News 4/18/18

Top News

UNC Health Care (NC) announces that it has achieved HIMSS Stage 7 for inpatient, ambulatory, and analytics, of which neighboring Duke Health was the first trifecta winner.

The announcement includes a little dig at Duke, noting that UNC is “the only health system in the US to achieve Stage 7 status on all three HIMSS Analytics domains … and also honored as ‘Most Wired Advanced.” UNC is one of the 17 health systems (of which Duke isn’t one) to be so recognized in that latter contest.

UNC also announces UNC Urgent Care 24/7, which offers $49 video visits via MDLive’s service.

Reader Comments

From Private Privatized: “Re: Share Lab. The joint venture between HCA and Sharecare is shutting down and had layoffs last week.” Unverified. I didn’t get a response from Sharecare to my inquiries. The JV was formed in January 2015 to “create innovative digital patient engagement solutions.” Sharecare was founded in 2010 by TV huckster Dr. Oz and WebMD founder Jeff Arnold. Share Lab was working on enterprise scheduling and provider search. UPDATE: A Sharecare spokesperson confirms that the project is being placed on hold. More in the next HIStalk news post.

From Languishing Liz: “Re: MHS Genesis. DoD doctors prefer it over AHLTA,  according to this article’s headline. The story is ridiculous.” The health IT “news” site’s 17-paragraph story – illustrated with gratuitous clipart and crafted by a 2016 creative writing graduate – simply re-words a story from the Pensacola News Journal that was in turn syndicated by something called Military Update by Tom Philpott. Tom didn’t exactly knock himself out on research for this article, having interviewed a single, DoD-chosen doctor (yes, ONE, which is why I passed on the story) to conclude that MHS Genesis is experiencing “gains in user support.” Everyone involved in passing off this lazy fluff as news (including those who tweeted it out) should be ashamed. In addition, you would certainly hope that doctors like Cerner better than the bottom-ranked AHLTA (vs. the VA’s #1 rated VistA) given its many billion dollar price tag, a characteristic it shares with both AHLTA and VistA.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Pivot Point Consulting. The Brentwood, TN-based firm is a healthcare IT consulting leader that offers strategic advisory services, EHR and ERP implementation, training and activation, project management and PMO, optimization, technology services, managed services, and permanent placement. Clients range from large, multi-hospital networks to academic institutions, pediatric hospitals, and local community clinics. The company has earned industry and workplace quality recognition, including being the highest-rated vendor in KLAS Implementation Services Select Category (July 2017 report), #1 in KLAS for Epic Consulting in the Select Category in 2016, and #9 in Modern Healthcare’s Best Places to Work in 2016. Thanks to Pivot Point Consulting for supporting HIStalk.

Webinars

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

Acquisitions, Funding, Business, and Stock

Livongo Health acquires 80-employee, Chicago-based Retrofit, which provides online programs for weight management and disease prevention. The company has raised $16 million, but its most recent funding round was in December 2013. It pivoted from a direct-to-consumer model to emphasize corporate programs in early 2015, although it still offers the consumer service starting at $248 per month (no wonder it needed to pivot at those prices). A 2016 company-sponsored study found that around half of participants had a clinically significant weight loss after 12 months, although that excludes the 40 percent of participants who dropped out.

Nokia is close to unloading the assets of France-based consumer connected health hardware vendor Withings, which it acquired for $190 million less than two years ago. The French government is pressing Nokia to find a buyer in France, reports say, which could box out Google, which has reportedly expressed interest.

Signify Research questions why it took GE so long to decide to unload its struggling health IT business, postulating that the company was unwilling to exit the population health management market. It notes that Project Northstar – which is developing an ambulatory PHM solution – is part of the package that is being dealt off to Veritas Capital, but Caradigm will remain with GE despite a puzzling fit that could make it next on the block if GE investors continue to press the company hard. I interviewed GE Healthcare VP/GM Jon Zimmerman about Project Northstar when it was announced in May 2016.

Amazon abandons its plan to become a drug distributor to hospitals, saying it’s too hard to convince hospitals to reconsider buying through their group purchasing organizations from traditional middlemen like Cardinal Health and McKesson. Drug distributor and chain drugstore shares rose on the news.

Greenway Health, spurred by $520,000 in state in local incentives, has added 104 jobs at its Tampa headquarters as it closed offices in Lake Mary, FL, Birmingham, AL, and Atlanta.

I’m not sure the “affordable” thing fits.

Sales

Puerto Rico Primary Care Association Network selects Health Gorilla as its clinical information exchange platform. The announcement notes that half of doctors in Puerto Rico don’t use an EHR and thus the platform has to manage faxes.

People

Michael Farrell (Cerner) is named SVP/GM of the hospital business of virtual visit provider MDLive.

Janet Moga (Genentech) joins Carevive Systems as VP of research operations.

Prime Healthcare hires Will Conaway (Dignity Health) as CIO.

Optum promotes industry long-timer Vito Augusta to VP.

Announcements and Implementations

A small KLAS study of medical staff credentialing services and software vendors finds that Verge Health, ASM’s MD-Staff, and HealthStream’s Morrissey (presumably not the English singer who recorded “We Hate It When Our Friends Become Successful”) lead the tiny pack. It’s written in a confusing manner, especially in intermingling product and company names, so my already slight interest was reduced quickly. Three of the six reviewed vendors declined to participate. On the plus side, KLAS provided the number of responses it received for each vendor, which ranged from six to 19.

A Black Book satisfaction survey of 19,000 ambulatory EHR users names AdvancedMD, Modernizing Medicine, NextGen, Epic, and Allscripts as vendor performance leaders. It also notes that smaller practices are the most dissatisfied with EHRs, but are also less likely to use advanced EHR tools. Nearly one-third of practices in the 12-and-over practitioner category say they’ll replace their EHR by 2021, hoping most for cloud-based systems that offer analytics, telehealth, and speech recognition.  

Government and Politics

The GAO previously placed the VA on its High Risk List of programs that are vulnerable to fraud, waste, abuse, and mismanagement. The VA announces the five mostly vague improvements it will make, one of them being implementing Cerner to improve interoperability with the DoD and community health partners.

Interim VA CIO Scott Blackburn, who was heavily involved in its plan to implement Cerner, resigns for unspecified reasons.

Other

A JAMA op-ed piece looks smartly at the myth vs. reality of mentoring millennials.

A small study published in JAMA Internal Medicine finds that people with poorly controlled blood pressure who were sent medication reminders via the Medisafe smartphone app showed minimal improvement in medication adherence and zero improvement in systolic blood pressure. Even worse, study participants were chosen from a volunteers who were not only motivated, but technologically capable to use the app, which might not be generalizable to patients as a whole. Participants were also required to take their blood pressure “periodically” over the 12-week study using a study-provided home device, which in itself may have improved medication adherence. The listed study limitations don’t include what I would think is a considerable one: the short-term variability of medication effect on patients already known to have poorly controlled BP.

Michigan State University — reacting to the sexual assault conviction of its medical school professor Larry Nassar, DO — says in a board of trustees meeting that its MSU HealthTeam physician practice now documents in its EHR that a chaperone is present during sensitive examinations. The group has also updated its treatment consent form to notify patients that chaperones are permitted for adult patients and required for minors. That bit of news was overshadowed by an 18-year-old victim of Nassar’s, who claimed in a statement presented at the same meeting that MSU Interim President John Engler pressed her to settle her civil lawsuit without her attorney present. She also said Engler told her that the sexual misconduct arrest of Nassar’s former boss — resigned medical school dean William Strampel, DO — was “only just a slap on the butt” and that MSU’s osteopathic doctors are being unfairly lumped in with one bad one. She didn’t get to finish her statement to the board – Engler stopped her, saying her “time was up,” an unfortunate choice of on-the-record words given the existence of the celebrity #TimesUp movement against sexual harassment and assault.

Struggling Sonoma West Medical Center (CA) — which was making $1.25 million per month by performing mail-in toxicology tests for Florida-based rehab testing lab – says it needs to “increase revenue through extra lines of work” after insurer Anthem got wise to the scam and sued the ambulance-chaser lawyer who owns the rehab testing lab. The hospital was billing at hospital rates that were up to 10 times what a toxicology lab would have charged and Anthem wants its money back. Googling also turns up that the rehab testing lab’s owner bought Chestatee Regional Hospital (GA) for $15 million, ran the same billing scheme through that hospital, and is now shutting the rural hospital down. He also owns Jenkins County Medical Center (GA) and sends bills through it.

The Vanderbilt Children’s Hospital (TN) contracted window-washer who earned national attention in 2014 for dressing up as Spiderman to cheer up the children inside may have had a darker motivation – he’s been sentenced to 100 years in prison for molesting two children and posting photos of the attacks on the Internet, with prosecutors saying  his Spiderman garb was an attempt to “access other vulnerable children” at the same time the acts occurred.

Sponsor Updates

• Docent Health team members support Dignity Health’s Marian Regional Medical Center Foundation’s Day of Hope.
• AdvancedMD publishes a new e-guide, “5 Ways to Increase Front Desk Revenue.”
• Aprima will exhibit at the Colorado Rural Health Center Forum April 19-20 in Lakewood.
• Carevive co-founder and Chief Clinical Officer Carrie Stricker, RN talks about patient engagement at #AMCCBS.
• Change Healthcare will exhibit at the ACMA 2018 National Conference April 23 in Houston.
• CoverMyMeds will present at AMCP April 23-26 in Boston.
• CTG will exhibit at the Texas Regional HIMSS Conference April 26-27 in Dallas.
• Parallon Technology Solutions leads the Meditech Ambulatory 6.15 go-live of Cass Regional Medical Center (MO).
• Dimensional Insight will exhibit at the HIMSS Southern California Chapter’s Annual Healthcare IT Conference April 20 in Los Angeles.
• Elsevier Clinical Solutions will exhibit at the American Society of PeriAnesthesia Nurses event April 29 in Anaheim, CA.
• EClinicalWorks and IMAT Solutions will exhibit at the NAACOS 2018 Conference April 25-27 in Baltimore.
• Hyland Healthcare announces several recent go-lives.
• Healthwise will exhibit at the Healthcare User Group April 22-25 in San Antonio.
• OmniSys and Comprehensive Pharmacy Services partner to support the hospital outpatient pharmacy market.
• Wolters Kluwer Health expands the global reach of its Ovid Discovery with more multi-language search offerings.
• Casenet announces the speaker lineup and program for its Connect 2018 conference, which will take place April 23-25 in Boston.
• InstaMed will exhibit at Health Evolution Summit April 18-20 in Laguna Beach, CA.
• Intelligent Medical Objects will exhibit at the Allscripts Mid-Atlantic Client User Group Meeting 2018 April 19-20 in Baltimore.
• Kyruus will exhibit at the 2018 Texas Regional HIMSS Conference April 26-27 in Dallas.

