News 8/21/19

Top News

Nature magazine has run some good healthcare related articles lately (they are always called to my attention via tweets from Eric Topol). A new perspective piece covers the responsible use of machine learning in healthcare, containing many points that are likely new to the healthcare-inexperienced technologists who might be searching for any protruding nail for their proudly-created hammer:

• Choose the right problem, not just one for which a convenient ML training database exists. You can predict in-hospital mortality from a wealth of data, but does it tell clinicians something they don’t already know? Will the right people be involved in considering the actions that will be taken in response?
• Make sure the data elements are appropriate. ICD-10 codes entered after the patient’s encounter won’t be available when they are needed. They may also be driven by billing requirements rather than clinical ones.
• Account for inconsistent data collection practices across departments and health systems.
• Make sure that training data represents all populations.
• Watch for potential bias, such as creating an algorithm of whether a patient should have surgery based on those patients who actually did, who are probably more affluent than those who didn’t. Or in cases of a system that can infer information that the patient declined to provide, such as smoking or HIV status, which may cross ethical boundaries.
• Avoid “label leakage” in model testing, such as randomly assigning X-rays between training and testing sets without recognizing that patients have multiple images, which would then overweight the model’s accuracy.
• Break out the model’s testing results into the specific areas where it either excels or fails. Potential users need to know what a particular model works well in adults but not pediatrics, for example.
• Use clinically relevant evaluation metrics that look at the positive predictive value and sensitivity. A model whose high false-positive rate predicts a situation that requires high-cost, limited-value drug therapy isn’t going to be useful.
• Publish results with restraint, sharing code, data sets, and documentation so that other researchers can make their own assessments of usefulness.
• Test the system on real-life patients in silent mode only, where clinicians review the predictions without acting on them. Then move on to randomized controlled trials while recognizing that randomization at the patient or physician level is difficult and could endanger patients.

Reader Comments

From Mo Exposure CEO: “Re: links. Thanks for linking to our company’s news item. The response from HIStalk readers was amazing.” Thanks for deciding to sponsor the site as a result, especially since I don’t run fluff news pieces, meaning your announcement had to earn its way into my news post. Items I mention sometimes get a lot of clicks. Even webinar announcements sometimes get a couple of thousand clicks, and announcing a new sponsor always draws several hundred. Sponsor support comes from having loyal, influential readers, so my only job and outcomes measure is to make it worth their while to return.

From She Lives on Love Street: “Re: [RCM business line omitted.] Word on the street is that it’s been sold to [acquirer name omitted].” I’ve emailed the rumored acquirer’s PR contract but haven’t heard back. I’m running the redacted version to remind myself to follow up.

From Core Cutter: “Re: Apple. This CNBC article suggests internal trouble with its health offerings.” Reporter Chrissy Farr sometimes writes good health IT-related stories, but this isn’t one of them. I suspect her editors are pushing her too hard into drumming up questionably researched, speculation-based stories that hold minimal news value, as in her never-ending quest to take guesses at “what Amazon is doing in healthcare” because naming those big names draws eyeballs, but leave their owners with little useful information. This one tries to extrapolate Apple’s health-related departures into “differing visions for the future” that aren’t backed up by the stated facts. My take:

• She interviewed “eight people familiar with the situation,” none of whom are the people whose departures she noted, and those people she spoke to are simply speculating on why those people left.
• The five folks listed as having departed held wildly unrelated Apple “health” jobs, ranging from marketing to wellness clinic executives. It’s not like a mass exodus, either in numbers or in area of focus.
• The denominator of health-related jobs at Apple isn’t given, so we only know that it’s five positions out of hundreds.
• The story reports from the unnamed sources a difference of opinion among health-related employees about Apple’s direction, but those weren’t tied directly to the departures and those former employees didn’t say that’s why they were moving on.
• The clickbaity, present-tense headline implies a sudden uptick in internal tension, but does little to back that up with facts.
• We don’t have anything to suggest that Apple is disappointed in its health-related results or that it would like to change direction.
• Health and health IT have always had high turnover, some of it based on unreasonable expectations or finding out that big companies just want to make money instead of making people healthier, but in Apple’s case there’s also the possibility of parlaying an Apple credential into an even better job.
• Even if the story is right in claiming internal tension, so what? You’ll know if Apple makes major product or organizational changes. Speculating beforehand may be entertaining doesn’t really add value, except for the sites trying to sound insightful.

HIStalk Announcements and Requests

I Google-discovered Zenni in helping a friend get eyeglasses and it’s pretty cool. You key in the vision numbers from your eye doctor’s prescription (they don’t want the actual prescription), use a ruler to measure the distance between your pupils, and then head off through a long list of frames to choose your glasses. It takes a couple of weeks to received them in the mail from China and then you’re set unless you need to bend them a bit like your optician does for a perfect fit (not necessary in his case). The biggest draw beyond convenience is price – a pair of snazzy progressive glasses cost him less than $50 (they look exactly like his $300+ pair from Costco), single-vision sports glasses with polarized lenses were $60, and no-nonsense single-vision sunglasses were $15 (!!). At these prices, you could stash a pair of prescription sunglasses in every car, get some glasses set for computer monitor distance, and get backup normal glasses for next to nothing.  What you end up with is pretty much exactly what the optician would sell you for five times the price after two trips to the store. You still need an eye exam every year or two, but what happens afterward is Zenni’s strong suit. You could do a life-changing but inexpensive good deed by treating someone who can’t afford glasses to a pair of Zennis.

Color me skeptical: a new Frost & Sullivan white paper (which you can download only if you provide work details) predicts that clinical decision support systems “are poised to become the user interface of choice for clinical interaction with health IT,” replacing the EHR. My take is exactly opposite – clinical decision support systems will feed their information and recommendations through the EHR, disappearing in the background but providing no less of a service in recognizing that clinicians rightfully want everything placed into their EHR workflow and design. Nobody in their right mind would suggest that CDSS systems contain everything a clinician needs to see, or to visualize how those systems would interact with the user when several are in use (one for radiology image appropriateness, one for antibiotic stewardship, etc.) I think F&S is way off base here, and had I cared enough to download the report, I bet I would find some CDSS vendor involvement. The HIMSS rag gave it a dramatic headline, a pointless stock art photo, and a non-critical acceptance of what the report’s author said, assuming they paraphrased it accurately. This is one of those reports that predicts huge growth in some market segment, knowing that a more realistic report wouldn’t exactly fly off the shelf.

Webinars

September 5 (Thursday) 2:00 ET. “Driving 90% Patient Adoption Across Your Network: How US Dermatology Partners is Showing Us The Way.” Sponsor: Relatient. Presenters: Michele Perry, CEO, Relatient; Sara Nguyen, VP of applications and integrations, US Dermatology Partners. US Dermatology Partners is helping its physicians reclaim time they can spend with patients and is turning patient engagement strategies into business results across its 90 locations in eight states. Attendees will learn how US Dermatology Partners defined its patient engagement objectives and physician-optimized strategies. They presenters will provide advice on starting or accelerating  patient engagement goals.

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

Acquisitions, Funding, Business, and Stock

The newly hired, cost-cutting CEO of India’s second-largest hospital chain will slash its expenses by 20% in trying to recover from the misappropriation of company funds by its previous owners. Publicly traded Fortis Healthcare will reduce doctor pay, replace people with software, close underperforming hospitals, sell non-essential assets, and ensure that nurses perform only those tasks that lower-paid employees can’t do.

EHealth Exchange announces go-live of a national, single-connection, InterSystems-powered gateway service whose charter members include the VA, AdventHealth, InterCommunity CCO, and OCHIN.

Sales

• Vanderbilt Health chooses Sectra for PACS and VNA in diagnostic radiology and cardiology.
• Medical records retrieval vendor Womba chooses Allscripts Veradigm EChart Courier to aggregate provider patient records to its attorney clients.

People

Spok hires Matt Mesnik, MD (Vigilant Diagnostics) as chief medical officer.

Josh Hoders, MBA (DrFirst) joins Forward Health Group as sales VP.

FDA hires Vid Desai (Vyaire Medical) as CTO.

Announcements and Implementations

A KLAS review of drug diversion monitoring technology finds that Omnicell Analytics is the most widely adopted solution, but many customers fail to achieve their expected outcomes because they decline to pay the extra cost of EHR integration.Medacist RxAuditor has a lot of customers, but outdated technology and workflows cause most of them to use only its simplest dispensing reports in then chasing down problems via manual workflows. Kit Check’s Bluesight for Controlled Substances holds promise based on early adopter reports.

Other

The URL of Sonoma Valley Hospital (CA) is “maliciously acquired,” forcing the hospital to change its prized three-letter domain name of “svh.com” to “sonomavalleyhospital.org.” The hospital’s URL registration was good through late 2021, but someone updated it using credentials from an unknown source to take control, which an expert contacted by the local paper says is nearly impossible to reverse. I checked the Whois for the URL and it’s now running on China-based servers with “registrar lock” turned on. I thought it was straightforward to contact the web registrar or ICANN with proof of ownership to get the transfer reversed, but regardless, hospitals should:

• Use complex passwords for their domain service’s website.
• Change the registration address if it points to the same domain since otherwise you’ll lose the ability to be contacted if someone grabs that URL.
• Turn on the “registrar lock” option of your domain service so it can’t be transferred.

A fired VA hospital chief pathologist is charged with three counts of involuntary manslaughter after a review of his needle biopsy cases showed a misdiagnosis rate of 10%, 10 times the expected rate. The VA says he was responsible for at least 15 deaths and an unknown number of incorrect diagnoses. Colleagues had complained of his erratic behavior for years, but the VA let him continue working while he underwent drug and alcohol rehab, finally firing him in 2018 after a DUI arrest.

