Monday Morning Update 8/13/18

Top News

The Wall Street Journal posts another critical review of IBM Watson Health for oncology, saying that “the diagnosis is gloomy” for Watson’s ability to improve cancer treatments.

Reader Comments

From Axe the Fax: “Re: fax machines. Finally someone is pushing to get rid of them in healthcare.” We healthcare folks are always embarrassed by technologies that, while understandably outdated in the consumer arena and in other industries, are nearly perfectly suited for our needs. We have a zillion things wrong with the healthcare non-system, and fax machines and pagers — while emblematic of healthcare’s resistance to change – can be swapped out whenever a provider finds a better alternative (and while CMS has jumped on the bandwagon, I bet they still require providers to fax in information to support claims or information requests). Fax machines are the one form of interoperability that data-hoarding and technically incompetent providers can’t suppress, and in that regard, are disruptive in their own way. They require no training, they always work, and incoming faxes are easily noticed and sorted without sitting down with a keyboard. I wish we would save the righteous indignation and smarmy dismissiveness for things that should truly embarrass us, like poor value, self-serving clinical and administrative practices, and treating patients like the widgets of profit. We spent billions of taxpayer dollars on EHRs, and while they allowed health systems to preen about their high-tech wonderfulness, most of those providers didn’t see their cost or quality needle move one iota and neither will dumping fax machines – a better hammer doesn’t necessarily make you a great carpenter.

HIStalk Announcements and Requests

Most poll respondents don’t like the idea of someone having to file bankruptcy over medical bills. PFS_Guy says people don’t manage their money well and he doesn’t have good answers on how to help them, hoping that those in need look to charity or hospital financial assistance programs. Greg Park advocates Medicare-for-all because the profit-driven system preys worst on those with little or no insurance. Cosmos says someone has to pay for medical care, and if your short-sighted, invincibility-fueled decision to not buy insurance turns out to be unwise, you should have to take financial responsibility, including filing bankruptcy if needed. He adds a hypothetical example in which someone’s life is saved with a million-dollar hospital bill – is it unreasonable that bankruptcy gives that health system part of your life’s income in the form of a repayment plan? 

New poll to your right or here, continuing with the theme and getting right to the heart of today’s healthcare debate: Is it OK for insurers to charge sicker people higher health insurance premiums or refuse to cover them as was common pre-ACA and is about to become common again? A follow-up question might ask what should then be done when someone quickly runs out of resources and simply signs up for Medicaid so taxpayers foot the bill.

Responses to last week’s question are here.

We’re in peak vacation season, which raises this week’s question: what have you done with time off that turned out to be especially motivating, enriching, or transformative? Something that changed your life, maybe? Those of us looking for something beyond the usual vacations need some guidance.

Here’s my favorite quote of the moment, which I thought of upon biting my lip as an acquaintance who is dying of cancer explained that she still puts in endless work hours because nobody else can do her job: “Graveyards are full of indispensable men.”

Webinars

August 15 (Wednesday) 1:00 ET. “Raising the Digital Trajectory of Healthcare.” Sponsored by: Health Catalyst. Presenter: Dale Sanders, President of Technology, Health Catalyst. Healthcare ranks lowest in McKinsey’s Digital Quotient (data assets x data skills x data utilization) of all industries except mining and has largely ignored the digitization of patients’ state of health, but that’s changing. This webinar will describe the empathetic components of healthcare digitization strategy; the AI-enabled encounter; why today’s digital approach will never work and instead sucks the life out of clinicians; the role of bio-integrated sensors, genomics, and the “digitician;” and the technology and architecture of a modern digital platform. It’s going to happen, so let’s make it happen the right way.

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

Acquisitions, Funding, Business, and Stock

This should stir up some debate. FDA approves the first “gene-silencing” drug that treats a rare nerve destruction disease. The company spent $2.5 billion to develop Onpattro and will sell it for $450,000 per patient per year, including a money-back guarantee. The chief medical officer of Express Scripts applauds the company for “taking a responsible approach to pricing and patient access in the rare disease space.” About 50,000 people worldwide have the condition, of which 100 percent will want the drug versus the approximately 0.0 percent that can afford to pay for it. What do you do?

Decisions

• Abington Hospital (PA) went live with Oracle HR software in January 2018.
• Southeast Georgia Health System (GA) will go live with Kronos HR information system in September 2018.
• Wake Forest Baptist Health (NC) plans to switch from Oracle HR information system to a new vendor that has not yet been chosen.
• Sedgwick County Health Center (CO) switched from Azalea Health to MedWorks on February 1, 2018.
• Parkside Psychiatric Hospital (OK) went live with Paycom HR software in spring 2018

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

People

Ashish Sant (McKesson) is named SVP/GM of enterprise imaging of Change Healthcare.

CancerLinQ, a non-profit data initiative of the American Society of Clinical Oncology, hires Corey Wiegert (IBM Watson Health) as CEO.

Announcements and Implementations

Mobile Heartbeat launches CURE Analytics, which allows users of its mobile communications platform to improve communications processes and quality and to add communication data to a data warehouse.

LOINC releases its FDA-funded “Guide for Using LOINC Microbiology Terms.”

Other

The government of India develops “e-mortality” software, hoping to improve on the 90 percent of death records that are not medically certified to include ICD-10 codes that indicate the underlying and contributing causes.

Minnesota’s health department finds that an appendectomy can cost as little as $6,600 or as much as $35,500, due not to which hospital is doing the work or how risky a particular patient is, but rather the secret price negotiations between health systems and insurance companies. Hospitals with little competition charged 15 percent more and patients are getting stuck with ever-higher bills because of high insurance deductibles and co-pays. 

In the UK, Alder Hey Children’s NHS Trust wants to use Microsoft HoloLens for a heads-up display for surgeons and Surface Hub for single-screen collaboration in sharing EHR data and medical images.

Guess which country isn’t home to this market research firm whose website self-aggrandizes its “well-endowed research teams headed by true curators of talent and strong-headed individuals?”

Weird News Andy confides that he heard about this in a tweet. A bronchoscopy reveals that a four-year-old boy’s mysterious, whistling-like cough is being caused, in fact, by an actual toy whistle.

Sponsor Updates

• Medicomp Systems is exhibiting at Greenway Health’s Engage18 customer conference in National Harbor, MD August 10-13.
• Iatric Systems posts a case study titled “Prevent Third-Party Breaches, Protect PHI, and Avoid the “Wall of Shame” with Iatric Systems SecureRamp.”
• Black Book updates its mobile healthcare survey apps.
• Liaison Technologies achieves record-breaking growth in the first half of 2018.
• Lightbeam Health Solutions will exhibit at the SHIEC Conference August 19-22 in Atlanta.
• Vyne President and CEO Lindy Benton joins the Florida State University Alumni Association National Board of Directors.
• MedData’s Pulse intranet software wins ThoughtFarmer’s annual Best Intranet Awards in the Innovation category.
• Surescripts will exhibit at the 2018 Aprima User Conference August 17-19 in Grapevine, TX.
• SymphonyRM and ZappRx achieves AICPA SOC 2 Type 2 compliance.
• TriNetX releases the agenda for its annual user conference September 25-26 in Boston.

Blog Posts

• We’re Serious About Security, But You No Longer Have to Take Our Word For It (PMD)
• The Sticky Situation of Attempting Digital Transformation with Legacy Technology (Liaison Technologies)
• Nursing Resilience and Workplace Safety: Addressing Root Problems in Healthcare (LiveProcess)
• A Product Manager’s View: Interoperability, Bigfoot, and Unicorns (Vyne Medical)
• Keep Your RCM Team from Feeling the Burn (Waystar)
• Embracing Technology and Networks to Connect Care and Reduce Costs (National Decision Support Co.)
• A new approach to self-pay collections (OnPlanHealth)
• Patient Scheduling – Improve Your Patients’ Access to Clinical Care (Parallon Technology Solutions)
• Cloud Readiness: What does it mean to you? (CloudWave)
• Viewing Healthcare from a marketer’s shoes (Experian Health)
• PatientPing Success Story: Generations Family Health Center (PatientPing)
• Making it Memorable by Giving Back (Patientco)
• The unfortunate truth about healthcare interoperability (Redox)
• Innovation Amidst the Crisis: Health IT and the Opioid Abuse Epidemic (Sansoro Health)
• Surgery Center Prices and the Transparency Movement (The SSI Group)
• Collaboration in Healthcare: A Product Manager’s Experience at the HIMSS18 Interoperability Showcase (Summit Healthcare)
• An end-to-end solution for next generation sequencing (NGS) (Sunquest)
• Bold Humility: How Human-Centered Leadership Pays Dividends (Vocera)
• 3 Smart Ways to Use Data Reports in Your PT Practice (WebPT)

Contacts

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

What I Wish I’d Known Before … Turning 40

That perception is nine-tenths of reality.

In the work context, learn how to spot an incompetent and/or malicious boss faster and get out quicker instead of trying to hold on because I liked the company. Job hop sooner, avoid the suffering, and find the good team. Regarding personal spending, committing to a higher level of savings to make retirement possible five years earlier. (Age 60, likely to work past 65)

That I’d be divorced the year I turned 40 because (in part) I traveled too much for my job.

I wish I’d understood more the importance of good body mechanics and specific techniques to maintain optimum physical health. It’s so easy to think you’re going to be able to do everything you do in your 20s and 30s but much of your bad habits won’t ‘tell their tales’ until after your in your 50s and 60s. Moral of the story: Never underestimate the importance of taking your body in for it’s regular maintenance and tune-ups!

I’m playing catch up now and often wonder how much better shape I could be in.

That I wouldn’t feel that much older! And that listening to coworkers moan about turning 25 would be extra hilarious.

Two things: the impact that a career can have on a family. A co-worker helped me with this one when I considered returning to school to get a bachelors degree with kids nine and 10 years old. She said, “Why do you want to go back to school? Because if you think you will get paid more, that may not be the case” AND how important it is to grasp opportunities as the “right” time will never come. An executive took me to lunch at the nicest place in town and offered me a position in management. I declined, stating that I was not ready, but maybe in six months. Well, the six months never came and the executive was one of the most successful in the company. Lesson learned, especially since we were both female.

I wish I had known before I was 40 that as a female salesperson, I didn’t have to, nor should I have to, put up with sexist behavior like having the sales team go out for drinks at a strip club after team meetings. Luckily much of that B.S. has become acknowledged as inappropriate, but before I was 40, I thought I had to blend in. No more blending, boys!

That turning 50 and 60 are a heck of a lot harder. Just a number and not a milestone!

That job hunting is exponentially harder. Despite claims to the contrary, ageism exists.

Life not only gets busier, but goes by quicker. Work to live and don’t live to work.

Trusting yourself that you can start a business and learn to be productive and likely successful long before you turn 40.

That your 40s are awesome if you let them be.

