Monday Morning Update 9/23/19

Top News

Campbell County Health (WY) goes on diversion and transfers some patients out after a Friday ransomware attack.

Reader Comments

From XModem: “Re: patients downloading their health data. The government is puzzled why it isn’t happening.” Several recent reports indicate that people aren’t interested in downloading their medical records even though the industry is working frantically to allow them to do so. I’m not a bit surprised since I don’t do it myself and I suspect most HIStalk readers don’t either, so imagine the vast majority of people with high-cost chronic diseases who lack technical knowledge, don’t have consistent insurance and thus aren’t spinning out webs of claims data, or who just don’t worry about their health until they need to. My personal reasons:

• While the general concept of health is ongoing and far-reaching, healthcare is episodic and specific. I don’t really think about my data until I need it for some specific purpose. I don’t think of my health as being limited to what providers have done to me.
• I’m not so sure that those providers have cracked the health code any better than I have, or if so, how much of it is relevant to me. Ample numbers of clinicians fail the “do as I do” test.
• My information is scattered all over the place, much of it within individual provider portals that have their own logins, web addresses, etc.
• I use software when it solves a problem, which is rarely the case with health data.
• Providers aren’t going to look at my self-collected data from other providers anyway in my allotted 15 minutes, so it won’t save me money, prevent unneeded tests, or improve my outcomes.
• Most of what’s important about my health is not available or easy to find in my health records, so the health picture that a provider would get from it would be no more accurate than looking at my car’s oil change history to figure out whether I’m leading a swell life.

From Banner Health Phoenix Nurse: “Re: downtime last week. Cerner went down first, then all the phones. I had noticed Pyxis acting up, monitor displays not connecting with heart monitors, the web-paging tool went down. It was brief, but phones going out all across Banner is crazy!” Unverified. IT people are regularly reminded that ubiquitous connectivity, application integration, and middleware means that downtimes are usually no longer limited to a specific department or physical location. We used to worry mostly about a backhoe cutting a fiber link, an overheated data center, or server failure, but now the potential problem areas are everywhere. You’re not a health IT expert if you haven’t had to explain to the C-suite why a IT-managed phone system, which is just another software application, has gone down and left the hospital disconnected from the entire world.

From Usurious Interest: “Re: readers. Are they Net Promoters of HIStalk?” I barely know what that means, but I’ve learned that regular readers go two ways: (a) they feel HIStalk is useful or enjoyable and want to share it with others; or (b) they are sort of embarrassed that they read amateur-produced news and opinion or they don’t want to share the competitive advantage with peers. The independent Reaction Data of CIOS and CMIOs found HIStalk to be #1 among major health IT sites in readership, influence, generating company interest, providing job-enhancing information, and being recommended most, but even then I’m sure quite a few of those folks don’t broadcast that they’re big fans of Weird News Andy or my musical meanderings. I write for myself, though with the knowledge that others may be reading over my shoulder, occasionally attracting curious passersby.

From Krill Cracker: “Re: hospitals. Business or charity?” Yes. I know of few legally created charities that run such huge and sometimes ruthless bureaucracies, unless it would be behemoths like Goodwill or American Red Cross or perhaps universities. It seems odd that our country in the mid-1960s decided that hospitals need to operate like any other business except with huge government payments, tax advantages, and a carefully crafted image of being selfless while ringing the cash registers.

From Branding Is Life: “Re: new HIMSS conference name. Is it really global? Is it really health?” HIMSS is attempting to bolster its declining attendance by renaming the conference “The HIMSS Global Health Conference.” It is “health” in hawking technology for profit-maximizing providers and it is “global” because it is marketing itself around the world. Otherwise, it’s the same old exhibitor-powered boat show and, seems to me, should be portrayed as such. They say 80% of health has nothing to do with providers, so how is that represented on the show floor?

HIStalk Announcements and Requests

Most poll respondents got their current jobs because of their work history or connections, so I take the career to-do’s as: (a) spend more time creating and maintaining your network; and (b) practice your interview skills.

New poll to your right or here: for those over 50, what do you regret most in life so far? Click the Comments link after voting to provide advice to the younger folks who might change their life’s course as a result of your wise counsel.

The pundits from Pune gave me my best laugh of the weekend in their offer to share their deep health IT knowledge in a $3,500 report.

Webinars

September 26 (Thursday) 2 ET. “Patient Education Data: A Key Ingredient for Improving Quality and Patient Experience.” Sponsor: Healthwise. Presenters: Victoria L. Maisonneuve, MSN, RN, director of the Nursing Center for Excellence and Magnet program, Parkview Health; Marta Sylvia, MPH, senior manager of quality improvement and outcomes research, Healthwise. Healthcare data is everywhere! It’s scattered across various systems and in countless formats, making it difficult to collect and glean actionable information. Knowing where to start depends on what your organization wants to accomplish. By focusing on your patient education data, you can drive quality improvement across your organization. Vicki Maisonneuve will share how her team analyzes data around the use of patient education. By combining different data sets, she can easily identify trends, gaps, and opportunities to improve quality and patient experience across Parkview Health

October 2 (Wednesday) 1:00 ET. “Conversational AI in Healthcare: What About ROI?” Sponsors: Orbita, Cognizant. Presenters: Kristi Ebong, SVP of strategy and GM of healthcare providers, Orbita; Matthew Smith, AVP and conversational AI practice leader, Cognizant. Conversational AI holds great promise to drive new opportunities for engaging consumers and customers across all industries. In healthcare, the stakes are high, especially as organizations explore opportunities to leverage this new digital channel to improve care while also reducing costs. The presenter experts offer a thought-provoking discussion around conversational AI’s timeline in healthcare, the factors that organizations should consider when thinking about virtual assistants through chatbots or voice, and the blind spots to avoid in investing in those technologies.

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

People

David Jones –- the Louisville lawyer who with partner Wendell Cherry created the country’s largest nursing home chain as a side business, then its biggest hospital chain in Humana, and then top health insurer Humana — died last week at 88.

Other

A small observational study finds that ED residents often create EHR documentation of their physical exam and review of systems that doesn’t match what they actually did. Cynics might note that documentation, rather than action or outcomes, drives payment and thus rewards creative writing.

CNBC’s Chrissy Farr sits in on an Amazon PillPack new hire training session for empathy, in which the employees simulate the experience of the company’s senior citizen target audience by wearing mobility-limiting gloves and vision-blurring glasses while working against the clock to redistribute complicated prescription meds into individual day-and-time compartments (which is what PillPack does for them).

A former hospital pharmacy technician is charged with stealing 13,000 doses of controlled substances after she found a bug in its automated dispensing cabinet that allowed her withdraw doses for inactivated nursing unit names.

Weird News Andy titles this story “Left-Handed Compliment.” Surgeons in England create a new tongue for an oral cancer patient by using skin and an artery from her arm. The woman credits cancer psychology counseling sessions for her recovery.

Sponsor Updates

• Lightbeam Health Solutions will exhibit at the AMGA IQL 2019 Conference September 26-27 in Las Vegas.
• Health Catalyst will exhibit at the 2019 Patient Safety, Quality & Sepsis Symposium September 23-24 in Harrisburg, PA.
• Waystar will exhibit at the MedInformatix MISummit 2019 September 24-27 in Pittsburgh.
• NextGate will exhibit at the HIMSS Washington Chapter Innovation Summit September 26 in Seattle.
• Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the Perinatal Partnership Conference September 22 in Concord, NC.
• OmniSys will exhibit at the PDX Chain Link event September 28-October 1 in Fort Worth, TX.
• CereCore congratulates partner Cuero Regional Hospital on its Leadership Culture Award from the Texas Organization of Rural Community Hospitals.
• Phynd joins Epic’s App Orchard, allowing Epic users to search the company’s network of 4.6 million providers and enroll them directly in Hyperspace.
• Experian Health will exhibit at the NAACOS Fall Conference September 25-27 in Washington, DC.
• MadStartups features “Redox Cofounder Niko Skievaski’s journey through Madison’s startup ecosystem.”
• ROI Healthcare Solutions celebrates its 20th anniversary.
• Surescripts will exhibit at FMX 2019 September 24-28 in Philadelphia
• TriNetX will host its annual Summit September 24-25 in Boston.
• Visage Imaging will exhibit at the SIIM Conference on Machine Intelligence in Medical Imaging September 22-23 in Austin, TX.
• Vocera will exhibit at the 2019 Illinois Health and Hospital Association Leadership Summit September 26-27 in Lombard.
• Wellsoft will exhibit at Emergency Nursing 2019 September 28-October 2 in Austin, TX.

Blog Posts

• OIG Series Strategy 2: Engaging Beneficiaries (Lightbeam Health Solutions)
• Prepare Your Hospital for an Active-Shooter Emergency (LiveProcess)
• Strengthening Patient-Provider Relationships and Minimizing Physician Attrition (Loyale Healthcare)
• Progress in the fight against the opioid epidemic (Meditech)
• How Artificial Intelligence Can Overcome Healthcare Data Security Challenges and Improve Patient Trust (Health Catalyst)
• Physical Therapy Practice HIPAA Compliance – 3 things you can do in 30 minutes (MWTherapy)
• Medical Device Security: How to Assess Your Organization’s Readiness in 2019 (Fortified Health Security)
• Why Patient Matching is Crucial in the Fight Against Opioids (NextGate)
• Power in Collaboration: Co-Responder Program Partners with Local Law Enforcement (Netsmart)
• APIs: Your Revenue Cycle’s New Best Friend (Recondo Technology)
• How to improve patient engagement with a data-driven marketing plan (Experian Health)
• PatientBond Achieves Industry-Leading Net Promoter Score (PatientBond)
• Patient on a Healthier Path Following ‘Ping’ Intervention (PatientPing)
• Patient Engagement Tools for a Better Experience (Patientco)
• Embracing Both the Old and the New (SailPoint)
• Five Things to Help You Through SCRIPT v2017071 Migration (Surescripts)
• VUE19: 3 reasons to register today! (Voalte)
• Let’s Celebrate Global PT Day of Service 2019! (WebPT)

Contacts

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

Weekender 9/20/19

Weekly News Recap

• Australia’s Queensland Health struggles with its new EHR and ERP systems.
• Alphabet restructures its DeepMind health business to report to Google Health.
• Warburg Pincus acquires behavioral health and human services EHR company Qualifacts for over $300 million.
• Jonathan Bush (Athenahealth) joins video and office visit provider Firefly Health as executive chair.
• Leidos sells its Leidos Health EHR implementation and consulting business to private equity firm A&M Capital.
• Specialty practice EHR, PM, PACS, and AI chat bot vendor OrbCare is reportedly nearing insolvency just six months after announcing a $2 million seed round.
• Livongo’s shares drop below their July 25 initial offering price after its first quarterly report shows widening losses.

