecessarily burdening our users.

What are the best practices in getting clinician feedback when developing and monitoring CDS alerts?

You need to involve clinicians when you are developing any alert that will affect them. There’s this tendency for orthopedic surgery to say, “We should ask anesthesia to respond to this alert. We should really tell those guys what to do.” That’s almost never the right answer. It almost always works better when users are involved in the development of an alert.

I’m also a huge fan of using data. We have enough data in our data warehouse to forecast ahead of time when an alert will fire, who it will fire to, and which patients it will fire on. Looking at the data is often really illuminating. We’ve just been dealing with some alerts here at Vanderbilt that were firing in the operating room and suggesting giving a flu shot to a patient who’s in the middle of surgery. That’s just not a timely moment to give a flu shot.

You can figure that out after it’s live, but you are better off looking at some data and guessing what’s going to happen. Then making sure that you’ve added all the proper exclusions and tailoring to make sure that it’s firing for only the right people. That’s the most important thing in building the alert and designing it to not frustrate people.

Once it’s live, you need to, on almost on a daily basis, look at your alerts and see how often they are firing, who they are firing for, and trying to figure out if some users are particularly likely to accept an alert or particularly unlikely to accept an alert. There’s this classic problem where alerts fire for patients who might be on comfort measures only. That may not be appropriate for a lot of alerts. Or there’s a particular user type, like a medical assistant, who may not be empowered to act on an alert, but is receiving it anyway. We have found that by looking at the data, we can add additional restrictions and exclusions to the logic until we get the alerts to the right person at the right time.

We have a goal of between 30% and 50% acceptance for our alerts. We don’t always get there, but we see in the literature a lot of places that are at 1% or 2% acceptance for alerts. That is almost certainly a problem, because then people get fatigued and start tuning the alerts out.

Are hospitals comfortable including a “did you find this alert useful” feedback mechanism, knowing that they are then obligated to take action accordingly? Or to allow clinicians who don’t find an alert useful, such as a nephrologist who is annoyed at drug-renal function warnings, to turn them off?

We have a policy here that we are trying to build feedback buttons into all of the alerts. When you see an alert, there’s a little set of smiley faces in the corner. You can vote whether you like the alert a lot, not too much, or not at all. You can click to vote and you can type in a comment. I try to respond to all of those quickly and try to understand the person’s thinking, their rationale.

We were worried that people would use the feedback comments to to grumble about alerts or how they don’t like the EHR. In fact, people tend to give thoughtful comments about why the alert didn’t apply to a patient or it didn’t fit well in their workflow.

We got another one about a week ago about influenza vaccinations. Some clinics don’t stock the flu shot. They don’t have it in their refrigerator, so they can’t give it. We had some conversations with our leadership about whether we should start stocking and administering the flu shots in those clinics, but decided that wasn’t going to be practical. We were able to then edit the alert so that it doesn’t fire for those people.

I agree that some alerts that might make sense for a primary care doctor or hospitals that wouldn’t necessarily make sense for a specialist who really knows that area. It’s futile to show an alert to somebody who says they don’t want it and our data suggests that they are unlikely to accept it. We have to  target our alerts to people who are likely to be willing to accept them.

It’s almost a false sense of security. If we are really worried about renal dosing for medicines and we know that we have an alert that doesn’t work, we shouldn’t just congratulate ourselves for having a renal dosing alert. We should consider more carefully what workflows we have and what additional protections we could put in place to make sure that patients with impaired renal function get the proper medicines rather than congratulating ourselves for having an alert that we know doesn’t do anything.

Default ordering values are important, as emphasized again in a recent study that demonstrated reduced opioid use when default prescribing quantities were lowered. Do you account for this by assuming that physicians aren’t paying attention and will most often accept whatever comes up by default, or is more complex psychology involved?

We had an admission order set that had cardiac telemetry checked by default. We saw that people were ordering telemetry on almost all of the internal medicine patients when they used that order set. We were getting feedback that in many cases, it wasn’t appropriate. As an experiment, we kept it in the order set, but switched it from being checked by default to being unchecked by default. We saw a huge reduction in the number of patients who were ordered cardiac telemetry.

We worried about the risk of that. We did some analysis to see if patients were either having more bad cardiac events or even just if people were then ordering cardiac telemetry the next day or later in the visit, like they somehow missed it in the admission. What we saw was that there was no increase in cardiac problems. There was no pattern where people were ordering delayed telemetry.

You have to be thoughtful about this. You have to get clinical feedback from users. You have to understand what the risks are. I am a huge fan of measurement. We made this change and we measured it the next day. If we had seen that there was a problem, we would have felt confident that we could quickly roll the change back and analyze it. We felt safer knowing that we would be able to monitor it.

In terms of the psychology, some of it is just being on autopilot. You’re admitting a lot of patients, and the computer in some ways seems to almost speak for the institution. The computer is telling you, “We generally recommend that you order cardiac telemetry for patients like this.” That may not be what the builder of that order set intended when they checked it off, but that’s the message that is getting communicated to the intern or PA. They’re likely to trust that that’s the standard of care, that’s the practice here. I’ve seen that again and again. People are willing to trust defaults.

I don’t think it’s laziness. I don’t think it’s that they don’t read it. A lot of things in medicine are soft calls. You might just want to do what people usually do. Seeing something checked or not checked in an order set is an easy way to think that you’re getting a read of the organization’s standard practice.

Your two most recent jobs have been with huge health systems that were among the last to switch from a homegrown EHR to a commercial product in Epic, and both institutions were known for programming their self-developed systems to give clinicians extensive, documented guidance for making decisions upfront rather than punishing them with warnings when they did something wrong. Does Epic give you enough configuration capability provide similar order guidance capability?

Both organizations had for decades developed and used their own electronic health record and CPOE system and then switched to Epic in the last few years. I had a lot of anxiety about that switch. We were used to having the total control that comes with having developed your own software. We could literally pull up the source code of the order entry screen and change it to do whatever we wanted.

I would say that I’ve been pleasantly surprised by the number of levers we have and customizations that we have available to us in Epic. They have thought through most of the common use cases and built some hooks so that we can even go so far as to write custom MUMPS code that changes the way things work.

We have generally been able to find ways to implement things. They might happen at a slightly different point in the workflow or they might look a little bit different than the user expected, but I would say that it’s rare that we come up with a piece of clinical logic that we are not able to faithfully implement in Epic. I was pleasantly surprised. I was actually quite nervous about this and it went better than I thought it was going to.

How do you approach EHR configuration knowing that changes may take more clinician time or increase their level of burnout?

The EHR gets a lot of blame for burnout, and some intrinsic properties of the EHR contribute to burnout. But I also think there’s a lot of regulatory, quality, and safety programs that are implemented through the EHR. The EHR gets blamed for having to enter all this information or to sign the order in a certain way, but some of that is triggered by external forces, like how we get paid for healthcare or how we report quality.

I generally don’t like it when I am asked to implement decision support purely for an external reason, such as because some regulator or somebody else wants us to do it. I would rather partner with clinicians who are likely to have to actually do the work, asking them if are there alternative workflows that we didn’t think of that could achieve the same regulatory goal and meet our obligation to our payers and regulators without  burdening people with point-of-care, interruptive pop-up alerts.

As we  move toward value-based payment, where we’re paid to take care of a patient over the course of a year, we have more opportunities to use things like registries and dashboards. We can have a care manager or a navigator do some of the work, or send some messaging directly to the patient, instead of popping up a message at the beginning of the primary care doctor visit and forcing them to answer a question right then.

One of the things that I’ve tried to do everywhere I’ve worked is to look at requests such as, “Please build a new interruptive pop-up that affects user X.” We go one step backwards and say, what’s going on that makes you think we need to do that? Have we considered all the options before we do this last-ditch effort of interrupting somebody in the middle of their visit?

What are the most pressing informatics priorities at Vanderbilt?

Physician burnout is certainly one of them. We are hearing increasingly from our users that they are spending a lot of time outside the clinic writing notes and finishing their documentation. We are also adapting the EHR to new care models, like value-based payment and telemedicine. We’ve been working on some new approaches for patients to get care either at home or at satellite sites that are not right here in downtown Nashville that might be more convenient to them. There’s been a lot of work trying to get the EHR to do that.

I also have a big interest in academic informatics. Eighty percent of my job is working as a professor. We started this new VCLIC, the Vanderbilt Clinical Informatics Center. One of the goals of that is to help us navigate this transition from a self-built EHR to Epic. There’s a lot of things that we used to know how to do. How do we get data out of our system? If we have a new idea for a medication prescribing workflow, how can we pilot it in the EHR? Some of that knowledge went away when we made the transition to Epic.

