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Morning Headlines 10/2/18

October 1, 2018 Headlines 1 Comment

Advisory council stunned to learn about parallel health information exchange efforts

Tasked with overseeing Connecticut’s latest HIE effort, members of the Health IT Advisory Council express disbelief and frustration when they learn that a separate state-run agency has been developing its own HIE.

DAS Health Announces Record 3 Concurrent Acquisitions

EHR reseller DAS Health acquires M E Computer Systems, MECS Billing Services, and the Aprima business of consulting firm CriticalKey.

MediQuant Receives Significant Growth Investment from Silversmith Capital Partners

Health data archiving company MediQuant promotes Jim Jacobs to CEO, coinciding with an investment from Silversmith Capital Partners.

Audit Highlights Erlanger’s Continued Net Patient Revenue Growth Of 13%; New Ventures Carried Out Despite $124 Million Uncompensated Care Expense

Erlanger Health System (TN) reports positive year-end income despite predicted shortfalls related to the implementation of its $100 million Epic system last year.

Curbside Consult with Dr. Jayne 10/1/18

October 1, 2018 Dr. Jayne 2 Comments

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I occasionally do a little bit of work for a local personal injury attorney. It’s not the big-time expert opinion work you hear about physicians doing on the side, but more of a translation service. Basically, I take hundreds to thousands of pages of printouts from EHRs and try to reconstruct a coherent timeline of what happened and who documented which data, so that the legal team can understand the facts of a case and determine whether they have something they want to take forward. At least the printouts are virtual, and I’m sifting through PDFs rather than dealing with boxes of documents delivered to my door.

I worked on a case over the weekend from a local hospital where I have never been on staff. The most striking part of the assignment was the poor quality of the records.

The case involved a “routine” outpatient surgical procedure that ended in the patient’s death. The entire episode of care lasted barely more than 24 hours, but there were six different PDFs sent, ranging from 20 pages to 370. Although all the notes and entries were electronically signed by the pertinent physicians, it was quickly apparent that the physicians hadn’t really read the notes before authenticating them. Either that, or they read them and just have a passing familiarity with the idea of matching the pronoun to the gender of the patient or ensuring that the note actually makes sense. Especially since this episode of care contained a profound medical misadventure, one would think that the attending physician (who was going to receive attribution for the case) would have made sure the key portions of the record made sense.

The hospital had numbered the PDFs from one to six, and I quickly realized that the numbering was not at all related to what one would expect in a typical chart. Each file contained a mixture of timelines and care locations (pre-operative area, operating room, intensive care) and was so confusing that I actually thought about printing the whole thing out so I could sort it into chronological order. The admission history and physical was in the middle of the third file, and the discharge summary (also known as the death note) was in the middle of the second. It probably would have been better if the discharge summary was at the end of the last file, because after reading it, I was so aggravated that I had to take a break.

Although the document was clearly identified as a death note, it also contained “Home Instructions for the Patient” and a list of “Medications You Should Continue at Home.” I imagined myself as the widow of this patient reading that and how insensitive it must have seemed to her. She had requested the records personally and provided them to the attorney after she was unable to get answers to her questions from the hospital’s risk management team.

I imagined how confused she must have been by the six files, how disjointed they were, and why she felt she needed to ask the hospital for clarification because the records didn’t make sense. I also put on my EHR hat and thought about how easy it would be to have a separate template for the death note that didn’t have those components that only apply if a patient is actually leaving the hospital.

When I finally made it to the physician notes, I noted how poorly the history of present illness (HPI) was written even though it was either dictated or typed as free text. The patient had been transferred from the operating suite to the intensive care unit after being emergently intubated and placed on a ventilator, which the HPI described as “the patient was difficult to breathe.” The patient was referred to twice as “her” and the rest of the time as “him,” the latter of which was appropriate. Another physician note said that the patient had been “electively intubated for the outpatient procedure” which was incorrect, which somewhat makes one question the accuracy of the documentation in general.

The nursing notes were also interesting, with a nurse documenting that a fall risk assessment was performed and “the patient verbalized understanding” despite the patient being paralyzed, sedated, and on a ventilator, with a documented Glasgow Coma Scale of 3 which basically means the patient was nonverbal and unresponsive to verbal or painful stimuli. One can perhaps blame that one on a macro or shortcut being used, but as a healthcare provider I was embarrassed to see it. The patient also had a “weapons assessment” performed upon arriving to the intensive care unit, although I’m not sure how he could have become armed after being assessed similarly in the pre-anesthesia care unit and having been unconscious most of the time. I understand the value of checklists, but it was just one more thing clogging up the notes that didn’t make sense.

I was heartened to see that the hospital was using a virtual sepsis protocol and remote ICU services from a tertiary care center. My enthusiasm was curbed, however, when I reached the laboratory data section, which displayed the data in an extremely hard-to-read grid (above). I can’t imagine that there was much clinical input on or approval of that document before putting it into the system, and if there was, would love to have a conversation with whoever approved it to go into production. I’m sure users are reading the data on a screen with a scalable display in real time, but it’s still important to be able to have a printout that makes sense.

The attorney who sent me the case felt that there was not likely a valid claim, but had asked me to review to help provide answers to the family. Even in that context, I always review to see if there was an element of negligence or substandard care. I wasn’t pleased to see that the consent for surgery document didn’t have the patient’s name filled out or the surgeon’s name completed in the respective blank spaces. It did have a patient sticker and MRN on it, but not using the blanks as designed just makes it feel like either someone was in a hurry or someone didn’t care, neither of which are great when there has been a poor outcome.

The bright spots of the entire chart were the chaplain’s notes. They were free-text narrative, and although I couldn’t tell whether they were dictated or typed, they were cohesive and actually told the story of what had happened to the patient far better than the physician progress notes (each of which was 8-10 pages long because they contained copy-and-paste content from previous notes). The chaplain’s notes also contained detailed summaries of what was discussed with the family and their responses to the information provided. Those chaplain’s notes were probably the most solid piece of documentation in the chart and they illustrated that the clinical team acted within the standard of care after the initial event.

In the healthcare IT world, we think of projects and timelines and budgets and deliverables, but often we struggle to find the time to think about patients and their families and how those individuals would view our efforts. This family probably doesn’t think very much of the quality of records at this institution and I know the attorney doesn’t either.

As a CMIO, a patient, and a family member of patients, I’m appalled by what I saw. We can do better, and our patients deserve it.

I’d like to throw out a challenge to readers. Take a look at the documentation your systems are producing. Find a death note or a discharge summary with an outcome of “deceased” and see what’s in it. Make sure that you are producing documentation that you would want a patient’s widow or child to see. If you’re a vendor, take a look at your document production code and see if you’re contributing to the problem or helping to solve it. I challenge you to find the development budget to make these issues right if you’re the cause.

Do your users read and correct their notes, or just sign them? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 10/1/18

September 30, 2018 Headlines No Comments

Facing Crisis, Sloan Kettering Tells Exec to Hand Over Profits From Biotech

Memorial Sloan Kettering Cancer Center tells VP Gregory Raskin, MD to turn over $1.4 million worth of biotech company shares that he personally owns, and promises to revise its commercialization and investment policies so that it will retain any proceeds accruing from the involvement of its executives instead of enriching those execs.

Diagnosing the Orion Health buyout deal: Q&A

Orion Health shareholders approve the company’s plan to sell its only profitable division, which offers the Rhapsody integration engine, to a private equity firm that will run it as a private company.

Health care payments firm wants to merge with Athenahealth

Revenue cycle technology vendor NThrive (the former MedAssets and Precyse) is the previously unnamed strategic bidder that has offered to buy Athenahealth.

SingHealth COI hearing: Former IHiS CEO dismissed staff for ethical breach, didn’t probe alleged vulnerability

The former CEO of SingHealth’s IT services organization IHIS, testifying in hearings about its recent massive IT breach, says she immediately fired an employee who in 2014 discovered a security vulnerability in Allscripts Sunrise Clinical Manager and then emailed Epic to suggest using his information to increase market share.

Monday Morning Update 10/1/18

September 30, 2018 News 2 Comments

Top News

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Memorial Sloan Kettering Cancer Center tells technology commercialization VP Gregory Raskin, MD to turn over $1.4 million worth of biotech company shares that he personally owns to MSKCC.

MSKCC had invested in the cancer drug company — which just went public at a share price that values the health system’s stake at $73 million — and had assigned Raskin as its representative on the board of Y-mAbs Therapeutics, for which the company gave him stock options.

MSKCC says it will change its policies so that it will retain any proceeds accruing from the involvement of its executives instead of enriching those executives.

The new policy will not be retroactively applied to MSKCC’s high-profile involvement with Paige.AI. In addition, MSKCC’s CEO will be allowed (at least for now) to continue serving on the board of cancer drug maker Merck.


HIStalk Announcements and Requests

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The vast majority of poll respondents don’t want researchers or insurers monitoring their social media activities, no matter how pure their intentions. Also noted in the poll’s comments is that our approval as consumers isn’t really necessary anyway – once you’ve posted your data online, anyone can buy and sell it.

New poll to your right or here: to what extent do you use a smart speaker (such as Amazon Echo or Google Home) at home? I like the Google Home Mini that I bought for $20 last Christmas, but I admit that I haven’t done much with it beyond asking it for the weather and setting timers for cooking (it’s totally worth it for just those two things, however). Add your comment after voting to inspire me with ideas of how I can use my gadget more productively.

