News 7/13/18

Top News

Facebook eliminates a privacy setting that allowed third parties to glean the names of users who participate in private, closed Facebook groups.

The company also shuts down the Grouply.io Chrome extension that was designed to allow marketers to harvest such information on a large scale.

The latter problem was discovered by the moderator of a group for BRCA-positive women who worried that their potential breast cancer information could be shared with insurance companies, with the extension’s behavior documented and reported to Facebook by healthcare technologist Fred Trotter.

Reader Comments

From Dockside: “Re: BJC HealthCare Information Services. Laid off 68 employees and 45 contractors Wednesday following the Epic rollout on June 2 at the remaining facilities. Health Information Partners (HIP), the internal group responsible for the Epic implementation (a joint venture with BJC and Washington University) did not seem to suffer any layoffs. We knew this would be coming at some point, but in our opinion it was handled very poorly. People were told individually and were given an hour to remove their personal items prior to being walked out. Those on PTO were given the news by telephone and told not to return to the office – their personal items were shipped to them. Those of us who were left finally received an email saying what was going on just after 4:00 pm Wednesday. Any semblance of the ‘family’ culture that originally came from the hospitals pre-merger has pretty much been wiped out and replaced with the typical cold corporate culture.” I reached out to June Fowler, BJC SVP of communications, marketing, and public affairs, who confirmed Wednesday’s elimination of about 10 percent of the health system’s IT workforce. She provides this statement:

Market forces are driving all healthcare organizations to deliver patient care services in new, more efficient, and more cost-effective ways. BJC’s positioning for sustained long-term success in response to these pressures will rely increasingly on information technology and IT expertise for innovative solutions. As a business enabler, IT must increase focus on strategic priorities and align work and resources in support of these priorities. Reprioritizing the work towards improved system stability, strengthening of information protection, and disciplined execution requires changes in the IT staffing structure. This realignment includes an adjustment of skills and capabilities required in IT and will eliminate some current positions. In some cases, new job roles and responsibilities will be created to enable improved capabilities and assure accountability for execution as well.

To adjust staffing levels to meet current priorities, we made the difficult decision to reduce the IT workforce effective July 11. The workforce reduction affects 68 employees and 45 IT contractors.

We recognize any action that results in job loss has a significant impact on employees and their families. There is a comprehensive compensation and outplacement support package in place to assist those who are directly affected by this necessary action. The BJC human resources team is working closely with these affected colleagues to support them through this transition. The reduction initiates action towards a major transformation of our delivery capabilities where IT will realign resources to deliver against BJC’s most strategic intents.

From Plebe: “Re: health IT influencer blogs. What do you think of this site’s list?” It’s not up to me to decide who influences whom, but I checked out the 32 sites and found that: (a) 13 are no longer online; (b) nine rarely post anything; and (c) the remaining 10 write something at least occasionally. I’m not getting into a quality debate on the content of those 10, but for most, their rather simplistic articles wouldn’t seem likely to influence anyone who themselves have actual influence.

Webinars

July 26 (Thursday) 1:00 ET. “The Patient’s Power in Improving Health and Care.” Sponsor: Health Catalyst. Presenter: Maureen Bisognano, president Emerita and senior fellow, Institute for Healthcare Improvement. Patients, even those with chronic diseases, only spend a few hours each year with a doctor or a nurse, while they spend thousands of hours making personal choices around eating, exercise, and other activities that impact their health. How can we get patients to be more engaged in their care, and help physicians, nurses, and healthcare providers transition from a paradigm of “what’s the matter” to “what matters to you?” This webinar will present stories of patients and healthcare organizations that are partnering together with tools, processes, data, and systems of accountability to move from dis-ease to health-ease.

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

Acquisitions, Funding, Business, and Stock

On-demand birth control delivery startup Nurx raises $36 million in a funding round led by Kleiner Perkins. The San Francisco-based company, which has raisd $41 million since launching four years ago, also offers access to anti-HIV medication and plans to offer at-home HIV testing lab kits.

Alphabet’s Verily health business will partner with medical device company ResMed to apply sleep data to study the health and financial impacts of undiagnosed and untreated sleep apnea. I’m not sure how that will work since ResMed mostly sells CPAP equipment that would be prescribed only after a positive diagnosis for sleep apnea.

Analysts predict that health IT company Henry Schein will downsize after a regulatory filing hints at plans to increase efficiencies. The Melville, NY-based company spun off its animal health business in April and announced a joint dental software venture with Internet Brands last week.

Epic Systems founder and CEO Judy Faulkner climbs three spots on the latest Forbes list of richest self-made women, proving that the “extreme fame leverage” of list cover girl Kylie Jenner (#27) isn’t necessary to achieve a net worth of $3.5 billion and the #3 ranking behind women involved in ABC Supply and Little Caesars (does anyone actually still buy awful Little Caesars pizza except as evening-out sustenance to be left for the kids and babysitter?)

People

Eric Pupo (Accenture) joins Columbia University Irving Medical Center as CIO.

Divurgent hires Sarah Sample-Reif (Modis) as VP of client services.

Sales

• Hospital management company Candor Healthcare will implement MedSphere’s CareVue Cloud EHR at Rock Regional Hospital (KS) early next year as part of a facility-wide roll out that will include ChartLogic’s EHR and RCM software and services.
• Benefis Health System (MT) selects patient self-scheduling and EHR integration software from MyHealthDirect.
• Eagle Physicians & Associates (NC) opts for real-time patient care alerts from PatientPing.
• MemorialCare Health System (CA) chooses RTLS-based patient workflow technology from Vizzia Technologies.

Announcements and Implementations

Virginia Hospital Center goes live on Bernoulli Health’s clinical surveillance, analytics, and medical device integration software.

CompuGroup Medical announces GA of Electronic Videoconsulting.

PatientSafe Solutions develops an app for rounding and clinical communications.

Allscripts, Athenahealth,  CareCloud, and DrChrono users can offer patients appointment scheduling through Alexa using Nimblr’s virtual assistant, Holly. Integration with Epic is scheduled for Q3.

CipherHealth introduces patient engagement technology for ACOs, including targeted outreach and care coordination tools.

Healthcare Growth Partners publishes its always-brilliant midyear health IT market review. It notes:

• Despite $29 billion in health IT investment since 2014, broad impact on care delivery, cost, and outcomes has been muted, but value is accruing.
• Healthcare’s IT spending as a percentage of revenue is close to the average across all industries at 3.5 percent, but still runs about half of what banking and securities companies spend.
• That healthcare IT spending, however, has been spent on infrastructure and by providers switching from one EHR or billing system to another, gaining little improvement in cost and quality.
• M&A activity for smaller companies have three points at which value is assigned – proof-of-concept (the product can be sold and deployed commercially, with annual revenue less than $1 million); growth scalability (the company shows signs of profitability and growth scaling, with revenue $5-10 million), and mature scalability (the company takes on real infrastructure and begins to show strong profitability, with revenue $20 million and up).
• HGP’s HIT Index gained 25.7 percent in 2017 and added another 21.6 percent in the first quarter of 2018.
• Leading the Q1 HIT performance in share price change are Tabula Rasa Healthcare (up 128 percent), Connecture (up 116 percent), Evolent Health (up 71 percent), and Teladoc (up 67 percent). 
• Bottom-performing in the Q1 HIT index are Inovalon Holdings (down 34 percent), Invitae (down 19 percent), Oneview Healthcare (down 19 percent), and Allscripts (down 18 percent).
• Health IT IPOs have dried up completely, with zero in 2017 and so far in 2018.

A new KLAS report on non-US EHR activity finds that Epic gained 16,000 beds in signing six contracts in 2017, more than doubling its small, non-domestic market share as concerns about high-profile problems at Cambridge’s implementation in the UK faded. InterSystems continued its rapid growth, especially in smaller, multi-hospital organizations, while Cerner’s growth was moderate and lagged its primary competitors. The early days of the UK’s Global Digital Exemplar program has seen only four new contracts signed, of which Epic earned two, System C one, and Allscripts one.

