News 2/8/19

Top News

Greenway Health will pay $57 million to settle Department of Justice allegations that the company falsified the certification process for Prime Suite EHR and paid kickbacks to customers who recommended its product.

DoJ accused Greenway of falsely obtaining 2014 Edition certification by modifying its software to look as though it used standardized clinical terminology. DoJ also says Greenway failed to correct an error in its calculation of the percentage of patients who were given clinical summaries, allowing Prime Suite users to inappropriately earn EHR incentive payments.

Greenway also entered a five-year HHS OIG Corporate Integrity Agreement, pledging to:

• Hire a third party to review its software quality control
• Notify customers promptly of known software bugs that place patient safety at risk
• Offer free upgrades to the latest version of Prime Suite or provide free data conversion to another EHR upon customer request

HIStalk readers have been reporting red flag rumors for several weeks. Greenway recently recommended that customers file a MIPS hardship exemption because Prime Suite was calculating their measures incorrectly

Reader Comments

From CICIO: “Re: CHIME. In between extended breakfasts with consultants, strategic vendor partnerships lunches, and evening bashes to unwind from the long day, CHIME members can earn up to $2,400 by participating in focus groups while at HIMSS. To acquire that windfall you do need to spend almost 20 hours sequestered in hotel meeting rooms with vendors, so value will be in the eye of the beholder. There should be time to get to the booth of the vendor showcasing the AI powered blockchain bots for patient engagement.” I really dislike the idea of encouraging vendors to buy time with prospects, not to mention the HIMSS practice of segregating CIOs off on their own private conference tracks far from the unwashed so they can charge vendors more for access to them. Any time someone says it’s not the money, it’s the money, even if they do call it honoraria to make it sound less greedy. On the other hand, CIOs are paid plenty well enough that earning just $100 for fidgeting through a 90-minute vendor pitch shouldn’t be attractive. I should get someone to take names of the vendors and CIOs who play this rather seedy game. Imagine a CIO having to explain their attendance to patients of their hospitals who can’t pay their inflated bills.

From Imran of Imuran: “Re: sports spread. Explain again how it isn’t what people think.” Most sports betting in this country involves bookmakers setting a spread as a risk management strategy. It’s not the consensus opinion of sports experts of who will actually win or lose the game and by what margin, but rather the dynamically recalculated number that will attract an equal number of bettors on both sides. The bookmaker doesn’t care about the game, just having enough losing gamblers to cancel out the winners so they can pocket a predictable percentage as vig without risking wild gains or losses. The spread, therefore, reflects the belief of armchair quarterbacks rather than experts, rather like company share prices.

From Groundhog Day: “Re: HIMSS TV. Believe they got the year wrong.” Quite a few readers chuckled at last year’s email that was accidentally and obviously repurposed Thursday by HIMSS Media (you know, the journalism people). Still, I’ll forgive sending the wrong email a lot quicker than the fact that last year’s email called Las Vegas “Vegas,” which I detest since surely even we verbally challenged Americans can spit out three full syllables instead of two.

HIStalk Announcements and Requests

Welcome to new HIStalk Gold Sponsor Oneview Healthcare. The company’s inpatient solution helps patients (education, meal ordering, entertainment, and video chat) and caregivers (rounding, telehealth consultations, screencasting, and service requests) in improving patient experience, clinical outcomes, and caregiver productivity and satisfaction. It offers the Connect mobile app for outpatients, Pathways for managing clinical pathways, and a senior living solution. See them in #450 at HIMSS19. Thanks to Oneview Healthcare for supporting HIStalk.

It seems like only yesterday that I was turning down whiny hospital users who were demanding that part of our underpowered IT budget be used to replace their CRT monitors with the state-of-the-art, $1,500 15” flat panel versions that we approved only for HIM employees (as IT’ers know, employees are always asking for technology they don’t really need for their jobs in seeking a tangible love token of their value, a practice that will send a lot of people to HIMSS19 next week). I noticed a monitor deal I couldn’t pass up this week – a massive 32” Dell for $160. It dwarfs the desk, but it’s pretty great if you regularly open several windows on a single monitor (or if you just like to see really big text).

It’s been too long since I’ve run outdoors and my previous training app hasn’t been updated for years (even though it’s still listed in the app stores of Apple and Android), so I tried to find a “couch to 5K” type program that includes music to get back into shape without hurting myself. I came up blank except for an app developed by NHS England that unfortunately can’t be downloaded outside that country, as enforced by the app stores. However, NHS offers a great solution – a series of podcasts featuring a trainer’s instruction over music that can be downloaded and played on any podcast player. NHS continues to impress me. Can they open a branch here?

I see from a HIMSS email that pre-registered HIMSS19 attendees can pick up badges staring Saturday afternoon at the airport, outside the luggage “carrousels” (interesting spelling).

Speaking of HIMSS19, its speakers are dropping like flies as HHS Secretary Alex Azar finds that he can’t unite with all his fellow champions of health after all.

Here’s my HIMSS guide, which will help you find my sponsors in the exhibit hall’s vast ocean of commercial excess and check out their HIMSS19 activities. Lorre will be in #4085, hoping that you wash up as you leave the adjacent bathroom on the way to shake her hand. No offense to our fellow tiny-boothers, but other than National Decision Support, I’ve never heard of any of them. I might have to reconsider spending the money next year since the return is zero and I have to decide based on how much fun it provides.

I just realized today that I can post the HISsies winners at any time since there’s no HIStalkapalooza that requires fake drama, so here they are.

I won’t run a Weekender on Friday, so we’ll pick it back up here with a Saturday or Sunday post if I have anything interesting, then we begin the snarky booth commentary and skeptical review of mostly pointless announcements that vendors save up for the conference for some reason. Safe travels to everyone going to HIMSS19. 

Webinars

March 6 (Wednesday) 1:00 ET. “Pairing a High-Tech Clinical Logistics Center with a Communication Platform for Quick Patient Response.” Sponsored by Voalte. Presenters: James Schnatterer, MBA, clinical applications manager, Nemours Children’s Health; Mark Chamberlain, clinical applications analyst, Nemours Children’s Health. Medics at Nemours Children’s Health track vital signs of patients in Florida and Delaware from one central hub, acting as eyes and ears when a nurse is away from the bedside. Close monitoring 24 hours a day integrates data from the electronic health record, such as critical lab results, and routes physiological monitor and nurse call alerts directly to the appropriate caregiver’s smartphone. This session explores how the Clinical Logistics Center and more than 1,600 Zebra TC51-HC Touch Computers running Voalte Platform connect care teams at two geographically dispersed sites for better patient safety and the best possible outcomes.

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

Acquisitions, Funding, Business, and Stock

Trinity Health will centralize patient billing in a move that will force 1,650 employees to change jobs or relocate. The 22-state health system will also transfer 450 IT employees who support legacy applications to Leidos as it moves to Epic.

Orion Health Group founder Ian McCrae plans to take the company private once again after four years on the New Zealand and Australian stock exchanges. He and several other colleagues will form a holding company to buy up the necessary shares to take controlling interest. The company’s stock has fallen since selling off its Rhapsody and population health units to private equity firm Hg last year.

Health Catalyst secures up to $100 million in a Series F round led by OrbiMed, increasing its total to $392 million. The new funding gives the company a paper valuation of $1 billion.

From the Cerner earnings call:

• The company will announce a “refined operating model” at HIMSS19.
• As usual, it was lower-than-expected low-margin technology resale that caused the revenue miss. I don’t really understand why the company can’t fix this since it bites them every quarter. Maybe they should create a separate company just for technology resale, or perhaps get out of that business entirely if it’s as low-margin as they always say.
• The company expects that “less than three percent” of its employees will leave under its voluntary separation program.
• The company added just one ITWorks client in the quarter, increasing its total to 32.
• ITWorks and RevWorks are single-digit margin contracts.
• The company formed a separate group to go after big health systems that are buying hospitals and practices and thus want to thin their EHR herd.
• Cerner will run “kind of an incubator concept” to get ideas to market faster.
• The EHR replacement market is declining.
• The company announced that it will start paying a dividend for the first time, saying that 80 percent of comparable S&P companies do it and more investors will buy shares if they earn dividends.
• Executive bonuses will be changed from just hitting EPS targets to also include revenue and free cash flow.
• The company expects the VA business to ramp up linearly from $250 million in annual revenue this year to $1 billion in four years.
• Cerner will look at acquisitions to round out its HealtheIntent platform.

People

Cambridge Health Alliance (MA) promotes Brian Herrick, MD to CIO.

MedAptus appoints Susan Sliski, DNP, RN (Harvard Pilgrim Health Care) as CNO.

Jay Colfer (Acorn Credentialing Solutions) returns to The SSI Group as COO.

Kevin Weinstein (Analyte Health) joins Apervita as chief growth officer.

Sales

• HIE NY Care Information Gateway selects the InterSystems HealthShare Patient Index.
• Children’s of Alabama selects medication safety and stewardship technology from Children’s Hospital of Philadelphia spinoff Bainbridge Health.
• Billings Clinic (MT) will roll out Health Catalyst’s Data Operating System as part of its population health initiatives.
• Franciscan Missionaries of Our Lady Health System (LA) contracts with Nordic for managed services for its 18 Epic applications.
• California-based health data network Manifest MedEx will implement HealthShare patient care record software from InterSystems, and de-duplication medical records software from Verato. 
• Atrium Health (NC) will use Koan Health’s population health analytics and consulting services.
• Reliance eHealth Collaborative, an HIE with members in Oregon and Washington, selects Zen Healthcare IT’s Gemini integration software.

Announcements and Implementations

MDLive announces GA of MDLive Go, chatbot-managed virtual visit capability that the company guarantees will return a physician-reviewed diagnosis and electronic prescription to the patient within two hours.

Mayo Clinic and Leidos will build an accelerator at the health system’s campus in Jacksonville, FL that will foster research, development, and commercialization of technologies and therapeutics.

Manifest MedEx rolls out Audacious Inquiry’s real-time Encounter Notification Service.

A new KLAS report on home health EHRs finds that while Homecare Homebase and Epic lead in mindshare, Thornberry (for small agencies) and Meditech (for agencies affiliated with Meditech-using health systems) top the satisfaction list.

Government and Politics

After learning that the VA’s EHR project could balloon beyond its estimated $16 billion budget, lawmakers call for an interagency leader to oversee the EHR overhaul and integration efforts of the VA and DoD. The Interagency Program Office has assembled a task force to determine how to move forward with accountability for both projects and will release its findings by the end of the month.

Other

Facebook will launch a tool that will allow hospitals, blood banks, and the Red Cross to ask for blood donations. Users who opt in will receive notifications of blood shortages in their areas. The company launched a similar feature in Brazil, Bangladesh, Pakistan, and India, where users are allowed to approach one another with donation requests – a capability that has led to several shady black market blood deals.

An NHS report determines that aging IT systems have become detrimental to the health service’s 11 screening programs, which are maintained by a legacy database that depends upon a variety of IT systems that are between 10 and 30 years old. NHS came under fire last year for an IT oversight in its breast screening program that resulted in a failure to encourage 122,000 women to obtain screenings over a nine-year period, likely contributing to the early deaths of 270 women.