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I’m improbably penning this from the sparse plains of Thackerville, OK. Mrs. HIStalk mysteriously announced last week, “We’re flying to DFW Saturday morning. Pack casual clothes for two days and don’t Google to figure out where we’re going because it’s a surprise for you.” Our destination turned out to be front-row seats at The Roots concert at WinStar Casino. It was as stunning as you might expect – I’m convinced that they’re the most talented, hardest-working band in the US and Black Thought and Questlove are geniuses in several disciplines. I’ll be playing their back catalog and revisiting Black Thought’s epically poetic 10-minute freestyle rap – imagine the talent required to throw out off-the-cuff, rhythmically resonant lines such as, “As babies we went from Similac and Enfamil to Internet and fentanyl.” Kudos for them for increasing the number of things I can stand about Jimmy Fallon to one. Trivia: Questlove’s father was Lee Andrews, singer for the great 1950s doo-wop group Lee Andrews & The Hearts (“Long Lonely Nights.”)


Webinars

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


Acquisitions, Funding, Business, and Stock

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In New Zealand, Orion Health shareholders unenthusiastically (given the lack of better options) approve the company’s plan to sell its only profitable division, which offers the Rhapsody integration engine, to a private equity firm that will run it as a private company. Orion’s other divisions (population health management and hospital software) are big money-losers and did not attract buyer interest. Orion blames its poor results on cash-strapped US hospitals cancelling orders before the company could develop a cloud-based version of Rhapsody. It also says the former Amalga HIS and RIS/PACS it acquired from Microsoft in 2011, developed by another company at Thailand’s Bumrungrad International Hospital, were more of a mess than it thought.  

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The New York Post says revenue cycle technology vendor NThrive (the former MedAssets and Precyse) is the previously unnamed strategic bidder that has offered to buy Athenahealth. NThrive CEO Joel Hackney is a former GE colleague of Athenahealth board chair Jeff Immelt and NThrive owner Pamplona Capital Management could fund the deal by taking on debt.


People

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Konica Minolta Business Solutions USA promotes Joe Cisna, MBA, MHA to global director of vertical solutions and digital marketplace.


Announcements and Implementations

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National Decision Support Company expands its CareSelect solutions for Cerner users to include decision support for laboratory, blood management, and the ABIM Foundation’s Choosing Wisely. Cerner customers were already widely using its image stewardship program to support Medicare’s upcoming imaging appropriate use criteria.

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TriNetX announces self-service precision medicine capabilities for its researcher users, adding Patient Journey Analytics, the ability for researchers to apply their own predictive model to patient data, and giving them the capability to create and monitor de-identified patient cohorts.

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UNC-affiliated Nash UNC Health Care (NC) goes live on Epic, replacing Cerner to run the same system used by UNC, Duke, and Vidant. The president and CEO says the upfront costs are straining the hospital’s bottom line, but annual costs after Year Three will be the same as it was spending on Cerner.  


Privacy and Security

Michigan Medicine notifies 3,700 patients that a fundraising mailing mistake contained one patient’s name on the label but a different patient’s name on the enclosed letter. The fundraising office says it will begin using windowed envelopes to avoid future mishaps.


Other

The former CEO of SingHealth’s IT services organization IHIS, testifying in hearings about its recent massive IT breach, says she immediately fired an employee who in 2014 discovered a security vulnerability in Allscripts Sunrise Clinical Manager and then emailed Epic to suggest using his information to increase market share. IHIS did not, however, follow up on the vulnerability the employee had discovered, assuming that it was no longer a problem since Sunrise had been upgraded. An Allscripts executive complained to the CEO, who then dismissed the employee who had warned that the SCM flaw “could lead to a serious medical leak or even a national security threat.”

Las Vegas’s University Medical Center has still not changed its practices for using an “internal disaster” alert that tells first responders to send patients elsewhere a year after the Route 91 Harvest Festival shooting, where at least two shooting victims were taken to another hospital instead of UMC, which is the state’s only Level 1 trauma center. The county designed the alert so that hospitals can notify first responders about flooding or power issues, but it has no power to insist that hospitals stop using it when their EDs are at capacity.

The New York Times notes that nursing homes are closing at a rapid rate, plagued with low occupancy, changes in Medicare payment policies that favor home care, and the problem of offering a service that nobody wants until their other options have been exhausted. Medicaid’s long-term care payments have shifted from 90 percent going to nursing homes 30 years ago to 43 percent today. Aging baby boomers may reverse the trend, however, and nursing homes are retooling to chase the higher payments offered by Medicare for short-term rehab.

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CB Insights perceptively covers the impact of “The Wellness Economy” in which the vague idea of healthy, holistic, experience-driven lifestyles is driving many industries other than healthcare. It predicts the waning of gyms as people (especially Millennials) purse at-home fitness, an increased focus on smart cities, repositioning of nutrition and beauty brands, and an increase in corporate wellness services, providing as evidence the funding and strategic changes companies are adopting to capture new markets.

In India, family members of a man who died during an inpatient stay accuse the private hospital of storing his body for three days afterward so it could bill them for more services.


Sponsor Updates

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Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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Weekender 9/28/18

September 28, 2018 Weekender No Comments

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Weekly News Recap

  • VA Secretary Robert Wilkie tells the Senate VA Committee that he and representatives at the DoD are working to create a “single point of authority” for their respective EHR projects with Cerner
  • CNBC reports that two private equity firms and one strategic buyer have expressed interest in acquiring Athenahealth, but at a per-share price that carries no premium
  • Several provider organizations develop Health Record Request Wizard, an online tool that walks patients through submitting a request to providers for electronic copies of their medical records
  • CenTrak acquires the security solutions assets of Elpas Solutions, which include infant protection, wireless call, staff duress, man down, and wander management
  • Memorial Sloan Kettering Cancer Center leadership defends itself to its employees following reports that it gave for-profit AI startup Paige.AI exclusive access to its 25 million pathology slides in return for an equity stake for itself and several MSKCC executives
  • MITRE partners with Intermountain Healthcare, the American Society of Clinical Oncology, and ASCO’s CancerLinq subsidiary to develop a set of cancer data elements culled from EHRs that will help providers make better treatment decisions at the point of care
  • Ochsner Health System (LA) and LSU Health Shreveport will invest in EHR, digital health, and telemedicine enhancements as part of a new joint operations agreement

Best Reader Comments

The influence of social determinants on community wellness is influencing a surge in community-based coalitions. In support of this recognition, we need predictive analytics, patient monitoring approaches that extend beyond care navigation outreach – including all the author calls out above and more, EHR’s that have real estate for care collaboration along the recovery process, and processes in place that will take in patient provided data so that care teams can make timely decisions on treatment plans. (Lauren McDevitt)

Nice to see folks starting to understand the connection between life in general and the 15 minutes the doctor spends with the patient in the clinic. Creating a network of social services that includes the healthcare system is our only hope. We don’t want to alert the doctor! If your AI is really AI, then the machine should be able to alert the person who can take action. This could be the social worker on the care team, the entity who is holding risk on the patient, the minister, etc. You can’t take all the social services needs and dump them on the clinical team – that will just lead to more disaster. (Lee Blanco)

It was always an incorrect extrapolation to assume that because survival of a subgroup with coronary disease improves with aspirin that everybody’s survival does. You’re not pointing out a failure of evidence-based medicine. You’re pointing out a failure of medicine to follow evidence. (Robert D. Lafsky, MD)

I have to guess that most healthcare provider organizations and related EHR vendors still are not aware that in 2008, PDF became an international, OPEN standard (ISO 32000-1, Document Management – Portable Document Format – PDF 1.7). As such, PDF has been recognized worldwide as the most reliable, flexible, and feature-rich document format for information exchange because it supports and manages any type of file format, including structured data, text, graphics, x-rays, and video that are used in the healthcare industry. However, what saddens me is that for the past 10 years, healthcare provider organizations and related EHR vendors still are not familiar with the attributes of the DYNAMIC format of the PDF document (NOT the static format, with which all users are familiar, including the above user and EHR vendor). This is probably one reason why PDF Healthcare, a 2010 Best Practices Guide (BPG) supplemented by an Implementation Guide (IG) (i.e., PDF-H was never a proposed standard) was never accepted by the healthcare information technology industry. (Woodstock Generation)

I applaud your comment of “doing as doctors often do in shooting the EHR vendor messenger without realizing that it wasn’t them who made the workflow decisions” because this is the primary reason that most EHRs are not as “intuitive” or “usable” as we would like. I have frequently seen that the decision of one person or group has deleterious effect on others using the system. I’ve also seen situations where the vendor will speak up and tell the decision-makers that this would not be a good workflow and the decision remains unchanged. (Paulette Fraser)

This MSK-Paige.AI deal seems to be a case of the a total absence of governance and due process. How such a sweet deal for founders, board, and MSK to profit from slides can pass regulators is unfathomable. (AI-Bot)

The AI/ML companies need someone clinical to provide them their training cases, and the executives mistakenly think the data isn’t worth anything since it’s just “sitting there.” Lots of AI/ML companies are getting away with a treasure trove of valuable data very inexpensively. (DrM)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. B in Mississippi, who asked for telescopes, microscopes, and science experiment kits for her fifth grade Super Scientist project, in which a weekly “Scientist of the Week” takes home resources to complete a project with their family and then reports back to the class. She says, “It has truly been a blessing to teach fifth grade science, and with your help, they can learn so much more at the convenience of their own home. It allows them to share education with their siblings and parents. You can actually see the importance of it and the responsibility they have had with the items from this project. I couldn’t thank you enough and promise you this will bless a child for many years to come.”