Virginia Hospital Center (VA) goes live on Bernoulli One for clinical surveillance, medical device integration, and real-time analytics.

Advisory Board’s annual survey of health system CEOs finds that their top concern is preparing for sustainable cost control and creatively reducing expenses, followed by finding diversified revenue streams. A fast-growing #5 was meeting rising consumer demands for service.

Government and Politics

The House Committee on Veterans’ Affairs names to the subcommittee that will oversee the VA’s Cerner implementation Rep. Jim Banks (R-IN, chairman); Rep. Conor Lamb (D-PA, ranking member); Rep. Jack Bergman (R-MI);  Rep. Mike Coffman (R-CO); and Rep. Scott Peters (D-CA).

HHS awards Cue Health a $14 million contract to develop app-based flu-testing kits for the home and office that will include virtual consult and prescribing capabilities. The company announced a $45 million Series B funding round earlier this week. Diassess has been awarded a $10 million contract to develop a similar kit, though its focus will be on creating a disposable, battery-powered device for use during public health emergencies.

Privacy and Security

Public health officials in Nashville, TN discover that the PHI of thousands of HIV patients was accessible to all employees on a Metro Public Health server for almost nine months. The database, typically accessed by a small group of physicians, is used to track and help patients living with HIV.

Children’s Mercy Hospital (MO) faces its fourth data breach-related lawsuit, this time pertaining to an email phishing scam discovered in January that potentially exposed the data of 63,000 individuals. Children’s Mercy faced another suit from the same firm over a 2017 breach involving the PHI exposure of 5,500 patients. Two additional lawsuits involved the theft of paper records from employee vehicles.

Fortified Health Security releases its mid-year cybersecurity report, noting that 28 percent of breaches so far this year involved an email attack.

Other

The FDA issues recalls on 39,000 Medtronic implantable heart devices after the company alerts providers that the devices need software updates to avoid potentially adverse events.

In England, the Royal College of Surgeons calls out the NHS after discovering the health service is still using 9,000 fax machines despite a nationwide push to convert to digital technologies. “NHS hospital trusts remain stubbornly attached to using archaic fax machines for a significant proportion of their communications,” says RCS chair Richard Kerr. “This is ludicrous. The NHS cannot continue to rely on a technology most other organisations scrapped in the early 2000s.”

UC Health describes its central data repository for all six UC Health systems at its Data Day in San Diego, noting these points:

• The scientific method of asking questions and then making observations is becoming obsolete as ample data already exists, with the bottleneck not being the gathering of information, but rather “asking the killer questions.”
• UC Health’s tools include UC-Rex, a search engine for anonymized patient information, and Epic’s SlicerDicer, which creates patient cohorts from EHR data.
• Studies now start with looking at what has happened to patients clinically, then getting IRB approval to dig deeper.
• Information that is being added to the data warehouse includes patient satisfaction and survey results, hospital operations data, claims data, and eventually genomics data.
• Data analysis includes looking at how physicians spend their time and looking for potential burnout risk factors.

CNBC reports that Amazon and Xealth, a digital prescribing and analytics startup, are in talks with several health systems to develop bundled medical product recommendation and delivery services for patients just before discharge.

Weird News Andy is proud as a peacock that New Zealand scientists have performed the first 3-D, color X-ray on a human.

Sponsor Updates

• CarePort Health extends its discharge planning and referral management software agreement with Jackson Health System (FL), and helps JHS integrate its software with the hospital’s Cerner EHR.
• Elsevier Clinical Solutions will exhibit at the APC 2018 Annual Meeting July 15 in San Diego.
• EClinicalWorks will exhibit at the 2018 FSASC Annual Conference July 18-20 in Orlando.
• Optimum Healthcare IT publishes a video describing SkillMarket, software to manage EHR go-live resource evaluation, compliance, and scheduling.
• Meditech publishes a case study titled “The Clatterbridge Cancer Centre NHS Foundation Trust Transforms Cancer Care.”
• IMAT Solutions will exhibit at HealthImpact East July 18-20 in Washington, DC.
• Butler Health System (PA) achieves 97-percent patient-matching accuracy using solutions from LexisNexis Risk Solutions and Occam Technologies.

Blog Posts

• EHR Training: Don’t Forget These 7 Areas (The HCI Group)
• Making Preventive Healthcare Services a Priority (Healthgrades)
• 2 truths and 1 lie: Healthcare and fax machines (Hyland)
• Using Education to Get Patients Back in the Office (Solutionreach)
• The Top Three Keys to Preventing a Cyber-Attack (Iatric Systems)
• The Power of Analytics in Diagnosing Physician Burnout (Dimensional Insight)
• Timely Filing: Optimizing Revenue Cycle Team Performance (Impact Advisors)
• The US House of Representatives passes The EPCS Act (Imprivata)
• Healthcare CRM Use Case Beyond Marketing: Provide Patients with Post-Discharge Follow-ups (Influence Health)
• For Your Eyes Only: Data Privacy and Best Practices (InterSystems)
• 3 Key Themes from the 2018 Healthcare Call Center Times Conference (Kyruus)

Contacts

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

EPtalk by Dr. Jayne 7/12/18

California’s new data privacy law comes under fire from tech companies that want to modify its impact before it goes into effect in 2020. The California Consumer Privacy Act of 2018 (CCPA) is one of the most stringent data privacy laws in the US. Under the law, Californians can access and delete the data that various companies collect on them, and can opt out of the sale of their data. The law is aimed at businesses with more than $25 million in annual revenue, or that amass data on more than 50,000 persons, or that generate more than 50 percent of their revenue from selling consumers’ personal information. Although this protects small businesses, it draws in a large number of entities.

One of my favorite privacy advocates was just at a seminar covering the General Data Protection Regulation (GDPR) enacted by the EU and notes many similarities between it and the CCPA. The so-called “right to be forgotten” is similar, along with the rights of data access and portability. However, the CCPA includes a provision for explicit damages in the event of a breach. The CCPA covers “consumers” who are California residents and also addresses metadata through the use of categories of personal data, categories of data sources, and categories of third parties with whom data may be shared. The CCPA also includes more prescriptive language about explanations that cover what data will be used for and requires businesses to add an opt-out link to their web page.

The CCPA also has a provision that allows the attorney general to prosecute on behalf of a consumer, along with some language that may limit class action lawsuits. There will be a public consultation period in 2019 where modifications may be made before the law goes into effect. Given the large number of tech companies in California, there’s a lot of lobbying going on for the likes of Google, Uber, Amazon, and Facebook, that are worried that the law will impact their operations. The Internet Association trade group has indicated it will be part of negotiations over coming months. The passage of the law prior to a June 28 deadline ended a movement for a ballot action in November, so it will be interesting to see what consumer groups think of industry lobbyists and whether the law will stay in its current state as it goes into effect. Critics note the speed at which the law was passed (one week) compared to its impact.

While tech companies hope to limit its impact, the American Civil Liberties Union of Northern California feels it hasn’t done enough and that it “fails to provide the privacy protections the public has demanded and deserved,” noting that it was “hastily drafted and needs to be fixed.” California is progressive in a variety of ways, so we’ll have to get out our “fifty nifty” scorecards and see who is ready to follow suit.

It’s a sign of our times: GoFundMe’s CEO tells Minnesota Public Radio that medical bills and related expenses now account for one-third of GoFundMe campaigns. There are over 250,000 medical requests launched each year, with more than $650 million raised. The campaigns include both uninsured and underinsured individuals, and request assistance for high medical bills, travel to specialty care facilities, and procedures denied or uncovered by insurance.

JAMIA publishes a study titled “Research use of electronic health records: patients’ perspectives on contact by researchers.” The authors note that “researchers will almost certainly discover discrepancies in EHRs that call for resolution, and in some cases, raise the ethical dilemma of whether to contact patients about a potentially undiagnosed or untreated health concern” and set out to “explore patients’ attitudes and opinions about potential contact by researchers who have had access to their EHRs.” Researchers used focus groups where situations were described and discussed. Many patients did feel researchers should act if a current health issue was identified, but felt that communicating through the patient’s physician was the best way to handle notification. Rural participants had a strong preference for researchers to take action compared to urban participants. The authors conclude that study construction should allow for addressing discrepancies found in the EHR and communicating with patients. The article is worth a read to see some of the actual patient comments noted in the focus groups.

