News 11/13/19

Top News

Google announces Project Nightingale, a partnership with 150-hospital Ascension in which the company will gain access to the identifiable data of potentially all of Ascension’s patients to apply predictive analytics for patient care.

Business Insider reports that the information of 20 million patients has been uploaded to the cloud, with that of another 30 million patients scheduled for transfer in February.

The Wall Street Journal says the data being shared is not de-identified and is essentially the patient’s entire record. It also notes that at least 150 Google employees have access to the data.

The organizations are testing EHR search software and tools that present EHR data graphically to clinicians.

Ascension’s patients and doctors were not notified of the project, except for the 2,000 doctors and nurses who are testing the EHR search function.

Ascension says the deal meets HIPAA requirements because Google has signed a Business Associate Agreement.

Quoted in the announcement was Ascension EVP / Chief Strategy and Innovation Officer Eduardo Conrado, who spent 26 years as a Motorola IT and marketing executive and four years as an Ascension board member before joining the health system’s executive team in September 2018.

Reader Comments

From Laid Off and Up: ”Re: recent layoffs. Why do companies fail to understand how bad they look laying off employees in November and December?” I assume that unrestrained desperation to make Excel cells jump forcibly through hoops to earn a bean counter hurrah outweighs the justified black eye that results from showing previously valued “associates” the door during the two-month holiday window. It’s never a great time to lose your job, but prospects are dim until after New Year’s, long nights invite depressing self-analysis, and it’s an unenviable acting job trying to appear upbeat along with holiday-spirited family and friends. Layoffs are a management failure, but November and December cutbacks suggest a higher level of knee-jerk incompetence. I’ll offer my advice from having served on both sides of the forced march out the door — you don’t want to work for a company that conducts regular layoffs anyway, so they’re doing you a favor by forcing you to choose a better employer.

HIStalk Announcements and Requests

I’m excited that my pre-ordered copy of “Man’s 4th Best Hospital” by Samuel Shem was deposited into my Kindle library upon its release today. I expect that will be the subject of my next book review. Meanwhile, if you think I should read a particular book and report on it, let me know.

Webinars

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

Acquisitions, Funding, Business, and Stock

Cerner lays off 131 employees in its latest round of cost-cutting. 

Value-based care clinical quality platform vendor Apervita raises $22 million from an incremental investment.

Premier launches Contigo Health, a network of member health systems that will use EHR-integrated, evidence-based clinical decision support to optimize care for employees of its employer members. It will also identify available employer health and wellness programs. Premier acquired evidence-based clinical decision support vendor Stanson Health a year ago for $51.5 million, which I would guess forms a key part of this offering. This announcement is a pretty big deal – as big tech companies start trying to figure out this maddeningly complex market, publicly traded Premier knows it inside and out (supply chain, quality improvement, analytics, technology, clinical delivery, etc.) and has now, via Contigo Health, formed relationships with 35 health systems representing 440 hospitals as well as several national employers to address cost and quality issues (also note that health systems are longstanding Premier member-owners). I wrote here several years ago that Premier was the company to watch in terms of disruption and execution and this announcement doesn’t throw water on that prediction. If I were Google or Amazon and was anxious to get a healthcare foothold… well, let’s leave it at that.

Sales

• Mercy will implement Bright.md’s asynchronous virtual care platform to provide online triage, diagnosis, and treatment for patients at any location at any time.
• In Northern Mariana Islands, Commonwealth Healthcare Corporation will upgrade its Medsphere legacy system to CareVue EHR and revenue cycle.

People

Jon Zimmerman (Athenahealth) joins Holon Solutions as CEO.

Datica CTO Travis Good, MD will leave the company’s management team. He will remain a Datica board member and is starting a new venture that is focused on personal data and privacy

Announcements and Implementations

Cricket Health Chief Product Officer Geoffrey Clapp builds VA Care Finder, a free Amazon Alexa skill that allows veterans to provide an address and to be given the closest three VA locations by driving distance (including traffic conditions), powered by the VA’s Facility API. The screenshot above is from an Echo Show device. He’s working on enhancements to use Alexa’s default home location, answer questions about specific facility hours or address, and answer questions about service lines, such as mental health, rather than all locations. Alexa’s limitations don’t allow him to link to external services or to use mapping tools. He’s hoping to explore the VA’s many other APIs to see if appointment scheduling is a possibility. He concludes in his Veterans Day post,

With these APIs — and there is much, much more than just the facilities subset API that I’ve exposed here — the developer community can now get access to data we only dreamed about back in the highly-mentally-scarring VistA integration days of yore. The fact that nearly all the data that is available to internal development teams at the VA or USDS is also available to every hacker, startup, and BigCo means we can do what APIs are meant to — OPEN THE DATA — and build stuff no one ever thought of (or, thought of but didn’t have the budget for…I see you, VA) and there are few populations as deserving of innovation as our Veterans.

A Black Book survey of health information management professionals finds that 93% are optimistic that AI can streamline document creation and capture a holistic patient history to improve outcomes and revenue integrity.

Prepared Health develops an API that users FHIR 4.0 to connect home care agencies and other providers to health plans and hospitals for referrals, care management, and billing.

Government and Politics

Politico reports that CMS Administrator Seema Verma signed a $2.25 million government contract to hire at least 40 consultants to polish her personal brand, several of them former Trump campaign workers who billed taxpayers up to $380 per hour to perform tasks that have always been managed by CMS’s civil servants. HHS cancelled the contract in April 2019 after Politico reported on it, but at least $744,000 had already been spent.

Other

In Israel, Sheba Medical Center says it will create “the first fully VR-based hospital.” That’s certainly a press release stretch, unless the hospital plans to sell off all those buildings in the photo above and instead pass out VR headsets to patients. They calmed down a little further down the page, specifically listing that the hospital will use virtual reality for therapy services and education.

The non-profit Health Care Cost Institute gains access to de-identified Blue Cross Blue Shield claims in a multi-year partnership agreement. UnitedHealthcare stopped sharing its claims data with the group earlier this year, citing privacy concerns about HCCI, which is a non-profit competitor to its claims data-selling Optum subsidiary.

The Environmental Protection agency is proposing to ignore the conclusions of academic studies in its rulemaking unless the authors submit all raw data, including any patient medical records that were reviewed, for public inspection. EPA says outsiders should be able to independently review all study data to verify the conclusions of the researchers. The measure would make it more difficult to pass new environmental laws because the personal health information that was involved is often collected under confidentiality agreements. EPA’s proposed standard would exceed those for published medical studies, which do not require investigators to submit raw data.

A newspaper in India interviews Viren Prasad Shetty, the COO of India-based Narayana Health, which plans to expand from its 30 hospitals and 6,000 beds to 30,000 beds. Interesting points:

• The company plans to create a virtual health network that involves apps rather than buildings in an Uber-like model that will allow it to grow more quickly at a lower cost.
• He says India’s plan to add a new medical school in every three districts of India isn’t adequate because many of the graduates leave the country, noting that the US has more India-graduated nephrologists than India itself.
• He predicts that “the biggest export-earning industry of this country will be our manpower,” specifically medical caregivers as declining populations leave Western countries with no one to care for their senior citizens.
• Narayana’s 20% annual growth in cancer services eclipses that of its primary focus of cardiac services, so “we will want to convert all our hospitals into cancer hospitals.”
• He says the company’s strength is that is led by a core group of doctors – including cardiac surgeon and CEO Devi Shetty, MBBS – instead of business executives, which makes it attractive to doctors.

A man who expected his hernia repair to cost around $10,000 is shocked at the for-profit hospital’s $116,000 bill for the 91-minute outpatient procedure, including $1,700 for a pair of scissors. He had passed on buying real health insurance and instead enrolled in a health-sharing ministry that pools medical bills among self-pay patients outside the purview of insurance regulations. He was approved for up to $50,000, but inadvertently chose the most-expensive area hospital and didn’t realize that patients who are covered by health-sharing ministries are billed at the same rate as uninsured or cash-paying patient without the benefit of heavy insurer-negotiated hospital discounts. The hospital refuses to budge on the $67,000 balance he owes. He’s demanding that Virginia’s consumer protection office force the hospital to write off his balance, but an attorney with Virginia Poverty Law Center says the hospital will probably just sell off his debt to a collection agency for 10 cents on the dollar. 

An American Osteopathic Association survey finds that 75% of Americans feel lonely. My free advice – forget your pretend friends on Facebook and make an effort to interact with actual human beings instead of accidentally trampling them on the sidewalk while staring down in wonderment at your phone’s compelling but imaginary world. The most provocative art I’ve seen recently is by photographer Eric Pickersgill (above), who showed what real life would look like once the “small, cold, illuminated devices” of social media addiction are removed. He describes it as: “This phantom limb is used as a way of signaling busyness and unapproachability to strangers while existing as an addictive force that promotes the splitting of attention between those who are physically with you and those who are not.”

Sponsor Updates

• Apixio will exhibit at the Rise Annual Risk Adjustment Forum November 12-14 in Scottsdale, AZ.
• Clinical Architecture will exhibit at AMIA November 16-20 in Washington, DC.
• Diameter Health will exhibit at the Advent HEDIS 2020 Client Conference November 19 in Scottsdale, AZ.

Blog Posts

• Give your practice the financial breathing room it needs (AdvancedMD)
• You don’t have to list your negotiated rates (yet): Our 3 key takeaways from the HOPPS final rule (Advisory Board)
• Better. Faster. More Efficient. (Agfa Healthcare)
• Keys to a Successful Laboratory System Implementation (Optimum Healthcare IT)
• Analytics for Whole-Person Care: The Rise of the Connected Behavioral Health Network (Arcadia)
• HIPAA Security Rule Checklist: What is the HIPAA Security Rule? (Atlantic.Net)
• The State of AI in 2020: 35 Stats You Need to Know (Avaya)
• HIPAA vs. HITRUST (Datica)
• 6 Reasons to Initiate a Network Assessment Now (Burwood Group)
• nteroperability: Why It Matters So Much to the Current and Future State of Healthcare (ChartLogic)
• Basic Principles That Could Transform Your Practice (EClinicalWorks)
• Recap: ACEP19 Focused Heavily on Workplace Violence (Collective Medical)
• Why a Manufacturer Cash-Price Program Can Be a Better Option for Patients Purchasing Prescriptions (CoverMyMeds)

Contacts

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

Morning Headlines 11/12/19

Our partnership with Ascension

Google clarifies its HIPAA-compliant work with multi-state Ascension after multiple media outlets report that its employees have questionable access to millions of medical records through a secret data-sharing project dubbed “Project Nightingale.”

KKR Makes Formal Approach to Walgreens Boots on Record Buyout

Walgreens shares rise on the news that New York City-based private equity firm KKR has submitted a proposal to take the company private.

Healthcare Leader Jon Zimmerman Named CEO at Holon Solutions

Former Virence Health President Jon Zimmerman joins Holon Solutions as CEO.

Access Physicians Receives Investment to Expand National Acute Care Delivery via Telemedicine

Acute care-focused telemedicine vendor Access Physicians raises $9.3 million in a Series A funding round.

Curbside Consult with Dr. Jayne 11/11/19

My recent conversation with a local university student about how the US looks at public health efforts got me interested into digging in a little more into a local health system’s work to address social determinants of health. I reached out to a former colleague who is now in a leadership role. He asked to remain off the record, since not all of his views fully align with what he is working on as part of the health system’s efforts. I totally understand having to stay off the radar to keep your job, so I was happy to oblige.

One of the major pushes of the health system has been expanding access to care, whether it’s with a mobile unit to visit areas that don’t have providers or whether it’s creation of school-based clinics. They are finding that even those approaches sometimes aren’t enough.

One of the areas where they set up a school-based clinic has a high absenteeism rate, with girls posting higher numbers than boys. Digging deeper, they found that teen girls sometimes aren’t in school due to lack of access to menstrual products. As someone who has worked with a church group to sew reusable menstrual pad kits for girls in developing nations, this doesn’t seem like something we should be seeing in the US. The clinic set out to solicit donations for menstrual products, and guess what? The absentee numbers went down. It’s a great example of how we need to really understand all the factors that are driving health, education, and wellness.

This approach may resonate with practices who help care for high-risk patients by providing transportation or assist with obtaining housing or groceries. If patients aren’t able to meet their most basic needs, they’re not going to be focused on things higher up the hierarchy, like healthcare and medication.

My colleague said this approach is something he actually struggles with philosophically. Some programs focus on those individual social needs, but don’t look at how you need to go about improving the underlying social and economic situation in communities as a whole. The individually-focused interventions are cheaper than delivering more intense medical interventions for sure, but they don’t assist people who haven’t become patients yet or who aren’t in the healthcare system.

