Weekender 4/20/18

Weekly News Recap

• The Illinois state procurement board recommends voiding University of Illinois Hospitals’ $62 million Epic contract, saying that Cerner’s bid was lower and referring the issue to the state’s Executive Ethics Commission after noting that Impact Advisors was involved in the selection and could have been awarded implementation services work as a result.
• Livongo Health acquires Retrofit.
• VA Interim CIO Scott Blackburn, who was heavily involved in its plan to implement Cerner, resigns and is replaced by the White House with by the Trump campaign’s former data director.
• A study finds that app-issued medication reminders don’t help people with high blood pressure bring it down.
• Hospital chain Community Health Systems lays off at least 70 Nashville-based corporate IT employees.

Best Reader Comments

Regarding VA software: The most interesting part of this is the conflict of interest with Leidos leading the Epic MASS project. SMS was part of the Lockheed acquisition with Leidos. SMS/Leidos was required to rebid on the MASS project in 2017 with an updated ROM. Leidos leads the DoD Cerner implementation, and now the Epic MASS scheduling implementation. Given the history surrounding the Coast Guard failed Epic install in 2016, this seems like a conflict of interest for sure. (Douglas Herr)

Providers prefer MHS Genesis to AHLTA, the absolute worst EMR ever. And yet, AHLTA is still more interoperable, because AHLTA is connected to the read-only Joint Legacy Viewer (JLV) and Genesis is not. Live for a year and connected to nothing and no one. It’s either “can’t” or “won’t” and neither is an acceptable answer. (Vaporware?)

Is it a good or bad thing that Dr. Jeffrey Johnson stopped practicing (at this hospital at least) because he wouldn’t learn how to use an EHR? I don’t know if it’s good or bad. But I wouldn’t want my money riding on the chance that a 75 year-old obstetrician is keeping up with the latest practice standards and could really do the job that an OB-GYN needs to do. I would not be surprised if some of his colleagues are relieved. Something had to “force” him into retirement, maybe it’s good that it was this. (Filutanion)

Mumps evolved to Standard M before InterSystems consolidated its dominance on the M market, and Caché to this day not only fully implements Standard M, but all the modern object-oriented extensions are built seamlessly on top of Standard M. Another current Standard M implementation is GT.M Many people don’t realize that M(umps), being the original NoSQL platform, is very well suited for the type of data processing that’s needed in healthcare. (Eddie T. Head)

Watercooler Talk Tidbits

Readers funded the DonorsChoose teacher grant request of Ms. M in Philadelphia, who asked for headphones for the classroom learning center. She reports, “The headphones have been great for students to use during their time on the computers. There is no longer a noise distraction to the other students who are working on something other than the computer. The students who are on the computers can hear the sound more clearly now that they have headphones. I’m so glad that the students are now able to go to their centers and produce quality work with a noise distraction! We are so grateful!”

We also supported Mrs. I’s South Carolina classroom project to promote gender and ethnic diversity in STEM fields, proving it with a camera and supplies. Individual students passed along their thoughts:

• The STEM career project really helped me get more insight on what I want to be. It gave me an exposure on what to expect and what classes I need to focus on in high school and in college. I appreciate the fact that we had a guest speaker and she was great! (Samantha)
• Thank you for your generous donation to us. Thank you for making it possible for us to get exposed to the different carriers on the STEM fields. The STEM career project has made me more aware of the field in OB-GYN and has made me feel like I am ready for my future. The guest speaker made me realize that money is not everything. I learned that the love for the profession is more important and should be what drives you to do your best every day. (Joseph)
• The project has really opened my eyes and it is making me want to strive for greatness. I am not happy with the number of years I have to be in school to become a medical doctor. But I would still try, because the guest speaker was a minority and I believe that if she could do it, then I can do it too. She taught me to keep going and never give up no matter what.

I’m all-Android except for my aging IPad Mini, so I rarely have reason to visit the Apple Store. I dropped in today to check out the new 9.7” IPad since I think it’s probably the best tablet available in that price range ($329, although it’s galling that Apple still charges a lot for extra memory instead of supporting SD cards like Android tablets do). The store seems to have gone downhill – it was slightly crowded (less than I recall from my last visit) and I was happy not to be waiting for the Genius Bar, but employees ignored me even though they were just standing around. I asked an Apple guy who was steadfastly avoiding eye contact about the tablet and he just pointed at a table and said, “First two corners.” Nothing in the whole store was labeled or priced, so you had no idea what you were looking at, and had those products been truthfully labeled, the sign would have said “overpriced and uninspiring.” I may still end up with their tablet since they’ve priced it low since it’s little improved from the old one, but the experience so far was memorable only in negative ways. It feels like that dent in the universe is repairing itself.

