News 3/14/18

Top News

A blog post from UCSF’s Center for Digital Health Innovation takes exception to Epic’s claim that it offers a “comprehensive health record.” The authors say EHR vendors are missing the point that no EHR can be comprehensive since important information is also generated by patients, families, and caregivers; includes genomic information, and is sourced from non-clinical settings. It concludes,

Interoperability is not and must not be defined by being able to pick up and move a giant digital stack of records from one hospital system to another, with the hope that the patient’s various providers will all be able to accumulate everything, like a cartoon snowball rolling downhill … interoperability is a national priority precisely because no single vendor EHR system is comprehensive… Given this, we say “connected health record,” not comprehensive health record, and we are not alone … a chorus of physicians and patients is crying out that EHR systems are already cumbersome and inefficient. Imagine how much worse this might become if EHR systems grow and grow to accommodate new use cases … technological advances have led other industries to adopt an API-based model, in which modules, devices, and software from different vendors can easily connect. That way, each vendor can focus on what it does best, and the user can benefit from an ecosystem of technology and software that work seamlessly together.

Reader Comments

From Jorge DiSelva: “Re: Cerner’s revenue mix. Did you notice how far it has swung from license fees to services? Pretty amazing.” It is indeed amazing. Annual revenue has nearly doubled in the past five years and 43 percent of software revenue is now coming from subscriptions. Services revenue is also huge at 72 percent of the $5 billion total, with 62 percent of Cerner’s annual revenue being recurring. Companies have chased the subscription-based revenue model with varying degrees of success to try to smooth out revenue swings due to the timing of contract signings, but Cerner has delivered. Customers could theoretically displace its products more easily under the subscription model, but few will do so given the lack of alternatives and the effort they expended to implement them in the first place. Investors aren’t loving everything about Cerner, though – the health IT market is changing pretty quickly, the company’s margins have slipped a bit, the VA deal hasn’t yet played out as expected, and the new CEO is an unknown factor. CERN shares are up 16 percent in the past year, which sounds great except that just investing that the Nasdaq composite would have yielded nearly double that.

From Math Challenged: “Re: HIMSS conference combo deal. They tweeted that a combo pass for HIMSS19 and Health 2.0 is a ‘2 for 1 Deal … for the price of 1 ticket.’ Not so – the website says the combo for HIMSS members is $1,799.” I don’t understand that claim either. The HIMSS early bird registration rate for members was $795 this year, so that means you’re paying $1,034 for Health 2.0 instead of its early bird price of $1,199, which isn’t much of a deal.

From Old Timer: “Re: open position at BIDMC. Is John Halamka leaving?” The job posting is for CIO of just the physician group from what I can tell.

HIStalk Announcements and Requests

Datica Chief Data Officer Mark Olschesky tweeted out a challenge at the HIMSS conference in which he offered to donate $1 to my DonorsChoose project for each attendee at his session on HIPAA and GDPR compliance for developers. His donation (and your attendance, if you were among the 300 there) along with matching funds fully covered these teacher grant requests:

• 12 sets of headphones, a microphone, and a barcode scanner for Mrs. R’s elementary school class in Tucson, AZ
• A document camera for Mrs. S’s second grade class in Charlotte, NC
• Two tablets for programming robots for Ms. C’s middle school class in Fresno, CA
• Two tablets and cases for robotics programming for Mrs. A’s elementary school class in Theodore, AL
• Speakers for Mrs. D’s elementary school class in Holyoke, MA
• Eight LCD writing boards for Ms. C’s elementary school class in Memphis, TN

Welcome to new HIStalk Platinum Sponsor Hyland Software. The company combines information management and enterprise medical imaging with business process and case management capabilities to deliver a suite of unparalleled content and image management solutions to address the clinical, financial, and operational needs of healthcare organizations around the world. More than 2,000 healthcare organizations use Hyland Healthcare’s world-class solutions every day to become more agile, efficient, and effective. The product suite – Acuo by Hyland, Brainware by Hyland, NilRead, OnBase by Hyland, PACSgear, Perceptive Content, and ShareBase by Hyland – helps complete patient records, eliminate reimbursement delays, and enhance business processes. Hyland Healthcare is a part of Hyland, a leader in providing software solutions for managing content, processes, and cases for organizations across the globe. Thanks to Hyland Healthcare for supporting HIStalk.

Webinars

April 5 (Thursday) 1:00 ET. “Succeeding in Value-Based Care Via a Technology-Driven Approach.” Sponsor: Health Fidelity. Presenters: Adele L. Towers, MD, MPH, senior clinical advisor, UPMC Technology Development Center; Adam Gronsky, director of advisory services, Health Fidelity. Success in value-based care requires a thorough understanding of how risk-based payment models work. To prosper in this data-laden era of care, providers need to manage their patient populations holistically rather than through a collection of individual episodes and be able to accurately identify, document, and report risk scores. Given the stakes, is your provider organization adequately set up to take on and succeed in managing risk? In this webinar, learn how technology-enabled risk capture optimization is helping providers succeed in risk-based payment models.

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

Acquisitions, Funding, Business, and Stock

Cognizant will acquire Louisville, KY-based RCM services vendor Bolder Healthcare Solutions, adding to its previous health IT-related acquisitions TMG Health and TriZetto.  

Greenway Health will close its Lake Mary, FL office in late April and lay off 27 employees who work there. The company had previously announced the closure of that office as well as those in Atlanta and Birmingham as it consolidates operations in Tampa, FL.

The White House kills Broadcom’s hostile takeover of Qualcomm, meaning that Capsule Tech will remain a Qualcomm subsidiary. Thanks to reader Dr. Trump, who reminded me of the healthcare IT connection. Qualcomm acquired medical device integration vendor Capsule Technologie in September 2015.

Sales

Virginia Hospital Center (VA) will implement the Spok Care Connect unified communication platform.

People

Former HIMSS President and CEO Steve Lieber joins association software vendor Next Wave Connect as executive advisor.

Advocate Health Care SVP/CIO Bobbie Byrne, MD is named CIO for Advocate Aurora Health once the Advocate-Aurora merger is completed in the next few weeks. Aurora CIO Preston Simons will “retire.” The CEOs of each health system will serve as co-CEOs of the merged organization, which never works even though it gets the deal signed in bypassing egos. I question the focus of a company that doesn’t have enough decisiveness to put one person in charge, although the co-CEO arrangement is usually abandoned fairly quickly anyway.

Intelligent Medical Objects promotes Matt Cardwell, PhD to chief product officer and Jose Maldonado to chief solutions officer.

Collective Medical promotes Andrew Reeve to SVP of sales.

Influence Health promotes Mike Oakman to COO.

Announcements and Implementations

GetWellNetwork adds Healthwise’s patient education video library to its patient experience platform.

Medable announces Insight, a blockchain-powered medical data exchange platform for research studies. The company offers tools for building secure data-related applications, analytics, alerts, and data visualization. It claims that researchers can develop a clinical study app in one day.

CompuGroup Medical launches a project to create new ambulatory products for several countries, with the US at its center. The core product can be customized to individual markets but will share a code base, tools, and processes.

DirectTrust’s board calls for nominations for new board directors and for the CEO position being vacated by David Kibbe, MD, MBA at the end of the year.

Datica launches a Kubernetes-enabled version of its security and compliance technology that will allow AWS and Microsoft Azure users to deploy Datica’s platform on their own cloud accounts.

Government and Politics

Media reports suggest that President Trump is considering replacing VA Secretary David Shulkin with Energy Secretary Rick Perry, who is a former Texas governor and Air Force captain and pilot. 

Other

ECRI focuses on diagnostic errors in its top 10 patient safety issues for 2018, with “incorporating health IT into patient safety programs” being the only pure IT item on the list.

FYI: the latest update to the Chrome browser adds the desperately-needed option to permanently mute a site, preventing the heart-stopping racket that some sites create with auto-play video (CNN and local TV station sites are the worst offenders). Right-click a tab and the “mute site” option appears.

A JAMA article says out-of-control US healthcare spending is driven by high prices and administrative overhead rather than overutilization. It notes in comparing the US to 10 high-income countries that the US:

• Spends twice as much on medical care, representing 17.8 percent of GDP vs. the next-highest 12.4 percent
• Covers 90 percent of residents with health insurance vs. the next-lowest country at 99 percent
• Has the highest obesity rate, the lowest life expectancy, and the highest rate of infant mortality
• Has about the same number of doctors, nurses, and hospital beds per 1,000 people , but pays clinicians a lot more
• Spends 8 percent on healthcare administrative costs vs. the next-highest 3 percent
• Spends $1,443 per person on prescription drugs vs. the next-highest $939, with drugs here costing up to 10 times what people in other countries pay

Epic’s Judy Faulkner tells Politico that the company won’t challenge the VA’s single-source Cerner contract choice (“we feel it’s the customer’s right to pick whatever they want”), but she estimates that Epic would have charged at least $3 billion less than Cerner and would offer more interoperability with providers who see veterans that seek care outside the VA system.

Sponsor Updates

• Formativ Health announces a patient engagement solution for Salesforce Health Cloud.
• Meditech will exhibit at the Texas Organization of Rural & Community Hospitals (TORCH) 2018 Conference in Dallas April 10-12.
• CareSync publishes a new report on chronic care management for rural health clinics and FQHC practices.
• Carevive will present and exhibit at the ACCC Annual Meeting and Cancer Center Business Summit March 14-16 in Washington, DC.
• Software Advice includes ChartLogic in its list of frontrunners in the EHR software market.
• EClinicalWorks will exhibit at Endo Expo 2018 March 17-20 in Chicago.
• Ellkay joins the CommonWell Health Alliance.
• Healthfinch receives an Innovation Award from Athenahealth for its Charlie Practice Automation Platform.
• Healthwise announces new health educational content partnerships with TeleHealth Services, and Mytonomy.
• InterSystems and Rhode Island Quality Institute deliver designee alerts for patient empowerment.
• IMO and Aorn Syntegrity partner to create a consolidated surgical scheduling procedure list.
• Kyruus integrates IBM Watson Virtual Agent with its ProviderMatch technology to enable AI-assisted patient-provider matching and scheduling
• Clinical Architecture CEO Charlie Harp discusses interoperability on CommonWell TV.

Blog Posts

• Revisiting Deconstructed PACS (Visage Imaging)
• Top 3 Trends to Improve Patient Experience With Healthcare (ChartLogic)
• Grocery store walkthroughs: One step toward improving health literacy (Meditech)
• 4 Questions with James Feen, VSP and CIO at Southcoast Health (Optimum Healthcare IT)
• What Steps are Involved in the EMR Migration Process? (Access)
• The Role of Practice Automation in Healthcare Communication (AdvancedMD)
• #HIMSS18: French delegation and Augmented Intelligence (Agfa Healthcare)
• Removing Friction from the Prescribing Process (Aprima)
• 2018 Healthcare Trends Part 4: Clinicians as Developers (Datica)
• When Strategy Meets Reality: Value-based Discharge Planning (CarePort Health)
• Deadline for Reporting MIPS Data and 10 More Facts for 2018 (CareSync)
• Top 3 Trends to Improve Patient Experience with Healthcare (ChartLogic)
• Federal movement around EPA (CoverMyMeds)
• Demonstrating the Value of the Health Information Exchange Through Qualitative Research (Diameter Health)
• Nine Steps to Getting Rid of the Urgent Care Waiting Room (DocuTap)
• HIMSS 2018 – A Nurse’s Retrospective Part 1 (Engage)
• Client Success: Better Care Management at Maine FQHC (HBI Solutions)
• Managed IT Services for Healthcare: 4 Considerations for Choosing the Ideal Partner (The HCI Group)
• For Physicians, a Little Investment in Patient Reviews Goes a Long Way (Healthgrades)
• What Works – Huntzinger Defines IT Merger, Acquisition & Affiliation Playbook (Huntzinger Management Group)
• Time Matters with Sepsis – Here’s One Minute That Really Counts (Iatric Systems)
• 5 Things to Consider Before Hosting Smaller Facilities on Your Shiny New EHR (Impact Advisors)
• Why patient identification matters more than ever in 2018 (Imprivata)
• Getting Executive Buy-In for Reputation Management (Influence Health)
• Four Tips to be a Better Steward of Opioid Prescriptions (Ingenious Med)
• Be a Better Communicator: How to Set Patient Expectations and Get Paid (InstaMed)
• Leveraging Community Data for Continuous Innovation (InterSystems)

Contacts

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

Morning Headlines 3/13/18

Mercy Health launches new department

Mercy Health (OH) hires former Angel MedFlight Worldwide Air Ambulance Services CEO Jason Siegert to head up its new analytics department, which will bring together business intelligence, and quality and population health analysis to better evaluate data.

