News 9/19/18

Top News

Activist investor Elliott Management — whose criticism of Athenahealth caused the company to fire founder and CEO Jonathan Bush, cut costs, and seek a buyer – joins several other would-be suitors that will pass on acquiring the company at Elliott’s previously offered price of $160 per share.

Elliot says its due diligence has turned up significant Athenahealth problems. ATHN shares dropped sharply on the news.

Athenahealth will extend its bid deadline by 10 days through September 27.

Critics of Elliott’s tactics speculate that the firm is hoping that Athenahealth will accept a fire-sale price to avoid the public embarrassment of eliciting no acceptable offers.

Reader Comments

From NXGN Woes: “Re: Nextgen. Employees were told last week that two C-level executives are leaving the company. Operations employees will report to the CFO.” Unverified. NXGN Woes provided names, although I’ll decline to include them since their LinkedIn entries and the company’s executive page remain unchanged. UPDATE: a reader tells me that marketing SVP Tamra Rushing has been replaced and provides this internal email from CEO Rusty Frantz:

Due to personal reasons and effective immediately, Scott Bostick has made the decision to step down from his position as Chief Operating Officer and into an Individual Contributor role reporting directly to me. Please join me in thanking Scott for his leadership as he transitions into this new role. Further, in the coming weeks, the executive team will work with the senior leaders within the client services organization to ensure a successful transition under the leadership of our Chief Financial Officer, Jamie Arnold. The leaders who will now be reporting to Jamie Arnold include: Mitch Waters –  SVP, Sales, Colleen Edwards – SVP, Marketing, Allen Plunk – SVP, Managed Services, and Ben Clark – SVP, Client Services. At this time, we will not be backfilling the Chief Operating Officer role. We will move forward with a flatter organizational structure to ensure continued success of the commercial client facing organization.

From Jellico: “Re: KLAS. We dropped out of the relationship after they failed to contact any of the dozens of our consulting firm’s clients whose names we provided. All of the four KLAS reps we had been assigned over several years have left the company. I’ve kept in touch with two of those and both say they were uncomfortable collecting money from vendors they were rating. It will be interesting to see if Black Book gains traction. They appear to be more straightforward and they don’t accept monies from vendors they rate.” I’ve found KLAS’s market reports to be informative in how they broadly characterize a particular market segment. I have less confidence that they use enough statistically defensible methodology to rate individual vendors reliably. Still, the company’s business model is propped up by (a) the high-ranked vendors who usually keep paying in hoping of remaining on top, and (b) the also-rans who believe – accurately or not – that maintaining or increasing their KLAS payments will improve their chances of earning KLAS bragging rights. No CIO in their right mind would buy something based on KLAS scores and I suspect that few do, but anxious vendors are always looking for a competitive advantage and hope KLAS can provide it, even if indirectly. In KLAS’s defense, consulting firms (of which they are arguably one) often make recommendations to clients based on laughably subjective factors gleaned from casual conversations that they package up into impressive PowerPoints, so it’s hardly a new concept. I enjoy the Black Book survey results, where they survey huge numbers of people and then slice and dice their responses into a mind-boggling set of reports whose statistical underpinning and transparency seems reasonable. A significant deficiency of many of the survey-type reports I see is that they fail to categorize respondents (do they work for a single hospital, a health system in a corporate role, or a medical practice?) and they often fail to distinguish between a vendor and its multiple products (which Allscripts EHR were the respondents talking about?)

Webinars

September 26 (Wednesday) 12:30 ET. “How to Ensure Patient Records are Always Available.” Sponsor: Goliath Technologies. Presenter: Goliath Technologies engineering staff. This webinar will discuss how an early warning system can help your organization ensure your EHR systems and patient records are always available. You’ll also learn how to proactively anticipate, troubleshoot, prevent, and resolve end user experience issues before users or patients are impacted.

Previous webinars are on our YouTube channel. Contact Lorre for information.

Acquisitions, Funding, Business, and Stock

Waystar will acquire workflow and predictive analytics vendor Connance to enhance its revenue cycle management capabilities.

Hospital purchased services technology vendor Valify acquires Lucro, which offers a hospital-vendor marketplace.

Signet Accel, the Ohio State University spinoff that offers the Avec data integration platform, has reportedly downsized and parted ways with CEO John Raden. I also noticed that former EVP of Sales and Marketing Brenda Barry has gone back to her previous employer after one year on the job. Regenstrief President/CEO and AMIA board chair Peter Embi, MD, MS was a Signet Accel co-founder and medical advisor.

Aramark will sell its Charlotte, NC-based hospital medical equipment management and clinical engineering business to Trimedx for $300 million.

Silicon Valley venture capital firm Kleiner Perkins will spin off its digital health group – which includes some of its most prominent partners, who have invested in Uber and Stripe – into an independent group. The early-stage team will continue to operate under the Kleiner Perkins name. The firm’s healthcare technology investments include Collective Medical, Livongo, and Mango Health. It previously invested in Teladoc.

The Justice Department approves the $52 billion merger of insurer Cigna and pharmacy benefits manager Express Scripts.

Sales

• Beacon Health System will implement MyHealthDirect’s patient self-scheduling system.
• Children’s Health (TX) signs a 15-year, $75 million agreement with Philips for patient monitoring and PACS technologies.
• DCH Health System (AL) chooses Santa Rosa Consulting to lead its Meditech Expanse implementation.
• Cigna will expand its diabetes prevention program in collaboration with Omada Health.

People

GetWellNetwork hires Peter Keating (Advisory Board) as chief people officer.

Jeff Sturman (Cumberland Consulting Group) joins Memorial Healthcare System (FL) as SVP/CIO. He was previously SVP of IT there from 2004 to 2012, where he led its selection and implementation of Epic.

PatientPing hires Sagnik Bhattacharya (Epic) as VP of payer and provider initiatives.

Jesus Delgado (Rush University Medical Center) joins Community Healthcare System’s Community Foundation of Northwest Indiana as VP/CIO.

Healthcare investor and innovator Tom Main, managing partner of 7wire Ventures, died Sunday.

Announcements and Implementations

VisualDx launches Aysa, a consumer app that inspects a user’s skin condition photos, asks relevant questions, and then provides possible causes. 

Meditech announces Greenfield, a third-party app development environment that supports FHIR and will offer a store of approved apps. 

Mercy Technology Solutions launches a cloud-hosted, pay-per-study PACS offering.

EPSi adds Ilerasoft’s medical equipment investment and usage capabilities to its capital budgeting system.

Ciox Health announces HealthSource Gym, a learning environment that will help healthcare organizations assess, train, and develop medical coders.

Government and Politics

HHS publishes a report covering the state of its data sharing among its 29 agencies, noting problems that include a lack of standards for inter-agency data requests; variation in technical formats and approaches; the variety of statues that regulate data collection project; and the increased chance of privacy violations as data availability increases.   

Other

California doctors will be required to consult the state’s prescription drug monitoring program database before prescribing opiates under a law that takes effect October 2. The CURES system was developed in 1997 and updated in 2009 and 2016, but a 2012 newspaper investigation found that less than 10 percent of doctors and pharmacists had even bothered to sign up for access.

Amazon Web Services features Angel MedFlight Worldwide Air Ambulance’s self-development of an IPad charting application that uses AWS and Salesforce

In Africa, the governor of Nairobi makes an unannounced visit to a maternity hospital to follow up on complaints of negligence, orders an employee to open several unlabeled boxes and bags in a storage room. and finds the bodies of 12 infants. Reports suggest that the babies died when the hospital’s incubators lost electrical power. The government will follow up with investigations into rumored child trafficking and giving babies to the wrong families. Kenya’s public hospitals are mismanaged, underfunded, and staffed by doctors and nurses who have gone on strike over low pay and poor working conditions.

A Cincinnati neighborhood creates a Christmas celebration for a two-year-old whose aggressive brain cancer is likely to kill him before December. Six neighbors of Brody Allen’s family put up their Christmas lights early, sent cards, and will have a Christmas parade that includes fire trucks and supporters driving their own cars. He is too weak to walk, so his siblings wheel him around the neighborhood in a Red Flyer wagon covered with blankets.

Sponsor Updates

• CenTrak donates $5,000 to the Kerala Flood Relief Charity Fund.
• ACOs using Lightbeam Health Solutions achieved 1.7 times the savings generated by non-Lightbeam ACOs.
• Cumberland Consulting Group will sponsor and present at the Medicaid Drug Rebate Program Summit October 1-3 in Chicago.
• Formativ Health adds several new features to its Patient Engagement Platform including payment functionality powered by Patientco.
• Wolters Kluwer highlights patients as an underutilized resource in the fight against sepsis.
• AdvancedMD will host its EVO18 annual user conference October 3-5 in Salt Lake City.
• Aprima and Direct Consulting Associates will exhibit at the Ohio MGMA Fall Conference September 19-21 in Columbus.
• Jason Spurck (SOS Tech Group) joins Audacious Inquiry as support engineer.
• TechVibe Radio features Arcadia CTO Jon Cook.
• Datica publishes a new book, “Complete Cloud Compliance: How regulated companies de-risk the cloud and kickstart transformation.”
• Burwood Group will host “Cloud Revolution with Burwood, Citrix, & Google” September 27 in Chesterfield, MO.
• CarePort Health will exhibit at ACMA Kentucky/Tennessee September 24 in Nashville.
• CoverMyMeds will exhibit at the PCMA Annual Conference September 23-25 in Scottsdale, AZ.