Kaiser Health News covers the plight of several “no-stoplight” rural towns that believed Miami entrepreneur Jorge Perez, who promised to save their tiny local hospitals but instead used them in a massive insurance fraud scheme that took advantage of higher lab billing rates for rural hospitals. A 14-bed hospital cranked out bills for $120 million in just six months, of which $80 million went to the hospital’s new owner and little to the hospital, as employees reported running out food, cleaning supplies, and IV fluids, with patients in one of them displaced because their hospital beds were repossessed while they were still occupying them. When insurers eventually stopped paying, 12 of the hospitals filed bankruptcy and eight closed. Perez paid $3.5 million to settle the the DoJ’s false claims charges and says he’ll now focus on his software businesses.

Sponsor Updates

• Hackensack Meridian Health Jersey Shore University Medical Center reduces stroke-related readmissions by 50% after implementing Vocera Care Inform to provide personalized audio discharge instructions and educational materials.
• Healthfinch announces several new customers of its Epic-integrated Charlie Practice Automation Platform and its exhibit at Epic’s UGM next week.
• Aprima will host its 2019 User Conference August 23-25 in Grapevine, TX.
• Artifact Health publishes a new case study describing how its mobile physician query tool helps Western Maryland Health System accurately code episodes of care in a quality-based reimbursement program.
• Burwood Group is raising money for the Boys & Girls Club of Greater San Diego.
• Wolters Kluwer Health releases six new Audio Digest Topical Collections for CME.
• CoverMyMeds and Culbert Healthcare Solutions will exhibit at Epic’s UGM August 26-29 in Verona, WI.

Blog Posts

• Healthcare ERP System Selection (Optimum Healthcare IT)
• Receive a well-rounded educational experience at Evo19 (AdvancedMD)
• 5 years ago, Mayo Clinic made 3 huge bets. Are they paying off? (Advisory Board)
• How Are IT Risks Different For A Company That Handles Protected Health Information? (Fortified Health Security)
• How do you build, deploy and maintain an imaging data management strategy? #The Imaging Data Management Strategy Series (Agfa Healthcare)
• More Than Medicine: Southcoast Health Raises the Bar with Avaya (Avaya)
• Collective Medical Stands by ACEP’s Efforts to Make EDs Safer (Collective Medical)
• Updates from Our 2018 CoverMyQuest Winners: Part 2 (CoverMyMeds)

Contacts

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

Morning Headlines 8/20/19

US healthcare BPO may be valued at $225 million: PE firms in race to acquire emids Technologies

Several investment firms, including Everstone Capital and ChrysCapital Advisors, are in talks to buy Nashville-based health IT vendor Emids Technologies for between $200 million and $225 million.

athenahealth Appoints Simon Mouyal as Chief Marketing Officer

Simon Mouyal (Medidata Solutions) joins Athenahealth as chief marketing officer.

Two Chairs raises $21M to continue to build out its mental health clinics

Mental healthcare company Two Chairs will use a $21 million Series B funding round to expand its clinic footprint in California, and improve and expand upon its patient/provider matching technology.

Curbside Consult with Dr. Jayne 8/19/19

I wrote back in 2017 about the All of Us research program, sponsored by the National Institutes of Health. Originally they were trying to build a cohort of 1 million patients to help them look at genomic, clinical, and lifestyle data over a 10-year period. The New England Journal of Medicine recently published an update on the program’s progress.

Following the original beta program that I wrote about, All of Us opened for general enrollment in May 2018. Elements of the program include health questionnaires, EHR data, physical measurements, and the collection of biospecimens.

As of last month, more than 175,000 participants had contributed biospecimens, with more than 80% of those participants being from “groups that have been historically underrepresented in biomedical research. That’s a pretty big deal, since it’s difficult to recruit research subjects from certain subsets of our population. They’ve also collected EHR data on more than 112,000 participants from 34 recruitment sites. Should the researchers meet their goals, the robust nature of the data would allow researchers to explore factors related to individual lifestyle differences, socioeconomic factors, environment, and biology in order to better understand how we can prevent, diagnose, and treat diseases.

Having historically underrepresented patients join the program is great since those populations often have inadequate access to healthcare. Although some conditions can be linked to race and ethnicity, they’re only pieces of the puzzle. Other factors influencing health include age, sex, gender identity, sexual orientation, disability status, access to healthcare resources, income, educational level, ZIP code, and more. Researchers are prioritizing those underrepresented populations for physical measurements and biospecimen collection.

Unlike other data-gathering programs, All of Us doesn’t focus on any particular set of diseases like cardiovascular conditions or cancers. It seeks to create a broad data set that can be used for a variety of investigations, including outcomes research. Although they’re currently only enrolling adults with the ability to participate in an informed consent process, they’re looking at protocols for enrolling minors as well as adults who might be cognitively impaired. The materials are only available in English and Spanish, so it’s not a true cross section of the population, but the program is moving in the right direction.

The program has launched a web-based data browser where you can search concepts for some of the conditions and statuses being tracked. Although patients can only see their biometrics and survey responses, the researchers are working to build protocols to share genetic, laboratory, and EHR data back to participants. Priority will be given for actionable genetic information and pharmacogenetic results, delivered to those patients who have elected to receive that information.

Since the database is intended to be longitudinal, it will be interesting to see how many patients continue to participate over time. Since its inception, Congress has allocated $1.02 billion to the program, including funding for genome sequencing and setup of genetic counseling resources for participants receiving actionable results. The 21st Century Cures Act authorized funding through 2026 in the amount of $1.14 billion.

Another element that they’re still trying to work out is the incorporation of wearables data. Patients can share data gathered from Fitbit devices and investigators are looking at collection of data from other sources. Given the number and diversity of devices out there, they would need to support quite a few platforms to be able to get a good sampling. My extended family’s affinity for devices ranges from Garmin to Fitbit to Apple. Even with concerns about the validity of data from wearables, it’s interesting to note that simply having a wearable health tracker of any kind says something about a patient’s socioeconomic status and awareness of health issues.

One of the challenges noted by the authors is the incomplete nature of some of the EHR data, along with variability in that data. They are working to harmonize the data that they bring in from EHRs at recruiting institutions and are discussing ways to incorporate data from patients receiving care in rural settings. Health Information Exchanges might be another data source for those patients.

A quick tour through the online data browser illustrates some of the challenges of managing the data. The concept of diabetes can be rendered as the presence of disease, as a factor leading to adjustment of other lab values, and as a status identifier. There are also issues with EHR data in that it’s not always going to be complete enough to have the statistical power that you might find with data collected as part of a prospective trial. Still, it’s better than some of the current options, and I’m eager to see how things develop.

The biggest challenge they’ll have to face, however, is recruiting the more than 800,000 patients they still need to create their target population. It’s likely that in the early days of the program enthusiasm and awareness were high, resulting in the enrollments they already have. They’re going to have to stay on pace at the recruiting centers they already have up and running or dramatically expand the number of locations that can assist in the recruiting process.

Another option is to expand what they call direct volunteers, which are patients who come to the program from outside the designated recruiting centers. Reaching those folks who might be in rural areas or who just don’t come into care and are therefore less likely to be recruited requires different kinds of efforts. I haven’t personally heard anything about the program except from healthcare IT sources, and I’m constantly in and out of medical centers across the country. I’ve seen more signage about Ebola virus than I’ve seen about the program.

Given the size and breadth of our reader base, I’m hoping someone has first-hand experience with All of Us, either as a researcher or as part of one of the recruiting institutions. What has your experience been? How enthusiastic is the team? What can the rest of the healthcare community to do help you meet that million patient goal? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 8/19/19

Starboard Value shrinks stake in Cerner

Activist investor Starboard Value, which scared Cerner into giving it board seats in a “cooperation agreement” in April 2019, has sold CERN shares as the price moves up.

Cape Cod Healthcare to build $180M patient tower on Hyannis Harbor

Cape Cod Healthcare will build a $180 million patient tower in Hyannis and will implement Epic.

The Patient Record Scorecard: What is it and Why we did it.

Consumer health data platform vendor Ciitizen rates hospitals on how well they respond to patient requests for copies of their own information.

Monday Morning Update 8/19/19

Top News

Consumer health data platform vendor Ciitizen rates hospitals on how well they respond to patient requests for copies of their own information.

It’s an interesting idea that isn’t well fleshed out in this initial effort due to a tiny, possibly non-representative sample size and reliance on self-reported hospital policies that were collected via a survey.

This limited information, along with anecdotal stories (such as my own), don’t paint a true picture. I would rather see the federal government (via HHS / CMS / ONC) provide a mandatory records request portal that requires the hospital to log its eventual actions (with timestamps) and allows patients to add comments or complaints. That bypasses the problem in trying to educate masses of consumers about the legal obligations of providers and how to file a complaint when they aren’t met.

Otherwise, hospitals seem happy with their contrived system of paper forms, in-person HIM department visits, faxed copies, and high fees since they don’t really want to share the data of patients anyway due to competitive and malpractice concerns.

Reader Comments

From ApplestoApples: “Re: JAMA article on Apple Health Records. It’s Apple-only and the highlighted use of FHIR is irrelevant. The next report should cover providers that offer a published mechanism for any vendor who wants to be a member, given the article’s prediction of an eventual ‘ecosystem’ (that number would be zero right now). Even better, how about limiting it to those providers who make the full EHR record of the patient available as HIPAA requires? Until the right to access records is not just the law and the subject of toothless Office for Civil Rights letters, HHS infographics and YouTube videos but also enforced, FHIR doesn’t matter. But definitely cool that JAMA gave us some pretty underwhelming Apple Health adoption data.” Agreed on all counts. The industry whines about proprietary solutions, then embraces the most proprietary technology vendor in touting Apple-only patient access to a tiny subset of their own Epic-only records (IOS represents less than half the US mobile device market). The article reports that only 0.7% of the patient portal users of the studied health systems have used Apple Health Records. It did not attempt to quantify any outcomes that resulted or the extent of ongoing patient use and for what purposes. I agree that health systems, including the Apple-partnering ones, make it difficult for patients to obtain electronic or paper copies of their complete medical records and HHS does nothing to make them comply with federal regulations.