Lake Mary firm to close, lay off employees

Greenway Health announces it will close its Lake Mary, FL and Birmingham, AL offices as it continues to consolidate operations at its headquarters in Tampa, FL.

Intermountain Healthcare Launches New Company, Expanding Access to Proven Mental Health Integration Approach

Intermountain Healthcare (UT) spins off Alluceo, a new company that will help providers apply technology to the integration of primary and behavioral healthcare.

Losing Software Bidder Charges University of Illinois is About to Make a $100M Mistake

After making a stink about the amount of money Illinois tax payers will have to pay if the University of Illinois Hospital & Health Sciences System moves forward with its Epic contract, Cerner convinces the Illinois Procurement Policy Board to convene all parties to explain their bids and the procurement process.

Curbside Consult with Dr. Jayne 3/12/18

Based on some networking accomplished at HIMSS, I’m about to begin work with a new client. The nature of the work requires me to have a medical license in their state, so I jumped right in Friday morning to get the process rolling. The licensure process can vary from state to state and I haven’t completed an application in years, so I wanted to get going quickly.

The first place I visited was the Interstate Medical Licensure Compact website to see if that might be a pathway to speed things along. When the Compact was introduced several years ago, it was touted as a way to increase delivery of care to underserved areas as well as to better enable telemedicine.

Unfortunately, the state where I primarily practice doesn’t participate in the Compact, nor do any of the states where I’m secondarily licensed, so that was a bust. Even if it had panned out, there is a $700 application cost plus the cost of the license in the target state. I have the luxury of being able to pass this on to my client since it’s their requirement, but that fee is far from pocket change.

I then investigated licensure directly with the state and found that they have an online portal. After creating an application, I learned that if I’m licensed in a state with similar requirements, they have an attestation pathway, where it should be easier to credential than if I were applying from scratch. This state borders my own and I have many colleagues that practice across state lines, so I thought it might be fairly easy.

Unlike a paper application, the online application directs the user through a rigid pathway of data-gathering. You can’t even see what the subsequent requirements are until you supply the preliminary data, which wasn’t close at hand. I found an instruction sheet PDF through an online search, but it had an older date on it and I wasn’t sure whether it was still relevant. Although I was sitting with copies of all my board certification information, medical school and college diplomas, and more, I became hung up because I couldn’t supply the date of my high school graduation or the date that enrolled in college.

I pawed through some boxes in my basement for a bit to see if I could come up with the high school diploma, but that wasn’t fruitful. I visited my high school website to see if they had an online request form. They don’t, but I was able to download a paper form to mail or scan back, which allows them to send me an unofficial transcript by email.

In my subterranean digging, I found my final college transcript, but of course it didn’t have the enrollment date on there, so I’ll be requesting that from my undergraduate institution as well. The application also requires my dates of attendance at medical school, but I was able to figure that out from my first tuition bill, which I must have saved as a memento.

I have no idea what kind of information they will want from residency. Probably similar information, and it should be a little easier to find because it’s more recent. Still, it will require either some digging or sleuthing to get it done and I’ll be in a state of curiosity until the rest of the application is revealed to me.

The bottom line though is that this “by attestation” pathway seems about as complicated as trying to apply for a license from scratch, minus having to submit USMLE scores. (For the first-time applicant, they have a nice current instruction sheet that spells out everything you need to apply.)  Fortunately, when I packed up my diplomas and certificates in leaving my corner office at Big Health System, I had scanned all those documents so that information is at least at my fingertips. Hopefully they won’t want anything too unusual.

I will have to travel to the state in question and be fingerprinted by their state police organization. I’m not sure why I can’t be fingerprinted by my own state police and submit that, but I’ll be sure to factor that travel into the contract for my new client.

For a physician who has been in practice the better part of two decades, certified by two different medical boards (one of them multiple times), and possessing multiple unrestricted licenses to practice medicine, this process seems a little cumbersome. I’m not sure why it’s relevant to document what date I began high school in order to be licensed to practice medicine. But it is what it is, and if you want to practice in another state, you have to play their game (and pay their fee, which in this case is more than $700 plus a state controlled substance license, and I haven’t even started that process yet). Once you are granted the license, you have to pay to keep it up even if you’re not sure you’re going to continue to do it because it is such a cumbersome process to be re-licensed.

It seemed like the Interstate Compact was the answer to all of this, but the reality is that only 22 states participate, leaving the rest of us in the cold and completing lots and lots of forms if we want to change where we practice. Several other states have passed legislation and the implementation is delayed and other states have introduced legislation. But it looks like those of us in the other 22 states are stuck with the traditional process. I’d be interested to hear from physicians who practice telemedicine or from those who practice as locum tenens in multiple states – are there any secrets, tips, or tricks to make this easier? Certainly there has to be a better way.

In the meantime, I’ll be watching my email for that high school transcript and my postal mailbox for the college information. At least I can use the Postal Service’s Informed Delivery to see what is headed my way when I’m out traveling. Nothing says road warrior like stalking your postal mail from the other side of the country.

Have secrets for multistate licensure? Leave a comment or email me.

Email Dr. Jayne.

The Smokin’ Doc Celebrates a Successful HIMSS

The exhibit hall closed Thursday at 4:00 p.m. Lorre and Brianne had already packed up our little bundle of booth furnishings and were saying goodbye to their new friends at booth neighbors Avelead and Valcom.

Setting up and then abandoning a booth is like camping, where you start with an empty patch of woods, turn it into a festive home and have a great few days in it, but are then shocked afterward to see that when you take everything down, it was just a quiet, sad little spot all along. The space was transformed into something else by the people who temporarily inhabited it.

For that reason, we always leave the Smokin’ Doc standee in the booth for the staff to deal with after the exhibit hall closes for good. He can’t be reused, but we can’t bear to just stuff him into a convention center trashcan. We always just walk away, and in our minds, he stands guard forever over our now-forlorn booth space.

The  ladies joked with Paul from Valcom that they wanted to get a final photo of the Smokin’ Doc at a slot machine if his folks could help carry him over. Paul said he would do them one better – they would take him out on the town and show him a good time with photos to prove it. Lorre said we didn’t expect them to haul a six-foot cardboard figure around, but Paul assured her that, “If we say we’ll do it, we will.”

What followed was a weekend of texted Smokin’ Doc photos from all over Las Vegas at all hours. We laughed every time our phones pinged.

Here’s a recap of how the Smokin’ Doc spent his post-HIMSS celebration weekend in Las Vegas, with the text messages that accompanied the photos.

[Just to allay any suspicions of a phony stunt — which is what I would automatically assume if I were reading this — the Valcom folks had never heard of HIStalk until the exhibit hall opened and I’m still not sure they know what we do, so they certainly weren’t looking for exposure. What they did was entirely on their own and we had no idea what was happening back in Las Vegas until the photos started arriving as we were heading home. We asked afterward if it was OK to give them a little plug.]

[Lorre responds that we’ve never named him and that they can choose a name that fits his personality].

[Robert Bell is a former Harlem Globetrotter and police officer who now devotes his time to anti-bullying]

[Contact Paula Burrier, executive casino host at The D Las Vegas.] 

Paul made us laugh, so here’s a little plug for Valcom in return. Roanoke, VA-based Valcom sells communications solutions to schools, commercial, healthcare, and government that include mass communications, voice paging, outdoor emergency help-summoning call boxes, and an audible sound curtain that prevents hallway and exam room conversations from being overheard as a HIPAA violation. They offer an emergency lockdown system that secures buildings after a threat has been identified. Lorre asked Paul to describe an event he mentioned to her in the booth: “A little over a week ago, one of our higher education clients had to use our IP6000 and eLaunch system to lock down the entire school because of an active shooter. Once this lockdown occurs, it makes it hard for a wrongdoer to stay the course. No lives were lost that day and our system did what it was designed to do. I take pride in working for a company that saves lives when seconds count and is 100 percent American designed, manufactured, and supported.” Paul will offer a site inspection and consultation, including on site and web demos, to readers who contact him at pburton@valcom.com.

Morning Headlines 3/12/18

Minneapolis-based Ability Network sells to Inovalon for $1.2 billion

Analytics vendor Inovalon will acquire competitor Ability Network for $1.2 billion, doubling the 2015 investment of the latter’s private equity owners.

Nuance lands a major partner in the health care sector

Epic will integrate Nuance’s AI-powered virtual assistants into its Haiku, Rover, and Cadence software.

Cerner Investment Community Meeting HIMSS Las Vegas -2018

Cerner reps announce during a HIMSS investment presentation that the VA will go live in 48 waves that will begin in Q4 2019 with pilot sites and then run through 2027, while DoD go-lives beyond the pilot sites will start this fall and go live in 23 waves.

Monday Morning Update 3/12/18

Top News

Cerner says in its HIMSS conference investor presentation that the VA will go live in 48 waves that will begin in Q4 2019 with pilot sites and then run through 2027, while DoD go-lives beyond the pilot sites will start this fall and go live in 23 waves (assuming the project reviews in both result in a go-ahead verdict). The company is also pursuing government opportunities with the Coast Guard, Indian Health Services, and CDC. 

Reader Comments

From Amy Contagious: “Re: HIMSS. I’m wondering what if any sickness people returned from the conference with? I have a light case of norovirus or similar. Wondering how many colds, flu, food issues, etc. since I don’t recall anything except exhaustion last year.” Attendees, tell us here. I’m happy to have returned just fine, other than I’m scared to get on the scales to measure the after-effect of a week’s worth of dietary destruction. Some of it was worth the calories, such as the amazing burger and fries, pizza, and wings at Home Plate Grill & Bar. I didn’t go to a single party or vendor event, spending my evenings in the rental house writing HIStalk, so low-key places nearby were just fine.

From Patiently Participating: “Re: patients at HIMSS. Did you sponsor patients to attend again this year?” I did not. I like the idea of having tech-savvy people who are actively involved in managing their chronic conditions (as well as caregivers) participate in health IT. However, I learned last time that more prep work is needed before just turning people loose in the glitzy exhibit hall to challenge random booth salespeople. Like most trade group conferences, HIMSS isn’t really designed for people who aren’t working in the field  (whether that’s a feature or a bug is debatable) and just having consumers drop in isn’t necessarily productive despite noble intentions. My recommendations for offering scholarships are:

1. Determine the desired outcomes of such participation.
2. Develop a plan of how patients (or consumers in general) can constructively participate in the conference as a representative of others like themselves. It’s too easy to get caught up in the parties and giveaways while forgetting the real point of being there.
3. Create a mandatory online training program for prospective attendees to help them understand the most effective ways to be a patient advocate and how to train others.
4. Document the technology usage, frustrations, and desires of those attendees in advance so that they can be shared.
5. Require as a condition of participation that attendees report to their community at large what they did there to advance their collective cause.
6. Work with vendors to determine how to best engage consumer representatives during and after the conference.
7. Create an online directory of companies looking for consumer guidance and for patient advocates interested in providing it.
8. Set up specific meetings at the conference with the right vendor people, particularly those in product design.
9. Make participation ongoing to whatever level those attendees and vendors want.
10. Choose new participants regularly to bring in fresh, objective viewpoints.