Blog Posts

• Using Agile concepts to improve task management (Bluetree)
• 3 Ways Electronic Mental & Behavioral Health Screening Increases Patient Engagement (AssessURHealth)
• Facilitating and Operationalizing Continuous Surveillance (Bernoulli Health)
• The Clinical Side of Case Management (CarePort Health)
• NCPDP Real-Time Prescription Benefit Task Group: Why Stakeholders Need to Take Notice (CoverMyMeds)
• Deduplication of Clinical Data Without Data Loss: Critical to Meeting User Needs (Diameter Health)
• How Analytics Can Help Improve Falls (Dimensional Insight)
• Urgent Care Best Practices for Anti-Kickback Statute Compliance (DocuTap)

Contacts

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

Morning Headlines 9/18/18

Apple has hired a top exec from a hospital chain to help run its employee health clinics

Apple hires M. Osman Akhtar away from Fairview Health Services in Minnesota to run its AC Wellness employee clinics.

Aramark Announces Agreement for Sale of Healthcare Technologies Business to TRIMEDX

To better focus on its food, facilities and uniforms segments, Aramark sells its Healthcare Technologies business to clinical engineering and asset management company TriMedx for $300 million.

Waystar to Acquire Connance, Expanding Powerful Revenue Cycle and Predictive Analytics Technology for Health Systems and Hospitals

Waystar acquires RCM software competitor Connance for an undisclosed sum.

Congress Doesn’t Know Who’s in Charge of VA’s $10 Billion Health Records Overhaul

Lawmakers are convinced that a lack of accountability among the various government agencies, offices, and committees created to oversee the VA’s transition to Cerner will lead to wasted taxpayer dollars and project delays.

Curbside Consult with Dr. Jayne 9/17/18

To maintain my board certification, I have to do a variety of coursework “modules” on an ongoing basis. Sometimes they’re more academic, such as learning the latest and greatest clinical guidelines, and sometimes they’re more practical, such as a practice improvement project around handwashing by providers and staff. For those of us who aren’t in traditional practice, the choices are sometimes slim since we don’t have continuity patient panels that we can research with or look at trends in quality. One of the offerings that I completed for my upcoming board certification renewal was a module on cultural competency.

In healthcare, cultural competency means caring for patients in a way respects their health beliefs and cultural practices. Sometimes it can directly impact medical treatment, such as not making recommendations for animal-derived products when that would be contrary to a patient’s beliefs or preferences. In other situations, it might be more subtle, such as having an understanding of the communication preferences of different cultures and how decisions are made within extended family structures. It can also be having an understanding of medical treatments performed by different groups, including everything from cupping to intercessory prayer. It might also be respecting a patient’s desire to entirely reject treatment regardless of the potential for success.

Understanding different cultural beliefs of your patients can certainly help build trust and rapport with them, as well as helping to identify treatments that they will accept and complete. Letting patients know that you’re interested in learning about their values and beliefs helps them feel empowered and part of the care team. It’s great that healthcare providers are thinking about cultural competency, but learning more about it got me thinking about cultural competency in that context of the general workplace.

I recently worked with a company that placed a priority on this, creating various forums for employees to interact based on their family situations, ethnic groups, or interests outside of work. It was great to watch people who might not normally interact get together around a common characteristic and get to know each other.

I’ve also worked with companies that don’t have even a basic understanding of cultural sensitivity. In our increasingly polarized society, some people push back against the idea of political correctness, but rather than thinking about it that way, one might want to consider that it’s just a basic human kindness to respect the beliefs of others. I’ve been at a company that was hosting a development team from India (along with the host team’s existing multicultural employees) where the catered lunch that was ordered consisted entirely of barbecued beef and other items that had meat in them, including the baked beans and the potato salad. I cringed when I saw several people with plates of only corn bread and coleslaw.

I’ve been in meetings where the presenters used hunting metaphors such as, “You can’t shoot the moose from the lodge” and other gems, not noticing that it wasn’t playing well to the non-sportsman audience. Of course, the audience can exhibit cultural sensitivity and understand that the presenter is reflecting his own cultural practices as well rather than just acting horrified. Cultural sensitivity is a two-way street.

That’s the challenge in coaching people to develop a workplace demeanor that allows them to respect their own beliefs and traditions without stepping on those of their colleagues and employees. There’s certainly a continuum of behavior, ranging from insensitive to boorish with many different shades in between.

It’s important to understand the potential for difficulty here, because when someone in a leadership position doesn’t understand that balance, it can be perceived as creating a hostile workplace. Even when it’s unintentional or through sheer ignorance, a pattern of disrespectful behavior can become a serious workplace issue. Some companies have responded to this by formally implementing diversity training programs employee education, but it needs to go beyond that. Sometimes those programs are highly focused around specific groups rather than focusing on the more general concept of acting in a way that would make people comfortable regardless of their cultural background or beliefs.

Assuming that people from a specific background don’t eat or not eat specific foods can be an issue. I’ve worked with dozens of people whose practices are very different from their historical roots. Sometimes it’s easier to think about these challenges in a broader way – for example, thinking of dietary needs as not only a cultural issue, but also a medical one. Asking a more open-ended question around whether people have any dietary restrictions or requirements is more inclusive than asking whether people need a specific type of meal. I’ve been to plenty of corporate-type lunches where the question is never asked. That’s an easy pitfall to avoid and keeps the meeting planner from trying to figure out what different parameters they need to accommodate.

From a healthcare provider perspective, it’s great to learn about different traditions and practices so that you’re not surprised by the descriptions of treatments that patients may be doing at home, or that so you can have an understanding of how those therapies might complement or conflict with what you might recommend. However, a larger part of cultural competency is just learning how to talk with people about they prefer to be treated and being considerate of fellow human beings. It’s about not making assumptions and not trying to cast your own beliefs and values on the people with whom you interact.

There is a tremendous amount we can learn from each other and it just takes being open to learning about other people’s beliefs and needs and understanding how they may differ from your own. It’s about going back to the basics of hospitality and helping ensure that people feel comfortable regardless of where they come from or where you are going.

How does your organization approach cultural competency? Leave a message or email me.

Email Dr. Jayne.

Morning Headlines 9/17/18

GRAChIE Using eHealth Exchange to Mobilize Connection Points for Hurricane Florence Evacuees

Georgia’s GRAChIE HIE is working to connect Southeast providers via the EHealth Exchange to meet care needs that are being challenged by Hurricane Florence.

etHIN Establishes Connection to North Carolina HIE to Support Medical Records Exchange for Evacuees

HIEs in Tennessee and North Carolina take just 48 hours to connect their respective systems to allow Tennessee providers to pull up records for North Carolina evacuees who require medical care there.

Hurricane Florence and HIPAA Bulletin: Limited Waiver of HIPAA Sanctions and Penalties During a Declared Emergency

HHS reminds hospitals in North Carolina, South Carolina, and Virginia that it is temporarily waiving several HIPAA Privacy Rule sanctions and penalties.

Monday Morning Update 9/17/18

Top News

Paper EHR woes following Hurricane Katrina created the push for EHRs and interoperability in 2005 (and propelled Karen DeSalvo into the National Coordinator role in early 2014), so it’s fitting that Georgia’s GRAChIE HIE is working to connect Southeast providers via the EHealth Exchange to meet care needs that are being challenged by Hurricane Florence.

In related news, HIEs in Tennessee and North Carolina take just 48 hours to connect their respective systems to allow Tennessee providers to pull up records for North Carolina evacuees who require medical care there.

Also, UNC Health Care waives fees for its MDLive-powered virtual visits during the hurricane.

HHS reminds hospitals in North Carolina, South Carolina, and Virginia that it is temporarily waiving several HIPAA Privacy Rule sanctions and penalties:

• The requirement to obtain patient consent to speak with family members and friends about their care
• The requirement to honor patient requests to opt out of the facility directory
• The requirement to provide a notice of privacy practices
• The right of the patient to restrict uses and disclosures and to request alternative forms of confidential communications

I would be interested in hearing from IT folks hurricane-affected hospitals about how they prepared for the storm or responded to its effects.

Reader Comments

From Silver Surfer: “Re: KLAS. We’re a vendor and cancelled our agreement three years ago after KLAS assigned 18 months of feedback from our clients to the wrong vendor. Three years later, anyone searching KLAS for our consulting firm gets a message that our results don’t meet minimum KLAS Konfidence levels, meaning that we might be losing business from prospects who see that as a negative for our company even though it was KLAS’s error.” Unverified. The strongest complaints I get regarding KLAS’s methodology involve (a) how many of a vendor’s clients they survey; (b) how they select those they speak to; and (c) whether that small subset of clients is representative. People also express concern that paying KLAS to survey more clients than they might otherwise contact gives deeper-pockets vendors a chance to gain ground.