Best Reader Comments

I don’t think people in general really care that much about their information getting out there or the government having it. People hand all their data over to Facebook, there is no organized movement around data leaks, and there has been very weak opposition to the Patriot Act or the Snowden leaks. The reason that we don’t have a national patient identifier is largely a result of it being bad for special interests. In the US political process, if you have a large sum of money you can always drum up “grassroots” efforts to stall legislation or pay politicians in power to pretend to hold a view. (People)

The term “copy / paste” is used excessively in a way that obscures problems with current EMR use. Plagiarizing someone else’s free-text information should be seen as very bad. Regurgitating your own previous note with minimal or no changes is merely bad and more responsible to the note bloat issue cited. But talking about the “past medical history” that autopopulates most EMR notes as if it were somehow reliable and true is naive. At minimum it’s often either incomplete or redundant and, worse, internally contradictory. Worse yet, free text narrative history notes from specialists often contradict medical history imported elsewhere into the selfsame note. Are there any examples where this sort of thing had legal ramifications? (Robert D. Lafsky)

The real irony is that in 1965, the AMA was vehemently opposed to Medicare. They claimed it would ruin the doc-patient relationship and make docs wards of the state. They were right — it has ruined the relationship, and given their income levels today, most of which comes from taxes, they are wards. Poor things. They must be gleeful just thinking about Bernie’s Medicare for all. (Frank Poggio)

Watercooler Talk Tidbits

A sexual harassment lawsuit brought by a since-deceased ED doctor against her hospital employer continues, with her husband claiming that the stress of her boss’s rejected sexual overtures followed by his work-related retaliation led her to die of gallbladder cancer in 2017 at 53.

Several biohackers who believed the health claims of “hydrogen-infused water” company Trusii say they were scammed into taking out high-interest loans of up to $12,000 to buy its home water fountain, with the company promising to send them monthly checks if they posted glowing social media reviews of its health benefits. Trusii’s owners say they’re the victims of mob mentality, it’s their competitors organizing the bad PR, and that they actually overpaid users, some of whom didn’t meet its testimonial requirements. The CEO was arrested in February for alleged scams related to his previous used car business.

University of Michigan will build a $920 million, 264-room patient tower that it says is “an investment in Michigan Medicine’s mission of advancing health to serve Michigan and the world.” Existing semi-private rooms will be converted into private rooms, adding a net bed count of 154 (at a cost of $6 million per bed).

NPR notes that government-employed doctors in Venezuela earn less than $2 per month, forcing them to live on free food provided by local merchants and bus money offered by patients. At least half of the country’s medical employees have left the country or changed jobs, not just because of wages, but because Venezuela’s economic woes under an authoritarian government have left it without medical supplies, drugs, and hospital air conditioning as annual inflation rates have risen to 10,000,000%. Doctors report being fired or threatened for complaining about patient endangerment due to situations such as having to use their cellphone lights to perform surgery.

A 23-year-old Iowa State football fan whose on-camera ESPN College GameDay sign asked viewers to Venmo him beer money receives $1,600 in donations, leading him to decide to buy one case of Busch Light and send the rest of the money to University of Iowa’s Stead Family Children’s Hospital. Anheuser-Busch – owned by Belgium-based InBev – promoted his cause and offered matching funds. The donation total now exceeds $350,000.

In Case You Missed It

• News 9/20/19
• EPtalk by Dr. Jayne 9/19/19
• Shared Medical Systems 50-Year Reunion
• News 9/18/19
• Curbside Consult with Dr. Jayne 9/16/19
• HIStalk Interviews Jeremy Pierotti, CEO, Datica
• Monday Morning Update 9/16/19

Get Involved

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

Morning Headlines 9/20/19

Texas Health Care Fraud and Opioid Takedown Results in Charges Against 58 Individuals

The Justice Department charges 58 people in Texas, including three EHR hackers, for participating in Medicare fraud schemes and operating pill mill clinics that doled out 6.2 million pills at a cost of $66 million.

Queensland Health headaches continue as suppliers aren’t paid on time

Queensland Health Minister Steven Miles takes heat for spending $92 million on supply ordering software that crashed hours after launch.

Telemynd Readies Plan For Mini IPO

Behavioral telehealth and analytics company Telemynd hopes to raise over $8 million in an IPO of its common stock.

News 9/20/19

Top News

Alphabet brings AI innovation unit DeepMind underneath the Google Health umbrella as announced last year.

Alphabet acquired the British company in 2016 for $500 million. It has since embarked on several high-profile projects with the NHS and VA.

The transition comes several weeks after DeepMind co-founder Mustafa Suleyman confirmed an unexplained leave of absence. He headed up the organization’s division that looked for ways to use AI in healthcare and energy, with rumors suggesting that Google plans to take more direct control of that aspect of the business, leaving DeepMind to function mostly as an AI university.

The company, which will maintain its London headquarters, will now report to Google Health VP David Feinberg, MD, MBA, who joined after leaving Geisinger Health as CEO in January.

Webinars

September 26 (Thursday) 2 ET. “Patient Education Data: A Key Ingredient for Improving Quality and Patient Experience.” Sponsor: Healthwise. Presenters: Victoria L. Maisonneuve, MSN, RN, director of the Nursing Center for Excellence and Magnet program, Parkview Health; Marta Sylvia, MPH, senior manager of quality improvement and outcomes research, Healthwise. Healthcare data is everywhere! It’s scattered across various systems and in countless formats, making it difficult to collect and glean actionable information. Knowing where to start depends on what your organization wants to accomplish. By focusing on your patient education data, you can drive quality improvement across your organization. Vicki Maisonneuve will share how her team analyzes data around the use of patient education. By combining different data sets, she can easily identify trends, gaps, and opportunities to improve quality and patient experience across Parkview Health.

October 2 (Wednesday) 1 ET. “Conversational AI in Healthcare: What About ROI?” Sponsors: Orbita, Cognizant. Presenters: Kristi Ebong, SVP of strategy and GM of healthcare providers, Orbita; Matthew Smith, AVP and conversational AI practice leader, Cognizant. Conversational AI holds great promise to drive new opportunities for engaging consumers and customers across all industries. In healthcare, the stakes are high, especially as organizations explore opportunities to leverage this new digital channel to improve care while also reducing costs. The presenter experts offer a thought-provoking discussion around conversational AI’s timeline in healthcare, the factors that organizations should consider when thinking about virtual assistants through chatbots or voice, and the blind spots to avoid in investing in those technologies.

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

Acquisitions, Funding, Business, and Stock

Robin Healthcare raises $11.5 million in a Series A round. The company’s digital Robin Assistant captures clinical notes through audio and optional video during an appointment and transmits them to the provider’s EHR.

PE Hub reports that Warburg Pincus has acquired behavioral health and human services EHR company Qualifacts for over $300 million.

Sales

• In Kenya, Aga Khan University chooses Meditech Expanse, which it will implement in Kenya, Pakisan, Afghanistan, and Uganda.
• Rush Health Systems (MS) will implement Epic as provided by Ochsner Health System (LA).

People

Collective Medical names Vatsala Pathy (Rootstock Solutions) VP of policy.

Announcements and Implementations

Covenant Health (TN) implements Wolters Kluwer Health’s UpToDate Advanced and Lexicomp interactive clinical decision support and drug information tools.

3M Health Information Systems announces GA of AI-enhanced CDI software that incorporates natural language processing technology from MModal, which it acquired in February.

Health First (FL) implements Privia Health’s proprietary practice management technology, including EHR, patient portal and app, and online scheduling.

A new KLAS report on the use of Epic Community Connect in practices of 1-10 physicians finds that Epic performs better than most small-practice EHR vendors in the areas of value and system performance; the practices are happy with integration with local ACOs and IDNs; and nearly all would choose Epic again. However, Epic’s usability scores lagged due to deep but not necessarily relevant functionality and cumbersome workflows. Unrelated to Epic itself, most users aren’t happy with the support they receive from their host organization, with some striking deals with Epic itself or seeking a different host. 

Government and Politics

In Australia, Queensland Health Health Minister Steven Miles assures the press that a full review of the recent five-hour Cerner EHR outage at 14 hospitals is underway. He’s also taking heat for the state’s $92 million supply ordering system, which crashed hours after launch on August 1. One frustrated politician says it’s become almost impossible for nurses to order basic items. “Nurses having to put Band-Aids on the corporate bank card is absolutely appalling. Last week I heard nurses were actually buying food for patients from Woolworths. This is just absolutely ridiculous.”

The Justice Department charges 58 people in Texas for participating in Medicare fraud schemes and operating pill mill clinics that doled out 6.2 million pills at a cost of $66 million. Three of those charged broke into a provider’s EHR to steal patient data that they then sold to durable medical equipment providers and contractors for $1.4 million.

Other

In Arizona, Summit Healthcare Regional Medical Center’s August 1 switch from eight separate systems to Allscripts Sunrise has left many patients frustrated by long waits, chaos in the ER, and difficulty obtaining prescriptions. Numerous down times have occurred, creating backlogs in several departments. An executive admits, “We did have issues and we know we had things that didn’t work at first. Going from eight systems to one, you practically have to reinvent the wheel.”

A Colorado man whose bachelor party hangover led him to seek rehydration in a freestanding ED generates a bill for $12,600, double the cost of the wedding itself. For that, he received two IV bags of saline and a dose of the anti-nausea drug Zofran, which the facility says justified a severity of four on a five-point scale and thus a facility fee of $7,644. The insurer’s negotiated price and payment left him with a balance of $2,600, which he says he can’t pay. Rural Colorado has only eight freestanding EDs and all of them in affluent ski resort towns. This one is owned by publicly traded hospital operator HCA. It says it has to overcharge patients with insurance because it can’t turn away those who can’t pay. The article notes that a local, spa-like hangover treatment center offers basically everything the groom received for $168.  

Sponsor Updates

• Elsevier Clinical Solutions will exhibit at CAP19 September 21 in Orlando, FL.
• EClinicalWorks will exhibit at the AMA’s 2019 FMX September 25-27 in Philadelphia.
• Ellkay will exhibit at the Mayo Leveraging the Laboratory event September 24-25 in Nashville.
• Ensocare will exhibit at the ACMA Maryland Chapter Annual Conference September 21 in Hunt Valley, MD.
• Greenway Health will exhibit at the Virginia MGMA Fall Conference September 22-24 in Williamsburg.
• InterSystems will host Global Summit 2019 September 22-25 in Boston.
• Kyruus publishes a new case study, “How Providence St. Joseph Health Increased Visibility into a Growing Provider Network to Boost Demand Conversion and Improve the Patient Experience.”
• AlayaCare adds Waystar’s RCM capabilities to its home care software.
• Madison Magazine names Nordic as the best place to work in Madison, WI. 
• Nuance develops pediatric-specific versions of its clinical communication, documentation, and analytics software.
• Kyruus adds Uber ride-sharing capabilities to its ProviderMatch appointment-booking software for hospital access centers.

Blog Posts

• Congratulation to our MVPs (EPSi)
• A CIO’s guide to cloud success: decouple to shift your business into high gear (Google Cloud)
• 2 steps to boost technology use and avoid burnout (Greenway Health)
• Sepsis Awareness Month: Shocking Levels of Community Acquired Sepsis (HBI Solutions)
• Leading Thoughts: It’s Hard to Shine When Health IT is Burned Out (HCTec)
• 3 Things Most People Don’t Know About Healthfinch (Healthfinch)
• Stop Guessing About Your Patient Satisfaction Scores (Healthwise)
• Improve Data Archiving with an Applications Portfolio (Impact Advisors)
• Healthcare Value Unbounded (InterSystems)
• How to be a modern healthcare organization without forgetting to pay the electric bill (Nordic)

Contacts

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

EPtalk by Dr. Jayne 9/19/19

Patient engagement is a hot topic in US healthcare, so I’m always interested to see how it plays out in other countries. A recent effort looked at the challenges of treating tuberculosis, specifically in ensuring that patients take their medications consistently during the six months needed to eradicate the disease. Patients in Nairobi, Kenya were enrolled in a program that delivered repetitive cellphone texts to encourage patients to take their medications. Those who participated had fewer negative outcomes compared to the control group. The texts ask patients to actively confirm that they have taken their medications. Those who responded were thanked and informed of their standings compared to other patients, including whether they made it to the “winners circle” for those with 90% adherence. Non-responsive patients receive additional texts, phone calls, and potentially in-person case tracking.

