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Morning Headlines 12/27/19

December 26, 2019 Headlines No Comments

The Watch Is Smart, but It Can’t Replace Your Doctor

A physician author says in a New York Times article that the public health value of the Apple Watch’s atrial fibrillation detection capability is overhyped and that even study participants mostly ignored its guidance.

Artificial Intelligence Is Rushing Into Patient Care – And Could Raise Risks

AI systems have already made significant healthcare mistakes as technology companies their rush products to market without the benefit of peer-reviewed studies and with minimal FDA oversight.

Mayo Clinic names chief digital officer to lead transformative digital strategy, create Center for Digital Health

Mayo Clinic hires Rita Khan (United HealthCare, Best Buy, Macy’s) as chief digital officer.

Augmedics Announces FDA 510K Clearance and U.S. Launch of xvision, the First Augmented Reality Guidance System for Surgery

Chicago-based Augmedics earns FDA’s F10(k) clearance for its augmented reality system that allows surgeons to visualize 3D spinal anatomy and track instruments and implants while looking directly at the patient.

News 12/27/19

December 26, 2019 News 8 Comments

Top News


An atrial fibrillation detection study of 420,000 Apple Watch users finds that just over 2,000 of them received irregular pulse warnings, but only 450 followed up with the offer of a free telemedicine visit and verification via an EKG sensor patch. Of those 450, atrial fibrillation was confirmed in 153, with the actual outcome and health benefit to the population as a whole remaining unknown.

The physician author of the New York Times article concludes, “While there may be reasons to own an Apple Watch, using it as a widespread screen for atrial fibrillation probably isn’t one.”

Reader Comments

From Juneau Boy: “Re: CoverMyMeds. Hacked, maybe? Their prior authorization system gives users a warning that their computer has been compromised and they need to call a telephone number to get it resolved.” Unverified. I don’t know how their system is accessed, but if it’s via browser, it may be the user’s computer that has been compromised and not theirs since malware-produced scammer pop-ups are common.

From OptumOrange: “Re: Optum. Laid off many in behavioral health on 12/23. Merry Christmas.” Unverified, but widely reported on and not too shocking given that the healthcare-milking company has 175,000 employees who are collectively insignificant compared to investors. Another round of layoffs is rumored to be on the books for January 3. The warning signs from my experience (other than working for a huge, publicly traded company, which is the most relevant layoff tell of all) are: (a) managers start disappearing for lengthy meetings, possibly offsite, to prevent leaks; (b) their assistants look dejected because they have to do the dismissal paperwork and deploy security guards and boxes of tissue to the impromptu departure lounge from which their colleagues will be forcefully bidden adieu; and (c) the managers stop looking employees in the eye, especially the ones they have chosen for the executioner, because even the microscopic, situationally malleable conscience of managers feels a tiny bit of shame at being involved in the door-showing of people who got them where they are.

HIStalk Announcements and Requests


I hope you had a memorable Christmas, whether you specifically celebrated that holiday or not. It’s always interesting to see how infrequently-seen relatives handle family get-togethers – the inevitable personal drama and political arguments, toddlers and some adults who are too preoccupied by shiny objects like toys and phones to interact socially, and the important ritual of telling family stories and collectively rekindling memories for the next generations. It’s also a time of despair for those who can’t be with family, those whose life circumstances present few reasons to celebrate, and those who actually believe the self-stroking fiction people post on Facebook and conclude that their less-photogenic lives must indicate some degree of personal failure in falling short of Hallmark Channel expectations. In any case, the National Suicide Prevention Hotline is 800.273.8255. We all struggle, just differently.


Here’s why you shouldn’t trust Amazon reviews for products made by companies you’ve never heard of, most of them being in China. I bought a junky flash drive that was DOA and immediately returned it to Amazon in a great customer service moment (fast and easy). When it first arrived, the company offered a second drive for free if I would post a positive Amazon review, but instead I wrote an appropriately scathing one. This week, the company offered me a $50 Amazon gift card to take the review down (which of course I did not). I immoderately love most things Amazon and Prime, but even I’m getting fed up with its lack of control over third-party sellers, counterfeit products, and the artful gaming of its review system to scam Amazon customers. Mark my words – Amazon will be the next EBay if it can’t protect one set of customers (consumers) from the other set (the third-party sellers that contributed $43 billion in Amazon revenue in 2018).

I received lots of nice emails, even several on Christmas Day, from teachers whose Donors Choose projects were fully funded by donations from HIStalk readers and my Anonymous Vendor Executive (AVE). Ms. M said the Chromebook we provided to her class is a “true blessing” since she can’t afford to buy one for her class given her $46,000 salary after 20 years of teaching. Anyway, AVE has replenished the matching funds that reader donations thankfully depleted, so we’re back on for funding more projects.

I’m pondering the past tense of “intake,” as in the “patient intake process.” When it’s over, have they been intaken, intaked, or intook? It’s a fair question when people start using made-up words and phrases, sort of like “executive producer” that begat the awkward “executive produced.” It’s also not the best reflection of the noble nature of healing the sick to impersonalize the process as “patient intake” like they are birds being sucked into a jet engine.

Listening: Shudder to Think, a long-defunct DC indie hardcore band whose album was tracking in the vinyl store / bar I was in today as I was looking over an album by Lothar and the Hand People, which I would bet nobody in the place ever heard of except me.


None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.



House call provider Landmark Health hires Rod Jardine (DST Systems) as CIO.


Scientific American says the rush of artificial intelligence systems into patient care has significant potential, but those systems are overhyped, they are often created by technology companies whose rush to market may endanger patients, they sometime deliver illogical results after being trained on illogical data, and companies haven’t proven their effectiveness via peer-reviewed journal articles. An industry expert says AI developers aren’t interested in spending the time and money on clinical trials, noting that, “It’s not the main concern of these firms to submit themselves to rigorous evaluation that would be published in a peer-reviewed journal. That’s not how the US economy works.”


An outcomes expert questions a study claiming that Livongo for Diabetes reduced medical spending by 22%, noting:

  • The article was written by Livongo employees and employees of drug manufacturer and Livongo partner Eli Lilly.
  • Journal of Medical Economics, in which the article appeared, fast-tracks such articles for cash.
  • The journal’s measured influence is low and the article has been cited few times since it ran.
  • The authors were asked to disclose that they couldn’t prove that Livongo users had lower medical spending, so they said the results “imply” it.
  • The “participants versus non-participants” study design is known to be invalid, with the difference in outcomes always attributable to study design rather than the intervention itself.
  • The author called the author of website HIT Consultant “the dumbest member of the media” after it “swooned over Livongo’s outcomes” without understanding the study’s many flaws.

The Pentagon urges service members ignore their 23andMe and Ancestry Christmas gifts, warning that sending off their DNA samples could compromise security and place their military career at risk if their information is exposed and suggests risks to military readiness. They also note that the tests are unreliable anyway.

A Kaiser Health News article says EHRs are creating a “new era” of healthcare fraud, but it’s all over the place, trying to connect the dots from previous new stories, some of them involving accusations that haven’t yet been proven:

  • EHR vendors are concealing software problems that endanger patients.
  • EHR vendors gamed the Meaningful Use payout system by falsifying certification test results even though it was an “open book test” where their systems had to perform a limited, published set of tasks.
  • Hospitals and practices falsely attested to having met MU requirements to earn their chunk of the $38 billion in federal payouts.


A fascinating set of tweets addresses the admirable American phenomenon of “aging in place” that conflicts with our suburban sprawl of cul-de-sac neighborhoods where public transportation can’t effectively reach. The result: aging people remain in their homes but are unable to drive, so they assume their transportation needs will be met by unpaid family and caregivers, but the reality is that they rarely leave. I suppose ridesharing services are the answer for those seniors who are comfortable using smartphone apps and who can afford the fare. 


Penn Medicine Listening Lab invites people to share their stories about experiencing real communication as a form of care during their illness. One submission was from a doctor who noticed that his new patient was clutching a large envelope, and when he looked up from EHR data entry long enough to ask about it, the man explained that his son had died of cancer at 32 and “he was looking for a chance to tell his son’s story before he told his own.” That reminded me of project my health system ran years ago in which employees were coached to go beyond the rote performance of their duties to ask patients, “Can I help you with anything else? I have the time.” The “I have the time” part is the secret sauce, because we healthcare people are always rushing around in front of our current patient / widget. Our IT field support techs had already learned this – they knew that once they went out to a nursing station to work on a printer or something, they could make themselves and the rest of us heroes by simply looking up from the paper jam to ask the folks around them how it was going. It was initially surprising how many problems our clinical employees asked them for help with email, browsers, Wi-Fi, etc. and we could have fixed them easily had they opened a support ticket. We got even smarter and started rotating our support center people out on the floors, which dramatically increased empathy on both sides of the IT fence.


Charities, including hospitals, are fundraising by running telethon-like pitches to the live streams of online gamers and other streamers. St. Jude’s Children’s Research Hospital has raised $20 million from 20,000 participants since 2014, while Children’s Miracle Network Hospitals has taken in $70 million.



Mr. H, Lorre, Jenn, Dr. Jayne.
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Morning Headlines 12/26/19

December 25, 2019 Headlines No Comments

Artificial Intelligence Is Rushing Into Patient Care – And Could Raise Risks

Experts say AI could have a big healthcare impact, but worry about excessive hype, the tech industry’s mantra to “fail fast and fix it later,” systems whose training allows them to base predictions on meaningless data points, and the absence of any randomized clinical trials proving that such systems actually work.