From Vishnu: “Re: [vendor name omitted]. Protecting its managers and team leads against internal sexual harassment accusations. Hopefully in time they will do what’s right.” I’ll omit the company’s name in the absence of legal evidence, such as a filed lawsuit.

From Dr. Ross: “Re: Epic in Denmark. I was in southern Europe for a conference and this article seems to be all the talk, even though I haven’t seen it mentioned in the US.” Three doctors in Denmark’s Capital Region refer to its newly implemented system (in a Google-translated page) as “the killing platform,” saying that it’s cumbersome, illogical, and doesn’t easily share data with quality and research databases (they expressed their concerns in a Danish language video that doesn’t include an English translation). The doctors say the Region’s claim that 30 systems have been replaced by one is “fake news,” as departments that previously used 6-7 systems are still running 3-4, and warns that reduced productivity may bankrupt the Region. They conclude that the system was built for private hospitals in the US and isn’t suitable for those in Denmark despite the claims of “US salesmen and lawyers,” urging the Danish Parliament to take over the project instead of “cling[ing] to a mistake just because you spent a lot of time making it.”

From Udon: “Re: ERISA. Would love to see an expose on that statute, which renders most state-level legislative and regulatory actions meaningless because it governs employer-funded health plans. If you are denied a scan or behavioral stay, you have to sue the health plan – which will fight it tooth and nail – and the most you can get is the cost of the denied benefit.” ERISA, which sets standards for private health and pension plans, got a recent spotlight when an HCA hospital assured a heart attack patient that his out-of-network stay would be covered by his insurance, then went after him for the $109,000 balance beyond what Aetna paid because his employer-provided insurance was self-funded (as is true of 60 percent of people), meaning he’s not protected by state-mandated prohibition of balance billing. On the other hand, those state protections are not common anyway and are often not comprehensive. ACA prohibits balance billing for out-of-network ED visits, but still allows out-of-network doctors, hospitals, and ambulance services to demand payment from the patient beyond the negotiated amount their insurance pays. So, Mr. Life-Threatening Emergency Patient, your job before breaching a hospital’s financially (and sometimes clinically)dangerous wall is:

• Study your employer’s insurance ahead of time to see if it’s self-funded.
• Keep a list of which hospitals are in your policy’s ever-narrowing provider network.
• Never travel beyond the immediate vicinity of those in-network hospitals.
• Stay conscious at all times during your medical crisis (or better yet, bring a medical bodyguard) so you can ask every person you see whether they’re in your network since hospitals are notorious for letting people work out of their building who are anxious to bill you separately and who don’t need your approval to do so.
• Remember that you don’t have a choice of ED doctor, surgeon, anesthesiologist, hospitalist, etc. and your condition makes elective transfer unlikely, so wear ear plugs to mute the sound of the ever-ringing cash register.
• Assume that despite paying for what looks like decent insurance, an unplanned medical event could progress quickly into an unplanned medical bankruptcy courtesy of healthcare profiteers and their political lap dogs who like things just the way they are.

HIStalk Announcements and Requests

Poll respondents express little interest in paying for expanded consumer genetics testing at a higher price, with the most significant concern being that long-term care insurers could use your personal data against you — the testing companies aren’t covered by HIPAA’s minimal protections and therefore your data can be sold to anyone.

New poll to your right or here: How much impact will Apple Watch’s announced EKG recording capabilities have on overall population health? I admit I’m skeptical about all consumer diagnostic tools for these reasons:

• Our system is already burdened by excessive use and cost, so further clogging up EDs and PCP offices with Apple Watch wearers demanding to have providers interpret their likely meaningless readings isn’t necessarily a good thing
• Many millions of Americans have already been accurately diagnosed with life-affecting conditions they can’t afford to have treated and this further aligns people into have/have not categories
• It reinforces Silicon Valley’s misperception that our poor public health is caused by underdiagnosis or misdiagnosis rather than a screwy system of misaligned incentives and the siphoning off of most of our healthcare spending to episodic care providers rather than toward population and public health
• Such tools also reinforce the inaccurate idea that funneling symptom-free people into a healthcare system that can do more harm than good is in their best interest, especially the largely elderly population likely to experience atrial fibrillation

Thanks to Jenn for covering for me for a few vacation days. I’m happy to have rendered myself at least temporarily redundant so I can take occasional worry-free time off without being chained to a computer all day. You may notice the difference since my writing is grumpier and more wearily skeptical than Jenn, whose forte is admirable journalistic excellence rather than pent-up, post-vacation ranting.

Spam protection has made sending bulk email – such as my HIStalk “we’ve published something new” notices – a crapshoot. People tell me every day they aren’t getting the updates, yet the problem always involves their email server’s settings that I can’t fix. I can only suggest that you enter your email again if you aren’t getting my updates, which is risk-free since you won’t get multiple email copies no matter what.

Welcome to new HIStalk Gold Sponsor LightSpeed Technology Group. The Chapel Hill, NC-based company’s VeriDOCs revenue cycle solutions offer a secret sauce for professional fee coding and billing in emergency, anesthesia, and hospitalist management services in supporting technical disparity and diverse coding volume across many locations. It offers interfacing (EHR integration, demographics, billing); the VeriCODE quality-driven medical coding application; a web-based coder QA pre-billing audit application; a physician peer review tool; and VeriNET workflow oversight and reporting. The end result is that coders and auditors work from a streamlined, secure platform that drives faster onboarding, more efficient coding, and faster bill turnaround. Thanks to LightSpeed Technology Group for supporting HIStalk.

Webinars

September 26 (Wednesday) 12:30 ET. “How to Ensure Patient Records are Always Available.” Sponsor: Goliath Technologies. Presenter: Goliath Technologies engineering staff. This webinar will discuss how an early warning system can help your organization ensure your EHR systems and patient records are always available. You’ll also learn how to proactively anticipate, troubleshoot, prevent, and resolve end user experience issues before users or patients are impacted.

Previous webinars are on our YouTube channel. Contact Lorre for information.

Acquisitions, Funding, Business, and Stock

Outgoing Cerner President Zane Burke has sold $52 million worth of CERN shares in the past couple of weeks. I notice. CERN shares are down 6 percent in the past year versus the Nasdaq’s 24 percent gain.

Netflix co-founder Marc Randolph, speaking at Health Catalyst’s Health Analytics Summit, urges attendees to develop optimism, confidence, and a tolerance for risk in describing how the tiny, struggling, two-year-old Netflix practically begged Blockbuster to buy it for $50 million and was quickly shown the door. He advocates “testing it without doing it,” explaining that Netflix “was not about having good ideas. It was about a system and a culture of trying lots of bad ones. What we realized is that the key to this is not the good idea. It was how quickly and easily and cheaply you could try as many ideas as you could think of.”

Sales

• Wyckoff Heights Medical Center (NY) chooses Allscripts Sunrise Abstracting.
• Chicago area home care provider Bowes In Home Care joins PreparedHealth’s EnTouch network that connects hospitals with post-acute providers to improve outcomes.

Decisions

• Stevens Community Medical Center (MN) will replace Cerner and EClinicalWorks with Epic in November 2018.
• Summit Healthcare Regional Medical Center (AZ) will go live with Allscripts Sunrise in 2019, replacing Allscripts Paragon.
• IU Health Jay Hospital (IN) replaced Meditech with Cerner on March 1, 2018.

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

People

Industry long-timer Jonathan Niloff, MD, MBA died Saturday of cancer at 64. He was chief medical officer of Diameter Health, a board member of HIMSS North America, and founder of MedVentive (acquired by McKesson in 2012) as well as a former cancer surgeon and ovarian cancer researcher.

Announcements and Implementations

A new Reaction Data survey of 300 providers finds that 62 percent are using speech recognition in their EHRs, with another 15 percent working on it and a stubborn 23 percent saying they’ll never use EHR speech recognition. Not surprisingly, Nuance is the big dog and is gaining ground, while MModal’s much smaller market presence still makes them Nuance’s only real competitor and its user satisfaction is higher. Epic is by far the most commonly used speech-integrated EHR. Only 3 percent of speech recognition users say they might switch vendors.

A new KLAS report on clinical documentation improvement says that Nuance and ChartWise provide the strongest financial ROI, Iodine’s high-satisfaction tools are disruptive in prioritization functionality, and 3M’s offerings are overhyped. Claro Healthcare leads a small pack of services firms that offer CDI optimization and outsourcing.

Other

AMA’s newswire highlights a JAMIA-published comparison of order entry clicks between Cerner and Epic under the title of “62 clicks to order Tylenol? What happens when EHR tweaks go bad.”

An investor in online pharmacy Pillpack — whose value went from zero to more than $1 billion in five years when it was recently acquired by Amazon from its early 30s founders above — lists the company’s lessons learned:

• Relentlessly focus on the end user
• Build a full technology stack that allows the company to control its own destiny (Pillpack spent $10 million building its systems)
• Stand your ground against larger competitors
• Realize that you can’t grow and optimize a business simultaneously – design for scale, don’t code before understanding processes, and don’t industrialize without understanding the problem you’re trying to solve
• Hire executives and board members who have a founder mentality
• Invest in culture, which will be harder to manage as the company grows
• Don’t aim for a people-free business – human touch is essential
• Hire strong operations leaders who have a bias for action
• Hire a strong CFO/COO

In India, the state of Uttarakhand orders the government to provide printers so that every doctor’s prescription can be printed out before signing, addressing a problem in which patients and pharmacists often can’t read the doctor’s writing.