InteliSys Health CEO Tom Borzilleri told me in a recent interview that CVS and Walgreens charge a lot more for prescriptions than independent or grocery store pharmacies despite consumer perception that they’re the price leaders. A new Consumer Reports article proves Tom to be correct. The magazine price-checked a one-month supply of five commonly prescribed generic drugs and found a range of $66 (from HealthWarehouse.com) to $928 (CVS). Independent pharmacies were among the cheapest, but the range was huge ($69 to $1,351). I hadn’t heard of HealthWarehouse.com, but it looks great for cash-paying patients – it sells a 90-day supply of generic Lipitor for $19.80, for example. They also sell over-the-counter drugs, diabetic supplies, and veterinary prescriptions (their prices for flea and tick meds are really low).

Bloomberg profiles data mining company Palantir Technologies, started by Peter Thiel and other former PayPal executives. The article describes JP Morgan’s use of the product to monitor its bank employees, summarizing it as “an intelligence platform designed for the global War on Terror was weaponized against ordinary Americans at home” as it analyzed bank employee emails, browser histories, GPS locations reported from company-issued phones, recorded phone call transcripts, and printer and download activity. It is being used by police departments in several US cities and those agencies can now identify more than half of US adults. JP Morgan invested in the company as well, but the company cut back on its use after it was exposed. Palantir has scandals of its own: it admitted to stealing some of its technology (claiming it had a right to do so because it was for the greater good) and it pitched programs to sabotage liberal groups, spy on and infiltrate progressive activist groups, run bot-powered social media campaigns, and plant false information to discredit liberal groups.The company, once exposed, used the Cambridge Analtytica excuse – they say it was the unauthorized work of a single rogue employee. Palantir offers healthcare solutions such as clinical trials analysis, fraud detection, and value-based care analysis for insurers.

I missed this first time around. An office design ideas site profiles the new Chicago digs of Strata Decision Technology. This is one more reason I know I’d make a terrible CEO – I would be too cheap to spend more than the bare minimum on everything, so my company’s offices would like like one of those unfinished farm garages made of sheet metal.

“Big Pasta” fights back against the low-carb movement, with companies such as Barilla funding the research behind mass market headlines such as “Eating Pasta Linked to Weight Loss in New Study.” This is a reminder for those who don’t understand that not all research is created equal: (a) someone has to fund a study to begin with, and the funder often has a financial interest in the findings; (b) studies that don’t deliver the hoped-for findings are often buried while the favorable ones are promoted; and (c) headlines are chosen for clickbait value rather than for scientific validity, with the publisher basically colluding with the study funder to make the findings seem a lot more significant and trustworthy than the underlying research supports. Highly-touted studies should always be approached with skepticism – who paid, who did the work, what methodology did they use, and how generalizable are the results?

Hiral Tipirneni, candidate for the Arizona House and a former ER physician who hasn’t practiced following a 2007 malpractice judgment, takes heat from her opponents for running a campaign ad showing herself in scrubs but wearing an Apple Watch that indicates the photo was made long after her physician days were over. 

Princeton University will hold an on-campus memorial service for highly influential professor and health economist Uwe Reinhardt on Saturday, April 21. He died November 15, 2017 at 80 after a 50-year Princeton career.

Yale health economist Zack Cooper, PhD isn’t impressed with the just-announced consumer health platform project between Independence Health and Comcast.

In Case You Missed It

• News 4/20/18
• EPtalk by Dr. Jayne 4/19/18
• HIStalk Interviews Nathan Read, Senior Director of IT, The George Washington University Hospital
• News 4/18/18
• Curbside Consult with Dr. Jayne 4/16/18
• HIStalk Interviews Matt Sappern, CEO, PeriGen
• Monday Morning Update 4/16/18
• What I Wish I’d Known Before … Selecting a Consulting Firm for EHR Implementation or Optimization

Get Involved

• Join my Rolodex to provide occasional news reaction or ideas
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• Sign up for email updates
• Connect on LinkedIn
• Contact Mr. H

Morning Headlines 4/20/18

Tulare hospital’s creditors lining up in court

Healthcare Conglomerate Associates – former management company of Tulare Regional Medical Center (CA) – attributes its past struggles with payroll to glitches in the Cerner system it implemented in 2016. Parent organization Tulare Local Healthcare District filed for bankruptcy last fall.