HIStalk Announcements and Requests

Most poll respondents found at least some forms of technology useful in their most recent provider visit, with the patient portal topping the list and the virtual visit bottoming it. I get the sense that few of us place a lot of value on the IT aspects of our provider encounters, while my previous poll results suggest that even fewer of us – even among my healthcare IT-centric readership who obsess over “Most Wired” type self-stroking awards — choose providers based on the technologies they use or even care one way or another.

New poll to your right or here: How proud are you of the largest healthcare system near you in terms of patient outcomes, community benefit, and financial practices? Click the Comments link after voting to explain.

Webinars

September 5 (Thursday) 2:00 ET. “Driving 90% Patient Adoption Across Your Network: How US Dermatology Partners is Showing Us The Way.” Sponsor: Relatient. Presenters: Michele Perry, CEO, Relatient; Sara Nguyen, VP of applications and integrations, US Dermatology Partners. US Dermatology Partners is helping its physicians reclaim time they can spend with patients and is turning patient engagement strategies into business results across its 90 locations in eight states. Attendees will learn how US Dermatology Partners defined its patient engagement objectives and physician-optimized strategies. They presenters will provide advice on starting or accelerating  patient engagement goals.

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

Acquisitions, Funding, Business, and Stock

Activist investor Starboard Value, which scared Cerner into giving it board seats in a “cooperation agreement” in April 2019, has sold CERN shares as the price moves up.

Sales

• Nebraska Health Information Initiative chooses InterSystems HealthShare for provider data-sharing.

Announcements and Implementations

Cape Cod Healthcare will build a $180 million patient tower in Hyannis and will implement Epic. Its most recent tax filings show a profit of $48 million on revenue of $871 million, with the CEO earning $1.6 million and the CIO $367K. I believe Cape Cod Hospital was an original Meditech site going back to the late 1960s, then switched to Siemens / Cerner Soarian in 2010.

Other

Sources report that informatics pioneer Donald Lindberg, MD has passed away. He was a pathologist, former director of of the National Library of Medicine, and the first president of AMIA, having focused on informatics since 1960. He was 85.

The New York Times profiles the thousands of outsourced workers who sit in cubicles India all day marking up medical images to train AI systems. It observes that the systems they are training may eventually reduce human employment, but in the mean time have created jobs that range from decent to exploitative. One woman’s entire workday was spent listening to recordings of people coughing to help train a diagnostic system. 

A commercial construction magazine previews “smart hospitals” that include such technology such as heart attack alerts that are triggered by patient alarms that then call the care team members, detect their locations, and then override elevator settings to get them to the patient’s room quickly. Engineering firms are also looking at ways to incorporate smart speakers.

A Nature op-ed piece says that the AI algorithms touted in research articles aren’t really usable by providers because: (a) they don’t change the incentives that led to optimizing processes for the current state; and (b) individual providers don’t have the technology and expertise to train the algorithms for local conditions and to test for bias. The authors draw a comparison with EHR “data liberation,” which sounds great but doesn’t happen because entrenched players are rewarded by the status quo. It concludes,

Health systems are faced with a choice: to significantly downgrade the enthusiasm regarding the potential of AI in everyday clinical practice, or to resolve issues of data ownership and trust and invest in the data infrastructure to realize it … the opportunity exists to both transform population health and realize the potential of AI, if governments are willing to foster a productive resolution to issues of ownership of healthcare data through a process that necessarily transcends election cycles and overcomes or co-opts the vested interests that maintain the status quo—a tall order. Without this however, opportunities for AI in healthcare will remain just that—opportunities.

An NHS hospital in Scotland apologizes to 400 patients whose discharge letter incorrectly indicated that they have cancer, an error the hospital blames on a computer system switchover.

Vermont State Rep. Ben Jickling resigns his seat (and his golf course day job) in accepting a job offer from Epic. The 24-year-old doesn’t appear to fit the usual Epic profile since he didn’t graduate from the small liberal arts college he attended.

Non-programmers won’t get this: a security researcher who bought a vanity license plate of “NULL” in trying to avoid getting traffic tickets by confusing California’s DMV system gets the opposite result – he has racked up $12,000 in tickets that were intended for other drivers whose tag number was accidentally omitted by the citing officer. The state’s ticketing subcontractor will cancel his individual tickets only if he can’t prove he wasn’t involved, potentially preventing him from renewing his registration. A Wired journalist named Christopher Null says he could have told the man that using the word “null” in any form is asking for problems because poorly tested programming often mishandles it.

A woman who boiled eggs in the microwave as instructed by YouTube videos is rushed to a hospital burn unit when the eggs explode upon removal, causing skin and eye damage that doctors worry could be permanent.

Sponsor Updates

• Waystar donates over 100 used laptops to families in the Louisville area to help support tech education in underserved neighborhoods.
• NextGate will exhibit at the 2019 SHIEC Conference August 18-21 in National Harbor, MD.
• Netsmart will exhibit at the Florida Behavioral Health Conference August 21-23 in Orlando.
• Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the 6th Annual OBGYN Conference for Nurses and Physicians August 22-23 in Chattanooga, TN.
• Diameter Health will exhibit at the SHIEC conference August 18-21 at National Harbor, MD.
• Relatient expands its offerings in the Greenway Marketplace to include patient self-scheduling, patient intake, online payments, visit surveys, and two-way messaging.
• Nordic posts a podcast titled “How to drive efficiencies between your ERP and EHR in OR and beyond.”
• Surescripts will exhibit at the 2019 Aprima User Conference August 23-25 in Grapevine, TX.
• TriNetX will exhibit at the International Conference on Pharmacoepidemiology & Therapeutic Risk Management August 24-28 in Philadelphia.

Blog Posts

• The Secrets of Great Telehealth Quality (MDLive)
• How to improve discharge procedures for homeless patients (Meditech)
• Evolving CMS Quality Measures Move Towards More Patient-Centered Care, Less Burden for Clinicians (Health Catalyst)
• 5 Things to Look Forward to at MHUG 2019 (Mobile Heartbeat)
• 2020 Medicare Proposed Changes for PTA and OTA Billing, Modifiers, and Reimbursements (MWTherapy)
• An Eye in the Sky for Social Determinants of Health, Part 1 of 3 (Omni-HealthData)
• The Growing Importance of RCM (EClinicalWorks)
• 3 ways to use social determinants of health data for better care management (Experian Health)
• What is Patient Empowerment & How Does It Impact Health Outcomes? (PatientBond)
• Piedmont’s VP of Experience on Personalized Patient Care (Patientco)
• Did EHRs Light the Physician Burnout Fuse? (PatientKeeper)
• Healthcare IT: Facing the Staffing Crisis through an Alternative Approach (Fortified Health Security)
• Top Considerations for a Meditech Implementation (Santa Rosa Consulting)
• When Paperwork Comes Before Patients: Missing Key Information Complicates Specialty Prescribing (Surescripts)
• The 2020 Proposed Rule: Bite-Sized Edition (WebPT)

Contacts

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

Morning Headlines 8/16/19

Nurx Secures $52 Million to Expand Access to Sensitive Health Needs

Contraceptive and at-home STI testing telemedicine company Nurx raises $52 million in a Series C round led by Kleiner Perkins Digital Growth Fund and Union Square Ventures.

Accenture Federal Services Wins U.S. Navy Bureau of Medicine and Surgery Contract to Help Transform Healthcare Delivery for Sailors, Marines and their Families

Navy Medicine awards Accenture a $79 million contract for program and project management support for EHR optimization and health informatics, virtual health, and AI initiatives.

Computer blunder forces Queensland hospitals back to paper records

A handful of Queensland Health hospitals in Australia revert to paper for several hours after a routine overnight update to the state’s beleaguered IEMR system goes awry, making the medical records of male patients inaccessible.

News 8/16/19

Top News

Navy Medicine awards Accenture a five-year, $79 million contract for program and project management support for EHR optimization and health informatics, virtual health, and AI initiatives.

Webinars

September 5 (Thursday) 2:00 ET. “Driving 90% Patient Adoption Across Your Network: How US Dermatology Partners is Showing Us The Way.” Sponsor: Relatient. Presenters: Michele Perry, CEO, Relatient; Sara Nguyen, VP of applications and integrations, US Dermatology Partners. US Dermatology Partners is helping its physicians reclaim time they can spend with patients and is turning patient engagement strategies into business results across its 90 locations in eight states. Attendees will learn how US Dermatology Partners defined its patient engagement objectives and physician-optimized strategies. They presenters will provide advice on starting or accelerating  patient engagement goals.

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

Acquisitions, Funding, Business, and Stock

Ambrosia founder Jesse Karmazin says the anti-aging blood transfusion business has shut down for good. The company, which pitched transfusions of “young” blood to older people for $8,000 a liter, shut down for a few months earlier this year after receiving a warning letter from the FDA. Karmazin managed to get operations back up and running in two states, and now says he has started a new company called Ivy Plasma, which will offer transfusions from people of all ages.

Sales

• Providence Health & Services (OR) will implement the Loopback Rx Platform from Loopback Analytics at its Credena Health pharmacy.
• Quorom Health (TN) will implement Medhost’s clinical and financial software at 25 hospitals over the next 20 months.
• HIEs OneHealthPort (WA) and Healthcare Access San Antonio select health data integration software from Diameter Health.

Announcements and Implementations

St. Claire HealthCare implements emergency department information exchange software from Collective Medical through a partnership with the Kentucky Hospital Association first announced last December.

Florida’s E-FORCSE PDMP uses technology from Appriss Health and Express Scripts to connect to the Military Health System PDMP, which now shares data and analytics with 39 state-based PDMPs.

The People-Centered Research Foundation will use data de-identification services from Datavant to securely link patient data across its National Patient-Centered Clinical Research Network. Organized with funding from the Patient-Centered Outcomes Research Institute, the network comprises 70 provider and payer organizations that share data for research purposes. Datavant added de-identification capabilities to its health data management services when it acquired Universal Patient Key last year alongside a $40 million funding round.