NYU Langone Health’s magazine notes that for the first time, all eight of its surgery chief residents are female.

A jury awards $4.6 million to a cruise ship passenger whose flu symptoms were mismanaged by the ship’s doctor, claiming:

• The Colombia-trained physician (which the lawsuit misstates as “Columbia-trained”) was inexperienced and gave a 25 mg dose of promethazine IV instead of safer, better drugs
• The doctor missed the patient’s cubital vein and instead injected the drug quickly into his ulnar artery
• Staff ignored the patient’s report of a burning sensation, declining to evacuate him by helicopter and instead waiting until the ship’s next port
• The patient developed compartment syndrome, requiring his arm to be amputated at the elbow

Weird News Andy says that despite early examples of scientific hype that turned out to be wrong (“nuclear power will be so cheap it won’t be worth metering usage”) he still likes that we’re getting closer to a Tricorder-like device. University of British Columbia engineers develop a Band-Aid sized ultrasound transducer that could turn a smartphone into an ultrasound machine for $100.

Odd: a Pennsylvania court upholds the prison sentence given to a man who in 2015 dialed 911 while choking. First responders found the 47-year-old passed out on his living room floor, clad only in underwear and socks in front of his computer monitor that was displaying a child pornography chat room. He unsuccessfully claimed that unnamed enemies framed him, with his daughter providing a heartwarming family moment in testifying that her dad isn’t smart enough to know how to download porn.

Internal medicine resident Mike Natter, MD notes that the relationship between the number of things carried and level of medical training is inverse.

Sponsor Updates

• Voalte announces that its VUE user conference, to be held October 3-5 in Sarasota, FL, has sold out for the first time in its history.
• LogicStream Health publishes a new report, “The New Healthcare Imperative.”
• MedData will exhibit at the Ohio American Academy of Pediatrics 2018 Annual Meeting September 21-22 in Dublin.
• Waystar will exhibit at Ohio MGMA September 21 in Dublin.
• The American Heart Association/American Stroke Association names Nordic a “Get with the Guidelines”-compatible vendor.
• Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the annual Georgia Perinatal Conference September 19-21 in St. Simon’s Island, GA.
• Experian Health and PatientKeeper will exhibit at AHIMA September 22-27 in Miami.
• PerfectServe will co-host the Hospital for Special Surgery Educational and Networking Open House September 21 in New York City.
• Redox will present at Health 2.0 September 16-19 in Grapevine, TX.
• T-System offers disaster relief T Sheets free of charge to hospitals in the path of Hurricane Florence.
• Mazars USA welcomes Chief Human Resource Officer Julie Venkat.

Blog Posts

• A Person-Centered Approach for Success in Intellectual and Developmental Disability Services – Part II (Netsmart)
• Optimize Your Billing Office – Improve Workflows through Consolidation and Automation (Parallon Technology Solutions)
• Wasteful Ordering? Meet Order Manager (Experian Health)
• Four simple steps for reducing third-party service costs (PerfectServe)
• Healthcare communication is catching up. (Voalte)
• Designing Safe and Effective Digital Health Applications (Sansoro Health)
• Four Keys to EHR Go-Live Success (Santa Rosa Consulting)
• The 8-Minute Rule: What it is and How it Works in WebPT (WebPT)

Contacts

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

Weekender 9/14/18

Weekly News Recap

• Cigna invests $250 million in a new corporate venture fund that will target companies working in the areas of care delivery and management, digital health and retail, and insights and analytics.
• Memorial Sloan Kettering Cancer Center (NY) CMO José Baselga, MD comes under fire (ultimately resigning) after media outlets report he failed to disclose his financial ties to research journals in which he was published.
• Cerner President Zane Burke announces he will leave the company November 2. John Peterzalek, EVP of worldwide client relationships, will assume Burke’s responsibilities and the title of chief client officer.
• Former VA Secretary David Shulkin, MD joins Sanford Health (SD) as chief innovation officer.
• Apple introduces the fourth iteration of the Apple Watch, featuring fall detection and heart monitoring features that include the ability to record ECGs.
• General Atlantic invests $200 million in new cancer care company OneOncology, which aims to bring the latest in oncology care to patients in community settings using technology from Flatiron Health.

Best Reader Comments

Re: 340b comments. Sounds awfully familiar. Regulatory bodies ask for public comment, then that process is abused via copy/paste comments and identity theft to support corporate positions. At what point do we start prosecuting people for this? (340b)

With Zane out the door as a scapegoat for the first three years of DoD vaporware delivery, who does Cerner send up next to stammer empty assurances to Congress? John Peterzalek? Or does the world finally get to meet Brent Shafer? (Vaporware)

Mediware /Wellsky…marketing runs rampant again! Their PR states: “We stand at the forefront of innovation that will eliminate the fragmentation that exists in health and community care… By integrating its offerings under one brand, WellSky is better positioned to partner with providers and organizations to create and sustain communities that thrive.

Please explain how re-branding under one new name really accomplices product integration for customers when their 30 diverse products hardly talk to one another?? They probably spent big bucks to come up with this new name. Would be better spent on developing code that really integrates their 30 disparate product lines. Whatever you brand it doesn’t matter, Wellsky is still a tornado of flotsam. (HISjunkie)

Watercooler Talk Tidbits

Researchers uncover a 2016  Amazon patent for a transport system in which a human worker would sit in a metal cage atop a robotic trolley, an engineering design they call “an extraordinary illustration of worker alienation, a stark moment in the relationship between humans and machines.” Amazon reps contend the company has never and will never develop such a system, adding that sometimes even bad ideas get submitted for patents. Given the company’s intensified focus on lowering employee healthcare costs, I can’t help but wonder what sort of ICD-10 codes might be warranted at its future employee clinics by injuries sustained within the hypothetical people-movers.

Perhaps Amazon should consider installing these on its warehouse floors: EIR Healthcare in Philadelphia starts a “tiny hospital” movement with the development of a prefabricated modular hospital room that comes pre-wired with fall-detecting sensors and a smart TV. CEO Grant Geiger boasts that “it should be the only option worth considering when building new hospital construction from this point forward.”

The Washington Post looks at the increase in electric scooter-related trips to the ER, interviewing emergency docs in seven cities – all of whom have seen a spike in injuries since shared scooter services became available in their areas. Start-ups like Bird, Lime, and Skip are riding on the coattails of ride-hailing and bike-sharing companies thanks to investments from Uber, Alphabet, and Sequoia Capital. Yet their business practices are being called into question by riders who end up in the ER with severe injuries due to mechanical malfunctions. “Injuries are coming in fast and furious,” says  Scripps Mercy Hospital (CA) Chief of Medical Staff Michael Sise. “It’s just a matter of time before someone is killed. I’m absolutely certain of it.”

In Case You Missed It

• News 9/14/18
• EPtalk by Dr. Jayne 9/13/18
• News 9/12/18
• Curbside Consult with Dr. Jayne 9/10/18
• Monday Morning Update 9/10/18

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Morning Headlines 9/14/18

Introducing WellSky — A New Approach to Health and Community Care

MediWare Information Systems rebrands to WellSky in an effort to better unify 30 brands across multiple companies in the US and abroad.

Babylon Healthcare targets chronic disease in $100 million expansion

Babylon Health will spend $100 million to double its workforce, aiming to hire 500 additional staff within the next nine months.

Alameda Health System Names Mark Amey as Chief Information Officer

Mark Amey (UC San Diego Health) joins Alameda Health System as CIO ahead of its $200 million Epic implementation.

News 9/14/18

Top News

Apple’s latest product announcement regarding the new Watch’s ability to record ECGs and monitor heart rhythm for abnormalities leaves healthcare reporters salivating and clinical experts torn between guarded optimism and healthy skepticism. The device, which can also detect when a user has fallen and alert emergency services, will start at $400 when it debuts later this year.

Industry folks were quick to point out that the device could lead to over treatment, and that its FDA clearance states the new apps are “not intended to replace traditional methods of diagnosis or treatment.” FDA Commissioner Scott Gottlieb, MD also tweeted out amidst his Hurricane Florence PSAs that app clearance is “a significant step forward in FDA policy because we decoupled review of the app from review of the watch itself. The watch isn’t a medical device, just the apps that help consumers detect serious medical conditions.”

Webinars

September 26 (Wednesday) 12:30 ET. “How to Ensure Patient Records are Always Available.” Sponsor: Goliath Technologies. Presenter: Goliath Technologies engineering staff. This webinar will discuss how an early warning system can help your organization ensure your EHR systems and patient records are always available. You’ll also learn how to proactively anticipate, troubleshoot, prevent, and resolve end user experience issues before users or patients are impacted.

Previous webinars are on our YouTube channel. Contact Lorre for information.

Acquisitions, Funding, Business, and Stock

Cigna allocates $250 million for a new corporate venture fund that will target companies working in the areas of care delivery and management, digital health and retail, and insights and analytics. Cigna’s previous health IT investments include MDLive, Omada Health, and Cricket Health.