An MIT researcher observes that connected home intelligence devices — such as Amazon Echo and Google Home – seem to be offsetting social isolation that is especially problematic among older adults. He notes that half of people 65 and over surveyed in the UK said their main form of company is the TV, concluding,

In the absence of a warm-blooded alternative, even a brief interaction with a “voice” that serves, interacts, and responds every time, all the time, may someday transform our collective perception of AI from that of a simple tool that “does stuff” around the house to a presence that is a real part of our social self.

Spotify adds a custom playlist generator based on DNA test results from Ancestry, making the dubious claim that ethnic heritage drives musical preferences.

Rural hospital operator LifePoint Health proposes that four of its executives divvy up $120 million in golden parachute money upon completion of its $5.9 billion acquisition by RCCH HealthCare Partners.

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In the latest “marketing gone mad” example, Weight Watchers renames itself WW, claiming itself to be a “true partner in wellness” that will embrace wellness-related apps, online communities, and integration with Amazon Alexa and Google Assistant. It should come as no surprise that the announcement was made by the company’s “chief brand officer,” who babbled on about the “new articulation of the WW brand” and a new brand identity that  will “come to life across all brand touchpoints and member experiences” as the company emphasizes its expertise in behavioral science . My alternate interpretation is that Americans don’t want to pay a company to remind them they’re fat, so WW will distance itself from that unforgiving metric and instead lay claim to less objectively punitive “health.” Above is the amazingly creative and daring new logo around which all this hubbub orbits. It should be noted that when asked, the company’s president could not explain what WW stands for, and Adweek panned the new “marque” in saying WW is chasing trends from fear of being disrupted.

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Renaissance man Patrick Soon-Shiong’s NantEnergy (which I hadn’t heard of among all the health-related Nants) says it has developed a low-cost alternative to lithium-ion batteries that has been deployed to several villages and cell tower sites around the world. An expert says “if this is true, it would be great,” but wants to see evidence and a test of how long the batteries will last.

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In Russia, the father of a deceased 25-year-old woman erects a five-foot tall tombstone that resembles her IPhone, crafted by a company that offers” death accessories.”


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Morning Headlines 9/28/18

September 27, 2018 Headlines No Comments

Athenahealth fields multiple bids, but offers not much higher than current stock price, sources say

Shares of Athenahealth rise slightly after CNBC reports that two private equity firms and one strategic buyer have expressed interest in acquiring the company for close to $131 a share.

‘State of the VA is better,’ Wilkie says, but not ‘good’ or ‘excellent’

VA Secretary Robert Wilkie tells the Senate VA Committee that he and representatives at the DoD are working to create a “single point of authority” for their respective EHR projects with Cerner.

Dozens more jobs being cut at Adventist Health Bakersfield

Adventist Health Bakersfield (CA) will do away with 60 financial services jobs early next year as part of a billing and collections outsourcing deal with Cerner that has already impacted 175 employees over the last six months.

Wearables pioneer Jawbone is back with a new mission: Warning you about health problems you didn’t know you had

Jawbone founder and CEO Hosain Rahman says the company has pivoted from fitness trackers to a device-agnostic remote patient monitoring business that will act as a health check-engine light for monthly subscribers.

News 9/28/18

September 27, 2018 News 2 Comments

Top News

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Shares of Athenahealth rise slightly after CNBC reports that two private equity firms and one strategic buyer have expressed interest in acquiring the company for close to $131 a share.

The company’s board members are reportedly “motivated to get a deal done.”


Reader Comments

From Former Road Warrior: “Re: HCTec Partners. Checks went out this week to 2,271 current and former consultants who were not paid overtime for working more than 40 hours in one week. The total settlement was $4.5 million.” Unverified since court documents are now almost always unavailable without cost, but I can at least see that the case was settled in July.

From Fall Out Boy: “Re: hackers at Lutheran Hospital. Owner Community Health Systems provides the IT network for spinoff Quorum Health and was infected by malware via QHC’s network. CHS still has several thousand unpatched Windows 2003 servers that include McKesson Horizon applications used at Lutheran. CHS had to shut down those Windows 2003 servers to contain the malware. The upgrade project has been going on for three years now without any results.” Unverified.


HIStalk Announcements and Requests

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It’s officially fall. Soon it will be the winter holidays and then HIMSS19. That means it’s time for my usual end-of-year deals for new HIStalk sponsors and webinar presenters, whereupon I look away demurely as Lorre offers inducements like a car salesperson anxious to make quota (and to re-stroke my fragile ego with such markers of industry relevance). See what it’s like being one of the cool kids who get a figurative leg up on their less-hip competitors. Now is better since it will get crazy in the less than six weeks between New Year’s Day and HIMSS19.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Adventist Health Bakersfield (CA) will do away with 60 financial services jobs early next year as part of a billing and collections outsourcing deal with Cerner that has already impacted 175 employees over the last six months. The majority of those were re-hired by Cerner and stayed on at the hospital. Cerner has said it will invite the next wave of laid-off staffers to apply for positions at its Missouri headquarters, though as one angry ex-Adventist employee notes, they’ll be competing with former Adventist employees from other parts of the country.

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Los Angeles-based Aiva Health, which has developed virtual assistant-based patient engagement and care coordination software, secures funding from the Google Assistant Investment Program and Amazon’s Alexa Fund.

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Women’s virtual health company Maven raises $27 million, increasing its total to $42 million.

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Cerner will move into 38,000 square feet of office space in Rosslyn, VA to house employees working on the company’s contracts with the VA and DoD.

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Jawbone founder and CEO Hosain Rahman tells ReCode that the company has pivoted from fitness trackers to a device-agnostic remote patient monitoring business that will act as a health check-engine light for monthly subscribers. The new Jawbone Health will use Salesforce’s Health Cloud to securely share customer data with providers, who it seems will then weigh in with treatment advice. The company, which has shrunk from 600 to 110 employees, sputtered out in mid-2017 after mounting financial pressures and competition, including a lengthy patent infringement lawsuit against Fitbit.

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Signify Research describes four ways EHR vendors can continue their growth as the EHR market matures:

  • Diversify into related areas such as population health management, RCM solutions, and IT outsourcing (Cerner, for example, drives 40 percent of revenue from non-core EHR business)
  • Expand the basic EHR offerings
  • Sell outside the US (only Cerner, Epic, Allscripts, and Meditech have done much of this and even they are having challenges) although it’s hard to displace local vendors, making acquisition attractive
  • Pursue acquisitions that drive market share expansion

Cerner expects its Cerner Health Conference to bring 14,000 attendees to KCMO October 8-11, with the conference theme being “Smarter Care.” CHC will also serve as the coming-out party for Chairman and CEO Brent Shafer as well as the resigned Zane Burke’s semi-replacement, Chief Client Officer John Peterzalek.

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Virtual coaching vendor Virta Health hired some new executives this week, which wasn’t as interesting as a review of the components of its type 2 diabetes program – physician supervision, an individualized treatment plan, a personal diet and health coach available by chat, and digital health devices that collect readings in an app  (a digital scale, blood pressure cuff, and glucose testing supplies).


People

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Mandira Singh (Athenahealth) joins Collective Medical as head of product.

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SnapMD hires Deric Frost (Equality Health) as chief revenue officer.

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The Chartis Group appoints Mark Krivopal, MD (GE Healthcare Partners) to its Performance Practice leadership team.

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Nordic begins looking for a new CEO after Bruce Cerullo announces he will transition from the role to chairman of the board.

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Kristi Ebong (Cedars-Sinai) joins Orbita as SVP of strategy and general manager for healthcare providers.


Sales

  • Pershing Health System (MO) will install Cerner Millenium via CommunityWorks.
  • CHI Franciscan Health (WA) will work with GE Healthcare to develop an AI-powered command center to better coordinate patient stays.
  • Signature Healthcare (MA) selects care coordination and communication software from Medarchon.
  • Cabell Huntington Hospital (WV) will implement Wolters Kluwer’s POC Advisor for sepsis surveillance.
  • Geisinger will deploy Chess Health’s addiction management technology at its Medication Assisted Treatment Centers in Pennsylvania.
  • Three DoD facilities will implement Vecna’s patient check-in solution.

Announcements and Implementations

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UnityPoint Health–Marshalltown (IA) transitions to Epic as part of a system-wide roll out.

Centric Home Health & Hospice (TX) implements DrFirst’s Backline secure messaging software.

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Olmsted Medical Center (MN) will go live on Epic this weekend, replacing Cerner CommunityWorks inpatient and McKesson ambulatory.


Government and Politics

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Health Management Associates pays $260 million to settle whistle blower lawsuits related to allegations that HMA coerced its physicians into unnecessarily admitting ED patients to the hospital. One lawsuit contended that HMA set up admission benchmarks driven by cost projections rather than medical necessity, which resulted in CMS footing the bill for Medicare and Medicaid beneficiaries. Community Health Systems bought HMA in 2013 for $7.6 billion and has struggled to adjust to the acquisition, which left it $14 billion in debt. CHS sold off 40 hospitals and laid off 70 corporate IT employees earlier this year.

After 60 days on the job, VA Secretary Robert Wilkie tells the Senate VA Committee that he and representatives at the DoD are working to create a “single point of authority” for their respective EHR projects with Cerner. Wilkie and his team are also preparing an EHR governance report for Congress. “If we don’t get the front-end of a member’s service right with the electronic health record,” he told the committee, “it really doesn’t help us when that veteran comes into our system. One of my goals is to make sure that the DoD end works.”


