Morning Headlines 5/3/19

Allscripts announces first quarter 2019 results

Allscripts announces Q1 results: revenue flat, adjusted EPS $0.16 vs. $0.15, beating on earnings but falling short of revenue expectations.

CirrusMD Announces $15 Million in Series B Funding and New Plans to Improve Care Delivery For Veteran Population

CirrusMD raises $15 million in a Series B funding round, and announces that its chat-based telemedicine software will be implemented at three VA medical centers.

Insiders describe aggressive growth tactics at uBiome, the health start-up raided by the FBI last week

UBiome places its co-CEOs on administrative leave as the company deals with fallout from an FBI raid and highly questionable business practices that included pressuring doctors to approve its tests and billing payers multiple times without patient consent.

News 5/3/19

Top News

Allscripts announces Q1 results: revenue flat, adjusted EPS $0.16 vs. $0.15, beating on earnings but falling short of revenue expectations. 

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor SailPoint Technologies. The Austin, TX-based company’s platform manages digital identities, allowing organizations to see and control access to apps (on-premise, cloud, web), devices, infrastructure, and structured and unstructured data. Deployment options include SaaS, AWS or Azure cloud, data center, or via a managed service provider. Specific functionality includes provisioning, self-service access requests, access certifications, separation of duties, user-managed password resets, file access management including Microsoft Office, and AI-driven reporting. Specific platforms supported include Epic, Cerner, SAP, Workday, Box, Dropbox, and SharePoint. PeaceHealth dropped its 28-day turnaround time for providing access to two days, is able to run yearly employee access certification campaigns, and has reduced provisioning contractor headcount by 25. Thanks to SailPoint Technologies for supporting HIStalk.

Listening: the new, final album from The Cranberries, completed by the band from demo tracks found on the hard drive of singer Dolores O’Riordan, who died in January 2018 at 46 of accidental drowning. The Cranberries have made recordings in that manner before — she poured so much emotion into the demos that her studio versions couldn’t match them, so they sometimes went with the first draft. She had been through a lot, so the new album is more wistful, reflective, and less angry than “Zombie,” of which I would say her 1995 performance on SNL is still one of the rawest and best in that show’s history from long ago when singers wrote their own songs, performed them with emotion, and used minimal stage equipment with no computers, Auto-Tune corrected vocals, or sequiny dancers. My expectation of just listening to the new album without emotion turned out to be unrealistic as I spent the afternoon looping the achingly perfect title track “In The End.”

It’s a big holiday weekend, so happy Cinco de Cuatro to all.

Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information.

Acquisitions, Funding, Business, and Stocks

CirrusMD raises $15 million in a Series B funding round. Its chat-based telemedicine software will be implemented at three VA medical centers.

Medical device integration and patient monitoring company Capsule Technologies acquires clinical surveillance software vendor Bernoulli Health. Capsule Technologies was acquired by Francisco Partners from Qualcomm just before HIMSS, where it re-emerged from its Qualcomm Life brand as Capsule Technologies (before Qualcomm, it was Capsule Technologie).

CBNC reports why the FBI raided venture-funded microbiome startup UBiome: the company was billing insurers multiple times without patient consent and pressuring its doctors to approve its tests (which it should be noted have zero proven clinical value). The company has placed its two co-founders – who are also its co-CEOs – on administrative leave.  

Medhost adds hospital business office outsourcing services.

ResMed announces Q3 results: revenue up 12%, adjusted EPS $0.89 vs. $0.92. 

Inovalon reports Q1 results: revenue up 57%, adjusted EPS $0.10 vs. –$0.04.

Sales

• Oklahoma Spine Hospital selects Evident’s Thrive EHR.

People

Netsmart promotes Kevin Kaufman to CFO.

Mindy Heintskill (Walgreens) joins MDLive as chief marketing officer.

Medhost promotes Jason Myers to CIO and Rick Brown to chief development officer.

Cerner Chief People Officer Julie Wilson will retire on June 30 after 16 years in that position and 24 with the company.

Announcements and Implementations

Cantata Health adds a resident referral portal to its NetSolutions EHR for skilled nursing facilities.

In Massachusetts, Lahey Health System and Tufts Medical Center implement secure communications and notification capabilities from Secure Exchange Solutions as part of the ELINC HIE.

Woman’s Hospital (LA) goes live on Meditech Expanse Point of Care.

North York General Hospital in Toronto goes live on Spok’s Care Connect contact center technology.

Other

AMIA announces its first group of Fellows (FAMIA) in applied informatics. 

DirectTrust seeks members to serve on its Direct Standards Consensus Body.

Medlio co-founder Lori Mehen recounts her negative experience in applying for the Cedars-Sinai Accelerator, saying that the CIO (presumably Darren Dworkin) told her seven minutes into her 15-minute scheduled meeting with him that not only would he vote no, but that he would also “veto anyone who says yes,” describing his tone as “belligerent and hateful” in telling her, “We don’t need your help getting our patients to find our doctors.” (It should be noted that this is one side of the story and other companies, especially those who were actually accepted into the program, have spoken positively about their experience and Darren’s involvement). She concludes:

We’re certain that we’re not going to be accepted. Nevertheless, it was imperative that I write this before they make their final decision. I’ve discussed this with my partners and they both agree, in the off chance we would have been accepted, we want to go on record as saying Cedars can go f%&k themselves. I’m not supposed to say this because doing so will almost certainly cost me, but that’s exactly why I must. Not just for me, or for my co-founders, but for all the other startups he has abused and will continue to abuse.

The University of Maryland works with local officials to deliver a kidney via drone to the University of Maryland School of Medicine three miles away, where it was successfully transplanted into a 44 year-old woman who had been on dialysis for eight years. Baltimore traffic must be awful to risk having a kidney-bearing drone come crashing to earth for such a short trip.

I’m not sure if this is an example of social engineering hacking, incredibly bad security practice, or incredibly good cybersecurity humor.

Sponsor Updates

• Securance Consulting gives Engage a five-star for the fourth year in a row for being a Best Practice Meditech Hosting Provider.
• Elsevier will work with PhactMI to develop a new semantic search portal that will offer providers scientifically accurate, current, and unbiased information.
• EClinicalWorks will exhibit at the 2019 AAOE Annual Conference May 4-7 in Nashville.
• EPSi extends early-bird pricing for the Visis EPSi Summit, taking place October 22-24 in Austin, TX, through May 31.
• HCTec publishes a new case study featuring St. Luke’s University Health Network.
• Iatric Systems will exhibit at the NCHiMA Quad-State event May 5-8 in Myrtle Beach, SC.
• InterSystems will exhibit at the DoD/VA & Gov Health IT Summit May 8-9 in Alexandria, VA.
• Kyruus announces the availability of ProviderMatch DirectBook in the Cerner App Gallery for direct scheduling into Cerner Millenium.
• OptimizeRx will integrate Eversana’s patient support and specialty distribution models into its real-time EHR network.
• Artifact Health partners with HCPro to provide compliant, time-saving CDI templates for provider queries.
• The Customer Relationship Management Institute awards Wolters Kluwer customer support teams the NorthFace ScoreBoard Award for exceeding customer service expectations.
• Henry Ford Health System (MI) expands its use of CarePort software with the implementation of Guide, Connect, and Insight solutions.
• ROI Healthcare Solutions launches a new “day-in-the-life” content series focusing on its project managers.
• Dimensional Insight publishes a new white paper, “How Successful Are Healthcare Organizations with Clinical Analytics?”

Blog Posts

• 4 Ways to Reduce Physician Burnout with EClinicalWorks (EClinicalWorks)
• Targeting Populations Prioritized by Risk Factors: The First Attribute in a Modern Care Management Model (Ensocare)
• Healthcare Executives Share Ideas on Optimizing Billing Compliance Programs (Hayes Management Consulting)
• User Story: Epic Health System Troubleshoots ‘Citrix is Slow’ (Goliath Technologies)
• Leading Effective Protocol Consensus Meetings (Healthfinch)
• Is the Wrong Health Education Solution Crippling Your Care Managers? (Healthwise)
• Coming soon to a city near you: Hyland Healthcare Forums (Hyland)
• The Two Tales of Remote Access Security (Iatric Systems)
• Expanding Data Access: Considerations for Decentralizing Analytics (Impact Advisors)
• Introducing Healthcare Seamless SSO: Q&A with Wes Wright (Imprivata)
• Demystify Payroll Taxes with this BSI Solution (ROI Healthcare Solutions)
• 4 Opportunities to Reduce Costs in Your Hospital (Optimum Healthcare IT)

Contacts

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

EPtalk by Dr. Jayne 5/2/19

I’m continually surprised by the inability of EHR vendors to add fairly straightforward safety features to their systems. A reader sent in this screenshot that shows a patient’s pulse documented as 12,224 beats per minute. They also shared screenshots of other parts of the EHR with similar issues. The blood pressure field isn’t divided for systolic or diastolic entries, but rather requires the user to type a “/” between the values, leading to potential errors.

Since I’ve been on the vendor side of the house, I understand that it’s not as simple as it seems to make these kinds of corrections since they may require changes to the database. However, it’s not as difficult to make changes to the screens where data is entered. In this situation, they could limit the entered data to three characters. Frankly, if you need to enter a fourth digit, your patient has probably just died of rampant tachycardia.