The goal of VCLIC is to make people at Vanderbilt say, it’s easy to interface with EStar, which is what we call Epic here. Whether that means getting data out of the system or putting a new intervention in the system. I want people in the informatics department, in clinical departments, or the pharmacy to be able to know how to get the data and know how to do stuff.

We call it paving the road. Getting access to the data warehouse might be based on bumping into the right person or getting a favor. We want to figure out, what are the requirements to get access? What training do you need to have? What do you need to do or sign to acknowledge the privacy issues? How do you protect the data? Then make it clear to people how they can interact with this new commercial EHR in the ways that they were used to in interacting with our self-developed EHR for the last couple of decades.

Do you have any final thoughts?

This is an exciting time in the field of informatics. We got through this hump of adoption of EHRs. Most doctors and most hospitals are using EHRs. There’s a growing sense that we are not getting everything we expected or hoped out of that investment.

The good news is that achieving adoption was one of the hardest parts. Now we need to be thoughtful about using data, engaging with users, getting feedback, and making smart decisions about how we can improve the EHR so that we get the value out of it in terms of improved patient outcomes and reduced costs that we were hoping would appear.

Some people are in a moment of despair about EHRs. I’m actually in a moment of real excitement. We have everything lined up to be able to give value. We just need to be smarter about how we do that.

Morning Headlines 2/19/20

February 18, 2020 Headlines No Comments

Health Catalyst Announces Agreement to Acquire Able Health, a Leading SaaS Provider of Quality and Regulatory Measurement Tracking and Reporting

Health Catalyst will acquire Able Health, which offers quality and regulatory measurement tracking and reporting tools.

VA Reveals Industry Partners for First 5G-Enabled Hospital

Technology and services from Verizon, Microsoft, and Medivis power the VA’s 5G-enabled hospital in Palo Alto, CA.

Amazon Care, the company’s virtual medical clinic, is now live for Seattle employees

Amazon goes live with its virtual Amazon Care clinic for its Seattle-based employees and their dependents.

Cerner Announces Leadership Changes Focused on Increasing Alignment with Client Success

Cerner promotes Don Trigg to president and John Peterzalek to chief client and services officer.

News 2/19/20

February 18, 2020 News 6 Comments

Top News

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China’s COVID-19 containment efforts include requiring online and physical pharmacies to capture the ID card information of anyone who buys over-the-counter fever or cough medicine and send their identity to the government for follow-up.

Meanwhile, China’s state-run news agency says 5G and AI-driven chatbots are allowing doctors to provide virtual visits to help prevent and control the epidemic.

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Several China-based mobile healthcare app vendors have banded together to make 10,000 clinicians available to provide free online medical consultation. Nearly 100 Internet hospitals are offering online diagnosis.

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Universities are providing support to frontline workers using videoconferencing.

Services are also offering psychological hotline support for fatigued doctors and nurses.


Reader Comments

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From Tally Ho: “Re: Health Data Management shutting down. That just leaves the former Healthcare Informatics as an independent, dead tree health IT publication.” I don’t know anything about any of them since I’m not a reader, but the former Healthcare Informatics has apparently undergone some corporate gyrations, too. Private equity-backed Endeavor Business Media was formed in 2017 to buy trade publications and has accumulated a bunch of them, including Healthcare Informatics (which it bought, along with its summit meetings business, from Vendome Group, which closed its doors immediately afterward) and Health Management Technology (from NP Communications). It merged those publications, both of which had been publishing for 40 years, into Healthcare Innovation. Its focus now is on events that include Hosted Buyer Summits, the sales-oriented concept it gained from another acquisition. Googling for background reminded me of the once-hot thing Institute for Health Technology Transformation (IHT2), which was acquired by Vendome in 2013 and went missing shortly afterward.

From Ben Gender: “Re: your People section. I know women are getting new jobs, but they aren’t equally represented in HIStalk. I went through eight months of posts and 70% involved men.” I publish every health IT hire I see as long as (a) the new job is VP level or above; and (b) the person has a connection to the industry. In other words, it’s not a new CFO who came over from a poultry processing plant. I look at all new hire announcements as well as scouring my LinkedIn connections for unannounced job changes, so if I’ve missed anyone, it’s because nobody announced anything and I was short on omniscience.

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From Promo: “Re: my job. Loved it, lost it, looking.” I’ve never lost a job that I loved through adverse circumstances (layoff, reassignment, management conflict, etc.) because those key issues had already made me anxious to bail and I just needed someone else to pull the trigger. More common, I suspect, is accepting a promotion to a job you’ll eventually hate (for many technical or clinical folks, that means all levels of management) instead of staying with one you love and for which your talents are more appropriate. I’m annoying in always bringing up the Peter Principle – you get promoted until you finally reach a state of unhappy incompetence, then get stuck there because there’s no graceful way to go back down the ladder.

From Inferior Consultant: “Re: HITECH. Twitter users remind is that it’s the 11th anniversary of the $35 billion HITECH program and ask whether its 11 principles of health IT are being met.” Here are the mandated ONC responsibilities and my grade on each.

  1. Ensures that each patient’s health information is secure and protected, in accordance with applicable law. B. We’ve had some big breaches, but most were due to organizations not following accepted standards.
  2. Improves health care quality, reduces medical errors, reduces health disparities, and advances the delivery of patient-centered medical care. C. The potential benefits remain mostly a work in progress. The best ONC can do is to encourage use of technology that can support these goals, but it’s really up to providers to voluntarily act in the best interest of patients in the absence of incentives for doing so.
  3. Reduces health care costs resulting from inefficiency, medical errors, inappropriate care, duplicative care, and incomplete information. D. Providers who use technology sub-optimally and who refuse to share patient information have prevented any significant improvement in these goals and costs obviously continue to rocket out of control.
  4. Provides appropriate information to help guide medical decisions at the time and place of care. A. Providers don’t always use the information, but it’s there.
  5. Ensures the inclusion of meaningful public input in such development of such infrastructure. F. I don’t know that patients contributed much to the EHR discussion, but I doubt they were clamoring for patient portals.
  6. Improves the coordination of care and information among hospitals, laboratories, physician offices, and other entities through an effective infrastructure for the secure and authorized exchange of health care information. F. The standard called for actually improving the outcome, not just making technology available that providers ignore because of competitive data hoarding. This was an admirable but naive goal in assuming that providers will do the right thing rather than the most profitable thing.
  7. Improves public health activities and facilitates the early identification and rapid response to public health threats and emergencies, including bioterror events and infectious disease outbreaks. A for the outbreak part (Flint water crisis), but we lag most of the developed world in addressing public health and no amount of technology will change that. Our health system, like our national health, is awful if you’re poor.
  8. Facilitates health and clinical research and health care quality. A. Quality measurement hasn’t done much to improve our expensive, underperforming health system, but research capabilities have improved a lot (which unfortunately gives drug and device companies even more widgets they can shamelessly overprice).
  9. Promotes early detection, prevention, and management of chronic diseases. B. I’m almost willing to give an A here, but our fragmented, misaligned healthcare delivery system hasn’t improved chronic disease management as much as it could have, especially in “populations” rather than “patients.”
  10. Promotes a more effective marketplace, greater competition, greater systems analysis, increased consumer choice, and improved outcomes in health care services. F. EHRs and aggressive billing algorithms allowed rich health systems to get richer, suppress competition, and become even more brazen in their pricing practices.
  11. Improves efforts to reduce health disparities. F. This will happen only when it affects the bottom line of providers.

HIStalk Announcements and Requests

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Thanks to the reader who alerted me that I forgot to enable the “multiple answers” option on this week’s poll. I’ve fixed it and reset the results, so please vote again.

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I’m not sure why I thought about HBOC’s legendary book-cooker Charlie McCall today, but assuming he’s still alive, he is now 75 and presumably still a federal inmate for his role in our industry’s version of Enron. Here’s one of his Florida houses that I ran across while Internet snooping. It’s for sale at $10.8 million if you’re flush. Former McKesson CEO Mark Pulido — who pushed through the $14 billion HBOC acquisition despite investor resistance and surely regrets letting Charlie snooker him — sits on Inovalon’s board, was chairman and CEO of Ability Network through April 2018, and is now focusing on making great Cabernet with his wife at Pulido-Walker Cellars (fun fact: the label on the $240 bottles contains an apothecary symbol – Pulido was raised in Tucson, AZ and graduated from University of Arizona as a pharmacist). I started to Google stalk Charlie’s HBOC lieutenants Al Bergonzi, Jay Lapine, Richard Hawkins, etc. but realized that I don’t really care after all these years. I’m sure they’ve done well because that’s how wealth redistribution works for rich guys – you take their money and five years later they’ll have it back.