Other

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A survey finds that 72 percent of consumers don’t think insurers should be allowed to use big data to determine insurance policy risk, 55 percent think it’s just as threatening to have insurers accessing private data as Facebook, and 18 percent would allow insurers to test their DNA if they might get lower prices. Startlingly, 8 percent said they would allow a video camera to be installed in their home and 11 percent would be OK with having a biometric tracker installed in their body if it might lower their rates. One in five respondents say no correlation exists between their health and their social and economic situations. As other surveys have found, Americans are strongly pro-privacy until someone offers to pay for their most precious secrets.

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Brilliant: a Twitter user describes how she used IOS 12’s scripting-like shortcut creation tool to create a Siri-launched Mayday shortcut that sends an “I’m in trouble” text message to friends that includes her latitude, longitude, altitude, and Wi-Fi network name (to help them find her in, including if she’s in a large building or shopping mall); her phone’s battery level; her IP address; and a warning that the phone will automatically go into “do not disturb” and “low power mode” to avoid alerting whoever is threatening her that help is on they way. She just has to say, “Hey, Siri, Mayday” and her IPhone does the rest.

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The Maryland Health Care Commission launches a “Wear the Cost” campaign to get people talking about and comparing the prices of procedures, which can vary wildly between hospitals. Harvard Medical School professor and pricing transparency expert Ateev Mehrotra, MD (who says he’ll gift the shirts to his health policy friends) believes the campaign may wind up being more about hospital price shaming than encouraging patients to shop around. “To date,” he explains, “price transparency initiatives that have been rigorously assessed have had little to no impact on prices in the health care system. The reason so far is few people are using those websites.”

Memorial Sloan Kettering Cancer Center quickly ditches the AI-focused “Harnessing Big Data” theme of its annual fund-raising campaign following its Paige.AI equity controversy. The campaign, which usually raises around $1 million, will instead emphasize patient care.

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A radiologist who was transported by helicopter to a trauma center in Texas is left holding a $45,000 bill from national air ambulance Air Evac Lifeteam after his insurer agrees to pay just $12,000 since this particular company is not in its network and bystanders who called for help had no way of knowing that. The air ambulance company and several others are owned by private equity firm Kohlberg Kravis Roberts. Their charges are considered aviation rather than healthcare expenses, so they can (and do) charge whatever they want. The radiologist lost his arm in the accident, soon to be followed by his remaining arm and a leg courtesy of KKR. The industry’s trade group claims each flight costs an air transport company $10,200, but they have no choice but to stick insured patients for higher amounts to cover Medicare, Medicaid, and uninsured patients.


Sponsor Updates

  • Parallon Technology Solutions publishes an e-book titled “7 Key Epic Optimizations Can Have a Direct Impact on Your Bottom Line.”
  • Elsevier Clinical Solutions will exhibit at the American Society Clinical Pathology 2018 Annual Meeting October 3 in Baltimore.
  • EClinicalWorks, Ellkay, Healthfinch, Intelligent Medical Objects, and PMD will exhibit at MGMA September 30-October 2 in Boston.
  • PatientPing selects Amendola Communications to support its growth initiatives.
  • Crossings Healthcare Solution develops Cerner MPage-driven Insulin Management Advisors that provide evidence-based recommendations for IV fluid management, glucose correction, electrolyte replacement, acidosis and anion gap correction, and subcutaneous insulin transition.
  • Healthfinch achieves HITRUST CSF Certification.
  • Healthwise will exhibit at AdvancedMD’s Evo18 conference October 2-6 in Salt Lake City.
  • InterSystems will host its Global Summit 2018 September 30-October 3 in San Antonio.
  • Kyruus announces a panel of leading health system CEOs at its upcoming 2018 Annual Thought Leadership on Access Symposium October 15-17 in Boston.

Blog Posts


Contacts

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

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EPtalk by Dr. Jayne 9/27/18

September 27, 2018 Dr. Jayne No Comments

The request period for CMS to provide a MIPS Targeted Review is open for less than three weeks. Eligible Providers who participated in the Merit-based Incentive Payment System in 2017 can review their final scores and performance feedback on the QPP website. These scores will determine whether providers receive a positive, negative, or neutral payment adjustment for Medicare-covered services in 2019.

A Targeted Review can be requested if MIPS-eligible clinicians or groups believe that an error has occurred in the payment adjustment calculations. Examples where this applies include data quality issues, eligibility issues (such as being below the low-volume threshold but being assigned a penalty) or not being treated appropriately if qualifying for reweighted scores due to extreme and uncontrollable circumstances. Based on the chatter in the physician lounge, it seems that hardly anyone is reviewing these, so they’ll just be surprised when they find out if they’re getting an incentive or penalty. If you think you should have a review, requests can be made until 8 p.m. ET on October 15.

A group of 29 participants in the CMS Next Generation Accountable Care Organization program is uniting to work with CMS to ensure continuation of the Next Generation ACO program. This is in response to some pushback against the program, which allows organizations to take on greater financial risk in return for expanded flexibility for care coordination and other services. Some organizations feel the promised savings hasn’t appeared as quickly as expected. Participants in the coalition include Dartmouth-Hitchcock Medical Center, Henry Ford Health System, Mission Health, Carillion Clinic, and Trinity Health.

The group members plan to “focus on developing elements of future payment policy, network design, and beneficiary engagement.” They also plan to share best practices and show how risk-bearing arrangements can accelerate transformation in care delivery. Next Generation ACOs were responsible for more than $61 million in savings in 2016, when there were only 18 organizations participating. That number is now up to 51 organizations, which are focusing on chronic care and disease management as well as expansion of primary care services.

Speaking of healthcare savings, a new report from The National Council for Behavioral Health’s Medical Director Institute shows that simply getting patients to take their medications as prescribed could lead to substantial cost savings and improved clinical management. It’s long been quoted that nearly half of people who are prescribed medications don’t take them as instructed. The problem is complex and involves many factors: understanding the need for medication, being able to acquire it (cost or transportation issues), understanding how to take it, and actually taking it at the right time and under the correct circumstances each day.

The institute projects a potential $2 billion yearly savings from reduced hospital costs alone, assuming that a number of its recommendations are adopted over the next five to seven years. Some of the recommendations seem straightforward, such as “better communication between physicians and patients” and improved risk assessments to determine who might not take their medications. However, under our current fractured and stressed system, even something like communication is a challenge, with little time available to actually sit with patients and ensure they understand why they need medication, how to take it, and what to expect.

Of course, technology can help with some of these, such as embedding risk assessments into the EHR or serving them up via a patient portal, but the latter assumes patients have Internet connectivity and a certain degree of health literacy. Data sharing can be used to identify non-adherence – I love the medication history in my EHR that lets me see when patients refill their medications, which can be a proxy for not taking it as directed if the dates aren’t as expected. Other solutions require more cooperation from other parts of the healthcare system, such as expanding use of long-acting injectables as compared to daily oral medications and increasing patient access to pharmacy services.

The institute cites data that one in six Americans take psychiatric drugs and notes the risks to patients not taking medications as directed. I saw this in my practice the other day with a patient who came in for fatigue and lethargy, and it was most likely a medical misadventure with incorrectly administered psychotropic medications. It took me a good 30 minutes to get to the root of the matter, which caused a backup in the clinic and skewed my productivity numbers for the day. Sitting with the family was the right thing to do, but not all clinicians are going to do it (and I doubt my emergency department-trained midlevel providers would have). The patient hasn’t had a psychiatrist for six months due to insurance issues and I ultimately wasn’t able to “fix” the problem, but at least was able to point his family in the right direction.

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Most of the news coverage coming out of Washington, DC this week is swirling around the Supreme Court nomination, but I was glad to see that Congress is still at work trying to complete legislation dealing with opioids. A deal reached on Monday includes a measure to allow use of Medicaid funds for inpatient treatment of addiction. The so-called “IMD provision” (Institution for Mental Disease) lifts a ban on using those funds for treatment. The initial ban was put in place because of a concern that scarce funds would be paid to higher-priced inpatient facilities. It’s not like addiction goes away because someone is hospitalized, and since there generally aren’t enough beds to go around already, I don’t think the availability of funds is going to significantly impact utilization. It’s hard to charge for a bed that doesn’t exist. There are also waivers already granted for 15 states with waivers pending for 11 more, but that doesn’t cover everyone which explains why Congress is stepping in.

It’s hard to tell exactly what’s going on in the measure, though, because the final legislative text is not yet publicly available. According to my sources, the Senate bill lifts the ban, and the House version provides for treatment of all addiction, not just restricting it to treatment of opioids and cocaine. There is still some contention around HIPAA and confidentiality rules, with healthcare providers pushing to align the confidentiality rules with HIPAA so that clinicians could share information. It looks like the current law will stay in place, keeping additional protections for records of substance abuse treatment.

The House also blocked changes to the Medicare Part D “donut hole” that were requested by pharma. No one wants to be looking like they’re allowing pharma to benefit while allowing the proposed changes to ride the coat tails of bills targeted at the opioid epidemic. I’m sure we’ll see pharma trying to tack this onto something else as the legislative season continues.

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I’ve been struggling this week due to a catastrophic outage at my hosting vendor, whose disaster recovery plan completely unraveled. Apparently it started with a server administrator who was supposed to perform a “file system trim” but mistakenly executed a “block discard” instead. Needless to say, the storage platform immediately dropped all data and crashed everyone. In a serious of unfortunate events preceding that calamity, someone had disabled the snapshot functionality, so there was nothing to use to quickly restore data. Instead, they tried to access the off-site backup server in another state, finding an I/O capacity issue that limited restoration efforts.

