Weekender 1/17/20

Weekly News Recap

• Masimo buys NantHealth’s Connected Care business for $47 million in cash.
• ONC publishes a draft of its “2020-2025 Federal Health IT Strategic Plan” for public comment, due March 18.
• Physicians spend 16 minutes per encounter doing EHR work, according to a Cerner study that reviewed client data from its Lights On Network.
• Medsphere raises $40 million in new funding to support growth and pursue acquisitions.
• R1 RCM acquires SCI Solutions for $190 million just days after SCI announced its acquisition of Tonic Health.
• Former US Senator Bill Frist, MD launches CareBridge, a Nashville-based technology company that will use an initial $40 million in funding to improve home healthcare.
• Teladoc will acquire telehealth platform vendor InTouch Health for $600 million in cash and TDOC shares.

Best Reader Comments

We are in the strangest time in my career, with so many mergers and acquisitions by competitors and VC firms. I started as a consultant on Millbrook/Paradigm PM and MedicaLogic/Logician EMR which became the initial GE Centricity suite, on two separate platforms smushed together. Now that product line has been acquired again. I also work with another full PM/EMR that was just acquired by a competitor who is owned by a VC. The mission of a VC is different than the traditional EMR vendor, so we’ll see how it shakes out. In the more than a decade GE had Centricity, changes were made for mandatory programs, but there was never any real product development after the acquisition. That’s always the fear, your EMR will be acquired at some point, by whom and why will dictate if the product continues to be developed or not. Everyone is for sale for the right price at the right time. (PM Consultant)

While non-competes are largely not legally enforceable – they are enforceable in operational practice. Epic practices this, or at least used to, by restricting UserWeb access, access to resources, or just general threats to the consulting firms that work with them. In this David vs Goliath fight of worker rights and hiring freedom, Epic is a Goliath that doesn’t look like it’s found a worthy David to keep it in check. It continues to not only hurt and frustrate their own employees, clients, and partners, but it also hurts local businesses in the Madison area. These local groups constantly deal with the Ex-Epic people starting jobs to only leave after a year to chase the consulting money increasing their turnover and decreasing their ability to hire reliable staff and hurting trust in hiring anything from Epic. (Epically Annoyed)

In the case of Epic, you’re now limited not only by your own non-compete, but the separate agreements that Epic has made with the various consulting firms. For instance, I left Epic in 2018 with a 1 year non-compete. When my year was almost up, I started reaching out to various hospitals and consulting firms. I heard back from several of the bigger consulting firms saying that they couldn’t even begin conversations about employment until I had been away from Epic for 1.5 years.

Due to these newer agreements between Epic and the consulting firms, I essentially had an additional non-compete that extended beyond the one I signed when I was hired. Furthermore, preventing employment conversations to even start until the wait period ends just adds extra time beyond the non-compete that you will most likely remain unemployed since you can’t get a jump start on the process. (Ex-Epic Chiming In)

If Cerner received top marks for IT hospital support, then I cannot imagine how bad it really is out there. Cerner IT support is about as helpful as the worse DMV experience you can imagine. I am a front line MD, and if they are the benchmark, then we need a whole new paradigm. EHRs are an abomination and the support of them is equally terrible. CMS and Congress did patients and MDs a HUGE disservice by enabling this artificial market for Cert EHR and its resultant disaster we all live in today. It has set back REAL innovation in EHR/HealthIT at least a decade, maybe 20 years. I’m not sure how many more articles, research, studies, etc we need to show that the current crop of EHRs are almost criminal in terms of safety, security, outcomes, burden to MDs nursing, and the ridiculous buzzword care (MACRA, ACO, Value based care) are complete and utter nonsense and HORRIBLY expensive and causing devastating damage to the practice of medicine. When will we learn that Washington DC’s policy wonk, non practicing CMS staff have NO idea how to practice medicine safely, securely, and with the help of customized technology. We do NOT need more program changes unless they are…hey…we only make a mess of things…we are getting out of the way of physicians and IT and let them actually work together instead of the data click driven nightmares they continue to pile on to us. Its time to just say no to all of this. Stop trying to fix the unfixable. When will we learn that when government runs healthcare it turns into the VA and postal service combined. (meltoots)

Watercooler Talk Tidbits

GoodRx co-founder Stephen Buck (who also happens to be co-founder of a wine tour and experience company) turns his attention to cancer survival rates with the launch of CancerSurvivalRates.com. Using public data from the National Cancer Institute, the site offers survival rates of up to five years based on a cancer patient’s stage, grade, time since diagnosis, and histology. Buck, who bootstrapped the project with co-founder Omar Mehmood, would like to eventually sell the site to Google: “It would be ideal to maintain as a free public resource that comes up when someone searches on Google.”

Mona Siddiqui, MD announces she will step down from her position as chief data officer within HHS. HHS CIO Jose Arrieta, who has also claimed the role of CDO under the ambiguously structured Foundations for Evidence-Based Policymaking Act, says he will hire the agency’s “first” CDO. Politico reports that she will become a VP at Humana.

Chiropractor Gregory Johnson, DC credits his practice’s surge in popularity to Youtube, where he has gained an online following of “crack addicts” who have traveled far and wide to take advantage of his signature spine realignment known as the “Ring Dinger.” Johnson earns around $20,000 each month for the 10-minute videos he makes with his cell phone’s camera and a selfie stick.

Goop just keeps going: Netflix will release “The Goop Lab” next week. Billed as a “docu-series,” the six episodes are, according to one critic, a thinly veiled infomercial for Gwyneth Paltrow’s pseudo-scientific lifestyle brand.

Just what every Oscar winner wants: Academy Awards swag bags will offer urine sample collection devices and genetic testing kits to select nominees. No word yet on whether or not Goop will include one of its wacky products.

In Case You Missed It

• News 1/17/20
• EPtalk by Dr. Jayne 1/16/20
• Readers Write: Amazon is Coming, Here are the First Steps to Prepare
• HIStalk Interviews Charles Corfield, CEO, NVoq
• News 1/15/20
• Curbside Consult with Dr. Jayne 1/13/20
• HIStalk Interviews Marisa MacClary, CEO, Artifact Health
• Monday Morning Update 1/13/20

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Morning Headlines 1/17/20

Buoy Health Raises Investment from Cigna Ventures

Digital triage startup Buoy Health raises $20 million in an oversubscribed Series B round.

The Future of Healthcare Tech Support, Black Book Research Releases 2020 Outlook

Cerner achieves top marks for hospital technology support services for the fourth year in a row, according to Black Book Research’s latest survey of senior-level health IT end users.

Piedmont Names New Chief Health Information Officer

Piedmont Healthcare (GA) names Lacy Knight, MD (Northwestern Medicine) chief health information officer.

News 1/17/20

Top News

ONC publishes a draft of its five-year strategic plan for federal health IT initiatives. Goals include promoting health and wellness; enhancing care delivery and experience; building a secure, data-driven ecosystem to accelerate research and innovation; and connecting stakeholders and their data through interoperability. Comments are due March 18.

Webinars

January 29 (Wednesday) 2:00 ET. “State of the Health IT Industry 2020.” Sponsor: Medicomp Systems. Presenters from Medicomp Systems: Dave Lareau, CEO; Jay Anders, MD, MS, chief medical officer; Dan Gainer, CTO; Toni Laracuente, CNO. Despite widespread adoption of EHRs, healthcare professionals struggle with several unresolved systemic challenges, including the lack of EHR usability, limited interoperability between disparate systems, new quality reporting initiatives that create administrative burdens, and escalating levels of physician burnout. Join the webinar to learn how enterprises can address current industry roadblocks with existing market solutions and fix health IT’s biggest challenges.

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

Acquisitions, Funding, Business, and Stock

Bon Secours Mercy Health makes an undisclosed investment in Lirius Health and will adopt the company’s AI-based behavioral change software for women’s health programs and those that encourage use of digital health tools like patient portals. The organizations will also develop and market programs for patients at risk of chronic disease.

Digital triage startup Buoy Health raises $20 million in an oversubscribed Series B round.

Sales

• WakeMed Health and Hospitals (NC) will implement Health Catalyst’s Data Operating System and Rapid Response Analytics.
• ChristianaCare (DE) selects patient engagement and payment software from Cedar.
• PIH Health (CA) extends its enterprise solutions, services, and outsourcing agreement with Allscripts through 2025; and will implement Sunrise, TouchWorks, and CareInMotion at the recently acquired Good Samaritan Hospital.
• Utah’s UHIN HIE will replace its patient-matching software from IBM with NextGate’s Enterprise Master Patient Index.
• Orlando Health (FL) will deploy Andor Health’s care team communication technology.

People

Piedmont Healthcare (GA) names Lacy Knight, MD (Northwestern Medicine) chief health information officer.

First Databank promotes Bob Katter to president. He succeeds Charles Tuchinda, MD who becomes executive chairman.

Announcements and Implementations

MDLive announces GA of virtual primary care services for health systems and payers that enable patients to develop ongoing relationships with the same telemedicine doctor.

Michigan Health Information Network Shared Services leverages CarePort Health’s care transition and management capabilities to improve the experiences of patients in the state’s Dual Eligible Demonstration program.

HSHS St. Mary’s Hospital (IL) implements tele-ICU software and services from Advanced ICU Care.

Other

Cerner achieves top marks for hospital technology support services for the fourth year in a row, according to Black Book Research’s latest survey of 2,448 senior-level health IT end users. The study also found:

• Ninety percent of survey-takers believe multi-level tech support will be a key differentiator in health IT purchasing over the next five years.
• Though the same number of respondents won’t look for replacement systems in the coming year, 80% believe it is easier than it was five years ago to take their business elsewhere.
• Fifty-three percent say they’d pay more for greater tech support that results in enhanced provider productivity and improved patient satisfaction.
• Eighty-two percent prefer tech support come directly from their vendor.
• Of those that do outsource, 81% are significantly dissatisfied with service quality and support levels in the first year after go live.