Blog Posts

• How eForms Give Surgeons and Patients What They Want (Access)
• What’s the difference? See it for yourself: image processing, image quality and dose in neonatal radiography (Agfa Healthcare)
• The Value of Clinical Data Registries: Improving the Quality and Safety of Patient Care (pMD)
• 2018 Healthcare Trends Part 6: Beyond Digital Health Hype (Datica)
• 5 Dangers of Not Having Call Recording in Your Call Center (Spok)
• Artificial Intelligence as Solution for Physician Burnout (CareSync)
• Tips for Managing Coding Quality (Impact Advisors)
• Why Your Practice Should Be Embracing Digital Health (ChartLogic)
• Healthcare ERP Technology Talent Shortage (Divurgent)
• Petaluma Health Center: Unified Community Care (EClinicalWorks)
• Project Spotlight: Calderdale & Huddersfield NHS Foundation Trust (UK), Part 1 – Owen Williams, Chief Executive (The HCI Group)
• Healthgrades and the Denver Tech Sector Are Attracting Talent from Silicon Valley (Healthgrades)
• Why Accuracy is So Important for Dominating Local Search in Healthcare (Influence Health)
• HIMSS18 in Three Quick “Bites” (InterSystems)

Contacts

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

Morning Headlines 4/17/18

CMS Paid Practitioners for Telehealth Services That Did Not Meet Medicare Requirements

An OIG analysis finds that CMS erroneously paid out $3.7 million for telemedicine claims that did not meet Medicare requirements.

Pentagon wants to spot illnesses by monitoring service members’ smartphones

DARPA awards a $5.1 million contract to KryptoWire to develop the Warfighter Analytics using Smartphones for Health program.

HealthInsight and Qualis Health Announce Formal Merger Agreement

Healthcare consulting firms HealthInsight and Qualis Health announce formal merger plans.

Nokia’s Health division is up for sale (again) and Nest is interested

Google-backed Nest expresses interest in purchasing Nokia’s consumer health division, which includes the Withings assets acquired for $190 million in 2016.

Curbside Consult with Dr. Jayne 4/16/18

I’ve written a bit lately about burnout and how it’s impacting people in healthcare IT. A couple of years ago, I took up a hobby that was 180 degrees from my day job. I don’t fancy myself an artist, but it was a way to use my mind in a different way than I typically do while creating projects that others can enjoy, or at least find useful.

The Internet has been a great teacher. I’ve been able to benefit from various teachers who have published videos to help beginners, as well as some who conduct web-based educational sessions. With travel and work responsibilities, I don’t have much time to attend classes or workshops in town, but I keep my eye out for various opportunities. I had heard about a craft retreat more than a year ago and languished on the waitlist for nearly a year, but ended up being able to go this weekend.

I was looking forward to getting away from the informatics rat race and focusing on learning new techniques, meeting new people, and being able to spend some time in a beautiful place recharging my mental batteries. Of course, there was the standard pre-vacation hustle as I tried to tie up all the loose ends before leaving, and I’m not looking forward to the post-vacation shuffle as I work to handle everything that accumulated in my inbox and on my voice mail while I was gone.

Since most of the meetings and conference I go to revolve around healthcare or IT and are held at large convention centers or well-known hotels, I was looking forward to the more casual atmosphere of the state park where it was held (although I did opt for a room in the lodge rather than in a yurt, which was also available.)

When I’m meeting new people in a non-work environment, I don’t advertise that I’m a physician, especially when part of the purpose of doing something like this is to get away from the industry and the stress. People do tend to talk about what they do in their day jobs and I usually say I work with medical office software. I was surprised when the first person I said that to asked if I worked for Epic, since knowing what company is your physician or hospital’s vendor might not be the most common scenario. The woman I was talking to was a nurse who recently retired from a hospital as they transitioned from McKesson to Epic. We talked about burnout in nursing and she mentioned that several other people at the conference that she knew from previous years were also in healthcare.

It turns out that of the 80 or so people at the retreat, more than a dozen were escapees from the healthcare arena. Mostly nurses, with a respiratory therapist, a hospital social worker, and a medical transcriptionist in the mix. It was really a cross-section of people, with 26 states and two countries represented besides the US. The organizers encouraged people to mix it up at meals and breaks. I met a former welder who became disabled after a car accident, a recent MBA grad who found his accounting work “soulless,” and quite a few retirees and semi-retirees who are supplementing their incomes through craft fairs and online shops.

I didn’t hear a peep about healthcare until breakfast on the last day, when someone was talking about flu season and the conversation morphed into a discussion of unanticipated medical expenses. As a physician and as someone who works closely with healthcare organizations in crafting their strategies, it was like watching a focus group without having to recruit people or do the meeting planning. A few minutes into the discussion, I wished that I had a hidden camera to capture the conversation, because it hit on many of the issues that patients face that sometimes we on the administrative, care delivery, and informatics sides don’t understand as well as we might think we do.

As expected, high premiums and high deductibles were topics. One attendee is a teacher in Colorado and is thinking about switching her insurance to a catastrophic plan, but is worried that she can’t get coverage because of her age. She is a fairly savvy consumer, having researched what it would look like to pay cash – and having received a quote from her primary care physician of over $600 for a well visit with some basic lab work. The physician didn’t offer any kind of discount for being self-pay up front, which seemed surprising. She mentioned the practice is hospital-owned, which may be part of the issue. Her plan is to use the urgent care, which charges $99 for an office visit, as her primary until she goes on Medicare.

Other topics included the wackiness of pharmacy benefit management plans, how long it takes to get bills from medical providers, and liking the fact that they could see their lab results on their phones. One attendee at our table was from Canada and spent a bit of time explaining her personal experience with that health system (which was overwhelmingly positive).

Each person had some kind of healthcare story. The general theme is that we in the healthcare business can do better and should be doing better for our patients. I’d love to have hospital executives hear about people’s experience with the cost of healthcare when they are thinking about building that new bed tower or spending tens of thousands of dollars rebranding the hospital. I’d enjoy seeing legislators hear the stories of people who live in rural areas and have to drive hours to see physicians because their states haven’t figured out how to address telemedicine. I’d like to see IT directors and software engineers sit down with people who have retired from caregiver positions because the tools they are expected to use to do their jobs add stress with little benefit. And I’d like to see policymakers interact with people who just want to get the most out of life so they can spend time fishing, crafting, raising their kids, or playing with their grandchildren and keep everyone as healthy as possible.

I’d like to challenge people in healthcare, technology, and administration to get out and interact with the people they serve, whether they serve caregivers, end users, patients, or other parts of the system. Hear their voices directly, not just through marketing and survey data. Understand the challenges they’re facing and what we can do to help. Learn what is working and what is broken in our crazy system.

And while you’re at it, sit by a lake and watch the ripples in the water. Contemplate the value of things other than your stock price or what your shareholders will think. As yourself whether you’re doing the right thing for the people you serve or whether you’re just marking time or playing it safe. Listen to pine needles crunching under your feet. Find something outside of work that challenges you in a different way or makes you feel happy and fulfilled. It might just give you a new perspective when you go back to your day job.

How do you recharge your emotional batteries? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Matt Sappern, CEO, PeriGen

Matt Sappern is CEO of PeriGen of Cary, NC.

Tell me about yourself and the company.

I’ve been in healthcare IT for more than 15 years, holding various leadership roles across product development, services, support, and sales. Probably most formatively, I was at Eclipsys in the years leading up to its acquisition by Allscripts, and then I spent some time at Allscripts as well.

PeriGen has been a remarkable learning opportunity for me over the past six years. PeriGen uses artificial intelligence to build nursing productivity tools, and more importantly, early warning tools for labor and delivery. All of these tools are embedded in PeriWatch, our comprehensive electronic fetal surveillance system, or EFM.

We’ve also just started to sell tools that work outside of the EFM of record so that hospitals don’t have to rip and replace their current system. I’ve heard too many department heads say, “I really need to use your analytics to provide better care, but we have to use Cerner’s system or we just signed a contract with another vendor before you got to us.” For those situations, we’ve developed Vigilance, an early warning system that works independently and provides the capacity for every nurse, every doc, every mother, and every baby to benefit from real-time analytics in labor without a costly rip-and-replace project.

What are the hot issues in labor and delivery?

The same chronic issues affecting all service lines. The rise of diabetes, hypertension, and obesity are extremely bad for the baby. Mothers are also getting older, which presents some complications as well.

At the same time, a lot of nurses are leaving the field. Phenomenally experienced baby boomer nurses are retiring. Young nurses have great levels of energy and great training, but they don’t have 10 years of experience and that developed gut to fall back on.

You have fewer OBs, less-experienced nurses, and nurses who are being asked to do quite a bit more relative to documentation and helping colleagues at the same time as you have a more complex maternal profile. It’s the perfect storm for trouble.

The US infant mortality rate is among the worst in the developed world, although the contributing factors are mostly social rather than medical. Have hospital advances made their care safer?

Well, we certainly have. We published a study along with MedStar where including our solution reduced unanticipated admissions to the NICU by about 50 percent. That’s pretty remarkable.