He recounted a recent meeting among community health stakeholders, where they spent nearly two hours debating and defining what they mean when they say “social determinants of health.” The phrase was being thrown around and meant different things to different people, and they felt it was important to get everyone on the same page.

Although I don’t doubt that it was probably a painful meeting, it sounds like it was necessary. As he was telling me the story, it reminded me about how people throw around “pop health” and “population health management” and various permutations that may not mean the same thing depending on who is using the phrases and where they’re coming from.

During one of their community-focused initiatives, they actually had quite a bit of resistance from a small segment of community members. Some felt that the hospital’s participation was a way of trying to “medicalize” issues that community activists want to have a much more social and/or services focus. Instead of heaving the health system lead the charge, they want to see it led by community centers, faith-based organizations, and other community-led groups.

In addition to concerns about medicalization, there were also concerns about the hospital staffers not reflecting the community demographic and the optics of having a primarily Caucasian outreach team working with a community whose makeup is predominantly African-American. That’s something that isn’t always thought about, but may certainly be part of how interventions are received.

Patients and community leaders are also skeptical about value-based care. Some see it as rationing by another name, especially when it’s being primarily led by the medical establishment. Others see it as a way for conglomerate health systems to increase their dominance, which can lead to the erosion of community-focused health services.

My colleague mentioned that he struggles a bit going back and forth between the community outreach projects and the health system’s flagship hospital, where he has an office. The hospital’s lobby looks more like a high-end hotel than a healthcare establishment, and executives regularly divvy up the organization’s luxury box tickets for events at the local stadium. When he sees what might be considered excesses, he immediately thinks of how many social services could be delivered using the money spent.

He also has a hard time wrapping his head around the half billion dollars that has been spent on a recent EHR implementation and associated consulting services when his repeated requests to add a social worker to his team have been rejected. He notes that the EHR project hasn’t been all bad since it has made it easier to obtain and use data about different outreach projects they’ve been doing. It’s been useful for clinical reminders and identifying gaps in care to try to optimize health for individual patients. They’ve also been able to use address data to refine locations for community-based health screenings and vaccination clinics. He notes that has been easier since his request for a 0.5 FTE data analyst position was approved.

Apparently there are some ongoing tensions with the local public health organizations, who feel that competing health systems are more about bringing attention to their facilities than about advocating for essential public health needs such as sanitation, preventive services, and immunizations. The health system is having a retreat in a couple of months to talk about its community health efforts and it will be interesting to check in with him and see if there are any major changes to strategic direction or if the plans remain status quo.

I wonder what that retreat would look like if they invited public health leaders, or better yet, also included representatives from the other major healthcare players in town? Maybe that could lead to a more coordinated effort, but I’m just hypothesizing. I wish there were words to describe the eye-roll that resulted when I made that suggestion.

On a side note, I wanted to say thank you to all our readers who are veterans and also to their families and loved ones. We appreciate your service and your sacrifice.

How does your organization integrate with the local public health infrastructure? Is it working, or are there suggestions you would offer? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Bob Segert, CEO, Athenahealth

Bob Segert is chairman and CEO of Athenahealth of Watertown, MA.

Tell me about yourself and the company.

I’ve been a serial CEO. I have been working in the private equity space for the last 11 or 12 years. This is the fourth company that I have had the privilege to run as CEO. I’ve been largely focused on software and services. This is my first foray into healthcare.

Athenahealth is going through an interesting and fruitful transformation from being publicly held to privately held. This is providing significant opportunity for us to rethink some of the old paradigms and the ways we thought about the business. This allows us to reposition ourselves to ignite against our new vision, which is to create a thriving ecosystem that delivers accessible, high quality, and sustainable healthcare for all.

What do you bring to the table as someone with no healthcare experience?

The real advantage I have is that I can ask all the silly questions and not feel like I should already know the answer. That allows me to get to first principles.

We are all users of healthcare, so we’re all somewhat familiar with some of it, but it’s cursory knowledge. You understand some of the steps. That at least allows you to focus in and have an objective view on the data that you hear.

The value that I bring to this enterprise is that I’ve been a longtime software and services exec and I’ve been in a lot of different industries across the United States and internationally. That allows me to think about this platform business and the apps that we have a different way.

I think about Athenahealth as being a technology company that provides solutions that help doctors be more efficient and effective in what they do. But the underlying core assets that we need to continue to improve and drive value with are, fundamentally, software and services assets. That’s where my strength and background has been in for the last 20-25 years.

What opportunities do you see with the Athenahealth network that connects hundreds of thousands of users on a single platform?

It’s the most powerful asset that Athena has. We believe in an open ecosystem. That’s why our new vision is about creating that thriving ecosystem.

Ecosystems must be dense, resilient, utilized, and open. Think about Athena in that context. We are the only platform out there that has that type of capability. We are fundamentally a SaaS-based application. All our customers are on the same code. We don’t have versions of the code. We update our software every night. Everyone gets it. You don’t have to reinstall it. If you want to get a new code, just refresh your browser and it’s there.

This allows us to powerfully change our rules and change our workflows to be more reactive to changes in the healthcare system and ways to make things better. We don’t have to wait for the next release a year from then. We don’t have to wait another three years for our customer base to adopt it.

The other thing that we’ve invested in, which is an amazing asset, is the data lake. We’ve abstracted all data out of our relational tablespaces that we have for each of our customers into a data lake. We have a full API gateway that is opened up to that. With permission, any person can get into that network of data and provide additional services, whether that’s the hospital system or ambulatory system on their own or whether that’s a third-party provider that has authorization from that practice to access their data. They can now access that seamlessly through the data lake.

Our real advantage comes from the scale of that network and the openness of that network. We have 160,000 providers that are part of our company today. We process over 10 billion transactions every year. It’s a massively scaled platform, open at its core, that fundamentally will continue to be a vanguard and leader in interoperability. Healthcare needs platforms that break down the silos, the information asymmetries, and the incentive asymmetries to enable a fragmented system to thrive.

How does Athenahealth work with vendors that don’t sell EHRs but offer add-on or complimentary products?

We have the Athena Marketplace, with almost 300 partners. Frankly, I think we have underutilized the benefit and the potential of that. I’d like to see 2,500 to 3,000 partners in our marketplace.

We want to make our network open and extensible. We will let anybody come and play in that network and add value to our customers. We think it also adds value to the healthcare system. We think it drives better outcomes, whether it be accessibility, quality, or sustainability.

We are very open to driving that open marketplace and we will continue to invest in that. That’s a key part of our strategy as we think about the business going forward.

We are also committed to driving interoperable solutions at an experiential level, at a physician level. One patient, one chart. The ability to schedule and refer across ambulatory and acute care settings. We want to be able to do that with every single EHR out there that’s willing to connect with us.

Our goal is not to hoard relationships or try to be a closed system. Our goal is to enable better healthcare outcomes. If we can do that, we will prosper, and the American public will benefit.

Do you see a role in helping those companies develop a business?

We have done that in several cases, where we have worked with small businesses that are exclusive partners to Athena to help them gain traction with our customer base. We’ve provided lead referrals. We’ve provided free office space in our main headquarters building in Watertown so people can develop their products and solutions. We’ve been a big proponent of trying to help our partners be successful.

I think we have a lot more that we can do. There are investments we want to make in marketing and onboarding and enablement that will allow us to treat that with a channel support-type mindset so that we can enable the success of those partners.

Of course, there are always opportunities for us to have a broader relationship with the companies that really take off and are doing well within our customer base, for us to have a broader relationship with them. That could be a joint venture, a minority interest investment, or even ultimately an acquisition by Athena.

What is your relationship with Walmart and their use of Athenahealth systems in their Walmart Health pilot in Georgia?

We are doing work with Walmart. We see that as a significant opportunity for us as we move forward. It’s a pilot program right now, but we see that hopefully being able to expand to many more sites over the coming months. We have a lot of other programs in the retail space that will be similar. We think it will be a big growth area for us going forward.

We are seeing demand there because of our SaaS-based platform. People who are trying to use cloud-based technology, SaaS-based technology, to enable outcomes naturally gravitate towards the type of platform that we have. It is dynamic, flexible, configurable, and adaptable.

Competing vendors seem to be addressing a mature EHR market by either expanding into areas that haven’t been big EHR users or cultivating relationships with pharma. Are either of these areas attractive?

We’re not focused on the pharma space. That’s not where our strategic intent lies. You’re not going to see us pivoting into pharma, either from a data standpoint or a broader services standpoint.

Where you will see us focused is on alternative sites of care. You’ll see us increasingly in employer clinics, retail clinics, the ER, and eventually in virtual medicine and telemedicine in the home. We want to be able to meet our patients where they are and help our physicians create a seamless, end-to-end experience across the care continuum as we expand our service offerings and our capabilities in those spaces.

But fundamentally, where you’ll see us double down is investing in our fundamental clinical workflows at the front door of medicine. Peds, OB-GYN, internists, primary care physicians — that’s where we are going to focus. We’re going to focus a lot of dollars on improving that EHR, improving those workflows, and then enabling the exposure of data to help them close care gaps in real time, when the patient is in front of the doctor. That is the key thing that we think we can drive in the industry that others have a hard time matching.

It was a seemingly odd mash-up of cultures to combine the old Athenahealth with the GE business to form the new Athenahealth. How would you characterize the company’s focus and culture now compared to what it was in those previous companies?

I would say it’s evolving. We are leveraging some of the best traits of both businesses.

In Virence, the old GE Centricity business, you had some long-tenured, expert capabilities — specialty workflow experts, anesthesiology, cardiology. You have hospital-related capabilities and RCM. GE had discipline, while Athena was traditionally more freewheeling, with an entrepreneurial, founder-led culture and all those elements that has made Athena such an amazing place to work.

You take that additional expertise and specialty workflow capability and pair that with that front door capabilities that Athena had, where because of its SaaS-based platform, it could succeed with one- and two- doctor practices, because that the delivery model makes so much sense for them, whereas premise-based software doesn’t. It’s a nice mash-up between the two.

We are right in the middle of it since it has been around nine months since the transaction closed. The cultures are coming together nicely and it’s going to continue to evolve over time. You don’t move cultures quickly — cultures evolve. We’re committed to taking the best of both and bringing them together to be even a more dynamic and exciting place to work.

Athenahealth seemed to struggle in its final publicly traded days with a post-Meaningful Use mature market. How does that affect your business strategy?

There’s no doubt that Meaningful Use, the emergence of EHRs, and the incentive to adopt EHRs floated all boats. A lot of companies sprung up because of that. As the Meaningful Use hurdles get higher and higher each year and certification become more and more difficult, I think you’re going to see increasing pressure on some of the smaller EHRs that may not have the engineering wherewithal and financial background to be able to survive.

It is a replacement market. It’s going to be a consolidating market. You’ll see some of the smaller players thrive less than they did in the past. Some specialized small players will continue to do extremely well and grow based upon a focused strategy. You’re going to see some of the bigger players like Athena working to differentiate ourselves in the marketplace, trying to gain relative share as these opportunities come up for replacement.

My view, and what I’ve seen since being inside the tent, is that we have amazing products that people really, really love. We’re not perfect, but people love these products. When we get into a demo environment, when we get a chance to get in with the physicians and show them what Athena can do, we win more times than we lose.

Our big challenge right now is how to get market awareness of the brand, what we’re doing and the favorability around the brand, and to get more at-bats. We know when we get in the batter’s box, we tend to get a base hit or more.

Is it difficult to get the attention of those small practices cost-effectively to earn a sale?

I don’t know if difficult is the right word. Each market segment has a different set of tactics that you need to employ. Small groups, those practices with six doctors or fewer, make up a different market mix. It’s a lot more online advertising. It’s business development resources that are calling and trying to reach doctors and try to set up meetings.

It’s very fast deal cycle. You set up a meeting, have a phone call, set up a meeting two weeks later, and go do a demo. Two weeks after that, you have a signed contract. You literally need two weeks to 30 days to sign a contract. It’s more of a flow business. You must have the resources upfront to canvas the marketplace to make those phone calls. That must be supported with good marketing campaigns that are focused, with real content and intellectual property that gets the doctors to step up and notice.

In our major cities, we just launched the “State of the Smart” campaign. You’ll see a lot of out of home advertising. We just had a full page in the Boston Globe on Sunday. We’ll have another one coming up. You’ll see a lot more Internet-based advertising and print advertising as we continue to position our brand out in the marketplace.

Enterprise is a little bit different. Sales cycles are longer and it’s more of a direct sales relationship sale. But we have a strong engine. I would say almost 40% of our bookings are coming in the small group space. We see that as being increasingly an area of strength for us as we move forward.

Who are your most significant competitors, taking into account the spread of Cerner and Epic into smaller practices and Allscripts saying it will develop a new EHR?

