News 6/15/18

Top News

Cancer informatics technology vendor Inspirata acquires Caradigm from GE Healthcare. Imprivata bought Caradigm’s identity management business in October 2017. Microsoft, originally a 50-50 Caradigm joint venture investor with GE Healthcare to which it contributed its Amalga data platform, sold its share to GE Healthcare in April 2016.

Reader Comments

From Witty Lad: "Re: Techsoft’s MDRhythm. We are considering their EHR for a volunteer-run clinic. I can’t tell if they’re still in business, but I want to give them the benefit of the doubt with[out] embarrassing them if they indeed are. Wondering if you know anyone who is a current or former client?" Not off the top of my head, so I’ll invite readers to weigh in. I discovered they are indeed still in business after a quick phone call to the company (answered promptly by the helpful Maria once I navigated through the automated phone tree), though their website is woefully out of date.

From Pampered Poodle: “Significant layoffs at Ascension Information Systems today. Ascension has been in financial strife and is in the process of a major reorganization of IT services.” I assume PP means Ascension Information Services, the IT shop out of the similarly named St. Louis-based health system. Unverified, though in line with a reader’s comment shared in April.

Webinars

June 21 (Thursday) noon ET. “Operationalizing Data Science Models in Healthcare.” Sponsor: CitiusTech. Presenters: Yugal Sharma, PhD, VP of data science, CitiusTech; Vinil Menon, VP of enterprise applications proficiency, CitiusTech. As healthcare organizations are becoming more adept at developing models, building the skills required to manage, validate, and deploy these models efficiently remains a challenging task. We define operationalization as the process of managing, validating, and deploying models within an organization. Several industry best practices, along with frameworks and technology solutions, exist to address this challenge. An understanding of this space and current state of the art is crucial to ensure efficient use and consumption of these models for relevant stakeholders in the organization. This webinar will give an introduction and overview of these key areas, along with examples and case studies to demonstrate the value of various best practices in the healthcare industry.

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

Acquisitions, Funding, Business, and Stock

Cardinal Health sells a majority stake in post-acute care services and analytics company NaviHealth to private investment firm Clayton, Dubilier & Rice for an undisclosed amount. Cardinal acquired the private equity-backed company in 2015 for $290 million.

Google looks to grow its Medical Digital Assist project, which seems to be toying around with physician note transcription using the company’s AI-powered Home and Assistant technology. Project team members have been working with Stanford Medicine (CA) on a digital scribe study that will conclude in August. Stanford physician and Google project liaison Steven Lin, MD admits training AI-powered speech recognition software to extract meaningful data to add to an EHR is “more of a complicated, hard problem than we originally thought.”

Text-based telemedicine app company Medici raises $22 million in a Series A funding round.

Strategic Management Consultants acquires Digital Reasoning’s anesthesiology-focused Shareable Forms (fka Shareable Ink) clinical documentation technology.

Hackensack Meridian Health (NJ) dips into its $25 million innovation investment fund to finance Pillo Health’s digital home health companion. Hackensack and Pillo will work to launch a medication management pilot using the device with an eye towards eventual commercialization.

People

Nick Martin (Optum International) joins DuPage Medical Group (IL) as CTO.

The American Medical Association names psychiatrist Patrice Harris, MD president-elect at its annual meeting. She will succeed newly sworn-in New Mexico Oncology Hematology Consultants CEO Barbara McAneny, MD.

Cantata Health hires Wesley Brown (SQLWatchmen) as VP of development.

Outcome Health picks up the pieces with the appointment of Matt McNally (Publicis Health) as CEO. The waiting room media company has spent the last several months settling lawsuits stemming from allegations that it misled advertisers and investors, shuffling CEO Rishi Shah and President Shradha Agarwal to less visible positions, and watching its $5.5 billion valuation take a beating in the press. Publicis Health was an Outcome Health advertiser, having pulled out pending the results of a third-party verification of Outcome Health’s audience – the results of which haven’t yet been released.

Sales

• The HealtheConnect Alaska HIE will implement NextGate’s Enterprise Master Patient Index.
• Nantucket Cottage Hospital (MA) selects bedside patient engagement software from Aceso.
• Tallahassee Memorial HealthCare (FL) chooses Voalte’s clinical communication and alert notification system.
• The New Jersey Hospital Association and its Health Research and Educational Trust will offer Collective Medical’s opioid tracking tool to EDs across the state.

Announcements and Implementations

SoutheastHealth (MO) develops a virtual ICU program with technology from Avera ECare.

Cohealo develops cloud-based software that uses EHR data to help hospitals better manage and utilize medical equipment.

Other

The Cardiovascular Research Consortium will leverage TriNetX’s data aggregation capabilities and analytics to give its biopharma partners access to clinical data.

I can’t decide whether this article is a disturbing look at the sleazy means some plastic surgeons will use to puff up their already inflated egos, hopefully gaining new patients in the process, or an accurate portrayal of the way surgeons and their savvy marketing teams use social media to get the word out about their services.

Sponsor Updates

• The PatientKeeper team volunteers at The Giving Factory and donates over $5,000 to its Cradles to Crayons program.
• Adventist Health System (FL) expands its use of Stanson Health’s clinical decision support software across its 46 hospital campuses.
• Liaison Technologies and Aberdeen release the results of a new survey, “Enterprise Data in 2018: The State of Privacy and Security Compliance.”
• Navicure/Waystar will exhibit at Florida MGMA June 20-22 in Orlando.
• Nordic will exhibit at the Healthcare Industry User Group meeting June 17-20 in Phoenix.
• Recondo Technology signs a large IDN, several major universities and an affiliated large physician group, helping it close $5 million in new contracts so far this year.
• Experian Health achieves HITRUST CSF Certification and EHNAC Healthcare Network Accreditation.
• To improve care coordination, the Wisconsin Statewide Health Information Network will offer participating providers and payers access to PatientPing’s real-time patient notifications.
• Pivot Point Consulting hires Jenn Bula, RN (MedSys) as director, advisory services.
• EClinicalWorks will exhibit at the North Carolina Primary Care Conference June 14-16 in Charlotte, NC.
• HBI Solutions will exhibit at the Minnesota Dept. of Health E-Health Summit June 14 in Brooklyn Center.
• Healthfinch will present at the AMDIS Physician Computer Connection Symposium June 18-22 in Ojai, CA.
• Ciox Health Chief Digital Officer Florian Quarre joins the Forbes Technology Council.
• Image Stream Medical parent company Olympus partners with accelerator MedTech Innovator.
• InterSystems will exhibit at HL7 FHIR DevDays 2018 June 19-21 in Boston.
• Intelligent Medical Objects will exhibit at the AMDIS Physician Computer Connection Symposium June 18-22 in Ojai, CA.
• Kyruus will exhibit at the Cleveland Clinic Patient Experience Summit June 18-20 in Cleveland.
• Patientco adds AccessOne financing products to its SmartFinance patient financing feature.
• ChartLogic publishes a new white paper, “The True Value of Using Revenue Cycle Management.”
• KLAS recognizes TransUnion Healthcare’s EScan Insurance Discovery solution with an an overall score of 89.4 out of 100 for Coverage Discovery in its latest software and services report.
• HBI Solutions announces that two customers have implemented its predictive suicide risk model.

Blog Posts

• Righttime Medical: Building a New Medical Model (EClinicalWorks)
• Building a Healthcare Chatbot isn’t Brain Surgery (The HCI Group)
• Industry Outsiders Seek to Solve Non-emergency Medical Transportation Dilemma (Healthgrades)
• Taking control of our health: A HIMSS Europe 2018 recap (Hyland)
• Unlocking mobility in healthcare with mobile device access: A Q&A with Clinical Workflow Specialist Claire Reilly RN MSc (Imprivata)
• House of HIT Pain (Influence Health)
• Active-Active Series Part 1: High Five to Five-Nines Reliability (Liaison Technologies)
• Gaining Patient Buy-in for Chronic Care Management (Lightbeam Health Solutions)
• Reducing healthcare waste through clinical process improvement and technology solutions (LogicStream Health)
• 3 Lessons from the FIFA World Cup (Navicure/Waystar)
• Implementing the Second Electronic Health Record – Part 1 (Netsmart)
• Ditch the spreadsheets and supercharge productivity with these automated solutions (Experian Health)
• Four Questions Series: Mary Niemczura, Post-Acute Care Coordinator, Cone Health/Triad HealthCare Network (PatientPing)
• What Consumers Want, Pt. 1: Clarity (Patientco)
• 4 Key Considerations for Analysts When Implementing an EHR (Pivot Point Consulting)
• Cultural Considerations for Mergers and Acquisitions (Optimum Healthcare IT)

Contacts

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

EPtalk by Dr. Jayne 6/14/18

Mr. H has mentioned the rise of private equity in healthcare, most recently in this week’s news and morning headlines. I’ve seen it both from the consulting side and from the trenches as I’ve watched several of my friends sell their independent practices.

It’s amusing to watch their thought process. These are the same physicians who wouldn’t consider selling their practices to a local health system for fear of being beholden to “the man,” yet they’ll get in bed with private equity. Even before the ink is dry, some of them have seen their worlds completely reorganized with less of a focus on clinical quality and patient care and more of a focus on profits. I’m not sure why my colleagues are surprised when this happens. By definition, private equity firms are investment management companies,. Not healthcare companies, not charities, and certainly not physician-led organizations.

Allowing private equity investments puts you on a slippery slope, but selling to private equity moves you squarely into the realm of being a for-profit business, whether you want to put an altruistic healthcare face on it or not. I’ve been in consulting engagements (working for physician groups) where the PE firm brings in its own consultants and starts slashing and burning before even trying to understand the practice’s culture, patient population, and what they’ve tried to do already. I’ve watched dermatology practices converted to almost exclusively cosmetic enterprises over the protests of the former controlling physicians who actually want to practice dermatology.

There’s only so much money out there. It’s tempting to think that the PE firm is actually going to invest in you and grow your business the way you might have done on your own, but in reality, they’re likely to drastically change your way of life and profit will be the driving force behind most decisions moving forward. Caveat emptor!

I got a kick out of Jacob Reider’s comments about potential suitors for Athenahealth following the departure of Jonathan Bush. He discounts the possibilities of Apple, Cerner, and Microsoft, but gives 10 percent odds to Salesforce. He also throws the possibility of Roper/Strata Decision into the mix. I agree with Jacob that Strata CEO Dan Michelson gets the EHR market, and the last time I saw him in action, it made me want to go home and learn more about cost accounting – something you don’t hear too many people hankering to do in their free time.

From No Surprise Here: “Re: HDHPs. Check out this article about high-deductible plans keeping patients from accessing preventive care services. No surprise, right?” The link is from the American Academy of Family Physicians and cites a study from the Robert Graham Center for Policy Studies in Family Medicine and Primary Care. The study found that patients who have high-deductible health plans but who do not have health savings accounts to go with them are less likely to receive preventive care or care from primary physicians or subspecialty service providers. The authors looked at data from 2011-2014 for almost 26,000 privately insured adults in four categories: no deductible, low deductible, high-deductible plan with savings account, and high-deductible plan without savings account. Those in the latter category were 7 percent less likely to receive breast cancer screening and 8 percent less likely to receive a flu vaccine. Screenings for hypertension were slightly (4 percent) less.

Under the Affordable Care Act, preventive care is supposed to be exempted from out-of-pocket charges, including deductibles, but this only applies to certain identified preventive services. It definitely doesn’t apply to my breast MRI, which is indicated due to my very high lifetime cancer risk, and fortunately as a physician, I can afford to pay for it. But for those services that are explicitly exempted — such as well visits, screening tests, and vaccinations — many patients don’t realize they have access without a deductible, so they don’t seek care.