I don’t mind my websites being down, but it also took out my email for several days. Although I was able to reach out to key clients and pass along an alternate address, I suspect a number of people think I’m just ignoring them and have no idea what I’ve missed. The outage was long enough that most mail servers would stop trying to redeliver.

Having been on the other side of outages, my heart goes out to the admin who created the problem as well as the company’s leadership who is finding out that “trust but verify” is a lot more important than they thought. As I followed their updates (which were extremely transparent) and the customer forum, I was amazed by the number of fellow customers that had no backup of their sites and no disaster recovery plan of their own. There was talk of how much money they were losing, but no discussion of business continuity insurance or even of disaster planning. There was a lot of screaming in all caps and little realization that flooding the support center with tickets asking them to “FIX THIS MESS NOW!!!!!!” probably wasn’t helpful, especially since they were posting real-time updates to all clients.

It’s a good reminder to make sure that your data is backed up in multiple places (and not just by your vendor, but by you personally) and that also your vendor is testing their backup system and restoration process frequently. Stuff happens, and having a plan makes it a lot less painful, that’s for sure.

When is the last time you tested your disaster recovery plan? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 9/27/18

September 26, 2018 Headlines No Comments

Maven Raises $27 Million in Series B Financing to Bridge the Gap Between Working Women and Families and Modern Health Benefits

Women’s virtual health company Maven raises $27 million in a funding round led by Sequoia Capital and Oak HC/FT.

Nordic CEO Bruce Cerullo announces long-term leadership succession plan

Nordic begins looking for a new CEO after Bruce Cerullo announces he will transition from the role to chairman of the board.

Healthcare IT Company Cerner Opening Office in Rosslyn

Cerner leases office space in Rosslyn, VA to house employees working on the company’s contract with the VA and DoD.

Readers Write: The Key to Population Health Management: The Convergence of Data, Technology, and Social Determinants of Health

September 26, 2018 Readers Write 3 Comments

The Key to Population Health Management: The Convergence of Data, Technology, and Social Determinants of Health
By Matt Miller, PhD

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Matt Miller, PhD is vice president of behavior science at StayWell of Yardley, PA.

Advances in technology are having a significant impact on the healthcare individuals receive. Patient DNA is used to personalize treatments with precision medicine. Artificial intelligence (AI) and machine learning are speeding diagnosis and helping providers determine the best courses of action. The Internet of Things (IoT) is enabling a wide range of remote clinical applications, from medication adherence to monitoring vital functions including glucose, heart rate, and blood pressure to configuring and gathering real-time data from medical devices such as pacemakers and defibrillators.

While these technologies are powerful on their own, the combination of these various patient-specific data streams can produce an exponential impact on improving patient outcomes when merged with behavioral and environmental insights. Integration of this diverse data, through electronic health records (EHRs) and other critical healthcare systems, will play an important role in creating an ecosystem that enables providers and patients to get the information they need, when they need it. In turn, this integration of data will support the larger goals of improving population health.

Modern healthcare is well positioned to reap the rewards of recent advances in technology. Silicon and graphene at the chip level and microelectromechanical systems (MEMS) in semiconductors are in devices used every day for diagnoses and treatment, such as CT scanners, X-ray machines, magnetic imaging, ultrasound, and for monitoring blood pressure, glucose levels, and other vital statistics. These components play critical roles in sensing, data processing, and controlling machines used to monitor and treat patients. Add data science – AI and machine learning – to the mix and the industry can begin to explore new frontiers in healthcare by expanding our ability to detect and interpret patterns.

We are beginning to see this convergence of new technologies emerge in targeted use cases. Computer vision and convolutional neural networks are helping radiologists identify malignant tumors, minimizing the pain, inconvenience, and cost of biopsies. Pharmacogenomics and precision medicine are enabling researchers to identify first-line medications for patients based on their genomes and develop therapeutics based on the unique characteristics of the individual and his or her disease.

These applications are just the beginning of innovations that will redefine healthcare in the 21st century. But there may be a simpler example of how today’s data capture technology can make an equally significant impact in improving population health. This approach involves integrating behavioral, environmental, and social data directly into physician’s workflows, so healthcare professionals can have a more robust understanding of a patient’s risk factors and take proactive steps to help patients remain, or become more, healthy.

Social determinants of health (SDOH) are macro-level factors responsible for influencing health risks and health outcomes. SDOH include economic stability, neighborhood and physical environment, level of education, access to healthy food and quality healthcare, available support systems, and stress. These factors contribute to an individual’s life expectancy, mortality, healthcare expenditures, health status, and functional limitations, according to the Henry J. Kaiser Family Foundation.

Research demonstrates the enormous influence of behavior and SDOH on patient outcomes. Clinical interventions impact only 10 to 20 percent of a person’s health outcomes, while socioeconomic and environmental factors determine 80 to 90 percent, according to The National Academy of Medicine.

Consider the possibilities if a physician had access to social and behavioral information alongside lab tests, imaging results, and other background information about the patient. Not only could the doctor see that his 50-year old female patient’s glucose is high and creatinine and hemoglobin are slightly off, he could also evaluate the impact of her adherence to taking prescription medicine, stress level, and the fact that she lives in an urban food desert and doesn’t have access to regular care.

These types of solutions are already coming to fruition, in a variety of forms and functionality. Consider the offering developed by Proteus Digital Health, which combines ingestible sensors, a small wearable sensor patch, and mobile application to monitor patient health patterns and medication adherence behaviors. The objective information collected by the Proteus system enables doctors to initiate, adjust and measure treatment effectiveness, saving patients and payers money while optimizing care and amplifying outcomes.

Johns Hopkins University School of Medicine was also recently awarded a grant to continue research of the Emocha mHealth app, which tracks medication details and care management for individuals with tuberculosis, a diagnosis where strict medication adherence is essential for positive outcomes. The app connects patients and providers for Directly Observed Therapy (DOT), in which patients record themselves taking prescribed medication. The video is uploaded to a telehealth portal, where providers can confirm the medication was taken correctly and collaborate with patients on care management. Early results show that Emocha app boosted medication adherence rates by 94 percent and saved almost $1,400 per patient in treatment costs.

Using multiple data points to triangulate a patient’s condition enables physicians to deliver healthcare with a more holistic perspective. Understanding the gravitational force SDOH has on health outcomes, physicians not only can address the symptoms of disease, but can also respond to variables known to cause and/or exacerbate illness. With these types of insights, they can make more informed decisions around diagnosis, treatment and the continuum of care.

It can be a challenge for physicians to get insights into social and behavioral factors. But the move to EHRs, plus greater integration and effective data exchange through standardization efforts like Fast Healthcare Interoperability Resources (FHIR), are beginning to make these promises a reality. By capturing more data points through EHRs and having access to complete records regardless of where healthcare services are delivered, physicians will have a more comprehensive picture of patients’ background and health, empowering them to provide the care and resources to meet the unique needs of each patient.

Several device manufacturers are already offering remote monitoring tools capable of capturing patient health data at home and uploading it to an EHR for physicians to track.

For example, Boston Scientific’s Latitude Home Monitoring System enables physicians to monitor implanted devices to manage heart conditions. A five-year study of the system showed that there was a 50 percent relative risk reduction of death as compared to patients who only went to the clinic for device checks. Honeywell’s Genesis Touch collects biometric information, such as oxygen saturation, blood pressure, and weight and shares them with physicians. The related mobile app also enables video visits between patients and physicians and offers an interactive teaching tool to demonstrate techniques to manage various conditions and ensure the patient understands the treatment protocols.

Now take this integration a few steps further. Imagine,that through the power of AI and machine learning, a physician could be proactively alerted to key data points about a patient, in real time, outside of a hospital or office visit. Machine learning would identify certain thresholds that trigger the need for the physician to send a message containing educational materials to the patient, change a prescription based on data trends, or even alert emergency services.

Lessons learned from these types of just-in-time, adaptive interventions can be extrapolated to improve population health services by empowering physicians to offer data-driven recommendations to their patients.

For example, many practices may offer a universal stress reduction program to their patients. However, stress can manifest itself in a myriad of ways for different people at different times in their lives. By using the full scope of data available to understand the stressors – physical, social, and behavioral – and other factors impacting each patient, providers can do more than simply and generically “manage stress.” They can develop an intervention that helps specifically manage that patient’s unique stressors.

The future of each individual patient’s outcome is brighter when you combine the nuance and tailoring of personalized medicine with the reach of population health. Advances in science, technology, and use of SDOH brings this future within reach.

Readers Write: Projects and Costs Out of Control? Take a Low-Dose Aspirin

September 26, 2018 Readers Write 3 Comments

Readers Write: Projects and Costs Out of Control? Take a Low-Dose Aspirin
By Frank Poggio

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Frank Poggio is president and CEO of The Kelzon Group.

A recent announcement in the news about the lack of effectiveness and risk of taking daily low-dose aspirin triggered my re-thinking about the age old question of, “Why is healthcare IT so far behind commercial industry?” or, “Why is healthcare delivery so costly and inefficient?”

“Experts” always say we can improve costs and quality if we practice evidence-based medicine. OK, I can buy that, but what if the evidence keeps changing every few years? I am willing to bet that in about five years some researcher will say that new data shows daily aspirin is good for you, so hope you didn’t stop taking it. How many times have we seen that with other foods like coffee, red wine, etc.?

