News 9/18/19

Top News

Jonathan Bush (Athenahealth) joins video and office visit provider Firefly Health as executive chair.

Bush’s appointment was announced in the same press release as the company’s $10.2 million Series A funding round.

The two investment groups taking part in the funding round – F-Prime Capital and Oak HC/FT — are represented by former Athenahealth executives Carl Byers and Nancy Brown, respectively. 

Firefly’s founders are from Harvard Medical School.

Firefly bills a patient’s insurance for co-pay and video visits, with no charge for messaging. In-office visits are conducted only in Wellesley, MA, and the company does business only in that state. Firefly says it will “enter several new markets” in 2020.

Reader Comments

From Wall Flyer: “Re: Leidos Health. Sold to private equity firm A&M Capital last week. I’m interested in your perspective of what this might mean. Leidos Health was the commercial healthcare business unit of Leidos, which essentially consisted of MaxIT and Vitaliz that were purchased by SAIC before spinning off into Leidos and Leidos Health.” Verified that the commercial EHR implementation business has been acquired, although I don’t have deal details yet since the announcement isn’t scheduled to come out until next week. The DoD’s Cerner project isn’t included — Leidos runs that project through its federal business unit. The portfolio of A&M Capital Partners includes government health IT contractor CNSI, which it acquired in April 2018. I’ll probably have more to say once I see the announcement. UPDATE: The Leidos PR contact graciously offered to answer my questions ahead of the announcement:

• The affected business unit is Leidos Health, LLC, which does healthcare staff augmentation and EHR implementation and optimization work, basically the former MaxIT Healthcare and Vitalize Consulting Solutions.
• About 850 Leidos employees will transfer to A&M Capital.
• The reason for the sale is, “This transaction emphasizes Leidos’ focus on what it does best – creating and delivering solutions and services that drive improvements in patient care and make managing and delivering healthcare less costly and more effective. Additionally, the sale aligns the commercial EHR staff augmentation services business with a parent company that has a robust growth strategy that provides increased opportunities for employees focused on commercial EHR implementation services.”
• The DoD’s MHS Genesis is not affected. It is operated the federal business unit of Leidos.
• Terms of the sale will not be announced.

From Who Dis: “Re: HIMSS20 keynote speakers. They just announced Chris Christie (former Governor of NJ) and Terry McAuliffe (former Governor of VA) for the Friday morning session. Does that change your mind about attending?” It confirms the wisdom of my decision to skip the last day, as I always do. I doubt that even the few folks who stick around all week will be anxious to hear more political yammering. I’ll spend that time waking up at home or at the beach (maybe Chris Christie will join me). I’m more interested in who gets the primetime agenda slots, which usually ends up being some minor celebrity (Dana Carvey comes to mind as one of the worst, with Dennis Quaid a distant second) or big-company executives. My wild guesses for the good spots: someone from “Shark Tank” (Robert and Mr. Wonderful spoke at HIMSS17), Barack Obama, Malcolm Gladwell, Nicholas Webb, David Feinberg or Toby Cosgrove from Google, Amy Abernethy from the FDA, Sean Parker, Jay Leno, Bill Gates, or someone from Walmart or Amazon. My off-the-wall suggestions, who you can Google if you don’t know them: Jen Gunter, MD; Ken Jeong, MD; Jonathan Bush; Devi Shetty, MBBS; Elizabeth Holmes (or John Carreyrou in her probable absence); Atul Gawande, MD (since he bailed out this year); Stephen Bergman, MD, PhD (aka Samuel Shem); and Neil Pappalardo. I would have said Martin Shkreli, but he’s still in prison, although maybe he can tele-keynote.

Webinars

September 19 (Thursday) 1:00 ET. “ICD-10-CM 2020 Code Updates.” Sponsor: Intelligent Medical Objects. Presenters: June Bronnert, MSHI, RHIA, director of terminology mapping, IMO; Theresa Rihanek, MHA, RHIA, classification and intervention mapping lead, IMO; and Julie Glasgow, MD, senior clinical terminologist, IMO. The 2020 regulatory release is right around the corner. Join IMO’s top coding professionals and thought leaders as they discuss new, revised, and deleted codes; highlight revisions to ICD-10-CM index and tabular; discuss changes within Official Coding Guidelines; share potential impacts of the code set update; and review ICD-10-CM modifier changes.

September 26 (Thursday) 2:00 ET. “Patient Education Data: A Key Ingredient for Improving Quality and Patient Experience.” Sponsor: Healthwise. Presenters: Victoria L. Maisonneuve, MSN, RN, director of the Nursing Center for Excellence and Magnet program, Parkview Health; Marta Sylvia, MPH, senior manager of quality improvement and outcomes research, Healthwise. Healthcare data is everywhere! It’s scattered across various systems and in countless formats, making it difficult to collect and glean actionable information. Knowing where to start depends on what your organization wants to accomplish.  By focusing on your patient education data, you can drive quality improvement across your organization. Vicki Maisonneuve will share how her team analyzes data around the use of patient education. By combining different data sets, she can easily identify trends, gaps, and opportunities to improve quality and patient experience across Parkview Health.

October 2 (Wednesday) 1:00 ET. “Conversational AI in Healthcare: What About ROI?” Sponsors: Orbita, Cognizant. Presenters: Kristi Ebong, SVP of strategy and GM of healthcare providers, Orbita; Matthew Smith, AVP and conversational AI practice leader, Cognizant. Conversational AI holds great promise to drive new opportunities for engaging consumers and customers across all industries. In healthcare, the stakes are high, especially as organizations explore opportunities to leverage this new digital channel to improve care while also reducing costs. The presenter experts offer a thought-provoking discussion around conversational AI’s timeline in healthcare, the factors that organizations should consider when thinking about virtual assistants through chatbots or voice, and the blind spots to avoid in investing in those technologies.

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

Acquisitions, Funding, Business, and Stock

The New York Times confirms that two big financial backers of Doctor Patient Unity – which has spent $28 million to squash proposed legislation that would eliminate surprise medical billing – are the private equity-owned physician staffing and practice operators TeamHealth and Envision Healthcare, which make fortunes sending out-of-network bills. Just in case you’ve forgotten that healthcare is a big business, Blackstone Group bought Team Health for $6.1 billion in 2016 and KKR took over Envision Healthcare in 2018 for $9.9 billion. DPU warns that hospital will close and doctor shortages will arise if the government requires companies to accept the median in-network payment instead of whatever inflated amounts they dream up. They advocate for independent dispute resolution instead, which is already the standard in New York. 

Toronto-based specialty practice EHR, PM, PACS, and AI chat bot vendor OrbCare is reportedly nearing insolvency just six months after announcing a $2 million seed round. The company’s problems came to light when one of the investment firm’s partners, who had been announced as OrbCare’s new COO, found that its monthly revenue was half of what it had reported. The founder and CEO gave a variety of excuses – he was dealing with family matters, the company’s debt was incurred after the funding round, revenue was reported for clients who ultimately never signed up, he intentionally did not share a re-filed financial report with investors, and he never intended to be CEO in the first place. The investment firm provided a $1.2 million loan and has offered another $1.2 million to buy the company in a stalking horse bid. I don’t know how good its products are, but it sure has a bunch of them, so perhaps there’s intellectual property in play.

People

Cerner hires Darrell Johnson (Medtronic) to the newly created position of chief marketing officer.

Pivot Point Consulting promotes Keith Olenik to VP of revenue cycle services.

Vince Vitali (Vitali & Associates) joins NextGate as VP of strategy and business development.

Ricci Mulligan (Leidos Health) joins Grant Thornton’s healthcare practice as director. She previously held leadership roles the VA’s OIT department and retired from US Army Intelligence after 21 years.

Government and Politics

A woman who bought her family short-term health insurance (aka a “junk plan”) gets a $244,000 hospital bill after her husband’s emergency bypass surgery. Her plan didn’t cover pre-existing conditions and limits hospital payments, so it covered only $4,000. She says “negative stories” had kept her from buying real insurance through Healthcare.gov, which she found afterward would have cost her less than the junk plan’s $400 per month premium. The real beneficiary was publicly traded insurance broker Health Insurance Innovations (HIIQ), whose share price tripled from 2016 to 2018 as its annual revenue grew to $350 million, valuing the founder’s stake at $150 million at its peak and earning its CEO $14 million since 2016. A White House executive order expanded the scope of short-term plans, resulting in a six-fold increase in policies since the end of 2018 to  600,000. Big insurers have jumped on board since they aren’t required to spend 80% of premiums on claims like they are for ACA-compliant plans, and in fact are averaging just 39%, making the plans highly profitable with minimal regulation. Meanwhile, HIIQ just paid $70 million to acquire a company that sells insurance via TV ads to senior citizens, so it sees promise in the “low-hanging fruit in the over-65 space.”