It’s a very competitive market. We compete with all the major players. We compete with all the specialty EHRs when it comes to some specialty practices. We compete on a broader outsourcing model with the companies that are providing broader RCM solutions. It’s a dynamic marketplace for sure.

Everyone is focused on trying to create value for customers. We’re no different. We believe that our core advantage sits around our expertise, the type of people that we have. It sits around our platform and the open interconnectedness into it. It sits around our ability to drive value from data analytics and benchmarking from the real-time execution of our processes. That enables us to differentiate ourselves in the marketplace vis-a-vis some of those other competitors.

Hospital consolidation will continue, there’s no doubt. Hospital bed stays are going down. More and more procedures are moving into the ambulatory care setting. Clinical advances, along with patient experience and preferences, are driving that. We are going to continue to see a robust and valid market in our core segment of ambulatory care. Even if there is some additional hospital consolidation, it’s not going to take the lion’s share of the market. There’s plenty of room for us to continue to grow and thrive.

Are you still planning to release an inpatient hospital system?

We had developed an inpatient EHR platform and sold it to several customers. We will continue to maintain that platform, the rules engine, and certification. We are not actively selling that in the marketplace today. We are redirecting our full focus into core clinical workflows, rev cycle, and the ambulatory care market. But just to be really clear, we will continue to support that hospital product.

We are also strong in hospitals with our Centricity assets. If you look at Virence and the Centricity Business platform, it has a world-class central billing office capability that cuts across both the acute and ambulatory care settings. It is focused on large IDNs and research hospitals. It is one of the gold standard rev cycle products out there in the market today. We are fully committed to Centricity Business. We will continue to invest in that and we see that as being a long-term part of the Athena portfolio going forward.

What about Epocrates?

Epocrates is a part of our business. It’s a relatively small portion of the company today. We see additional opportunity in Epocrates. We believe that there’s more that can be done, more that can be leveraged as we think about how to extend the value of that platform to physicians.

We know that the people who use Epocrates love Epocrates. It’s got a very good brand reputation. We see people using the product and it influences their drug prescribing decisions. It has value in the market. We see that as an asset that can be further invested in and leveraged. Epocrates is part of our family. It’s a smaller part of our family, but we believe there are opportunities there.

Private equity acquisitions often involve cutting costs and selling off non-core businesses to boost profit, then flipping the company or going public three or four years later. How do you see Athenahealth’s future given your background working with companies that grew in different ways?

The right mindset to have with private equity is that they are equity investors. Whether it’s private or whether it’s public equity, equity value and firm value magnifies itself with growth. Every great private equity investor is trying to drive growth. Our investors are no different. This is not about us trying to maximize and take every cost dollar out of the system we can.

We have seen things that we think can be done better. We can be more efficient. We can reprioritize some of our assets and investments outside of areas where we were investing and reprioritize those in other areas. Private equity has a specific focus on value levers and how you drive value creation.

That’s the way you should think about our owners, as being people who want to invest in the business. We made a big, one-time investment in technical debt to improve the platform so that we have a more solid foundation to continue to innovate on. They are very focused on us driving growth. They are very focused on us being innovative.

They have been great partners in the process, and they’re all about creating a great company. They are not about squeezing every last nickel out of the business, because that’s not the way you create long-term value. It needs to be a sustainable enterprise.

My experience with private equity has not been about crash and burn. It’s been about focus, re-prioritizing investment on the things that drive the highest level of growth, and creating the most value for customers. If you create the most value for your customers, then you get to take some of that value yourself.

Do you have any final thoughts?

Athenahealth is an amazing company. It has an amazing heritage. It’s a business that has the right to succeed and the right to thrive. We have a set of unparalleled assets in our employees, our customers, and importantly, the platform and the ecosystem we’ve built. We now have a leadership team in place, a team that’s behind us, and investors who are focused that will allow us to make the smart investments that we need to make to reposition the business for long-term growth and prosperity. That will benefit all the physicians in the United States and the entire system as we create a thriving ecosystem that delivers accessible, high quality, and sustainable healthcare for all.

Book Review: It Shouldn’t Be This Hard to Serve Your Country

David Shulkin, MD, the ninth Secretary of Veterans Affairs, is the latest in the seemingly endless cavalcade of fired President Trump appointees whose tell-all books profitably pay penance for their participation in a divisive administration. The cash registers of websites, TV networks, newspapers, and booksellers everywhere can’t stop ringing from peddling controversy from both sides of the fence.  

I wasn’t going to read “It Shouldn’t Be This Hard to Serve Your Country,” to be honest. I’m wary of whitewashed stories told by humiliated former government officials and politicians who decide to bare their souls in a safe environment where only their own uncontested voice is heard. My experience with that kind of book is that the authors always claim to be misunderstood, selfless saints who just want to set the record straight in clearing their good name (as well as the path to future beneficial endeavors). An HIStalk reader sent me an Amazon gift card to cover the book’s cost and said he wanted to hear my take on it, so that guilted me into buying the Kindle version.

It’s a great title, by the way, referring to both veterans and to the author himself.

Shulkin is an internist who didn’t serve in the military, although much of his family did. He served in several medical school roles, was chief medical officer in an academic medical center, was president and CEO of Mount Sinai’s Beth Israel Medical Center in New York City for four years, and was then president of Morristown Medical Center (NJ) for five years before being tapped by President Obama to be the VA’s under secretary for health in 2015.

I generally believe Shulkin’s contention that he was a selfless advocate for the health of veterans, improving the VA system, and trying to protect the VA from the meddling of limelight-seeking members of Congress. Surely he could have found jobs that weren’t so soul-sucking if his goal was self-aggrandizement or lining his pockets.

Spoiler: Shulkin was fired because of the meddling of political appointees who want to see the VA system dismantled and by a president whose vanity requires him to distance himself from underlings who get bad press that interrupts the mandatory adulation.

The snips Shulkin mentions about President Trump suggest that the President has good intentions, values loyalty above all else, rules by executive order while refusing to talk to the other side, doesn’t have the attention span to analyze issues and relies on subordinates to form opinions for him, and is in far over his head in turning the government over to clueless power-grabbers who wage full-time war against career government workers who actually understand the issues. The Trump administration is dogged by infighting, revolving door cabinet members, and leaks of information that, whether factual or not, are often intended to discredit his legitimacy as President.

It’s also clear that the so-called Mar-a-Lago Three – Marvel Comics chairman Ike Perlmutter, physician Bruce Moskowitz, and lawyer Marc Sherman – had the President’s ear, represented themselves as his personal emissaries, and demanded full participation in all aspects of the VA’s operation. Perlmutter reminded Shulkin constantly that he was meeting with President Trump all the time and summoned Shulkin and others to the President’s Florida resort to tell them what to do, not just with regard to the VA’s EHR project, but in all aspects of the VA’s operation. Shulkin insisted that the three “counsel” him individually rather than as a group since the latter could have been interpreted as an illegally operating “federal advisory committee” that requires public oversight. Shulkin says he wasted a lot of his day dealing with them, with Perlmutter calling him several times a day with one naive idea after another.

Shulkin notes that, like President Trump, none of the three had ever even visited a VA facility and declined opportunities to do so. Only Perlmutter is a military veteran and that was in Israel, not the US.

Shulkin spends a lot of pages defending the travel expense controversy that helped get him fired, providing details that he says prove just how ridiculous the claims were that he was junketing around with his wife on the taxpayer’s dime (which was certainly true of other Cabinet members, but not Shulkin, according to Shulkin). I actually believe him here as well, and while I’m skeptical of the whole “fake news” excuse for unflattering exposes, it seems that the Trump-created 24×7 frantic news cycle where tweets earn headlines has roped even credible media outlets into running poorly vetted stories hoping to wrest eyeballs from equally lurid sites. Once Shulkin got on the wrong side of the headlines, the former Obama-Trump golden boy had to be sacrificed to protect the President’s thin skin, not to mention that cabinet member travel excesses stories were all the rage for newspapers back then thanks to former HHS Secretary and jet-chartering Tom Price.

Shulkin describes some of the improvements he made to the VA, often decisively and with little support – fixing the wait time problems, publishing operational statistics, trying to modernize its HR policies of basically firing nobody regardless of their level of incompetence, and addressing veteran suicide. He observed that the competitive innovation model rolled out by former Undersecretary for Health Ken Kizer, MD, MPH – especially a star ranking system — encouraged VA facilities to hoard best practices to keep other facilities from stealing their stars. Shulkin rolled out five priorities for improvement – care access, employee engagement, care coordination, veteran trust, and best practices sharing.

President Trump’s election brought in a flood of political appointees who knew nothing about their assigned areas of responsibility. The “politicals” ran off career professionals, leaked false information to the press, and stabbed each other in the back. Shulkin notes that not only did the President have zero government background, most of the cabinet secretaries he chose didn’t either, and some of them had spent their careers opposing the agencies they were empowered to oversee. Shulkin said he was told to find jobs for 30 people, which he thought was reasonable given the size of the VA. The person the White House had assigned to dole out the plum jobs was a 24-year-old former Trump campaign intern whose father was a “Fox and Friends” host. Shulkin was told that he had to accept any appointees the White House sent over and was given a direct order not to fire them. 

Shulkin had an obvious problem with some of the appointees who claimed to represent the White House or who wanted to oversee other appointees. One of them followed Shulkin’s staff meetings with his own sessions that included only the politicals, who would then be told to do something else in dividing the department between the “secretary’s team” and the “political team.” He was also getting beaten up by members of Congress who told him privately that he was doing a great job, but warned him that they would be grandstanding with bitterly negative criticism once the cameras started rolling. He assigned one of the politicals – who he names specifically – to serve on a White House committee who then leaked false information, threatened outside groups who didn’t support specific bills, and ran his own agenda in claiming to represent the President.

He also struggled with high-level VA positions that remained unfilled because the White House didn’t like some of his choices, including “a former CEO from one of the country’s largest public health systems” who was rejected because he had once served on a healthcare advisory committee for Hillary Clinton.

It was surprising to me how much influence that veterans service organizations such as American Legion and Disabled American Veterans wield. One of those that had been basically ignored as lobbying group a by the Obama administration – the Koch Brothers-funded Concerned Veterans of America – was welcomed by the White House despite its agenda of privatizing the VA. That issue kept Shulkin in trouble – nobody wants to admit to voting veterans that they want to shut down their healthcare system, so everybody accuses each other of having a hidden privatization agenda.

Shulkin says he made the right choice to replace the VA’s skunk works-developed VistA software. It made the VA paperless and was widely known because two-thirds of doctors trained in the US rotate through the VA, but Shulkin says the VA had made a mistake in allowing each of its 130 medical centers to create their own customized instance of it. He also noted the lack of interoperability with the Department of Defense’s systems, the high cost of maintenance, and the estimated $19 billion the VA would have spent to modernize VistA.

He admits, however, that he was naive in not realizing how his job would be threatened by his decision to bypass traditional contracting and to simply choose Cerner outright because “I was convinced that immediate action was necessary” because of a never-ending lack of DoD interoperability.

The VA engaged with Cerner under a little-used government contracting option called “determination of findings,” which allows a detailed vendor discussion without a formal commitment. He denies New York Times reports that cited a White House leak saying that Jared Kushner was advocating for Cerner. He says he was instead being pushed by former DoD employee John Windom and members of Congress to get moving with Cerner so the VA could align with DoD’s implementation schedule.

Shulkin says his main requirement was interoperability and Cerner wasn’t convincing in that area, offering only minor sharing of administrative data and the dataset used for government reporting. Or as he put it, “The Cerner team was in full sales mode.” He told Cerner’s then-President Zane Burke that he was ending negotiations until Cerner stepped up to the interoperability plate.

Shulkin worked with outside groups and with academic medical center CIOs to make sure the Cerner contract was solid. However, he was getting pushback from the political appointees, some of whom started showing up uninvited to EHR meetings and reporting back to the Mar-a-Lago Three with their concerns about the contract. One of the politicals was telling everyone that Shulkin was rushing to sign a flawed Cerner contract, urging that he be fired before he did so. Which, as it turns out, was exactly what happened.

In the last conversation Shulkin had with President Trump, the President told him, “You’re killing me with all the bad press coming out of the VA” and asked about the Cerner contract, “Can’t you find a cheaper alternative?” Later that afternoon, Shulkin – who had learned he was being hired as VA secretary only when he saw it on TV news — was fired by tweet. Access to government email and phones had already been turned off. He wasn’t allowed to return to the VA to pick up his personal items or to say goodbye to his team. He then was warned by a colleague that the politicals were making up a story that he had walked off with sensitive government information after being fired, so he returned all his electronic devices at 10 at night.