And what about classic annual diagnostic procedures like Pap smears, mammography, and PSA tests? Or therapies like angioplasty, tonsillectomy, bloodletting, or frontal lobotomy? The list goes on. All deemed good one day in the past, but not so good or maybe deadly soon after.

This obsession with comparing medicine and healthcare to other industries falls apart if you look at a simple example. Say you are washed up and stranded on a large island. As it turns, out there is an abandoned cabin on the island with a motorized boat left at the dock. You also find a set of mechanic’s tools in a storage area, and lucky you, you happen to possess a little mechanical talent from your high school shop class. What you do not have is any documentation covering the boat or engine, but with your cursory experience with cars, you figure out how to start the engine. But alas, it will run only for a few minutes.

You tinker with it for days, but without any owner’s or repair manuals or other specs, everything you do is hit or miss. Of course you take an evidence-based approach, using trial and error and a little creativity. As you fail to make headway and start experiencing severe hunger pains, you take the engine apart to try to get a better understanding of its engineering and how it should function. Put it back together, try again, no luck, apart again, try again, and on and on.

Wouldn’t it easier if you had some documentation, like maybe a troubleshooting guide? Every boat engine that comes off an assembly line has one. If only the original owner had kept it, you could avoid all the time-wasting reverse engineering. And thank heavens the engine isn’t amorphous or biological, which brings us back to the human condition.

When you were born, didn’t the doctor give your mother your owner’s manual, troubleshooting guide, design specs, and of course a warranty? What, you say, you can’t find them, and the frustration is giving you a severe headache? Too bad, maybe try this aromatherapy — it worked for me.

Morning Headlines 9/26/18

September 25, 2018 Headlines No Comments

New Tool Can Help Patients and Family Caregivers Get, Use, and Share Health Records

Several provider organizations develop Health Record Request Wizard, an online tool that walks patients through submitting a request to providers for electronic copies of their medical records.

CenTrak Bolsters Security Solutions through Elpas Acquisition

CenTrak acquires the security solutions assets of Elpas Solutions, which include infant protection, wireless call, staff duress, man down, and wander management.

Google Assistant Investment Program Invests in Aiva Health, First Voice Platform for End-to-End Care

The Google Assistant Investment Program makes its first foray into healthcare with an investment in Aiva Health, which has developed virtual assistant-based patient engagement and care coordination software.

StartUp Health Raises $31M From Novartis, Ping An Group, Chiesi Group, GuideWell and Otsuka

Digital health investment collaborative StartUp Health closes a $31 million fund that it will use to invest in “healthcare moonshots.”

News 9/26/18

September 25, 2018 News 2 Comments

Top News

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Several provider organizations develop Health Record Request Wizard, an online tool that walks patients through submitting a request to providers for electronic copies of their medical records. It extends a previous form developed by AHIMA by adding branching logic.

Despite the headline proclaiming that it helps families obtain and share their records, it doesn’t – it addresses the 2 percent of the work involved in providing a standard user interface for such requests while neatly turfing off the 98 percent of technical integration to EHR vendors who may not see the value in supporting someone else’s front end. Only three health systems and no EHR vendors have pledged to support it.

Plus it doesn’t support the most prevalent and essential healthcare technology – the fax machine.


Reader Comments

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From HIT Medical Student: “Re: JAMA article. I think your readers will find the author’s conclusion as ridiculous and insulting as his title. How are physicians still using ‘autism’ as a pejorative in professional settings? At what point, if ever, are all physicians going to understand that EMR documentation is a vital part of patient care and population health management?” The JAMA Pediatrics opinion piece titled “The Electronic Health Record and Acquired Physician Autism” was written by Palmetto Health (SC) psychiatrist Peter Loper, Jr., MD. He blames a “fixation on the EHR” for his being “abrupt and crass” with patients, complaining that he had previously refused to use an EHR during encounters and admitting that he was “chronically behind on documentation.” His point is that focus on the EHR during encounters causes doctors to “exhibit the same behaviors that render this disorder so socially incapacitating for those on the autistic spectrum” while failing to note the humanity of the encounter and that the physician-patient relationship is key to disease management. He could have made his point without the autism reference, and had he done that, I would defend him since he’s a child-focused psychiatrist and EHRs (Palmetto uses Cerner) do little to improve his practice over paper other than to get him paid. He also suffers from the ubiquitous misperception that his N-of-one experience is generalizable to the entire medical profession and also fails to consider how his employer chose to configure the EHR and mandate its use, doing as doctors often do in shooting the EHR vendor messenger without realizing that it wasn’t them who made the workflow decisions.  

From Crass is Greener: “Re: Memorial Sloan Kettering and Paige.AI. Your update makes me wonder about its business relationships with IBM and Allscripts looks like, knowing that IBM needs to prove out Watson and Allscripts’ propensity for ‘doing deals’ (see Verity Health).” Hospitals excel at cloaking business deals behind lofty, altruistic proclamations (this is especially common with oncology and pediatrics since everybody is extra empathetic to those patients.) It would be interesting to see MSKCC’s contract with IBM, especially since reports suggest that Watson Oncology is more of a mechanical turk that just sends whatever recommendations MSKCC’s doctors manually offer while disguising it to look like machine-powered insight. I wouldn’t trust any deal involving Patrick Soon-Shiong’s Nant companies, and the apparent enthusiasm with which Allscripts did so suggests desperation on both ends of the transaction, leaving the now-bankrupt Verity in the middle of a Sunrise implementation they didn’t want and their financial Santa Claus moving on to other shiny objects after just one year. My life’s most relevant lesson learned is that people and organizations (including many non-profits and all health systems) do whatever benefits them the most, so follow the money.


HIStalk Announcements and Requests

Listening: new from Badflower, LA kids who can crank out some hard rock. They are touring tiny venues (like bars) right now – they’ll be in Madison, WI on October 12. I’m enjoying their music along with the best manufactured cookie I’ve had in years, Oreo Thins with pistachio (I expect the coconut to be equally wondrous). 


Webinars

September 26 (Wednesday) 12:30 ET. “How to Ensure Patient Records are Always Available.” Sponsor: Goliath Technologies. Presenter: Goliath Technologies engineering staff. This webinar will discuss how an early warning system can help your organization ensure your EHR systems and patient records are always available. You’ll also learn how to proactively anticipate, troubleshoot, prevent, and resolve end user experience issues before users or patients are impacted.

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


Acquisitions, Funding, Business, and Stock

CenTrak acquires the security solutions assets of Elpas Solutions, which include infant protection, wireless call, staff duress, man down, and wander management.


People

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Akron Children’s Hospital (OH) promotes pediatric hematologist-oncologist Sarah Rush, MD to CMIO.

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Intelerad Medical System hires Paul Lepage (Telus Health) as president/CEO.


Announcements and Implementations

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Cancer management and patient engagement technology vendor Carevive goes live with its patient care planning software at University of Missouri Health Care’s Ellis Fischel Cancer Center, where it is integrated with Cerner Oncology.

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I missed this earlier: a Rand report recommends that patients get involved with provider record-matching challenges, with these suggestions:

  • Implement a voluntary universal identifier, managed by an organization that does not store PHI
  • Implement a patient-managed public key
  • Expand the use of government-issued identifiers such as driver license numbers
  • Match records by asking patients to verify their identity by answering “what you know” type security questions
  • Use biometrics with demographics
  • Verify the identity of patients by sending one-time verification codes to their phones
  • Implement consumer-directed exchange
  • Use regional health record banks
  • Give patients a user interface so they can verify record matches themselves
  • Have patients supply their own record location information

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In urge-to-merge and marketing provider news, Greenville Health System and Palmetto Health will rename their South Carolina partnership to Prisma Health, while in Florida, Orlando Health and Lakeland Regional will end their affiliation October 1 after just one year due to their “different strategies and distinctive communities served” that were apparently not evident 12 months ago. One might assume it was an uneasy relationship between Orlando and Lakeland since the websites of both systems have been scrubbed of any evidence of the affiliation, including their rosy press releases from last year that predicted improved patient access and clinical quality. And in Maine, Eastern Maine Healthcare Systems (which oddly makes “system” plural) will rename itself Northern Light Health, following the lead of hospitals that have eschewed their confusing “health system” moniker to make a land grab for the “health” label even though hospitals have only a tiny impact on health while taking the lion’s share of healthcare expenditures.


Other

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Intermountain precision genomics director Lincoln Nadauld, MD, PhD decries EHR-generated PDFs as a crude form of interoperability, noting that a particular patient’s 143-page record could not be searched, viewing it caused it to re-default to 6-point font with each page flip, it could not display CT scan images, and it contained only the first page of genomic testing results. He advocates a patient-controlled, cloud-based, searchable repository, not surprisingly since he wrote the piece for Ciitizen, a pre-beta vendor that will offer such a sharing platform. It sounds a bit like CareSync, which unfortunately couldn’t make a go of offering a stellar service that also included having humans obtain the subscriber’s medical records (my CareSync experience was excellent). I’m ever-skeptical about a business model that expects patients to obtain and upload their own records since they historically won’t bother.

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An Associated Press analysis finds that despite the White House’s claim in May that drug companies would announce “massive” price cuts almost immediately, 2018 has seen 96 price increases for every one price reduction. HHS Secretary Alex Azar — a former executive of a drug company that dramatically increased insulin prices during his tenure — says he’s not counting on “the altruism of pharma companies lowing their prices.” Drug price hikes are often small but frequent and makers of competing products often raise prices in lockstep.