With bad outcomes in labor and delivery, it often comes down to the nurse not recognizing that there’s a problem on the strip. They don’t see the trends, they haven’t been trained, or they don’t have the equipment to see the long-term patterns. We show trending data, as opposed to, “In this second at this point in the day, there’s a fetal heart rate deceleration.” We’re showing the four-hour trend and a 12-hour trend, so the nurses get a more complete picture.

When you talk about reducing unanticipated NICU events by 50 percent, that’s remarkable. At MedStar, we took their medical malpractice payouts that were associated with OB from a full third of what they were paying in medical malpractice awards to — I think the last number I saw was in 2016 — about 8 percent, which is virtually unmatched by other hospitals in the country.

Unnecessary C-sections also affect outcomes and cost. Is that still a big issue?

C-sections are always going to be a heated debate. A lot of health systems have done a great job at managing the C-section rate, at least the low-hanging fruit where voluntary C-sections or planned C-sections have been reduced. You’re seeing a lot fewer planned C-sections for convenience, so that’s a good thing.

The trick is to not focus on too few or too many C-sections, but rather, “Have we made this decision with all the right data?” We’ve had hospitals use our solution to decide to not do a C-section and the mother had a successful vaginal birth 20 minutes later. It’s really a question of what data you have access to at that critical moment of judgment.

C-sections and labor progress for many years was focused purely on a linear time measurement. We’ve built tools that look at other issues. What’s the gestational age? Have they had a child before? Did they have an epidural? Have they had a C-section before? These are things you can do in real time with algorithms and artificial intelligence that can’t be done any other way.

Having worked with artificial intelligence, what are the lessons you’ve learned or your feelings about its place in healthcare?

It’s a very powerful tool that can be harnessed to help the clinician. There’s so much data that’s being generated. More and more monitoring is being done, both in the inpatient and outpatient world. But all of this data needs to be managed somehow. You need to take an approach of looking for exceptions in data. That’s what we use AI to do.

We use Google’s TensorFlow tools. We’re fairly advanced in how we use them. We work with a consortium of other Google users in Montreal, where we have a lab. As one builds algorithms, with machine learning, it is critical to teach these tools what they’re looking at and for. After that complex process, we lock down that algorithm and then build it into our application. We’re an FDA-cleared device, so we can’t have algorithms that are changing all the time.

We’ve taken a group of experts and used their review of many thousands of strips to teach the TensorFlow system what it needs to be looking for. We validated that, locked it down, and sent it through the FDA. It’s complex to use AI when you are working with software as a medical device.

What opportunities exist from having all of this data being collected electronically?

The challenge with data is its accuracy. Nurses, who generate a huge percentage of the data out there, are often challenged to be documenting exactly what should be documented at exactly the right time. Clinical settings are pretty crazy and they are always going to put the patient’s health above documenting, so there are inconsistencies in EMR documentation.

That’s just the nature of anything that is based on human input. There will always be levels of subjectivity. There will always be issues associated with time lag. That’s why we largely focus on data that’s being generated directly from medical devices.

That’s what makes our partnership with Qualcomm so interesting. They feel the same way. They bought Capsule and they’re focused on how to take information directly from medical devices and make it usable in real time. That’s what we do today. We’re the poster child for what Qualcomm is trying to do with Intelligent Care.

How does the Qualcomm relationship work?

PeriGen takes data directly from a device, digests it in real time, and serves it up to the clinician in a helpful manner to help them make decisions and monitor patients. That’s really what this relationship is all about. That’s what Qualcomm Life’s Intelligent Care platform is all about. Qualcomm looked at PeriGen and said, we need to be doing this across all service lines, both inpatient and outpatient.

We’re working with Qualcomm Life to think about what ambulatory devices in obstetrics can become. How data management in the ambulatory arena, how non-stress tests can be made more affordable, more frequent. Things that are going lead to better outcomes for premature babies as well. They’re a great partner. We think exactly alike and approach it from different and complementary strengths.

How can clinicians monitor that huge amount of data?

It’s a big issue. More often than not copious data becomes a tremendous distraction. It’s not only the amount of data, but the quality of data. The degree of human intervention is directly related to the degree of inaccuracy that you’re going to have in this data.

Better to take the data directly from devices, perform real-time analytics on it, and present it up to the clinician to help their view of what’s going on with the patient. Not to tell the doctor what’s happening to this patient and certainly not to tell the doc what to do to this patient, but to serve it up to the doctor and nurse as, “This is what we are seeing. Your health system has asked you to consider something when this is going on.”

When we started working with HCA, they said, “We have developed some of the most remarkable safety protocols for managing oxytocin and other things. How do we help the nurses in a clinical setting on the floor take advantage of these protocols? When a patient starts exhibiting non-reassuring signs, how do we make sure that we’re getting to that patient in a timely fashion across the board in a standardized way? How do we automate our checklists?”

That’s what PeriGen does. Nurses and docs know how to care for patients in certain conditions. We’re just trying to make sure that they understand and see those conditions coming much more frequently, more consistently, and in a more standardized fashion.

Is there overlap with what EHR vendors are doing with their products?

We’re quite complementary to what most of the EMR vendors are doing. We’re not about documentation and that’s their strong suit. Epic, Cerner, Allscripts, and Meditech manage an awful lot of data. They are looking at ways that they can create specific alerts and reports from the data and create telemedicine monitoring capability. I applaud that. Those are all things that must happen in healthcare.

We’re doing the same thing. We’ve created a telemedicine platform that allows a single clinician to look out over 10, 12, or 20 hospitals and intervene on only the cases that are starting to show non-reassuring trends. The difference is that the EMR vendors are using EMR data, which is meaningful, but often subjective, and the timing is somewhat subjective as well. We’re taking information directly from the medical device in real time.

I think there’s a great alchemy there. We have clients using Epic’s tools for telemedicine in unison with some of the tools that we provide. They seem happy having access to both. It’s sort of a left and a right side of the brain effect.

We continue to roll out our telemedicine functionality at Ochsner. Just about every client and prospect we’re talking to right now is interested in our telemedicine hub, which allows a single clinician to look out over multiple labors and determine if there’s something out of the norm that needs intervention. Some of our clients want to make a business out of it, where they provide an over-watch service for community hospitals in their regional area. Some will use it with a single individual who provides great clinical leverage across the entire health system.

Do you have any final thoughts?

My hope is that a lot of other companies start doing what PeriGen is doing in terms of managing data and making it meaningful. We can’t lose sight of the fact that improved and distributed capability for monitoring patients generates more and more data that has to be managed by fewer and fewer clinicians. There will continue to be a reliance on tools like PeriGen’s to separate the wheat from the chaff. What do I have to tackle immediately and intervene before it gets tough?

I would challenge the rest of the industry to be looking for ways to employ artificial intelligence and other types of algorithmic approaches to managing data. It’s just overwhelming for clinicians at this point.

Morning Headlines 4/16/18

CHS lays off dozens of corporate employees

Nashville-based hospital chain Community Health Systems lays off at least 70 corporate IT employees. Rumors suggest data center and deployment areas were hit hard.

GE Healthcare IT unit carveout backed by US$850m in loans

Veritas Capital has arranged $850 million in leveraged loans to support its acquisition of GE Healthcare’s IT business for $1.05 billion.

CVS Hires Doctor From Health Startup in Sign of Medical Ambition

CVS Health hires the chief medical officer of Iora Health as CMO for its MinuteClinic division, further fueling rumors of its interest in providing services to Medicare Advantage patients as part of its proposed merger with Aetna.

Physician turned entrepreneur begins work with new patients: Union-Tribune and L.A. Times

Billionaire NantHealth CEO Patrick Soon-Shiong, MD outlines his plans to take over ownership of The Los Angeles Times, The San Diego Union-Tribune, and several Southern California-based community papers in a $500 million deal expected to close later this month.

Medical records of Texas Health patients may have been exposed in data breach

Texas Health Resources notifies 4,000 patients of a data breach involving email accounts last October.

Monday Morning Update 4/16/18

Top News

Nashville-based hospital chain Community Health Systems lays off at least 70 corporate IT employees. Anonymous rumors say the data center and deployment areas were hit hard and the company may be looking to send data center support offshore.

Wayne Smith, CEO and board chair of the publicly traded company, was paid $5 million with an $812,000 performance bonus in 2017 even as the company lost $2 billion and share price dropped 52 percent. CHS has sold 40 hospitals recently as it struggles to absorb its 2013 acquisition of Health Management Associates for $7.6 billion that left the company $14 billion in debt.

Over the past five years, CHS share price has slid 88 percent vs. the Dow’s 64 percent gain, decreasing its market cap to just $466 million. 

Microsoft sued the company two weeks ago, claiming that CHS intentionally facilitated unauthorized use of its software in some of its divested hospitals and obstructed Microsoft’s ability to perform a full enterprise software audit as its agreement allows, claiming that limited information suggests that CHS’s enterprise size is at least six times what CHS had indicated. 

HIStalk Announcements and Requests

Just 9 percent of poll respondents think their de-identified patient data is safe from being re-identified. One respondent recalls the 1990s brash assurance of Massachusetts Governor William Weld that the publicly released hospital records of state employees were safe because they had been de-identified. Graduate student Latanya Sweeney (now a computer science PhD and Harvard professor) easily found the governor’s hospital records, including his diagnoses and prescriptions, and sent them to his office. She knew he lived in Cambridge, so she paid $20 to buy the city’s voter registration rolls and matched up the records from the two databases – only six residents shared the governor’s birthdate, only three of those were men, and only one lived in his ZIP code. Sweeney later showed that 87 percent of Americans can be uniquely identified by just their ZIP code, birthdate, and gender. Imagine what Facebook could do with its technology, money, and huge store of personal information.

New poll to your right or here: How important is Twitter to your exposure to health IT knowledge, news, or opinions? Click the Comments link after voting to explain further.

Check out the responses to my question, “What I Wish I’d Known Before … Selecting a Consulting Firm for EHR Implementation or Optimization.”

Answers to this week’s question might help those trying to decide if taking college courses while working is doable and worth the effort.