Privacy and Security

A ProPublica investigation identifies 187 Internet-accessible, unsecured servers that hold the medical information of 5 million Americans. Many of those records belong to mobile X-ray provider MobilexUSA – whose parent company Trident USA is operating under Chapter 11 bankruptcy – but the company says it has beefed up security after being notified of the exposure by ProPublica. DICOM overseer Medical Imaging & Technology Alliance says that secure connection capability was added to the standard in 1999 and any lack of security is the responsibility of the operator, but adds that some of the insecure systems don’t contain live patient information and instead are being used for product development and testing.

Other

Cardiac surgeon and India hospital operator CEO Devi Shetty, MBBS makes some fascinating points in an interview:

• Doctors will continue to be the most important people in a hospital, but they will need to be backed by skilled executives who know how to run the business.
• The MBBS (MD) degree has lost its relevance because specialists make the broadest impact. He says lack of safe surgery kills 70 million people in India each year and 90% of India’s healthcare problems could be solved with emergency C-sections, laparotomy for burst appendix, and compound fracture repair.
• Analytics holds great promise in healthcare, but 95% of hospitals in India don’t use EHRs, which is why his Narayana Health built its own after finding commercial products lacking.
• Shetty’s hospitals perform 15% of all heart surgeries that are done in India and the company is using the huge volume of data that results to predict outcomes.
• He does ICU rounds using Microsoft Kaizala encrypted mobile messaging and will soon have access to cardiac monitor live streaming.   
• Shetty says that the keyboard is the biggest roadblock in capturing and using information. He predicts that voice-powered phone apps will overcome loneliness in elderly people by providing alarms, reminders, physiologic monitoring, and wellness checks.
• He scoffs at the idea that AI will replace radiologists, saying that as with airline pilots, radiologists who use AI will replace those who don’t.
• Shetty predicts that India will “become the first country in the world to disassociate healthcare from affluence,” unlike every other country where the cost of healthcare rose with incomes.

A husband and wife are charged in federal court with stealing trade secrets from Nationwide Children’s Hospital (OH), where they worked as exosome researchers. They are charged with selling the results of their research through companies they formed in the US and China. They also filed four patents in China. The indictment calls for the couple to forfeit $876,000 in cash, $450,000 in stock payments, and their shares in two biotech companies. The FBI is also investigating possible ties to the Chinese Communist Party and the Chinese government-sponsored “Thousand Talents Program” that encourages its citizens who work abroad to return to China with their newfound knowledge. The couple’s attorney scoffed at most reporter questions with the response, “Research while Asian.”

Sponsor Updates

• Audacious Inquiry prepares blessing bags for the Manna House in Baltimore.
• AdvancedMD will exhibit at WebPT’s Ascend Conference September 19-21 in Minneapolis.
• Arcadia Healthcare Solutions will exhibit and present at the NAACOS 2019 Fall Conference September 25-27 in Washington, DC.
• Bluetree and Dimensional Insight will present at IntegraTe HIMSS South Florida September 24 in Davie, FL.
• CarePort Health will exhibit at ACMA Maryland September 21 in Hunt Valley, MD.
• Clinical Architecture will exhibit at the InterSystems Global Summit September 22-25 in Boston.
• Redox joins the Allscripts Developer Program and earns its first global integration engine certification.
• CompuGroup Medical will exhibit at the AZ MGMA Conference September 24-25 in Chandler.
• Rob Gallo joins The Chartis Group’s informatics and technology practice as a principal.
• CoverMyMeds will exhibit at the PCMA Annual Meeting September 23-25 in Scottsdale, AZ.
• Cumberland Consulting Group will lead sessions at the Medicaid Drug Rebate Program Summit September 23-25 in Chicago.
• Diameter Health will host its 2019 Customer Forum October 2-4 in Dedham, MA.

Blog Posts

• Make sure patients keep their appointments (AdvancedMD)
• Patrick Conway led the industry in healthcare transformation at CMS. At Blue Cross NC, he’s not stopping. (Advisory Board)
• NAACOS Can’t-Miss Discussion: Contracting with Commercial Payers (Arcadia Healthcare Solutions)
• Going Mobile: Creating Experiences that Matter with the Avaya Mobile Experience (Avaya)
• 50 Best HIPAA-Compliant Cloud Storage Solutions, Part 2 (Datica)
• IT Strategy – Planning for 2022 and Beyond (Optimum Healthcare IT)
• Helping You Navigate CMS’s Proposed Rule for 2020 (ChartLogic)
• Burnout is an Occupational Hazard, Here’s How to Mitigate It (Collective Medical)
• A Pillar of Stability in Historic Franklinton for 114 Years (CoverMyMeds)
• Patient Access – Staffing (Culbert Healthcare Solutions)
• Dimensional Insight Sponsoring St. Jude Walk/Run Boston (Dimensional Insight)
• Tips for a Smooth Health Information Technology (HIT) Hiring Process (Divurgent)

Contacts

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

Morning Headlines 9/17/19

Firefly Health Closes $10.2 Million Series A Funding Round to Expand New Primary Care and Patient Experience Platform

Primary care startup Firefly Health raises $10 million in a Series A funding round and names Jonathan Bush executive chairman.

VA Launches VITAL Training Ahead of First Electronic Health Records Rollout

The VA launches an 18 month-long EHR training program for 76 providers ahead of the Cerner system’s 2020 roll out at VA facilities.

Cerner Announces New Chief Marketing Officer

Former Medtronic executive Darrell Johnson joins Cerner as its first chief marketing officer.

HMS Acquires VitreosHealth

HMS acquires predictive analytics company VitreosHealth for $36.5 million.

Curbside Consult with Dr. Jayne 9/16/19

This week was one of those where I question my life decisions, particularly the one where I chose to spend my clinical time in the emergency department.

Due to a perfect storm of maternity leaves, provider illness, and other factors, I ended up working entirely too many shifts in a row, which always leaves me feeling a little overwhelmed. Twelve-hour shifts are never only 12 hours, and once you get home, scare up some dinner, and deal with any urgent home issues, it’s time to hit the sack and get ready to do it again.

The mix of patients I saw this week says a lot about what is going on with our healthcare system (or lack thereof). There were too many patients who had put off care due to fear of excessive costs or high deductibles, which unfortunately led to even higher costs due to complications. Quite a few patients tried to receive care from their primary physicians, but were stymied by lack of available appointments (and sometimes by lack of someone even calling them back). There were also far too many patients who didn’t need to be there, those who hadn’t even tried a shred of self-care before deciding to come in.

As a clinical informaticist, times like these always make me think of whether there are viable technology solutions we could bring to bear on the problem. There are a host of solutions that can help, and some of them are already being employed across the country – patient portals, virtual visits, after-hours nurse coverage, remote patient monitoring, medical advice apps, and more. Sometimes these solutions do more harm than good, such as when test results are released to anxious patients before their physicians have contacted them regarding the results.

I cared for one of these patients this week. She received results through the patient portal on a Friday night and was unable to reach her physician. The results included an abnormal imaging study and some vague radiology references to “clinical correlation needed.” The patient, who already had a diagnosis of anxiety, began to have panic attacks after consulting Dr. Google, and those panic attacks manifested as chest pain. Since she had risk factors, we were obliged to work her up with an EKG and cardiac enzyme testing. Many hundreds of dollars later, she was sent home with a better explanation of her results and a recommendation to follow up on Monday with her primary physician.

Some hospital systems embargo their results until the ordering physician has contacted the patients, while others auto-release results after a predetermined delay. This particular facility releases its results on a delay, but apparently the ordering physician was much delayed in his discussion with the patient, leading to the situation.

Although technology can help the provider streamline his or her inbox and make more time for handling results such as these (as can delegation, improved office workflows, and more), there aren’t too many other tech solutions to this problem. It all boils down to capacity – whether the provider is able to care for patients in the manner in which they want to be cared for, on a timeline that is acceptable to them. The patient empowerment movement has shown us that what is acceptable to one patient isn’t always acceptable to others, and that we need to learn to meet patients where they are at if we want to deliver care that works for them. This is challenging for providers and organizations that weren’t trained this way and whose behaviors aren’t incented in this regard.

Despite all of our talking about value-based care, there are still too few organizations practicing what they preach. Patients also don’t always understand how to operate in these systems.

I had several community physicians yell at me recently because their patients were in my ED. These physicians, who are part of a notoriously controlling hospital physician group, were upset that their patients were in the “wrong” facility. I certainly didn’t go out and drag them in off the street, but I was on the receiving end of rants that were largely triggered by the fact that the whole system is broken. Now those patients are going to show up on some leakage report, and there will be many hours spent trying to build systems to try to make sure they go to the “right” facility next time.

Of course, my facility is part of the problem. Since our state has a weak HIE and there’s no easy way for me to access the patients’ records, I likely ordered unnecessary testing, which just further stresses the system. One of the docs suggested I just use the patient’s phone to parse through the patient chart, but that’s not a realistic solution either in a busy ED where it’s easier to just re-run the labs. I hate being part of the problem, but sometimes you have to choose the least of the evils in front of you.

There are so many cool tech solutions out there that I can’t keep up with them all – chatbots that help community health centers better communicate with their patients, apps to support chronic care management, telehealth platforms, virtual care, and more – but we’re still lacking in basic interoperability. We don’t even have a universal patient identifier to tie records to, even if we could tie them all together. What if each patient had a universal identifier card and we could query a master database for the patient’s record when they came in?