Pentagon Warns Military Personnel Against At-Home DNA Tests

The military urges service members to decline to take consumer DNA tests because they create security risks, their results are unreliable, and they could lead to unintentional discovery of genetic information that could jeopardize their military career.

CoverMyMeds about to grow to 1,500 jobs – as outgoing CEO Matt Scantland charts what comes next

CoverMyMeds will grow to 1,500 employees by the end of March, triple its headcount since McKesson acquired the medication prior authorization company three years ago.

Morning Headlines 12/24/19

December 23, 2019 Headlines No Comments

Electronic Health Records Creating A ‘New Era’ Of Health Care Fraud

Kaiser Health News covers fraud by hospitals and medical practices in receiving Meaningful Use payments, by vendors that overstated their MU compliance, and in false claims settlements by Greenway Health and EClinical Works, with experts concluding that the MU program was poorly conceived and that most of the money was handed out too early in the program when providers were paid for doing little beyond agreeing to participate.

Health documents reveal patient harm linked to Queensland’s new medical record system

In Australia, a TV news department’s Right to Information request finds that 95 cases of patient harm have been attributed to Queensland Health’s Cerner IEMR system in just over a year, with 45 incidents being caused by user error and 32 by poor usability.

Sunnybrook Health Sciences Centre and Evident Partner to Improve Patient Outcomes in Canada

CPSI’s Evident business unit and Sunnybrook Health Sciences Centre announce plans to develop a Canada-specific hospital information system that will combine the health center’s Sunnycare system with the Evident EHR.

Besler acquires majority ownership in Panacea Healthcare Solutions Inc.

Reimbursement solutions vendor Besler acquires a majority ownership position in Panacea Healthcare Solutions, which offers physician revenue cycle services and technology. 

For Her Head Cold, Insurer Coughed Up $25,865

A woman’s insurer pays $26,000 for a PCP visit in which she received only a throat swab and blood test, with much of the expense being the exotic DNA tests – all of which were negative – the doctor sent off to an out-of-network lab whose price was 20 times higher than average in her area. The lab is apparently owned by the doctor. 

New FDA Commissioner Takes Over Predecessor’s Twitter, Deletes All Previous Tweets

New FDA Commissioner Stephen Hahn, MD converts the @SGottliebFDA twitter account to @SteveFDA to keep his predecessor’s 44,000 followers for “maximum exposure,” but also deletes all of Gottlieb’s tweets and public comments, which some some experts say raises ethical concerns.

Curbside Consult with Dr. Jayne 12/23/19

December 23, 2019 Dr. Jayne 2 Comments

A student reached out to me recently, looking for a primary care physician willing to host him for a four-week clinical clerkship. I used to be a preceptor for both of the local medical schools but haven’t hosted anyone since I stopped practicing traditional primary care more than a decade ago. A call to the primary care clerkship office revealed that a computer glitch brought me back from the virtual dead, along with a number of physicians who are no longer able to host, and we were able to get it straightened out pretty quickly.

Still, I enjoyed chatting with the student, who had never heard of clinical informatics and had no idea what a physician might do besides conducting research or seeing patients clinically.

I was a little shocked by this since the medical school he attends is affiliated with a health system that just spent nearly half a billion dollars on an EHR overhaul. He’s already in the middle of his first clinical clerkship year, so theoretically he has been exposed to the hospital and countless resident and attending physicians complaining about the EHR or how it works. I would have hoped that the orientation to the EHR might have included an outline of how to request changes in the system, which would theoretically include mention of physicians serving on committees or in leadership roles who would have input into any requested changes. Apparently none of these things happened or were ever discussed, or my potential student missed the mention.

In hindsight, I think it’s more likely the former, since the hospital (and health system) in question still does not have a functional CMIO role. They have a number of clinical VPs and other titled people who are supposed to play a role in the governance of clinical informatics, but the reality is they have a number of other things on their plates that takes them away from actual informatics work. From what I understand from my peers, they don’t have functional governance structures and part of the IT team is devoted to just building what is needed to silence the squeaky wheels. The community physicians are up in arms about changes that are put in place for the academic faculty, and there’s a lot of duplicate work going on as they build different work streams without a unified approach.

I think the student enjoyed hearing about alternative careers for primary care physicians, especially once we talked a little about healthcare finance in the US and the high level of burnout among primary care physicians. His school isn’t doing a good job educating him on that topic either, since he had little understanding of Medicare or Medicaid or commercial insurance and the pressures felt by physicians as they try to navigate our healthcare non-system on behalf of their patients.

I suppose this might be one of the key goals of the primary care clinical clerkship, to expose students to such things since they’re probably not seeing it in the halls of the ivory tower. On the other hand, especially with the new push for premedical students to already have clinical experience before they apply to medical school, I was surprised by how little he knew.

He was also unaware of the salary limitations for primary care physicians. When I asked him if he had a ballpark idea what he might make in practice, he quoted a starting salary that was more than one and a half times that of an independent primary care physician with a well-established practice and an excellent payer mix with minimal Medicare and no Medicaid.

In my heart, I don’t want students to choose their specialties based on earnings potential, but I don’t want them to be surprised, especially when they’ll be leaving school with nearly half a million dollars in student loan debt. Granted, physicians still make a very good living, but many of us now in practice didn’t graduate with anywhere near that kind of debt. I was lucky with no undergrad debt, but still had to borrow the entire amount for medical school over and above what I had saved from jobs at the golf course, the donut shop, editing people’s term papers, and substitute teaching.

We talked a lot about how I came to be in clinical informatics and how I see the role. Usually I summarize it as being a translator or mediator – being able to work with clinical teams, operations teams, and the technology teams to identify ways that we can better the mission of patient care. Sometimes it’s process improvement work, sometimes it’s deep technology design work, and sometimes it’s just handholding for providers who are at their wit’s end. There are days when it’s sheer boredom (lab interface crosswalk build – if you’ve never tried it, you’re missing out) and some days are exhilarating (go-lives gone well). The rest of the time can be a roller coaster, but I wouldn’t trade what I do for a more traditional medical career.

I’m sorry I wasn’t able to teach him how to be a family physician, or to share how enjoyable it can be to take care of patients over time and to get to know them and their families. I like to think that he did learn something over the course of our conversations, though, even if it was just that he needs to do a little more investigation before he decides on a specialty. He has a few months left before he has to start applying for residency positions, when seems relatively short when you’re deciding how you want to spend the rest of your life.

I also gave him my standard advice: learn about the business of healthcare; learn about personal finances; don’t spend “like a doctor” when you get out of school; and find some non-work-related activities that will keep you company for the rest of your life. I was lucky to have learned many of those lessons along the way, but some of my peers, and many non-physicians as well, learned those topics the hard way.

I wonder how the medical school would receive the idea of a class covering these topics. Healthcare has certainly changed in the time I’ve been out of school, and not always for the better. There are driving forces that many in the industry don’t understand, whether they’re clinical or not.

On the other hand, isolating students from the reality of what they’re getting into might be useful to maintain the physician pipeline. I know quite a few of us who wouldn’t have done it had we known then what we know now. I see some of those former colleagues in hospital administration roles, industry roles, etc. You can always tell the people who really enjoy patient care because they often fight for the ability to keep their toes in the water, even if it’s only a couple of days a month. Of course, not all employers are sympathetic, and many more are forced to give up their clinical aspirations.

What does this have to do with the larger topic of healthcare IT? It’s food for thought to help us understand the force that shape clinicians and why they might act the way they do when faced with uncomfortable or unwanted change, or when some bit of technology puts them over the edge. Maybe if they were better integrated into the healthcare IT ecosystem earlier in their training, we would be fighting fewer (or at least different) battles. Maybe they wouldd feel more empowered to demand better usability and not just go along with what their hospital says they are going to use. Maybe they would see “the IT people” as less of a threat and more of a team working towards common goals.

How does your organization onboard medical students? Do they understand what the technology teams do? Leave a comment or email me.


Email Dr. Jayne.

Morning Headlines 12/23/19

December 22, 2019 Headlines No Comments

Australians shun My Health Record with only 9 per cent ever logging in

Government health officials in Australia admit that while 23 million people have a My Health Record online health account, 91% of them have never logged in and most of those who did log in have not returned.

Abbott Labs kills free tool that lets you own the blood-sugar data from your glucose monitor, saying it violates copyright law

Drug maker Abbott Labs issues a takedown notice to a diabetes support group that told users how to extract their own blood sugar readings from the company’s continuous glucose monitor and monitor them on a free software tool.

New Software Targets ICU Delirium

Epic works with Vanderbilt University Medical Center (TN) to release workflows that prevent ICU delirium.

Monday Morning Update 12/23/19

December 22, 2019 News 2 Comments

Top News


In Australia, government health officials admit that while 23 million people have a My Health Record online health account – most of them only because enrollment was changed from opt-in to opt-out early this year – 91% of them have never logged in and most of those who did log in have not returned.

A large percentage of public hospitals, pharmacies, and medical practices are connected, but only 33% of private hospitals and less than half of medical and diagnostic labs.

The Australian Digital Health Agency has had to pay software vendor, pathology providers, and imaging providers for integration in trying to boost data availability and usage.

The system cost more than $1 billion to develop and annual maintenance costs are estimated at $350 million.

