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EPtalk by Dr. Jayne 5/3/18

May 3, 2018 Dr. Jayne Comments Off on EPtalk by Dr. Jayne 5/3/18

I had a medical student working with me this week and delivered a mini-lecture on healthcare funding in the United States and why some practices don’t take Medicaid or opt out of Medicare. It was an eye opener to a student in his third year, which tells me that healthcare finance isn’t part of his medical school’s curriculum. He was surprised to learn that compared to the cost of delivering care in our metropolitan area, that Medicare typically pays 80 cents on the dollar but Medicaid only pays 24 cents on the dollar. Something tells me that after our conversation, his primary care fire is not burning bright.

We spent some time talking about concierge medicine and direct primary care, and he found this piece about concierge emergency services. Apparently, patients on New York’s Upper East Side can afford to pay upwards of $5,000 annually for access to a private emergency practice plus per-visit fees. According to the article, the facility keeps two physicians and a physician assistant ready to see patients at all times, but only see a handful of patients each day. I couldn’t help but try to calculate their expense model in my head while he was telling me about the piece, and as I saw my 16th patient in three hours, I began to wonder if they are hiring.

We also discussed this American Academy of Family Physicians “In the Trenches” blog post addressing the need for competition and innovation in the EHR market. It brings up some good tidbits that I had forgotten. First, let’s take a look back to 2004. President George W. Bush included computerized health records in his State of the Union Address, and in April of that year launched a campaign to promote healthcare transformation. The initiative projected that “within the next 10 years, electronic health records will ensure that complete healthcare information is available for most Americans at the time and place of care, no matter where it originates.” That decade has come and gone, and for most of us, health records are held in a patchwork of systems that don’t talk to each other.

My favorite quote from blog author Shawn Martin is regarding EHRs: “They suck. They suck as products, and they suck the life out of everyone that uses them.” He goes on to describe other technology platforms such as Facebook, Twitter, iPhone, Uber, and others, which significantly transformed how people communicate and interact, and the lack of transformation in healthcare technology. That’s not to say that innovative tools aren’t out there, but there are quite a few dinosaurs that feel like they should already be extinct. One of my colleagues jumped into the conversation, and we reminisced about a couple of key features that we used to have in our ancient Medical Manager OmniDoc system circa 2003 that we still don’t have in our current system in 2018, despite numerous “enhancement requests.”

Martin hits the nail on the head with his summary of the AAFP efforts to improve innovation: “Eliminate or reduce administrative requirements placed on health IT products – the poor usability of EHRs is often due to external requirements established by regulators and payers, such as clinical documentation, which do not add clinical value.” I remember the copy of the physician note that my father brought back from a trip to Australia, when he had a wicked case of sinusitis. Basically, it documented a brief history, described the physical exam as it related to sinus findings, then proceeded to a diagnosis and an antibiotic recommendation. There was no capturing bullet points to substantiate billing requirements or other such nonsense. The detail told me exactly what was going on with the patient and didn’t drive me to distraction. Sure, it didn’t include an assessment of my father’s chronic conditions, his nutritional status, whether he is a fall risk, or a number of other data points, but I envy the physician who was able to focus on the problem at hand and still get paid, even in the outback. I look forward to the day when we have systems that are better at highlighting important data while allowing less-critical data points to fade to the background unless clinical decision support or other algorithms identify a need to bring that information to the front.

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I heard about the idea of “signing your scrub cap” several months ago, but hadn’t seen it in person until this week. I was attending a Grand Rounds lecture at my hospital, and several people walked in with their name and role written on their scrub caps. Of course, one always has to wonder why people wear their caps outside the surgery suite, but I appreciate the move towards clear identification of the care delivery team. Having been the nameless student responding to “you, more tension on the retractor” for several years, it might have added some humanity to medical school rotations. As a patient, there are so many people in and out when you’re having a procedure, it would be great to not have to guess who is who especially when you have mind-altering drugs dripping through your IV.