When reporting these types of issues to vendors, we are often told that it’s not on the development roadmap, that it would be too technically difficult, or that it would require more development hours than are available. When we’re talking about data entry errors and patient safety, however, how much time is too much time to spend on something like this? Not to mention that if you’re trying to exchange data and want to be truly interoperable, this kind of bad data is going to be an issue for practices trying to consume data from flawed sources.

With all the certification requirements, why haven’t we mandated management of basic patient safety issues like this? As much as we’re told that paper kills, I doubt there were too many instances where a technician would have documented a pulse of 12,000 in a paper chart.

You know people are desperate when felony colonoscope theft becomes an issue. Two men and a woman burglarized a Philadelphia-area hospital and made off with tools from the colonoscopy suite. Police fear the devices may be sold on the black market. If that’s the case, I hope they go through a thorough cleaning cycle first.

I had a conference call today with a potential employee who dialed into the meeting from a shared work space with little privacy. There were people walking back and forth in the background during the entire call, and in a couple of instances, the interviewee even turned around to see what was going on behind him. If this is the best environment he could come up with for a job interview, I wonder what his daily work environment might look like. He mentioned that he likes to work away from home because “it’s less boring,” but failed to elaborate. That’s a trip directly to the round file for this candidate.

Other occupants of the round file include people who try to conduct their entire lives from their phones, leading to emails saying they can’t open attachments on their phones or have trouble accessing various resources on their phones. Mobile is a great extender, but if you’re going to do a serious job in IT, you have to understand when it’s appropriate to use a more traditional laptop, tablet PC, desktop, etc.

In response to my recent piece about Ovia and other fertility apps, a reader shared this Washington Post follow-up that discusses ways women protect their privacy on these apps. One woman drew the line at providing the name and date of birth of her baby – she was willing to share her own personal information, but not that of her newborn.

Over 100 women responded to a request from the Post. Respondents “often said they felt trapped by an unfair choice: They cared about privacy, but they also found the digital trackers too valuable to give up.” Women used pseudonyms, logged only a minimum of information, and modified some data to preserve anonymity. Others noted that the apps weren’t that helpful. One commented that they “led to micromanaging my body and habits, which led to stress.” Another noted deliberate gaming of systems used by employers who are trying to get data on staffers: “If my employer was offering money for pregnancy tracking, I would probably do the same thing I already do with the fitness tracking and just input false content.”

The reality is that personal health information is everywhere, whether people are providing it willingly with the understanding that they can’t control it once it’s out of their hands, or whether they want to use it for specific purposes. There is a great deal of discussion about the role of patient-generated health data in clinical care. Many clinicians are uncertain about its role in driving outcomes and contributing to clinical quality. There are also concerns about how to handle the data. Clinicians find the idea of receiving hundreds if not thousands of data points into their EHRs to be particularly daunting. Some of these physicians were concerned in the paper days about patients bringing in blood pressure or blood sugar logs, so it’s not surprising that they are uncertain about the data in the electronic world.

There are also concerns by both patients and providers about data security, but it’s hard to quantify the pros and cons. An article in the Journal of the American Medical Informatics Association notes that patients are open to various methods for data collection, whether it is through a medical history, patient questionnaires and surveys, or biometric and activity data. Researchers interviewed health system leaders, EHR vendor leaders, and leaders of third parties providing patient-generated health data tools to health systems. They also interviewed patients with chronic conditions, with half of those patients having experience with generating data. The number of survey participants was small, but the authors conclude that patient-generated health data really isn’t being pursued at broad scale, largely due to concerns about its value.

What do your providers think about patient-generated health data? Are you using it? Does it add more confusion? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 5/2/19

Capsule Technologies Acquires Bernoulli Health

Medical device integration and patient monitoring company Capsule Technologies acquires clinical surveillance software vendor Bernoulli Health.

Teladoc Health Reports First Quarter 2019 Results

Teladoc exceeds analyst expectations, posting $129 million in revenue for the quarter, 4 million new members, and a 75% increase in visits.

AMN Healthcare to Acquire Advanced Medical

AMN Healthcare Services will acquire Advanced Medical Personnel, which offers healthcare staffing services that include telemedicine positions, for $200 million.

VA, DoD Electronic Health Records Still Aren’t Compatible, and Lawmakers Are Angry

Despite a decade’s worth of promises and billion-dollar expenditures, lawmakers continue to express outrage over the combined inabilities of the DoD and VA to merge EHR systems.

Morning Headlines 5/1/19

Health Catalyst Aims to Raise $150 Million to $200 Million in IPO

The Wall Street Journal reports that Health Catalyst expects to raise up to $200 million in its IPO.

MEDITECH Announces Professional Services

Meditech launches a professional services division that will include quality initiatives, physician consulting, performing interoperability assessments, and lending expertise to analytics and population health projects.

Philips’ Q1 core profit misses estimates on bleak sales

Philips announces poor Q1 revenue and earnings that strong growth in China could not offset.

News 5/1/19

Top News

Meditech posts Q1 results: revenue down 5.7%, EPS $0.97 vs. $0.08. The big bump in earnings was due to a $46 million year-over-year swing in unrealized marketable securities gains.

Product revenue dropped 21%, operating income was down 33%, and net cash earned from operations was down 44%.

Reader Comments

From Dramatic Entrance: “Re: provider online reviews. This survey says patients find them critical when choosing.” This gives me an opportunity to illustrate how the headline of a survey’s results is often misleading or its methodology so shaky that the results mean little. For this particular one:

• The survey’s 839 respondents were self-selected, recruited by using a survey tool’s survey bank and thus likely not validated in any way.
• The survey question asked whether a positive online reputation is important, where a better question would have been, “How important was online reputation when you chose your most recent provider?” Never ask people what they think or believe when you could just as easily ask them what they actually do.
• Half of respondents said they have submitted negative provider feedback but were never contacted, but the question didn’t ask how they submitted their criticism (Yelp? The practice website’s contact form? Complained to the front desk person on the way out?)
• The survey lumped all providers together, everything from hospitals to dentists to doctors. That means the somewhat skimpy respondent count was then segmented further.
• The company that performed the survey sells reputation management services. They did not engage an independent survey organization that would have followed defensible methodology.
• Perhaps worst of all, lazy sites that are desperate for “news items” reworded the results into a pointless story with unrestrained headlines and no disclaimer about the obvious validity concerns.

From Ornery Cuss: “Re: health IT startups. Why do you let other sites offer more coverage?” My audience is mostly at the health system C-level, and as the lack of market success of most startups validates, those self-proclaimed disruptors don’t typically fare well trying to pass off half-baked outsider ideas to conservative health systems that are looking for solutions to real problems that offer quick return on investment. Sites that love writing about startups are usually run by people with minimal actual health IT experience who find their naiveté less of a hindrance when they write speculatively about companies nobody’s heard of. I’ll give those companies airtime once they’ve done something impressive enough to take up reader time, which right there excludes 90% of them. Otherwise, it’s like a major league baseball fan studiously following tee-ball games.

HIStalk Announcements and Requests

Listening: new from Interpol, Manhattan-based indie pop-rockers who have been at it since 1997 and who still sound great (think Joy Division). I was excited about hearing them for the first time, at least until I used the HIStalk search function to realize that I first recommended them in January 2009. At least I still do.

Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information.

Acquisitions, Funding, Business, and Stock

Philips announces poor Q1 revenue and earnings that strong growth in China could not offset. Its connected care group posted a 1% revenue drop, while its Personal Health businesses grew sales 5%. The company’s strongest segment was electric toothbrushes. The company said in the earnings call that “we are developing a much more end-to-end care orchestration environment that hospital and care providers are excited about,” but it is taking time to roll that out.

Computer Sciences Corp accuses India-based Tata Consultancy Services of stealing its source code to develop a competing life insurance administration application. Epic won a $420 million trade secrets award from Tata in 2016, claiming that company employees exploited their role as Kaiser consultants to download proprietary Epic materials to help them develop competing software.

The Kansas City business paper digs up some interesting Cerner SEC filings related to the involvement of activist investor and tiny shareholder Starboard Value, with which Cerner signed a legally binding cooperation agreement for reasons I can’t fathom other than Starboard’s swagger scared rookie Cerner CEO and board chair Brent Shafer into avoiding the kind of public battle that took out Athenahealth’s Jonathan Bush:

• Starboard Value made its run at Cerner two days after Shafer announced his new “operating model.”
• Two of Cerner’s four new board members were nominated by Starboard – former AliphCom President Melinda Mount (AliphCom was the original name of now-liquidated Jawbone) and former Cloudmark CEO George Reidel.
• Cerner agreed in writing to implement profit-boosting cost cuts and operating changes and to announce those plans via a press release.
• Cerner agreed to reimburse Starboard up to $275,000 for the legal fees the investor spent to force its way onto Cerner’s board.

The Wall Street Journal reports that Health Catalyst expects to raise up to $200 million in its IPO.

Sales

• Metro Health – University of Michigan Health chooses Glytec’s FDA-cleared EGlycemic Management System to standardize best practices in glycemic management.
• HealtHIE Nevada and the Nevada Hospital Association will implement Collective Medical to provide point-of-care insights to reduce avoidable admissions by supporting care collaboration and event notification across EDs, hospitals, post-acute care, behavioral health, and ambulatory settings.
• Catholic Charities of Baltimore will implement the SmartCare EHR from Streamline Healthcare Solutions.

People

OptimizeRx hires Stephen Silvestro (Wolters Kluwer) to the newly created position of chief commercial officer.

OurHealth names Brian Norris, RN, MBA as interim VP of IT.