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I was Googling for clueless companies that tout their participation in the “HIMMS” conference when I found this clever web page from Relatient. Well played, although a nitpicker would note the missing “and” in the HIMSS name.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Health Catalyst will acquire Able Health, which offers quality and regulatory measurement tracking and reporting tools.


Sales

  • I’m never sure whether a health system’s decision to not fire its vendor with a contract extension constitutes a “sale,” but either way, Intermountain Healthcare extends its agreement with Cerner. They must have renewed early since the original 10-year agreement was signed in late 2013.

Announcements and Implementations

Meditech announces Expanse Patient Care, a customizable mobile app for nurses and therapists that includes access to bedside verification, clinical decision support tools, patient assessments, and patient record review.

India-based Manorama Solutions will integrate Allscripts DbMotion with its EHR software. A quick glance at the company’s name in the headline made me think that it was an entirely different sort of business.


Other

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I was looking at future HIMSS conference dates and was surprised to see that Chicago – where HIMSS is located — is back in the mix for 2023 after failing miserably twice before (Strike 1 for HIMSS12 was the high cost of dealing with indifferent McCormick Place union workers, Strike 2 for HIMSS19 was finding that RSNA got lower hotel room rates). That pushes HIMSS23 back to the more blizzard-friendly dates of April 17-21, several weeks later than usual. I enjoyed Chicago last time because I rented a house near the White Sox’s Guaranteed Rate Field (what a horrible name), took Lyft back and forth to McCormick Place, and steered clear of the sterile hotels and overzealous glad-handers in favor of a quiet neighborhood that was near Greek and dim sum places. It was HIMSS09 (the year that both Cerner and Meditech elected to pass on exhibiting, as I recall) when the land bridge leading to the opening reception showed near-whiteout conditions on April 5. Coat check folks made mint.

Radiologists who work for big tech companies launch a “Ditch the Disk” campaign in touting image sharing that goes beyond CDs (spoiler: they work for companies that stand to make money from disk-ditching).

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Researchers question whether smartphone-based research studies, such as those powered by Apple’s Research app, can ever provide generalizable results since so many participants drop out. Most of the eight studies that were reviewed could not get an ethnically and geographically representative sample of participants. The biggest drivers of ongoing participation were (a) having the study recommended by a clinician; (b) being paid; (c) being diagnosed with the condition being studied; and (d) being at least 60 years of age. The authors recommend that studies start in soft mode for the first week or two so that early dropouts won’t affect the result. They also note that a positive outcome is that researchers can study the dropouts to figure out why people in general aren’t interested in participating in research projects.

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The local paper questions whether Cerner will meet its obligation to add retail stores to its $4.5 billion, 290-acre South Kansas City, MO Innovations Campus as required by its $1.63 billion incentive package. Cerner says it is struggling to attract developers that can meet the tax break’s requirement that they be owned by women or minorities and that they pay a prevailing wage. Cerner wants to amend the deal so it can sell off the retail part of the property and give up the incentives. A Cerner VP admits that the company had “total ignorance” about the process. The only development so far is a Hampton Inn and a Taco Bell, while locals who were anxious to gain access to restaurants and stores in return for the city’s diverted money still have to leave town, along with the Cerner employees who hit the Interstate to go home elsewhere without contributing to the local economy or culture.

Four hospital patients in Montana sue Ciox Health, claiming that the company overcharged them for copies of their medical records. The state caps charges at $0.50 per page for paper copies plus a maximum of $15 for retrieval. Ciox Health billed one patient $902 last fall, which included the allowed per-page and retrieval fees plus $56.80 in shipping even though the records were delivered electronically. The hospitals involved were also named in the lawsuit.

A South Carolina physical therapist who was fired for falsifying patient records for services he didn’t perform blames his heavy workload and faulty software that forced him to make entries on incorrect patients. The state has fined and reprimanded him.


Sponsor Updates

  • Strata Decision Technology CEO Dan Michelson will offer “Tales from the Trenches” at Matter February 26 in Chicago.
  • The Chartis Group’s Center for Rural Health releases the 2020 Top 100 Critical Access Hospitals and the 2020 Top 100 Rural & Community Hospitals.
  • Diameter Health launches a new customer portal.

Blog Posts


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Morning Headlines 2/18/20

February 17, 2020 Headlines No Comments

Google to restructure Cloud business, with some roles eliminated

Shortly after closing its $2.6 billion acquisition of analytics startup Looker, Google announces layoff plans within its Cloud business as part of an overall restructuring that it says will help it better compete in five markets, including healthcare.

TTUHSC El Paso, TTP El Paso partner with Paso Del Norte Health Information Exchange

Texas Tech University Health Sciences Center El Paso and its physicians group have joined the Paso Del Norte HIE.

TapestryCare completes Series A Financing Led by Sopris Capital

Skilled nursing facility telemedicine company TapestryCare will use a Series A investment to expand into home health.

Curbside Consult with Dr. Jayne 2/17/20

February 17, 2020 Dr. Jayne 3 Comments

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It was a wild and crazy weekend, as I got to experience what it was like to get rained on with 100,000 of my closest NASCAR friends. The race was postponed, so I get to do it again Monday, minus the presidential visit and military flyover since I doubt they’re going to send Air Force One and the Thunderbirds again.

I’ll be spending a lot of time in airports trying to get home due to the changes. When I fly, I usually try to catch up on continuing education or read something for my book club, because it doesn’t matter as much if I get distracted versus trying to do actual work. Most of my continuing ed journals are in the realm of emergency medicine or primary care, so I was happy to run across an interesting read in the healthcare IT arena.

A couple of days ago, a “published ahead of print” manuscript authored by some prominent clinical informaticists made some waves. Appearing in the online version of the journal Academic Medicine, it addresses the idea of commercial interests in continuing medical education, and how electronic health record vendors play a role.

Looking back 20 years, there was a great deal of continuing education that was sponsored either directly or indirectly by pharmaceutical companies. During medical school, pharmaceutical representatives would bring breakfast to a session with the not-so-subtle title of “Drugs and Donuts.” They would talk about their products and when they should be used, and I don’t doubt this led to heavy prescribing of the products.

A few years later, this evolved to a more subtle sponsorship of our Grand Rounds lunchtime lectures, where it was obvious who was paying for the steaming pans of sweet and sour chicken and what drug they sold. The reps no longer addressed the crowd, but were available to detail folks afterwards and hand out promotional items. At my school, some of these sessions were accredited for formal continuing education credits and the objectivity of the program was addressed, but others were much looser.

As the authors note, the Accreditation Council for Continuing Medical Education (ACCME) won’t give accreditation to commercial entities that produce, market, resell, or distribute health care goods or services used by or on patients. However, they will accredit academic institutions and other bodies who want to provide credit for courses they sponsor, and those institutions can accept pharmaceutical funding.

For now, ACCME doesn’t categorize EHR vendors as commercial interests and thus provides them accreditation to deliver continuing medical education. The authors note, “Like pharmaceutical company-sponsored CME events, EHR vendor activities, which inherently only focus on use of the sponsoring vendor’s EHR system despite its potential intrinsic limitations, can lead to physician reciprocity. Such events also may inappropriately influence EHR system purchases, upgrades, and implementation decisions. These actions can negatively influence patient safety and care.” They continue to “call on the ACCME to recognize EHR vendors as commercial interests and remove them from the list of accredited CME providers.”

I’ve had the opportunity to attend CME sessions put on by multiple vendors. They vary greatly in their content and how much general education is given versus how much it is really just a veiled training session. Some of the best sessions I’ve been to revolve around newer models of care delivery such as Patient-Centered Medical Home, Chronic Care Management, or Transitional Care Management. A good session will include an in-depth discussion of how the programs benefit patients, what they entail, how to bill for them, and what outcomes you might be able to glean from using them. Only a small percentage of the session is actually learning how to document the program in a given EHR. Bad sessions are little more than click-by-click directions for how to use the EHR, with CME provided to entice providers to attend when they otherwise didn’t participate in training.

I fully agree that being able to execute a workflow well in the EHR is beneficial to patients, as their data is more likely to be documented accurately and comprehensively. That doesn’t necessarily make a class worthy of continuing education credits, but I’ve seen it done.

The authors go on to explain why EHR vendors should be considered commercial entities. They note, “Even though the 21st Century Cures Act excluded EHR systems from the Food and Drug Administration’s (FDA’s) oversight they should be considered medical devices similar to pacemakers, insulin pumps, and CT scanners, which are all under the purview of the FDA. No other commercial device or technology is used more often by physicians and other health care professionals than EHRs.”