I wrote about the All of Us Research Program some time ago, and its national launch is finally here. Beginning on May 6, adults 18 and older can join this project, which is part of the Precision Medicine Initiative. Billed as potentially the longest and most diverse longitudinal health research program ever developed, it needs more than a million individuals to provide data. Participants will share both patient-generated and EHR data, and may also be asked to provide biometric data along with blood and urine samples. The consent process takes up to 30 minutes to complete and can’t be interrupted, so if you decide to take part be sure you have a comfy chair to work from.

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Not from Weird News Andy, but might as well be: A hotel guest recently allowed to stay at the Fairmont Empress in Victoria after being banned more than a decade ago due to some bad decisions involving pepperoni. As the story goes, the traveler had a “suitcase full of pepperoni” and left it near an open window so it would stay cool. While he was out of the room, seagulls discovered the suitcase, ate the pepperoni, and left a mess in the room. I’ve seen a raccoon open a tab-top soda can, but after reading the story I wasn’t exactly sure how a seagull opens a suitcase. Fortunately, NPR had some more thorough reporting and explained that the pepperoni was actually laid out on a table near the window.

Email Dr. Jayne.

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Morning Headlines 5/3/18

May 2, 2018 Headlines Comments Off on Morning Headlines 5/3/18

Beth Israel Deaconess Medical Center Launches Health Technology Exploration Center

Beth Israel Deaconess taps CIO John Halamka, MD to lead its new Health Technology Exploration Center, which will explore the role of emerging technologies like blockchain and IoT in healthcare delivery.

Cerner Reports First Quarter 2018 Results

Cerner shares drop after the company reports lower than forecasted Q1 revenue of $1.29 billion.

Nokia is selling its smart watch and digital health business

After acquiring Withings in 2016 to build out its digital health business, Nokia plans to sell the business to Withings co-founder and former chairman Éric Carreel.

Comments Off on Morning Headlines 5/3/18

Morning Headlines 5/2/18

May 1, 2018 Headlines Comments Off on Morning Headlines 5/2/18

Health2047 Inc. Secures $27.2M Investment From the American Medical Association to Fuel Business Momentum

AMA invests $27 million in the Health2074 technology company it founded in 2016 with a $15 million investment.

EXL deepens investment in Healthcare and Analytics by signing a definitive agreement to acquire payment integrity and population risk management company SCIOInspire Holdings, Inc.

Operations management and analytics company EXL will acquire SCIO Health Analytics for $240 million.

Jackson Won’t Return As Trump’s Personal Physician, Report Says

White House officials conclude that several of the allegations made against President Trump’s former personal physician and VA Secretary nominee Ronny Jackson, MD released last week by Senator Jon Tester (D-MT) are not true.

Comments Off on Morning Headlines 5/2/18

News 5/2/18

May 1, 2018 News 10 Comments

Top News

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Reports surface that West Palm Beach family physician Bruce Moskowitz, MD has participated in several planning calls with the VA/Cerner contracting team, and may in fact be responsible for its delay. Moskowitz, who has ties to President Trump’s inner Mar-a-Lago social circle, has been vocal about his dislike of Cerner’s software based on his use at two Tenet hospitals in Florida – technology deemed out of date by investigators from the VA’s Office of Information and Technology.

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Moskowitz’s influence and that of Marvel Entertainment Chairman Ike Perlmutter, who has also been on the calls, reportedly rankled former VA Secretary David Shulkin, MD and clinicians involved with the EHR project. Their influence came to national light in 2016, when they helped to convene a hush-hush meeting at Mar-a-Lago between President-elect Trump and leaders from the Cleveland Clinic, Johns Hopkins, the Mayo Clinic, and Partners HealthCare.


HIStalk Announcements and Requests

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Responses to this week’s question are trickling in, with most emphasizing the tightrope managers must walk in firing someone that deserves it, but not being able to articulate the reasons why to the rest of the company for confidentiality reasons. I hope you’ll add your experience to the mix.


Webinars

May 9 (Wednesday) 2:00 ET. “How to Make VBC Work for You: The Business Case to Transform Into the Health System of the Future.” Sponsor: Philips Wellcentive. Presenters: Mason Beard, co-founder and chief product officer, Philips Wellcentive; Scott Cullen, MD, principal, ECG Management Consulting; Seema Mathur, director of strategy, Sage Growth Partners. How well is your organization funding its transformation to VBC? This free webinar explains how to achieve ROI as your organization transforms to meet the future. You’ll learn how VBC is impacting healthcare system management, three strategies for funding your transformation, and what the healthcare system of the future will look like.