New CHCF Investment Streamlines Care Coordination in the Safety Net

California Health Care Foundation’s innovation fund invests an unspecified amount in Collective Medical.

Comcast and Independence Health to partner on new health care platform

Comcast and Philadelphia BCBS insurer Independence Health will launch a health technology platform for consumers that will focus on patient communication and education, and telemedicine.

News 4/20/18

Top News

The State of Illinois Procurement Board finds evidence of a conflict of interest in the $62 million contract awarded to Epic by University of Illinois Hospitals and Health Sciences System, prompting the board to refer the matter to the state’s ethics commission for a public hearing. The review follows a protest by Cerner that it lost the bid despite offering a lower total price. 

Cerner was one of the health system’s incumbent vendors, along with Epic and several other companies.

Board members seemed to agree with Cerner’s attorney that it may have been improper for the health system to hire Impact Advisors to assist with the selection since they also provide Epic implementation services.

Cerner also claims that Epic’s bid did not include the price of those implementation services, which it says could reach $100 million, and that it was not allowed to demonstrate its software.

Reader Comments

From The Hypocritical Oath: “Re: Cerner’s protest at U of Illinois. It’s especially embarrassing given: (a) the hypocrisy of its $16B no-bid VA contract, and (b) the fact that they’re the incumbent vendor and the client hates them so much that they’d rather start over with a new EHR instead of continuing the relationship. I don’t think a demo is going to change much.” Losing vendor protests don’t usually turn out well, especially with regard to public perception (do I as the next potential customer want to consider someone who might sue me if I don’t choose them?). It certainly didn’t help Allscripts when it tried the same thing years ago, when it finally smartened up and dropped its absurd lawsuit against NYHHC and Epic only after firing its own executive team. Imagine the frosty relationship if Cerner prevails and the hospital is stuck implementing a system that it doesn’t want.

From Jolly Rancher: “Re: UNC Health. Several sites have mistakenly said they were the first health system to earn Stage 7 in the HIMSS Analytics categories of inpatient, ambulatory, and analytics this week. They were not.” The HIMSS-owned rag made a mistake in re-wording UNC’s press release in an attempt to look like an actual news report, apparently failing to notice that UNC’s press release said it was the only health system to earn all three Stage 7 designations that has ALSO been named as “Most Wired Advanced” in an unrelated award (the release clearly trying to one-up Duke by even bringing that up). Duke did its three sevens (I’m tired of typing it, so I’m dubbing the trifecta as AM21) on February 22. Other sites embarrassed themselves by either making the same mistake or by using the HIMSS rag’s site as their source instead of reading the actual press release.

From VA Software: “Re: the Columbus, OH Ambulatory Care Center. Went live last weekend on MASS (Medical Appointment Scheduling System). Its backbone is Epic (just the scheduling application) that then writes data back to VistA.” The MASS project was announced in 2015, with Systems Made Simple (Lockheed Martin) and Epic being awarded a $623 million bid in what I think was a competitive RFP. The project was placed on hold in 2016 while the VA tried to decide whether to develop its own system, but Congressional pressure (or so I’m assuming) led for it to be restarted even as the VA decided to give Cerner a no-bid contract. Maybe the VA wants MASS to succeed to prove the value of commercial software, or maybe it hopes it fails so that Cerner looks like the only viable commercial software choice – I really don’t know, but would enjoy hearing from someone who does.

HIStalk Announcements and Requests

I need more responses to my question this week – care to chime in?

I’m already tired of this phrase that everybody is copying after hearing it: “punching above their weight,” which Google turns up as being used by news sites 3,000 times all of a sudden. I’m hoping against hope that it will die out as people stop trying to be imitatively clever. Soon it will fade and you’ll hear it only from folks who still post-faddishly write “to die for” and “I threw up in my mouth a little bit.”

Webinars

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

Acquisitions, Funding, Business, and Stock

Provider data management and scheduling software vendor Kyruus raises $10 million in a corporate funding round, increasing its total to $72 million.

Health IT appears to have created cash flow problems within the financially strapped Tulare Local Healthcare District (CA), which filed for bankruptcy last fall. Former management company Healthcare Conglomerate Associates, which is hoping to recoup over $16 million from the district, attributed its struggles with payroll at Tulare Regional Medical Center to glitches in the Cerner system it implemented in 2016. An independent EHR implementation consultant is also looking to be paid, which lawmakers say may not happen any time soon.

Medeanalytics relocates its headquarters to its expanded office in Richardson, TX.