Sponsor Updates

• Formativ Health’s enterprise-wide scheduling solution, DASH, is now available on the Salesforce Appexchange.
• With the help of Meditech’s integrated supply chain functionality, East Tennessee Children’s Hospital will save $1.3 million in costs this year.
• Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the Society for Maternal *Fetal Medicine February 11-16 in Las Vegas.
• PatientBond identifies five psychographic segments through analysis of its fifth national market research study of healthcare consumers.
• VentureFizz profiles PatientPing and its new Boston headquarters.
• CB Insights names Qventus as one of 2019’s 100 most innovative AI startups.
• Sansoro Health’s 4×4 Health Podcast convenes experts to discuss health IT predictions for 2019.
• DrFirst and Meditech partner to give EHR users the ability to access California’s Cures 2.0 PDMP.
• SymphonyRM will sponsor and present at the Healthcare Marketing & Physician Strategies Summit May 21-23 in Chicago.
• TriNetX benefits from Snowflake’s data warehouse built for the cloud.
• Spectralink certifies Imprivata’s Mobile Device Access for its Versity enterprise smartphone.
• HGP publishes its January health IT insights.
• Nuance rolls out its virtual assistant technology to Dragon Medical One users.
• Holy Redeemer Health System expands its partnership with Prepared Health’s post-acute management EnTouch Network.
• Meditech adds an Opioid Stewardship Toolkit to its Expanse EHR.
• PCare integrates Mobile Heartbeat’s MH-CURE clinical communications and collaboration technology with its interactive bedside patient system.
• Collective Medical names Allison Barlow (Allison Barlow HR Consulting) head of people.
• Lightbeam Health Solutions releases Version 3.0 of its population health management software.

Blog Posts

• 6 Strategies for Growing Your Panel, Boosting Loyalty (Formativ Health)
• Quality Management is Key to Optimizing the Business of Healthcare (Hayes Management Consulting)
• Evangelical Hospital improves Physician and Healthcare Worker User Experience Related to Citrix, Allscripts, and Business Applications with Goliath Performance Monitor for XenApp & XenDesktop 6.5 (Goliath Technologies)
• Charlie by the Numbers: 2018 (Healthfinch)
• Extend healthcare interoperability to documents (Hyland)
• A proposed solution to the challenges of patient matching, in response to the GAO report (Imprivata)
• Uniting Healthcare for a Bright New Data-Driven Future at HIMSS19 (InterSystems)
• A Series on Chatbots: Using Chatbots to Deliver Self-Service Access to Care (Kyruus)
• Why Situational Awareness is Critical for Hospitals and Healthcare Teams (LiveProcess)
• The History of the Fax Machine (Vyne Medical)
• When Disaster Strikes (Netsmart)
• The Healthcare Financial Experience Matters When Patients Choose a Provider (Patientco)
• Presenting the New PerfectServe Family (PerfectServe)
• You Are Not Alone – The DNFB Challenge (ROI Healthcare Solutions)
• What is a Health Information System? (Sansoro Health)
• 5 things for hospitals to look for in an integrated communication platform. (Voalte)
• Founder Letter: Guts and Data – Why You Need Both to Make Better Business Decisions (WebPT)
• Simplify Nurses’ Lives: 5 Ways to Streamline Nursing Workflows (Spok)
• HIMSS19 – Champions of Healthcare Unite (Optimum Healthcare IT)

Contacts

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

HIStalk Interviews Nora Lissy, Director of Healthcare, Dimensional Insight

Nora Lissy, RN, MBA is director of healthcare for Dimensional Insight of Burlington, MA.

Tell me about yourself and the company.

I’ve been a registered nurse for over 30 years. I started out as a clinician, with the majority of my time spent in the emergency room. I then got interested in hospital operations and working with the operational folks and leadership. As healthcare evolved, I evolved with it and got into analytics, understanding numbers and outcomes. I used Dimensional Insight’s system in three different organizations in three different roles and found that I loved what I was able to do with it. I came on board with the company in 2013. I help organizations understand their information, their data, and to get the right data to the right people so that they can act upon it.

Do health systems underuse nurses and other clinicians in using data to make decisions?

Yes. Our president likes to talk about the “data gene,” which some people have and some don’t. Every organization definitely has pearls — not only nurses, but lab and rad techs who actually understand the global picture. There’s always one person in every department where everybody knows that if you need an answer, you go to them. Those people are usually data-driven to begin with, just naturally.They do get underutilized, or shall I say mis-utilized. They have their regular job, and then when they have a chance, we’ll  have them do reports and stuff like that for us. But some very strong care providers are also analytical and would be helpful in pushing forward the analytics process.

BI and analytics tools triggered a buying frenzy. What was the result?

Like you said, it was a frenzy. Everyone felt like they had to get it. Many people are influenced by pretty pictures, or they go down a path and they’ve got someone who’s caught their interest.

What I’ve noticed in working with customers and in the literature is that sometimes customers take on too much. BI is a journey. When an organization tries to do 15 projects at the same time, it’s inevitable that none of them will get finished. A project gets started. Then it’s like, OK, this is cool, we can use that same tactic over here. They start big project B before finishing big project A, with the same people working on both. Now you’ve pulled them in two different directions and nothing gets finished.

The successful ones that I’ve seen have stayed within the guidelines of their strategic plan. Some people feel it takes too long to get that done, but you need to have a plan, a path you’re going down. Not just say, “We’ve got BI and we can do everything.” Every tool can, but you have take the steps and do it and close the loop before you go to the next one.

I’ve worked in organizations that had four or five BI tools, so they had four or five reporting teams. They still had the same problem — my BI tool says this, your BI tool says that. They never really got together and said, what do we say as an organization?

Does BI get the credit way down the line when the decisions it influenced finally produces positive, measurable results?

I think so. What I’ve seen is that there’s a big fervor at first. Everybody gets it, they see stuff, and they go wow.  But a BI install suddenly provides access to a lot of information. That’s the other “aha” that gets you. We have all this data and we don’t know what to do with it. We had none, now we have too much. How do we core it down to what’s going to be meaningful to us?

That’s where I think the BI tool can come into play, to help us focus on what we need to focus on because we have so much out there. Healthcare is just loaded with data, and more comes in every day. We want to use these complex business rules and these algorithms, but we could have obtained the same answer if we had just used a quicker approach.

Health systems have all this new data, multiple teams, and a mix of acquired health systems and practices using different systems and different terminologies, plus trying to decide whether to centralize the analytics function. Do these factors make it tougher to do analytics right?

Absolutely. It’s an absolute challenge, everything you just said. You might have a hospital organization that has been using an embedded BI tool for years. Then all of a sudden they acquire, or they’ve been acquired. They decide that they don’t want A, or they really want B. Then you have to go through a conversion of what they’ve done. Aside from just the acquisition process, you have to work on linking and cross-walking different EMRs or even the same EMR implemented with different approaches.

I’ve worked in two organizations that had four or five reporting teams. We were chasing our tails. Who do you believe? Who has the loudest voice this month or with this leadership? The people who really need the BI, the operational and front-line people, throw up their hands and say, “I don’t even know what I’m getting any more, so I don’t even care.” You look at who is using the BI and there’s little utilization. The people we’re trying to help don’t even get all the information they need because there are too many competing answers.

I find that the best success is when you bring in not only stakeholders, which is your leadership, but also the people that you’re expecting this data to help. They need to be a part of the process. You can’t just put this together and say, here you go, you’re on your own, take it and run with it. You have to bring them into the process so that they understand the value they’re getting. It’s one thing bringing a BI tool in, but what’s the value I’m going to get from it? Is it just one more report that I have to go through, or will it give me value and make my day better?

My experience is that the people who use analytics the most are department managers and directors instead of C-level executives who don’t even have computers on their desk. Should the C-suite be involved or pay more attention to what data is available and how it’s being used?

I would say that over the last two or three years, I’m seeing more and more C-suite involvement. I have a couple of customers that if the information isn’t available when the CEO comes to work, he or she is calling and saying, where are my numbers? So I am seeing more senior suite involvement.

There are two types of BI – the “how are we doing” numbers for the C suite and then the operational things, which are near and dear to my heart. The things that I had to do as a clinician or as a manager of clinicians. The things that I needed to arm them with. We can give that to them. Before, we would have to go through 15 reports to try to figure it out. It’s making their life easier.

There are so many rules and regulations coming out in healthcare. I have to remember to dot my I and cross my T. Maybe if I had a queue list to tell me that these are the three things I have to worry about, that would make my life easier.

It’s like anything else you do in life. It’s a daunting task if you have a room full of garbage and you have to decide where to start. You have to pick at it and say, I know I’m going to keep the stuff over there. That’s one fewer thing I have to worry about. From a BI perspective on the operational side, they see their page with their three things and they’re all green and they’re good. If one is red, they have to go focus on that. It’s helping them get through their day-to-day operational side.

We haven’t quite gotten the value from BI because healthcare and the operational side of things are complex. When I say operational, I’m thinking about your clinical folks. Was the assessment done in 24 hours? When was the last time case management saw these patients? There are standing operating procedures that are in place that if something goes wrong, we might stop and take a look at it. But generally speaking, it just goes along day by day until the holes in the Swiss cheese line up and you realize you should have been seeing this. But life’s busy in the hospital. We need to provide actionable information to the day-to-day providers so they can prevent the harm.

What new data elements are available for that alerting and trending analysis and how are they being used to impact individual patient care instead of just giving executives a stoplight report?

It’s more the capacity of how BI itself is evolving and how data is being pulled. The old world of BI was SQL queries. Now you’re getting into columnar databases that allow for a faster retrieval and for more data to be viewed at one time. That technology allows you to cipher through millions of rows of data. 

Think about it from a lab perspective. When I was at a healthcare organization in North Carolina, I worked with a clinical pharmacist to identify the five or six high-risk drugs that they wanted to have insight into. Then we got a tickler every time the lab values changed. We added the information to their hourly census, so that when the lab values came in and the patient was on this particular medication, they would see the trend before it got to a critical point. They would see that it’s been rising for the last two days by 0.2 percent each time, so we had better keep an eye on it.

It becomes more useful with the ability to visualize and manage more data at one time. I have another organization whose pharmacists use it to look at critical medications. They bring in over 40 million rows of data to use their work queues to improve their movement from IV antibiotics to PO antibiotics so they can lower cost, improve patient care, and hopefully get the patients out of the hospital sooner than later.

The BI approach uses technology to highlight exceptions to the defined desired values, while the machine language approach would be to throw a lot of data at the system to identify new problems or opportunities that humans have missed. How do those approaches co-exist?

Machine learning has a way to go, in my opinion. Someone still has to feed that machine some kind of algorithm, and it has to know what it’s looking for. Some are more sophisticated and can do patterning and I think that will become invaluable over time. It’s not mature yet, where physicians believe that it shows them what they expect. But it will be an invaluable asset as it continues to grow and as we continue to understand how all the data fits together.

Why have we stopped hearing the most overused term on the planet, “big data?”

Because everything is big data. It was just a catch phrase. I don’t know where it started, and then all of a sudden, it just went away and no one is even saying it any more. This may sound ignorant, but it’s the same thing when we talk about AI and machine learning. What do we mean by AI and machine learning? What concept do people have of that? What are the developer’s concepts? What do its potential users think? It raises the same kind of question as the term big data.

Do you have any final thoughts?

I really enjoy what I do now because I get to work within my passion in using analytics to help providers — who need it more than anybody else – and to help the operational folks with their daily operational process that is very difficult. There’s a lot of expectation that the people on the front line will get things done, remember all these rules, and do all these things. As we move forward in analytics, we will hopefully be able to make that life easier for them and help them focus on getting back to taking care of the patient.