May 24 (Thursday) 1:00 ET. “Converting Consumers into Patients: Strategies for Creating Engaging Digital Experiences People Demand.” Sponsor: Healthwise. Presenters: Antonia Chappell, director of consumer solutions, Healthwise; Josh Schlaich, senior product manager, Healthwise. Nearly three-quarters of US adults use a digital channel to manage their health and the internet to track down health information. It’s clear that consumers have come to expect online interactions as an integral part of their overall patient experience. In fact, the Internet may be the first way people come in contact with your organization. They have more choice than ever on where to get healthcare services, and their decisions are increasingly influenced by how well organizations connect with them in the digital space. This webinar will show you how to create engaging digital and web experiences that convert casual consumers into patients and keep them satisfied throughout their entire patient journey.

June 5 (Tuesday) 1:00 ET. “Increase Referrals and Patient Satisfaction with a Smarter ‘Find a Doctor’ Web Search.” Sponsors: Phynd Technologies, Healthwise. Presenters: Joseph H. Schneider, MD, MBA, FAAP, retired SVP/CHIO, Indiana University Health; Keith Belton, VP of marketing, Phynd. A recent survey found that 84 percent of patients check a hospital’s website before booking an appointment. However, ‘Find a Doctor’ search functions often frustrate them because their matching functionality is primitive and the provider’s information is incomplete or outdated. Referring physicians need similarly robust tools to find the right specialist and to send the patient to the right location. Attendees of this webinar will learn how taxonomy-driven Provider Information Management improves patient and referrer satisfaction by intelligently incorporating the provider’s location, insurance coverage, specialty and subspecialty, and services offered that can be searched via patient-friendly terms.

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


Acquisitions, Funding, Business, and Stock

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Agfa Healthcare receives FDA 510(k) clearance for its DR 800 multipurpose digital imaging system.

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Enterprise telemedicine vendor InTouch Health acquires competitor Reach Health for an undisclosed sum.

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AMA invests $27 million in the Health2047 technology company it founded in 2016 with a $15 million investment. The company launched health data network Akiri (fka Switch) last year, and plans to develop additional companies in the areas of physician productivity, value-based care, chronic disease, and data exchange.

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Operations management and analytics company EXL will acquire SCIO Health Analytics for $240 million.

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Health data management company Datavant raises $40 million and acquires data de-identification vendor Universal Patient Key. Former FDA CIO Eric Perakslis now serves as Datavant’s chief scientific officer.


People

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Lety Nettles (Baker Hughes) joins Novant Health as CIO.

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Omkar Kulkarni (Cedars-Sinai) joins Children’s Hospital Los Angeles as its first chief innovation officer.

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Clearwater Compliance names John Moore (PwC) chief risk officer and Richard Staynings (Cisco) chief security and trust officer.


Announcements and Implementations

In an effort to keep up with the Apple and Amazon Joneses, Fitbit will use Google’s Cloud Healthcare API to share user data with providers via their EHRs.

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Providence St. Joseph Health (WA) launches a Virtual Health System comprising 50 telemedicine programs across 100 facilities in five states.

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UCHealth Yampa Valley Medical Center (CO) will go live on Epic in early May.

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Kaweah Delta Medical Center (CA) goes live on Cerner. The organization was due to replace its Cerner/Siemens Soarian system with Cerner Millenium in November 2017.

Main Line Health (PA) integrates Bernoulli Health’s clinical surveillance, medical device integration, and data analytics platform with its EHR at four hospitals.

The SSI Group adds patient payment management capabilities to its Access Management line of revenue cycle software.


Government and Politics

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CDC Director Robert Redfield, MD asks for and receives a pay cut after reports surface that his projected salary of $375,000 was far above those of his HHS colleagues, including his boss, HHS Secretary Alex Azar. Redfield’s initial compensation was determined by the Title 42 salary program, which was established to attract top-notch researchers to government posts.