As I’ve said before, there’s not the greatest incentives for insurance companies to advertise all the services they cover at minimal cost to the patient since the return on investment is likely to be years down the road when the patient may be with another payer. One would hope the payers could adopt the attitude of “we’re all in this together” since the number of patients moving around is likely to impact all of them, but I haven’t seen much education to patients in this regard. Failure to have patients take advantage of preventive services that are shown to be cost-effective illustrates the lack of attention to public health efforts in our nation. We’re relying on the primary care workforce to identify all these gaps in care and take care of them, but if the patients don’t have a primary to see (the wait in my community is well over six months), aren’t eligible to be seen at a clinic, or just don’t go, then no one is handling it for the patient.

I’ve always found the AAFP to be a solid source of information, both as a physician and as a patient. I was sad to see their writeup on increased suicide rates across the US. Looking at data through 2016, the suicide rate has increased nearly 30 percent, with 45,000 Americans age 10 or older taking their own lives. We hear about the celebrities, but we don’t hear about the others, and we don’t hear enough about the people who tried and didn’t succeed.

One of the most heartbreaking situations I ever encountered was a pre-teen who tried to hang himself and was found by his parents, but not quickly enough, resulting in severe anoxic brain injury. I cared for him several years later due to some complications of his multiple medical issues. It’s never to early to talk about mental health.

In the times that suicide has touched me personally, for most, there was no warning. This is borne out by data that shows that in states reporting complete information for 2015, 54 percent of the time there were no known mental health conditions. The data also shows an increase in visits for non-fatal self-harm, rising 42 percent between 2001 and 2016. Firearms were used in 48 percent of cases.

Suicide is preventable. The article lists key strategies:

• strengthening economic supports (housing stabilization policies, household financial support)
• teaching coping and problem-solving skills to manage everyday stressors and prevent future relationship problems, especially in early life
• promoting social connectedness to increase a sense of belonging and access to informational, tangible, emotional and social support
• identifying and better supporting people at risk (military veterans, people with physical or mental health conditions)

As a side note, the next to last bullet does not refer to Facebook, Snapchat, Instagram, or other social media that can actually increase feelings of decreased self-worth and hopelessness. We’re talking real, interpersonal connections that might be made when people are actually together interacting like human beings. I see a lot of people who are well “connected” but have no one they can really turn to. Reach out to your friends, your neighbors, and the people you know and consider getting to know them better.

I’ll get off my soapbox now and get back to the business of working on a lab interface. Thanks for listening.

Email Dr. Jayne.

Morning Headlines 6/14/18

Medici Raises $22M+ in Private Capital

Text-based telemedicine app company Medici raises $22 million in a Series A funding round.

CD&R and Cardinal Health to invest in naviHealth

Cardinal Health sells a majority stake in post-acute care services and analytics company NaviHealth to private investment firm Clayton, Dubilier & Rice for an undisclosed amount.

Countess of Chester cosies up with Cerner in 15-year deal

The Countess of Chester Hospital NHS Foundation Trust will replace its Meditech software with Cerner Millenium.

Morning Headlines 6/13/18

Private equity’s thirst for health care providers

Triggered by news of KKR’s planned acquisition of Envision Healthcare Corporation for $9.9 billion, a new report says that private equity firms love buying healthcare provider companies that wield a lot of market power, especially physician and ED staffing groups and air and ground ambulance companies.

Biotech’s Soon-Shiong hiring bankers for Nant cancer drug IPO

Billionaire doctor Patrick Soon-Shiong, MD says that despite the poor stock performance and heavy criticism of his two publicly traded companies NantHealth and NantKwest, he will IPO a new chemotherapy development company later this year.

GPB Capital Acquires Health Prime International, Building Upon its Healthcare IT Portfolio

Private equity firm GPB Capital acquires Maryland-based RCM/EHR vendor Health Prime International.

Moody’s says Lahey merger could help bond rating of Beth Israel parent

Moody’s downgrades the credit rating of Beth Israel Deaconess Medical Center parent CareGroup, citing concerns about its $534 million BIDMC expansion project and significantly lower margins at Mount Auburn Hospital following its $110 million FY2017 implementation of Epic.

Inspirata Acquires Health Analytics Company, Caradigm; Plans to Use its Award-Winning Platform to Accelerate Development of its Cancer Information Data Trust

Cancer informatics technology vendor Inspirata acquires Caradigm from GE Healthcare. Imprivata bought Caradigm’s identity management business in October 2017. Microsoft, originally a 50-50 Caradigm joint venture investor with GE Healthcare to which it contributed its Amalga data platform, sold its share to GE Healthcare in April 2016.

News 6/13/18

Top News

An Axios report says that private equity firms love buying healthcare provider companies that wield a lot of market power, especially physician and ED staffing groups and air and ground ambulance companies. Those businesses make money when their providers are forced on hospital inpatients (often at out-of-network rates) or during moments when the patient has no choice.

Part of the company’s high margins come from the “surprise” portion of bills that insurance doesn’t cover.

The article was triggered by news of KKR’s planned acquisition of Envision Healthcare Corporation for $9.9 billion.

Envision provides ED doctors, hospitalists, anesthesiologists, radiology, and children’s services in 1,800 clinical departments in 45 states. It also operates a freestanding surgery center.

Elizabeth Rosenthal, author of last year’s bestseller “An American Sickness” and editor of Kaiser Health News, tweeted out in response her book’s rules of our medical market.

HIStalk Announcements and Requests

This week’s question has generated quite a few heart-wrenching but sometimes uplifting recaps. I didn’t explain well why I solicited stories that are in ample supply elsewhere — these are coming from health IT peers and might resonate more strongly with struggling folks who work in our industry.

My least-favorite word of the moment: “seasoned,” a self-descriptive adjective used mostly by executives but sometimes companies who feel their experience needs its own laudatory designator. The mental picture it always creates for me is either (a) someone getting salted and peppered, or (b) a person or company as a stack of firewood that has dried up and is ready to go up in flames. It’s kind of like “innovative,” “nimble,” “entrepreneurial,” and “successful” in being self-congratulatory, yet conveniently unquantifiable.

Listening, only because it immediately caught my ear as played on a pirate sort of anti-corporate streaming radio station: Kevin Ayers, whose 1969 “Lady Rachel” was new to me (as was he himself, in fact). He was an original member of Soft Machine in the mid-1960s and played in the prog subtype of Canterbury Sound, which can range from whimsical to psychedelic, but always melodic (Soft Machine shared bills with Pink Floyd). Kevin died in 2013 at 68 with his Soft Machine heyday long passed. The lyrics and the voice he sings them in are kind of creepy: “Then she unwraps the parcel, And discovers a castle inside, The drawbridge is open, And a voice from the water, Says welcome my daughter, We’ve all been expecting you to come. She climbs…” His life’s finale was 2007’s “The Unfairground,” recorded with members of then-popular bands such as Teenage Fanclub and Roxy Music. 

Webinars

June 21 (Thursday) noon ET. “Operationalizing Data Science Models in Healthcare.” Sponsor: CitiusTech. Presenters: Yugal Sharma, PhD, VP of data science, CitiusTech; Vinil Menon, VP of enterprise applications proficiency, CitiusTech. As healthcare organizations are becoming more adept at developing models, building the skills required to manage, validate, and deploy these models efficiently remains a challenging task. We define operationalization as the process of managing, validating, and deploying models within an organization. Several industry best practices, along with frameworks and technology solutions, exist to address this challenge. An understanding of this space and current state of the art is crucial to ensure efficient use and consumption of these models for relevant stakeholders in the organization. This webinar will give an introduction and overview of these key areas, along with examples and case studies to demonstrate the value of various best practices in the healthcare industry.

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

Acquisitions, Funding, Business, and Stock

Billionaire doctor Patrick Soon-Shiong says that despite the poor stock performance and heavy criticism of his two publicly traded companies NantHealth and NantKwest, he will IPO a new chemotherapy development company later this year. Investors might want to proceed cautiously – shares in NantHealth and NantKwest have dropped 77 percent and 46 percent since their respective IPOs.

Private equity firm GPB Capital acquires Maryland-based RCM/EHR vendor Health Prime International. Among GPB’s other holdings are dozens of car dealerships, several garbage collection companies, a concert video streaming service, life sciences firms, and health IT vendors Cantata Health, ITelagen Healthcare, MDS Medical, and Meta Healthcare IT Solutions.

Inova’s healthcare accelerator invests in CoverMyTest, which automates prior authorization workflow for genetic and genomic testing. The company name seems like it would be legally challengeable by McKesson-owned CoverMyMeds, which offers the same type of PA service for medications.

Sentry Data Systems, which sells 340B hospital drug subsidy program software, wins the first round in its antitrust lawsuit against CVS, which bought its own 340B administrator and required that its hospital and clinic customers use that company exclusively.

Moody’s downgrades the credit rating of Beth Israel Deaconess Medical Center parent CareGroup, citing concerns about its $534 million BIDMC expansion project and significantly lower margins at Mount Auburn Hospital following its $110 million FY2017 implementation of Epic. Moody’s also worries about planned Meditech upgrades at three CareGroup community hospitals. However, the ratings firm says a proposed merger with Lahey Health would create economy of scale and market share that could make CareGroup competitive with Partners HealthCare in the Boston area.

People

John Elms (Connexall USA) joins nurse call system vendor Critical Alert Systems as CEO.

Announcements and Implementations

A Cincinnati Children’s study that is really small in sample size and scope finds that TempTraq’s Bluetooth-powered continuous temperature monitoring patch detects early fevers better than the usual episodic methods. The company says it can be integrated into central monitoring and EHR systems.TempTraq is part of Blue Spark Technologies, which makes flexible printed batteries similar to the temp-monitoring patch.

The Concord newspaper profiles former medical software technologist Chris Stakutis, who is working on a skill for Amazon Alexa for elderly people that reads news and emails aloud, allows creating messages, and asks questions about their health.

Other

In Australia, doctor finder and appointment scheduling service HealthEngine is caught modifying more than half of patient-submitted practice reviews to make them sound more positive, with the local paper somehow tinkering with the site’s HTML to obtain before-and-after images. The company says it “has never intended to be a traditional ratings and review site” since its goal is to “celebrate high-performing practices” by publishing only positive reviews and sending negative ones privately to the practice (which is the real story that the paper mostly missed). Hopefully it takes fewer liberties with its medication management app. Meanwhile, it has removed the reviews from its site as it contemplates its future.

A new KLAS report on digital rounding technologies – which includes rounding by nurses as well as non-clinical employees – finds the market to be immature, with few use cases and low customer expectations beyond replacing paper-based systems. Most of the vendors had too few customer responses to assure data validity.

Spok’s annual mobile strategies report, derived from a smallish survey of 300 hospital employees, finds that 57 percent of hospitals have a mobile strategy, a decrease from 2017. Half said their strategy addresses communications needs, with 25 percent each saying it’s either a clinical or a technology initiative. The survey found that clinicians are increasingly involved in developing mobile policies, mostly to offer input on technology selection and to improve adoption rates. In-house Wi-Fi and cellular coverage remains the biggest problem, reported by more than half of respondents.

Weird News Andy gets this potty started by filing this breaking news item under Porta-Jong. A North Korean defector who served in the military says that Kim Jong-un always travels with his own private restroom, including one that’s installed in an armored black limousine for motorcading. WNA assumes that if Western intelligence agencies gained access to his leavings, it might lead to a serious data dump about his health, although he acknowledges that the rumor was leaked by a stool pigeon. 