EPtalk by Dr. Jayne 2/7/19

Physicians are always up in arms about quality reporting, having been burned by payer, federal, and institutional quality programs. The American Academy of Family Physicians released a position paper recently that hopes to help influence the development and use of quality measures in physician payment initiatives. The Academy plans to use the principles outlined in the paper in its discussions with payers, health plans, and healthcare IT developers.

The first principle involves differentiating between quality measures and performance measures, with a goal of using the former for internal clinical improvement while reserving the latter for comparative data and resource allocation efforts. AAFP supports the use of performance measures, not to drive penalties, but to show where investment should be made to improve access and equity in healthcare.

The second principle addresses integration of quality measures into an overall methodology, allowing for “a safe space to allow honest assessment of care without fear of punishment and without pressure to increase revenue or produce bonus payments.”

The third principle outlines the need for a single set of universal performance measures that “focus on outcomes that matter most to patients and that have the greatest overall impact on better health of the population, better healthcare, and lower costs.” A secondary goal is limiting the measures that are included in value-based payment programs since “giving in to the temptation to measure everything that can be measured drives up cost, adds to administrative burden, contributes to professional dissatisfaction and burnout, encourages siloed care, and undermines professional autonomy.” It goes on to say the standard set of measures should be used across all payers, programs, and populations.

Principle Four addresses the application of performance measures at the system level, with risk adjustment as needed for demographics, case severity, and social determinants of health.

Principle Five addresses primary care features such as access, coordination, patient and family engagement, and care management.

The sixth principle calls for health IT redesign, encourage automated data collection and quality measurement while eliminating the need for self-reporting. I’m not thrilled that AAFP left this one at the bottom of the list as it is so critical to the success of primary care moving forward.

I’m working with a couple of vendors that are taking existing EHR data and using it in novel ways at the point of care, focusing on making life easy for clinicians and improving outcomes for patients. It’s been refreshing to see their enthusiasm, but the rubber will meet the road as they begin integrating with EHRs since their products essentially replace clunky or non-existent EHR features that clinicians need and want. The future of healthcare IT is bright and there are many challenges to come, a good thing since unless I win the PowerBall, I’ll be here for a while.

My curiosity was piqued by a pre-HIMSS email for Edgility, a vendor that claims to be “bringing situational awareness to healthcare.” It’s always interesting when a phrase can be used in multiple contexts, and seeing “situational awareness” my mind went directly to my most recent self-defense class. If you’ve ever spent time with military or law enforcement people, you’ll know what I mean about situational awareness. You will have had to sit where you don’t want to sit so that someone else can have their back to the wall.

For those of you who might not be preppers, here’s a quick summary of how others think of the phrase. It’s amazing how the 10 tips provided in the article directly apply to what we do in healthcare IT: learn to predict events; identify elements around you; trust your feelings; limit situational overload; avoid complacency; be aware of time; begin to evaluate and understand situations; actively prevent fatigue; continually assess the situation; and monitor performance of others. Even the ad for the bug-out bag applies, knowing how hospital staffers coped with working during recent natural disasters.

One of the sessions that caught my eye for HIMSS is one covering a Centers for Disease Control project that is digitizing infectious disease guidelines to work within EHRs. The team’s goal is to create digital algorithms and guidelines that could be easily consumed by various EHR platforms, shortening the time that it takes to implement that kind of decision support within the EHR. In our global environment, there’s a need to stay vigilant about emerging diseases. My dermatologist’s office still has a sign up advising patients to let staff know if they’ve traveled from West Africa, even through it’s been years since Ebola was in the US.

It’s also important to be able to use guidelines for diseases that we see more than we should, such as the current measles outbreak. If this topic floats your boat, you can join me on Tuesday the 12th at 3 p.m. in room W311E.

Neurodiagnostics vendor Oculogica, Inc. recently received FDA approval for its EyeBOX concussion detection tool. It can be used on patients from five to 67 years old and employs eye-tracking technology to identify patients with suspected concussion. I regularly see concussions in clinic and not just from football any more. Some of the worst I’ve seen have been from water polo and field hockey. The EyeBOX solution doesn’t require documentation of a testing baseline for athletes and isn’t easily gamed by someone who is eager to return to play, unlike some of the alternatives.

I’m engaged in a health exchange project that happens to include a client using the Greenway Health EHR, so you can bet there was plenty of buzz today about the payment the company will be making to settle recent False Claims Act allegations. One of the key allegations was Greenway’s modification of the software that is used in the certification testing so that it appeared that Prime Suite had certain capabilities. News flash, folks — it’s not just Greenway. I suspect there are plenty of other vendors out there who cooked their software a bit to either pass certification more easily. I’ve seen functionality that was included for testing that was later implemented in a materially different way for the rollout to actual clients.

The only way to truly protect consumers is to require testing on off-the-shelf products by independent testers, not a dream-team of vendor employees who know how to grease their way through the defects. This is similar to what we saw with Volkswagen sneakily modifying test builds for their diesel vehicles. I’ve already heard other vendors bad-mouthing Greenway and all I’ll say is that people in glass houses shouldn’t throw stones.

I’ll be headed to sunny Orlando soon, so this will be my last post until HIMSS starts on Monday. Watch this space for all the news, rumors, party updates, and great shoes.

Email Dr. Jayne.

Morning Headlines 2/7/19

Electronic Health Records Vendor to Pay $57.25 Million to Settle False Claims Act Allegations

Greenway Health will pay $57 million to settle DoJ allegations that include misrepresenting the capabilities of its software during the certification process and doling out kickbacks to customers who recommended its products.

Alphabet’s Verily is building a high-tech rehab campus to combat opioid addiction

Verily, Kettering Health Network, and Premier Health will develop a campus of addiction recovery services in Dayton, OH that will use technology to analyze and measure the effectiveness of interventions.

Trinity Health Announces Technology Changes and Revenue Initiatives Expected to Improve Patient Experiences

Trinity Health will offer 450 IT employees positions with its managed services partner, Leidos, as part of a multi-year restructuring effort that coincides with its transition to Epic.

Orion Health’s McCrae to take firm private – again

Orion Health Group founder Ian McCrae hopes to take the company private after a disappointing four years as a public business.

HISsies 2019

HIStalk Interviews Terry Edwards, CEO, PerfectServe

Terry Edwards is founder, president, and CEO of PerfectServe of Knoxville, TN.

Tell me about yourself and the company.

I started PerfectServe in the late 1990s after spending a few years in a technology company called Voice-Tel, which was one of the early pioneers in interactive voice messaging. At that company, I saw the need to improve communications in healthcare and later started PerfectServe. The company started in managing communications in the physician’s office, extending later into managing nurse-to-physician communication in the hospital and acute care environment while still doing the physician work. We evolved that over the last several years into one of the most comprehensive communication platforms in the industry.

How will the mid-January acquisition of Telmediq, the top-rated secure communications vendor, change your business?

PerfectServe was acquired by the Los Angeles private equity firm K1 Investment Management in the middle of last year. That was part of the plan to get our early venture investors out. They had been invested in PerfectServe for a long time and stood behind the company. We were able to give them a successful exit.

With that, we were also able to clean up PerfectServe’s balance sheet and to gain the backing we needed to execute on a broader strategy. As you and I have talked about in the past, the industry in which we operate is that outside the realm of the EMR, the technologies are fragmented. We started to see this just in the fragmentation of communications alone. But in addition, other technologies that are adjacent to communications could be part of a more comprehensive platform.

We surveyed the landscape and saw the opportunity to consolidate some of the stronger players within our category. Telmediq was at the top of that list. It had capabilities that we did not have, such as in the contact center and call center space as well as in nursing mobility. We thought those would be valuable to our customers. While there’s overlap in what both companies do, Telmediq was doing some things better than PerfectServe, and PerfectServe was doing some things better than Telmediq. By bringing these two together, we believe we’ve created the leading communications platform in the marketplace.

How important is it for a CEO to work with investors who can help take the company to the next level or help it clarify its acquisition and positioning strategies?

K1 is a growth investor. There are different kinds of private equity firms and different business models. Some will find slower growth opportunities with companies that might be growing five or 10 percent a year, then put two of them together and then take out costs and try to drive synergy.

K1 is a growth company where they are looking to invest. They are about building leaders in the category. As they evaluated PerfectServe, one of the opportunities was that PerfectServe could be the cornerstone of a much larger and broader care team collaboration product offering strategy. That led to the opportunity to acquire Telmediq.

We just announced two other acquisitions. Lightning Bolt Solutions, which is in the physician scheduling space, and CareWire in the patient communications space. Our broader strategy is to build the care team collaboration platform of the future. We will do this through both acquisition — and integration of the acquisitions — as well as organic development. That takes capital to do well, which is why we have K1 at the table with us.

Was the death of pagers greatly exaggerated?

[laughs] They are dying a slow death, but there’s a long tail.

Consumers seem to be using phones more often for texting more than for making phone calls or sending email, and now they are using speech recognition to drive that messaging. How is that  impacting healthcare communication?

I’ve been amazed to watch the adoption of texting as a mode of communication. When we started PerfectServe, everything was voice driven. In fact, the first version of the PerfectServe platform was purely an interactive voice response platform. All the communications were voice driven and interacting with the keypad.

We first entered the acute space in 2005. Due to the nature of the platform, 100 percent of the communications we were processing were over the phone, either as a live call or sending a page or text message. The text messages could be as an alphanumeric page or SMS and they were all system generated.

We later introduced our web interface and then our mobile interface. With mobile came texting. We started to see texting rise.

About 18 months ago, we introduced a new user object so that nurses could authenticate in the same way as our physicians. With that, we were able to facilitate bidirectional communication. A nurse can send a text to a doctor via the secure platform, then the doctor can reply. In our newest hospital environments, 90-plus percent of all the communication that’s running through the platform is text, and it is secure text, which has been fascinating to see. It’s convenient and that’s the benefit.

What is being done to make communications part of the overall workflow?

Gartner has classified us in the category of clinical communication and collaboration, or CC&C. They gave it that name to help communicate to hospital buyers that communication is more than just secure texting. Secure texting is a component of a broader communication strategy.

But as we’re looking at this — and I think it’s consistent with how Gartner is looking at this – the clinical communication platform is a core component or pillar of a broader care team collaboration platform. It needs to encompass the communication modalities of secure texting, paging, SMS messaging, email notifications, and voice calling, whether it’s a cellular, voice over IP, or landline. You have to have this omni-channel communications component.

The key to PerfectServe since Day One has been our workflow capabilities. We are automating a communication workflow to make sure that we can connect the initiator – a nurse or a doctor or some other caregiver — to the person they need to reach, who can then take action at that moment in time. Workflow is a component of this.

As you think about workflow, there’s not only the algorithms around routing, but also call schedules. PerfectServe as well as Telmediq built call schedules into our platforms, but they were limited to the schedules specific to a communication workflow. Medical groups, for example, have scheduling needs that are broader than that, that go across the whole workforce. That is where Lightning Bolt comes into play.

These adjacent technologies move beyond communications to staff scheduling, referral management, rounding, and integration into other technologies like alarms, alert systems, nurse call, and interactive patient care. Our vision is to build the most comprehensive care team collaboration platform, either by building or acquiring technologies that make sense to be a part of it, and then integrating with those that are adjacent but outside the domain, such as nurse call.

How have the communications needs of health systems changed as they acquire hospitals and practices?