The well-tweeted excesses and idiosyncrasies of the JP Morgan Healthcare Conference come to an end in San Francisco.

Kudos to the organizers of this fundraising campaign for trying to funnel some of that excess into ameliorating the city’s homelessness problem. Looks like they are over halfway to their $15,000 goal.

Sponsor Updates

• Patientco staff sort 849 pounds of medical products and pack 102 boxes for MedShare, impacting 708 patients.
• Healthcare Growth Partners advises medical device company ImPact Applications in its acquisition by Riverside Insights.
• Ensocare hires Jennifer Gardner and Parker Stock as regional sales directors.
• Hayes Management Consulting extends early bird registration for its MDaudit User Group Meeting in May to January 31.
• Impact Advisors hires John Klare (Navigant) to lead its Performance Excellence service line.

Blog Posts

• The State of Telehealth in 2020 (EClinicalWorks)
• AWS re:Invent brings EPSi together with technology leaders for innovation and transformation (EPSi)
• How Chrome is helping enterprises still using Windows 7 (Google Cloud)
• How One Major Health Plan is Tackling Care Manager Efficiency (Healthwise)
• HIMSS interview: The future of Australian medicine (Hyland)
• 2020 Already Becoming Year of Social Determinants of Health for Payers (Imat Solutions)
• Why SSO is the key to unlocking digital transformation in the NHS (Imprivata)
• Streamlining Vitals Technology: The Future of Bedside Care (Capsule)
• Revisiting Some of 2018’s Most Significant Healthcare IT Topics in 2020 (Optimum Healthcare IT)
• Augmented Intelligence is the New “AI” (Definitive Healthcare)

Contacts

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

EPtalk by Dr. Jayne 1/16/20

Support of Windows 7 came to an end this week, and many organizations seem to be willing to take the risk that comes with not having security updates. My practice waited until the last two weeks to upgrade all the clinical workstations, resulting in countless hours being spent by end users rebuilding bookmarks, re-saving passwords and logins, and rearranging desktops as people try to get their computers to look and work “like they used to.” All of our staff rotates among a dozen or so locations, meaning they have to repeat the process multiple times because user profiles don’t sync across the organization. I think the most annoying piece was they didn’t announce they were going to do it, or which locations were going to be impacted, so every shift has been a little bit of a surprise.

The providers would have definitely preferred this be done in September or October, before the busy flu season hit. If I was wondering why I felt so beaten down after my last few clinical shifts, the month-end data explained it. My “patients per hour” metric was the highest it’s been since I’ve worked in the practice. Interestingly, even though patients had longer wait times and I had a couple of patients give me low ratings this month, my patient satisfaction score was the highest it’s ever been. I do enjoy being able to see data that explains what we’re feeling in the trenches, and being able to use it to improve how we work.

I’ve been reading reports from the recent Consumer Electronic Show. Many offerings have been over-hyped (“swim like a mermaid” had no tail) but others are kind of cool – the Mateo Smart Bathroom mat can track weight and evaluate posture while integrating with your phone, but the $179 price tag seems a bit steep. Withings has been in the health tech business for a while, and brings its clinically-tested ScanWatch, which is pending FDA approval. The cool part is its 30-day battery life. Kaiser Permanente is expanding its investment in a program using Samsung smart watches as part of a remote cardiac rehab program, with current technology showing promising results, so we’ll have to see what the next generation of tech brings.

Not all the technology that caught my eye was tech-related – the Juno Chiller can chill a bottle of wine in three minutes, but for $299 I think I’ll plan ahead instead, or just keep a bottle perpetually chilled. Other products on display are a bit much – such as Kohler’s line of Moxie showerheads, which include a magnetic Bluetooth speaker that fits in the middle. I shouldn’t be surprised, as Kohler already has a Bluetooth bathtub that features lights and vibration in addition to actual water. The LuluPet litter box uses images of feline stool and urine to monitor cat health, and can distinguish between different cats as well as weighing them. Get ready to have a discussion with Alexa about your cat’s waste, because it’s integrated.

Technology doesn’t always make things better and I’ve found that for many people, it has resulted in significant time-wasting as they struggle to keep up with multiple social media channels. The concept of “time affluence” being at an all-time low in the US was addressed in a recent Dropbox blog, which noted that 80% of 2.5 million people surveyed felt they did not have the time to do everything they felt they needed to do. According to the piece, people who feel like they don’t have enough time are more likely to be depressed and anxious than those who feel they have adequate free time. That’s been my experience in real life – you can tell the people who thrive on deadlines from those who feel overwhelmed.

The blog cites data from the Bureau of Labor Statistics that shows that people have more free time than they did 50 years ago, but for many people it doesn’t feel like it. It attributes this feeling to “the digitization of society,” along with information overload, and the fragmentation of time. Feeling distracted increases the perception of time stress. The blog also calls on companies to set protocols that enhance available free time, and practice them. I still see companies that don’t set appropriate rules for meetings and that fully support time-wasting practices such as double booking of meetings and not allowing people enough control over their calendars so that they can actually get work done.

Time is running out for anyone interested in the Primary Care First payment model and who hasn’t yet applied. Practices have until January 22 to apply. Modeling by the American Academy of Family Physicians “indicates that it should consistently work better than the Medicare Quality Payment Program’s Merit-based Incentive Payment System, even for those getting the maximum MIPS bonus.” They go further to say that the ideal successful practice will have at least 600 Medicare fee-for-service beneficiaries and should already be involved in value-based programs with Medicare Advantage or managed Medicaid.

Time is also short for those who are awaiting the ONC final rules on interoperability, which are expected late this month. The rules went to the Office of Management and Budget for review in September. The ONC annual meeting takes place January 27 and 28 and might be an opportune time for an announcement. CHIME recently wrote to members of Congress noting that the proposed rule doesn’t adequately address concerns about health IT security for third-party apps that are not created by organizations covered under HIPAA. They are concerned that without protections, third parties will be able to share or sell sensitive patient information.

From Jimmy the Greek: “I know you enjoy the outdoors, did Santa bring you one of these?” He had me at the headline: “This Floating Tent Offers You A Cool New Way To Die While Camping.” I don’t think I’ll be adding it to my arsenal, given it’s hefty $1,999 price tag or its equally hefty 75lb weight. The tent has a graphic of a campfire on its floor – although it’s the manufacturer’s logo, I hope no one gets the idea that it’s an indicator that you should build a fire on the base of the floating dome that is your home. I think I’ll stay with my standard issue REI on solid ground.

What’s the wackiest gadget you’ve seen, from CES or anywhere else? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 1/16/20

2020-2025 Federal Health IT Strategic Plan

ONC publishes a draft of its “2020-2025 Federal Health IT Strategic Plan” for public comments, due March 18.

Fellow Health Partners Acquires Billing Services, Inc.

Fellow Health Partners acquires New York-based competitor Billing Services for an undisclosed amount.

Bon Secours Mercy Health and Lirio Announce Partnership and Investment

Bon Secours Mercy Health adopts behavioral change software programs from Lirio and makes an undisclosed investment in the company.

Readers Write: Amazon is Coming, Here are the First Steps to Prepare

Amazon is Coming, Here are the First Steps to Prepare
By Derek Baird

Derek Baird, MBA is SVP of Avia of Chicago, IL.

Amazon made another high-profile hire last week, further raising the anxiety level of traditional healthcare providers. Dr. Gupta (no, not that Dr. Gupta) has impressive credentials and joins a cast of other smart hires. Though, despite Business Insider’s clickbait headline, I’m not ready to agree with the media experts (?) who quickly posited that this hire means Amazon Care will be available to the public any day now. However. whether it’s tomorrow or in 2022, most predict that the services Amazon is testing with employees will make their way to Prime customers.

Quick refresh: In September, Amazon announced a virtual medical clinic called Amazon Care for use by employees. The services include nurse chat, video visits, and house calls. One month later, they announced the acquisition of Health Navigator, a tool that provides online symptom checking and triage tools to route patients to the appropriate care setting. It’s no secret that Amazon is planning to provide convenient, technology-enabled options for consumers to find and receive physical or virtual care.

Amazon Care services will someday show up next to my book recommendations. Health system executives need to be planning as if that’s going to happen sooner rather than later. That plan must include an aggressive roadmap (and sizable accompanying investments) to develop and scale a digital front door.

ICYMI, digital front door became a buzzworthy phrase in provider-side healthcare in 2019. The digital front door includes consumer-facing capabilities, not hidden behind a friction-filled portal login, to support easy access to information or care. Core components include physician search, online scheduling, video visits, and virtual triage. 

A key reason to develop a digital front door is to attract the increasingly large group of consumers who don’t care about their parents’ advice, physician credentials, or US News awards. They don’t have a PCP, and above all, they value convenience. Many of our health system clients believe three points of commercial market share are at risk, depending on whether they delight or disappoint consumers with the convenience of their front door offerings. CFOs can quickly do the math, where that 3% may be the difference between being in the red or black.

Back to Amazon. A health system’s competition no longer just includes the neighboring health system and the upstart urgent care operator in town. The list is long and growing: Optum, CVS, Walmart, virtual solutions like 98point6, and (soon) Amazon. These tech-enabled competitors will change the expectations and requirements of consumers. If a traditional provider organization falls too far behind, consumers will make choices based on convenience and develop habits that take them elsewhere. Now is the time to become known as the friendly, convenient, transparent place to seek care.

This doesn’t mean another year of dabbling. Many health systems have rolled out a physician finder, video visits, or online scheduling. The results have been underwhelming, in large part because the pieces and parts don’t fit together in a way that supports a seamless consumer journey.

The digital front door is a complicated creative assembly project that requires multi-year focus and investment from many departments: IT, marketing, strategy, innovation, patient experience, and more. If a health system leadership team doesn’t have a robust plan and roadmap, now’s the time to rally colleagues, allocate funding, and get to work.

If health systems don’t get ahead of the digital convenience curve, the impact isn’t just losing flu visit volume. One downstream effect will be further fracturing an already broken continuity of care. It will be much harder to deliver effective population health management when patients are increasingly “seeing other people” who don’t aren’t aware of, or don’t care about, the patient’s chronic condition. 