Sponsor Updates

• ChartLogic’s ambulatory EHR earns ONC’s 2015 Edition certification, with the company noting that 100 percent of its clients who participated in its 2017 MIPS program attested successfully.
• Memorial Medical Center (TX) is featured in a video testimonial about its use of the hosted version of the Obix Perinatal Data System.
• Santa Rosa Consulting publishes a white paper titled “Utilizing Lean Management Principles During a Meditech 6.1 Implementation.”
• Meditech posts a podcast titled “Rural Healthcare and the Role of the CIO,” featuring Methodist Hospital CIO and 2017 Gall CIO of the Year winner Randy McCleese.
• In Ireland, Aut Even Hospital moves to an integrated radiology department with Agfa HealthCare’s enterprise imaging.
• A new customer study shows that medical practices using Aprima’s EHR with Kno2 saved 103 hours per provider annually.
• AssessURHealth publishes a new customer success story featuring Mark Weissman, MD of GMS Florida West Coast.
• Burwood Group accelerates its cloud management practice with the adoption of HyperGrid’s HyperCloud platform.
• Change Healthcare will exhibit at the AMDIS 2018 Physician-Computer Connection Symposium June 18-23 in Ojai, CA.
• Divurgent publishes a new white paper, “Blockchain: The Challenges and Opportunities in Healthcare.”

Blog Posts

• Sparta Home Health Administrator Cheryl Adams Wins Helen Heyrman Award (Meditech)
• Increase reimbursements with voice recognition software (AdvancedMD)
• Is there a doc on board? How airlines prepare for medical emergencies – and (sometimes) ‘bypass’ onboard recommendations to land. (Advisory Board)
• Why is the Opioid Epidemic Different? (Arcadia)
• Security as Part of the M&A Due Diligence Process (Datica)
• Alert Fatigue – Striking a Balance (Culbert Healthcare Solutions)
• How You Can Better Visualize Your Data (Dimensional Insight)

Contacts

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

HIStalk Interviews Jeremy Schwach, CEO, Bluetree Network

Jeremy Schwach is CEO of Bluetree Network of Madison, WI.

Tell me about yourself and the company.

I’m Minneapolis-St. Paul-born, so I’ve got those Midwest roots. I was born to an accountant and a microbiologist, and unfortunately, I didn’t get either of those skills, so I was forced into business. I found myself at UW, where I started my first company out of my dorm room. It was a bus company. That went pretty well and whetted my palate for the entrepreneurship journey. It didn’t really run in the family, but I had a very good support structure. I had supporting parents and they said failure was OK, which pushed me out of my comfort zone.

I got the first company running. Then I found this weird little software company out of Verona right out of UW. After a brief stint living in South Africa, I moved back to Wisconsin and started my career at Epic. I was there for about six years. After living out my non-compete at a large health system and understanding how hard it is to deliver healthcare, I jumped into this next entrepreneurial thing with co-founders and started Bluetree.

We today are about 250 or so people. We’re not that great at marketing, so people don’t know this, but we’re about 60 percent staff augmentation, specifically in the Epic space. But about 40 percent of what we do is what we call solutions, which is more around strategy. Clients come to us to ask, “We’ve got all this data coming into Epic. Can you help us make sense of it and maybe pull payer data in?” Or, “We know we can do a lot more and make our physicians more productive. Can you guys help us do that?”

Where we’re a little bit different is that we focus on Epic because we know it so well. We like to come in and help with figuring out what the plan is, the strategy, but then we get our teeth into actually getting it done. We always say that ultimately we want our result to be that we delivered something tangible that worked well for our client.

How do you differentiate yourself in that market where there are a lot of competitors?

We didn’t actually want to be a consulting company. We raised a little bit of friends and family. The problem we were trying to solve was that having worked at Epic– and about 40 percent to 50 percent of us came from Epic — we looked out in the wild and saw all of these different consultants, but there weren’t a lot of great consultants.

We thought technology could solve that, so we started as a matchmaking platform. Luckily I failed many times in life, so I knew after that didn’t work, there was still a path forward. We were trying to solve this quality problem. We built this matchmaking platform and went out to clients and said, “You can find the specific skill sets within Epic that you need. Everybody’s going to get reviewed Amazon ranking style. Pretty soon you’ll start to see who all the great people are.”

Potential clients said, “You kids know nothing. It’s a good idea. The transparency and quality problem is a real problem for us. But we’re not going to social network our way to consultants. Sometimes we need 10 people. If things are going great, we want to just pick up the phone and call you. For all those reasons, we’re not going to use your silly platform. But here’s all our needs.”

That was 2013. We learned pretty early on that the market wasn’t ready for a tech platform, but that this consulting thing could probably work. We just said, if we’re going do this like everybody else, let’s stick to our guns on the core quality piece in this area that we know really well called Epic. That was the differentiator.

With some dumb luck on timing, we grew really quickly post the big implementation boom, after everybody had Epic live and had to figure out, what do I do with this super powerful machine now that it’s up and running? Clients started saying not just, “Do you have a strong hospital billing person?” but also, “Our AR over 90 is spiking,” or, “We’ve got to figure out how to build managed care dashboards.” The questions started to change. That was the impetus for the shift to a more outcome-based strategy or solutions.

Half our company comes from the provider space, knows the business of healthcare, knows what it’s like working in a health system. Half of us come from Epic, so we know this tool really well and we’ll be able to maximize the power of it. That’s how we differentiate and have been able to continue growing over the last six years.

Sometimes hospitals only care about getting someone who holds a specific certification. How much of what you learned from your original iteration of letting customers rate their consultants did you apply to the way that you hire and place consultants at Bluetree?

It’s the big reason that we stuck around in the Epic space. We constantly have questions about, should we help Cerner clients or Meditech clients? What we found is we know the Epic space so well that we can use our network and feedback from our clients to help differentiate who’s the rock star. They say in service work that a great person is 10 times better than the median. That is precisely the reason we’ve stayed focused in the Epic niche. We feel like we’re able to differentiate that quality piece.

How has the Epic consulting market changed in the past two or three years?

Again, a lot of life is just dumb luck. Not a lot of people know this, but the only reason I picked Epic out of UW is because they were going to pay me $1,000 extra over Maytag. I very easily could be servicing Home Depots right now.

In terms of our trajectory, we found our footing in 2013 and 2014. There was still a lot of implementations, but you had some really big players that specialized in implementations. Therefore, a lot of our early clients had Epic live and were figuring out what to do next. We got a little bit lucky in that we were on the end of that wave, perhaps the downward slope, as optimization, the next level wave, took off. All of our growth is in what we call solutions. It’s managed services. It’s everybody trying to figure out, how do we do this thing much more cost effectively?

Epic is a really robust, big system. Five years ago, we weren’t seeing that a lot of clients were ready to outsource a lot of that. Now I think the opposite is happening. We see that growing pretty quickly. Then it’s all this stuff, all the buzzwords you read about. We’re on the ground working with clients to figure out, how do we make physicians — happier is not a great word — but how do we ensure that they’re able to get their work done the way that they perceive that they used to? What we’re finding on that particular front is that it’s not about squeezing in extra patients. Physicians are documenting and then going home and having dinner with their kids and then documenting again before they go to sleep. A lot of what we’re doing now is, we might not be able to squeeze in extra patients, but we can help you get more efficient. You’ve got this amazing system that frankly you’re probably not using to the best of its abilities. It’s those types of conversations that now make up the majority of what we’re doing.

What interesting things are you seeing clients do with the wealth of Epic data they’re suddenly sitting on?

Man, I wish I had a lot of cool stories. A lot of what we’re seeing is more foundational. You go live with Epic. You have a massive amount of data. As users start to get comfortable with the data, they start to ask the right questions. From there, you have to figure out, what’s the strategy so that we can iterate fast enough? A lot of our work is around that basic foundation. A lot of clients have data warehouses. They also have Caboodle. Many of them have visualization tools. A lot of our work is around the strategy of, how do we make sense of all of these tools? How do we help you iterate faster?

I don’t know if this is cool yet. I think the outcomes are going to be really cool, but even getting payer data back into the warehouses, back into Epic, is a relatively new thing. We’re seeing more and more clients start to work with payers who, perhaps not overly surprisingly, don’t all want to give up their claims data. Part of the work is figuring out how to work with the payer to get the data back, and then once it’s in Epic, that’s the opportunity to start using it. We’re seeing a lot of foundational type of stuff happening.

What are the most impactful things that you learned from working at Epic that affect how you do business now with your own company?

This perhaps isn’t controversial, but I cannot think of a place I’d rather start than Epic. We’ve grown from zero to well over 250 employees in five and a half years. I truly believe that without learning a lot of those fundamental lessons that I learned and we learned at Epic, I don’t think we would have been able to do it.

First and foremost, Epic does such a good job training their people. It’s not just training, but it’s giving people opportunity. One of the best technical people I worked with at Epic was a philosophy major. Epic just found a smart person and said, “We can use this raw talent and mold it.” I really respect that philosophy. We see some of our clients taking a similar philosophy — hire a lot of really smart people, regardless of whether they’re healthcare or not, and then introduce them to healthcare and train them on their processes and allow them to fail and learn. Epic was just so good at that.

I think the other thing they did pretty well is that the talent bar stayed high at Epic. That’s probably easy when you’re a small company, but it gets progressively harder as you grow. You have to be laser focused and deliberate about keeping that quality bar high. Epic used to say, get those A players. Get the best people. Those best people will figure anything out, regardless of the problem. Then those A players will find other A players, and you’ll be able to scale that way. You’re going to make mistakes. You’re going to hire B’s, and that is OK, but you have to fix the mistake. You have to grow those people, Because if you don’t, those B players make mistakes and hire C’s, the C’s hire other C’s, and pretty soon the A’s are looking over at the C’s and saying, “Why am I doing all this work?” and they leave.

Epic did such a good job training and was focused on giving people opportunity. Then they did a fabulous job, mostly through culture, of keeping the strong people there. I was there for about six years and it was just a remarkable experience.

Do you have any final thoughts?

Can I use this time to promote something unrelated? I don’t get a lot of opportunities. There’s a great non-profit I’m associated with called Year Up. They’re a workforce development program in about 15 cities. They’re trying to bridge the opportunity divide. There’s a lot of really talented urban, young adults who have raw talent and are looking for work. There’s a lot of companies with open, entry-level positions. They do a good job facilitating those connections. It’s about a year-long program where they’re taking these talented young adults and training them up to start a career in corporate America. There’s a big focus on finance and software development in certain regions, and there’s a push for healthcare. Northwell in New York uses Year Up interns and one of the Sutter hospitals uses them. There’s just an amazing opportunity to get really smart young people trained up in healthcare and do good while doing it.

If I get to reach any health systems that are interested, they should feel free to contact Year Up directly or reach out to me and I’ll connect them.

Morning Headlines 6/12/18

IBM’s problems with Watson Health run deeper than recent layoffs, former employees say

Former IBM employees say Watson Health’s troubles stem from the company’s inability to successfully merge the health data assets of Phytel, Explorys, and Truven Health – companies it acquired between 2015 and 2016.

VA Awards Contract to 1Vision and AMC Health for Telehealth Solutions

AMC Health and 1Vision will provide enrolled veterans access to telehealth services as part of the VHA Home Telehealth Program.

Apple, Cerner, Microsoft, and Salesforce

Former deputy national coordinator for health IT and Alliance for Better Health CEO Jacob Reider, MD downplays the likelihood of top Athenahealth suitors successfully picking up where Jonathan Bush left off.

HIStalk Interviews John Birkmeyer, MD, Chief Clinical Officer, Sound Physicians

John Birkmeyer, MD is chief clinical officer of Sound Physicians of Tacoma, WA.

Tell me about yourself and the company.

I’m a general surgeon and a health services researcher by training. I spent most of my scholarly life focusing on the phenomenon of variation in surgical performance and outcomes.

I am chief clinical officer of Sound Physicians, which is a national physician practice focusing on hospital-based position practices. I also serve on the advisory board for Caresyntax, which is a technology company that specializes in big data integration and offers a variety of tools for helping improve the performance of operating surgeons.