Quality of life makes a BIG impact on your business. Stress can ruin you from the inside out. Do not let your business ruin your health. Incorporating meditation, exercise, and getting adequate rest to reduce stress levels will improve working smarter. And incorporating meditation, exercise, and rest gives you time for a fresh perspective. Sometimes it’s best to not respond immediately!

That before I knew it, I would be 60.

Save, save, save. And all of the little pains.

Weekender 8/10/18

Weekly News Recap

• CMS releases a draft rule that would overhaul the Medicare Share Savings Program
• UnitedHealth Group is reportedly the only non-financial company that’s in the running to acquire Athenahealth
• Northwestern Medicine (IL) lays off 60 IT employees after completing its Epic go-live
• CVS Health adds MinuteClinic-branded virtual consults from Teladoc to its CVS Pharmacy app
• Doctor appointment booking service Zocdoc postpones its announced pricing changes after practices complain about being charged $35 to $100 for each booked appointment instead of paying just an annual fee
• Allscripts announces that it will sell its joint venture stake in behavioral technology vendor Netsmart
• Henry Ford Health (MI) signs its first direct contract with an employer, touting Epic’s MyChart as a patient perk for GM employees

Best Reader Comments

Auto insurance is required in all 50 states, with two limited exceptions: NH, where you are still personally liable for damage done, and VA, which requires you to pay $500 annually if you don’t want to insure. The premise for these laws actually map quite well to healthcare. Imagine without the legal requirement – one person without insurance crashes, damages a building, injures a bunch of people, and ultimately declares bankruptcy to avoid the expense for liability. Everyone else gets to cover the tab. Requiring insurance puts money into the system to spread some of the risk. (Ummmmm)

CommonWell hooks itself up to the rest of the world! Only three years late and still not generally available. (DoD will be first in line once it’s ready, so as to exhibit “leadership,”right?) This is the great golden spike moment for interoperability – except with the Carequality Railroad traversing the entire continent to connect CommonWell San Francisco trolley network. (Vaporware?)

[Project] branding becomes important at this scale. With departmental or smaller implementations, using the vendor/product as a brand isn’t usually a problem. However once you hit “whole organization” level systems, as you do with an organization-wide EMR/EHR, putting a bit of distance between you and the primary vendor becomes important. (Brian Too)

I worked in an organization that had policy of renaming all vendor systems to a name of the organization’s choosing. Although this might seems confusing, it was actually very useful. Many implementations consisted of more than one licensed product so calling it the name of the dominant product wasn’t accurate. It also reinforced the notion that it was our system running our processes for our patients and members. The name was first coined for the initial implementation and stayed with the system through retirement. Our marketing people were definitely involved because the names were thoughtfully chosen and reflected the purpose of the system and the aspirations of the organization for the benefits it would bring. (A Rose By Any Other Name)

Watercooler Talk Tidbits

Reader donations funded the DonorsChoose teacher grant request of Ms. J in Missouri, who asked for building materials for her classroom of mostly refugee students whose primary language isn’t English. She reports, “This has been an extremely valuable learning tool in the classroom and very motivating for the students. We have done three challenges so far. The one in the pictures was to build a house. It had to have certain components, like a window, a door, some furniture on the inside. When the students finished their creations, they shared about them (first with a partner, then with the whole group). The reason I had them share with a partner first was so they could improve their houses with additional ideas. They really like their remodeling stage. Once we shared out as a whole group, the students wrote about their houses. We have done similar projects with math shapes and animals. The students love it when we get out the Legos. They are excited to hear about the challenge and their discussions of what fits in the expectations and what does not are amazing. Their reasoning is incredible. Thank you for providing these experiences for my students. Their ability to use their language and reasoning to convey their ideas will serve them very will as they move through school. We know that they are learning – even if they just see it as ‘Lego Challenges.’ We are grateful for all you do to support the growth of students — linguistically, socially, and academically.”

In Germany, neuroscientist and empathy expert Tania Singe, PhD is accused by current and former colleagues of being overly controlling and prone to bullying. They claim she had little empathy of her own, reserving her harshest behavior for pregnant employees — denying moms-to-be parental leave, calling them slackers who would need to work twice as hard to make up for their absence, and telling one who had miscarried that she would no longer be allowed to keep doctor appointments during work hours.

CNBC gets a first look at augmented reality headset Magic Leap, which has been shrouded in secrecy during its seven years of development and $2.3 billion in investment. The $2,300 developer’s edition is now available and the writer’s experience was mixed, saying it’s pretty cool to view a 3-D world being displayed on untethered goggles, but it’s hard to describe what the device does, there’s no way to show real screenshots since the human brain does the processing, it has limitations with ambient brightness and displaying human-like field of vision, and it will probably take years to get the product ready for mass consumption. Potential medical uses include supporting surgeries and offering chats with an AI-powered image of a doctor, but then again those use cases didn’t save Google Glass. 

The ambulatory surgery center lobbying group urges members to post positive comments on locally republished copies of a Kaiser Health News article that describes the lax state of ASC regulation. KHN found that state rules vary widely such that oversight of injuries and deaths can be minimal and doctors who have lost their hospital surgical privileges for misconduct are free to open their own surgery centers. One surgery center for colonoscopy had two patients die in the same month during what is normally among the safest of surgical procedures, and in at least 17 states, surgery centers don’t have to report patient deaths. 

A Pittsburgh local news site’s guest op-ed piece by healthcare transformation organization Lown Institute says UPMC’s planned $2 billion expansion should not be allowed or the health system should be stripped of its non-profit status, observing that UPMC receives $200 million per year in tax breaks but wants to build three high-profit specialty hospitals (cancer, transplant, and heart care) that don’t address local health needs such as obesity, asthma, binge drinking, and health disparities. UPMC wants to market the hospitals to wealthy patients abroad and wants to build two of them in suburbs where the percentage of insured residents is higher. UPMC CEO Jeffrey Romoff says, “UPMC desires to be the Amazon of healthcare.” Romoff was paid $6.9 million in UPMC’s most recently reported fiscal year, joining 32 UPMC executives who earned more than $1 million.

A New York Times opinion piece written by a hospice nurse and book author says more attention should be paid to the gut feelings of nurses, which she says aren’t really feelings but rather the clinical judgment that results from years of personal observations and experiences. Theresa Brown, RN, PhD notes that doctors generally ignore those feelings as documented in the EHR’s nurse notes. She talks up the Rothman Index, which combines EHR data – including that generated by nurses – to provide an early warning system for detecting at-risk patients. I interviewed co-creator Michael Rothman, PhD way back in 2010, but his comments are even more valid today:

We extract the amount of risk which is inherent in the value of each of these measurements and come up with a single score. Now in a sense, that’s what a doctor or nurse does when they go in. They come up with an overall sense of how the patient is and a good doctor does it well, or a good nurse does it well. But the problem is if a doctor is rushed, a nurse is rushed, how completely can they really evaluate all the data that’s there? Even even more importantly, do they really know how that patient was the day before when maybe this is the first time they’ve ever seen the patient? Getting that trend is very difficult to do, even if you’re a doctor and you’re sitting down and studying what’s in the medical record. It’s hard to figure out what the trend is, especially if it’s a gradual deterioration.

There’s one other thing, and that is, doctors tend to look at three things when they’re doing an evaluation. They look at vital signs, they look at lab tests, and they look at the last doctor’s notes. However, there is a source of information that they tend to overlook, and that is the nurse’s assessments. The nurses do what is called “the head to toe assessment” of the patient. It’s something that’s taught at nursing school. They evaluate each physiological system and they record it on the computer. Really, doctors don’t look at it. One of the things that we’ve done is we’ve said, “Hey, this is actually very valuable information about how someone is.” So we used nursing data in the calculation of our score. It gives the doctor access to something that he doesn’t normally look at.

Total property values of Madison and Dane County, WI have exceeded that of the city and county of Milwaukee for the first time even though Milwaukee has nearly triple the population of Madison. Dane County’s population grew by 40.7 percent from 1988 to 2017 – largely driven by technology companies such as Epic — while Milwaukee County had just a 1.5 percent increase.

Bizarre: doctors coin the term “Snapchat dysmorphia” to describe teens who seek plastic surgery to “look better in their selfies” and to make them look like their Snapchat-filtered selves.The JAMA Facial Plastic Surgery article summarizes,

Social media apps such as Snapchat and Facetune are providing a new reality of beauty for today’s society. These apps allow one to alter his or her appearance in an instant and conform to an unrealistic and often unattainable standard of beauty … it can be argued that these apps are making us lose touch with reality because we expect to look perfectly primped and filtered in real life as well. Filtered selfies especially can have harmful effects on adolescents or those with BDD [body dysmorphic disorder] because these groups may more severely internalize this beauty standard.

Of course hacker conference attendees would quickly figure out how to override a hotel’s thermostat and then tweet out instructions so colleagues can try it at their own hotels. The guy above was asked whether it’s a tampering felony to mess with a hotel’s thermostat, which is says isn’t because it’s an intended feature of the thermostat (as long as the hotel doesn’t make guests sign a EULA before using, he says with nerd tongue in cheek).

A 2 1/2-year-old toddler leaves Boston Children’s Hospital for the first time, having spent her entire life on a ventilator until she received a double lung transplant in September. It’s a feel-good (no pun intended) story as long as you can suppress your curiosity about what it cost and who paid.

In Case You Missed It

• News 8/10/18
• EPtalk by Dr. Jayne 8/9/18
• Readers Write: A Smart Telehealth Strategy Creates Great Value While Meeting Myriad Needs
• HIStalk Interviews Paul Roma, CEO, Ciox Health
• News 8/8/18
• Curbside Consult with Dr. Jayne 8/6/18
• Monday Morning Update 8/6/18
• Examples of a Boss Doing Something Heartfelt or Supportive

Get Involved

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

Morning Headlines 8/10/18

Pathways To Success: A New Start For Medicare’s Accountable Care Organizations

CMS Administrator Seema Verma summarizes the 600-page, just-published proposed rule that would overhaul the Medicare Shared Savings Program.

Amazon has plans to open its own health clinics for Seattle employees 

Amazon will open primary care clinics for employees at its Seattle headquarters with a pilot getting underway this year.

Connecting to Epic: Un-Users Group Meeting

Epic will hold its first Un-Users Group Meeting at its Verona campus on September 26, with an agenda aimed at non-Epic using provider leaders who want to exchange information with Epic customers.

UnitedHealth in second round of bidding for athenahealth

UnitedHealth Group, Bain Capital, and TPG are among the second-round bidders in the running to acquire Athenahealth.

News 8/10/18

Top News

CMS Administrator Seema Verma summarizes the 600-page, just-published proposed rule that would overhaul the Medicare Shared Savings Program in a Health Affairs blog post.