The digital health agency’s CEO is Tim Kelsey, who just resigned to take an SVP job with HIMSS. 

HIStalk Announcements and Requests


About half of poll respondents who had a provider visit in 2019 had to provide the same information to a different provider who didn’t have access to it otherwise, while 9% found that the information their providers shared contained errors and 2% experienced clinical harm from a lack of data sharing. Half-Wit says her 35-year health IT career seemed like a waste of time when a GI specialist remembered only after asking her a long list of questions that she could have simply looked it up in the EHR in front of her. HISJunkie gave an Epic MyChart download on thumb drive to a new, Allscripts-using practice and was told that they can’t use the electronic information, and when he gave the doctor a hard copy printout of the same information, the doctor insisted on asking him questions off his own EHR screen instead of looking at the paper and even then entered only about half the information.

New poll to your right or here: Which winter holiday is most important to you?


None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.


  • Northeast Georgia Health Systems (GA), Salem Health (OR), and Saber Healthcare Group choose Hyland Healthcare’s OnBase enterprise information platform.



Beaumont Health hires Hans Keil, MBA, MA (PerkinElmer) as CIO.


Gary Gerber (Hyland) joins Heartbeat by Intelligent Imaging as chief strategy and revenue officer.


Verge Health promotes Connie Moser, MBA to CEO and board member, replacing Mark Crockett.

Announcements and Implementations

Epic works with Vanderbilt University Medical Center to release ICU Liberation Bundle, workflows that prevent ICU delirium by reminding clinicians to discontinue analgesics and sedatives, test the patient’s waking and breathing, perform delirium assessments, and get the patient out of bed to encourage mobility and exercise.

Government and Politics

CHIME expresses its support for Congress’s spending deal, which calls for HHS and ONC to support private sector patient matching initiatives. The spending bill does not lift the government’s ban on funding such a program directly.

Sutter Health will pay $575 million to settle the state of California’s claims that it engaged in non-competitive behavior. Sutter will also be prohibited from using “all or none” terms in requiring insurers to include all of its facilities if they include any of them, and also from charging excessively for providing out-of-network services.



The Madison paper profiles Kiio, a 14-employee startup whose app assesses low back pain, refers the patient to the appropriate resource, and provides a customized exercise program with animated instructions. The company says users report a 50% reduction in pain and 90% of them would recommend the program.

Drug maker Abbott Labs issues a takedown notice to a diabetes support group that told users how to extract their own blood sugar readings from the company’s continuous glucose monitor and monitor them on a free software tool. Abbott says the free tool infringes on its copyrights and claims that a patient’s own blood sugar readings are its copyrighted property.

A Columbus, OH ED doctor ponders the amount of time she spends reassuring healthy patients that despite what they have found in their Internet medical searches, they don’t need emergency treatment. She also wonders how she should close those encounters without triggering low-score patient satisfaction surveys.

Sponsor Updates


  • Nordic staff volunteer at The River Food Pantry in Madison, WI.
  • PCare publishes a new solutions paper, “Patient Ambassador Program Best Practices.”
  • Gartner recognizes PatientSafe Solutions in its “Market Guide for Clinical Communication and Collaboration.”
  • KLAS Research recognizes Arcadia’s population health management platform for its ability to support identifying and closing gaps in care.
  • Redox releases a new podcast featuring Dr. Bill Hanson, CMIO of Penn Medicine.
  • Relatient publishes a new case study, “Kentuckiana Pediatrics Group Finds Patient-Centered Billing is Key to the Patient Journey.”

Blog Posts



Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
Send news or rumors.
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Weekender 12/20/19

December 20, 2019 Weekender No Comments


Weekly News Recap

  • The National Academy of Medicine publishes an overview and recommendations for the use of artificial intelligence in healthcare.
  • LifeLabs, Canada’s largest lab testing company, admits that it paid a hacker’s ransom to recover its systems in an October breach that affects 15 million patients.
  • Amazon Web Services adds ICD-10 and RXNorm linking to its Amazon Comprehend Medical natural language processing service.
  • HIMSS hires Tim Kelsey, CEO of the Australian Digital Health Agency, for an SVP of analytics job.
  • Hackensack Meridian Health, New Jersey’s largest health system, admits that it has paid a ransomware hacker to regain access to its systems.
  • A Florida pain management chain pays $85,000 to settle HIPAA charges that it ignored a patient’s request to send an electronic copy of their medical records to a third party.
  • Partners HealthCare announces a five-year, $100 million digital health initiative.

Best Reader Comments

The data quality problems occur because of the vendors, the practices, the clinicians, and external bias generators (Insurance, MU, etc.) These causalities all have an impact to the data at its source. Extracting data and transforming it only makes the data worse. And I find that most people working the data do not consider the source, or the destination of the data,  to understand how it was created and what the requested usage is. Lots of problems to be solved here before we start thinking that AI can create”‘whirled peas.” (HITInteropGuy)

As a parent of a teenager with type 2 diabetes using the Dexcom continuous glucose monitor synced to my iPhone, please alert your readers that this monitor does not sample blood glucose levels. In fact, it is measuring interstitial fluid ( lymphatic fluid) glucose levels and there’s quite a delta in the reading accuracy, especially during large swings. We had to stop using it because of his sports and my obsession watching his glucose levels fluctuate on a minute by minute basis.(El Comandante)

I believe one of the unstated goals of the Meaningful Use program was to reduce the number of EMRs available by creating a certification process that required significant development investment. The ONC was clearly aware that interoperability was hard, and that by reducing the number of EMRs, it becomes less of a burden. The result was a reduction in the total number of ambulatory EMRs as smaller players couldn’t afford to develop the required capabilities.A conspiracy theorist might posit that this also aligns with the fact that smaller EMR companies are not funding campaigns and lobbying efforts. The benefit of MU primarily accrued to the large EMR vendors. (Notmeaningless)

I don’t know how it is in the EMR space; I’m in the imaging space, but there the smaller players sometimes can and do develop the required certification capabilities. The hurdle is often in another place entirely — they can’t afford to invest in the certification process. That being said, not every smaller player is good in terms of capabilities. Some are downright terrible. So certification has its place, if done right. (Clustered)

Interesting that OTTO was headed by ex-Epic Sarah Green. Also another Ex-Epic just became CEO of IDX, an AI diagnostics company. Curious how many other old colleagues are now in C-Suites. (AnotherExEpic)

If this is how data ownership should work, why would this be limited to only healthcare? Credit rating agencies make huge amount of money buying, aggregating, and selling data about your credit worthiness. Online data brokers make even more money collecting and selling data about your online habits. Assuming that our society decides that “data about me” is automatically “data that belongs to me” for healthcare, does it stop there? Why would “data about my body” be more sacred than “data about my habits”? (TH)

Watercooler Talk Tidbits


I received generous Donors Choose donations from Mark, Dana, Friend at Impact, and the IT directors of Atlantic Health System (NJ), which with matching funds from my Anonymous Vendor Executive and other sources fully funded these teacher projects, all of which involve schools in high-poverty areas:

  • Math manipulatives for Ms. O’s kindergarten class in Creedmoor, NC
  • Math manipulatives for Ms. P’s elmentary school class in Minneapolis, MN
  • A learning table for Ms. H’s elementary school class in Philadelphia, PA
  • Codable Legos for the coding club of Mr. M’s middle school class in San Diego, CA
  • Lego sets for the fourth grade class of Ms. C in Williamsburg, KY
  • Flexible seating for Ms. A’s kindergarten class in Cape Coral, FL
  • Copy paper, composition books, and cleaning wipes for Ms. C’s elementary school class in Hempstead, NY
  • Math tiles for Ms. S’s elementary school class in Woodside, NY
  • Learn to Code Ladybug for Ms. P’s kindergarten class in Dallas, TX
  • STEM Lego sets for Ms. G’s elementary school class in Baltimore, MD
  • Math manipulatives for Ms. M’s elementary school class in Yakima, WA
  • A field trip to the Discovery Lab for Ms. M’s elementary school class in Tulsa, OK
  • Programmable robotics kits for Ms. D’s elementary school class in Tamarac, FL
  • Five tablets and cases for Ms. M’s elementary school class in Magnolia, MS
  • Two Chromebooks for Ms. M’s elementary school class in Miami Gardens, FL
  • A Viewsonic projector and bluetooth speaker for Ms. P’s elementary school class in Baltimore, MD
  • Three laptops for Ms. C’s elementary school class in Washington, DC
  • STEAM sensory tiles for the children with disabilities elementary school class of Ms. A in Staten Island, NY
  • Video production equipment for Ms. M’s middle school class in New Cumberland, WV
  • Accommodations for a field trip to Washington, DC for the fifth grade class of Ms. C in Brooklyn, NY


Surveyed doctors and nurses say that “Scrubs” and “ER” are the most realistic medical TV shows. They note that unlike what other shows portray, doctors don’t really cover everything from surgery to OB, they don’t sprint through the ED doors to meet ambulances, and they don’t usually respond to emergency cases with an insightful diagnosis of some weird problem and instead focus on stabilizing the patient.


The families of people who die at home in France must have a doctor’s signed death certificate before moving the body, but a shortage of GPs willing to travel to the homes of patients they don’t know for a flat rate of $110 means families often must leave the body in their homes for several days. Some towns have passed laws that make dying at home illegal.