What causes surgical variation how much does it affect outcomes?

If you think about it, there’s no reason to be surprised that surgeons would vary in their performance, skill, and ultimately outcomes any more than tennis players, golfers, or musicians. It’s a pretty fine skill. Surgeons just vary in the degree to which they ultimately master it.

If you look at the scientific literature, depending on what procedure and what specialty you’re talking about, there is, give or take, a three- to five-fold spread in surgeon outcomes and costs. At the end of the day, that has enormous implications for both public health and healthcare costs, particularly as you consider that 40 or 50 million surgical procedures get done in the US alone every year. There’s a very deep and complex body of research that aims to understand what drives observed variation in surgeon outcomes.

Part of it, depending on the procedure, is driven by environmental factors and attributes of the hospital at which a surgeon is practicing. Certainly there’s aspects of the team — the skill and competence of anesthesia and critical care — that ultimately drive how well a surgeon’s patients do. However, my own work, as well as that of others, has shown that a lot of that variation is driven by the intrinsic ability of the operating surgeon. While technical skill and proficiency isn’t the only type of surgeon attribute that varies, it’s the most important and the most obvious.

My hospital experience is that surgeons are fiercely autonomous and aren’t all that interested in having others get involved in their work. How much of the issue of variation is based on surgeon psychology?

There’s no doubt that there’s a stereotype associated with surgeons, which is partly true and partly reinforced by how important surgeons are to the economics and to the smooth running of any hospital. I think part of what you’re describing about surgeons is something that is not specific to surgeons, but it’s a paradigm that’s applies to all physicians. There’s this general assumption that if you’re smart and if you do four,  five, or up to seven years of post-medical school training, then you’re good to go. You’re at the flat part of the curve with regards to your abilities in your mastery of the craft.

Given how complex surgery is, and even given the scientific literature, it’s clear that surgeons continue on the learning curve for many, many years after they finish their training. My belief is that surgeons could be so much better than they are if they adapted a philosophy of deliberate practice and continuous learning and if they increasingly started to harness some of the empirical tools that are being brought to bear in many other disciplines.

Your video study of procedures found that some surgeons have easily observed poor technique, yet no surgeon thinks they are a less-than-average performer. How much of the surgical process is based on defensible, concrete standards?

Perhaps it’s not a surprise, given the stereotype associated with surgeons, that most surgeons think they’re above average. There’s no doubt that part of what made my own research feasible was the willingness of surgeons to supply videos of themselves operating, probably under the assumption that their peers could learn from watching them. We all know that it’s just a fact that in any sample, that half of all the members will be average or below average.

The things that surprised me about that particular study in The New England Journal of Medicine were, number one, just how stark the differences were in both technique and skill. Number two, it was amazing to me just how immediately obvious those variations in skill were. Not just to professional observers — surgeons watching each other operate — but if you show those 20 videos to lay observers who don’t know anything about surgery, they can almost just as easily segregate the best from the worst. In fact, there’s great research that’s recently been published showing that crowdsourcing by lay observers gets you basically to the same ratings as professional ratings by surgeon peers. Finally, I was really shocked by just how powerfully related surgeon skill was to various outcomes that are relevant either to patient outcomes or to cost.

As I watch all of those videos, as somebody who’s himself a practicing bariatric surgeon, there was not a single surgeon whose technique was outside of the standard of care. Nobody was violating accepted professional standards for how to do that procedure. It just speaks to the fact that our standards are fairly loosey goosey, to the extent that we have a very imprecise estimate of what’s optimal technique and what’s not. It also speaks to the fact that it’s not so much the technique that a surgeon deploys as it is the fidelity or the precision in the skill by which that technique is deployed.

The surgeons who contributed their videos were self-selected, which probably means that you were not seeing the worst surgeons in the US. Beyond observing voluntarily donated videos, what data elements or analysis would allow assessment of all surgeons?

You’re absolutely right that in my study, that was a self-selected group of surgeons. But it was also a group surgeons that had the luxury of being able to choose their best case. Nobody sent me videotapes of cases gone sour. They basically sent me what they thought was typical in sometimes their best work. Imagine what it would look like if it was just a random sample of everybody in all cases.

I’m sure that, for many procedures, if you really did have the universe and the entire library of all of their cases, that there’s a significant minority of surgeons that half the peers would say, “This person should not be operating or should not be doing procedures as complex as this.”

The second part of your question was about what’s a scalable strategy for vetting and providing feedback to all surgeons, not just this highly selected group of volunteers. That’s what’s attractive to me about technology approaches. Such a high percentage of surgical procedures these days, particularly those that are most complex and are the highest stakes from the perspective of patients, are done videoscopically, which means that there’s a real-time video recording of what’s going on in the surgical field and at the tips of the surgeon’s instruments.

What’s really exciting to me is to leverage all of that rich data infrastructure and convert the real-time video information to digital, empirical information that gives surgeons real-time feedback about how they’re doing relative to techniques and maneuvers that ultimately lead to the best outcomes. Google and Uber may ultimately get us to a self-driving car — with all of the externalities, in all of the craziness that has to be accounted for — and can help the car or the driver make better decisions. 

I don’t think it’s a huge stretch, given how reproducible certain types of procedures are, that machine learning based on digital video-based information could do the same thing. With regard to not only providing digital analysis and giving a surgeon a report card about how well he or she did with that case that just ended, but also giving real-time information that could help those procedures be better in the first place. Like the angle of attack, how much random motion there is, the amount of force that’s being applied either to the instrument or to the tissue. All of these things that we measured holistically and by human judgment in my study could, in my belief, very readily be replicated in a much more powerful way using the data technology.

Every surgeon wants to do a good job, but nobody likes to judge or be judged by peers. Doctors are competitive enough to want their numbers to look good. Will the procedure data be acted on through self-policing or will hospitals need to get involved?

I think the answer is both. At the end of the day, there needs to be more rigorous procedures for doing two things. One, identifying and policing that small subset of surgeons that really should not be operating, or at least should be operating with a less-complex scope of practice. Number two, finding ways to make all surgeons better. In other words, not just worrying about the bad apples on one tail of the distribution, but finding a way to shift that whole performance curve to the right and make everybody better via the data-informed practice.

With regards to self-policing, there’s a whole bunch of discussion underway about the role of the American Board of Surgery and similar boards for using that as a part of the board certification. Hospitals are increasingly insisting that new surgeons submit videotapes of themselves operating as part of their hospital credentialing process. Those are all fairly important but low-tech approaches to identifying that small number of surgeons who just are not ready for prime time.

What’s most exciting to me is how you make everybody better. Certainly there are practical and sociological barriers to making everybody better purely via a paradigm of person-to-person coaching. Not just because that’s expensive, because surgeon time is expensive, but also because a lot of surgeons just are reluctant to be taught or coached by their peers. They think they’re done and it’s an admission of inferiority to accept that kind of coaching when you’re well-established in your practice.

That’s what’s so appealing to me about the more anonymous, confidential, data-driven performance feedback that I believe is eminently feasible now with both robotic surgery and other types of videoscopic surgery. There still is a lot of work to be done in terms of exactly what that feedback would look like and how to get that feedback in real time to surgeons as they’re operating in a way that does not distract them from what they’re doing, but improves what they’re doing. I think it’s really exciting. I don’t think that it’s 15 years from now. I think we’re getting very close.

As an informaticist, could the expanded information about how a patient’s surgery was performed be connected to other existing data to look at whether the surgical technique contributed to patient outcomes?

If I were chunking this up into three informatics needs, all of which need to be present to some degree to get to the outcome that I was describing earlier, I’d say that number one is there needs to be continued advances in how we collate, curate, and link very heterogeneous, very complicated sources of data that ultimately allow us to link empirical information from the procedure itself to the late outcomes of surgery. Most of which don’t occur during the operating room — they occur the next day or the next week or the next month. If you can’t link measurable aspects of skill in the procedure itself to outcomes later, you just simply don’t have all the data that you’d need for that system to learn.

Once that data platform is in place, there need to be both statistical and probably machine learning-based tools that allow you to identify a subset of high-leverage maneuvers or skills that the surgeon is deploying and to be able to measure them and link them to outcomes in the most parsimonious way.

Obviously there’s a thousand potential micro processes that a sophisticated algorithm could pick up during the course of an operation. Machine learning could help us identify the most important four, five, or six levers and avoid information saturation with the surgeon by focusing on just a small number of levers to get better. It’s much the same way when you take a golf lesson. It’s generally a bad idea for the pro to tell you 14 different things that you should be doing different on your golf swing. You typically do it one or two changes at a time. I think there’s some aspects of that muscle memory in operative surgery as well.

Finally, there is a technology need to not only identify what optimal practices are, but ultimately to get them in the hands of the surgeon in real time, allowing them to modify the course of the procedure as it is being performed. As I think about it, there’s really two ways that that could happen. One way is simply a dashboard in the corner that blinks red when something is sub-optimal and allows the surgeon to self-correct. The second option would be something akin to autopilot, whereby for certain parts of the procedure, you’re letting the technology take over and letting the surgeon guide it and override it exactly as if you’re flying a plane or you’re driving a self-driving car of the future.

What is the prevalence of robotically-assisted devices in the OR and how is that field progressing?

That field is progressing really, really fast. The vast majority of community hospitals, at least those with at least 100 beds, have at least one robot. At the hospital that I was most recently associated with before I joined Sound Physicians, there were four robots that were used virtually around the clock in thoracic surgery, general surgery, urology, and OB-Gyn. It’s really been staggering to see how quickly robotic surgery has started to take over many of the biggest surgical disciplines.

There’s lots of reasons why that is. While we’re collectively on this big learning curve, it also creates this huge opportunity for digital technology to not only make it feasible to conduct more operations through minimally invasive techniques, but also to create this new opportunity for us to do those procedures better than we had in the past.

What steps would you take if you were personally facing a significant surgery?

Unfortunately, surgical patients have very limited publicly available information on which to choose a surgeon. I’m hoping that that may change sometime in the future as a corollary to what we’ve been talking about.

Right now, if I needed some procedure, I would stick with the tried and true techniques for identifying best surgeons. The first is that for whatever type of procedure I need — particularly if it’s one that is complex and/or high-risk — I would learn which surgeon had the highest volumes and specialized in those types of procedures. Both volume and specialization are hugely correlated with better outcomes with most procedures.

Second, I would ask my primary care physician about the reputations of surgeons for the sub-specialties that attach to the procedure I needed. There’s scientific evidence showing that traditional things like the surgeon’s pedigree — in terms of medical school and training — are very poorly correlated with outcomes. Hospitals are small enough places that a physician’s reputation is usually much better than not having that information at all. Even though it’s imperfect, it certainly will help you surface and help you avoid that small number of surgeons that are known to have poor skill or poor outcomes.

Curbside Consult with Dr. Jayne 6/11/18

I’ve been doing a bit of locum tenens work lately. It’s always interesting because it exposes you to not only new people, but different healthcare technologies. It also tends to invigorate my consultant brain, as I am exposed to all kinds of people and situations.

This particular assignment was a veritable cornucopia of adventure. I was looking forward to it, because the rural emergency department I signed up to staff has an EHR system I’ve not used before. It’s always good to see whether the grass is really greener on the other side of the fence or not, but in this case it was hard to tell whether there was going to be grass there at all.

Typically, my locum agency will send me some introductory training material or links to online training if the facility has a system that I haven’t worked with before. That lets me get up to speed before I have a crash course with a super user at the site once I arrive. Depending on the contract, the facility might allow a couple of hours for training or maybe even a half day. Facilities that have scribes may not include training time, but I think that’s a bad idea since the physician still needs to be able to use the EHR in at least a rudimentary fashion. Generally, I avoid those kinds of postings, because if the facility is too cheap to include a couple of hours for training, it’s probably going to be painful in other ways.