The various federal rules that have come out over the last year are so large that I never make it through any of them in their entirety. I missed the fact that CMS intends to force adoption of the NCPDP SCRIPT Standard, Version 2017071 beginning on January 1, 2020. Although some may think it’s just another item to mark off on a checkbox, it adds significant benefits for many providers. My favorite improvement closes out an “enhancement” request I made back in 2003, when I implemented Medical Manager’s OmniChart product which used ProxyMed for e-prescribing. If you’re a provider who has ever had to prescribe a complicated prednisone taper or give detailed instructions for migraine medications, you’re going to be happy. Once the transition to the new standard is complete, providers will be able to send instructions that are larger than the current 140-character limit. They’re giving us a full 1,000 characters to play with, but there will be issues during the transition if provider systems are upgraded but pharmacies are not. In those cases, if instructions of more than 1,000 characters are sent, they will be rejected on the pharmacy side.

I’m looking forward to being able to spell out my favorite treatment for severe poison ivy without resorting to error-prone abbreviations. Until then, you’ll have to take your prednisone 3 PO TID for three days, then 2 PO TID for three days, then 1 PO TID for three days. And remember to wear long sleeves and long pants and also wash with Fels-Naptha soap when you come in from the woods.

What’s your favorite custom SIG for medication instructions? Are your providers going to do a happy dance? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 7/12/18

Alphabet and ResMed are spinning out a start-up to solve sleep apnea, a hidden health crisis

Alphabet’s Verily and ResMed will use “billions of night’s of data” to jumpstart a joint venture focused on diagnosing sleep apnea more effectively and helping patients better manage the condition.

Nurx raises $36 million and adds Chelsea Clinton to its board of directors

Birth control-focused telemedicine startup Nurx raises $36 million in a funding round led by Kleiner Perkins.

Medtronic says thousands of heart devices need software upgrades

The FDA publicizes Medtronic notices alerting providers that 39,000 implantable heart devices need software updates to avoid potentially adverse events.

Readers Write: Augmented Intelligence: Virtual Assistants Come to Healthcare

Augmented Intelligence: Virtual Assistants Come to Healthcare
By Andrew Rebhan

Andrew Rebhan, MBA is a health IT research consultant with Advisory Board of Washington, DC.

Natural language processing (NLP) techniques allow digital systems to streamline user interactions allowing machines to read text, understand meaning, and generate narratives from existing information. Recent advances in artificial intelligence (AI) technologies have accelerated progress in a broad range of NLP applications for healthcare, including digital assistants for clinical staff, concierge services for patients, and digital scribes to streamline documentation processes.

For example, last Fall Nuance Communications released its Dragon Medical Virtual Assistant to help health care providers interact with clinical workflows using NLP and other conversational AI functionality. Nuance announced at HIMSS18 that it will integrate its virtual assistant technology into Epic’s EHR.

According to the news release, the new partnership allows physicians to use the virtual assistant to ask for information from a patient’s chart, retrieve labs, medication lists, and visit summaries using Epic Haiku. Nurses using Epic Rover can use the assistant to conversationally interact with flowsheets to enter and confirm patient info and vitals. Finally, scheduling staff using Epic Cadence can converse with the assistant to check physician schedules and create or modify patient appointments. Vanderbilt University Medical Center recently announced it is leveraging Nuance’s technology to build a prototype voice assistant called “V-EVA” (Vanderbilt EHR Voice Assistant) to help caregivers navigate the hospital’s Epic EHR using natural dialogue.

A number of other healthcare providers have started piloting voice assistants. Northwell Health is testing Amazon’s Alexa across multiple use cases, including one that helps users determine the wait time at nearby emergency rooms and urgent care centers in Northwell’s system. People can ask their Alexa-enabled home devices to either search for the shortest wait time based on their ZIP code, or can ask for the wait time for a specific location. Once the user asks for this information, Alexa queries Northwell’s database of wait times (which analyzes check-in data every 15 minutes) for the best option. The Alexa feature can respond back with the location’s name, address, and wait time.

In another example, the University of Pittsburgh Medical Center (UPMC) is collaborating with Microsoft to create an intelligent scribe called EmpowerMD. The project is part of Microsoft’s Healthcare NExT initiative, which aims to use AI to accelerate healthcare innovation. The virtual scribe listens to conversations doctors have with patients, analyzing speech for clinically relevant concepts to make suggestions in the medical record. The goal is to allow doctors or other staff to engage with patients face to face, without the need to divert their attention to a computer screen. The scribe can make suggestions or take notes for follow up, which the doctor accepts or modifies after the encounter. Staff can also view a transcript of the conversation for greater context on the assistant’s suggestions. Using machine learning, the virtual assistant improves its performance as suggestions are accepted, rejected, or modified by the user.

Patients are also interested in AI-powered virtual assistants. Accenture recently released the findings of its 2018 Consumer Survey on Digital Health, which polled 2,301 US consumers on topics such as wearables, virtual care, and AI. Among the findings, the survey showed that roughly one in five consumers has experienced health-related AI, and in particular, showed an openness to using intelligent virtual assistants:

• 61 percent said they would use “an intelligent virtual health assistant that helps to estimate out-of-pocket costs, schedule healthcare appointments and explain benefit coverage, bills, and payment options”
• 57 percent would use an intelligent virtual coach
• 55 percent would use “an intelligent virtual nurse that monitors your health condition, medications, and vital signs at home”
• 50 percent would use “an intelligent virtual clinician that helps to diagnose health issues and navigate you to the right treatment options”

Is your team interested? Here are some considerations to get you started.

Identify your Goals

Virtual assistants can perform a variety of tasks described above. In addition, they can set reminders, answer basic patient questions, call for a nurse, or even address loneliness. However, virtual assistants may not always be the best solution for a given problem, particularly complex tasks that may benefit from visual displays (such as on a computer or tablet). Make sure your team is specific about how the technology will improve processes and where it fits into existing workflows.

Explore What’s Possible

The major technology companies such as Google and Amazon are trying to make their software development kits and APIs as open and user-friendly as possible – which means your organization can build new skills into these virtual assistants to better suit your needs, assuming you have the right staff skills to code these features. As you evaluate options, ensure that potential solutions are properly evaluated for HIPAA compliance, as natural language interfaces in a healthcare setting may capture sensitive information whether or not that is not part of their intended use.

Expect Change

The healthcare industry is starting to see rapid advancements in NLP, computer vision, and other subsets of AI, but the use of virtual assistants in hospitals is still nascent. The technology will likely continue to evolve as more organizations adopt and test these devices, and the broader industry forms new ways to implement and regulate their use. Early adopters will have an advantage in getting to use and gain experience with these tools, but may also have to update them more often as vendors release new editions with enhanced capabilities.

HIStalk Interviews Dan Burton, CEO, Health Catalyst

Dan Burton is CEO of Health Catalyst of Salt Lake City, UT.

Tell me about yourself and the company.

Health Catalyst was founded by a couple of folks from Intermountain Healthcare. We provide a data platform that’s really good at aggregating data from lots of different sources. We analyze the data and we have a layer of analytics apps that pinpoints opportunities for improvement clinically, financially, or operationally. Then we provide clinical, financial, and operational expertise to go after those opportunities.

What led to the Medicity acquisition and what synergy do you expect to see?

We have deep roots and connections to Medicity going back to the company’s founding. Former Medicity President Brent Dover joined Health Catalyst a number of years ago, as did the former head of sales and other management team members. Like us, they are headquartered in Salt Lake City.