I don’t think they are changing, but the expansion is enabling them to put in stronger governance structures to drive higher levels of standardization. One of our clients, Advocate Health Care in Chicago, has been a model in terms of saying, these are the parameters upon which we’re going to communicate with you. We’re going to have these minimum standards around fail-safe notification processes and escalation and things like that. This starts to move the organization away from letting doctors do it however they want, which might be might be efficient for them but not for nurses or colleagues who need to reach them.

What do you as a CEO do during the HIMSS conference?

[laughs] It’s usually a pretty packed schedule. I will spend a little bit of time in our booth, and that’s unstructured. But for the most part, I’ve got meetings scheduled, a mix of customer meetings, new prospect meetings, analyst meetings, and sometimes meetings with folks in the financial community. It’s usually a pretty intense time, one of those events that I look forward to, but that I also hope to never attend again.

Do you have any final thoughts?

I’m excited about where PerfectServe is. Not just for me personally or our company, but for our customers. I’ve been in this space for a long time and I’ve seen a lot of things. There’s this bigger vision that I started to see about three or four years ago and it is here now. PerfectServe and our customers have the opportunity to deliver even greater value than I envisioned. I’m excited about that and excited about the future.

Morning Headlines 2/6/19

Cerner Reports Fourth Quarter and Full Year 2018 Results and Announces Plan to Initiate Quarterly Cash Dividend

Cerner reports Q4 results: revenue up 4 percent, adjusted EPS $0.63 vs., $0.58, meeting earnings expectations but falling short on revenue.

CommonWell Health Alliance Launches CommonWell Connector™Program

CommonWell announces a Connector program in which health IT vendors can connect to its services through a CommonWell integration member without joining CommonWell themselves.

VA’s Health Record Overhaul Could Get Even More Expensive, Officials Say

After learning that the VA’s EHR project could balloon beyond its estimated $16 billion, lawmakers call for a much needed interagency leader to oversee the EHR overhaul and integration efforts of the VA and DoD.

Design and build digital services for the NHS

NHS Digital publishes its front-end code in GitHub to help third parties build mockups, prototypes, and working applications that connect to NHS’s websites and services.

PerfectServe Acquires Lightning Bolt and CareWire, Reinforces Vision of Care Team Collaboration Platform

PerfectServe acquires scheduling software vendor Lightning Bolt and patient engagement company CareWire.

News 2/6/19

Top News

Cerner reports Q4 results: revenue up 4 percent, adjusted EPS $0.63 vs., $0.58, meeting earnings expectations but falling short on revenue.

The company announced plans to start paying a quarterly dividend of $0.15 in Q3 2019.

Also in Cerner news, the company will lay off 129 employees at its Augusta, GA office on March 31, according to WARN Act filings. I assume that’s at Augusta University Health, which I believe outsourced IT to Cerner a few years back but seems to be using at least some Epic now.

Reader Comments

From Slack MF: “Re: Slack. Looks like it’s getting into healthcare.” The CNBC story suggesting that Slack will target the provider market for information sharing is is a stretch, based on the collaboration technology vendor’s security page being updated to say that its product is HIPAA compliant. It’s good practice for general tech vendors, especially those like Slack who are about to IPO, to make sure they meet HIPAA business associate requirements, but that doesn’t mean they will go after that (or any) end user market specifically. Slack is like Salesforce in offering the core technology and leaving most of the industry-specific content to third-party app developers, so I would expect its new HIPAA status to create interest among vendors to use its API to develop new healthcare tools, such as patient messaging and engagement. I wouldn’t expect Slack to suddenly delve into a specific healthcare product and sell it directly, especially as it tries to optimize its first few quarterly reports. A lot of time and energy is being wasted speculating on whether or how Amazon, Google, or other tech giants will invade healthcare instead of just waiting to see what they announce. Meanwhile, if you’re a health IT vendor dealing with PHI and are looking for a pivot or expansion area while riding some big coattails, give Slack’s API specs a look.

From Amish Avenger: “Re: ICD-10. It’s interesting that people can submit ideas for new terms.” An expert says CDC is overwhelmed and thus way behind in reviewing code requests for newly discovered rare diseases, with the ICD-10 codes being important for quantifying each condition’s prevalence and for performing research. The article also notes that ICD-11 is scheduled to take effect on January 1, 2022.

From Talking Dead: “Re: broadcasting from HIMSS19. Who is consuming all of those podcasts, fake TV shows, and audio and video interviews that clog up the exhibit hall aisles?” No one. It’s just a vanity project for the people who produce them. Just because someone lugs video gear around the exhibit hall or perches in front of the lights answering questions doesn’t mean anyone else cares. I recall few times that I’ve even glanced at those videos and no times that I missed anything when I didn’t. I notice that some questionable sites are taking vendor payoffs to do their interviews and gabfests directly in their booths, which should immediately evaporate whatever credibility they had in the first place (think Fyre Festival, and I’m resisting hard saying FHIR Festival).

HIStalk Announcements and Requests

Expectations were appropriately low for Super Bowl halftime performer Maroon 5 — which has racked up a puzzlingly long yet entirely undistinguished career peddling corporately-crafted drivel like “Moves Like Jagger” — but the bland – er, band – managed to underwhelm anyway. The dull show, which bisected a dull game, sent America to console itself in guacamole and wings. Here’s my too-late, Georgia-focused alternative of some real music: get REM to reunite, maybe with the B52s backing (as long as they don’t play “Shiny Happy People”). My set list: (1) “Texarkana;” (2) “What’s The Frequency, Kenneth?;” (3) “Losing My Religion;” (4) “Man On the Moon;” and (5) the obvious and appropriate closing number, “It’s The End Of The World As We Know It (And I Feel Fine).”

Dann, who started the HIStalk Fan Club on LinkedIn forever ago, tells me it has over 3,700 members. I don’t look at it unless someone’s asking me for a favor, in which case seeing that logo on their profile makes me a lot more likely to help.

Webinars

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

Acquisitions, Funding, Business, and Stock

Premier Inc. announces Q2 results: revenue up 3 percent, adjusted EPS $0.66 vs. $0.50, beating expectations for both. COO Mike Alkire said in the earnings call that the November acquisition of Stanson Health was highly strategic and its decision support product is selling well, although that business’s revenue is only in the $3-5 million range.

Sales

• Four hospitals in Europe choose Hyland Healthcare for enterprise imaging.

People

Healthwise hires Daniel Meltzer, MD, MPH (Blue Cross of Idaho) as chief medical officer.

Announcements and Implementations

A new KLAS report on EHR/PM systems for practices of 10 or fewer doctors finds that they’re looking for products based on functionality, usability, and support – they don’t care much about about outcomes or technology. NextGen Healthcare, CureMD, and Aprima were the vendors most aligned with those product attributes, while the lower user satisfaction with CareCloud, Cerner, and EMDs may be due to their technology focus.

MedStar Health’s National Center for Human Factors in Healthcare and the American Medical Association launch “See What We Mean,” a campaign for EHR safety and usability. It asks people to sign a letter asking Congress to push ONC to implement the EHR Reporting Program that was mandated in 2016 by the 21st Century Cures Act.

Baylor Scott & White Health and Memorial Hermann end their merger discussions.

In England, NHS Digital publishes its front-end code in GitHub to help third parties build mockups, prototypes, and working applications that connect to NHS’s websites and services.

CommonWell announces a Connector program in which health IT vendors can connect to its services through a CommonWell integration member without joining CommonWell themselves.

“A Machine Intelligence Primer for Clinicians” by Alexander Scarlat, MD is now available on Amazon. He wrote the 12-part series on HIStalk and he clearly knows his stuff from both a machine learning and MD perspective.

Other

The US Patent Office publishes a 2017 Google patent application for AI-powered software that would use aggregated EHR information collected via FHIR to predict and summarize medical events, sending its findings to individual providers as a patient timeline. The focus seems to be on mining valuable information that would otherwise be lost in the EHR clutter, including a quote, “A wealth information creates a poverty of attention.” I can’t figure out how some sites concluded from the patent application that Google is developing an EHR.

A study published in Health Affairs finds that hospital prices – not those of physicians who bill for services they provide in hospitals – are responsible for driving up healthcare costs, according to the first research to distinguish between the two. Hospital inpatient prices increased 42 percent over eight years. The data came from the Health Care Cost Institute, which made headlines recently when UnitedHealthcare said that it will no longer share its claims information with the organization.

We’ll need a new ICD-10 code for the time doctors spend debunking the dopey and sometimes dangerous health ideas of Gwyneth Paltrow’s Goop, which has bagged a docuseries deal with Netflix from which GP will dispense the “more strategic, bigger stories we want to tell,” presumably to gullible women who trust that Gwyneth’s “lifestyle brand” products (vitamins, sex toys, cookbooks) will help them lead the full lives that have otherwise escaped them. We’re in the public health danger zone when people trust obviously underqualified “experts” or their own “feelings” to decide which parts of proven science they choose to ignore.

Doh! The Super Bowl featured a male Nipplegate, so now we have a HIPPAgate.

A former nurse of Vanderbilt University Medical Center is indicted for making a medical error in which she injected an elderly patient with the paralyzing agent vecuronium (Norcuron) instead of the ordered sedative midazolam (Versed) that was intended to to overcome the patient’s claustrophobia before having a PET scan. The nurse withdrew the wrong medication from the automated dispensing cabinet after typing in the letters VE for versed, then after not finding the drug’s name, overriding the system to gain access to the vecuronium. The patient was left alone in the scanner for up to 30 minutes where she experienced cardiac arrest and brain death, then died the next day after life support was turned off. The Tennessee Bureau of Investigation charged the nurse with reckless homicide and impaired adult abuse after Vanderbilt fired her. So much for a non-punitive culture that encourages a review of errors to help prevent more instead of coming down hard on a professional who makes a mistake (which is all of them). Having reviewed thousands of medical error reports in hospitals over the years, I guarantee that the “Swiss cheese effect” was in place, where the nurse’s carelessness wasn’t the only procedural irregularity that day. For example, the CMS investigation contains these big red flags that go beyond an incompetent nurse going rogue:

• Pharmacy had not approved the nurse’s dispensing cabinet override.
• The nurse didn’t document the administration in the EHR after asking the charge nurse how to do it, being told that “the new system would capture it on the MAR.”
• I assume barcode verification was not used since it should have prevented the error, perhaps because the medication was administered in radiology rather than in the usual patient care areas.
• The nurse was assigned as a “help-all,” for which no specific job description exists.
• She was talking to an orientee who was assigned to her while she was working hard to obtain the wrong drug.
• The nurse was asked to administer the drug in the radiology department, but she wasn’t assigned to work in radiology, so she left the patient immediately after injecting her.
• The radiology control room had cameras, but they don’t show sufficient detail to detect whether a patient is breathing. The techs assumed that the patient’s eyes were closed because of the bright lights.
• The nurse gave the patient’s primary care nurse the bag containing the medication vial immediately after the injection, but that nurse didn’t look at it for 15 minutes because he was charting.
• The event occurred on December 26, 2017. I would have looked into whether VUMC’s Epic go-live on November 2, 2017 might have contributed to the error because of the related changes (ADC interfaces, labels, documentation, etc.)
• That date might have had its own impact – the radiology department told CMS they were swamped that first day after Christmas. Staffing levels may also have been affected in that vacation-popular week between Christmas and New Year’s Day.

A Canada-based cryptocurrency exchange says its clients will lose their $190 million in holdings after the only person who knew the password to its storage system – the company’s 30-year-old founder – has died. Questions are understandably being raised about whether perhaps his death was faked and he’s off somewhere having fun with the money given that currency-moving transactions have occurred after the account was locked. Not that cryptocurrency attracts scammers or anything.