Stanford Medicine has launched a digital consult service to assist in diagnosis of challenging patient cases. They parallel the offering on the “curbside consult,” where physicians ask their colleagues about a case, hoping to draw from experience and past patients. The Clinical Informatics Consult solution has been in the works for more than a decade, and is currently live as a research project that can query data from millions of patients. Clinicians submit a clinical query and receive a report with summaries of similar patients in Stanford’s clinical data warehouse, including how they were treated and what outcomes resulted. The team has responded to over 150 consult requests from Stanford physicians. Developers hope that other academic hospitals may be able to use similar technology to help their own physicians.

I was recently asked to provide a reference for a former employee. The process was conducted using an online portal called SkillSurvey. The company claims to provide a data-driven hiring approach to assist employers in identifying job-related competencies along with soft skills. According to their data, 85% of references typically complete the company’s online survey and most do so within two days. Employers receive a report that claims to be predictive of a candidate’s chances for a successful first year on the job. The data shows how a candidate ranked across multiple references which sure sounds like more fun than trying to compare screening notes from HR staffers that don’t completely hit the mark, as I frequently experienced in a past life.

They didn’t go into the detail of how a potential employee likes to do their work, which I think would also provide useful data points prior to hiring. I recently had to have a “counseling” opportunity with an employee who thinks that trying to do the majority of your work on a smart phone is a good idea. Consultants are always busy, but they need to figure out what you can get away with doing on a small-format device and what requires you to just park yourself in front of a laptop or desktop. The biggest issues I tend to see with phone-related work behaviors are these: failing to see all of the recipients on an email before replying to all (especially when the reply is inappropriate for the entire audience); failure to see email attachments; difficulty adequately managing the calendar because of limited screen real estate; increased typos; and failure to read the entire email before responding, leading to comments that waste other people’s time. I’m all about being able to be mobile, but sometimes you just need to do your work on a big screen and with a keyboard.

A colleague of mine keeps trying to recruit me to the Medici platform, which offers everything from secure physician-patient communication and referral routing to billable audio/video consultations and ePrescribe services. Their marketing is straightforward, listing three simple steps to allow you to “get paid for texting with your patients.” Many physicians might not understand the nuances of what it means to begin using a service like theirs, particularly with regards to how those patient-physician communications get documented in the patient chart (or perhaps not) and whether the auto-translation features it offers are accurate. The company also offers texting with other professionals, such as veterinarians. The Austin-based startup has raised $46 million and has used analogies to identify themselves alternately as the Uber of healthcare or the WhatsApp of healthcare. I’m not sure of the origin of their name, but of course it reminds me of the Medici family, who schemed their way through Tuscany in the 15th and 16th centuries.

Speaking of telehealth apps, Planned Parenthood has entered the telemedicine space with the launch of their new app, Planned Parenthood Direct. It offers birth control options, including contraceptive pills, patches, and rings, along with treatment for urinary tract infections. The app is live in 27 states and the District of Columbia, with plans to expand to all 50 states by next year. It also allows patients to book in-office appointments for other contraceptive services such as IUDs, implants, and injections.

I recently encountered a situation where an elderly family member was receiving unneeded screening tests on the recommendation of their physicians. Knowing the physicians in question, I had a couple of suspicions. The first physician is part of a large medical group owned by a hospital system that sees itself as a major player in value-based care, and I wondered whether it was easier for him to just order screenings rather than exclude the patient in their crazily complicated EHR. The second is an independent physician who was ordering tests that would mostly lead for profit for his practice, which was particularly disturbing because the tests in question are invasive. A recent article in the Journal of the American Medical Association adds another scenario, which is the possibility that physicians don’t want to stop ordering screening tests because it will make them seem like they’re giving up on their patients. The decision to provide less care for older patients is a difficult one, and I hope more physicians, patients, and families are up to the task given the size of our aging population.

Sometimes companies don’t have the wherewithal to perform the difficult tasks that need to be done within an organization, so they bring in consultants. I’ve been on both sides as companies use consultants to downsize unwanted employees or deliver other reorganization strategies. It’s unsavory and has even been the stuff of movies such as “Up In the Air” with George Clooney. Having been party to horrific termination meetings in the past, I really enjoyed this piece about a New Zealand employee bringing an emotional support clown to his own firing. The clown mimed crying as the employee was fired and created balloon animals, even though they were a bit noisy. Kudos to the employee for having a sense of humor and being willing to spend $200 to give his former employer something to talk about.

Email Dr. Jayne.

Morning Headlines 9/19/19

Robin Healthcare Raises $15 Million to Build Digital Assistant for Doctors, Launches Partnerships with Leading Health Systems, and Adds Siri Co-Founder Tom Gruber as Advisor

AI-powered clinical documentation company Robin Healthcare raises $11.5 million in Series A funding led by Norwest Venture Partners.

DeepMind’s health team joins Google Health

Alphabet’s AI-focused DeepMind subsidiary officially becomes a part of Google Health.

Review under way into major Queensland hospital software crash

Queensland Health Minister Steven Miles assures the press that a full review into last week’s five-hour Cerner EHR outage at 14 hospitals is underway.

Warburg snaps up Qualifacts in $300 mln-plus deal, following larger bet for WebPT

PE Hub reports that Warburg Pincus has acquired behavioral health and human services EHR company Qualifacts for over $300 million.

Shared Medical Systems 50-Year Reunion

Vince Ciotti attended the recent reunion of former employees of SMS. He sent some photos, augmented by those of SMS veteran Bob Haist (his photos label those employees whose names he jotted down).

We held the 50th reunion of early employees of Shared Medical Systems (SMS) this past Saturday, September 14 in King of Prussia, PA, the location of its early HQ. An amazing count of 140 ancient “King of Prussians” showed up, about 100 former employees and 40 (bored) spouses. It was quite a treat to see so many old friends, recognize their faces, and actually remember many of their names.

The highlight of the evening was an introductory speech by Harvey Wilson, co-founder of SMS in 1969. Harvey founded SMS along with Jim Macaleer, who sadly passed away quite recently, and Clyde Hyde, who passed away far too many years ago.

You may recognize Harvey’s name as the founder of Eclipsys in the mid-1980s, an early EMR vendors that he later sold to Allscripts. It is incredible that one man could be the founder of two of the leading vendors in the HIS industry!

Check-in (show your Medicare card).

Amazing how good SMS co-founder Harvey Wilson looks after all these years!

Harvey’s introductory speech gave most of the credit for the company’s success to its hard-working employees.

On the left is Keith Phillips, an early marketing superstar, trying to stop me on the right from guzzling too much Chianti.

Another leading SMS executive from those days was Karl Witonsky, VP of development, in center in the back in the blue sweater. He gave a moving speech about life in the early days of IBM mainframe computing.

Another leading SMS veteran was Ken Shumaker, with a beard in the center, drawing a diagram of how he programmed Unifile.

See also a PDF of Bob Haist’s photos with names.

Morning Headlines 9/18/19

Millions of Americans’ Medical Images and Data Are Available on the Internet. Anyone Can Take a Peek.

A ProPublica investigation identifies 187 Internet-accessible, unsecured servers that hold the medical information of 5 million Americans.

OrbCare is Bankrupt and Looking for a Buyer After Misrepresented Finances and Debt

Toronto-based specialty practice EHR, PM, PACS, and AI chat bot vendor OrbCare is reportedly nearing insolvency just six months after announcing a $2 million seed round.

Rush Health Systems and Ochsner Health System Announce Strategic Partnership

Rush Health Systems will gain access to Epic and telemedicine capabilities through a new partnership with Ochsner Health System.

Navigating Cancer, the Leader in Oncology Patient Relationship Management, Receives $26 Million in Oversubscribed New Funding

Oncology-focused patient relationship management vendor Navigating Cancer raises $26 million in a Series D round of financing.

News 9/18/19

Top News

Jonathan Bush (Athenahealth) joins video and office visit provider Firefly Health as executive chair.

Bush’s appointment was announced in the same press release as the company’s $10.2 million Series A funding round.

The two investment groups taking part in the funding round – F-Prime Capital and Oak HC/FT — are represented by former Athenahealth executives Carl Byers and Nancy Brown, respectively. 

Firefly’s founders are from Harvard Medical School.

Firefly bills a patient’s insurance for co-pay and video visits, with no charge for messaging. In-office visits are conducted only in Wellesley, MA, and the company does business only in that state. Firefly says it will “enter several new markets” in 2020.

Reader Comments

From Wall Flyer: “Re: Leidos Health. Sold to private equity firm A&M Capital last week. I’m interested in your perspective of what this might mean. Leidos Health was the commercial healthcare business unit of Leidos, which essentially consisted of MaxIT and Vitaliz that were purchased by SAIC before spinning off into Leidos and Leidos Health.” Verified that the commercial EHR implementation business has been acquired, although I don’t have deal details yet since the announcement isn’t scheduled to come out until next week. The DoD’s Cerner project isn’t included — Leidos runs that project through its federal business unit. The portfolio of A&M Capital Partners includes government health IT contractor CNSI, which it acquired in April 2018. I’ll probably have more to say once I see the announcement. UPDATE: The Leidos PR contact graciously offered to answer my questions ahead of the announcement:

• The affected business unit is Leidos Health, LLC, which does healthcare staff augmentation and EHR implementation and optimization work, basically the former MaxIT Healthcare and Vitalize Consulting Solutions.
• About 850 Leidos employees will transfer to A&M Capital.
• The reason for the sale is, “This transaction emphasizes Leidos’ focus on what it does best – creating and delivering solutions and services that drive improvements in patient care and make managing and delivering healthcare less costly and more effective. Additionally, the sale aligns the commercial EHR staff augmentation services business with a parent company that has a robust growth strategy that provides increased opportunities for employees focused on commercial EHR implementation services.”
• The DoD’s MHS Genesis is not affected. It is operated the federal business unit of Leidos.
• Terms of the sale will not be announced.