Some of the patients I saw during my recent experience with global healthcare described systems like that from their home countries. Our culture is different in the US, though, and it feels like patients wouldn’t be willing to accept something like that due to risks of privacy or having the government have their data. The reality is that a lot of our data is already out there anyway.

If you asked physicians and healthcare providers whether they would be willing to give up some level of privacy for the sake of better medical accuracy or a more complete record, I wonder what they would say? I certainly would, especially knowing the pitfalls of having inaccurate or missing data and knowing how much it costs to repeat studies that are already documented somewhere but just aren’t accessible at the time they are needed. Even when I can track down results, they’re almost always faxed to our front desk rather than being consumable within the electronic chart.

Since my state isn’t exactly a hotbed of data sharing, I’m curious how others operate in this environment or whether the grass is really greener on the other side of the fence.

Do you have a complete picture of your patients’ health? What would it take to make that happen? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Jeremy Pierotti, CEO, Datica

Jeremy Pierotti is co-founder and CEO of Datica of Minneapolis, MN.

Tell me about yourself and the company.

I’ve been working in healthcare IT for about 20 years. I started off working at Allina Health in Minneapolis and ended up doing consulting. Then I co-founded Sansoro Health. Sansoro and Datica merged in June 2019, with the go-forward company name being Datica. We help healthcare move to the cloud by addressing compliance and data integration challenges.

What can the merged companies do more effectively than they could have done as separate organizations?

We knew that healthcare is moving to the cloud at an accelerating pace. As Travis Good and I started talking, we recognized that we had a complementary set of products, technologies, and team talent, and that if we put the companies together, we could help digital health engineering teams address the two challenges that they have to solve. Those are cloud compliance — which increasingly means meeting the HITRUST CSF requirements — and data integration, being able to exchange data bi-directionally between lots of different digital health applications. Electronic health records, but also all the different supporting systems that every health system runs.

How far along is healthcare in its seemingly inevitable move to the cloud?

It is toward the beginning of its journey, and it’s going to move fairly quickly. We’ve read lots of reports that show anywhere from 10 to 20% CAGR growth over the next five to seven years, and we’re experiencing that ourselves.

Like every other industry, healthcare is recognizing that what the cloud brings is not just running your software on somebody else’s computer in a data center that they manage, but providing access to a whole new set of tools for data analytics, supporting mobility, and integrating lots of types of data from lots of sources. You just can’t develop software with those features using an on-premise architecture. You are increasingly seeing large companies develop their new applications on a public cloud framework because it gives them the flexibility and the power of the toolset to leverage the capabilities of engineers and development teams all across the world.

How does the work of Cerner, Epic, and Meditech fit into a strategy of making their data available for use by cloud-based services?

They are moving deliberately and cautiously, understanding that they can’t make dramatic changes overnight. Their customers are big, complicated provider organizations for whom stability is enormously important. They are all looking for the right balance of making new capabilities available and taking advantage of cloud functionality that will give customers the features that they want, while at the same time, keeping their core systems stable. That means something a little bit different to each of those vendors, but they are all trying to find and strike that balance.

Would a move to the cloud change the exclusive relationship between a health system and their primary EHR vendor?

In the short term, I don’t think it changes anything significantly. I certainly don’t think it makes it more exclusive. In the long term, I think it makes it less exclusive.

I was listening to a podcast from Andreessen Horowitz, where Mark Andreessen was talking about how in Silicon Valley, you have this rich ecosystem of API-driven data exchange and whole companies that have been developed just to facilitate the development and management of APIs within industries. What we see in other industries will come to healthcare, too. When you have increasing adoption of cloud-based application development, you end up stitching those pieces together with API-driven data exchange. We’re seeing that same thing in healthcare as you look at the emergence of FHIR and other API toolsets for patient data exchange.

A move to the cloud by Cerner, for example, is not going to tie the hands of Cerner’s clients and make them any more dependent on Cerner. It is just part of the the slow, steady move toward health systems being able to choose from a variety of tools and integrate the tools that work for them best.

What is creating the demand for cloud-based services?

My colleague and our chief medical officer, Dave Levin — who used to be CMIO of at the Cleveland Clinic – says he spends all day working in healthcare and then he goes home to the 21st century. The reality is that it’s consumers. It’s our everyday experience with smart phones, tablets, and advanced software that we run on whatever device we choose and that allows us to move from one device to another almost seamlessly.

Those experiences that we who work in healthcare have every day in every other part of our lives make us realize that we need that same type of functionality when we’re delivering healthcare services to patients. When we’re managing populations of patients or health plan members, we need those same capabilities, those same toolsets.

To take the simplest of examples, there’s no reason that if I’ve been to the same doctor’s office six times in the last year, that I should have to fill out the same piece of paper on the same clipboard the seventh time. When when I walk into all sorts of other businesses, they know who I am. They have read my license plate or I’ve agreed to have my smartphone notify them when I walk in, so they know from the beacon  at the front door that I’ve arrived and they’re ready for me. It’s those kinds of experiences — the scalability, the mobility — that is driving healthcare organizations to create software with those same capabilities.

Will it be hard for healthcare IT vendors to move their systems to the cloud?

Vendors are looking to do that module by module. I don’t have deep insight into the Cerner-AWS announcement that came last month, but the way I understand it, Cerner is not saying that all of a sudden they’re going to move all of their clients who use Cerner Millennium onto AWS servers or AWS services. But they will be increasingly developing new software capabilities on the public cloud. On AWS specifically, for Cerner.

Going back to what I said earlier about the need for stability and reliability by providers and payers, but especially providers, our expectation is that you’ll see vendors developing their new software, their new modules, in the public cloud, taking advantage of those capabilities. They will work deliberately over time to figure out what makes sense in terms of potentially migrating their legacy products to a cloud infrastructure. I’m not sure I have any unique or special insight into that, but that’s the trend I’m seeing, health IT companies developing their new stuff in the cloud and migrating their customers who want those new features to that new platform.

Health IT vendors seem obligated to name-drop AI and analytics in their cloud announcements. What kind of learning curve will they and their cloud services vendor encounter as they modernize healthcare applications?

I wish I knew the answer to that. There clearly are some tremendously exciting applications of artificial intelligence and machine learning in healthcare. I’ve also read many pieces recently about the need to approach it carefully. Any time you’re going to train a machine to learn something, you need to make sure that you’re training it in the right way, otherwise you can create more problems than you’re solving.

But the cloud is a big part of that, because there are so many AI and ML services that are available through a public cloud infrastructure. AWS announced Comprehend, their natural language processing service, a couple of years ago. It allows users to train it and it comes at a competitive price point. That’s an example of how cloud service providers and application developers in AI and NL are looking to leverage the cloud — making those services available, allowing lots and lots and lots of engineers and creators to experiment with those services, test them, and determine what can have a real, positive impact on patient outcomes.

Big provider organizations are announcing their own cloud partnerships, such as Mayo Clinic and Google Cloud. How will those organizations work directly with cloud providers?

It speaks to the amount of data that providers are accumulating. They need to find ways to support the efficient storage and analysis of that data so that they can learn from it as quickly as possible and apply that to better operations and better patient care. It’s not surprising to me at all and I think we will see more of it. It’s understandable, because in other industries, you have big players, big companies that are on a daily basis using cloud platforms and the analytics capabilities of cloud platforms. To improve their products, to improve their customer service, and to improve their deployment of personnel.

Healthcare has the same needs and the same demands of end users to capture those capabilities without having to invest in standing up a new data center full of physical hosts and a big huge team of devops engineers, DBAs, and others to manage all of that traditional infrastructure. You’ve got all of that data and you need somewhere to quickly and efficiently store it and analyze it.

What impact do you expect to see from the federal government’s implementation of the interoperability and data blocking implications of the 21st Century Cures Act?

We’re waiting just like everybody. Our sense is that when the final rule is released, it will raise the floor, but it won’t necessarily raise the ceiling. We are looking to continue to push the ceiling with innovative solutions for integration.

We recognize that even when ONC and CMS release those new rules, it’s likely to be several years before they’re enforced. It’s going to take the vendors time to develop the technology and capabilities that those rules may require. We’re not waiting. We are working every day with health systems and innovative health IT companies to figure out how they can make the most of the data exchange capabilities that exist today.

The bottom line is that we’re eager to see what comes out. Industry discussion of those rules has been robust and the public itself is highly interested in it. Every person has a personal investment in being able to get access to and make portable their health information. So it’s fascinating, but we recognize that it will be years before anything is actually required and implemented. Our goal is to help our customers, providers, and payers take advantage of what they’re capable of right now.

Is the federal government at risk of oversimplifying the interoperability challenge in declaring mission accomplished just because the use of APIs and FHIR has widened?

As I listened to the debate over the last several months, and certainly after the draft rule was released, I was struck by how thoughtful and mature the discussion was across the board on these rules. There is a broad recognition within health IT that if this were easy, we would have solved it.