Sharecare SVP of Corporate Communications Jen Martin Hall responded to my inquiry about its joint venture with HCA, confirming the rumor reported by reader Private Privatized earlier this week:

HCA and Sharecare are putting operations of Share Lab, their joint venture to develop a next-generation online scheduling product, on hold. While the Share Lab team built a great product which was successfully deployed into an HCA facility and was demonstrating promising initial results, we couldn’t agree on a go-to-market strategy.

California Health Care Foundation’s innovation fund invests an unspecified amount in Collective Medical, which closes patient care communication gaps by using analytics to create a shared set of patient information, such as turning HIE data into clinically useful information. The company’s November 2017 Series A funding round raised $47.5 million.

Sales

• Rio Grande Valley HIE (TX) selects data normalization and quality reporting services from Diameter Health.
• Tufts Medical Center (MA) joins the the global health research network of TriNetX.
• West Virginia University Health System will utilize analytics and consulting services from Premier.
• TriHealth (OH) signs a $10 million contract with IBM for Watson Health enterprise imaging solutions and cloud-based clinical review services.
• The Menninger Clinic (TX) chooses Cerner Millennium and RCM.

People

GetWellNetwork names Nikia Bergan (Advisory Board) as chief revenue officer.

Ciox Health hires Arvind Ramakrishnan (IRI) as chief operations officer for clinical data acquisition and insights.

Announcements and Implementations

Comcast and Philadelphia BCBS insurer Independence Health will launch a health technology platform for consumers that will focus on “the effectiveness and efficiency of patient communications and education” that includes patient education and telemedicine. The insurer got the idea from the Amazon, Berkshire Hathaway, and JP Morgan project, explaining, “We’re going to use all of the data that we have from both companies and actually be able to create specific journeys for you.”

Frankfort Regional Medical Center (KY) goes live on Meditech Expanse with help from Parallon Technology Solutions.

The Fred & Pamela Buffett Cancer Center at the University of Nebraska Medical Center implements an HL7-based discrete genomic results reporting system from GenomOncology to access results more easily via EHR.

Olympus will allow endoscopy images to be shared across health systems via its Knowledge Exchange System connected to InterSystems HealthShare.

Government and Politics

The White House assigns Camilo Sandoval to acting CIO of the VA following Scott Blackburn’s resignation earlier this week, giving him a potentially important role in its Cerner project. Sandoval, a former Trump campaign data director later named as senior adviser to the undersecretary for health, was one of several political appointees who former Secretary David Shulkin accused of conspiring to get him fired. The White House says a permanent candidate for the job is being vetted.

The FDA includes cybersecurity as part of its new Medical Device Safety Action Plan, emphasizing the need to shore up device vulnerabilities that could compromise patient safety. The plan will also help direct the ongoing establishment of the FDA’s National Evaluation System for health Technology (NEST) program.

Other

The local paper covers Mayo Clinic’s (MN) employee training ahead of its May 5 Epic go-live. Over 26,000 staff have been shuttled to a training center daily over the last three years. The clinic has hired 260 trainers to handle the crowds. The center will stay open for ongoing training through 2019.

A new KLAS report on inpatient systems in under-200 bed hospitals contains interesting facts:

• The most-installed vendor systems in order are from Cerner, Epic, Meditech, CPSI, Allscripts, Medhost, and Athenahealth, with those first three getting most of their count from hospitals that are part of a multi-hospital health system.
• KLAS notes that Meditech’s cloud-based Expanse system has  allowed the historically “mediocre developer” to elbow its way into the #3 spot in perceived innovation, behind Athenahealth and Epic and ahead of Cerner (but it’s a close race among all four). Allscripts Paragon, Medhost, and CPSI Evident trail the others by far.
• Allscripts is trying to salvage Paragon despite McKesson’s fumbling that caused some customer loss, although Allscripts is belatedly developing an integrated ambulatory EHR (Avenel) that help may keep customers in the fold.
• On the RCM side, Epic and Meditech customers like their respective product capabilities; those of Cerner like its RCM services while continuing to be disappointed with its revenue cycle software; Athenahealth’s users appreciate its percentage-of-collections cost model; and Paragon, Evident, and Medhost customers say their vendors do little to help them reduce costs or provide new revenue models. 
• Some Meditech legacy users have defected instead of upgrading due to ineffective support and a prohibitive cost structure.
• Some customers have cancelled their Athenahealth contracts and gone back to previous vendors CPSI and Medhost doe to perceived gaps in functionality.
• Most new deals outside of critical access hospitals are going to Epic and Cerner. with Epic’s weak spot being its provider-hosted model and Cerner’s being its longstanding problems with its revenue cycle software.