From Who Dis: “Re: HIMSS20 keynote speakers. They just announced Chris Christie (former Governor of NJ) and Terry McAuliffe (former Governor of VA) for the Friday morning session. Does that change your mind about attending?” It confirms the wisdom of my decision to skip the last day, as I always do. I doubt that even the few folks who stick around all week will be anxious to hear more political yammering. I’ll spend that time waking up at home or at the beach (maybe Chris Christie will join me). I’m more interested in who gets the primetime agenda slots, which usually ends up being some minor celebrity (Dana Carvey comes to mind as one of the worst, with Dennis Quaid a distant second) or big-company executives. My wild guesses for the good spots: someone from “Shark Tank” (Robert and Mr. Wonderful spoke at HIMSS17), Barack Obama, Malcolm Gladwell, Nicholas Webb, David Feinberg or Toby Cosgrove from Google, Amy Abernethy from the FDA, Sean Parker, Jay Leno, Bill Gates, or someone from Walmart or Amazon. My off-the-wall suggestions, who you can Google if you don’t know them: Jen Gunter, MD; Ken Jeong, MD; Jonathan Bush; Devi Shetty, MBBS; Elizabeth Holmes (or John Carreyrou in her probable absence); Atul Gawande, MD (since he bailed out this year); Stephen Bergman, MD, PhD (aka Samuel Shem); and Neil Pappalardo. I would have said Martin Shkreli, but he’s still in prison, although maybe he can tele-keynote.

Webinars

September 19 (Thursday) 1:00 ET. “ICD-10-CM 2020 Code Updates.” Sponsor: Intelligent Medical Objects. Presenters: June Bronnert, MSHI, RHIA, director of terminology mapping, IMO; Theresa Rihanek, MHA, RHIA, classification and intervention mapping lead, IMO; and Julie Glasgow, MD, senior clinical terminologist, IMO. The 2020 regulatory release is right around the corner. Join IMO’s top coding professionals and thought leaders as they discuss new, revised, and deleted codes; highlight revisions to ICD-10-CM index and tabular; discuss changes within Official Coding Guidelines; share potential impacts of the code set update; and review ICD-10-CM modifier changes.

September 26 (Thursday) 2:00 ET. “Patient Education Data: A Key Ingredient for Improving Quality and Patient Experience.” Sponsor: Healthwise. Presenters: Victoria L. Maisonneuve, MSN, RN, director of the Nursing Center for Excellence and Magnet program, Parkview Health; Marta Sylvia, MPH, senior manager of quality improvement and outcomes research, Healthwise. Healthcare data is everywhere! It’s scattered across various systems and in countless formats, making it difficult to collect and glean actionable information. Knowing where to start depends on what your organization wants to accomplish.  By focusing on your patient education data, you can drive quality improvement across your organization. Vicki Maisonneuve will share how her team analyzes data around the use of patient education. By combining different data sets, she can easily identify trends, gaps, and opportunities to improve quality and patient experience across Parkview Health.

October 2 (Wednesday) 1:00 ET. “Conversational AI in Healthcare: What About ROI?” Sponsors: Orbita, Cognizant. Presenters: Kristi Ebong, SVP of strategy and GM of healthcare providers, Orbita; Matthew Smith, AVP and conversational AI practice leader, Cognizant. Conversational AI holds great promise to drive new opportunities for engaging consumers and customers across all industries. In healthcare, the stakes are high, especially as organizations explore opportunities to leverage this new digital channel to improve care while also reducing costs. The presenter experts offer a thought-provoking discussion around conversational AI’s timeline in healthcare, the factors that organizations should consider when thinking about virtual assistants through chatbots or voice, and the blind spots to avoid in investing in those technologies.

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

Acquisitions, Funding, Business, and Stock

The New York Times confirms that two big financial backers of Doctor Patient Unity – which has spent $28 million to squash proposed legislation that would eliminate surprise medical billing – are the private equity-owned physician staffing and practice operators TeamHealth and Envision Healthcare, which make fortunes sending out-of-network bills. Just in case you’ve forgotten that healthcare is a big business, Blackstone Group bought Team Health for $6.1 billion in 2016 and KKR took over Envision Healthcare in 2018 for $9.9 billion. DPU warns that hospital will close and doctor shortages will arise if the government requires companies to accept the median in-network payment instead of whatever inflated amounts they dream up. They advocate for independent dispute resolution instead, which is already the standard in New York. 

Toronto-based specialty practice EHR, PM, PACS, and AI chat bot vendor OrbCare is reportedly nearing insolvency just six months after announcing a $2 million seed round. The company’s problems came to light when one of the investment firm’s partners, who had been announced as OrbCare’s new COO, found that its monthly revenue was half of what it had reported. The founder and CEO gave a variety of excuses – he was dealing with family matters, the company’s debt was incurred after the funding round, revenue was reported for clients who ultimately never signed up, he intentionally did not share a re-filed financial report with investors, and he never intended to be CEO in the first place. The investment firm provided a $1.2 million loan and has offered another $1.2 million to buy the company in a stalking horse bid. I don’t know how good its products are, but it sure has a bunch of them, so perhaps there’s intellectual property in play.

People

Cerner hires Darrell Johnson (Medtronic) to the newly created position of chief marketing officer.

Pivot Point Consulting promotes Keith Olenik to VP of revenue cycle services.

Vince Vitali (Vitali & Associates) joins NextGate as VP of strategy and business development.

Ricci Mulligan (Leidos Health) joins Grant Thornton’s healthcare practice as director. She previously held leadership roles the VA’s OIT department and retired from US Army Intelligence after 21 years.

Government and Politics

A woman who bought her family short-term health insurance (aka a “junk plan”) gets a $244,000 hospital bill after her husband’s emergency bypass surgery. Her plan didn’t cover pre-existing conditions and limits hospital payments, so it covered only $4,000. She says “negative stories” had kept her from buying real insurance through Healthcare.gov, which she found afterward would have cost her less than the junk plan’s $400 per month premium. The real beneficiary was publicly traded insurance broker Health Insurance Innovations (HIIQ), whose share price tripled from 2016 to 2018 as its annual revenue grew to $350 million, valuing the founder’s stake at $150 million at its peak and earning its CEO $14 million since 2016. A White House executive order expanded the scope of short-term plans, resulting in a six-fold increase in policies since the end of 2018 to  600,000. Big insurers have jumped on board since they aren’t required to spend 80% of premiums on claims like they are for ACA-compliant plans, and in fact are averaging just 39%, making the plans highly profitable with minimal regulation. Meanwhile, HIIQ just paid $70 million to acquire a company that sells insurance via TV ads to senior citizens, so it sees promise in the “low-hanging fruit in the over-65 space.”

Privacy and Security

A ProPublica investigation identifies 187 Internet-accessible, unsecured servers that hold the medical information of 5 million Americans. Many of those records belong to mobile X-ray provider MobilexUSA – whose parent company Trident USA is operating under Chapter 11 bankruptcy – but the company says it has beefed up security after being notified of the exposure by ProPublica. DICOM overseer Medical Imaging & Technology Alliance says that secure connection capability was added to the standard in 1999 and any lack of security is the responsibility of the operator, but adds that some of the insecure systems don’t contain live patient information and instead are being used for product development and testing.

Other

Cardiac surgeon and India hospital operator CEO Devi Shetty, MBBS makes some fascinating points in an interview:

• Doctors will continue to be the most important people in a hospital, but they will need to be backed by skilled executives who know how to run the business.
• The MBBS (MD) degree has lost its relevance because specialists make the broadest impact. He says lack of safe surgery kills 70 million people in India each year and 90% of India’s healthcare problems could be solved with emergency C-sections, laparotomy for burst appendix, and compound fracture repair.
• Analytics holds great promise in healthcare, but 95% of hospitals in India don’t use EHRs, which is why his Narayana Health built its own after finding commercial products lacking.
• Shetty’s hospitals perform 15% of all heart surgeries that are done in India and the company is using the huge volume of data that results to predict outcomes.
• He does ICU rounds using Microsoft Kaizala encrypted mobile messaging and will soon have access to cardiac monitor live streaming.   
• Shetty says that the keyboard is the biggest roadblock in capturing and using information. He predicts that voice-powered phone apps will overcome loneliness in elderly people by providing alarms, reminders, physiologic monitoring, and wellness checks.
• He scoffs at the idea that AI will replace radiologists, saying that as with airline pilots, radiologists who use AI will replace those who don’t.
• Shetty predicts that India will “become the first country in the world to disassociate healthcare from affluence,” unlike every other country where the cost of healthcare rose with incomes.

A husband and wife are charged in federal court with stealing trade secrets from Nationwide Children’s Hospital (OH), where they worked as exosome researchers. They are charged with selling the results of their research through companies they formed in the US and China. They also filed four patents in China. The indictment calls for the couple to forfeit $876,000 in cash, $450,000 in stock payments, and their shares in two biotech companies. The FBI is also investigating possible ties to the Chinese Communist Party and the Chinese government-sponsored “Thousand Talents Program” that encourages its citizens who work abroad to return to China with their newfound knowledge. The couple’s attorney scoffed at most reporter questions with the response, “Research while Asian.”

Sponsor Updates

• Audacious Inquiry prepares blessing bags for the Manna House in Baltimore.
• AdvancedMD will exhibit at WebPT’s Ascend Conference September 19-21 in Minneapolis.
• Arcadia Healthcare Solutions will exhibit and present at the NAACOS 2019 Fall Conference September 25-27 in Washington, DC.
• Bluetree and Dimensional Insight will present at IntegraTe HIMSS South Florida September 24 in Davie, FL.
• CarePort Health will exhibit at ACMA Maryland September 21 in Hunt Valley, MD.
• Clinical Architecture will exhibit at the InterSystems Global Summit September 22-25 in Boston.
• Redox joins the Allscripts Developer Program and earns its first global integration engine certification.
• CompuGroup Medical will exhibit at the AZ MGMA Conference September 24-25 in Chandler.
• Rob Gallo joins The Chartis Group’s informatics and technology practice as a principal.
• CoverMyMeds will exhibit at the PCMA Annual Meeting September 23-25 in Scottsdale, AZ.
• Cumberland Consulting Group will lead sessions at the Medicaid Drug Rebate Program Summit September 23-25 in Chicago.
• Diameter Health will host its 2019 Customer Forum October 2-4 in Dedham, MA.

Blog Posts

• Make sure patients keep their appointments (AdvancedMD)
• Patrick Conway led the industry in healthcare transformation at CMS. At Blue Cross NC, he’s not stopping. (Advisory Board)
• NAACOS Can’t-Miss Discussion: Contracting with Commercial Payers (Arcadia Healthcare Solutions)
• Going Mobile: Creating Experiences that Matter with the Avaya Mobile Experience (Avaya)
• 50 Best HIPAA-Compliant Cloud Storage Solutions, Part 2 (Datica)
• IT Strategy – Planning for 2022 and Beyond (Optimum Healthcare IT)
• Helping You Navigate CMS’s Proposed Rule for 2020 (ChartLogic)
• Burnout is an Occupational Hazard, Here’s How to Mitigate It (Collective Medical)
• A Pillar of Stability in Historic Franklinton for 114 Years (CoverMyMeds)
• Patient Access – Staffing (Culbert Healthcare Solutions)
• Dimensional Insight Sponsoring St. Jude Walk/Run Boston (Dimensional Insight)
• Tips for a Smooth Health Information Technology (HIT) Hiring Process (Divurgent)

Contacts

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

Morning Headlines 9/17/19

Firefly Health Closes $10.2 Million Series A Funding Round to Expand New Primary Care and Patient Experience Platform

Primary care startup Firefly Health raises $10 million in a Series A funding round and names Jonathan Bush executive chairman.

VA Launches VITAL Training Ahead of First Electronic Health Records Rollout

The VA launches an 18 month-long EHR training program for 76 providers ahead of the Cerner system’s 2020 roll out at VA facilities.