I’m not saying that it’s challenging mostly from a technology standpoint. It’s challenging mostly because there are lots of competing interests that have to be resolved, and they’re not necessarily easy to resolve. There are ways to do it, and our company and I personally have our own views on how to address some of those challenges. But it’s been a robust, mature discussion about how we balance the interests of different players, always keeping in mind that the goal here is the delivery of better patient care at lower cost and having better outcomes.

Do you have any final thoughts?

My colleagues and I are excited about the pace of innovation in health IT. If we weren’t, we would go find something else to do, since goodness knows the world has plenty of other problems to solve. I look forward going to work every day because of the opportunity to partner with people who feel emotionally compelled to bring positive change to something that impacts every single person — the delivery of quality healthcare.

Morning Headlines 9/16/19

Livongo Reports Second Quarter Financial Results

Livongo says it will lose $40 million on the year after reporting Q2 results: revenue up 156%, adjusted EPS –$0.46 vs. -$0.31.

Varian and Oncora Partner to Accelerate Precision Medicine in Radiation Oncology

Cancer powerhouse Varian will invest an unspecified amount in Philadelphia-based Oncora Medical, which offers precision radiation oncology software.

Tyler & Company Seeks CIO for Penn State Health

Penn State Health system (PA) enlists an executive recruitment firm to help it find a Cerner-savvy SVP/CIO.

Monday Morning Update 9/16/19

Top News

A report from the American Hospital Association and consulting firm EY says that participatory health, or “healthcare with no address,” is coming. It predicts that health systems will respond to consumers who want on-demand, connected, and data-driven services.

The report says a participatory health framework will require health systems to offer:

• Health and wellbeing support.
• A personal health cloud containing the patient’s own data, including biometrics.
• AI analysis of the data to create new insights and solutions.
• A demand-driven global marketplace.

The report predicts that physicians will become “data-driven conductors” who will take responsibility for managing the lifestyle and wellness of patients.

The authors observe that while the future is more patient-centric and participative, health systems must move toward value while continuing to earn most of their revenue for volume. They will also have deliver anywhere, anytime care even though they have spent a lot of money on brick-and-mortar locations.

Nontraditional players such as entrepreneurs, retailers, and technology companies are ahead of health systems in offering consumer-oriented health services. Value-based payments favor non-hospital locations such as retail clinics and consumers prefer those anyway, with the next step for those retail locations being to offer chronic care management via telehealth.

Time zone differences also encourage global approaches, such as ICU monitoring virtual second opinions.

The article also calls out successes in which health systems have applied their quality improvement and relationship-building expertise to partner with their communities to address social determinants of health. 

Reader Comments

From Set in Code: “Re: CPT codes. I work in a large Medicaid health plan. CMS requires use of AMA-copyrighted CPT codes. We are now being charged per member for each instance of the CPT code set that is used in any of our systems, meaning that we’re paying AMA multiple times for the same member. It also seems that organizations pay radically different per-member rates. AMA has created a monopoly and I believe that CPT licensing revenue is its largest revenue source, but I would like to see leverage applied to keep the cost reasonable as AMA seems to be offsetting shrinking membership by forcing health plans and providers to make up the gap.” AMA’s most recent tax filings show a profit of $26.4 million (up from $9.4 million last year) on revenue of $317 million, of which only $38 million came from membership dues. Royalties generated $148 million of the “other revenue” total of $191 million. AMA paid its EVP/CEO $2.2 million, its COO $1.2 million, and the former Allscripts executive who heads up the CPT group $900,000. About 80% of US doctors are not AMA members. AMA made $1.5 million in political contributions last year and spent $20 million on lobbying, just in case you want to launch a grassroots effort to get politicians to rein in its CPT fees. Like a lot of member organizations (including HIMSS), the organization’s most significant revenue comes from selling access to members and running businesses that actually compete with the work of some of those members (as I always say, that’s the “ladies drink free” business model). 

From Jonas Sister: “Re: Epic’s employee testing. Some of your readers have spoken, but you haven’t.” My position is that: (a) Epic can use whatever methods it wants to hire employees and it’s nobody else’s business; (b) you can argue theoretically why Epic’s tests shouldn’t be good predictors of job performance, but you can’t argue with the success Epic has had for decades in using those tests virtually unchanged to hire thousands of employees; (c) people who complain about Epic’s tests as being irrelevant or unfair are usually folks who weren’t hired, either by Epic itself or its health system customers who administer the same tests to their own prospective Epic team members; and (d) while we might personally believe that our experience should be valued over test scores, that’s not the case with Epic, who sees greater long-term promise in a blank canvas. Also note that Epic has an endless supply of applicants, the company is an efficient machine in onboarding new hires and either moving them up the ladder or out the door, and its processes are apparently so well laid out that it doesn’t need people who have learned bad habits from crappy health IT companies. I will give more credence to passionate arguments about how Epic’s hiring and retention practices are wrong once I see the company struggling because of them. It hurts to be passed over purely based on the results of a “lions, tigers, and cages” type question or a MUMPS-like programming logic quiz, but the most important logic question is why anyone would expect Epic to ditch practices that made it the industry leader.

HIStalk Announcements and Requests

Two-thirds of the employers of poll respondents have laid people off recently, and of those, about half say that older or sicker employees seemed to have been targeted. Not Exactly says his EHR vendor laid off to hit a payroll dollar target, so that raised the risk for experienced, higher-paid employees. Cosmos says their vendor employer reduces headcount by running long hiring freezes instead of layoffs, but the folks who leave are often younger ones with better options and who don’t need the health insurance instead of those who might be laid off otherwise.

New poll to your right or here: Which factor do you think was most important in being hired by your current employer?

Welcome to new HIStalk Platinum Sponsor Zynx Health. The Los Angeles-based company, which is part of the Hearst Health Network, offers ZynxOrder (evidence-based order sets and clinical decision support rules); ZynxCare (evidence-based plans of care); specialty content packages (home health, pediatrics, skilled nursing, chronic conditions); Knowledge Analyzer (evaluation and optimization of clinical content and processes); and the recently introduced Lumynz (analytics that looks at orders vs. evidence, including the financial impact). Its Vital Interventions has identified high-impact interventions (mortality, cost, length of stay, admissions and readmissions, and hospital-acquired conditions) that align with performance measures and quality and cost objectives. The company just announced new Knowledge Analyzer reporting capability that allows hospitals to map clinical decision support to best outcomes and to prioritize the potentially most impactful interventions. Thanks to Zynx Health for supporting HIStalk. 

I was playing some country music on the Sonos for a visitor who, unlike me, enjoys it. Just about every song featured cartoonishly cowboy-hatted, testosterone-swaggering male singers with questionable Southern accents. I looked up how many of the 20 or so songs that we heard were actually written by the throaty twangers themselves. Answer: zero, although a couple of them shared a songwriting credit with an actual songwriter in what I imagine was a pay-to-play deal to get the tune recorded in the first place. Country and pop were about the same on Billboard’s current top 10 charts – lots of co-writing credits, but no singer actually wrote their hit solo. Conclusion: as in acting, comedy, politics, and maybe most other areas, music stars are usually just reading someone else’s thoughts since they are entirely separate forms of craftsmanship, although (a) those with star power in TV and music can command inflated billing as executive producers or co-writers, respectively; and (b) in music, at least the less-recognizable people who actually create the songs are earning publishing royalties in perpetuity instead of swigging vodka from an onstage water bottle while unenthusiastically shouting “How you doing tonight, Omaha?” from their gig in Kansas City.

Webinars

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

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

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

Acquisitions, Funding, Business, and Stock

I missed this last week. Livongo reports Q2 results: revenue up 156%, adjusted EPS –$0.46 vs. -$0.31. The company says it will lose $40 million on the year. Shares dropped 17% on news of widening losses, with LVGO shares now trading at under $25 versus their first-day offering price of $28 and first-day close of $38.10 on July 25, meaning that someone who spent $10,000 jumping on the IPO now has less than $6,500 worth of shares. The company is valued at $2.4 billion. From the earnings call:

• The company says it met all of its financial and operational objectives in the quarter, with increased enrollment and 720 clients signed.
• Livongo touted its increasing total contract value, which it calculates using percentage enrollment assumptions that are applied to company headcount. Contracts runs 1-3 years.
• The company didn’t directly answer an analyst’s question about how many users drop out, but later said it lost about 2% of users during the year and three-fourths of that was due to employees leaving their companies that provided the platform.
• Livongo is cross-selling among its products – hypertension, weight management, diabetes management, and behavioral health – but its diabetes offering is generating almost all its revenue so far.

Cancer powerhouse Varian will invest an unspecified amount in Philadelphia-based Oncora Medical, which offers precision radiation oncology software.

Sales

• Thomas Health (WV) outsources its Level 1 help desk to CereCore.
• England’s East Lancashire Hospitals NHS Trust joins the global health research network of TriNetX for searching patient cohorts, querying study-related data, and adding study visibility to pharmacy and contract research organizations.

Announcements and Implementations

Nordic creates Registry Direct, which offers automated, FHIR-powered abstraction for sending EHR data to the American Heart Association’s Get With The Guidelines online registry.