Webinars

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

Acquisitions, Funding, Business, and Stock

Veritas Capital has arranged $850 million in leveraged loans to support its acquisition of GE Healthcare’s IT business for $1.05 billion.

Need proof that healthcare is a business rather than a compassionate service to humankind? Goldman Sachs warns gene therapy companies that “one shot cures” will not deliver sustained cash flow compared to the recurring revenue generated by treating — but not curing — chronic conditions.

CVS Health hires the chief medical officer of Iora Health as chief medical officer for its MinuteClinic division, perhaps signaling CVS’s interest in providing services to Medicare Advantage patients as part of its proposed merger with Aetna.

An LA Times article describes the lawsuit filed by California’s attorney general that claims that Sutter Health has used its market power to inflate Northern California inpatient costs to as much as 70 percent more than in Southern California. The article says:

• Prices rose 113 percent at Sutter and Dignity Health systems from 2004 to 2013 vs. 76 percent for all California hospitals.
• Sutter acquired Summit Medical Center in 1999 and raised prices by 72 percent, a practice that experts say allows all competitors to also raise prices.
• Sutter’s insurance contracts don’t allow any of its hospitals to be excluded or for patients to be charged a higher co-pay at specific hospitals regardless of their cost or outcomes. Sutter claims otherwise, but previous testimony showed that its conditions were that out-of-network visits – most commonly, ED visits where Sutter hospitals are the only option — would be charged at 95 percent of billed charges. Blue Cross estimated that Sutter’s profits on those visits would be 270 percent.
• Employers are forbidden legally from sharing cost information with third parties.

Sales

Drug maker Pfizer joins the global health research network of TriNetX, which will enable the company to access clinical, genomic, and oncology data for study design, site identification, and patient recruitment.

Decisions

• Hutchinson Regional Medical Center (KS) will switch from Philips Healthcare to Merge Healthcare cardiology information system in September 2018.
• Hannibal Regional Hospital (MO) is considering purchasing a new hemodynamic recording system.
• Pikeville Medical Center (KY) plans to switch from Philips to a Merge cardiology information system.

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

People

Sound Physicians hires Lisa Shah, MD (Evolent Health) as chief innovation officer. The company provides hospitalists and other physician services.

Announcements and Implementations

WiserTogether adds risk warnings to treatment recommendation plans in its Return to Health platform that include opioids as a treatment option.

Memorial Hermann Health System (TX) joins the Greater Houston Healthconnect Network.

Privacy and Security

Judges in the UK and France order Google to remove search result links to old stories covering the criminal convictions of two executives. The men complained that laws don’t require them to report previous convictions to prospective employers and therefore Google is presenting irrelevant information that infringes on their “right to be forgotten.” 

Nova Scotia’s government charges a teen with unauthorized use of a computer after discovering that he had created a script to download all documents stored on a Freedom of Information Act portal, some of which weren’t supposed to be publicly available. The province had implemented no security on the site – documents were numbered sequentially, so the teen simply wrote a script to increment each URL and download the corresponding document, bypassing the site’s public page. Privacy experts say the government is looking for a scapegoat since the teen did nothing with the information he retrieved.

Other

Seventy-five-year-old Jeffrey Johnson, MD gives up his obstetrics privileges at St. Alexius Medical Center (IL) after refusing to take its EHR training classes. He said, “I can’t practice any more at our hospital because I don’t know how to do the computer efficiently. I don’t really give a damn. I care that I can’t practice any more and I care that the corporation who bought our hospital says that I have to know how to do the computer to continue to practice.”

India-based Apollo Hospitals develops a heart risk scoring tool that use Microsoft’s healthcare AI technology to analyze EHR data.

The New York Times exposes law firms that hire telemarketing firms to cold-call women who have received vaginal mesh implants and urge them to have them removed at company-hired surgery clinics. The reason: the law firms are pursuing mass tort lawsuits against the manufacturer and have realized that settlements are lower when the implant remains in place. The women were flown to Florida and Georgia, housed in motels, and sent to walk-up clinics for their procedures without meeting the surgeon first. Doctors who performed the surgeries made up to $14,000 per day, while the medical centers kept at least $15,000 per case even as some women experienced debilitating effects from the removal surgery. The patients sign a form binding them to pay back the surgery cost plus double-digit interest if their case is favorably settled, with upfront funding provided by firms that are backed by international banks and hedge funds.

I’ve been looking over Alex Scarlat, MD’s book, “Medical Information Extraction & Analysis: From Zero to Hero with a Bit of SQL and a Real-life Database.” It’s a hands-on clinician guide for using SQL (the database tools and de-identified patient database are included) to answer common clinical / informatics questions, such as, “What are the number of patients and admissions associated with sepsis-related diagnoses?” I think it’s important for clinicians to be able to do their own data discovery – sometimes you don’t realize what information is available or how it’s represented until you look at the underlying database, which often then leads to more useful queries. I’m pretty good with SQL and understanding data definitions and table relationships, but for those who aren’t and who learn best from hands-on experience (which is nearly everyone), then you’ll have fun with this book.

Banner Health will pay $18 million to settle False Claims Act charges, but HealthLeaders Media finds the most interesting aspect to the story – this is the third such lawsuit filed by the same whistleblower involving previous health system employers. Cecilia Guardiola has netted $6 million from filing her lawsuits after just 16, 19, and 3 months of employment at Christus Spohn, Renown Health, and Banner, respectively. She’s both an RN and a JD and appears to have worked for Optum as a clinical documentation improvement specialist. Banner must not Google prospective hires since her previous lawsuits were filed before they hired her in mid-2012.

Vince and Elise complete their series on 2018’s top health IT vendors by annual revenue by reviewing the companies in positions 7-10 – CPSI, Harris Healthcare, Medhost, and Cantata Health.

Odd: a couple in China dies days before their scheduled in vitro fertilizations, after which their respective parents sued each other hoping to convince a judge to give one of the couples access to the frozen fertilized embryos as “the only carriers of the bloodlines of both families.” The court agreed to release the embryos to a hospital, but since surrogacy is illegal in China, the four parents had to hire a woman in Laos to carry the baby. The baby boy was delivered on December 9, 2017, four years after his parents died.

Sponsor Updates

• The SSI Group will exhibit at the AL HIMSS Spring Conference April 18 in Huntsville.
• Huron will exhibit at the HCCA Annual Compliance Institute April 15-18 in Las Vegas.

Blog Posts

• Preventing the Next Cambridge Analytica from using your Medical Records (Redox)
• Smart Patient Access Reduces Hospital Debt & Improves Clean Claims Rate (The SSI Group)
• Do You Know Your Downtime Reporting System? (Summit Healthcare)
• Liberating Healthcare through Data Liquidity and Consumer Engagement (Medecision)
• Modern facilities are held back by old communication tools. (Voalte)
• Postcards from HIMSS18: Top Themes for Vocera Customers (Vocera)
• Playing for Keeps: The How and Why of Patient Loyalty (WebPT)
• Advance your referral intelligence (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 … Selecting a Consulting Firm for EHR Implementation or Optimization

Make sure consultants have a basic orientation to your organization, especially around acceptable use policies, communication, security.

They don’t know everything — trust, but verify.

Don’t let them burn billable hours with your vendor or other consultants without your participation or approval.

The #1 job of consultants is to create fear, uncertainty, and doubt (FUD) that you can survive without them.

Don’t be fooled by the sample resumes. In most cases, it is unlikely those will be the resources on your project. Bait and switch is common.

Don’t forget to factor in travel expenses — the more distance, the more $$$. Make sure they find your travel guidelines acceptable.

Call lots of references. Not the ones they gave you, but others on their “we’ve worked for every health system in country “ logo slide. Find out who is on their A team and get them.

Check their quoted number of employees (many firms are 70 percent temporary people). Go to LinkedIn and see how many people actually list them as an employer. Find out their turnover rate (both senior management and staff consultants) — again, LinkedIn is useful for this.

Unless they’re sharing financial and other risks with you, they’re not your “partner.” Let them do something small successfully, then sign them up for something larger. Interview their consultants and ask hard technical questions.

Always remember that they know more about you than you know about them. Consulting firms are notorious at being opaque. Beyond them really screwing something up and you spreading the word, they have very little accountability.

That they’d then try to get me fired so they could put their replacement in as interim leadership and bill for it.

How they vet their consultants.

I wish we’d had more perspective on the specific skill sets those working with us would have to ensure they fit the roles as we’d defined them.

Weekender 4/13/18

Weekly News Recap

• FDA approves IDx’s AI-powered diabetic retinopathy screening system for use by PCPs.
• Theranos lays off most of its remaining employees, having cut its 2015 headcount of 800 down to around 20.
• Mayo Clinic offers voluntary severance packages to 400 transcriptionists whose it no longer needs because of speech recognition.
• The Coast Guard announces that it will piggyback on the DoD’s Cerner contract, with the additional contract cost yet to be determined.
• Netsmart acquires Change Healthcare’s home and hospice care software solutions.
• Facebook acknowledges that it tried to convince the American College of Cardiology to share de-identified patient data with it.

Best Reader Comments

I have to beg for de-identified data for EHR testing purposes, but Facebook gets it wholesale from a professional organization. If this isn’t a HIPAA violation, particularly with the re-identification plans, what is? And who can be called upon to get medical data protected properly? (Kitty)\

I’m not sure I’d want to pay for Facebook’s ad targeting or trust that they could re-identify data correctly. (1) Facebook flagged me with their African-American multicultural marketing flag. I am in fact a white Midwesterner who didn’t even encounter a black person until college, so even if they couldn’t tell from the hundred pictures they have of me, it’s not like I’m steeped in African-American culture. It’s very flattering that Facebook feels I empathize, but I’m pretty sure no actual person would identify me this way. (2) After I looked up Chicago the band, I got ads for weeks about events happening in Chicago the city. If this is representative of their big data skills, let’s hope that Facebook isn’t starting a self-driving car business anytime soon. (Midwest User)

While healthcare is much more complex than banking, the bankers had their game together very much earlier. I could travel 2000 miles and withdraw cash from my bank account in 1990. I would still have problems today to give a doctor 2000 miles away ANY electronic access to my medical records. (Fat Hertime)

Watercooler Talk Tidbits

Readers funded the DonorsChoose teacher grant request from Ms. O in Texas, who reports on her class’s use of a programmable robot. “My students are having a blast making our Lego robot. They learned quickly that they would need to talk to each other to figure out which part came next. Once this was established, the quick building began. They have loved putting this robot together so much that I do not think they realize how much they were learning. My students are using area and perimeter with the robot, along with following directions from pictures (no teacher help). Next they will be coding the robot to walk and move around. Thank you so much for bringing this activity to my students.”

