Curbside Consult with Dr. Jayne 4/15/19

I was out with a friend on Saturday, at least until he had to leave to go to a planned downtime event at work. He mentioned that in all the years he had been with his company, it was rare for a downtime or disaster-recovery prep event to go as planned.

Maybe his industry has less tolerance than we do in healthcare, but it got me thinking about the impact of downtime in the patient care environment. The Journal of the American Medical Informatics Association published an article on this recently: “Clinical impact of intraoperative electronic health record downtime on surgical patients.”

Many of us just read the abstracts, and a quick pass yielded some interesting information. Researchers looked at the impact of EHR downtime events lasting more than an hour over a six-year study window. Specifically, they looked at adult patients undergoing surgeries more than 60 minutes in length during an inpatient stay lasting longer than 24 hours. Since it’s hard to do certain kinds of controlled studies on events like this, they matched more than 4,000 patients exposed to one of 176 downtime episodes with 4,000 patients who weren’t similarly exposed.

Looking at the math superficially, this means that the facility was averaging more than 29 downtime episodes a year, each lasting more than an hour. That’s pretty striking – approximately one every 12 days. I’ve never worked in a facility that had that kind of downtime and I can’t imagine the anxiety that clinicians might feel in that situation.

The authors found that although the patients exposed to a downtime event had operating room times and postoperative length of stay that were slightly more than unexposed patients, the 30-day mortality rates weren’t any different. In short, there wasn’t an appreciable link between the length of the downtime event and significant adverse events.

I wondered whether the sheer volume of downtime episodes might have been protective in this facility and decided to dig deeper than the abstract to find out more about the study site. The devil is in the details in this scenario, especially since the data was gathered at the Mayo Clinic. The identified downtimes could have occurred in any of the seven applications considered core clinical systems in support of the operating room. These included the anesthesia information management system, PACS, CPOE, clinical documentation, an integrated clinical viewer, the surgical information recording system, and the surgical coordination system.

Researchers categorized the length of the downtime as well as its impact, whether limited functionality was available or whether it was a complete outage. Scheduled downtime events were excluded as were those less than 60 minutes long. When matching exposed and unexposed patients, the team looked at day of the week as well as time of day to control for any variation in staffing, facilities, and EHR load. The patients were also paired according to surgical specialty, emergency / non-emergent status, and physical status.

The typical downtime was on a weekday between 7 a.m. and noon and was not a complete outage. The most commonly impacted systems were the integrated clinical information viewer, PACS, and CPOE. Surgical subspecialties most commonly impacted included general surgery, orthopedic surgery, and cardiac surgery. The median age of patients was 61 years, with a range of 49 to 71.

Although 30-day mortality wasn’t impacted by downtimes, interoperative duration was about 10% longer for the procedures where there were outages or interruptions. Longer operative times have been linked to greater risks of complications and also can lead to higher costs to the facility. In my experience, this also impacts physician morale, with surgeons who feel their schedules have been delayed becoming irritated and at times agitated. The operating suite is one of the parts of the hospital where the adage about time being money is truly applicable. They also noted a 4% increase in length of stay, which also has cost implications. Both increases underscore the need to have strong plans in place to help staff contend with unplanned downtime.

The authors further conclude that there is a need for future studies looking at scheduled vs. unscheduled downtime and parsing it down to specific systems to determine impacts at a more granular level. They also note the need to look at data from different facilities and healthcare settings. They also identified a limitation in the matching, namely that procedures weren’t matched year by year. Since there are constant changes in surgical technique and significant changes in some procedures, the year could have been a confounder. They also noted that, “In this context, it is not possible to generalize the results of this study at our institution to the potential impact of resilience and specific contingency planning to other hospitals.”

I don’t see other facilities planning to line up to bare their downtime data. Additionally, investigators at other institutions may not have the robust longitudinal downtime data that these authors had access to and they may not have the full cooperation of information technology staffers. I still see hospitals where the culture of fear is alive and well and efforts to study incidents in order to improve processes may still be met with suspicion. There are also those where downtime processes are fairly disorganized and they wouldn’t be suitable candidates for study.

I got a surprise Saturday evening when my friend reappeared unexpectedly from his downtime event. His comment about his company’s events not going as planned was prophetic because they actually canceled the downtime before it even started. It was good for a chuckle, although the theoretical risk of downtime events in the patient care environment is no laughing matter.

I’d be interested to hear what readers think about this EHR downtime study and whether they believe their institutions would be willing to undertake that type of analysis of their own data.

Got downtime? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 4/15/19

How elderly, sickly farmers are quenching China’s thirst for data

Private healthcare company WeDoctor sends medical vans to rural areas to perform mandatory exams on behalf of the Chinese government, enabling it to collect enormous amounts of patient data that it uses to train its AI-powered diagnostic engine.

Highmark IT solutions company sheds 239 workers

After adding over 1,000 employees in the last five years, Highmark’s HM Health Solutions IT company lays off 239 workers.

Amazon Alexa is luring health developers, but it will be a while before we use it to call a doctor

Despite Amazon Alexa’s newly announced HIPAA compliance, privacy concerns will compel it to take baby steps in developing skills that will enable patients to connect directly with physicians.

British doctor-on-demand app Babylon bulks up US team to seize slice of projected $400bn market

After announcing last fall that it would spend $100 million to ramp up its hiring for its London-based operations, telemedicine company Babylon Health plans to more than double staffing for its US and Canadian operations.

Monday Morning Update 4/15/19

Top News

A private company in China is deploying medical vans to rural areas to perform exams and to test urine and blood, but it’s not a benevolent government project. Private healthcare company WeDoctor (part of technology giant Tencent) offers the service so it can collect enormous amounts of patient data that it uses to train its AI-powered diagnostic engine.

Participation isn’t optional since the government requires villagers to submit to examination. They don’t necessarily know that a private company is involved.

WeDoctor, whose valuation is several billion dollars, operates online hospitals, sells data to drug companies, and offers appointment scheduling and video visits. It is connected to 2,700 hospitals, 220,000 doctors, 15,000 pharmacies, and 27 million active users. The founder saw an opportunity to disrupt a clogged medical system in which patients wait in line for hours just to schedule an appointment or resort to buying timeslots from scalpers.

WeDoctor says it has the healthcare information of 180 million people, and while China has no laws that protect personal information, the company says it uses only de-identified patient data for its AI work.

China is gaining an edge in healthcare AI because government control allows collecting and using patient data in ways that would not be legal in most countries.

Reader Comments

From Unilateral Disarmament: “Re: Cerner. The financial community is expressing amazement that Cerner paid so much attention to Starboard Value given the hedge fund’s low percentage ownership.” Quite a few experts are shocked that Cerner gave the Starboard Value hedge fund two seats on its board when it holds barely more than 1% of CERN shares. As one analyst said, 1% doesn’t give you much power to force change – just sell your shares if you don’t like the company’s operation, adding that two board seats usually comes only with a 5-10% position. Cerner rationalizes by saying it approved the new board members and they are well qualified (which they are), but the company did indeed capitulate quickly. They may regret that later now that they’ve invited a hedge fund into their house. Cerner also made it clear that they intentionally replaced visionary co-founder Neal Patterson (who, when healthy, would have told Starboard where to stick their ideas) with an “operator” in Brent Shafer, which sounds like a message that resonates better with a hedge fund than customers. He is an untested CEO and the whole “operational model” thing he keeps talking about sounds like something dreamed up by accountants rather than leaders, which if you are pandering to Wall Street, is probably the right thing to do. Maybe I’m just bitter in missing the competitive healthcare passion among pre-operator founders Neal, Judy, and Jonathan Bush.

From Dudevorce: “Re: Inova Genomics. FDA warned them about illegally marketing their tests and predicting response to medications. Their MediMap web pages went down shortly afterward. Oncologist Donald “Skip” Trump, MD was hired by Inova to develop a cancer genomics program as the Inova Schar Cancer Institute. He recently disappeared from the Inova websites.” FDA issued a warning letter to Inova Genomics Laboratory on April 4, saying that its MediMap genetic tests for predicting medication response has not earned FDA’s marketing approval, also noting that the tests were being ordered by lab doctors with the results sent directly to patients without involving their own doctor. Links to the MediMap web pages now forward to Inova’s main site (I took the screen grab above from a cached copy). That other Donald Trump no longer appears under Inova’s “find a doctor” page.

HIStalk Announcements and Requests

Most vendor poll respondents have seen business conditions slip in the past couple of years, whether than means reduced sales activity, provider consolidation that leads to bigger but rarer deals, or longer sales cycles.

New poll to your right or here: How much time do you spend each week reading healthcare and health IT news, online or in print, excluding social media but including peer-reviewed journals?

Listening: new from Darlingside, extremely likeable, Boston-based indie folkies who huddle around a single microphone and create amazing harmonies around thoughtful lyrics that sometimes involve a dystopian future of uncertain outcome. Perhaps I was just in the mood for it after spending extra time in bed Sunday morning reading old Rolling Stone interviews with John Lennon. You might picture him as having been bitter, cynical, and slightly wacky with regard to Yoko Ono, but only the last one is true – he was a troubled troubador who lacked confidence about his musicianship and just wanted to play 1950s American rock and roll as a guitarist who was “not technically good;” saw the Beatles through the lens of always being pressured to write songs even as he and Paul McCartney fought for album space and collaborated less and less over time; and worried about where the world was heading. It’s hard to believe how thoughtful, worldly, and searingly honest he came across even in early interviews in his 20s. You can feel his pain in this 1970 interview when he declared that the Beatles were the best rockers in Britain until Brian Epstein put them into matching suits and booked them for 20-minute shows instead of their usual 6-7 hours: “The Beatles music died then, as musicians. That’s why we never improved as musicians. We killed ourselves then to make it and that was the end of it. George and I are more inclined to say that. We always missed the club dates because that’s when we were playing music, and then later on, we became technically efficient recording artists – which was another thing – because we were competent people, and whatever media you put us in, we can produce something worthwhile.”

Webinars

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

Acquisitions, Funding, Business, and Stock

The Detroit business paper profiles Detroit Medical Informatics, an EHR consulting firm started in 2015 by Hass Saad, MD. He says the company is generating $4-6 million in annual revenue, has four full-time employees, and works with 300 physician consultants in serving 20 clients.

A Stat editorial compares the proposed information-sharing rules of ONC/HHS to the Protestant Reformation, where information previously accessible only to priests was made available to everyone via the newly invented printing press, but notes that the final rule could be diluted through the influence of the AHA and lobbyists who are not fans of losing Medicare money when caught hoarding patient information out of competitive spite.

It’s interesting when member organizations change their names or membership criteria to spur growth outside their original mission, such as CHIME when it weakened its membership criteria to include non-CIOs. The latest is AONE (American Organization of Nursing Executives), which in realizing that the “executives” part of its name limits its membership count, has thus decided to rename itself American Organization for Nursing Leadership. The doors have been flung open to dues-payers who are “not just defined by your title, but above all by your actions.” Someone should do a study on how much hospitals spend on dues and conference attendance whose value is primarily driven by vanity.