My agency said the hospital never sent any materials despite having been asked for it several times. They didn’t even provide a version number for the software so I could do a little research on my own. Without it being clear what product was in use, I didn’t want to waste time trying to scrounge up materials, since that’s a challenge in itself because vendors don’t exactly broadcast their workflows on their websites. Not to mention that even the most straightforward product can be customized to the point of being nonfunctional. I decided to just see how it went when I got there.

I arrived in town over the weekend because I wanted to be able to check out the area, stock up on groceries, and figure out my non-work plans for the engagement. In smaller towns, the lodging facilities vary greatly and it’s worth spending a couple of hours figuring out if you’re going to be able to stock in a week’s worth provisions, whether you can cook, or whether you’re going to be working with a dorm-sized refrigerator and a sketchy toaster oven. This was one of the better assignments, with a hospital-owned apartment that they use to house locums and visiting subspecialists from a children’s hospital that sends out subspecialists a couple of days a month. I knew I’d have the place to myself the first week for my 24-on, 24-off adventure.

People always ask how I handle those long shifts, and in a rural emergency department it’s not that big of a deal since there’s not a steadily high volume of traffic. It’s possible to nap during the day and often to get at least four hours of uninterrupted sleep overnight. However, when it’s busy, it can be scary-busy since you’re the only show in town and some of the cases are challenging – patients having strokes when the nearest stroke center is hours away, patients having heart attacks, and patients with major trauma.

Often in the smaller facilities, attending physicians come into the emergency department to work up their patients, which is great as far as feeling like you have backup along with generating a sense of belonging. People also tend to do double-duty at times, such as seeing pediatric patients when they’re not a pediatric subspecialist or covering subspecialty areas that are bit outside what their specialist colleagues would practice in a larger city. I learned this all too well a bit later in the engagement.

The first day of work was uneventful, with me getting my badge, signing paperwork, having a four-hour block of training with a super-user, and then working 10 hours in the emergency department as a “training shift” with one of the full-time emergency physicians. The patient mix was pretty routine, with asthma exacerbations, pneumonia, a motor vehicle collision, some stitches, and a broken arm following toddler vs. trampoline. They were handled the same way I’d handle them in the urgent care at home, and patients didn’t mind my slowness as I documented in the room with them. I went home, ready to hit the sack and return the next morning for my first solo shift.

The next morning was pretty slow as far as emergency patients, although I was called to the medical / surgical floor a couple of times to assess patients who were having issues and there was going to be a delay in their own physician being able to get there. Most of the physicians work out of an office suite that is attached to the hospital, so it’s not a frequent problem during the day unless the attending physician has a day off without close coverage. It was kind of fun feeling like a resident again, when we could be called to see a patient on any floor for any issue, although I was much more comfortable reliving those non-glorious years in a sparsely-populated 60-bed hospital as opposed to the 600+ bed hospital of my residency days.

When I got back to my cubby after one of those sojourns, I found a printed email and packet of documents from the ED nurse. Apparently there had been an EHR upgrade over the weekend and they were just sending out the vendor’s release notes – three full days after the upgrade. This was a new one for me since I’m used to being on the other side of the equation, translating the vendor release notes into an actionable document for my end users. Maybe the unmentioned upgrade was the reason they wouldn’t send over any documentation or training materials prior to my arrival.

This particular document was not only less than timely, but included documentation of features that clinical users normally don’t see, like the charge master setup screens, along with features that the hospital didn’t even have live, such as patient portal statements and payments. Did I mention the document was 24 pages long, in spreadsheet format, and printed landscape with items wrapping from page to page? It’s unlikely that physicians are going to sit and read that, not to mention the level of distraction with irrelevant features.

The only pieces that were important to me were the fact that a medication database update was installed as was a formulary update, and those were both summarized in the email. The rest of the features were specific to other disciplines, but it was fun to see what other vendors do as far as documentation. Pro tip: less is more.

Mid-week, I was invited to attend a medical staff meeting, which seemed like a great chance to meet other physicians as well as to score a dinner I didn’t have to cook myself or eat at a local restaurant where everyone else knows each other. In reality, it was a prime opportunity to see the kind of turf war I hadn’t seen in years.

In a large city, people are always competing for business and insurance is always changing, so when patients move around, it’s not a big deal. In a small community, though, where there may only be two physicians in a given subspecialty, “poaching” may be taken as a personal affront. There are complex unwritten rules about non-solicitation of patients, even after physicians cross-cover each other’s patients, and apparently someone had stepped out of line. I thought it was going to come to blows, but the president of the medical staff did a great job disarming them. Although he is young and the squabbling physicians were his senior in several ways, he used some great de-escalation skills and leveraged other leaders in the room to calm the situation. It was like being in a role play for management training.

Over the first weekend, I had my first “pack and ship” experience, which basically means the patient is critically ill and needs to go to a facility with more capabilities, either by ambulance or by air. The facility had a great checklist and the nurses were outstanding, making all the phone calls and getting the paperwork ready while all I had to worry about was the patient. In situations like this, the first thing the physician should do is check his or her own pulse. At moments I did have to remind myself to breathe, but in less than an hour, the patient was on his way to a higher level of care. I’ve spent more time on the receiving end of those cases and have seen people at the tertiary care center belittle the work that’s done at smaller hospitals, but I have to say my team was first rate.

The second week was largely uneventful, with a steady flow of respiratory problems, orthopedic injuries, and minor trauma. The one thing I noticed was that during the time I had been there, the patients were much sicker than I saw at home and often had been referred in by their physician, who called ahead for them rather than just having patients show up. The primary physicians and orthopedic doctor in this community tended to see many walk-in patients every day and patients were happy to wait in line to be seen where they were known, rather than roll to the emergency room first. You knew when they sent someone over that they needed help – patients weren’t just coming out of convenience or lack of being able to be seen elsewhere. I had expected to see more minor sick cases since there isn’t an urgent care or retail clinic anywhere around, but it just didn’t turn out that way since they were being seen at the office.

The uneventful nature of the week came to a screeching halt, though, during the overnight portion of my second-to-last shift. I was napping in the ED call room when one of the nurses threw open the door and flipped on the light switch. Since they would never normally do that (these were nurses that apologized profusely when they had to wake you), I knew something was up. She threw me a set of shoe covers and said, “We have to go to the OR.” I knew something was up. We headed to the operating suite, where an emergency C-section was about to take place.

Long story short and intentionally left vague, I was asked to pinch-hit for a provider who was called in but couldn’t make it to the hospital. In a case like this, I suppose a family medicine doc turned ED locum tenens is better than no one when you need multiple licensed physicians in the room and lives are possibly at stake. It’s amazing how your reptilian residency brain kicks in. I started to scrub while thinking through what might happen next. My ears caught up to my brain as the staff told me which providers were already in the room and who was on the way — they only wanted me there as a precaution. I must have missed that on the way over and was glad to hear it, but still on an adrenaline rush.

I was gowned and ready, but mom and baby were stable. I got to stand there with a surgical towel over my hands, watching a midwife and a physician assistant give directions and prepare the patient until the rest of the team was in place. You can bet that my pulse slowed considerably at that moment. I was ready to head back to the ED once everyone was scrubbed in, but they asked me to stay just in case they ended up needing an extra set of hands with the baby.

As much as health IT has evolved, C-sections haven’t changed much in the decade since I last saw one, and we’re still using the Apgar score after 66 years. I did wind up helping a bit and was still hopped up on adrenaline when I made it back to the ED, so I stayed up chatting with the night nurse. Apparently, similar situations happen more often than you’d think, with weather being a challenge during the winter as well as the chance of two patients needing to unexpectedly go to surgery at the same time. Many medical leaders have the luxury of not thinking about that kind of scenario, but it was a good reminder of the fragile system of care that many Americans live with every day.

My last shift in the ED brought a cake, a couple of jars of homemade pickles and jelly to take home, and a goofy picture of me with one of the nurses at the local sale barn after I had just stepped in something less than floral but decidedly fresh. Overall, it was a great experience, and I hope they request me the next time they need a locum. At least then I’ll know what EHR to expect and I’ll remember to bring an old pair of boots.

Email Dr. Jayne.

Morning Headlines 6/11/18

UMass Inventor Insists On Due Credit For Nurses Who Innovate

UMass Amherst nursing professor Rachel Walker, PhD, RN is named to the American Association for the Advancement of Scientists.

“SHE ABSOLUTELY HAS SOCIOPATHIC TENDENCIES”: ELIZABETH HOLMES, SOMEHOW, IS TRYING TO START A NEW COMPANY!

WJS reporter and “Bad Blood” author John Carreyrou provides a couple of new tidbits about Elizabeth Holmes.

NYU Langone Health tests out Amazon Business programs

NYU Langone Health is testing Amazon Business for allowing employees to order supplies directly as it works to evolve into a more digitally-savvy organization.

VA Moves to Launch Implant Registry with FDA, CMS, DoD Input

The VA will create a medical implant registry to allow it to notify patients about recalls, identify devices in emergencies, and track outcomes.

Monday Morning Update 6/11/18

Top News

UMass Amherst nursing professor Rachel Walker, PhD, RN is named to the American Association for the Advancement of Scientists.

Walker says doctors are too often credited with innovations that were actually invented by nurses, such as feeding tubes, hospice care, and hand sanitizer.

Walker’s own inventions include glasses that measure fatigue in cancer patients, a machine that turns water into IV fluid in disaster zones, and a device that measures chemotherapy toxicity. Her background includes working as a rural EMT, volunteering with the Peace Corps, and oncology nurse certification.

She serves on the steering committee of Center for Personalized Health Monitoring, with her interest being using smartphone-connected wearable sensors rural areas that don’t have broadband access.

Reader Comments

From Cosmos: “Re: pre-existing conditions. Please comment on this news item if you would be so kind.” The Trump administration says its Department of Justice will no longer legally defend the ACA requirement that insurers offer the same coverage and premium price to everyone regardless of their medical history, threatening the guaranteed insurance coverage of somewhere between 50 million and 130 million people with pre-existing conditions. The challenge of 20 conservative states isn’t likely to succeed since Congress explicitly retained the pre-existing requirements (probably because voters would have reacted negatively otherwise) and there’s also the tricky legal footing involved with the White House ordering DOJ to selectively defend and enforce only the laws it likes. Regardless of this announcement, it’s going to be a new financial world for providers as the rate of uninsured patients goes up because of ever-increasing premiums, lack of companies willing to sell policies to individuals or to those with a history of illness, the sale of junk policies riddled with coverage exclusions, and the realization by many people that they might as well drop their expensive insurance and go without because they don’t have the money to even hit their deductible before insurance starts helping. US healthcare just keeps getting uglier in its transition from charitable human endeavor to big business to political weapon.

HIStalk Announcements and Requests

Insurance companies were most identified by poll respondents as being responsible for high US healthcare costs, with drug and device vendors coming in second and health systems a distant third. Readers noted the lack of regulation over insurance companies, employer-provided insurance that separates patients from payments, aging Baby Boomers, poor lifestyle choices, and a society willing to spend big on delaying death.

New poll to your right or here: will Athenahealth be a better company without Jonathan Bush as CEO? Vote and then click the poll’s “comments” link to explain why you think so.

I’ve been happy with the IPad Mini 2 that I bought in late 2015, but it had lost its snap in sometimes locking up on web pages full of crappy ads and videos and it was finicky about its WiFi connection, not to mention that it seemed to be shrinking the more I enviously saw people using larger ones with shockingly crisp displays. My decision was made when I ran across Apple’s GiveBack trade-in program, in which they gave me $90 toward the $329 cost of the 32GB IPad 9.7-inch model, which I can confidently say is the best value among all tablets for 95 percent of people. I’m happy in every respect so far, especially since the Mini originally cost me only $199 at Walmart. My Apple Store experience, unlike my last visit, was stellar – I was greeted quickly, my salesperson walked me through the transaction in a friendly and efficient manner, and I got to hang out with the cool kids at the “setup table” as they made sure my ICloud restore worked (which it did, flawlessly). I’m happy it uses the same Lightning connector and mini headphone jack so that I don’t need to buy anything else other than a case.