From Tarheel: “Re: Novant SVP/CIO Dave Garrett. Has left the organization.” Unverified. Dave hasn’t ever been listed on the health system’s leadership page from what I can tell, but it now contains the bio of EVP/Chief Digital Officer Angela Yochem, who was hired in January. She doesn’t have any healthcare experience except for a short stint as CTO for drug maker AstraZeneca. Novant paid Dave $1 million per year, according to its latest tax forms, but he still made less than the chief consumer officer ($1.5 million) and several others just in case you were thinking that “non-profit” implies “modestly-compensated executives.”

HIStalk Announcements and Requests

With HIMSS behind us, let’s get back to the “What I Wish I’d Known Before” question about taking your first hospital IT executive job. Or more specifically, your response. Here’s mine: I wish I’d know that non-profit health systems have just as many conniving middle managers as any business, stabbing your back regularly in trying to wrest internal or external IT control. A lot of hospital people are really nice, but quite a few aren’t.

My Android phone puts me in the one-third minority among poll respondents.

New poll to your right or here: HIMSS attendees, which of the Big Five inpatient vendors made the best impression last week?

I’m interest in your thoughts about the conference. What were the best and worst parts?

Since I didn’t do a “Weekender” post last week, here’s a DonorsChoose update from Ms. M in New York City, who asked for take-home math tools for her third graders. She reports, “They couldn’t wait to see all the math games. They were even more excited when they found out they were going to be able to take the materials home with them for homework. They are so excited! These materials will help us strength our math skills and prepare us for the state exam coming up. These games will allow my students to review past math chapters in a fun and interesting way. Once again, thank you for the donation!”

My Biggest HIMSS Conference Takeaways

1. The White House and HHS used the HIMSS conference to come out shockingly forcefully in vowing to attack information blocking; to give patients more control over their information; to move more quickly into value-based care; to reduce physician EHR burden; and to disrupt the system in which health systems keep charging more without delivering commensurately improved outcomes. Nobody knows how these populist talking points will get turned into policy.
2. VA and DoD EHRs remain a contentious topic.
3. The big keep getting bigger in healthcare, including in health IT.
4. Microsoft, Amazon, and Google have their eyes on earning a chunk of our massive healthcare spending by replacing local data centers with cloud hosting and back-end services.
5. AI is ready for prime time, at least in the context of powering virtual assistants that make clinician EHR interaction more tolerable.
6. Health IT is spreading beyond health systems and practices to skilled nursing facilities, home health, public health, behavioral health, and pharma.
7. Everybody is talking about consumerism despite little evidence that it actually exists in the classic sense due to lack of provider transparency and the involvement of intermediaries such as insurers.
8. The real Meaningful Use ROI is just now becoming obvious as massive amounts of electronic data are being used for research, outcomes studies, financial analysis, and whole-patient views, all of which provide evidence to support policy and practice changes that would not have been possible otherwise.
9. Interoperability is improving, but far from solved, as providers still have no financial incentive to demand it of their vendors and competitors.
10. HIMSS keeps acquiring and growing its way to a bigger bottom line.

HIStalk Image Sizes

A reader complained about too-small images in news posts and I said I would put it to a vote. The choices are as follows.

Option 1 – No Change

Use small images (250 pixels wide) for low-detail items like a hospital photo, larger images (350 pixels) for web captures or anything that would be hard to read in the smaller size. Even the large size could be hard to read if the image contains a lot of text (like a dense web page). Examples are below.

A 250-pixel image.

A 350-pixel image.

Option 2 – Use Mostly Larger Images

This option involves making the standard size 350 pixels wide in all most cases, even low-detail images such as the hospital example above. The downside is that wider images are also taller, meaning it requires a bit more scrolling to read the entire post.

Option 3 – Use Thumbnails

Images would be displayed as a “thumbnail” preview that’s about the same size as the current small image. Clicking the image displays it larger, and the larger size could be much bigger than the current 350 pixels. Downsides: pretty much every image would need to be clicked to view it. You have to page back after reviewing to return to HIStalk. Accidentally hitting the image with your finger on a mobile device takes you out of the HIStalk page.

Vote for your preferred option.

Webinars

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

Acquisitions, Funding, Business, and Stock

HIMSS extends its lease through 2021 of the top floor at Cleveland’s Global Center. They should get the American Optometric Association on board since the building’s visually jarring design has probably spurred quite a few eye exams.

Decisions

• Fairfield Medical Center (OH) will switch from McKesson to Cerner on April 1, 2018.
• Central Montana Medical Center (MT) will go live on Cerner in 2019.
• Hermann Area District (MO) will go live on Cerner in June 2018.

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

People

Contra Costa Health Services (CA) promotes CIO Dave Runt to COO.

Deloitte Consulting hires Douglas Rosendale, DO (CAIRNformatics) as federal chief medical interoperability officer.

Other

Pharma bro Martin Shkreli — who had previously boasted that prosecuting attorneys in his securities fraud case were “junior varsity” — cries like a baby before being sentenced to seven years in prison. His own attorney said in his closing statement that while he sometimes wants to comfort his client, “there’s times I want to punch him in the face.” Note that Shkreli was found guilty only of ripping off fellow rich people – ripping off not-rich patients and their insurers by jacking up the price of Daraprim by over 5,000 percent remains perfectly legal and, from a purely business standpoint, admirable.

Odd: a 52-year-old, female New York City EMT is arrested for hitting a hospital employee over the head with a computer tablet following an argument.

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
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Dr. Jayne at HIMSS 3/8/18

No matter how comfy of shoes I pack, my feet are always tired by my last day at HIMSS and I find myself questioning why I come every year. I was able to go to some good sessions, earn some hard-to-find continuing education credit for the Clinical Informatics board certification, and learn about some up and coming vendors and potentially disruptive products that I’d like to see succeed. Today was a good reminder though that healthcare IT is full of people who really care, people who have passion, and people who are trying to have some fun along the way.

I started my day cruising some booths with Dr. Lyle Berkowitz, getting his thoughts about various technologies and where he sees things going in the next few years. Some of us work in relative isolation and it’s good to know that what we perceive as trends are being seen by others, and that we’re sharing the same struggles. We ran into some folks he knew at WiserCare, which is working to engage patients around various clinical issues including end-of-life conversations. They deliver education to make those critical conversations more productive or to encourage their occurrence when they’re not happening. Having families engage in these discussions is something I’m passionate about, so I’m always excited to see someone working to improve the process.

From there, we made our way to the Newwave Telecom & Technologies booth which delighted us in several ways. First, there was the donut bar, where you could select a dip or drizzle for your donut, followed by toppings including whipped cream, chocolate chips, M&Ms, pecans, bacon, and more.

I thought I heard Lyle yell “Bingo,” but it was only in my head, when we saw their buzzword wall.

He had a busy schedule, so we headed our separate ways. I talked to some folks at HealthGrid about their mobile patient engagement platform. They’re doing some work to help organizations that might have multiple patient portals as they work to give their patients a more seamless experience. Their booth was clean and well-organized and I liked their floral display.

I spent a little time with First Databank learning about what they’re doing with device management and solutions to make clinical alerts more relevant. I was most taken by their Meducation offering, which gives patients instructions on taking their medications in a clear and easy-to-understand way. It’s available in 24 languages and anyone who has had to explain how to measure medication in a syringe should appreciate the clear, dose-specific pictures that show up on the print-out.

I ran into several engaging booth staffers today. On the main floor, Dave at the RFIDeas booth caught my eye with his cowboy hat and spent some time showing me solutions from their partner SerialIO. They offer a variety of RFID, NFC, and barcode scanners and sensors at good price points. On the lower floor, Mark at the Epson booth showed me some scanners I was interested in for our ever-expanding practice. We really only scan insurance cards and IDs anymore, and they’ve got some small footprint options that I didn’t know about.

Crowds were significantly thinner today and I was able to hit the Venetian food court at 12:15 and actually find a seat. I visited several sponsors. Legacy Data Access had a nice green theme to match our signs. Patient Keeper and Agfa also had their signs prominently displayed.

Many vendors come to HIMSS but don’t have booths. I ran into this guy in his mobile office behind the Epic booth. He offered me a spot on his cushy carpet while I checked email and we had a Judy Faulkner sighting.

This booth was empty of people but full of luggage, including someone’s shirt hanging over the pipe-and-drape to the empty booth next door. A closer look revealed the HIMSS18 Exhibitor Move-Out Bulletin in the trash can. I didn’t read it, but I’m sure it had instructions about how to depart gracefully. Several booths had trash on the tables, empty bottles, and were in general disarray.

Leaving your booth unattended is not only a waste of money but also a potential business liability. Beware of sketchy characters who might decide to make themselves at home and confuse potential customers.

I had been looking for the Optiv booth since the opening reception, when I came across it and found it interesting because there was nothing about the booth that said what the company did. I couldn’t find it in the directory, and since they were a first-time exhibitor, I wanted to see what they were all about. By 1:15 today, they had everything packed up, the screens turned off, and the remaining booth staffer was more interested in packing then chatting.

Transcend had the latest fashion for hospital security personnel. We wandered around looking for the Uber Health booth, but all the reps were busy assisting other customers.

We had a good chat with these guys at HipLink, who always look great in their racing shirts. One was rocking some great tennis shoes and they shared their secrets of how to stand just on the edge of the more-padded booth carpet to give your feet a break. I’ve written about them for several years – they’re always engaging and have a variety of solutions including messaging and business continuity. They cross industries to utilities, transportation, and a host of others. We talked about the vibe in Hall G and one commented that it was “Trade Show, Old School.” We laughed about show swag: pens that don’t write, flashlights that are dead by the time you get them home, and all sorts of squishy stress relief items. Someone had abandoned a squishy tree in their booth and it was hiding behind their desk display. Note the lack of cell phones, lack of clutter, and total focus on the aisle. These guys are pros.

These folks from CosmoKnows became frustrated with lack of communication between different care venues and were tired of waiting for vendors to solve their problems, so they started their own company. Their enthusiasm was contagious, for sure.

The body-painting weirdness continued today, this time with an airbrushed skeletal system.

The “First Time Exhibitor Stylin’ and Profilin’ Award” goes to Merino Computer concepts. It was late in the day and they were in massage chairs, but they were engaging. If you look carefully, you can see the booth staff represented in their IT Superheroes montage.

I was puzzled by these InstaMed bottle openers.

By the end of the Booth Crawl, I was dragging. Jellyfish Health saved the day when they offered me a cold Diet Coke. It was nearly 3 p.m. but the booth staff was still fresh and eager to talk even when the booth teams around them were starting to bail.

It was then time to head to the airport. Due to the traffic, I had plenty of time to catch up on email and texts. My favorite HIMSS BFF sent me this picture from his Uber. To all of our readers, whether you attended HIMSS in person or vicariously through our posts, we wish you “every success in your job.” Another HIMSS is in the books and we’ll see you next year in Orlando!

From HIMSS 3/8/18

Newsy Items

DoD doctors and software technicians tell Politico that the Cerner rollout at four pilot sites is plagued with system bugs, inadequately trained users, and login times of up to 10 minutes. Problems reported by those interviewed and in a previous internal DoD assessment of the pilot project include:

• Doctors can’t treat as many patients.
• Software-related patient safety incidents are being filed almost daily and some doctors have quit over fears that patients will be harmed.
• Interfaces are problematic.
• Documentation is outdated.
• Training, especially for clinical specialties, was inadequate or non-existent.
• Users complain that workflows are more cumbersome than with the system Cerner replaced.
• The pilot site has no failover capability.
• Extensive cybersecurity vulnerabilities mean the system could not survive a cyberattack.

DoD officials acknowledged the problems in a hastily arranged conference call, but say the rollout will continue as scheduled. As it should – the laundry list Politico ran is from just a handful of users and , other than the last two items, you could copy and paste it into any EHR implementation project that’s just a few months in.

Singapore decides to use two EHR vendors instead of make a single-vendor selection, initially causing Allscripts shares to drop to the point that the company files an SEC 8-K form indicating that while it didn’t get the single-vendor bid, at least its existing Sunrise business in Singapore isn’t at risk.