Impact Advisors promotes Erin Svarvari to VP of operations.

Announcements and Implementations

A new KLAS report looks at hospital EHR market share and makes these points:

• Epic gained a net 121 hospitals in 2018, losing just one existing customer.
• Cerner’s net hospital gain was 100, mostly because of its VA deal that represented 167 hospitals, but it lost 65 Millennium accounts, nearly all of which moved to Epic.
• Nearly all large hospitals and multi-hospital systems that are choosing EHRs (which is not all that many these days) are choosing Epic, while Cerner is selling mostly to smaller hospitals.
• Meditech had a net loss of 18 hospitals, while Allscripts lost 28 while gaining only three.
• Market share in hospitals of 500+ beds is mostly Epic, with 58% vs. Cerner’s 27%.
• Meditech Expanse is selling well and customers are upgrading, but its users are mostly small hospitals, quite a few of which are being acquired by large systems that then convert Meditech to their corporate standard of Epic or Cerner.
• Allscripts is losing Sunrise and Paragon customers to other vendors as few choose to replace their Allscripts-acquired legacy products with Sunrise.
• Athenahealth has stopped hospital sales at least temporarily, while EClinicalWorks sold no new hospital contracts in 2018 and the hospital product has not yet reached beta testing.

Imprivata launches IAM Cloud Platform, a cloud-based identity and access management platform that is powered by Microsoft Azure Active Directory. The initial release includes Healthcare Seamless SSO single sign-on.

Meditech launches a professional services division, expanding its implementation offerings to include spearheading quality initiatives, physician consulting, performing  interoperability assessments, and lending expertise to analytics and population health projects.

Verisk will analyze EHR data collected by Human API for life insurer risk scoring and benchmarking.

Other

Paychecks at 34,000-employee Hackensack Meridian Health are incorrect for the second consecutive pay period due to what it says are problems related to its Oracle PeopleSoft payroll implementation. One employee’s paycheck was for 19 cents, while others have reported that errors caused them problems in qualifying for a mortgage and avoiding bank overdraft charges.

Bob Wachter makes an interesting observation – a doctor told him that he enjoys the companionship and collegiality of working with a scribe just as much as he enjoys their help with documenting patient care. I had never really considered that a typical practice or clinic doctor interacts only superficially with employees and even that might be awkward because of the perceived rank and authority issue. This reflects on what Dr. Jayne just wrote about in hospitals ending the old-school “medical staff dinners” where everybody got together with their peers for decent food, socializing, and hospital updates, building trust all around (as we say in IT, a lot of people like our employees but hate our department). I’ll also add my own observation – frontline doctors are an easy target for drug company reps who are trained to push emotional buttons (fake friendship, fake mutual interests, fake romantic interest) to generate more prescriptions. In fact, I’ll add observation #2 – doctors (especially procedure specialists like surgeons) often behave bizarrely and childishly when attending hospital-convened meetings because they live their work lives in a fluorescent caves where they are expected to issue curt orders while never really learning professional niceties, while hospitalists and other non-procedure docs who have to get along with patients and families are not much different from the rest of us in skillfully riding the conference room chairs. I bet I could sit here and cobble together a burnout remediation strategy around these factors.

Business Insider tries DNTL, a New York City “walk-in dental bar” that offers online appointments, IPad form completion, a massage exam chair, and a TV in the treatment room. Its services are covered by dental insurance. Maybe the important takeaway here is that consumers value convenience and atmosphere topmost when they consider a service – such as teeth cleanings or even dental procedures — to be a commodity where outcomes are assumed to be similar everywhere (whether that’s actually the case is irrelevant). Contrast that with the average clinic or doctor’s office, where patients wait in uncomfortable waiting rooms to be seen later than scheduled, nobody really cares if they are comfortable or anxious, treatment is mostly episodic and impersonal, and it’s like cattle being prodded through an abattoir on the frustrating round-trip journey from and back to the sidewalk (hopefully in no worse shape).

In China, police haul a thoracic surgeon away in handcuffs after he refuses to see a patient whose husband had jumped the line, then tells officers he can’t leave to make a statement because he has patients waiting. In a slight medical irony, the surgeon — perhaps aided by knowing where to punch when a scuffle ensued – broke the husband’s rib.

Weird News Andy codes this story as W61.92 and expresses relief that the birds that were involved weren’t sick because that would have been “ill eagle.” A woman who is taking photos of a sky full of eagles is hit by a pair of them who were engaged in the mating ritual called “cartwheeling,” whereupon they drop from the sky, and in this particular case, into her lap. The happy couple flew away unharmed, but the accidental falconer required bandages and a tetanus shot.

Sponsor Updates

• AdvancedMD will exhibit at ACOG May 3-6 in Nashville.
• Mumms Software will integrate DrFirst’s e-prescribing and medication management software with its hospice EHR.
• CoverMyMeds will exhibit at the NCPDP Annual Conference May 6-8 in Scottsdale, AZ.
• CTG will exhibit at the KACHE event May 2-3 in Garden City, KS.
• Diameter Health will present at the Annual DoD/VA & Government HIT Summit May 8-9 in Alexandria, VA.
• DrFirst structures a new $17 million commercial financing facility with SunTrust.
• Wolters Kluwer accelerates healthcare data mapping with artificial intelligence to bridge data silos.

Blog Posts

• New Survey: Only 1 in 5 Healthcare Orgs Use Analytics for Population Health (Dimensional Insight)
• TEFCA in a Nutshell – Part 2 (Impact Advisors)
• Vendor Agnostic Solutions Give Hospitals Options (Access)
• 5 Key Questions Every Practice Owner Should Ask (AdvancedMD)
• How the Avaya Global Talent Exchange Program is Transformative in More Than One Way (Avaya)
• Preparing for value in a volume world (Bluetree)
• What clinicians can learn from commercial aviation (Bernoulli Health)
• 5 Storage and Data Management Trends to Watch (Burwood Group)
• Working Together Emerged as Theme at This Year’s ACMA Conference (CarePort Health)

Contacts

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

Morning Headlines 4/30/19

CareDx Agrees to Acquire OTTR Complete Transplant Management

Transplant patient-focused molecular diagnostics company CareDx acquires organ transplant patient tracking software vendor OTTR for $16 million.

HealtHIE Nevada, Nevada Hospital Association and Collective Medical Announce Collaboration to Reduce Avoidable Readmissions

The Nevada Hospital Association will leverage data and services from HealtHIE Nevada and Collective Medical to help its member hospitals better identify and support vulnerable patients at risk for readmission.

Michael J. Fox Foundation and 23andMe Launch Fox DEN, a Data Platform Combining Patient-Reported Outcomes and Genetic Information in Parkinson’s

The Michael J. Fox Foundation for Parkinson’s Research and 23andMe develop the Fox Insight Data Exploration Network to enhance the foundation’s online clinical study with improved analytics and data access.

Curbside Consult with Dr. Jayne 4/29/19

As much as we complain about our technology, there are days when I’m glad to have it. This week was one of those, when I was confronted with multiple patients who had been exposed to wild animals and I had to quickly determine whether rabies exposure was a risk in our area.

Barely a decade ago, this question would have required a fair bit of research and possibly a phone call to the county health department. Although we determined that being scratched by a squirrel wasn’t considered a risk factor because the incidence of rabies in the squirrel population in our area is relatively low, apparently the largest reservoir in our area is the woodchuck. I always thought they were a slow animal that doesn’t do much, but apparently when they are rabid, they will chase people. I’ll be on the lookout for any deranged woodchucks on my upcoming outdoor adventures.

It’s also fantastic to have data from the Centers for Disease Control at our fingertips – where we are in the current influenza season (almost done!), how many people have died this year (fewer than 55,000 compared to last year’s 80,000), and what the current recommendations are for our patients who are traveling to various parts of the world.

When I work with physicians who complain about having to use computers in the exam room, I challenge them to think of ways that computers are beneficial and how they might learn to better use the computer as part of the patient visit rather than fight it. Even the most reluctant physician can usually think of a handful of positives.

Some of the concerns I hear from physicians are part of a larger issue with organizational dynamics. I was pleased to see a recent editorial in the Journal of the American Medical Association addressing the need to build trust as part of relationships between clinicians and healthcare organizations. The authors note that although many books cover this in the business world, there is little addressing how it impacts clinician relationships with their employers or sponsoring organizations. They note that we have likely arrived at this place of mutual distrust due to the size of many healthcare organizations and the insertion of management layers between frontline clinicians and senior leadership.

Often changes that are being driven by payers or the market result in hostility towards organizational leaders. I see this often in the EHR trenches, as providers fail to fully understand the role of government mandates and payment incentives / penalties in driving EHR use.

The authors also cite poor communication as a key reason for lack of trust. I agree wholeheartedly with that assertion. I still see organizations that have fractured communication pathways. This may result in chain-of-command communications that reach clinicians at different speeds and sometimes not at all, or inconsistency in the messaging.

During some of my interim CMIO engagements, I’ve seen meetings canceled with no explanation, which leads to feelings of uncertainty and a lot of time spent by invitees in trying to figure out why it was canceled or whether policy has changed. It’s unfortunate because a simple explanation with the meeting cancellation would have created a lot of goodwill – “canceled due to schedule conflict, will be rescheduled” would go a long way to silence what I’ve seen turn into full-blown organizational conspiracy theories.