Reader Comments

From Glandular Enlargement: “Re: MED3000. Heard that McKesson will stop supporting it at the end of the year.” Unverified. That revenue management product hasn’t received much attention since McKesson bought it in 2012.

HIStalk Announcements and Requests

This weekend’s Monday Morning Update just won’t be the same unless you provide wisdom on what you wish you’d known before turning 40 (assuming you’re 40 or over, of course, otherwise feel free to read this weekend).

Webinars

August 15 (Wednesday) 1:00 ET. “Raising the Digital Trajectory of Healthcare.” Sponsored by: Health Catalyst. Presenter: Dale Sanders, President of Technology, Health Catalyst. Healthcare ranks lowest in McKinsey’s Digital Quotient (data assets x data skills x data utilization) of all industries except mining and has largely ignored the digitization of patients’ state of health, but that’s changing. This webinar will describe the empathetic components of healthcare digitization strategy; the AI-enabled encounter; why today’s digital approach will never work and instead sucks the life out of clinicians; the role of bio-integrated sensors, genomics, and the “digitician;” and the technology and architecture of a modern digital platform. It’s going to happen, so let’s make it happen the right way.

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

Acquisitions, Funding, Business, and Stock

Analytics and CRM company Trilliant Health raises $12 million in a Series A funding round. The company came together last year through the merger of Aegis Health, Clariture Health, and Expression Health Analytics. The unification coincided with the hiring of Hal Andrews (Shareable) as CEO.

After hiring hundreds to implement its Epic system, which went live in March, Northwestern Medicine (IL) lays off 60 IT employees in an increasingly common thanks for a job well done.

Insiders say that Amazon will open primary care clinics for employees at its Seattle headquarter with a pilot getting underway this year. Amazon’s primary care expertise includes Martin Levine from Iora Health, Christine Henningsgaard from One Medical, and Atul Gawande, MD, CEO of the company’s joint healthcare venture with Berkshire Hathaway and JPMorgan Chase.

App-based New York City prescription delivery service Capsule raises $50 million.

Dealreporter says that UnitedHealth Group Bain Capital, and TPG are among the second-round bidders in the running to acquire Athenahealth.

Health and wellness technology vendor Dynamic Healthcare Strategies acquires the Connect patient check-in and secure communications technology from CrossChx and renames it DHS SecurePass. CrossChx announced last week that it was renaming itself Olive following a $33 million funding round that will allow it to move into AI-powered healthcare automation.  

People

CHIME names Jennifer Ramstrom (Connection) VP of CHIME Technologies and the CHIME Foundation.

Salesforce promotes Keith Block to co-CEO alongside co-founder and chairman Marc Benioff.

Jennifer Musich-Rehmann (Cerner) joins Goliath Technologies as VP of corporate development.

Recondo Technology promotes Heather Kawamoto to the new role of chief product officer.

Justin Collier, MD (HCA) joins technology solution provider World Wide Technologies as US East CMIO.

Just Associates names Robin Gates (NextGate Solutions) as VP of sales for the southern region.

Sales

• Torrance Memorial Integrated Physicians and Torrance Health IPA (CA) select population health management and risk adjustment software from Evolent Health.

Announcements and Implementations

Teladoc beats out American Well and Doctor on Demand to supply virtual care consults for CVS Health’s new MinuteClinic-branded offering in the CVS Pharmacy app. Aetna, which CVS is in the process of acquiring for $69 billion, rolled out Teladoc-powered visits to its members several years ago.

ActX announces GA of GenoAct, a genetics-based, clinical decision support service embedded within a provider’s EHR.

Epic will hold its first Un-Users Group Meeting at its Verona campus on September 26, with an agenda aimed at non-Epic using provider leaders who want to exchange information with Epic customers. The $100 registration fee includes transportation to and from the hotel; a welcome reception; a crash course on data exchange (Carequality, Care Everywhere, HIE, and Direct) and Epic’s patient offerings (MyChart, Share Everywhere, Lucy, and Blue Button); lunch with Epic developers; interoperability success stories from Sutter Health and Children’s Health System of Texas; an overview of coordinated care; and an optional campus tour.

Behavioral health management company Beacon Health Options will offer virtual consult services from MDLive to its customers, including employers, payers, Medicaid programs, and military personnel.

Boston Children’s Hospital will add Buoy Health’s smart symptom checker to its website. The hospital will work with the Boston-based startup on future AI product development.

England’s Cambridge University Hospitals goes live on Epics’ EpicCare Link, which allows medical practices to view the hospital information of shared patients.

Government and Politics

A ProPublica piece on President Trump’s unofficial VA advisors, known to Washington insiders as the “Mar-a-Lago Crowd,” paints a picture of behind-the-scenes maneuverings by a good-old-boys network intent on shaking up VA leadership with little government oversight or healthcare knowledge. The trio – Marvel Entertainment Chairman Ike Perlmutter, Bruce Moskowitz, MD, and lawyer Marc Sherman – seem intent on privatizing the VA, and may have had a hand in stalling the agency’s decision to move forward with the Cerner deal. Insiders are now waiting to see if newly appointed Secretary Robert Wilkie will seek the their approval or move forward with staffing and project decisions on his own terms. 

An HHS OIG report finds that Medicare Part D spending for compounded creams and ointments increased 24-fold from 2010 to 2016 and triggered a bunch of fraud cases. OIG recommends that CMS clarify its policies; that it remind companies providing the coverage that they can make it exception-driven; and that it recommend utilization management tools. OIG also suggests that CMS investigate 550 pharmacies that drove most of the charges that also had questionable billing (a high percentage of patients receiving compounded products, repeated billings for the same items, a high per-prescription cost, high dispensing for a specific prescriber, and a big billing increase from 2015 to 2016). OIG also suggests reviewing 124 prescribers who ordered more than $250,000 each of compounded prescriptions from those questionable pharmacies, many of them crossing state lines that suggest no doctor-patient relationship existed. This is a brilliant use of claims data, although it’s always frustrating to realize just how CMS’s pay-and-chase policies allow robbing the system for years without much danger of serving time.

The 10-Q quarterly report filing of Community Health Systems discloses that the for-profit hospital operator is the subject of unspecified investigations related to Meaningful Use payments and running servers that still use Windows 2003.

Privacy and Security

Open-source EHR and practice management software collective OpenEMR issues a software update after patching security vulnerabilities found by cybersecurity consulting firm Project Insecurity. The vulnerabilities, found through a manual review of source code, could have given hackers the ability to access patient records and system data, upload files, and execute system commands.

Tweeting from the Black Hat USA conference, @drnic1 discovers that the FDA is thinking about creating a CyberMed Safety Analysis Board that would weigh in on the “assessment and validation of high-risk/high-impact device vulnerabilities and incidents.”

Other

A hospital consortium in South Korea, led by Asan Medical Center, will invest $32 million to develop an AI-based, precision medicine support tool Korean physicians are likening to IBM’s Watson. Dubbed Dr. Answer, the software will diagnose and offer treatment options for eight conditions, including heart disease, breast cancer, dementia, and prostate cancer.

A CoverMyMeds survey of 1,000 patients on prescription pricing transparency finds that:

• Half did not fill their prescriptions at the pharmacy because of cost.
• 37 percent stopped taking a medication because it was too expensive.
• 75 percent have been prescribed medications that cost more than expected.
• 87 percent wish their provider knew medication costs at the point of care.

Sponsor Updates

• CompuGroup Medical sponsors the Bowling for Barrow event in Scottsdale, AZ that raises funds for Barrow Neurological Institute’s Concussion and Brain Injury Center. CGM USA also earns BBB accreditation and an A+ for outstanding customer care.
• EClinicalWorks will exhibit at the CPCA 2018 Billing Managers Conference August 14-15 in Monterey, CA.
• Imat Solutions and Iatric Systems will exhibit at the SHIEC Annual Conference August 19-22 in Atlanta.
• InterSystems will exhibit at the Medical Enterprise Systems Conference August 13-16 in Portland.
• Intelligent Medical Objects will exhibit at Greenway’s Engage conference August 10-13 in National Harbor, MD.
• Loopback Analytics adds its Connector App to the Epic App Orchard.
• Audacious Inquiry publishes a new white paper, “Technology Reuse: Want to Avoid Recreating the Wheel?”

Blog Posts

• Empowering Women to Own Their Health Journeys (Healthgrades)
• Don’t lose another patient referral (Hyland)
• Mass lawmakers embrace electronic prescribing of controlled substances (Imprivata)
• Clinical Summit 2018: Fostering a Clinical Community (Kyruus)
• Marketing: Your Hospital’s Secret to an Amazing Patient Financial Experience (Influence Health)
• 4 ways to improve and maintain a quality patient experience (Meditech)
• 3 Things Healthcare Providers Should Be Using By 2020: Artificial Intelligence, Machine Learning, Automation (The HCI Group)
• A Loved One’s Perspective on Alarm Management (Spok)

Contacts

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

EPtalk by Dr. Jayne 8/9/18

Throughout my medical training, my early days in practice, and during countless go-lives, I’ve experienced some degree of sleep deprivation. I look forward to weekends when I’m not seeing patients and when I can sleep in, trying to (at least psychologically) catch up on all those “lost” hours. Today my hopes were dashed, with news that sleeping too much might be bad for one’s health. Researchers conducted their analysis using combined data from three million patients across numerous studies. They concluded that sleeping more than the recommended 8 hours can be associated with a higher rate of death. The study, published in the Journal of the American Heart Association, also proposes that poor sleep quality can be associated with cardiovascular disease.

Sleeping for 10 hours was linked to a 30 percent higher risk of death, where the nine-hour threshold was linked to a 14 percent higher risk. The National Sleep Foundation’s guidelines recommend 7-9 hours of sleep for most adults under age 65 and 7-8 hours for the retirement set. It’s not just about the number of hours, though – increased sleep can be associated with underlying chronic diseases that cause fatigue or increase sleep including thyroid dysfunction, anemia, depression, and other conditions. Decreased activity levels and unemployment can also negatively impact sleep, as can social, psychological, and environmental factors. The authors note that clinicians should further explore both duration and quality of sleep when assessing patients.

I’ve been doing some work with an organization that is considering enhancements to its clinical decision support capabilities. They’re looking at adding some provider dashboards along with peer data transparency as a way to drive adoption of clinical protocols. A recent study looked at how well physicians adhere to guidelines for prescribing certain cholesterol-lowering drugs. The physicians who had visibility into the prescribing habits of their peers showed a significant increase in prescriptions for statin drugs. The authors designed the study to be outside the EHR in order to better measure its effect and to create an ideal design. They did note, though, that although use of dashboards can increase compliance with guideline-based prescribing activities, the dashboards “may need to be designed to better fit within clinician workflow.” They also surmised that there may be better response to communications from physician and practice leaders rather than from researchers.