One of their major points is that when EHR vendors sponsor CME sessions, they focus only on the vendor’s system and its benefits without mentioning competitor options. “Because every EHR system has intrinsic limitations, attendees are not adequately trained on alternate ways to solve problems… Instead of learning best clinical informatics practices and challenging the vendor to improve its product, attendees are presented with only the vendor’s worldview, which may result in their suboptimal or inappropriate use of EHR products or services on patients.”

One of their comments particularly resonated with me: “EHR vendors focus physicians’ attention on future enhancements to their systems so physicians may miss opportunities to implement available solutions that are more congruent with the needs of their patients, organizations, and the community.” I’m still waiting for an enhancement I requested back in 2006, despite the fact that other vendors include the request in their core functionality. Because the vendor kept promising it, there was no way my employer was going to fund an alternative solution.

The authors made some outstanding points, which was to be expected since several of them are leaders in the American Medical Informatics Association. This fact prompted a statement from AMIA noting that the article wasn’t reviewed or endorsed by the AMIA board of directors. Regardless, the AMIA statement calls on the ACCME to “recognize and consider the potential for bias when HIT vendors offer education to health care professionals” and goes further to urge ACCME to define EHR vendors as “commercial interests” in the same way that pharmaceutical or device manufacturers fit the definition.

AMIA states that although education on the use of EHR products is appropriate and relevant, it may not be appropriate for continuing education credit. The AMIA board asks CME organizations to “establish rules and processes by which they may support certified CME in a manner that is independent and unbiased,” just like drug and device companies must.

Knowing what I know about the ACCME, it will likely be some time before they respond to these calls to action. I’ll be curious whether they make a decision or whether they take it under advisement for further review. For many physicians who stay current in their specialties, it’s not hard to accrue all your required CME hours without relying on vendor-sponsored hours. Many of my colleagues have two to three times the number of mandatory hours simply but doing what they’re already doing to further their knowledge for patient care. I’ve got a couple of friends on vendor CME committees, and I’ll reach out and report back on what they have to say.

What do you think about EHR vendor-sponsored continuing medical education credits? Leave a comment or email me.

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Email Dr. Jayne.

Readers Write: Is Healthcare Ready for a New Era of Transparency?

February 17, 2020 Readers Write No Comments

Is Healthcare Ready for a New Era of Transparency?
By Miriam Paramore

Miriam Paramore is president and chief strategy officer of OptimizeRx of Rochester, MI.

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It’s not only patients who are demanding greater transparency around healthcare costs. It’s physicians and state and federal government officials. In just one year – January 2021 – a new federal rule will go into effect that requires all hospitals to post standard charge information, including discounted cash prices, payer-specific negotiated charges, and charges for at least 300 “shoppable” services, such as imaging, lab tests, and outpatient visits.

The rule, and associated rules for insurance companies, point to a new era of transparency driven by deepening healthcare consumerism. Increasingly, patients will be armed with data that allows them to guide their healthcare decisions in coordination with their healthcare providers, ultimately leading to more patient-centered care.

But this transparency also changes the patient-provider relationship. It’s never been more important to give both patients and doctors tools to navigate care options efficiently, allowing them to work together to make the best healthcare decisions, personalized to each patient.

The hard truth is that out-of-pocket healthcare costs for consumers continue to soar, creating notable financial burdens for patients and negatively impacting medication adherence and clinical outcomes. Amid continued growth of high-deductible health plans, deductibles alone rose 26% in 2019 from 2008, and expenditures are expected to continue to rise in 2020. Consequently, patients increasingly look to their providers for financial guidance and assistance.

Consider the impact of treatment cost on the day-to-day interactions between physicians and their patients. In May 2019, dermatologist Jack Resneck Jr., MD, chair of the AMA Board of Trustees, testified before Congress in a hearing on high drug prices about the experience of one of his patients. He noted that the wholesale price of the patient’s medications had quadrupled in price over the past 15 years. Faced with a pre-deductible PPO copay of 40%, the patient made the choice to stop his treatment. It’s stories like this one that contribute to rising healthcare costs.

Non-optimized medication therapy, including non-adherence, is linked to $528 billion in potentially avoidable healthcare cost. Notably, the vast majority of patients discuss healthcare costs with their doctors, according to a recent survey of 642 physicians across a variety of specialties. Doctors want patients to take medication that works for their health and their pocketbooks, and they know that one is often dependent on the other.

In the same survey, doctors indicated an overwhelming willingness to engage in these cost conversations with patients. Eighty-six percent of physicians surveyed indicated that they are comfortable discussing health care costs with patients, and over 90% believe they have a role to play in discussing healthcare costs with patients.

So how does the healthcare industry make these conversations part of standard practice? New platforms that build on healthcare providers’ existing electronic health records to streamline the reams of data – pharmaceutical options and costs, drug compatibility and patient adherence – are an important piece of the puzzle. Physicians need access to the data the pharmaceutical industry maintains, such as pricing and saving opportunities, while in the examining room with patients. Digital communication pathways that provide these resources to physicians will facilitate informed discussions that will ultimately drive a patient’s decision to follow through on recommended treatment.

Greater transparency is better not only for patients, who will have the opportunity to work in concert with providers to get the healthcare they can afford, but also for doctors, who will have access to the drug cost information their patients are requesting and to increase the likelihood of their patients following through on recommended care. Doctors already know that discussing drug cost is essential: 73% of physicians in the survey indicated that they feel the patient’s responsibility for cost is important when making a prescribing decision.

Digital tools are poised to facilitate this new era of transparency and improve healthcare outcomes and patient and physician success rates. Let’s make sure we encourage their implementation in time to move seamlessly into a patient-centered healthcare future.

Morning Headlines 2/17/20

February 16, 2020 Headlines 1 Comment

Feds probing how personal Medicare info gets to marketers

HHS OIG finds that CMS’s lack of oversight of its Medicare Part D eligibility database has allowed companies to submit millions of inquiries to harvest the personal health information of Medicare beneficiaries, potentially for use in telemarketing scams.

Innovaccer, the Leading Healthcare Technology Company, Raises $70 Million From Tiger Global, Steadview Capital, Dragoneer, Westbridge, Mubadala and M12 (Microsoft’s Venture Fund)

Patient records aggregator Innovaccer raises $70 million in a Series C funding round, increasing its total to $120 million.

Flywire Acquires Simplee to Transform Healthcare Payments Experience

Payments company Flywire acquires healthcare payments platform vendor Simplee.

Monday Morning Update 2/17/20

February 16, 2020 News 3 Comments

Top News

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HHS OIG finds that CMS’s lack of oversight of its Medicare Part D eligibility database has allowed companies to submit millions of inquiries to harvest the personal health information of Medicare beneficiaries, potentially for use in telemarketing scams.

OIG looked at 30 pharmacies that are heavy users of the system – which processes E1 transactions that verify prescription eligibility — and found that 98% of them weren’t filling prescriptions for the patients whose information they retrieved. Those 30 providers submitted nearly 4 million eligibility verification transactions from 2013 to 2015.

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Four of the pharmacies allowed outside telemarketers to use their provider numbers to do their own patient lookups. One provider had agreements to provide patient data to six marketing companies, who used that provider’s ID to submit 100,000 E1 transactions. An unnamed pharmacy management software company’s access was blocked after it responded to a CMS questionnaire.

HHS OIG has launched an investigation that it says will include several providers.

The report recommends that CMS (a) monitor providers whose E1 transaction volume is high compared to the number of prescriptions they submit; (b) issue guidance to remind users that E1 transactions cannot be used for marketing; and (c) make sure that only pharmacies and other authorized entities are submitting E1 transactions.

In a possibly related story, Surescripts terminated network access to healthcare data vendor ReMy Health last fall, claiming that the company was requesting patient and insurance information using the NPIs of providers who hadn’t treated those patients and then selling the information to drug marketing websites, including Amazon’s PillPack pharmacy. ReMy Health’s website is offline and former president Aaron Crittenden’s LinkedIn says he left the company this month and now serves as a business consultant for prescription discount vendor GoodRx.


Reader Comments

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From Nightly Job: “Re: Atrium Health. Confirming that it is moving to full Epic in replacing Cerner and other systems. No announcement was made, but kickoff meetings start this week.” I assume that replacement includes Macon-based Navicent Health, a longtime Cerner user that Atrium Health acquired last year. Atrium Health has nearly as many hospitals and employees as AdventHealth, which announced last week that it will also replace Cerner with Epic.