We provided after-school STEAM project kits for Ms. P’s special needs K-5 class on a Native American reservation in Idaho. She reports, “After showing everything and talking about them, the students wanted to make slime first! I was so amazed at how much they listened to and remembered the information about polymers. The students have stepped up to the plate and have accepted the challenge to work together to figure things out. They are coming up with so many more ideas than I thought they would. They love to be able to take turns to be the teacher to explain their project. You are a hero to me and my students. They recognize that we wouldn’t have these things without your help.” 

I downloaded Facebook’s archive of information it knows about me (click Settings, then “Download a copy of your Facebook data.”) even though I do basically nothing on Facebook, rarely look at it, and don’t use Messenger or any app. The archive included:

• All contacts from my phone (the contact name I assigned and their phone number)
• Every login date and time
• Facial recognition data
• Messages
• Ads I’ve clicked
• A huge list of advertisers who uploaded a contact list with my info (a subset is above), an odd lot that included politicians from states I’ve never even visited, Dierks Bentley, drug companies, bands, and for some unknown reason, a ton of rappers. 

CB Insights mined its earnings call transcripts to see how often Wall Street analysts suck up to company executives while asking them questions and found that use of “great quarter, guys” peaked in 2008, although the most common compliment remains, “Congratulations on a great quarter.” I’m signing up to see how often analysts use trite terms in asking questions like, “Can you provide some color around that number?” 

Talkspace, which offers online counseling and therapy, claims it has 1 million users, is marketing services to employers, and is contemplating an IPO. A Verge review from late 2016 wasn’t complimentary, noting:

• Therapists are hired as 1099 independent contractors and bear all the responsibilities since the company says it’s not a medical provider. The company pockets half of their billed amounts.
• Talkspace owns the medical records of patients and therapists don’t have access to them once they’ve stopped working for the company, making the patient transition difficult.
• Therapists are required to follow scripts.
• The company set a rule that therapists could not complain about it internally on its Slack channels.
• Patients are anonymous, so therapists have no way to contact authorities if they appear to be a threat to themselves or others.
• Therapists say the company places client retention above all else.
• Talkspace’s terms of service agreement says patients should not make health or well-being decisions purely on their use of the service, which they add is not a substitute for face-to-face therapy sessions.

Kaiser Family Foundation SVP Larry Levitt notes that despite this short-term insurance plan’s name and choice of cover stock photos, it doesn’t cover mountain climbing injuries. The plan – of the type the Trump administration wants to roll out more widely – also doesn’t cover pre-existing conditions, prescriptions, pregnancy and childbirth costs, kidney disease, skin conditions, long-term care, sports injuries, or injuries incurred while under the effects of alcohol or drugs. The insurer also has no provider network, which I assume means that services will be billed as out-of-network visits with the patient being balance-billed – the plan pays a flat 150 percent of Medicare-allowable expenses and you’re on your own after that. I checked premium prices for a 30-year-old male in Chicago and they ranged from $88 to $177 per month with deductibles from $1,500 to $5,000. It may be better than having no insurance at all for some people (like those who don’t expect to actually require care), but make no mistake, those having it could be wiped out financially very, very easily from the unjustifiably high charges generated in a single hospital or ED visit.  

Japan-based drug maker Otsuka, whose antipsychotic drug Abilify is available in a “smart pill” form using technology from Proteus Digital Technology, has owned California winery Ridge Vineyards since 1986. The company says the winery is profitable, but its other use is for executives to entertain business partners during the JP Morgan Healthcare Conference in January.

BMJ Case Reports describes an ED patient who complained of dry heaves and thunderclap headache after eating one of the world’s hottest chili peppers in a contest, causing reversible cerebral vasoconstriction syndrome in his brain that could have caused a stroke or heart attack. The article didn’t mention his final standing on the leaderboard. 

Police file charges against a nursing student who was shadowing staff nurses at Lahey Hospital and Medical Center (VT) after he was caught hiding a video camera in an employee restroom. A housekeeper found the pen-sized device almost immediately. He wasn’t smart — a review of the camera’s contents clearly showed his face and ID badge as he recorded himself adjusting the camera’s angle to face the toilet.

Stat excerpts fun stories from the new book (due to be released on May 21) about Theranos, written by Wall Street Journal reporter John Carreyrou, who exposed the scandal:

• Theranos faked a demo of its non-functional technology to drug company executives way back in 2006, and when the CFO of Theranos heard about it and raised concerns, Elizabeth Holmes fired him on the spot.
• The head of the software development team bragged that he could write the company’s software faster in Flash, after which someone noticed a “Learn Flash” book on his desk.
• Elizabeth Holmes hired her brother – who had no obvious qualifications – as a product manager, after which be brought on several of his Duke University fraternity brothers to form what insiders called the “Therabros” or “The Frat Pack.”
• A former employee heard Holmes speak in a higher-pitched voice, leading them to speculate that she intentionally speaks in public in a low baritone to fit in with Silicon Valley’s male-dominated executive culture.
• Carreyrou writes that Holmes had a romantic relationship with Theranos President Sunny Balwani, breaking up with the man 20 years her senior only after she had to fire him as the company’s story began unraveling.

Bizarre: a plastic surgeon in Germany is arrested for unintentionally killing a woman he met online for sex by sprinkling cocaine on that particular part of his anatomy to which she was voluntarily providing oral attention.

In Case You Missed It

• News 4/13/18
• EPtalk by Dr. Jayne 4/12/18
• News 4/11/18
• Curbside Consult with Dr. Jayne 4/9/18
• Monday Morning Update 4/9/18
• What I Wish I’d Known Before … Serving on the Board of a Company or Non-Profit

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 4/13/18

FDA permits marketing of artificial intelligence-based device to detect certain diabetes-related eye problems

IDx receives FDA clearance to market its AI-based diabetic retinopathy diagnostic system to PCPs, giving them access to a tool that assesses patients without need for physician analysis.

This Woman’s Apple Watch Helped Detect Her Severe Thyroid Problem

Twenty five year-old Heather Hendershot’s Apple Watch alerts her to an abnormally high resting heart rate – a lone symptom that led to a diagnosis of and hospital stay for hyperthyroidism.

Committed to proactively addressing the security concerns of our customers

Philips warns that security vulnerabilities in its ISite and IntelliSpace PACS products could affect patient confidentiality and system integrity, some of which could expose systems to remote attacks using publicly available exploits.

News 4/13/18

Top News

IDx receives FDA clearance to market its AI-based diabetic retinopathy diagnostic system to PCPs, giving them access to a tool that assesses patients without need for physician analysis.

The company received its clearance via the FDA’s Breakthrough Devices program.

Eric Topol noted in a tweet that only four AI medical algorithms – all of them related to pattern recognition – have earned FDA’s approval. Two are for imaging, one for is ECGs, and now IDx’s for retinal changes.

Reader Comments

From Rif’d Me a New One: “Re: Hitachi Vantara. RIF’d a number of us, with rumors of 800 to 14,000 globally. What amazes me is how they’ve been able to keep this out of the news. I’ve also found it interesting how certain executives have been getting promotions and pay increases, which might be better spent keeping a few more workers.” A Hitachi Ventara spokesperson responded to my inquiry with this statement: “As we continue to transform to help our customers unlock the value in their data, we must shift certain resources to best support our business. Hitachi Vantara is, in fact, growing significantly. In the past year we have hired more than 1,300 new employees to support high-growth segments of our business, with over 230 current job openings.” The digital tools company that focuses on IoT– a subsidiary of Tokyo-based Hitachi — was formed in September 2017 by combining Hitachi Data Systems, Hitachi Insight Group, and Pentaho.

From Pleasant Valley: “Re: MModal. Has had stability problems nationally for the past couple of weeks with its software as a service product (Fluency for Transcription).” Several transcriptionists on the MT Stars forum have reported having problems, but only over the past couple of days. A company spokesperson provided this response to my inquiry: “As we experience ongoing growth, we continue to scale and have been upgrading our infrastructure to ensure further resiliency, high availability, and adequate capacity. We are proactively addressing any performance concerns to further support a consistent experience for transcriptionists who use top-ranking M*Modal Fluency for Transcription to improve their everyday workflows, quality, and productivity.”

From History Repeated: “Re: Epic and Meditech. As they approach their 40th and 50th anniversaries, respectively, it would be neat to see an article about how Judy Faulkner and Neil Pappalardo met. Ideally as a joint interview, but individual recollections would be fine. The stories I’ve heard are that Judy came to Neil seeking advice about starting a company. What did they think of each other then? Now? Epic uses MUMPS, which Neil invented – was that part of the conversation?” Those two folks are #1 and #2 on my most-wanted interview list, but both also decline every time I ask. It would be fun to capture their memories and, as always, I’m here to do so if they are willing. Above are early company photos of both from the sunny slopes of long ago.

HIStalk Announcements and Requests

This week’s question of “What I Wish I’d Known Before … Selecting a Consulting Firm for EHR Implementation or Optimization” is still open.

Listening: new from Denver-based Nathaniel Rateliff & the Night Sweats, big-sounding soul music recorded in Rodeo, NM. There’s also new music from a band I really like but forgot about, The Magic Numbers, whose new single more ballad-y hard rock than before. Their 2005 debut remains one of the best I’ve heard. To address my frequent need to hear the soaring virtuosity of progressive rock, I moved on to Kaipa, a Swedish band that’s been around since 1973 and that spawned the musical career of Roine Stolt, later of The Flower Kings, Transatlantic, and now The Sea Within (whose first album is due in June).