From Not So Scientific: “Re: KLAS. I just pulled ten of our last deals and seven of them stated that they looked at KLAS as part of their decision-making process. They are no Consumer Reports — wish there was a different option.” I suppose there’s a second question – did they look at KLAS reports just to validate their choice, or did it actually change their minds?

From Jemima: “Re: women. Al the acutely ill ‘patients’ in the Masimo beds are women, heavily made up. I guess men don’t end up in the hospital?” I wanted to interview one of those ladies to see what it’s like lying in a bed all day, trying to look sick with people staring at you. The job description must include “strong bladder.”

From Emily Peters: “Re: women. My worst encounter was when a HIMSS attendee asked if we had ‘any executives at the booth, or just women?” a few years ago. ARG. A younger colleague of mine posted photos of putting on a fake diamond ring to ward off creeps this year. Some things never change at HIMSS, it seems.” Next conference I’m arming an attractive female attendee with a hidden audio recorder to capture inappropriate comments for memorializing on HIStalk. I’m actually not joking about that. I don’t think we males understand what it’s like to receive unwanted attention or to be demeaned individually or collectively, intentionally or otherwise.

From Come Again?: “Re: women. Cerner CFO Marc Naughton during the HIMSS investor briefing, and on International Women’s Day, no less: ‘Instead of teacup rides and ‘It’s A Small World’ soundtrack at Disney, Vegas has crack and hookers. So basically the same. Speaking of hookers, I heard this morning that this year at HIMSS represents the first time ever that investment bankers have outnumbered prostitutes in the city, and that’s pretty amazing. Actually, I should probably apologize for comparing bankers to prostitutes. After all, that’s really unfair to the prostitutes.” Unverified. Although to be fair, some prostitutes are male, so to assume otherwise from his comments is in itself ironically sexist.  

The past several days have led me to detest the Sands Expo, which opened nearly 30 years ago (eons in Las Vegas implosion years) as an overflow space for the Las Vegas Convention Center. It feels outdated and I suspect it was not designed to hold a mega-booth exhibit the size of HIMSS, although it hosts larger conventions. The odd layout (especially the upstairs / downstairs) means full-paying exhibitors get fewer visitors than they should, it’s almost impossible to orient yourself to even leave the hall, and the too-few concession offerings are pathetically poor. I also found the restrooms inside the hall to be small and primitive and I’m not a fan of the congested hallways outside the hall and throughout the complex. About the only positive is the attached hotels that replaced the old Sands Hotel in 1999. Orlando is light years better and so were the convention centers in HIMSS-abandoned cities like New Orleans and Chicago. Las Vegas has always been my least-favorite city in the world and the convention center holds a similar spot in my heart.

Despite the choice of venue, kudos to HIMSS for developing and running a hugely complicated conference while making it look easy. I realized as I wrote my convention center critique that I have nothing bad to say about the event itself. I can’t even imagine the work required years before the first attendee shows up.

The announced registration through Thursday (since the HIMSS link for Friday’s numbers doesn’t work) was 43,857, up 4 percent from HIMSS17 but about the same as HIMSS15.

My favorite giveaway this week: cool socks. Thanks, Geneia. I may steal the idea for next year.

Lorre is still offering her “Cellar Dweller Special” for our Hall G neighbors who want to sign up as a new sponsor. A year online is better than three days in the basement.

It was cool to see software groups from Bavaria, Austria, and Israel down in Hall G. These candies were so pretty that I didn’t take one – it would have felt like defiling and art display.

Germany-based Future-Shape makes a capacitance-powered sub-flooring that turns any room into a touchscreen-like tracking system that can detect falls, issue warnings for unusual movement (like someone who’s been in a hospital bathroom for a long time), and track movement for workflow redesign.

Learn on Demand Systems helps vendors set up large-scale training and testing environments for their software, with options for cloud-based demonstrations and labs that can be used anywhere (proof is their 24-hour training activity hotspot video). They also offer cybersecurity training. 

I don’t drink hot tea, but if I did, I’d want this.

I like this booth design – the layout and lighting were well done.

This magician does an amazing vanishing act.

I was shocked that vendors were still offering refreshments on Thursday, the last (and shortened) exhibit hall day. The best item of the whole week was the doughnut bar of InterSystems, where you choose a doughnut type, pick which warm sauces you want, pick a fruit glaze if you want, and then decide what toppings would best round it out. My personal doughnut chef recommended a chocolate cake doughnut with warm dark chocolate sauce, large candied pecans, hunks of real bacon, and whipped cream, when he then garnished nicely. It was as fabulous as it looks.

What goes great with a doughnut? A mimosa.

What is it about these people that screams, “I’m not really a clinician?”

Walking through this ugly passageway between the halls is like car washes that finish up with a hurricane-like blast of drying air, except this particular blast was icy cold.

TigerText has renamed itself to make sure people understand that they move all kinds of data around, not just text.

Dell EMC’s booth was so large that they offered audio tours like you see at museums. I sat through their theater presentation, which was spectacularly uninteresting.

Alert Medical was global before it was HIMSS-cool, showing up every year in their red-and-white suits even though I don’t think they’ve ever sold a US customer and maybe aren’t even trying. This demo was being done in another language.

I got a demo of ClearSense, which offers a “Mission Control for Healthcare” dashboard that has a lot of smarts and good UI in presenting an intelligent view of just about every type of data you can throw at it. A user from Meharry Medical College said they’re doing cool things with it, with their next step being to create a data science institute.

That’s the HIMSS18 wrap-up unless I think of something else. It’s back to the usual Monday Morning Update next week. Let me know what you thought of the conference and any life-altering takeaways it provided. It’s back to Orlando February 10-15, 2019.

Jenn’s HIMSS 3/8/18

My last day at HIMSS kicked off with a pit stop for breakfast in the press room, which was refreshingly free of sugar-filled pastries (or perhaps they were just all gone by the time I got there). The Sands was decidedly quieter than Tuesday and Wednesday, with more than a few attendees exhibiting that glazed-over look that comes from too little fresh air and sunlight, and too much caffeine and alcohol.

Many female HIMSS-goers wore purple in honor of International Women’s Day, which, according to the IWD website, is an homage to the purple, green, and white worn by members of the Women’s Social and Political Union in the UK in the early 20th century. Purple represented justice and dignity, green hope, and white purity. Today, the color purple reflects the day’s goal of celebrating women’s social, economic, and political achievements and the need for gender equality.

Madhuri Kudrimoti, director of clinical informatics at Froedtert & Medical College of Wisconsin, proudly sported the color during the morning’s Mentoring Meetup, which paired over female 100 attendees with table moderators to discuss topics like work/life balance, networking, and salary negotiation. I had the chance to chat with Kudrimoti about her organization’s health IT needs before the meetup got into full swing. Froedtert recently hired its first chief analytics officer – a woman, no less – who has tasked Kudrimoti with looking for analytics solutions that can help their organization aggregate their four or five data warehouses into one. Analytics are part of a five-year strategy Froedtert has just started to embark upon.

Karen Marie-Wilding, table moderator and senior director of quality and value-based care at The University of Maryland Medical System, was quick to tell me that E&M (evaluation and management) coding needs to be retired when I asked her what topic or theme seemed to be prevalent at HIMSS. “Provider documentation needs to change in a big way,” she added, telling me that  topic had come up in nearly every session she attended. Nuance solutions seemed to have also generated some buzz among her documentation circles.

Fun fact on IWD: The name of the new Allscripts EHR, Avenel, does in fact have a story behind it (despite booth reps telling Mr. H it had no known provenance), as the tweet above can attest.

I didn’t see much purple as I made my way into the exhibit hall. Trick shots from Chef Anton (who was in fact a chef) were in abundance at the Iatric Systems booth, though. Just after I snapped this pic, the man on the pool table reached into his pocket and grabbed his phone for a selfie.

RTLS vendor CenTrak seemed to have decent traffic for the last day of HIMSS.

Clinicspectrum CEO Vishal Gandhi always looks sharp on the show floor. He had on a different but equally eye-catching jacket every day of the conference.

The LogicStream Health team is always welcoming when I stop by. This time around I got to meet founder and CEO Patrick Yoder, who happened to be chatting with friend and former colleague Ray Wolski, VP of strategic solutions at Wolters Kluwer.

Zebu Compliance Solutions had a friendly blowup of the South Asian domestic cattle the company is named for.

I had a great conversation with the folks at Fitbit, who showed me some of the compelling ways its users are sharing their personal health success stories using the new social sharing feature on its app. A first-time exhibitor, the company was touting its recent acquisition of Twine Health and the deeper dive it hopes to take into health management.

By the last day of HIMSS, I’m pretty immune to booth stunts, but the get-up above definitely got my attention. Paessler System Engineer Greg Ross donned his lederhosen to attract attendees to the German IT infrastructure monitoring company’s booth, and it seemed to work given the regret he had over not wearing the outfit Tuesday or Wednesday.

While vendors were scurrying out of the shuttered exhibit hall, I headed over to the session on physician suicide and clinician engagement tools presented by psychotherapist and StelliCare CEO Melissa McCool and Lifely Insights Chief Strategy Officer Janae Sharp, who shared a very personal story of her physician husband’s suicide several years ago. Between 15 and 20 hands went up in the audience when Sharp asked who had known a physician that committed suicide, and nearly everyone acknowledged knowing someone that had attempted or committed suicide.

Health IT came up, of course, but the ladies emphasized that EHRs and the like aren’t as much of a contributor to physician burnout and suicide as headlines would have us believe. Data from KLAS backed up their point. Solutions offered include changing licensure requirements so that mental health issues don’t have to be reported for re-licensure – a change that would hopefully result in MDs being more likely to seek proactive help, less burdensome interactions with EHRs, less burdensome federal regulations, and offering physicians more coping tools and support (like mental healthcare via telemedicine) without any stigma attached.

One sobering session led into another, with my last of the day – Lessons Learned from the Boston Bombing – proving to be my absolute favorite. Former Boston Chief of Police Dan Linskey took attendees through the day of the bombing, showing video footage and playing audio to help us understand the way in which emergency services from all sectors of the city came together in a crisis. We laughed, we cried, and we finally gave him a standing ovation. It was a far more compelling session than any HIMSS keynote I’ve ever seen. I couldn’t help but think HIMSS-goers would have been more inspired by Linskey’s experience and lessons on strategic planning and leadership than any tune from a Voice contestant or buzzword uttered by Eric Schmidt.

I took one last walk through the Venetian and called it an early night. Thanks to everyone who stopped by our booth. Your words of gratitude and encouragement keep us going year round. HIMSS18 is in the books. See you in Orlando for HIMSS19!

Dr. Jayne at HIMSS 3/7/18

Today was undoubtedly the busiest day of HIMSS for me, and my trusty Garmin certainly agrees with my assessment since it shows 22,212 steps. I started my day at the Edifecs booth (1674) chatting with them about their #WhatIRun campaign to elevate the visibility of female healthcare leaders and to inspire young women to pursue STEM careers. They’ve partnered with Ryka to give away some outstanding pink suede slip-ons while promoting the initiative. I’ll be sporting a pair tomorrow in the hall since my feet definitely need some TLC after today.

Healthcare IT remains male-dominated across many domains and it’s important for girls and young women to see women who code and women who lead. This is the third year for Edifecs to lead this charge at HIMSS and I’m grateful. I’ve been the recipient of a couple of sexist comments this week – things that people would never, ever say to a male CMIO – so we definitely have a long way to go. Stop by and say hi, grab a tee shirt, pick up a Ryka discount card, and enter to win a pair of sweet treats for your feet.

Speaking of treats for your feet, today was a target-rich environment for great shoes. Since we didn’t have a HIStalkapalooza shoe contest this year, I’m sharing my picks:

In the “Best Comfort Shoes for Women” category, I spotted a sassy marketing staffer getting ready to change into these as she transitioned from day to evening.

The “Best Total Footwear Ensemble” category, I spotted Drew Madden with blue laces to match his striped socks. The gents from Lightbeam Health had been in the running until Drew knocked them out of contention.