A start-up in England invents a toilet with an “inconveniently sloped” seat that intentionally makes users uncomfortable after five minutes, citing the employer productivity benefits from shortening the average 28-minute bathroom break. This if anything proves that it’s time to make “Office Space 2.” Or to launch a startup selling corporate-issued diapers.


Twitter hackers post flashing strobe light GIF images to followers of the Epilepsy Foundation, apparently hoping to induce seizures. I’m beginning to think that humans are too evil to allow anonymous public postings.


A Harvard Medical School analysis of US doctor traffic tickets finds that psychiatrists are the most likely to be caught for “extreme speeding,” while cardiologists are the most common Ferrari-driving specialty.


A teenager who was hospitalized with lupus during Christmas two years continues her annual tradition of creating Christmas tree kits for kids at UC Davis Children’s Hospital. She and her family brought 60 sets of decorated trees to the hospital.

In Case You Missed It

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Morning Headlines 12/20/19

December 19, 2019 Headlines No Comments

NCPDP & Experian Health Announce 100% of the U.S. Population Has a Universal Patient Identifier, Powered by Experian Health UIM and NCPDP Standards™

Standards developer NCPDP and Experian Health announce that they have assigned a Universal Patient Identifier to all 328 million Americans.

Hospital execs say they are getting flooded with requests for your health data

Hospitals report that they are being inundated with requests to sell patient information to technology companies, many of them well-funded Silicon Valley startups that need to train their newly developed AI systems.

Mass General team detects Alzheimer’s early using electronic health records

Massachusetts General Hospital scientists say they can predict dementia by scanning their EHR data for a list of cognitive-related terms using natural language processing.

News 12/20/19

December 19, 2019 News 3 Comments

Top News


The National Academy of Medicine publishes “Artificial Intelligence in Health Care: The Hope, the Hype, the Promise, the Peril.” Its major points:

  • EHR and consumer data are widely available, but wider adoption of common data models and FHIR are needed to support AI projects.
  • Inclusion and equity must be incorporated to prevent expanding existing health outcomes inequities as has occurred with other consumer-facing technologies.
  • Transparency guidelines need to be developed to create trust.
  • Near-term focus should be on supporting what clinicians already do rather than replacing them, such as by providing guidance to non-specialists, filtering low-acuity or normal cases, addressing inattention and fatigue, and automating business processes.
  • AI training and education should be incorporated into continuing medical education.
  • Health systems should implement AI solutions only if their IT governance process is mature and only if no low- or no-technology solutions already exist. National efforts will be required to support AI deployment in lower-resource environments to support healthcare equity.
  • Regulatory challenges will remain for AI developers, but the FDA approach of considering the level of patient risk, the level of AI autonomy, and the level of static or dynamic AI behavior should be taken into account and post-marketing surveillance is needed to evaluate a given model’s ongoing learning. 

Reader Comments


Randy Bak, MD, JD added a comment — in response to my observation that doctors aren’t good at practicing evidence-based medicine – that is worth running here (with my edits):

Not all patients fit the target of a care guideline. They become care guidelines when most patients should be treated that way. You could call the result art rather than science, but some hardheadedness still applies. If you treat most patients as exceptions to the guideline, then you are out of bounds, just as you are if you treat all patients by the guideline. The key is understanding what makes an exception, and even then realizing that sometime you will be wrong.

Managers looking at how clinicians respond to guidelines need to look at actual practice, but they also need to apply the same kind of hardheadedness about measurement and its conclusions.

Small sample sizes don’t tell you a lot about a practice pattern. They say it takes about 30 samples to get a reasonable approximation of the normal curve of a phenomenon, so if you start judging physician practice based on 10-20 cases, you’re looking for trouble. Even when you get decent sample sizes, they remain just that– samples. Regression to the mean is a real phenomenon. Worse is that, especially in low sample-size settings, last year’s champion can be next year’s black sheep. Sampling must be repeated over time get to the “truth.”

Use case exists where real measurement can be applied, such as surgical procedures. Just about every practice has something that occurs frequently enough to allow reliable measurement. There is not infrequently a halo effect or inference that can be made from what is measurable to what is not, which can drive management of that clinician. Still, caution is due.

As in sports, individual measures may not tell the whole story.  I am fascinated at how pro sports geeks have gone “moneyball” on metrics, trying to find measurements that tell them how to spend their team budget. Is there a way to get to “outcomes above replacement” or such things that tell you this clinician improves the care all around them?

HIStalk Announcements and Requests


Unrelated, other than seasonally: Rev, the transcription company I use for interviews, sent a holiday email that contains the perfect mix of humor, holiday cheer, and sly self-promotion.


Thanks for the cool holiday swag from Ellkay, which included several flavors of honey from the company’s rooftop beehives. I don’t usually get vendor marketing stuff other than at the HIMSS conference, but Ellkay’s is the best, and the honeybee connection is the most memorable, feel-good tie-in that I can think of.


None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.

Acquisitions, Funding, Business, and Stock

RCM vendor Streamline Health will sell its legacy enterprise content management business to Hyland.


  • Baptist First Health (KY) will integrate ActX’s genomic decision support software with its Epic EHR.



Aspire Health co-founder Brad Smith will become the new head of the Center for Medicare & Medicaid Innovation.


Augmedix names Davin Lundquist, MD (CommonSpirit) as chief medical officer.

Announcements and Implementations


OhioHealth implements KitCheck’s Bluesight for Controlled Substances across 10 hospitals.


Rush University System for Health (IL) integrates Mytonomy’s Patient Experience Cloud care education software with Epic’s MyChart.


Online health and wellness company Hims & Hers will offer customers in Florida access to telemedicine for chronic conditions through Ochsner Health System (LA) beginning next year.


Employer-sponsored provider QuadMed implements Epic.


KLAS is apparently branching out from purely technology coverage given its new reports on worksite health services and value-based care consulting. I’m not all that interested in either, but the first report gives Cerner a B- and QuadMed – announced above as having implemented Epic – a D+, while the second puts Deloitte at the top as a transformational partner.

Government and Politics


CMS temporarily shuts down the Blue Button 2.0 system after a developer notifies the agency of a bug that may have exposed Medicare beneficiary data. CMS will restore service after it finishes a quality and validation review.

Privacy and Security


LifeLabs, Canada’s largest laboratory testing company, notifies patients of an October ransomware attack that compromised a server used for online appointment bookings. The company, which admits that it paid the hacker’s demanded ransom, says 15 million customers were affected and the lab results of 85,000 of them were exposed.



Standards developer NCPDP and Experian Health announce that they have assigned a Universal Patient Identifier to all 328 million Americans. Experian Health creates the UPI when a a provider, pharmacy, or lab sends it patient demographic information, then sends back specific identity information. The assigned UPI itself is not disclosed to the patient or provider to prevent its misuse.

Hospitals report that they are being inundated with requests to sell patient information to technology companies, many of them well-funded Silicon Valley startups that need to train their newly developed AI systems. Jefferson Health says companies that get a firm “no” from its executives then try to twist the arms of individual doctors and researchers. Jefferson Health’s cancer center director Karen Knudsen, MBA, PhD drily observes, “We often find, once we look deeper into the pitch, that it starts as a joint development project and ends up somehow with us being both the product and the customer that pays for the product.”


The CEO, a director, and four researchers of H. Lee Moffitt Cancer Center & Research Institute (FL) resign after its compliance department finds conflict of interest violations in their ties with research organizations in China. The cancer center’s founder says the group was found to be “secretly accepting money from China.”

Massachusetts General Hospital scientists say they can predict dementia by scanning their EHR data for a list of cognitive-related terms using natural language processing.


MIT researchers say their Gates Foundation-funded, patch-based vaccine delivery system would not only eliminate the need for syringes, it wouldn’t require an EHR for documentation either since the patch leaves a skin pattern that can be detected by smartphone.

Sponsor Updates

  • PatientPing makes Vynca’s advance care planning data available to providers within its real-time care collaboration network.
  • Meditech releases a new video, “Meditech Expanse Delivers the Power of Mobility to Androscoggin Valley Hospital.”
  • Pivot Point Consulting names Kyle McAllister (Nordic) director of strategic implementation.
  • Greenway Health makes the Carequality Interoperability Framework available to its Prime Suite and Intergy EHR customers via the CommonWell Network.
  • CHIME interviews The HCI Group’s VP of Operations and Strategy, Chris Belmont.
  • PatientSafe Solutions is recognized in Gartner’s “Market Guide for Clinical Communication and Collaboration.”
  • The New Pittsburgh Courier honors ConnectiveRx Director of Pharmacy Operations Natalie Tyler with a Women of Excellence Award.
  • LaTonya O’Neal (Change Healthcare) joins The Chartis Group as principal.
  • Vyne Medical and its Trace interaction capture solution are featured in KLAS’s “2019 Revenue Cycle Unicorns Report.”
  • Cigna expands its relationship with MDLive to include virtual visits for behavioral healthcare.

Blog Posts



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Donors Choose Updates 12/19/19

December 19, 2019 Announcements, News No Comments


This will be a lengthy summary of this week’s Donors Choose activity, all of which was funded by HIStalk reader contributions. Donation instructions:

  1. Purchase a gift card in the amount you’d like to donate.
  2. Send the gift card by the email option to (that’s my Donors Choose account).
  3. I’ll be notified of your donation and you can print your own receipt from Donors Choose for tax purposes.
  4. I’ll pool the money, apply all matching funds I can get, and publicly report here which projects I funded, including teacher follow-up messages and photos.