From Bicuspid: “Re: clinical software implementation and upgrades. What are some best practices for getting go-live user feedback and providing updates?” I can only speak from my personal experience, but here you go:

  • Make it easy for users to communicate with someone who understands their software and job. Traditional help desk triage isn’t good for that since users don’t want to get stuck in the call queue knowing that the person they’ll get probably can’t help them.
  • Get support people out of the war room and onto the floors to interact with users. Assign each person an area to cover and have them do a twice-daily walk through to seek feedback. An “ask me” brightly colored T-shirt or vest helps.
  • Meet with key groups at their shift change so you can catch two sets of users at once to hear issues and communicate status. You’ll know things have settled down when there’s little left to talk about.
  • Send  a daily or twice-daily email that includes a description of newly reported problems, closed problems, and issues that are being investigated that require more examples. This lets frontline people know that problems are actively being solved and calls attention to the issues they may experience. It also saves everybody time in avoiding duplicate problem reports.
  • Assign each problem a severity and include the new/open/closed count in the daily email.
  • Include user tips in the daily email update, which you glean from support calls and observed issues
  • Put together quick Camtasia videos showing how to perform specific functions that seem to be misunderstood and link to them from a website or the update emails. This is a good way to show users any configuration changes they will experience (night shift and offsite employees are otherwise hard to reach).
  • Get problems to the vendor or any other groups promptly and keep your own record of what was reported, who’s working in it, and when resolution can be expected.

From Piney Woods: “Re: [medically related site name omitted.] They haven’t shut down yet like Health Data Management, but they are cutting back on conference coverage and have started running vendor propaganda pieces for cash, which they swore they would never do.” I’ve decided that Epic is to health IT news sites as Craigslist was to newspapers. They have marginalized or killed off a lot of software companies that advertised, and since Epic doesn’t run ads for the most part, that leaves a big void for sites that until recently had all kinds of cash-waving vendors jockeying for eyeballs. Sites with high expenses or an unattractive audience of non-decision makers will have to shrink for sure now that the Meaningful Use gold rush is over. Some of the health IT sites are so inexpertly done that I’ve always marveled that they commanded advertisers even in boom times, but this particular somewhat related one is the only site I envy for its quality, the community it has created, and the smart way it monetized that audience without shamelessly pimping itself out.


HIStalk Announcements and Requests

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Only 40% of poll respondents think employers use their employee wellness programs and apps to rid themselves of workers who incur high medical costs. Alex says we overestimate employers since they probably don’t even remember that they offer wellness programs until contract renewal time. T. Morris says companies would be stupid to risk being called out for such behavior, but another respondent’s firsthand experience is that companies target employees with cancer or even those who have taken maternity leave. Realistic CIO says self-insured employers surely track their high-utilizer employees and/or family members, but most aren’t heartless enough to shed that cost as much as they would probably like to do so.

New poll to your right or here: Which organization would you trust to keep your identifiable health information private? (you can check more than one).

Listening: new from Violent Soho, a long-time Australian hard rock outfit that sounds remarkably like prime time Pixies and thus elicited my frantically unskilled air drumming. Spotify’s “Fans Also Like” option led me to the just-reunited Children Collide, which also sounds good.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Patient records aggregator Innovaccer raises $70 million in a Series C funding round, increasing its total to $120 million.

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Payments company Flywire acquires healthcare payments platform vendor Simplee.


People

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Julie Murchinson, MBA (Health Evolution) joins Avia as executive in residence.


Announcements and Implementations

Dimensional Insight  partners with Stoltenberg Consulting to offer a service desk performance visibility and accountability analytics.

HIMSS announces COVID-19 related plans for the conference:

  • HIMSS is working with foreign registrants who have to cancel because they will be in China within 14 days of the conference and can’t get into the US.
  • They are asking hotels and the convention centers to adhere to CDC and WHO disinfection procedures.
  • Orlando health systems will provide input on the conference’s emergency response plan.
  • Three medical offices will be operated in the convention center, one of them dedicated to attendees who have flu-like symptoms.

Other

London’s Royal Free Hospital blames a Cerner upgrade error for the non-delivery of 30,000 letters to patients and doctors over six months, with the hospital convening an internal inquiry into whether patients were harmed as a result.

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The local paper covers the use by Medical City Dallas’s use of robots from Diligent Robotics for deliveries.

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I was surprised when a reader told me that Health Data Management has shut down abruptly after 25+ years. Parent company Arizent — which renamed itself from SourceMedia a month ago – recently restructured under a new CEO, who replaced the whole executive team and announced plans to move beyond B2B publications. Arizent is owned by Observer Capital, whose initial holding was Jared Kushner-founded publisher Observer Media. I’m puzzled that they’re closing the HDM doors instead of selling, although maybe they tried and found no takers. They’re also killing off Information Management magazine.Fun fact: Bahrain-based private equity firm Investcorp paid $350 million for SourceMedia in 2004, split off the business unit that assigns banking routing numbers in 2009, sold that business for $530 million in 2011, and then sold the rest of the company in 2014. I’m sure Lorre will make it easy for any interested former HDM advertiser to become an HIStalk sponsor.

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An article in Academic Medicine calls for EHR vendors to be treated like drug companies in not being allowed to offer accredited continuing medical education. The authors say EHR vendors could use CME events to influence doctors who are involved in EHR decisions.

Psychologists and public health experts explain why people all over the world are unreasonably scared of COVID-19 – which has infected just a handful of Americans and caused just 1,100 deaths worldwide – when plain old flu killed 34,000 Americans last year and 61,000 the year before. They say human brains evaluate threats irrationally:

  • Press coverage of COVID-19 fatalities makes it seem like a big, dangerous problem, when in fact 98% of people who have it are recovering.
  • Flu creates the opposite perception, where people underestimate the danger because they only see people who recover uneventfully.
  • The human mind is conditioned to pay the most attention to new threats, not longstanding ones like flu and automobile accidents.
  • Upsetting imagery, such as city lockdowns and overcrowded hospitals, makes the risk seem higher.

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Doh!


Sponsor Updates

  • The local business paper profiles MDLive’s role in treating flu patients.
  • Meditech provides decision support and guidance for COVID-19.
  • HealthPartners enlists Patientco for Epic-integrated payment processing.
  • Netsmart will exhibit at the GA Hospice and Palliative Care Organization Annual Conference February 19-21 in Athens.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the AWHONN California Section Conference February 20 in Long Beach.
  • Redox releases its latest podcast, “Healthcare Data Privacy Rights with Attorney Matthew Fisher.”
  • Spok publishes an e-book titled “How to improve clinician experience through better communications.”
  • Relatient will exhibit at the HFMA Region 5 Southeastern Summit February 18-21 in Charleston, SC.
  • TriNetX offers turnkey protocol and site feasibility analyses on a per-study basis.

Blog Posts

Sponsor Spotlight

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AGS Health provides revenue cycle and coding services that ease our customers’ administrative and financial burden, enabling them to focus on their core mission of high-quality patient care. We do this by delivering unprecedented quality and liquidation results, often delivering 3-4x ROI. (Sponsor Spotlight is free for HIStalk Platinum sponsors).


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
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Weekender 2/14/20

February 14, 2020 Weekender No Comments

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Weekly News Recap

  • CVS talks up its in-store HealthHubs in its earnings call, saying its Aetna customers are interested in engaging with health navigators and its pharmacists can review a patient’s medical issues using both pharmacy and claims data.
  • CPSI’s Q4 results beat expectations as the company says it is benefitting from Athenahealth’s withdrawal from the inpatient market and Cerner’s declining interest in selling to small hospitals.
  • AdventHealth, which operates 67 hospital and ED facilities, announces that it will drop Cerner and several other EHRs and systems and replace them with Epic.
  • The VA pushes back its planned March 28 Cerner go-live at Mann-Grandstaff VA Medical Center (WA) until at least the end of April, saying integration isn’t ready.
  • Open Source Electronic Health Record Alliance announces that it will shut down on February 14.
  • Imprivata’s private equity owner is reportedly preparing the company for sale at a price in the $2 billion range.
  • An article whose author includes the AMA’s burnout expert calls for EHRs to report standard efficiency metrics using their log data, including measures of how doctors spend their time.
  • Nuance says in its earnings call that it will roll out its ambient clinical intelligence “exam room of the future” for five medical specialties in Q2.