Webinars

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

Acquisitions, Funding, Business, and Stock

Glen Tullman’s Livongo Health raises $105 million in a Series E funding round, increasing its total to $248 million. The company announces that it will work with Cambia Health Solutions to develop and market new consumer-friendly digital health offerings for people with chronic conditions.

Sales

• Peterson Regional Medical Center (TX) selects CloudWave’s OpSus Backup, Archive, and Recover services.
• Eleven-bed critical access hospital Munising Memorial Hospital (MI) chooses Cerner CommunityWorks.

People

Russ Johannesson (Sharecare) joins diabetes management platform vendor Glooko as CEO. Former CEO Rick Altinger will transition to EVP of corporate development.

Martin Tursky (Firelands Regional Medical Center), who spent a couple of years as VP/CIO at Aultman Health Foundation (OH), is named president and CEO of McLaren Central Michigan (MI).

Announcements and Implementations

MedData develops OneTouch RCM software to bring patient financial services onto a single platform.

PatientPing expands the availability of its real-time clinical and administrative data sharing technology for ED patients beyond Massachusetts to hospitals across the country.

CVS Health unveils a set of tools to help pharmacists, physicians, and patients make more cost-conscious decisions about prescription drugs.

Privacy and Security

St. Peter’s Surgery & Endoscopy Center (NY) notifies 135,000 patients of a January data breach in which its servers were hacked.

Philips warn that security vulnerabilities in its ISite and IntelliSpace PACS products could affect patient confidentiality and system integrity, some of which could expose systems to remote attacks using publicly available exploits. The company recommends enrolling in its ongoing patch program, which remediates all critical vulnerabilities, or upgrading to newer versions of IntelliSpace and Windows.

Other

At an AMIA briefing on Capitol Hill, Geisinger Health System (PA) Chief Clinical Informatics Officer Alistair Erskine, MD points out that Apple’s Health Record app initiative is more limited than headlines suggest, given that it excludes Android users and does not yet give users access to their full medical records. Geisinger was one of the original 12 beta testers of the app; 39 health systems have signed up to partner with Apple so far.

This article, highlighting the experiences of early adopters Penn Medicine (PA) and Johns Hopkins Medicine (MD), also presses pause on the Health Record app hype machine, pointing out that providers at non-participating organizations must proactively ask patients to share their data and are then faced with the question of what to do with it in its raw form.

A Black Book survey of health technology managers finds that hospitals that have implemented an enterprise master patient index have fewer duplicate patient records, reducing their cost, denied claims, and the number of repeated tests and procedures. QuadraMed’s product is #1 in user satisfaction and loyalty.

Sponsor Updates

• HIE technology provider Koble Group will integrate patient risk management software from HBI Solutions.
• Lightbeam Health Solutions will exhibit at CAPG April 19-21 in San Diego.
• LiveProcess will exhibit at the Preparedness Summit April 17-20 in Atlanta.
• MedData will exhibit at the HFMA Florida Space Coast Educational Event April 18 in Titusville.
• Navicure, a Waystar company, publishes “Easily Increase Patient Collections: Six Steps to Energize Front-Line Processes.”
• Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the AL HIMSS 2018 Spring Conference April 18 in Huntsville.
• Experian Health will exhibit at HFMA AR April 18-20 in Hot Springs, AR.
• Daw Systems adds electronic prior authorization technology from CoverMyMeds to e-prescribing functionality within its ScriptSure EHR.

Blog Posts

• Hospital versus Hospitality (Mobile Heartbeat)
• In Case You Missed It: Connections2018 Day 1, 2, and 3 (Netsmart)
• The Most Meaningful Work I’ve Done as a Healthcare Consultant (Nordic)
• Voice Your Concern to CMS About New MBIs (Experian Health)
• How Pharmacy APIs can Improve Patient Adherence and Outcomes (PokitDok)
• Managing the surprisingly troublesome impact of real-time healthcare on clinical decision-making (PerfectServe)
• Public Cloud Strategies (Huntzinger Management Group)
• How do eForms Improve the Patient Intake Process? (Access)

Contacts

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

EPtalk by Dr. Jayne 4/12/18

I read a lot of press releases and this one from CMS particularly caught my eye this week. Normally a fairly bland and non-partisan source of news for all things CMS, the media relations group has really dialed up the rhetoric on this one. I don’t disagree that the Affordable Care Act is imperfect and we have a long way to go in achieving a workable and affordable system of healthcare in the US, but it feels like we’re losing the ability to participate in constructive discourse and everything is becoming polarized.

From Gone to the Dogs: “Re: burnout. My institution has dealt with this issue as it deals with many issues. The phrases ‘pennywise and pound foolish’” and ‘putting lipstick on a pig’ are perhaps the best descriptors.They’ve put together various wellness committees, invited speakers on mindfulness, and hired (costly) consultants on ‘improving communication.’ The most legitimately helpful thing they’ve done is have a puppy-petting party with a group of prospective guide dogs (which helps the dogs get socialized and relaxes the staff). At the same time, they continue to ratchet up required numbers of RVUs (on threat of contract non-renewal if targets aren’t met), throw people under the bus for any untoward events, display a general lack of supportiveness, etc. The broader burnout issues are also unchanged: insane regs, endless documentation requirements, frustrating pre-approval demands from insurers, and still trying to help really sick patients.” Our local high school invites a therapy dog agency to work with the students during finals week. I have to say, it’s hard to be aggravated when you’re staring at a cute puppy (unless that cute puppy just chewed the heel off your favorite pumps). The comment about RVUs is also particularly striking since we’re not supposed to be focused on visit volumes in the new world of value-based care. Keeping patients healthy and having fewer visits should be the goal, right? I still see RVUs as a metric in 90 percent of the organizations I serve.

Several readers sent their own “weirdest interview ever” stories.

My weirdest interview was with a major consulting firm. I had passed two telephone interviews and was flown out to have the final round of interviews with major players. I first met with president of the branch and he was bland and did not have many questions or comments (or energy). Then I met with one of their directors who had previously worked at another consulting firm that I had also worked at. He was a great interview and covered a lot of items. But the kicker was the last interview. This director sat down and nearly choked on her coffee when she realized that the date on my resume was when I graduated with my masters and not what she had assumed was my birth date! She didn’t believe I had any of the experience on my vitae, nor did she want to hire someone of my age. She excused herself and had security walk me out of the building. I’m not sure if she had many bad experiences with interviewing candidates, but security? At least I had a nice trip on their dollar.

I once interviewed for a position with an organization where the decision-maker shared a large office with another high-level person in the organization. Let’s call them Mr. Abbott and Mr. Costello. Mr. Costello would ask me questions, while Mr. Abbott, within earshot the whole time, was ostensibly engaged in other matters. But at different points in the process, Costello would call across the room to ask for Abbott’s thought or opinions. Abbott generally replied, “It’s your interview, I don’t know why you’re asking me,” or, “I don’t know – you should know that.” This went on for about 20 minutes or so, at which point I got up and said, “Thank you very much. I am not interested in the position” Costello had difficulty understanding why I abruptly made up my mind that this was not a place I wanted to work, but was apologetic. I don’t know where those two and the firm wound up, but I hope they started group therapy sessions as soon as I walked out the door.

That last story really resonates with me. As a candidate, when we attend interviews, we tend to be on our best behavior and I think we assume the people we are meeting with are likewise on their best behavior. I am sometimes left wondering that if what I have just seen is an organization putting their best foot forward, how wild it must be when they’re not trying.

From Crazy Ivan: “Re: tradeshow booths. This is my favorite ever. The only thing missing is the unmarked white van.” Every year one of my booth crawl BFFs and I fantasize about taking over one of the no-show booths at HIMSS and using the company’s name to create a fake business just to see if we can get prospects to stop by and chat. This year our delusion expanded to a couple of other people in our circle and the idea is gaining steam for next year. Another good reason to always check out the “little guys” on the trade show periphery – you never know who you’re going to find there.

From The Big Divide: “Re: this article. Would love to hear your thoughts. Is this a trend? It makes me nervous. Can’t help but believe it does deepen the divide in healthcare.” Concierge medicine is certainly a trend, although its market penetration varies across different regions of the country. I do see a fair number of direct primary care practices, many of which are priced in a way to be much more accessible to a broader swath of patients especially when those patients have a high-deductible health plan. The more accessible versions differ from typical concierge practices in that they’re more about cutting out the middleman (insurance) and providing value then they are about the white-glove service or 24×7 access than some retainer/concierge practices would be. I think the Michigan program especially raises concerns because of its association with a teaching hospital, and many teaching hospitals have a historical mandate to serve the underserved.

The hospital affiliated with my medical school had a “concierge floor” back in the day, where VIPs were cared for in swanky rooms with better meal service and no house officers. We only had a chance to breathe that rare air in the event of a code blue, when it was all hands on deck for the on-call team. They also sometimes had poorer outcomes because there were no house officers, which sometimes means less attention. Depending on the reason you’re in the hospital in the first place, not having interns and residents and students bothering you can be a bad thing.

On the other hand, when looking at concierge practices, they seem inevitable with the commoditization of medicine. One knows that when one purchases a Lamborghini, they will receive a different level of service than if they purchase a Chevrolet. People of means pay cosmetologists to come to their house to perform a pedicure rather than go to a salon. They have housekeepers rather than clean the bathrooms themselves. If the practice of medicine is no longer a calling but rather a business, why should it be any different than any other service? Even in a hypothetical single-payer system, there will always be people who are willing to pay more to get more. The question is whether we as a society are willing to commit to a minimal level of care for everyone else.

What do you think of concierge practices or direct primary care? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 4/12/18

Apple’s iOS 11.3 electronic health record initiative ‘might be overhyped’

At an AMIA briefing on Capitol Hill, Geisinger Health System (PA) Chief Clinical Informatics Officer Alistair Erskine, MD points out that Apple’s Health Record app initiative is more limited than headlines suggest, given that it excludes Android users and does not yet give users access to their full medical records.