A new KLAS report covers payer care management, a term it uses to encompasses utilization management, disease management, case management, care coordination, and member engagement. ZeOmega and Cognizant are most often considered in new decisions, but VirtualHealth and AssureCare are making inroads as newer market entrants. Medecision is the vendor most often mentioned as potentially being replaced, while Casenet leads in overall satisfaction but is trending down due to missed expectations. 

Privacy and Security

Intraprise Health develops BluePrint Protect security software to help enterprises with third-party risk management.

Other

A handful of Queensland Health hospitals in Australia revert to paper for several hours after a routine overnight update to the state’s beleaguered IEMR system goes awry, making the medical records of male patients inaccessible. Hospital staff attributed the glitch to a later-than-normal start time.

Developers of the Anura app claim its machine learning technology can accurately assess a user’s heart rate, stress level, body mass index, blood pressure, and risk for heart disease and attack from a 30-second selfie using transdermal optical imaging. Research published last week in an American Heart Association journal found that the app could measure blood pressure accurately 96% of the time.

Sponsor Updates

• Elsevier Clinical Solutions will exhibit at NACDS TSE 2019 August 24-26 in Boston.
• EClinicalWorks will exhibit at the East Hawaii IPA Annual Healthcare Symposium August 16-18 in Waimea.
• Ellkay, Imat Solutions, and InterSystems will exhibit at the 2019 SHIEC Conference August 18-21 in National Harbor, MD.
• Ensocare will exhibit at the ACMA Florida Chapter Annual Conference August 22-23 in Championsgate, FL.
• Hayes Management Consulting names Craig Surette (Athenahealth) senior solutions engineer and William Heuschneider (Athenahealth) client success manager.
• HCTec Marketing and Sales Operations VP Rob Borella joins the Tennessee HIMSS board.
• Imprivata makes Identity Governance available to customers working with Microsoft Azure Active Directory.
• Nordic releases a new podcast, “How to drive efficiencies between your ERP and EHR in OR and beyond.”

Blog Posts

• Dawn of the Age of Population Health (EClinicalWorks)
• Can You Find and Secure the Sensitive Information in Your Organization’s Network Infrastructure? (Fortified Health Security)
• The expanding role of the EHR in the opioid battle (Greenway Health)
• Why an EHR Alone Isn’t Going to Make Population Health Possible (The HCI Group)
• Why Social Media in Healthcare is Important (Optimum Healthcare IT)
• After the Fever Pitch, Prevent the “Helpless” Desk (HCTec)
• Is Remote Staffing Right for your Prescription Renewal Center? (Healthfinch)
• The Value of Using the Right Health Education Videos (Healthwise)
• 3 considerations for multifactor authentication in healthcare (Imprivata)
• The Interoperability Directive: What the Proposed ONC and CMS Regulations Mean – Part 3 (InterSystems)
• Keynote Spotlight: Former CEO of Cleveland Clinic Shares How to Expand the Boundaries of Healthcare (Kyruus)

Contacts

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

EPtalk by Dr. Jayne 8/15/19

EHR vendors, get ready to make some updates: The US Preventive Services Task Force (USPSTF) plans to recommend screening all adults for illicit drug use, including inappropriate use of prescription drugs. The draft recommendation statement is open for public comment through September 9. As an EHR client, we expect these kinds of recommendations to play out in our EHR as soon as they’re published, but for many vendors it’s a long road between when a recommendation is issued or a guideline is updated and when it actually is in the hands of the majority of their clients. I’d be interested to hear from vendors how they approach these types of updates and how quickly they can get them to the point of care.

Speaking of recommendations and regulations that never become reality, here comes yet another delay for implementation of the Appropriate Use Criteria for advanced diagnostic imaging that was initially passed in 2014. NPR reports that the delay will continue, with 2020 as a “testing” year where Medicare will not block inappropriate scans. CMS won’t make a decision until 2022 or 2023 on whether (and when) penalties will begin. The reality is that Medicare and other payers continue to pay for unneeded diagnostic exams. These exams are often ordered because patients demand them, even though they show low clinical utility. Physicians increasingly worrying about being “dinged” on patient satisfaction scores that go along with it, often under duress. Advanced imaging services are a profit center for many medical institutions and physicians chafed at the idea that they’d have to log additional keystrokes in the EHR to document compliance with the criteria.

A friend of mine who used to work in corporate IT has recently moved into the world of healthcare IT. I’ve been enjoying his reactions as he learns about all the crazy stuff that we have to deal with, including managing claims, handling capitation payments, and more. He recently visited a practice that was processing data using stacks of papers to trigger the workflow and track who was doing the work. I’m thinking about prescribing him some muscle relaxers to counteract the ill effects of all the head shaking he’s probably doing. It’s always amusing, but sad in many ways, to watch someone experience the dirty underbelly of healthcare. It’s a mix of shock, disbelief, and outrage. Those are the same emotions I’m feeling while I read “Code Blue: Inside America’s Medical Industrial Complex” by Mike Magee. I had started it prior to my international medical adventures and resumed the read after hearing from my fellow volunteers. Hearing from them about how healthcare is delivered with lower cost and higher quality in their countries just makes my blood pressure rise. I sold any stock in EHR vendors long ago, but will be divesting some remaining pharma investments shortly. Shareholders are part of the problem, not the solution.

Corporate profiteering is everywhere, and I experienced it in another conversation today. One of my residency colleagues went to work last year for a group that does Direct Primary Care as an employee benefit. She’s been enjoying the work, especially the part where she has an hour for new patient visits and 30 minutes for regular visits, and feels like she actually has time to partner with her patients to improve their health. She wanted me to know that her company is expanding to my area and to see if I was interested in a referral to their recruiter. Since that’s a major aspect of primary care that I miss in my current clinical practice, I said I was game.

She proceeded to tell me a little more about the company, including that they were recently purchased by a PE firm and that there has been the addition of a good number of VPs that don’t seem to do anything but have titles in sales, marketing, and operations. That’s part of why and how they’re expanding; the PE money is an infusion but also increases the need to create some revenue from the system. Although their profit is largely driven by the difference between what the employers pay and the services the patients use, she agrees it’s only a matter of time before the nature of the practice changes. For providers in the trenches, though, it’s a difficult balance between practice paradigms that have good elements but some features that are unsettling. Her final thought was that it’s still better than the HMO she used to work for, so I guess there’s that.

I’ve always wanted to visit Spain, and I wish I was still doing a reasonable volume of lab work so I would have justification to attend the upcoming LOINC Conference outside of Barcelona. Both the Laboratory and Clinical LOINC Committees will be at the same meeting for the first time, and the conference fee is low compared to other organizations. For those of you heading to the sun-drenched Mediterranean, enjoy!

The next couple of months are full of meetings and functions. ONC is hosting an interoperability forum  August 21-22 that has a good-looking agenda, but there are too many parallel tracks – I wouldn’t be able to pick just one to attend. There’s also a symposium on September 6 around patient matching for prescription drug monitoring programs. This also starts the User Group meeting season, beginning with the Aprima User Conference from August 22-25 in the Dallas area. I hear that’s a fun one, but have never been able to make it work with my schedule.

New Hampshire becomes the latest state to expand telehealth services, with Governor Chris Sununu signing a bill expanding the scope of services covered under Medicaid. Previous regulations limited telehealth services to specialists, but the new law mandates coverage for virtual primary care, remote patient monitoring, and substance abuse disorder treatment as long as the patient has already established care face-to-face. The definition for “originating sites” for those face-to-face services has been expanded from medical offices to include “the patient’s home or another nonmedical environment such as a school-based health center, a university-based health center, or the patient’s workplace.” It’s not as expansive as providers might like, but it definitely helps the state move forward. The law also creates definitions around asynchronous telehealth for non-urgent issues, which will help provide services when video visits might not be realistic.

I skim a lot of journals and publications, but have to admit I wasn’t aware of the Renal & Urology News before a reader sent me this snippet: A recent study looked at referral patterns at Wake Forest School of Medicine and found that patients with rare genetic conditions might be more likely to refer themselves to an academic medical center based on information they find on the Internet. The authors noted that primary care physicians might not be aware of certain rare conditions, so “If patients suspect a rare disorder that is undiagnosed by their physicians, actively pursuing self-diagnosis using the Internet can be successful.” Dr. Google, take note.

Email Dr. Jayne.

Morning Headlines 8/15/19

Grays Harbor Community Hospital Provides Notice of Recent Ransomware Attack

Grays Harbor Community Hospital and Harbor Medical Group in Washington confirm that a ransomware attack caused their downtime in June.

The founder of a startup that charged $8,000 to fill your veins with young blood says he’s shuttering the company and starting a new one

Controversial blood transfusion startup Ambrosia shuts down for good after receiving an FDA warning that prompted it to close its operations in all but three states earlier this year.

Ancestry’s CEO signals a major healthcare play is on the horizon

Genealogy and consumer DNA testing company Ancestry is actively building out its health team as it prepares to move into precision medicine.

Morning Headlines 8/14/19

Mercy’s Tech Arm Launches a Nationwide Real-World Evidence Network to Pool Clinical Data for Advanced Analysis

Mercy Technology Services launches a real-world evidence database in which de-identified data from a consortium of health systems will be sold to drug and medical device manufacturers.

Microsoft welcomes new Chief Medical Officer Dr. David Rhew

David Rhew, MD (Samsung Electronics) joins Microsoft as chief medical officer/VP of healthcare.

Q-State Biosciences and 2bPrecise Announce Partnership

Allscripts backs a partnership that will combine the precision medicine data tools of 2bPrecise (in which Allscripts is the primary investor) with those of genetic sequencing vendor Q-State Biosciences.

News 8/14/19

Top News

Mercy Technology Services launches a SAP-powered real-world evidence database called Real-World Evidence Insights Network in which de-identified data from a consortium of health systems will be sold to drug and medical device manufacturers.

Providers will be paid each time the data of their patients is accessed by a subscriber’s query. They can also use the analytics-generated evidence to help make their own business and clinical decisions.