Former UN Secretary General Ban Ki-moon says the US healthcare system, the world’s most expensive by far, is morally wrong in that “nobody would understand why almost 30 million people are not covered by insurance.” He says drug companies, hospitals, and doctors are using their lobbying power to avoid universal healthcare. 

A Michigan jury awards $130 million to the family of a boy who in 2006, as a two-month-old, developed cerebral palsy that the family’s attorneys claim was due to a botched IV start at Beaumont Hospital. The family’s lawyers say the now-12-year-old is a “charming and beautiful boy” who needs help getting in and out of the bathtub.

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I’ve lost interest in the heavy-handed and unrealistic medical program “The Resident,” but  its Season 2 premiere this week borrowed an idea from year-old episode of “Grey’s Anatomy” by featuring a cyberhacking story line. The hospital’s drama-filled blackout turns out to be the work of a hacker who got herself admitted to the hospital so she could breach its systems from the inside (Hollywood loves “the call is coming from inside the house” as a shocker) in revenge for high medical bills that forced her to drop out of college. Least believable (and that’s saying a lot for this episode) is that the hacker was admitted for a UTI instead of being streeted with a prescription for antibiotics, and when confronted about the breach, she handed over a thumb drive backup that somehow fixed everything. Not unbelievable is that the hospital fired an uninvolved IT guy over the incident. 


Sponsor Updates

  • Crossings Healthcare Solutions will demonstrate its clinical decision support tools for physicians, nurses, and informaticists at the 11th Annual DV/NJHIMSS Fall Event this week in Atlantic City, NJ and at the Cerner Health Conference October 8-11 in Kansas City, MO.
  • ROI Healthcare Solutions is featured on the TV program “Newswatch.”
  • Kyruus will convene a CEO panel at the Fifth Annual Thought Leadership on Access Symposium in Boston October 15-17.
  • MModal and Enjoin will partner to offer a technology-driven clinical documentation improvement advisory solution to address population health.
  • The Wisconsin State-Journal profiles Nordic Data & Analytics Services Delivery Manager Eric Pennington.
  • Nordic’s managed services division has signed 20 clients and expanded to 100 consultants.
  • Healthwise launches its FHIR app in Epic’s App Orchard.
  • Aprima will offer HIPAA compliance programs from Abyde.
  • Mmodal partners with Enjoin to offer clinical documentation consulting services.
  • ZappRx partners with specialty pharmacy Dunn Meadow to speed up prescription access for oncology and pulmonology patients.
  • FDB publishes a new case study describing how Health First improved medication adherence with FDB’s Meducation in its Allscripts Sunrise EHR.
  • AdvancedMD will exhibit at WebPT’s annual Ascend conference September 28-29 in Phoenix, AZ.
  • Aprima, CoverMyMeds, CTG, Culbert Healthcare Solutions, and Direct Consulting Associates will exhibit at MGMA September 30-October 2 in Boston.
  • CarePort Health will exhibit at ACMA Maryland September 29 in Baltimore.
  • Change Healthcare will host Inspire 2018 September 30 in Phoenix, AZ.
  • Cumberland Consulting Group will exhibit at the MDRP Summit 2018 October 1-3 in Chicago.
  • Dimensional Insight will exhibit at 2018 IntegraTe October 2 in Davie, FL.

Blog Posts


Contacts

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

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Morning Headlines 9/25/18

September 24, 2018 Headlines No Comments

UMass Memorial Health Care Entities to Pay $230,000 to Resolve AG’s Lawsuit Over Data Breaches

UMass Memorial Medical Group and UMass Memorial Medical Center will pay $230,000 to settle a lawsuit related to employees improperly accessing patient medical records, and then using their data to open cell phone and credit card accounts.

Memorial Regional Health to request approval to sell dirt lot, wins $200K grant

Memorial Regional Health (CO) will move to Epic as part of a new affiliation with SCL Health St. Mary’s Regional Health System (CO).

Ochsner Health System, LSU Health Shreveport join forces to improve healthcare in north Louisiana

Ochsner Health System (LA) and LSU Health Shreveport will invest in EHR, digital health, and telemedicine enhancements as part of a new joint operations agreement.

Curbside Consult with Dr. Jayne 9/24/18

September 24, 2018 Dr. Jayne 1 Comment

Being in the consulting world, I am exposed to a large variety of practices, partnerships, health systems, integrated delivery systems, and more. It’s always challenging when clients and prospects want me to “find someone that looks just like us” before they agree to start working on a project.

I let them know that it’s not just a question of finding someone in my client base that has similar characteristics, but sometimes even finding someone in the healthcare realm that looks like them is challenging to impossible. Explaining this can be difficult, especially after clients have interacted with vendor sales reps who have done their best to convince them that as long as they talk to someone in the same specialty, or as long as they talk to a group of the same size, that they can expect to have comparable experiences.

I see this with both small and large clients, even with large health systems that think that just because XYZ health system on the other side of the country did a certain project a certain way, that they will have similar outcomes. There are so many variables that play into a project’s success, that it often becomes one of those “your mileage may vary” situations.

I ran across this recently with an organization that was looking to understand what size of a team they needed to support their ambulatory EHR needs after migration to a new system. They seemed rather upset that I couldn’t just tell them how many people to hire, without performing some level of discovery around the level of support they planned to provide, what their proposed governance structure would look like, what the organization’s support budget was, and what skill set they expected the team to have.

It’s a complex equation, and I always try to attack the idea of governance – both clinical and application – as the first step in figuring out what makes a group tick and what their needs might be. Organizations that understand the value of governance are like gold to me. They understand that decision-making is important, as is understanding who owns the application and who is responsible for making decisions related to implementation, maintenance, support, and upgrades.

When an organization decides to have tight governance, it can result in not only cost savings due to decreased variation, but also in measurable quality when providers understand that it’s important for people to deliver care in a standardized way. Many organizations do a good job with this during the design and build phases of an implementation, but once the system goes live it’s tempting to fall into bad habits.

Organizations may make customizations to appease a single provider or a small group of providers, which not only consumes resources in the present time, but also in the future, as those customizations have to be constantly evaluated against upgraded software versions. Some organizations I’ve worked with don’t even track their customizations, so they can’t possibly evaluate them. Each upgrade becomes a bit of a surprise as they try to figure out what the “out of the box” software looks like vs. what they have installed in their environments.

My first Lean Sigma project years ago was to work on an EHR upgrade, and I admit that the project itself failed – we ended up not taking the upgrade – but we learned a tremendous amount about the methodology needed to successfully evaluate a new release and get it through the upgrade process. We created an evaluation paradigm that I still use today, across multiple vendors and even outside of EHR applications.

Sometimes the decision to modify the application rests with a clinical committee, but other times it’s the nebulous “IT” that reviews requests and makes the changes. This is unfortunate because technology projects require care and feeding not only by the technical team, but by clinical and operational owners. However, it’s easier to blame “IT” rather than addressing inadequate or absent governance. Other groups may keep their governance structures after go-live, but they become weak over time due to shifting priorities, members’ attention being focused elsewhere, or outright neglect.

It’s great when things are ticking along just fine, but bringing your governance group together quarterly even if there aren’t major decisions to be made isn’t a bad idea. There may be issues that are brought to light or maybe the group just confirms that things are going well, but it’s one of those things that if you don’t ask, you might be missing problems that you didn’t even know existed. If you can’t even get people in the room, that might be a red flag for apathy or end users checking out rather than engaging.

Governance can be tightly linked to management, although it’s best if neither exists in a vacuum. Strong management helps ensure that decisions that are made are carried out in an effective and cost-efficient manner. Effective management is what transforms an organization to being reactive towards the squeaky wheel into one that can proactively look for issues and identify solutions before things turn into problems. It’s often difficult though to have strong management with physician groups, especially when there are numerous competing personalities and where organizational politics becomes a factor.

I’ve seen so many groups take a page out of “Lord of the Flies” rather than be willing to address difficult colleagues or tackle ineffective team members. When I work with them, I present techniques for communication and consensus-building and sometimes it seems like this is the first time they heard that there are “treatments” that can help get them through the rough spots just like there are remedies for medical conditions.

Both governance and management can be tightly linked to culture. I frequently encounter organizations that can’t articulate their culture, and I guarantee that if the leadership can’t even define the concept, they’re not doing a great job of carrying it to the rest of the organization. If leadership is preaching the need for strong governance and effective management,and then doesn’t deliver on those expectations at the highest levels, it becomes not only demoralizing, but often costly for the organization which ends up floundering. The importance of these relatively “soft” disciplines shouldn’t be underestimated.

It’s with all of these factors mind that I approach each organization I work with. One has to understand who they are, where they have been, where they are going, and where they want to be before you can make recommendations to help them. When you’ve seen one organization, you’ve seen one organization, regardless of how similar they may be in size, scope, specialization, etc. It’s tough to determine whether your experiences might be like someone else’s without asking some difficult questions.

I challenge organizations who are in the market as buyers to consider this concept when you are presented with a reference site or a case study that someone is trying to use to convince you to buy, or when you’re trying to determine your implementation or support model. You might find yourself asking some difficult questions of your own organization. Uncomfortable as it might feel, it’s a good thing.

How does your organization approach concepts like governance? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 9/24/18

September 23, 2018 Headlines 1 Comment

.@sloan_kettering sent a note to staff today after my story with @katie_thomas @nytimes.