They note other drivers of distrust, such as “poorly conceived or implemented electronic health records, competing interests, and misaligned incentives” that add to the confusion. Other factors include a perceived lack of clinician input, overly rapid changes to processes or metrics, administrative burden, and inadequate support staff. They also note that clinicians struggle to buy in when standardized care processes are discussed along with other changes that might negatively impact clinician autonomy.

I agree with the authors that it is easy to violate trust and extremely challenging to rebuild it. They call on organizations to engage “leaders who are visible, available, and responsive and who know how to develop and foster positive relationships.” Having worked with several boorish leaders over the last several years, I’d also suggest that leaders be educated on their constituents and how they will perceive anecdotal stories that the leaders might throw out.

I worked with one CEO who constantly talked about his ski trips, his sailboat, and his house in Jackson Hole. Let’s just say that didn’t resonate with primary care physicians who were driving 10-year old Hondas. Nor did the story about the year he took off work to coach his son’s baseball team. Some background research on what made that particular group of physicians tick or what their economic status was might have been helpful and would have saved everyone a bit of angst.

I enjoyed the section that mentioned that “marketing slogans are no substitute for a clearly articulated purpose that is consistently and continually reinforced through action and policy.” One well-known health system had a campaign around “world’s best medicine made better.” What does that mean, exactly? What is the goal? How do frontline physicians play a role?

The authors note that although trust is a two-way street, “organizational leaders are best positioned to take the first step in establishing trust. Clinicians are unlikely to shift from suspicion and disengagement to being fully trusting unless they experience leaders who are trustworthy, but also must act in ways that engender trust.”

I was surprised that there weren’t more comments on the article, only one that identified lack of departmental meetings as a driver of distrust since face-to-face interactions were reduced. We used to have quarterly medical staff meetings at our hospital that were a big deal, with a catered sit-down dinner. Big issues were discussed and the majority of the medical staff made a point to be there. However, as costs were cut, those dinner meetings gave way to lunch meetings, which disenfranchised those of us who didn’t practice on the hospital campus. Those were in turn canceled due to “poor participation” and what used to be a vibrant discussion was reduced to the occasional email blast telling us about the hospital’s priorities.

I’m interested to hear what readers think about the state of trust in healthcare organizations. What is your organization doing well? What could use improvement? Leave a comment or email me. And watch out for rabid woodchucks.

Email Dr. Jayne.

HIStalk Interviews Dan Dodson, President, Fortified Health Security

Dan Dodson is president of Fortified Health Security of Franklin, TN.

Tell me about yourself and the company.

I’ve been in healthcare for most of my career. I have always been inspired to give back to healthcare and patients. I have an MBA in health organization management and have always been intrigued at the concept of using my business degree to help provide better patient experiences. I’m blessed to do that at Fortified Health Security.

We are a cybersecurity company, a managed security service provider. We provide a wide range of managed services to healthcare organizations to help them combat threats and comply with regulatory requirements.

How does a health system decide where to focus their cybersecurity efforts and funding?

I have that conversation with organizations every day. The majority of healthcare organizations understand that it starts with a risk assessment. Pick a framework and do an assessment. From there, figure out where you have deficiencies or opportunities for enhancements. Every health system is different on what their next step will be, but the core of every good cybersecurity program requires performing an assessment of where you are, then driving your strategy from that.

Then, think about the perceived value of your cybersecurity spending and the actual value that you are receiving. A lot of organizations look to buy the next shiny security tool. The board and C-suite perceive that the purchase of that technology will better protect them from adversaries and from hackers. That is true to some degree, but when we implement those technologies within a healthcare environment and its many nuances, we lose sight of what we actually need to do to operationalize that technology.

I encourage organizations to think about not only how they are deploying capital for buying new technologies or implementing new services, but how they are making sure that they are working in concert with prior investments whether they are supporting them operationally to extract the value that they perceive those tools provide. Tools can be quite sophisticated, but they require people and process to extract their full value. We see a lot of under-implemented, underutilized technology in healthcare organizations that we work with.

Sensationalistic headlines talk about theoretical risks that have never actually happened in the real world, such as medical device hacking and inserting malware in medical images, which doesn’t seem to offer much incentive for a hacker. Are hospitals chasing those hypothetical problems instead of the duller but more dangerous ones that don’t make headlines, such as the usual email-launched attacks?

Certainly some companies and folks are chasing those headlines with their solutions. No single bullet will protect you and secure you 100%. You have to take a layered approach that is appropriate for your organization.

We do a lot around medical device security. The threat to medical devices is real, but we are seeing it manifested by adversaries and hackers using them as a jumping-off point to get to the valuable data, not necessarily to disrupt the clinical performance of that device. They use the medical device to get to EPHI.

What new cybersecurity threats have you seen recently that are most worrisome?

We are seeing a lot of just the fundamental attacks, such as insiders and users and clicking on bad links in email. Those are still some of the highest threats that face organizations. Attacks such as phishing and vishing are increasing and becoming more sophisticated.

We encourage people to think about the fundamentals of a security program. The unsexy things — patching, making sure that they are doing vulnerability scanning, making sure that they are identifying where they have EPHI, monitoring the networks, and looking at logs. The traditional core fundamentals. Often when we peel back the layers of what happened in a big breach, a user inadvertently or purposefully did something, or there was a lack of internal blocking and tackling for security. We encourage folks to think about whether they are executing a good, solid fundamental program before investing in the latest and greatest gear and tech.

Organizations that are forced to admit that they have been breached always claim it was a sophisticated attack and sometimes imply that a state-sponsored hacker was involved, perhaps to make themselves seem to the public to have been more security-aware than they really were. That can lead the organization’s cybersecurity insurers to refuse to pay their claims because they can say that implicating state hackers suggests an act of war that their policy doesn’t cover. What is the level of threat from state-sponsored hackers in healthcare?

Healthcare is vulnerable. ARRA and HITECH spurred rapid digitization that wasn’t always implemented on modern, secure networks and infrastructure. The increased amount of valuable electronic health information is stored on the path of least resistance. State-sponsored attacks and hackers look for the path of least resistance, so we are vulnerable at the onset.

You brought up cyberinsurance, which is important to understand. Procurement of cyberinsurance in a healthcare organization may or may not involve IT or security. It might be procured by the legal or compliance department. A cyberinsurance policy’s actual insurance binder contains the requirements for that policy to be in force. It is important that organizations know what’s in that binder so if they have an incident, they actually get paid.

We are seeing that during the claim review process, cyberinsurers are doing claw backs or denying claims because the organization wasn’t meeting the requirements contained in the insurance binder. That’s a critical area of focus. Don’t get a false sense of security just from having cyberinsurance. You have to make sure you are doing whatever the binder requires. It has gone unfavorably for healthcare organizations that failed to do that.

Why do we keep seeing major information exposure from unsecured servers that are open to the Internet?

Networks have sprawled over time with health system acquisitions and consolidation. We see that every day. This cobbled-together infrastructure and process allows it to happen. We are all shocked when it happens and of course we want to avoid it.

It goes back to the fundamentals and looking at root cause. We need to have asset inventories, know where our EPHI is stored, and understand how it is performing on our network and within our environment. Spending time on the blocking and tackling fundamentals reduces the chance of finding yourself in that situation.

Quite a few breaches were caused by a health system’s third-party vendor. Has anything changed with regard to the role of business associate agreements in a security plan?

It is important to understand third-party risk, the types of data you are sharing, and how you are sharing it. The lines of responsibility have become blurred within the context of those types of relationships.

It’s important to have business associate agreements in place. I always chuckle when I say that because we still find people not doing that. Then it’s important to have risk stratification of those third-party partners to make sure that you understand what they’re doing from a security perspective to better isolate the data that we create and that we’re responsible for safeguarding.

How common is it for a health system to have a chief information security officer position that is staffed by someone whose credentials would qualify them to work outside of healthcare?

There’s a human capital problem in cybersecurity for all industries. Depending on what rags you read, millions of cybersecurity jobs are open worldwide at all levels. As you narrow that down to healthcare specifically, we see that a lot of the larger organizations have a CISO on staff full time. When you get to the mid- market, they probably have a person who is dedicated to security, but who has other functions as well. The organization may engage in some type of virtual information security offering to offset that, to bring in expertise and guidance without necessarily keeping somebody full time.

The big challenge is that the role turns over every couple of years. Folks do not tend to stay long in this job. That can cause challenges for the healthcare organization because they’re changing strategy every couple of years when the leader changes.

Do you have any final thoughts?

We are in an interesting time with cybersecurity and the threat landscape. I’m encouraged by the progress that most organizations are making in this space. I encourage everybody to continue to focus on the fundamentals. To those who have partnered with Fortified and our employees, thank you for driving our mission to increase the security posture of healthcare.

Morning Headlines 4/29/19

Notification of Enforcement Discretion Regarding HIPAA Civil Money Penalties

HHS announces that it will use its discretion to set maximum annual HIPAA fines based on level of culpability, reducing the amount for those with no knowledge from $1.5 million to $25,000.

uBiome, the health start-up just raided by the FBI, had been double billing insurers

The FBI raids the San Francisco office of UBiome, which sells questionably useful AI-powered microbiome test kits for gut health and women’s health that are ordered by its own telemedicine doctors.

The future of health to have new home

Arizona State University and Mayo Clinic break ground in Phoenix on the Health Futures center, which will house a medical technology accelerator, research labs for biomedical engineering and informatics, and nursing programs.

Tech Billionaires Give $200 Million to Mass. General Hospital

InterSystems founder Terry Ragon and his wife Susan donate $200 million to Massachusetts General Hospital to endow a vaccine research center, piggybacking onto their $100 million donation 10 years ago to fund AIDS vaccine research.