Best Reader Comments

Another government response to the proposed interoperability rule that doesn’t actually address any of the privacy concerns that the letter / follow-up post contained. If he’s going to talk about walking the walk, then they need to be seriously pushing for HIPAA to be expanded in a way that accommodates the environment they’re trying to create.(Ex-Epic Chiming In)

This isn’t the first time it’s been reported that Cerner did that pricing. Same thing happened at University of Illinois Chicago. They had such an old / customized version of Cerner that it was reported that the cost to basically rebuild Cerner and modernize it was the same cost or close to it as moving to Epic. Keep in mind that Cerner’s revenue on actual licenses for Millennium is minimal at best (check the earnings report). Their largest cash cow is their consulting organization. (Associate CIO)

Nurses were “rescheduling” the patient’s meds on the Medical Record to an hour later to avoid those [late med reason question] popups. This disguised the problem of how often medications were actually being given late. Sometimes it takes empathy and seeing the problem with your own eyes before we can really make things better. More data collection does not always make a better metric and can sometimes miss the mark. (Robert Buehrig)

Those metrics look decent for ambulatory usage. You really only want EHR vendors to expose these metrics rather than try to operationalize them because you don’t want the EHR vendor to decide how much of your time you should spend writing notes. That means that it’s going to be up to your management to respond to those metrics. (What)

I do worry that the metric of “undivided attention” suggests that ANY attention the doctor pays to the information about the patient in the record is considered to be not in the patient’s best interest. One could imagine taking that to an unproductive extreme. I suspect that most patients these days are counting on the doctor’s taking the time to become informed about their care. When I go to my internist, I am counting on his putting it all together and coming up with a plan. He can’t do that without breaking eye contact with me, and I am OK with that. (Andy Spooner)


Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Ms. H in Pennsylvania, who asked for a new table for her elementary school class. She reports, “Thank you so much for our new table! This year we are lucky to have 22 students in our class, but were we pretty cramped at the old furniture that we have. Little by little I have tried to trade out our furniture for newer and more spacious materials. Thank you for being part of our growth!”

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An Illinois pediatrician who committed suicide last fall left a note that suggested he regretted falsifying medical records over a 10-year period for parents who didn’t want their children vaccinated. Van Koinis, DO practiced holistic medicine and was sought out by parents who needed falsified vaccination records to allow their children to attend school. The sheriff warns that the ambiguity of the doctor’s note may also mean that he didn’t give vaccines even when the parents assumed that he did.

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Corpus Christi, TX police arrest a hospital’s on-duty ED doctor for public intoxication after witnesses reported that he was belligerent and walking around the ED’s public area wearing only underwear.

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Overworked clinicians in Wuhan, China are shaving their heads to make it easier to don makeshift hazmat suits and are using adult diapers to save bathroom break time. China has only two doctors per 10,000 people and many of them do not have degrees. Hospitals are running out of medical supplies, protective suits and masks, and food. Some doctors have been assaulted by people who were upset about wait times, while others reported that the hospital’s entire supply of N95 protective masks had been seized by hospital executives for their own use. 

CDC mistakenly tells a San Diego hospital that several of its patients had tested negative for Covid-19 even though the samples of three of them had not yet been processed, allowing them to be returned to military base quarantine. One of the patients was later found to be infected. CDC blames an unspecified labeling error that may have been caused by the hospital’s assignment of phony patient names to protect privacy.

Kenya has spent $625 million since 2015 to lease diagnostic medical equipment from companies like Philips and GE, but more than one-third of the machines are sitting idle in hospitals that don’t have radiologists to operate them. Critics say the government should have spent the money on clinics and midwives, speculating that diverting the money into procurement contracts gave health officials a chance to line their pockets. Hospitals say they weren’t asked about their needs and in some cases received unneeded duplicate machines. The health ministry refused the auditor general’s request to review the contracts.


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Morning Headlines 2/14/20

February 13, 2020 Headlines No Comments

CVS Health beats on fourth-quarter earnings and revenue

CVS Health reports Q4 results: revenue up 23%, adjusted EPS 1.73 vs. $1.68, beating Wall Street expectations for both.

Carevive Systems raises new financing round with Philips and Debiopharm to accelerate advances in cancer care delivery

Oncology-focused technology company Carevive Systems raises a Series C round of financing led by Philips Health Technology Ventures and Debiopharm Innovation Fund.

Computer Programs and Systems (CPSI) Surpasses Q4 Earnings and Revenue Estimates

CPSI announces Q4 results: revenue down 2%, adjusted EPS $0.78 vs. $0.78, beating Wall Street expectations for both.

News 2/14/20

February 13, 2020 News 3 Comments

Top News

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CVS Health reports Q4 results: revenue up 23%, adjusted EPS 1.73 vs. $1.68, beating Wall Street expectations for both.

The company, which acquired Aetna in late 2018 and also owns the Caremark pharmacy benefits manager, is tracking at more than $250 billion in annual revenue.

CVS said in its earnings call that nurse practitioners in its drugstore-based HealthHubs can treat 80% of what a PCP can manage. However, the company also added that its Aetna members value their relationships with their PCPs are and looking for local health navigators in a concierge-type program.

CVS says its pharmacists are counseling patients on their health issues by reviewing their combined pharmacy and claims data. It is modernizing its business by using robotics, moving to a hybrid cloud environment, using AI and other technologies in its call centers, and applying analytics to employee scheduling.

CVS shares closed up slightly Wednesday following the earnings announcement. They are up 21% in the past year vs. the Dow’s 12% rise, valuing the company at $94 billion.


Reader Comments

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From Fickle Pickle: “Re: Atrium Health. Surprised in your mention of AdventHealth’s planned replacement of Cerner with Epic that you didn’t mention Atrium Health’s plan to do the same, announced a couple of months ago.” I’m not sure I knew about that. The organization posted a a bunch of Epic-related jobs in mid-January. Atrium Health has nearly 50 hospitals and 65,000 employees.

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From Half Wit: “Re: Children’s Mercy Hospital, Kansas City, MO. Stands to lose its $500K city subsidy, which coincides with the amount it paid for naming rights for the Kansas City, KS soccer field, home of the team previously owned by Cerner’s Neal Patterson before his death. The hospital says the loss of funding will greatly impact their operations since they rely on it to provide care for uninsured patients.” The city says it had to balance scarce resources and the hospital is making a profit, unlike other local organizations that provide services to children. The hospital’s most recent tax filing shows a $267 million profit on $1.4 billion in annual revenue. Health systems are profit-maximizing entities and this one is obviously hoping to get future profitable business from putting its name on a business whose customers are less likely to be on Medicaid and Medicare, but I can understand why the city might wonder why it is writing checks to a cash machine whose community benefit is indirect at best. The stadium previously bore Lance Armstrong’s Livestrong name – and apparently was paying that organization for the privilege instead of being paid – but that deal fell apart in 2013 when Armstrong finally admitted to doping accusations. I checked on how Livestrong and its ubiquitous yellow wristbands did after the revelations — it reported $15 million profit on $103 million in revenue in 2011, but that had dropped to an $11 million loss on $46 million in revenue in 2018. Fun fact: Armstrong’s Austin, TX coffee shop is named Juan Pelota Cafe, which is funny if you know Spanish and that he had testicular cancer.


HIStalk Announcements and Requests

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Thanks to the folks who have responded to my annual reader survey. I’ll leave it open for another couple of days, then draw from the respondents for one or more $50 Amazon gift card winners (depending on the number of responses I get). Meanwhile, for the respondent who said they are pining for the return of the Smokin’ Doc, here you go from some T-shirts I had printed awhile back (and like most of my well-intentioned reader swag, that I got stuck with). I still have a box somewhere with several of the six-foot-tall Smokin’ Doc standees we used to display in the booth, and if I were more creative, I would turn them into some kind of Donors Choose fundraising opportunity.

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Welcome to new HIStalk Platinum Sponsor Wolters Kluwer Health Language. Wolters Kluwer delivers powerful, innovative data quality solutions that are tailored to the needs of health systems, payers, health IT vendors, HIEs, researchers, and government. Its Health Language solutions transform disparate data assets to optimize reimbursement, regulatory compliance, operational efficiency, care coordination, and interoperability. Its healthcare content library of standard terminologies and custom content and value sets can extend existing data and provide a single source for content needs. The advanced Health Language software applications helps model, map, group, and search healthcare codes, all on a cloud-based platform. The global team of Health Language clinical experts—including physicians, nurses, pharmacists, and AHIMA-approved ICD-10 coders, and trainers—help ensure clinical data accuracy. Thanks to Wolters Kluwer Health Language for supporting HIStalk.

Dr. Jayne’s most recent post called out that most of the country will “spring forward” into Daylight Saving Time on March 8, which is the day before the official start of the HIMSS conference. Quite a few folks who live in the eastern parts of their respective time zones will enjoy leaving the convention center in semi-broad daylight with the palm trees waving.

Speaking of HIMSS, I keep putting off any planning for what Jenn, Dr. Jayne, Lorre, and I will do there, especially since I’m not exhibiting. Usually we just wander around looking and listening for insights to write about, but if you have ideas, let me know. I’ve activated my burner phone at 615.433.5294, although I probably will use it just for text messaging.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Meditation app developer Headspace will use $93 million in new financing to develop Headspace Health, which will offer mental health tools for chronic disease patients. Founder Andy Puddicombe boasts a degree in circus arts and ordination as a Tibetan Buddhist monk.