Cerner Announces New Chief Marketing Officer

Former Medtronic executive Darrell Johnson joins Cerner as its first chief marketing officer.

HMS Acquires VitreosHealth

HMS acquires predictive analytics company VitreosHealth for $36.5 million.

Curbside Consult with Dr. Jayne 9/16/19

This week was one of those where I question my life decisions, particularly the one where I chose to spend my clinical time in the emergency department.

Due to a perfect storm of maternity leaves, provider illness, and other factors, I ended up working entirely too many shifts in a row, which always leaves me feeling a little overwhelmed. Twelve-hour shifts are never only 12 hours, and once you get home, scare up some dinner, and deal with any urgent home issues, it’s time to hit the sack and get ready to do it again.

The mix of patients I saw this week says a lot about what is going on with our healthcare system (or lack thereof). There were too many patients who had put off care due to fear of excessive costs or high deductibles, which unfortunately led to even higher costs due to complications. Quite a few patients tried to receive care from their primary physicians, but were stymied by lack of available appointments (and sometimes by lack of someone even calling them back). There were also far too many patients who didn’t need to be there, those who hadn’t even tried a shred of self-care before deciding to come in.

As a clinical informaticist, times like these always make me think of whether there are viable technology solutions we could bring to bear on the problem. There are a host of solutions that can help, and some of them are already being employed across the country – patient portals, virtual visits, after-hours nurse coverage, remote patient monitoring, medical advice apps, and more. Sometimes these solutions do more harm than good, such as when test results are released to anxious patients before their physicians have contacted them regarding the results.

I cared for one of these patients this week. She received results through the patient portal on a Friday night and was unable to reach her physician. The results included an abnormal imaging study and some vague radiology references to “clinical correlation needed.” The patient, who already had a diagnosis of anxiety, began to have panic attacks after consulting Dr. Google, and those panic attacks manifested as chest pain. Since she had risk factors, we were obliged to work her up with an EKG and cardiac enzyme testing. Many hundreds of dollars later, she was sent home with a better explanation of her results and a recommendation to follow up on Monday with her primary physician.

Some hospital systems embargo their results until the ordering physician has contacted the patients, while others auto-release results after a predetermined delay. This particular facility releases its results on a delay, but apparently the ordering physician was much delayed in his discussion with the patient, leading to the situation.

Although technology can help the provider streamline his or her inbox and make more time for handling results such as these (as can delegation, improved office workflows, and more), there aren’t too many other tech solutions to this problem. It all boils down to capacity – whether the provider is able to care for patients in the manner in which they want to be cared for, on a timeline that is acceptable to them. The patient empowerment movement has shown us that what is acceptable to one patient isn’t always acceptable to others, and that we need to learn to meet patients where they are at if we want to deliver care that works for them. This is challenging for providers and organizations that weren’t trained this way and whose behaviors aren’t incented in this regard.

Despite all of our talking about value-based care, there are still too few organizations practicing what they preach. Patients also don’t always understand how to operate in these systems.

I had several community physicians yell at me recently because their patients were in my ED. These physicians, who are part of a notoriously controlling hospital physician group, were upset that their patients were in the “wrong” facility. I certainly didn’t go out and drag them in off the street, but I was on the receiving end of rants that were largely triggered by the fact that the whole system is broken. Now those patients are going to show up on some leakage report, and there will be many hours spent trying to build systems to try to make sure they go to the “right” facility next time.

Of course, my facility is part of the problem. Since our state has a weak HIE and there’s no easy way for me to access the patients’ records, I likely ordered unnecessary testing, which just further stresses the system. One of the docs suggested I just use the patient’s phone to parse through the patient chart, but that’s not a realistic solution either in a busy ED where it’s easier to just re-run the labs. I hate being part of the problem, but sometimes you have to choose the least of the evils in front of you.

There are so many cool tech solutions out there that I can’t keep up with them all – chatbots that help community health centers better communicate with their patients, apps to support chronic care management, telehealth platforms, virtual care, and more – but we’re still lacking in basic interoperability. We don’t even have a universal patient identifier to tie records to, even if we could tie them all together. What if each patient had a universal identifier card and we could query a master database for the patient’s record when they came in?

Some of the patients I saw during my recent experience with global healthcare described systems like that from their home countries. Our culture is different in the US, though, and it feels like patients wouldn’t be willing to accept something like that due to risks of privacy or having the government have their data. The reality is that a lot of our data is already out there anyway.

If you asked physicians and healthcare providers whether they would be willing to give up some level of privacy for the sake of better medical accuracy or a more complete record, I wonder what they would say? I certainly would, especially knowing the pitfalls of having inaccurate or missing data and knowing how much it costs to repeat studies that are already documented somewhere but just aren’t accessible at the time they are needed. Even when I can track down results, they’re almost always faxed to our front desk rather than being consumable within the electronic chart.

Since my state isn’t exactly a hotbed of data sharing, I’m curious how others operate in this environment or whether the grass is really greener on the other side of the fence.

Do you have a complete picture of your patients’ health? What would it take to make that happen? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Jeremy Pierotti, CEO, Datica

Jeremy Pierotti is co-founder and CEO of Datica of Minneapolis, MN.

Tell me about yourself and the company.

I’ve been working in healthcare IT for about 20 years. I started off working at Allina Health in Minneapolis and ended up doing consulting. Then I co-founded Sansoro Health. Sansoro and Datica merged in June 2019, with the go-forward company name being Datica. We help healthcare move to the cloud by addressing compliance and data integration challenges.

What can the merged companies do more effectively than they could have done as separate organizations?

We knew that healthcare is moving to the cloud at an accelerating pace. As Travis Good and I started talking, we recognized that we had a complementary set of products, technologies, and team talent, and that if we put the companies together, we could help digital health engineering teams address the two challenges that they have to solve. Those are cloud compliance — which increasingly means meeting the HITRUST CSF requirements — and data integration, being able to exchange data bi-directionally between lots of different digital health applications. Electronic health records, but also all the different supporting systems that every health system runs.

How far along is healthcare in its seemingly inevitable move to the cloud?

It is toward the beginning of its journey, and it’s going to move fairly quickly. We’ve read lots of reports that show anywhere from 10 to 20% CAGR growth over the next five to seven years, and we’re experiencing that ourselves.

Like every other industry, healthcare is recognizing that what the cloud brings is not just running your software on somebody else’s computer in a data center that they manage, but providing access to a whole new set of tools for data analytics, supporting mobility, and integrating lots of types of data from lots of sources. You just can’t develop software with those features using an on-premise architecture. You are increasingly seeing large companies develop their new applications on a public cloud framework because it gives them the flexibility and the power of the toolset to leverage the capabilities of engineers and development teams all across the world.

How does the work of Cerner, Epic, and Meditech fit into a strategy of making their data available for use by cloud-based services?

They are moving deliberately and cautiously, understanding that they can’t make dramatic changes overnight. Their customers are big, complicated provider organizations for whom stability is enormously important. They are all looking for the right balance of making new capabilities available and taking advantage of cloud functionality that will give customers the features that they want, while at the same time, keeping their core systems stable. That means something a little bit different to each of those vendors, but they are all trying to find and strike that balance.

Would a move to the cloud change the exclusive relationship between a health system and their primary EHR vendor?

In the short term, I don’t think it changes anything significantly. I certainly don’t think it makes it more exclusive. In the long term, I think it makes it less exclusive.

I was listening to a podcast from Andreessen Horowitz, where Mark Andreessen was talking about how in Silicon Valley, you have this rich ecosystem of API-driven data exchange and whole companies that have been developed just to facilitate the development and management of APIs within industries. What we see in other industries will come to healthcare, too. When you have increasing adoption of cloud-based application development, you end up stitching those pieces together with API-driven data exchange. We’re seeing that same thing in healthcare as you look at the emergence of FHIR and other API toolsets for patient data exchange.

A move to the cloud by Cerner, for example, is not going to tie the hands of Cerner’s clients and make them any more dependent on Cerner. It is just part of the the slow, steady move toward health systems being able to choose from a variety of tools and integrate the tools that work for them best.

What is creating the demand for cloud-based services?

My colleague and our chief medical officer, Dave Levin — who used to be CMIO of at the Cleveland Clinic – says he spends all day working in healthcare and then he goes home to the 21st century. The reality is that it’s consumers. It’s our everyday experience with smart phones, tablets, and advanced software that we run on whatever device we choose and that allows us to move from one device to another almost seamlessly.

Those experiences that we who work in healthcare have every day in every other part of our lives make us realize that we need that same type of functionality when we’re delivering healthcare services to patients. When we’re managing populations of patients or health plan members, we need those same capabilities, those same toolsets.

To take the simplest of examples, there’s no reason that if I’ve been to the same doctor’s office six times in the last year, that I should have to fill out the same piece of paper on the same clipboard the seventh time. When when I walk into all sorts of other businesses, they know who I am. They have read my license plate or I’ve agreed to have my smartphone notify them when I walk in, so they know from the beacon  at the front door that I’ve arrived and they’re ready for me. It’s those kinds of experiences — the scalability, the mobility — that is driving healthcare organizations to create software with those same capabilities.

Will it be hard for healthcare IT vendors to move their systems to the cloud?

Vendors are looking to do that module by module. I don’t have deep insight into the Cerner-AWS announcement that came last month, but the way I understand it, Cerner is not saying that all of a sudden they’re going to move all of their clients who use Cerner Millennium onto AWS servers or AWS services. But they will be increasingly developing new software capabilities on the public cloud. On AWS specifically, for Cerner.

Going back to what I said earlier about the need for stability and reliability by providers and payers, but especially providers, our expectation is that you’ll see vendors developing their new software, their new modules, in the public cloud, taking advantage of those capabilities. They will work deliberately over time to figure out what makes sense in terms of potentially migrating their legacy products to a cloud infrastructure. I’m not sure I have any unique or special insight into that, but that’s the trend I’m seeing, health IT companies developing their new stuff in the cloud and migrating their customers who want those new features to that new platform.

Health IT vendors seem obligated to name-drop AI and analytics in their cloud announcements. What kind of learning curve will they and their cloud services vendor encounter as they modernize healthcare applications?

I wish I knew the answer to that. There clearly are some tremendously exciting applications of artificial intelligence and machine learning in healthcare. I’ve also read many pieces recently about the need to approach it carefully. Any time you’re going to train a machine to learn something, you need to make sure that you’re training it in the right way, otherwise you can create more problems than you’re solving.

But the cloud is a big part of that, because there are so many AI and ML services that are available through a public cloud infrastructure. AWS announced Comprehend, their natural language processing service, a couple of years ago. It allows users to train it and it comes at a competitive price point. That’s an example of how cloud service providers and application developers in AI and NL are looking to leverage the cloud — making those services available, allowing lots and lots and lots of engineers and creators to experiment with those services, test them, and determine what can have a real, positive impact on patient outcomes.

Big provider organizations are announcing their own cloud partnerships, such as Mayo Clinic and Google Cloud. How will those organizations work directly with cloud providers?

It speaks to the amount of data that providers are accumulating. They need to find ways to support the efficient storage and analysis of that data so that they can learn from it as quickly as possible and apply that to better operations and better patient care. It’s not surprising to me at all and I think we will see more of it. It’s understandable, because in other industries, you have big players, big companies that are on a daily basis using cloud platforms and the analytics capabilities of cloud platforms. To improve their products, to improve their customer service, and to improve their deployment of personnel.