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Former HHS Secretary Tom Price, MD gives a keynote at the World Health Care Congress, during which he admits that doing away with the individual mandate “actually will harm the pool in the exchange market because you’ll likely have individuals who are younger and healthier not participating in that market. And, consequently, that drives up the cost for other folks in that market.”

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White House officials conclude that several of the allegations made against President Trump’s former personal physician and VA Secretary nominee Ronny Jackson, MD released last week by Senator Jon Tester (D-MT) are not true. Jackson, who withdrew his nomination after the allegations came to light, will stay on as an active duty Navy physician within the White House medical unit.


Sales

  • University of New Mexico Hospital will implement Glytec’s eGlycemic Management System.

Privacy and Security

The NHS will convert all devices to Windows 10 in an effort to prevent cyberattacks like WannaCry, which last year hit a third of its facilities and led to the cancellation of thousands of appointments and procedures.


Other

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As part of its $1.5 billion transition to Epic this weekend, Mayo Clinic will activate 51 patient intake kiosks at its campus in Rochester, MN. This won’t be the health system’s first foray into kiosks. It tried out two HealthSpot telemedicine kiosks in 2014 to remotely serve a local school and employer. That endeavor ended when HealthSpot went out of business two years later.


Sponsor Updates

  • Pivot Point Consulting partners with Trinisys to help customers migrate their legacy EHR data to new systems.
  • Clinical Architecture and CompuGroup Medical will exhibit at HLTH 2018 May 6-9 in Las Vegas.
  • KLAS gives Health Catalyst an “A” for high rates of customer satisfaction and customer retention in a new report, “Decision Insights 2018: National Trends & Best Practices.”
  • AdvancedMD will exhibit at APA’s annual conference May 5-9 in New York City.
  • Docent Health CEO Paul Roscoe will speak at HLTH 2018 May 8 in Las Vegas.
  • Casenet adds MCG Health’s Chronic Care Guidelines to its new TruCare Assessment and Care Plan Interface.
  • Aprima and Surescripts will co-present at Asembia’s 2018 Specialty Pharmacy Summit May 2 in Las Vegas.
  • Bluetree Network will exhibit at the 2018 Spring Hospital & Healthcare IT Conference May 2-4 in Atlanta.
  • Datica CEO Travis Good, MD will present at HLTH 2018 May 6-9 in Las Vegas.
  • Cumberland Consulting Group will exhibit at the NCPDP Annual Technology and Business Conference May 7-9 in Scottsdale.
  • Surescripts publishes a new white paper, “Changing the Course of the Opioid Epidemic: The Power and Promise of Proven Technology.”
  • Vyne develops an exchange platform to help payers manage member-related communications.
  • Medecision adds appeals and grievances monitoring, tracking, and management capabilities for payers to its Aerial product line.
  • GCS Medical College, Hospital & Research Centre in India selects the eClinicalWorks Hospital Management Information System.
  • ZappRx adds FDB’s e-prescribing capabilities to its specialty drug prescribing and prior authorization platform.

Blog Posts


Contacts

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

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Morning Headlines 5/1/18

April 30, 2018 Headlines 2 Comments

Fitbit stock soars after announcement of collaboration with Google

Fitbit will use Google’s Cloud Healthcare API to share user data with providers via their EHRs.

American Well to Acquire Avizia, Deepening Capabilities in Acute Care Delivery

American Well will acquire acute care telemedicine vendor Avizia for an undisclosed sum.

‘Who the hell is this person?’ Trump’s Mar-a-Lago pal stymies VA project

Reports surface that a West Palm Beach physician with ties to President Trump’s inner circle may be behind the VA/Cerner contract delay. Bruce Moskowitz, MD has expressed dissatisfaction with Cerner’s technology based on his use at two hospitals in Florida.

Datavant Acquires Universal Patient Key and Closes $40M Financing Round

Health data management company Datavant raises $40 million and acquires data de-identification vendor Universal Patient Key.