Shulkin notes that seven weeks after he was fired, “The political appointees apparently determined what I had known all along: the options for IT modernization were limited and the Cerner contract was the best option for the VA and for taxpayers. In the end, the right decision was made, and the VA was on its way to gaining a cutting-edge system to propel it into the future.” He also notes that the President took credit for the VA’s accomplishments at a White House event to which no Democrats or VA professionals had been invited. Shulkin was surprised that the press didn’t pick up on a published email in which one of the politicals laid out the firing of Shulkin, his deputy secretary, and his chief of staff, which was to be coordinated by Citizen Perlmutter to happen only after the President was able to take personal credit for completing several VA initiatives.

Shulkin had a lot of problems with the VA’s OIG, a 1,000-employee, much-feared organization that he accuses  of being “secret police” that aren’t always fair or thorough in their investigations.

He says he worries most about the clueless politicals who have run off qualified employees who could have overseen the Cerner project, explaining, “Getting a contract signed is one thing, but carrying out the real work involved is quite another. My years of experience with EHR implementations taught me that doing this well will require participants with real experience and knowledge that is unfortunately in short supply within the VA’s political leadership today.”

I found this book to be interesting, but depressing. Government is even more dysfunctional than we probably all suspect, and the motives of those involved can often be traced back to pettiness and personal gain (and the same can be said of the press, most likely). I don’t have a clue about how to fix that, but I do believe that David Shulkin was doing good for veterans until that opportunity was taken away by partisan politicians who accept incompetence as long as it is cloaked in political loyalty, just like the politicians who came before them and those who will follow.

As a cheap seats observer, I didn’t find Shulkin’s explanation of why he needed to rush into a no-bid Cerner contract to be convincing, but he’s right that he didn’t have any great alternatives. The Coast Guard’s struggle with Epic probably killed its chances, self-development was a non-starter, and not choosing Cerner when the DoD had already done would have been politically risky. He gives himself a convenient excuse should the project fail, warning in advance that incompetent VA politicals aren’t capable of implementing Cerner. 

The book was more interesting than I expected. Glimpses into how government works were fascinating, although not always encouraging. Maybe Shulkin is the self-sacrificing saint he describes in his book or maybe he isn’t, but regardless, I’m left with a more positive impression of him than before (and I was fairly positive about him before). He was unanimously confirmed twice for high-level VA jobs under wildly different administrations, developed consensus that crossed party lines, and as far as I can tell made veteran wellbeing his agency’s top priority. I think veterans were better off when he was in charge.

Morning Headlines 11/11/19

Kaiser Permanente CEO Bernard Tyson dies at 60

Kaiser Permanente Chairman and CEO Bernard Tyson died unexpectedly Sunday of unspecified causes. He was 60 years old.

Intelerad, Novacap-backed medical imaging software maker, heads to first rounds

Canada-based Intelerad Medical Systems is reportedly seeking a buyer.

U of Chicago wants hospital dismissed from class action accusing it of sharing patient data with Google

University of Chicago wants its medical center dismissed from a class action lawsuit that accuses it of sharing patient information with Google in an agreement that the plaintiff says violates his HIPAA rights.

Sony Scrubs In to Help Operating Room Devices Talk to Each Other

Sony expects to earn FDA clearance next month for Nucleus, an OR integration tool it acquired in 2016 that is sold outside the US.

Monday Morning Update 11/11/19

Top News

Kaiser Permanente Chairman and CEO Bernard Tyson died unexpectedly Sunday of unspecified causes. He was 60 years old.

EVP/Group President Gregory Adams will serve as interim chairman and CEO.

Reader Comments

From Jake the Snake: “Re: health IT blog sites. Some of them seem to be violating FTC’s endorsement rules in running puff pieces that don’t disclose payments or business relationships.” The reader provided examples in which (a) a company rep’s thinly disguised sales pitch that wasn’t listed as a paid spot even though I’m guessing it was; and (b) an article that talked about an industry issue, but then made the leap to quoting someone from the company or pitching their product as a solution. The Federal Trade Commission’s endorsement guidelines prohibit making a statement that a consumer might reasonably assume is an honest opinion and not an advertiser message. That includes being shown using a product, being paid to mention a product (even if indirectly), or being given a product to try and then either making misleading claims or failing to disclose being paid to mention the product. I doubt the examples provided run astray of FTC’s guidelines. For me, I quit reading one local food site that was pitching particular restaurants, chefs, or menu items in a blatant pay-for-play “featured restaurant” manner without disclosing it, which was pretty obvious since the same handful of places kept popping up despite unenthusiastic online reviews.   

From Ghost in the Machine: “Re: Cerner’s acquired Siemens businesses. Norway is very small in the overall story. Some of the platforms from that deal will be put out onto the market. Apparently the German workforce has been told that its multiple offices will consolidate to Berlin. The changes are unrelated to the Sweden delays — they are part of the business focus on earnings and product portfolio.” Unverified.

HIStalk Announcements and Requests

Eighty percent of poll respondents believe that their employer gets at least 50% of the benefit of their conference networking.

New poll to your right or here: Will the collaboration between Allscripts and Northwell result in delivery of a commercially successful EHR within three years? Click the poll’s Comments link after voting to make your case in ways that a binary response cannot.

I’m becoming more uncomfortable with the idea that when I thank a service member, my motivation might be influenced by my urge to feel virtuous by throwing out that increasingly automatic and empty saying. It’s better to hire a veteran or their family member, donate to support groups, and vote for politicians who support veterans (and ideally, who are veterans themselves who understand the responsibility involved in sending people off in harm’s way). I’m also not to sure that someone who has served in the military necessarily gets good vibes from a “Happy Veterans Day” greeting or anything else that requires them to acknowledge my recognition. For today, I will just say to veterans out there that I know you made a sacrifice that I didn’t and thus will never fully understand, and for that, I honor you. 

I haven’t thought of Robert Lorsch of MMR Global very much since I interviewed him in 2013 after his company filed lawsuits against EHR vendors, Walgreens, non-profit hospitals, and the government of Australia for developing personal health record technology that he claimed – not very convincingly — infringed on his intellectual property. Turns out he died in May 2017 and the company seems to have met its maker before Bob. 

Webinars

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

Acquisitions, Funding, Business, and Stock

Canada-based Intelerad Medical Systems is reportedly seeking a buyer. 

People

Toni Laracuente, RN (Change Healthcare) joins Medicomp Systems as chief nursing officer.

Accreditation Council for Graduate Medical Education hires Bruce Metz, PhD (University of Connecticut Health Center) as its first CIO.

Announcements and Implementations

Michigan HIEs Michigan Health Information Network and Great Lakes Health Network will merge to form an organization with $28 million in annual revenue and 169 employees. The governor recently vetoed $1 million in funding for MiHIN.

Privacy and Security

University of Chicago wants its medical center dismissed from a class action lawsuit that accuses it of sharing patient information with Google in an agreement that the plaintiff says violates his HIPAA rights. The university’s motion says that while the plaintiff claimed that the de-identified information could be re-identified through timestamps and free-text notes, he never claimed that Google actually did so and that its contract with Google prohibits it from even trying to re-identify patient data. The university added that its Notice of Privacy Practices informs patients that their data might be used for research and they won’t be paid even if a commercially viable product results.

Other

Sony expects to earn FDA clearance next month for Nucleus, an OR integration tool it acquired in 2016 that is sold outside the US. The hardware device displays multiple simultaneous images – including 3D and 4K — from video-based medical equipment that can also be recorded, broadcast, or routed to a different display.

In India, government-run Rajendra Institute of Medical Sciences will track its 300 doctors via GPS to make sure they are physically present in the building during their paid hours of  9:00 a.m. to 5:00 p.m. The hospital administrator says he expects doctors to eat in the building because leaving means they won’t make it back in their allotted one hour.

Weird News Andy awards an A for effort to this life sentence prisoner who argued that doctors who were treating his septicemia had to revive him with epinephrine, so that meant he was “dead” and thus had fulfilled his sentence. The appeals court disagreed, finding that life sentences aren’t satisfied just because doctors revive someone.

Sponsor Updates

• CereCore staff prepped and served lunch to over 400 people at the Nashville Rescue mission.
• CMS selects Lightbeam Health Solutions as a stage 1 participant in its Artificial Intelligence Health Outcomes Challenge to demonstrate how AI tools can predict risk.
• LiveProcess will present at the IAEM Conference November 15-20 in Savannah, GA.
• Meditech congratulates customers recognized by CHIME as Healthcare’s Most Wired organizations, including Avera Health (SD), Frederick Regional Health System (MD), Lima Memorial Health System (OH), Woman’s Hospital (LA), and Doylestown Hospital, PA.
• Mobile Heartbeat will exhibit at the Pediatric Trauma Society’s Annual Meeting November 11-16 in San Diego.
• Nordic and Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the HIMSS Gulf Coast Chapters GC3 Conference November 13-15 in Biloxi, MS.
• Gartner names OpenText a leader in its 2019 Magic Quadrant for Content Services Platforms.
• PatientPing congratulates its national network of ACOs for generating more than $430 million in shared savings in 2018 under the MSSP.
• Wisconsin Health News profiles Redox.
• SymphonyRM publishes a new white paper, “AI Next Best Actions vs. Traditional CRM.”
• Voalte will host VUE19 November 13-15 in Sarasota, FL.

Blog Posts

• AI, and Then What? (Lightbeam Health Solutions)
• Cyber Attacks in Healthcare Emergency Management (LiveProcess)
• Hospital Patient Revenue Cycle: Providers Can Turn Pain into Gain (Loyale Healthcare)
• Face to face: On site at Halifax Health (Meditech)
• A New Era of Personalized Medicine: The Power of Analytics and AI (Health Catalyst)
• How to Improve Your OB/GYN With Your EHR (EClinicalWorks)
• Build a Better User Management Solution for Your IT Team (Mobile Heartbeat)
• 2020 Medicare Final Rule Released (MWTherapy)
• 4 Keys to Post-Acute Interoperability (Netsmart)
• How Nordic’s Managed Services can help with short-term demand spikes (Nordic)
• Here’s how medical groups can use digital care coordination to improve patient access and build loyalty (Experian Health)
• How Does Patient Loyalty Affect Your Practice Financially? (PatientBond)
• Improve Patient Experience Before, During, and After Care (PerfectServe)
• Are You Compliant with New CMS Discharge Planning Rule? (Prepared Health)
• Answer These Cybersecurity Questions & We Will Tell You If You’re Smarter Than a 5th Grader (SailPoint)
• Why Vendor-Specific Tools for Test Automation Come Up Short (Santa Rosa Consulting)
• Healthcare Safety: The Big Picture (Vocera)
• The Secret Connection Between People and Profitability (WebPT)

Contacts

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

Weekender 11/8/19

Weekly News Recap

• A study finds that only 10% of discharged hospital patients look at their medical information online afterward.
• CompuGroup Medical is rumored to be a bidder for Agfa’s health IT business.
• The VA makes patient records available on Apple Health Records.
• A federal court orders behavioral EHR vendor ZenCharts to pay rehab EHR vendor Kipu Systems $19.5 million for stealing its trade secrets.
• University of Rochester Medical Center will pay $3 million to settle OCR charges involving loss of two unencrypted mobile devices.
• Google announces that it will acquire Fitbit for $2.1 billion in cash.
• CMS delays implementation of a requirement that hospitals publicly share their negotiated contract prices.
• Allscripts announces Q3 results that beat Wall Street expectations on adjusted earnings, but fell short on revenue.
• Wake Forest Baptist Medical Center will bring registration and billing back in-house two years into a seven-year agreement with NThrive, which will eliminate 839 jobs in central North Carolina as a result.