More frequent reminders or provision of peer data may also make a difference. I worked with a startup a few years ago that used single sign-on (SSO) technology to make that kind of dashboard data visible for individual patients at the point of care, but they had some challenges with overall adoption of the SSO platform that effectively killed the patient-centric display of data. The authors also noted that their approach allowed for physicians to complete the intervention by prescribing medication outside of an office visit. They note the challenge that “physicians with larger patient panels may face difficulties managing these types of decisions outside of their traditional clinic model when they receive a long list of eligible patients at one time without additional support.” They conclude that there may be benefit in delivering regular feedback over a longer period and leveraging “multiple opportunities to address gaps in care for smaller subsets of patients.”

When I was reading the article, I was having flashbacks to the annual “report cards” that a couple of my insurance plans would send to my practice before the days of EHR. They’d have large lists of patients who were identified as missing services. They were created using only claims data, and since they were only sent out annually, there was a high likelihood that they were outdated. The arrival of the reports would send my staff into a mad scramble of chart-pulling and review, followed by outreach to patients to determine whether they had the services somewhere else, paid cash, or attended a free screening. If not, we’d arrange the services. If they did, we’d have to get copies of the data, update the charts, prepare a response to the payer, and get ready to start the cycle over again once the next payer’s packet arrived. Of course, there was no coordination between the cycle on which I received my reports and when my partner received his, or among payers, so it seemed like we were in a state of constant chart-pulling and review. Thinking back, I have to laugh – we could have completed the exercise in the EHR in a matter of hours rather than days, assuming we hadn’t already identified those gaps in care and acted on them ourselves.

WalletHub released its list of “Best & Worst States for Health Care” this week. The analysis looked at 40 measures of cost, quality, and access across the 50 states and the District of Columbia. Vermont, Massachusetts, New Hampshire, Minnesota, and Hawaii led the list based on aggregate scores; North Carolina, Arkansas, Alaska, Mississippi, and Louisiana round out the bottom. My own state lands somewhere in the middle, which really doesn’t make me feel that much better. There are also lists looking at average monthly insurance premium cost, hospital beds per capita, physicians per capita, and more.

I’m a sucker for healthcare IT-related headlines, even though they may be clickbait. I was drawn in by mention of a CMS call to put an end to physician office fax machines by 2020. CMS Administrator Seema Verma delivered this challenge as part of a push for digital health information, leading up to the Blue Button 2.0 Developer Conference that starts next week. There wasn’t much more meat on the bone here, but I was suckered into reading nevertheless.

I continue to see fax machines in most of the offices I visit, even those that are live on nationwide data-sharing platforms. It’s not just physician practices that are complicit in the continuing need for “faxes” even if they are generated and received electronically. I recently had a change in my pharmacy benefit manager, which requires that either my physician fax a prescription to them or that I mail in a paper document. I specifically asked about electronic prescribing and the phone agent said no – even though I know they accept it – so giving that message to patients is not helpful. I mentioned to the phone agent that when I order new contacts, I can send a photo of my script to the vendor to speed things along – no such luck for drug prescriptions. I guess I’ll wait the advertised 10-12 days until my script comes in.

When is the last time you used a fax machine? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 8/9/18

CVS Health’s MinuteClinic Introduces New Virtual Care Offering

CVS Health adds MinuteClinic-branded virtual consults from Teladoc to its CVS Pharmacy app.

Northwestern Medicine lays off 60 IT workers after launch of new electronic medical records system

After hiring “hundreds” to implement its Epic system, which went live in March, Northwestern Medicine (IL) reorganizes and lays off 60 IT employees.

OpenEMR security flaws could have exposed millions of patient records

OpenEMR patches nearly 20 security vulnerabilities brought to its attention by a team of Project Insecurity researchers.

Readers Write: A Smart Telehealth Strategy Creates Great Value While Meeting Myriad Needs

A Smart Telehealth Strategy Creates Great Value While Meeting Myriad Needs
By Ray Costantini, MD

Ray Costantini, MD, MBA is co-founder and CEO of Bright.md of Portland, OR.

Friction is the enemy of efficiency, whether it’s an automotive engine clogged with grime or an athlete’s muscles slowed by lactic acid. Our healthcare system is stymied by high levels of friction throughout. Fortunately, for hospitals, doctors, and other healthcare providers seeking an edge in today’s highly competitive healthcare environment, a smart telehealth strategy presents an opportunity to slice through much of this friction and create great value in the process.

Telehealth is a broad category. At one end of the spectrum, it involves managing complex, high-risk conditions such as stroke through remote monitoring and consultation. At the other, it entails providing high quality, on-demand convenience care (or virtual care) for a range of acute, episodic, and non-emergent conditions in an effective, rapid, and cost-effective manner. There are many points across this spectrum to create and capture value for health systems and their patients. Telehealth services hold the promise of unlocking that value and now is an excellent time to think about integrating them into practice.

Several converging trends are contributing to this window of opportunity. One is the shortage of primary care physicians. Did you know that a patient in Boston typically has to wait up to 66 days to see a doctor through a traditional in-clinic visit? If you’re lucky, you’ll get sick in San Diego, where the elapsed time from scheduling to care is just seven days.

Another contributing trend is the consumerization of healthcare. Patients today are increasingly savvy. Empowered by technology, they expect on-demand access to care, and if they don’t get it or don’t like what they get, they’re all too ready to take their business elsewhere. This is one reason we’re seeing a proliferation of independent “retail care” locations, which by the way exacerbate the shortage of providers and add to the friction in the system.

What’s a provider to do to seize the telehealth opportunity? First, you’ll need to come up with a telehealth strategy. There’s no “one size fits all” approach here. For example, one system may be struggling with access issues, while another may face the challenge of serving a specific population group or demographic. The right solution with a tuned operational plan behind it can solve either of those issues. Start by taking an inventory of the pain points you want to solve. Also helpful: stop thinking in terms of return on investment or revenue created and instead begin thinking about the value created by your telehealth strategy and virtual care solutions. There are many different ways to create value, but you’ll have to decide on the right mix for your particular needs.

A smart telehealth strategy entails a comprehensive set of solutions, what I call a “ladder of care.” This could include options such as self-triage, nurse advice, and asynchronous virtual care for common ambulatory conditions. For higher-acuity issues, it could include video visits. In-person visits would be reserved for conditions where multiple comorbidities exist (diabetes and flu, for instance), or when a physical procedure is required (a minor procedure such as wart removal).

How does such an approach unlock value? First, it creates access and capacity in the system. Asynchronous virtual care visits can take less than two minutes of provider time and can be delivered from a smartphone with even a 3G connection from wherever the provider happens to be. One full-time equivalent of physician or Advanced Practice Clinician can deliver more than 20,000 of these virtual visits per year. Compare that with just 2,000 20-minute in-person or video visits for an in-clinic provider. This approach also attracts new patients and retains existing ones, which in turn drives downstream revenue and adds to your brand bank, building loyalty and positive word of mouth through innovation and patient-centered service delivery.

A ladder of care approach also ameliorates provider burnout by giving providers time to focus on higher-acuity patients (and generate associated reimbursement) in clinic and top-of-license practice. If the telehealth solution can automatically generate a chart-ready SOAP note, that dramatically cuts down on clerical work.

The value created pays dividends at the system, clinician, and patient levels of the healthcare ecosystem. At the system level, in a FFS (fee-for-service) world, a smart telehealth strategy can unlock downstream revenue through both patient acquisition and retention. In a capitated model, it helps keep the patient population healthy while preventing minor ailments from becoming major ones due to a lack of treatment or access.

A smart telehealth model can help cut your losses on primary care while also shifting fixed costs to variable costs. Instead of building or leasing and outfitting a two-clinician clinic, you would instead spend a fraction of that cost to provide a far more efficient usage basis. Integrating the staffing of your telehealth with existing retail or urgent care efforts would help fill the more than 30 percent of idle provider time that’s all too common in those settings. The list goes on.

For your patients, there are savings in time, money and more. Patients regain the hours it takes to schedule, wait for, and be evaluated by a physician, also avoiding lost wages, childcare costs if they have to visit the doctor, and so on. Telehealth patients report getting healthier sooner, recovering 1.5 days faster. For clinicians, a tele-visit can turn a 20-minute low-acuity visit into a higher-value visit with a patient who really needs it.

Meanwhile, the barriers to telehealth are quickly coming down. According to a 2016 Medscape study, both patients and physicians have improved their attitudes when it comes to embracing telehealth, with nearly two-thirds of patients surveyed expressing comfort in virtual care, diagnoses, and treatment plans. Add to that an increased availability of telehealth services from providers and a growing sense of patient trust versus privacy and security issues. With so many tech companies turning their focus to healthcare, many of the technology challenges associated with telehealth (bandwidth, availability, etc.) are a thing of the past.

Bottom line: this is no time for hospitals and doctors to retreat into traditional, friction-bound approaches to healthcare delivery. Your patients are already moving to a technology-enabled future of on-demand access to timely, convenient care. A smart, well thought out telehealth strategy is your ticket to join them and ride the next wave of patients and value-creation opportunities.

HIStalk Interviews Paul Roma, CEO, Ciox Health

Paul Roma is CEO of Ciox Health of Alpharetta, GA.

Tell me about yourself and the company.

I have been the CEO of Ciox for a little over a year. I came from the professional services world as the global head of analytics for Deloitte & Touche, which constituted 87 countries and all of the analytics work that that global firm does. My background throughout my entire professional services career, outside of running the global analytics business, was healthcare — life sciences, domestic government work, international healthcare work, providers in health insurance.

Consumers complain about the cost of getting copies of their electronic information from their providers and Ciox has sued over the HIPAA limitation on how much providers can charge. What are the current topics around that issue?

Just to be clear, Ciox is not suing over what consumers get charged, so let me reframe that a bit. We are, in particular, very pro-consumer and consumers getting their health records. I want to be 100 percent clear on that. Our lawsuit has nothing to do with the rate in which consumers are charged or whether they’re charged.

Our view is that there is a burden that is put on hospitals and physicians in professional, for-profit situations. The legal profession, the insurance profession, and others are using a consumer angle to create a burden on the doctors to feed them the record at a very low rate. Our lawsuit has to do with that. We believe that the people that are using information for commercial purposes should pay, and that the cost of producing that information in the proper format should not solely rely on the doctor and be a loss item on their balance sheet. They should be reimbursed for it. That is the bulk of our beliefs and our lawsuit.

So a for-profit company using a patient’s medical record for commercial purposes is different than patients getting copies of their own records?

It is, yes. There’s a explicit differentiation between the two.

Say I get a study done. I go to one of my local hospitals and I want to get that record to bring it to my primary care physician. We do literally millions of those, sometimes multiple millions a month, in which we either don’t charge at all, which is the usual case, or we charge very little. We are very pro consumers getting their health information.