Curbside Consult with Dr. Jayne 4/30/18

April 30, 2018 Dr. Jayne Comments Off on Curbside Consult with Dr. Jayne 4/30/18

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A former colleague of mine is working on some health system initiatives to deliver community-based care. They’re working to identify the disease states that have the most potential to benefit patients who frequently wind up in the emergency department due to lack of care for chronic conditions. While they sort through the data, they’re already partnering with a set of local charities to address basic issues such as food insecurity through school-based food pantries. For many of the children in their target communities, the federal school lunch program may be providing the only balanced meal of the day, and this changes dramatically when schools let out for the summer. They are also working to provide clothing including school uniforms, and have found additional challenges with families who may receive uniforms but don’t have access to facilities to launder them. The health system is working under the hypothesis that they’re not going to be able to drive the needle on patient outcomes unless they address some of the basic needs in the community, in partnership with organizations already working in that direction.

The health system is already targeting adult populations with a mobile unit that performs diabetes outreach, but they’ve found that many of the patients that come to the mobile unit are already diagnosed and have physicians, but visit the van for testing that they feel is more convenient than going to the doctor’s office. There’s a risk of care fragmentation in that scenario, and the mobile unit has had to change its protocols to shift from strictly performing screening to adding care coordination and communication with primary care physicians. In looking at the next phase of community-based care, they have completed an amazing amount of analysis with emergency department records, community health clinic records, and data from state registries.

She told me about a couple of organizations that they have researched as potential models for their programs, and I took a peek at one of them. There is truly some amazing work going on that goes right along with the transformation to value-based care, but aren’t readily visible to many of us in the trenches. One of them is Mobile Care Chicago, which deploys vans to address childhood asthma in underserved communities. Their community health workers partner with schools to screen children for asthma symptoms, then reach out to the parents of those children to consent for care. Those who opt in receive an examination and often a diagnosis of asthma. The van visits schools monthly and tries to ensure the patients have continuity of care with providers over time.

Patients are seen an average of four times during the first year, and those who are not showing progress are referred for home visits. The cost savings data is pretty impressive, especially considering that some children with asthma might visit the emergency department more than a dozen times in a year, often without a formal diagnosis of asthma or a commitment for follow-up. Missed school days are down; emergency department visits and admissions are down as well, from 36 percent to 3 percent. The cost savings is impressive – it costs $900 annually to deliver care via the van, versus $15,000 for children who have to be hospitalized. The potential savings to local health systems is over $6 million.

Mobile Care Chicago also offers a dental van and a general children’s health van in addition to the asthma van. I’m curious what systems they use for documentation, to ensure the patients have a comprehensive health record and to make sure data is available for continuity purposes if a patient would arrive at the emergency department. There are always challenges when public and private organizations are involved, and sometimes data ownership and coordination become barriers. Years ago, I worked on an HIE project where various community clinics couldn’t agree on data sharing and governance, resulting in a structure that resembled more of a data vault than something that was truly interoperable. Providers could view data from other facilities but couldn’t download it or incorporate it into the clinical chart, making it less attractive to use especially given the separate login and clunky web interface. There were always battles about how new interfaces were going to be funded and whether new member organizations would be allowed to submit their data for viewing. Based on recent projects I’ve seen, those kinds of challenges are still out there.

I’d be interested to hear from clinical informaticists that are working with organizations like Mobile Care Chicago on how they leverage technology to make this all happen. Are they using available public health data from sites like HealthData.gov or gathering their own from local providers and facilities? How do they decide what communities to target? Do they change their outreach strategies based on modeling versus current data trends? Is it better to expand over a wider geographical area or to add more depth to services in areas that are already being served? In looking at potential models for our community, there will have to be a fair amount of consideration of the mobile approach versus trying to develop school-based clinics. I’m sure there are a multitude of legal and regulatory hurdles that will need to be fully evaluated for either option.

The Mobile Healthcare Association helps connect groups interested in mobile clinic operations, and offers regional coalitions for shared learning along with special interest groups for mammography and vision care providers. The organization advocates for mobile health delivery organizations and hosts an annual forum for members. They also help connect organizations with other members who might be selling their pre-owned clinics, and provide tips on selecting a diesel- or gasoline-powered vehicle. Those are entirely new dimensions for healthcare delivery that I hadn’t even considered.