Monday Morning Update 4/29/19

Top News

HHS announces that it will use its discretion to set maximum annual HIPAA fines based on level of culpability, reducing the amount for those with no knowledge from $1.5 million to $25,000.

Above are the old vs. new penalty tiers.

HIStalk Announcements and Requests

Nearly 40% of a large number of poll respondents don’t see Epic, Cerner, and Meditech getting new EHR competition in the next 10 years, although 25% of respondents think Silicon Valley firms could potentially enter that market. Holly says EHRs are a dying breed with the only hope being third-party add-ons to make it all work, while Bitbot foresees data science-driven workflows that will overshadow outdated databases and processes. DrLyle takes the long view that the future entails a lot more home care, virtualization, and at-risk entities setting up clinics whose needs could be met by a slimmed-down EHR for care tasks. Matthew Holt agrees that hospitals have tied themselves to Epic and Cerner and sees the threat being that chronic care will move to the home and hospitals see their business cut back to performing procedures and attending to dying patients.

New poll to your right or here, as suggested by a reader who is COO of a health system that is making an EHR decision and looking at vendor interoperability capabilities and federal initiatives: When will every provider in every care setting be able to reliably exchange all clinically relevant patient information? (continuity of care document, consultation notes, discharge summary, imaging integration, DICOM diagnostic imaging reports, history and physical, operative note, progress note, procedure note, and unstructured document).

I’m interested in interviewing insightful, non-vendor people who are doing work that would inspire my readers. Let me know who you recommend. Many of those I reach out to don’t have the interest, time, or organizational approval to speak frankly (and some don’t have the courage to undergo an unscripted conversation), so I’m casting the net.

Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information.

Acquisitions, Funding, Business, and Stock

From the Cerner earnings call following release of quarterly results that met Wall Street expectations:

• Chairman and CEO Brent Shafer says the involvement of activist investor Starboard Value was consistent with the company’s existing efforts to improve company financial performance.
• Cerner has engaged turnaround consulting firm AlixPartners to look for efficiency and cost-saving opportunities that won’t negatively impact Cerner clients.
• Key projects include looking at management structure and costs, reviewing the company’s product portfolio, rationalizing its facilities, and reviewing non-personnel costs.
• The company will be more selective in evaluating low-margin deals.
• Cerner will go at-risk with providers to generate higher-margin business.
• The company notes that while the EHR market is mature, it can cross-sell revenue cycle and ambulatory products to that client base.
• Cerner admits that companies will likely issue “competitive messaging” to Cerner’s clients about its focus on increasing margins, but says those clients needs the company to be more efficient and to bring products to market faster.
• Asked by an analyst about the apparent de-emphasizing of the RevWorks revenue cycle management business, the company says it contributes about $200 million in annual revenue but isn’t growing, suggesting that other opportunities are more promising. It also notes that Cerner uses its Works offerings “to more tightly align the client to Cerner” for additional software and services sales and it reviews the profitability of individual clients.
• CFO Marc Naughton notes that Cerner’s $4.5 billion Innovation Campus was completely paid for by Missouri and Kansas City tax incentives.

Meanwhile, Cerner implements a hiring freeze, telling employees that “we can do better if we target our attention on areas that represent the largest and most profitable growth opportunities and drive client satisfaction and retention.”

The New York Times notes the sometimes clinically sloppy practices of online birth control seller Nurx, which has used unlicensed personnel to dispense medications that had sometimes been returned by other customers, told its doctors to prescribe birth control to at-risk women as long as the patient agreed, and followed the Silicon Valley mantra of asking forgiveness rather than permission. The company responded to the article by saying that those practices ended a year ago with executive replacements.

The FBI raids the San Francisco office of UBiome, which sells questionably useful AI-powered microbiome test kits for gut health and women’s health that are ordered by its own telemedicine doctors. Reports suggest that insurers complained about being overbilled by the company, while individual customers had previously filed Better Business Bureau complaints saying that their insurance was billed thousands of dollars for tests they thought they were buying in full for less than $100. The FBI is also apparently interested in how the company pays its doctors for referrals. In an interesting twist noted by CNBC’s Chrissy Farr, UBiome’s former product VP is now CEO at Nurx (see the item above).

Tampa-based, Hearst-owned MHK (formerly known as MedHOK) moves to a new 30,000-square-foot office at Harborview Plaza this week. The company has 250 employees.

Vocera announces Q1 results: revenue down 12%, adjusted EPS -$0.17 vs. $0.04, beating Wall Street expectations for both. From the earnings call:

• The company had its strongest non-healthcare bookings ever in Q1, including a multi-million dollar deal with retailer Nordstrom that was triggered by a former IT person at a hospital customer site who joined Nordstrom’s IT group and suggested Vocera as a solution.
• Provider consolidation is leading to larger deal sizes, which adds complexity to the sales and approval process, but benefits Vocera as a unified platform vendor.
• The company is winning 70-80% of the deals it is involved with, with little competitive impact from Cerner CareAware and no effect so far from Hill-Rom’s pending acquisition of Voalte.
• The company was awarded authority to operate with the Navy and Air Force.
• Market acceptance of the company’s new Smartbadge has exceeded expectations.

Sales

• SacValley MedShare HIE chooses Zen Healthcare IT as its data integration platform in the “integration as a service” model.

Announcements and Implementations

InterSystems founder Terry Ragon and his wife Susan donate $200 million to Massachusetts General Hospital to endow a vaccine research center, piggybacking onto their $100 million donation 10 years ago to fund AIDS vaccine research. The couple, whose net worth has been estimated at $2.5 billion, has signed the Giving Pledge, in which they will give most of their assets to philanthropic causes. Terry Ragon founded InterSystems in 1978 as a vendor of the MUMPS (Massachusetts General Hospital Utility Multi-Programming System) that was invented by two eventual Meditech pioneers (Neil Pappalardo and Curt Marble) and MD/PhD student Robert Greenes (now a biomedical informatics professor at Arizona State University). MUMPS powers systems sold by Epic, Meditech, and many other health IT vendors as well as the VA’s VistA. Privately held InterSystems has since added sophisticated database, integration, HIE, and clinical systems to its portfolio for both healthcare and non-healthcare sectors.

Other

Arizona State University and Mayo Clinic break ground in Phoenix on the 150,000-square-foot Health Futures center, which will house a medical technology accelerator, research labs for biomedical engineering and informatics, and nursing programs. The facility, which will open in 2020, will be connected to Mayo Clinic

Sponsor Updates

• Lightbeam Health Solutions will exhibit at the BCBS 2019 National Summit April 29- in Grapevine, TX.
• Qventus will present at the 2019 EDPMA Solutions Summit April 28-May 1 in Scottsdale, AZ.
• Mobile Heartbeat will exhibit at the Trauma Center Association of America’s Annual Conference April 28-May 3 in Las Vegas.
• Netsmart Director of Post-Acute Community Strategist Teresa Craig will speak at the 2019 Association for Home and Hospice Care of NC Expo April 29 in Raleigh.
• Nordic will host receptions during Epic XGM on April 30 and May 7 in Madison, WI.
• Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the AWHONN Michigan Section Conference May 3 in Frankenmuth.
• T-System will exhibit at the 2019 EDPMA Solutions Summit April 28-May 1 in Scottsdale, AZ.
• Redox will exhibit at Epic XGM April 29-May 10 in Verona, WI.
• The SSI Group will exhibit at the Louisiana HFMA Annual Institute May 5-7 in Lafayette, LA.
• Surescripts will exhibit at the AMIA 2019 Clinical Informatics Conference April 30-May 2 in Atlanta.
• The Healthcare Rap podcast features SymphonyRM Director of Client AI Chris Hemphill.
• Wolters Kluwer Health will present at the AMIA 2019 Clinical Informatics Conference April 30-May 2 in Atlanta.

Blog Posts

• 5 Evaluation Criteria for Choosing an Integration Solution (Liaison Technologies)
• Consumers are Online. Why Aren’t They Using Healthcare Provider Portals? (Loyale Healthcare)
• Take the journey to Expanse with these Meditech customers (Meditech)
• Cultivating Partnerships to Pave the Way for Exceptional Care (Netsmart)Ardent Health CTO Sheds Light on the Value of Outsourcing Support (CereCore)
• How Blessing Health System automated patient estimates across their practices (Experian Health)
• How Does Patient Loyalty Drive Revenue? (PatientBond)
• Recap: PatientPing’s Leadership Collective Roundtable (PatientPing)
• Digital First Billing and Why It Matters (Patientco)
• How to Improve Your Patient Experience (Practice Velocity)
• Phone Tag is Sabotaging Patient Retention – Here’s How To Stop It (Relatient)
• Nursing leaders project a positive vibe. (Voalte)
• A Better Experience for Patients and Staff with Vocera Easter Eggs and Code Lavender (Vocera)
• Act Now! How to Properly Use CTAs in Your Clinic’s Marketing (WebPT)

Contacts

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

Weekender 4/26/19

Weekly News Recap

• Cerner announces Q1 results that meet Wall Street’s revenue and earnings expectations
• Seattle-based genetic testing and health coaching startup Arivale shuts down after burning through $50 million in funding
• CPSI announces plans to acquire patient engagement vendor Get Real Health
• Bain Capital hires financial advisors to help it assess the potential sale of RCM vendor Waystar
• The FTC files an antitrust lawsuit against Surescripts for allegedly monopolizing the e-prescribing market
• Athenahealth lays off 200 employees
• HHS announces CMS Primary Cares, two value-based care payment models launching in 2020 that it says will cover at least 25% of Medicare beneficiaries and providers
• HHS opens Draft 2 of its Trusted Exchange Framework and Common Agreement for public comment