Healthcare has the same needs and the same demands of end users to capture those capabilities without having to invest in standing up a new data center full of physical hosts and a big huge team of devops engineers, DBAs, and others to manage all of that traditional infrastructure. You’ve got all of that data and you need somewhere to quickly and efficiently store it and analyze it.

What impact do you expect to see from the federal government’s implementation of the interoperability and data blocking implications of the 21st Century Cures Act?

We’re waiting just like everybody. Our sense is that when the final rule is released, it will raise the floor, but it won’t necessarily raise the ceiling. We are looking to continue to push the ceiling with innovative solutions for integration.

We recognize that even when ONC and CMS release those new rules, it’s likely to be several years before they’re enforced. It’s going to take the vendors time to develop the technology and capabilities that those rules may require. We’re not waiting. We are working every day with health systems and innovative health IT companies to figure out how they can make the most of the data exchange capabilities that exist today.

The bottom line is that we’re eager to see what comes out. Industry discussion of those rules has been robust and the public itself is highly interested in it. Every person has a personal investment in being able to get access to and make portable their health information. So it’s fascinating, but we recognize that it will be years before anything is actually required and implemented. Our goal is to help our customers, providers, and payers take advantage of what they’re capable of right now.

Is the federal government at risk of oversimplifying the interoperability challenge in declaring mission accomplished just because the use of APIs and FHIR has widened?

As I listened to the debate over the last several months, and certainly after the draft rule was released, I was struck by how thoughtful and mature the discussion was across the board on these rules. There is a broad recognition within health IT that if this were easy, we would have solved it.

I’m not saying that it’s challenging mostly from a technology standpoint. It’s challenging mostly because there are lots of competing interests that have to be resolved, and they’re not necessarily easy to resolve. There are ways to do it, and our company and I personally have our own views on how to address some of those challenges. But it’s been a robust, mature discussion about how we balance the interests of different players, always keeping in mind that the goal here is the delivery of better patient care at lower cost and having better outcomes.

Do you have any final thoughts?

My colleagues and I are excited about the pace of innovation in health IT. If we weren’t, we would go find something else to do, since goodness knows the world has plenty of other problems to solve. I look forward going to work every day because of the opportunity to partner with people who feel emotionally compelled to bring positive change to something that impacts every single person — the delivery of quality healthcare.

Morning Headlines 9/16/19

Livongo Reports Second Quarter Financial Results

Livongo says it will lose $40 million on the year after reporting Q2 results: revenue up 156%, adjusted EPS –$0.46 vs. -$0.31.

Varian and Oncora Partner to Accelerate Precision Medicine in Radiation Oncology

Cancer powerhouse Varian will invest an unspecified amount in Philadelphia-based Oncora Medical, which offers precision radiation oncology software.

Tyler & Company Seeks CIO for Penn State Health

Penn State Health system (PA) enlists an executive recruitment firm to help it find a Cerner-savvy SVP/CIO.

Monday Morning Update 9/16/19

Top News

A report from the American Hospital Association and consulting firm EY says that participatory health, or “healthcare with no address,” is coming. It predicts that health systems will respond to consumers who want on-demand, connected, and data-driven services.

The report says a participatory health framework will require health systems to offer:

• Health and wellbeing support.
• A personal health cloud containing the patient’s own data, including biometrics.
• AI analysis of the data to create new insights and solutions.
• A demand-driven global marketplace.

The report predicts that physicians will become “data-driven conductors” who will take responsibility for managing the lifestyle and wellness of patients.

The authors observe that while the future is more patient-centric and participative, health systems must move toward value while continuing to earn most of their revenue for volume. They will also have deliver anywhere, anytime care even though they have spent a lot of money on brick-and-mortar locations.

Nontraditional players such as entrepreneurs, retailers, and technology companies are ahead of health systems in offering consumer-oriented health services. Value-based payments favor non-hospital locations such as retail clinics and consumers prefer those anyway, with the next step for those retail locations being to offer chronic care management via telehealth.

Time zone differences also encourage global approaches, such as ICU monitoring virtual second opinions.

The article also calls out successes in which health systems have applied their quality improvement and relationship-building expertise to partner with their communities to address social determinants of health. 

Reader Comments

From Set in Code: “Re: CPT codes. I work in a large Medicaid health plan. CMS requires use of AMA-copyrighted CPT codes. We are now being charged per member for each instance of the CPT code set that is used in any of our systems, meaning that we’re paying AMA multiple times for the same member. It also seems that organizations pay radically different per-member rates. AMA has created a monopoly and I believe that CPT licensing revenue is its largest revenue source, but I would like to see leverage applied to keep the cost reasonable as AMA seems to be offsetting shrinking membership by forcing health plans and providers to make up the gap.” AMA’s most recent tax filings show a profit of $26.4 million (up from $9.4 million last year) on revenue of $317 million, of which only $38 million came from membership dues. Royalties generated $148 million of the “other revenue” total of $191 million. AMA paid its EVP/CEO $2.2 million, its COO $1.2 million, and the former Allscripts executive who heads up the CPT group $900,000. About 80% of US doctors are not AMA members. AMA made $1.5 million in political contributions last year and spent $20 million on lobbying, just in case you want to launch a grassroots effort to get politicians to rein in its CPT fees. Like a lot of member organizations (including HIMSS), the organization’s most significant revenue comes from selling access to members and running businesses that actually compete with the work of some of those members (as I always say, that’s the “ladies drink free” business model). 

From Jonas Sister: “Re: Epic’s employee testing. Some of your readers have spoken, but you haven’t.” My position is that: (a) Epic can use whatever methods it wants to hire employees and it’s nobody else’s business; (b) you can argue theoretically why Epic’s tests shouldn’t be good predictors of job performance, but you can’t argue with the success Epic has had for decades in using those tests virtually unchanged to hire thousands of employees; (c) people who complain about Epic’s tests as being irrelevant or unfair are usually folks who weren’t hired, either by Epic itself or its health system customers who administer the same tests to their own prospective Epic team members; and (d) while we might personally believe that our experience should be valued over test scores, that’s not the case with Epic, who sees greater long-term promise in a blank canvas. Also note that Epic has an endless supply of applicants, the company is an efficient machine in onboarding new hires and either moving them up the ladder or out the door, and its processes are apparently so well laid out that it doesn’t need people who have learned bad habits from crappy health IT companies. I will give more credence to passionate arguments about how Epic’s hiring and retention practices are wrong once I see the company struggling because of them. It hurts to be passed over purely based on the results of a “lions, tigers, and cages” type question or a MUMPS-like programming logic quiz, but the most important logic question is why anyone would expect Epic to ditch practices that made it the industry leader.

HIStalk Announcements and Requests

Two-thirds of the employers of poll respondents have laid people off recently, and of those, about half say that older or sicker employees seemed to have been targeted. Not Exactly says his EHR vendor laid off to hit a payroll dollar target, so that raised the risk for experienced, higher-paid employees. Cosmos says their vendor employer reduces headcount by running long hiring freezes instead of layoffs, but the folks who leave are often younger ones with better options and who don’t need the health insurance instead of those who might be laid off otherwise.

New poll to your right or here: Which factor do you think was most important in being hired by your current employer?

Welcome to new HIStalk Platinum Sponsor Zynx Health. The Los Angeles-based company, which is part of the Hearst Health Network, offers ZynxOrder (evidence-based order sets and clinical decision support rules); ZynxCare (evidence-based plans of care); specialty content packages (home health, pediatrics, skilled nursing, chronic conditions); Knowledge Analyzer (evaluation and optimization of clinical content and processes); and the recently introduced Lumynz (analytics that looks at orders vs. evidence, including the financial impact). Its Vital Interventions has identified high-impact interventions (mortality, cost, length of stay, admissions and readmissions, and hospital-acquired conditions) that align with performance measures and quality and cost objectives. The company just announced new Knowledge Analyzer reporting capability that allows hospitals to map clinical decision support to best outcomes and to prioritize the potentially most impactful interventions. Thanks to Zynx Health for supporting HIStalk. 

I was playing some country music on the Sonos for a visitor who, unlike me, enjoys it. Just about every song featured cartoonishly cowboy-hatted, testosterone-swaggering male singers with questionable Southern accents. I looked up how many of the 20 or so songs that we heard were actually written by the throaty twangers themselves. Answer: zero, although a couple of them shared a songwriting credit with an actual songwriter in what I imagine was a pay-to-play deal to get the tune recorded in the first place. Country and pop were about the same on Billboard’s current top 10 charts – lots of co-writing credits, but no singer actually wrote their hit solo. Conclusion: as in acting, comedy, politics, and maybe most other areas, music stars are usually just reading someone else’s thoughts since they are entirely separate forms of craftsmanship, although (a) those with star power in TV and music can command inflated billing as executive producers or co-writers, respectively; and (b) in music, at least the less-recognizable people who actually create the songs are earning publishing royalties in perpetuity instead of swigging vodka from an onstage water bottle while unenthusiastically shouting “How you doing tonight, Omaha?” from their gig in Kansas City.

Webinars

September 19 (Thursday) 2:00 ET. “ICD-10-CM 2020 Code Updates.” Sponsor: Intelligent Medical Objects. Presenters: June Bronnert, MSHI, RHIA, director of terminology mapping, IMO; Theresa Rihanek, MHA, RHIA, classification and intervention mapping lead, IMO; and Julie Glasgow, MD, senior clinical terminologist, IMO. The 2020 regulatory release is right around the corner. Join IMO’s top coding professionals and thought leaders as they discuss new, revised, and deleted codes; highlight revisions to ICD-10-CM index and tabular; discuss changes within Official Coding Guidelines; share potential impacts of the code set update; and review ICD-10-CM modifier changes.

September 26 (Thursday) 2 ET. “Patient Education Data: A Key Ingredient for Improving Quality and Patient Experience.” Sponsor: Healthwise. Presenters: Victoria L. Maisonneuve, MSN, RN, director of the Nursing Center for Excellence and Magnet program, Parkview Health; Marta Sylvia, MPH, senior manager of quality improvement and outcomes research, Healthwise. Healthcare data is everywhere! It’s scattered across various systems and in countless formats, making it difficult to collect and glean actionable information. Knowing where to start depends on what your organization wants to accomplish.  By focusing on your patient education data, you can drive quality improvement across your organization. Vicki Maisonneuve will share how her team analyzes data around the use of patient education. By combining different data sets, she can easily identify trends, gaps, and opportunities to improve quality and patient experience across Parkview Health.

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

Acquisitions, Funding, Business, and Stock

I missed this last week. Livongo reports Q2 results: revenue up 156%, adjusted EPS –$0.46 vs. -$0.31. The company says it will lose $40 million on the year. Shares dropped 17% on news of widening losses, with LVGO shares now trading at under $25 versus their first-day offering price of $28 and first-day close of $38.10 on July 25, meaning that someone who spent $10,000 jumping on the IPO now has less than $6,500 worth of shares. The company is valued at $2.4 billion. From the earnings call:

• The company says it met all of its financial and operational objectives in the quarter, with increased enrollment and 720 clients signed.
• Livongo touted its increasing total contract value, which it calculates using percentage enrollment assumptions that are applied to company headcount. Contracts runs 1-3 years.
• The company didn’t directly answer an analyst’s question about how many users drop out, but later said it lost about 2% of users during the year and three-fourths of that was due to employees leaving their companies that provided the platform.
• Livongo is cross-selling among its products – hypertension, weight management, diabetes management, and behavioral health – but its diabetes offering is generating almost all its revenue so far.