Super Bowl viewers seemed mostly unimpressed with the all-important commercials, but this one from Microsoft is not only touching and relevant to the company’s business, but it’s also an ode to diversity, inclusiveness, and resilience that the country can certainly use.

Sponsor Updates

• Mobile Heartbeat’s 2018 monthly active user count for its MH-CURE communications and collaboration platform doubled year over year, with hospitals averaging 1,150 regular users.
• Providence St. Joseph Health expands its use of provider data management and patient access solutions from Kyruus.
• AssessURHealth will participate in the Startup Grind Global Conference February 11-12 in Silicon Valley.
• Culbert Healthcare Solutions will exhibit at the WRUG Winter Conference February 14-15 in Las Vegas.
• UConn Technology Innovation Program’s first growth award goes to Diameter Health.

Blog Posts

• HSCC Releases New Framework For Medical Device Security (Fortified Health Security)
• Survey Says: Paper Informed Consents Used in Up to 93% of Cerner, Epic and Meditech Hospitals (Access)
• Optometry can advance 3 of your top strategic goals. Here’s what you need to know. (Advisory Board)
• The Engage Suite Series #5: Who needs a Care Plan? Engaged patients and informed care teams (Agfa Healthcare)
• Healthcare Hosting Checklist 2019: What is HIPAA Compliant Healthcare Hosting? (Atlantic.Net)
• How To Get Your Unified Communications “Flow” (Avaya)
• MEDITECH and NTT DATA Reduce Supply Chain Costs by $1.3M for East Tennessee Children’s Hospital (Meditech)
• Part II: Preparing a successful downtime preparedness strategy (Bluetree)
• Re-Imagining the mission of patient safety technology (Bernoulli Health)
• 4 reasons to connect with Nordic at HIMSS19 (Nordic)
• HIMSS 2019 Survival Guide (Datica)
• The Transition to Post-Acute Care: A Challenging Juncture in the Patient Journey (CarePort Health)
• This Time of Year Sees a 54 Percent Increase in PA Requests. Are You Prepared? (CoverMyMeds)
• Meet with DCA at HIMSS 2019 (Direct Consulting Associates)
• 3 Ways Analytics Can Help with Adolescent Mental Health (Dimensional Insight)
• Why I Love Being a Docent (Docent Health)

Contacts

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

Morning Headlines 2/5/19

Amazon-led health venture hires technology chief to work under Gawande

The healthcare venture of Amazon, Berkshire Hathaway, and JP Morgan hires former Zocdoc CTO Serkan Kutan to head up technology efforts.

Providence St. Joseph Health Announces New Enterprise Population Health Company, Ayin Health Solutions

Providence St. Joseph Health spins off new population health management company Ayin Health Solutions.

Slack is setting itself up for the $3.5 trillion health-care sector

Slack files a confidential IPO and adds HIPAA compliance language to its security page, leading analysts to predict a foray into enterprise healthcare messaging.

Google Has Its Own EHR Plan

Google submits a patent for an EHR that incorporates predictive analytics to give physicians a better idea of which patients need their immediate attention, and what data is most relevant to that patient’s care at that time.

Curbside Consult with Dr. Jayne 2/4/19

Our EHR friend John Halamka, MD co-authored a piece in the Harvard Business Review earlier this month regarding strategies for making EHRs less time-consuming for physicians. Their ideas are sound, although I’d like to expand on them a bit from the trenches.

The first point made is the need to “standardize and reduce payer-imposed requirements.” On the surface, they’re talking about the documentation requirements for an office visit, which in the US is approximately 700 words. This is significantly longer than the average note in other industrialized nations, including Canada, Australia, and the UK.

CMS is attempting to provide leadership here in blending the codes for certain Evaluation and Management (E&M) codes, therefore “reducing” documentation in some areas, but it doesn’t go far enough. Instead of trying to describe complex rashes, why can’t we upload pictures and have that count for payer documentation? Instead of trying to describe a trauma or laceration, we could fully document it. In those situations, the adage about a picture being worth a thousand words is true.

Getting relief from onerous workflows in the EHR is one thing, but if you want to impact clinician satisfaction and reduce burnout, I’d go a step beyond to look at other payer-driven workflows such as pre-authorizations, pre-certifications, and peer-to-peer conversations that waste clinician time.

I was called recently to provide documentation to prove why I needed to order a CT scan of a patient’s abdomen since an insurance reviewer felt I hadn’t given the right information. I asked the reviewer if she bothered to look at the patient’s CT scan result. Perhaps the large pancreatic tumor that was discovered — based on my clinical suspicion and corroborating exam findings — should be enough to prove why the CT scan was necessary. She stated she didn’t have access to the reports. Instead of using their own resources to review the outcome, they wasted my time trying to prove something that turned out to be obvious.

The second point made by Halamka et al is that EHR workflows need to be improved. I whole heartedly agree with the need to remove non-value-added steps from the workflow and to minimize disruptive or unnecessary alerts. Information needs to be available to the people who need it, at the time they need it, and at the appropriate level of detail. Our EHR went haywire for a while and every user was seeing a popup declaring that “Eligibility Checking has returned on John Doe,” which was ridiculous and took several days to correct.

No matter how much improvement vendors make in their workflows, however, there is still the tendency for practices to misapply those workflows, either through lack of understanding or lack of skill. Our EHR continues to throw errors whenever we try to prescribe certain medications because the NCPDP codes aren’t mapped. I know our vendor uses the premier database for medications, so I have to assume that it’s poorly implemented in the practice. If there are risks that a client might not keep their formularies up to date or might have implementation issues, then vendors should consider process that provide automatic updates so that physician workflows are preserved. A nice side effect is that confidence in the vendor will increase, since physicians rarely understand that their own practice has misapplied the technology and tend to blame it on the vendor.

The team’s third point is that the EHR user experience needs to be improved. I don’t know of a physician out there who wouldn’t agree with this point. I continue to see EHR “upgrades” and “enhancements” that are downright silly. One EHR that was shown to me by a client had a title bar that was blue and displayed the patient’s name and information. Since the EHR would allow you to have multiple patient charts open at the same time in separate windows, the title bar was essential so you could not only see quickly which patient was loaded, but also so that you could tell which window was active. In the interest of making the screens more “vanilla,” the vendor removed the blue title bar, making it much more difficult to see which window was active, forcing users to go to the Windows taskbar and click on the different taskbar buttons to cycle them and reactivate them. The upgrade was definitely a downgrade, and since it’s been that way for a year, I doubt the vendor thinks it’s an issue.

Another EHR claims to be “mobile friendly” but the screens don’t fit on a standard mobile device, requiring right-to-left scrolling of popups, which isn’t very mobile friendly. When trying to use it on my Microsoft Surface, it won’t accept the native handwriting recognition input and instead makes me use a tap-tap-tap keyboard to enter data. What a waste of time. The same EHR doesn’t have restricted fields for blood pressures, allowing nonsense values such as 80/1000 to be entered. For years, vendors used the ongoing proliferation of regulatory requirements as an excuse for why they couldn’t develop “nice to have” features that end users had requested. Now that those requirements have slowed a bit, I don’t see vendors sinking vast amounts of R&D funding into usability.

I continue to see healthcare IT products that don’t include basic elements of usability, such as using indicators beyond color to indicate whether lab values are high or low. Someone who is red/green colorblind isn’t going to see your red/green schematic – they need other indicators, such as graphics or text, to provide meaning. I see vendors that include password requirements that don’t meet current NIST recommendations, such as requiring overly long passwords with high degrees of complexity or mandating changes every 30 days. Clients can’t opt out in many cases and are stuck with a vendor’s interpretation of security needs that is out of date or untenable. I see EHR searches that can’t handle partial strings or aren’t intelligent enough to recognize typos.

I can’t wait to get to HIMSS next week and see what vendors have been up to and whether they should move up in my Hall of Fame or should be relegated to the Hall of Shame. I’d like to see some bold new user interfaces with lots of bells and whistles intended to keep physicians happy. I hope I’m not sadly disappointed.

If you’re a vendor and have bells and whistles you want to show off, leave a comment or email me. I’ll be sure to drop by anonymously and check it out.

Email Dr. Jayne.

Morning Headlines 2/4/19

3M Completes Acquisition of M*Modal’s Technology Business

First announced last December, 3M wraps up its acquisition of MModal’s technology business for $1 billion.

Why You Should Be Careful About 23andMe’s Health Test

The New York Times warns that 23andMe’s consumer DNA testing performs poorly in predicting the risk of developing chronic diseases because it only recognizes a few relevant genetic mutations and thus isn’t a substitute for medical office testing.

‘Flawed’ privacy in Queensland Health’s electronic medical record, expert says

A law professor questions why any doctor at Queensland Health in Australia can change the medical record of any patient in the nine hospitals where IEMR is live.

CommonSpirit Health™ Launches as New Health System

Dignity Health and Catholic Health Initiatives complete their merger to form the 142-hospital, $29 billion CommonSpirit Health.

These 3 high-profile DOD systems have persistent operational flaws, according to testing

The DOD Office of the Director of Operational Test & Evaluation’s 2018 report finds cybersecurity vulnerabilities within MHS Genesis that lead it conclude that the EHR “is not survivable in a cyber-contested environment.”

Monday Morning Update 2/4/19

Top News

Dignity Health and Catholic Health Initiatives complete their merger to form the 142-hospital, $29 billion CommonSpirit Health.

The new health system said in the announcement, “We didn’t combine our ministries to get bigger, we came together to provide better care for more people.” I’ll be interested to see the post-merger metrics that prove success beyond the “bigger” part.

CommonSpirit Health will be run by co-CEOs (a horrible idea) from its ritzy headquarters in Chicago. The system does not otherwise operate in Illinois.

Interim co-CIOs Laura Young-Shehata and Denis Zerr are running IT until a replacement for Deanna Wise is hired.

Reader Comments

From Significant Brother: “Re: HIMSS health IT trends forecast. What did you think of it?” I didn’t see anything in it that was particularly insightful or interesting, to be honest, so I didn’t even mention it (plus they called it the “first annual” report, which is a journalistic no-no – you describe something as “annual” only after it has been around for two years). The full-body photo and boilerplate quote from CEO Hal Wolf did little to dispel the perception that it’s just a vanity piece intended to remind everybody how influential HIMSS thinks it is. It also focuses entirely on care providers rather than public health (the former has only a tiny impact on the latter). We have the cliche reference to “the perfect storm” and the yet-again maturing of digital health. The report was obligingly parroted as news by the HIMSS marketing – err, media – division. That group just did a conference tips video that was absolutely painful, ranging from the obvious (wear comfortable shoes, make a schedule, allow enough time between events) to the self-serving (watch HIMSS TV, track down the social media ambassadors as the “celebrities of HIMSS,” and read the vendor-friendly HIMSS publications).

Here’s my scorecard from two years ago on rating self-proclaimed industry thought leaders, which might work well in scoring the LinkedIn profiles of those “celebrities of HIMSS” in the form of social media ambassadors. I hadn’t heard of a particular one, so I checked that person’s LinkedIn and calculated a score of exactly zero — no healthcare experience, no degree, no membership in HIMSS, few health-related tweets, few health-related followers, and a ton of Twitter followers that mostly seem to be the phony ones you buy online to look influential.