Bringing healthcare to the people isn’t a new concept, but it’s something to think about every time a hospital builds a shiny new addition. Are we really serving patients better by expanding tertiary referral centers versus considering alternate delivery options such as mobile, school-based, or workplace clinics? It should be fairly straightforward to analyze the data over the next few years and determine who really is getting the best bang for their buck.

Are you involved in the delivery of mobile healthcare? How does your organization leverage information technology? Leave a comment or email me.

Email Dr. Jayne.

Comments Off on Curbside Consult with Dr. Jayne 4/30/18

Morning Headlines 4/30/18

April 29, 2018 Headlines Comments Off on Morning Headlines 4/30/18

DOD’s e-health record implementation to kick back off in 2019

DoD officials reassure legislators that the MHS Genesis roll out will pick back up with West Coast facilities in 2019, and that full deployment by 2022 is still achievable.

Erlanger earnings take a hit from new record system

Erlanger Health System (TN) attributes its third quarter $4 million shortfall to a 10-year, $100 million Epic implementation that kicked off with inpatient services last fall.

Jeremy Hunt launches review into training NHS staff to use new tech

In the UK, Health Secretary Jeremy Hunt brings in Eric Topol, MD to lead a review of how to best train NHS staff on using new technologies including AI, digital health, robotics, and genomics.

Comments Off on Morning Headlines 4/30/18

Monday Morning Update 4/30/18

April 29, 2018 News 3 Comments

Top News

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DoD officials reassure legislators that the MHS Genesis roll out will pick back up with West Coast facilities in 2019, and that full deployment by 2022 is still achievable. Implementation of the Cerner-based system had been paused for several months to deal with issues at the program’s four pilot sites, including problems with e-prescribing, referrals, log-in time, and training. The DoD has been sharing its experiences with VA officials on a regular basis to prepare them for their own Cerner roll out, provided a contract is signed in the coming months as some still optimistically expect.


HIStalk Announcements and Requests

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The contract drama playing out in Illinois hasn’t swayed the majority of poll respondents to think more positively about the parties involved, though Cerner does have a slight lead in a vendor-to-vendor matchup (an outcome one reader has attributed to ballot-box stuffing). At this point, I have to wonder how in-the-trenches end users feel. Email me if you happen to work at the health system, or have experienced a similar situation at another organization and would like to share your thoughts – anonymously, of course.

New poll to your right or here: Have recent privacy headlines impacted your interest in consumer genetic testing services? It seems we live in a time when data breaches are par for the course, and signing away your data rights just to trace your ancestry doesn’t give people as much pause as it should. I could offer a number of response options, but I’m keeping it simple with just three in hopes that you’ll explain in the comments why your interest has waned, stayed the same, or increased.

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Check out reader responses to “What I Wish I’d Known Before … Creating, Defending, or Managing a Hospital IT Budget.” While I can’t say I’m surprised by any of them, I can say I appreciate the advice of “realistic contingency” from a reader’s college professor.

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This week’s question seems timely given the plethora of headlines surrounding government officials who are being shown the door through media (and Twitter) pressure.


Webinars

May 9 (Wednesday) 2:00 ET. “How to Make VBC Work for You: The Business Case to Transform Into the Health System of the Future.” Sponsor: Philips Wellcentive. Presenters: Mason Beard, co-founder and chief product officer, Philips Wellcentive; Scott Cullen, MD, principal, ECG Management Consulting; Seema Mathur, director of strategy, Sage Growth Partners. How well is your organization funding its transformation to VBC? This free webinar explains how to achieve ROI as your organization transforms to meet the future. You’ll learn how VBC is impacting healthcare system management, three strategies for funding your transformation, and what the healthcare system of the future will look like.

May 24 (Thursday) 1:00 ET. “Converting Consumers into Patients: Strategies for Creating Engaging Digital Experiences People Demand.” Sponsor: Healthwise. Presenters: Antonia Chappell, director of consumer solutions, Healthwise; Josh Schlaich, senior product manager, Healthwise. Nearly three-quarters of US adults use a digital channel to manage their health and the internet to track down health information. It’s clear that consumers have come to expect online interactions as an integral part of their overall patient experience. In fact, the Internet may be the first way people come in contact with your organization. They have more choice than ever on where to get healthcare services, and their decisions are increasingly influenced by how well organizations connect with them in the digital space. This webinar will show you how to create engaging digital and web experiences that convert casual consumers into patients and keep them satisfied throughout their entire patient journey.