A Chicago Tribune investigative report finds that Bala Hota, MD – former Cook County Health and Hospitals System CIO / CMIO – fraudulently obtained reimbursement for $248,000 in expenses that he claimed were work related but that in fact involved purchases of toys, ITunes products, and a piano, leading to his resignation in 2014 as auditors uncovered the issues. He repaid the money last year and is now VP, chief analytics officer, and associate CIO of Rush University Medical Center.

Employees of Theranos – back when they had some – drank the Elizabeth Holmes Kool-Aid in believing that Wall Street Journal reporter John Carreyrou was mistreating the company in exposing its fraud to the world, so they created a Space Invaders-type game called “Haters Gonna Hate” that used Carreyou’s head as the invaders to be shot at. Not only was this possibly the only company technology that ever actually worked, insiders went all Jim Jones in chanting “F— you, Carreyou” at an all-hands meeting. They have a dazzling array of reasons to be feeling really stupid right about now.

Sponsor Updates

• EClinicalWorks publishes a new customer success story featuring Righttime Medical Care.
• LifeImage publishes a new white paper, “Healthcare network as a catalyst for a convergent industry influencing clinical outcomes.”
• Lightbeam Health Solutions will exhibit at NAACOS April 25-27 in Baltimore.
• Mobile Heartbeat achieves Zebra Technologies Validation for its MH-CURE clinical communications and collaboration platform.
• Netsmart will exhibit at at NATCON April 23 in Washington, DC.
• Nordic releases a new podcast, “What is it like to be an affiliate project manager?”
• PokitDok demonstrates its commitment to security through SOC 2 Type II Certification.
• Forbes includes Impact Advisors in its list of best management consulting firms for 2018.
• Surescripts becomes a benefactor sponsor of the National Council for Prescription Drug Programs.

Blog Posts

• Interoperability 2.0 – Creating a Holistic Model of Care Part 2 (Medicity)
• Documentation at Phoenix Children’s saves time, money (Medicomp Systems)
• An Insider’s Look at Unique Device Identifiers (FDB)
• From the Road – A Consultant’s Perspective, Volume 1 (Optimum Healthcare IT)
• How to Eliminate Alert Fatigue (Meditech)
• Three Key Steps to Prepare IT for Machine Learning (Liaison Technologies)
• Help Your Employees Roll with the Changes (Access)
• Rethinking the Traditional Approach to Revenue Cycle Management (MedData)
• Trend-Weaving Medecision Liberation 2018 – Part 1: Liberating Healthcare Through Data Liquidity and Consumer Engagement (Medecision)
• Experts in Home Health Give Their Thoughts and Advice for 2018 – Part VI (Netsmart)
• Parallon Technology Solutions successfully leads Cass Regional Medical Center to Meditech Ambulatory 6.15 go-live (Parallon Technology Solutions)
• Should your health system offer automated payment plans? (Patientco)
• Three Areas Providers Should Focus on to Maximize Savings and Deliver Quality Care (Pivot Point Consulting)

Contacts

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

EPtalk by Dr. Jayne 4/19/18

So many things are going on in the healthcare IT world that it’s impossible to keep up. I came across an article about the telehealth program at New York Presbyterian, which has been implemented in the emergency department to reduce wait times. The Express Care program is credited with a significant impact, moving the needle on low-acuity patients from a more than two-hour wait to one that sits closer to 30 minutes. The patient care flow is integrated into the existing emergency department care path. At the time of the initial nursing examination, patients who meet criteria are asked if they want to participate in a virtual visit in a private room rather than waiting for an in-person visit. Patients are seen by the system’s existing emergency physicians, which is said to reduce potential patient concerns about quality of care.

New York Presbyterian is known for some of its other virtual programs, including a second opinion program that is delivered through an online patient portal. They also have an inter-hospital consult program for system physicians to collaborate along with a digital urgent care service. Virtual visits can be done in lieu of some office visits, and they also staff a mobile stroke unit.

I did some additional research into telehealth, looking particularly at the demographics of patients who gravitate towards the services. One might be tempted to assume that it would be millennials and Generation Y. I found some data from an Advisory Board survey of close to 5,000 patients that indicated that although more than 75 percent of patients said they’re open to a virtual visit, only 20 percent have actually experienced one. Of those who have used the services, nearly 60 percent are under age 50.