Many health systems are already taking action to make sure this doesn’t happen. Others need to get organized and mobilized ASAP to build their own front doors, plus develop plans to work well with the other doors that consumers will use, e.g. Google, Amazon, and Yelp.

Note: I believe Walmart is a more formidable competitor than Amazon, but we will save that for another day.

HIStalk Interviews Charles Corfield, CEO, NVoq

Charles Corfield is president and CEO of nVoq of Boulder, CO.

Tell me about yourself and the company.

I am CEO of NVoq, which is a Boulder, Colorado based technology company. We are active in the HIT space. We provide end customers and technology companies with voice recognition services to help them in their workflows, or in the case of software developers, to incorporate speech recognition into their products and enhance the experience of their  own users and customers.

What is left to accomplish with speech recognition now that it has become ubiquitous and of high accuracy?

There a still quite a lot to be done in terms of accuracy. You need the speech recognition to respect the domain in which somebody is talking and how they want the results to come back. That may vary from somebody who is getting the results directly back in front of them to somebody who may be a transcriptionist incorporating this into some other work. Or indeed, in the case of software developers, what they would like extracted from the recognized speech for their own programs. There is still a lot of post-processing work to be done. 

I should put in the caveat that it’s easy to confuse speech recognition from mind-reading. Remember that a computer CPU sitting there has not had the social immersion that a human has had. It doesn’t watch TV, it doesn’t go to the pub, it doesn’t get into arguments. It is very easy for us to project onto a computer CPU all sorts of human attributes which it does not have. Part of our skill as a technology company is to set the appropriate expectations amongst consumers of recognized speech as to what’s really going on and how to leverage it best for their own purposes.

Do the sellers of consumer-grade voice assistants try to make them seem smarter than they really are?

That depends what your end user experience is. Many people can have the experience on the one hand that it nails something, but then it appears as dumb as bricks at the next point. It’s no fault of the technology. It’s simply there are limits to what it can do. Because it is missing social context, the recognition mistakes are still there. I don’t think humans are in any danger of being replaced by these digital assistants anytime soon.

Has technology advanced to the point that computers can mimic human interaction?

You have to be careful that you get what I might call the clever dog trick syndrome. You can train a dog to do all sorts of interesting acrobatic tricks, but it’s extremely narrow what the dog can master. You are still left with that question at the end of the day, having been very impressed by what the dog can do — how does it pay the rent? There’s a versatility that humans have. Most humans who have walked the planet, and we’re talking adults here, have got a couple of decades of social immersion under their belts.

We should be cautious that we don’t over-hype what the machines can do. If we keep the machine’s focus on fairly narrow tasks, there’s plenty of opportunity for rote tasks to be automated and, shall we say, narrow social interactions to be automated. But if I might be somewhat tongue in cheek, artificial intelligence has a ways to go before it catches up with natural stupidity. [laughs]

Will ambient clinical intelligence, like that being developed by Nuance, be able to extract data from an encounter and allow the physician to work hands free?

Again, it’s a question of the focus. In doing the speech recognition in different environments, audio environment is not really the issue. It is, what are you trying to extract from what you have recognized? In fact, if you go back to a paper that Google published a little while back, they noticed in their own tiptoeing into this arena of ambient recognition that the problem was much, much harder than they initially thought. It comes down to all those other environmental cues about what is going on.

The computer is like the proverbial story of the blind man encountering an elephant. The computer sees the trunk, or the computer sees the tail. It’s hard for the computer to get the whole picture. Whereas the human, who is apparently so much slower and less able than the computer chip, actually readily digests the social cues as to what is expected and makes very good predictions in that environment.

Computers will get better at that, but I think we should be cautious that we don’t over-hype what they can do today. The best one in the world, even the biggest GPUs out there that are used for artificial intelligence, the amount of memory and processing power at their disposal is actually quite limited. I can stack up your common garden bee against one of those GPUs and note that the bee, with a brain the size of a pinhead, is able to communicate to other bees the location of food sources, navigate to those food sources without killing too many pedestrians on the way, and land upside down in reverse on that moving parking spot. You know, not bad. [laughs] Let’s not get carried away here.

That gives you my philosophy. I grew up in a culture where it was drilled into our heads that we should focus on meat and potato problems. [laughs] In other words, don’t get carried away. Go after the real meat and don’t be too proud to tackle what may, on the surface, seem too simple a problem.

You’ve said you don’t use speech recognition yourself even though some, including me, would say you are the father of it.

In my private life, I’m pretty low tech. About as high tech as I get is when I’m in my workshop making up a new pair of running shoes. [laughs]

As a vendor in health IT, how do you view that marketplace and the recent changes in it?

It’s a marketplace which is going to evolve enormously. The acute space is undergoing a lot of changes. Then there is a growth in post-acute and ambulatory going on. What you are seeing is the issue of data privacy, where consumers are now perhaps getting a little concerned about things they find scary about state-sponsored surveillance when they read stories about what is going on in China.

What about private sector surveillance, which if anything in America, is even more intrusive than government sector surveillance? Then combine that with the hackers who are busy ransacking every healthcare clinic or HIT provided to those healthcare clinics. They’re busy trying to loot them for as much ransom as they can get their hands on.

The issue about data privacy and security has become enormously more important. Without naming any names, some notable HIT vendors themselves have run into trouble on that score. For me as a vendor, it’s certainly one of the things that I spent a lot of time thinking about – how to put as many obstacles in the way of the black hats, and when and if your day comes up, how to limit the amount of damage that they can inflict.

Health IT vendors are partnering with big tech companies like Google, Amazon, and Microsoft. Should they be worried about getting too close to technology companies that are a lot bigger and smarter than they are?

There’s always that concern that, “Are you going to be road kill on the information superhighway?” as it was once put. The concern you’ve got is where Google is trying to open up partnerships with some of the larger healthcare providers to get access to their records and Cerner went through some sort of heartache over whom to partner with on that because of this issue. Will they just get disintermediated? I can’t say that I can look in the crystal ball and give you an answer to that, but it’s a concern.

For us as a vendor, the old mantra is that you want to be outside the kill zone. In other words, do not do something which is right in the target of what the major platforms are going to be doing. Do something which is differentiated, which is not worth their while to do, but which they would like to have as part of their ecosystem. That’s our approach. You’ll get to see over the next few years whether we’re right or wrong.

What has happened in the last couple of years with NVoq and where do you see the company going in the next few years?

It’s a bit like that old BASF tagline. “We don’t make the products you buy. We make the products you buy better.” There is IP know-how and what have you that we can bring to the table for the people who wish to incorporate voice into their own product offerings, where we can save them an awful lot of ramp-up time and we can save them from a lot of missteps. So for us, the next a few years is going to be a story of the partnerships that we build out there and the value that we can add to other people’s stories.

You developed the technical document processor FrameMaker over 30 years ago and sold it Adobe 25 or so years ago. How does it feel to know that software you developed generations ago is still being used and sold today?

I had the privilege of being connected to the engineers who now maintain it a couple of few years back. As I talked to them, we eventually ended up talking about some of the algorithms in it. What I found interesting was here we were all these years later and I said, “Well, haven’t you just rewritten all that stuff for something better?” And they said, “No, actually your original algorithm is still state of the art.” [laughs]

And then I had this thought. I wonder if it’s going to be a point that, should make it into my eighties, that I’m going to be speaking to some other engineers, finding out what sorts of things I’m worrying about today are either stupid or still state of the art? [laughs]

Maybe well-designed algorithms don’t have a shelf life.

You have no idea at the time. You’re simply just trying to crack a problem. There’s no textbook you get to look it up in. You do the best you can and then you have to move on to the next thing. It was kind of an interesting calibration experience, getting decades-later feedback like that. [laughs]

I saw in the infinite font of knowledge of Wikipedia that you have a species of lizard named after you. Who makes that call to let you know?

Goodness knows. [laughs] I think somebody with a wicked sense of humor. I will take it as a compliment and hope there’s nothing too horrible about the lizard or whichever reptilian species it is. [laughs]

Do you have any final thoughts?

In the world of HIT, it’s going to be a very exciting time, technology-wise. The impact of the cloud is going to come to bear. Even within an area like speech recognition, which has been around for a very long time, we will see a lot more application of it in different workflows. It’s the proverbial, “You ain’t seen nothing yet.” If you think about it, the number of people who are actually using voice recognition within healthcare is quite limited compared to the total number of people — consumers, clinicians, therapists, or what have you — who are out there in the field. 

I think we will see some very interesting value propositions emerge, and from a diversity of players as well. Keep your eye on some of the emerging startups, who may be just incorporating it into whatever newfangled clinical offering that they’re doing. It’s going to be an exciting time.

Morning Headlines 1/15/20

Physician Time Spent Using the Electronic Health Record During Outpatient Encounters: A Descriptive Study

Physicians spend 16 minutes per encounter doing EHR work, according to a Cerner study that reviewed client data from its Lights On Network.

Medsphere to Grow Interoperable Healthcare IT Platform with $40 Million Preferred Equity Investment from TPG Sixth Street Partners

Medsphere raises $40 million in new funding to support growth and pursue acquisitions.

Masimo to Acquire Connected Care Business from NantHealth

Masimo buys NantHealth’s Connected Care business for $47 million in cash.

AHRQ Advances New Frontiers in Digital Healthcare

AHRQ launches a Division of Digital Healthcare Research, which will produce and disseminate evidence about how digital health can support healthcare quality, safety, and effectiveness.

News 1/15/20

Top News

Physicians spend 16 minutes per encounter doing EHR work, according to a Cerner study that reviewed client data from its Lights On Network.