Decisions

• Humboldt General Hospital (NV) will replace Medhost with Cerner in November 2019.
• Kingman Regional Medical Center (AZ) will implement Meditech this spring, replacing Cerner.
• Van Wert Health (OH) switched from Cerner to Epic in June 2018.

These provider-reported updates are supplied by Definitive Healthcare, which offers a free trial of its powerful intelligence on hospitals, physicians, and healthcare providers.

Other

Imprivata explains further the Windows API flaw it commendably discovered in testing its product against new Windows updates (and which Microsoft not-so-commendably broke with a failing API with no acknowledgment to developers who rely on it). I agree that the QE team deserves acknowledgement – I’ve been loaned out to testing teams over the years and it is thankless, unbelievably complex work where 99% of the tests turn up no problems, but some weird example fails only in a particular series of steps that must be replicated and documented for fixing. Those testing teams I worked on also got no love from developers, who were more exasperated than appreciative that their bugs were caught before code was shipped, so it’s nice that Imprivata gives those folks a shout-out:

Imprivata’s core Epic user switch functionality continues to work as intended with or without the Windows API. Instead, the feature that was affected by the API deprecation was a failsafe mechanism and not core functionality. For this to be seen at a customer site, a series of unfortunate events would need to occur, and we would define it as more of an edge case. However, due to the potential it has on our customer’s clinical workflows, we felt it important enough to notify our base as soon as we discovered it. Kudos to our QE team for finding this during our qualifications!

Researchers find that cancer surgery outcomes are poorer in affiliates of top-ranked cancer hospitals that share their name. The authors conclude that hanging the big-brand cancer center’s name on the affiliate makes patients think they will receive care as good as that delivered by the mother ship, but that doesn’t actually happen. To me, the fact that a cancer hospital is a desirable brand is a troubling in itself – having worked for a hospital that affiliated with one of the big names, we talked a lot about sharing protocols and tapping the Big Cancer Center’s expertise, but I’m not sure it really made a positive difference. The health system eventually dumped the affiliation for that of another Big Cancer Hospital, which should have raised all kinds of questions about the before-and-after advantages, the cost to rent the big name, and whether patient outcomes changed as a result.

Sponsor Updates

• Netsmart will exhibit at the NHPCO Leadership and Advocacy Conference April 15-17 in Washington, DC.
• Sansoro Health releases a new podcast, “Tacking Information Blocking with an ONC Expert.”
• Surescripts will exhibit at the 2019 OCHIN Learning Forum April 16-18 in Portland.
• Vocera will exhibit at the 2019 Argentum Senior Living Executive Conference & Expo April 15 in San Antonio.
• Wolters Kluwer Health CEO Diana Nole discusses areas where AI will impact future patient care.

Blog Posts

• Hot Topic: How Analytics Can Help During a Measles Outbreak (Dimensional Insight)
• Five Communication Challenges and Solutions for Healthcare Team Coordination Workflows (LiveProcess)
• Tackling Surprise Medical Bills: The First Step Toward a Comprehensive Patient Financial Experience Strategy (Loyale Healthcare)
• Lead With Your Values During a Merger, Revenue Will Follow (Waystar)
• Clinician Satisfaction: Cornerstones of Care (Netsmart)
• Artificial Intelligence and Magical Thinking (NVoq)
• Three Ways to Improve Supply Chain Processes: Inventory Management, Integration, and Reconciliation (CereCore)
• How can customizable edits improve your denial rate? (Experian Health)
• How to Build Relationships With Patients Through Ongoing Communication & Keep Them Coming Back (PatientBond)
• A Better Patient Financial Journey Relies on These 6 Elements (Patientco)
• Creating a Better Physician Work Environment Can Benefit a Hospital’s Bottom Line (PatientKeeper)
• Practice Velocity’s eReg Admin Portal Brings Customization to Users (Practice Velocity)
• Earn Preferred Provider Status: 6 Tips (PreparedHealth)
• Making sense of the proposed CMS interoperability rule update requiring electronic patient event notifications (Redox)
• How to Avoid Common Project Failures and Join Those Who Get It Right: Part 1 (ROI Healthcare Solutions)
• Excessive Healthcare Costs Burden Hospitals (The SSI Group)
• 5 ways a communication platform helps prevent burnout. (Voalte)
• 4 Ways to Market Your PT Clinic’s Culture (WebPT)

Contacts

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

Weekender 4/12/19

Weekly News Recap

• Cityblock Health raises $65 million just three months after announcing a Series A round of $21 million
• Partners HealthCare (MA) will equip its clinicians and researchers with the tools necessary to develop their own AI algorithms
• Cerner bows to pressure applied by an activist investor by appointing four new board members as nominated by hedge fund operator Starboard Value
• Microsoft announces that it will shut down its HealthVault personal health records service on November 20, 2019
• Google Cloud opens its healthcare API for beta testing
• Urgent care EHR/PM vendor DocuTAP and urgent care solutions vendor Practice Velocity announce plans to merge

Best Reader Comments

I’m assuming that the single-digit margin you refer to is the margin on your institution’s whole operation, and therefore represents money that is left over after the institution pays for all its costs (salaries, equipment, etc.). Your vendor’s 30% margin is, on the other hand, probably the margin on a single product – and the only costs that are covered before that 30% margin are costs that are directly related to that single product. The 30% margin goes on to pay for things like accounting department, promotional efforts including sales team (without which there would be no business), facility, investment in R&D for new products, and so on. It’s not really an apples-to-apples comparison. (Clustered)

If your primary purpose of going to HIMSS as a vendor is to get quantified leads and build sales pipeline, don’t get a booth if you are a small or mid-sized vendor. (Lazlo Hollyfeld)

I really don’t understand why half of Wall St. is just putting blind faith in Apple. This basically amounts to “healthcare is a big industry, Apple is a company that could take advantage of this industry”. Do any of these analysts realize that Apple devices and the App store are already used in healthcare? And that it’s not making an impact on patient outcomes or the company bottom line? (Elizabeth H. H. Holmes)

My understanding is Cerner is making the Soarian Financial customers migrate over to the Millennium financials. However if they are trying to meld the two together to make a super system in concert with the Millennium Clinical system (so actually three together) does anybody who has been in the EHR industry for the last 3-4 decades think that can really work this time? The EHR minefield is littered with craters of vendors who tried to create a synergy between technologies that were created under separate paradigms and methodologies. (Smartfood99)

If you are trying to attract CIOs from non-profits to your event at Pebble Beach, please don’t. Some younger CIOs may not appreciate that this could end their career. Experienced executives will know that events like this or like the one I have turned down three times – attend the Masters and then play at Augusta – are just not worth being fired for over a compliance issue. We may not like the rules, but if we choose to work in this industry successfully, we need to follow them. (Justa CIO)

Watercooler Talk Tidbits

Readers funded the DonorsChoose teacher grant request of Ms. T in California, who asked for lap desks and floor cushions for her kindergarten class. She reports, “Thank you for your generous donation to give our class materials for flexible seating in the classroom. My kindergarten students were so excited to see the new lap desks and cushions. They love being able to move around the classroom more while they are working. The days are long for kindergarten students, and being able to have a more flexible seating arrangement is helping my students to have more fun while they are working. Sitting in a chair all day long is difficult, and gets boring for many students. The lap desks give my students a chance to sit in a different place in the classroom. They also feel special when they are using the flexible seating.”

Boston Children’s Hospital sues a Saudi prince who volunteered to cover the treatment cost of a two-year-old girl with a rare genetic disorder, then ignored the hospital’s bills for $3.5 million. The hospital says they wouldn’t have admitted the child without his promise of financial backing.

Those who have never worked in a hospital can’t imagine what it’s like on the front lines of human misery and emotion and to have horrible images burned forever into your brain. Example: a Texas man whose grandchild was in the PICU after being severely beaten threatens to kill the hospital’s nurses and the grandchild because employees couldn’t give him information about the child’s condition.

Apparently there’s no limit to our demand for Elizabeth Holmes-related entertainment as the Theranos story will get yet another on-screen treatment, with SNL’s Kate McKinnon playing the disgraced CEO in a Hulu limited series. I’m sensing a missed opportunity here – Holmes is tarnished for life, so why not just do her own documentary, drama, or instructional video? I bet plenty of people would pay for personal coaching in how to run a personality-driven scam.

Tesla is reported to have strong-armed the doctor who runs its on-site factory clinic to keep worker injuries off the books to make its workplace injury record look better and to reduce its self-insurance costs. One of the doctors who could be counted on to give company-friendly diagnoses was about to lose his medical license for sexually assaulting two female patients.

New York’s health department investigates Danielle Roberts, DO for branding women with the initials of Keith Raniere and actress Allison Mack as part of their NXIVM sex-slave cult, of which she was a member. You have to wonder what could have convinced her that this was OK. She’s now hawking memberships in a holistic healing group she formed. Now every time I hear Twitterati yapping about their anemic “personal brand” I’ll think of these images.

In Case You Missed It

• News 4/12/19
• EPtalk by Dr. Jayne 4/11/19
• HIStalk Interviews Luis Castillo, CEO, Ensocare
• Vendor Alternatives to Exhibiting at the HIMSS Conference
• News 4/10/19
• Curbside Consult with Dr. Jayne 4/8/19
• Monday Morning Update 4/8/19

Get Involved

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

Morning Headlines 4/12/19

Better care, block by block.

Cityblock Health raises $65 million just three months after announcing a Series A round of $21 million.

Teladoc Health to Develop First Pediatric-Specific Consumer Telehealth Platform with Cincinnati Children’s

Teladoc Health will work with Cincinnati Children’s Hospital Medical Center to develop telemedicine software for pediatric hospitals.

Physician-researcher awarded federal grant to bridge evidence and practice for clinicians via electronic medical record

AHRQ awards Northwell Health (NY) SVP Thomas McGinn, MD a $1 million grant to further his work on developing a clinical decision support system that integrates seamlessly with EHRs and presents minimal disruption to provider workflows.

LRGH losing $1M a month

Hospital management company LRGHealthcare (NH) blames a a $13.3 million operations loss in 2018 on an expensive Cerner install and millions paid to service outstanding debt.

News 4/12/19

Top News

Cityblock Health raises $65 million just three months after announcing a Series A round of $21 million.

The New York City-based company was spun out of Alphabet’s Sidewalk Labs in 2017.

The company offers care coordination services and technology that cater to Medicaid patients in underserved areas.