From Crafty Ploy: “Re: HIMSS. Are you interviewing CEOs there?” No. I attend anonymously with a phony name, job title, and employer name on my badge. I meet with no one, attend no parties, and don’t even utter the word HIStalk. I just trudge the exhibit hall and then go back to my VRBO place to write up what I saw and heard. You can’t be objective while hanging out with executives or sucking up trying to bag ego-flattering speaking engagements or advisory board positions. Remaining anonymous keeps me objective and transparent since it’s all right here on the page.

From Truant: “Re: Best in KLAS. I didn’t see some department systems in there, like pharmacy.” Best-of-breed ancillary systems have mostly died off. First to go were pharmacy and medication administration systems (due to the need to integrate with ordering), then radiology, and finally lab systems. Those departments liked their standalone systems better, but were outvoted in favor of enterprise integration. About the only survivors in hospitals – and it’s a short-term position as Cerner, Epic, and Meditech eat the world – are LISs from Orchard, SCC, and Sunquest. You do not want to be a standalone hospital system vendor whose company future depends on your customer not ousting you in favor of their EHR’s integrated module. The appeal is obvious — integration becomes a single vendor’s problem and you’re down to one throat to choke.

From Ignoble End: “Re: doctors getting lap dances to prescribe opiates. What’s the world coming to?” The world has already arrived at this destination. Regardless of their expressed noble intentions, everybody (doctors, corporations, patients, software vendors, social media platforms, and politicians) will do whatever rewards them the most. Your only hope is that their most-sought reward is something more altruistic than cash, but you’ll be wrong in most cases. It’s also true that doing something slimy that involves only a relatively small punishment is still a net win. It’s nice but unreasonable to think that doctors are more virtuous than the rest of us.

HIStalk Announcements and Requests

Three-fourths of poll respondents say they’ll be working harder next week, with identical percentages for attendees as well as those left behind. Let’s agree not to think about how much productivity is lost from attending the annual spring boat show.

New poll to your right or here: Did the VA make the right decision in abandoning its Epic schedule pilot and implementing Cerner instead?

My once-yearly reader survey has drawn the usual mix of positive and negative, but I appreciate every response equally because someone cared enough to fill it out — indifference kills more sites than anything. One randomly chosen respondent will be reimbursed (aka “paid,” but we coyly don’t call it that in healthcare) with a $50 Amazon gift card, so fill it out and nobody will be the wiser whether you’re being nice or just looking for Amazon giftage. I try not to peek before all responses are in, but I’m touched by how many folks have kept reading even after they retired or moved to other industries, as well as by those who apparently worry daily that HIStalk will have gone dark because I’ve lost interest or died (I’m hoping for the former if forced to choose). I can also say that while my audience is self-selecting, I’m sitting on a treasure trove of their feedback that tells me why they keep reading year after year and everybody knows that rewarded behavior is likely to recur.

Here’s the digital technology that could revive Apple and maybe some people besides – create a real-time sensor for measuring blood levels of alcohol and recreational drugs, or use existing ones to detect overdose symptoms and call a pre-defined friend for help.

I got wrapped up in the music that was cranking in a small store I was in the other day, picking up on some deep tracks from Pink Floyd and a few other prog bands. The kid working said it was a Pandora Pink Floyd playlist customized via extensive use of the thumbs up/down option, which I always forget about. It had a few missteps, such as Credence and the Rolling Stones because older people listen to older music and fool the algorithms, especially Spotify’s, into thinking the bands are similar. My search for early Pink Floyd jams led me to new music from Rodrigo y Gabriela, a Mexico-based acoustic guitar duo whose all-guitar cover of Pink Floyd’s “Echoes” (from 1971’s “Meddle”) is perfect. I then understandably needed to revisit the stunning original, as recorded by the visionary Floyd live (using their regular touring gear) in the ruins of Pompeii in 1972 with no audience present in a brilliant exploration of a new art form by impossibly god-like band members who were all in their 20s. The contributions of the underappreciated Nick Mason (drums) and Richard Wright (keyboards and vocals) are evident, even more so on “A Saucerful of Secrets.” No crowd noise, no idiots waving cell phones, just the band getting deep into the zone in broad daylight (for some of the tracks) while ignoring the film crew. Just because it’s not loud or flashy doesn’t make it for stoners only. Music as contemplative art for the ages  – what a refreshing idea.

If Pink Floyd isn’t your thing (how is that even possible?) then there’s new music from one of my favorite hard-rocking bands, Norway’s The Dogs.

Dear industry people who aren’t technologists: please stop using the phrase “full stack” immediately. Thank you.

Orlando’s weather for HIMSS19 is looking about as good as it did in 2017 in my photos from then above, with highs predicted to be around 80 and lows in the mid-60s. You’ll be sunning yourself while sprawling in the convention center’s questionably hygienic grass under that HIMSS sign before you know it.

Welcome to new HIStalk Platinum Sponsor Avaya. The Santa Clara, CA-based company offers unified communications and contact center products and services. For healthcare, that means collaboration solutions (mobile communications, multimedia, automated workflows); patient services (resource matching, omnichannel solutions, automated administration), and virtual care solutions and outreach. Seamless care team member communication improves outcomes, provides patient support, and keeps EHR information updated; patient services such as digital scheduling, referrals, reminders, and revenue cycle inquiries create a better patient experience; and telehealth video and outreach provide remote access to specialists and care teams and support care plan coordination. See Avaya at #6451 at HIMSS19 for communications solutions demos. Thanks to Avaya for supporting HIStalk.

Thanks to these companies for recently supporting HIStalk. Click a link for more information.

Webinars

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

Acquisitions, Funding, Business, and Stock

People

Waystar hires Steve Levin (Connance) as chief strategy officer and Bill Barrett (Connance) as general counsel.

The SSI Group promotes Mark Blossom to chief data operations officer and Will Israel to VP of enterprise analytics solutions.

Other

The editorial board of the New York Times warns that 23andMe’s consumer DNA testing performs poorly in predicting the risk of developing chronic diseases because it only recognizes a few relevant genetic mutations and thus isn’t a substitute for medical office testing, calling it “more parlor trick than medicine.” The authors describe the company’s BRCA breast cancer test as “like proofreading a document by looking at only a handful of letters” since 23andMe tests only two rare BRCA mutations while ignoring 1,000 others. The tests also offer predictions for diseases that aren’t most often cause by genetics. The article notes that FDA reversed its decision to allow the company to perform health-related tests only because the company posts a host of disclaimers.

In Australia, a law professor questions why any doctor at Queensland Health can change the medical record of any patient in the nine hospitals where IEMR is live.

It’s not just this country that spends ridiculous sums erecting ornate hospital buildings that do little to improve patient care or access – the estimated cost of Ireland’s National Children’s Hospital has swollen to $2.3 billion, or $4.7 million per bed. That price doesn’t include IT systems, the research center, and integrating the three existing hospitals that will be combined. The wildly over-budget project is so expensive that only four beds will be added beyond the total of 473 that were already available.

Here’s a good example of something that clinicians do better than EHRs, at least for now – compare the rise in abnormal liver lab results with courses of drug therapy to see what caused the damage (or false positives, you could also interpret). This might be something that a well-trained machine learning algorithm could have kicked out as suspicious.

Thanks to ethnographic researcher Sam Ladner, PhD (she’s a female, by the way) for tweeting out the link to this Microsoft paper titled “Guidelines for Human-AI Interaction.” The 18 AI design guidelines it lists include some that are particularly relevant to healthcare:

• Time services based on the user’s current task
• Make it easy to invoke and dismiss the system’s service and to correct it when it’s wrong
• Clarify the user’s intent or “gracefully degrade” the system if the user’s goals are not clear
• Remember recent interactions to provide user context
• Personalize the user’s experience by learning from their behavior
• Notify users when capabilities are changed or added

This is a fresh take. IT systems often provide value in catching physician mistakes, but sometimes are over-programmed as an enforcement tool by hospital executives and ancillary departments who are convinced that doctors will harm patients without their wise oversight. That’s a dynamic that needs to be better understood – just how clinically autonomous should physicians be? What organizational structures and policies best protect the patient’s interests? Are we expecting too much or too little from the decision-making of doctors? Should we trust them to turn off EHR oversight (like certain warnings or informational pop-ups) that they find more intrusive than helpful? If medical practice is to be standardized and corporatized, what is the best use of physician expertise?

Sponsor Updates

• Liaison Technologies releases a new executive perspective video, “Digital Transformation Starts With Data.”
• LiveProcess publishes a hospital emergency preparedness self-assessment quiz.
• Health systems realize significant financial benefits from AI-driven revenue cycle solutions from Recondo Technology.
• Pivot Point Consulting will exhibit at the AHA Rural Healthcare Conference 2019 February 3-6 in Phoenix, AZ.
• Zen Healthcare IT partners with Aigilx Health to deliver healthcare data exchange and interoperability services.

Blog Posts

• Integrated prescription drug monitoring supports smarter opioid prescribing (Meditech)
• Understanding clearinghouses: why the back end of your PM system matters (Waystar)
• Part 3: What You Need to Know About the 21st Century Cures Act: Maintaining a Proactive Clinical Workflow (Netsmart)
• Is Your Community Connect Program Delivering Results? (CereCore)
• How to increase clean claims and reimbursement rates (Experian Health)
• The Surprising Link Between Vendor Management & a Modern Payment Experience (Patientco)
• More Voices Join the Physician Burnout Chorus (PatientKeeper)
• Top 52 Health IT Conferences to Attend in 2019 (Sansoro Health)
• Why PTs Must Stop Obsessing Over Reimbursement Rates (WebPT)

Contacts

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

Weekender 2/1/19

Weekly News Recap

• EMDs acquires Aprima
• Nordic acquires Healthtech Consultants
• Harris Healthcare’s Iatric Systems acquires Haystack Informatics
• The VA ends its pilot of Epic scheduling and will instead implement Cerner at all facilities
• KLAS releases “Best in KLAS 2019”
• Australia’s Queensland Health and SA Health struggle with their Cerner and Allscripts projects, respectively
• FDA Commissioner Scott Gottlieb, MD outlines several ways in which the agency will use digital systems to make healthcare more efficient and patient focused
• The VA’s Office of Electronic Health Record Modernization opens positions for deputy chief medical officers to help oversee its Cerner implementation

Watercooler Talk Tidbits

Readers funded the DonorsChoose teacher grant request of Ms. K in Indiana, who asked for math manipulatives and calculators for her fifth grade class. She reports, “My students are very excited about these fun new activities. We use them daily to play math games, explain and show different math processes, and even to check our everyday calculations. Having these hands on tools will allow my current as well as my future students to learn numerous math skills. Being able to visualize, draw, and understand these foundational math skills will allow these kids to become life long learners and the future leaders of America!”

The Internet lit up this week with endlessly retweeted “news” that scientists in Israel have confidently predicted that they will develop a cure for cancer within a year with a “cancer antibiotic.” The coverage proves that even news sites will run anything that draws clicks, actual journalism is basically dead for lack of demand and the real goal is to be first rather than best, and that consumers have no ability to realize they’re being misled. The holes in the story are ample:

• Every website picked up the story from the Jerusalem Post without digging further.
• The original story had just one source – an interview with the board chair of the company working on the treatment, who has no clinical credentials and is not a scientist (despite the headline). The “complete cure for cancer” quote was his. His previous experience includes running a chicken breeding operation and consulting for a business intelligence company.
• The company lists just three employees on its website.
• The company has not conducted any human trials, published any research articles, or enlisted the involvement of outside oncology experts, saying it doesn’t have enough money to do so. It has completed one experiment in mice.
• The New York Post, Forbes, and Fox News ran with the Jerusalem paper’s headline without doing any research or asking local experts to evaluate the company’s claim. They backtracked a bit afterward, but the revised tweets drew just a fraction of their original uncritical stories.
• The company backtracked after higher-quality news organizations questioned the comment, explaining that “cure” means “starting human trials within a year.”