Epic won’t protest Coast Guard move to Cerner

Epic will not protest the Coast Guard’s decision to move on from its failed $60 million Epic implementation and join the DoD’s $4.3 billion Cerner contract.

Livongo Health Raises $105 Million

Livongo Health raises $105 million in a Series E funding round and announces it will work with Cambia Health Solutions to develop and market new consumer-friendly digital health offerings for those with chronic conditions.

Morning Headlines 4/11/18

Theranos Lays Off Most of Its Remaining Workforce

Theranos lays off most of its remaining employees following SEC fraud charges and ahead of a likely bankruptcy filing, leaving around 20 employees.

Mayo Clinic offers 400 transcriptionists buyout packages

Mayo Clinic offers voluntary separation packages to 400 transcriptionists as technology replaces them even before it goes live on Epic.

Veterans Affairs on course to top agency health IT spending

Analysts attribute projected growth in federal health IT spending to VA and DoD investments in new EHR software and related network and infrastructure upgrades.

Allscripts Care Management Joins With CarePort Health to Build Next Generation Care Coordination Solutions

Allscripts repositions its care and referral management system under CarePort, the outcomes technology vendor it acquired in October 2016.

News 4/11/18

Top News

The Coast Guard, which previously failed in its attempt to go live on Epic, will instead implement Cerner as part of the DoD’s MHS Genesis project.

The DoD will revise its contract with primary contractor Leidos to incorporate the Coast Guard’s requirements. It says it won’t know whether the contract cost will increase until that work is finished.

The Coast Guard spent five years and $60 million – vs. the original budget of $14 million – trying to bring Epic live, only to give up and go back to paper after retiring the systems it was supposed to replace in early 2016.

Reader Comments

From Chance the Rapper: “Re: VA’s VistA. They should keep it, according to this poll.” The HIMSS-owned rag’s poll suffers from a multitude of problems that make its “keep VistA” conclusion useless beyond its intended clickbait purposes. Polls covering a detailed technical topic that generate a small number of responses from unvetted participants are pretty much worthless and certainly not something I’d splash all over social media. Most sites that run health IT polls intentionally hide how poorly they were designed and thus how questionable their results are.

From Firehydrant: “Re: Ascension. Cerner is possibly a victim of Ascension incompetence and political back-stabbing. Ascension IT has eliminated 20+ CIOs and 30+ directors as they drive strategy from St. Louis. They’re focusing on talent from Express Scripts. A recent all-hands webinar was marred by heckling staff using pseudonyms, with executives threatening to eliminate chat tools if the staff can’t be trusted.” Unverified.

From Someone Formerly of NextGen: “Re: NextGen. Tweeting to hire new talent. Two days after they announced their $300 million credit with JP Morgan, they laid off 60 people, some of them key individuals in charge of implementing the new vision of NextGen. Depending on how they recovered from last year’s mass exodus of veteran sales professionals, this puts them at a 2-3 percent reduction of workforce.” Unverified. But I’ll say in the company’s defense that layoffs are common in health IT (especially the publicly traded ones like NextGen / Quality Systems) and companies are always cutting back headcount in some areas while expanding in others. It’s too bad that employees assigned to a particular project are often let go, but that’s the easiest way out for executives. QSII shares have lagged the Nasdaq for years, shedding 23 percent in the past five years vs. the Nasdaq’s 116 percent gain. The only QSII executive who’s been with the company longer than three years is the HR VP (who’s also the only woman among the six executives). CEO Rusty Frantz said in last month’s earnings call that “85 percent of our effort is focused on monetizing our existing client base” and that “the replacement market’s a tough place right now,” with obvious hope placed on the August 2017 acquisition of physician practice analytics vendor EagleDream Health as well as the new sales force he brought in.

Webinars

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

Acquisitions, Funding, Business, and Stock

Allscripts repositions its care and referral management system (the former ECIN, relabeled as Care Management) under CarePort, the outcomes technology vendor it acquired in October 2016. I interviewed CarePort co-founder and CEO Lissy Hu, MD in February.

Healthfinch raises $5.7 million in a funding round.

Theranos lays off most of its remaining employees following SEC fraud charges and ahead of a likely bankruptcy filing, leaving around 20 employees left vs. the 800 it had in late 2015.

Sales

HealthlinkNY selects the Quality product of Diameter Health, which is certified for more of NCQA’s e-clinical measures than any other firm.

Freeman Health Systems (MO) will conduct an extended pilot of Mobile Heartbeat’s MH-CURE secure smartphone platform after completing a pilot in Freeman Hospital West’s cardiology department.

Waverly Health Center (IA) will replace Allscripts Paragon with EClinicalWorks.

People

Omnicell hires Scott Seidelmann (Candescent Health) as chief commercial officer. He founded radiology workflow technology vendor Candescent in March 2015 and sold it to Envision Healthcare in August 2017.

Dennis Shin (The Advisory Board) joins oncology precision medicine software vendor Syapse as chief commercial officer.

Announcements and Implementations

Phoenix Children’s Hospital (AZ) reports that its use of Medicomp’s Quippe Clinical Documentation has increased clinician productivity and enhanced documentation quality while nearly eliminating its $1 million annual transcription costs.

Netsmart announces MyUnity, a cloud-based EHR for home care and senior living providers. It’s being demoed this week at the company’s CONN18 user conference in Phoenix.

Phynd integrates Healthwise’s clinical taxonomy into its Provider Information Management solution.

AMA and its Integrated Health Model Initiative launches an interoperability challenge – sponsored by Google – that calls for ideas on: (a) how patient-generated data can be moved from their mobile devices into physician workflow, and (b) how physician-generated data can be sent back to the patient’s device for action. Prizes are offered, but in the form of one-year Google Cloud credits instead of cash. Residents from anywhere in the world can participate except those countries labeled by the State Department as sponsoring terrorism (North Korea, Iran, Sudan, and Syria) and those in Canada, Mexico, and Brazil (I’m not sure how they got on the wrong side of the AMA to be lumped in with terrorist countries).

Video visit provider Doctor On Demand will enhance its lab ordering services via Change Healthcare’s network, which will allow patients to work with their doctor to choose the closest in-network lab location.

Inovalon launches services for clinical data extraction and natural language processing for its value-based care platform.

Government and Politics

FDA caved to pressure from emotional patients and families two years ago in approving the expensive new drug Nuplazid for Parkinson’s diseases psychosis despite several studies that showed it ineffective at best and dangerous at worst. Now the adverse events reports are piling up.

CMS issues its 2019 insurance exchange rules, with Administrator Seema Verma loading her quotes and tweets with political derision in referring to “the harmful impacts of Obamacare” and “the previous Administration’s one-size-fits-all approach.” States will be given more flexibility in defining Essential Health Benefits, insurer risk adjustment will be tweaked, states will be allowed to request a lower Medical Loss Ratio for insurers to stabilize their markets, and the SHOP insurance program for small businesses will be moved from the exchanges to individual insurance agents. Verma said in a tweet that insurance premiums doubled in states that participated in the federal exchange even as fewer choices were offered, requiring regulatory reform.

Privacy and Security

The congressional testimony of Facebook CEO Mark Zuckerberg  suggests that Facebook’s platform is so complex that even the company didn’t know how it could be abused. He said:

• Facebook versions through 2014 allowed companies to create quizzes that would give access to the information of the quiz-taker’s Facebook friends even though those friends hadn’t given permission and weren’t alerted.
• Facebook learned from a newspaper story that a personality quiz developer had shared user information with Cambridge Analytica, after which that developer was banned and forced to delete the data.
• Just two weeks ago, the company found out that a feature that allows looking someone up by their phone number and email address “was abused” by linking public Facebook information to their phone number.
• Access to user data will be removed for apps that a given user hasn’t run for three months.
• Apps will only be able to see user name, profile photo, and email address.
• Users will see in their News Feed which apps they’ve authorized to use their data and whether Cambridge Analytica extracted their information.
• Facebook will restrict use of some APIs, such as for groups and events.
• Advertisers will have to confirm their identity and location before running political and issue ads.
• Zuckerberg vows that “advertisers and developers will never take priority” over “bringing the world closer together” even though they are Facebook’s customers.
• Some of the mostly elderly, non-technically savvy members of Congress seemed clueless about Facebook, with 84-year-old Senator Orrin Hatch (R-UT) asking Zuckerberg, “How do you sustain a business model in which users don’t pay for your services?” Zuckerberg couldn’t help smiling as he responded: “Senator, we run ads.”
• Zuckerberg had to explain several times that Facebook doesn’t sell data, it only uses it to target ads.
• Pressed hard on whether he would support a law requiring that users of any web service opt in before their data is used, Zuckerberg finally said yes.

As someone tweeted, above is a suddenly relevant 2003 article from The Harvard Crimson.

Other

A Black Book survey of 19,000 physician practices finds that small-practice doctors who use specialty-specific EHRs are the happiest EHR customers. Leading the satisfaction pack are AdvancedMD, Drchrono, Epic, NextGen, Netsmart, Modernizing Medicine, and SIS Amkai. Other satisfaction leaders are T-System EV (emergency medicine), Praxis EMR (family practice), Surgical Information Systems (general surgery), DocuTap (urgent care and occupational medicine), and PointClickCare (geriatric medicine). The survey also found that while most practices regularly use basic EHR capabilities, those with six or fewer physicians rarely use electronic messaging, clinical decision support, interoperability, and patient engagement.

Mayo Clinic offers voluntary separation packages to 400 transcriptionists as technology replaces them even before it goes live on Epic.

Scientists propose defining Alzheimer’s disease by biological signs that can be observed 15-20 years before the first dementia symptoms are seen, a change that will greatly increase the count of people with the disease. They’re hoping to improve outcomes by starting treatments before brain damage has occurred. The researchers hope to get more patients enrolled in pre-symptomatic stage studies, but don’t recommend that people get tested on their own since there’s no available Alzheimer’s treatment.