Reader Comments

From Ralestorm: “Re: Windows APIs. Check out this problem, in which a sign-off Epic user’s session is restored when a different user logs in afterward. I’ve seen this with other systems and vendors as a CMIO over the years.” This is a timely reminder that APIs create dependencies that can screw things up. Imprivata found out from internal testing that a Microsoft Windows 10 API is no longer working, so that when users switch within a XenApp session, the new user will be dropped back into the previous user’s session. The interesting aspects are these:

• Microsoft has never told software developers who use the API that it is no longer working or why it’s broken. It has not been officially deprecated, but reports are widespread that it fails.
• Imprivata caught the problem in its Windows 10 testing, which a lot of vendors might not have done.
• The problem is technical, but the result could be clinical – users could sign on and inadvertently start entering orders on the wrong patient.
• Imprivata has modified its OneSign agent to use a new Windows API and will post a hotfix before qualifying Windows 10 1809, a nifty bit of release coordination.
• Microsoft is touting its new commitment to healthcare, and while this is not a healthcare-specific issue, it might make you wonder whether it really understands the critical nature of its internal APIs and has the communications channel in place to work with vendors who rely on them.
• As quaint as it seems today as everybody pins interoperability hopes on APIs, this is the problem that healthcare software vendors avoided years ago by refusing to use third-party software components published by companies whose conduct and business outcomes were outside of their control. 

From Jiggy Jardust: “Re: Cerner. Will it follow the path of Athenahealth now that an activist investor is embedded?” Maybe. My thoughts:

• Cerner’s share price has been going in the wrong direction for quite some time, even now down considerably since before it signed huge contracts with the DoD and VA. Clearly the company wasn’t impressing investors.
• The hedge fund activist investor Starboard Value wasn’t as venomous as the one involved with Athenahealth’s – which used some truly deplorable smear tactics to get Jonathan Bush fired so that the reputation-faded Jeff Immelt could broker a questionable deal to sell out – and Cerner was unusually pliable about agreeing to making changes even before the hedge fund had a chance to go low. Starboard wasn’t even a significant holder of CERN shares.
• Brent Shafer had already laid out Cerner changes, but whether he will survive in his first CEO job reporting to an activist-heavy company board of nearly all new members is anyone’s guess.
• Whether you like Cerner’s changes may well depend on whether you are an investor or a customer. The recent announcements seem to shift focus to the former, who like the idea of the latter covering the cost of higher company revenue and profit, and Starboard’s track record of making money from activist investing is outstanding. Customers, however, aren’t necessarily going to be big fans of plans to boost profits by cutting costs and increasing revenue.
• Today’s Cerner is vastly different from the one that Neal Patterson was running until he died in mid-2017. The contrast between the publicly traded Cerner and its chief rival in privately held Epic was already sharp, but even more so now that Cerner is seeking fresh horizons and has involved hardcore Wall Street types for whom it’s just another investment to milk hard.

From Clinical Trials Curious: “Re: software to manage clinical trials. A researcher from a large academic medical center is surprised that we don’t have a platform for managing our clinical trials. We’re a medium-sized health system using an EHR, but manage trials outside it. Are people using specific software?” I’ll invite readers from similar organizations to respond. If you work for a clinical trials management software vendor that has community health system customers, I’ll waive my rule and allow you to give your company‘s information in your comment.

From CIO a NO GO: “Re: MD Anderson. Reportedly offered a candidate the CIO role after a long search with many fits and starts. The ‘recruit’ insisted on tenure status and that stopped the process. They are in desperate need of direction after the Epic Rollout Blowup but it doesn’t appear that they will budge or that anyone will jump into the deep end without a life jacket.” Unverified. I haven’t followed that position since Chris Belmont left in August 2017. The organization struggled with post-Epic financial problems (since resolved, apparently), a high-profile failure to make IBM Watson Health do anything useful, and the resignation of its president following investigation of institutional upheaval and a heavy-handed management style. The new president comes from Canada, so I don’t know how much relevant IT background he brings, especially regarding Epic.

HIStalk Announcements and Requests

Provider IT people — here’s a final chance to explain to outsiders who think we drag our feet on implementing disruptive technologies. I’ll recap soon.

Webinars

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

Acquisitions, Funding, Business, and Stock

Multi-vertical records retrieval company Ontellus acquires medical records request vendor ChartSwap. Healthcare Growth Partners advised ChartSwap on the transaction. Ontellus President Newton Ross will lead the new ChartSwap division, while Dawn Toups (Verisma Systems) will join the company as VP of provider sales.

Glytec receives another patent allowance for systems and methods related to its Therapy Advisor. When released, the new product will broaden the company’s capabilities beyond insulin optimization to include inhaled, oral, and non-insulin injectable diabetes medications.

People

Patient transfer software company Central Logic names Matt Dinger (Epic) VP of professional services.

Government health IT vendor Ventech Solutions promotes Tonia Bleecher to chief growth officer and hires Timothy Moore (Auburn University) as SVP of commercial health IT and Nathan Anthony (IBM Watson Health) as VP of healthcare enterprise solutions.

Sales

• In Canada, Mackenzie Health will deploy patient engagement software and services co-developed by GetWellNetwork and FlexITy at a new hospital set to open late next year.
• Summit Health Management will deploy population health management technology from Arcadia across its physician practices and New Jersey-based Summit Medical Group.

Announcements and Implementations

Partners HealthCare (MA) will equip its clinicians and researchers with the tools necessary to develop their own AI algorithms through its MGH & BWH Center for Clinical Data Science. The center collaborated with the American College of Radiology and computing company Nvidia to develop a similar set of software and services that will be offered for free to radiologists around the country.

Frances Mahon Deaconess Hospital (MT) goes live on Meditech Expanse with consulting help from Engage.

Teladoc Health will work with Cincinnati Children’s Hospital Medical Center to develop telemedicine software for pediatric hospitals. The hospital opened a telehealth command center several years ago.

Government and Politics

AHRQ awards Northwell Health (NY) SVP Thomas G. McGinn, MD a $1 million grant to further his work on developing a clinical decision support system that integrates seamlessly with EHRs and presents minimal disruption to provider workflows.

Sponsor Updates

• EClinicalWorks will exhibit at the ACP Internal Medicine Meeting April 11-13 in Philadelphia.
• Ensocare will exhibit at the ACMA 2019 National Conference April 14-17 in Seattle.
• EPSI extends early-bird pricing for its 2019 summit through April 30.
• Modern Healthcare ranks Optimum Healthcare IT as #2 among the largest healthcare IT consulting firms.
• Healthwise will exhibit at ANIA April 11-13 in Las Vegas.
• Mobile Heartbeat releases a new video featuring its clinical communication and collaboration work with Freeman Health System.
• PatientPing transforms care for high-risk, high-utilizing patients across North Carolina through its care coordination platform.
• Vocera will add Julie Iskow (Medidata Solutions) and Bharat Sundaram (Vizient) to its board.
• SyTrue names former HMS Holdings EVP/Chief Strategy Officer Cynthia Nustad to its advisory board.

Blog Posts

• CCM: From Zero to 800 Patients in Just 10 Months (EClinicalWorks)
• Imagining the Clinical Workflow via Smart Speaker (Ensocare)
• Is it Time for Healthcare to Disrupt Itself? (Formativ Health)
• 3 Great Communication Channels for EHR Implementation Teams (The HCI Group)
• A Winning Recipe for New Parenting Content: Collaboration + User Testing (Healthwise)
• Adena Regional Medical Center Makes 250 Best Hospitals List (Huntzinger Management Group)
• Successful Site Visits for Go-Live Support (Optimum Healthcare IT)
• Blockchain in healthcare: Reality vs. hype (Hyland)
• 5 ways to boost lab efficiency and improve patient care through Epic’s Beaker LIS reports (Nordic)
• Health Payers: Tips for Enhancing Provider Engagement (Imat Solutions)
• Measuring Your Organization’s Telehealth Maturity (Impact Advisors)
• Laying the Track for National Interoperability (InterSystems)
• Work with a Deeper Meaning – Learning About Dialysis (PMD)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
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EPtalk by Dr. Jayne 4/11/19

The World Health Organization (WHO) has released its draft strategy on global digital health. Their goal is to “improve health for everyone, everywhere by accelerating the adoption of appropriate digital health.” The strategy calls for a united approach to the awareness and understanding of the role of technology while tailoring solutions for each country. The strategy has two major components: the first outlines four strategic objectives while the second creates a four-part framework for action. WHO is accepting public comments through April 30.

I had the chance to meet up for lunch with a former residency colleague who has also gone through the looking glass to health information technology as a career. He was interested to discuss the dissolution of Google’s AI ethics board less than one week after it was formed. The external advisory board, dubbed the Advanced Technology External Advisory Council (ATEAC), was designed to monitor how Google uses artificial intelligence, but the selection of members became problematic. There is so much to keep up with in the tech world that I hadn’t realized Google had been criticized for its role in a Pentagon drone project and since has said it won’t work on AI-related weapons systems. Google plans reconsider the role of an advisory board entirely, stating it “will find different ways of getting outside opinions on these topics.”

Since he works for a major health system, we also had a chance to discuss our thoughts on accountable care organizations and the shift towards value-based care. He wasn’t aware of recent survey data that shows that more than one-third of participants in the Medicare Shared Savings Program (MSSP) are considering leaving the program. Our friends in governmental organizations love renaming programs, but I’m not sure calling it “Pathways to Success” isn’t going to make it any more palatable for organizations that are concerned about their ability to take on higher levels of financial risk. This year’s survey data represented approximately 40 of the 200 ACOs. Those that are more likely to consider leaving the program included hospital-led ACOs, which have tended to perform below their physician-led ACO peers.

We also had some good conversation around whether medicine is still a vocation or whether it’s becoming commoditized like many other industries. He’s no longer in clinical practice, and like many of our peers, attributes the decision to hang up his stethoscope to the moral injury that healthcare providers face on a daily basis. The reality of clinical informatics is that you don’t have to tell anyone that they have cancer and that their insurance won’t pay for treatment, or have to try to figure out how to help patients pay for their medications when they’re barely covering the rent. I think a string of practice and hospital mergers and acquisitions probably also contributed to his lack of zeal for the primary care trenches.

He hasn’t lost his sense of humor, though, and one of the funniest comments of the day was about trying to address governance and adoption issues while his health system’s physicians are spending a great deal of innovative energy finding new ways to try to say no to technology. We discussed what it would look like if people spent that time learning and mastering a system or re-engineering their practices rather than just raging against the machine. The bottom line is that even across the country and with a different physician population, many of us are facing the same issues every day.

Over the last several decades, the healthcare industry has been increasingly concerned about the role of government in healthcare, so I was excited to see an editorial in the Journal of the American Medical Association on “Building Trust Between the Government and Clinicians.” Co-authored by former CMS Administrator Donald Berwick, it notes that building such trust “requires understanding, empathy, and humility.” It encourages clinicians and policy-makers to walk the proverbial mile in the other’s shoes. The piece calls out several data points that are important – that the US spends nearly double what other similarly-developed nations spend on healthcare without significantly better outcomes or quality.