Best Reader Comments

If you listen to the [Allscripts earnings] call, it is pretty clear that the Wall Street folks don’t buy it. They made Rick say twice that there wouldn’t be any increase in R&D spending due to the Northwell agreement. (TheyDidn’tBuyIt)

Most of the article [a physician’s New York Times complaint that Epic’s screen messages aren’t empathetic] could be rephrased as “I find my HIM department annoying.” (Iam)

I don’t consider myself an old fogey. but “pop-ups would float into view as small islands of empathy?” Seriously? In a NYT piece? Millenials these days, am I right? (CynicalIguess)

Epic has “unintelligible medical notes?” Nope, Epic has no such thing. I don’t think it has achieved sentience yet (thankfully). Talk to your co-workers who wrote the notes. “Urgent, intimidating, and tinged with allegation?” She’s looking for comfort and empathy from a computer system? (AC)

Everything about this op-ed by this physician is what is wrong with this country at this point. How in the world do people get through their day-to-day lives if every word that crosses their screen is “offensive” to them? It’s absurd. There are plenty of things wrong with EMRs in today’s world, but guess what — colors and “word choices” are not one of them. Not everything is about offending you, it’s simply just a word that by definition means something whether it hurts your feelings or not. Get over yourself. (EMR Snowflakes)

Would Epic benefit from having a better UI and more clinicians actively involved in software and workflow design? Absolutely. But the idea that “deficiencies” is something that Epic dreamed up and foisted upon their users? Come on, Epic configuration is heavily controlled by your own organization. You want Epic to be nicer to you? Talk to administrative and operational leadership at your organization. I’m sure they could ask IT to write an alert to pop up once a week to say “Great job!!” which everyone would then complain about being distracting and adding clicks. (AnonZ)

The authors rail against profit-seeking entities. Very slippery slope. No margin, no mission. Physicians can certainly fulfill their sense of moral mission and alignment in volunteer work, free clinics or other worthy ventures. Those skills are needed everywhere. (FreeMarkets)

Facebook design is meant to maximize engagement so that they can deliver the most ads. Do you want to maximize engagement with your EHR or do you want to make eye contact with the patient? (Lookatme)

One example that we started at a previous organization is to make sure there is a hyperlink (or text in the alert) that shows with each BPA (pop-up alert) which links to the decision-making body that approved it. Typically, it has a colleague on the committee that they know and can email directly or ask them about it. This provides accountability to the alert committee as well as the operational leaders that may have come up with the “software solution to a peopleware problem.” (David Butler)

Watercooler Talk Tidbits

Actor Will Smith creates a clever and disarmingly funny video as he undergoes his first colonoscopy. He said, “They said you can’t get to 50 million followers on IG without showing your butt.” Afterward, he finds that he had a pre-cancerous polyp removed during the procedure. He urges, “There’s a certain amount of commitment and embarrassment involved with being healthy. You just gotta do it, man.” I don’t watch many movies and thus have only seen Smith in “Independence Day,” “Men in Black,” and “The Pursuit of Happyness,” so I have to say this is my favorite of his films.

The former Hewlett-Packard Enterprise worker who shut down Oregon’s Medicaid computer system in October 2016 in retaliation for being laid off is sentenced to a year of home detention, 500 hours of community service, and four years of probation.

Fedscoop notes that HHS has two people who claim to be its chief data officer – one within the CTO’s office, and the other being the CIO, who says he is acting in that role until he can hire HHS’s “first chief data officer.”

A Pennsylvania nursing home assistant is arrested for taking photos of deceased residents and sharing them with with friends and co-workers. Stephanie Thomas says she took the pictures because her former boyfriend “liked that kind of thing,” but friends to whom she texted photos said she has an “obsession with death” and police examination of her phone turned up pictures of dead animals.

A woman takes an after-work photo of her twin sister, a labor and delivery nurse who had worked 53 hours in four days, and posts it on Facebook with description of what the nurse deals with in a typical work day. She took the picture as her sister broke down after a day in which she helped deliver a stillborn baby. The post has earned 225,000 likes, 23,000 comments, and 133,000 shares. Her sister’s post explained what was going on:

Have you guys ever really thought about what a labor and delivery nurse sees? They see great joy in smooth deliveries and healthy moms and babies. They see panic and anxiety when a new mom is scared. They see fear when a stat C-section is called. They see peace when the mom has support from her family, because not all new moms do. They see teenagers giving birth. They see an addicted mom give birth to a baby who is withdrawing. They see child protective services come. They see funeral homes come. Did you know that they have to make arrangements for the funeral home to come pick up the baby? I didn’t either.

A 57-year-old nurse adopts a 27-year-old man after he is ruled ineligible for a heart transplant because he has no family to care for him. He was in and out of hospitals for weeks, often discharged to a men’s shelter because he had nowhere else to go. Piedmont Newnan Hospital (GA) gave PACU nurse Lori Wood its President’s Award for going above and beyond for patients. She had known Jonathan Pinkard for just two days before suggesting that she become his legal guardian. He hopes to return to his office clerk job next month.

In Case You Missed It

• News 11/8/19
• EPtalk by Dr. Jayne 11/7/19
• Health IT from the Investor’s Chair 11/6/19
• HIStalk Interviews David Lareau, CEO, Medicomp
• News 11/6/19
• Curbside Consult with Dr. Jayne 11/4/19
• Book Review: Lethal Injection
• Monday Morning Update 11/4/19

Get Involved

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

Morning Headlines 11/8/19

Most patients with access to electronic medical records not using it

Just one in 10 discharged patients go online to access their medical information, according to a study that looked at data from 2,410 hospitals over a two-year period.

American Well® Acquires Aligned Telehealth to Expand Behavioral Health Virtual Care

American Well acquires behavioral telehealth and telepsychiatry service provider Aligned Telehealth.

Elizabeth Holmes dodges questions about unpaid legal bills as charges fly over case documents

Lawyers for Elizabeth Holmes contend in a hearing that the FDA destroyed emails that are vital to her defense.

Michigan Health Information Network Shared Services integrates Great Lakes Health Connect

Michigan Health Information Network Shared Services and Great Lakes Health Connect will combine their HIE operations by the end of the year.

News 11/8/19

Top News

Just one in 10 discharged patients go online to access their medical information, according to a study that looked at data from 2,410 hospitals over a two-year period.

The analysis also found that patients at non-profit hospitals are more likely to take advantage of access than their counterparts at for-profit organizations, as are patients at teaching hospitals.

The authors conclude that “policy efforts have failed to engage a large proportion of patients in the electronic use of their data or to bridge the ‘digital divide’ that accompanies health care disparities.”

Reader Comments

From Being There: “Re: HLTH conference. As a participant and attendee, I found this to be a first-rate event. Other than a couple of HHS speakers who seemed more intent on politics versus real healthcare, the rest were engaging, interesting, and first rate. I especially like the panel discussion format used in the tracks I attended. As an exhibitor, I was disappointed in the value provided for the cost incurred. Activity was low most of the time, including the happy hour which helped a bit, but not enough. My theory is that there is just too many good speakers and sessions which are running concurrently such that, if I didn’t have to be in the exhibit area, I would have been attending tracks and sessions instead. PS: the free Mimosas on Sunday morning were especially nice.”

From Mandibular Process: “Re: HIMS. Why in the world would a company name themselves this?” I took “in the world” part of this question literally, assuming that a company that was started in 2014 would choose this name only if (a) it is clueless, or (b) it is brazenly hiding behind some other country’s less-litigious legal system. Not so. Even though the HIMS website does not list people or places (not uncommon with foreign companies trying to look domestic), I tracked them down to Arizona, where a postal race is probably unfolding to see whether our industry’s HIMSS or from the Viagra-selling website HIMS will land the first cease-and-desist letter.

Webinars

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

Acquisitions, Funding, Business, and Stock

Reuters reports that CompuGroup Medical is one of two top bidders for the health IT and integrated care parts of Agfa’s European healthcare business.

American Well acquires behavioral telehealth and telepsychiatry service provider Aligned Telehealth.

Lawyers for Elizabeth Holmes contend in a hearing that the FDA destroyed emails that are vital to her defense. The former Theranos CEO and co-defendant Ramesh “Sunny” Balwani –a former Theranos executive and romantic partner of Holmes — face up to nine counts of wire fraud and two counts of conspiracy to commit wire fraud. The FDA has admitted to having only partial emails from the former director of its diagnostics regulatory division, which it blames on a faulty email storage system.

Sales

• The Ohio State University Wexner Medical Center will implement Visage Imaging’s Visage 7 Enterprise Imaging Platform in all of its radiology departments, replacing its legacy PACS.
• Boston Health Care for the Homeless will use an addiction treatment-focused EHR from Netsmart to help care for patients with opioid use disorder.
• Prisma Health (SC) selects telehealth technology and services from MDLive.
• Health and human service agency network Innovative Management Solutions (NY) will implement population health analytics and risk management tools from Arcadia.

People

Federal health IT vendor DSS names Christopher Kunney (Coker Group) chief of strategy and business development and Roy Hammar (Cerner) chief of client engagement.

Announcements and Implementations

The National Council for Behavioral Health and disaster relief non-profit Americares pilot a text-based messaging program at eight Texas health clinics that uses patient engagement software from Epharmix to help patients with medication adherence.

California-based HIE Manifest MedEx and HBI Solutions develop MX Analyze, a predictive analytics tool designed to help providers manage high-risk patients and care transitions.

A new KLAS report says that the patient engagement ecosystem is a complex and overwhelming area of health IT that spans 80 capabilities and “a slew of vendors claiming to offer them.” KLAS analysts didn’t interview clients in this case – they compared vendor claims to provider priorities. Among vendor-agnostic products, Allscripts, CiperHealth, and GetWellNetwork offer multiple solutions that align with market priorities. EHR vendor patient portals from Epic, Athenahealth, and NextGen, even though their use is limited, meet the key provider demands for bill payment and self-scheduling. Sonofi Health and PCare lead in the interactive patient systems category, Orca and Luma are notable outreach vendors, and Salesforce and Docent Health perform well in the broad category of CRM, rounding, and wayfinding. KLAS notes that providers reap most of the benefit of these systems, with only 20% of vendors claiming improved clinical outcomes.

Government and Politics

The VA gives all veterans access to their medical records via Apple’s Health Records app following an earlier limited rollout.

Privacy and Security

The Government of Nunavut in northern Canada prioritizes getting its health department’s Meditech system back online after a DoppelPaymer ransomware attack over the weekend crippled digital services across its networks. Officials anticipate returning to normal operations within a week.

Other

Researchers at Emory University in Atlanta find a direct correlation between opioid abuse-related tweets and overdose deaths in several Pennsylvania counties. The researchers hope to further refine their machine-learning algorithm to help public health officials monitor opioid abuse within certain populations.

Kyruus surveys 1,000 consumers for the third year in a row to better understand their healthcare access preferences. A few findings:

• Consumers are relying more heavily on hospital websites than in years past when it comes to searching for healthcare information.
• Scheduling appointments by phone, while still the dominant method, is losing losing ground to online booking.
• Consumers care more about insurance acceptance and clinical expertise than a health system’s reputation or appointment availability.
• Thirty-three percent of respondents say they would switch providers for access to virtual visits.

Sponsor Updates

• EClinicalWorks and HealthCrowd will exhibit at the TAHP Texas Covered Health Care Conference + Expo November 11-12 in Austin.
• Ensocare will exhibit at the 2019 Leadership and Physician Advisor Conference November 15-17 in Miami.
• EPSi will exhibit at the HFMA Region 9 Annual Conference November 10-12 in New Orleans.
• Formativ Health will sponsor the Wounded Warrior Project Carry Forward 5K November 9 in Jacksonville, FL.
• Patientco celebrates new office space in Atlanta.
• Healthwise, Imprivata, and Intelligent Medical Objects will exhibit at NextGen UGM 2019 November 10-13 in Orlando.
• Hyland names the State of Minnesota Department of Health as the winner of its 2019 Government Innovation Award.
• InterSystems debuts its PulseCast podcast, “John Halamka: Making the Most of Decentralized Data.”
• Definitive Healthcare SVP of Strategy Kate Shamsuddin wins the Worcester Business Journal’s Outstanding Women in Business Award.
• Glytec publishes a new study focused on the “Current State of Inpatient Diabetes Care and Glycemic Management.”

Blog Posts

• Taking Control of Your PCP with CPC+ (EClinicalWorks)
• Connect 19 annual Spok conference recap (Spok)
• Prescriptions for healthcare data management systems on GCP (Google Cloud)
• To achieve true innovation in healthcare, we must work together as an industry (Greenway Health)
• HCI Group at CHIME10 Fall CIO Forum (HCI Group)
• HGP HIT October Insights (Healthcare Growth Partners)
• Piloting a Centralized Prescription Renewal Workflow (Healthfinch)
• The 5 Rights: Expanding Your Definition of Patient Access to Look Beyond Right Care, Place & Time (Kyruus)

Contacts

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

EPtalk by Dr. Jayne 11/7/19

It’s been a crazy week, with a couple of days of travel being paid back with hundreds of emails in my inbox. Even as I unsubscribe and use filters, it seems like there is always something going on that generates more correspondence than it should (think reply-all apocalypse).

I’d love to sell services around creating an effective email policy to some of the organizations I work with. It seems to be a skill that is sorely needed both in the commercial space and in the volunteer space. I’m getting ready to head out for a week-long trip and am trying to pre-tie loose ends, and predicting what might need to be taken care of in my absence is always a challenging exercise.