I gained a new appreciation for marketing and PR folks after reading their responses to “What I Wish I’d Known Before … Working in Public Relations or Marketing,” which should be mandatory reading for C-level executives and salespeople.

This week’s question will be more serious as I try to make sense of the death of Anthony Bourdain. Your responses are anonymous and may help someone.

Webinars

June 12 (Tuesday) 2:00 ET. “Blockchain in Healthcare: Why It Matters.” Sponsor: Quest Diagnostics. Presenter: Lidia Fonseca, CIO, Quest Diagnostics. Blockchain technology is gaining traction in many industries, including healthcare. It’s not only a hot topic, but is also showing promise with real-world applications. This webinar will share how blockchain may play a key role in the future of healthcare IT by helping to solve some of the industry’s challenges, distinguishing the hype from reality by discussing how it works, how it can impact healthcare providers, and its future application in healthcare IT.

June 21 (Thursday) noon ET. “Operationalizing Data Science Models in Healthcare.” Sponsor: CitiusTech. Presenters: Yugal Sharma, PhD, VP of data science, CitiusTech; Vinil Menon, VP of enterprise applications proficiency, CitiusTech. As healthcare organizations are becoming more adept at developing models, building the skills required to manage, validate, and deploy these models efficiently remains a challenging task. We define operationalization as the process of managing, validating, and deploying models within an organization. Several industry best practices, along with frameworks and technology solutions, exist to address this challenge. An understanding of this space and current state of the art is crucial to ensure efficient use and consumption of these models for relevant stakeholders in the organization. This webinar will give an introduction and overview of these key areas, along with examples and case studies to demonstrate the value of various best practices in the healthcare industry.

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

Acquisitions, Funding, Business, and Stock

WJS reporter and “Bad Blood” author John Carreyrou provides a couple of new tidbits about Elizabeth Holmes. He says she believes Theranos employees were responsible for the company’s problems and that “she sees herself as sort of a Joan of Arc who is being persecuted.” Amazingly, Holmes is apparently pitching a new startup idea (hopefully not healthcare-related) to potential investors who must certainly be out of their minds to even listen.

Decisions

• Garfield County Memorial Hospital (WA) will replace its NextGen ambulatory EHR with Athenahealth in September 2018.
• Pickens County Medical Center (AL) will go live with Cerner by fall 2018.
• Fillmore County Hospital (NE) will go live with Cerner in October 2018.

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

Announcements and Implementations

William Hersh, MD and Robert Hoyt, MD publish the seventh edition of “Health Informatics: Practical Guide.”

Newly formed Lancaster, PA-based accelerator Smart Health Innovation Lab will offer a 12-week certification program for validating new healthcare technologies and integrating them into clinical workflows. 

Government and Politics

The VA will create a medical implant registry to allow it to notify patients about recalls, identify devices in emergencies, and track outcomes.

Other

Vanderbilt University Medical Center fires Asian-American surgery resident Eugene Gu, MD three years into his five-year program after his social media criticism of President Trump, Republicans, gun culture, and the hospital itself. He was one of seven people who successfully sued President Trump for violating their First Amendment rights by blocking them on Twitter. Vanderbilt says it decided not to renew his contract because of unspecified work performance issues, adding that it has chosen not to address his “many claims over the past two-plus years.”

A federal judge certifies as class action a 2012 lawsuit brought by a nurse practitioner against the VA that claims that NPs and physician assistants are required to work unpaid overtime to monitor its View Alerts patient updates system.

In England, Sandwell Hospital cancels 147 appointments and goes back to paper when an “unplanned internal update” takes several of its IT systems offline. They’re putting their planned go-live on their Unity project (which I believe is Cerner) on hold to catch up on the patient backlog and will freeze IT changes until after go-live.

North Carolina’s legislature considers giving police officers access to an individual’s records in the state’s controlled substances prescribing database when they are working an active case, raising privacy concerns. One of bill’s sponsors admits, “We are not going to arrest our way out of the addiction epidemic.”

NYU Langone Health is testing Amazon Business for allowing employees to order supplies directly. Amazon Global Healthcare Leader Chris Holt said in speaking at the hospital’s Health Tech Summit that location and past experience won’t be enough to attract patients to hospitals as telehealth takes over, adding, “”Probably in the next 10 years, I’m only going to interact with a person for the most acute care issues in my life. Everything else will be done digitally. You’re going to have reinvent your brand in a digital setting with a new type of customer.”

Rhode Island Hospital will spend at least $1 million to improve its patient-order matching process following mistakes in which it performed three tests (a CT angiography, an angiogram, and a mammogram) on the wrong patients and operated on the wrong vertebra of another patient. Among the consent agreement’s requirements is that the hospital give the Department of Health a worksheet listing all of its EHR users and the number of patient records they can open, access, or edit simultaneously, suggesting that a contributing factor was charting orders on the wrong patient because of multiple open EHR windows.

A Massachusetts court rules that a pharmacist must alert both the prescribing doctor and the patient when a prescription requires prior authorization, triggered by the 2009 seizure death of a 19-year-old woman who went without her anticonvulsant  prescription when Walgreens didn’t send the PA forms to her doctor. A previous ruling had found that Walgreens isn’t responsible for serving as the intermediary between doctor and insurer.

In India, five ICU patients die when the hospital’s air conditioning fails. Some families claim that the AC worked, but was turned on only when doctors were rounding. Daily temperature highs in Kanpur reach 105 to 110 degrees. 

Sponsor Updates

• Qventus will exhibit at the Lean Healthcare Transformation Summit June 14-15 in Chicago.
• The SSI Group will exhibit at the Gulf States ASC Conference June 13 in Biloxi, MS.
• Surescripts will host the 2018 Empowering Exceptional Care User Conference June 13-15 in Dallas.
• Vocera’s Rounds solution wins the Best Overall Patient Engagement Solution Award from MedTech Breakthrough.
• Philips Wellcentive will exhibit at the NG Healthcare Summit June 13-15 in Houston.

Blog Posts

• Four Steps to Succeed in BPCI Advanced (Medecision)
• REST Easy Integrating Healthcare Applications (Sansoro Health)
• Ambulatory Surgery Center Financial Outlook and Structure (The SSI Group)
• It’s Time to Make Interoperability Meaningful (Summit Healthcare)
• Healthcare communication is not an app. (Voalte)
• Turning Values into Value: Respect at NewYork-Presbyterian (Vocera)
• 5 Innovative PT Business Models (WebPT)
• Scaling care management while activating patients and providers (Philips Wellcentive)

Contacts

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

What I Wish I’d Known Before … Working in Public Relations or Marketing

Management would want entire marketing plans in 5-point type on one slide.

The number of PowerPoints you will create. My daughter thinks that is what I do for a living — make and edit decks.

That sales won’t partner with you (not everywhere, but it’s common) and you will be viewed as a source of tchotchkes and money for golf outings, or be expected to be a savior when the numbers are bad.

Trade shows are a LOT of work!

How little people *actually* read.

How little time and energy I’d have to dedicate to my personal brand while I was busy helping build someone else’s.

How the work lives in “never-done” limbo. There is always another improvement that could be made to content, always another distribution channel to explore, always another deadline looming. Silver lining: job security?

How contentious the space between sales and marketing can be and how beautiful it is when you can effectively bridge the gap between the two.

How critical having a provider that’s willing to publically vouch for a vendor company would be to gain traction with and attention from healthcare editors.

How difficult it would be juggling multiple PR and marketing initiatives on behalf of multiple accounts. I managed marketing efforts end to end for a single vendor in my past life. While my to-do list often pulled me in multiple directions on any given day, it utterly pales in comparison to how it feels to project-hop across multiple accounts with very different content needs serving distinctly different healthcare niches. The scatterbrained effects of that kind of multi-tasking can be overwhelming.

What I learned while working in technology strategic marketing and product management: “The best strategy is one that the competition can’t respond to.”

I wish I’d known how quickly relevancy dies out. Even if the content / context is good, your sales team won’t absorb it and they’ll want the next best thing you haven’t created yet.

I wish I’d known marketing would grow so expansive. The company recognizes “marketing” and thinks you can do it all.. but today, there’s all the traditional stuff, plus Content Marketing, Digital Marketing, Social Media Marketing, Influencer Marketing, Email Marketing, PPC/SEO, Video, Graphics, Website / HTML. Once person can’t do it all, and you now need both creative and technical elements in order to be successful.

Your budget will never be what you need it to be.

Everyone believes we have to do marketing and PR, but no one outside of marketing believes it can deliver measurable results.

Telepathy is at least equally important—probably more—than any other skill you bring to the table.

Everyone – I mean everyone – has an opinion. I spent hours debating the color scheme of some billboard or brochure with clinicians, even finance people. I would never tell them how to do their job, but everyone felt very comfortable telling me how to do mine.

How great of a part of any org that marketing is! As a corporate events director I am usually involved in the rally cry of the company,  so exciting and ever-changing I wouldn’t have it any other way. I am constantly educating my niece and her friends on what marketing is and the opportunities that it offers. I feel not enough of us take the time to do this.

That I would be regularly and stridently asked to make mediocre or bad products sound amazing by people with full knowledge of their mediocrity.

That I would be able to measure the impact of marketing initiatives in actual dollars. Before I had a marketing role, I looked at marketing as fluff. Once I was in a marketing role, I learned there were ways to measure the impact not only of programs, but of individual messages (split testing) in actual orders taken and dollars booked. It was a real eye-opener, and I gained more respect for the profession as a result.

People often think that since they are consumers of products and services that doing marketing is easy and that anyone and everyone is an expert. As a lifelong marketing professional, that is very irritating. Also, the field of marketing and PR is ever changing and is far more software an metrics-driven, which is good, but because of that, far too many analytical people are drawn to the field. What they lack is clear and concise writing ability and creative aptitude – which will ultimately hurt this profession.

It can be gratifying to know that you’re providing information in a useful way; information that will help people do their job better. It can be disheartening when you can’t get layperson-understandable information out of the technical and other operations teams – or when the news is bad and you have to make it sound better because otherwise senior leadership will complain.

How difficult it would be to get a happy customer to sign off on publishing a story about the successes they’ve had with your product.

How hard it is to buck the general mindset that marketing is parties and pretty designs. Great marketing is as strategic as any other business discipline and can be tied directly to business outcomes (although that takes a lot of effort). Because it does have a creative aspect to it, it often misunderstood, resulting in less respect.

I’ve worked in both. I changed careers from publishing / editorial to PR, then to health IT Marketing. I knew that it would not be glamorous, but I would learn a lot and meet great people. I didn’t know that the work would include a lot of internal paperwork, getting stalled by processes, regulations, internal tools that don’t work, and fighting internal stakeholders. The hours are long and you can lose a week at a time due to travel in the blink of an eye. Integrating IT systems with partners takes much longer than expected and the projects often don’t make it to completion. I’ve spend countless months working on integration V-teams only to have a partner or management abandon the projects with nothing to show for it. Very frustrating.

Turnover at C-level and upper management levels bog down projects, your messaging direction and priorities, partner execution, and overall direction for most projects far more than you would expect. I’ve been in health IT marketing since the mid-90s. It is never boring! I didn’t expect to meet so many customers doing great things to help patients and hospital systems. I didn’t expect to be in IT marketing for so long, or like it as much as I do. That said, I want to quit just about every month due to all of the above. The pace of change in our industry leads to burn out. But I’m not going anywhere soon!