It goes on to note that some policy makers focus on clinicians who put self-interest above the needs of our society, resulting in the creation of systems to “guard the public from them.” It uses the example of Medicare recovery audit contractors who are paid based on the number of issues they find, putting all physicians on the defensive when only a few are committing fraud. The authors note that “out-of-control oversight and policing for the 1% who warrant this type of scrutiny burdens the daily work of the 99% who do not.” I think most of us in the trenches would agree. In 20+ years in practice, I’ve never had a prior authorization request or precertification request denied, yet I have to continue to jump through hoops to order medically necessary tests.

The editorial calls on clinicians and policy-makers to find common ground that supports both stewardship of resources and the patient care mission. This resonated with me. For policy-makers, achieving fewer and more efficient regulations would be more likely if they spent time understanding the position of the clinicians whom their policies affect. The realities clinicians actually face should provide a lens to view and judge new policies. Unless and until policy makers trust with their heads and feel in their hearts that the vast majority of physicians and other health professionals are well intentioned, they will continue to design policies around the exceptions rather than the rule. Policy-makers should regularly spend time visiting physicians’ offices and hospitals to better understand the ripple effects of policies on those providing care.

It’s similar to having software engineers actually visit clinician practices using the systems they design and create, so that they’re not operating in a vacuum. I’d love to see them observe the folly that my staff had trying to get a CT scan approved after the fact (emergencies don’t occur during normal business hours) when the payer was pushing back because my documentation of the patient’s abdominal pain did not use the word “severe.” I finally asked if anyone at the plan had actually looked at the scan results. Had they done so and seen the enormous and life-threatening pancreatic tumor that was found, maybe they would have toned it down a notch. Instead, they were arguing over semantics. Perhaps they would have preferred to care for a catastrophic event when it eroded through a blood vessel rather than the controlled hospital admission we provided.

They also call on clinicians to learn how the other half lives, understanding policy needs and learning about healthcare spending during medical school. In turn, “the vast majority of physicians who deserve to be trusted” would be rewarded with fast-track of pre-check systems like those used by the TSA. It remains to be seen whether legislators and other policy-makers will heed this advice, but we can be ever optimistic that perhaps someone will see through the money and special interests and give it a shot.

I’m constantly re-engineering my home office and it’s easy for me to take a break because I can just wander to the sofa and put my feet up. Having spent entirely too much time in cubicles and small circulation-less conference rooms, I was intrigued by the idea of a nap desk. Naps are supposed to help improve mental awareness, but I’m not sure I would want to sack out under my desk even if it is made of stylish lacquered wood, metal, and leather. The desk is just a prototype for now, and unless you have your own office, I can’t imagine it would be terribly restful.

What’s your strategy for catching a couple ZZ’s during the work day? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 4/11/19

Partners HealthCare Embraces the Democratization of AI to Accelerate Innovation in Medicine

Partners HealthCare (MA) will equip its clinicians and researchers with the tools necessary to develop their own AI algorithms through its MGH & BWH Center for Clinical Data Science.

InTouch Health Unveils the First Fully Integrated Virtual Care Platform

InTouch Health develops telemedicine software that can be used in any type of healthcare setting.

Feds Charge 24 In Alleged $1.2 Billion Medicare Fraud Scheme

Federal prosecutors charge 24 people, including executives at five telemedicine companies, with $1.2 billion in Medicare fraud.

Concerto HealthAI Enters Precision Oncology Collaboration with Pfizer

Concerto HealthAI will work with Pfizer to advance AI capabilities for oncology using its proprietary AI technology, EHR software, and claims data.

HIStalk Interviews Luis Castillo, CEO, Ensocare

Luis Castillo is president and CEO of Ensocare of Omaha, NE.

Tell me about yourself and the company.

Ensocare is a care coordination platform that helps move patients to the right level of care along the care continuum. We’ve been doing this for about 10 or 11 years and I’ve been there five years.

I’ve been in healthcare IT for a long time. I don’t think I’ll ever go back to big company. I’m having the time of my life running this small company.

What are the benefits and challenges for hospitals in getting discharged patients placed and coordinating their care afterward?

The big EMR push, Meaningful Use, and even ICD-10 took people’s attention away from the post-acute care side. What happens once you leave the hospital? I lost my brother about two years ago and I remember trying to get him placed into hospice. I had to go to our network and ask my team. Who is available Des Moines area? What are their CMS scores? Because the hospital handed me what looked like the cardboard filler that comes in a shirt. It was laminated and had a bunch of numbers on it. Some were scratched out, some were written over.

They said, here you go, it’s up to you. Make some calls and figure out where to put him. There was no automation and no ability to tell me which facilities were better or which ones weren’t. That discharge and placement process is highly fragmented and not very process driven.

We put automation and technology behind this very manual place. Nurses typically stand in front of a fax machine for 5-6 hours a day getting this done, so we let them go back to working at top of license and get them back in front of the patient — case managers, social workers, and so forth. But we also impact length of stay, so if I can decrease it by a quarter-day for patient population, that’s big money over the year.

Hospitals sometimes leave placement decisions to the patient and family to make sure they aren’t accused of playing favorites or being held accountable for placements that don’t work out. Is their challenge in advising patients and families due to lack of knowledge or a reluctance to exert undue influence?

That’s a really tricky question. I still remember when health providers and payers couldn’t even be in the same room together. There was this hatred for each other. But now health plans own hospitals and hospitals create their own health plans. With some of the Medicare Advantage plans, people who are taking on risk can manage and direct patients to places if it’s their own population.

But you bring up a great point. The IMPACT Act says you have to give a patient choice. You have to disclose any financial relationship you have with that home care agency or that behavioral health provider that is affiliated with your IDN.

Our system lets you put all the choices in front of the patient and give them an unbiased score, such as the CMS scores for quality. They can flip through almost a Hotels.com interface on the tablet and look at the places that have a bed available. They can see if they are pet friendly, check which churches are nearby, see a picture of the area.

Hospitals aren’t supposed to direct people or to steer them. They have to manage that closely. Our application helps document that they gave the patient choices.

In the absence of something like a Tripadvisor that includes detailed reviews and scores from individuals, should I as a patient or family member trust the CMS star ratings?

We’ve been asked by our customers to do some kind of independent rating score for post-acute care facilities based on the data that we have, such as readmit ratios and quality scores. But I’ve been hesitant to do that. We offer the post-acute care network a free portal. We don’t charge them to belong to this, although some of our competitors do. We try to get them to be engaged, to answer inquiries within 30 minutes, and to keep their engagement level up.

We have something that is more on the predictive side on our roadmap. Predictive analytics that say, based on what we know of this patient and the performance of organizations in our network, here’s where we think this patient will do best. They need DME, infusion, dialysis, and these levels of care, and these places do really well with that. I don’t want to become a Class II device and make a clinical recommendation, but I will start scoring and show them a predictive model.

How important is it to have access to actual empathetic humans and not just technology and information when making what could be one of the most important decisions in someone’s life?

I remember when Gateway and Dell came into the PC market. Nobody thought they would ever pick a laptop or desktop off a pick list since technology was intimate in some ways. You wanted to see it and touch it. You would never buy it sight unseen. But the paradigm has shifted. We buy online, even for major purchases like cars, and just have it delivered.

You probably won’t pick a provider via technology, but you’ll get a list of 10-12 places that have a place for Aunt Betty. You take a look on the tablet at their quality scores and decide which three to visit because they meet the criteria. You’ll physically go and take a tour to see if it’s the right place.

The predictive modeling will make it more interesting in being able to show outcomes and recommendations. I’m not sure if I’m going to develop a Yelp-like thing, but people want to know what other people felt about their visit there and what it was like.

It’s also true that everybody is not in the same financial situation. We are looking at working with payers to provide an estimated out-of-pocket expense. That is powerful because you may not be able to afford the five-star rated place.

Given that not everyone is willing or able to pay for a Ritz Carlton, can someone with a Motel 6 budget at least look up how satisfied others like them with similar expectations were with a particular facility instead of just comparing absolute satisfaction numbers?

Not today. The closest thing involves discharges, although it’s hard to quantify with so many variables and I can’t say for sure if I’m impacting it. But we’ve seen a big change in HCAHPS scores. On discharge, people afterwards didn’t understand the discharge because it was in the wrong language, she spoke very quickly, they were pushing me out the door, the ambulance was late. They list all these things, but an HCAHPS-type measure does not exist for the post-acute care visit right now. But as you start managing populations, I think it’s coming.

What does a hospital need to do to get started with your program?

They start by listing their favorite facilities in the area, the ones they use frequently and discharge to most often. We build that into a quick list in the system. We reach out to all those post-acute care providers, train them on our portal, and get them to understand that there’s an engagement value here that says you have to answer referrals within 30 minutes. Seventy percent of Ensocare calls are outgoing as we are managing the network. That’s different from some of other solutions that just buy a CMS database, import it into their system, and call it done.

I build my database organically. Every time I do these outbound calls, I know which facilities aren’t responding. Our customer support people and customer experience people call them proactively to say, we notice that you aren’t responding to the referrals we’ve been sending you. Is there a problem? Many times it’s, oh, the lady that had the app on her phone left and we don’t know how to answer any more.

We deal with post-acute care facilities that are very technically advanced and are part of large national chains. But we also work with home care mom-and-pop organizations in rural parts of the country, so it can be challenging. But we actively engage and manage the network to make sure they are responding.

You wrote after HIMSS19 about how smart speakers like those powered by Alexa might be used in healthcare. What do you predict?

The interface is becoming more reliable. Nine times out of 10, Siri or Alexa gets it right. One of the biggest potential uses I see is managing the population after discharge. Once you get a risk score through LACE or some other technology, you know that this patient has two co-morbidities, is high risk, and has a lot of social determinants. The nurse wants to follow up, but they’re going to call you, ask you to enter information into a mobile device on an app. Many patients aren’t all that technology savvy. But if you send them home with a smart speaker, it could automatically populate population health platforms with vital signs. The nurse is now calling only the people who need intervention as opposed to calling everybody every day. That model is unsustainable.

I recently was at a hospital that had a warehouse full of 75 nurse navigators. All they do, all day long, is call people. I’m following up on your primary care visit. Did you pick up your prescriptions? Did you do these things? Tools like the smart speakers are going to begin to invade that space.

Do you have any final thoughts?

I worked for two large companies. Shared Medical Systems taught us how to be close to the customer. Siemens, true to its German engineering background, taught us all about process and engineering. A healthy combination of both of those things is appropriate.

But the one thing that can’t be supplanted, the one thing that you always have to keep at the top of your radar, is high-touch customer service. We have a person at the end of the phone each time. You don’t get routed and automated and have to press two and three to talk to a representative. We have a high-touch customer service that our customers appreciate.

Vendor Alternatives to Exhibiting at the HIMSS Conference

The HIMSS conference exhibitor roster turns over every year as a significant portion of companies either sign up for the first time or previous exhibitors decide not to return. I’ve heard from more of that latter group after HIMSS19 who are questioning the return on investment, which for most of them means generating sales leads.