What Medicity does is complementary to what we do. The data asset that we have amassed is rich, especially on the acute care side, with about 100 million patient records. But it’s lighter than we would like on the ambulatory side, which is Medicity’s strength. They have about 75 million patient records, largely coming through the ambulatory space. Adding that data asset and the transactional capabilities of being effective in moving data to lots of different places felt like an important complement to the ability of our platform to meet the needs of our clients.

From a mission orientation perspective, the folks at Medicity are focused on using data to improve outcomes. That’s why we exist. We felt like from a data asset perspective and from a mission perspective, it lined up well.

How much of the information that a provider organization needs to meet today’s challenges exists outside their EHR?

The province of Alberta, Canada did a study about two years ago to try to answer that question. Their conclusion was that to effectively run population health for their province, only about 8 percent of the relevant data existed in the EHR. We think that’s about right, and our experience with our clients is similar. The EHR is an important source of data, but we have many clients that need to pull information from 50 or 100 additional sources. We also have clients that have four or five EHRs whose information needs to be brought together into a single source of truth.

What is the level of provider analytics maturity and what are the higher achievers accomplishing that the lower achievers are not?

We are still in the very early innings of analytics prowess or analytics maturity. Even our most advanced clients are still facing some of the same challenges that the rest of the client base that we work with seems to face.

One is a talent shortage. It’s hard to find great data scientists and great analysts in competing with Silicon Valley, with Google, Microsoft, Amazon, and many other tech companies. We’ve seen a real gap in our clients being able to staff the kind of analytics talent that they would like to have. That’s one of the reasons that our analytics expertise, our services offering, has exploded over the last three years. We’ve been fortunate to compete pretty well for talent against Silicon Valley, so we can bring that talent to bear.

It’s not surprising that our industry is early in developing analytics capabilities. It has taken us a long time to transition from paper to electronic data. Without electronic data, there was nothing to analyze. Since we’re early relative to other industries in that transition, it follows pretty naturally that we would be early in developing significant analytics prowess.

The best conference speaker I’ve heard was Billy Beane from the Oakland Athletics at your Healthcare Analytics Summit a few years back, who in “Moneyball” used analytics rigor to find market inefficiencies that could be exploited by an underfunded baseball team. Do we have a Billy Beane-like provider who is taking the culture in a new direction in ways that everybody else is missing?

The analogy is important, including the cultural change required and the doubts he had to overcome from within his organization. We experience a lot of the same in healthcare. But we see some of our most innovative health systems choosing to face the truth from the data, to realize that they have significant inefficiency and significant variation. There’s a lot of vulnerability, for example, in facing patient injury elements, but that’s a necessary step to transform and dramatically improve.

We are also seeing an interesting uptick in innovative openness to being data-driven, coming maybe from outside of the traditional provider segment of the healthcare ecosystem. I think that pattern will continue for a decade or more, where you will see innovative employers thinking differently about how they utilize the data they can collect on the health of the population that they care about most, which is their employees and their loved ones.

We think data and analytics have an important role to play through many different vectors, including the traditional delivery mechanisms, but it will play a role in non-traditional ways, too.

Health Catalyst spent a lot of money to create the Data Operating System. What does it offer that a data warehouse doesn’t?

A lot of value can still be realized from the concepts that were breakthrough for us a decade ago, like a late-binding data architecture. In many ways, that has become a more common practice in healthcare, which is great for the entire industry since it still offers value.

What we saw a number of years ago — and I’ll credit Dale Sanders, our head of technology, for seeing this before many others — was that there would be an explosion in the number of potentially relevant data sources. Specific use cases exist where having access to data sources such as genomics and social determinants of health data leads to much better decisions and dramatically improved outcomes, both financially and clinically.

That explosion in potentially relevant data sources requires a much more scalable data platform. A traditional, on-premise data platform using 10-year-old technology just can’t handle that level of scale. We feel that the right combination is a more modern technology stack that takes advantage of the best Silicon Valley thinking coupled with deep healthcare domain expertise.

We made a bet a few years ago to invest $200 million in this next-generation Data Operating System data platform to support that need to scale. We’re early in enabling our clients to realize the return on that investment, but we’re not super early. We’re seeing more and more interesting use cases where you bring in non-traditional data sources and you have compute power through an Azure-based, cloud-based, scalable technology infrastructure that you just couldn’t achieve in the old model.

Analytics is often applied to address clinical quality and outcomes, but health system cost pressure is increasing. What data tools do organizations use to manage costs?

A cost focus and a precise ability to measure cost at a granular level will become a central focus over the next five years. The low-cost providers will be the survivors, and those who are going to be low cost have to first understand their costs.

There are real challenges, partly because we are not systematically collecting all the data needed to answer the question of, what are my precise costs on a given day, with a given provider, in a given location, with a given procedure? There is data that needs to be collected at a very specific level, but that isn’t being collected today.

We’ve spent a good deal of time over the last five years developing a Pareto version of precise activity-based costing for healthcare, where you get 80 percent of the precision benefit with about 20 percent of the effort. It’s hard to do precision-based costing all the way. It’s incredibly expensive to collect all of that data in every case. We hypothesize an 80/20 rule that we’re finding actually exists. We co-developed this with UPMC.

My opinion is that five years from now, every surviving health system will be collecting all of that data and analyzing it very carefully to identify the hundreds and even thousands of cost-savings opportunities. The health systems that execute most flawlessly against those improvement opportunities will be the health systems that thrive and survive. Those that don’t pay attention are very much at risk.

Health Catalyst is on everybody’s list of health IT companies that are expected to go public next. I know you can’t talk about that specifically, but what does it take to prepare a company for growth?

It’s very hard to do. That’s probably appropriate. To become a successful publicly-traded company requires that size and scale be in place and to have predictability to the business model and the revenue. There needs to be stability in the client base and a significant Net Promoter Score or satisfaction level. In our opinion, there needs to be a culture that is built to last and team members who are deeply engaged in the company’s mission and the success of a client.

That’s a model that we have tried to follow in the event of a scenario where our board decides that going public would be the right path for our company to pursue. We have obviously chosen to raise capital from investors, so we understand that those investors eventually need liquidity and a return on their investment. One way that can happen is through the public markets.

One element that the leadership team really likes is the opportunity to remain as Health Catalyst for the long haul. That’s very important to us, and an appealing element of the public company path.

In any regard, preparing to be a successful public company overlaps significantly with preparing to be a scalable, independent, sustainable company as well. For a number of years, we’ve been trying to prepare ourselves to be the latter, and by preparing for the latter, you are also preparing for the former.

Do you have any final thoughts?:

It’s an exciting time to be in healthcare. It’s a time of transition, which can evoke feelings of nervousness and anxiety for good reason. But it also represents a real opportunity to think about things differently. Data and analytics provide us with visibility we’ve never had about what we should change and what we should do differently so we can see the industry transform. It’s a great thing to be a part of. It’s a meaningful activity to get up in the morning and work hard to fulfill.

Morning Headlines 7/11/18

Ingenious Med Announces Nimesh Shah as New CEO

Nimesh Shah (McKesson) replaces Joe Marabito as CEO of Ingenious Med.

Children’s Mercy faces class action lawsuit over data breach affecting thousands

Children’s Mercy Hospital (MO) faces another data breach-related lawsuit, this time pertaining to an email phishing scam that potentially exposed the data of 63,000 individuals.

Layoffs likely ahead at Henry Schein in latest move

Analysts predict health IT company Henry Schein, which recently spun off its animal health business, will downsize after a regulatory filing hints at plans to increase efficiencies.

News 7/11/18

Top News

Cerner will partner with value-based care services operator Lumeris to create a combined VBC technology product to be called Maestro Advantage. Lumeris will also adopt Cerner’s HealtheIntent platform.

Cerner will make a $266 million investment Lumeris, acquiring a minority share.