This might be due to payment policies more than affinity for technology, due to the Medicare restrictions on telemedicine services. It could also be due to employers providing telehealth services as a way to offset declines in employer-paid coverage and rising deductibles. A good number of parents would consider using a virtual visit for a sick child, and I suspect this is not only a function of accessibility and wait times but also one of convenience as workers struggle with leaving work for medical visits.

There are some variations in how medical providers want to approach telehealth. I was approached at HIMSS by vendors in two different models – one which was third party and another which hoped to leverage a client’s existing physicians to deliver services. As a provider, there’s a certain allure to having your patients cared for by members of your group, but that arrangement still requires providers to take call and provide services after hours. That arrangement is less appealing to physicians who see medicine more as a business than as a calling. Telemedicine visits tend to skew around a couple of key areas – acute care needs, and routine requests such as medication refills.

Lots of conversation in the physician lounge this week about Amazon exiting the pharmaceutical business before it even really got started. The company has spent the last year soliciting approval from state pharmacy boards so that they could become a wholesale pharmacy distributor. They completed the process in just 12 states and apparently discovered that it’s harder to recruit large hospitals away from their existing suppliers and contracts then they thought. In my experience, hospitals tend to be locked in with either McKesson or Cardinal Health or tend to be part of larger group purchasing programs that don’t make it easy to change suppliers. According to some reports, Amazon also failed to fully appreciate the complexity of fulfilling medical supply orders when some of the items must be refrigerated or frozen. That’s a wrinkle that certainly doesn’t fit smoothly into their well-oiled logistics and warehousing process.

Some of my procedural colleagues in smaller organizations had been hoping Amazon would be able to make a go of it, to enable speedy deliveries of smaller-scale orders so that they don’t have to deal with the larger vendors. The ability to ask Alexa to ship you a couple of cases of normal saline or some assorted suture materials certainly might be a draw when you’re already using her to order your coffee and restock your household supplies. Amazon may still head in this direction, delivering medical office supplies such as gloves and other consumables to smaller organizations such as independent ambulatory surgery centers and physician practices. For that book of business, they’re already approved for licensure in 47 states plus the District of Columbia. There is still a fair amount of speculation that Amazon might be entering the retail pharmacy or direct to consumer spaces. It would be interesting to see how they tackle some of the rebate issues that exist in the retail space and add confusion to the price of medications.

A reader reached out regarding my recent comments about groups that compensate providers based on RVUs as opposed to making the transition to value-based compensation. She recently did some compensation analysis research and noted that the majority of physicians are compensated largely based on productivity, with potentially 10 percent or 20 percent being paid relative to quality metrics, patient satisfaction, or access. She found an interesting trend with groups that are moving towards paying physicians a guaranteed salary in order to account for time spent on non face-to-face activities such as chronic care management. Guaranteed salaries are also cited as a way to help smooth out access issues in group practices, where one provider might create bottlenecks because he or she won’t allow patients to see a colleague due to fear of lost income. Guaranteed salaries may also hold potential for reducing burnout and increasing collaboration. These goals are typically aided by structures which might pay bonuses based on group growth rather than individual productivity. New models of compensation which include guarantees typically include a performance threshold to ensure physicians maintain a minimum level of activity.

These new compensation models may lead to increased reporting needs for organizational leaders, which translates to requests for IT teams to generate data for compensation analysis. Several of the practice management systems I work with struggle with functions like capitation and prospective payment management, so they may also be ill-equipped to handle this level of productivity reporting. If you’re on the technical or support side it might be tempting to ignore trends in provider compensation, but it might be worth following if those trends are going to start sending more work your way.

Is your organization structuring compensation to encourage collaboration? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 4/19/18

Warnings of $100M Overpayment Prompt Recommendation to Void Contract

The State of Illinois Procurement Board finds evidence of a conflict of interest in the $62 million University of Illinois Hospitals EHR implementation contract awarded to Epic, prompting the board to refer the matter to the state’s ethics commission for a public hearing.

Statement from FDA Commissioner Scott Gottlieb, M.D., on new efforts to enhance and modernize the FDA’s approach to medical device safety and innovation

The FDA includes cybersecurity as part of its new Medical Device Safety Action Plan, emphasizing the need to shore up device vulnerabilities that could compromise patient safety.

Kyruus Raises $10 Million to Fuel Continued Growth

Provider data management and scheduling software vendor Kyruus raises $10 million, bringing its total funding to $72 million.