Most vendors have no plans to stop exhibiting. Some are happy with the value they receive in having a lot of people they need to see who are in a single place at a single time. Others worry that their absence will be exploited by competitors as a sign of weakness or that customers will question their commitment. The exhibit hall is likely safe from mass defection, especially for long-established and large vendor players.

However, small and medium-sized vendors who rack up significant booth, travel, and staffing costs for just three frantic days may wonder if they should be spending the money elsewhere. That’s especially true as the industry has settled down into less of a land-grab mentality now that Meaningful Use money has been spent, major software decisions have been locked in at health system corporate levels, and health systems worry about margins as their core business faces unknown changes.

I asked vendor readers for ideas of how they might reallocate some or all of their HIMSS exhibition costs into efforts that would yield more tangible business results. Thanks to those who took the time to share their thoughts.

We don’t exhibit, but we send more than 10 people to HIMSS and get a meeting room instead. We set up meeting room appointments prior to the conference so we can use our time efficiently. We’ve gotten a lot out of this and plan to keep it up.

We use our budget to attend the shows where we already have a big client presence. We go as attendees, offering a dinner with our strategic client advisory board. We don’t get leads, but the partnerships lend to better product strategies and focus areas for the business. HIMSS isn’t a big lead generator for us, so the rest of the budget I would diversify into PR activities and a solid PR agency. We also do sponsored blog content and attend smaller conferences.

We go every year because we want our name on there and it’s an opportunity to meet with customers and partners. But we absolutely do not recover the cost of attendance in ROI. HIMSS is where vendors show off to each other, not where customers come away having made purchasing decisions.

We exhibited at one HIMSS conference 15 years ago as a startup selling a small departmental system and decided never again. Every year a few of us attend the show (we can always rustle up some guests-of-vendors badges), and we set ~20 meetings with current and potential partners. Every year we’re grateful we don’t exhibit. We’re still spending money attending the shows, so we’re not saving as much as we could be, but our expenses are less and we get good value out of the face-to-face meetings. We’ve never specifically allocated the funds we would have spent at HIMSS to other efforts, but the remainder has gone toward our general marketing budget.

We stopped exhibiting at HIMSS following the 2018 show. Even though we booked a booth for 2019 during the 2018 show, we forfeited our deposit because it was cheaper than following through and burning the hundreds of thousands we’d have to shell out to be present as we originally planned. Instead, we found smaller, more regional shows that offered more engagement with our specific target audience. We carried out some branding campaigns, spent more on content development and distribution, and sponsored some webinars that again allowed us to better target our outreach and drive the right people to our event.

We also invested in some technologies to help us connect with our target audience, including ZoomInfo and Definitive Healthcare. That way we could identify the accounts (health systems and hospitals) we wanted to contact and find out exactly who the people were who should be our target buyers. A quarter of a million to half a million dollars can go a long way when you spread it out to different activities and you identify those that will support your marketing and sales efforts. And we’re just a former 20×20 vendor. Think about the major players and all the floor space and investment they burn.

We will continue to exhibit, but an alternative would be to do a roadshow. We would evaluate which cities would be the best locations for existing and targeted prospects. Select an event marketing team to pick venues. Then use the money for team, rent venues, catering, AV, travel, swag, etc. A key component would be to pay to have featured customers and internal team members travel to and speak at event.

An alternative to paying for a large booth is to simply downsize and pay for a 10×20 or even a 10×10 booth. Your company will save a ton on expenses and will benefit from reduced staffing and reduced equipment, etc. But you still maintain a listing in the HIMSS guide so that customers and partners can find you. This will also force you to choose the most impactful people that need to attend and forces a decision on what products you really need to showcase. Sort of like downsizing when you move — it forces some tough decisions.

We stopped three years ago. We spent about $300,000 on a booth, had 90 leads (most were students) and only 12 actual decision makers. Twelve leads for $300,000 is a bad investment. Now we hold an industry breakfast and it has been a great event – CIOs, CTOs, and CMIOs only. We had 30-40 people for about $20,000, a much better investment. The attendees are the ones driving this and frankly we’ll spend our dollars elsewhere. This convention has become nothing but a money grab for HIMSS and the value is long gone.

I would invest those resources in organic PR, meaning I would take the time and effort to document client success stories, translate them to meaningful, educational information to prospects, and pitch that content to trade press, national media, etc. (not sponsored content). I would also consider investing in good, well-produced, reusable video content.

As a small company, we stopped having a physical booth at HIMSS a few years ago for many of the reasons you described — cost, being lost in caverns and hinterlands of the exhibit hall, very few real leads, etc. We still have what we believe is a strong presence for our size by doing other things — working with partner companies in their booths, leveraging healthcare ecosystem areas like the Intelligent Health Pavilion, and partnering with our customers to have educational sessions on the agenda. We also promote our attendance at HIMSS before the conference with customers and on our website / social media so we can make sure to connect with those who we need to see during the show. A few weeks prior, we do a press release about the various ways we will be participating at HIMSS, and during the show we are posting / tweeting “Live from HIMSS”. I guess you could say we have virtualized our booth for HIMSS!

Register as a participant, attend be at all the social events and relevant educational sessions, keep the elevator speech short (2-3 sentences), arrange for a Wednesday or Thursday evening offsite event that can be promoted over the week. Don’t try to cram so much in up front. Create some mystery and intrigue. Useful or unique bling (or chocolate) may help.

This actually occurred at my last company. We opted to host an event at HIMSS, a one-night, blowout event that was half the cost of the booth for the week. We spent months prospecting and getting folks to the event, while setting up meetings outside of the exhibit area (restaurants, hospitality suite, etc.) for 1:1 meetings. This works much better in Las Vegas than it does Orlando.

Is HIMSS a huge financial commitment? It sure is. And if all you’re going to measure is lead generation, then it won’t be worth it. The cost per qualified lead at HIMSS in my experience is north of $10K or even $15K. And clearly there are cheaper ways to get to leads if that is your only measure of success.

But HIMSS is also a place to get stuff done. Strategic partnerships, briefings with current and potential partners, window shopping for possible M&A, early look at emerging trends and competitor positioning, and … gasp … customer engagement (which shouldn’t be confused with lead generation.) A well-planned and executed HIMSS with proper organizational support yields far more benefits than simple leads.

Having said all that, if HIMSS were to disappear as an expo, I would not be all that disappointed. It’s become more of a place to be seen. The nuclear arms race of HIT marketing, if you will. Unfortunately denuclearization only works if everyone disarms. And we know that won’t happen. So we make the most of it with planning and outreach months in advance.

Finally let’s not forget the HIMSS points system. If you have years spent supporting HIMSS, pulling out for even one year knocks you back to zero. And suddenly you’re at the back of the bus in terms of booth selection, making it an even harder ROI to justify.

Have a party right across the street with free alcohol and food. Has that been done before?

Invest in breakfast briefings and lunch and learns as a way to drive targeted executives interested in your solutions and offerings.

As a provider, I don’t care if vendors exhibit, especially if I’m told in advance the reason for not having an actual booth. Having some company representation at the conference to meet with, even if not at a booth, is generally sufficient for my needs.

Exhibit at AHIMA and select state HIMA conferences.

No customers come to HIMSS,  just other vendors. I would rather invite customers and prospects to a smaller, more intimate event and invest in interesting thought leadership or education for that base. For example, physician roundtables with an industry thought leader.

Work with Becker’s and CHIME more closely.

Drive a subject matter interest thought leadership 1.5 day summit for 50 persons

Morning Headlines 4/10/19

Cerner Announces Agreement with Starboard Value Regarding Board Refreshment, Operational Improvement Initiatives and Expanded Capital Return Program to Drive Next Phase of Profitable Growth and Value Creation

Cerner bows to pressure applied by an activist investor by appointing four new board members as nominated by hedge fund operator Starboard Value, which owns 1.2 percent of outstanding CERN shares.

Diameter Health Announces $9.6 Million in Series A-1 Funding Round

Clinical data integration vendor Diameter Health raises a $9.6 million Series A-1 funding round led by new investor Optum Ventures.

Microsoft is shutting down its HealthVault patient record service

Microsoft will shut down its HealthVault service on November 20, 2019.

Ontellus Acquires B2B Health Information Exchange ChartSwap

Multi-vertical records retrieval company Ontellus acquires medical records request vendor ChartSwap.

News 4/10/19

Top News

Cerner bows to pressure applied by an activist investor — and perhaps as a result of its own self-examination led by Chairman and CEO Brent Shafer, who was hired in January 2018 — by appointing four new board members. Hedge fund operator Starboard Value owns 1.2% of outstanding CERN shares.

Starboard was less adversarial in this case than with previous targets, steering clear of public criticism of the company and not delving into operating minutiae with a public call for changes.

In a previous example, Starboard took control of Darden Restaurants despite owning just 10% of the company by observing that its Olive Garden restaurants are too generous with breadsticks, use non-standard sized drink straws, and over-salt the pasta. Starboard managed to get every member of Darden’s well-qualified board replaced in October 2014, since which DRI shares have since risen 169% vs. the Dow’s 60%.

The new, well-credentialed Cerner directors — former top executives of Hill-Rom Holdings, MedAssets, Jawbone, and Cloudmark, two of them nominated by Cerner and two by Starboard – now represent 40 percent of the board. Another board member will be retiring.

Chairman and CEO Brent Shafer stated previously and reiterated today that the company has identified opportunities to “unlock the company’s significant potential” in creating a new operating model and will focus on improving profits and efficiency along with ramping up innovation. He says Cerner has:

• Replaced the president position with chief client officer
• Eliminated the strategic business unit structure
• Reviewed its product portfolio to maximize development resources
• Centralized operational functions that were previously spread across multiple executives who reported to the COO
• Announced plans to pay share dividends, repurchase more shares, and add free cash flow generation as an executive bonus metric
• Expanded margins

Starboard Value was a significant shareholder and an activist investor in MedAssets a few years back. It also triggered the sale of physician services vendor Envision Healthcare to a private equity firm last year.

CERN shares were up 10% at Tuesday’s market close. They’re up 17% over the past five years vs. the Nasdaq’s 93% rise.

Perhaps I missed it, but I wasn’t aware that Cerner was being pressured by Starboard, although in this case the relationship seems more collaborative than Starboard’s history would suggest and Shafer had already implemented changes to reposition the company in ways that Starboard would likely have found aligned with its own areas of focus.