Reader Comments

From You Dubbed: “Re: UW Medicine’s EHR project. You shouldn’t have included the link from your reader since other sites used it without listing HIStalk as a source.” That happens quite a bit when I run insider-reported news that competing sites have to pretend they discovered on their own even though the source is obvious due to timing and the link (or lack of a link). I don’t mind that they do it, but I do mind that they intentionally don’t give credit, which I would unfailingly do. The most head-scratching commentary was added by the 2017 journalism graduate of Becker’s, who ill-advisedly went off script in pondering to a stated CIO audience, “UW Medicine has not revealed whether it will build its own system or select an EHR vendor for the $180 million effort,” missing the obvious points that (a) no health system has built an EHR in many years; (b) the project budget clearly indicates the line item involved with buying the unnamed vendor’s product; and (c) the rollout will start in a few months.

From Blank Cheque: “Re: HIT family tree. Looking for the graphic depiction you ran.” The most recent version I have of the thoroughly researched and incredibly complex document that was created by Constantine Davides (now a managing director at investor relations firm Westwicke Partners) is from 2015. From which I shall extract this trivia question: what was the former high-flying point-of-care patient safety technology vendor that Cerner acquired for just $11 million in 2005? You might also want to consult Vince Ciotti’s HIS-tory, which I believe had similar depictions.

Webinars

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

Acquisitions, Funding, Business, and Stock

Medical practice technology vendor AdvancedMD acquires competitor NueMD, which offers practice management and billing applications that include clearinghouse capabilities.

Verity Health System (CA) is looking for a buyer of some or all of its six hospitals, hoping to “address challenges our hospitals face after a decade of deferred maintenance, poor payor contracts, and increasing costs.” Patrick Soon-Shiong’s NantWorks bought a majority interest in the health system last July from its hedge fund owner, which retained a minority share and provided additional funding. That announcement touted the health system’s access to new technologies such as the ones NantWorks sells. Shortly after the announcement, Verity moved to implement Sunrise from Allscripts, of which Soon-Shiong was also an investor, a move so embarrassingly self-serving that the Allscripts sales announcement declined to refer to Verity by name. 

Population health management technology vendor Arcadia opens a Pittsburgh office, where it will add 30 software engineering jobs by the end of the year.

Sales

• Catholic Health Initiatives chooses CTG to implement Epic in its Chattanooga, TN region.
• Non-profit Manifest MedEx adds two large California medical groups and Stanford Health Care to its network that provides real-time patient encounter notification and a display of aggregated patient data. CEO Claudia Williams and Chief of Staff Erica Galvez previously worked for ONC on interoperability.
• Avera Health (SD) will implement PeriGen’s PeriWatch labor analysis software in its birthing units and will add the full PeriGen suite that includes its fetal monitoring solution. 
• Nova Scotia Health Authority chooses Corepoint’s integration engine for province-wide interoperability for its One Person One Record initiative.

People

Ingenious Med hires Nimesh Shah (McKesson) as CEO. He replaces Joe Marabito, who was hired for the CEO job in September 2016.

Announcements and Implementations

State of Alaska hospitals can view view prescription drug monitoring program information at the point of care via Collective Medical’s network and platform, which also allows providers to identify their highest-need patients in real time and collaborate to meet their needs. Collective’s system is endorsed as a best practice for emergency medicine by ACEP, whose state chapter was involved in the rollout.

KLAS introduces high-mindshare precision medicine vendors in a new report that will be followed in Q4 by a more detailed version that will include customer opinions.

InstaMed makes its External Payment Page Integration available in Epic’s App Orchard, allowing sites to create a seamless, secure online payment experience without requiring them to store credit card and bank payment information.

Government and Politics

In England, Secretary of State for Health and Social Care Jeremy Hunt replaces the resigned Boris Johnson as foreign secretary. Taking over Hunt’s job in a flurry of Brexit-related resignations is culture secretary Matt Hancock, a 39-year-old former economist and technologist. 

The White House eliminates most of the remaining CMS funding for navigators who help people sign up for Affordable Care Act policies, also requiring groups who apply for navigator grants to pitch short-term and association health plans that offer cheaper but less comprehensive coverage, charge sicker people higher premiums, and exclude pre-existing conditions.

Other

Drug users are monitoring their post-ingestion heart rates on their fitness trackers and posting screen shots on Reddit and other sites to show the effects of what they took. A quantified selfer reports, “Drugs are the only reason I wear a Fitbit. I want an early warning system for when my heart’s going to explode.” Experts warn that this is a really bad idea given the inaccuracy of the devices and maybe for taking potentially deadly drugs in the first place.

More interesting claims from Tennessee’s lawsuit against OxyContin maker Purdue Pharma:

• The company’s sales reps, none of whom were medical professionals, were told to claim medical expertise and to focus their sales efforts on overworked, lesser-trained doctors
• The company paid to create noble-sounding advocacy groups that called the opioid epidemic as a “psuedoaddiction” that could be prevented by prescribing higher doses to eliminate addiction symptoms
• Reps were ordered to keep selling to doctors known to be running cash-for-pills operation and whose patients were dying of overdoses
• Purdue Pharma specifically targeted military veterans as opioid patients with a campaign called “Exit Wounds”
• The company’s tagline was to “sell hope in a bottle” and it urged reps to “always be closing”

A woman with a family history of cancer celebrates her 23andMe BRCA1/2 breast cancer genetic test results that showed no variants, only to receive hospital results four weeks later indicating that the company’s less-than-thorough testing missed the fact that she’s genetically at risk. 23andMe’s fine print indicates that it tests only the most common genetic variants. The woman will have her breasts and ovaries removed this month to reduce her 70 percent chance of getting cancer.  

Sponsor Updates

• Solutionreach adds the voice of three patient advocates to its company blog.
• Datica joins the Cloud Native Computing Foundation.
• CRN recognizes Burwood Group’s Joanna Robinson as one of its 2018 Women of the Channel.
• CenTrak expands IoT location and sensing services to Awarepoint customers.
• Change Healthcare introduces Member Healthcare Payments, a consumer payment tool that helps payers display patient financial information in one place

Blog Posts

• Standard or Encrypted Pagers: What’s the Difference and Which Is Best for My Hospital? (Spok)
• 4 Questions with Anna Turman, CEO, Chadron Community Hospital and Health Services (Optimum Healthcare IT)
• Tiny issues can ruin reputations (AdvancedMD)
• From nurse to CEO to AHA chair: Nancy Howell Agee on her improbable rise and the future of value-based care (Advisory Board)
• Imagine if you could … leverage the wealth of your clinical data (Agfa Healthcare)
• A quick intro to optimizing and refreshing your EHR performance (Nordic)
• You Just Can’t Trust Medication Adherence Data – or Can You? (Aprima)
• #TrotForTri4Schools (Bluetree Networks)
• Defining Clinical Surveillance (Bernoulli)
• Tips and lessons learned for a successful clinical EHR implementation (Meditech)
• Best Practices are Best Practices: How Datica Handles Global Compliance (Datica)
• How Contact Center IT Can Help Health Systems Compete for Patients (Burwood Group)
• Clinical Optimization: What Is It and Why Is It Important? (Leidos Health IT)
• How to Navigate an Acquisition While Maintaining Your Company Vision (CarePort Health)
• Defining What is Value-Based Care for Patients with Relapsed/Refractory Chronic Lymphocytic Leukemia (CareVive)
• Moving the Needles on Interoperability Part 1: Taking the First Step – Defining the Most-Needed Data (Casenet)
• The Shrinking EHR Vendor Space (Culbert Healthcare Solutions)
• ERP: Online Focus Group Recap (Divurgent)

Contacts

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

Curbside Consult with Dr. Jayne 7/9/18

I took some time off this week to celebrate my birthday along with our nation’s 242nd. In coming back to the office, I heard some awful stories of fireworks injuries that made me glad I wasn’t working over the holiday.

According to our friends at University of Washington School of Medicine, legal “shell and mortar” fireworks cause the most adult injuries based on data from Harborview Medical Center. Each year, more than 10,000 people seek care for fireworks-related injuries, which doesn’t account for those tending injuries at home. Teens are more prone to injuries from homemade fireworks, and children are at higher risk from injuries from bottle rockets and similar products. More than 90 percent of injuries occur in male patients. Not surprisingly, limb and eye injuries lead the pack, with 37 percent of hand injury patients requiring at least one partial or whole finger or hand amputation. More than 60 percent of patients with eye injuries had permanent vision loss. I hope you had a safe and injury-free Independence Day.