The network will initially focus on orthopedics, cardiology, and oncology.

MTS notes that the SAP HANA database – which took 10 years to create – uses natural language processing to extract information from physician notes to provide deeper clinical intelligence.

Mercy previously announced three medical device manufacturers as customers of its own patient database – Johnson & Johnson Medical Devices, Medtronic, and BD.

Reader Comments

From I Was There: “Re: Vince Ciotti’s HIS-tory. I see quite a few inaccuracies that might only be noticed by those of us long-timers who have moved on.” Vince covered a massive amount of HIT ground going back five decades, so he has always solicited corrections and clarifications from those whose personal experience gives them a sharper memory into long-faded details. I’m sure he would still enjoy hearing from anyone who notices mistakes or can add their own interesting stories. Email him at vciotti@hispros.com and we will append your new information. Many of the industry’s pioneers from the 1970s and 1980s have retired, left the industry, or in some cases, passed away, so this is the last best hope to get the history nailed down for posterity.

From No See-Ums: “Re: paywalled newspaper and journal articles. Your links to them are frustrating since I can’t read them.” I link to paywalled articles only if I can find a reliable summary or abstract posted elsewhere since I can’t see them, either. I’m unwilling to pay for a subscription to a local or specialized publication that I would rarely use, which always leads me to conclude that someone should either sell a mass subscription or charge a low national price for reading just one article (vs. the high price that medical journals charge). The danger of ITunes-like news is, of course, that it would encourage the same bad practices for journalism as it did for music, unleashing a flood of clickbait and populist drivel. Craigslist,  Facebook, and vulture capital firms helped kill dead tree publishers, but their biggest problem is the lack of ongoing demand for intelligent, accurate news reporting. 

From Post-Acute Pat: “Re: post-acute healthcare market. I’ve been reading your site since 2010 and your blurb about hospice /nursing homes and Gordon Gekko was spot on. I don’t think the average person understands how private equity has gobbled up the entire post-acute market and none of them care about the patient or HCAHPS. I work for a huge, PE-owned home care and hospice provider that keeps merging with other PE-owned companies. See the attached email from our CEO, which came out right after we had massive layoffs, raises were cancelled, 401K match was eliminated, and hospice services such as music and physical therapy were eliminated and telehealth was greatly reduced to meet only payer contract minimums. Our PE owners require a 10% annual return and anyone who says that isn’t possible are shown the door.” The RN CEO urges his underlings to focus on revenue generation, earnings, and cash collections. That’s not unlike his non-profit health system peers, however. All of us pretend that when we need care, it’s going to be like in those golden, pre-Medicare years in which healthcare was run by empathetic locals who felt a calling to alleviate the suffering of their fellow citizens under a self-imposed honor system in which hospitals were modestly-run charities. Now it’s all about profits, cash hoarded to buy up (and screw up) competitors, or construction companies called in to soothe the organizational Edifice Complex with phallic towers. Odds are good that the first and last people you’ll see in your life are employees of profit-obsessed organizations. In between, you will be bounced around profit-maximizing health systems, clinics, insurers, drugstores, drug and device manufacturers, and ambulance services until either your health or your health insurance runs out. Then it’s off to PE-owned nursing home, hospice, home health, or rehab until finally your cooling corpse is trucked off to a PE-owned funeral home. Some or most of the frontline people will serve as a credit to their chosen profession and calling, sometimes defiantly treating patients in do-unto-others mode instead of how the corporate whip-crackers demand. Unfortunately, faceless money-lenders impact our life as Americans a lot more than we realize.  

Webinars

September 5 (Thursday) 2:00 ET. “Driving 90% Patient Adoption Across Your Network: How US Dermatology Partners is Showing Us The Way.” Sponsor: Relatient. Presenters: Michele Perry, CEO, Relatient; Sara Nguyen, VP of applications and integrations, US Dermatology Partners. US Dermatology Partners is helping its physicians reclaim time they can spend with patients and is turning patient engagement strategies into business results across its 90 locations in eight states. Attendees will learn how US Dermatology Partners defined its patient engagement objectives and physician-optimized strategies. They presenters will provide advice on starting or accelerating  patient engagement goals.

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

Acquisitions, Funding, Business, and Stock

Allscripts backs a partnership that will combine the precision medicine data tools of 2bPrecise (in which Allscripts is the primary investor) with those of genetic sequencing vendor Q-State Biosciences. Q-State co-founder and board chair David Margulies, MD was the first CIO at Boston Children’s Hospital in the late 1980s and served as a Cerner executive from 1990 to 1996. 2bPrecise leadership is mostly folks from the Allscripts-acquired DbMotion. MDRX shares dropped in an up market following the news.

Point-of-care pharma promotional platform vendor OptimizeRx reports Q2 results: revenue up 37%, adjusted EPS $0.09 vs. $0.07. The company said in the earnings call that it has integrated with Epic and Cerner to present in-workflow patient savings opportunities, broadening its EHR reach following a previous agreement and integration with NextGen Healthcare.  

Business Insider reports that consumer DNA testing and family history company Ancestry will follow the lead of competitor 23andMe in offering genomics and individualized medicine products.

Performance-based collaboration platform vendor Apervita acquires Qcentive, which offers technology to support value-based contracting and payments.

Specialty-specific EHR/PM vendor Compulink acquires contact lens ordering site MyEyeStore, which optometrists and ophthalmologists can use to sell other retail products.  

People

Struggling drugstore chain Rite Aid hires as its new CEO Heyward Donigan, who was previously CEO of healthcare shopping app vendor Sapphire Digital, formerly known as Vitals. RAD shares dropped 5.3% Tuesday after the announcement, down 77% in the past year vs. the Nasdaq’s 2.6% gain, valuing the company at $357 million.

David Rhew, MD (Samsung Electronics) joins Microsoft as chief medical officer/VP of healthcare. 

Announcements and Implementations

England’s Basildon Hospital rolls out Maternity Direct, a chat application that connects pregnant women with an NHS registered midwife who can answer questions and offer advice at no charge. Basildon and Thurrock University Hospitals NHS Foundation Trust developed the app along with software developer Acadiant.

A new KLAS report on enterprise-level medication inventory management (MIM) finds that Omnicell’s optimization analytics solution leads the pack, although it has been implemented by only a few customers due to cost, the breadth of underlying Omnicell products that is required, and Omnicell’s need to educate prospects on the goals of MIM and how it is supported by the company’s IV room and robotic dispensing systems. Problems with newer versions of Omnicell’s automated dispensing cabinets have also led to customer wariness. KLAS says Epic’s Willow Inventory MIM isn’t used much because of limited reporting and par management capabilities that force customers to use the inventory systems of their equipment vendor. Cerner customers “have primarily been left to drive development themselves” and the company hasn’t integrated its own RxStation dispensing cabinet with its MIM software.

Clinical Architecture releases Pivot, a turnkey data interoperability and data quality solution that processes inbound messages (in FHIR, CDA/C-CDA, HL7, and customer formats); applies Symedical normalization NLP, and clinical reasoning; and then delivers an outbound message that meets the requirements of the receiving system.

CHI Franciscan Health opens the analytics-powered Mission Control Center in its clinic in Gig Harbor, WA, from which the health system will monitor patient care and capacity in eight of its hospitals. GE Healthcare is the health system’s partner on the project.

Government and Politics

CompuGroup Medical lauds the ruling of a federal appeals court in favor of the American Clinical Laboratory Association, which sued HHS in claiming that its implementation of the Protecting Access to Medicare Act (PAMA) oversteps its authority in collecting market-based lab data to set Medicare payments. ACLA says HHS’s exclusion of hospital labs via a change to the “majority of revenues” test will skew its market studies. The case will go back to the district court.

Other

A Stanford School of Medicine study finds that privately insured patients are billed out-of-network charges in 43% of ED visits, 42% of inpatient admissions, and 86% of ambulance rides. Admitted inpatients faced a median surprise bill of $2,040, well beyond the financial resources of most of them. The study looked at claims data through 2016, so It’s probably reasonable to assume that the situation has worsened since. It’s interesting that more than 900 hospitals issued surprise bills for more than 90% of their ED visits, which one might speculate is an intentionally hospital-designed feature rather than a bug.

A newspaper’s investigation finds that Tennessee’s health department knew that Nurse Practitioner Jeffrey Young, who calls himself “Rock Doc,” was working without a doctor’s supervision, writing high numbers of opioid prescriptions, and having sex with patients that was described as “non-consensual,” but they didn’t shut him down during a four-year investigation. The state’s lead investigator admitted that she started carrying a gun to work after questioning Young about a patient’s overdose death. A follow-up article promises to disclose that Young was providing prescriptions to local police officers in return for favors. Young has been indicted by the federal government for prescribing 1.4 million opioid pills and 1,500 fentanyl patches in three years, after which a drug company sales buddy texted a death threat to the DEA’s lead investigator. “Rock Doc” also starred in a failed reality TV show pilot called “Rock Doc TV,” in which he kinds of looks like talentless but likeable TV food hack Guy Fieri while rapping against his “haters” who spread stories about him.

A Wall Street Journal report notes that health systems such as Geisinger, Mount Sinai Health System, and Mayo Clinic are selling the genetic profiles of patients to drug companies, reaping hundreds of millions of dollars without the patient’s knowledge or approval. 

Cerner locks down its Continuous campus in Kansas City, KS after a man armed with an assault rifle claims to have killed his wife and says he’s going to the adjacent outlet mall next. He opened fired on responding police officers, who killed him. Nobody else was injured, although the man’s wife has been missing since Monday morning.

A woman whose breast cancer required two surgeries and 20 rounds of radiation sues faith-based health-sharing ministry Aliera Healthcare, which is one of several companies that regulators in several states say are sham operations designed to bypass insurance regulations. Aliera refused to pay for the woman’s first surgery, for which the hospital billed her $195,000, saying her breast cancer was a pre-existing condition. Her attorneys say the company spends only 30% of its $180 million in annual revenue on medical bills, the rest being pure profit. Aliera responded to a TV station’s inquiry, “Healthcare sharing ministries provide members with a more flexible method for securing high-quality healthcare at an affordable price, something that is more important than ever to Texas residents who face increasing costs for traditional health insurance.” Washington’s state insurance commissioner fined the company $1 million last week, while Georgia has forwarded complaints about it to the FBI.