Government and Politics

An article in Foreign Affairs says that China is following the economic growth script of Germany, France, and Japan in moving up the food chain from manufacturing cheap global goods to creating an innovation powerhouse that is being driven by a world-leading economy and government-led investment in research. It predicts that China will soon end the US’s 70-year run as the world’s leader in science and technology. The authors cite JAMA, which predicts that China will become the world’s leader in drug development in the next five years. The well-credentialed authors recommend that the US government spend more on scientific research, push efforts to translate the results into marketable products and services, and create jobs outside of the usual hub cities like Seattle, San Francisco, and Boston and instead focus on cities where land is cheaper and people can be more productive.  

Privacy and Security

Facebook warns users that new privacy protections are enabled by default in IOS13 and Android 10 that prevent the app from tracking its users in real time, which Facebook insists (without irony) is a problem because users will thus be deprived of valuable services such as location-targeted ads. The new features mimic privacy options that are already available in Facebook, but Facebook knows that few users modify its defaults and in any case will struggle to find the option within its complex privacy settings menu.

Other

The Chicago business paper looks at the highest-paid executives of Lurie Children’s Hospital, including the CEO ($2.2 million) and the CIO ($460,000).

Britain’s health secretary Matt Hancock declares that he won’t let his country’s drug usage “escalate to the level seen in the United States,” following release of a new government report that says 25% of people in Britain are taking meds for pain, anxiety, depression, and insomnia, with half of those being long-term users of at least a year. More than 10% of Britain’s population take antidepressants and nearly that many are taking opioids, with women and people in poorer parts of the country having higher rates. England and Wales have a long way to go to hit US-class opioid death rates, as just 2,200 people there died of opioid overdoses last year vs. 47,600 in the US.

The 33-year-old investor co-founder of Hims – which peddles erection and baldness treatment drugs following an “online assessment” that is reviewed by “our network of doctors” – publicly announces his expectation of being a billionaire “by my mid to late 30s” in a Quora post he later deleted in a late-onset attack of faux humility. If you want to upend US healthcare and save billions of dollars, make all drugs available without a prescription since consumers who want them will get them at any cost regardless.

@DrJenGunter explains why she became a patient advocate in answering the call of Bernie Sanders to describe “the most absurd medical bill you have ever received.”

Sponsor Updates

• Health Catalyst will exhibit at the 2019 MHA Fall Convention & Trade Show September 18-20 in Billings, MT.
• Mobile Heartbeat will exhibit at the Chief Nursing Officer Summit September 16-17 in Scottsdale, AZ.
• Waystar will exhibit at CareVoyant UGM September 18-20 in Schaumburg, IL.
• Netsmart will exhibit at the Ohio Council for Home Care and Hospice Annual Conference and Tradeshow September 17-18 in Columbus.
• Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the Perinatal Partnership Conference September 22 in Concord, NC.
• OmniSys will exhibit at the Pennsylvania Pharmacists Association’s Annual Conference September 19-22 in Seven Springs.
• PatientKeeper will exhibit at AHIMA through September 18 in Chicago.
• Health Catalyst shares insights from its annual Healthcare Analytics Summit.
• Wolters Kluwer Health announces efforts to promote Sepsis Awareness Month, including a new blog series and its Sepsis Resource Center.

Blog Posts

• How Erlanger Health Systems is using data to improve patient throughput (Nordic)
• OIG Series Strategy 1: Working with Physicians (Lightbeam Health Solutions)
• Sharing Knowledge and a Shared Vision for Health (EClinicalWorks)
• Why Financial Engagement Should be on Every Provider’s Priority List (Loyale Healthcare)
• Can we talk? Communication isn’t just for patients and physicians anymore (Meditech)
• Finding the Courage to Ask (Netsmart)
• Highlights from UGM 2019 (CereCore)
• How a Universal Patient Identifier can help solve pharmacy’s patient matching problem (Experian Health)
• Market Share: How to Compete with Larger UCC Groups & Health Systems (PatientBond)
• PatientTouch Introduces New Enhancements for Physicians and Workflows for Nurses (PatientSafe Solutions)
• Improved Patient Financial Engagement in 5 Steps (Patientco)
• Molina Healthcare Builds Operational Efficiency with SailPoint (SailPoint)
• Out with Manual Testing in Healthcare, in with Automation (Santa Rosa Consulting)
• “When It Goes Well, It Feels Like Magic” Two HIT Experts Chat about the Real-World Impact of Interoperability (Surescripts)
• Edward Marx’s Healthcare Innovation Roadmap Checklist (SymphonyRM)
• How doing more in less time helped one OR add 200 cases per year. (Voalte)
• Celebrating Star Trek and the Next Frontier of Voice Communication in Healthcare (Vocera)
• Even Small Practices Face Cybersecurity Threats and Government Scrutiny (WebPT)

Contacts

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

Weekender 9/13/19

Weekly News Recap

• Surescripts cuts off prescription data access to Amazon’s PillPack mail order pharmacy.
• The premier of Queensland, Australia promises to investigate a 14-hospital downtime of several hours that was caused by a Cerner upgrade.
• Apple announces that it will partner with several high-profile healthcare institutions to conduct studies related to hearing, women’s health, and heart health using its new Research app.
• Mayo Clinic signs a 10-year partnership with Google in which Google Cloud will provide Mayo with data hosting, cloud computing, analytics, and machine learning and AI.
• Bayfront Health St. Petersburg (FL) pays $85,000 to settle HHS OCR’s first case under the Right of Access requirement to give patients complete copies of their medical record within 30 days.
• Hackers breach DDS Safe, a cloud-based records retention and backup solution that is sold to dental practices, and use it to install ransomware on the computers of hundreds of dental practices.

Best Reader Comments

Private equity can jump in the line of who all are screwing the consumer –bloated organizations, vendors charging five times what it would cost out of healthcare, solutions bought not needed, physicians making a fortune off their patients’ problems, and hospital execs stuffing pockets while driving up costs. Next up: pediatric offices charging based on parent fear level. (Overcharged)

I use PillPack and one of the things that appealed to me was that it took five minutes to sign up and they had my insurance information and prescription information without my needing to supply it. If this had been manual, I would have never signed up. (To be or not to be)

Is a really high deductible and co-pay actually “coverage” or just the illusion of coverage? (Brian Dale)

I’m honestly thrilled that a hospital / health system got nailed for obstructing access to patient records. It’s overdue. As a hospital, I owe it to my patients to assure that they can get to their records in a timely manner. I don’t always know why they need it, and it isn’t my problem. It is their information. They should have a right to it. (MEDITECH Customer)

In effect, Epic aptitude testing tries to determine if you are a smart person. The assumption is, if you are a smart person, you can be a good IT analyst. Good grief! Only your job history proves that and I already have that. (Brian Too)

Epic doesn’t tell you how you do on the exams, but you can assume you did well if you’re offered the job. Carl Dvorak, in a new hire class, told us that the aptitude and personality tests were better predictors of how well Epic employees would perform than their college major, job history, college, etc. (Publius)

Worked in a border city in a prior life — we had hospitals in both states. One state required a physician signature on every individual script, the other allowed batch signing. EMR workflow was a nightmare, as was physician adoption for the physicians that worked in both hospitals. (Was A Community CIO)

Burnout is a real condition, but for most of organized and academic medicine, it has provided a handy new topic to generate more content for sale and consultation fees. (Kevin M. Hepler)

If the AMA was fighting for us, they would be loudly demanding truly radical restructuring of US health care rather than tweaking the existing one with apps, conferences, wimpy comments on CMS rule-making, etc. The solution to our problem isn’t going to come from the AMA until they recognize that they helped to create the problem. (Joe Schneider)

That’s the nature of implementation in general. People who have previously done the exact same thing as you need command a premium salary. Most of the work isn’t really that complicated and is just grunt work. Therefore vendors provide the grunts and let the high-powered implementation people go become consultants that the customer can pay high salaries if that’s what the customer wants to do with their money. (Grunt)

I like where you are going with a basic skepticism of feedback you receive from folks who have not yet bought your product. In the startup world, a little book called “The Mom Test” has become the standard for the “customer discovery” process, in which you learn that people desperately want to tell you what they think you want to hear – and it’s usually not helpful. (Michael Burke)

Watercooler Talk Tidbits

The Seattle newspaper recites yet another example of The Joint Commission giving a hospital a glowing review while state inspectors were nearly simultaneously threatening to shut it down for safety problems, highlighting the Commission’s self-proclaimed role as being the non-punitive advisor to hospitals that want to improve.

Google adds naloxone-finding tools and addiction recovery meeting locations to Maps.

An 86-year-old Georgia doctor who operates a weight loss clinic is arrested for illegal drug distribution and money laundering, charged with taking cash from former NFL linebacker Sedrick Hodge for providing him with prescription medications to sell on the street.

San Diego physician Murray Alsip, DO discovers that he can continue practicing medicine even after a heart transplant left him unable to see patients in an office by signing on as a telemedicine doctor with MDLive. Alsip previously met with the former girlfriend of 20-year-old man whose heart he received so she could hear it beating in his chest.