Cancer powerhouse Varian will invest an unspecified amount in Philadelphia-based Oncora Medical, which offers precision radiation oncology software.

Sales

• Thomas Health (WV) outsources its Level 1 help desk to CereCore.
• England’s East Lancashire Hospitals NHS Trust joins the global health research network of TriNetX for searching patient cohorts, querying study-related data, and adding study visibility to pharmacy and contract research organizations.

Announcements and Implementations

Nordic creates Registry Direct, which offers automated, FHIR-powered abstraction for sending EHR data to the American Heart Association’s Get With The Guidelines online registry.

Government and Politics

An article in Foreign Affairs says that China is following the economic growth script of Germany, France, and Japan in moving up the food chain from manufacturing cheap global goods to creating an innovation powerhouse that is being driven by a world-leading economy and government-led investment in research. It predicts that China will soon end the US’s 70-year run as the world’s leader in science and technology. The authors cite JAMA, which predicts that China will become the world’s leader in drug development in the next five years. The well-credentialed authors recommend that the US government spend more on scientific research, push efforts to translate the results into marketable products and services, and create jobs outside of the usual hub cities like Seattle, San Francisco, and Boston and instead focus on cities where land is cheaper and people can be more productive.  

Privacy and Security

Facebook warns users that new privacy protections are enabled by default in IOS13 and Android 10 that prevent the app from tracking its users in real time, which Facebook insists (without irony) is a problem because users will thus be deprived of valuable services such as location-targeted ads. The new features mimic privacy options that are already available in Facebook, but Facebook knows that few users modify its defaults and in any case will struggle to find the option within its complex privacy settings menu.

Other

The Chicago business paper looks at the highest-paid executives of Lurie Children’s Hospital, including the CEO ($2.2 million) and the CIO ($460,000).

Britain’s health secretary Matt Hancock declares that he won’t let his country’s drug usage “escalate to the level seen in the United States,” following release of a new government report that says 25% of people in Britain are taking meds for pain, anxiety, depression, and insomnia, with half of those being long-term users of at least a year. More than 10% of Britain’s population take antidepressants and nearly that many are taking opioids, with women and people in poorer parts of the country having higher rates. England and Wales have a long way to go to hit US-class opioid death rates, as just 2,200 people there died of opioid overdoses last year vs. 47,600 in the US.

The 33-year-old investor co-founder of Hims – which peddles erection and baldness treatment drugs following an “online assessment” that is reviewed by “our network of doctors” – publicly announces his expectation of being a billionaire “by my mid to late 30s” in a Quora post he later deleted in a late-onset attack of faux humility. If you want to upend US healthcare and save billions of dollars, make all drugs available without a prescription since consumers who want them will get them at any cost regardless.

@DrJenGunter explains why she became a patient advocate in answering the call of Bernie Sanders to describe “the most absurd medical bill you have ever received.”

Sponsor Updates

• Health Catalyst will exhibit at the 2019 MHA Fall Convention & Trade Show September 18-20 in Billings, MT.
• Mobile Heartbeat will exhibit at the Chief Nursing Officer Summit September 16-17 in Scottsdale, AZ.
• Waystar will exhibit at CareVoyant UGM September 18-20 in Schaumburg, IL.
• Netsmart will exhibit at the Ohio Council for Home Care and Hospice Annual Conference and Tradeshow September 17-18 in Columbus.
• Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the Perinatal Partnership Conference September 22 in Concord, NC.
• OmniSys will exhibit at the Pennsylvania Pharmacists Association’s Annual Conference September 19-22 in Seven Springs.
• PatientKeeper will exhibit at AHIMA through September 18 in Chicago.
• Health Catalyst shares insights from its annual Healthcare Analytics Summit.
• Wolters Kluwer Health announces efforts to promote Sepsis Awareness Month, including a new blog series and its Sepsis Resource Center.

Blog Posts

• How Erlanger Health Systems is using data to improve patient throughput (Nordic)
• OIG Series Strategy 1: Working with Physicians (Lightbeam Health Solutions)
• Sharing Knowledge and a Shared Vision for Health (EClinicalWorks)
• Why Financial Engagement Should be on Every Provider’s Priority List (Loyale Healthcare)
• Can we talk? Communication isn’t just for patients and physicians anymore (Meditech)
• Finding the Courage to Ask (Netsmart)
• Highlights from UGM 2019 (CereCore)
• How a Universal Patient Identifier can help solve pharmacy’s patient matching problem (Experian Health)
• Market Share: How to Compete with Larger UCC Groups & Health Systems (PatientBond)
• PatientTouch Introduces New Enhancements for Physicians and Workflows for Nurses (PatientSafe Solutions)
• Improved Patient Financial Engagement in 5 Steps (Patientco)
• Molina Healthcare Builds Operational Efficiency with SailPoint (SailPoint)
• Out with Manual Testing in Healthcare, in with Automation (Santa Rosa Consulting)
• “When It Goes Well, It Feels Like Magic” Two HIT Experts Chat about the Real-World Impact of Interoperability (Surescripts)
• Edward Marx’s Healthcare Innovation Roadmap Checklist (SymphonyRM)
• How doing more in less time helped one OR add 200 cases per year. (Voalte)
• Celebrating Star Trek and the Next Frontier of Voice Communication in Healthcare (Vocera)
• Even Small Practices Face Cybersecurity Threats and Government Scrutiny (WebPT)

Contacts

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

Weekender 9/13/19

Weekly News Recap

• Surescripts cuts off prescription data access to Amazon’s PillPack mail order pharmacy.
• The premier of Queensland, Australia promises to investigate a 14-hospital downtime of several hours that was caused by a Cerner upgrade.
• Apple announces that it will partner with several high-profile healthcare institutions to conduct studies related to hearing, women’s health, and heart health using its new Research app.
• Mayo Clinic signs a 10-year partnership with Google in which Google Cloud will provide Mayo with data hosting, cloud computing, analytics, and machine learning and AI.
• Bayfront Health St. Petersburg (FL) pays $85,000 to settle HHS OCR’s first case under the Right of Access requirement to give patients complete copies of their medical record within 30 days.
• Hackers breach DDS Safe, a cloud-based records retention and backup solution that is sold to dental practices, and use it to install ransomware on the computers of hundreds of dental practices.

Best Reader Comments

Private equity can jump in the line of who all are screwing the consumer –bloated organizations, vendors charging five times what it would cost out of healthcare, solutions bought not needed, physicians making a fortune off their patients’ problems, and hospital execs stuffing pockets while driving up costs. Next up: pediatric offices charging based on parent fear level. (Overcharged)

I use PillPack and one of the things that appealed to me was that it took five minutes to sign up and they had my insurance information and prescription information without my needing to supply it. If this had been manual, I would have never signed up. (To be or not to be)

Is a really high deductible and co-pay actually “coverage” or just the illusion of coverage? (Brian Dale)

I’m honestly thrilled that a hospital / health system got nailed for obstructing access to patient records. It’s overdue. As a hospital, I owe it to my patients to assure that they can get to their records in a timely manner. I don’t always know why they need it, and it isn’t my problem. It is their information. They should have a right to it. (MEDITECH Customer)

In effect, Epic aptitude testing tries to determine if you are a smart person. The assumption is, if you are a smart person, you can be a good IT analyst. Good grief! Only your job history proves that and I already have that. (Brian Too)

Epic doesn’t tell you how you do on the exams, but you can assume you did well if you’re offered the job. Carl Dvorak, in a new hire class, told us that the aptitude and personality tests were better predictors of how well Epic employees would perform than their college major, job history, college, etc. (Publius)

Worked in a border city in a prior life — we had hospitals in both states. One state required a physician signature on every individual script, the other allowed batch signing. EMR workflow was a nightmare, as was physician adoption for the physicians that worked in both hospitals. (Was A Community CIO)

Burnout is a real condition, but for most of organized and academic medicine, it has provided a handy new topic to generate more content for sale and consultation fees. (Kevin M. Hepler)

If the AMA was fighting for us, they would be loudly demanding truly radical restructuring of US health care rather than tweaking the existing one with apps, conferences, wimpy comments on CMS rule-making, etc. The solution to our problem isn’t going to come from the AMA until they recognize that they helped to create the problem. (Joe Schneider)

That’s the nature of implementation in general. People who have previously done the exact same thing as you need command a premium salary. Most of the work isn’t really that complicated and is just grunt work. Therefore vendors provide the grunts and let the high-powered implementation people go become consultants that the customer can pay high salaries if that’s what the customer wants to do with their money. (Grunt)

I like where you are going with a basic skepticism of feedback you receive from folks who have not yet bought your product. In the startup world, a little book called “The Mom Test” has become the standard for the “customer discovery” process, in which you learn that people desperately want to tell you what they think you want to hear – and it’s usually not helpful. (Michael Burke)

Watercooler Talk Tidbits

The Seattle newspaper recites yet another example of The Joint Commission giving a hospital a glowing review while state inspectors were nearly simultaneously threatening to shut it down for safety problems, highlighting the Commission’s self-proclaimed role as being the non-punitive advisor to hospitals that want to improve.

Google adds naloxone-finding tools and addiction recovery meeting locations to Maps.

An 86-year-old Georgia doctor who operates a weight loss clinic is arrested for illegal drug distribution and money laundering, charged with taking cash from former NFL linebacker Sedrick Hodge for providing him with prescription medications to sell on the street.

San Diego physician Murray Alsip, DO discovers that he can continue practicing medicine even after a heart transplant left him unable to see patients in an office by signing on as a telemedicine doctor with MDLive. Alsip previously met with the former girlfriend of 20-year-old man whose heart he received so she could hear it beating in his chest.

In Case You Missed It

• News 9/13/19
• EPtalk by Dr. Jayne 9/12/19
• HIStalk Interviews Steve Shihadeh, Founder, Get-to-Market Health
• News 9/11/19
• Curbside Consult with Dr. Jayne 9/9/19
• HIStalk Interviews Ken Misch, President, Medhost
• Monday Morning Update 9/9/19

Get Involved

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

Morning Headlines 9/13/19

Healthy.io Raises $60 Million in Series C Funding and Receives FDA Clearance for Smartphone-Based Test to Diagnose Chronic Kidney Disease

Healthy.io raises $60 million and receives FDA clearance for the use of its smartphone-based ACR test to be used in diagnosing chronic kidney disease.

TrialCard Announces Acquisition of Mango Health

Digital prescription savings company TrialCard will acquire medication management app Mango Health.

GE’s health unit wins first FDA clearance for A.I.-powered X-ray system

GE Healthcare receives FDA clearance for its Critical Care Suite, an AI-powered X-ray device that can reduce the time between diagnosis and treatment for a collapsed lung to as few as 15 minutes.

Google and others ‘not interested in electronic patient record market’

Google Cloud Executive Advisor Toby Cosgrove, MD says that health systems have spent so much on Cerner and Epic that Google, IBM, and other companies aren’t interested in trying to launch competing EHR products.