We also do tens of millions of doctor requests for information for continuity of care and things like that, for which we don’t charge, of course. If it is for the consumer and for their health, we are very much in favor of that information being dispersed, being liquid, and transacting at a frequency and rate that is conducive to health being improved.

Are you seeing anything on the horizon that would change the way that the ownership and exchange of medical records will work in the US?

Near-term, no. Long-term, in my opinion, it is somewhat inevitable that the benefit of the data flowing in a secure, de-identified, and traceable way and being available for research outstrips all the reasons the walls are built up for us not to share the information. Long-term — whether it’s a change in definition, a change in regulation, or a change in the belief system of how that information moves — I do think we will see change.

What is the interoperability technology marketplace position of the newly announced HealthSource?

HealthSource fits squarely in the enterprise need for clinical information. We service providers, health plans, life insurance companies, and life sciences companies. HealthSource is a cloud-based, HITRUST-certified product that allows for both the interoperability with third parties — because we have hundreds of thousands of digital connections that we build into workflows — and sharing within the enterprise.

At some of our larger clients, we service 100 different use cases that require clinical information. Health insurance examples would be prior authorization, medical management, risk adjustment, and quality. Our HealthSource software integrates to those use cases and provides the information that they need from the medical chart, the EMR, to improve their process with the clinical information instead of relying on, in the health insurance case, claims and other secondary clinical information. We’re using the primary source to improve their use case.

How much technology and labor is involved in providing a complete electronic chart?

It varies. I’ll say two things. One would be that, as both a citizen and someone running a business, I wish it didn’t vary. I wish it was more liquid and that the outcomes were faster. The reality of the situation is that a large integrated health system has, on average, 17 different EMR systems. A vast majority of hospital systems have not even brought their acute systems to a single system, let alone all the specialty, post-acute, ambulatory, and other. Even within one practice area, they haven’t centralized. I would say that’s the norm.

Because of that, to your point on labor, about half of the cost comes from technical integration, formatting, and information and data management. About half the cost is still from manual touches, whether that be on the front end to work with the information or on the back end from a QA perspective.

Our particular business is reliant on, and cautious of, the regulations that are put on it. We are fully compliant to SAMHSA, as an example, which is a federal regulation to redact substance abuse information. There are many other things that we do. We not only get the information and put a longitudinal view together, but we structure the information — both technically as well as from a redaction perspective — so that it is compliant in the situation we’re offering.

One of the major distinctions for us that has cost associated with it is that we are not a generic exchange for clinical information. We are very particular as to what we’re sharing and making sure that it meets the regulations, that the information’s been redacted appropriately, and that the endpoint is receiving the format that it needs. All of those things are unfortunately more costly than just broadcasting information.

We have the possibility of expanded data sets that include genomics data, wearables data, and other data sources that aren’t being widely captured and collected and stored today. How do you plan for that as a company?

Our clients ask us to add a major source almost monthly. Many are the examples that you just gave. For example, genetic information and the translational makeup of information that combines phenotypic and genotypic data together to create a full picture of the person’s health and vitality. That’s been in our system for a long time, so we’re covered off on that. But below that, there are numerous social determinant categories, such as activity-based tracking from wearables and other IoT devices. We have a backlog on a monthly basis for life science companies and health insurance companies that are driving those changes and requests for further integration.

We lean in heavily on the Argonaut system, which is HL7 standards-based FHIR communication. It simplifies those things. The endpoint can communicate with us at that standard and they’re using the CCDA format, which we use. It’s pretty easy. But some of them still require proprietary interfaces. We maintain at this point about 700 different interfaces, so it’s still pretty costly to do all the endpoint integrations.

Are you seeing promising uses of artificial intelligence or machine learning to make sense of that wealth of data that we now have moving around?

This is a whole topic in and of itself. My background is as a data scientist and my formal work is in the technology of artificial intelligence and cognitive computing, so we can go as deep as you want.

Current state is that for us as company, it’s our largest investment — the structuring of data and the intelligent understanding and summarization of that data. Within the HealthSource product, we have a component called Smart Chart that takes all of the unstructured elements — progress notes in the EMR, a pathology report that’s coming out of the prognostic indications or from test results — and structures those and puts them in an analyzable format.

To your point on AI and cognitive technologies, we then come back through in a cognitive match and build a probabilistic model with confidence levels that deciphers the diagnosis codes, the DRG codes, and many of the other prognostic indications and then builds insights from those. Those insights in our generally-available product are generating tons of value.

To get back to the first part of your question, those technologies I just described are already showing literally hundreds of millions of dollars of increased profit for our clients. Hundreds. Not tens, hundreds. That fuels our investment and the industry’s investment. The “man versus machine” shift in terms of capital investment in those things is increasing on a monthly basis. There’s more information that leans in on the limitation of what a human can decipher.

But the information and the correlation of that information is also getting to the point of complication. Even if you or I are reading it, it’s a 1,200-page EMR. You’re deciphering a list of genetic bases from the four billion genetic bases that are written in a progress note that don’t have a paint-by-numbers key next to them. I have an MTHFR gene expression and I happen to know that that’s a methyl pathway issue that could cause drug toxicity. There’s lots of other things. But that’s in the progress note written out, and as the clinician looking at it, there’s four billion of them. How in the world do I decipher that?

I’m using the most acute example, genetic basis, just because of the number. But the complication of this information has exceeded what even the most well-trained doctors can comprehend. That comes back and fuels the investment curve. There’s been so much progress made and it’s starting to pay off.

Do you have any final thoughts?

The US needs a better way of sharing information — with consumers, for seeding research for better therapies, and getting better information to doctors. Ciox is in the middle of helping all three and that’s the mission that we’re on. The HealthSource product is squarely designed to first give better information to doctors, second to facilitate consumers to get that information in a format they can use, and then third to power research and insights at these large organizations — health insurance, life sciences — that are ultimately trying to create better therapies for us. We’re excited to be part of that mission and believe there’s a lot of value in it.

Morning Headlines 8/8/18

Digital health start-up Zocdoc is wrestling with a price change that could cripple doctors

Doctor appointment booking service Zocdoc postpones its announced pricing changes after practices complain about being charged for each booked appointment instead of paying just an annual fee.

Bluetree Network, an Epic consultant firm, adds staff, branches out

Bluetree Network moves to a 15,000-square-foot office in Madison, WI as it expands headcount to an eventual 450 and annual revenue to $55 million.

GoodRx valued at about $2.8 billion after Silver Lake investment, sources say

Prescription discount card vendor GoodRx takes a private equity investment that values the company at $2.8 billion.

Tenet shares dive 15% as company reveals subsidiary sale still in process

Tenet Healthcare misses its self-imposed deadline concerning the sale of subsidiary Conifer Health Solutions, sending shares tumbling by over 15 percent during Tuesday trading.

News 8/8/18

Top News

Doctor appointment booking service Zocdoc postpones its announced pricing changes after practices complain about being charged for each booked appointment instead of paying just an annual fee.

A dermatologist says his $3,600 per-doctor annual cost would jump 700 percent and might run afoul of Stark restrictions since the practice would then be paying a per-referral charge.

Zocdoc is valued at $2 billion in having raised $145 million in four funding rounds, with investors that include Amazon’s Jeff Bezos and Salesforce’s Marc Benioff (although the proposed pricing is sort of anti-Amazon Prime in focusing on per-item charges instead of a blanket fee).

The company claims that reducing the annual fee and adding a per-appointment fee of $35 to $100 (depending on specialty) will lower the provider cost of entry and leave most of its practices paying the same or less.

Reader Comments

From Generic Competitor: “Re: Crisis Text Line. Heard about it on TED Talks and thought you would be interested.” The non-profit Crisis Text Line offers free, 24×7, text message support from trained volunteers to “help move from a hot moment to a cool moment.” The organization supports its mission via for-profit, software-powered subsidiary Loris.ai, which teaches companies how to communicate with empathy and cultural competency using insights derived from applying data analysis to Crisis Text Line’s dozens of millions of text-based interactions.

From Monetary Exigency: “Re: medical bankruptcy. If we want to live in any sort of insurance system (and they do work in other countries) then there has to be a real imperative to have insurance. Just like car insurance. You have a lot to lose if you don’t have it. My suggestion, though, would be to allow people to be sued into medical bankruptcy, but only at the then-current Medicaid rate for those exact services. Uninsured patients are being charged against a fee schedule that no reasonable payer would ever pay against. Health systems chase the patients down to bankruptcy and still post beautiful ‘charity care’ numbers on their mission page on their website.” I like that idea, although I’m still a fan of forcing providers to charge everybody the same price to eliminate the secret contracts, cost shifting, and the absurd situation where the cash-paying customer pays more than anyone else.

HIStalk Announcements and Requests

Listening: new from the 43-year-old, Canada-born R&B singer-songwriter Tamia. I was only vaguely aware of her and thus learned two interesting factoids: (a) she’s married to former NBA player and Atlanta Hawks co-owner Grant Hill; and (b) she has well-controlled multiple sclerosis. Requiring insulin for this somewhat sugary mix, I injected myself with new music from Sweden-based melodic metalcore band Amaranthe, which to my ear sounds like Adderall-fueled Abba jamming with Nightwish. 

Webinars

August 15 (Wednesday) 1:00 ET. “Raising the Digital Trajectory of Healthcare.” Sponsored by: Health Catalyst. Presenter: Dale Sanders, President of Technology, Health Catalyst. Healthcare ranks lowest in McKinsey’s Digital Quotient (data assets x data skills x data utilization) of all industries except mining and has largely ignored the digitization of patients’ state of health, but that’s changing. This webinar will describe the empathetic components of healthcare digitization strategy; the AI-enabled encounter; why today’s digital approach will never work and instead sucks the life out of clinicians; the role of bio-integrated sensors, genomics, and the “digitician;” and the technology and architecture of a modern digital platform. It’s going to happen, so let’s make it happen the right way.

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

Acquisitions, Funding, Business, and Stock

Prescription discount card vendor GoodRx takes a private equity investment that values the company at $2.8 billion.

Family-owned Michigan and Illinois Medicaid benefits provider Meridian Health Plan sells out for $2.5 billion, giving the family of founder and former OB-GYN David Cotton a $2 billion after-tax windfall.

Medication optimization technology vendor Tabula Rasa HealthCare reports Q2 results: revenue up 65 percent, adjusted EPS $0.20 vs. $0.08.

Sales

• England’s Maidstone and Tunbridge Wells NHS Trust chooses Allscripts Sunrise, adding to its Allscripts patient administration system deployment.
• Hunt Regional Healthcare (TX) will use pre-bill coding analysis technology from Streamline Health Solutions.

People

Holon Solutions hires Renee Broadbent, MBA (UMass Memorial Medical Center) as SVP of population health.

Forward Health Group hires Kerra Guffey (WPS Health Insurance) as chief administrative officer.