Reader Comments

From OK Competer: “Re: non-compete agreements. It’s time for employers to stop requiring these from staff-level employees, which seems un-American. I’ve been affected by this several times, most egregiously when I was notified of my pending layoff by a healthcare IT consulting firm right after it was acquired by a large corporation. I was denied the opportunity to accept a job from one of the large corporation’s clients in my home town even though I had not served as a consultant for that client.” Abolishment of those requirements is being considered in proposed legislation and an FTC review (public comments are welcome). I’m not surprised that lame companies include such language in their desperate attempt to wield control over employees, but taking the devil’s advocate position, a lot of bad corporate behavior is enabled because employees voluntarily sign their rights away and then complain only later when their personal circumstances are impacted. The most insulting example is that a fast food worker, like the minimum wage kid who assembles your Subway sandwich who is not allowed to take their vast corporate insider knowledge to Jimmy John’s for 50 cents more per hour. I agree that non-competes for marginally skilled workers need to be made illegal, while acknowledging that it’s a sad state when employers can be counted on to misbehave to whatever extent the law allows. They would stop if people refused to work for them.

From Epically Annoyed: “Re: Epic. It is boosting its non-compete back up to 18 months from one year, and it’s a massive list of firms. It hurts not only those who leave the company, but those customers working to hire quality employees, as every one of Epic’s clients are included in their non-compete.” Unverified. A purported list of the non-compete companies listed is on Reddit, while an annoymous Glassdoor poster says the non-compete was increased to 18 months for consulting firms. 

Webinars

January 29 (Wednesday) 2:00 ET. “State of the Health IT Industry 2020.” Sponsor: Medicomp Systems. Presenters from Medicomp Systems: Dave Lareau, CEO; Jay Anders, MD, MS, chief medical officer; Dan Gainer, CTO; Toni Laracuente, RN, chief nursing officer. Despite widespread adoption of EHRs, healthcare professionals struggle with several unresolved systemic challenges, including the lack of EHR usability, limited interoperability between disparate systems, new quality reporting initiatives that create administrative burdens, and escalating levels of physician burnout. Join the webinar to learn how enterprises can address current industry roadblocks with existing market solutions and fix health IT’s biggest challenges.

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

Acquisitions, Funding, Business, and Stock

Revenue cycle services vendor R1 RCM acquires scheduling and patient access solutions vendor SCI Solutions for $190 million in cash. The acquisition comes three days after SCI Solutions announced that it had acquired patient access vendor Tonic Health.

Former Senator Bill Frist, MD launches Nashville-based CareBridge, which will offer electronic visit verification, information sharing, and decision support in serving long-term home care patients. The company is backed by $40 million from investors that include Google.

Medsphere raises $40 million in new funding to support growth and pursue acquisitions.

Industry data and analytics vendor Definitive Healthcare acquires six-employee PatientFinder, which analyzes patient claims data to identify doctors as sales prospects for drug and medical device vendors.

Infor aquires RTLS systems vendor Intelligent InSites to enhance its CloudSuite Healthcare clinical offerings.

Global Healthcare Exchange acquires Lumere, which offers drug and medical device supply chain and pharmacy technology.

Arcadia raises $29.5 million in closing its fully subscribed growth equity investment.

Masimo buys NantHealth’s Connected Care business for $47 million in cash. NantHealth Chairman and CEO Patrick Soon-Shiong says the sale will allow the company to focus on its healthcare communications, clinical decision, and analytics businesses. NH shares jumped 12% on the news to $1.36, valuing the company at $150 million. NantHealth acquired Harris Corporation’s FusionFX integration business medical device connectivity vendor ISirona, both in 2015.

Sales

• Northwell extends its Allscripts Managed Services agreement through 2026, adding $500 million to the company’s contract backlog.
• Carilion Clinic (VA) will implement VisitPay, which allows patients to pay online and set up payment plans.

People

Collective Medical hires Wayne Grodsky (SOC Telemed) as chief revenue officer.

Announcements and Implementations

Black Book lists its top-dated healthcare analytics solutions vendors and consultants for 2020.

KLAS reports on digital faxing as healthcare organizations work on eliminating paper faxing. KLAS proposes a four-step digital maturity framework: (1) secure digital fax via APIs; (2) outbound fax integration; (3) document routing, both inbound and outbound, to specific applications; and (4) allowing digital fax documents to be interrogated using NLP or OCR. The sampled customer bases were tiny (two to five customers each), but responding customers of the four vendors studied (Concord, EtherFax, J2 Global, and OpenText) say the vendors haven’t gotten very far in developing intelligent automation.

AHRQ launches a Division of Digital Healthcare Research, which will produce and disseminate evidence about how digital health can support healthcare quality, safety, and effectiveness.

Other

UCSF Medical Center adds diagnostic images to its Epic MyChart patient portal.

Proteus Digital Health, once valued at $1.5 billion for its technology that monitors when patients take their pills, loses the drug company contract that yielded the FDA’s approval of its technology. The company, which has raised nearly $500 million in funding, is laying off employees and pivoting in trying to get insurers rather than drug companies to pay for its services. Drugmaker Otsuka gave Proteus a financial lifeline in buying exclusive rights to use the technology for mental illness. Insiders say the technology worked, but didn’t fit well into hospital workflow, patients didn’t like wearing the required patch, and physicians didn’t really know what to do with the reams of data the device produces. Surely all of this was painfully obvious to everyone except investors.

Odd: In Bahamas, publicly traded Doctor’s Hospital Health System will redirect its strategic focus from medical tourism to using AI and machine learning.

A Madison newspaper editorial by former Wisconsin governor and HHS secretary Tommy Thompson says HHS’s proposed data-sharing requirements will harm Epic and the Wisconsin economy with no benefit to patients, giving “Silicon Valley and new entrants an unfair leg up at the expense of Wisconsin jobs” in forcing Epic “to spend a significant amount of its time on work to share its trade secrets with newcomers.”

Weird News Andy flexes his keyboard-buffed biceps with this story, which he retitles “Working Out is for Schmucks.” Scientists find that a naturally occurring protein mimics the effects of exercise. The subjects of the study — laboratory mice and flies — are reportedly abandoning their Orange Theory memberships while waiting for the websites Hers and Hims to start selling it.

Sponsor Updates

• Hyland Healthcare announces GA of new enterprise imaging tool PACSgear Video Touch 4K.
• Pivot Point Consulting’s parent company, Vaco, expands its offices in Miami and West Palm Beach, and hires new managing partners.
• FDB VP Tom Bizzaro retires after more than 20 years with the company.
• Optimum Healthcare IT publishes an infographic titled “Q4 2019 Heathdata Breach Report.”
• AdvancedMD will exhibit at Hawaiian Eye 2020 January 18-24 in Koloa.
• EMedix Reimbursement Solutions, a CompuGroup Medical brand, achieves the CAQH Committee on Operating Rules for Information Exchange Phase 1 Certification Seal.
• CoverMyMeds shares 2019 milestones, including 3,000 volunteer hours with Besa Community and $13,000 raised for Pelotonia.
• Patientco achieves HFMA Peer Review designation.
• IDC MarketScape names Arcadia a leader in its population health management 2019 vendor assessment.

Blog Posts

• On Notifications in FHIR (Audacious Inquiry)
• New Year, New Codes (Bluetree)
• Choose Your Future, Part 1: Wow Patients with AI (Bright.md)
• A Decade in Review with CarePort (CarePort Health)
• Top 10 challenges for health IT teams in 2020 (and the skills they can improve) (Spok)
• Letter by Vercillo Regarding Article, “Use, Temporal Trends, and Outcomes of Endovascular Therapy After Interhospital Transfer in the United States” (CentralLogic)
• 7 Cybersecurity Priorities for Healthcare in 2020 (CI Security)
• 5 Data Analytics Trends for 2020 (Dimensional Insight)

Contacts

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

Morning Headlines 1/14/20

Bill Frist launches CareBridge, a new health care tech company backed by Google

Former US Senator Bill Frist, MD launches CareBridge, a Nashville-based technology company that will use an initial $40 million in funding to improve home healthcare.

DrChrono Raises $20 Million Growth Capital Round to Accelerate Growth

EHR, practice management, and RCM vendor DrChrono raises $20 million from Orix Growth Capital.

R1 Announces Agreement to Acquire SCI Solutions, a Leading Provider of Digital Patient Engagement Solutions

R1 RCM acquires SCI Solutions for $190 million just days after SCI announced its acquisition of Tonic Health.

Arcadia Finishes Strongest Performance Year Ever by Closing Fully-Subscribed Growth Equity Investment

Population health management vendor Arcadia raises $29.5 million through an investment from Cigna.

Framingham’s Definitive Healthcare expands its data business by acquiring PatientFinder

Market intelligence company Definitive Healthcare acquires PatientFinder, which has developed software companies can use to find physicians with patients who would benefit from their products.

Curbside Consult with Dr. Jayne 1/13/20

I’ve been thinking a lot lately about market consolidation. Mr. H always captures the movements: Teladoc Health is acquiring InTouch Health, SCI Solutions is acquiring Tonic Health, and MTBC is buying CareCloud.

Sometimes competitors buy each other, but the strategy can be somewhat murky. Are they trying to get better technology to improve their core product? Or are they trying to consolidate market share? Other times companies are buying specific pieces of technology that they lack in an attempt to stop the bleeding of customers going elsewhere for a more complete offering.

I’ve consulted for vendors during these acquisitions. My favorite type of engagement is helping the potential buyer to perform the due diligence around the potential purchase.

Usually the target company is keen on being purchased, so they are reasonably willing to get you dig around as much as needed. Sometimes, though, they may occasionally put obstacles in your way to keep you from figuring out how weak their product actually is compared to its marketing.

I worked with one vendor who thought they were getting a niche EHR that would complement their existing offerings. Unfortunately, they missed the part where that niche EHR really didn’t have a practice management system. Without the ability to bill for services, providers aren’t going to be thrilled with the fact that they’re going to have to buy a separate billing system and then try to mesh them together.

I say they “missed” the part where there was no billing system with some sarcasm. Of course they knew it was lacking, but chose to ignore it and hoped they could find enough gullible customers to come on board. Along with other members of the due diligence team, I was able to convince them they should take a pass, which hopefully saved them (and their potential customers) a good deal of heartache.