The Drug Enforcement Agency is one of the major causes of increased email traffic in my inbox. It seems like my recent renewal has triggered enrollment in a number of mailing lists that have to be individually stamped out like a game of Whack-a-Mole. Some of them have forced me to go through the unsubscribe process twice to get them to stop. The mailing list preferences have names like “Prescribers” and “Prescribers-All” so you don’t know what you’re really unsubscribing. I like to have as little contact with the US Department of Justice as possible, so I hope I have finally gotten things back to where they were prior to my renewal.

Registration is open for the 2020 ONC Annual Meeting, with the theme of “Connecting Policy and Technology: Bringing the EHR to the Patient.” The event will be held in January 2020 in Washington, DC. The published agenda only shows the various time blocks for sessions, with a note that the full agenda is coming soon. Personally, I like to see the agenda before I plunk down money on a conference, but I’m guessing that most of the people who attend the ONC meeting are going to go regardless.

I enjoy attending conferences as a way of learning new things and engaging with people in person, but the cost of many of them poses a barrier. Maybe we should start a “Send Jayne On the Road” conference fund so I could report from around the country and across the globe. Warm locations preferred between November and February, of course.

CMS is plugging information sessions for its new Kidney Care First (KCF) and Comprehensive Kidney Care Contracting (CKCC) Model Options, which are part of the Kidney Care Choices (KCC) model. They are targeted towards nephrologists and dialysis facilities along with accountable care organizations that focus on kidney disease, and build on the Comprehensive End-Stage Renal Disease Care Model structure.

It’s good to see a model with a goal to delay the need for dialysis and encourage transplantation, but the reality is there is still a shortage of kidneys out there. We also need to be spending money to reduce the causes of chronic kidney disease, including diabetes and hypertension.

I recently attended a local health IT event and sat with some students. One of them was from a different country and is in the US pursuing a master’s in public health. His big observation is that public health in the US is far less prominent (and less well-funded) than in his home country, which was a surprise because he had assumed that because the US has “rich resources” that we would have it together.

Public health often gets the short end of the stick. I learned a great deal about public health informatics while working towards my clinical informatics board certification. It’s a fascinating field that has great potential to positively help people.

If you haven’t received your influenza vaccine, there’s still time, but the season is ramping up. Flu season officially began October 1 in the US and roughly two percent of all visits to healthcare providers in the past week were for influenza-like illnesses.

We’re seeing quite a bit of it at our facility, and even though the flu tests may be negative for influenza A or B, if it walks like a duck, quacks like a duck, and has a bill and webbed feet, we’re treating it as such. Louisiana leads the nation at reporting “widespread” flu activity, so make sure you’re prepared if you’re headed to the Big Easy.

Patients are always surprised when I quote flu statistics to them. I receive a weekly virology digest from our medical center’s infectious disease division that shows how many patients were tested and which viruses are prevalent in the community. I want my patients to know that we’re using evidence and data in their care and not just our best guess.

With Google recently announcing the decision to buy Fitbit, I’ve been asked a couple of times what I think about the company’s role in healthcare. A recent CNBC piece quoted Google Health head David Feinberg outlining plans to bring Google search technology to bear against EHRs as well as generally improving health-related searches on Google. Feinberg spoke at the recent HLTH conference and outlined some pretty far out sounding uses for auto-complete in the EHR as well as better enabling surgeons who visit YouTube before operating on patients.

I like my physicians to already have necessary skills before working on me and am not sure I want them watching a video to know what to do before they walk in the room. I just referred a patient to the emergency department this week because she needed a procedure that I haven’t done in 20 years and my physician assistant hadn’t done in 15. Although it was tempting to watch a refresher video and give it a go, that’s not the best care for the patient.

My clinical care recently has been challenging enough, and the root of much of what I have been seeing is our broken and chaotic healthcare system. One morning I saw a patient who had been briefly paralyzed after a fall, but who came to urgent care because he didn’t have insurance and didn’t want to go to the emergency department. The diagnosis was an unstable neck fracture that could have led to more permanent paralysis at any time, and yet he still refused our calling an ambulance to take him to the ED.

The following day, I saw a patient who qualified for Level 1 trauma status after a vehicular-pedestrian hit and run who also came to the urgent care because he didn’t have insurance. He at least consented to the ambulance transfer. The ED physician called me to give follow up and was shocked that patients like that come into the urgent care. We see them all the time, and unfortunately their visit to us just adds another layer of cost to the system. It’s a sad commentary for healthcare in general.

What’s the saddest commentary on healthcare you’ve seen recently? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 11/7/19

Compugroup shortlisted in Agfa Gevaert unit sale: sources

Reuters reports that Compugroup Medical is one of two top bidders for Agfa’s health IT business.

Health Records on iPhone now available to veterans across the US

Nearly a year after announcing the project, the VA gives veterans access to their medical records via Apple’s Health Records app.

HCAP Partners Announces New Investment in TCS Healthcare Technologies

Private equity firm HCAP Partners makes an undisclosed investment in managed care software vendor TCS Healthcare Technologies.

Health IT from the Investor’s Chair 11/6/19

The Investor’s Chair Returns to HLTH: The Good, The Bad, and the Kind of Weird

Loyal readers might recall I attended the inaugural HLTH Conference last year and, as I wrote here, came away pleasantly surprised. I eagerly returned to see how its second edition would play out.

The questions bubbling through my mind on the flight were: Is it really, as its website claims, “the largest and most important conference for health innovation?” Can it really cope with “6,000+ attendees and 6,000+ 1:1 Meetings?” And once again, do we really need another conference?

Our esteemed Mr. HIStalk told me when I e-mailed from on site that he was “slightly surprised that HLTH rebounded after its disastrously ill-informed decision to immediately follow HIMSS in Las Vegas.” With all due respect, I disagree with that assessment. As I wrote last year, HLTH follows the formula of its founders’ previous and very successful conferences, Money2020 and ShopTalk. Part of that formula, I believe, is making it easy for people to come and party together.

Don’t get me wrong, I have no great love of Vegas except when comparing it to Orlando, but it’s easy to get to, relatively affordable, and perhaps most importantly, exceptionally easy to navigate, with lots of venues near the convention center to drink, dine, and debauch. If it ain’t broke, they won’t be fixing it.

HLTH already announced Caesar’s Palace for next year (rather than Boston, as had been previously announced). I don’t view Vegas as a misstep, but exceedingly on-brand. For HLTH, not for actual health – I get more secondhand smoke there then the rest of my year combined.

If nothing else, HLTH thrives on branding, and in doing so, creates for the most part a great user experience. I arrived at the MGM Grand and was greeted by its famous lion, this time dressed for the occasion! I checked in and was handed a Livongo-branded key. HLTH is in many way, a perfect conference for Livongo to be a top sponsor – interesting, yet slightly over-promotional. LVGO is the lowest market cap company sponsor, and why UPMC as a not-for-profit health system sponsored at the top level is another interesting question.

I opted to arrive after Sunday’s sessions and accompanying party and so began my day on Monday, walking through a dark tunnel and new age music to emerge at the light at the end of the tunnel ,which was of course HLTH. Perhaps a bit dramatic, and I honestly don’t know if this was supposed to represent birth (long, womblike corridor) or even death, but it definitely was … kind of odd, at least to me. Someone later said app company and sponsor Calm was responsible, but absent any branding, it just seemed rather outré.

Speaking of kind of odd, this was the first time I’d seen hair-cutting options in an exhibit hall! Perhaps I’m old school, but I get my hair cut before conferences. Both men’s and women’s sides were occupied most times I walked by. Someone told me a presenter mentioned them on Sunday, pointing out that for poorer communities, barber shops and salons were key places to impact social determinants of health (SDOH was, of course, a big theme at HLTH), but given that I saw no obvious branding nor could the haircutter I asked tell me who sponsored, I’ll have to take their word for it.

Reports on content were more varied than last year. One attendee described them as, “more like TED Talks than actionable ideas.” Another observed more commercials from the podiums as opposed to accurate portrayals of what the companies are actually accomplishing.

In talking to a mid-level marketing professional of an exhibiting company, he said he would definitely exhibit again next year, but the attendees weren’t his true target market like those who attend smaller, benefits-focused events. Rather it was “vendors talking to vendors,” albeit 70% vendors as opposed to the 90% he had feared it might be.

That said, much of the target market here is folks who serve vendors (bankers, investors, and consultants) rather than folks who actually purchase goods and services from vendors. If you’re looking for the former, though, this is a great place to find them.

More of the good. The exhibit hall wasn’t the overwhelming boat show that HIMSS has become. Booths were smaller and it was possible to have a conversation. As with last year, there were also meeting pods on site outside the exhibit hall for those that sponsored them, of course. Optum had a fabulous outdoor patio area with conversation spaces, fresh squeezed orange juice, and a coffee truck with branded foam.

When it came time for the reception, this Sonoma-dwelling correspondent was actually quite pleased with the quality of the wines on offer. Finding all this networking and disruption all too stressful? Aetna’s booth had actual certified emotional support dogs to pet and cuddle. I tell you, people just don’t realize how hard we all work to make healthcare accessible!

Some of the bad. Elements were a bit too contrived, self-impressed, and vaguely, as another few attendees commented, millennial. For example, one hopes people are actually there to work, and networking definitely counts as working. That means, in my opinion at least, that a DJ blaring is not a value-add. This unfortunate music trend persisted throughout. The full conference sessions had intro music that I could feel in my chest and fillings, and worse still, at the very end of HLTH was the reception for Women in HLTH. It’s an important event with unfortunate timing – you’re really important, but also dead last after the majority of attendees have cleared out.

After the final panel, it was time for a brief networking reception, and again there was music playing throughout and clearly above background level. News flash – we’re here to connect and learn and excess music does not help! (#getoffmylawn)

More importantly, beyond the company commercials from the speakers, there was an element of self-congratulatory behavior that I found somewhat off-putting. John Moore of Chilmark Research, an industry analyst I admire greatly, commented in his excellent blog post that the best talk was Mark Cuban’s, in which he told people that they “weren’t truly disrupting their business.” 

I think that’s a real problem with healthcare today and HLTH is just a more glaring symptom. With all due respect, while healthcare is in dire need of disruptive change, disruption for its own sake is hard, and in fact, dangerous. I’ve spent the bulk of my career observing healthcare IT and have learned the hard way that the challenge is adoption, not disruption. And even adoption is hard.

An article on Stat News last April said it more eloquently than I can: “The most glaring deficiencies don’t stem from a lack of technology or creativity or innovation. Many shortcomings could be solved by adopting widely recognized best practices and committing to a handful of mundane, lifesaving processes. Think surgical checklists, timely removal of central venous catheters, and adoption of safe birth practices.” But not only are those ideas not disruptive, they’re unlikely to raise venture dollars any time soon.

More of the weird: Even more startling than the long dark corridor or the haircut opportunities, I personally thought using toilets as branding sites was kind of bizarre! “Don’t Miss,” heh heh, yeah, not so much. There were similar signs on stalls and over sinks, but this was a bit too much (and I like puns as much or more than the next blogger.

The bottom line: once again I ask, what is the future of “The Future of Healthcare?”

As I observed last year, from an attendee perspective, HLTH was incredibly well organized. Helpful staffers abounded, there were plenty of places to convene along with a plethora of phone charging banks (sponsored, of course), and a definite “who’s who” vibe going on. More than one attendee “bemoaned” the fact that this was likely becoming another “must attend” event like the JP Morgan Healthcare Conference (JPMorgan).

Mr. HIStalk himself observed, “My working theory as a cheap seats observer: HIMSS is for selling product, HLTH is for selling investors, and JPMorgan is for selling companies.” I actually think this observation is spot-on and makes perfect sense. HIMSS is sponsored by vendors, HLTH is sponsored by a venture fund, and the JPMorgan Conference (née the H&Q Conference) is sponsored by a bank whose most profitable activity is advising on mergers and acquisitions.

To put it another way, HIMSS is Macy’s (at best), JPMorgan is Mall of America for healthcare (pharma, biotech, devices, services, HCIT, and more), and HLTH is more like Nordstrom’s. As an aside, Health Evolution Summit is kind of like a pricy boutique on 5th or Michigan Avenue.

The bottom line on having multiple conferences is that I don’t think that the hotels and restaurants of the City of San Francisco need fear attendance loss to Vegas, rather that people might have a few more brief “meet and greets” at HLTH, allowing for more substantive meetings nine or 10 short weeks later. Recall that only a small percentage of those who “go to” JPM actually attend the conference itself; rather they hang out in coffee shops and bars and meet with other folks who come in for the exact same reason.

Overall, I admire both the organizers and their investors. We didn’t know we needed this conference until they created it,  kind of like mobile data and iPads. HLTH more than met my expectations and I’m glad I went. The conference was well attended and had a good range of professionals from all sectors, younger in many ways than HIMSS or JPM, which is a nice contrast. It won’t replace other industry conferences, but it will augment.