Since we’re giving out awards, “Best Booth Snack” goes to Bonny Roberts at Diameter Health in the Interoperability Showcase. Yesterday she was giving out Girl Scout Cookies, although I didn’t see any today.

Medicomp Systems always has a game in their booth (3616) and this year’s Quippe Virtual Experience game could win you $100. Cheers to their neighbor Blackbox, reflected in the image, who hosted a happy hour and was inviting everyone who passed by to partake with them, whether vendor or attendee.

“Best Booth Décor” goes to LRS Output Management with this phenomenal ice sculpture. They have a different one every day.

“Best Promotional Item” goes to Jeff at Grammatech (12144) with what every developer needs: a bug-removal device. Jeff was engaging and caught our attention.

“Most Organized Merchandising” goes to CTAC in booth 11616. I’ll forgive them the accessory Diet Coke because the person working on the merchandising set it down to step out of the photo.

“Best Jacket” goes to OnRamp, who had several booth staffers sporting this look.

There was plenty of sartorial splendor on display today, with these chaps from MD EMR Systems.

I’m a sucker for exhibitors that are doing good for the world, including Connection (3828), who invited attendees to fill a bag with art supplies for donation to children. On Thursday, they’ll be making no-sew blankets for charity as well.

Lots of positive vendor engagement today, with Hanna from Zayo Group catching our attention during my annual BFF booth crawl with the incomparable Evan Frankel. Effective strategies: catching someone’s eye, asking them what they do, asking what they are interested in at HIMSS, and figuring out how to tie it to your company. I’m going to track them down next time I’m in Boulder, Colorado.

Blackbaud was giving out faux script pads.

More anatomic body painting today, although the guy was wearing a shirt and shorts where yesterday’s model was wearing the equivalent of a bikini swimsuit.

Plenty of sponsor signs out in force today. I loved Optimum Healthcare IT’s astronauts. Signs were also spotted on prominent display at Meditech, Waystar, Access, Iatric Systems, and Redox.

I bumped into Jenn at the Strata Decision Technology booth and had a chance to talk to CEO Dan Michelson about the challenges of helping healthcare organizations truly understand cost accounting and what they need to get a handle on if they’re going to try to lower costs and increase value. He sent me on my way with some in-flight reading material, in case I don’t have Wi Fi on the way home.

I stopped by the Vocera booth to get a look at their Collaboration Suite, which integrates with AirStrip patient monitoring. Being able to view the rhythm strip of a telemetry patient from my family medicine clinic would have saved me a lot of heartburn when I cared for hospital patients.

I finished out the day with Zynx Health, looking at their Knowledge Analyzer solution. It allows organizations to update order sets and perform a gap analysis of their current implementation against best-available medical evidence, guidelines, and performance measures. I’ve got some battle scars from trying to harmonize order sets across various groups of attending physicians and across hospitals within Big Health System and I wish I had a solution like this years ago.

The evening was full of adventure, starting with the New Media Meetup at Senor Frog’s at Treasure Island. I enjoyed connecting with other bloggers, vloggers, and social media personalities while trying to juggle my drink, grab some snacks, and stay anonymous. From there it was on to the Nordic reception at Caesar’s Palace at the Mr. Chow restaurant. The main dining room features a large kinetic sculpture that raises, lowers, splits, turns, and rejoins itself. The best part of the event was the pool-view balcony, where I eagerly took in the fresh air I had been missing most of the week.

Thursday is my last day at the conference, so it’s off to pack and get some rest before I cram in the last round of booth visits.

Jenn’s HIMSS 3/7/18 (Part 2)

The second full day of HIMSS dawned with overcast skies and a slight chill in the air. As the week wears on, I grow happier that I decided to book a room next to the Venetian. My morning commute clocks in at around 10 minutes on foot. It’s been nice not having to wait in taxi queues or shuttle bus lines.

A quick check-in at our booth found our pile of Smokin’ Doc Polaroids growing larger. (Stop by booth 11228 for the inside scoop on what we’re doing with them.) The cameras – $99 from Best Buy – have been conversation starters all by themselves. They are indeed more novelty than anything else, given their cost and the time it takes for the image to develop (longer than the original Polaroids, I’m told).

I try every year to show my home state some love, and so stopped by the Georgia Pavilion to hear Atlanta-based Rimidi founder Lucienne Ide, MD present on the way FHIR is powering the chronic disease management company’s technology. The company’s solution, which right now is focused on diabetes and heart failure, is aimed at helping physicians close care gaps.

Clinical communications company Doc Halo, along with Waystar, splurged for a digital billboard that greets travelers as they leave the airport and head toward the strip. I’d be interested to know what kind of ROI they expected (increased foot traffic at their booth?) and what they got out of that type of signage.

HealthTap pulled me in with its unique Lego theme and surprisingly tasty kale-based juice. Product Manager Subarna Mitra patiently walked me through a demo of their “Query to Care” capabilities, which offer patients personalized care plans and algorithm- and text-based triage – all of which a provider can purchase as a white-label solution that feeds a patient’s app activity into their EHR.

Nordic’s booth seemed to have steady interest. I noticed they weren’t giving out branded coffee beans this year.

I had a chance to chat with Strata Decision Technology CEO Dan Michelson (right) as I was dropping off their booth sign. He tells me they are using the same booth as they were five years ago. “Why spend money on a new booth,” he asked, “when you can spend it on giving your customers what they want?” I don’t think they need to change a think. The water wall was particularly soothing amidst the exhibit hall hustle and bustle.

The ladies of VitalHealth were sporting such brightly hued sneakers that I just had to stop and snap a pic. Apparently their entire booth staff are similarly shod. This type of footwear makes so much since. I have literally winced after seeing women walk by in high heels, knowing the agony their feet will be in by the end of the day.

I loved the mod look of these Protenus meeting pods. I’ve noticed many booths seem to have upped their furniture décor this year, particularly in the seating area. Even the HIMSS Living Room looks like it was inspired by Magnolia Home.

PatientSafe Solutions had the biggest iPhone I’ve ever seen on display.

This ice sculpture literally stopped me in my tracks. I didn’t even think it was ice at first, until I noticed the dripping bottom. LRS provides document output management services for Cerner, Epic, GE, and Siemens.

I liked the way Stanson Health had its HIStalk sign cozily tucked amongst its awards from HIMSS and Black Book.

Redox drew me in with its tennis ball dog toys. Its office is so dog friendly that it has created a company calendar featuring the dogs of its employees. I suggested they add a canine-focused charitable effort to next year’s edition.

Liaison Technologies had one of the most creative giveaways with its blood bag ice packs. It just goes to show that you don’t have to go big to grab people’s attention. (Plus, I’m always running out of ice packs.)

AssessURHealth seems to be making important headway in generating awareness around the need to end mental health stigmas. Its “Shock Wall” highlights the number of people who have died from suicide, opioid overdose, and alcohol abuse since HIMSS opened at the beginning of the week. It’s a pretty sobering statistic, reinforced by the fact that every employee I spoke with had a personal story to tell of a friend or family member who has suffered from or succumbed to mental health-related conditions. Kudos to them for their #EndTheStigma campaign.

I popped in to their conference room to attend an intimate talk with McKinsey Senior Expert Jessica Kahn (left). As a former CMS director of data and systems for Medicaid, she had unique insight to share on the challenges Medicaid providers and their patients face when it comes to implementing and accessing behavioral health technology. She is a big believer in the role telemedicine has to play in bringing much-need mental health services to Medicaid populations.

Another round of booth time found me chatting almost non-stop with readers and sponsors like Reaction Data Marketing Director Taylor Madsen and Gwinnett Medical Center (GA) SVP and CIO Patty Lavely. They seemed to like the shirts we’re giving out at the booth (112288).

Last year’s Miss HIStalkapalooza winner Bethany Miller-Urroz stopped by to see if her reign was technically over. I say, if the sash still fits, wear it! She was bummed she didn’t think to bring it to HIMSS this year.

I’ve noticed several exhibitors using paper to highlight their digital processes. One company several rows over from ours seemed to be having fun luring attendees in to bash open its fax machine piñata.

My last foray into the exhibit hall gave me a chance to catch the Healthfinch team accepting an innovation award from Jonathan Bush at the Athenahealth booth for its Charlie Practice Automation Platform, which makes refill management and visit planning in EHRs more efficient.

Afternoon happy hours got started around 4:30. Arcadia had by far the fanciest appetizers – in both presentation and ingredients – I’ve ever seen at a tradeshow.

I find myself running into friends and colleagues like Starbridge Advisors Principal Sue Schade and Datica CEO Travis Good, MD who, unbeknownst to me, already know one another. Health IT can seem like a very small world at times, especially when surrounded by 43,000 of your closest colleagues.

NextGen’s newly rebranded booth looked nice.

The CoverMyMeds end-of-day soiree was busy. Company reps were no doubt bringing customers up to speed on their new, real-time prescription benefit solution developed with RelayHealth Pharmacy Solutions.

Tomorrow promises a slightly quieter exhibit hall, given that many vendors will start packing up early to head home. I hope to stop by the Interoperability Showcase and Connected Health Pavilion, though HIMSS has a habit of pulling us all in a million different unexpected directions. Feel free to email me with your suggestions of can’t-miss exhibits or sessions for Thursday.

From HIMSS 3/7/18

Newsy Items

Analytics vendor Inovalon will acquire competitor Ability Network for $1.2 billion, doubling the 2015 investment of the latter’s private equity owners. 

The Wall Street Journal reports that Cigna is close to buying Express Scripts for at least $50 billion as industry consolidation runs rampant. Wow.

HHS Secretary Alex Azar lays out – in an admirably direct manner – his vision of the transition to value-based care in a speech to a hospital trade association, of which I’m paraphrasing. Note that he’s basically throwing down the “no more business as usual” gauntlet to the people who will be most resistant to the planned changes. He previewed some of the the items covered in Tuesday’s presentation by CMS Administrator Seema Verma and White House Senior Advisor Jared Kushner. High points:

• The hospital industry has dragged its feet on being paid for value and health systems are charging too much without delivering good outcomes.They also haven’t done enough to manage chronic diseases.
• The White House and HHS are not afraid to disrupt the status quo “simply because they’re backed by powerful special interests.”
• HHS will emphasize giving consumers control of their health information via interoperable, accessible health IT. He said, “Patients ought to have control of their records in a useful format, period. When they arrive at a new provider, they should have a way of bringing their records, period. That’s interoperability. The what, not the how … Too often, doctors and hospitals have been resistant to giving up control of records, and make patients jump through hoops to get something as basic as an image of a CT scan. The healthcare consumer, not the provider, ought to be in charge of this information.But we do know that the barrier is not always the provider’s decision to shield that information. Sometimes it’s that there aren’t systems for easily disseminating it, and we aim to work with the private sector to open up avenues that will empower patients.”
• He calls for transparency in drug pricing at all levels.
• Azar bluntly concludes, “Our current system may be working for many. But it’s not working for patients and it’s not working for the taxpayer … This won’t be the most comfortable process for many entrenched players. But those who are interested in working with us to build a value-based system will have the chance to take advantage of a market where consumers and patients will be in charge of healthcare.”

Today was overcast and cool, not that it matters much when you’re inside a windowless casino complex jam-packed with way too many people. 

From New Health IT Investor at HIMSS: “Re KLAS. On the first day of HIMSS, I inquired about KLAS and three times got the same word from vendors – extortion. I asked Epic’s competitors and they say Epic pays nearly $6 million a year. Tonight I looked up KLAS’s public declaration of income to the VA in March 2017 and they stated $12M in annual revenue. So half of KLAS’s income is from Epic?” I disagree that it’s extortion. Vendors make a business decision to pay KLAS what amounts to advertising fees expecting to make a return on that investment in the form of sales. KLAS also claims to be the voice of the customer, but only an incompetent vendor would need a third party to tell them what their customers think. No major vendor has had the nerve – so far – to break ranks and stop supporting a system they complain about, so KLAS just keeps happily minting money. I would be shocked if KLAS only makes $12 million per year and even more so if Epic pays them $6 million. I’ve asked a few folks to guess at KLAS’s revenue and they usually say maybe $20-30 million, with those same guessers thinking Epic pays maybe $1 million. But’s all speculation since, unlike the “Consumer Reports” to which KLAS is often inappropriately compared, KLAS is for-profit, is not financially transparent, uses statistical methods that range from unstated to unscientific, and makes most of its revenue from the same companies it claims to objectively review. KLAS is not evil, they’ve just created a great business based on vendor insecurity that paying KLAS increases sales, which I would argue is more perception than reality. In fact, it would be fun to commission a truly independent and statistically valid survey to determine if providers actually used KLAS services as a major factor in their most recent system purchases.