Donations from Christina, Bill, Mike, Carla, and Diameter Health

These donations totaled $2,850. My Anonymous Vendor Executive matched their donations two-for-one, plus I found third-party matching (up to five-to-one) that allowed me to fully fund at least $30,000 worth of classroom projects. I choose mostly math and science teacher grant requests unless a teacher’s write-up moves me to meet a different type of classroom need.

  • Physics lab supplies for Ms. S’s high school class in Hayward, CA
  • A Lego station for Ms. S’s first grade class in Grants Pass, OR
  • Headphones for Ms. M’s kindergarten class in Chandler, AZ
  • Game buzzers and wobble cushions for Ms. H’s elementary school class in Pink Hill, NC
  • STEM activity kits for Ms. A’s elementary school class in Glendale, AZ
  • Programming logic games for Mr. C’s elementary school class in New York, NY
  • Electronic white board technology for Ms. E’s elementary school class in West Sacramento, CA
  • A programmable robot for Mr. L’s middle school class in Espanola, NM
  • A document camera for Ms. R’s middle school class in Houma, LA
  • A physics professional development course for Ms. S, a high school teacher in Hayward, CA
  • Computer lab headphones for Ms. M’s pre-school class in Theodore, AL
  • STEM kits for Ms.G’s first grade class in Los Angeles, CA
  • Wiggle chairs for Ms. E’s first grade class in Richton, MS
  • Osmo coding games for Ms. F’s first grade class in Ypsilanti, MI
  • Dry erase boards for Ms. G’s technical high school class in Cleveland, OH
  • Legos and K’Nex kits for Ms. P’s elementary school class in Stratford, CT
  • STEAM lab kits for Ms. H’s elementary school class in Glenarden, MD
  • Robotic programming kits for Ms. P’s kindergarten class in Moreno Valley, CA
  • Headphones for Ms. S’s elementary school class in Miami, FL
  • Math centers for Ms. T’s elementary school class in Frankfort, KY
  • Robotic competition supplies for Mr. H’s high school class in San Francisco, CA
  • Hands-on math activities for Ms. T’s pre-K class in Houston, TX
  • STEM supplies and reading games for Ms. N’s elementary school class in Miami, FL
  • A programmable scientific calculator for Mr. H’s high school class in Bakersfield, CA
  • STEAM kits for Ms. C’s elementary school class in Las Vegas, NV
  • A table for Ms. M’s middle school class in Palermo, CA
  • Programmable robots for Ms. E’s first grade class in Emerson, GA
  • Programmable robot for Ms. L’s pre-K class in Halifax, VA
  • A projector and Chromecast for Mr. G’s middle school class in Penitas, TX
  • A programmable robot for Ms. B’s middle school class in Phoenix, AZ
  • Classroom supplies for Ms. G’s elementary school class in Bayonne, NJ
  • A document camera for Ms. P’s elementary school class in Irvington, NJ
  • A programmable robot for Ms. M’s elementary school class in Seguin, TX
  • Composition supplies for Ms. C’s International Baccalaureate class in Hempstead, NY
  • Dry erase boards and chart tablets for Ms. J’s elementary school class in Springfield, MA
  • Headphones for Ms. K’s elementary school class in El Monte, CA
  • Library carpet and seating for Ms. S’s kindergarten after-school program in Philadelphia, PA
  • Math towers and indoor recess supplies for Ms. W’s all-girl fourth grade class in Bronx, NY
  • A classroom library of books for Ms. O’s middle school class in Glendale, AZ
  • A trip to the health museum for Ms. C’s high school class in Houston, TX
  • A programmable robot center for for the elementary school library of Mr. H in Stockbridge, GA
  • Wiggle chairs and math games for Ms. S’s kindergarten class in Cincinnati, OH
  • Pep club supplies for Ms. M’s middle school class in Ayden, NC
  • Multicultural learning materials for Ms. M’s preschool class in Fayetteville, NC
  • Math games for Ms. H’s preschool class in Midland, MI
  • STEM centers for Ms. S’s elementary school class in Brooklyn, NY
  • Space learning materials for Ms. B’s elementary school class in St. Louis, MO
  • STEM and coding resources for Ms. R’s elementary school class in Grand Prairie, TX
  • An Apple TV for Mr. K’s high school class in Kansas City, MO
  • An interactive learning tablet for Ms. M’s head start class in Kalamazoo, MI
  • Lego kits for the library of Ms. G in Dallas, TX
  • STEM kits for Ms. O’s elementary school class in El Paso, TX
  • STEAM kits for Ms. W’s elementary school class in Chesapeake, VA
  • Programmable robots for Ms. O’s elementary school class in Paintsville, KY
  • Wi-Fi microscopes and headphones for Ms. W’s elementary school class in Cleburne, TX
  • Math manipulatives for Ms. C’s preschool class in Blountstown, FL
  • Programmable robot for Ms. K’s gifted elementary school class in Atlanta, GA

A Sample of Initial Teacher Responses

I want to thank you for contributing to this project. Thank you for caring for 28 girls you have never met BUT whose lives you have impacted.

This is my first experience with Donors Choose. What an amazing experience it has been! The idea that we, in public education, have partners who look for opportunities to fund learning activities for our students is life changing. Funds are hard to come by in an urban school. Our students will be building Lego projects in the library for years to come. Who knows where they’ll go from here? My heartfelt thanks.

Thank you for gathering my students in your arms and giving them a huge hug. Thank you for “dropping a stone” and creating a positive ripple in each of these kids’ lifelines.

Christmas came early in Room 305! Thank you so very much for your generous donation!! My students and I are so excited for the STEM activities to arrive! I can’t wait to see their little creative minds grow!

Thank you so much for your contributions that led to the funding of my project! Because of your contribution, I will be able to grade student work more efficiently, spend greater time planning dynamic, student-centered learning activities for my students, and introduce them to technology they will use increasingly more as they progress to more advanced math classes. Your donation will allow me to be more effective as a teacher by providing me with a valuable tool used in evaluating student work and in planning student learning. Thank you so much for this generous donation to my classroom!

I am overwhelmed by you generosity! This kind of project is something that will really motivate my students and I couldn’t have funded it without you. This is incredible news that will shape the rest of the school year. A classroom full of Kindergarten students says thank you, thank you, thank you

Words cannot express how appreciative of your generosity I truly am. My students will enjoy the ability to code and build using the new tools they will be getting thanks to your donation. Our classroom will be an energized, STEM class when our new tools get here. Thank you again for your support!

Thank you so much for supporting my students and their learning! I hope to be able to use these headphones to enhance their learning during Tech time and improve their scores in both Math and Language. They are going to be so very happy to have their own headphones now!

I’m overjoyed to be able to bring hands-on coding experiences to my youngest students. You made this possible with your generous donation. I plan to quickly implement lessons where the Code and Go Mouse kit and the board game will allow my students to fully comprehend coding while using computational thinking. Thank you for making this all possible!

Thank you so much for investing into the lives of the scholars in my classroom! Every Friday, we set up STEAM labs for scholars to rotate through where they are free to explore, create, and investigate. Thanks to your donation, we can continue to strengthen the curious minds of 20 scholars who come from environments where success is just a dream!

On behalf of the third grade students here at Cooke Elementary, we thank you for helping us achieve science greatness. We have learned to love science, but with the new microscopes it will deepen our love because we will be able to seen the unseen. The earphones will give us the opportunity to learn with disturbing others around us.

WOW is all I can say. You have made our dreams come true. I can see my students growing and learning by leaps and bounds. They love computer time and their biggest complaint was they wished they had headphones to hear better. The kids are blown away by your kindness. Thank you for the headphones and Happy Holidays.

This will make me and my class so happy!! These items will make coming back to school after break that much more exciting. You have no idea how appreciative we are. I can’t wait to show my mini engineers in action.

Thank you from the bottom of our hearts. Your kindness has warmed this cold day and made us all believe in the kindness of others. All I can say right now is WOW! You all have made our learning dreams come true. These supplies are going to motivate our students to think and dream big. They already LOVE learning. Thank you for the coding projects. Again, THANK YOU so much for supporting our class!

My students and I deeply appreciate you taking the time to make our dream come true. We are very excited about having an active Pep Club at our school. With your help, our Pep Club will be able to provide support to all of our teams at all of our events. You have helped ensure that our students will have a very Happy New Year. We wish the same to you.

Words can’t express the happiness I feel that my students get to experience this field trip. They would not otherwise been presented with an opportunity as this. Thank you very much for helping me to give another avenue for presenting my subject to my students. Thanks for your donation.

As an educator, it is very important for me to enhance my knowledge and teaching skills from time to time, to better serve my students. But the tuition sometimes withhold an educator. Your support is very appreciated. It will help me to do my job effectively. This course will enable me to learn new strategies to teach high school science by incorporating, math, and engineering in it. This will impact all my students by increasing their subject comprehension. Thank you once again!

I cannot thank you enough for your generosity! The supplies will provide my students will the tools that they need to understand the importance of physics concept-waves and relate it to real life. These supplies will help my students to do real science by experimenting ( and not just reading about it). Thank you so much for considering my project. The supplies will help me to teach science effectively.

Words can not express my gratitude toward you for fulfilling my project. Books are a very important part of a child’s education. I explained Donor’s Choose to my students and they are also very grateful and wanted me to thank you from them.