In Case You Missed It

• News 9/13/19
• EPtalk by Dr. Jayne 9/12/19
• HIStalk Interviews Steve Shihadeh, Founder, Get-to-Market Health
• News 9/11/19
• Curbside Consult with Dr. Jayne 9/9/19
• HIStalk Interviews Ken Misch, President, Medhost
• Monday Morning Update 9/9/19

Get Involved

• Sponsor
• Report a news item or rumor (anonymous or not)
• Sign up for email updates
• Connect on LinkedIn
• Contact Mr. H

Morning Headlines 9/13/19

Healthy.io Raises $60 Million in Series C Funding and Receives FDA Clearance for Smartphone-Based Test to Diagnose Chronic Kidney Disease

Healthy.io raises $60 million and receives FDA clearance for the use of its smartphone-based ACR test to be used in diagnosing chronic kidney disease.

TrialCard Announces Acquisition of Mango Health

Digital prescription savings company TrialCard will acquire medication management app Mango Health.

GE’s health unit wins first FDA clearance for A.I.-powered X-ray system

GE Healthcare receives FDA clearance for its Critical Care Suite, an AI-powered X-ray device that can reduce the time between diagnosis and treatment for a collapsed lung to as few as 15 minutes.

Google and others ‘not interested in electronic patient record market’

Google Cloud Executive Advisor Toby Cosgrove, MD says that health systems have spent so much on Cerner and Epic that Google, IBM, and other companies aren’t interested in trying to launch competing EHR products.

News 9/13/19

Top News

Surescripts finally severs ties with ReMy Health, which supplied Amazon-owned mail order pharmacy PillPack with patient prescription data collected by Surescripts.

Surescripts CEO Tom Skelton told customers the move was made to ensure the “integrity of its network.” It came after Surescripts allegedly discovered that ReMy had requested patient insurance information and prescription pricing data that it then passed on to drug marketing websites without permission. ReMy has denied any wrongdoing.

The tit-for-tat amongst the trio has been going on for several months, with Surescripts claiming it would take its complaints to the FBI and Amazon retaliating with threats of a lawsuit.

The FTC filed an antitrust lawsuit against Surescripts in April for allegedly monopolizing the e-prescribing market, specifically in the areas of routing and eligibility.

Reader Comments

From MIPS Maven: “Re: MIPS. More than a dozen major EHRs have not released full 2019 MIPS functionality. Practice Fusion just released their dashboard yesterday after months of customer complaints. MIPS is a FULL YEAR program that began on January 1, 2019. How are EHR vendors not being fined for failing to offer MIPS functionality when they are ONC certified?”

From Attendance Mandatory: “Re: conferences. Don’t you find it ironic that telemedicine conferences require in-person attendance?” I find it ironic that any technology-related conference requires in-person attendance, but I also know that the cash register rings hardest from vendor booths, hotel room bookings, and endless venue advertising. You could easily live-stream every conference education session or just put the video on YouTube as we do webinars. However, attendees are most interested in socializing, making personal connections, or cruising the show room floor, so just watching podium presentations – which are often not very good or very timely anyway – won’t cut it. Conferences provide the supply of whatever it is that the market demands. I’m interested in how the heavily investor-funded HLTH conference will fare in October, having sat out 18 months after making the disastrously stupid decision to launch its initial conference immediately following HIMSS and in the same city of Las Vegas. I haven’t heard any buzz about the 2019 version of HLTH despite its many “media partners” (although quite a few of those are lame).

From Dr. Doctor Please: “Re: surprise medical bills. This is one of the most depressing stories about my profession that I have ever read. Goes well with your recent remarks about how we doctors brought a lot of the burnout-causing conditions on ourselves and how medicine is just another business.” Kaiser Health New says that physician groups are among the biggest and well-funded opponents of laws that would prohibit balance billing, but the real force behind the media blitz is private equity and venture capital firms that have bought physician staffing companies. That earns them fortunes as they intentionally remain out of insurance networks so they can charge whatever they want and leave the patient owing the difference. A snip:

In some areas, doctors have few options but to contract with a staffing service, which hires them out and helps with the billing and other administrative headaches that occupy much of a doctor’s time. Staffing companies often have profit-sharing agreements with hospitals, so some of the money from billing patients is passed back to the hospitals. The two largest staffing firms, EmCare and TeamHealth, together make up about 30% of the physician-staffing market. That’s where private equity comes in. A private equity firm buys companies and passes on the profits they squeeze out of them to the firm’s investors. Private equity deals in health care have doubled in the past 10 years. TeamHealth is owned by Blackstone, a private equity firm. Envision and EmCare are owned by KKR, another private equity firm.

With affiliates in every state, these privately owned, profit-driven companies staff emergency rooms, own dialysis facilities, and operate physician practices. Research from 2017 shows that when EmCare entered a market, out-of-network billing rates went up between 81 and 90 percentage points. When TeamHealth began working with a hospital, its rates increased by 33 percentage points.

Webinars

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

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

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

Acquisitions, Funding, Business, and Stock

Healthy.io raises $60 million in a Series C funding round and receives FDA clearance for the use of its smartphone-based ACR test to be used in diagnosing chronic kidney disease. The company released a smartphone-based urinalysis app last year.

Digital prescription savings company TrialCard will acquire medication management app Mango Health. Co-founder and CEO Jason Oberfest left Mango Health to join Apple’s health team late last year.

Health IT consulting firm HCTec will invest $500,000 in expanding its workforce by 100 employees over the next five years in Tennessee.

GE Healthcare receives FDA clearance for its Critical Care Suite, an AI-powered X-ray device that can reduce the time between diagnosis and treatment for a collapsed lung to as few as 15 minutes. The company is working with scientists at the University of California to develop screening capabilities for additional conditions.

Sales

• Provincial Health Services Authority in British Columbia signs a three-year contract with Vocera for its care team communication technology.
• WellStar Health System expands its use of Glytec’s EGlycemic Management System two eight additional Atlanta-area facilities.

People

University of California promotes Tom Andriola to the newly created position of vice chancellor of IT and data at the University of California, Irvine, which includes UCI Health.

Announcements and Implementations

Christie Clinic (IL) will implement Epic through a Community Connect arrangement with neighboring Carle Health System.

A new KLAS report on EHR implementations outside the US finds that Epic has the highest satisfaction and its customers implement the widest variety of software modules. Allscripts customers report budget overruns and worry that the company is more focused on sales than implementation; InterSystems overpromises on scope and timelines; and Meditech customers are most likely to report budget overruns due to unexpected third-party and infrastructure costs. However, Meditech finished first on hitting the timelines that are under its control. Epic takes the highest amount by far of EHR project budget at up to $164 million, while Meditech, Philips, and MV had narrower cost ranges that were in the single-digit millions.

Redox posts the agenda for its Healthcare Interoperability Summit, convening in Boston on October 15.

Government and Politics

In Australia, Queensland Premier Annastacia Palaszczuk promises to investigate the IEMR crash that occurred Tuesday afternoon across 14 hospitals. The $1.2 billion system was down for several hours after a routine Cerner software patch caused a “system degradation.”

Privacy and Security

Healthcare technologist Fred Trotter says Facebook still hasn’t fixed some privacy-compromising features of its Groups function, potentially exposing the medical information of people who sign up for health groups. Facebook did a partial fix: (a) you can no longer download the information of group members unless  you yourself are a member; (b) Facebook users can no longer add other users to a group without their consent; and (c) groups are set to be “private” by default. Fred says Facebook needs to add name privacy, so that members are listed by only their first names and are not linked to their full Facebook account, which means the user can interact with the group but nobody can find out more information about them. This is similar to how Facebook set up its “dating” feature” to facilitate privacy. 

Other

A cardiologist’s New York Times opinion piece says that doctors are always outraged and surprised at onerous or ineffective regulations that are forced upon them, but have done little to offer their own solutions to problems such as inappropriate imaging. He notes interestingly that Medicare created a physician golden goose in 1965 in virtually guaranteeing that medical services would be paid for, but doctors cashed in while ignoring waste and fraud that was eventually addressed by insurers and lawmakers in the form of managed care. He concludes that doctors can retain their independence only if they become more active in addressing healthcare’s problems, some of they they themselves created.  

Google Cloud Executive Advisor Toby Cosgrove, MD – formerly CEO of Cleveland Clinic – says that health systems have spent so much on Cerner and Epic that Google, IBM, and other companies aren’t interested in trying to launch competing EHR products. He said in a conference this week that IBM and Google both considered developing ad EHR, but it’s probably too late.

University of Oxford researchers have designed an algorithm that can detect potential signs of heart attacks years before traditional methods. The technology can flag indicators like inflammation, scarring, and changes in blood vessels that supply blood to the heart. When combined with traditional scans, researchers hope that the software will assist providers in early intervention and treatment strategies.