News 9/13/19

Top News

Surescripts finally severs ties with ReMy Health, which supplied Amazon-owned mail order pharmacy PillPack with patient prescription data collected by Surescripts.

Surescripts CEO Tom Skelton told customers the move was made to ensure the “integrity of its network.” It came after Surescripts allegedly discovered that ReMy had requested patient insurance information and prescription pricing data that it then passed on to drug marketing websites without permission. ReMy has denied any wrongdoing.

The tit-for-tat amongst the trio has been going on for several months, with Surescripts claiming it would take its complaints to the FBI and Amazon retaliating with threats of a lawsuit.

The FTC filed an antitrust lawsuit against Surescripts in April for allegedly monopolizing the e-prescribing market, specifically in the areas of routing and eligibility.

Reader Comments

From MIPS Maven: “Re: MIPS. More than a dozen major EHRs have not released full 2019 MIPS functionality. Practice Fusion just released their dashboard yesterday after months of customer complaints. MIPS is a FULL YEAR program that began on January 1, 2019. How are EHR vendors not being fined for failing to offer MIPS functionality when they are ONC certified?”

From Attendance Mandatory: “Re: conferences. Don’t you find it ironic that telemedicine conferences require in-person attendance?” I find it ironic that any technology-related conference requires in-person attendance, but I also know that the cash register rings hardest from vendor booths, hotel room bookings, and endless venue advertising. You could easily live-stream every conference education session or just put the video on YouTube as we do webinars. However, attendees are most interested in socializing, making personal connections, or cruising the show room floor, so just watching podium presentations – which are often not very good or very timely anyway – won’t cut it. Conferences provide the supply of whatever it is that the market demands. I’m interested in how the heavily investor-funded HLTH conference will fare in October, having sat out 18 months after making the disastrously stupid decision to launch its initial conference immediately following HIMSS and in the same city of Las Vegas. I haven’t heard any buzz about the 2019 version of HLTH despite its many “media partners” (although quite a few of those are lame).

From Dr. Doctor Please: “Re: surprise medical bills. This is one of the most depressing stories about my profession that I have ever read. Goes well with your recent remarks about how we doctors brought a lot of the burnout-causing conditions on ourselves and how medicine is just another business.” Kaiser Health New says that physician groups are among the biggest and well-funded opponents of laws that would prohibit balance billing, but the real force behind the media blitz is private equity and venture capital firms that have bought physician staffing companies. That earns them fortunes as they intentionally remain out of insurance networks so they can charge whatever they want and leave the patient owing the difference. A snip:

In some areas, doctors have few options but to contract with a staffing service, which hires them out and helps with the billing and other administrative headaches that occupy much of a doctor’s time. Staffing companies often have profit-sharing agreements with hospitals, so some of the money from billing patients is passed back to the hospitals. The two largest staffing firms, EmCare and TeamHealth, together make up about 30% of the physician-staffing market. That’s where private equity comes in. A private equity firm buys companies and passes on the profits they squeeze out of them to the firm’s investors. Private equity deals in health care have doubled in the past 10 years. TeamHealth is owned by Blackstone, a private equity firm. Envision and EmCare are owned by KKR, another private equity firm.

With affiliates in every state, these privately owned, profit-driven companies staff emergency rooms, own dialysis facilities, and operate physician practices. Research from 2017 shows that when EmCare entered a market, out-of-network billing rates went up between 81 and 90 percentage points. When TeamHealth began working with a hospital, its rates increased by 33 percentage points.

Webinars

September 19 (Thursday) 2:00 ET. “ICD-10-CM 2020 Code Updates.” Sponsor: Intelligent Medical Objects. Presenters: June Bronnert, MSHI, RHIA, director of terminology mapping, IMO; Theresa Rihanek, MHA, RHIA, classification and intervention mapping lead, IMO; and Julie Glasgow, MD, senior clinical terminologist, IMO. The 2020 regulatory release is right around the corner. Join IMO’s top coding professionals and thought leaders as they discuss new, revised, and deleted codes; highlight revisions to ICD-10-CM index and tabular; discuss changes within Official Coding Guidelines; share potential impacts of the code set update; and review ICD-10-CM modifier changes.

September 26 (Thursday) 2 ET. “Patient Education Data: A Key Ingredient for Improving Quality and Patient Experience.” Sponsor: Healthwise. Presenters: Victoria L. Maisonneuve, MSN, RN, director of the Nursing Center for Excellence and Magnet program, Parkview Health; Marta Sylvia, MPH, senior manager of quality improvement and outcomes research, Healthwise. Healthcare data is everywhere! It’s scattered across various systems and in countless formats, making it difficult to collect and glean actionable information. Knowing where to start depends on what your organization wants to accomplish. Vicki Maisonneuve will share how her team analyzes data around the use of patient education. By combining different data sets, she can easily identify trends, gaps, and opportunities to improve quality and patient experience across Parkview Health.

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

Acquisitions, Funding, Business, and Stock

Healthy.io raises $60 million in a Series C funding round and receives FDA clearance for the use of its smartphone-based ACR test to be used in diagnosing chronic kidney disease. The company released a smartphone-based urinalysis app last year.

Digital prescription savings company TrialCard will acquire medication management app Mango Health. Co-founder and CEO Jason Oberfest left Mango Health to join Apple’s health team late last year.

Health IT consulting firm HCTec will invest $500,000 in expanding its workforce by 100 employees over the next five years in Tennessee.

GE Healthcare receives FDA clearance for its Critical Care Suite, an AI-powered X-ray device that can reduce the time between diagnosis and treatment for a collapsed lung to as few as 15 minutes. The company is working with scientists at the University of California to develop screening capabilities for additional conditions.

Sales

• Provincial Health Services Authority in British Columbia signs a three-year contract with Vocera for its care team communication technology.
• WellStar Health System expands its use of Glytec’s EGlycemic Management System two eight additional Atlanta-area facilities.

People

University of California promotes Tom Andriola to the newly created position of vice chancellor of IT and data at the University of California, Irvine, which includes UCI Health.

Announcements and Implementations

Christie Clinic (IL) will implement Epic through a Community Connect arrangement with neighboring Carle Health System.

A new KLAS report on EHR implementations outside the US finds that Epic has the highest satisfaction and its customers implement the widest variety of software modules. Allscripts customers report budget overruns and worry that the company is more focused on sales than implementation; InterSystems overpromises on scope and timelines; and Meditech customers are most likely to report budget overruns due to unexpected third-party and infrastructure costs. However, Meditech finished first on hitting the timelines that are under its control. Epic takes the highest amount by far of EHR project budget at up to $164 million, while Meditech, Philips, and MV had narrower cost ranges that were in the single-digit millions.

Redox posts the agenda for its Healthcare Interoperability Summit, convening in Boston on October 15.

Government and Politics

In Australia, Queensland Premier Annastacia Palaszczuk promises to investigate the IEMR crash that occurred Tuesday afternoon across 14 hospitals. The $1.2 billion system was down for several hours after a routine Cerner software patch caused a “system degradation.”

Privacy and Security

Healthcare technologist Fred Trotter says Facebook still hasn’t fixed some privacy-compromising features of its Groups function, potentially exposing the medical information of people who sign up for health groups. Facebook did a partial fix: (a) you can no longer download the information of group members unless  you yourself are a member; (b) Facebook users can no longer add other users to a group without their consent; and (c) groups are set to be “private” by default. Fred says Facebook needs to add name privacy, so that members are listed by only their first names and are not linked to their full Facebook account, which means the user can interact with the group but nobody can find out more information about them. This is similar to how Facebook set up its “dating” feature” to facilitate privacy. 

Other

A cardiologist’s New York Times opinion piece says that doctors are always outraged and surprised at onerous or ineffective regulations that are forced upon them, but have done little to offer their own solutions to problems such as inappropriate imaging. He notes interestingly that Medicare created a physician golden goose in 1965 in virtually guaranteeing that medical services would be paid for, but doctors cashed in while ignoring waste and fraud that was eventually addressed by insurers and lawmakers in the form of managed care. He concludes that doctors can retain their independence only if they become more active in addressing healthcare’s problems, some of they they themselves created.  

Google Cloud Executive Advisor Toby Cosgrove, MD – formerly CEO of Cleveland Clinic – says that health systems have spent so much on Cerner and Epic that Google, IBM, and other companies aren’t interested in trying to launch competing EHR products. He said in a conference this week that IBM and Google both considered developing ad EHR, but it’s probably too late.

University of Oxford researchers have designed an algorithm that can detect potential signs of heart attacks years before traditional methods. The technology can flag indicators like inflammation, scarring, and changes in blood vessels that supply blood to the heart. When combined with traditional scans, researchers hope that the software will assist providers in early intervention and treatment strategies.

Orig3n CEO Robin Smith pushes back against the accusations of 17 former employees who claim the genetic testing company manipulated results to cover up testing errors that led to radically different results when the same genes were tested separately for fitness and nutrition profiles. They claim to have logged 407 such errors in a sample of 2,000 tests over a three-month period, and say that marketing, rather than science, was the priority. Smith says the claims are inaccurate and that “former employees are former employees for a reason.” This is the same at-home testing company that made news last summer for failing to recognize that one customer’s DNA sample was actually from a dog.

Sponsor Updates

• EClinicalWorks will exhibit at Health 2.0 September 16-18 in Santa Clara, CA.
• Ensocare will exhibit at the ACMA Illinois Chapter Conference September 17 in Rosemont.
• FormFast will exhibit at AHIMA September 14-18 in Chicago.
• Greenway Health will exhibit at the NIHB Annual Tribal Health Conference September 16-20 in Temecula, CA.
• Hayes hires Jessica Kender (PrismHR) as senior implementation project manager, and Julie Anne Bonee (Change Healthcare) as client success manager.
• HealthCrowd will exhibit at the MHPA 2019 Annual Conference September 18-20 in Washington, DC.
• Hyland will host CommunityLive September 15-19 in Chicago.
• InterSystems will exhibit at the CIO Summit September 19 in Boston.
• Intelligent Medical Objects will exhibit at AHIMA September 14-18 in Chicago.
• Pivot Point Consulting names Jeff Maris (Cerner) head of its Cerner Strategic Implementation and Partnerships team.
• PatientSafe Solutions adds enhanced security and mobile features to its PatientTouch Clinical Communication platform.
• Prepared Health will lead a roundtable, “Becoming a Preferred Provider: Home Health’s Role in Hospital and Skilled Nursing Transitions,” at the at the Home Health Care News Summit September 18 in Chicago.
• Vocera announces that Metro Health – University of Michigan Health has improved its stroke time to treatment from 53 to 29 minutes, in part through Vocera communication technology.

Blog Posts

• How Long-Term Thinking Improves Healthcare (EClinicalWorks)
• How Google and Mayo Clinic will transform the future of healthcare (Google Cloud)
• Hack attack! A Greenway customer shares his experience (Greenway Health)
• Healthcare Data is Your Organization’s Crystal Ball (Healthwise)
• Know before you go: 8 tips to get the most out of #CommunityLive (Hyland)
• Challenges and Opportunities in Today’s Healthcare Ecosystem (EClinicalWorks)

Contacts

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