OneOncology launches with a $200 million investment from General Atlantic and health IT support from Flatiron Health. Created by a partnership between Tennessee Oncology, New York Cancer & Blood Specialists, and West Cancer Center (TN), the company aims to offer oncology patients access to providers, treatments, and clinical trials typically unavailable in smaller, community-based settings. Former CVS Health EVP Tracy Bahl will serve as president and CEO.

MediWare Information Systems rebrands to WellSky in an effort to better unify 30 brands across multiple companies in the US and abroad.

In the UK, Babylon Health will spend $100 million to double its workforce, aiming to hire 500 additional staff within the next nine months. The plan is part of the virtual consult company’s efforts to expand its chat bot symptom assessment technology to include chronic disease management for diabetes and depression. The company is perhaps best known for powering the NHS telemedicine app GP at Hand.

Nuance and ChartWise top the list of CDI vendors driving the most tangible financial outcomes, according to a new KLAS report, while Iodine Software surpasses both when it comes to enabling efficient workflows. Third-party CDI firms like Claro Healthcare, Navigant, PwC, and Huron all score similarly on value and satisfaction. 

People

Mark Amey (UC San Diego Health) joins Alameda Health System as CIO ahead of its $200 million Epic implementation.

Akiri, a health data network spun out of AMA’s Health2047 business development and commercialization arm, names David Watson (The SSI Group) CEO.

Caradigm co-founder Warren Ratliff joins Seattle Children’s Hospital analytics spin-off MDMetrix as CEO.

Kermit Randa (Waystar) joins Kaufman Hall as CEO of its Software Division.

Access appoints Davin Marceau (Success Group) COO and promotes Cody Strate to the new role of VP of strategy and innovation.

Sales

• Bristol Hospital (CT) selects ESO’s Health Data Exchange software for improved data-sharing between its ED and EMS agencies.
• San Luis Valley Health Regional Medical Center (CO) will implement FormFast’s FastPrint Enterprise and ESignature bundle.

Announcements and Implementations

The North Carolina Health Information Exchange Authority rolls out subscription-based clinical event alerts to members of the NC HealthConnex HIE.

Marin General Hospital (CA) will install University of California San Francisco Health’s Epic software as part of a strategic alliance that includes co-branding and designating UCSF as its academic and teaching partner.

Regional West Health Services (NE) prepares to go live on Cerner Millenium this weekend.

Mercy Technology Services develops a cloud-based imaging solution that comprises Visage’s imaging software, workflow technology from Medicalis, and speech recognition and reporting capabilities from Nuance.

Other

FHIR architect and interoperability consultant Grahame Grieve tells the Australian Senate an IT overhaul is needed to assure the success of the My Health Record initiative. The national digital records database, which he has been an advisor on, has come under fire over the last several months thanks to a questionable opt-out policy, and privacy and governance concerns. Grieve, an Australian native, told the Senate ahead of a September 17 inquiry into the program that, “The design of the system and the standards it is based on were state of the art in 2007. Although a more distributed design was initially planned, it is now, unfortunately, a centralised national database of static summary documents. This was an inevitable consequence of the technical standards used at the time, but now constrains the use, extensibility and therefore the value of the system.”

A survey of 109 providers finds that 68 percent have not yet developed a disaster preparedness plan, despite having experienced two such events within the last five years. All bets are off when it comes to securely communicating with hospitals during and after weather events: 25 percent of specialty providers have used unsecured text messaging to reach hospital staff, and 22 percent have used the same method to reach patients and their family members. Hospital-based respondents take secure messaging more seriously, perhaps because they already have resources in place: 44 percent believe secure messaging to be a key component of preparedness plans, surpassed only by the need for backup generators and extra supplies and medication.

Sponsor Updates

• EClinicalWorks will exhibit at Health 2.0 September 16-19 in Santa Clara, CA.
• Formativ Health partners with Lyft to help get patients to medical appointments.
• Broadlawns Medical Center adds FormFast’s Go electronic document solution to its existing Capture software.
• The HCI Group publishes a new white paper, “You’ve Signed a New EHR Contract: Now What?”
• Loyale Healthcare explores healthcare CEOs and innovation in a new video, “Who Thrives? Who Survives?”
• Politico features PatientPing in “Connecting your medical data could be the next big payoff.”
• Consulting Magazine ranks Impact Advisors third on its list of best small firms to work for.
• Hyland Healthcare collaborates with Change Healthcare to speed and simplify claim attachments for providers and payers.
• InterSystems adds a mobile, touchscreen-enabled user interface to its TrakCare health information system.
• Intelligent Medical Objects will exhibit at the 2018 OR Manager Conference September 17-19 in Nashville.
• Kyruus will present at the 2018 Tri-State Conference September 19-21 in Wisconsin Dells, WI.
• Join Meditech in signing the World Sepsis Declaration.
• TransUnion Healthcare announces its support of nonprofit RIP Medical Debt.
• Dimensional Insight publishes a new case study featuring Doctors Hospital in Puerto Rico.
• Voalte’s annual Vue user conference, set to take place October 3-5 in in Sarasota, FL, sells out for the first time.
• PatientKeeper and Medhost enter into a reseller agreement.
• Hayes Management Consulting hires Mark Rivero (Athenahealth) as director of client experience.
• EPSi partners with MPA Healthcare Solutions to offer customers risk-adjustment and clinical analytics.

Blog Posts

• Finding the best long-term home for Aries Systems (Elsevier Clinical Solutions)
• Implementing a Plan to Unite Clinicians, Compliance and Revenue Cycle Teams (Hayes Management Consulting)
• Are EHR Companies Difficult to Work With? (Goliath Technologies)
• Digital Disruption in Healthcare: How to Accelerate Innovation and Progress (Healthgrades)
• Ciox Believes Mandate is Necessary to Achieve a Fax-free Future (Ciox Health)
• Four Keys to Frustration-Free Health Education Care Managers Love (Healthwise)
• Kudos to Texas Scottish Rite Hospital for Children – Named One of the Top-Performing Children’s Hospitals (Huntzinger Management Group)
• Top HIEs Advancing Interoperability, Data Quality and More (Imat Solutions)
• The Broad Impact of Unique Patient Identifiers (Imprivata)
• Getting Buy-In for Healthcare Technology: Winning Over Physicians (Influence Health)
• Sowing the Seeds for EMR Satisfaction (InterSystems)
• Understanding Patients and Providing Personalized Experiences in Healthcare (Kyruus)
• Combating Sepsis: How University of Utah Health Saved Lives and Cut Costs (Spok)
• The Anatomy of a Successful Community Connect Install (Optimum Healthcare IT)
• Staying connected: 5 blogs about interoperability (Meditech)
• Keep Patient Satisfaction High at Bedside and Discharge (Access)

Contacts

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

EPtalk by Dr. Jayne 9/13/18

As we move into hurricane season, the American Academy of Family Physicians has released disaster preparedness resources for both practice and personal needs. I’m always amazed by the practices I visit that don’t have an EHR downtime strategy or business continuity plan. Even if they have plans, it’s rare that they have done drills or really discussed what would happen in a serious emergency. I’m not a serious doomsday prepper, but I do have some survival basics in my car including water, food, a first aid kit, and a survival blanket. There are plenty of organizations that end up having staff sleep at the hospital or medical office buildings in the event of major disasters, so it’s not a bad idea to keep some extra clothing and essentials like a toothbrush in your “go bag” because you never know where an emergency is going to happen.

Backup solution vendor Webair is offering complimentary offsite backups and disaster recovery services for business affected by Hurricane Florence. Clients can select backup replication sites on the West Coast or outside the continental US. I took a look at their offerings and was happy to see that they include up to 72 hours per month for disaster recovery testing. Far too few sites test their backups or disaster recovery strategy, so this is a plus.

HHS has declared a public health emergency in the Carolinas in preparation for Hurricane Florence. The public health emergency eases some restrictions for Medicare and Medicaid providers, and likely will lead to accommodations for various reporting requirements for 2018. I know all of us hope that the storm will not be as bad as predicted and are sending our prayers to the East Coast.

CMS is convening a Technical Expert Panel to look at the Merit-based Incentive Payment System, specifically the Improvement Activities (IA). This panel will give feedback and provide “direction and thoughtful input on the improvement activities during development and maintenance.” They’re looking for a dozen clinicians with expertise in the Improvement Areas, consumer/patient/family caregiving, healthcare disparities, performance measurement, and quality improvement. Nominations close at 5pm PT on September 22.

A wise man once told me to always spend a little time looking for my next career move, so I keep my eye out for interesting postings or opportunities. On Tuesday, I received a notice from ONC that they were looking for a medical professional in the Clinical Division. I have no desire to relocate to Washington, DC but was curious about the posting. Clicking the link embedded in the email took me to Indeed.com, where the header said the posting was no longer available on Indeed. It’s going to be difficult to recruit someone if you don’t keep the posting live, and the email from ONC made it sound like it would be open through September 19. It did cross-link me to a Medical Officer posting, which was interesting in that it was targeted to someone who is already employed by a governmental or academic institution that is willing to contract them out for a period of two years. Despite the requirement that the candidates be MD or DO physicians, the salary range is $114k to $164k, and there is no eligibility for federal benefits. I wonder if they will have candidates beating down the doors for this one given the cost of living in the DC area and the earnings potential for physicians in clinical practice.