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The Australian Financial Review notes the strong financial performance of imaging platform vendor Pro Medicus as it moves customers to the cloud. The company says US healthcare interest in cloud computing wasn’t significant until Mayo Clinic announced its partnership with Google Cloud. Most of the country’s revenue comes from the North American market, where it offers imaging products under the Visage name, and sales here were up 43% in the most recent six-month reporting period. Pro Medicus is adding AI capabilities and a breast density algorithm that it co-developed with Yale is waiting for FDA’s approval. The two co-founders each hold shares worth $500 million.

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CPSI announces Q4 results: revenue down 2%, adjusted EPS $0.78 vs. $0.78, beating Wall Street expectations for both.


Sales

  • Geisinger (PA) signs a six-year agreement with Omnicell for its automated medication dispensing systems.
  • Memorial Sloan Kettering Cancer Center (NY) extends its Allscripts Sunrise contract through 2026.
  • Atrius Health (MA) will implement provider search and scheduling software from Kyruus across its 30 practices.

Privacy and Security

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Malware causes a system outage across facilities associated with the Pediatric Physicians’ Organization at Boston Children’s Hospital, which has not been affected. PPOC facilities went live on Epic several years ago.


Other

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A small survey of health system providers and HIE staff conducted by the EHealth Initiative and NextGate finds that data-entry errors are the top cause of duplicate medical records. Over one-third of surveyed providers say they’ve incurred an adverse event within the last two years due to patient-matching issues. Providers say that a lack of funding and technology are the biggest barriers to patient-matching improvement, while HIE leaders point to insufficient funds and staff. Most respondents seem to be in agreement that federal funding should be made available for a national patient identifier.

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The Chinese government develops an app that alerts users when they come into close contact with a person infected with Covid-19. Experts warn that the app may offer a false sense of security and non-exposure if it can’t detect people who are symptom-free.

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A literature review of six smartphone-based skin cancer apps finds that they miss melanomas, produce false positives, are poorly regulated, and don’t inform users of their limitations. None of the six have received FDA approval.

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A BMJ article ponders if AI can be trusted to not perpetuate racial bias and prejudice, listing the usual concerns of (a) training the system on a non-representative data set; (b) investor-backed companies whose incentive is to rush a product to market that isn’t ready; and (c) dermatology-focused products that don’t necessarily work equally well on patients of different skin colors. British AI researcher Eleonora Harwich refreshingly concludes in a non-BMJ sort of way, “There is so much hype around AI and these snazzy algorithms that sometimes I feel like people think it will absolve them of the need to think. It will never absolve you from having to think hard about big problems. Technology can’t choose what outcomes you want to achieve, or what type of society you want to be in. Those are very deep human questions that no one is going to answer for us. If you let them be answered for you, then you’re in deep shit.”


Sponsor Updates

  • EPSi will exhibit at the HFMA Region 5 Southeastern Summit February 18-22 in Charleston, SC.
  • HIMSS names Greenway Health CMO Geeta Nayyar, MD one of its 2020 Most Influential Women in Health IT.
  • The HCI Group partners with the Tim Tebow Foundation’s Night to Shine in Jacksonville, FL.
  • InterSystems releases novel coronavirus screening functionality for TrakCare.
  • CarePort Health makes its CarePort Transition Extender available with Epic’s App Orchard.
  • Capsule Technologies reports that its systems passed all required tests at the IHE North American Connectathon.
  • The Chartis Group names Robert Faix (Impact Advisors) a principal in its I&T practice.
  • Premier partners with Gavs Technologies to form a new joint venture, Long 80, which will bring AI-based IT and security operations to healthcare organizations.

Blog Posts

Sponsor Spotlight

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Crossings Healthcare Solutions was established in 2014 to provide custom clinical decision support software that optimizes the Cerner Millennium System. Our award-winning MPages and Advisors solutions have been installed at more than 76 hospitals across the U.S., including California, Nevada, Texas, Oklahoma, Florida, South Carolina, Tennessee, Montana and Missouri, as well as Washington DC. These solutions are seamlessly integrated into clinical workflow to enhance usability, efficiency and communication. (Sponsor Spotlight is free for HIStalk Platinum sponsors).


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EPtalk by Dr. Jayne 2/13/20

February 13, 2020 Dr. Jayne 2 Comments

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My HIMSS schedule planning is being hampered by some kind of bug in Outlook, where the time zones aren’t displaying correctly for HIMSS week. They are accurate the weeks before and after, but the week of the 8th is a mess. I suspect it has to do with the time change to DST, but it’s weird. I’ve asked a couple of other Outlook users and they’re not having the issue, which leaves me doing all kinds of shenanigans with my calendar to make sure I know when and where I need to be. If you have any tips on this, or are seeing it yourself, let me know. I doubt too many people run three time zones on their calendars, so it may be a fairly limited problem.

Signing up for events at HIMSS is becoming more complicated. Gone are the days when you could just attend vendor events as a mere HIMSS attendee. Citrix is requiring people to be “qualified” to attend and will get back to me in 48 hours to let me know if I’m on the list. Others such as Capital One / Ziegler are a little more accessible. One of the things I loved about HIStalkapalooza was that everyone was invited – there was a great mix of people which led to lots of interesting conversations. I respond to invitations with my real name and credentials, so I’m getting a feel for how the average attendee is handled.

I worked some unscheduled clinical time this week in order to cover a colleague with influenza. I was surprised that the EHR had been upgraded with no notification or explanation. Although the changes were minor, it created an unsettled feeling as you wondered what was different that you might be missing. Although some of the enhancements were nice, a few missed the mark in that they were only partial fixes to issues. Our vendor is going through some growing pains and I’ve heard good things are coming, so I’ll remain optimistic.

The lack of notification may be part of an overall change in communication patterns for the practice, and not necessarily for the better. I’d love for them to hire me to put on my standard “Effective Communication Strategies” workshop because they’re not doing a great job. In order to prevent people’s email from being inundated, they’ve gone from a “push” communication strategy to a “pull” one, and unfortunately, it’s not working.

When I do my workshop as a consultant, I walk organizations through the creation of a communications matrix, where they define the different kinds of communications, the audience, and how they should best be delivered. For some critical communications, such as how to handle the novel coronavirus (now named COVID-19 by the World Health Organization), you might want to communicate in multiple channels and blast the important items to people via text or email.

Instead, our practice leadership sent an email that essentially said, “So that we don’t send you emails that would quickly become outdated, we’ve put everything on a website that you should check daily.” Unfortunately, the website doesn’t have a clear section that spells out “what’s new,” which means providers have to read through the whole thing and try to figure out what has changed since the last update. It’s not a terribly effective way to communicate key information in a rapidly evolving situation. I can pretty safely predict that people will just stop looking at it, much like they stopped looking at a quality improvement website that worked in the same way.

Several of my clients have reached out for advice on how to handle various aspects of the COVID-19 situation. If you’re not already freaked out about being exposed to germs because you’re part of the healthcare IT infrastructure, you might be when you hear the latest data. According to the Journal of Hospital Infection, coronaviruses can survive on surfaces for up to nine days, although the majority die after four or five days. Low temperatures and high humidity increase the lifespan. I wonder if vendors whose products include solutions for disinfection and sanitation will see an uptick in foot traffic at HIMSS.

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I was glad to see that National Coordinator for Health Information Technology Don Rucker called out the hospitals that signed Epic’s anti-interoperability rule letter. He notes that only three in 100 academic medical centers signed it. He went further to criticize one of the signers, saying, “One of the signers of the letter is known for taking thousands of patients to court. If you take someone to court, that information becomes public discovery. Their medical care is now public. It’s part of the court record… Looking at protecting privacy, we need to walk the walk here as we look at who is saying what and letter-writing campaigns.” It’s always good to look below the surface – sometimes what you find is pretty interesting.

In other news from ONC, the Health IT Advisory Committee (HITAC) is launching a new task force, the Intersection of Administrative and Clinical Data Task Force. It will focus on connecting data standards to improve interoperability, reducing clinician burden, and improving efficiency. Additional information on task forces is available on the HITAC website.

A recent article noted that little news has come out of Amazon, Berkshire Hathaway, and JPMorgan Chase’s Haven since its founding. It last issued a public statement in March 2019. We’ll have to see if there’s any buzz around or after HIMSS. If anyone has anything to share, feel free to reach out and we’ll keep you anonymous.