HIStalk Interviews Nathan Read, Senior Director of IT, The George Washington University Hospital

Nathan Read is senior director of IT at The George Washington University Hospital in Washington, DC.

Tell me about yourself and the hospital.

I’ve been in healthcare IT my whole career, which is going on 20 years now. The first 15 to 20 years was working on the software vendor side. I was a software developer for a laboratory information company and an EMR company in Texas. I ultimately became the COO of that company that led to an acquisition by a publicly-traded healthcare company, NextGen, where I stayed on there as vice-president of R&D for a few years before I moved over to hospital IT operations. It’s an interesting background in the sense that I’ve been on both sides of the business for my career.

I’m the CIO / senior director at an academic hospital in the heart of Washington DC. We’re engaged and involved in a variety of technology-related projects that are specific to all hospitals and healthcare. Being located in DC, we have some uniqueness into the types of things that we pay attention to.

What are your major technology platforms?

We’re a big Cerner shop. We have IBM/Merge, which has a pretty significant presence in terms of imaging at the hospital.

As a former vendor executive, what was the biggest surprise or the biggest change when you took the job at the hospital?

How lean hospitals run. When you’re selling healthcare products, a lot of the products on the market are very expensive. There’s always pushback for discounts and pricing. But to see how lean hospitals in general, not just in IT, have to operate with the limited budget and a lot of the pressures that the hospitals feel from the insurance companies and payers. They’re always getting crunched from a price point.

It’s kind of interesting seeing this day coming where the technology solutions are expensive and their prices are only going up, and yet the reimbursement for the patients that we’re caring for tend to be going down. The hospital market in general is lean. There’s not a lot of margin in it. Those two worlds are going to collide at some point, probably in the near future. Technology purchases are going to be limited because of that.

Knowing the financial constraints, what does it take to get you to investigate a product?

A good champion in the hospital. The person bringing it has to be strong and supportive. If there’s not a clear ROI that we can come up with relatively quickly, it’s not worth doing any other parts of the investigation. Is it improving patient safety? Those are probably the top three things.

What makes an ROI attractive?

Obviously there’s the financial side. Is there a financial benefit to the organization through the purchase? Also compliance and patient experience. It’s important to our organization to have a positive reputation and have our customers who are our patients have a high level of satisfaction. But that factors into reimbursement as well, so it comes a little bit back to the financial side. Really our mission is patient care and the focus is on that.

There’s some cool technology stuff that we do, especially being an academic hospital, that’s new to the marketplace. We do those things, but they are usually offered at a highly discounted price or are free because they’re interested to get their product proven in the marketplace and in an academic setting. We’re doing some virtual reality stuff that’s relatively new to the marketplace.

What technologies are attractive in terms of patient experience and patient engagement?

Anything that gives you real-time data on the patient experience so that you can react to it. I don’t know if this is unique to being in the DC marketplace, but if our patient is not having a positive experience, they’re quick to report that. Within 24 to 36 hours, you’ll see patients escalate within our own organization if they’re not having a good experience.

The ability for us see, in real time, if there’s a patient not having the experience we want them to have that we can then respond to is powerful for us. It doesn’t do us any good to find out a week later or a month later that a person had an experience that wasn’t what the hospital wanted. We need to know within 24 hours of that happening so that we can do some service recovery and respond to those patients. Luckily we don’t have a lot of that, but there are human interactions that at times create perceptions that we want to address quickly.

How do you get that real-time patient satisfaction feedback?

Right now it’s not through technology. It’s manual. We do rounding every day. Outside of the nurses who are required to round on their patients hourly, management rounds on patients every day. Even myself as the IT leader will go up and round on five or six patients every day. I talk to them about their experience, whether it’s the cleanliness of the environment, physician communication, nursing communication, or pain control. We have a template that we go through. If every leader is doing five or six patients, that pretty much covers every patient at the hospital every day. If there’s any patient experience issues, there’s a protocol we follow to address those right away. That’s been very successful.

There are some technology solutions that we have started to look at where, through the TV system, patients can provide real-time surveys or concerns that are reported back quickly. We haven’t implemented anything like that, although I know some hospitals have. It’s something that we’re looking at.

What hospital strategic decisions or changes are requiring IT participation?

Patient experience. Improving our overall scores, the CMS score that came out. There’s a lot of focus on our part about how we move those scores up. Our reputation in the community, improving that reputation and continuing to work towards being seen as the top academic hospital in this region. Those things typically drive leadership conversations and then what IT systems can be put in place to support that.