It’s that time of year to start talking about flu season preparedness. This week brought a blip in reported flu cases, and I hope it’s not a predictor of an early or more severe flu season. Vaccinations arrived at my clinical office on Tuesday, and everyone rolled up their sleeves and got it done. After seeing the number of seriously ill patients we saw last season, no one wants to experience that personally. Please consider a flu vaccination to protect patients, your family, and the community.

LOINC is holding its annual Fall Conference next month in Salt Lake City. Workshop topics include Document Ontology, the use of the RELMA mapping assistant, Clinician Perspective, and FHIR. I’ve been doing LOINC mapping for clients for nearly a decade and appreciate the logic and deliberate construction of the framework. Sometimes the specificity of some of the tests seems complicated to those who haven’t worked in the depths, but when you’re looking for granularity with lab data it’s important to be as accurate as possible.

The Pew Charitable Trusts, the AMA, and MedStar Health have released a new report detailing recommendations for improving EHR usability and safety throughout the software life cycle. It also identifies what can be considered rigorous strategy testing and how to create testing scenarios based on currently-understood EHR safety issues. The report also addresses the culture of safety along with EHR user training as ways to improve patient safety. Other topics covered include EHR design and development, EHR implementation, configuration and customization by end users, and EHR upgrades.

This is National Suicide Prevention Week and gives us the opportunity to reflect on the lives lost each year due to suicide. I think often of my medical school classmate, the high-school student I taught, and a family member we lost to suicide. Our local high school’s Harvard-bound valedictorian went missing after graduation and committed suicide. It really is everywhere, and it can be prevented. TMF Quality Innovation Network is hosting a webinar titled “Suicide Prevention Tips for Physicians, Clinical Staff and Their Patients,” to be held September 18 at noon CT. It features Christine Moutier, MD, CMO of the American Foundation for Suicide Prevention, along with Leah Patterson, a survivor. They will offer practical tips for clinicians to address suicide risk for patients, peers, and themselves.

Email Dr. Jayne.

Morning Headlines 9/13/18

With OneOncology, Flatiron and Cancer Docs Aim to Boost Community Care

General Atlantic invests $200 million in new cancer care company OneOncology, which aims to bring the latest in oncology care to patients in community settings using technology from Flatiron Health.

Cigna Announces Cigna Ventures with $250 Million to Fund Transformative Innovation and Growth for Health Care

Cigna invests $250 million in a new corporate venture fund that will target companies working in the areas of care delivery and management, digital health and retail, and insights and analytics.

Apple Watch Series 4 can detect falls, take ECGs, and lead you through breathing exercises

Apple introduces the fourth iteration of the Apple Watch, featuring fall detection and heart monitoring features that include the ability to record ECGs.

Morning Headlines 9/12/18

FDA Designates AliveCor’s Bloodless Hyperkalemia Test a “Breakthrough Device.”

The FDA grants “breakthrough device” status to heart health technology company AliveCor for an algorithm it has developed that can detect high blood potassium levels through EKG analysis.

Former VA leader David Shulkin joins Sanford Health

Former VA Secretary David Shulkin, MD joins Sanford Health (SD) as chief innovation officer.

Nellis first base to use Tele-ICU

The Mike O’Callaghan Military Medical Center on Nevada’s Nellis Air Force Base becomes the first base to connect with the VA’s Tele-ICU center in Minneapolis.

News 9/12/18

Top News

Cerner President Zane Burke announces he will leave the company November 2. John Peterzalek, EVP of worldwide client relationships, will assume Burke’s responsibilities and the title of chief client officer. Burke joined the company in 1996 and took on the title of president in 2013. Analysts have expressed little surprise at his impending departure, given that he had just about reached the pinnacle of the company’s corporate ladder.

Webinars

September 26 (Wednesday) 12:30 ET. “How to Ensure Patient Records are Always Available.” Sponsor: Goliath Technologies. Presenter: Goliath Technologies engineering staff. This webinar will discuss how an early warning system can help your organization ensure your EHR systems and patient records are always available. You’ll also learn how to proactively anticipate, troubleshoot, prevent, and resolve end user experience issues before users or patients are impacted.

Previous webinars are on our YouTube channel. Contact Lorre for information.

Acquisitions, Funding, Business, and Stock

Clarify Health Solutions raises $57 million in a Series B round led by KKR. The San Francisco-based company has developed analytics-based software to help providers better match and assist patients with tailored clinical services.

In the face of Verity Health’s bankruptcy filing, California legislators stress that owner Patrick Soon-Shiong, MD must uphold the original ownership agreement approved by the state attorney general, especially as it pertains to safety net care and the continued employment of 7,000 staff across six hospitals and affiliated facilities.

The FDA grants “breakthrough device” status to heart health technology company AliveCor for an algorithm it has developed that can detect high blood potassium levels through EKG analysis. Traditional detection methods require a blood sample. The Mayo Clinic-backed company’s products include an EKG smartphone attachment and app, and an Apple Watch band with similar capabilities. CEO Vic Gundotra expects it will take a year to bring the new technology to market.

Nostrum Laboratories hikes the price of an antibiotic for bladder infections from $474.75 to $2,392, a move CEO (and avowed Martin Shkreli supporter) Nirmal Mulye believes is in keeping with the “moral requirement to make money when you can … to sell the product for the highest price.” He adds that, “This is a capitalist economy and if you can’t make money you can’t stay in business.”

People

Former VA Secretary David Shulkin, MD joins Sanford Health (SD) as chief innovation officer.

LHC Group promotes EVP and Chief Innovation Officer Bruce Greenstein to the additional role of chief strategy officer.

Nanticoke Health Services (DE) promotes Steffan Williams to CIO.

HCA President and COO Sam Hazen will succeed CEO Milton Johnson when he retires at the end of the year.

The Value-Based Care Solutions Group names Bob Segert (Aspect Software) chairman and CEO, and has promoted Jon Zimmerman to president. Veritas Capital acquired the group from GE Healthcare in July, and intends to rebrand the company.

Announcements and Implementations

Q-Centrix adds natural language processing capabilities to its clinical data registry reporting software.

Sales

• Unity Health (AR) will implement IntelliPass+ patient payment software from PatientMatters at its three hospitals.
• Jamestown Regional Medical Center (TN) will go live on Evident’s Thrive EHR in December. JRMC has selected cloud-hosting and RCM services from Evident’s sister company, TruBridge. Both are subsidiaries of CPSI.

Government and Politics

A Kaiser Health News analysis of 1,406 comments on President Trump’s proposal to cut down the 340B hospital drug discount program finds that half were submitted anonymously and contained suspiciously similar wording, with two submitted hundreds of times containing the same grammatical error. Further digging by KHN also found that some patients can’t remember commenting, implying that they were unwittingly coerced into submitting them by practices affiliated with the Community Oncology Alliance, a nonprofit trade organization funded by drug manufacturers. CMS Administrator Seema Verma and Deputy Secretary Eric Hargan pointed to patient comments as a big part of their decision to cut annual 340B payments to hospitals by $1.6 billion.

The Mike O’Callaghan Military Medical Center on Nevada’s Nellis Air Force Base becomes the first base to connect with the VA’s Tele-ICU center in Minneapolis. Installed in five of the center’s rooms, the extra set of virtual “eyes” have especially helped in the prevention of ventilator-associated pneumonia, catheter-related bloodstream infections, and stress ulcers.

Other

The latest report from KLAS looks at the shrinking pool of release-of-information vendors and their ability to deliver consistently across customers. While Ciox Health continues to dominate thanks to the combined customer bases of its predecessors, IOD and HealthPort, it lags behind Verisma and MRO in customer satisfaction. While some Ciox customers seem prepared to leave over a lack of focus, culture, and personal touch, others are optimistic that the company’s new automated technology will close performance gaps. Customers give MRO high marks for high-quality customer service, especially in the areas of educational programs and training. Verisma, the smallest vendor, has experienced steady growth along with high levels of satisfaction for personal attention and access to the executive team – traits that may be hard to maintain as the company grows.

Sponsor Updates

• AdvancedMD will exhibit at the Healthcare Business Management Association Conference September 12-14 in Charlotte, NC.
• Agfa HealthCare embraces intelligence in its health IT and imaging solutions to enable Care You Can See at RSNA18.
• Aprima recaps its ninth annual user conference.
• The local business paper profiles Diameter Health co-founder Eric Rosow.
• Greenway Health names AssessURHealth its Marketplace Rookie of the Year.
• Arcadia will present at the EOCCO Clinician Summit September 20 in Hermiston, OR.
• Redox will exhibit at HITRUST September 11-13 in Grapevine, TX.
• The latest Black Book Market Research survey names Leidos Health the 2018 top health information technology consultant.
• CarePort Health will exhibit at ACMA Illinois September 18 in Rosemont.
• Dimensional Insight will exhibit at the MDM Analytics Summit 2018 September 18-20 in Denver.
• University of Texas Medical Branch CEO Donna Sollenberger joins Nordic’s Board of Directors.
• Health Catalyst creates a Patient Safety Organization to give customers an avenue through which to share best practices, plus other benefits.