An man who made several ED visits for swallowing problems finally gets an accurate diagnosis eight days later – he had swallowed his false teeth during minor surgery. The dental appliance was then surgically removed, but repeated bleeding required further hospitalizations, blood transfusions, and emergency surgery for a torn artery.

Sponsor Updates

• Aprima will host its annual user conference August 23-25 in Grapevine, TX.
• Datica co-founder Travis Good, MD will speak at a Catalyst HIT Lunch & Learn on August 28 in Denver.
• Diameter Health becomes the first organization to earn EMeasure certification from NCQA and ONC.
• PMD successfully completes its second SOC 2 and HIPAA security audits.
• CarePort will exhibit at ACMA Florida August 22-23 in Champions Gate, FL.
• CompuGroup Medical responds to the Court of Appeals ruling in support of the American Clinical Laboratory Association.
• Cambia Health Solutions features Collective Medical CEO Chris Klomp on its HealthyChangers podcast.
• Clinical Architecture will exhibit at the 2019 SHIEC Annual Conference August 18-21 in National Harbor, MD.
• Culbert Healthcare Solutions will exhibit at East Coast CORE August 14-16 in Boston.

Blog Posts

• What Not to do When Insourcing VBC RCM (AdvancedMD)
• Building a strong Imaging Data Management Strategy #The Imaging Data Management Strategy Series (Agfa Healthcare)
• HITECH Funds are available for a limited time – follow these 6 steps to continue your health IT work when they run out! (Audacious Inquiry)
• How Should You Prepare for the Next Wave of Ransomware, Malware, Network, and File Vulnerabilities? (Atlantic.Net)
• 8 Ways to Use AI in the Contact Center (Avaya)
• Analytics Upgrade Strategy: The Basics (Bluetree)
• Boost Clinician Satisfaction with EHR Optimization (ChartLogic)
• Updates from Our 2018 CoverMyQuest Winners: Part 1 (CoverMyMeds)

Contacts

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

Morning Headlines 8/13/19

Akira Health Acquired by Telus Health

Canadian health IT company Telus Health acquires Toronto-based Akira Health, which offers app-based and in-person care.

CHI Franciscan introduces new healthcare hub at its acute care hospitals

CHI Franciscan (WA) goes live with a new Mission Control Center that uses predictive analytics from GE Healthcare to streamline patient care at eight of its hospitals.

Internet Brands’ WebMD Acquires QxMD

WebMD acquires QxMD, a Canadian company that offers providers digital point-of-care educational resources and medical calculators.

These health-tech veterans want to avert the next Theranos disaster with ‘medical diligence’

Former 23andMe VP Ruby Gadelrab and former Color Genomics CMO Jill Hagenkord, MD launch MDisrupt to help investors thoroughly vet health IT companies looking for financing.

Curbside Consult with Dr. Jayne 8/12/19

I had lunch with an old friend today and was surprised to learn that he has engaged with a telehealth client. Although he’s a database guy at heart, he’s also got a mind for developing solutions, and that’s how he wound up in the space.

He’s working for a group that is developing chatbot technology for health systems that want to incorporate asynchronous visits into their offerings. Rather than just script out various scenarios, however, they’re working to leverage existing data to design responses and offer care to patients, so I was intrigued. Right now they have some flexibility since they aren’t billing for the service (it’s being offered as a perk of being a patient in the practice) and don’t have to worry about checking boxes for claims and billing. It will be interesting to see where things go.

Telehealth is definitely at the forefront of many organizations’ strategic plans. Whether you’re a dedicated telehealth vendor or a practice looking at it as a solution to reduce revenue leakage, if it’s not part of your plan, you need to be thinking about it.

Physicians are looking at telehealth as a way to improve their work-life balance. Although many have been doing the equivalent of after-hours visits for free for decades, they’re now looking to be paid for their services and compensated for their time away from family (or away from sleep, in many cases).

Patients are also highly interested in telehealth from a convenience standpoint, although they’re not always well versed in whether the services are going to be covered. I’ve seen some backlash from patients concerned about being billed for a visit that they didn’t really consider to be a visit, since in the past they had talked to their physician after hours for free. There will definitely need to be education on what services are truly telehealth vs. phone calls after typical office hours.

As a physician who has started to deliver telehealth visits, I’ve found it challenging. You have to use different skills than you might in a face-to-face encounter, even if video is enabled. There are subtle differences in the interaction, and I feel like I’m drawing a lot on my experience as a physician in making sure I’m not missing anything.

As residency programs issued their new graduates at the end of June, I’ve heard of several new grads that are going straight to telehealth without ever having had a face-to-face practice. I remember how uncertain I was as a new grad in solo practice and didn’t have colleagues to bounce things off of. I would think that feeling would be magnified for a new grad, especially if their residency program didn’t really prepare them for telehealth. I don’t think there are that many programs that do, at least not in family medicine. If there’s any mention of telehealth, it’s as an adjunct to the traditional physician-patient relationship, not as a standalone.

Physician specialty organizations are eager to push back at the idea of standalone telehealth. The American Academy of Family Physicians recently highlighted a study about the value of the physical exam. The group describes the physical examination as “central to the relationship between physician and patient for millennia,” but notes recent “skepticism about tis role in patient care.” Researchers looked at a very small (16) set of family physicians to understand how they perceived physical examination experiences and what those physicians identified as objective and subjective benefits of the exam as part of patient care. Some described the actual examination as critical, with one saying that providers who don’t conduct exams are not good doctors. Others said they used the exam to confirm or disprove their suspicious after discussing the history of the present illness. One physician said there was an expectation to perform an exam, and therefore doing it helped build the relationship.

I have a different take on exams after staffing the World Scout Jamboree. Our exams there were entirely dictated by physician preference and the patient’s presentation, with no consideration given to billing, body systems, or bullet points. Some of our patients were healthy teens with self-limited problems that dictated a minimal exam, while others were diagnostic dilemmas that required more.

On the world stage, at least in that environment, I don’t think that doing more vs. less made a difference to the patients. One of my Swedish colleagues at the Jamboree noted that physicians there do a minimal exam. The focus is more about sitting down and talking through things rather than the laying on of hands, at least in his experience.

The study authors also note the emotions felt by physicians during the physical exam, especially when assessing sick patients. They also reveal their own emotions by saying that “we should not dismiss physical examination as nostalgia” in favor of technology.

I suspect that physicians that perform minimal exams in the face-to-face setting are doing so because it’s clinically appropriate. I too often see people examining unrelated body parts just out of habit or because they think they need to, regardless of whether it will affect the care plan. This is difficult to address when precepting students, but an important topic as we look at evidence and data-driven approaches to care.

I had a teacher once who insisted that no physical exam was complete without a rectal exam. He legitimately expected the interns to perform that exam on every single inpatient. Several of us refused, citing the odds of finding an incidental rectal cancer as completely out of balance with the invasive nature of the procedure and the discomfort caused to patients. That’s an extreme example, but I also see students and new grads that examine thyroid glands on every patient, just because it’s habit and regardless of the chief complaint.

Mysticism and romanticization of the exam aside, sometimes you just don’t need to see the patient, let alone examine them, and it’s entirely possible to deliver quality care without laying on of hands. That’s going to be difficult for many audiences to accept.

Pediatricians are also coming out with concerns about telehealth, particularly regarding over-prescription of antibiotics. That’s not been my experience as a telehealth provider, where the degree of antibiotic stewardship is highly visible and frankly much more strict than my face-to-face practice. I’m sure there are bad actors out there, but painting everyone with the same brush isn’t ideal. I also see plenty of traditional family medicine docs who call out a Z-Pack for upper respiratory infections even if the infection is most likely viral. I see those patients in the urgent care setting when they complain that their antibiotics didn’t work, and get to spend plenty of time counseling them on the differences between bacteria and viruses and exactly why their antibiotics didn’t work.

It’s important to also note that not all telehealth is direct to consumer. Some services are offered as part of a traditional practice, others are arranged by an employer, and still others are funded by insurance companies and other payers looking to keep costs down. It’s a complex solution that isn’t one size fits all and doesn’t always fall under similar models. The only thing I know for sure is that telehealth isn’t going away anytime soon.

How aggressively does your organization track antibiotic stewardship? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 8/12/19

Mueller: Centra’s Billing a Top Priority

The president and CEO of Centra Health (VA) apologizes to the community for billing problems that followed its September 2018 rollout of Cerner, which it also blames for recent operating losses.

Nuance Communications (NUAN) Q3 Earnings and Revenues Top Estimates

Nuance reports Q3 results, noting that although its healthcare revenue increased 2%, its HIM and EHR implementation businesses underperformed.

Gates Foundation snaps up top Apple Health researcher to run a new digital health group

Apple healthcare expert and radiation oncologist Andrew Trister, MD, PhD leaves the company after three years to join the Gates Foundation, where he will help US digital health entrepreneurs take their products to the developing world.

Monday Morning Update 8/12/19

Top News

From Thursday’s Allscripts earnings call:

• Two Paragon accounts added ambulatory as part of their contract extension in the quarter, with 20 clients having signed long-term agreements since the Paragon business was acquired from McKesson in late 2017.
• Two clients bought Sunrise, 61-bed San Gorgonio Memorial (CA) and an 1,100-bed hospital in the Philippines.
• The company is negotiating a contract extension with its biggest customer, Northwell, and expects a decision to made by the end of the year.
• Allscripts says it knew that the Department of Justice was investigating Practice Fusion pre-acquisition, and while the $145 million settlement amount “is not insignificant,” it is in line with settlements made by other EHR vendors that were under similar investigation and paying a settlement will allow Allscripts to put that history behind it.
• Allscripts expects that “recoveries from a variety of third parties” will “help offset a portion of the amounts” of the $145 million DoJ settlement that is being negotiated.
• Paul Black says that the company’s expansion into the high-growth payer and life sciences markets distinguishes it from its EHR peers.
• The company continues to seek “strategically priced M&A” to drive growth.
• Allscripts says its ZappRx and HealthGrid acquisitions haven’t made a significant impact on revenue so far.
• The company is happy with its retention of the former Practice Fusion customers.