Announcements and Implementations

Epic-focused consulting firm Bluetree Network moves to a 15,000-square-foot office in Madison, WI as it expands headcount to an eventual 450 and annual revenue to $55 million. The company will also add a managed services center to help front-line provider employees.

Piedmont Athens Regional Medical Center (GA) goes live on Epic.

Dell Medical School creates a Biomedical Data Science Hub and hires quantitative scientist Paul Rathouz, PhD from University of Wisconsin’s medical and public health schools to run it.

Phynd adds expanded health plan participation and network affiliation tracking tools to its provider profile and network management platform.

A CommonWell blog post says it’s on track to release connectivity to Carequality by the end of summer following its testing with customers of Cerner and Greenway Health in which 4,000 documents have been exchanged.

Change Healthcare releases Dual Enrollment Advocate, AI-powered technology that helps health plans identify, engage, and enroll Medicare Advantage members who are also eligible for Medicaid.

Electronic dental claims attachment technology vendor NEA Powered by Vyne announces Vyne Connect, a secure practice-patient communication system.

Privacy and Security

Interesting: consumers who get a genetic test from companies like Ancestry and 23andMe must disclose that fact when applying for long-term care insurance, and companies can then use the information to decide whether to issue a policy and how much to charge for it. The federal Genetic Information Nondiscrimination Act applies only to health insurers, not those who sell policies for long-term care, life, or disability.

Facebook asks large US banks to share customer information – including their credit card activity and checking account balances – so it can increase user engagement by allowing those users to bank via Facebook Messenger.

Singapore is studying the use of virtual browsers after hackers penetrated SingHealth and compromised the information of 1.5 million patients. A virtual browser, offered by Citrix and other companies, runs remotely, is isolated from the local computer and network, stores no information on the user device, and clears itself when the session is terminated. 

Other

Fast Company profiles Savvy, a patient-owned data cooperative which invites patients to contribute their medical information, which is then made available to providers who are interested in performing research surveys, testing, or focus groups. Patients pay $34 to join, then share in the company’s profit from fees charged to practitioners

. 

A small study finds that health systems are using skilled nursing facilities to improve post-discharge quality and costs under bundled payment model via two strategies:

• Reducing referrals to SNFs by using risk stratification to decide which patients can go home instead
• Integrating with SNFs to gain influence over their quality and costs, such as sharing EHR access and data, hiring care coordination staff, and embedding providers across facilities

The US Preventive Services Task Force finds insufficient evidence to assess the usefulness of screening symptom-free adults over 65 for atrial fibrillation to get them started on stroke-preventing anticoagulant therapy, possibly throwing shade on the remotely monitored app and patch vendors that portray such mass screening as a great medical advance compared to traditional methods.

In Japan, Tokyo Medical University apologizes for modifying its medical school application software to subtract points from the test scores of women, a change it made in 2006 in response to having too many qualified female applicants, which raised its concern that they would leave the workforce and cause a doctor shortage.

A woman whose 18-year-old diabetic daughter was turned away from the hospital ED because “our server’s down – IT’s working on it” complains to the local TV station and the board and attorney of South Central Kansas Medical Center (KS) about her resulting three-day ICU stay at another hospital. The daughter says, “I work at the local donut shop, and when we have computers go down, we write everything down and we put it in the computer later. We always have a backup plan for something. The fact that the hospital didn’t have a backup plan is kind of frustrating.”

Sponsor Updates

• Imat Solutions introduces its C3 framework (clean, comprehensive, and current data) for HIEs, payers, and providers.
• Aprima announces that KLAS Arch Collaborative Ambassador Mike Davis will keynote its annual user conference, August 17-19 in Grapevine, TX.
• Audacious Inquiry publishes a new white paper, “Medicaid IT Funding.”
• AssessURHealth and CoverMyMeds will exhibit at Greenway Health’s Engage conference August 10-13 in National Harbor, MD.
• Burwood Group achieves Cisco Lifecycle Advisor status.
• CarePort Health will exhibit at ACMA Florida August 16-17 in Championsgate, FL.
• Carevive releases a new video, “Patient Engagement in Value-based Care: Real World Case Studies Using Shared Decision-Making and ePROs.”
• CenTrak will present at the Georgia Biomedical Instrumentation Society annual conference in Atlanta on August 11.
• CTG will exhibit at the PCMH Congress August 14-16 in San Diego.
• Divurgent releases a new white paper, “Flying Lessons: Crew Resource Management in Healthcare.”

Blog Posts

• The EHR Journey – Workflow Analysis, Ease of Use & Best Practices (Optimum Healthcare IT)
• USA Today’s expose highlights a real problem. Here are 5 answers to the questions that executives and board members should be asking. (Advisory Board)
• Moving the Needles on Interoperability Part 2: Making the Connections (Casenet)
• How Cancer Immune Therapy Went from ‘Tested’ to InterQual Recommended’ (Change Healthcare)
• Key Ways to Improve Claims Management and Reimbursement (ChartLogic)
• Healthcare Information Quality – What is Quality? (Clinical Architecture)
• Patients over Paperwork – Who will be the true winners? (Culbert Healthcare Solutions)
• Effective Ways to Close an Interview (Direct Consulting Associates)
• How to Solve the Data Crisis Caused by a Hospital Merger (Dimensional Insight)

Contacts

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

Morning Headlines 8/7/18

Careexpand to Transition Its Full-Service Chronic Care Management Business to Chronic Care Management, Inc.

Chronic Care Management acquires Careexpand’s CCM assets for an undisclosed amount.

Apple records keep on expanding

Apple Clinical & Health Informatics Lead Ricky Bloomfield announces that several new health systems have joined the company’s health record project, including Texas Health Resources and UCLA Health (CA).

In a first for Michigan, Henry Ford Health signs direct contract with GM

Henry Ford Health (MI) signs its first direct contract with an employer, touting Epic’s MyChart as a patient perk for GM employees.

Curbside Consult with Dr. Jayne 8/6/18

The Atlantic recently ran a great piece that talks about why physicians should read fiction. It discusses a paper recently published in Literature and Medicine that suggests that working with literature can help physicians think more broadly and can help them better understand the situations their patients are facing.

My medical school was progressive in this regard, offering a writing elective for first-year students. We met with a member of the faculty who was also a writer and worked through both reading and writing exercises. Of course, we talked about famous physicians who were writers, such as Chekhov, but also had the opportunity to write about our experiences with medicine both personally and professionally.

Hot on the heels of some short story classes in college, I wrote a story about my grandfather’s having a heart attack and dying at a fairly young age. It was a challenge to think about it from a medical perspective and to try to link together some of the things that occurred prior his death, in the greater context of the disease that ultimately took him. I’m not much of a poet, but one of my classmates wrote some moving verse about her experiences in the neonatal intensive care unit. It was great to see a different side of my classmates, considering we spent most of our time competing for the scarce A grades our professors were willing to award.

In particular the paper, titled “Showing That Medical Ethics Cases Can Miss the Point,” talks about ethics cases that healthcare students might review as part of their coursework. The goal is for students to think how they might react in similar situations, and what different options they and their patients might have to choose from. The paper suggests that the case studies are lacking in style, and don’t include the nuances or tidbits that would help the characters come to life. Author Woods Nash feels the sparseness of the case studies might limit their ability to impact students. He uses examples to show the difference between a story that explains characters and their motivations and a dry ethics case that tries to boil the issues down to a minimum of words.

When Nash works with medical students, he assigns stories that the students have to try to distill to an ethics case study. The students then read each others’ work and talk about whether students make different assumptions about the situations or whether they include the same details in their respective write-ups. The point is to help students understand that style can influence how a case is perceived.

Nash told the Atlantic that case studies might need to fall by the wayside: “The real world is messy, of course, and ethics cases often teach us (implicitly) to clean up that mess by oversimplifying it.” He goes on to say that ethics cases “are themselves a byproduct and reflection of clinical practice’s overemphasis on efficiency. Not just in primary care, but in many areas of medicine, doctors spend far too little time really listening to patients and trying to appreciate the depths of their patients’ problems.”

As our healthcare system continues to press for efficiency, it makes it harder for physicians to listen to their patients. Market forces are driving physicians to only see the sickest patients, leveraging care teams including midlevel providers to deliver the more routine visits, including preventive visits. For younger patients, the preventive visit might represent the sole interaction with a physician each year.

As patients age, their needs increase and those visits become more frequent, resulting in the intensification of the patient-physician relationship. Of course, this assumes that the patient’s insurance hasn’t changed, they haven’t had to move to a different primary care physician, and that they’ve been able to maintain continuity. From experience, it’s much easier to advise a patient and his or her family on end-of-life issues if you’ve known them for some time and have been able to build that relationship. In the world of six-minute office visits, that’s a much taller order to try to fulfill.

The practice of medicine is messy and I’m glad to have come across authors who recognize that and can lead people through some of the challenges we face. A favorite author who is very good at this is Chris Bohjalian, whose book “Midwives” captivated me in medical school. The book deals with a particular medical scenario, where a midwife performs an emergency C-section on a patient who may not have been dead. It goes through the resulting legal issues and trial, and brings up a lot of questions about what happens in the heat of the moment when there is a medical emergency. I hadn’t read anything of his until recently, when I came across “The Double Bind.” It also has some medical overtones as well as being a good read.

Being in healthcare can lead many of us to question our own humanity. I don’t think it’s exclusive to people who are providers, but I think it starts to flow over to people in related fields such as healthcare IT and health policy. As we start to look more at populations and cohorts of people, will that lead us to stop thinking about individuals and their unique situations? Will we be more likely to treat the statistics rather than treating the patients in front of us?

As cool as I think big data is and how great it is to be able to look at population-based data, it’s hard to explain odds and statistics to families who want everything done for their loved ones despite insurmountable odds. Population health is great when it helps us reach patients who might not be receiving recommended preventive services or who are at risk for serious health conditions. The ability to protect patients and preserve health is amazing. At some point, however, population health technology might be used to identify people who are receiving what some might perceive are too many services or too many treatments given their age and condition. Where do we go from there?

I always ask myself whether I’m considering everything a patient is going through when they make what might initially seem like an unreasonable request. Are they just having a bad day, or is there something else going on? What else can we in the healing professions do to help? Those questions are difficult to contemplate in a short visit, but reading about similar experiences may help prime our brains so that we’re better prepared to address complex situations when they come our way. That’s the point of ethical case studies.

Are they as helpful as we think? Will they better prepare us for the challenges we face in healthcare? Does your organization use them? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 8/6/18

Allscripts Healthcare Solutions (MDRX) Q2 2018 Results

Allscripts will sell its joint venture stake in behavioral technology vendor Netsmart.

LRHC taking steps to seek new electronic health records software

Lexington Regional Health Center (NE) gets board approval to replace its unnamed EHR vendors, explaining that it can’t deal with poorly integrated integrated inpatient, ambulatory, and ED systems and such systems hurt its recruiting efforts.