Summer typically brings a boom in trauma for hospitals, which can present challenges when critical drug products are in short supply. My practice is still dealing with intermittent shortages of IV fluids that our distributor indicates are due to manufacturing disruptions following last year’s Hurricane Maria. Basic medications, such as injectable morphine and lidocaine, are also only available in limited quantities and sometimes in sizes that staff members aren’t used to dealing with. When you’re used to drawing up 4mg of morphine from a single vial and now the vial contains 5mg instead, it’s a recipe for medication errors.

We’ve had to redo some of our EHR templates and defaults to address these changes in our drug supplies, which has led to issues with executing orders and quite a lot of read-back and clarification. Generic products such as IV fluids and morphine tend to have low profit margins, narrowing the available sources and increasing the risk of disruption. There have also been some quality-related recalls that can be at least correlated with manufacturers failing to invest in facilities that make these low-margin products.

Drug shortages aren’t something we like to think about in the US, but they can be challenging when a physician has to use an unfamiliar drug because of availability issues. I recently removed an embedded fish hook from a patient’s finger, and rather than having access to quick-acting lidocaine to deliver a nerve block, I had to use a drug with which I was less familiar and which took five times longer for the patient to experience anesthesia after I injected it. It meant more time for the patient to be in pain as well additional time for staff monitoring and disruption in my ability to see patients while I had to keep checking to see if he was numb. A recent survey  from the American College of Emergency Physicians notes that four in 10 physicians surveyed felt patients were negatively impacted by drug shortages. The FDA is trying to ease some of the shortages by allowing damaged products to be sold when they previously would have been recalled – morphine with cracked syringes was allowed onto the market with instructions for physicians to filter the drug before using it.

Speaking of the FDA, mobile app maker Headspace is hoping the agency will approve a prescription app for meditation. It subsidiary, Headspace Health, hopes to submit an application by 2020 and is preparing to launch clinical trials in support of the project. The app aims to help treat a variety of health problems, although the company is keeping mum on which ones due to concerns about competition. While meditation is increasingly popular, the health benefits have not been proven to the degree required by many evidence-based institutions although some studies show impacts on lowering blood pressure, reducing back pain, and improving irritable bowel syndrome. There is even less data on app-guided meditation. I know my Ringly bracelet and its associated app have some meditation features, but I haven’t tried them yet. I do like my singing bowl, however, for bringing calm into my often crazy days.

The Government Accountability Office released a document this summer that looks at the challenges faced by small and rural practices participating in the Merit-based Incentive Payment System (MIPS). The GAO interviewed 23 stakeholders including CMS and Medicaid employees, physician groups, and small/rural practices. Smaller organizations often experience challenges maintaining EHR systems of the quality needed to succeed under MIPS. In my experience, vendors can underestimate the complexity of running a rural health organization, whether it is specifically designated as a Rural Health Clinic by Medicare or is just in a rural area. Small and rural practices typically have fewer employees and are challenged by a smaller hiring pool that may not include potential employees with significant EHR experience.

I’ve worked with my share of rural practices, who often find the travel costs for onsite assistance to be daunting. This makes it difficult to see how their providers are using the system on a daily basis. Having them explain their pain points over a web conference just isn’t the same as following them into the exam room and watching their interactions with the patient and with the computer. It also makes it challenging to figure out causes of performance issues, such as office staffers streaming Netflix in the break room, because you’re not there to see it.

As a small-time consultant, I can get creative with those engagements and am willing to sleep in the hospital call room rather than at a hotel 90 miles away if it helps convince them to bring me onsite so I can roll up my sleeves and really see what is going on. I once stayed with a pediatrician at his home, which had a “mother-in-law” suite that hosted visiting medical students and prospective partners before I arrived on the scene. It was almost like being at a bed and breakfast, although he did ask me to bring a jar of sun-dried tomato spread with me when I arrived “from the city.”

If you’re a consultant or a road warrior, what’s the weirdest place you’ve ever stayed? Leave a comment or email me.

Morning Headlines 7/10/18

AdvancedMD Completes Acquisition of NueMD

EHR and practice management vendor AdvancedMD acquires competitor NueMD for an undisclosed amount.

Verity Health System Announces Exploration of Strategic Options

A little over a year after Patrick Soon-Shiong’s NantWorks buys a controlling interest in Verity Health System, the California-based nonprofit decides to look at selling some or all of its six hospitals.

Cerner and Lumeris Will Launch Offering to Reduce Complexities for Health Systems Delivering Value-Based Care

Cerner and Lumeris develop combined technologies and services aimed at helping health systems succeed with Medicare Advantage programs.

Cass Regional Medical Center hit by ransomware attack

Cass Regional Medical Center (MO) shuts down its Meditech system after discovering a communications and IT data breach Monday morning.

Morning Headlines 7/9/18

UW Medicine Clinical Transformation: Approve Project, Budget, and Internal Lending Program (ILP) Funding

University of Washington Medicine prepares to move to a single EHR in a 30-month, $180 million project.

The one big winner of the Obamacare wars

Politico surmises that never-ending government healthcare changes and resulting uncertainty, especially those driven by the Affordable Care Act, have been a boon for consultants.

Health Insurers Warn of Market Turmoil as Trump Suspends Billions in Payments

The White House suspends the Affordable Care Act’s risk adjustment payments, which without further action will drive more insurers from the market and increase premiums.

Monday Morning Update 7/9/18

Top News

A reader-forwarded committee meeting agenda from University of Washington Medicine dated July 12 indicates that the health system will move to a single EHR in a 30-month, $180 million project.

The health system is using Cerner inpatient at University of Washington Medical Center and Harborview Medical Center, Cerner Soarian at Northwest Hospital, and Epic for ambulatory.

The document doesn’t say which system UW Medicine has chosen, but all of the peer group hospitals mentioned in another document I found online use Epic.

Reader Comments

From Ricardo Researcher: “Re: my journal article. I was hoping you might mention this one on HIStalk.” I’m increasingly frustrated by articles that exist only behind a paywall, which of course is the ridiculous default for peer-reviewed journals that make a fortune by selling access to articles they didn’t themselves write, describing important research work that they didn’t themselves perform, and funded in many cases by taxpayers who aren’t allowed to look at it. It does no good to proudly tweet out links when non-subscribers don’t have access. I usually won’t mention those articles unless the author emails me a copy since I don’t trust someone else’s summary, especially if they don’t have relevant medical or technical background. 

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor MDLive. The Sunrise, FL-based virtual care provider has since 2009 offered high-quality, convenient, and cost-efficient virtual care to meet the medical, dermatological, and behavioral health needs of its 25 million members. Consumers, health plans, health systems, and self-insured employers enjoy 24/7/365, anyplace access to its network of board-certified doctors and therapists via mobile app, online, or phone. Health systems can get a free virtual care assessment to learn how the company’s end-to-end virtual care solution reduces readmissions, removes barriers to ongoing care, increases brand loyalty, drives utilization, and optimizes provider schedules. Informatics luminary Lyle Berkowitz, MD (DrLyle) recently joined the company as chief medical officer, EVP of product strategy, and president of its medical group. Thanks to MDLive for supporting HIStalk.

I found this MDLive intro video on YouTube.

Provider poll respondents mostly spend 1-2 work weeks each year attending conferences.

New poll to your right or here, repeating one I did two years ago to see what’s changed since: have you participated in a virtual visit in the past year? Click the poll’s “comments” link after voting to explain why or why not.

Every year I offer a “Summer Doldrums” deal on newly signed sponsorships and webinars to overcome the seasonally-induced vendor siesta that makes me question whether I have slipped into irrelevance. Contact Lorre. Extra points for naming the summer movie depicted above.

The week of July 4 is traditionally one of the slowest for real news and having the holiday fall on a Wednesday encouraged a week-long work slowdown. You will likely not resent the idea of having less to read knowing that while I wrote less, I still covered everything important.