My students are going to love the STEM Kits you helped bring to our classroom. Preparing our children for the future is key and with your generosity, we are getting them on their way! We truly appreciate your support and thoughtfulness!

I couldn’t believe it when I opened my email and saw that my project was fully funded. My students are going to be so excited to be able use Legos and K’nexes to test and explore Science, and engineering concepts. Thank you again for supporting my students’ learning!

With these additional Osmo resources, my students will be able to work independently or collaborate with other students. These games will increase our coding skills, critical thinking, reading, and leadership habits. I can’t wait to watch my students get started!

Thank you so much for your donation and support of Donors Choose, public school, and my classroom. I cannot tell you how much this means to my students and classroom. Having adequate and functional workspace is so important to student learning and classroom culture. Thank you, thank you! My students are going to be thrilled. I cannot wait to tell them the good news. Thank you for your generosity.

These multicultural books and posters that will give my students exposure to the world around them. The posters are real and relevant pictures of real families from around the world and the diverse photos of people of all ages and cultures from all over the world! I could not provide the hands on materials my young students nee without donors like you and Donors Choose. I am externally grateful!

We have really been working on math skills and helping families so that they can work with their child at home too. We are so excited to be able to offer fun games and activities to families during our March into Math event!

Thank you so much for your generous donation! I cannot wait to start implementing this interactive board and I am excited for all the possibilities to further engage my students. This device can be used in math, ELA, science, and all other content areas. I know my students will be incredibly excited to use this!

My students will be able to truly see their work come alive in front of them. Their level of understanding is going to jump by leaps and bounds. Their ability to read and be successful writers is going to be so much more obtainable. I thank you for taking a part in our future leaders and being so selfless to change the trajectory of a child’s future.

My students will be very happy when they use the kits to develop their programming skills. They are going to show their coding skills to their parents and friends. It is the best Christmas gift for my students and my school. Thank you.

Thank you so much for funding my Wobble and Buzz project! My students are super excited about the wobble seats and buzzers so they can wobble and buzz themselves to success. My students will be more attentive during activities involving our buzzers by using the wobble seats to help them stay focused.

We are excited to learn all about space with the many goodies we will receive! I know students will enjoy counting astronauts, putting together the spaceship gears, and listening to the many space stories coming our way. The planets will be perfect for when we learn all about them! Thanks again.

Headphones will benefit my students tremendously since many of them have a reading deficit and need passages and questions read to them. This will be another learning tool that will be beneficial in learning centers and online interventions. Thank you again for your generosity!!

With your help we are building a robotics problem that is free for the students and their parents or guardians. These items help build a robot that the students can compete against more well-funded high schools. Thanks again for your support.

We are so appreciative and thankful that you chose to fund our project! There are so many amazing things that we will be able to do with these supplies! We will use these supplies in ALL of our learning centers! Thank you again and again!!

I am in shock, and so grateful that my students will be able to have these dry erase board to use in class! These dry erase boards will allow my students so many opportunities in class! Thank you so much, once again this means the world to both myself and to my students.

I am beyond grateful for the opportunity to bring 21st century skills into my gifted classroom! I am always on the lookout for innovate resources to enrich and engage my gifted students. Students will be so excited to dig into coding when we return from Winter Break.

EPtalk by Dr. Jayne 12/19/19

December 19, 2019 Dr. Jayne 2 Comments

There’s a battle raging in Colorado over the Drug Enforcement Agency’s ability to access data within the state’s prescription drug monitoring program. In the course of investigating pharmacies, the DEA requested the data via a subpoena rather than a search warrant. The state claimed that the DEA request was indiscriminate, requesting six years’ of data for over 200,000 prescriptions. They offered to provide anonymized data and to comply with more specific requests with names.

The American Civil Liberties Union has entered the fray in Colorado district court, claiming that tight standards are required to protect privacy and requesting that patients should be alerted that the data will be disclosed or that the court should require a search warrant. The prescription drug monitoring databases have been a significant benefit for clinicians – it’s much easier to identify patients who might be inappropriately using controlled substances. This can lead to earlier interventions and improved outcomes. Let’s hope the legal battles have a favorable outcome that doesn’t take away from the important

A recent JAMA Network Open research letter looked at EHR usability, finding that progress is slow and sometimes nonexistent. The authors looked at 70 vendors who had participated in the Meaningful Use program over multiple years, finding that a good number fell short in usability testing. Only 27 vendors met the inclusion criteria, which included having a computerized provider order entry system, certification according to the safety-enhanced design criteria, and a reported System Usability Scale (SUS) for 2014 and 2015 usability requirements. They found that “there was no statistical improvement in EHR SUS scores between products certified according to 2014 and 2015 standards. One-third of 2014 products and one-quarter of 2015 products fell below the average benchmark SUS score.”

Despite the implications of EHR dissatisfaction on clinician burnout and patient safety, SUS scores decreased for 44% of vendors from 2014 to 2015. The authors note that the study has limitations, including that the SUS scores were vendor-reported and may not fully reflect EHR satisfaction. They go on to conclude that, “An increased focus on clinician end users during product design and development as well as optimized certification requirements are needed to improve usability.”

My personal, albeit anecdotal experience with usability is that for many vendors, it improves in fits and spurts. When they’re under the gun with certification requirements, they focus on it less, and when there is more breathing room, they seem to make a little progress. Given the amounts of money that health systems have spent on EHRs, they’ve created captive EHR users who are basically stuck with what they have. Even if it’s a failure, there’s little money left to make a change.

I enjoyed this Forbes piece on “Why Big Tech Companies Won’t Solve Healthcare’s Biggest Challenges.” Google and Apple are trying to disrupt healthcare, and both have the potential of significant earnings in the process. Still, it remains to be seen whether they truly understand the complexities of healthcare and whether they’re going to be able to set aside profit motive for altruism when it counts. There are also concerns about companies with obvious retail and profit motives having as much access to personal data as they might have moving forward.

The piece brings up some interesting points about whether patients should share in the profit from the use of their data. They point out the situation of Henrietta Lacks, whose cancer cells were used for decades of research without appropriate compensation. If you’ve never read it, “The Immortal Life of Henrietta Lacks” is worth a read. Hopefully we can all look back in a decade or two and see that good things have happened with the tech giants, but I agree that they’re not likely to find magic solutions for all our healthcare and technology problems.

I’m working on a project with a client where I’ve been asked to cull through potential technology solutions for a new service line they hope to take on. I’ve been sifting through websites, marketing collateral, and the pedigrees of various company leaders trying to determine whether the solutions are even viable. There are a lot of cool technologies out there, but some companies don’t look like they will have much staying power in the market.

We’ve moved into demos from some of the vendors, and I was shocked today to find myself on one where the demo data was not only nonsensical, but offensive. The patient scenarios used were degrading and it left me wondering whether they actually have any physicians on staff to guide them. Even if you’re a startup, spend a little money on physician expertise to ensure you don’t look foolish to potential clinical end users. If you’re not ready for a full-time physician on staff, there are plenty of clinical informatics experts who do contract work.

Despite the overwhelming coverage of impeachment proceedings, Congress is still getting other work done. The Telemental Health Expansion Act of 2019 has been introduced and referred to the Energy and Commerce Commerce. The Act would expand Medicare coverage for mental health services delivered via telehealth, and include the patient’s home as an acceptable “originating site” for services. This is much more useful to patients than having to go to a PCP or other office to receive telehealth services from another provider. There are several similar bills already working their ways through the halls of Congress, so perhaps one of them might be successful.


Tis the season of giving, and many of us are looking for ideas for our friends, family, and coworkers. I thought this piece on “Thoughtful and Useful Gift Ideas for Doctors” might be helpful. The first suggestion was a book on preventing burnout, which was a turn off. Much more interesting was their list from last year, which lead off with “caffeine and booze.” Some of the other items on the list were snoozers, although giving the gift of a defensive shooting class caught my attention.

In other holiday news, there’s support for why some of us dread listening to holiday music. There’s data showing that increased repetition of songs can lead to oversaturation and negative responses. Adding this to existing holiday stress and the effects can be compounded. According to data from Consumer Reports, nearly a quarter of Americans dread holiday tunes. I certainly enjoy holiday music in live performances, but the versions typically heard while shopping can be annoying.


Email Dr. Jayne.

Morning Headlines 12/19/19

December 18, 2019 Headlines No Comments

Streamline Health(R) Announces Signing of Definitive Agreement to Sell Enterprise Content Management (ECM) Business to Hyland

RCM vendor Streamline Health will sell its enterprise content management business to Hyland.

Blue Button 2.0 API Update

CMS temporarily shuts down the Blue Button 2.0 system after a developer notifies the agency of a bug that may have improperly exposed Medicare beneficiary data.

NTT DATA Services to Acquire NETE, Expanding Digital Transformation Capabilities in the Federal Healthcare Sector

NTT Data Services will acquire 300-employee NETE, which provides digital services including analytics and cybersecurity to NIH, CMS, and HRSA.

LifeLabs users wise to worry about fraud, ID theft after mass data breach say experts

Canada’s largest laboratory testing company notifies patients of an October ransomware attack that compromised a server used for online appointment bookings.

HIStalk Interviews Laura O’Toole, President, Santa Rosa Consulting

December 18, 2019 Interviews 1 Comment

Laura O’Toole is president of Santa Rosa Consulting of Franklin, TN.


Tell me about yourself and the company.