That said, a common complaint I heard was that it was less intimate than last year. I heard a rumor of over 10,000 expected next year, and maintaining user experience and a degree of intimacy in the face of that kind of growth will be a real challenge. As another conference organizer has observed, everyone wants intimacy, but everyone also wants to be able to attend, and I don’t know how to reconcile those two goals.

On the other hand, I haven’t successfully sold two earlier conferences for astronomical sums, so they clearly know things about this topic that I do not. Will it be like other short lived events like MS-HUG (remember when it had its own conference?) or TEPR (which I’d frankly forgotten until reading about it in John’s post’s comments), or will it become the newest pilgrimage that FOMO (and fun) requires people to show up for? I look forward to 2020 back in Vegas to see how it evolves.

Ben Rooks has now attended every HLTH, 25 HIMSS, 10 HESs, and JPMorgans as far back as its H&Q Days. He’s also been proud to write this column for HIStalk for over a decade, albeit not often enough, so feel free to e-mail him questions or ideas for future installments. He also really enjoys his day job at ST Advisors.

HIStalk Interviews David Lareau, CEO, Medicomp

David Lareau is CEO of Medicomp Systems of Chantilly, VA.

Tell me about yourself and the company.

Medicomp provides a clinical engine and tools to use it that provide physicians, nurses, and other clinicians what they need at the point of care so they can do their jobs. We give them what they need when they need it, stay out of their way, and let them focus on the patient. I discovered Medicomp in 1992, joined the company in 1995, and have been CEO for about 10 years. We are continuing to build our content and tools to support point-of-care use for better patient care.

How would you characterize the EHR industry and how it has changed?

Over the last few years, I would say the last 10 years, the focus has been on getting the money. Getting the $30 billion to $40 billion that the government gave out to promote and make electronic records ubiquitous in the industry. That’s been done, but I don’t know that it has moved the needle at all in providing better patient care.

Now the industry is being forced to turn away from the number of transactions processed or encounters documented to, how well are we taking care of these patients? How do we report that? How do we measure it? How do we make it happen? How do we prove that we did it? It’s a major change to try to make these systems usable for clinicians at the point of care.

Are EHR vendors committed and capable of making usability what users want it to be?

I’m not sure they are. As part of my evidence for that, people seem to be thinking they can rely on artificial intelligence, NLP, and machine learning to solve the problem of usability. Or the use of scribes. That indicates to me that they recognize that they can’t do what it takes to make these systems, the way they’re currently constructed, usable for physicians at the point of care to meet all the requirements that they need to. They need to be efficient, effective, they need to meet these quality metrics, and they need to do it without getting in the physician’s way or slowing them down.

They seem to be turning to, “OK, ambient AI. Say anything you want and the machine will figure it out.” The problem with that is that the machines are taught by programmers, not necessarily by clinicians. So I don’t see where the ball has been moved toward clinical usability much at all in the last 10 years.

Is it fair or unfair to say that EHRs cause burnout?

It’s fair to say that EHRs cause burnout, because EHRs, as currently constructed and implemented, weren’t designed with the patient or provider in mind. They were designed to maximize reimbursement and track transactions. Clinicians they have this reputation as being difficult to work with because they are the most highly trained knowledge users in the world and the systems they are using actually dumb them down. They get no benefit from it. They pour stuff in there and they get nothing out of it that helps them, because they already know what to do. Just get out of my way and let me do it.

What value can be added to a vendor’s EHR to make it more useful and satisfying to clinicians without having the EHR vendor themselves making changes?

Every EHR should have a problem list. If there’s something in the problem list, you ought to be able to just click on that problem and see everything in the patient’s chart that’s relevant for that problem. For diabetes, you ought to be able to see on one screen the lab results, medications, symptoms, relevant family history, relevant past procedures, et cetera.

We provide a huge clinical engine that has about 120,000,000 links between problems and the other clinical concepts related to that problem. That helps people get clean data in, use it, and see it at the point of care, rather than having to go to six different places in the EHR to look at labs, meds, and procedures. It needs to be pulled together. Physicians, because of their training and experience, already know what they need to see. They’re highly trained. They know it. Just give it to them.

We’ve been working with clinicians for 41 years to say, if you’re thinking about diabetes, what do you need to see? If you’re thinking about chronic renal failure, or thinking about this other issue, what do you need to see? They know it. Just give it to them and they can focus on the patient in front of them at that moment without having to navigate through the EHR to find every little piece of information.

How has private equity and other forms of investment changed healthcare lately?

You had a nice article on Jonathan Bush where he said, boy, once you let them in the tent, they own the tent. There’s really no room for anybody else. They have a three- to five-year time horizon to get in there, get things lean, flip it, and get out. Typically. Typically. Now, a lot of them say they’re long-term investors.

We’ve been doing this 41 years. We’ve decided to keep it, and we will continue to keep it, private and closely held so that we can continue to focus on doing what we’re doing and not be distracted by the flavor of the month. “Why aren’t you guys doing NLP? Why aren’t you guys doing AI?” We have a form of AI. Our engine was built using doctors to say what’s relevant, but we don’t talk about it as machine learning. It was actually taught by our clinicians.

If we accepted private equity money or outside investors at this point, we would lose our focus on the long-term vision, which is providing tools to let clinicians provide better care for patients at the point of care. That’s really what we’re trying to do here. Everybody has their own idea of the latest thing they should focus on. We stick to our knitting.

Is it hard not to get wrapped up in the AI buzzword that everyone suddenly claims to be using in their old products?

It’s tough. What is competition? Competition is anything that causes people to not engage with you at this point in time.

People have been telling me for three to five years that, “In three to five years, AI and machine learning will be able to do what you do.” That’s competition for us, in that it causes somebody to say, OK, we will wait and see what happens with that. People are now getting used to the fact that even if you use artificial intelligence and machine learning that’s programmatically-based rather than clinically-based, if you put garbage into these systems, you get garbage out. What error rate are you willing to accept?

We don’t try to compete with AI or machine learning. I don’t want to sound like a troglodyte. It’s valuable in identifying associations from large populations of data, saying, “We need to do more of this. We need to do more of that. This is happening in our population.” But for an individual patient, at any point in time at the point of care, I don’t think it’s going to be ready any time soon.

What are the secrets of working with EHR vendors instead of trying to compete against them?

You have to provide something of value to them and to their users. We provide a clinical data capability that they don’t have otherwise. 

One of the secrets is when they say, “We have to have certain technologies. We need Angular. We need React. You have to do Docker containers. You have to host it in the cloud. It must be able to be  web-based. We don’t want to use your UI, we just want to call out to it and have it linked,” you have to  make sure that whatever tools you create allow them to stay in place to do all the things that they do well. Patient registration — we don’t do that. Storing of data — we have data services that pass it back and forth.

You’ve got to be willing to not enforce your vision of what their application should be. You’ve got to make your tool customizable enough and flexible enough and you’ve got to constantly redevelop your technology so that it meets the latest requirements for integration with these systems.

With these systems, the concrete is poured. They’ve got a bridge in and the concrete is poured. They want to improve their roadway? Yes, we can put down parts of a roadway, but we can’t rebuild the bridge, and nobody wants us to. So you’ve got to be willing to be part of their implementation. And in our case, our clinical stuff becomes a core piece of what they do, but it doesn’t look like it is to their customers. It just does what it needs to do and sits there. You’ve got to make it work in their environment.

Health IT vendors are making splashy announcements about embracing Amazon Web Services, Google Cloud, or Microsoft Azure and using their tools for AI and speech recognition. How will that change your business?

We’ve already begun part of that. We already have people using AWS and Microsoft Azure to host our stuff, or their applications with our stuff in it.

We will probably be asked very shortly to provide some sort of a clinical relevancy service to some of these people who are making announcements so they can find anything they want with just one or two words. For clinicians, finding anything you want means finding the things that are relevant to that, given the fact that somebody has asthma.

Over time, probably in the next two or three years, we will probably have to split our stuff into separate consumable services, one of which we’re already doing with our HCC and Medicare Advantage service, so that people who aren’t even using our concepts, engine, or terminology can do risk adjustment reviews if you just give a problem list based on SNOMED or ICD-10.

Microservices was a big buzzword a few years ago. We’re probably going to have to be willing to work with not just vendors, but suppliers of technology to those vendors, by allowing people to consume services from our engine, but not necessarily the whole thing.

Google has expressed interest in creating an EHR search engine, but it seems like it would find “patient denies chest pain” just as readily as “patient complains of chest pain.” How important is the contextual element of the search?

There is no question that natural language processing, based on noun phrases alone, is not going to work in medicine. You need context, you need to know relevancy. Is pain relevant for somebody with asthma? Yes, chest pain. What about wheezing? Did it start suddenly or not? The more that people drill down into this, the more they realize that you really need the clinical context within which the phrase you’re looking for exists.That’s a big part of what we provide.

What do you expect to see at HIMSS20?

A lot of the vendors complain that the CIOs, CMOs, and CMIOs don’t go to HIMSS. I think that’s true more and more. If they already have a platform — Epic, Cerner, Meditech, Allscripts, some of the big guys — there’s nothing they can do about it. They’ve got it. They might go to HIMSS looking for the ancillary vendors to add on certain products. We’re still seeing those people come through.

Ten years ago, health systems would send like 15 people, and say to the 15 people, “Fan out. You check this out, you check this out, you check this out.” You’d see them meeting at breakfast and planning their day because they were going to switch vendors. They were looking for a vendor. You don’t see that much any more. Because we’re not there to replace vendors, we’re there to have our stuff in as additive value, the fact that those people aren’t there doesn’t affect us so much any more.

Going into HIMSS last year, I was thinking about downsizing the booth. But by being there and by making a stronger statement about what we do – “We fix EHRs” — people said, “Finally, somebody says what they do. No buzzwords.” We met two major new accounts and opportunities that we have license agreements with. I decided for the first time to splurge and get a booth on the main aisle, because if you’ve got a good message and you know who your target market is, it’s still worthwhile for people like us. But boy, there’s a lot of noise. 

Half the team you bring is there just to figure out, “Somebody just stopped by the booth. Are they serious, or are they not?” We’ve been going to HIMSS since 1996, so we’ve gotten pretty good at that.

It’s worthwhile for us still because we’re solving a problem that everybody has, and they know they have, which is clinical usability. We’ve managed to hone our message on that in the last few years, so it’s effective for us. But if I was going in there for the first time, it would be like a deer getting caught in the headlights.

How do you see the future of the company?

We’ll continue to do what we do. We’ve been doing it since 1978, 41 years. We’re really starting now to benefit from people realizing, “We’re not just tracking transactions any more. We’ve got to manage the patients better. It takes really good data to do that. We’ve got to make it usable at the point of care. What are we going to do? What are we going to do?”

This, I think, is our time. We’ve got to stay focused on what we do. Going after outside investors, changing ownership, changing leadership would just distract us from our mission. One of my main challenges is identifying and nurturing the next generation of leadership here, because we’re going to continue to do what we’re doing. I look at the senior people at companies to see, how long have they been there? How many generations of those people have they been through in the last 10 years? If it’s more than two, that’s a bad sign for continuity. The only way we can continue to do what we’re doing is by continuing to do what we’re doing.

Morning Headlines 11/6/19

Medical E-Records Provider Scores $19.5M IP Verdict in Miami

A federal jury orders behavioral EHR vendor ZenCharts to pay rehab EHR provider Kipu Systems $19.5 million in damages for stealing its trade secrets.

800 jobs may be headed back to Wake Forest Baptist. Hospital to bring billing services in house, rehire employees

NThrive will eliminate 839 jobs in central North Carolina following Wake Forest Baptist Medical Center’s decision to bring registration and billing back in house after signing a seven-year outsourcing deal with the vendor in 2017.

Failure to Encrypt Mobile Devices Leads to $3 Million HIPAA Settlement

University of Rochester Medical Center (NY) will pay $3 million to settle OCR charges resulting from the 2013 loss of an unencrypted flash drive and the 2017 theft of an unencrypted laptop.

Healthify Raises $16 Million to Integrate Health and Social Services

Social services coordination software vendor Healthify raises $16 million in a Series B round led by SV Health Investors.

Walgreens explores going private in what could be largest LBO in history

Walgreens is reportedly talking to some of the world’s largest private equity firms about taking the company private in a leveraged buyout.

News 11/6/19

Top News

A federal jury orders behavioral EHR vendor ZenCharts to pay rehab EHR provider Kipu Systems $19.5 million in damages for stealing its trade secrets.

The court found that a now-closed rehab center signed a contract with Kipu 2013, then shared the design details of that product with ZenCharts so it could develop a competing product.

Evidence was introduced in which one of the rehab center’s owners said in a 2012 email, “I’m building an EMR for treatment centers” and discussed the possibility of reverse engineering Kipu’s product.