Federal authorities arrest three people for running “birth tourism” companies that charge wealthy, pregnant women who are Chinese citizens big money to bring them to the US for delivering their babies in hotel-like birthing houses, which under US law makes the babies immediate US citizens. The company’s websites pitched customers that their children could get US government jobs, free education through high school, and Social Security benefits even when living outside the country. The companies told the women to lie on their visa application, wear lose clothes through customs to hide their stomachs, list their destination as the Trump Hotel in Honolulu to improve their chances of being ignored by immigration officials, then fly to Los Angeles to deliver. One couple paid a hospital its indigent care rate in cash, then hit Beverly Hills for a shopping spree at Rolex and Louis Vuitton. Sixteen of the 19 people who were charged were clients who ignored court orders to remain in the US to assist with the investigation. They also skipped out on their hospital bills. Estimates suggest that up to 36,000 Chinese citizens have babies in the US each year.

Non-profit dental insurance company Delta Dental takes heat for paying its CEO $14 million (until they fired him for having an affair with a subordinate), paying its top 10 executives more than $30 million, flying board members and their families to Barbados for company meetings, and planning to acquire a for-profit competitor. Dental insurers are minimally regulated, with no requirement that they spend a specific percentage of revenue on care, and are exempt from paying federal income tax. The company gave the excuse all non-profit healthcare companies use when caught lining executive pockets  – we have to pay well to attract top talent to benefit patients and we use outside companies to make sure pay is appropriate.

Shriners Hospitals for Children will stop offering inpatient care for children at five of its 20 hospitals, saying fewer patients need care of that level of complexity.

A Miami plastic surgeon’s nationally marketed cosmetic surgery practice – located in a strip mall and offering discounts and payment plans to working-class Hispanic and African American patients – has had eight patients die after botched cosmetic procedures performed in assembly-line fashion. The owner had previously lost his license for allowing unlicensed employees to perform surgery and had changed the business name several times over the years.

A pain management doctor pleads guilty to stealing the IDs of his patients to obtain opioid prescriptions for himself.

A reader sent a link to something that has zero to do with health IT, but is cool (no pun intended). A Michigan school superintendent and a high school principal create a fabulous snow day announcement, featuring amazing acting, humor, and singing to the tune of “Hallelujah.” Surprised by their video going viral, the talented duo followed up with another vortex-related video, this one set to “Frozen.” I could watch these guys all day.

Our Lady of the Lake Children’s Hospital (LA) will stream the San Diego Zoo Kids channel to patient rooms. In related news, Baton Rouge Animal Hospital will offer its patients San Diego Jail TV.

In Case You Missed It

• News 2/1/19
• EPtalk by Dr. Jayne 1/31/19
• News 1/30/19
• HIStalk’s Guide to HIMSS19
• Curbside Consult with Dr. Jayne 1/28/19
• HIStalk Interviews Jason Krantz, CEO, Definitive Healthcare
• Monday Morning Update 1/28/19

Get Involved

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

Morning Headlines 2/1/19

eMDs Acquires Aprima, Further Strengthening Position as a Leading Healthcare Ambulatory Solutions Organization

EHR and practice management company EMDs acquires competitor Aprima.

Freshman Lawmaker Will Oversee VA’s Multibillion-dollar EHR Overhaul

Rep. Susie Lee (D-NV) will take over as head of the House Veterans Affairs Committee’s Technology Modernization subcommittee.

Nordic adds Healthtech Consultants, enters Canadian market

Nordic acquires Canada-based Healthtech Consultants, increasing its headcount to over 1,000.

Harris Healthcare, Through Iatric Systems, Acquires Haystack Informatics

Iatric Systems acquires Haystack Informatics, a patient privacy monitoring startup spun out of Children’s Hospital of Philadelphia in 2014.

VA Going with Cerner Scheduling Software

The VA will scrap its successful MASS pilot of Epic scheduling and instead use Cerner at all of its facilities.

News 2/1/19

Top News

EHR and practice management company EMDs acquires competitor Aprima.

Reader Comments

From On the Hunt: “Re: Health Catalyst. Completed its second RIF in six months, with all affected employees working in the HCI division (the former Medicity).” I reached out to Health Catalyst, whose statement I’ll summarize as follows:

• The company identified an unspecified number of positions that were not financially sustainable as it integrated the former Medicity.
• The affected employees will be invited to apply for the company’s 40 open positions, where they will automatically be considered finalists.
• Those who aren’t offered or don’t accept a new position will receive a minimum severance of three months and the company’s help in finding a new job.
• The company increased headcount from 500 to over 700 in 2018 and expects to add 100 more in 2019.

From Vaporware?: “Re: DoD. I was wrong when I accused Cerner of not being able to share data.” A Bloomberg Law article – of which I can read only the first couple of paragraphs that aren’t paywalled – says that hackers found that the MHS Genesis Cerner system was “not survivable” when military hackers tested its cybersecurity. That sounds like the report from October 2018, but perhaps the formation of a new DoD cybersecurity working group is the new development.

From Robert Lafsky, MD: “Re: NEJM article. I know you’re not a sports guy, but I’m sending this because of its privacy implications and potential qualification as a Weird News Andy item if you read to the end.” A NEJM case study recaps the abdominal issues of an unnamed 18-year-old professional athlete. It wouldn’t take much to identify him from the article – he plays professional sports in the Boston area; he weighs just 72 kg (so that rules out football and probably basketball); he’s just 18, making baseball a strong possibility, probably on a farm team at that age. I scanned past rosters and found one pitcher from the Lowell, MA minor league affiliate that was the only match, although perhaps the patient has been traded in / out since the medical incident whose date was not indicated. The WNA connection is that the patient’s problems and hospital encounters were caused by a toothpick he had swallowed. I’ve poked my nose (and nearly my eye) with a restaurant sandwich’s well-hidden toothpick more than once, so I’m all for stopping the practice of overstuffing sandwiches to the point that inedible hardware is required to hold them together.

Webinars

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

Acquisitions, Funding, Business, and Stock

Nordic acquires Canada-based Healthtech Consultants, increasing its headcount to over 1,000.

RTI Institute becomes a minority equity investor in analytics and population health management vendor SPH Analytics. The nonprofit healthcare research organization plans to help SPH broaden the scope of its research and consulting services.

Livongo acquires MyStrength, adding the startup’s app-based mental health therapy software to its digital diabetes management program.

Iatric Systems acquires Haystack Informatics, a patient privacy monitoring startup spun out of Children’s Hospital of Philadelphia in 2014. Terms were not disclosed, though the deal went through Iatric parent company Harris Healthcare. I interviewed co-founder Bimal Desai, MD, MBI in August 2017.

CNBC reports that GE Healthcare will sell off half of its healthcare business in an effort to pay down debt, a move that, combined with its other planned business dealings, could generate $50 billion. GE plans to take its healthcare unit public later this year.

Meditech files its annual report: revenue up 2 percent, EPS $1.51 vs. $2.08. Revenue rose to $488 million, the highest since 2014’s $517 million. Last year’s net income of $56 million is by far the lowest since 2014 and less than half of the $124 million that was booked in 2014 specifically. Product revenue has jumped 30 percent in the past two years. The report indicates that the company commendably pays its executives extraordinarily modestly, gives them tiny bonuses, and does not offer them stock options.

McKesson announces Q3 results: revenue up 5 percent, adjusted EPS $3.40 vs. $3.41, beating Wall Street expectations for both. That excludes the huge boost in last year’s earnings from the White House’s generous corporate tax cuts.

People

Paul Grundy, MD (HealthTeamWorks) joins Innovaccer as chief transformation officer.

Solutionreach hires Nagi Prabhu (Icertis) as chief product officer.

Provider management and credentialing company Symplr promotes Amie Teske to VP/GM of provider management operations and Randy Bahr to VP of product development.

Livongo hires Anmol Madan (Ginger.io) as chief data officer and Julia Hoffman (VA) as VP of behavioral health strategy.

HealthStream names Scott McQuigg (GoNoodle) as SVP of HStream Solutions.

Former National Coordinator Karen DeSalvo, MD, MPH joins venture platform LRVHealth as executive advisor.

Sales

• Total Life Healthcare, part of the St. Bernards Healthcare system in Arkansas, selects medication risk mitigation, e-prescribing, and EHR software from Tabula Rasa Healthcare.
• The VA will implement UpToDate Advanced decision-making software from Wolters Kluwer Health.
• Northwell Health (NY) will integrate Jvion’s predictive analytics with its Allscripts EHR to reduce readmissions at 15 hospitals.
• Sanitas will offer CirrusMD’s white-label chatbot app to patients at its medical centers in Florida.

Announcements and Implementations

Meditech adds Nuance’s Dragon Medical Virtual Assistant to its Expanse EHR and enhances its population health capabilities using data and analytical insights from Arcadia.

New York HIEs HealthlinkNY and HealtheConnections will merge to create the state’s largest HIE, covering 26 counties.

KLAS issues its “Best in KLAS 2019” report, with overall software suite rankings above and these winners being the most interesting to me:

• Large hospital EHR: Epic
• Large hospital patient accounting and management: Epic
• Community HIS: Athenahealth
• Ambulatory EMR >75 physicians: Epic
• Ambulatory EMR 11-75 physicians: Epic
• Practice management >75 physicians: Epic
• Practice management 11-75 physicians: NextGen Healthcare
• Practice management < 10 physicians: Aprima, an EMDs Company
• HIE: Epic
• Laboratory: Epic
• Claims and clearinghouse > 20 physicians: Waystar
• Home health: Thornberry
• Long-term care: MatrixCare
• ERP: Workday
• Patient access: DCS
• Front-end EMR speech recognition: MModal
• Patient portal: Epic
• Population health: HealthEC
• Application hosting: Epic
• Management consulting: Premier
• Health IT advisory: Optimum Healthcare IT
• Enterprise implementation: Impact Advisors
• Implementation support and staffing: Galen Healthcare
• Partial IT outsourcing: ROI Healthcare Solutions
• Revenue cycle outsourcing: Navigant
• Strategy, growth, and consolidation consulting: Premier
• Value-based care managed services: Arcadia
• Cardiology imaging: IBM Watson Health
• Large hospital PACS: Sectra
• VNA: Carestream
• Care management: Casenet

KLAS’s Category Leaders include:

• Community hospital EMR: Athenahealth
• Community hospital patient accounting and patient management: Athenahealth
• Care plans and order sets: Elsevier
• Clinical decision support point-of-care clinical reference: Wolters Kluwer
• Emergency department: Wellsoft
• Retail pharmacy: Epic
• Ambulatory RCM: Greenway Health
• Ambulatory specialty EMR: PCC
• Ambulatory therapy / rehab: WebPT
• Behavioral health: Credible
• Urgent care: Practice Velocity
• Business decision support: Strata Decision
• Clinical documentation improvement: MModal
• Computer-assisted coding: Dolbey
• Credentialing: Verge Health
• Document management and imaging: Hyland
• Patient flow: Epic
• RTLS: CenTrak
• Staff scheduling: Schedule360
• Physician scheduling: Shift Admin
• Talent management: Workday
• Time and attendance: Kronos
• CRM: Salesforce
• Secure communications: Telmediq
• Single sign-on: Imprivata
• Business solutions implementation: ROI Healthcare Solutions
• CDI services: Claro Healthcare
• Clinical optimization: Impact Advisors
• Revenue cycle optimization: Navigant
• Transcription services: MModal
• Price transparency: Change Healthcare

KLAS also released its “Global Best in KLAS 2019,” with the leading EHRs by region being:

• Asia / Oceania: Cerner
• Canada: Meditech
• Europe: Epic
• Latin America: MV
• Middle East / Africa: Cerner

Government and Politics

The VA will scrap its sucessful MASS pilot of Epic scheduling and instead use Cerner at all of its facilities. Epic went live on time and on budget after nine months in Columbus, OH and delivered significant improvement in patient access metrics. Epic also offers FHIR-powered Book Anywhere, which allows VA schedulers to book appointments at any site whether they use Epic or not.