I’m interested to follow along as Teladoc Health purchases InTouch Health. I do believe that given our current culture and people’s desire for convenience, along with the need for providers to try to manage more patients more efficiently, virtual care is going to move to the forefront of healthcare.

The existing paradigms will continue to evolve. Hospitals that don’t have experts in a given subspecialty can contract with providers hundreds of miles away to provide care for their patients. Intensive care units can hire virtual teams to not only help manage patients after traditional business hours, but to review treatments and care plans as an extra set of expert eyes to make sure the best care possible is delivered. Patients can interact directly with their providers in a more efficient manner, saving the time needed to drive to an office and wait for care. Although these service lines already exist, more organizations are going to embrace them, and those that are already working in this manner will continue to evolve.

Teladoc Health already has the direct-to-consumer piece, and InTouch Health has a pretty solid institutional platform. The announcements focus on this, calling out the new company’s ability to manage patients longitudinally from the home setting to the intensive care unit. Regardless of their strengths and weaknesses, there will have to be a great deal of digging by teams on both sides to figure out exactly how their technologies might be able to work together vs. how much work will be needed to bring them together.

I worked with one vendor who had an EHR and a practice management system built on the same database platform but using different programming languages. As they tried to bring them together, they ended up halting all development on one side of the house while they rewrote the application to play nicely with the other side. The budgetary impact was significant, and it also caused the project to lose momentum. Eventually they got everything on the same page, but the product still died on the vine.

Many who have never been through the process of trying to bring disparate products together don’t realize what a long road it will be to seamless interaction between the direct-to-consumer offering and the in-hospital solutions. I love that kind of work – figuring out what can be kept, what needs to be refactored, and what might just need to be started over again from scratch in order for everything to work as intended.

In order to be successful, the various teams need to leave their egos at the door and focus on the end result, creating something new that will be greater than the sum of its parts. Sometimes, though, there isn’t enough budget allocated and the organization fails to address cultural issues, so what results is a shadow of what it might have been.

I have friends working at organizations that have struggled while trying to bring acquisitions together. One team worked for nearly two years to try to integrate the solutions, only to finally give up and demand that customers of the smaller vendor migrate to the larger vendor’s platform. Another team hurried to bring customers live on a shiny new tool they had purchased, not realizing that it wasn’t HIPAA-compliant until they started seeing unanticipated outcomes for what should have been routine workflows.

Of course, there is a negative impact on customers and their patients. These scenarios are also accompanied by declines in morale for the people doing the work. Sometimes key players will even leave because they don’t feel their opinions are being respected and they see their pride and joy being dissected during the process.

I hope that the companies involved in these acquisitions reach out to professionals to help manage the “soft” issues involved in bringing large teams together. From experience, they would likely benefit from an objective analysis and guidance in how to make everyone feel appreciated and to reduce the fear of being downsized or pushed aside. Most companies don’t do this, and they ultimately reap what they sow as the integration becomes increasingly difficult and the conversations more contentious. Some of the recent mergers and acquisitions in the healthcare IT world seem to be healthy, but others seem to be under a bit of duress.

Have you been through a merger or acquisition? Do you have advice for the impacted employees? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Marisa MacClary, CEO, Artifact Health

Marisa MacClary, MBA is co-founder and CEO of Artifact Health of Boulder, CO.

Tell me about yourself and the company.

I co-founded Artifact with my partner Meir Gottlieb in 2014. Artifact is first to market with a solution that makes it easier for physicians to manage an important administrative task for the hospital — clarifying physician documentation for accurate coding.

The query process has a huge impact on the hospital’s quality data and reimbursement. Typically this task is extremely burdensome for physicians. It’s the last thing that they want to do in their day. We at Artifact Health have tried to change all that. We’ve taken this burdensome task and made it lightning fast and easy. The result is happier physicians, better quality scores for the hospital, and accurate reimbursement.

How extensive is the problem of hospitals having to ask doctors to provide answers to CDI and coding queries?

It’s extremely common. All hospitals, large and small, struggle with this process. Today in most hospitals, physicians are interrupted by CDI staff with these questions about their documentation. They are fielding the questions by email, fax, handwritten notes, or perhaps in the in-basket or message center for Epic and Cerner users. Typically it’s a time-consuming, multi-step process that physicians find very burdensome. They often ignore it because it’s not directly correlated with patient care, or at least it’s not the top-of-mind goal that they have for that day.

My partner and I have been working in healthcare IT for all of our careers, specifically, designing software systems for physicians. Through that, we have a lot of appreciation and empathy for clinicians. We saw this process as one that could have a better, faster, and easier workflow. So much for the hospital hangs upon it in terms of their quality scores, their rankings, and their reimbursement.

That’s why we decided to narrowly focus. We wanted to build a standalone platform that could work across any EMR system, any coding system, and address this one very big and important problem, which is the physician query workflow.

What is the mechanism for physicians to receive these messages and respond to them?

We decided to make the main mechanism the mobile app, because we felt that that was where healthcare was moving as one of the technologies that was going to become important to physicians. We made that decision early on. I remember in early conversations that people were saying to me, “Physicians aren’t going to want to use their phone to answer queries.”  We bet on that. We started developing in 2014.

That has been the most delightful and pleasing delivery mechanism for queries. They can answer them any time. A lot of the feedback we receive is, “Wow, you’ve enabled me to make my downtime productive. I can answer queries when I’m in an elevator or walking between meetings.” It’s so much easier for them to do that than having to log into the EMR and all of the steps that it would typically take to respond to a query. Now we can distill that down to a 30-second action on their mobile device.

Do they just leave the app open all the time? Is in intuitive enough to use so that not a lot of training or setup is needed?

We built it intentionally so that providers would not need to be trained. It’s something that they can download and immediately know how to use.

They don’t leave the app open, typically. They’re notified through a variety of ways from Artifact that they have open queries. They can be notified by email, text, or push notifications to the phone. Then they can stay securely logged in for a period.

It’s very fast and easy for them to open the application and respond, but we also were cognizant of physicians who might not want to use a mobile device. We have an ability for them to go to the website and answer over the web. Also, we’re integrated with some EMRs, so that when they’re charting, they can also click over to answer queries in Artifact. We give them a variety of ways to access Artifact and respond to queries.

Can they answer most of the queries off the top of their head or do they need to have the chart or documentation open?

When a query is sent to a provider, the clinical documentation specialist or coder is required to enter supporting information for that question. They have that supporting information in front of them in Artifact when they answer the question. We also have the ability to attach documentation from the EMR, so they can pull up a progress note or a discharge summary and review that before answering the question.

I would say about 95% of the time, they do not have to go back to the chart to respond to queries. For some very complicated patients, it might require them to do that, but most of these questions are pretty straightforward and they can answer them quickly and easily.

What feedback do you get from physician users?

They actually call it joyous. We were launched at Johns Hopkins, where we got started as part of their Joy of Medicine initiative as a give-back to the physicians. They are actually really delighted by it.

We also have a gamification piece. We track them and show them their scores compared to their peers on response rate and response time. We’ve gotten so much positive feedback about that that we just recently added an ability for them to share their scorecard over social media, just because they enjoy that. We made it fun for them.

For physicians, there’s not much fun in the technology that they use today. The fact that they can get something done and resolved is huge for them. Getting it off their plate quickly has been the key to their happiness. We hear that across the board from all of our customers. That’s been the deciding factor for many of our customers to move to Artifact.

How important is it that AHIMA and other groups have standardized the queries?

That’s an exciting part of our business as of recent times. We forged those relationships early last year and it has proved to be well received by our customers. Hospitals are building and creating their own templates or they rely on the expertise of their CDI staff and coders to create compliant queries. The query is the greatest compliance risk in CDI. Hospitals can be audited for and penalized for sending leading inquiries. There are many examples of that.

Hospitals are very concerned about being compliant in their query workflow. Having expert organizations like AHIMA and HCPro come in and provide templated queries that are written in a non-leading way, and to help them understand which clinical information they need to be entering into that query to help the provider answer it appropriately, has been such a relief. 

Our customers see it as a huge burden lifted for them. It takes away the time they spend putting together these templates, but more importantly it allows them to enforce standardization across the organization. Some of our larger customers, such as hospital networks, are trying to get control of their facilities by pushing out standardized templates to everyone and then being able to track them. That is a huge asset in helping them manage the risk of being compliant in this workflow.

What lessons have you learned about communicating effectively and efficiently with physicians?

We’ve learned a lot. Much of it was from our history of working with physicians for years. It’s also looking at the tools that they have at their disposal today, which they often say feed burnout and take time away that they could be spending with patients.

We’ve learned that just like anybody, they want things to be easy, especially when it comes to administrative tasks that take them away from patient care. It seems obvious, or at least it was obvious to us, that we needed to design something that made this a simple and fast process. Whenever we are designing a new feature in Artifact, we always have the physician as the first stakeholder in mind and think about how that physician would want this to work.

With every decision we make, we err on the side of what will make it easier and more pleasing for the physician. That’s important. Physicians are tricky customers. You have one shot to get it right for them. One strike and you’re out. 

That was probably the hardest part of building this application. Building something simple is actually quite complicated, and being able to get it right the first time so that you’re adopted is essential for hospitals then who are pushing technology out to their physicians. Physicians can kill a pilot in a minute if they don’t find it useful.

That was probably our biggest challenge and I’m happy we were able to accomplish it. A testament to that is that we haven’t changed the physician application very much over the years since we launched. We did our homework and got it right the first time.

Do you see an opportunity to take what you’ve learned and extend it into other forms of physician communication?

It’s a good question, because once we go live at a customer site, that’s always the next question they have. “What else can we drive through Artifact? We’ve engaged our providers in a way that we’ve never been able to do before. What else can we throw into Artifact to get done?”