Best Reader Comments

The EHR’s screen can be really busy and have many redundant ways of doing similar workflows. This causes some levels of frustration because various trainers or local support folks will show different ways to accomplish a task (at times it’s the incorrect / non-best practice way). I remain empathetic to my colleagues as I know that they are constantly flooded (brain blocking) from all the tech tips etc. However, I just encourage them to “make it yours” via personalization of the user interface and data entry areas a little at a time. Over a few months, they’ll find that they are recouping a few minutes a day. (Dave Butler)

I’ve not been directly involved with IBM Watson Health, but from its beginning, I have always seen Watson as a hammer looking for a nail. Not to say that it doesn’t work (I don’t know), but it is an expensive way to already do what humans do pretty well, like diagnose patients. At best, it probably is 10 years ahead of its time, before the needs and questions appear that it best answers. (Prof. Moriarty)

Watercooler Talk Tidbits

Ms. V in Texas asked for an Apple TV for her Houston-area students — all of them English language learners and many of them living in temporary housing following Hurricane Harvey — via a DonorsChoose teacher grant request. She reports, “The Apple TV has impacted my classroom in ways I didn’t even imagine. I have seen students more engaged and excited about lessons in class. The students are eager to answer and ask many questions while learning! My students love when I use the iPad connected to the Apple TV. I am able to walk around the room while I teach. This allows me to keep an eye on student engagement as well as incorporate the students into the lesson. My students enjoy being able to show their work on the iPad as well. I have downloaded an app that allows me to put PDFs on my iPad, which include worksheets, textbooks, etc. With this app, I am able to teach from these items and students are able to write over them. It’s amazing! This technology has changed the way I teach for the better, I am so grateful for these wonderful resources!”

Wisconsin Public Radio covers the “My Life, My Story” project in which volunteers talk to hospitalized VA patients about their lives and enter their story into the EHR. One of the project’s organizers says, “”The [electronic medical] record is a mess. If you were to try to get a sense of someone’s life from that record, it might take you days.” The idea came from a VA medical resident who realized that residents rotate out of a given facility quickly, but patients in the resident clinic stay the same as they just keep meeting new doctors. A survey found that 85% of clinicians find it worth their time to read the stories of their patients to help them communicate with them as individuals.

I guess North Korea is out of network – the federal government reportedly approved paying (but apparently never actually paid) a $2 million hospital bill to gain the release of detained US citizen and University of Virginia student Otto Warmbier, who was sentenced to 15 years of hard labor for removing a hotel’s propaganda sign. It’s not exactly value-based care, either – Warmbier was returned in a coma and died shortly afterward, with a US court finding the North Korean government liable for his torture and death.

A former pediatric resident who was fired by UK Hospital (KY) in 2017 for possessing child pornography on his work computer is charged with that crime. The Linkedin of Ryan Keith, DO extols his residency performance without noting its undistinguished end, but he has since found a career (likely not long-lasting, if I were betting, given new media exposure) as a quality associate at IV manufacturer Baxter Healthcare.

In Australia, an ED doctor is suspended for six weeks for posting patient photos online, proclaiming that mental illness involves “the only language these people understand is the language of violence,” posting anti-gay comments, and posting explicit photos of his psychiatrist wife with the warning that a failed marriage “would end in murder.” A litany of his bizarre online commentary reveals some truly disturbing beliefs, which he says are irrelevant because he’s a great doctor.

A 19-year-old “Instagram butt model” and “influencer” convinces a Beverly Hills plastic surgeon – himself a self-proclaimed influencer – to declare her posterior free of surgery in what she says is “the first certified real booty.” I’m torn among directing my scorn to the US healthcare system, to social media, or to those so easily “influenced” by vapid societal non-contributors. 

An Oregon pediatrician who courts antivaxxer parents lobbies against a proposed bill that would eliminate non-medical exemptions for vaccination, all while pitching his YouTube channel, anti-vaccine book, nutritional supplements, and detox clinic.

The local paper profiles Duke Health spinal surgeon Oren Gottfried, MD, who has earned 100 on-screen TV credits for creating medical plot lines for TV dramas and then ensuring that they are portrayed accurately. He’s about to get his first on-screen appearance on “Chicago Med.”

In Case You Missed It

• News 4/26/19
• EPtalk by Dr. Jayne 4/25/19
• HIStalk Interviews David Wenger, CEO, Bridge Connector
• News 4/24/19
• Curbside Consult with Dr. Jayne 4/22/19
• Readers Write: AI and Machine Learning Only Work if You Do
• Monday Morning Update 4/22/19

Get Involved

• Join my Rolodex to provide occasional news reaction or ideas
• Contribute regularly as a provider CIO, IT director, or informatics nurse (anonymous or not)
• Be interviewed (providers)
• Deliver an educational webinar (providers)
• Sponsor
• Report a news item or rumor (anonymous or not)
• Sign up for email updates
• Connect on LinkedIn
• Contact Mr. H

Morning Headlines 4/26/19

Cerner Reports First Quarter 2019 Results

Cerner reports Q1 results: revenue up 8%, adjusted EPS $0.61 vs. $0.58, meeting expectations for both.

Scientific wellness startup Arivale closes abruptly in ‘tragic’ end to vision to transform personal health

Seattle-based genetic testing and health coaching startup Arivale shuts down and lays off its 120 employees without warning.

28 Health Systems Commit to Transforming Behavioral Health in Hundreds of Communities Nationwide

Twenty-eight health systems join the Medicaid Transformation Project to improve the delivery of behavioral healthcare services through the use of digital tools.

News 4/26/19

Top News

Cerner reports Q1 results: revenue up 8%, adjusted EPS $0.61 vs. $0.58, meeting expectations for both.

Reader Comments

From Vishnu: “Re: EClinicalWorks. This is the second example of the company ignoring sexual harassment. It simply relocates offenders when a problem is identified.” A Change.org petition filed by a Bangalore women’s rights organization – which should be noted to contain accusations that have not been proven as far as I know — demands that the company resolve the “indifference of the management and implicit and explicit sanction of sexual harassment” at the company’s Bangalore office. It names a company director as violating an employee who was then told that she had to “accept it in good spirit” if she planned to be promoted, had her email access turned off while on medical leave, had the person she had accused assigned to interrogate her on behalf of the company, and was threatened by the HR and legal departments before eventually being fired. 

From ATHBEL: “Re: Athenahealth layoffs. Most of the sales and some of the onboarding staff associated with the hospital product were let go. The majority of the operation staff was not eliminated. It was actually a pleasant surprise how much of the functional expertise in both product dev and support was retained and rolled into stable operating divisions within Athena. It was established with customers awhile ago that there would be no new sales or onboarding while the new ownership figured out what to do with the product. I have no idea what direction they’re taking the hospital segment and I don’t think Veritas does at this point either, honestly. The only speculation on sunsetting the product in any sort of near term is solely from competitors.” Unverified. Thanks for the info.

Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information.

Acquisitions, Funding, Business, and Stock

CPSI will acquire patient engagement vendor Get Real Health for $11 million. Get Real Health saw a surge in exposure earlier this year when Microsoft suggested that HealthVault users migrate their health data to the company’s Lydia PHR.

Seattle-based genetic testing and health coaching startup Arivale shuts down and lays off its 120 employees without warning. The company, which had raised $50 million, concluded that its annual consumer price of $1,200 to $3,500 didn’t cover the cost of performing the necessary tests. CEO Clayton Lewis also noted that Arivale wasn’t successful in convincing people that data and lifestyle changes would necessarily improve their health. Startup executives who love the idea of quantifying themselves or being paid for healthy lifestyles keeping learning an expensive lesson — they represent a tiny, navel-gazing minority whose time would be wisely spent studying their target audience as they prowl the junk food, cigarette, and alcohol aisles of Walmart while steering a wide berth around the pharmacy’s bathroom scales and blood pressure cuffs. 

Bain Capital hires financial advisors to help it assess the potential sale of Waystar. The RCM vendor was created in 2017 from the merger of ZirMed and Navicure, which joined Bain Capital’s portfolio in 2016.

ED software startup Vital launches with $5 million in seed funding. Developed by Mint.com founder Aaron Patzer, Vital’s technology uses predictive analytics to help ED staff identify high-risk patients, reduce wait times, and improve efficiencies.

The FTC files an antitrust lawsuit against Surescripts for allegedly monopolizing the e-prescribing market, specifically in the areas of routing and eligibility. It accuses the company of:

• Requiring long-term exclusivity from customers
• Punishing customers with higher prices if they obtain prescriptions from another company
• Illegally pressuring Allscripts to prevent it from taking its business elsewhere
• Sidelining RelayHealth’s ability to compete against Surescripts for six years through strict contract provisions

Sales

• Arkansas Children’s will automate workflows and documentation into its Epic EHR and Haiku application using Excel Medical’s medical device integration software.
• Duke Health (NC) signs a seven-year contract with Visage Imaging for its enterprise imaging software.
• Medical transportation company LogistiCare selects call center software and services from Avaya.
• Senior living provider Plum Healthcare (CA) will implement Netsmart’s MyUnity EHR as part of a 10-year partnership with the vendor that will involve the co-development of new senior-focused technologies and services.