Orig3n CEO Robin Smith pushes back against the accusations of 17 former employees who claim the genetic testing company manipulated results to cover up testing errors that led to radically different results when the same genes were tested separately for fitness and nutrition profiles. They claim to have logged 407 such errors in a sample of 2,000 tests over a three-month period, and say that marketing, rather than science, was the priority. Smith says the claims are inaccurate and that “former employees are former employees for a reason.” This is the same at-home testing company that made news last summer for failing to recognize that one customer’s DNA sample was actually from a dog.

Sponsor Updates

• EClinicalWorks will exhibit at Health 2.0 September 16-18 in Santa Clara, CA.
• Ensocare will exhibit at the ACMA Illinois Chapter Conference September 17 in Rosemont.
• FormFast will exhibit at AHIMA September 14-18 in Chicago.
• Greenway Health will exhibit at the NIHB Annual Tribal Health Conference September 16-20 in Temecula, CA.
• Hayes hires Jessica Kender (PrismHR) as senior implementation project manager, and Julie Anne Bonee (Change Healthcare) as client success manager.
• HealthCrowd will exhibit at the MHPA 2019 Annual Conference September 18-20 in Washington, DC.
• Hyland will host CommunityLive September 15-19 in Chicago.
• InterSystems will exhibit at the CIO Summit September 19 in Boston.
• Intelligent Medical Objects will exhibit at AHIMA September 14-18 in Chicago.
• Pivot Point Consulting names Jeff Maris (Cerner) head of its Cerner Strategic Implementation and Partnerships team.
• PatientSafe Solutions adds enhanced security and mobile features to its PatientTouch Clinical Communication platform.
• Prepared Health will lead a roundtable, “Becoming a Preferred Provider: Home Health’s Role in Hospital and Skilled Nursing Transitions,” at the at the Home Health Care News Summit September 18 in Chicago.
• Vocera announces that Metro Health – University of Michigan Health has improved its stroke time to treatment from 53 to 29 minutes, in part through Vocera communication technology.

Blog Posts

• How Long-Term Thinking Improves Healthcare (EClinicalWorks)
• How Google and Mayo Clinic will transform the future of healthcare (Google Cloud)
• Hack attack! A Greenway customer shares his experience (Greenway Health)
• Healthcare Data is Your Organization’s Crystal Ball (Healthwise)
• Know before you go: 8 tips to get the most out of #CommunityLive (Hyland)
• Challenges and Opportunities in Today’s Healthcare Ecosystem (EClinicalWorks)

Contacts

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

EPtalk by Dr. Jayne 9/12/19

My attorney friends are always asking me about the sheer volume of information in medical records that they see for personal injury cases. It’s staggering – what used to be a manila folder full of records now might be a copy paper box when printed.

Many of the notes incorporate (or simply regurgitate) other data, which just adds to the overall length – whether it’s a copy-and-paste situation or whether it’s embedding diagnostic results such as CT scans or laboratories. Either way, it’s difficult to sift through the information.

So-called “note bloat” is a problem, and some EHRs are better than others as far as helping providers visualize key patient information. It’s not surprising that the EHR is cited in medical malpractice suits. EHR-related claims have increased from 0.35% in 2010 to 1.29% in 2018. EHR adoption has jumped from 15% to 90% across that same time period.

According to recent data from The Doctors Company, this trend continues. Issues frequently cited include system design and usability problems, which are typically cited as contributing factors to a claim rather than as a primary cause. Issues around alerts were cited in 7% of claims, while fragmented records were cited in 6%. User-related issues are an issue, from problems with copy/paste to entering incorrect information.

The Doctors Company, a medical liability insurance carrier, offers some tips for avoiding EHR-related claims: avoid copy/paste except with past medical history; contact IT if data is being inappropriately auto-populated; review entries selected from drop-down menus; and review information thoroughly before treating patients. The latter is easier said than done.

I’m always interested in new apps, so was excited to hear about Foodvisor, which claims to use photo recognition and AI algorithms to identify the food on your plate and offer personalized coaching around your eating habits. Many of my patients who have tried to use food journals get frustrated with the tracking part, even using an app which they often find tedious. If the photos can accurately be translated to discrete data, this would be a leap forward for patients who have been unable to track their eating habits.

Patients can also use the app to track their activities, either keying them in or by syncing them from the IOS Health app. (I guess Android users are out of luck in that regard.) The company launched in 2018 in France and this month in the US after the system learned how to recognize foods that are popular here. I like their avocado mascot and am looking forward to seeing how they do in the marketplace.

Perhaps the app might be of use to medical students, whose rates of hypertension are more than twice that of the general public, according to a recent presentation at the American Heart Association’s Hypertension 2019 Scientific Sessions. The student rate of Stage 2 hypertension was 18%, compared to 8% for comparable members of the general public. The study looked at over 200 first- and second-year students at the DeBusk College of Osteopathic Medicine. Participants completed a survey on tobacco, alcohol, diet, exercise, mental health, social support, and past medical history. The real surprise was that only 36% of students had normal blood pressures – the rest were either elevated, Stage 1, or Stage 2.

They might also want to take advantage of recent data from the journal Heart was published last month and indicated that daytime naps may be linked to a lower risk of heart attack or stroke. Researchers looked at 3,500 people living in Switzerland and found that those napping once or twice a week were better off than those not napping at all. Participants ranged in age from 35 to 75 years and were healthy prior to the five-year study. The study was observational, meaning it doesn’t show cause and effect; but I’m certainly going to take those results to heart.

Each year in September, EHR/PM vendors and clients scramble to make sure they have updated CPT codes since the new codes typically go into effect on October 1. This year’s 248 new codes include six for online services, three for physicians and other qualified professionals and three for communications with non-physicians. Two additional codes cover self-reported blood pressure monitoring. Just because the codes exist is no guarantee that they’ll actually be paid for if used, so providers should check their payer contracts to see how new codes are handled before they get too excited. There are also 71 codes being retired and 75 being revised.

Providers typically look to their specialty societies for information on how they’ll be impacted by the changes. They also look to their IT teams to make sure the codes are loaded and mapped appropriately anywhere they might be embedded within technology, so good luck to those of you responsible for the changes.

HIMSS launched registration this week for the flagship annual conference, with the coming year’s theme of “Be the change.” There’s also apparently a rebranding effort going on, with insiders being excited by their kicky new font and expanded color palette. I guess they’ll have to commission a new set of giant letters to adorn the grassy slope outside the Orange County Convention Center. The conference itself even got a rename – it’s now the HIMSS Global Health Conference & Exhibition. According to the marketing staffer who gave me the scoop, this complements their new vision and mission of being focused on the health and wellness ecosystem. The good news is that no one really used the full name of the conference anyway, so the rest of us can still call it HIMSS20 and be good. I booked my hotel a few months ago to make sure it was affordable so now I just have to book the flight.

Speaking of HIMSS, they’re hosting their annual US National Health IT Week event later this month. Its theme of “Supporting Healthy Communities” is designed to promote transformational activities to drive better health outcomes and health equity. Points of engagement include public health, population health, workforce development, expanding access to broadband and telehealth, and addressing social determinants of health. Several governors are expected to issue proclamations in recognition of the event, but it doesn’t look like there’s much going on in my neck of the woods.

How to you plan to celebrate Health IT Week? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 9/12/19

It just got very hard for Amazon’s online pharmacy to access patient medication data

Surescripts ends its relationship with ReMy Health, which supplied Amazon-owned PillPack with patient prescription data collected by Surescripts.

A.I. technology could identify those at risk of fatal heart attacks, research claims

University of Oxford researchers have designed an algorithm that can detect potential signs of heart attacks years before traditional methods.

Kindbody Unveils New York City Flagship at 102 Fifth Avenue

Women’s health and technology company Kindbody opens its fourth clinic in Flatiron, NY, and announces plans to open three more by year’s end.

HIStalk Interviews Steve Shihadeh, Founder, Get-to-Market Health

Steve Shihadeh is founder of Get-to-Market Health of Malvern, PA.

Tell me about yourself and the company.

I’m the founder of Get-to-Market Health, a consultancy that helps healthcare technology companies accelerate their growth and revenue. I got my start in healthcare IT as a sales trainee with Shared Medical Systems, and through a series of growth experiences, ended up being their leader for commercial activities. I then had that same role at Siemens Medical after they acquired SMS, at Microsoft Health Solutions Group, and then finally at Caradigm, a population health company.

About two years ago, I formed Get-to-Market Health. I have a passion about the business and what technology can do. I also have a strong belief that high-quality commercial activities are an important part of any successful healthcare technology business.

What advice do you give a startup or a company that is getting into healthcare for the first time?

A big part of what we do is help people understand the market, but equally, help them understand how the market looks at them. Healthcare buyers are different. We will often have clients who want to enter a new space and it’s just not the right fit, or they need to make some adjustments. Lead generation, building a pipeline, qualifying — all those things are important, but the most important thing is figuring out where their product fits.

What help do companies need in deciding what product to bring to market or how to get it in front of the right people?

The healthcare market is incredibly complicated, in a good way. It’s not just hospitals and doctors any more. Trying to figure out who the real buyer is, who has the authority to buy, who has the budget to buy, and how to present a product in its best light is an important issue for any company, but especially smaller companies that are trying to grow.