We are very careful about that. As one of our advisors said to us, “Don’t step on the joy.” What he meant by that is. “It’s absolutely joyous that I’m barely cognizant that I’m in your application. I’m in it quickly and I’m out. Don’t make me hang out in it.” There are a lot of opportunities for expansion of Artifact, but we’re extremely careful about the ones that we’re going to take on.

The easy ones are when hospitals are coming to us and saying, “We also have queries on professional fee billing that we want to send out. We also have queries now in the outpatient environment, especially with value-based care payment models on HCC coding.” It’s been an organic expansion for us starting off in inpatient coding, but physicians demand that all their documentation-related queries come through Artifact because they find it so easy to use.

That’s where we’ve seen the most expansion of our product within our customer sites. But I do think there’s applicability in other areas and we’re absolutely looking at that for sure, and across other industries as well.

Will artificial intelligence, machine learning, or natural language processing affect what you do?

It’s not an area that we’ve dived into quite yet. But an interesting AI application is CDI prioritization. It dovetails nicely with our approach. In essence, it allows a hospital to identify cases where there is a very strong query opportunity. Having that piece of technology bolted on to Artifact makes a lot of sense, because you can queue up that query opportunity and Artifact then allows you to deliver it and take it over the finish line. We definitely see that as an application worth exploring in the future.

Do you have any final thoughts?

We are at the beginning of this, where our standalone application allows us to continue to work with customers across all different EMR systems and coding systems to help enhance this workflow. It’s an important culture shift that happens within hospitals when you give physicians technology that they find easy and convenient to use. Our goal at Artifact Health is to continue to build software solutions that appeal to physicians and to help hospitals and practices achieve their goals as well.

Morning Headlines 1/13/20

Teladoc Health to acquire InTouch Health

Teladoc will acquire telehealth platform vendor InTouch Health for $600 million in cash and TDOC shares.

Inside Google’s Quest for Millions of Medical Records

The Wall Street Journal reports that Cerner passed on Google’s offer of $250 million in incentives to use its cloud storage system because Google wouldn’t fully divulge its plans for using Cerner-stored patient EHR data, leading Cerner to choose Amazon instead.

SCI Solutions Acquires Tonic Health

Digital engagement technology vendor SCI Solutions acquires Tonic Health, which offers a mobile patient intake, survey, and payments platform.

A billion medical images are exposed online, as doctors ignore warnings

Researchers determine that lax cybersecurity at hundreds of healthcare facilities have left over 1 billion medical images exposed on the Internet.

HCA Healthcare Acquires Technology and Analytics Company Valify

HCA Healthcare acquires purchased services analytics vendor Valify.

Monday Morning Update 1/13/20

Top News

Teladoc will acquire telehealth platform vendor InTouch Health for $600 million in cash and TDOC shares, the companies announced Sunday.

InTouch Health reports annual revenue of $80 million and has raised $49 million in funding.

Teladoc Health says the acquisition makes it the virtual care leader since it can support both consumer and provider use cases, making it the partner of choice for health systems that are seeking a single solution for their entire virtual care strategy. 

Reader Comments

From Uncle Samuel: “Re: NextGen acquiring the telemedicine company Otto Health that I had never heard of. No SEC filing for any exchange of money or stock – was it an acqui-hire? Was the company bankrupt? Seems like a foreboding situation for over-valued telemedicine companies if they are being acquired for free. Also, who invested in that company and apparently didn’t get anything back?” Otto Health is a telemedicine platform vendor and NextGen partner – its system integrates with the EHRs of providers who can then offer telemedicine visits. Otto Health’s revenue and headcount are negligible, according to everything I’ve read. I haven’t seen a NextGen 8K filing, which is required if an investor might find the information useful in making an investment decision (with the absence of such filing presumably indicating that they would not).

From Controlled Chaos: “Re: my recent interview. Your reach is mind-boggling. I got several LinkedIn messages and I’m still hearing about it at the conference I’m attending.” Thanks. I don’t usually hear what happened post-interview, but a CEO once told me that he received 300 emails, texts, calls, and LinkedIn messages in the first few hours after I ran the interview. Readers don’t generally announce to strangers that they read HIStalk, but I see the stats and the names of industry notables who subscribe to my updates.

From A Real NY MD: “Re: non-MD medical doctors. Squirmy territory is when the state of New York uses the desire of doctors to avoid explaining comparable degrees to squeeze them out of $300.” New York’s Board of Regents will confer an MD degree to state licensees who have completed a foreign program such as an MBBS that it deems equivalent. That’s interesting since University of the State of New York is not an educational institution. The precedent may have been California, which I believe years ago gave out MD credentials to doctors of osteopathy (DOs). I would definitely do it for $300, then list both credentials just to be clear.

HIStalk Announcements and Requests

Bad timing by me: I publicly thanked my two long-time Founding Sponsors last week, and within 24 hours, one of them dropped out after 13 years. Contact Lorre to take their permanent #1 spot on the page next to Medicomp.

I was digging deep into the Netflix catalog trying to find something good to watch and ran across “Her” from 2013, in which a man falls in love with an AI-driven operating system. The premise seems goofy, but the movie wasn’t – it’s a funny-sad observation about people whose lives revolve around the tiny screens they stare into while ignoring the actual world and fellow humans around them. Joaquin Phoenix is as quirkily excellent as you would expect in being alone on the screen through most of the movie, but Scarlett Johansson as the expressive, emotional AI voice is truly amazing. Watch closely in the city scenes and you may recognize Shanghai standing in for Los Angeles for some dramatic shots.

Listening: Rush, in memory of drummer and lyricist Neil Peart, who died last week of glioblastoma at 67. The band retired in 2015 last year due to his then-unspecified health issues. He was the best drummer I’ve ever heard in concert and was a good author as well, with his several books describing his motorcycle journeys as he led his offstage life following the deaths of his wife and daughter. Trivia: he wasn’t an original Rush member – John Rutsey (who died in 2008) left the band right after recording its 1974 first album (which included “Working Man”) but couldn’t tour due to health issues.

Three-fourths of hospital IT poll respondents say a vendor or consulting firm has done an end run around the IT department to influence a decision or to get the IT person in trouble. Justa CIO says it must be black death for that vendor because they will push you out otherwise. Furydelabongo says new health system executive sponsors often naively trust their consulting connections over in-house experts. NE CIO says Cerner was the worst but the folks involved have left the company, while VendorEthics says it’s the Cisco way. 

New poll to your right or here: How will your employer’s business change in 2020?

Webinars

January 29 (Wednesday) 2:00 ET. “State of the Health IT Industry 2020.” Sponsor: Medicomp Systems. Presenters from Medicomp Systems: Dave Lareau, CEO; Jay Anders, MD, MS, chief medical officer; Dan Gainer, CTO; James Aita, MBA, director of strategy and business development. Despite widespread adoption of EHRs, healthcare professionals struggle with several unresolved systemic challenges, including the lack of EHR usability, limited interoperability between disparate systems, new quality reporting initiatives that create administrative burdens, and escalating levels of physician burnout. Join the webinar to learn how enterprises can address current industry roadblocks with existing market solutions and fix health IT’s biggest challenges.

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

Acquisitions, Funding, Business, and Stock

Digital engagement technology vendor SCI Solutions acquires Tonic Health, which offers a mobile patient intake, survey, and payments platform. Seattle-based Tonic Health had raised $6.4 million in a single venture round in mid-2016.

HCA Healthcare acquires purchased services analytics vendor Valify, which had acquired hospital vendor marketplace company Lucro in September 2018.

Sales

• Bay Area Hospital (OR) chooses Epic.

People

Indiana University Health hires Tim Tarnowski, MBA, MIM (UMass Memorial Health Care) as SVP/CIO.

Cynthia McIntyre (IBM Watson Health) joins MDLive as chief revenue officer.

Announcements and Implementations

Access publishes “Tablet & Peripherals Playbook for Healthcare,” a walk-through guide for choosing tablet selection and management, cases, sterilization, wear and tear, theft, charging practices, and fingertips versus stylus, highlighting the research done by its customer Parkview Medical Center (CO). 

Privacy and Security

Richard E. Davis, MD of The Center for Facial Restoration (FL) posts an unusually honest and heartfelt message to his patients after a hacker breaches his systems and then contacts individual patient seeking payment in return for not publishing their information. The doctors says that notifying 3,500 individual patients will take time because his system stores their information as a scan of the paper intake form that requires manual extracting of their information, adding, “I am sickened by this unlawful and self-serving intrusion, and I am truly very sorry for your involvement in this senseless and malicious act.” This is the first time I’ve read a breach notice that raises positive emotion.

Other

The Wall Street Journal reports that Cerner passed on Google’s offer of $250 million in incentives to use its cloud storage system because Google wouldn’t fully divulge its plans for using Cerner-stored patient EHR data, leading Cerner to choose Amazon instead. According to a Cerner executive who was involved in the discussions, “We could never pin down Google on what their true business model was.” The article says Intermountain Healthcare signed a deal with Google to share identifiable medical records in a EHR search project similar to that of Ascension, but hasn’t gone forward with the project.

Epic files plans with the City of Verona for its next round of campus expansion, with construction on Mystery (themed as a manor house) to begin this year and Castaway (modeled after a ship) to follow next year. This second phase of storybook-themed Campus 5 will add 180,000 square feet of floor space that will contain 700 offices. Mystery will be connected to Jules Verne (under construction) and Castaway via a skyway.

Healthcare investor Bijan Salehizadeh, MD, MBA, MPH says that at least four major health systems have shut down their venture funds, which he expertly summarizes as follows:

• Hospital CFOs look 1-3 years down the road and thus aren’t comfortable with the long-term money and risk involved with playing venture capitalist.
• It’s usually the board members of health systems that push such investments they like being able to name-drop when asked about innovation and also the CEOs, who like the idea of free Silicon Valley trips.
• The fund usually has no internal advocate when health system budgeting rolls around.
• Doctors want their own ideas funded by the health systems with which they are associated, not innovation from outsider companies.
• Health systems are inept at connecting with startups and instead invest in their own vendors, expecting their hospital team members to help without extra compensation.
• Health systems demand terms that favor their participation, which are a turn-off to institutional investors.
• The funds often claim to be driven by both financial return and strategic value, which is an impossible proposition.
• There’s the philosophical question of whether non-for-profit health systems who are mostly funded by taxpayers (via Medicare and Medicaid) should be running venture funds.