Blog Posts

• TAVR program requirements are changing, are you ready? (Advisory Board)
• Five Ways You’re Already Using Machine Learning: A Day with AI (Apixio)
• Getting data from Epic Caboodle back into Chronicles (Bluetree)
• Missed Google Cloud Next 2018? Our 7 Favorite Sessions (Burwood Group)
• Moving the Needles on Interoperability Part 3: Best Practices for an ADT Integration (Casenet)
• ChartLogic’s Revenue Cycle Management Provides True Value (ChartLogic)
• The Advent of EHRs and Better Patient Transparency (CoverMyMeds)
• The Changing Role of the CIO: Data Stewardship and Analytics (Culbert Healthcare Solutions)
• Customer Spotlight: Doctors Center Hospital (Dimensional Insight)

Contacts

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

Morning Headlines 9/11/18

Cerner President Zane Burke to Step Down

Cerner EVP of Worldwide Client Relationships John Peterzalek will assume the responsibilities of President Zane Burke when he steps down November 2.

Clarify Health Solutions Raises $57 Million in Series B Financing Round Led by KKR

Clarify Health Solutions raises $57 million to further develop and scale its analytics-based Care Journey software.

FDA awards $225M IT contract to track drug performance

The FDA awards Acumen, Dovel Technologies, and IQVIA Government Solutions $75 million apiece to develop data, tools, and infrastructure for its Biologics Effectiveness and Safety Initiative, which will ultimately include a network that can analyze large health data sets from sources like EHRs and claims.

Curbside Consult with Dr. Jayne 9/10/18

There’s such a range of activities that CMIOs perform in their daily work – it’s one of the reasons I enjoy what I do when I’m outside the realm of direct patient care. I’ve been working as an interim CMIO for a mid-size provider organization, and one of my projects is to assist in standardizing patient education materials. Many healthcare organizations subscribe to commercially available patient education databases, such as Healthwise, which integrates with the EHR. This organization had previously moved from a sorting cubby full of handouts at each location to a PDF-based repository on a shared network drive. However, over time many of the handouts had become dated or overly-customized, leading to the need for a review project. The existing medical leadership was overwhelmed with the work of running the group including contract negotiation, quality management, and more, hence the need for a CMIO to tackle more informatics-oriented projects.

The practice had hired the daughter of one of the managing partners as a summer intern, and since she was pre-med she was eager to help with clinical projects. In no time, she had catalogued well over a thousand documents, tagging them with dates for origination and most recent update, as well as the names of any providers who seemed to “own” the various documents. She found numerous duplicates where providers had saved copies of documents with their own naming conventions so they could find them more quickly. There were also materials that not only lacked freshness but contained clinical information that was out of date. Without a solid policy and procedure behind the creation of the shared repository, and without someone to hold people accountable for its use, it had taken on a life of its own.

This project was the intern’s first brush with clinical informatics. I suspected that at the beginning she was a little bored, thinking it was more administrative than clinical. However, we had some great conversations around the value of public health and the role that patient information plays in successfully managing health conditions, and I could tell she was starting to understand how important the project was, especially since the providers used many of the documents regularly. She quickly became educated in the softer skills that CMIOs have to use – expectation management, consensus building, communication plans, and creation of governance. We had provider listening sessions, rapid design sessions for the new repository, and deep dives into review of the actual documents.

There was a lot of conversation around social determinants of health and the need to make sure that patient education materials meet the patients where they are – specific to language, reading level, amount of detail included, and more. Those factors were part of the genesis of the practice having its own library. They wanted their materials to be culturally appropriate to their patient population and, when it was initially created, they didn’t feel that any of the available content met their needs, so they created their own. During the standardization project, they didn’t want to lose that flavor or personal touch, but they wanted materials that were consistent across the provider base and easily maintainable.

I also identified a number of opportunities for addition to their document library. Although most of the chronic conditions were covered, as were preventive services, there were whole areas of patient education that weren’t addressed. One of these was general navigation of the healthcare system. I suggested that we work on a couple of documents that explained various processes that patients need to understand better when they seek care under our current system. This included topics such as reading an Explanation of Benefits document; understanding the differences between primary care and subspecialist providers; understanding different locations of care; and understanding the basics of healthcare financing including terms such as coinsurance, copay, deductible, maximums, etc. The providers were on board with these additions, along with information on managing complex medication regimens and modifying the home environment to support aging in place.

My intern did a fair amount of research on the topics, making recommendations on whether they should personalize an existing open-source document or whether they should write something new from scratch. I paired her up with a couple of providers to work with on new documents, along with a small committee to use as a sounding board for evaluating documents from various national organizations that we might be able to use as-is. We’ve got the library about 75-percent complete, and although she has gone back to school, she’s still helping a couple of hours each week as we work on the remaining documents. I think she has a greater appreciation for the so-called “non-medical” work that physician leaders sometimes have to do, along with an understanding of the technology needed to deliver resources to the patient in a way that is trackable and complies with payer requirements.

In working on the documents we created to help patients navigate the health system, she also gained a new understanding of health literacy in her community and what patients need to be able to successfully care for themselves at home and to receive the care they need from a variety of different provider organizations. Many premedical students don’t have any exposure to what happens outside the exam room, so I’m hoping the experience helps her form a better idea of what she hopes to be able to achieve through a career in medicine. She also learned to read governmental documents with a critical eye, appraising them for how well patients and providers might understand them. She sent me a link to this CMS blog on Health Savings Accounts with her thoughts on how she felt it didn’t meet the mark – too many acronyms, too many text blocks, etc.

She also posed some critical questions around why certain healthcare payment mechanisms work the way they do. For example, why can’t everyone open a Health Savings Account? Why shouldn’t it be available to all consumers of healthcare rather than just those with high-deductible plans? Why are Flexible Spending Accounts “use it or lose it?” It was surprising to her to learn that many of these options are linked to tax savings for individuals, and that incenting people to move towards these plans can negatively impact the federal budget. She had a lot of questions about how healthcare works in other industrialized nations and why our system is so complex. There aren’t any good answers for many of her questions, but I was able to recommend some good resources for further reading.

I’m hoping I inspired her to think about medicine in a different way, and to consider options if she doesn’t ultimately make it to medical school. I think we may just have a public health informaticist in the making. Or perhaps a policy expert or a legislator. I enjoy working with curious young people and getting them thinking about topics they didn’t even know existed.

Did you have any thought-provoking encounters with interns this summer? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 9/10/18

Notable Health Closes $13.5 Million Series A Financing to Expand Artificial Intelligence Powered Physician-Patient Interaction Platform

Notable Health raises $13.5 million to further develop its physician-patient interaction software delivered via Apple Watch.

Medical Records Co. Reaches $4.9M Deal To Resolve OT Suit

Optimum Healthcare IT settles a class-action lawsuit related to unpaid overtime filed last year by two employees for $4.9 million.

Top cancer researcher didn’t list corporate ties when he published studies

Memorial Sloan Kettering Cancer Center (NY) CMO José Baselga, MD comes under fire after media outlets report he failed to disclose his financial ties to research journals in which he was published.

Monday Morning Update 9/10/18

Top News

Memorial Sloan Kettering Cancer Center (NY) CMO José Baselga, MD comes under fire after media outlets report he failed to disclose his financial ties to research journals in which he was published. Baselga has served on the boards of and performed consulting work for dozens of pharma and healthcare companies, yet has systematically failed to report the millions of dollars in payments received when speaking or writing about sponsored clinical studies.

Adding insult to injury is the fact that Memorial Sloan Kettering has not yet censured Baselga in any way, other than to call for its staff to do a better job of disclosing their corporate relationships.

Baselga’s lapse highlights not only a lack of ethics on his part, but the slippery slope prestigious research publications like The Lancet and New England Journal of Medicine must walk when deciding to publish research. Most rely on an honor system, and for some, it’s simply a matter of not enough background-checking resources to go around. While publications like the American Association for Cancer Research have never barred an author from publishing, many are now reviewing their submission and review processes. 

Reader Comments

From Vaporware: “Re: VA CIO nominee’s remarks on speeding up the Cerner project timeline. Summary: ‘We can do this faster,’ says someone who has never implemented an EHR. ‘You’ll be held accountable,’ says someone who never held anyone accountable. ‘LOL. $10 meeeellion dollars!’ says Zane on his way to the bank.” VA CIO nominee James Gfrerer told a Senate hearing committee last week that getting the Cerner switch flipped in under 10 years is definitely on the table. Nominated by President Trump at the end of July, Gfrerer spent two decades in the Marine Corps before serving as a senior military advisor in the State Department and then moving to E&Y’s cybersecurity practice.