Reader Comments

From Mark: “Re: HealthVault. Why can’t a company that’s worth $700 billion leave something running for probably $10,000 per year? They probably spend that on fancy coffee for management alone.” This is probably good news for Apple and other Microsoft technical competitors since MSFT tends to turn tail and run at spectacularly mistimed points after burning through a ton of cash and partner / customer goodwill with little to show for it as competitors find a way to sell their own versions of the same technology. This is the company that couldn’t figure out how to find success in offering a smartphone (Lumia and Windows Phone), a music player (Zune), a streaming service (Groove), a fitness tracker (Band), a browser (IE/Edge), a search engine (Bing), a smart speaker (Cortana), a tablet (Surface RT), a sophisticated movement tracker (Kinect), and now a personal health record even as Apple gets accolades for its own product and the government begins a hard push on giving patients their data. I’m being nice in not mentioning Microsoft’s healthcare-specific fumbling with Sentilion single sign-on and Azyxxi / Amalga / Caradigm. Keep that history in mind as the company starts playing the soothe-the-cobra music in trying to convince healthcare that this time, in the face of entrenched cloud competition from Google and Amazon, it’s serious about healthcare interoperability and AI.

From Spinal Screw: “Re: HIStalk. I find it hard to believe that anyone has time to read it all.” Not everyone does, but somehow quite a few folks – many of them running big provider and vendor organizations and some of them likely outcompeting you – invest the time in their success. I’m editorially selective and good at summarizing, but even I can’t tell you everything you need to know in a 30-second phone read in the coffee line or on the toilet and you may or may not be good at skipping stuff that you don’t think applies to you. I have no incentive to pad it out with fluff or verbosity. You might be in the wrong business or need a productivity makeover if you don’t have 5-10 minutes per day to follow your field.

HIStalk Announcements and Requests

A reader commented that opinions expressed on HIStalk – both mine and those of readers – “reek heavily of cynicism of status-quo-ism” in always being skeptical of potentially disruptive developments (such as AI, EHRs, digital health, etc.) without offering alternative solutions, all because we’re protecting our hospital paychecks. This tension between would-be disruptors and those who keep the IT lights on today is important – we’re always going to be defending ourselves to impatient, often naive disruptors whose technology hammer is desperately seeking a healthcare nail to pound as we try to maintain a responsible, enterprise-driven approach. Here’s your chance to respond, perhaps considering these issues in your comments on the survey form I created. I’ll recap our collective thoughts in a few days.

• Are provider health IT people really averse to investigating and using disruptive technologies or are we just jaded by a long list of previous failures?
• What are the outsiders missing about what makes healthcare different?
• What is the potential of technology-powered disruption in a mostly non-profit healthcare system that is heavily regulated and full of entrenched stakeholders ranging from hospitals to insurers to drug and device companies?

Welcome to new HIStalk Platinum Sponsor Relatient. The Franklin, TN-based company offers a patient-centered approach to patient engagement that recognizes that “it’s not just a phone, it’s healthcare’s digital front door.” Solutions include appointment reminders and rescheduling, on-demand outreach for events such as weather delays, patient self-scheduling and waitlisting, satisfaction surveys, AR balance messaging, MDpay balance collection, and health campaign management (recalls, education, portal promotion). The service requires no app, no portal, and no password (since the service validates directly to the phone) and communicates with patients via their preferred channel (phone, email, or text messaging, the latter preferred by a startling 98% of patients vs. the basically zero who like patient portals). Patients are engaged as comfortably as they would be with friends and families, using behavioral science to meet their wants and needs without having a clumsy app inserting itself. An Epic-using pediatric hospital dropped its clinic no-show rate by 27 percent within six weeks, while a FQHC uses it to help meet the needs of diabetic patients with transportation problems. It’s integrated with a long list of systems that include those of Epic, Cerner, Allscripts, Meditech, EClinicalWorks, and Athenahealth. Thanks to Relatient for supporting HIStalk.

Listening: King Crimson, purely because the reclusive and formerly retired Robert Fripp — the only consistent band member as its 72-year-old guitar player — just did an amazing press conference for the band’s 50th birthday as reported by Rolling Stone. It’s a delightful, wry look at the challenges and rewards of playing in a band whose membership is constantly evolving (Fripp loves blowing it up and starting over to stir his creative juices) and whose epic progressive music plays great live even though each musician must count different time signatures in their heads in front of thousands of audience members in playing songs recorded decades ago by someone else. Their tour goes out in June and has some US dates. Certainly many (including me) enjoy the take-no-prisoners “21st Century Schizoid Man” (original vocals by ELP’s Greg Lake) or the mostly improvised “Asbury Park,” but my favorite will always be “Starless.” How cool it must be to bemusedly explain to your grandchildren that time in 1969 when, as an impossibly young man of 23, Grandpa was rocking half a million people at England’s Hyde Park weeks before Woodstock and the moon landing, and now he’s about to hit the road again.

Webinars

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

Acquisitions, Funding, Business, and Stock

Morgan Stanley predicts that Apple’s healthcare opportunity is $15 to $313 billion in annual revenue within the next eight years, with analysts speculating (with little evidence to back it up) that the company could roll out medical-grade wearables within AirPods, integrate sensor-powered apps into the Watch, get insurers to pay for the Watch, or buy healthcare companies. The prediction seems laughable given its assumption that the company’s 2027 healthcare revenue could exceed today’s total revenue even as Apple scrambles to defend its mature market position. People keep trying to make excuses for Apple’s unpleasant slide into middle-aged corporate mediocrity and often predict healthcare as its savior based on one-off ideas like Apple Health Records and the Watch EKG that are interesting to consumers but don’t have any kind of monetization path (Rule #1 in healthcare – patients do not pay. Rule #2 – neither do doctors.)

Clinical data integration vendor Diameter Health raises a $9.6 million Series A-1 funding round led by new investor Optum Ventures.

DocuTAP and Practice Velocity announce that their merged companies will be branded as Experity.

Sales

• Acuity Healthcare, which owns three long-term acute-care hospitals, chooses HCS Interactant as its enterprise health IT platform. 
• AdventHealth will implement Par80’s referral management system.
• McKesson chooses Google Cloud as its preferred cloud provider for infrastructure, platforms, applications, and analytics.
• Australia’s NSW Health signs a 13-year contract with Sectra for enterprise radiology imaging for its 11 Local Health Districts.
• Signature Healthcare will implement Meditech Expanse.

People

OptimizeRx hires Denys Ashby (CaptureRx) as VP of hospital and health systems.

Jeff Fallon (Oneview Healthcare) joins patient experience technology vendor EVideon as CEO.

Announcements and Implementations

Google Cloud opens its healthcare API for beta testing, offering an interoperability engine that supports FHIR,  HL7v2, DICOM, patient de-identification, and machine learning.

Microsoft will shut down its HealthVault service on November 20, 2019. The notice – sent via email to registered users — expands the company’s January 2018 warning that it would retire HealthVault Insights and its December 27, 2018 announcement that Direct messaging would no longer be supported. Now the whole thing has been scrapped.

Fortified Health Security publishes its 2019 Horizon Report on the cybersecurity risks of connected medical devices.

Montefiore St. Luke’s Cornwall Hospital goes live on Artifact Health’s physician query solution to expedite accurate coding just four weeks after the project began.

Saratoga Hospital goes live on integration of B. Braun Medical’s smart IV pumps with Meditech Magic as delivered by Iatric Systems.

DirectTrust earns ANSI accreditation to develop interoperability and identity standards and invites industry stakeholders to participate.

Recondo Technology announces record bookings and growth in Q1.

Government and Politics

A jury finds a South Florida nursing home operator guilty of defrauding Medicare and Medicaid of nearly $1 billion via fraudulent billing. The best part of the story is this – he used part of the $37 million he pocketed to bribe a Penn basketball coach to get his son admitted into the Ivy League university. Former Penn basketball coach Jerome Allen, who has pleaded guilty to money laundering in connection with the incident, admits that he accepted $300,000 in bribes to get the son — Morris Esformes — admitted to the Wharton School, after which he never played a single second of Penn hoops. The son’s LinkedIn says he last worked as a summer analyst for merchant bank The Raine Group. Somehow I expected that – state-school guys like me who spent our summers sweating doing dirty, low-paid work outdoors (in my case, coal mines) always knew people with better-connected parents who got them clean, connection-creating jobs working as caddies or perhaps merchant banking. One guy I knew donated his daughter’s way into dental hygiene school (“I’ll buy the damned place if I have to,” he told everyone who would listen, which apparently included the admissions folks) and got his underachieving son into medical school despite the kid’s having been caught breaking into his undergrad college’s administration office to manually improve his grades.

Other

In Australia, newly opened, 488-bed Northern Beaches Hospital delays its HIE project after it finds “unacceptable errors and omissions.” A sign that the grand opening wasn’t going well – the CEO quit the day after the ribbon-cutting ceremony.

Massachusetts Governor Charlie Baker, speaking at a Partners HealthCare innovation event, says he is skeptical of the promises of AI. He adds that healthcare is rightfully held to a higher standard than other industries and that patient privacy must not be compromised. Baker was the final decision-maker for AI projects in his previous roles in government and provider organizations and says AI was often less useful than its developers thought, it takes longer than expected to make it work, and the choice and formatting of input data complicates the issue.

Ireland’s state data agency rules that people don’t have an absolute right to have their names spelled correctly, reviewing a TV producer’s complain that the fada (an accent or diacritic mark) in his name was omitted by University Hospital Galway because its software doesn’t support the special character.

Cigna’s PR people shrink from the glare of public spotlight as the insurer suddenly agrees to pay the out-of-network hospital ED bills of a woman’s two daughters who had attempted suicide – one by slashing, one by pills – by reversing its initial decision that neither event was life-threatening. The mother was relieved about the bill, but the story doesn’t provide any insight on what it’s like to have two daughters of unstated age who tried to kill themselves simultaneously.

Weird News Andy codes it as W61.42XA. A Detroit motorcyclist dies when one of several turkeys that were crossing the road take flight and hit him in the chest, causing him to lose control. WNA cautions, however, that we must escalate our coding work to keep up with the stupidity of people, providing as evidence this story in which a 10-year-old boy is critically injured after falling off the car driven by one of his parents as he “surfs” on the roof.

Sponsor Updates

• Audacious Inquiry joins HL7 and IHE.
• Spok announces its upcoming conference participation at AONE, the Healthcare IT Institute, and AMDIS PCC Symposium.
• Impact Advisors is named as one of Modern Healthcare’s largest healthcare IT consulting firms.
• Digital prescription savings company OptimizeRx announces integration with Cerner and Epic.
• Aprima will exhibit at the ACP Internal Medicine Meeting April 11-13 in Philadelphia.
• Audacious Inquiry joins Health Level Seven International and Integrating the Healthcare Enterprise as an organizational member.
• CompuGroup Medical will exhibit at the Henry Schein National Sales Meeting April 11-13 in Denver.