Document Storage Systems will integrate the MyCare iMedicware EHR from Eye Care Leaders with VistA at all VA eye care clinics.

VA Secretary Robert Wilkie downplays the notion that the agency is moving towards privatization in his remarks announcing proposed standards that will allow veterans to seek care outside of the VA system. As vets seek care further afield, the pressure (and media scrutiny) for interoperability between VA facilities and outside providers will likely mount.

Privacy and Security

In Canada, Health Sciences North CEO Dominic Giroux commends hospital staff for the way they handled downtime procedures after a virus took down its IT systems – and those of nearly two dozen area facilities — for several days earlier this month. He says:

• The IT staff’s quick decision to shut the system down prevented loss of data: “What we’ve learned from cybersecurity experts is that other hospitals who go through similar situations, 80 per cent of the time, decide not to shut down the systems. It ends up being the equivalent of trying to change the engine while the plane is still flying.”
• The HIS team had to manually re-enter data for hundreds of patients during the digital freeze.
• A pharmacy robot named Pixie was disabled “with 50,000 unit doses trapped inside it.”
• Emergency management training that was conducted a few days prior helped hospital leaders keep staff calm and focused so that clinical care was not affected.
• The hospital used runners to deliver lab results.

Other

In Australia, Queensland’s Department of Health puts a stop to the procurement process for a new patient administration system after discovering that EHealth Queensland CEO Richard Ashby had an inappropriate relationship with a staff member who was involved with the $210 million project. Ashby, who has been under investigation by the state’s Crime and Corruption Commission since last year, has resigned. As CEO, he was also the front man for the state’s struggling ieMR EHR roll out. DXC and Cerner had been contenders for the new PAS system, which some department employees said was too short of a list, and Cerner got the contract in 2015.

Interesting: a witness in the federal racketeering case brought against Insys Therapeutics says the drug company hired as a regional sales director a former stripper, who the witness observed at a company-sponsored dinner giving a lap dance to a pill mill doctor (to whom the company also paid consulting fees) in hopes of increasing his inappropriate prescribing of its addictive fentanyl spray.

Sponsor Updates

• Sansoro Health names Micky Tripathi (Massachusetts eHealth Collaborative) to its board.
• CarePort Health releases a new video, “Unlock Real-Time Data to Better Manage Care.”
• CTG appoints Romulo Juarez (Slalom Consulting) managing director, delivery, of its health solutions and life sciences business in North America.
• Surescripts joins the Elite Partners Program of the National Council for Prescription Drug Programs.
• QuadraMed partners with LexisNexis Risk Solutions to improve patient matching within its Enterprise Patient-Matching Index.

Blog Posts

• One Year After Surviving Pending Closure, Rural Alabama Hospital is Still Going Strong (Medhost)
• Successful Patient Engagement Strategies (EClinicalWorks)
• Healthcare execs and patients agree: AI can improve the patient experience (Formativ Health)
• CIOs: 8 Ways to Prepare Yourself for HIMSS19 (The HCI Group)
• Powering Patient Relationships – How We Can Help People Prepare for the Future and Still Hope for the Best (Healthwise)
• Integrated prescription drug monitoring supports smarter opioid prescribing (Meditech)
• Considering a Postmodern Approach to ERP System Selection (Huntzinger Management Group)
• Ten Best Practices to Mitigate Cybersecurity Threats (Iatric Systems)
• Overcome risk to drive a successful healthcare IT strategy (Part II) (Imprivata)
• The Evolution of Health IT: What Lies Ahead (InterSystems)
• 4 Ways to Make a Difference at HIMSS19 (Spok)
• Why Choose Community Connect? (Optimum Healthcare IT)
• Better Technology for the Patient’s Sake (EClinicalWorks)
• One Year After Surviving Pending Closure, Rural Alabama Hospital is Still Going Strong (Medhost)

Contacts

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

EPtalk by Dr. Jayne 1/31/19

It’s officially HIMSS time, with the first set of party invitations hitting my inbox this week. I am sad to say that there is so much overlap I’m not going to be able to make half of what I’d like to attend – too many events on Tuesday evening, for sure. I’ve heard from several vendors who are also doing happy hours in the exhibit hall (one that even lets you start getting happy at 3 p.m.) so it’s going to be all about pacing yourself, along with having good shoes.

I’m also starting to get information about product launches or significant updates that vendors are featuring. If you want me to consider dropping by your booth, let me know what you’re showcasing at HIMSS and I’ll see if I can work you into one of my booth crawl schedules. So far, my list of must-see booths include HIStalk sponsors FormFast (#2121 )and perennial Dr. Jayne favorite First Databank (#1921). I’m also looking to attend a session about Vanderbilt University Medical Center’s efforts to include voice assistants within their EHR.

I’ve also got Medicomp (booth 3901) on my must-see list, especially with their new OpEHRation Game. They’re giving away $100 every half hour, so I’m sure there will be lots of others checking it out. I’m looking forward to seeing how they deployed their Quippe Clinical Documentation solution within CareCloud’s platform. They have a dedicated HIMSS page, which was great for better understanding what they hope to accomplish at HIMSS and what they’ll be showing. I’ve heard they’re also getting into the HCC coding space.

I’ll definitely be strolling the hall with phone in hand, capturing the moment and the craziest things I see. After HIMSS, I’ll go back to my curmudgeonly self, keeping my phone out of sight and out of mind bolstered by research that continues to show that trying to capture the moment for posterity actually interferes with the experiences themselves. Research by faculty at the Olin Business School of Washington University in St. Louis also looked at texting during experiences and concluded that “behaviors, such as texting, tweeting, and posting on social media that surreptitiously distract people from the moment” result in “diminished enjoyment.”

I’m always exhausted when I return from HIMSS, so I’m wishing that someone would sneak in while I’m away and install this innovative new sleep platform that has been shown to improve sleep and memory. Maybe the sleep would be more restful – research subjects fall asleep faster when rocking and spend more time in deep sleep.

From Smoke ‘em if You Got ‘Em: “Re: recent piece Thanks for your recent piece on medical marijuana. You’re not the only one doing homework on the topic. Cleveland Clinic has also decided to Just Say No.” The Cleveland Clinic shared their opinion  earlier this month in an op-ed piece, stating, “We believe there are better alternatives. In the world of healthcare, a medication is a drug that has endured extensive clinical trials, public hearings, and approval by the US Food & Drug Administration. Medications are tested for safety and efficacy. They are closely regulated, from production to distribution. They are accurately dosed, down to the milligram. Medical marijuana is none of those things.” The piece calls on the US and Ohio governments to “support drug development programs that scientifically evaluate the active ingredients found in marijuana that can lead to important medical therapies.” I suspect the client I mentioned last week will likely decide along those same lines.

Planned Parenthood is entering the world of chatbots with its new offering Roo, which is designed to interact with teens 13 to 17 years old via text message. Topics include birth control and sexually transmitted diseases. The project was funded through a private grant with hopes that teens would embrace the anonymous nature of the chatbot to ask questions they may be afraid to ask elsewhere. When I was a medical student teaching sexual health in a school district where there was a high rate of teen pregnancy in their middle school, we used the low-tech “write your question down and throw it in the hat” to reduce barriers to asking questions. It was amazing what they didn’t know about their own bodies and how pregnancy and diseases can happen.

CMS has released the “What’s Covered” app to display what “Original” Medicare covers for patients. It distills some of the most-visited content from Medicare.gov into a format that can help beneficiaries and their caregivers see what is covered. I can tell you right now that most of my Medicare-eligible relatives have no idea whether they’re on Original Medicare or a Medicare Advantage plan, despite whatever any wording on their materials might say. CMS began its eMedicare initiative in 2018 to deliver information to its beneficiaries, noting that about two-thirds of them use the Internet on a daily or near-daily basis. Other tools are being designed to help patients sort through their coverage options and understand what their choices might do to their out-of-pocket costs. I hope that make those tools available to physicians, because half the time I can’t quickly find the information I need to best counsel patients and loved ones.

The institute for Medicaid Innovation is calling on EHR users to increase their use of ICD-10 codes to document social determinants of health. Z56 covers issues with employment and underemployment. I actually used Z56.5 (uncongenial work environment) last week to document a patient who was having issues with absenteeism due to a coworker harassing her. Z59 covers problems related to housing and economic circumstances including homelessness, poverty, lack of safe drinking water, and more. Both codes are non-billable, but help to quantify the number of patients facing serious challenges.

NCQA is redesigning its Patient-Centered Specialty Practice and Oncology Medical Home programs, with a launch scheduled for July 1, 2019. The redesign mirrors changes to the flagship Patient-Centered Medical Home (PCMH) program, redesigned in 2017. A crosswalk  matching the new PCSP program to the 2016 program is available along with a video summary of changes. Practices will engage in ongoing transformation with annual reporting instead of the current three-year recognition cycle. NCQA cites multiple reasons for the change, including increased flexibility for practices, simplified reporting, and better alignment with current public and private initiatives along with greater adaptability to future changes.

As we tick ever-closer to Valentine’s Day (which some of us will be celebrating at HIMSS) I’ll be mourning the loss of conversation hearts. Candy producer Necco folded last year and the new owner Spangler Candy Company decided not to make any this year because it couldn’t ensure it could meet consumer expectations since the acquisition didn’t occur until September. Hopefully they’ll be back for the 2020 Valentine’s season, but until then, I’ll be looking for other options. I’m betting more than one HIMSS exhibitor will be handing out candy.

If you’re exhibiting, will you be incorporating Valentine’s Day into your booth swag? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 1/31/19

Secretary Wilkie: Revolutionizing VA Health Care

VA Secretary Robert Wilkie downplays the notion that the agency is moving towards privatization in his remarks announcing new standards that will allow veterans to seek care outside of the VA system.

EPAS no more as SA govt moves to reset patient records system

SA Health in Australia will make immediate changes to its Allscripts-powered EPAS project after an external report criticized the project’s lack of accountability, poorly articulated clinical benefits, underuse of expert consultants, and lack of physician involvement.

UnitedHealthcare stops sharing data with research group

Healthcare pricing transparency advocates cry foul over UnitedHealthcare’s decision to stop sharing de-identified claims data with the Health Care Cost Institute, which expects a similar move from Humana next year.

Livongo Signs Definitive Agreement to Acquire myStrength to Address Behavioral Health Needs for People with Chronic Conditions

Livongo acquires digital mental health therapy startup MyStrength in an effort to bolster its chronic condition management services.