From Kodak Moment: “Re: HIStalk booth Polaroids. Saw those in a tweet – what are you doing with them?” I really don’t know – Lorre and Brianne are always full of surprises, some of which I like.

The Oneview Healthcare folks confirmed that HIMSS did indeed shut down their live Irish band and dancers in the exhibit hall Tuesday. They told me they had done the same performance for the past five HIMSS conferences without any problems, but I’m sure someone with a bigger booth complained about the noise (or that they were losing visitors to a more interesting booth). The company was pretty funny in tweeting out a doctored-up invitation in which the band and dancing references were redacted, but reminding everybody that the Guinness would still be flowing (which I confirmed in having one Wednesday afternoon).

A reader complained that the pictures I run are too small. It seems simple to just make them bigger, but I guarantee I’ve thought of all options and their pluses and minuses. I’ll explain after HIMSS and open it up to a reader vote. In the mean time, I’ll make the pictures bigger for the HIMSS posts and that will probably trigger an immediate minus – more scrolling will be required and people hate that, especially on mobile (which is why I sometimes but not always make the pictures bigger, depending on what’s in them). Part of the problem may be that I’m working from a laptop and my screen captures might not be as crisp as usual. I admit that I have no idea how that works.

Lorre said three new HIStalk sponsors have signed up in my “Cellar Dweller Special” bonus offering. Thursday is the last chance for those who could use more, less-expensive exposure over a full year than a three-day downstairs booth can provide. We have a good time with our sponsors, and while they don’t get influence over the editorial side of what I do (screw up and I’m going to say so), a some companies were unknown before their introduction as a new sponsor.

This will be the high point of the week for me. I was puzzled to see an elderly man walking slowly but ramrod-straight down the aisle by our booth wearing a “World War II Veteran” cap. I caught up with him and asked about his service. Bruce was a US Navy Seabee deployed to the Pacific theater, serving as part of the construction team that was tasked with building the structures required for the planned invasion of mainland Japan. I thanked him for his service – choking up a little bit thinking about what he has seen and done in his long life – then asked him what he was doing at the conference. He said his daughter is the academic VP of the college of health professions at Western Governors University (exhibiting in Hall G) and she brought him along as her guest. What an honor to have him at the conference – it was heart-warming to see people who were working the booths come out to shake his hand. I don’t know how old Bruce is, but I’m sure the memory of being shipped out as a young man for an assignment he almost certainly wouldn’t survive remains vivid even 75 years after the fact.

Optum was making donations for each attendee who colored in a section of their graphic, although I got so engrossed with trying to say inside the lines that I forgot to write down the details.

It seems like half the booths are, at any given moment, stuffed with video and/or audio recording equipment and people. You couldn’t walk 50 feet without trying to dodge tripods, stay out of a camera’s line of sight, or watch two people sitting on stools conversing on camera. I don’t know who will watch all that video (not me, I guarantee), but maybe I’m just out of touch with those who can’t consume content unless it’s dumbed down to short videos. I’m also questioning whether there’s enough people who have useful wisdom to fill up all that airtime, given the skimpy resumes some of the folks who couldn’t wait to start tweet-bragging that they had been asked to share whatever it is they know. 

Cerner used the outside walls of their booth for promotional posters a la Epic, but instead of KLAS excerpts, Cerner instead highlighted customer successes.

Cerner also took off the gloves inside its booth, deviating from never referring to Epic by name (“our primary competitor”) to even copying Epic’s logo.

I asked this guy if he was having a good show, but he told me to beat it.

The hall has all kinds of nooks and crannies devoted to special interest tracks. I accidentally ran across this Innovation Live stage and listened in to someone’s case study (I think it was Albuquerque-based Twistle, which offers a patient engagement app).

Stuck back in one of the innovator areas was Neurotrack, which uses a mobile device’s camera to track a user’s eye movements when various kinds of photos are displayed over a few minutes. It’s apparently good at identifying people who may be more likely to have dementia 3-5 years down the road, giving them enough time to implement lifestyle and mental exercise changes. The company has an investor from Japan and has made some inroads there, since insurers there pay twice for Alzheimer’s (once upon diagnosis and again at death) and thus will pay for early detection that may support prevention.

Think all the cool kids are in the upstairs exhibit hall? We got Uber in Hall G, y’all.

Another great ice sculpture, provided that you see the point of making ice sculptures (and I admit I kind of don’t, especially when they are made like a giant, shaped ice cube instead of hacked from a block).

Athenahealth Chairman Jeff Immelt and CEO Jonathan Bush were hanging around the rather dead Athenahealth booth that’s about as far from the main exhibit hall thoroughfares as you can get.

I stopped by the booth of South Korea-based Bestcare, which is always an interesting experience (“from Korea, like K-Pop,” one of their folks explained with an attempt at humor last year). This is the best-looking product on the floor as far as I’m concerned, with a slick UI and innovative ideas like a graphical patient journey timeline. I would show you what I’m talking about, but like last year, they turned me down cold when I asked to snap a picture and their handouts don’t show screens. Anyway, they’re trying to get into 13 US hospitals, but I see challenges that go beyond language and culture – they don’t have a billing system, the terminology is not always US standard (like “ward” instead of “nursing unit”), and they brag that they will modify the source code to accommodate a customer’s needs, which creates an upgrade nightmare.

Harris Healthcare’s person who engaged me was friendly. I asked if Orlando Health was still using the former QuadraMed Affinity and she said yes – it will be 20 years upcoming. I didn’t mention that they’re planning to replace it (and Allscripts Sunrise and whatever they use for ambulatory) with what I assume will be Epic or Cerner.

Some company had a guy pouring chilled wine at 10 a.m.

I visited AssessURhealth, which offers a five-minute patient mental health screening questionnaire usually given in a physician office’s waiting room. Patients respond more honestly to questioned asked by an app rather than a person, and the physician practice is notified if their answers suggest immediate further questioning about any intentions to harm themselves or others. I asked the crass question of who pays for the service and it’s the doctor’s office, since they may generate more billables even while doing a good deed.

I strolled by the Aprima booth just as our sponsor sign fell over on the table, after which I noticed one of the company’s employees rushing over to reverentially place it back in place like the Mona Lisa had just crashed to the floor.

The best booth person I’ve seen was Hanna from Zayo. I care very little about bandwidth provider and to be honest I’ve never heard of the company, but Hanna’s sparkling repartee got my interest. She’s a pistol down there in Hall G.

I had to watch Bob Garner in action at the Cantata Health booth again. Within 60 seconds of my arrival, he had described in considerable detail how an attendee’s brother-in-law had passed away, even giving his full name. She basically froze, unable to comprehend what she had just experienced, and I saw her wiping tears. Bob immediately told another attendee how his brother had passed away and he also just stood there dumbfounded.

I signed up for an impressive AI presentation by Nuance CMIO Reid Conant, MD. He showed how a doctor in an exam room outfitted with a wall-mounted speaker-microphone can conduct a complete patient session using their voice alone just like when you talk to your Amazon Echo or Google Home device and it speaks back to you. The virtual assistant technology integrated with an EHR is fantastic – it can fill in discrete data fields and answer questions such as “has the patient had a flu shot?” The doctor can say, “Hey, Dragon, show me the two most recent chest X-rays,” then say, “Read me the radiologist’s impression” and then say, “Add to Susan’s task list to recheck the lungs.” The PCP can say, “Call the on-call hospitalist” and have it launch a VOIP call to create a handoff. Nuance developed the virtual assistant / virtual agent technology years ago for the auto industry. It was impressive and seems to be available now. It’s the best hope I’ve seen for letting the doctor focus on the patient, skip the effort and distraction of typing, and create a satisfying EHR interaction instead of clicking without gaining useful information (even scribes can’t give machine-generated suggestions). Epic is apparently demonstrating its Nuance integration this week and Meditech is on deck.

Tomorrow is my last day at the conference, so my last recap will be Thursday evening. Safe travels, especially those who left the Northeast in winter weather and now have to return in equally bad conditions. Feel free to send me any conference observations as we tie a bow around HIMSS18 and call it done.

Jenn’s HIMSS 3/7/18

Yesterday’s HIMSS was, for me, about interoperability in all its many forms. Health data exchange and its impact on physician satisfaction and patient outcomes were mentioned in every session I attended, the first of which was a phoned-in pre-brief with CMS Administrator Seema Verma ahead of her live session introducing the new MyHealthEData Initiative. The initiative aims to put patients at the center of their care by putting policies in place that will ensure they have control of their shareable health data. Verma shared her own frustrations with lack of access to her husband’s health data during his heart attack event last year. When pressed, his providers finally gave her five pieces of paper and a CD-Rom. “Why are we giving patients their records in these formats,” she half-jokingly asked, “when Tesla is sending sports cars into space?”

She stressed that putting data into the hands of patients will help the industry transition more quickly to value-based care. “Many of you have heard this all before,” she said, “but I’ve always been struck by how seldom patients are mentioned in talks of value-based care. We will not achieve value-based care until we put the patient at the center of our healthcare system – until they can make decisions based on quality and value.”

Though she didn’t offer any concrete timelines, she did lay out a number of related efforts:

• CMS will overhaul Meaningful Use and the Quality Payment Program’s Advancing Care Information Performance Category (which got a round of applause from the audience) to help reduce clinician burden and burnout.
• Privacy and security will be at the center of the intiative’s efforts. Ensuring security will be required to avoid penalties and receive incentive payments.
• Blue Button 2.0 is in the works to give patients easier access to their digital data.
• Payers will be strongly encouraged to ensure their members have access to digital claims data.

Given the recent HIStalk reader back-and-forth over CommonWell, it’s lack of market penetration (a founding company left and a friend in the HIE space tells me it’s expensive to become a member), and upcoming partnership with Carequality, I thought it might be a good idea to attend the afternoon session on how HIEs, CommonWell, and Carequality can work together. Led by Indiana Health Information Exchange executives John Kansky and Keith Kelley, it followed Mr. H’s rule of only attending HIMSS sessions with zero vendor presence. The hour-long presentation did a good job of bringing me up to speed on the important role HIEs play in making nationwide interoperability happen (some day), and the challenges they face when it comes to selecting their method of doing so based on the needs of their regional members. As one would expect, there’s no silver bullet; HIEs will ultimately need to leverage a combination of CommonWell, Carequality, the Strategic Health Information Exchange Collaborative’s Patient-Centered Data Home model, and the Trusted Exchange Framework and Common Agreement, which is still in draft form awaiting comments.

“The truth is it’s complicated and confusing,” Kansky said. “We don’t even have one common definition for interoperability. There’s an unsupported belief that one approach is the best approach. That’s not the case. Don’t believe your vendor when they tell you you only need one interop solution.”

My favorite part of the presentation came during the Q&A, when an audience member – presumably a vendor – asked if blockchain has any role in the HIE/interoperability conversation. The presenters didn’t mince words with their negative reaction, pointing out that FHIR, which the industry has been talking about for the last four or five years, is only just now being piloted by various organizations across the country. Not one person in the several-hundred member audience raised their hand when Kansky asked if anyone was using blockchain, and just one – from Humana – admitted that their organization was contemplating it.