Two things:

(1) I thought I was “settling” for marketing (long story), but I wish I had known what a rewarding but challenging career it would be. When I started, I had no idea how many different aspects of marketing there are to learn (lead gen, brand, events, PR, writing, content management, marketing technology, graphic design, web analytics, customer experience, graphics, product marketing) and how I could keep learning new things over many years. It turns out I didn’t settle after all, but have been very blessed with this career.

(2) You can be in marketing and have integrity, honesty, and compassion. In other words, it has a bad rep, but there are many of us who are working diligently to just find the right solution to our customer’s problems. Yes, really.

One thing I hadn’t expected when I first started working in marketing is the dynamics between marketing and the sales organization. In reality, there are two sets of customers: your end-user customers who purchase your company’s products or services, and your sales team. If sales isn’t on board with your offering and the support you provide them, you won’t get anywhere. Also, they are often your best eyes and ears into the marketplace. Nurture those relationships and you will be not only more successful but more happy and satisfied in your work.

You must work for a market-focused organization to have an impact. Creating shiny object messaging is not a product strategy. Working with third-party lead generation companies can be akin to used car sales”men.” Wordsmithing for the sake of a press release is like eating confetti

How uninformed, arrogant, and self-important executives are in determining the importance of company updates and events. Not everything deserves a press release, case study, or blog post. I know the content I’m putting out is chock full of buzzwords, fluff, nonsensical phrases and, more often than I’d like to admit, outright lies, but I also know my job depends on cranking out that drivel.

Weekender 6/8/18

Weekly News Recap

• Jonathan Bush resigns as CEO of Athenahealth, which will review its options to sell, merge, or continue operating as a private company
• Apple releases an API that gives developers access to information stored in Health Records and HealthKit for building apps
• Microsoft acquires open source repository GitHub for $7.5 billion in stock
• A Stanford Medicine poll finds that more than half of doctors are dissatisfied with EHRs and desire short-term changes that include user interface redesign
• Teladoc acquires virtual visit competitor Advance Medical to expand its international offerings
• Illinois rejects Cerner’s challenge of the EHR selection of Epic by its customer, University of Illinois Hospitals

Best Reader Comments

Immelt’s comments are classic. Not a word about patients, clients, or employees. Sounds like my data is more valuable than my health. Certainly happy I am not a patient, client, or employee associated with Athena. (Duh)

For anyone at Athena to pretend this is a surprise is disingenuous at best. I have seen JB make inappropriate comments in person several times. The truth is that Athena stock value was served, or at least not harmed, by having a manic, headline-grabbing, consequences-be-damned CEO until now. (Healthcare Consultant)

“To ensure Athenahealth maximizes shareholder value.” Music to the ears of every current and future customer, right? (Sam Lawrence)

Dredging up every bad action in one’s past by a third party who wasn’t personally involved for the purpose of affecting public opinion negatively fits the definition of mud-slinging quite well. Especially when both the real women involved stated that they forgave and support him. (Dr. Gonzo)

Device overuse is like so many other issues: other people have the problem, but certainly not me! (Kevin Hepler)

Watercooler Talk Tidbits

Readers funded the DonorsChoose project of Ms. H in Nebraska, who asked for gloves and hats for her third graders, many of whom are recently immigrated refugees who don’t have warm clothes for recess or waiting for the bus. She says, “This winter, we have been able to play outside more often than in the past. Being able to go outside to run and burn off energy keeps my students more focused during the school day and provides a time to interact with peers and practice social skills. The students take very good care of their hats and gloves. They were so excited when I told them they would be able to take them home when we didn’t need them at school anymore. Some of them said they would keep them safe so they would have them next year.”

Johns Hopkins University honors its MPH graduate Virginia Apgar on what would have been her 109th birthday. She graduated medical school from Columbia; was steered away from male-dominated surgery into anesthesiology (which was almost all nurses back in the 1930s); created the Columbia’s Division of Anesthesia and was the only member of it for several years; and as a medical school professor, developed the baby health-measuring and still universally used Apgar Score in 1952.

Bloomberg profiles billionaire dermatologists Katie Rodan and Kathy Fields, whose celebrity-endorsed and infomercial-pitched acne product Proactiv made them rich in the 1990s, after which they started skincare product manufacturer Rodan + Fields, sold it to Estee Lauder in 2002, and bought it back as a multi-level marketing company in 2007 that now does $1.7 billion in annual revenue. It’s fascinating when you go to a dermatologist’s office how much of their business involves peddling big-profit vanity products and procedures that have next to nothing to do with the curative arts. Some of them seem more like those white-coated cosmetics makeover people in the mall than real doctors.

CNBC runs Jonathan Bush’s goodbye email to Athenahealth employees, saying that “working for something larger than yourself is the greatest thing a human can do” but acknowledging that the qualities that made him useful to the company for 21 years “are now exactly the things that are in our way” and that the company will heal “whatever wounds my own weaknesses have inflicted.”

Medicare trustees, most of whom are Republican government officials, say the White House’s elimination of the individual mandate and the Independent Payment Advisory Board as well as its tax cuts will cause its hospital insurance trust fund to be depleted in 2026. It says that dismantling of the Affordable Care Act is causing more people to be uninsured, leaving Medicare to have to pay hospitals disproportionate share subsidies.

Delaware hospitals are storing photos and footprint scans of newborns in their EHRs and sending electronic copies to the National Center for Missing & Exploited Children. The technology is provided by Fairfield, CT-based CertaScan Technologies, which charges a per-baby fee that the hospitals say is less than $10 and that eliminates the cost and aggravation of inkpad-and-paper capture. The company also provides 24×7 access to a specialist who can confirm a baby’s identity.

The San Diego paper covers the nascent bio-economy, where patients are paid “sequencing subsidies” by researchers who need more DNA. Today’s model is that consumer DNA testing companies like 23andMe and Ancestry sell the information directly to drug companies, while companies like Nebula Genomics  propose to create a marketplace between donors and buyers.

Puma and MIT Design Lab are working on Deep Learning Insoles, a shoe insert that analyzes sweat compounds to send real-time fatigue and performance information to the user’s smartphone. Under the hood (or foot) is technology from Penn startup Biorealize, which offers the Microbial Design Studio desktop bioprototyping studio for designing, growing, and testing genetically modified organisms.

A New York man CVS for HIPAA violations and for causing him “severe mental injury”of an unspecified nature when a drugstore employee mentions to his wife that their insurance won’t cover his new prescription for Viagra.

In Case You Missed It

• News 6/8/18
• EPtalk by Dr. Jayne 6/7/18
• HIStalk Interviews Thomas Charlton, CEO, Goliath Technologies
• Book Review: “Bad Blood”
• Jonathan Bush Resigns as Athenahealth CEO
• News 6/6/18
• Curbside Consult with Dr. Jayne 6/4/18
• HIStalk Interviews Helen Waters, EVP, Meditech
• Monday Morning Update 6/4/18
• Weed’s Legacy

Get Involved

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

Morning Headlines 6/8/18

CEO to be named soon for Berkshire, Amazon, JPMorgan healthcare venture

Berkshire Hathaway Chairman Warren Buffett tells CNBC that he and JPMorgan CEO Jamie Dimon have selected a CEO for their healthcare venture with Amazon and will name the individual within the next two weeks.

Clinical Trial Participants’ Views of the Risks and Benefits of Data Sharing

A survey of clinical trials participants finds that 93 percent are willing to share their clinical data with university scientists and 82 percent are OK with researchers from for-profit companies looking at their information.

MTBC Selected as Acquisition ‘Stalking Horse’, Sale Hearing Scheduled for June

A New York bankruptcy court selects MTBC as the “stalking horse” primary bidder for the assets of Houston-based Orion HealthCorp, which offers revenue cycle services, practice management, and group purchasing.

Unionize Epic

A Madison, WI weekly says its time for Epic employees to unionize following the Supreme Court’s ruling that forcing employees into arbitration over labor issues and prohibiting them from filing class action lawsuits is legal.

News 6/8/18

Top News

A survey of clinical trials participants finds that 93 percent are willing to share their clinical data with university scientists and 82 percent are OK with researchers from for-profit companies looking at their information.

Participants mostly aren’t concerned with how their information is used, although around one-third worry that their data might reduce study participation, could be used for marketing, or might be stolen. They also don’t trust drug companies.

Previous studies involving biospecimens and EHR data found that patients were less willing to share, which is a seemingly contradictory finding since clinical trials data is a usually a superset of EHR data. The authors speculate that clinical trials participants trust researchers and are enthusiastic about contributing to their scientific efforts.

Reader Comments

From Former Insider: “Re: University of Iowa Health Care. Never had any internal controls. The leaders were given $30 million to spend and spend it they did! Everyone is being let go. A tremendous waste of Iowa taxpayer dollars.” UIHC says it needs $7.5 million to exit the UI Health Alliance and dissolve its ACO, which is operated as a separate non-profit, UI Health System. Within UI Health Ventures is Community Connect, a 50-FTE operation that is implementing EHRs in seven critical access hospitals and clinics. A previous audit found that Community Connect had poor data controls, inaccurate patient scheduling and billing, and sloppy financial reporting, which the university still hadn’t corrected six months after the six-month deadline passed. Community Connect’s Epic implementation work will be transferred to UI Health Care’s IT department, which UI Health Care CIO Lee Carmen told me in November back when the decision was made.

HIStalk Announcements and Requests

Wednesday was a busy day on the HIStalk server as I got the Athenahealth news out before anyone else, even the Boston Globe, meaning that over 500 folks were online simultaneously for a couple of hours but with no ill effect except some minor site slowdowns. Page views for the day ended up at over 12,000, which isn’t hugely higher than normal, but it’s the burst of activity that sometimes causes a “server not responding” error at the peak. I had some adjustments made a few weeks ago (after the VA contract news) and that might have helped. The all-time high remains at 17,327 page views on July 30, 2015 when the DoD announced its Cerner decision and even I couldn’t get in that day.

I missed listing some companies the other day who won’t be continuing their HIStalk sponsorship, so I’ll add some additional thanks and goodbyes to:

• Logicworks
• Learn on Demand Systems
• Salesforce
• Sutherland

Webinars

June 12 (Tuesday) 2:00 ET. “Blockchain in Healthcare: Why It Matters.” Sponsor: Quest Diagnostics. Presenter: Lidia Fonseca, CIO, Quest Diagnostics. Blockchain technology is gaining traction in many industries, including healthcare. It’s not only a hot topic, but is also showing promise with real-world applications. This webinar will share how blockchain may play a key role in the future of healthcare IT by helping to solve some of the industry’s challenges, distinguishing the hype from reality by discussing how it works, how it can impact healthcare providers, and its future application in healthcare IT.

June 21 (Thursday) noon ET. “Operationalizing Data Science Models in Healthcare.” Sponsor: CitiusTech. Presenters: Yugal Sharma, PhD, VP of data science, CitiusTech; Vinil Menon, VP of enterprise applications proficiency, CitiusTech. As healthcare organizations are becoming more adept at developing models, building the skills required to manage, validate, and deploy these models efficiently remains a challenging task. We define operationalization as the process of managing, validating, and deploying models within an organization. Several industry best practices, along with frameworks and technology solutions, exist to address this challenge. An understanding of this space and current state of the art is crucial to ensure efficient use and consumption of these models for relevant stakeholders in the organization. This webinar will give an introduction and overview of these key areas, along with examples and case studies to demonstrate the value of various best practices in the healthcare industry.

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

Acquisitions, Funding, Business, and Stock

Athenahealth shares took a sharp turn upward Wednesday on the news of Jonathan Bush’s resignation and the company’s plan to explore strategic alternatives. ATHN shares rose 4 percent Wednesday and another 1 percent Thursday.

HP will lay off between 4,500 and 5,000 employees by 2019 as part of its ongoing restructuring plans.