Allscripts shares dropped 4% Friday after the report.

The all-time high for MDRX was in early 2000, with shares since having shed 88% of their value. A $10,000 investment in Allscripts five years ago would be worth $6,456, while putting the same money into Cerner shares then would be worth $12,000 today.

Reader Comments

From Imbued Dignity: “Re: patients participating in vendor product design and conferences. Aren’t all of us patients?” We are at one time or another, so “patient” in terms of industry involvement should probably mean “not working in health-related job.” So-called patient advocates (perhaps better labeled as “patient-advocates”) may add some value in hailing from outside the industry  — at least until they make a fill-time job from vendor payments — and may have gained more exposure to our system since they have chronic conditions. We all have our personal expectations and aspirations for healthcare and can obviously see (and say) when they aren’t being met, but we sometimes respond better to heart-tugging or indignation-raising stories about the frequent occurrences of where the system fails. Absent that aspect, we wouldn’t need patient advocates any more than we need advocates for using Facebook or paying the electric bill. The fact that healthcare and health IT executives are shocked, saddened, or motivated by the personal stories of patient advocates means that they are hidden away in their ivory tower. They just need to talk to real people, including their own employees. They also need to retain empathy after the heart-tugging speech is over, which may be their biggest challenge. Healthcare organizations and their executives may express support for a well-told patient story pointing out how the organization failed them, but I’m not too sure they go back home and actually fix the problems.

From Craniotomy: “Re: physician assistant buying a closed hospital. What’s your guess as to why?” He got a big-footprint commercial building for just $200,000 in the form of closed Cumberland Regional Hospital, most likely wildly underpriced because it’s located in a rural area where specialized real estate demand and investment money is limited, so he has a lot of options for expanding his own clinic business and bringing in other healthcare tenants. He can also cherry-pick the most profitable parts of the unprofitable hospital’s business – probably the ED, which was also the service most valued by the community – without trying run run acute care or skilled nursing beds. PA Johnny Presley also just offered $1 million for the closed Jamestown Regional Medical Center, which is next door to a clinic he owns. Tennessee is a certificate-of-need state, so he says he will apply to reinstate some JRMC services, such as a freestanding ED, outpatient diagnostic center, and surgery center. It seems that he’s just interested in the real estate and not the hospital or home health license, so hopefully he won’t follow the steps of others elsewhere who made big promises about saving a rural hospital and then used it purely as a billing machine for lab claims that are paid at higher hospital rates. Local politicians are in a tough spot when a hospital closes and thus displaces a bunch of employees who vote, given them obvious urgency to get it re-opened under whatever terms and/or vague promises they can get. 

From Exec Checker: “Re: Athenahealth. How much of the executive team remains from its days as a publicly traded company?” Not much. Veritas acquired the company in February 2019 and the eight-member executive team is mostly new – only one member joined the company before 2016. A couple of the execs have some healthcare experience, but the rest (including Chairman and CEO Bob Segert) do not. Here’s your “where are they now” moment looking back a few years vs. LinkedIn now:

• Jonathan Bush, chairman and CEO – no current job listed.
• Kyle Ambrester, SVP and chief product officer – CEO of Signify Health (clinical and social care coordination).
• Dan Haley, SVP /general counsel – no current job listed.
• Diane Holman, SVP/chief people officer – no current job listed.
• Stephen Kahane, MD, president – no current job listed.
• Prakash Khot, EVP/CTO – co-founder and CTO of Prekari Labs (privacy software).
• Timothy O’Brien, chief marketing officer – CEO of Groups Recover Together (addiction treatment).
• Jonathan Porter, SVP of network services – no current job listed.
• Todd Rothenhaus, MD, chief medical officer – CEO of Cohealo (health system capital equipment software).
• Karl Stubelis, SVP/CFO – CFO of Data Intensity (managed cloud services).

From The Usual Usury: “Re: Meditech. You didn’t offer your opinion when the reader asked about what they should do to grow.” That’s a tough one. Their sweet spot is small to mid-sized hospitals that want a proven, functional, full-hospital system whose upfront and annual maintenance costs are a lot less than those of Cerner and Epic. That’s Meditech, but the problem is that those prospects  are either (a) being acquired by large health systems, or (b) are also prospects for running Cerner or Epic as either a remote-hosted or client-hosted service offering, which also gives them easy connectivity to the larger health systems that almost always run Cerner or Epic. That leaves few prospects for vendors like Meditech, CPSI, Medhost, and others no matter what advantages they offer. Meditech is finally moving toward product the market wants – with integrated ambulatory, cloud hosting, and good support for web and mobile – but I don’t have a good feel on how many prospects remain. The other challenge is that while cash-strapped hospitals might save a fortune in maintenance costs switching off Epic or Cerner to Meditech, few of the hospitals that bought and implemented those systems recently are likely to want to start over with another round of disruption, not to mention that hospitals in cost-cutting mode are probably targets for being acquired or marginalized anyway.

From Green Machine: “Re: Cornerstone Advisors. Managing Principal Keith Ryan is no longer with the company.” Keith’s LinkedIn profile says he left Cornerstone in June 2019 after selling the company to cloud managed services vendor 8K Miles in December 2016. He has since turned his 500-acre farm in Tennessee into a hemp and CBD business. 

HIStalk Announcements and Requests

Only a small percentage of poll respondents expect the Cerner-Amazon Web Services agreement to produce much in the way of healthcare innovation. Dan agrees that “Cerner in the cloud” isn’t all that innovative, but believes it may increase CIO confidence that the cloud is viable, provide easier access to data onto which innovation can be layered, and give Amazon direct experience in supporting health IT and HIPAA.

New poll to your right or here: What technologies did you find personally useful in your most recent provider encounter? Click the Comments link after voting and add anything I missed.

A CIO asked me years ago to create the Consulting RFI Blaster, which provides an efficient, low-friction way to contact multiple firms by completing a single, simple form in which most fields are optional (like if you would rather be contacted by email instead of by telephone).

Listening: angry, dramatic music from Meg Myers, way too dark for one-time spin but loaded with nuance that grows on you.

Webinars

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

Acquisitions, Funding, Business, and Stock

Nuance reports Q3 results: revenue down 9%, EPS $0.31 vs. $0.28, beating analyst expectations for both. Healthcare revenue increased 2%, although the company’s HIM and EHR implementation businesses underperformed.

CPSI reports Q2 results: revenue down 3%, EPS $0.50 vs. $0.34, missing analyst expectations for both. The company said in the earnings call that customers are taking longer to make decisions and aren’t driven by urgency. It adds that it’s tough selling TruBridge because small-hospital personal connections and community image make it hard for those hospitals to outsource their business offices, while larger hospital prospects are outside CPSI’s client base. CPSI shares are down 12.5% in the past year, valuing the company at $332 million.

Apple healthcare expert and radiation oncologist Andrew Trister, MD, PhD leaves the company after three years to join the Gates Foundation, where he will help US digital health entrepreneurs take their products to the developing world.

Sales

• Quorum Health signs an EHR deal with Medhost to continue using its EHR in transitioning off a previous agreement with Community Health Systems, from which Quorum was spun off in early 2016.

People

Jacob Brauer (NextGen Healthcare) joins SymphonyRM as VP of engineering.

Announcements and Implementations

Two senior facilities operators go live on Netsmart’s Referral Manager, which they say has decreased their processing time by 73%. The system can be used standalone or integrated with EHRs such as Netsmart MyUnity.

Privacy and Security

Cybersecurity vendor UpGuard finds an Internet-accessible MongoDB database containing the health records of 37,000 people who had signed up with Neoclinical, an Australia-based clinical trials matching company. Neoclinical did not respond to emails or telephone calls, so public access to the information wasn’t removed until 25 days later. The psychology involved with helpfully telling a company that they are exposing sensitive information is complex, often leading to messenger-shooting.

Lehigh Valley Health Network (PA) admits that an admitted patient’s business partner – a plastic surgeon with whom he was feuding – inappropriately accessed his medical records in Epic. The patient, who is suing the health system, says it ignored his privacy complaints and did nothing for months. Investigation by the health system and the state health department corroborated the patient’s claim. The doctor insists that he had an active patient relationship with the patient, which the health department says wasn’t the case. 

Other

In Canada, Nova Scotia closes registration to the MyHealthNS patient portal after McKesson Canada declines to renew its contract due to low registrations under the contract’s pay-per-user pricing model. The government says it will replace the system, which was rolled out in 2017. Less than 10% of doctors have enrolled despite the province’s offer to pay them up to $12,000 per year if they encourage their patients to sign up, respond to electronic messages from patients, and share their test results via the portal.

The president and CEO of Centra Health (VA) apologizes to the community for billing problems that followed its September 2018 rollout of Cerner, which it also blames for recent operating losses. The health system says it spent $65 million on its first implementation phase vs. the $33 million that it originally budgeted under Cerner’s direction, much of that apparently related to the unexpected hiring of hundreds of consultants to train staff. Andy Mueller, MD, who took the top job in May 2019, says in an op-ed piece in the local paper:

I want to talk about one thing many of us in this community have struggled with, and that is Centra’s billing. Transitioning to a new electronic medical record last year seemed to compound an already weak process. From late bills, to incorrect bills to long wait times on hold for customer service — it has not gone unnoticed.  We must do everything in our power to help reduce the stress and anxiety of having to deal with health care bills. Plain and simple, we must do better, and we will. Period. We did not get here overnight, and correcting the system will also not be an overnight achievement. My ask for this community is to bear with us as we get our system corrected. We are working to review each account to ensure we have processes in place to make our billing accurate and more efficient. We’ve also embarked on additional system training and education for our staff. It’s all hands on deck here.