People

Jeff Macko (Revature) joins Continuum Health IT as president and managing partner.

T2 Tech Group hires Geri Pavia (Orion Health) as VP of business development.

Announcements and Implementations

Philips develops patient management software and companion practice management consulting services for radiation oncology departments.

Atchison Hospital (KS) goes live on Meditech Expanse with consulting assistance from Engage.

Privacy and Security

A JAMA-published finds that 29 out of 36 depression and smoking cessation apps transmit data to Facebook or Google, while only 12 disclose that fact in their privacy notices. The study’s authors advise that, “Users should be aware that their use of ostensibly standalone mental health apps, and the health status that this implies, may be linked to other data for other purposes, such as marketing targeting mental illness. Critically, this may take place even if an app provides no visible cues (such as a Facebook login), and even for users who do not have a Facebook account.” Facebook, meanwhile, expects to pay up to $5 billion in fines to the FTC for privacy violations.

Other

Twenty-eight health systems join the Medicaid Transformation Project to improve the delivery of behavioral healthcare services through the use of digital tools. The project’s next initiatives will focus on maternal and infant care and substance and opioid use. The project was launched last year by former CMS acting administrator Andy Slavitt and the Avia healthcare innovation network.

A joint study between Kaiser Permanente and FDB finds that the deployment of clinical decision support for drug-disease interactions generated acceptable interruptive alerts with which clinicians agreed 92-99% of the time. Kaiser Permanente plans to implement the decision support software beyond the four regions in which it was piloted.

Genital herpes diagnosis and treatment website HerpAlert handled 20 times its usual number cases after the Coachella music festival started, eclipsing the previous record that was set during 2018’s Oscars weekend. Patients submit photos and get a $99 doctor’s confirmation and a prescription sent to the pharmacy of their choice in an average of two hours. It’s pretty amazing that big businesses that are being built around the fact that FDA doesn’t allow over-the-counter sales of low-risk drugs for fairly obvious conditions. That business model wouldn’t work in many countries, where you can buy whatever you want from the pharmacy as a responsible adult without paying a fee to have an online doctor rubber stamp your request with a tech company taking its vig for medical matchmaking.

Sponsor Updates

• HCTec team members head to ThriftSmart for the company’s quarterly volunteer day.
• EClinicalWorks will exhibit at the 2019 IPHCA Annual Conference April 29-30 in Indianapolis.
• Ellkay will exhibit at the Executive War College Conference on Laboratory & Pathology Management April 30-May 1 in New Orleans.
• The California Health Care Foundation features Healthfinch and its work with safety-net clinics in California.
• InterSystems will exhibit at Epic XGM May 1-2 in Verona, WI.
• Ivenix will exhibit at the New England Nursing Informatics Consortium Annual Symposium April 26 in Waltham, MA.
• The “HIT Like a Girl” podcast features Kyruus CMO Erin Jospe, MD.
• ConnectiveRx will exhibit at the Asembia Specialty Pharmacy Summit April 29-May 2 in Las Vegas.
• Nordic unveils a new logo.
• PerfectServe achieves certified integration with the Spectralink Versity smartphone.
• Humber River Hospital in Toronto upgrades to Meditech Expanse.
• Optimum Healthcare IT publishes a new infographic, “Q1 2019 Health Data Breach Report.”
• Meditech publishes a new case study, “Kalispell Regional Advances Diabetes Management Through Patient Registries.”
• The Arizona Hospital and Healthcare Association offers PatientPing’s real-time care alerts and context stories to member hospitals through its Affiliated Partners Program.

Blog Posts

• TCM: From Post-It to Proactive (EClinicalWorks)
• ACMA 2019: Reflecting on the Annual Transitions of Care Conference (Ensocare)
• Helping Healthcare Go Mobile (Formativ Health)
• Noise or Signal? Rising Risk (HBI Solutions)
• Maximizing The ROI of EHR Implementation With Clinical Service Desk (The HCI Group)
• The Two Tales of Remote Access Security (Iatric Systems)
• Building The Digital Health Portfolio: Aligning Strategy & Execution (Impact Advisors)
• Critical Criteria in Evaluating Healthcare Analytics Vendors (Dimensional Insight)
• 3 Ways to Develop the Next Generation of Nursing Leaders (Spok)

Contacts

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

EPtalk by Dr. Jayne 4/25/19

CMS was busy this week, dropping several proposed rule changes for the 2020 fiscal year that begins in October 2019. Last Wednesday, they released a proposed rule updating Medicare payment policies for facilities that fall under the Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS). I love their language in how they explain what they are doing: “We are proposing to update IRF PPS payment rates using the most recent data to reflect an estimated 2.5 percent increase factor (reflecting an IRF-specific market basket estimate of 3.0 percent increase factor, reduced by a 0.5 percentage point multifactor productivity adjustment.” They plan to watch the numbers to see if they can further update the market basket and multifactor productivity adjustments in the final rule.

Then on Thursday, CMS released an update for the Inpatient Psychiatric Facility (IPF) Prospective Payment System and the IPF Quality Reporting program. There are more market basket adjustments to be found, including a proposal to “rebase and revise the IPF market basket to reflect a 2016 base year from a 2012 base year.” There are days that I wish I had taken more finance classes, despite spent a lot more time in the business school than my pre-med colleagues.

If you weren’t dizzy yet after those two, Friday brought proposed changes for Skilled Nursing Facility (SNF) rates. They’re proposing a new case-mix model called the Patient Driven Payment Model (PDPM) because we couldn’t possibly have had enough acronyms. The new model considers patient condition and care needs to determine payment amounts rather than the amount of care provided. As a physician, I’d think that ideally the care needs and care provided should be equal, but I suppose that’s not always the case.

The SNF rule also includes “sub-regulatory process for ICD-10 code revisions for PDPM,” which I’m sure has everyone excited. Friday’s festivities also included a proposed rule with updates for hospice payments, continuous home care, general inpatient care, and inpatient respite care per diem payment rates. Hospices that fail to meet quality reporting requirements will be hit with a 2% penalty on the annual market basket update for the year.

This Tuesday marked the release of a proposed rule to update Medicare payment policies under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS). The first push is for “Rethinking Rural Health,” by which Medicare plans to increase payments to so-called “low wage index” hospitals. The second set of buzzwords was “Unleashing Innovation,” which includes an increase to the new technology add-on payment when hospitals treat patients with high costs involving new technologies, such as expensive new antimicrobial therapies. As usual, CMS is accepting comments on all these proposals.

ONC was also busy with an updated draft of the Trusted Exchange Framework and Common Agreement (TEFCA) along with a Notice of Funding Opportunity for the Trusted Exchange Framework Recognized Coordinating Entity (RCE) Cooperative Agreement.  I just liked learning a new acronym since apparently I’d been ignorant of the NOFO until now. ONC also extended the public comment period for the 21st Century Cures Act proposed rule. It’s now open for an additional 30 days and comments are due June 3, 2019.

I’m extremely glad that influenza season is finally approaching its end, although we’re still close to December levels. My hospital logged only 15 positive flu tests this week, although other nasty bugs such as parainfluenza, rhinovirus, and enterovirus as still torturing people.

Although flu may be meeting its demise, the other big news around the physician lounge this week was the analysis that Medicare expects the hospital trust fund to be depleted in 2026. Social Security will exhaust its reserves by 2035, which is bad news for those of us who have many more years until retirement. Factors taking the blame include the rising number of beneficiaries as well as increase healthcare utilization (both volume and intensity). Until people understand what really happens in the hospital, we’ll continue to see tremendous (and often futile) expenditures in the last six months of life eating up the budget.

Arizona passed telehealth legislation this week, although it doesn’t go into effect until 2021. The new law adds asynchronous visits and remote patient monitoring to state guidelines for connected care and increases payer coverage for the services. Arizona needs all the help it can get since data shows it has one of the highest growth rates in the nation, but is near the bottom for access to primary care physicians. Arizona still prohibits audio-only telehealth calls, which I’d think would be more key to solving its issues than asynchronous communication.

Telehealth is potentially seen as a way to keep physicians in the workforce when they might retire or otherwise escape. There was a piece in the Washington Post a few weeks ago about when aging physicians should hang up their stethoscopes. During EHR implementations, I’ve run across many primary care physicians who should probably have called it quits long before the EHR ended up forcing them out. I don’t see that so much in the urgent care trenches, probably because the work is more physical and fast paced with more procedures than in a traditional primary care practice. I did enjoy one of the reader comments that most of the symptoms the article listed for potential cognitive decline “are the same as you see day to day from harried doctors who frankly aren’t paying attention.”

I saw three patients in the office today who had engaged in telehealth encounters, but weren’t getting better and had been told to seek in-person care. All three received telehealth services as an employee benefit. Two of the three had what I would consider appropriate care, but the third had a combination of medications prescribed that aren’t known to be effective for the condition for which they were given. Interestingly, none of them stated they received a copy of a care plan or any other written instructions, just prescriptions sent to the pharmacy. I was happy to steer them in the right direction with reassurance, a medication change, or an additional diagnosis.

What has your patient experience been with telehealth? Leave a comment of email me.

Email Dr. Jayne.

Morning Headlines 4/25/19

CPSI to Acquire Get Real Health to Expand Patient Engagement Solutions

Community healthcare EHR company CPSI will acquire patient engagement vendor Get Real Health for $11 million.