The interoperability theme continued during my last session of the day, a fireside chat between HIMSS North American Board Chair and Executive Director of the Georgia Health Information Network Denise Hines and National Coordinator Don Rucker, MD. As one would expect, the conversation was fairly high level and I frankly had a hard time paying attention given what I assumed was noisy casino activity on the other side of the wall. Topics ranged from ONC’s renewed dedication to open APIs and the evolving smartphone revolution in healthcare, patient-centered care, and the need to eliminate info-blocking to move interoperability along. Rucker also addressed some of the 250 comments ONC has received on TEFCA, which should be finalized in late spring. Top of mind on the comment pile are the issues of consent, how the framework will address differing state regulations, and what coordinating entity or collaborative will be put together to oversee it.

All that talk of frameworks, APIs, and info-blocking had me in need of some Vegas frivolity, so I stopped by Pivot Point Consulting’s party for a quick sec to enjoy some time with Elvis and the Rat Pack. Where else but HIMSS can one sidle up to Sammy Davis, Jr.? More to come tomorrow.

Dr. Jayne at HIMSS 3/6/18

As is usual when I go from East Coast to West Coast, I woke up insanely early compared to local time. It allowed me to head out to the strip for a good walk to check out all the changes that have happened since the last time I was here without a crush of people and without having to deal with people handing out stripper cards. Back in the room, I tried to log into my EHR to check messages and see if there were any charts from mid-level providers that needed signing, only to find that the system is down. I’m sure they’re having heart failure at the office since we’re still in the throes of flu season.

My hotel room has a lovely view of the roof of the expo center and I was glad to see some solar panels as well. After my usual HIMSS breakfast of a Clif Bar and Diet Coke, it was off to sessions. I hate fighting the coffee and breakfast lines at most conferences and HIMSS is always the worst. I’ve learned to bring my snack stash and especially so for this conference, since there won’t be any MedData scones.

I waited until the expo hall opened and it was still gridlocked when I headed down the escalator from the faux St. Mark’s square. Claustrophobic people should not attend HIMSS since the aisles were packed today, even in Hall G. I did spend a fair amount of time there today, mostly because the vendors were more enthusiastic and actually acted like they wanted to talk to you rather than seeing you as a distraction from their internal conversations.

Not every vendor was avoiding customers, however. I had some issues with vendors upstairs being overly aggressive, straying way outside their booth boundaries and actually stepping in front of attendees and blocking their way to try to talk to them. There were also lots of people shooting video in the aisles, even up on ladders taking pictures of their booth, which didn’t help the crowding.

Cheers to sponsors that had their signs out front and center: Aprima, Dr. First, Elsevier, Forward Health Group, Health Catalyst, and Fortified Health Solutions / Santa Rosa Consulting.

Jeers to Imprivata’s scrub-clad demo team, members of which were also wearing lab coats. No one is fooled by the fact that you’re not actual clinicians. I was surprised to see how many people were watching their demo.

I had a great chat about Office 365 with this gent from Tech Data, who humored me with a photo of his cloud suit. He promises a shorts version for next year in Orlando. There’s so much going on at HIMSS that you really have to have something to grab attendee attention – I’m not sure the “same old, same old” attention-grabbers in the booths such as golf swing analyzers and cheap giveaways are cutting it. NextGen showed off in Booth 3821 with a four-panel screen printing machine making tote bags on demand – for every bag given away, they’re donating food to needy youth.

In Touch Health had a soft serve bar, but they’re located in a far corner of the hall. I only ran across it because I was turned around and couldn’t figure out how to get out of the hall. Juniper Networks had their oversized Operation game. MedData had a vintage candy shop complete with Wax Lips, which I haven’t seen for decades. Kudos to them for finding something to (hopefully temporarily) replace the scones we all love. Edifecs had some super cute pink shoes on display as part of their #WhatIRun campaign.

I found these folks painting away in Hall G, in a mostly-anatomically correct way. You never know what you’re going to see at HIMSS, and so far, this is the weirdest thing.

I was gifted with some pink socks today and must say I am thrilled!

Towards the end of the afternoon, I ran into an old friend outside the Logicalis Healthcare Solutions booth in Hall G. We were chatting away and they were kind enough to let a couple of weary travelers enjoy their comfy chairs late in the day. We talked about marketing campaigns and sales tactics with one of their client executives, who was gracious and engaging. They seem to have a lot to offer, so stop by and check them out.

From there it was off to visit various booths for cocktails and then head to the Holon Solutions reception at the Venetian. I was excited to learn about their success at Banner Health, surfacing gaps in care within the EHR. I joined some old friends for dinner, and by the end, my feet were giving out, It’s going to be a relatively early night for me.

From HIMSS 3/6/18

Today started with a traffic jam near the Treasure Island in trying to take a Lyft to the convention center, followed by a deadlocked mass of humanity simultaneously navigating the convention center halls. I seriously worried that we might have crush-related injures or deaths like at the Hajj, where too many people and too few crowd control experts create situations in which you are first carried along helplessly by the Brownian-type collective movements of everyone around you, then smothered when your chest doesn’t have room to expand to allow breathing.

The big news of the day came in a scheduled session with CMS Administrator Seema Verma that included a surprise guest in White House Senior Advisor Jared Kushner. They vowed to address EHR interoperability by using CMS payments to punish information blockers; to streamline EHR incentive payments; and to expand the Blue Button project (which you don’t hear much about these days) to an API-powered 2.0 version that gives patients greater control. The Kushner-led MyHealthEData effort will focus on giving patients access to their own data.

The Ellkay folks were giving away honey harvested from their rooftop hives. They brilliantly package it in jars of a size that pass TSA checked luggage restrictions. I had a fun chat with co-founder Kamal Patel over an delicious afternoon “Ellkay special” drink made from bourbon, the honey, peach schnapps, sweet and sour mix, and probably other ingredients I didn’t notice (lots of booths had happy hours today). Ellkay (“Healthcare Data Plumbers”) is a great success story, started when Kamal got laid off from his programmer job and had to figure out how to cover his family’s bills.

I noticed that the Voalte folks have progressed from their early-day pink pants to pink shirts. They said they still enjoy wearing pink whenever the occasion calls for it. I also learned that the name Voalte comes from Voice, Alarm, and Texting, the platform’s original capabilities.

An interesting jacket choice from NextGate.

Splunk is a great company name. I assume they do something that might conjure a vision of “spelunking,” but the clever name was wasted since I couldn’t get their booth people to come up for air from talking to each other to give me a glance.

Change Healthcare’s booth was imposingly massive. So much so that I didn’t really want to enter their soft-carpet space.

I hope this poor girl was OK, brought back to health by all the doctors and nurses who, surprisingly, looked like salespeople wearing scrubs. Surely nobody would pass themselves off as a clinician knowing that real clinician attendees (and thus prospects) won’t appreciate having their profession reduced to an exhibit hall costume. I’m at least happy that I didn’t see any provocatively clad women straying into booth babe territory.

The most personable booth rep I met all day was Sohail from Google Cloud. We had a nice chat and then he disappeared to bring me back a surprise gift of these cool socks.

GE Healthcare did a five-minute overview stage presentation, then invited audience members (of which I was the only one) to try a hands-on demo. Unfortunately it was really confusing, and neither the booth person nor I could figure out what we were supposed to do. Maybe that says something. They did mention “digital twin,” a problem detection concept I keep hearing more about.

The Epic rep who engaged me was really friendly. As a reader predicted, the company’s non-marketing team had already turned the just-released (and controversial) KLAS interoperability report into a big wall poster. They get mileage out of the large sums they pay KLAS.

More Epic posters. The second company family tree one shows how Allscripts and Cerner have grown by acquisition and product integration, while Epic has acquired nobody and developed all its own software. I asked the Epic guy how they got so good at posterizing competitive information and he said they just developed internal expertise with practice. They even had images of all of the several posters on their walls collected into a handout. Those strong visuals are the most effective items I’ve seen at any HIMSS conference.

Epic art, of which there was a lot, was all wacky.

MedData can’t bake scones in Las Vegas, so they had retro candy like Necco Wafers and wax lips.

This was a real (and real big) ice sculpture.

Allscripts finally unveiled the former Care Otter skunkworks EHR project that is now named Avenel (the name means nothing, according to the booth person I asked). It’s a tablet-only EHR (and IOS-only as well) that connects to the cloud-based back end with a single desktop used to maintain the system. The “machine learning” claim refers to the system’s “surfacing” of relevant information and workflows as driven by observed user behavior rather than by creating a rigid user template. It was quite tablet-y in a way that doctors will likely enjoy once they get used to the idea that an open encounter is not required to bring up a task list or perform maintenance. It’s pretty cool, but it’s early in its life cycle and I guess it would need to be paired with a locally hosted PM system. At least they’re building something new and it looks like something docs would love – it reminded me of Medicomp’s Quippe, which had the same friendly, intuitive tablet-powered documentation system running several years ago.

A reader asked if Allscripts was demoing Paragon and Paragon Ambulatory. I asked the company’s booth desk people and they didn’t seem to know what Paragon is. They claimed unconvincingly that it was being demonstrated somewhere this week, but offered no particulars.

Someone at the EClinicalWorks booth gave me a demo of 10i, the company’s new hospital EHR that costs $599 per bed per month. I’m impressed – I took the rep off script in asking to see functionality with which I have a lot of experience (pharmacy, lab, etc.) and it was remarkably deep and broad. It shares a single database with ECW’s ambulatory solution and will provide even hardcore modules such as LIS, blood bank, RIS, and anesthesia documentation and OR management. They have around 20 hospitals that have signed letters of intent to get in line once the initial sites shake out the inevitable problems. ECW 10i looks like a potentially strong competitor to small-hospital systems and has been architected to handle larger ones. Worth watching.

Someone asked me who’s giving away sunglasses. Talk to Vyne Medical down in Hall G.

I was truly happy that Cantata Health lured the semi-retired but still magnificently entertaining Bob Garner back to their booth. I’ve seen his sessions at least a dozen times, and while he makes me laugh harder than just about anything, some of his shockingly accurate and personal insights (he says he’s not psychic, but I wonder) cause tears from attendees who weren’t expecting to be so profoundly affected. I urge you to trust me and go see what he does. He is always the high point of my HIMSS experience.

Ireland-based Oneview Healthcare had the best themed entertainment I’ve ever seen at a HIMSS booth – a good Irish band, a local Irish dance troupe, and Guinness on draft. The HIMSS police wasn’t happy with the band’s volume, however, and was threatening to shut them down as I moved on. I like that the company proudly embraced their heritage with a fun program.

I’m not exactly sure what was going on right around the corner from our Hall G booth. I averted eye contact since I can’t imagine this is a job that either of the folks pictured would go home and tell their kids about.

Our booth neighbors Nihon Kohden were pouring sake, which was a HIMSS first for me. Brilliant, and as in Oneview’s case, culturally relevant.

Kudos to NextGen Healthcare for a cool booth idea. They brought in local artists who imprint goodie bags with your choice of design. Inside is a card from Las Vegas’s Three Square Food Bank, to which NextGen donates a matching bag filled with food for underprivileged children. 

Grahame Grieve is one of our favorite people, the humble father of FHIR who isn’t really a health IT cheerleader as much as he just wants to do the right thing for patients. Lorre said he was being approached constantly like the rock star he is, yet he just went about his business like he wasn’t worthy. I think she was rejuvenated by his altruism that is refreshing among a glut of glory-seeking behavior.

Hall G is actually a fun and easily navigated space, much better than I cynically predicted. The challenges are (a) the absence of anchor tenants, who are all upstairs; and (b) the nearly invisible stairwells that lead down from the main hall level. It’s easy to find Hall G if you are on the ground level of the lobby (it’s near HIMSS Bookstore), but it’s maddeningly hard to find the down escalators from the upstairs exhibits (hint: look between the Cerner and Allscripts booths). I also felt like a rat in a maze upstairs when trying to find the exit doors – like the casinos, they don’t make it easy to walk away.