We have implemented patient portals and other technology solutions that were a Meaningful Use requirement. How can we enhance that experience to differentiate us from other healthcare facilities in the area?

What’s most different from the typical hospital in being a major teaching hospital in Washington, DC?

The complexity of the patients that come in. The DC metroplex draws a lot of different types of people. We have to be sensitive to variety of the patients that come into the hospital, which I’m sure is true of other big urban areas like New York. The case mix is diverse and the healthcare needs in the District are high, even though there are several hospitals in a pretty small radius. Most of them tend to be at capacity, so there’s always more need for more services in the District that aren’t necessarily provided.

Do you feel the impact of federal government decisions more acutely being in DC?

We have an opportunity to have some influence. For example, drug shortages are having significant impact on caring for certain patient populations. We have some government officials coming in this week to spend time with our physician leadership and walk around and talk to some of the nurses so they can better understand how these shortages are impacting care. I think that is a unique aspect of being here in the District.

Cyber security is obviously a huge topic in healthcare and has been for the last few years. We have some involvement with some of the agencies that come in and do some sessions with us to better understand our environment and to get feedback on potential regulatory changes and responses to cyber security. We’re physically located here and it’s easy for them to do that.

Morning Headlines 4/18/18

UNC Health Care Achieves Highest Rank Possible in Three Health IT Categories

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

Livongo Health Acquires Retrofit

Livongo Health acquires 80-employee, Chicago-based Retrofit, which provides online programs for weight management and disease prevention.

Greenway Health adds 104 jobs at Tampa headquarters, thanks to $520,000 in state and local incentives

Greenway Health has added 104 jobs at its Tampa headquarters as it closed offices in Lake Mary, FL, Birmingham, AL, and Atlanta.

VA loses its CIO, creating further uncertainty for EHR modernization

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

News 4/18/18

Top News

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

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

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

Reader Comments

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

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

HIStalk Announcements and Requests

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

Webinars

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

Acquisitions, Funding, Business, and Stock

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

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

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

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

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

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

Sales

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

People

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

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

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

Optum promotes industry long-timer Vito Augusta to VP.

Announcements and Implementations

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

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

Government and Politics

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

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

Other

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

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

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

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

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

Sponsor Updates

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

Blog Posts

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

Contacts

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

Morning Headlines 4/17/18

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

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

Pentagon wants to spot illnesses by monitoring service members’ smartphones

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

HealthInsight and Qualis Health Announce Formal Merger Agreement

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

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

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

Curbside Consult with Dr. Jayne 4/16/18

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

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

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

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

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

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

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

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

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

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

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

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

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

Email Dr. Jayne.

HIStalk Interviews Matt Sappern, CEO, PeriGen

Matt Sappern is CEO of PeriGen of Cary, NC.

Tell me about yourself and the company.

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

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

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

What are the hot issues in labor and delivery?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

How does the Qualcomm relationship work?

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

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

How can clinicians monitor that huge amount of data?

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

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

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

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

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

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

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

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

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

Do you have any final thoughts?

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

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

Morning Headlines 4/16/18

CHS lays off dozens of corporate employees

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

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

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

CVS Hires Doctor From Health Startup in Sign of Medical Ambition

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

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

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

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

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

Monday Morning Update 4/16/18

Top News

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

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

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

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

HIStalk Announcements and Requests

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

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

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

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

Webinars

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

Acquisitions, Funding, Business, and Stock

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

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

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

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

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

Sales

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

Decisions

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

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

People

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

Announcements and Implementations

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

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

Privacy and Security

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

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

Other

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

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

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

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

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

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

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

Sponsor Updates

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

Blog Posts

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

Contacts

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

What I Wish I’d Known Before … Selecting a Consulting Firm for EHR Implementation or Optimization

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

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

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

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

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

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

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

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

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

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

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

How they vet their consultants.

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

Weekender 4/13/18

Weekly News Recap

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

Best Reader Comments

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

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

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

Watercooler Talk Tidbits

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

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

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

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

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

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

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

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

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

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

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

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

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

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

In Case You Missed It

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

Get Involved

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

Morning Headlines 4/13/18

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

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

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

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

Committed to proactively addressing the security concerns of our customers

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

News 4/13/18

Top News

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

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

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

Reader Comments

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

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

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

HIStalk Announcements and Requests

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

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

Webinars

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

Acquisitions, Funding, Business, and Stock

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

Sales

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

People

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

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

Announcements and Implementations

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

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

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

Privacy and Security

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

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

Other

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

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

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

Sponsor Updates

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

Blog Posts

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

Contacts

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