Thanks to the following companies that recently supported HIStalk. Click a logo for more information.

Webinars

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

Sales

• Claxton-Hepburn Medical Center (NY) chooses Masimo’s Patient Safety Net remote monitoring solution that will automatically record vital signs in its Meditech system.

Government and Politics

A Politico article notes that never-ending government healthcare changes and resulting uncertainty, especially those driven by the Affordable Care Act, have been a boon for consultants, observing that, “American healthcare has no shortage of saviors. Some have brilliant insights that save lives and trim costs; others mainly generate invoices … Half of Twitter seems to consist of consultants. (The other half is developing health apps, which themselves spawn niche consultants.) They offer marketing, communication and wellness strategies; practice transformation; team-based-care building, revenue maximizing, behavioral health integration, pharmaceutical price-calibrating, and YouTube channels.”

The White House suspends the Affordable Care Act’s risk adjustment payments, which without further action will drive more insurers from the market and increase premiums. The payments to insurance companies, worth billions of dollars per year, discourage them from cherry-picking the healthiest and thus lowest-risk people as customers. CMS cites a recent New Mexico ruling in which a court found that the payment methodology is flawed in favor of large insurers, with the founder of a small, non-profit New Mexico insurer saying the decision will increase competition and reduce prices despite the commonly held perception that it’s just one more way for the Trump administration to sabotage the ACA.

Other

Informatics nurse and analytics guy Brian Norris is looking for responses to this poll. My choice would probably be email since (a) I don’t like getting voice calls, and (b) text messages are harder to manage, although I would also worry that the email would end up in my spam folder as is often the case these days.

Companies trying to attract investors by claiming their systems use artificial intelligence sometimes instead are sometimes using a “pseudo-AI, fake it until you make it” approach where humans are actually doing the work behind the scenes, or as an expert calls it, “prototyping the AI with human beings.” Examples:

• A company whose app converts voicemails into text message ran its service from an offshore call center instead of with technology
• A scheduling app vendor hired people to pretend to be a chatbot
• An expense receipt company admitted that receipts were sometimes entered by humans instead of its “smartscan technology,” sending work to Amazon’s Mechanical Turk crowdsourced labor tool that allowed low-paid workers to read the full information from user-scanned receipts
• Google admits that some third-party apps allow their developers to read user emails to collect advertising information or to refine the logic of their apps

In Australia, a hospital’s handwashing compliance rate drops from 94 percent to 30 percent after it replaces human auditors with an expensive, sink-installed automated surveillance system.

The parents of two unrelated 11-year-old Florida boys struggle to straighten out an insurance company identity mix-up, caused by the boys having the same full name, date of birth, and birth county. Their Social Security numbers are also one digit apart. The insurance company paid claims without questioning why an unrelated child would be covered on a family insurance plan. The parents worry about which child’s medical record would be displayed in an emergency, but are at least happy that both families are reasonable since “we have the most sensitive information about each other’s children.” 

Sponsor Updates

Blog Posts

• The Legal Risks of Paper Informed Consents – Surgeons and Hospitals in the Firing Line (Access)
• Pediatric Patients (and Pediatric EHRs) Must Be Treated Differently (Optimum Healthcare IT)

Contacts

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

Events and Updates

Upcoming Webinars
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Recorded Webinars
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Sponsor Announcements
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Weekender 7/6/18

Weekly News Recap

• England’s NHS announces December 2018 availability of a new app that will allow all citizens to book doctor appointments, order prescription refills, manage chronic conditions, and make calls to its 111 non-emergency medical helpline
• AMIA publishes the inaugural issue of its Gold Open Access journal that will showcase the best informatics research and applications
• UK-based private equity firm Hg will buy Orion Health’s Rhapsody healthcare integration technology business and 25 percent of its population health unit
• Rock Health’s midyear funding review says digital health investments are growing and are attracting more experienced investors, but IPO activity is down as companies remain privately held longer
• CNBC reports on “why telemedicine has been such a bust so far”
• T-System President and CEO Roger Davis resigns

Best Reader Comments

For those of us out in the field working with telehealth and its various service lines, we know it is a success. Children and adults are getting the care they desperately need but cannot access, stroke victims live normal lives and when tragedy strikes, and you find yourself in the ICU it is telemedicine that helps get home quicker. Telehealth and telemedicine isn’t a narrow service for treating common complaints and sniffly noses as the writer only references. (Michelle Hager)

A significant problem that I’ve encountered is that many smaller practices and physicians don’t make plans for what they will do with their paper records when they retire. Regulations vary from state to state, but they are often responsible for maintaining and providing access to patient records for 10 years from the last patient visit and i some cases up to 25 years or more for minor patients. Storing large volumes of paper records for that amount of time is fraught with risk and expense and the records may outlive the physician and become a burden for his or her family. (Greg Mennegar)

Our company provides, as an employee benefit, Dr. on Demand for a $5 payment. It’s been excellent and especially helpful as a first step to determine whether an in-person visit is necessary. They don’t just triage — in many cases, they also diagnose and prescribe, which is a great saving of time and money for us. (Judy Volker)

I don’t know if I’d call the DoD question to Zane a zinger. Kind of “oversight 101.” The response was brilliant in a way, since you can’t perjure yourself if you never answer the question. (Ex Epic)

Watercooler Talk Tidbits

Ms. S reports from North Carolina on the document camera and screen capacitance pens we provided for her second grade class per her DonorsChoose teacher grant request: “The document camera is such a simple yet versatile learning tool, but unfortunately with budget cuts, the math department is not allotted any. This is such a great gift. While the pictures might not have the normal wow factor that most project pictures do, please rest assured that this piece of technology is making a difference in my students’ lives. The ability to see what math skill I am demonstrating on a larger screen is much easier than trying to have all of the kids crowd around me as they try to see. Surprisingly, the styli are a crowd pleaser. They truly love that little added something.”

The Wall Street Journal chides itself for occasionally using clickbait-type headlines, providing lessons for all writers to avoid writing headlines that:

• Try to sound mysterious
• Promise readers a secret they will learn only if they click
• Ask a question, especially one that the article itself may not answer
• Do not match the tone of the story or that don’t assure readers that the story contains the promised details

A Science report finds that drug companies are paying after-the-fact compensation to members of FDA’s advisory committees who recommend whether a drug should be approved, with members who passed initial conflict of interest checks being rewarded afterward with jobs, research grants, and speaking roles. A majority of review committee doctors received at least $10,000 from a drug company whose product they approved, with seven of them earning more than $1 million.

Tennessee’s attorney general unseals details about the state’s lawsuit against OxyContin manufacturer Purdue Pharma, which contains details such as:

• 80 percent of the company’s OxyContin business came from repeat users
• Purdue kept hard-selling doctors who were known to be diverting drugs out of state or whose licenses were restricted due to overprescribing
• The company was warned about overdoses, muggings outside a pharmacy linked to a particular doctor, a high-prescribing clinic that had no medical equipment, a doctor’s waiting room overseen by an armed guard, practices whose parking lots were filled with cars with out-of-state plates, and standing room only waiting rooms.
• Tennessee prescribers ordered 104 million tablets of OxyContin from 2008 to 2017, the majority of them for high doses.

Researchers using MRI confirm our male suspicions that wearing a tie (especially one that is tightly tied with a stylish Windsor knot) restricts blood flow to the brain, which might explain why some of the dimmest people imaginable hold jobs that require their wear. It’s fun to question commonly accepted standards – why should men have to drape decorative cloth around their necks to project sincerity and authority? My observation is that for small to medium companies, guys who wear ties work for guys who do not – I’ve been to investor pitch-a-thons and you could easily tell who had money versus who needed it because the former were dressed like they just left a satisfying lunch at Golden Corral.

Apple celebrates the tenth birthday of its App Store and the impact it has had on developers, mobile-first businesses, gaming, in-app purchases, streaming, and health and wellness.