FTC Charges Surescripts with Illegal Monopolization of E-Prescription Markets

The FTC sues Surescripts for allegedly monopolizing the e-prescribing market, specifically in the areas of routing and eligibility.

Tencent-backed China online healthcare venture raises $250 million

Online Chinese healthcare company Tencent Trusted Doctors raises $250 million, bringing its valuation to $1 billion.

A machine learning device, meant to monitor the chronically ill, moves into homes

FDA approval will help move Current Health’s continuous monitoring device from the hospital setting into patient homes.

HIStalk Interviews David Wenger, CEO, Bridge Connector

David Wenger is founder and CEO of Bridge Connector of Nashville, TN.

Tell me about yourself and the company.

I’m the founder and CEO of Bridge Connector. Bridge Connector is an integration platform as a service with a data-driven workflow automation solution. It is focused on solving the business workflow aspect of healthcare and creating interoperability between systems and ease of communication without the need for code. It is a truly scalable platform that provides an affordable solution to any sized healthcare organization so that they can streamline their business use case workflows.

It’s unusual for someone with no healthcare or IT background to be diving deep into the technical aspects of interoperability. How did that come about?

I grew up around the medical field. My dad’s a doctor, a businessman, and an entrepreneur. I watched him my entire life and learned from him about healthcare and why it’s broken. I’m an entrepreneur. I started a marketing and advertising agency about six years ago that focused on branding, marketing, web development, and cool tasks like that. It focused on helping smaller healthcare systems, drug rehabs, and behavioral health facilities with marketing to get customers in the door as well as keep customers or patients. I learned healthcare through that.

I saw a really big problem with one of my drug rehab clients. We were hired to integrate their Salesforce instance with their electronic medical record software. They were getting 150 phone calls a day and had a full team of people in their office typing the information manually from one system to the other. It was a 30- to 45-minute process per patient. I said, we can build this integration, and it took about six months.

After we built that first integration, I thought that there must be a faster way to do this, where any of these drug rehabs or smaller healthcare organizations could connect System A to System B without having a full team of people trying to build the integration on a custom basis or manually typing the information back and forth.

My father owns a surgical center under Envision Healthcare, which is a very large company. I spoke to people at the company and learned that this is a problem across all of their surgical centers and doctor’s offices. They have no way to get the data from the doctor’s office to the surgical center, or vice versa, without having to manually type the information back and forth.

I decided to do more research and build a proof of concept. I hired some smart developers and bootstrapped the whole thing out of my own pocket with some help from some friends and family. We built and deployed a fully-functioning, working prototype. We partnered with companies like Salesforce, for example, in taking this to the masses, focusing on smaller businesses at first and scaling it from there.

Systems can talk to each other in many ways — FHIR, APIs, app stores, and traditional vendor interfaces. What are the technical and business challenges in solving the interoperability problem?

There’s a lot of standards out there, and a lot of companies that are stuck with the systems that they have. The solutions that are coming out are around API management or coding to specific APIs to build integration, so that developers have a tool they can easily use. We’ve taken a different approach. We have focused on meeting our customer at the spec their core system uses, whether it’s FHIR, HL7, API REST, SOAP, or a on-premise server solution.

We’ve created a way to connect to any type of standard and not make our customer have to code to any of those specs. We do it for them. Our platform is capable of digesting any of the types of information into one to make it a truly functioning integration. A solution like ours can go to the masses and be deployed to any type of healthcare organization, regardless of what system they’re using. As long as there’s a way to connect to that back-end system of truth or the other systems of truth, we have a way to do it, regardless of what standard they’re using.

What developments have you seen in making sure the information being exchanged makes sense to both sides and that it is inserted into the workflow at a point that makes it actionable instead of just making it available for a manual lookup?

We are focused on solving the business problems of healthcare. The problem in healthcare isn’t just clinical data. It isn’t just sending data back and forth. The problem is automating the business problem of healthcare. What drives physicians, what drives hospital organizations, isn’t just the money and patient care, but it’s automating the workflow so their daily processes can be as smooth as possible.

The government is saying to focus on interoperability. They’re trying to put a focus around it and develop it, making sure EMR companies or other vendors have fully-functioning APIs or FHIR standards. They are focused on trying to solve this problem. Companies like Bridge Connector and some of the other players out there are focused on building a standard that any sized system can easily connect to.

How do you work with traditionally low-technology, small-scale providers such as long-term care facilities and small medical practices?

We’ve partnered with the EHR companies in the long-term, post-acute care space. Their customers are requesting this type of integration and the ability to have their data flow easily. We partner at scale with a Salesforce, Clinical Care, or Brightree, for example, and provide a solution to all of their customers. The unique part about our platform is that once we build the connector or build an integration with one vendor, we’re able to rapidly deploy it again and again and again without the need for code.

Time to value, especially from a marketing brain, is everything. The faster you can go live, the better. The longer it takes, the more money the organization is losing. These smaller-sized facilities that aren’t at the leading edge of technology are trying to find ways to streamline their data so that they can solve their business workflow problem and then maximize their revenues by automation.

How does your social determinants of health functionality work?

We are launching our social determinants of health application. We’ve built a fully-functioning application on top of Salesforce. Anybody who owns Salesforce, such as a payer or large provider, can download this application that we’ve built — when it becomes available in the next month or so — and provide social determinants of health within their Salesforce org. They’re not only automating their workflow with integration and utilizing Salesforce to have all their customer data in one customer-centered place, but now they will be able to remove the barriers of care to their patients through this application that they can automatically deploy within their existing Salesforce org.

Salesforce made some healthcare-related announcements a couple of years ago, but I’m not clear what they are actually doing or who is using their product. How do you partner with them?

They are obviously a very, very fast-growing company. They have a significant interest in the healthcare space. They’re are doing a great job of providing value to the customers from a business perspective and automating that customer-patient view.

We partner with Salesforce to help the customers that they’re signing or customers that need integration. We partner with them to help automate those integrations and make them faster and make them easier to deploy, providing affordable solutions so that they can focus on what they need to focus on, which is obviously taking care of the patient.

Salesforce enables them to market to their patients and to schedule their patients. The functionality of Salesforce in healthcare is extremely impressive. We’ve been happy to partner with them and are excited to see where that goes.

What’s it like working with Salesforce, which was built on the concepts of openness and partnerships, compared to an EHR vendor?

Some EHR vendors have been slow to recognize that their customers want to be able to have the data flow as it needs to and to get the reporting that they need easily. The goal isn’t to take the data out of the EHR or make the EHR any less important to the healthcare organization. The EHR is important for the success of the business from a healthcare side as well as the patient.

The reputation of that openness of data is growing. EHR vendors are grasping the need and responding to what their customers are asking for, with integration and being able to have the data flow wherever it needs to. Obviously in keeping it secure and removing the identifiers and stuff like that. Salesforce is extremely secure. Bridge Connector is extremely secure, as well as the EHR. The core focus is taking care of the patient data and making sure it’s as protected as possible.

The company has grown quickly in headcount, customer count, and funding, but some see the healthcare IT market leveling off to some degree. How do you see that growth continuing and what will drive it?

We launched a year ago and we’ve raised $20 million so far. We had five people about 14 months ago and now we have 75 full-time employees. There’s such a need and so much customer demand for integration. Interoperability as a buzzword is more than just sending clinical data back and forth or patients having access to their medical records. The problems exist with the business use case. The markets that we’ve targeted, such as hospitals, are at the leading edge of technology.

We’re focused on the commercial space of healthcare. We are solving that business problem for those commercial vendors that can’t necessarily afford to spend money on a custom integration or developers building out integrations. They need is a rapidly deployable, affordable solution that generates immediate ROI.

We’ve grown so fast because of that, how we’ve partnered, and who we’ve partnered with. The overall need in the marketplace for a solution like what we have is driving our growth. Our growth is pretty astonishing to me, as someone who’s been here since the beginning and saw the idea and where it has taken us.

I think we are just getting started, to be honest. I think the growth will continue. We’ll continue to double in size. We’ll continue to rapidly increase revenues and customer counts and provide a solution that’s easily deployable to the masses over and over and over again, and at scale. We’re looking at hundreds of systems being rapidly deployable without the need for code over the next six to nine months. In healthcare, that solves a huge problem.

While the market might be leveling off a little bit, we think it will hit another inflection point in the next six months, where we will just continue to scale rapidly.

Do you have any final thoughts?

Healthcare is a semi-broken industry. Doctors need to focus on taking care of patients. A guy like my dad, for example, goes home every day after seeing 35-40 patients and types notes or does follow-up work on each patient. It’s an extremely draining task because of the need for notes or documentation, which are important, but there’s no way to easily do that.

The faster that the healthcare market allows for full interoperability or full connections between systems without EHRs getting in the way, from a API being available or charging customers lots of money to be able to have these integrations. As the market keeps growing, there will be a continuing need to connect systems, make the data actionable, and let the business automate workflows, Otherwise, the healthcare industry is not going to get fixed.

The way to fix it is to first solve the business problem, allowing System A, B, C, and D talk to each other. They can do that in every other industry in the world. Why can’t we do that in healthcare?

As a company that has grown as fast as we have, we feel that over the next year, we can help provide that solution to the masses. Not just hospitals, not just large enterprises, but to a small doctor’s office so their system can talk to other doctors’ offices, or have it talk to their billing system without having to go to their EHR vendor and paying thousands of dollars on top of the actual integration costs. The goal is to be able to deploy this to the entire healthcare market, not just the enterprise.