Blog Posts

• Empathy in Healthcare: Is There Room for It in the Technological Era? (Dimensional Insight)
• Get those donor dollars: Tips for soliciting philanthropic donor funds (Oneview Healthcare)
• 7 Customer Service Habits Your MD Practice Should Expect From IT Vendors (LightSpeed Technology Group)
• Cooper University Health Care + 4.5 Million Pieces of Paper Saved + Epic Informed Consents (Access)
• Considering hiring a revenue cycle management company? (AdvancedMD)
• 10 must-read books this spring (Advisory Board)
• Tuning Classifier Performance to Your Customer’s Goals (Apixio)
• How you can prevent medical identity theft (Atlantic.Net)
• What’s an Application Developer’s Responsibility for HIPAA? (Datica)
• Agile Practices: Burwood’s Story (Burwood Group)
• Seamlessly Align Infant Security With Clinical Workflow (CenTrak)
• The Process of Revenue Cycle Management (ChartLogic)

Contacts

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

Morning Headlines 4/9/19

Apple’s Health Opportunity Could be Triple Smartphone Market

Morgan Stanley analysts determine that Apple’s piece of the consumer-centered health pie could eventually be between $15 billion and $313 billion.

NVIDIA and American College of Radiology AI-LAB Team to Accelerate Adoption of AI in Diagnostic Radiology Across Thousands of Hospitals

With help from Nuance and GE Healthcare, the American College of Radiology adds Nvidia’s Clara AI Toolkit to free software it will offer radiologists to help them develop and use AI for diagnostic radiology.

Deep Lens raises $14 million to improve clinical trial recruitment with AI

Digital pathology imaging and diagnosis startup Deep Lens secures $14 million in a Series A round led by Northpond Ventures.

Info for wrong patients possibly sent to thousands of West Virginia veterans

The Veterans Health Administration notifies 4,882 patients of a Xerox software and printing problem that resulted in PHI, including lab results, being mailed to the wrong patients.

Curbside Consult with Dr. Jayne 4/8/19

I recently attended my medical school class reunion. It was my first time attending, and since it was a “big year” for our class, I figured I should go. I didn’t know what to expect, but it turned out to be a great experience.

The way our school handles reunions is that it has a major reunion event every year, celebrating the classes every five years starting at the 10-year mark. This year was primarily for the classes of 2009, 2004, 1999, 1994, and so on. Once you hit a certain point (possibly 50 years?) they welcome you at every year. We had about 20% of my class attend, and according to the organizers, that was a pretty good turnout.

The festivities started on the hotel shuttle from the airport, where we got to see members of the class of 1969 figure out that they were sitting next to each other and had no idea they were in the same class. Watching their faces light up as they figured it out was hysterical. They immediately started swapping stories about what it was like to be in school 50 years ago. For us relative youngsters, a lot of it was the same, even though times have certainly changed.

We had a member of the class of 1954 on the bus. In her class were four women, and she was delighted to learn that our class was the first one to have more women than men (even if it was only “more” by one person.) Doing the math, we figured she had to be close to 90 years old, but you couldn’t tell. She had a walker, but was carrying it folded up rather than using it.

From there, it was on to a cocktail reception, where two members of the third-year medical school class plopped down at our table. One of my classmates started probing them on “what is it really like to be a millennial,” which was pretty funny. We learned that most of the class doesn’t actually go to class since all the sessions are preserved on video. Back in our day, we had a “note-taking service” that tape recorded every class. The class then took turns transcribing it and highlighting the key points, leaving you with a great set of notes. Although the new students don’t have to attend class, they miss out on the distillation done by their peers, so I’m not sure they’ve really built a better mousetrap.

We must not have scared them too much since they stuck around for most of the reception, although I think they were relieved to not have to attend any other reunion events after that one.

The next day was full of continuing education sessions and tours of the medical center, parts of which have become unrecognizable in a research grant-fueled construction boom. The medical library has very few actual printed materials any more, with the stacks having been replaced by individual study spaces and administrative offices. A new computer lab allows for computerized administration of the tests that have to be taken during third-year rotations, and student-focused spaces now include lounge areas, video games, and areas for extracurricular groups to meet. It’s definitely more student friendly, although there should be more student-friendly resources given the more than doubling of the tuition since I graduated.

Our tour guide,  a fourth-year student who will be graduating soon, seemed surprised by the state of medical education back in our day. We were thrown out into the world to learn our craft on “real patients,” but they have state-of-the-art simulator labs where they are put through a variety of proctored scenarios so they are better prepared for their internships. The latter half of the fourth year provides opportunities to complete life support and trauma certifications, where we had none of that exposure until we walked in the door at our internships.

I have to say I was a little envious about the preparation they are receiving, I think it will make internship a lot less shocking. Our guide was surprised to learn that as recently as we had graduated, we were not subject to duty hour limitations. Her eyes were wide at learning how often we took call and for how many weeks of the year. On most of her rotations she didn’t take call, and when she did, it was one day a week and the shift was limited to 18 hours.

There were presentations from various medical school leaders, where we learned about upcoming curricular changes that are aimed to better prepare students for the realities of medicine. My school has a strong track record for cranking out researchers and academicians, and I was interested to hear that they’re attacking precision / personalized medicine as a way to reduce costs. I had never really thought about it in the way it was presented, that even with the high cost of some of those treatments, the real savings is in patients you’re actually not treating with standard therapies that might not be effective. It will be interesting to see how that plays out in reality. There were also discussions about whether our school will join the club of schools that are providing full tuition scholarships for the entire student body.

Of course the highlight of the reunion was hanging out with classmates and learning what everyone has been up to in the new century. Some are wholly career-focused and driven, others have dropped out of medicine entirely, and there are several of us in-between. As much as physicians tend to talk about the importance of work-life balance, I was surprised to hear one of my classmates make a negative comment about women who had children during their residency training. Instead of celebrating their ability to juggle that level of complexity, he commented “what a strain that must have been on the residency program.” He backtracked a bit when one of the women mentioned that she only took four weeks off after childbirth, because that was the amount of vacation allotted to all residents each year and she didn’t strain the system any more than her counterparts who went to the beach.

Based on our interactions with current students, I suspect there is going to be a lot more tolerance for work-life balance concerns. There may be a steeper learning curve in residency due to the changes in work hour restrictions as students are exposed to scenarios they haven’t seen before because they simply weren’t in the hospital overnight. On the other hand, they may learn faster or better because their brains won’t be mush from working hellish schedules.

I had the privilege of talking with a 90-year-old urologist and getting his thoughts on how things have changed over time. Based on his family history and state of health, the odds are good that I’ll be seeing him again in five years.

Have you ever attended a class reunion? Would you do it again? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 4/8/19

DocuTap merging with a competitor based in Illinois

Urgent care EHR/PM vendor DocuTAP will merge with urgent care solutions vendor Practice Velocity.

Data payday slow in coming for electronic medical records specialist

Crain’s Chicago Business says the attempt by Allscripts to diversify itself away from smothering competitors Epic and Cerner in a slowing EHR market hasn’t paid off for investors, as disappointing financial reports have sent shares down.

Hardin Memorial Hospital issues statement on ‘information technology disturbance’

Hardin Memorial Hospital (KY) is working to restore systems taken offline by a reported cyberattack of an unstated nature.

Monday Morning Update 4/8/19

Top News

Urgent care EHR/PM vendor DocuTAP will merge with urgent care solutions vendor Practice Velocity, the companies said in a teaser announcement that promises further details later. 

Reader Comments

From Not From Monterey: “Re: Cerner Rev Cycle. Can any site that has converted, including billing, say that claims are going out the door speedily, bills are being sent out, A/R is doing well, etc.? We have Cerner clinicals and a third-party reg/sched system. We need to either go all-Cerner or all-Epic and we’re not making any progress because of fear of Cerner Rev Cycle.” I’ll open the floor to readers.

From Weekend Warrior: “Re: Politico’s Morning EHealth. Cutting back to three days per week. Cue sound of bubble bursting?” Politico launched its free weekday newsletter in mid-2014 under the umbrella of “EHealth.” Healthcare technology has lost some of its luster due to the end of federal incentives, market saturation, the domination of a few broad-line vendors, and technology’s lack of success in improving outcomes, cost, or public health in general. As a result, HIMSS, other conferences, and low-value websites have had to trade their long-term credibility for short-term vendor cash where never is heard a discouraging word. Unlike those organizations, while I don’t find a lot I need to know from Politico and maybe 10% of any given issue at most seems relevant, they are good at bird-dogging government stories and that’s important. I think the toilet bowl water is already swirling around some poorly run sites and “curators” that can’t deliver decision-making eyeballs – the Reaction Data survey from a couple of years ago exposed the difference between having a enthusiasm-powered but expertise-light website, newsletter, or social media account that no C-level reader would ever follow.

HIStalk Announcements and Requests

Poll respondents are skeptical about any near-term benefits of artificial intelligence in healthcare. As they should be.

New poll to your right or here: Hospital software vendor employees: how are business conditions now compared to two years ago?

Thanks to the following companies that recently supported HIStalk (without gaining any editorial control for doing so, I should add). Click a logo for more information.

Webinars

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

Acquisitions, Funding, Business, and Stock

Crain’s Chicago Business says the attempt by Allscripts to diversify itself away from smothering competitors Epic and Cerner in a slowing EHR market hasn’t paid off for investors, as disappointing financial reports have sent shares down. It expresses some hope that selling patient data – through its Veradigm (the former Allscripts Payer & Life Sciences) and Practice Fusion businesses – will eventually boost financials, although analysts say competitors could easily enter growth markets such as population health with products better than those Allscripts sells. Above is the five-year share performance of MDRX (down 39%) vs. the Nasdaq (up 99%). Shareholders hate watching companies promising but failing to deliver, even with a good excuse such as being deep in a market that is receding and a consolidating customer base that is standardizing solutions from competing vendors.

I expected Inc.’s pretend letter to Apple CEO Tim Cook from Steve Jobs to be lame, but it was actually pretty brilliant in defining what Apple should be doing beyond sitting on a pile of cash, announcing late market entries in video streaming and credit cards, and allowing the Mac to age ungracefully. This is a great idea:

Google is our new nemesis, remember? They attacked our core business model with that Android PoC. But, Tim, c’mon… Google is weak. They can’t innovate worth beans and most of their revenue still comes from online ads, which are only valuable because they constantly violate user privacy. You could cut their revenues in half if you added a default 100% secure Internet search app to iOS and Mac OS. Spend a few billion and make it faster and better than Google’s ad-laden wide-open nightmare. This isn’t brain surgery.

People

Google Cloud healthcare vertical leader Greg Moore, MD, MS, PhD joins Microsoft as corporate VP, health technology and alliances. He was at Geisinger from 2010-2016.

Announcements and Implementations

Medsphere announces GA of its cloud-based Wellsoft Urgent Care, which includes the top-rated Wellsoft EDIS – which it acquired in late February 2019 — along with practice management and patient engagement applications.

Privacy and Security

Hardin Memorial Hospital (KY) is working to restore systems taken offline by a reported cyberattack of an unstated nature.