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If you’re still doing your Valentine’s Day shopping, there’s always the Samsung Galaxy X Flip phone, which launches on February 14 in the US. It’s got a slick one-inch OLED display on the cover that shows notifications when the phone is closed, and when the phone is open, you can use it as a full-screen or split-screen display for different apps. The screen is rated for 200,000 folds, which based on the phone habits of some teens I’ve seen lately, might last a year. Is $1,380 too much to pay for someone’s undying love and affection?

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Morning Headlines 2/13/20

February 12, 2020 Headlines No Comments

HealthLynked Signs Definitive Agreement to Acquire Cura Health Management, LLC, and ACO Health Partners, LLC Adding Significant Revenue and Profitability from Its Newly Formed Accountable Care Organization Division

Membership-based patient and provider network HealthLynked acquires Cura Health Management and its ACO subsidiary for $1.75 million.

Scoop: Headspace raises $93 million

Meditation app developer Headspace will use a $93 million funding round to develop mental health tools for chronic disease patients.

WELL Health Announces Agreement to Acquire MedBASE’s OSCAR EMR Business

In Canada, Well Health Technologies acquires MedBase Software’s Open Source Clinical Application Resource (Oscar) EMR assets.

Boulder raises $10.5M to expand access to opioid addiction treatment

Addiction-focused telemedicine startup Boulder raises $10 million.

Morning Headlines 2/12/20

February 11, 2020 Headlines No Comments

One of the nation’s largest health systems drops Cerner

Florida-based AdventHealth, renamed from Adventist Health System just over a year ago, will replace Cerner with Epic.

VA delays rollout of new electronic health record

The VA pushes back its scheduled March 28 Cerner go-live at Mann-Grandstaff VA Medical Center (WA) until at least the end of April.

Intuitive Surgical Expands Into Hospital Informatics With Orpheus Medical Acquisition

Da Vinci robotic surgery system vendor Intuitive Surgical acquires Orpheus Medical, which offers a video documentation system for surgery.

3M Sues IBM in Contract Spat Over Health-Care Software

3M’s Health Information Systems division accuses IBM and its Truven Health Analytics business of using 3M software to sell data to customers without the proper licensing agreements.

Malware attack disables medical records at Children’s Hospital affiliates

Malware causes a system outage across facilities associated with the Pediatric Physicians’ Organization at Boston Children’s Hospital.

News 2/12/20

February 11, 2020 News 4 Comments

Top News

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AdventHealth – the  Florida-based health system that was renamed a year ago from Adventist Health System – will replace Cerner with Epic.

An anonymous AdventHealth employee says the health system was discouraged by the work that would be needed to address Cerner’s ambulatory and revenue cycle shortcomings. That person also said that consolidating AdventHealth’s three prod domains to one – those systems can’t communicate with each other now – would cost nearly as much as buying Epic, which its physicians wanted.

Another anonymous AdventHealth employee had predicted the switch two months ago, saying that the health system was frustrated with Cerner’s revenue cycle offerings, its lack of integration with its ambulatory system, and the redirection of the company’s focus to its DoD and VA work.

AdventHealth also uses Athenahealth and several other EHRs that will be replaced by Epic.

The three-year project will begin within the next two weeks.

AdventHealth is among the country’s largest non-profit health systems. It operates 67 hospital and ED locations, generates nearly $20 billion in annual revenue, and employs 83,000. It is not related to California-based Adventist Health, which recently terminated its Cerner revenue cycle outsourcing contract.

Cerner shares closed up slightly Tuesday.


Reader Comments

From Newser Nabob: “Re: AdventHealth. Why was it breaking news that it will move from Cerner to Epic?” It’s important when one of the country’s largest health system decides to spend billions to switch EHRs, especially if you are one of 125,000 people who work for Cerner, Epic, or AdventHealth; if you own CERN shares; or if your company does business with AdventHealth or might get the opportunity to do so with a vendor change. It would be equally newsworthy if a similarly sized organization announced plans to move from Epic to Cerner.

From Rolling On: “Re: Advocate Aurora Health. Massive Epic go-lives, with 15 hospitals last weekend in Wisconsin and the central lab that performs 15 million tests annually going up on Beaker. This weekend, three hospitals including Advocate Children’s that total 1,000 beds on all modules. No issues.”


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor 314e (it’s an abbreviation for Pi, explained here). Services offered by the San Francisco-based health IT-only consulting firm include EHR (advisory, implementation, training, go-live support, optimization); interoperability (interfaces, data conversion and archiving, FHIR); analytics (BI, data science, AI); technology (programming, cloud adoption, automation, testing); and managed services and staff augmentation. The company has completed over 200 EHR implementation engagements, 180 of them Epic, with consultants averaging four certifications and eight years of Epic implementation experience. It also has Cerner and Meditech expertise and has contributed to projects involving EClinicalWorks, Athenahealth, and NextGen Ambulatory. Thanks to 314e for supporting HIStalk. 


Webinars

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


Acquisitions, Funding, Business, and Stock

Workforce management system vendor OnShift, which focuses on the senior care market, acquires Avesta Systems, which sells talent acquisition software.

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McKesson begins the process of selling its majority stake in Change Healthcare, offering MCK shareholders the chance to exchange their shares for discounted shares in SpinCo, the subsidiary that holds its Change Healthcare ownership.

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Da Vinci robotic surgery system vendor Intuitive Surgical acquires Orpheus Medical, which offers a video documentation system for surgery.

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Open Source Electronic Health Record Alliance (OSEHRA) — which focuses on the VA’s soon-to-be retired VistA system — will shut down Friday.


People

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Caroline Macumber, MS (Apelon) joins Clinical Architecture as EVP of professional services.


Announcements and Implementations

Medicomp adds clinical content and updates its clinical AI engine to include terms and mappings to support the documentation, reporting, and treatment of the 2019-NCov coronavirus strain.


Government and Politics

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The VA pushes back its scheduled March 28 Cerner go-live at Mann-Grandstaff VA Medical Center (WA) until at least the end of April. Schedule user training has been cancelled as the implementation team continues work on integration with other VA systems. Meanwhile, the VA requests $2.6 billion in 2021 to continue the rollout.


Other

Forbes reports that the DEA is asking EHR vendors to provide EHR patient information to help it investigate suspected opioid overprescribing. It says that EHR vendor DrChrono provided 9.3 GB of medical records in response to a DEA records request involving a small Arkansas medical practice.

CNBC reports that Google Health has grown to more than 500 employees who work from its Palo Alto, CA office under VP David Feinberg, MD, MBA. 

Interesting: the insurer for Utah’s state employees is paying for flights to Mexico for a test group of 10 people who get their prescriptions filled there. The state saves 50% of the $62,000 annual cost of arthritis drug Enbrel for a single patient, even after paying for airfare. Patients must take four trips per year because federal drug importation law allows them to bring back just a 90-day personal supply.


Sponsor Updates

  • Wolters Kluwer and Ariadne Labs celebrate their 10-year partnership providing UpToDate access to clinicians in resource-limited settings through the Better Evidence program.
  • The Boston Business Journal profiles Kyruus, highlighting the fact that the company plans to soon add 100 employees.
  • AdvancedMD becomes a corporate sponsor of the Association of Independent Doctors, offering half-off membership discounts to select applicants.
  • Avaya donates communications solutions to Wuhan Vulcan Mountain Hospital to help care for coronavirus patients.
  • Burwood Group will host an axe-throwing mixer on Valentine’s Day at STL Axe Throwing in St. Charles, MO.
  • The local news covers ConnectiveRx’s expansion plans in Pittsburg, including the addition of 1,500 jobs.
  • The Digital Healthcare Podcast features Diameter Health CEO Eric Rosow.

Blog Posts

Sponsor Spotlight

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PatientKeeper’s EHR optimization software solutions streamline physician workflow, improve care team collaboration, and fill functional gaps in existing hospital EHR systems. With PatientKeeper as the “system of engagement” complementing the EHR system of record, physicians can easily access and act on all their patient information from PCs, smartphones and tablets, improving physician satisfaction, efficiency, and patient care. PatientKeeper is used by more than 70,000 physicians at hospitals and health systems across North America. (Sponsor Spotlight is free for HIStalk Platinum sponsors).


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Reader Comments

  • Gonepostal: re: "Politico also reports that two senators have introduced legislation that would make the post office’s address mat...
  • Epic Dev: I think that your assessment of Epic's COVID response is focused on the wrong choice. Sure, we employees have the choice...
  • Bolognavirus: The statement made was that Epic is breaking the law. The answer clarified that it isn’t....
  • detroitvseverybody: As a member of an organization, it helps to conceptualize your options into three categories: exit, voice or loyalty[1]....
  • Deetelecare: It reminds me of the post-deregulation period in the airline business, 1980s into the 1990s, when airlines fetched this ...

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