I’ve been with Santa Rosa Consulting for 10 years and have played many roles here. I’m a passionate person. I pride myself on being a good mother and I live my life every day with gratitude and an appreciation for our industry because I’m a breast cancer survivor.

Santa Rosa is a professional services company that focuses on outcomes-based solutions for our clients. As of late, we are leading with more niche and meaningful services that we think our clients need to pivot to in continuing to be successful.

How did your experience as a patient with breast cancer change your perception of the healthcare system?

It has changed it a lot. It has certainly given me more appreciation for the importance of integration and communication among providers. That was a point that was very frustrating to me. Even as well as I can navigate the system, it also got me to see, upfront and center, how important it is to be an advocate for yourself. As a patient, you have to make a conscious choice to engage in your own care.

As somebody who has grown up in this industry and made it my whole career, it gave me a sense of empathy and almost a sadness for patients who don’t know as much as I do and the number of their questions that don’t get answered along the journey of being sick.

But mostly it gave me an appreciation for this industry and for what we all do. I do believe all of us — regardless if you’re a vendor, a professional services company, or whoever you are in this space that serves patients — want what’s best for patients. We as an industry have an obligation to do more to keep that patient at the center and to focus on the importance of clinical workflow.

It changed my life being sick, frankly. It made me look at everything differently. I live my life with a level of gratitude that I never had before. There’s still a lot to do in our space to make it better for patients.

How did you see the importance of technology as a patient versus what you expected?

Technology is the cornerstone of the building and at the center. Even as someone who operates every day in health IT, I never realized how important it is. If clinicians and providers could embrace technology as much as their IT counterparts do, we would start to see some real magic.

How has the demand for consulting services changed in the past few years?

The landscape has really changed. We have seen that as some firms are still around and some aren’t. Back in the day, everybody was focused on Meaningful Use because there was a lot of opportunity. I believe now that the healthcare professional services space needs to continue to put their clients at the center, but specifically to define value-add, niche, or bolt-on services.

So many of our clients now have implemented their core EHR. How do you take them to that next level? The consulting firms that can provide the most value to their clients are the ones that are looking out past where our client is today and listening to the client and what isn’t working for them.

We think the timing is right for test automation. Our clients simply cannot meet the escalating demand for the comprehensive testing that is required of the complex IT ecosystems that we’re seeing, along with the frequency of upgrades and releases from their EHR vendors. Clients don’t have the money or the resources to have armies of people, additional testers, and pulling their subject matter expects out of their day jobs away from being out in front with their business partners solving problems.

I believe that niche offerings like test automation — built from the ground up exclusively for healthcare and workflow centric — can give our clients more time, more energy, and more focus on their projects and patients. This is where the services for consulting companies need to go.

Integration as a service is critically important for our clients. Being able to fill a client’s needs just in time and to help them on the talent curve is also important.

The company does a lot of Meditech work and that company has made big changes to both its products and leadership team. How will their new professional services offering affect your business?

Certainly a large part of our business is around Meditech. We are a 6.1 Expanse partner. We have a detailed implementation methodology. I think we are the only firm that is confident enough in our delivery that we can provide that implementation on a fixed-fee basis. Meditech is transforming their business and their company. I believe they will be one of the three players left standing.

It’s interesting to me that they have focused on professional services. We believe it’s better to have an independent third party supporting our clients. We believe it drives better outcomes for our clients and that the client should always be at the center.

That said, we have great appreciation for what Meditech is trying to do. We will work alongside them, and with them, to continue to serve our clients and to do what’s right. I love the Expanse platform. It will take many of the Meditech clients that move to that platform to a whole other level of interoperability and care for their patients, so I commend them.

Are your clients asking for help with the industry’s move to the cloud?

Anything that we can do, or that vendors can do, to support interoperability for clients is the right thing to do. If you think back even if a few years ago, we had big health systems not wanting to share data and vendors not wanting to share information. But the constituents that need to share data are our patients and our clinicians. The more that we can evolve and support even bolt-on solutions or capabilities that provide interoperability is what is best. The cloud, and moving as much as we can to create a landscape that allows for more interoperability, is the right thing to do and what we all need to focus on. For our clients where that makes sense, that is our recommendation.

We also advise our clients that they need to look at other solutions and some bolt-on solutions that can take them up the delivery curve to best serve their patients and their physicians. It’s not always about the core vendor. Certainly that’s the cornerstone of the building, if you will, but there’s still a lot that can be done to make a difference and to get more niche services that can provide the optimum value.

How you determine the right time to develop a service line around a particular technology based on its maturity?

In professional services, it is “some days peanuts, some days shells.” You have to take the time to listen to your clients. We have built our company around several flagship accounts where we have done work from our inception as a company. We will continue to do that. We regularly talk with and use a core set of great talent within our client base to hear what their problems are, to try to get ahead of that curve.

There will be some that you will hit on, some that you will miss on. As I mentioned, test automation and the results and benefit for a client are just undivided. Clients like Novant Health, one of the leaders in the implementation of Epic, have realized dramatic improvements and time savings in their testing capabilities. They have been results driven and have the opportunity to reduce real risk in patient safety in clinical care and in revenue cycle integrity.

There’s a whole host of secondary benefits to that. Education and training. Everyone uses the word optimization. I don’t like that word, but taking their EHR up the value chain for their providers, for their clinicians, and improving data quality. If you focus on the core of what will make a health system successful and keep it around those offerings that can reduce time, save them money, and propel them into the future, you are doing the right thing for your clients.

You will always have some that that hit and some that don’t. You have to have a core base of flagship clients that know you, trust you, and know that you mean what you say and say what you mean. It becomes a personal commitment to serve them well. If you have that as the basis of who you are, you will do well, figure it out along the way, and as some offerings catch and some don’t, ride that wave and continue to do good work.

Do you see any little-recognized developments that could take the industry in a different direction?

I don’t see a tremendous amount on the horizon from a regulatory perspective as we did in the rear view mirror of the past. All of the clients that I talk to are trying to figure their integration and  governance strategy for telehealth. I think that will propel us. You’ll see a lot more in home health and outside the traditional box. Integration and integration as a service is an area we’ll focus on. 

You have to be able to plug and pull and have time available when a client needs it. They are just like us in going through ebbs and flows. There will be a dramatic need for high degrees of flexibility because our clients need to be able to provide quality care and some of them are struggling to get there without looking at the full landscape of everybody that is providing care in their ecosystem. Telehealth will be an interesting dynamic over the next several years.

Do you have any final thoughts?

I love our industry. All of us in healthcare want to provide value for our clients so that they can better serve their patients. Being a patient myself, I’ve gained such an appreciation for that and a gratitude for what providers and clinicians do every day to serve our clients. I look forward, as does Santa Rosa, to staying a part of that industry that supports care and makes a difference for people.

At the end of the day, we all have people who we love and care about that we want to see healthy. Healthcare is a beautiful place to be and I’m delighted to be a part of that industry and to serve it.

Morning Headlines 12/18/19

December 17, 2019 Headlines No Comments

Announcing ICD-10-CM and RxNorm Ontology Linking for Amazon Comprehend Medical

Amazon Web Services adds ICD-10 and RXNorm linking to its Amazon Comprehend Medical natural language processing service.

Nashville executive lands head job at CMS innovation center

Aspire Health co-founder Brad Smith will become the new head of the Center for Medicare & Medicaid Innovation.

Fujifilm to buy Hitachi’s diagnostic imaging business

Fujifilm will reportedly buy Hitachi’s diagnostic imaging business for $1.5 billion to improve its competitive position against Siemens, GE, and Philips.

Tidelands Health network impacted by malware attack

Computer systems of three-hospital Tidelands Health (SC) are apparently still down following a malware attack of an unspecified nature last Thursday.

1-800 Contacts Enters Agreement to Acquire Revolutionary Vision Start-Up 6over6 Vision

1-800 Contacts acquires 6over6 Vision, whose smartphone app allows consumers in certain non-US countries (including Canada) to perform their own eye exams.

News 12/18/19

December 17, 2019 News 4 Comments

Top News


Amazon Web Services adds ICD-10 and RXNorm linking to its Amazon Comprehend Medical natural language processing service.

Developers can use the API-driven, pay-per-use services to extract codes from unstructured text with higher accuracy than rules-based systems, according to AWS.

I’m impressed at how deeply AWS is pushing into terminology and semantics issues so early in its health IT work. Comprehend Medical was announced a year ago.

Reader Comments

From Jan Madrid: “Re: evidence-based medicine. You asked in your interview with Mr. Alkire from Premier why employers have to use the financial level to get health systems to follow accepted good practices. I found the answer enlightening – they are just now considering it.” Healthcare has always been slow (at best) or resistant (at worst) to insist that physicians practice according to widely accepted evidence in the inevitable tension of science versus art. Every doctor and hospital either thinks they’ve figured out the secret sauce for best outcomes (highly unlikely) or they are just too tied to business as usual to think through doing a better job. The percentage of medical decisions that can be based on available evidence is pretty small, but even then the practice variation is wide. One of our hospital’s lesser-skilled doctors told me rather defiantly a few years ago that he liked prescribing opiates to people with colds, adding that he was the doctor and nobody could second guess him. Many doctors, especially the older ones and surgeons, were trained to think they are infallible, God-like super-scientists who float in a higher plane than their peers and the rest of us. I don’t think medical education, especially residencies, is training doctors to become science-based, patient-centered team players, but then again, we don’t make their paycheck dependent on it (and in fact, it’s exactly the opposite since drug companies happily reward irrational prescribing). That’s the raison d’être for Premier’s Contigo Health as mentioned in the interview, i.e. the businesspeople who pay employee medical bills are asking doctors to behave rationally.