Dropbox pays a bounty of $319,000 for being made aware of 254 product security flaws that were documented by hackers who participated in a one-day security vulnerability bug hunt. The CEO of the hacker challenge company HackerOne suggests that companies not necessarily use the bounty programs to find their biggest vulnerabilities, but rather those with the most value at stake, such as systems that hold medical or customer data.

Other

The Madison paper belatedly notes the 40th birthday of Human Services Computing, launched March 22, 1979 in an apartment building basement by its only full-time employee, a computer science instructor named Judy Faulkner. She later renamed the company to Epic Systems, which now has nearly 10,000 employees, $3 billion in annual revenue, and a billion-dollar campus. The company still insists on the personal touch – incoming calls are answered by a human rather than a machine and outbound mail always bears old-fashioned postage stamps rather than electronic postage.

A breathless Google-Harvard Medical School NEJM article sees a time in which AI reviews every medical decision for appropriateness, catches provider mistakes, and refers tough cases to experts for diagnosis. Sounds good, but I’m puzzled at what the future of medical practice will be when on one hand you have frightful deviation in diagnosis and treatment (use of outdated data, refusal to follow evidence-based medicine, hurried decision that are often wrong, and a tendency to over-treat rather than to wait patiently) versus having AI simply calling the shots by looking deeply and broadly at what has worked on similar patients. Or, embedded the practices of the best doctors for the benefit of the majority. Do you allow those poorly-performing doctors to keep their involvement, just as we did in anointing hospitals as the overseer of population health even though they showed zero interest and aptitude in it when nobody was paying? We should just admit science doesn’t always drive medical decisions and the practice of medicine can be inconsistent, illogical, expensive, dangerous to patients, and not necessarily a positive influence on patient outcomes. My conclusion – do everything you can to avoid becoming enmeshed in the rabbit hole of diagnostic and treatment Whac-A-Mole – a well-intentioned medical system can cause more harm than good in unsuccessfully chasing one problem after another in an uncoordinated manner, especially when they’re getting paid either way. 

The New York Times notes the frightening but seldom-reported spread of drug-resistant fungal infections, likely caused by rampant antimicrobial overprescribing and use in feed crops. Government agencies and hospitals don’t usually publicly acknowledge outbreaks because of fears of negative publicity and the fact that patients can’t do much about it anyway. You have to admire those bugs – while humanity is divided into whether it’s us or the cockroaches that run out the clock, the ever-transforming bacteria, viruses, and fungi just keep adapting to whatever we throw at them and may eventually kill us all off (if we don’t do it to ourselves first). 

A 39-year-old Villanova adjunct professor should probably have questioned why the health insurance she bought over the Internet cost her just $250 per month. The answer: it wasn’t real insurance, but instead was a short-term junk insurance plans like the White House is pitching that does not cover pre-existing conditions and pays only a fixed price for a short list of services. She says the agent for the publicly traded insurance broker lied to her about the Chubb-provided coverage even though the acceptance letter she signed made it clear that the non-ACA compliant plan doesn’t cover emergency services, either. The plan offered to pay a grand total of exactly $0 for her $22,500 worth of emergency sepsis treatment, with the hospital demanding to be paid upfront for the resulting foot amputation.

Sponsor Updates

• MDLive and Redox will exhibit at ATA 2019 April 14-16 in New Orleans.
• Meditech, Mobile Heartbeat, PatientSafe Solutions, and Clinical Computer Systems, developer of the Obix perinatal data system, will exhibit at AONE April 10-13 in San Diego.
• NextGate and ROI Healthcare Solutions will exhibit at Cerner SERUG April 9-12 in St. Pete Beach, FL.
• The local paper covers PatientPing’s partnership with the Lewis and Clark Information Exchange.
• PerfectServe, Voalte, and Vocera will exhibit at ANIA April 10-13 in Las Vegas.
• PreparedHealth will exhibit at ACMA April 13-17 in Seattle.
• Optimum Healthcare IT announces a refreshed brand identity.
• Sansoro Health releases a new podcast, “Pigs, Pain Management & Palliative Care.”
• Surescripts will exhibit at the EClinicalWorks Health Center Summit April 9-11 in Boston.
• TriNetX acquires Custodix NV’s InSite network, establishing the world’s largest clinical research network.
• Wellsoft will exhibit at the Texas Organization of Rural and Community Hospitals event April 10-12 in Dallas.

Blog Posts

• Patient Access Week: An Overview of Innovative Work by Patient Access Professionals (Vyne Medical)
• Managing Patient Identity Takes a Village (NextGate)
• What’s to Come in Home Care and Hospice – Part 1 (Netsmart)
• Leveraging Your ERP Data (Optimum Healthcare IT)
• From weekend warrior to Epic trainer: how the military prepared Tech St. Stephen Hornsey for a career in healthcare IT (Nordic)
• The keys for improving the patient registration process and integrating automation (Experian Health)
• Which Healthcare IT Conferences will Patientco attend next? (Patientco)
• Why Patients Should Care How Their Doctor Feels (PatientKeeper)
• 4 reasons why patient education should be a priority (PerfectServe)
• Trust vs. risk: Balancing the benefits of new technology. (Voalte)
• What’s in a WebPT Membership? (WebPT)
• Three Ways Clinical Surveillance Technology can Improve Your Response to Measles (Wolters Kluwer)

Contacts

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

Weekender 4/5/19

Weekly News Recap

• PatientsLikeMe seeks a a buyer after the federal government’s foreign investment review committee demands that its majority investor, a China-base firm, divest its holdings
• Amazon announces the availability of six new HIPAA-compliant Alexa healthcare skills
• GAO officials tell the House Veterans Affairs Committee that the VA’s poor track record of CIO leadership has harmed its IT modernization projects and will continue to do so
• FDA names Principal Deputy Commissioner Amy Abernethy, MD, PhD to the additional role of CIO
• Walgreens says it will accelerate digitalization of the company, make executive team changes, cut costs, and redesign stores following poor quarterly results that sent shares down sharply
• A two-doctor ENT practice in Michigan closes for good and its partners retire after they refuse to pay a hacker $6,500 to restore their ransomware-encrypted systems

Best Reader Comments

AI is about six different things, with different methods and different targets. The fact that it gets rolled up into an undifferentiated mass screams that these are merely magic words meant to attract… well, suckers. Second, I would agree that resources could be spent better on other fronts. You mention lifestyle and similar social determinant factors. This reminds me that serious thinkers wonder whether diverting the last trillion or so marginal dollars from health care to education might actually improve public health outcomes more effectively. (Randy Bak)

Regarding the inability of financial incentives to change patient health behaviors, are the folks designing these studies basing them on any established health behavior change theories? If not, then there are good reasons that these interventions fail. (Mark Hochhauser)

Going to be really interesting when an AI says that we need to address behavioral health issues in a good portion of the population, only for us to realize that 1) there’s a huge shortage of workers; and 2) the reimbursement is not there to operationally break even. (NotTheDataYoureLookingFor)

Transfer of patient information results in decreased use of the healthcare system. Why? Because having those records available results in earlier intervention and in fewer repeated diagnostic tests. Decreased utilization of the healthcare system is important to the survival of only two parties I can think of: (1) the patient (obvious benefit), and (2) the payor (cuts costs). Therefore, we should be looking at the patients to pay, or the payors to pay [for data exchange]. No one else seems to have a dog in this fight. I realize it sounds quite callous to put it this way, but I feel it is realistic. There are indeed providers who act for the greater good and act in support of transfer of patient records. However, hoping that all providers will support timely transfer of patient info – without some inducement to do so – may be misguided. (Clustered)

The patient does not own the data. The data are about them and they have a right to see and distribute. Can they modify their record? Do they pay a record storage fee to the HC org to hold their data? If not, it’s not owned by the patient. (Data owner)

Initially or always for a percentage of tests, it might be a better idea to only give the AI verdict after the radiologist has given their opinion. You don’t want the radiologist to start being lazy/biased and lose their diagnostics chops either. (AC)

Watercooler Talk Tidbits

Readers funded the DonorsChoose teacher grant request of Ms. Z in Texas, who asked for STEM activities for her pre-K class. She reports, “They were so excited to see their new center materials. I enjoyed watching their creativity come to life and coming up with new things they could make. One of the lessons we did was using the 3 Little Pigs story and how they could come up with a house that was strong. They started coming up with so many different ways to use the materials and build houses. They were even coming up with things we adults didn’t even think of! I can’t tell you how happy and eager they were to go to their new STEM center and build their own creations! From the bottom of our hearts. we appreciate you giving these children the opportunity to expand their little growing minds!”

Conspiracy-obsessed Internetters are spreading rumors that rapper Nipsey Hussle was killed because he was working on a documentary about an alternative health guru who died in 2016 after claiming he could cure AIDS. The rumored conspirators behind both deaths are the always-collegial drug companies, medical societies, and regulatory agencies. Leading the charge with a list of 90 doctors who were mysteriously killed (by people such as their spouses or by auto accidents) is a “health nut” with no stated educational credentials whose website is full of anti-GMO conspiracy theories; vaccine theories; a recipe for a garlic soup that can cure flu and norovirus and a flatbread that “fights cancer with every bite;” and an online store that sells CBD skin serum and some seriously wacky products (all carefully disclaimed in the footnotes as not being a substitute for professional medical advice, diagnosis, or treatment). Her husband, a DO, runs a similar site, which she promotes in videos in which she languishes on a bed with little evidence of clothing.

An Arkansas man who is being treated at a hospital for bruises caused by bullets striking his bullet-proof vest tells staff and police officers that he and a friend were involved in a gunfight while protecting a mysterious man called “The Asset” who had hired them as bodyguards. His wife then arrived and set the record straight – the men were drinking on the back porch and dared each other to be shot while wearing a bullet-proof vest. The first man admitted that he was annoyed at being shot, so he emptied five .22 rounds into the second man’s back. Both are fine other than being charged with aggravated assault.

US Navy corpsmen are working at trauma units in Chicago, Cleveland, and Jacksonville to gain experience with gunshot wounds, burns, and hypothermia that are likely to occur in traditional warfare but that are seen less in the military’s terrorism-related activities in countries like Afghanistan. 

Johnston-Willis Hospital (VA) arranges for a dying mother to see her daughter graduate from high school in her hospital room, with the school principal delivering a brief commencement address followed by a  vocal performance by the college music fraternity of the graduate’s brother. The mother died the next day.

A baby who was born in drug withdrawal and who endured a five-month hospital stay without having a single visitor is adopted by the hospital’s nursing director.

In Case You Missed It

• News 4/5/19
• EPtalk by Dr. Jayne 4/4/19
• Readers Write: Systems Integration with SMART on FHIR ─ We’ve Come So Far, Yet …
• Readers Write: File-Sharing And HIPAA – How You Can Keep Health Data Secure in an Era of Collaboration
• News 4/3/19
• HIStalk Interviews G. Cameron Deemer, President, DrFirst
• Curbside Consult with Dr. Jayne 4/1/19
• Monday Morning Update 4/1/19

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