A Health Affairs blog post says that only 15-20 percent of Baby Boomers will be able to afford the long-term care services they will begin consuming on a massive scale in the next 10 years. It adds that Medicaid will be stretched as the default insurance for half those people, also noting that less-wealthy Boomers will have to get used to the idea of sharing rooms in old facilities.

This is the kind of careful editing that makes me comfortable sending $3,500 off to Pune to buy a Global Hospital Information Systems Market Report.

Sponsor Updates

• AdvancedMD will exhibit at ASCRS April 13-17 in Washington, DC.
• Agfa HealthCare acquires French e-health specialist Inovelan.
• Arcadia will host Aggregate2018 April 18-20 in Boston.
• Forbes names Direct Consulting Associates to its Best Professional Recruiting Firms of 2018.
• The Hospital Association of Southern California partners with Collective Medical to bring members cost-saving identification and support of frequent ED utilizers.
• CoverMyMeds will exhibit at the AAP Annual Conference April 12-14 in San Diego.
• Meditech certifies infrastructure provider SYSDBA as the only systems integrator for Africa and the UK.
• Spok executives will participate in upcoming events that include AONE, the AMDIS PCC Symposium, and the AHA Leadership Summit.
• Dimensional Insight will exhibit at the ACO & Payer Leadership Summit April 12-13 in Palm Beach, FL.
• EClinicalWorks will exhibit at the AAOE 2018 Annual Conference April 14-17 in Orlando.
• Ellkay exhibits at the ACMG Annual Clinical Genetics Meeting April 10-14 in Charlotte, NC.
• The HCI Group publishes a new case study, “Luke’s Goes 7 for 7 on HIMSS EMRAM Stage 7.”
• InstaMed will exhibit at the Office Practicum User Conference April 12-14 in Orlando.

Blog Posts

• Successfully Moving from Best-of-Breed to an Enterprise Lab System (Optimum Healthcare IT)
• The Importance of Governance in Aligning the Financial with the Clinical (Leidos Health)
• Healthcare CIOs Say Lift and Shift to the Cloud Not on Their Radar (Datica)
• A Proven Program for Managing 3-Day Rule Waiver Patients (CarePort Health)
• What Inspired You to Become a Nurse? (CareSync)
• CIO Chat – Russell Branzell, CHIME (Huntzinger Management Group)
• Reimbursement for Care Plans: The Cancer Care Planning and Communications (CCPC) Act (Carevive)
• The Digital Conundrum (CTG)
• 5 Biggest Resume Mistakes (CTG)
• Dimensional Insight Book Club: The Digital Doctor (Dimensional Insight)
• A Holistic Approach to Relationship Management (Docent Health)
• 11 Ways to Make Sure Your Contract Management Process is Meeting Your Organization’s Needs (Hayes Management Consulting)
• Translate Social Determinants of Health into Actionable Intelligence (HBI Solutions)
• Embracing Technology 2.0 – Preparing for the Future that is Now (Huntzinger Management Group)
• How a content services platform improves your Five-Star Quality Rating (Hyland)
• Seeing Is Believing: Thoughts from a first-time HIMSS attendee (Meditech)
• Advancing interoperability in today’s healthcare ecosystem (Imprivata)
• Three CRM Trends Impacting the Healthcare Market in 2018 (Influence Health)
• Airline Pilots & Doctors: What Can We Learn to Decrease Burnout? (Kyruus)

Contacts

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

Morning Headlines 4/10/18

After botched acquisition, Coast Guard joins Pentagon electronic health record system

The Coast Guard will implement MHS Genesis, joining the DOD’s 10-year, $4.3 billion contract with Cerner.

Google is teaming up with the largest doctor group for a medical data challenge

The AMA and Google launch the Health Care and Interoperability Innovation Challenge to uncover new ways of monitoring and sharing health data between chronic disease patients and physicians using mobile technology.

Specialist-Centric Systems Lead Small Physician Practice EHR Satisfaction, Black Book Survey

Seven vendors – each with specialty-focused EHRs that offer RCM, coding, and practice management tools – score highest for customer satisfaction in Black Book’s latest market analysis.

Curbside Consult with Dr. Jayne 4/9/18

It was a strange week in my little health IT world. I had my first prospective client call to ask about an “extension” in MIPS data submission. Although CMS extended the deadline from March 31 to April 3, my client had confused the deadline with the federal income tax deadline and thought that you could file an extension to get an even longer time to report.

Sorry, folks, but if you haven’t submitted by now, you’re out of luck. We’re in the 2018 reporting year, so if you haven’t started to get your plan ready, you need to dust yourself off from 2017 and head into the new year.

I also went on the strangest job interview of my life. I had been introduced to this potential position by a mutual friend who works for the medical group in question. The backstory I was given was this — a mid-sized medical group is looking for a blended CMIO / clinical role to complement existing CMO and medical director positions. The group is growing and realizes that they need more administrative leadership to move them through programs such as MIPS and to assist with managed care contracting and their transition into the ACO space.

It sounded right up my alley. The recruiter from the group validated the role by sharing a job description, doing a phone screen interview, making sure we were in the same compensation ballpark, and then scheduling me to come meet with the group.

My first conversation was to be with the group’s physician president, who apparently was “called away.” He didn’t give advance warning to the interview team, which is never a good sign. I was left sitting in a hallway for 20 minutes while they scrambled to find someone else to fill the time block, who of course was unprepared for the meeting and didn’t really know what the role was about. They were, however, a provider, so they could tell me what practice with the group was like, which was important since this role would involve a certain amount of time in clinic.

From a few things he said, though, it sounds like the president gets “called away” quite a bit, which sounds like either poor time management skills or a certain level of chaos that requires the group president to sort it out.

From there, I met with some nursing team representatives who told me more about the clinical aspect of the job as well as some of the pain points they hoped that the new CMIO role would help address. The discussion was candid, the interviewers were friendly, and I felt it was a good opportunity to share my philosophy of clinical practice as well as how I think teams best work together.

They handed me off to members of the informatics team, who met with me over lunch. It was a mix of interviewing and grilling, with many questions about whether I would try to restructure the informatics team or change how their jobs work. There were a lot of very pointed questions about how I work with technical resources. One analyst flat-out asked if I would automatically take a physician’s side in the event of a disagreement between the physician and IT.

The analysts seem to be a good group of people. Although they’re pulled in many directions, I think they are excited about the possibility of someone helping with governance and making sure they are doing well-considered projects rather than reacting to squeaky wheels or shiny objects.

From there, I met with the COO, who talked me through some of the nuts and bolts of the organization and how much she thought the new role would interface with the financial and operational aspects of the organization. It sounded like there has been some friction in the past among operations, IT, and the clinical stakeholders as they decide how to prioritize scarce resources and how they decide which initiatives to pursue as they create their annual planning and strategic roadmaps.

At this point, none of this was surprising or out of the ordinary compared to other interviews I’ve been on, except for the missing interview with the group president. At the end of the talk with the COO, she let me know that I’d have a brief break and then would be able to meet with the president, who had rearranged another meeting to accommodate our interview. It sounded good, so I grabbed a cup of tea and made some notes about what I was thinking so far about the position.

An assistant came by to escort me back to a conference room, which seemed a little strange that we’d meet there rather than in the president’s office. Regardless, I headed in and sat down. That’s where the wheels fell off.  Apparently, the group president wasn’t on the same page as anyone else about this new position. I’m sure my face betrayed what I was thinking about what I was hearing.

The conversation was fairly one-sided. It essentially sounded like he isn’t in support of the position, implying that the people I’d talked to weren’t supposed to be advocating the position I was interviewing for. He said that someone shouldn’t just get to “walk right in and be a leader of this organization,” but rather needs to be a staff physician first and considered for a leadership position only if he or she “falls in the top 25 percent of our productivity curve.” However, any potential CMIO would need to first be a medical director, then given a chance for a promotion if they prove they can “walk the walk.”

He then proceeded to explain that the medical director positions were “stipend positions” on top of a full clinical schedule, which basically means the job would be a 1.25 full-time equivalent. Being anything less than a full-time clinician would be non-negotiable.

I wasn’t sure I heard it right the first time since my brain was still trying to wrap itself around being at the top of the productivity curve, which is terminology I haven’t heard since value-based care started picking up speed. Most of the interviews I’ve been on describe evaluating physicians based on metrics that are scored for clinical quality, patient satisfaction, access, chart completion, cost of care, etc., but not outright productivity. I asked a few questions around that and it sure sounded like their docs are being incented on a cross between RVUs and clinical quality scores, but it wasn’t clear.

By this point, given the total disconnect between the group president and the rest of the people I had talked to, I knew this wasn’t going to be a process I wanted to take forward. Clearly this gentleman didn’t understand how CMIOs and other leadership-level physicians are usually brought into an organization. Can you imagine a hospital CMIO being told that he or she needed to work his way up through the ranks and maybe then he or she would get a shot at the C-suite?

I can’t help but believe that at some point during the conversation my mouth was agape. The rest of the interview ping-ponged around for awhile until the recruiter came back to pick me up and close out the day. She asked what I thought and I threw out some vague comments about it being an interesting opportunity and there being a lot to think about.

I’m not sure if they know how off-script their leader was or what was going on, but at this point, I don’t care if I hear from them or not. I hope they get their act together before they “interview” the next guy or gal (I use that term loosely considering how the day ultimately went). I can laugh about it after a glass of wine, but in retrospect it was rather bizarre.

What’s the weirdest job interview you’ve ever been on? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 4/9/18

Trump taps new director for office on Medicare reforms

The White House hires Landmark Health CEO Adam Boehler as director of the Center for Medicare and Medicaid Innovation.

Netsmart to Acquire Change Healthcare Home Care and Hospice Solutions

Netsmart will acquire Change Healthcare’s home care and hospice solutions, integrating them into its HIE, analytics, referral management, and mobility technologies.

Roche completes acquisition of Flatiron Health

Roche wraps up its $1.9 billion deal with New York City-based oncology EHR and research company Flatiron Health, which will continue to operate as its own business entity.