From AnonMD: “Re: Verge Health. Mark Crockett, MD has exited as CEO. Connie Moser has been appointing acting CEO.” Unverified. The company’s executive page and the respective LinkedIn profiles remain unchanged. I’ve emailed the company but haven’t heard back. UPDATE: verified by the company, with a press release to follow in 1-2 days.


From Boring Pants: “Re: VCU Health. Going to Epic, which will replace a Cerner implementation that has been in place for more than 15 years. IDX for rev cycle will be wiped away as well.” Unverified, but the source is internal.

From Value-Added Reseller: “Re: patient portals and Meaningful Use. Your note was on target. I hated it when practices answered the ‘why do you want an EMR?’ question with ‘we want the government to pay for it.’ I knew they wouldn’t expend the effort to make the EMR useful and productive and would then blame the vendor. Clients that view the EMR as a strategic asset tend to be most successful.” Many or most doctors, to be blunt, are terrible businesspeople, grabbing impulsively at anything that looks like it will put cash in their pockets. But in this case, it did exactly that, as long as they were willing to claim they were using the EHR meaningfully even when they weren’t. It’s also true when you think about it that the vast majority of doctors are using an EHR they didn’t choose or maybe didn’t even want, whether it’s in a medical practice, a hospital, or elsewhere. 

HIStalk Announcements and Requests


Welcome to new HIStalk Platinum Sponsor Central Logic. The Sandy, UT-based company’s pioneering, purpose-built Transfer Center platform helps health system transfer centers connect with their referring facilities to improve transfer efficiency, decrease costs, and realize revenue opportunities. Transfer Center is seamlessly integrated with On Call Scheduling (customizable calendars and schedules that can be shared, combined, and redeployed) and Advanced Reporting (real-time reporting of actionable information). Patients get routed quickly to the appropriate health system resources and the health system benefits from higher acceptance rates and the better load-balancing. Case studies include Mercy Medical Center – Des Moines, which replaced its outsourced transfer center with an internally managed solution, increasing transfers by an average of 9% per year and allowing analysis of external referral sources and the ability to perform case reviews. Thanks to Central Logic for supporting HIStalk.

Here’s a Central Logic explainer video I found on YouTube.


I’m embarrassed that I didn’t mention Donors Choose donations before Monday given that I have received quite a few new donations since, all of which will enjoy a two-for-one match from my Anonymous Vendor Executive (AVE). Unless otherwise instructed, I always mention only the first names of individual donors without their specific donation amounts, but I list the company and donation for those who mention their employer. Thanks to Christina, Bill, Mike, and Carla. Thanks also to Diameter Health, which provided an amazing $2,000 for classroom projects (which by the magic of AVE matching, will fund at least $6,000 worth of teacher projects). I’ll choose the projects – nearly $9,000 worth with the matching, plus I always find additional matching funds — and report back where the money went this week. I am confident that the butterfly effect of these donations will help turn some of these kids of today into tomorrow’s scientists, leaders, parents, musicians, teachers, or passionate pursuers of whatever interests them.

Listening: Trans-Siberian Orchestra. I took Mrs. HIStalk to see them recently and it was the most sensory-overloading, musically satisfying concert I have ever seen. Forget that their theme is Christmas – instead of Mariah Carey yodeling her way through a description of what she wants for Christmas (spoiler: it’s me), it’s like Pink Floyd and Van Halen rocking out while surrounded by lasers and pyro like you can’t even imagine. We will no doubt see them again every chance we get.


None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.

Acquisitions, Funding, Business, and Stock


HealthStream-owned credentialing vendor VerityStream acquires seven-employee competitor CredentialMyDoc for $9 million.


1-800 Contacts acquires Israel-based 6over6 Vision, whose smartphone app allows consumers in certain non-US countries (including Canada) to perform their own eye exams, skipping a trip to the eye doctor for new prescriptions for glasses and contact lenses. 1-800-Contacts already offers Express Exam, a $20 smartphone exam that is reviewed by a remote doctor. The American Optometric Association is, not surprisingly, is very much against having its members bypassed and has asked the FDA to shut Express Exam down. Purely out of concern for patient safety, you understand.  

Fujifilm will reportedly buy Hitachi’s diagnostic imaging business for $1.5 billion to improve its competitive position against Siemens, GE, and Philips.


  • BJC HealthCare chooses Sectra’s enterprise imaging solution for 14 of its hospitals.



Ryan Allen, MHA (State of Alabama) will join UAB Health System (AL) as CISO.

Announcements and Implementations


HIMSS and Forrester Research announce a research project (meaning an online survey) that will look at “the evolving digital doctor-patient relationship.” The survey is available via an open web link and doesn’t seem to limit who participates, so I’m not too sure I would trust the results. It’s also hard to believe that two big organizations did such a shoddy job designing the survey instrument – available responses for the very first question (above) are not only illogical, no combination of answers I chose allowed me to proceed to the second question. Clearly HIMSS needs some usability help.


A KLAS report on the care management component of population health management notes that Athenahealth, Allscripts, Epic, and Cerner aren’t delivering adequate customized workflows, leading to the success of Arcadia in supplementing their functionality.

Government and Politics

ONC posts the agenda for its annual meeting on January 27-28 in Washington, DC.


HHS publishes a report describing its plans to improve internal data sharing.

Privacy and Security


Computer systems of three-hospital Tidelands Health (SC) are apparently still down following a malware attack of an unspecified nature last Thursday.

The City of New Orleans lays out the effects of having the city’s 4,000 computers taken offline to remove ransomware from an attack last Friday: the police can’t run background checks, EMS phone lines are down, municipal and traffic courts are closed, Healthcare for the Homeless can’t see patients because its EHR is offline, WIC vouchers won’t be issued, online job search is down, businesses must file monthly sales tax forms manually, and all payments must be made via check or money order. Maybe HIMSS will move the annual conference there in sympathy again like it did in 2007, when the city was clearly not ready for prime time given the obvious shortage of hotel and restaurant workers and “don’t drink the water” signs all over the convention center due to another in a long string of infrastructure failures.



Tim Kelsey, CEO of the Australian Digital Health Agency, resigns after a couple of years to take a job as SVP of analytics with HIMSS. He oversaw the country’s MyHealthRecord project (which cost $1.5 billion plus $300 million in annual maintenance) that has had a lot of issues with security problems and poor public acceptance. He also co-founded Dr. Foster Intelligence, a UK analytics firm that reviewed NHS performance data.


Thailand’s largest healthcare group will provide video second opinions for residents of China in a partnership with China’s Ping An Good Doctor. The service, “Overseas Top-Tier Doctors,” will be available for purchase on Ping An Good Doctor’s mobile app. The hospital group manages 48 hospitals and employs 12,000 doctors. Ping An Good Doctor has more than 60 million active users.


The CEO of continuous glucose monitoring manufacturer Dexcom apologizes for the Thanksgiving weekend failure of its Follow data sharing function, which allows people (often parents of young children) to monitor a user’s glucose results. He says the company moved the function to a new cloud service without configuring it for optimal performance, causing it to fail. The company will also roll out an in-app messaging feature and dedicated update page for its website following complaints that it did not notify users for hours and even then only via a Facebook update.

Another “only in America” healthcare story – a man who performed thorough research into his hip replacement insurance coverage still gets a surprise bill for $3,000 – the certified registered nurse practitioner who entered the room to help out while the man was under anesthesia was out of network. The CRNP’s hospital-contracted employer said it rarely contracts with insurers. The hospital, showing either its incompetence or embarrassment at being called out, says the bill was a mistake and cancelled it, but only after a reporter started asking questions.

Sponsor Updates


  • CoverMyMeds employees help Gladden House deliver food for holiday meals to 110 seniors in Franklinton, OH.
  • InstaMed announces that Billie Jean King will keynote the Healthcare Payments Summit May 5-6 in Philadelphia.
  • AdvancedMD publishes an e-guide, “The ABCs of Patient Engagement.”
  • Frost & Sullivan honor Avaya with its 2019 Customer Value Leadership Award for Customer Journey Intelligence.
  • Wolters Kluwer adds Clinical Insights content from UpToDate to its Lexicomp drug information system.
  • Thomas Health (WV) goes live with Meditech Expanse.

Blog Posts



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Morning Headlines 12/17/19

December 16, 2019 Headlines No Comments

Bankrupt uBiome preliminarily sells patents for 1% of the poop-testing startup’s original valuation

Once valued at $600 million, bankrupt microbiome-testing startup UBiome auctions off its patents and intellectual property for $7 million to a consumer DNA testing company.

CMS Made an Estimated $93.6 Million in Incorrect Medicare Electronic Health Record Incentive Payments to Acute-Care Hospitals, or Less Than 1 Percent of $10.8 Billion in Total Incentive Payments

An OIG audit finds that, because of inaccurate hospital calculations, CMS paid out $93.6 million in incorrect Medicare EHR incentive payments to acute-care hospitals between 2013 and 2017.

Evaluating Improvements and Shortcomings in Clinician Satisfaction With Electronic Health Record Usability

A study of 70 EHR vendors with the most Meaningful Use attestations finds that physician satisfaction with EHRs is diminishing for nearly half of the products.

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