Samsung’s new smartphone features a dedicated button that launches the new push-to-talk capability of Microsoft Teams, which Microsoft touts as offering a secure, less-expensive, one-device walkie-talkie function for the frontline workers in workplaces such as hospitals. The Teams functionality supports multiple users on a single device, offers off-shift access configurability, and integrates with Kronos and JDA workforce management systems.

Weird News Andy says that we should all just chill, or maybe we already have. Stanford researchers find that the average body temperature in the US has dropped from the often-cited 98.6 degrees Fahrenheit by 1.06 degrees (men) and 0.58 degrees (women) in the past 100+ years, although they note that maybe those early-days mercury thermometers just weren’t all that accurate.

Sponsor Updates

• CereCore staff volunteer at the Second Harvest Food Bank.
• Russo Partners features MDLive CEO Rich Berner on its JP Morgan Healthcare Conference preview podcast.
• Thirty-three percent of Meditech customers have earned an “A” from The Leapfrog Group for meeting rigorous safety standards.
• Waystar, Relatient, and ROI Healthcare Solutions will exhibit at the HFMA Western Region Symposium January 12-14 in Las Vegas.
• PatientKeeper will exhibit at the HFMA MA-RI Annual Revenue Cycle Conference January 16-17 in Foxborough, MA.
• Redox will host a networking event at the JP Morgan Healthcare Conference January 14 in San Francisco.
• Surescripts will exhibit at ASAP 2020 January 15-17 in Amelia Island, FL.

Blog Posts

• Our 2020 Predictions at Lightbeam Health Solutions (Lightbeam Health Solutions)
• Cyber Attack Risk Assessment for Your Hospital Emergency Plan (LiveProcess)
• 40 Percent of Hospital Revenue at Risk: Patient Loyalty is Imperative (Loyale Healthcare)
• On the move: How mobility helps nurses and improves the patient experience (Meditech)
• Data-Driven Precision Medicine: A Must-Have for the Next-Generation of Personalized Care (Health Catalyst)
• A Year of Growth, Enhancements and Partnerships (Mobile Heartbeat)
• Medicare Releases MIPS data – Important Information for Physical Therapy Practices (MWTherapy)
• 3 Healthcare Initiatives Driving Patient Identification in 2020 (NextGate)
• Master Care Coordination: 5-Point Checklist (Netsmart)
• What to expect from OpenText in 2020 (OpenText)
• The State of Telehealth in 2020 (EClinicalWorks)
• How healthcare organizations can stop patient medication non-adherence (Experian Health)
• 5 Healthcare Technology Trends to Watch in 2020 (PatientBond)
• RCM Best Practices for the New Year (Patientco)
• New Decade, Old Problems (PatientKeeper)
• What will healthcare IT look like in 2020 and beyond? (Pivot Point Consulting)
• New Solution for JIT Ordering within Infor Lawson (ROI Healthcare Solutions)
• Bon Voyage 2019! (SailPoint Technologies)
• Award-winning study: Well-being program participation drives health risk improvement (StayWell)
• Robert Wachter, MD: Disruptive digital transformation is coming to a hospital near you. (Voalte)
• Five Ways Effective Use of Alerts Helps Improve Patient Safety (Vocera)
• So You Wanna Blow the Whistle: How to Report Fraud and Abuse in Health Care (WebPT)

Contacts

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

Weekender 1/10/20

Weekly News Recap

• EHR/PM vendor CareCloud, which has raised over $150 million from investors, sells itself for $17 million in cash and $41 million in total consideration.
• Premier delays efforts to find a buyer for the company while it sorts out how its health system shareholders will respond under a new owner.
• A high-profile project in which healthcare super-utilizers are given more aggressive care is found to have no impact on the readmission rate when studied in randomized controlled trials.
• Healthgrades acquires Evariant.
• Non-profit accreditor URAC acquires the programs of ClearHealth Quality Institute.
• Nurses top Gallup’s annual list of most honest and ethical professions by far in Gallup’s annual poll of most honorable professions, with doctors, pharmacists, and dentists also finishing in the top five spots.
• AMIA fires President and CEO Doug Fridsma, MD, PhD after five years.
• England’s NHS receives $50 million in funding to implement single sign-on in its facilities to save clinician time.

Watercooler Talk Tidbits

HIStalk readers funded the Donors Choose teacher grant request of Mr. K, who asked for programmable drones for his New Jersey elementary school class. He reports, “I love being able to use technology to supplement and enhance my teaching experiences with my students. These drones are doing this for my students! I continually see my students working together on the touch interface of the iPad to program the drone in order to learn the basics of computer programming. With a programmable drone, my students are exposed to a level of computer science that they otherwise would not have access to.”

Healthcare imaging startup Lyfebin exposes thousands of medical images by improperly securing an Amazon Web Services storage bucket full of DICOM files. The company claimed it was phony patient data used for testing, went silent when pressed further, and then threatened to sue TechCrunch for writing about the issue.

A medical staffing company takes down a job ad that said of the Arizona hospital for which it was seeking applicants, “Women don’t do well here” after a social media backlash.

Atlanta Hawks basketball player Trae Young donates $10,000 to retire over $1 million in medical debt for Atlanta-area patients through RIP Medical Debt, which buys portfolios of bundled medical debt on the secondary debt market for pennies on the dollar. It’s beginning to feel like the most prevalent health insurer other than Medicare is GoFundMe.

San Francisco workers who are ancient by tech company standards – over 35, but some as young as in their 20s – are boosting their youthful, high-energy images by undergoing plastic surgery, Botox treatments, facelifts, fillers, and ab sculpting to compete with newer, younger co-workers. Some of them bring in app-filtered photos or pictures of social media influencers to show doctors how they want to look. A  female sex therapist who offers charm coaching for men whose 16-hour workdays preclude cultivating relationships says it’s ironic to see men being forced to “play the game women have always had to play to get what they want.”

Kaiser Health News notes that high-deductible health insurance plans hurts rural hospitals disproportionately because patients there have lower incomes. The deductible is applied to the first site of care, so the bigger hospitals that receive those patients when transferred get their full payment while the local hospital struggles to collect the deductible. A rural Colorado hospital says the only available plan option for local employers carries a $10,000 deductible, meaning that patients go into bad debt the first time they use it for a serious problem.

A hospital whose life flight helicopter was mistaken as a drone by Facebook users who then urged people to shoot it down asks residents to please avoid doing so.

In Case You Missed It

• News 1/10/20
• EPtalk by Dr. Jayne 1/9/20
• HIStalk Interviews Al Lewis, Workplace Wellness Skeptic
• News 1/8/20
• Curbside Consult with Dr. Jayne 1/6/20
• HIStalk Interviews Joe Petro, CTO, Nuance
• Monday Morning Update 1/6/20

Get Involved

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

Morning Headlines 1/10/20

Kyruus Raises $42 Million in New Financing After Delivering Another Year of Record Growth

Kyruus raises $42 million in a Series D funding round, increasing its total to $125 million.

Support for Windows 7 is nearing the end

Microsoft’s support of Windows 7 will end on January 14, leaving some significant number of hospital and practice users without security updates.

Premier process on hold as ownership structure is considered

Premier postpones its sale for six months so it can poll its health system shareholders on whether they plan to roll their equity to a new owner or to cash out.

Apple Stole Tech for Watch, Masimo Claims in Patent Suit

Patient monitoring technology vendor Masimo files a lawsuit claiming that Apple hired away key employees in order to steal trade secrets that it used in the development of the Apple Watch.

News 1/10/20

Top News

Ambulatory health IT and RCM vendor MTBC acquires Miami-based competitor CareCloud for $17 million in cash and $41 million in total consideration, according to SEC filings.

The company, which will operate as an MTBC subsidiary, was once valued at $150 million.

Reader Comments

From Many Miler: “Re: Dulles airport. Saw this – I’ve never seen an Epic ad board outside of a HIMSS context.” Maybe for ONC’s annual meeting January 27-28?

From Debtor: “Re: CareCloud. $153 million invested, sold for $17 million. Whatever is left of the Meaningful Use bubble has officially burst.” Agreed. Many of us predicted an irrationally exuberant boom as taxpayer dollars were used to bribe providers to buy the same old EHRs they didn’t want when it was their own money (OK, technically they didn’t have to buy anything but simply use an EHR meaningfully, but pre-stimulus EHRs were uncommon in practices). Fast forward: the MU gold rush has ended, everybody has chosen their EHR dance partner, Epic keeps broadening its product line in squashing niche system vendors, and much of the consulting demand is either shifting or drying up as health systems snap up other hospitals and practices and reduce the potential customer base. Still, the market will always reward technology and consulting vendors that can reduce their costs, improve their outcomes, or enhance their profits at the expense of competitors – it just probably won’t be all the same vendors and the prospects will be larger but more cautious, especially if their margins slip. CareCloud’s annual revenue was reported as $25-30 million recently, so the discounted sale price surely reflected losses, debt,or diminishing prospects that were discovered in the kimono-opening process. Even PracticeFusion managed to find a $100 million buyer in Allscripts two years ago, and while that was way down from the original $250 million offer from Allscripts, the discount probably priced in fears of fraud charges against PracticeFusion over EHR certification, which turned out to be justified given the $145 million Allscripts had to pay the federal government in settlement charges just 18 months later.

From Six Degrees of Medicine: “Re: MD degree. Strange how some people claim they earned one from a school that doesn’t offer it.” I’ve known some informatics folks who feel it’s OK to claim they earned an MD degree when in fact they graduated from foreign medicals schools who instead confer only the equivalent MBChB or MBBS. Equivalent or not, it’s squirmy territory when someone’s official credentials claim a different degree than the one on their diploma to avoid explaining that they are a real doctor, just not an MD. Unrelated, but on my mind – I’m not a fan of padding a resume with ABD (All But Dissertation), in which the failed PhD seeker creates their own trophy in the absence of actually earning one.