How should companies approach a market in which Cerner and Epic have become dominant and may become even more so as providers consolidate to create a customer base that has fewer, larger players?

It’s funny how the market has swung. It used to be that everything was interfaced and people bought best-of-breed. Now the pendulum has swung the other way, where a few large companies dominate the space. But I don’t think you can keep innovation or innovators down. 

A lot of the work we do is coaching and helping innovators figure out whether they should have a relationship with one of those big companies. If they are going to compete, how? And if they are going to get out of the way of the big vendors, how do they do that and still be successful? It’s a tricky landscape.

I think of the relationship between newspapers and companies like Facebook or Google that send them much of their traffic, but also take a lot of their revenue. How can companies figure out how to cooperate with those big EHR vendors while remaining aware that they also compete with them?

We see that every day. There is coopetition, where companies are OK that you compete or you partner. But I think vendors and also providers are trying to watch the way the landscape is moving because hospitals and health systems have that same issue around digital traffic as well. It’s a pretty interesting time to be in this space.

Will big health systems succeed in their for-profit efforts to create IT companies, invest in startups, or run accelerators and incubators?

That’s the multi-million dollar question. The organizations you’ve written about, which I know well, have invested hundreds of millions of dollars to incubate businesses. They are  becoming the investor. 

I understand the argument. To have a strategic investor behind a product like that is a big deal and will clearly help with other providers deciding to do business with them. 

It’s early to declare success. You can certainly point to some great examples – UPMC, Providence, and Northwell  have made some  good investments. It’s a clear trend because they aren’t able to make the margin they want on the core business and they have valuable intellectual property that they want to leverage.

How do companies that bring in new investment money meet the accompanying heightened expectations for growth?

It may be a little overused term, but it’s clearly an inflection point. The investor is betting on a multiple and a growth that wasn’t there before the investor showed up. Often the company that has taken an investment hasn’t really thought through how they’re going to make that growth happen. It is a point in time where the business evolves. Sometimes the players stay the same but just change what they’re doing, sometimes there are new players, sometimes there are new markets. But generally when an investor writes a big check, something’s going to happen.

What catch-up work do small companies need to do once they’ve hit a higher revenue level and have to start behaving like a bigger company?

We generally get called in when there’s a realization by the leadership team or the investor that they want to do more in terms of marketplace growth. What got them to that point isn’t going to get them ahead, so they want to try something different. It could be new markets. We have one client that is bringing in an AI machine learning platform from Europe to the US. People are taking products up into the enterprise space where they just used to work in community hospitals. It’s a realization that they want to do something different and they’d like an outside point of view as they do that.

How does a company formalize its sales process?

That stereotypical sales guy or sales gal from the past still exists, I guess, but they are a dying breed. One of the biggest changes I’ve seen in my career is how much more capable providers are getting as organizations and as buyers. They are pushing and demanding more from their salespeople than just buying lunch and overseeing a good demo. It’s clearly gotten better. Often we get called in to help them improve the deliverable that their sales team provides to the buyer.

How much of a company’s success is based on the skill, personality, or perseverance of a superstar salesperson whose traits can’t be easily replicated or obtained elsewhere?

It’s an interesting point. I suspect that the head of engineering has a few people he or she really relies on. The head of services has a few key people they rely on. I can’t argue against salespeople who are stars.

However, it’s more of the whole commercial mechanism —  how the company presents the product to the marketplace, how it prices it, how it creates product awareness, how it names and positions the product, and how it approaches buyers. You have to approach the CIO IT shop with your act together. You have to be able to answer the security questionnaire. You have to answer how it integrates with the EMR platform. You have to be pretty buttoned up in order to be successful today. It takes more than just a great salesperson. Although they are good to have and everybody wants them, it’s far bigger than that.

How do you advise companies to fit user surveys from companies like KLAS and Black Book into their marketing plan?

Really small companies don’t have to worry about KLAS, but they have other activities. Big companies have to invest in KLAS, Black Book, and various awards. Folks on the buying side really do use it. You may not be number one, but you had better not be off the list. It’s an acquired skill to be great at both delivering customer satisfaction and managing your relationships with those companies.

Do vendors call you because they haven’t done a good job at developing relationships with their existing customers?

One of the cool things we’ve been doing a fair amount of lately is running focus groups with clients and potential clients, to help them understand how they are perceived and how their product comes through. It gives them a safe zone to test ideas and get honest feedback. We facilitate that and help them hear what the potential buyers say.

Cerner hired KLAS to convene some of its big customers to tell the company how to improve its revenue cycle product and to ensure accountability as they did so. Will other companies do something similar instead of just talking to those customers themselves?

I’m not sure I fully understand the Cerner-KLAS thing. I was reading something about it this morning, in fact. One of the most important things a healthcare technology company can do is to get honest feedback about what’s working and what isn’t working. However you do it, I think it’s great. We seem to be getting more and more requests to help with it.

How do you see your business changing over the next few years?

It’s an exciting business. I have learned over the years that I don’t know as much as I think I know. It’s going to change in different ways. You look at some of the big companies that are spending money and hiring people and doing things and clearly there will be some shakeout from that. I hope they have the staying power and don’t get exhausted before they deliver some real products and capabilities. With the IPO activity and the buyouts that have happened, there will be more investor appetite for innovation. That guy or gal with a great idea won’t have any problem finding investors. It will be interesting to see where the products have an impact.

What goes through your mind when you walk the HIMSS exhibit hall?

I’m one of the people who actually enjoys going to HIMSS. Not because of the environment, but because it’s the business I’ve been in my whole career. I love the energy. You can clearly see who’s doing it right and who’s not doing it right. There’s a bunch to be learned from it. It’s a pretty amazing business, and a fun thing about the business I’m in now is that I can have a broader view of it. The roles I had before, in hindsight, were fairly narrow considering how wide the healthcare space really is and all the ways it is interconnected.

It’s clear that companies need to have their A-game for HIMSS or they shouldn’t go. We’ve helped several clients get ready for HIMSS and to do it right, but we’ve also counseled some clients not to go to HIMSS. They wouldn’t be heard above the noise. Awareness and creating client interest is a key opportunity for any company. They really have to pick their spots, whether it’s HIMSS or HLTH or any of the other regional or local shows. They have to have their act together.

Do you have any final thoughts?

You and I are fortunate to work in a business that’s evolving, growing, and consuming technology. It’s a business that all of us will depend on at some point in our lives. My view is, let’s make it better. We get to work with diverse business leaders to simplify the complexity and buying patterns of the healthcare technology market. That simplified buying process, with a clear understanding of what a product does or doesn’t do, is good for everybody. It’s win-win. No one, especially today’s providers, has time or money to waste. We think effectiveness and efficiency matter. That’s what gets us up and going every day.

Morning Headlines 9/11/19

Apple announces three groundbreaking health studies

Apple will partner with several high-profile healthcare institutions to conduct studies related to hearing, women’s health, and heart health using its new Research app.

Google, Mayo Clinic strike sweeping partnership on patient data

Mayo Clinic signs a 10-year partnership with Google in which Google Cloud will provide Mayo with data hosting, cloud computing, analytics, and machine learning and AI.

Health IT firm to add 100 jobs in Lewis County

HCTec will invest over $500,000 to expand its Brentwood, TN-based consulting firm.

More trouble for Queensland hospital software after statewide issues

In Australia, Queensland Health’s $1.2 billion IEMR system goes down for several hours after a routine Cerner software patch causes “system degradation.”

News 9/11/19

Top News

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

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

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

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

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

Reader Comments

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

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

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

HIStalk Announcements and Requests

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

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

Webinars

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

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

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

Acquisitions, Funding, Business, and Stock

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

Sales

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

People

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

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

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

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

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

Announcements and Implementations

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

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

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

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

Government and Politics

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

Privacy and Security

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

Other

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

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

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

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

From the Apple Event 2019:

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

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

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

Sponsor Updates

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

Blog Posts

• 3 Roles to Support EHR Optimization (Optimum Healthcare IT)
• Time for an Epic security overhaul? (Leidos Health)
• From Ascension to Intermountain and now ‘home’ at SSM Health: How Laura Kaiser is ‘systematizing’ mission-based care (Advisory Board)
• AIRA Recap (Audacious Inquiry)
• Preventing Hospital-Acquired Conditions (Bluetree)
• Iowa Specialty Surgeons Journey with ChartLogic EHR & RCM Services (ChartLogic)
• How to Prevent Workplace Violence Without Increasing Bias (Collective Medical)
• Hot Topic: How Technology is Changing Nursing (Dimensional Insight)

Contacts

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

Morning Headlines 9/10/19

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

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

OCR Settles First Case in HIPAA Right of Access Initiative

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

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

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

A new policy on advertising for speculative and experimental medical treatments

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

Curbside Consult with Dr. Jayne 9/9/19

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Email Dr. Jayne.

HIStalk Interviews Ken Misch, President, Medhost

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

Tell me about yourself and the company.

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

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

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

How would you characterize the market that you serve?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What is the demand for interoperability in your market?

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

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

Do you have any final thoughts?

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

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

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