SmartER Acquires ConciergeStat

Patient engagement software company SmartER acquires care coordination tech vendor ConciergeStat for an undisclosed amount.

Monday Morning Update 8/6/18

Top News

Allscripts will sell its joint venture stake in behavioral technology vendor Netsmart, the company said in its quarterly earnings call Thursday. Allscripts acquired Netsmart for $950 million in April 2016 with the participation of a private equity investor.

Allscripts President Richard Poulton said:

Seizing on the momentum we’ve created in Netsmart during the quarter, we took further steps to position ourselves to unlock value for shareholders through monetizing our investment in Netsmart. After researching and discussing several possible alternatives, we began detailed negotiations with multiple parties on the sale of our interest. We have signed a letter of intent and buyer diligence currently continues. Based on the work accomplished to date, we expect to answer a definitive documentation on the sale during the third quarter.

Allscripts CEO Paul Black explained the rationale for the sale:

From the beginning, we set up a ownership structure that was not sustainable for the long term. It meant we were either going to be a seller or a buyer, ultimately, of the rest of that. What our shareholders are clearly telling us today is they don’t put a lot of value on our ownership in that today, based on where our stock is. You’re probably pretty familiar with what’s happening at some of the post-acute assets right now, which are trading at very high numbers. We think it’s in the best interest of our shareholders to let somebody who values this more own it and will reward our shareholders with the benefits of that. It’s really been more of a financial asset than a strategic asset for us and I think it’s the right thing for us to do.

Other items from the Allscripts earnings call:

• Recurring revenue made up 80 percent of the total.
• The absence of regulatory-motivated buying behavior has extended the software sales cycle and made revenue timing prediction trickier, especially in the hospital market.
• The company sold its first managed services deal to a former McKesson EIS client.
• Practice Fusion has had “tens of thousands” of paid signups since the June 1 termination of the free offering.
• Paul Black says companies that offer only EHR/PM systems, unlike Allscripts, will struggle in a competitive market.
• The company says M&A has never been a specific strategy, but they’ll jump on deals that increase the Allscripts scale or footprint.

Reader Comments

From CI-CI-O: “Re: project branding. I’m interested in your thoughts and those of your readers. As we embark on a project to move to a single EHR across our organization, I believe we need to brand this with our own name and avoid having our users refer to the EHR by the vendor’s name. My marketing leader disagrees. There seems to be people on both sides of this debate. Do you think in-house branding a makes a difference in how the EHR is perceived during or after a roll-out?” I think you absolutely should give your project a specific name, for a couple of reasons: (a) the effort goes far beyond that single vendor’s implementation and thus it is your project and your organization’s effort, not theirs; and (b) it needs to resonate with hospital employees who need a better visual than the company name alone can provide. Just don’t name it something goofy or overly ambitious (which is harder to do than it sounds). Skip the employee naming contest and get your marketing people involved to treat it like a business identity project in giving it a descriptive name, logo, and tagline. It sounds woo-woo, but it’s not. Your marketing people seem inept to not be jumping all over this opportunity to show their skill. Readers?

HIStalk Announcements and Requests

Two-thirds of poll respondents say it’s not acceptable to fire an employee over activities that are repugnant but legal. Nick says it’s just another form of lynch mob for unproven rumors similar to what’s happening in rural India. A couple of folks say it’s fine if the employee agreement contains a morals cause. B thinks companies have a responsibility to create a safe environment and thus to exclude those who promote violence. A few respondents say it’s a slippery slope in defining “unacceptable” behavior.

New poll to your right or here: Is it OK that medical bills regularly force people into bankruptcy?

Thanks for some good answers to last week’s question.

This week’s question: what do you wish you’d known before turning 40?

Webinars

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

Acquisitions, Funding, Business, and Stock

From the Cerner earnings call:

• The company’s 9 percent bookings growth included seven contracts valued at over $75 million.
• Work with the VA and DoD will accelerate efforts in the areas of population health, open platforms, and telehealth.
• Cerner says its work with Lumeris give it the ability to add provider health plan functionality to HealtheIntent and new markets for Millennium.
• The Lumeris investment is an example of looking for acquisitions that can provide a faster path to the $100 million level. 
• The VA contract, as expected, had minimal impact on the quarterly results.

Sales

• Hadassah Medical Center (Israel) joins the TriNetX global health research network.
• Flagler Hospital (FL) will use Ayasdi’s Clinical Variation Management system.

Announcements and Implementations

A small Reaction Data nurse survey about burnout finds that the most prevalent causes are dealing with internal bureaucracy, work-life balance, and dealing with regulations. The most-suggested solutions for each of those factors are more clinical input, flexible schedules, and reduce regulatory burden. Nurses say the EHR’s biggest problem is poor usability. 

Redox introduces its medication-related data model, which enables the exchange of new medication orders and modifications or cancellations to existing ones.

Other

Lexington Regional Health Center (NE) gets board approval to replace its unnamed EHR vendors, explaining that it can’t deal with poorly integrated integrated inpatient, ambulatory, and ED systems and such systems hurt its recruiting efforts. They’ve already chosen an unnamed vendor and can now negotiate a contact.

For-profit hospital operator Prime Healthcare will pay $65 million to resolve charges related to Medicare short-stay admissions, with founder and CEO Prem Reddy personally responsible for $3.25 million of the total.

The New York Times covers “post-hospital syndrome” that may explain why elderly patients are readmitted for unrelated problems in the weeks after discharge: hospital stays involve interrupted sleep, weight loss, stress, mild delirium, and weakness due to being in bed for days. Somehow you have to think that if you were designing a healing environment, it would look nothing like a modern medical center, but then again “healing” has been replaced by “fixing.” 

The Houston paper profiles MD Anderson’s in-hospital hair salon, which has been run by Justine Jordan for 10 years. She says,

It’s hard losing your hair and not knowing when it’s going to grow back, or if it’s going to grow back, and how people are going to look at you. I think most of my patients wonder if their husband is still going to think they’re beautiful. If they’re still going to look at them the same way … I want them to have the confidence and know that they’re beautiful, no matter how they look on the outside. And I think that’s what people really have to start saying to themselves: I’m beautiful … Treating someone nice, it makes them happy. It makes them feel like someone cares about them. And it costs nothing. It’s so free.

Sponsor Updates

• Liaison Technologies publishes a new e-guide, “Enterprise Data in 2018.”
• NPR’s BioTech Nation podcast features MDLive CEO Rich Berner.
• MedData will exhibit at the HFMA Region 8 MidAmerica Summer Institute 2018 August 6-8 in Independence, MO.
• Waystar will exhibit at Epic Core August 8-10 in Denver.
• Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the AWHONN Texas State Conference August 9-11 in Corpus Christi, TX.
• CloudWave achieves SSAE 18 standards compliance for its OpSus Healthcare Cloud services.
• Sansoro Health and Divurgent co-author a new white paper, “The Evolving Role of Health IT in Fighting the Opioid Crisis.”
• Wellsoft achieves 2015 Edition EHR certification.
• WiserTogether partners with Peers Health to deliver its Return to Health treatment guidance solution for disability and workers’ compensation markets.
• Wolters Kluwer Health will begin publishing The Journal of the Association of Nurses in AIDS Care from ANAC.

Blog Posts

• 3 Quick Tips for Way Better RCM (Revenue Cycle Management) (Waystar)
• Privacy Matters (NVoq)
• 3 Steps to Becoming More Proactive in Managing and Preventing Claims Denials (Parallon Technology Solutions)
• Need a reason to come and party with Nordic later this month? Here are 6. (Nordic)
• Create a strategy for patient collections (Experian Health)
• Four Questions Series: Joe Kachelski, CEO, WISHIN (PatientPing)
• Mammosphere, a Powerful Patient Engagement Tool, Enables Health Care Payers and Employers to Support Breast Health (LifeImage)
• Choosing the Right Patient Financing Vendor (Patientco)
• How to identify and address physician burnout (PerfectServe)
• The Elusive Healthcare Developer (Redox)
• How much incentive do you get for the max MIPS score of 100? (Advisory Board)
• Let’s make Wi-Fi great again (for the first time). (Voalte)
• Bold Humility: How Human-Centered Leadership Pays Dividends (Vocera)
• Founder Letter: It’s Time to Close the PT Gender Pay Gap (WebPT)
• “Allow Other People to Solve the Big Problems” The 5 Lessons I Learned Being a 20-Something Founder (ZappRx)

Contacts

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

Examples of a Boss Doing Something Heartfelt or Supportive

The owner discovered that one of the employees could not afford the additional cost of their honeymoon, and the newlyweds were planning to just stay home. The owner paid for a little getaway for the couple, including the food and the hotel suite.

Any time we had a collection at work (flowers for someone who lost a family member, baby shower for a co-worker, etc.), we would always end up with more than we thought we’d get. Turns out the boss at that time would find it how much had been given, then double it out if his pocket. He did it very quietly, not wanting attention. I airways looked at him differently after that.

Working extensively with HR to ensure that a co-worker with a new cancer diagnosis would be able to continue working while going through chemo

Years ago, we had an admin for our company who had to take a second job to support her family (single mom). Our CEO heard about it, and gave her enough of a raise so that she would not have to work all the time to make ends meet.

Our CEO at the time set up an employee fund to other employees to contribute too for a fellow employee that lost his entire home to a fire.

I think the best examples are the small, every day examples that assist a staff member to navigate their career in a way that supports their needs, whether that is offering new challenges that are right up their alley, supporting them as they seek work/life balance, or getting employee input as they craft plans for the organization. That is what I feel I have always had where I work (MEDITECH), and I can compare that to my spouse who tends to get treated like just one of many in an army of workers. When you truly know your staff, you can support them every day, but then also be there when major events occur.

A teammate went out with cancer who happened to be a single mom with kids. The C-suite quietly continued to give her a paycheck for a year until she passed away. It was a huge blessing to that family, although it hurt the team tremendously because they wouldn’t let her be replaced and it was a very small team. To this day it’s still a moral dilemma I struggle with, but I’m glad they were able to support her.

Before I started in HIT, I worked at a gas station / convenience store. One of my co-workers was a single mom, barely making ends meet. One day she called the store just after leaving work to say that her car had broken down right around the corner and could she leave it in the parking lot until she found someone to look at it. My boss knew she never put more than a gallon or two in at a time so he told me to grab the store gas can and go see if the issue was that she was out of gas. Turns out that was it. We got the car back to the store and he paid for a full tank of gas for her and a bag full of groceries to boot. It was a relatively small thing, but to this day I don’t think I’ve ever seen anyone more grateful than she was at the time.