The author of a biography of martial arts movie star Bruce Lee – who died mysteriously 45 years ago – speculates that he was killed by heatstroke after dubbing dialog for “Enter the Dragon” in a studio whose noisy air conditioning had to be turned off, compounded by the recent removal of his armpit sweat glands to prevent on-screen sweating.

In Case You Missed It

• News 7/6/18
• News 7/4/18
• Curbside Consult with Dr. Jayne 7/2/18
• Readers Write: The Opioid Crisis: Fix the Process, Fix the Problem
• Readers Write: Why It’s Time to Make Clinical Documentation Clinically Valuable
• Readers Write: EHRs Have Not Reduced Paper Usage Yet. Why? And How Do We Change This?
• Monday Morning Update 7/2/18

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 7/6/18

New NHS app will make it quicker and easier to access health services

England’s NHS announces December 2018 availability of a new app that will allow all citizens to book doctor appointments, order prescription refills, manage chronic conditions, and make calls to its 111 non-emergency medical helpline.

Cleveland Clinic Patients Have New Way to Access Personal Health Records

Cleveland Clinic becomes the latest of several dozen health systems to participate in the Apple Health Records beta.

FDA Regulation of Mobile Medical Apps

A JAMA opinion piece by FDA officials describes the agency’s efforts to foster digital health innovation by pre-certifying vendors instead of individual products.

News 7/6/18

Top News

England’s NHS announces December 2018 availability of a new app that will allow all citizens to book doctor appointments, order prescription refills, manage chronic conditions, and make calls to its 111 non-emergency medical helpline.

The app will also allow users to record their data-sharing, organ donor, and end-of-life care preferences.

Health and Social Care Secretary Jeremy Hunt said of the app, “I want this innovation to mark the death-knell of the 8 a.m. scramble for GP appointments that infuriates so many patients.”

Thursday was the 70th birthday of NHS, formed on July 5, 1948 to bring together all health services under a single organization.

Webinars

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

Acquisitions, Funding, Business, and Stock

The investment fund of David Einhorn – a long-time, vocal critic and stock-shorter of Athenahealth that he dismissed as “a business process outsourcer with a very promotional CEO” that stood no chance against Epic – is losing investors as the value of its investments dropped 11 percent from 2014 to 2017 as the S&P 500 rose 38 percent. Einhorn is also shorting Amazon and Netflix, which have gained value, and is long on Brighthouse Financial, whose shares have dropped 31 percent so far this year.

Sales

• In England, NHS Digital awards IBM a three-year contract for cybersecurity services that include vulnerability scanning, threat detection, and threat intelligence.
• Atrium Health (the former Carolinas HealthCare System) chooses Golden Hour’s EMSHIE solution for exchanging patient information with emergency responders.

People

Our Lady of the Lake Regional Medical Center (LA) hires Stephanie Manson, MBA, MS (Franciscan Missionaries of Our Lady Health System) as COO.

Announcements and Implementations

Holzer Health System (OH) goes live on Athenahealth.

Cleveland Clinic joins the list of hospitals that give patients access to their medical records on Apple Health Records. Apple lists more than 60 health systems that are participating in the Health Records beta.

Government and Politics

Politico reports that Cerner hired two former Congressmen as lobbyists for its VA project the day the contract was signed – Jeff Miller (R-FL) and James Moran (D-VA), both employed by McDermott Will & Emery.

Privacy and Security

A former patient information coordinator at UPMC and Allegheny Health Network (PA) is indicted on federal charges involving her retrieval of the information of 111 patients and her disclosure of the information of three of them “with the intent to cause malicious harm” if an unspecified nature. She faces an 11-year prison sentence and a fine of $350,000.

Facebook can continue tracking the browsing habits of people who have deleted their Facebook account, the company confirms, where it obtains information from any site that uses its Like or Share buttons or that runs Facebook ads to nag the former user into returning to Facebook and to serve them ads.

Other

A small study finds that adding a second exam room monitor that mirrors the clinician’s EHR screen can be helpful in engaging patients. Patients liked the transparency, not having to look over the clinician’s shoulder in feeling engaged, and having the clinician’s conversation reinforced by seeing their information on the EHR screen. However, they found the EHR user interface, screen-flipping, and on-screen jargon confusing. Clinicians liked the ease of sharing information with patients, but noted that not all patients are interested. They also worry that raising more patient questions would extend visit time. Both groups noted that exam rooms were not well laid out for adding a second monitor.

Epic adds to its quirky campus art collection by buying the old-fashioned carousel and decorations of the recently closed Ella’s Deli of Madison, saying that it was an easy decision to preserve part of the iconic landmark.

In Wales, Assembly member Lee Waters says the country is struggling with NHS’s IT systems, claiming that the unreliability of its Cancer Network Information System Cymru (Canisc) is causing daily problems. BBC says the system is over 20 years old, is not supported by Microsoft, and went down 11 times in a recent four-week period, delaying some chemotherapy and radiation therapy treatments.

A Fortune opinion piece by a venture partner observes that companies are claiming their systems are AI-powered when they are really capable of doing only basic data analysis via pre-programmed logic or plain old algorithms. His investment evaluation checklist for AI-claiming companies is:

• Do their systems get constantly smarter?
• Do they leave a large trail of proprietary data collected from interesting sources?
• Does their technology reduce the need for humans to be involved?
• Do the founders have deep technical understanding of machine learning models and how they can be applied to a large data set?
• Is their AI expertise so deep that they have an extreme advantage over competitors and can they attract the right talent to go after their market?

Independence Day always generates some fireworks-related cautionary tales. A Dayton, OH man who had just purchased fireworks couldn’t wait to light one and throw it out his car window, with his unsuccessful toss igniting his in-car stash and causing an explosion that severely injured him and several people nearby, set off car airbags down the street, and damaged a nearby house. A 21-year-old Maryland man sustains severe hand injuries when he tries to launch an illegal firework from a mortar over his head during a party, not realizing that he was holding the mortar upside down.  A Florida man holding an M80 blows off all his fingers. Another Florida man loses his fingers and eyebrows when a mortar he had modified went off in his hand. Kudos to NFL’er Jason Pierre-Paul, who, as he does annually, posted gruesome photos of his July 4, 2015 fireworks-caused hand injury in warning people to be careful with fireworks (ESPN’s tweeting of a hospital OR schedule to scoop the world on his finger amputation kicked off a privacy firestorm, you may recall). 

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Morning Headlines 7/5/18

A new journal for sharing informatics innovations: introducing JAMIA Open

AMIA publishes the inaugural issue of its Gold Open Access journal that will showcase the best informatics research and applications.

Diagnosing Fractures With AI

A JAMA Network article describes FDA’s approval of Imagen OsteoDetect for diagnosing adult wrist fractures.

Predictive modeling of U.S. health care spending in late life

Medicare claims data analysis finds flaws with the idea that spending 25 percent of in the last 12 months of life is wasteful, instead concluding that deaths are not predictable and patient conditions are rarely defined as hopeless to support reduced spending.

Twitter can’t even celebrate Independence Day without misspelling the hashtag

The US Air Force, the First Lady, and the city of Boston are among the patriotic tweeters who misspell the hashtag as #IndependanceDay, possibly because of Twitter’s autofill feature propagating an earlier error.

Morning Headlines 7/4/18

UK-based Hg to buy Orion Health’s Rhapsody for $205 million

UK-based private equity firm Hg will buy Orion Health’s Rhapsody healthcare integration technology business for $138 million USD and will pay another $14 million to acquire a 25 percent share of its population health unit.

2018 Midyear Funding Review: Digital health déjà vu in yet another record breaking half

Rock Health says digital health investments are growing and are attracting more experienced investors, but IPO activity is down as companies remain privately held longer.

150,000 medical records shared against patients’ wishes in data system glitch

NHS Digital blames one of its technology vendors (TPP) for failing to send it patient opt-out requests

Cordova hospital averts loss of internet access

The Alaska critical access avoids its planned closure after a cut in federal broadband subsidies left it with a million-dollar annual bill.