From Dr. Y2K: “Re: Philips Holter monitors. Are down and unusable due to a date problem with 2020.” Unverified.

HIStalk Announcements and Requests

Thanks for the HISsies nominations I’ve received so far. Who from the industry would you like to have a few beers with versus whose face would be on the receiving end of a pie if you were to launch one? I’ll give the nominations a few more more days and then create the voting ballot from the results. Nominate yourself if you want – you never know.

I had a teeth-cleaning appointment today and had two impressions: (a) the practice’s large, lit sign in the parking lot listed “Today’s Hours,” which cleverly might encourage drivers-by to stop in; (c) the waiting room’s sound system was playing Def Leppard’s “Pour Some Sugar On Me,” which might be a subtle effort to drum up more long-term business. That song came out 33 years ago, which means it will be playing in nursing homes in maybe 10-15 years.

Listening: Midnight Oil, which seems presciently appropriate since the “beds are burning” in their home country even though that’s not what the song was about. Singer-activist-conservationist Peter Garrett, who is 66, left The Oils to serve in government roles. His thoughts on the fires in Australia are as direct and angry as in “Beds Are Burning.”

Webinars

January 29 (Wednesday) 2:00 ET. “State of the Health IT Industry 2020.” Sponsor: Medicomp Systems. Presenters from Medicomp Systems: Dave Lareau, CEO; Jay Anders, MD, MS, chief medical officer; Dan Gainer, CTO; James Aita, MBA, director of strategy and business development. Despite widespread adoption of EHRs, healthcare professionals struggle with several unresolved systemic challenges, including the lack of EHR usability, limited interoperability between disparate systems, new quality reporting initiatives that create administrative burdens, and escalating levels of physician burnout. Join the webinar to learn how enterprises can address current industry roadblocks with existing market solutions and fix health IT’s biggest challenges.

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

Acquisitions, Funding, Business, and Stock

Kyruus raises $42 million in a Series D funding round, increasing its total to $125 million.

Analytics company Komodo Health will use a $50 million investment to develop new software and expand its Healthcare Map, which uses de-identified patient data from Allscripts to offer a real-time view of 15 million daily patient encounters and outcomes.

Verity Health seeks to close St. Vincent Medical Center in Los Angeles after its potential sale to a development group falls through. Health IT and newspaper mogul Patrick Soon-Shiong, MD took a controlling interest in the struggling health system, which once included six hospitals, in 2017. As an Allscripts investor, he was relatively quick to implement Sunrise system-wide. Verity declared bankruptcy a year later.

I missed this last week: Premier is reportedly postponing its efforts to sell itself for six months so it can poll its health system shareholders on whether they plan to roll their equity to a new owner or to cash out, an intention of much interest to prospective acquirers.

Sales

• Rush University System for Health (IL) selects RCM technology and services from R1 RCM. The organizations will also develop an innovation lab focused on value-based care and workforce development.

People

Sinai Hospital (MD) President Jonathan Ringo, MD will step down in April to launch telemedicine company Verappo.

Jason Hallock, MD (US Acute Care Solutions) joins SOC Telemed as chief medical officer.

Ooda Health promotes co-founder Seth Cohen to CEO, replacing co-founder Giovanni Colella, MD who becomes executive chairman.

Impact Advisors hires John Klare, MBA (Navigant) to lead its Performance Excellence service line.

Announcements and Implementations

Qliqsoft announces GA of customizable chatbot templates for a variety of healthcare settings. Sample uses include intake and post-discharge activities (hospitals and outpatient facilities), soliciting patient data and providing care information (post-acute facilities), and providing after-hours access to care information, scheduling, and appointment reminders (private practices).

Collective Medical announces the national rollout of a free enhancement to its real-time notification and care collaboration platform that identifies patients with a history of sepsis for quick intervention, citing a JAMA-published study in which 43% of severe sepsis survivors were re-hospitalized within 90 days.

A KLAS report on replacing glass pathology slides with digital pathology for primary diagnosis finds that the new technology might not be less expensive, but it provides insurance against predicted pathologist shortages in supporting remote work. Philips is the early leader and the first vendor to earn FDA approval, while Sectra is positioned to play a significant role. KLAS lays out the technology components as:

• A laboratory information system that is digital pathology enabled and that can apply barcodes to glass slides.
• An image capture scanner for slides.
• A pathology / PACS archive and viewer.
• Workflow tools, not all of which are appropriate for primary diagnosis.
• A workstation that can handle the display of large files to pathologists.

EHNAC publishes new criteria versions for all 18 of its interoperability accreditation programs that took effect January 1.

Government and Politics

DoD officials deem the second wave of MHS Genesis deployments a success after implementing the Cerner-based software at four bases last fall. Major infrastructure improvements and new training strategies, including a peer-expert system, helped to ensure smoother implementations than experienced in the first wave of go lives at facilities in the Pacific Northwest in late 2017. Twenty-five additional facilities will go live in June.

In Canada, the Nova Scotia Health Authority hires former Vancouver Island Health CEO Brendan Carr, MD to fulfill a similar role. Carr oversaw the contentious rollout of Cerner software at Island facilities between 2016 and 2017 and will manage a similar project in Nova Scotia, which has yet to decide between technology from Cerner and Allscripts. The project, which Carr says has been in the works for years, has been marred by allegations of bias from Evident and grumblings from other higher-profile vendors.

Other

Microsoft’s support of Windows 7 will end on January 14, leaving some significant number of hospital and practice users without security updates. I’ll say this from my own experience – Windows 10 is magnificent, in comparison or otherwise.

STAT finds little to show from billionaire Patrick Soon-Shiong, MD’s promise in 2016 that his Cancer MoonShot 2020 program would enroll thousands of people in clinical trials and develop a cancer vaccine. The project’s website has been taken down, social media accounts have been dormant for years, and a hacker is using its Twitter account for spamming. A USC oncologist says “it’s almost a slap in the face” to cancer patients when someone of Soon-Shiong’s wealth and influence promises hope, but then fails to deliver. All of the 17 leaders who were quoted in the initial PR splash refuse to comment. Soon-Shiong’s Nant companies, including NantHealth, have floundered as well after high-profile IPOs.  

The much-ballyhooed “hotspotting” project of Camden Coalition of Healthcare Providers – in which healthcare super-utilizers were given more aggressive care with a claimed huge reduction in their hospital readmissions, which seemed reasonable – fails to pass a randomized controlled trial, with no change in readmissions. The Coalition was honest and brave in questioning their own work early on and then allowing it to be studied afterward (imagine if a big drug or tech company was running the research). Three thoughts: (a) regression to the mean is real in everything from medicine to sophomore record albums, where a crazily successful initial measurement evens itself out with repeated measurement; (b) maybe hospital readmission rate is a poor measure of clinical success even though the government fixates on it in imposing payment penalties – it is highly unlikely that those interventions had no effect; and (c) the simplistic idea that an app, program, or policy change can quickly convert frequent flyers unfortunately underestimates the complexity of the challenge. And maybe a fourth one — we picture those frequent flyers as an unchanging group of patients when maybe they actually are high utilizers for a short time, then other patients with acute needs (which maybe more social than medical) trade places with them. OK, maybe even a fifth one – health is not influenced as much by healthcare as the people who are well paid to render healthcare services would like you to believe.

Stanford Medicine’s annual health trends report reveals just how well 700 physicians, residents, and students feel they’re prepared to interact with the latest digital innovations:

• Respondents believe a third of their duties could be automated within the next 20 years.
• Between 50% and 75% of respondents are pursuing additional training, with the biggest area of interest being AI.
• Between 63% and 79% believe patient-reported data from wearable devices and consumer genetic tests have clinical value.
• Nearly half of residents and students feel they are not being adequately prepared for emerging technologies like telemedicine.

AI expert Alexander Scarlat, MD sent this article that describes how sophisticated bots are poisoning public discourse. Example: a Harvard student used one to create 1,000 comments in response to draft Medicaid legislation and they were so realistic that the government accepted them as genuine concerns from the public. The student, unlike more nefarious players, told Medicaid about his experiment so they could remove the comments before they influenced policy. An FCC comment period drew 22 million comments, of which maybe half were fake in using stolen identities and at least 1.3 million used the same recognizable template.

Sponsor Updates

• Healthwise employees donate over 150 coats to City Light Home and Idaho Office for Refugees.
• Elsevier launches a new PracticeUpdate Center of Excellence focused on advanced melanoma.
• EPSi will exhibit at the HFMA 2019 Region 10 & 11 Western Region Symposium January 12 in Las Vegas.
• Glytec congratulates customers Advent Health, UVA Health, Novant Health, Orlando Health, Inova Health, and Amita Health on their inclusion in the Leapfrog Group’s list of Top Hospitals of 2019.
• Huron recognizes employee performance with 18 senior-level promotions. B

Blog Posts

• A Direct Path to Better Security (EClinicalWorks)
• For healthcare analytics, systems and culture breed success (EPSi)
• Google Cloud and FDA MyStudies: Harnessing real-world data for medical research (Google Cloud)
• What is a healthcare clearinghouse in medical billing? (Greenway Health)
• Using Data Analytics to Ensure Case Mix Index Accuracy (Hayes Management Consulting)
• What’s Holding You Back From Adhering to Prescription Renewal Guidelines? (Healthfinch)
• Legacy System Conversions: Security and Sensitive Data (Impact Advisors)
• IAAM Insights for Healthcare with Gus Malezis (Imprivata)
• Digital Transformation in Healthcare – What to Expect in 2020 and Beyond (InterSystems)
• Baby, It’s Code Outside (Intelligent Medical Objects)
• 5 Ways to Expand Digital Access While Maintaining Your Brand Experience: Insights from Banner Health (Kyruus)
• Time For Patient Financial Experience As A Service? (Patientco)

Contacts

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