In Australia, Queensland Health Minister Steven Miles says the crash of its behind-schedule, over-budget SAP S/4HANA ERP system right after go-live was caused by user error. He says in response to media reports that it’s not unusual for employees to stockpile inventory or to buy items with their credit cards.

Research by Johns Hopkins Bloomberg School of Public Health finds that independent charities that offer drug co-pay assistance – most of which get their tax-exempted funding from drug companies — usually cover only expensive, brand-name drugs and exclude those patients who don’t have insurance, with the end result most likely being that they increase overall healthcare costs.

Six Philadelphia-area health systems bid a surprising $55 million for the 550 medical residency positions being auctioned off by bankrupt Hahnemann University Hospital. A notable legal objection comes from CMS, which pays more than $100,000 per year for each resident and says it will be precluded from recouping any cost-based overpayments once control is transferred to a different owner.

Sponsor Updates

• Waystar publishes the results of a new study, “The Patient Financial Experience: Consumer Attitudes and Behavior.”
• CloudWave launches a new website for multi-cloud healthcare IT solutions.
• Wisconsin Women’s Health Foundation implements Redox’s health IT integration capabilities through the Redox Gives program.

Blog Posts

• Reduce Physician Burnout by Becoming a “Dot Connecting” Organization (Lightbeam Health Solutions)
• 5 blogs to improve your cybersecurity strategy (Meditech)
• Accurately Improving Accessibility of Patient Data with a Single File (NextGate)
• Q&A with Experian Health Patient Access leader on MyHealthDirect Acquisition and enhancing the patient experience (Experian Health)
• Leveraging AI to Improve Health Outcomes (PatientBond)
• Patient Payment Processing: A Checklist for Your New Solution (Patientco)
• Improve Well-Child Schedule Adherence with Patient Engagement (PerfectServe)
• Care Traffic Control: 6 Steps to Launch a Value-Based Care Model (PreparedHealth)
• How We Onboard Clients for Lasting IT Security Success (Fortified Health Security)
• Feet on the Street: Black Hat 2019 (SailPoint)
• Complete Guide to HL7 Standards (Datica)
• Experts share best practices in clinical communications. (Voalte)
• 3 Times When You Absolutely Must Issue a Patient Refund (WebPT)
• ZeOmega Contributes Expertise to HHS-CODE Roundtable on Privacy and Data Access (ZeOmega)

Contacts

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

Weekender 8/9/19

Weekly News Recap

• Allscripts announces mixed Q2 results, which include a $145 million charge toward settling any liability that results from the Department of Justice’s Meaningful Use investigation against its acquired Practice Fusion.
• CVS beats Wall Street’s quarterly expectations and announces plans to expand its HealthHubs concept and to implement “next best action” programs for chronic care management.
• England’s NHS announces plans to form an $300 million artificial intelligence lab.
• Truman Medical Center pays ransomware hackers to regain access to its systems.
• Duke Clinical Research Institute and Cerner announce a pilot project to study patient data from non-Duke sites as the initial step in forming Cerner’s Learning Health Network.
• The DefCon cybersecurity conference creates a mocked-up hospital full of medical devices for hackers to play with.
• A new funding round values London-based AI health services vendor Babylon Health at over $2 billion.
• Guidehouse will acquire Navigant for $1.1 billion.
• Beaumont Health responds to reports of IT-heavy layoffs and the recent departure of its CIO and CMIO.

Best Reader Comments

Are you getting your license in other states for telemedicine purposes?? It always interests me how you have to have to be credentialed in the state of the patient even though you are providing the service from a different state, right?. Then I think of weird examples, like if you are on the phone with a patient who is riding in a car and they drive across state lines. One second you are having a legal conversation with a person and the next second you might be breaking the law! (Creds)

Even the most tech-awarded CHIME and HIMSS hospital systems are relying on their insurance to protect the corporation (not patients’ privacy) from hackers, Shamefully, most hospital CIOs have maintained very small budgets for cyber protection solutions and put basic security on auto pilot. [Ransomware victim] Truman Medical Center is “Most Wired” since 2010, Stage 7 HIMSS Analytics since 2013, a 2015 Davies Enterprise winner, and a Cerner model show site in its home town. (Are CIOS Ignoring or Ignorant?)

We need a law that says that they can’t play around with “re-identifiable data.” At this point we’re all aware that de-identified really means “not immediately identified”, or “you have to put in some work to make identifiable again.” De-identified should become un-identifiable. Of course in order to do that, you’ll probably be destroying whatever value they’re getting out of it. But they shouldn’t get to call it de-identified, it’s still PHI/PII unless mathematically provable that you can’t use that data to get to the identity of the people. (AC)

Why is Eric Topol not brave enough to say it? If you are in hospital administration, the group that collectively lobbies for you is called the AHA. If you are a small business owner – physician, the group that collectively lobbies for you is the AMA. If you are an employee of either of those two, the group that collectively lobbies for you is called a union. Ask a nurse to explain it to you. (SelfInflictedWound)

Meditech’s sales revenue is declining again. The company’s progress seems to be one step forward, two steps back. Saying the company is profitable and the balance sheet looks good, as was heard at the shareholder’s meeting, is another way of saying they are surviving. Meditech has yet to explain to its shareholders why it suffered such a large contraction during the period of greatest expansion the market has ever experienced, placing it a very distant third behind Cerner and Epic. (Running on MT)

I’ve talked to 5+ doctors about the thought process that they use to diagnose patients. I would characterize it as being a “satisficing” approach and I don’t think that computers are going to help make it better. I’m curious, though, about the percentage of diagnoses people think are incorrect. It really depends on how you define a misdiagnosis. 10% seems reasonable. (IANAL)

What’s [tackling problems with more impact than misdiagnosis] worth in real dollars that real physicians or medical organizations are going to spend? Unless I can convince enough physicians to pay for that service, what good does that do? I have to pay for my rent and groceries, too. We can have as many clever ideas for improving outcomes and patient health as we like, but we can’t do it for free. (HIT Girl)

Watercooler Talk Tidbits

A doctor from University of Calgary’s medical school mines Alberta’s EHR to find 60 ED visits that contain the word “scooter” to determine the extend of e-scooter injuries, although he admits that word usage might compromise accuracy. He urges those using the scooters to wear a helmet, which few riders of the newly introduced rental e-scooters do. The city requires helmets for bicyclists but not scooter-riders and allows only scooters to be ridden on sidewalks. 

Doctors eventually find that a Michigan woman who had choked on the first bite of a grilled hot dog and then experienced repeated problems afterward with breathing, talking, and swallowing had a wire embedded in her throat, which turned out to be a bristle from a grill brush. Doctors removed it and she’s fine. She urges people to use plastic grill cleaning brushes, explaining that her husband later passed a magnet over the grill and picked up 30-40 more bristles.

A  man who was sentenced 20 years ago to jail and six months of psychiatric counseling for impersonating a doctor over a six-month period at UCLA Medical Center graduates from a Caribbean medical school at 47, admitting that it’s tough to get licensed and accepted into a US residency when his past includes forging prescriptions. His education probably isn’t helping his quest – a current student of the for-profit Saint James Medical School says the school has a minimum GPA of 2.0, an MCAT-optional admissions process, an attrition rate of 86%, an 8% first-pass NBME pass rate, and a low residency match rate. 

Physician assistant Johnny Presley buys the recently closed Cumberland River Hospital (TN), pledging to open his fourth outpatient clinic there within four weeks and then possibly eventually adding a standalone ED. He paid $200,000 for the hospital, which had been bought for $6 million by a local hospital in 2012 that closed it after ongoing financial losses. He explains, “I might not be hardly as smart as some people or have as much money as some people, but I’ll outwork anybody. I just apply a lot of commonsense approaches. It’s a one-man show … I spent my life working in rural hospitals and rural communities and it’s a needed service in these areas. Unfortunately, it’s like time left those places, and it’s very sad. Growing up and working in them, seeing them all start to close is very sad.”

The for-profit hospital operator that bought two Wheeling, WV-area hospitals two years ago announces plans to close them both. One started as a city hospital in 1890, while the other opened its doors in 1906.

A jailed, 77-year-old pain management doctor in Detroit who is accused by the federal government of bilking insurers out of $500 million in a scheme involving opioid prescribing and spinal injections offers to turn his lakefront estate into a privately guarded prison if authorities will release him. Raj Bothra, MD’s most prolific prescriber, Eric Backos, MD – who “specializes” in “pain management, medication management, opioid detoxification, EMG/NCS testing to identify specific location of nerve injury, Botox therapy, and acupuncture” – prescribed 5.9 million pills from 2013 to 2018, with 86% of them being opioids and with at least two patients dying of overdoses following their visit.

In Case You Missed It

• News 8/9/19
• EPtalk by Dr. Jayne 8/8/19
• HIStalk Interviews Peter Smith, CEO, Impact Advisors
• News 8/7/19
• Curbside Consult with Dr. Jayne 8/5/19
• Monday Morning Update 8/5/19

Get Involved

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• Contact Mr. H

Morning Headlines 8/9/19

Allscripts Announces Second Quarter 2019 Results

Allscripts announces Q2 results that include a $145 million charge to settle all criminal and civil liability related to the Department of Justice’s Meaningful Use investigations into its Practice Fusion unit.

Experian acquires MyHealthDirect, strengthening leadership position in patient access and engagement

Experian Health acquires care coordination and appointment scheduling software vendor MyHealthDirect.

NHS to set up national artificial intelligence lab

In England, Prime Minister Boris Johnson allocates $303 million for the development of a National Artificial Intelligence Lab that will operate within the national health service’s digital innovation unit.

Castlight Health Announces New Customer Center of Excellence in Utah

Castlight Health will open a new Customer Center of Excellence in Salt Lake City next year, and hire up to 200 new staff by 2022.