I strolled Hall G and here’s why it’s worth the trip downstairs. It’s really easy to navigate, with mostly straight aisles that aren’t broken by huge booths. The booths are modestly sized and you see more vendors in fewer steps while still seeing giveaways, happy hours, etc. The people seem friendlier and less frantic, both exhibitors and attendees. Best of all, the companies there have more focused product lines and it’s easy to decide which ones to visit purely from their signs. It’s like HIMSS conferences used to be before they got out of hand. 

Thanks to the many attendees who dropped by to say hello at our little Booth #11228 even though it was not the easiest to find. I’m rethinking the idea that our location is super important since today’s experience suggests people will seek us out, a luxury that vendors don’t necessarily have.

I’ve had a long day, and since it’s after 11 p.m. as I write this, I suppose I should go to bed in preparation for another long day tomorrow.

Jenn’s HIMSS 3/6/18

Tuesday dawned bright and rather bleary-eyed. After a thankfully restful night’s sleep, I woke up this morning to the realization that last night’s itchy left eye was probably developing into something more acute. I’m on the mend after an early-morning MDLive consult (a perk of my MediShare plan) from my hotel room and a prescription pick-up at the Venetian Walgreen’s. I had to laugh when the tele-doc suggested I visit the MDLive booth after I told him I was here at HIMSS. I’ll likely keep a low profile at the conference today, popping in briefly to say hi to Lorre at our booth, 11288, in Hall G. I’ll be using copious amounts of hand sanitizer, so will pick up one of Arcadia’s handy HIMSS18 Survival Kits they’ve so kindly supplied us with as giveaways.

But let me back up … Arriving a full day ahead of exhibit hall hours has been a thoroughly enjoyable experience aside from my health issues. I spent most of Monday morning wandering around the Venetian and Sands to reacquaint myself with the lay of the land. Much like my time in Venice years ago, it took me longer than I expected to orient myself. That time, though, was not lost, as it gave me a chance to chat with attendees like Orchid Webb, director of clinical transformation at GMP Network (MI), a physician-based organization that helps independent MDs with technology, payer relationships, and the overall move to value-based care. Webb had good things to say about EagleDream Health, a cloud-based analytics company acquired by NextGen last fall that has assisted GMP physicians with upping their population health efforts. Though she wasn’t at HIMSS to shop for anything in particular, Webb told me she does have telemedicine on her radar, validating my comment in yesterday’s write-up that attendees are looking more for immediate-impact patient care tools than the razzle dazzle of evolving concepts like blockchain.

I also had the chance to talk with a trio from St. Jude Children’s Research Hospital (TN), who had gathered outside of Starbucks to get their pre-conference symposia game plan together. Senior Clinical Analyst Jon Jernigan (left) and friends will be hitting the exhibit hall today to look at products related to interoperability and analytics. Vendors on their stop-by list include PatientSafe Solutions and Health Catalyst.

The foot traffic seemed slower, of course, than it will be today. I’ve read somewhere that HIMSS expects 50,000 folks to descend on the Sands, with that figure later being adjusted to 43,000. It might not be too far off the mark if standing-room only events like the first-timers orientation are any indication.

Several conference-goers found time to escape the escalating attendee rush near this fountain, which is surrounded by very tranquil Chinese décor. I love the fact that every coin tossed in is donated to The Dr. Miriam and Sheldon G. Adelson Clinic for drug abuse treatment and research here in Vegas.

I was happy to get off my feet for a bit in the media room where I caught up with Wellpepper CEO Anne Weiler and Mayo Clinic Global Business Solutions Senior Director Shayn Carlson. They brought me up to speed on Wellpepper’s new care plan partnership with the clinic. The organizations will launch Mayo Clinic care plans for cardiac rehab, headaches, and sports medicine on the Wellpepper Marketplace in the coming months, with additional plans in the works for later in the year. Wellpepper has developed a patient engagement platform that enables hospitals to deploy their own treatment plans within an app that guides care delivery outside of a provider’s four walls, and then collects outcomes data providers can use for analysis. The two organizations have known each other since 2015, when Wellpepper won Mayo Clinic’s first Think Big Challenge.

After some afternoon R&R at the hotel, I headed back to the conference for round two, which included a guided tour of Athenahealth’s new art installation, the keynote, opening reception, and an intimate dinner hosted by the AMA and IBM Watson. The 5,000-pound stack of paper above will surely drive traffic to their booth (plus they’re right next to the restrooms in Hall A, which is always a good spot to be near). Coupled with a pretty cool augmented reality experience, the artwork tells the story of paperwork’s burden on physicians in terms of cost and burnout. The company’s talking points this go-round will be expanded, machine-learning based services for document management and coding that will help physicians reduce paperwork and data entry. They’ll also be demoing a new, more EHR-friendly Epocrates app – a move that Chief Product Officer Kyle Armbrester is pleased about given the company’s heretofore lack of focus on that brand.

As expected, the keynote overflow room was filled to capacity and so I joined my colleagues in the press room to watch what passes for an Olympics-like opening ceremony at HIMSS. As Mr. H alluded to in his write-up, the vocalists from The Voice that preceded Eric Schmidt of Alphabet were certainly talented, but an odd choice. I couldn’t help but wonder how much money HIMSS could have saved, or diverted to other more patient-facing causes, had they passed on the opening act. I saw most of the keynote, but only heard the last 10 minutes thanks to audio issues in the press room. Eric Schmidt essentially told the audience to hurry up and catch up so that Google and other consumer-facing companies can put their technologies to good healthcare use.

The post-keynote opening ceremony was unusual in that it was held downstairs in Hall G (a ploy to get people down there today, perhaps?). I can’t remember a HIMSS where the opening reception was held in the exhibit hall. The theme was fun – 80’s nostalgia with a focus on arcade games and music, courtesy of a high-energy DJ. I didn’t stay long. But the vibe became too weird. I knew it was time to go when Baby Got Back started playing. All attempts at legitimate health IT-focused convo had to be abandoned.

I happily headed over to a far more intimate gathering hosted by the AMA and IBM Watson. It was nice have a sit-down meal with 40 of my closest peers to hear from AMA CEO James Madara, MD, IBM Watson Health Chief Health Officer Kyu Rhee, MD and Mayo Clinic CIO Criss Ross, who had many stories to tell of the positive impact Watson technology is having on Mayo Clinic point-of-care processes. (Ross is one of 60 Mayo staffers here at HIMSS, and considers himself to be a rookie among his Mayo colleagues, given that he’s been at the organization for only five years.) He made it clear amidst all the talk of AI and machine-learning, that, at only three years old, Watson is still learning and Mayo is still realizing its capabilities. It was refreshing to hear him say he’s more interested in “little AI” than “big AI,” meaning that’s he more likely to use it for simple utilities than big moonshots. Fun fact I didn’t know: Eric Schmidt is on Mayo’s Board of Trustees. After a delicious piece of tiramisu, I called it a night.

Dr. Jayne at HIMSS 3/5/18

I was on the schedule to see patients yesterday, so I had to catch an early flight to Las Vegas. The gate area was full of people also headed to HIMSS, by virtue of this being the first non-stop flight to Las Vegas for the day. Plenty of logoed backpacks and polo shirts made it easy to pick out people headed to the show.

I normally avoid flying on Monday mornings because it’s such a zoo and today was no different, although it was possibly more challenging than normal. The TSA Pre-Check line was as long as I’ve ever seen it and TSA kept routing people out of it into other lines, causing tension and some line-jumping that led to angry words. My Southwest flight had plenty of people trying to save exit row seats despite the no-seat-saving policy, and I thought two passengers were going to come to blows at one point. Fortunately, cooler heads prevailed.

Travel seems to losing civility with every trip I take. On this flight, one man yelled at the flight attendant for touching his arm as she passed (his arm was hanging out into the aisle, making it nearly impossible for anyone to get by). Although we were on a nearly new aircraft, the wireless wasn’t working, which I’m sure raised anxiety for people who had planned on doing work during the flight. Regardless, a gentle note to travelers: if you have company logo apparel and luggage tags, you might want to behave accordingly. I made a couple of notes to try to see if some of the less-well-behaved passengers turn up in their respective companies’ booths.

There were plenty of in-flight conversations about the need for comfortable shoes and where people were staying – lots of people off the strip and several companies renting houses rather than being in the HIMSS room blocks. The general tone is that HIMSS has become all about the exhibit hall and networking and that the keynote speakers are largely irrelevant. Most of the people who were chatting around me on the flight are from the vendor side of the house and didn’t have opinions about sessions or the educational value of HIMSS because they’ll be stuck manning their booths or doing coffee runs.

I was reading some continuing medical education materials during the flight and my seat mate asked whether I was a physician. He was curious as to what I thought about Uber’s new foray into healthcare. I have mixed feelings on the offering, considering that the physicians, hospitals, and care providers are expected to foot the bill. Sure, it’s cheaper than an ambulance and cheaper than noncompliance, but for small practices that are not in risk-sharing arrangements, it’s going to be one more thing to pay for and less likely to happen. These practices are already paying for translation and interpreter services that usually negate any profit they would make from a given visit, so when you throw transportation in the mix, it only works when there is a larger entity at play to absorb the costs. I did note that if patients have the regular Uber app, the visit isn’t billed – it’s not clear however how the drivers will be compensated in that situation.

It will take a special group of drivers to care for the Uber Health population, drivers who are aware of the needs of medically complex patients who may have difficulty getting out of the house, who may have accompanying medical equipment, or who may have challenges related to their medical conditions. I assume Uber has this figured out since Uber Health has been tested for more than six months by a group of 100 hospitals and physician offices. Patients can be scheduled by the practice up to 30 days in advance, which certainly can help patients keep their visits. I was interested to see that the Uber tools are “compliant with HIPAA,” which makes me wonder whether name and address are the only PHI elements they’re tracking.

There are also liability questions. When we have patients at our practice who require transportation, we provide contact information for various community and commercial services. Our contact sheet has a disclaimer that we are not affiliated with or recommending these services and are simply providing it as a convenience. If the physician office schedules transportation and an accident occurs, do they share the liability? What if an office sends an Uber but an ambulance was really more appropriate? We’ll have to see how things shake out over the coming months.

I finally arrived in Las Vegas late morning, and although check-in at my hotel was quick, they didn’t have a room ready for an early arrival. I spent some time tidying up some project plans and people watching at the Palazzo shops before meeting a former colleague for dinner. We hit some of the shops afterwards and then made our way to the opening reception in Hall G. This year’s reception had a Pac-Man theme that I didn’t quite get, although I did get a kick out of seeing the arcade games scattered around the subterranean Hall G. There was a crush of people trying to find the buffet tables that were scattered around the hall, leading to long bar lines and questions about what was being served. Even though there was a map of offerings at the entrance, I never saw half of the options that were listed. Although many booths were fully manned, some were still being set up and still others were totally empty. I’m sure this is the largest influx of people into the basement level for the week, so if you weren’t trying to grab attention, you missed out.

LogicNets was building an oversized Jenga game in its booth.

Lightbeam Health Solutions wins my prize for being the first booth I saw that had our sponsor sign proudly displayed. I was pleased to see that the HIStalk booth with its smoking doc is ready to greet attendees tomorrow, just down the aisle from not only the Philippine Trade and Investment Center booth, but also behind the Nihon Cohden America booth, which wins my prize for some of the creepiest imagery. They have a 3-D female figure that has pictures of organs project onto it, I think they’re responsible for a guy who was wandering around with medical tape and electrodes on his head. I tried to get a picture of that, but he got away.

I felt sad for the empty “first time exhibitor” booths where perhaps the exhibitors ran out of money before they made it to the show. It looks like there are plenty of things to see in Hall G – I will have to go back and investigate what looked like a large slot car track and also a couple of interesting booths. Optiv is a first-time exhibitor, and although I didn’t have time to stop by to see what it is they do, the booth was well put together and the team seemed to be ready to talk to people. I saw one booth whose tables were covered by leftover buffet trash even though there was staff present, giving it the air of the aftermath of a college party.

I closed out the night with my first martini of the year (!) with a friend and am off to bed so I can be well-rested for tomorrow. Who knows what HIMSS Tuesday will bring?

Email Dr. Jayne.