Memorial Sloan Kettering Cancer Center leadership defends itself to its employees following reports that it gave for-profit AI startup Paige.AI exclusive access to its 25 million pathology slides in return for an equity stake for itself and several MSKCC executives

Longmont-based software company helped hospitals keep track of patients during Florence evacuations

Emergency response software vendor Knowledge Center played a vital role in the evacuation of 313 patients from hospitals in the path of Hurricane Florence.

Biden Cancer Initiative Recognizes MITRE Partnership’s Core Cancer Model

MITRE partners with Intermountain Healthcare, the American Society of Clinical Oncology, and ASCO’s CancerLinq subsidiary to develop a set of cancer data elements culled from EHRs that will help providers make better treatment decisions at the point of care.

Monday Morning Update 9/24/18

September 23, 2018 News 8 Comments

Top News

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Memorial Sloan Kettering Cancer Center leadership defends itself to its employees following reports that it gave for-profit AI startup Paige.AI exclusive access to its 25 million pathology slides in return for an equity stake for itself and several MSKCC executives (in essence, profiting from the work of its pathologists and the property of its patients instead of by creating new intellectual property). The health system explains that:

  • It is sharing only de-identified patient data and not actual slides (note: the Paige.AI partnership announcement specifically says it gained “exclusive rights to MSK’s library of 25 million pathology slides” that are “accompanied by de-identified pathologic and clinical annotation”)
  • The relationship between its executives and the company was vetted for conflict of interest
  • Board members and faculty who received equity won’t participate in company decisions
  • They’ll kick back some of the proceeds to the pathology department

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MSKCC’s recent bad press – including unreported conflicts of interest by a since-resigned key researcher who was raking in drug company money and skepticism about its relationship with IBM Watson Health – add it to the list of health systems whose high-falutin’ patient care proclamations fail to hide the fact that it often acts like any other self-enriching business whose own interests come first. It paid its CEO $6.7 million (plus he gets a company house), its CIO $1 million, and its chief fundraiser $1.4 million, according to its most recent tax forms.

In case you missed it, sick and frightened cancer patients are a highly profitable widget in this country. As is typical in healthcare, nebulous consent forms allow their data to be sold to any willing buyer without their permission or benefit.

ProPublica notes that its report didn’t create the MSKCC Paige.AI controversy – it was MSKCC’s own pathologists who complained that their work had been taken for the benefit of top MSKCC brass. Surprisingly, they didn’t complain that Paige.AI’s business model requires the company to characterize the work of human pathologists as subjective, error-prone, and inefficient compared to allowing a computer to do their work.

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MSKCC’s former pathology department chair Marc Rosenblum, MD wrote the most brilliantly sarcastic internal email I’ve ever seen last month (subject: “Department: Fleece(d)”) in offering suggestions to hold a Paige.AI naming contest with stock options as a prize to “fully embrace the entrepreneurial tenor of our times;” to create a department logo to “trumpet where we’re going” that would look good on a Patagonia fleece; and to create a department fight song. 


HIStalk Announcements and Requests

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Poll respondents are skeptical about the population health benefits of the Apple Watch’s EKG recording capability.

New poll to your right or here: would you be OK with having your social media activities monitored for health research or to trigger personalized health improvement suggestions? I admit I’m fascinated by the human aspect of expecting an insurer to cover huge financial risk while denying them relevant information, which then goes back to the argument about universal healthcare, under which such lifestyle forensics would be unnecessary since the entire country would make up the risk pool. Life insurers are allowed to require medical exams, getting auto insurance involves having your pre-existing condition (driving record) examined initially to set premium prices and having that price jacked up (or the policy cancelled) following a paid claim, and all forms of business insurance (malpractice, cybersecurity, etc.) come with the expectation of allowing the insurer to assess their risk by inspecting sensitive records. Only with health insurance are we offended at the idea that insurers need to learn more about our health before agreeing to pay to maintain it, an expectation that has risen due to out-of-control hospital and drug costs in the absence of political will to address the issue.


Webinars

September 26 (Wednesday) 12:30 ET. “How to Ensure Patient Records are Always Available.” Sponsor: Goliath Technologies. Presenter: Goliath Technologies engineering staff. This webinar will discuss how an early warning system can help your organization ensure your EHR systems and patient records are always available. You’ll also learn how to proactively anticipate, troubleshoot, prevent, and resolve end user experience issues before users or patients are impacted.

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


People

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Mazars USA promotes Gil Enos to leader of its healthcare consulting group.


Announcements and Implementations

Wolters Kluwer Health launches a new version of its Sentri7 clinical surveillance solution.


Other

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Researchers question whether it’s a good idea to apply Cambridge Analytica-type social media “digital phenotyping” to target people for population health interventions. They note that such activities incur the risk of public backlash (when social media users realize they’re being monitored and controlled) and having those users go underground by avoiding using words that all out their health-harming practices.

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An oncologist’s Wall Street Journal op-ed piece ponders the dilemma in which drug companies charge whatever high prices the market will bear irrespective of their actual research and manufacturing costs and the extent to which the drug improves an individual’s health, noting that the US is the only country that approves marketing of drugs without negotiating the allowed selling price:

The extraordinary cost of these treatments presents a tragic dilemma: We may soon have a miracle drug for cancer whose cost, when multiplied across the population that needs it, could bankrupt the country. Consider what would happen if the new drugs were used to treat 250,000 cancer patients per year—just 40 percent of the Americans who die annually from cancer. At $373,000 per patient, a Kymriah-type immunotherapy treatment would increase drug spending in the US by approximately $93 billion a year. This would mean an almost 20 percent increase in the country’s total annual drug spending—for just one drug. To put that figure in perspective, it amounts to $300 per American, or $500 if we include associated medical services.

Why we should have been lawyers: a Georgia jury awards the family of a baby whose penis was injured during a midwife’s circumcision $30 million.

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A fun Bleacher Report profile of Laurent Duvernay-Tardif, MD – who is also a right guard for the Kansas City Chiefs who signed a five-year, $41 million contract extension with $20 million guaranteed last year – reveals interesting facts:

  • He made good money at 12 years old selling pesto that he made himself, explaining that it had to be very good since “I wasn’t cute enough to get any sympathy purchases.”
  • His parents took the children on year-long sailing trips carrying only rice and canned vegetables to show them that money isn’t all that important.
  • The Quebec born Duvernay-Tardif graduated from McGill University’s medical school even though he spoke only French and all his classes were conducted in English, so he played lecture recordings at half speed while looking words up in a dictionary.
  • He was on call on NFL draft day, so he gave his phone to a nurse and asked her to say yes to any team that drafted him while he participated in an emergency C-section.
  • He is only the 10th player ever drafted by the NFL from a Canadian college and the first active doctor to be on a team’s roster
  • The NFL denied his request to add “MD” after his last name on his jersey, which he says is OK since “my name is Duvernay-Tardif, and it’s plenty long enough like that.”
  • He explanations the motivation required to master two difficult professions: “My biggest fear is doing nothing. When you start downsizing your expectations of what you can do with your time, it’s hard to go back. If I spend an offseason doing nothing, I don’t know if that drive will come back. That scares me more than anything.”

Sponsor Updates

  • Lightbeam Health Solutions launches the Pop Health Podcast with an initial episode on gaining patient buy-in for chronic care management.
  • MedData and Experian Health will exhibit at the HFMA Region 7 Conference September 26-28 in South Bend, IN.
  • Kansas State University’s College of Engineering names Netsmart its 2018 Company of the Year.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the CSO HIMSS Leadership Symposium September 28 in Cincinnati.
  • PreparedHealth will exhibit at the Regional DV-NJ Chapters HIMSS Conference September 26-28 in Atlantic City.
  • The SSI Group will exhibit at the HFMA South Texas and TAHFA Fall Symposium September 23-25 in San Antonio.
  • Surescripts and ZappRx will exhibit at the NASP Annual Meeting & Expo 2018 September 24-26 in Washington, DC.
  • TriNetX will host TriNetX Summit18 September 25-26 in Boston.
  • Vocera will exhibit at the Illinois Health and Hospital Association Leadership Conference September 25 in Lombard, IL.
  • Consulting Magazine names Huron a “Best Firm to Work For” for the second consecutive year.
  • Wellsoft will exhibit at Emergency Nursing 2018 September 26-29 in Pittsburgh.

Blog Posts


Contacts

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

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Reader Comments

  • Frustrated Patient: " suggesting that my providers don’t really want to open up a can of medical worms by asking how I’m doing overall e...
  • AC: That's good to hear. So the major vendors have worked on this and provided tools. The question now becomes are organizat...
  • Associate CIO: Re: EHR internal timers and event log monitoring Cerner has this as well, it is called the Lights On Network. A curr...
  • Bob: Liked - "The jammed interoperability floodgates would magically open by Labor Day if their payments depended on it."...
  • Bob Smith: Great comment on the interoperability incentives. My experience having been a patient across at least 5 health systems t...
  • richie: Yes Anon, I believe it's in the referenced in supporting documents. Initial: Patients want to know who is grabbing thei...
  • Anonymous: Richie, as someone who hasn't read the proposed rule, do you mind elaborating? Does it really deny patients access to t...
  • InfoDoc: Your pain scale image reminded me of this: http://hyperboleandahalf.blogspot.com/2010/02/boyfriend-doesnt-have-ebola-...
  • Mr. HIStalk: The actual operating entity, according to the lawsuit, is Jack Hughston Memorial Hospital in Phenix City, which is physi...
  • Gitfishin: Re: AL hospitals paying sales tax on software purchases. Why would a not-for-profit pay taxes? Or does this only apply t...

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