The lawyer for ZenCharts unsuccessfully argued that the rehab center’s contract didn’t contain a non-compete clause, that Kipu’s EHR didn’t contain anything novel, and that a substantial verdict would bankrupt ZenCharts and increase the costs of addiction treatment.

Reader Comments

From Palate Cleanser: “Re: Cerner Scandinavia. Heard it is shutting down its Norway offices. Related to massive delays on two Swedish projects, or just more cuts?” Unverified. A Swedish newspaper recently reported that the Cerner project in Västra Götaland has been delayed for a year because Cerner hasn’t finished work on localizing Millennium to accommodate data laws.

From Banal Boy: “Re: your former 10×10 booth. HIMSS is pushing them specifically, maybe because as you mentioned they aren’t selling well.” HIMSS lists the benefits of the tiny booths that few attendees visit (five exhibitor badges and a booth guide listing are pretty much it). I should ask for a discount for buying several, then packaging them up with an HIStalk sponsorship that provides three and 365 days, respectively, of exposure. I could pitch them as a “neighborhood” of HIStalk-savvy vendors who can’t justify the cost of buying a big space that is used mostly by their reps for screwing around with their phones. I even have a Smokin’ Doc standee left over to serve as block captain. I was searching for a micro-booth photo when I rediscovered “The Smokin’ Doc Celebrates a Successful HIMSS,” in which some fun vendor folks took the cardboard character (they named him Dr. Brandon Pierce) out on the town in Las Vegas at HIMSS18, still one of the funniest things I’ve run here.

From Bookworm: “Re: health IT authors. This new one clearly used a vanity publisher.” I’ve seen a few books by health IT folks who hired vanity publishers that create low-quality books from whatever the “author” sends them, as long as one of the items is a check. Some vanity publishers repackage someone’s old reports and blog posts, conduct a short Q&A interview, then dump it all together into a “book” that requires no author effort. I suppose there’s nothing wrong with that, although labeling oneself an “author” on LinkedIn or Twitter is a bit of a stretch since it’s not like a publisher declared their manuscript worthy of their time and investment, then professionally edited and marketed the result and paid sales royalties accordingly.

From Snowflake Melter: “Re: UCSF doctor’s editorial on EHR screen wording. You failed to editorialize.” I think the doctor — whose LinkedIn suggests that she’s around 32 and considers writing, presenting story-telling shows, and podcasting as key elements of her identity – might have been unwise in complaining publicly about her employer’s tools and processes. She says Epic’s use of the word “deficiencies” is insulting, perhaps unaware that the term – which refers to the chart, not the chartist – was around long before hospital computer systems. She adds that  Epic doesn’t coddle her enough in failing to present “small islands of empathy” and thus “will continue to contribute to the profession’s growing sense of despair” (do SAP and Excel offer such user stroking?) Perhaps her insecurities are excessive, maybe she was short on something to write about, or perhaps she thinks she has life figured out two years out of residency, but crying to the public that Facebook (whose CEO’s name adorns the hospital that sends her checks) gives her birthday greetings that Epic doesn’t suggests that if this is the biggest issue with her job, she’s doing pretty well.

HIStalk Announcements and Requests

I bought a no-name, $20 128GB flash drive from Amazon that, perhaps predictably, didn’t work and couldn’t even be repaired or formatted by Windows. I was going to write it off as a lesson learned, but clicked Amazon’s “return” option for the first time ever, which is pretty slick. I chose the option to drop the item off at a UPS Store, where I will show them the QR code on my phone that Amazon emailed me and then I will walk away – they will box the item up, label it, and ship it back to Amazon. I’m ordering a different drive, but reviews for most are mixed even with the big-name products– people report premature failure, abysmally slow write speeds, and being locked out of their files. My new external hard drive won’t work in this case since I need to copy files from Mrs. HIStalk’s Mac and the file system isn’t compatible with Windows. Dropbox may be the right answer.

Thanks to the following companies that recently supported HIStalk. Click a logo for information. I see several new names on the list, so special thanks and welcome to the newcomers.

Webinars

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

Acquisitions, Funding, Business, and Stock

Allscripts announces Q3 results: revenue up 3%, adjusted EPS $0.17 versus $0.16, beating Wall Street earnings expectations but falling short on revenue. From the earnings call:

• The company says work on the EHR it is developing with Northwell Health will focus on user interface and workflows over the next six months, then development on top of the Avenel product, followed by Northwell’s implementation on the way to commercialization.
• The Northwell extensions contributed zero to bookings since it was not incremental business. It flows into backlog.
• Annual revenue from the Veradigm business is $150 to $175 million.
• The company expects to see revenue from its NextGen partnership scale up and is talking to other EHR vendors about similar arrangements.
• Allscripts responded to an analyst’s question about the technology involved in the Northwell project: “We’re definitely single database, multi-tenant, pure cloud technology. The focus is on ambulatory outpatient and so the workflows that go with that. So this is not an exercise to effectively integrate TouchWorks and Sunrise as we know them today, but this is a recognition that the user base would like a more user-friendly tool and we think they should do that with modern technology.”
• Paul Black declined to answer an analyst’s question about a revenue share or marketing agreement with Northwell for the new EHR being developed.
• President Rick Poulton says the company’s joint development effort with Northwell will not increase R&D spending.
• The company says Cerner’s move to Amazon Web Services could benefit Allscripts since any Cerner customer that faces switching costs might need to issue a board-mandated RFP.

A private equity firm acquires EDCO Health Information Solutions, which offers technology that converts unstructured patient data to EHR-ready information.

A Cerner spokesperson provided further information about my interpretation of an earnings call comment by EVP/CFO Marc Naughton, who said in discussing Adventist Health’s termination of its revenue cycle outsourcing agreement, “We aren’t going to do the full outsourcing.” I took that to mean that Cerner was exiting the RCM outsourcing business, but she says Naughton was referring to RevWorks, not revenue cycle management outsourcing (and I’ll admit that thought those were the same thing). The spokesperson explains:

At this point, the future of that business unit has yet to be determined. During the earnings call, Marc Naughton, Cerner’s Executive VP & CFO explains, “We’re going to look at the remainder of that revenue cycle business. If it doesn’t meet our selective criteria relative to margins, we’re going to determine what needs to be done with that business.”

Reuters reports that Walgreens is talking to some of the world’s largest private equity firms about taking the company private in a leveraged buyout. However, many PE firms aren’t convinced about the company’s business prospects, its $17 billion of debt, and their need to partner with competing PE firms to come up with the $55 billion or so that the company is worth today. The Italy-born CEO of Walgreens, Stefano Pessina, holds shares worth around $9 billion.

NThrive will eliminate 839 jobs in central North Carolina following the decision of Wake Forest Baptist Medical Center (NC) to bring registration and billing back in house after signing seven-year outsourcing deal with NThrive in 2017.

Sales

• Interactive patient systems vendor PCare chooses Redox for integrating its system with EHRs and other hospital platforms.

People

John Daniels, MSA (HIMSS Analytics) will join Building Industry Consulting Service International, a Tampa-based IT infrastructure professional association, as executive director and CEO.

Announcements and Implementations

A Black Book survey of hospital security professionals finds that nearly all respondents think that their security efforts are falling short and budget constraints are limiting their ability to protect their systems, leading Black Book to conclude that things will get worse in 2020. 

Collective Medical releases Flags, which allows health plans and ACOs to share member population information with point-of-care teams, with a use case example of patients who are concurrently taking opioids, benzodiazepines, and muscle relaxants.

KLAS and CHIME review the use of AI in healthcare, providing a working definition (which would probably exclude most of the vendors who see AI as a marketing rather than a technical term) and a look at six vendors, only one of which (Jvion) has enough customer responses to earn a full rating and even it earns only mediocre customer satisfaction. DataRobot and KenSci earned good scores, IBM Watson Health is improving but offers questionable value, Health Catalyst has the strongest healthcare expertise and diverse use cases, and SAS is being increasingly used for predicting by academic medical centers. KLAS warns that using AI in healthcare consumes a lot of effort to prepare the data, requires maintenance to keep models viable, needs department buy-in and effort to improve outcomes, and requires a culture shift to get employees and clinicians to trust its recommendations.

Privacy and Security

Slate magazine runs an excerpt from a new cybersecurity book that describes the NotPetya malware, which caused $10 billion in damage in 2017, including $870 million at drug maker Merck alone. The featured chapter involves Nuance, which reported a malware-caused loss of $92 million from its extensive transcription system downtime, but notes that hospitals – and thus patients, indirectly – were the real victim as they had to scramble to work around loss of a mission-critical system that directly impacts patient care. It highlights Sutter Health, which accumulated a backlog of 1.4 million patient record changes in the first 24 hours of Nuance’s downtime, which kept piling up over the two weeks Sutter needed to switch to a competitor’s transcription system. The author says Heritage Valley Health System (PA) lost every Windows machine as the malware spread to its systems from a single employee being logged into a Nuance server.

University of Rochester Medical Center (NY) will pay $3 million to settle OCR charges resulting from the 2013 loss of an unencrypted flash drive and the 2017 theft of an unencrypted laptop. The incidents affected the records of a total of 580 patients. 

Other

UPS delivers the first CVS Pharmacy prescriptions to customers via drone, dropping medications to two Cary, NC customers from 20 feet overhead. UPS’s UPS Flight Forward will expand the rollout of its FAA-approved drone service, which has completed 1,500 paid deliveries of lab samples at WakeMed Hospital (NC).

ProPublica calls out Dignity Health (motto: “Hello, humandkindness”) for billing one of its nurses $900,000 for the 105-day stay of her premature baby at UC Irvine Medical Center. UC Irvine’s billing department and her insurer assured her that the baby was covered, but she didn’t know that Dignity’s insurance plan required her to sign the baby up on its website within 31 days, so she didn’t. Dignity said it couldn’t make an exception and insisted she pay the bill, but when ProPublica picked up the story, Dignity added the baby to her coverage after the fact.

Sponsor Updates

• Avaya team members volunteer with Habitat for Humanity in Morristown, NJ.
• InterSystems holds its first Healthcare Asia Pacific Customer Meeting in Bangkok, Thailand, with over 100 attendees sharing their digital transformation experiences. 
• Glytec publishes results of a survey of healthcare professionals who are involved with inpatient diabetes care on the current state of inpatient diabetes care and glycemic management.
• Audacious Inquiry will present at the Florida Association of ACOs Annual Conference November 7-8 in Orlando.
• Arcadia releases a statement on predictive analytics and bias.
• Artifact Health will exhibit at the ACDIS Symposium: Outpatient CDI Conference November 14-15 in Austin.
• Bright.MD adds new functionality and content to its virtual care technology.
• Imprivata and Fortified Health Security earn top marks for client experience in Black Book’s latest survey on end-to-end healthcare cybersecurity solutions.
• CarePort Health will exhibit at ACMA Leadership November 14-17 in Miami.
• Collective Medical releases new functionality, enabling ACOs and payers to more readily share member population information with care teams at the point of care.
• Diameter Health publishes a case study titled “Ohio Health Information Partnership Delivers Consolidated Continuity of Care Documents to Support More Informed Clinical Decisions.”

Blog Posts

• Build a Better User Management Solution for Your IT Team (Mobile Heartbeat)
• Are You Compliant with New CMS Discharge Planning Rule? (Prepared Health)
• Why Quest Diagnostics’ CEO isn’t content to run the ‘world’s largest lab’ – and where he’s taking the $8B company next (Advisory Board)
• 3 Ways Care Management is Making an Impact for Healthcare Organizations (Arcadia)
• It’s the 4th quarter and CPT/HCPCS code updates are on their way! (Bluetree)
• Taking Control of Your PCP With CPC+ (EClinicalWorks)
• Interoperability is the key to virtual care success (Bright.MD)
• Supporting More Informed Decisions at the Point of Care with CCDs (Collective Medical)
• COSI and CoverMyMeds Expand STEM Training in Columbus (CoverMyMeds)
• Healthcare Rocks: How Technology is Helping to Drive Improved Outcomes (Dimensional Insight)

Contacts

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

Morning Headlines 11/5/19

Allscripts Announces Third Quarter 2019 Results

Allscripts reports Q3 results: revenue up 3%, with adjusted EPS of $0.17.

JPMorgan Tests Its Amazon-Berkshire Health Venture on Bank Employees

JPMorgan and Amazon will offer employees in select states access to deductible-free health plans administered by their Haven healthcare business.

Google Health is finally opening up about its plans, and they’re all about search

Google Health VP David Feinberg says the company hopes to develop a search bar that will assist doctors in pulling relevant content from their EHRs, as well as to improve healthcare search results for consumers.