Meditation app company Headspace launches a new subsidiary that will focus on developing FDA-approved, prescription-strength meditation apps targeted at specific medical conditions. Founder Andy Puddicombe became a Tibetan Buddhist monk and trained with the Moscow State Circus before starting the company in 2010.

A New York bankruptcy court selects MTBC as the “stalking horse” primary bidder for the assets of Houston-based Orion HealthCorp, which offers revenue cycle services, practice management, and group purchasing. You might be appreciating the irony of a revenue cycle services vendor going bankrupt, but there’s more to the story – it was part of Constellation Healthcare Technologies, whose since-fired CEO Paul Parmar and his fellow executives have been charged by the DOJ for part in an elaborate $300 million fraud scheme involving phony acquisitions. He claims he earns $1 billion per year and he lives in a 39,000-square-foot mansion worth a few dozen million.

People

Steve Wretling (DaVita) joins HIMSS in the new role of chief technology and innovation officer.

Act.MD names Amy Vreeland (LifeImage) as chief commercial officer.

Altruista Health appoints Brad Kuebler (Agiliko) VP of technology operations.

Berkshire Hathaway Chairman Warren Buffett tells CNBC that he and JPMorgan CEO Jamie Dimon have selected a CEO for their healthcare venture with Amazon and will name the individual within the next two weeks.

Sales

• Regional physician network Georgia Health Select will implement population health management software from EQHealth Solutions.
• Greater Ormond Street Hospital for Children in London contracts with Hyland Healthcare for its OnBase content management technology.
• Landmark Hospitals (FL) chooses RCM software and services from HCS Interactant.
• Ballad Health (TN) will implement Epic in a two-year process that will kick off in 2019.
• In the UK, Royal Devon & Exeter NHS Foundation Trust officials sign off on an Epic implementation that will begin in September.

Announcements and Implementations

Midland Health (TX) goes live on Cerner.

Patientco adds customizable SmartFinance patient financing options to its line of payment technologies and services.

DrFirst adds pharmacogenomic test ordering to its Rcopia e-prescribing system.

Government and Politics

The DOJ charges the CEO of a chain of Midwest pain clinics and laboratories, along with four doctors, for running a $200 million fraud scheme involving the prescribing of 4.2 million dosage units of medically unnecessary opiates to Medicare beneficiaries who were either addicted to the drugs or selling them on the street. DOJ says the doctors also required patients to consent to receiving the maximum number of injections that Medicare would pay for. CMS stopped payment to one clinic and a lab when it found that 100 percent of their claims were not eligible, after which it says the defendants created new shell companies and swapped out signs on the company doors so the billing could continue. Prosecutors say 37-year-old CEO Mashiyat Rashid lived in a $7 million mansion, drove a Lamborghini and Rolls Royce Ghost, and wore expensive designer clothes. Federal agents had him under surveillance last year when he withdrew $500,000 in 100-dollar bills from the bank, which his lawyer says is reasonable because he’s a venture capitalist. 

Privacy and Security

A presumably independent security researcher alerts consumer DNA testing company MyHeritage to an October 2017 data breach involving 92 million customer email addresses and passwords stored on an unauthorized server. The company may soon face scrutiny from the FTC, which is investigating the data privacy practices of competitors Ancestry.com and 23andMe.

Other

The Madison, WI hippie weekly says its time for Epic employees to unionize following the Supreme Court’s ruling that forcing employees into arbitration over labor issues and prohibiting them from filing class action lawsuits is legal. It adds that a union could also fight the company’s famous non-compete clause that prevents them from working at any Epic-using site, not just the company itself.

Over half of the 4,000 patients surveyed by University of Michigan Medical School researchers report that a physician’s attire is important and one-third admit it influences their level of satisfaction. Most prefer a white coat no matter the care setting, professional role, or gender of the provider.

Allscripts CEO Paul Black throws out the first pitch for the Healthcare Professionals Night at Wrigley Field for the Cubs vs. Phillies game. Not to be nitpicky, he’s not a healthcare professional even though Allscripts paid for the promotion. 

I wrote about the tiny California town whose one-bed hospital would either be sold to the only private investor who wanted it or be closed. They voted to sell Surprise Valley Community Hospital to 34-year-old Beau Gertz (above, right), the owner of nutraceutical and lab companies who plans to run his lab and telemedicine bills from all over the country through the hospital to earn higher payment. The hospital tried that previously with another company that left them high and dry. Apparently the main claim to fame of Cedarville, CA is that it’s the last chance to gas  up on the way to Burning Man.

The New York eHealth Collaborative expands patient care alerts for hospital admittance, discharge, and transfer across the state’s eight regional HIEs via the Statewide Health Information Network for New York.

Sponsor Updates

• Stanson Health’s Caden (Clinical Advisory Delivery Engine) goes live on Epic’s App Orchard.
• Lightbeam Health Solutions publishes a new case study, “Princeton HealthCare System Reduces Inpatient Admissions 15% using Care Management.”
• LiveProcess publishes a self-assessment quiz on the CMS Emergency Preparedness Rule.
• LogicStream Health receives the 2018 MedTech Breakthrough Award for Clinical Efficiency Innovation.
• Meditech will exhibit at the 2018 Nurse and Home Care Forum June 13-15 in Foxborough, MA.
• Netsmart will exhibit at the I2I Center for Integrative Health Spring Policy Forum June 11 in Raleigh, NC.
• DocuTap wins a MedTech Breakthrough Award for Best EHR Service; its Clockwise.MD technology wins in the Best Overall Patient Engagement Company category.
• Kyruus wins a MedTech Breakthrough Award  for best patient scheduling solution.
• Leidos Health will develop health IT for Maxim Healthcare Services and its post-acute care workforce.
• Glytec incorporates Smart Meter’s iGlucose diabetes care solution with its Glucommander Outpatient software.

Blog Posts

• Freeing Trapped Data for Health Research: It is Possible (Liaison Technologies)
• Virginia Medicaid Expansion (MedData)
• Epic Implementation at Integris Health (Optimum Healthcare IT)
• Here’s how 4 organizations are leveraging IT to address social determinants of health (Advisory Board)
• How to Start an Information Governance Initiative (Dimensional Insight)
• 3 Clever Ways to Get More Out of Your EHR (Spok)
• Winning Partnerships: How to make rural IT hosting relationships work (Meditech)
• Yes, you can strengthen portal security without disrupting patient satisfaction (Experian Health)
• Consultants as Business Partners: Cost Consciousness and the Bigger Picture (Pivot Point Consulting)
• Does Opaque Drug Pricing Affect Consumer Trust in Medicine? (PokitDok)

Contacts

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EPtalk by Dr. Jayne 6/7/18

Quite a few of my clinical informatics colleagues do public health work and the discipline is certainly part of the informatics board exam. I enjoyed this article mentioning the return on investment for public health interventions. As the article notes, funding for public health is low because “the private sector can’t make money on it.” Many of the interventions are long-term plays, such as the return on investment for vaccinations or disease prevention. In many situations, by the time the “savings” happens the patient will be on Medicare, so unless there’s a shorter-term benefit payers might not be willing to spend the money.

Given the current mobility of our work force, employers are challenged to see return on investment for the longer-term conditions as well. Even in this high-tech day and age we still struggle with things like safe drinking water. It’s not just in underdeveloped nations – it’s in places like Flint, Michigan. Even if spending on public health didn’t have demonstrable ROI, it’s something we should simply consider as the right thing to do for the future of humanity.

I just finished reading Atul Gawande’s book “Being Mortal,” which should be required reading for broad segments of the population, such as people who have elderly relatives or anyone who might at some point be elderly, which is (hopefully) most of us. I’m a huge fan of his work and now that I’m at a point in my life where handling affairs for elderly relatives is a reality, it was a timely read. It’s good for those of us who live on the bleeding edge of all kinds of healthcare technology to think about the value of interventions and, as Gawande says, “what matters in the end.”

Speaking of reading, one of my favorite professional journals is Family Practice Management, put out by the American Academy of Family Physicians. Historically, family medicine residency programs have put an emphasis on being able to actually run a successful practice, not just learning the medicine, and the journal cuts to the chase on many of the financial issues that primary care physicians face today. The journal’s online “In Practice” blog addressed quality reporting this week, simplifying some principles that I know many physicians are not thinking about when they consider MIPS quality measures reporting.

Here’s the Cliffs Notes version for those of you who advise physicians in this area. Because they care about their patients, physicians are often tempted to report on measures that have clinical significance to their practice, or on measures that they know they are doing well on. However, this doesn’t take into account the fact that MIPS quality reporting is based on performance to a benchmark and that decile scoring is involved. Even though a provider might do the “right” action 90 percent of the time, which sounds like good performance, if the rest of the world is performing that action 95 percent of the time, the provider may receive fewer points than they expect because they’re actually a low performer relative to benchmark. Some of these measures are also considered “topped out,” where the benchmarks are high enough that it’s extremely difficult to make it into the top decile.

Physicians may also not be aware of bonus points available for high-priority measures or certain reporting strategies. For providers trying to navigate MIPS and other programs on their own, it’s very challenging to understand all the nuances. I would encourage them to reach out to their professional societies to see what guidance is available, whether by specialty, region, or practice type.

The American Academy of Family Physicians does a fair amount of advocacy work for docs in the trenches. I applaud their recent efforts to encourage major national laboratory vendors such as LabCorp and Quest Diagnostics to improve reporting mechanisms so that data is more easily shared among care teams in value-based care paradigms. They’re also encouraging the labs to facilitate data sharing for small practices so they can more easily stay in the game and not be burdened by interface and other costs.

I’d love to see AAFP get into the fray with them (along with many other labs) about reporting LOINC data with results. LOINC codes are critical to strong performance in several reporting arenas, and when codes aren’t sent, it can result in low data quality or large amounts of manual work for practices to try to map results to codes. The latter can be problematic due to many LOINC codes for tests that are similar but not identical, resulting in errors.

I used to provide LOINC mapping for my clients, but there ended up being so much back-and-forth with the performing laboratories and too little information available in their online test directories to the point where I couldn’t make it a cost-effective offering. Ultimately, the performing laboratory is in the best position to know exactly what test they are performing and which methodology is being used, which drives the code. I’d like to see reference labs be mandated to provide the codes in results transmissions so that providers can have solid data.

Failing to require labs to send LOINC codes reminds me of requiring physicians to e-prescribe but not mandating that pharmacies deploy systems that can accept electronic prescriptions. Our patients deserve better and it’s time for non-provider parts of the healthcare system to start ponying up.

It’s never too early to begin shopping for great shoes for HIMSS parties, so I was delighted when a friend sent me a pic of these sparkly numbers. Alas, they’re halfway across the country, so I won’t be getting them, but they give new meaning to the term “reach for the stars.” Speaking of HIMSS, now that it’s summer it’s probably time for me to think about booking my hotel so I don’t get stuck riding the shuttle bus from somewhere in conference Siberia.

Email Dr. Jayne.

Morning Headlines 6/7/18

Trump seeks to reorganize the federal government

White House officials plan to propose a reorganization of the federal government that would consolidate welfare programs under HHS – a move that would necessitate renaming the department.

HP sees up to 5,000 job cuts as part of restructuring plan

HP expects to lay off between 4,500 and 5,000 employees by 2019 as part of restructuring plans originally announced in 2016.

MyHeritage Statement About a Cybersecurity Incident

Consumer DNA testing company MyHeritage alerts customers to a data breach that compromised the email addresses and passwords of 92,283,889 users.

A meditation app loved by Wall Street and Silicon Valley wants to unveil a prescription-strength version with FDA approval

Headspace launches new subsidiary Headspace Health with an eye towards developing FDA-approved, prescription-strength meditation apps targeted at specific medical conditions.