Daily encouragement and opportunities to speak up if things feel icky. Reminders of work / life balance and ensuring that, despite being a team that is all over the country / globe, we are 1 @googlecloud @GoogleGenomics

Buying an analyst a case of Diet Mountain Dew for the day of a Go-Live 😎

I gave my employee his choice of hours and location to take care of his wife with breast cancer treatment. My wife went through it, too. It consumes the individual, who really needs the support probably fears losing a high-paying IT job. I said nope, work can wait. We’ll hire some consultants for now.

I used to work down the street from a homeless shelter. Of the three brothers that owned the store, one was known for his grumpy personality. That is, until he hired a homeless woman and gave her cash to cover expenses until her first paycheck. I never let him forget that I was aware of his “soft side,” and that seeing it changed my image of him for the better.

Donating money to help a single, older employee pay for an expensive operation for a beloved pet.

When I first started out on the Rev Cycle business, the owner of the company, a small mom & pop shop at the time,  gave me a car because mine broke down. No excuses to not come to work! 🙂

When my daughter got sick, my employer allowed me to work remotely (2,500 miles away) for the past three years.

About 10 years ago, my new boss was starting our first cybersecurity department and we only had three employees. At Easter he went and bought us all very nice baskets with gourmet chocolate. Our department grew, but at least twice a year, this boss took all of us out to dinner with a guest to a local casino. After a very nice dinner, he got up and laid a $20 bill in front of each of his employees and said lets go have some fun. Just a few of the ways he supported us. Best guy I ever worked for and I try to repeat some of these items with my staff today.

My brother was killed, a victim of a robbery. Wrong place, wrong time. I was a mid-level manager in a software development organization, and had no notion that anyone would attend my brother’s funeral. I was surprised and touched that several people, including the two most senior execs and head of HR, made the 2 1/2 hour trip. My respect and appreciation for those folks rose to a new level as a result of that kindness. Thank you again Tom, Al, and Rita.

I had a project I had to complete, but the dreaded phone call from my son’s school nurse that my son had gotten sick at school. I let my manager know I’d pick up my son and finish the day from home so I could meet my project deadline. My manager assured me that my son was more important and told me to take the time I needed to finish it up. As a working parent, flexibility like this never goes unnoticed and I’m so thankful to have a manager that is so understanding and accommodating.

My last boss was a true nurturer. We had a colleague struggling with a terminal cancer. She arranged for ongoing cards to be collected, signed and sent so that there wasn’t a week that went by without kind words of support, strength, love, and family being shared. Not only was our colleague, but his entire family grateful for that support.

A boss in one division abruptly terminated my employment after many years of outstanding annual performance reviews. The only reason provided was, “I am going to take a different direction.” A dotted line boss in another division did not agree with what was taking place and brought me into his division to start a new business service line. My dotted line, now new boss, had a reputation for being very tough, having unreasonably high expectations, and impersonal. After this career changing event, I learned that you should not judge people by their outward persona. I am forever grateful for his support during an unexpected time of vulnerability and career difficulty that ultimately launched my career to the next level.

When my mother passed away several years ago, my CIO took the time to attend her calling. He had to drive for more than an hour (one way) to get to the funeral home at a time when I know he was extremely busy. He did this for just about everyone in the department who suffered the loss of a loved one.

Drove 3.5 hours one way for visitation of a co-worker’s parent. Pulled someone who had just been given bad news into their office so that person could react in private.

My boss organized my inpatient analyst team to help me move into a smaller house when I was dealing with my husband’s dementia and very poor health. I was so grateful to have the help and they really didn’t have to do that. My boss is fantastic and I am glad to be in his employ.

Weekender 8/3/18

Weekly News Recap

• Global Payments will acquire AdvancedMD from Marlin Equity Partners for $700 million
• Bob Wilhelm (Adreima) joins emergency and urgent care IT vendor T-System as CEO
• Athenahealth reports Q2 results: revenue up 10 percent, adjusted EPS $1.08 vs. $0.51
• Meditech reports Q2 results: revenue up 7.1 percent, EPS $0.65 vs. $0.39
• Cerner reports Q2 results: revenue up 6 percent, adjusted EPS $0.62 vs. $0.61, beating analyst expectations for both
• HHS OIG fines EClinicalWorks $132,500 for failing to file timely reports of patient safety-related software issues
• President Trump nominates Marine Corps veteran James Gfrerer to be the VA’s assistant secretary for IT, commonly referred to as its CIO
• The DoD justifies paying Leidos up to $1.1 billion more for its EHR implementation by mentioning the unstated cost of adding the Coast Guard while redacting the list of “as a service” requirements and their associated costs

Best Reader Comments

We must remember that in the paper or analog days, most clinicians took notes while speaking to patients so that they had a medical record of what transpired during the visit. These notes (SOAP, scribbles, whatever) were retrieved when the patient returned and/or when the clinician revisited the patient (e.g., in the hospital) so that the clinician had a handy memory jogger and/or quick analysis of the patient’s progress, test results, etc. Because the earliest EHRs were based on existing clinician workflows, the EHRs merely copied the paper workflow routines. What’s pitiful is that 40+ years later, the usability factors of the most popular EHRs have not changed, with companies blaming external regulations as the reason entire product rewrites have not occurred to make the EHRs more 21st century (e.g., Facebook-like) and less 20th century, while still storing key information. (Woodstock Generation)

We all knew that was going to be the case. I’ve been on client side where Cerner says, “That wasn’t in the RFP, but for $400k, we can add that in. Gee, thanks.” (Ex-Epic)

I recall launching an evidence-based focused program for a large academic facility, just to learn that the #1 reason we lost out to patients or companies was because the large academic facility on the other side of the same city included a free golf swing analysis. (Katie Goss)

Very insightful. Key insight: provider organizations spent a fortune on an OS, and now they have to go buy apps to get any value out of the effort. (Robert D. Lafsky, MD)

Watercooler Talk Tidbits

Reader donations funded the teacher grant request of Ms. C in California, who asked for two Kindles for programming her middle school class’s Dash and Dot robots. She reports, “With the new Kindle Fires, my class had only increased their passion for computer science and coding. We have been using our robots daily and integrating it in our curriculum to help them learn from many different perspectives. The students are really excited when they come to school and always ask if we will be coding today or using robots.”

A CNBC LinkedIn search finds that Apple’s employee health clinic unit called AC Wellness has hired at least 40 people recently, most of them focused on wellness rather than healthcare services delivery. The program is rumored to be led by Sumbul Desai, MD, previously of the Stanford Center for Digital Health.

A study by non-profit “patent detectives” I-Mak finds that manufacturers of the 12 best-selling drugs in the US have tried to stifle generic competition by filing an average of 71 patents per drug. Each of the top drugs has been on the market for at least 15 years and all but one have gone up in price, with an average hike of 68 percent.

Walmart announces that it will not renew its contract with price transparency technology vendor Castlight Health, with the news sending CSLT shares down 26 percent and forcing the company to embark on a restructuring and cost-cutting project.

The White House issues a rule that will allow less-expensive, short-term health plans, aka “junk plans,” to be renewed for up to three years versus the previous three months. The plans, which are not required to meet ACA requirements, typically don’t pay for prescriptions, pre-existing conditions, mental health, substance abuse, or maternity and may include low lifetime maximum payouts or tiny daily payments for hospital stays. Minimal coverage also gives insurers a profit margin of 50 percent or more on premiums versus the 20 percent maximum as ACA plans require. Everybody understands both the problem these plans solve (high premiums) and those they create (people won’t understand the coverage limits or will become expensively ill while covered by a plan that offers them little financial help). They also create profound questions:

• Nobody can afford the cost of major and/or long-term medical care, so is it OK for people to under-buy insurance such that their short-term cost savings require the rest of us to pay their bills – maybe for life — via Medicaid or cost-shifting charity care?
• Should sicker people to be charged more for insurance or to make them pay a higher portion of their medical bills depending on their risk, the same as most other forms of insurance? What if they can’t afford it?
• Is it OK to be forced into bankruptcy over medical bills?
• Americans barely understood health insurance even with the mandated coverage and easy comparisons the ACA introduced, so what small-print secrets will be stuffed into the plan documents they ignore when buying this new “insurance?”
• Aren’t we really just playing the shell game in allowing providers to charge wildly high prices for health services that provide questionable value while we argue over “who pays” versus “what it costs” in pretending that healthcare is like other services in which smart consumers buy only what they need and shop around for the best price?

Pediatrician, vaccine expert, and author Paul Offitt, MD says in a new book that scientists need to be able to explain themselves concisely in interviews and on social media to offset the passionate but wrong medical ideas spread by celebrities, activists, and politicians. He notes widespread misconceptions about genetically modified organisms and glutens, suggesting looking at the shelves of Whole Foods to see social denialism at work.

A 26-year-old woman who swears that her new diet of only beef, salt, and water cured her depression and arthritis solicits online donations and sells Skype consultations to support her “carnivore diet.” She has also given her year-old daughter nothing but breast milk and beef so far.

Maybe Theranos should have worked on this. A group of four tech-powered pharma anarchists develops plans for a homebrew MicroLab powered by a $30 computer that they’ve programmed to create drugs cheaply, so far allowing anyone to make their own naloxone, HIV drugs, and abortion-inducing drugs. The government and drug companies don’t make it easy for the group to obtain the raw ingredients, so they buy OxyContin from street dealers to modify into naloxone. They explain,

The rhetoric that is espoused by people who defend intellectual property law is that this is theft. If you accept that axiomatically, then by the same logic when you withhold access to lifesaving medication, that’s murder. From a moral standpoint, it’s an imperative to enact theft to prevent murder. So yeah, we are encouraging people to break the law. If you’re going to die and you’re being denied the medicine that can save you, would you rather break the law and live or be a good upstanding citizen and a corpse?

Apple becomes the first company to achieve $1 trillion in market value, having gone from near-bankruptcy to become the US’s most valuable publicly traded company. Hopefully we won’t see a Y2K-type effect from financial reporting technology firms that didn’t anticipate the need to express market cap to 13 digits.  

Tech expert and newly appointed New York Times opinion contributor Kara Swisher weighs in on the naivete of inexperienced, closed-culture, California-happy social media technology executives who won’t acknowledge the harm their products cause:

Facebook, as well as Twitter and Google’s YouTube, have become the digital arms dealers of the modern age. All these companies began with a gauzy credo to change the world. But they have done that in ways they did not imagine — by weaponizing pretty much everything that could be weaponized. They have mutated human communication, so that connecting people has too often become about pitting them against one another, and turbocharged that discord to an unprecedented and damaging volume. They have weaponized social media. They have weaponized the First Amendment. They have weaponized civic discourse. And they have weaponized, most of all, politics.

In Case You Missed It

• News 8/3/18
• EPtalk by Dr. Jayne 8/2/18
• News 8/1/18
• Curbside Consult with Dr. Jayne 7/30/18
• HIStalk Interviews Lillian Dittrick, VP of Actuarial and Healthcare Analytics, Health Alliance Plan
• Monday Morning Update 7/30/18

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