HIStalk Announcements and Requests

The majority of respondents would have no qualms about sharing their medical bills with media outlets in hopes of getting them reduced, though my use of the word “resort” implies that it would be a last-ditch effort after all other avenues have been exhausted. Greg points out that, “If the healthcare organization is not responsive or unwilling to work with me on the bill, the media is one outlet I’d consider reaching out to. Any business should expect what they say to their customers to end up in the news or on TV. With the laws in the US so skewed towards powerful interests, public shame in the media is one of the only options an average person has to fight with.” Lisa admits that it would “definitely not be my first choice, but as a last resort it’s better than bankruptcy. So far, I’ve been able to challenge and remove billing items that are clearly inappropriate, but what do you do if the billing folks refuse to clean up errors?” Mark says he’s “already used that approach and leveraged it effectively. Know your facts, prepare your facts, and share them with others so that all can benefit. When my wife had a hip replacement, without complications, and the net charges were 2x of the local competition, 2.5x what the facility accepts for a Medicare patient, put the the pen and paper (keyboard and email) to the task. Bottom line – fees reduced, perhaps humbled the facility, for a moment.”

New poll to your right or here: Would you purchase a “premium” genetics testing service from at-home kit companies like 23andMe?

Webinars

September 26 (Wednesday) 12:30 ET. “How to Ensure Patient Records are Always Available.” Sponsor: Goliath Technologies. Presenter: Goliath Technologies engineering staff. This webinar will discuss how an early warning system can help your organization ensure your EHR systems and patient records are always available. You’ll also learn how to proactively anticipate, troubleshoot, prevent, and resolve end user experience issues before users or patients are impacted.

Previous webinars are on our YouTube channel. Contact Lorre for information.

People

Lisa Johnson (Legacy Health) joins Bluetree’s executive leadership team.

Acquisitions, Funding, Business, and Stock

Quality Systems changes its name to NextGen Healthcare. Quality Systems created NextGen in 2001 through the merger of Clinitec and Micromed.

Notable Health raises $13.5 million to further develop its physician-patient interaction software delivered via Apple Watch.

Optimum Healthcare IT settles a class-action lawsuit related to unpaid overtime filed last year by two employees for $4.9 million plus $1.6 million in legal fees.

Healthcare Growth Partners recaps investment activity over the last year in RCM markets that include patient financial responsibility, complex claims from non-traditional payers, and coding and claims as they relate to connecting providers and payers.

Sales

• University of Louisville Hospital and Physicians (KY) select Health Catalyst’s Data Operating System and outcomes improvement professional services.
• Conway Regional Medical Center (AR) chooses post-discharge automated messaging software from CipherHealth.

Announcements and Implementations

Personalized cancer treatment company Driver develops an app that offers patients treatment options and follow-up care within its network of 30 cancer centers. The membership-based service includes medical record and tumor sample collection, appointment scheduling, and virtual consults.

OnlyBoth adds hospital performance to its line of consumer-friendly healthcare comparison websites.

Ciox Health announces GA of HealthSource, AI-powered software that locates, acquires, digitizes, and manages health data.

Nuance makes voice-enabled Dragon Medical workflows available through Epic’s mobile Rover documentation and barcode validation app.

Mobile Heartbeat develops a new user interface for its MH-Cure care team messaging software.

A new KLAS report on patient financial access finds that AccuReg ranks highest in customer satisfaction across categories, while Experian Health sees similar rankings from broad adopters. Recondo Technology leads the way in automated preauthorizations, but lags other vendors when it comes to customer perception of its positive impact on patients, staff, and billing. Experian Health’s customers, however, are the most likely to share patient access success stories. Change Healthcare wound up being the only vendor whose customers have all realized the benefit patient access solutions have on back-end billing.

Privacy and Security

British Airways suffers another privacy black eye after hackers breach its website and app, compromising personal and financial information tied to 380,000 passenger transactions. The airline came under fire in July when its social media team asked passengers with service complaints to post personally identifiable information on Twitter to help resolve their issues, claiming it was necessary to comply with GDPR. 

HITRUST introduces a Shared Responsibility Program to help organizations and their service providers clearly understand their roles regarding ownership and operation of security controls.

Other

CNBC survey-takers believe controlling costs to be the top reason companies like Apple and Facebook are bypassing third parties like Premise Health to set up on-site clinics for their employees.

Sponsor Updates

• LiveProcess will exhibit at the SONAR Safety Healthcare Conference September 14 in North Platte, NE.
• MDLive will present at the Healthcare Analytics Summit September 13 in Salt Lake City.
• Waystar will exhibit at the Mediware Conference September 10-12 in San Antonio.
• Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the AWHONN Ohio Section Conference September 13-14 in Sandusky.
• OmniSys will exhibit at the PDX Pharmacy Forum September 16-18 in Fort Worth, TX.
• Experian Health will exhibit at AAHAM MD September 11-13 in Ocean City, MD.
• Sunquest will exhibit at Precision Medicine for Hospital CEOs September 12-13 in Nashville.
• Visage Imaging will exhibit at the SIIM Conference on Machine Intelligence and Medical Imaging September 9-10 in San Francisco.
• Philips Wellcentive publishes a new white paper, “How rising risk impacts value-based care.”
• Voalte will exhibit at the Texas Health Association 2018 Quality and Patient Safety Conference September 13-14 in Georgetown, TX.

Blog Posts

• 5 Ways Healthcare Communication Technology Fosters Staff Connections (LiveProcess)
• Improving care coordination with a transition care center (Meditech)
• 5 Considerations When Designing Software for Clinicians (Mobile Heartbeat)
• Arming front desk staff with the tools for success (Waystar)
• Electronic Visit Verification (EVV) Requirements on the Horizon (Netsmart)
• Why secure messaging isn’t enough (PerfectServe)
• If It Ain’t Broke … Do You Need to Fix It? (CloudWave)
• Healthcare administration revolutionized (Experian Health)
• Thumbs Up: The Surprising Link Between Patient Satisfaction and Revenue Cycle (Patientco)
• 2019 is about Efficiency, Opportunity and Execution – Start Planning Now (Pivot Point Consulting)
• Contemporary Job Description for the Future of HR (ROI Healthcare Solutions)
• Founder Letter: Is Insurance Really the Enemy? (WebPT)
• Electronic Validation Saves Manual Steps in Emergency Medicine Billing to Help Providers Get Paid Faster (Lightspeed Technology)

Contacts

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

Weekender 9/7/18

Weekly News Recap

• Athenahealth prepares to take second-round bids as inside sources report that Cerner and UnitedHealthcare have passed on buying the EHR vendor.
• Theranos tells shareholders it will dissolve and will work to pay off its creditors with remaining cash on hand.
• Atul Gawande, MD taps former Comcast digital health GM Jack Stoddard to be COO of the still unnamed joint healthcare venture of Amazon, Berkshire Hathaway, and JPMorgan.
• Verity Health (CA) files for Chapter 11 in an effort to survive the health IT missteps of Patrick Soon-Shiong, MD who acquired the health system in July 2017.
• Tabula Rasa Healthcare acquires EHR vendor Mediture and its third-party administrative services subsidiary EClusive for $22 million.

Best Reader Comments

Methinks the emperor has donned new clothes ~ Argonaut Project -> Da Vinci Project (Clarence)

The travesty of the new normal known as outpatient procedures begins when the patient shows up at the crack of dawn to begin the process and extends through the point where, barely awake from anesthesia, the patient is thrust from curbside wheelchair onto waiting vehicle having been expected to digest postop instructions just reviewed. . . . Reminds me of medical care in a third world hospital where family provides food, bedding and nursing. (Kevin)

Watercooler Talk Tidbits

Readers funded the DonorsChoose teacher grant request of Ms. M in North Carolina, who asked for STEM craft materials related to the Winter Olympics and flexible floor seats. She says, "Students were excited when they opened the boxes and saw all the materials that our classroom received. They wanted to use the flexible seating right away. They also wanted to start on our Olympic projects right away and couldn’t wait until the next today to come to school. We have set up a rotation schedule for students to use the flexible seating. Our next step for using the materials is to create bobsleds that the students can race. We are always creating STEM projects in our classroom that connect to our math and science standards."

Nestle attempts to pivot from a peddler of sugary treats to the frontrunner in nutritional wellness with its Wellness Ambassador program. Initially rolled out in Japan, participants send pictures of their food via an app that then recommends special supplements and lifestyle adjustments. The program also offers a home DNA and blood testing kit to give users a more in-depth health and wellness workup. Campbell Soup made a similar move when it acquired Habit, a meal delivery service that combines DNA and blood profiles to make dietary recommendations.

Road warriors beware: Scientists determine that luggage trays at airport security checkpoints harbor more cold viruses than do any other areas within the facility, including toilets. It’s a timely observation given the spate of news this week pertaining to flights with sick passengers. A New York-bound flight from Dubai was quarantined after 100 people on board complained of feeling ill. Public health officials tested all 549 people on board for MERS; none tested positive for the syndrome, though nearly a dozen were sent to the hospital with flu-like symptoms.

CMS mistakenly sends Medicare termination letters to 38,000 Blue Cross and Blue Shield of Minnesota beneficiaries, blaming the mix up on bad data from the health plan.

IBM is developing a drone that, when paired with a companion app, could monitor a user’s health data to determine if they’d benefit from a cup of coffee, which it would then deliver.

In Case You Missed It

• News 9/7/18
• EPtalk by Dr. Jayne 9/6/18
• News 9/5/18
• Curbside Consult with Dr. Jayne 9/3/18
• Monday Morning Update 9/3/18

Get Involved

• Join my Rolodex to provide occasional news reaction or ideas
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