May 29 (Tuesday) 1:00 ET. “Increase Referrals and Patient Satisfaction with a Smarter ‘Find a Doctor’ Web Search.” Sponsors: Phynd Technologies, Healthwise. Presenters: Joseph H. Schneider, MD, MBA, FAAP, retired SVP/CHIO, Indiana University Health; Keith Belton, VP of marketing, Phynd. A recent survey found that 84 percent of patients check a hospital’s website before booking an appointment. However, ‘Find a Doctor’ search functions often frustrate them because their matching functionality is primitive and the provider’s information is incomplete or outdated. Referring physicians need similarly robust tools to find the right specialist and to send the patient to the right location. Attendees of this webinar will learn how taxonomy-driven Provider Information Management improves patient and referrer satisfaction by intelligently incorporating the provider’s location, insurance coverage, specialty and subspecialty, and services offered that can be searched via patient-friendly terms.

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


Acquisitions, Funding, Business, and Stock

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Erlanger Health System (TN) attributes its third quarter $4 million shortfall to a 10-year, $100 million Epic implementation that kicked off with inpatient services last fall. The system held off on billing during November as it worked through software issues, ultimately writing 30 million lines of code to resolve 15,000 workflow problems as part of an expected stabilization phase.

From the Athenahealth earnings call, which sent shares down 11 percent on Friday:

  • The company expects to continue to rely on its core ambulatory and growing small-hospital markets.
  • Management team and board member Dave Robinson and Chief Product Officer Kyle Armbrester have both left the company, with an ongoing search for a president progressing apace.
  • CEO Jonathan Bush admits the company hasn’t done much with market share: “We are good at getting our clients’ patients back, when it’s time for them to come back. But new work needs to be done to get net new market share for our clients. I believe I mentioned when we were talking about the cost guarantee a couple of calls ago that someday I wanted to have a market share guarantee.”
  • Bush also points out that the company’s coordinator and inpatient software may have been brought to market too early.
  • Sales and marketing spend may have been cut too drastically, though the company isn’t scrambling to adjust its budget yet. Its strategic overhaul of staff and spending is nearly complete.
  • With regard to a national patient-centric medical record, Bush said that the “ability to be integrated in to all the hospitals in the country, all the labs in the country to present whether it’s a pharmacy, clinical staffer, pharmacy based staffer or virtual physician or an emergency room doc, with a complete picture of a patient regardless of where they’ve gotten their care is a power position that no one has right now in the country, no one. We believe we will attain that position.”
  • The company’s lighter bookings season has given Bush’s team time to reassess the way it assigns customer success managers and on-boards new clients. “We’re getting much more instrumented,” Bush stressed; “we are working very hard on the number of days associated with ramping up some ones’ collections to full volume after they go live.”
  • Bush attributes churn to ambulatory M&A: “We’ve seen as groups get consolidated up in to bigger networks, if the bigger network is on competitive product, decision might be to go on to one platform, and that has tended to be the biggest driver of churn.”
  • Bush says, “Epocrates is crushing it. Docs on the app are increasing and the appetite to feed a content is increasing, the ability for us to manage content, serve it up in a modern way for our advertising customers is improving and the energy is just electric. I can’t tell you how proud we are after such a long road.”
  • Regarding recent layoffs and reductions, Bush says that “[a]fter-surgery recovery is a big deal, even if the surgery is life saving and Athena certainly inflicted surgery upon itself in the fourth quarter of last year. So attrition and cultural confidence, engagement, belief that there is not some other shoe looking to drop, these are the kinds of things that are the prime focus for me and my team right now.”

Sales

  • Cape Fear Valley Health System (NC) will replace two Cerner systems with Epic beginning in Summer 2019.

People

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Athenahealth SVP of Network Services Jonathan Porter takes on the role of chief product officer.


Privacy and Security

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In Montana, Billings Clinic notifies 934 patients of an email data breach that may have compromised patient names, birth dates, phone numbers, and some medical information.


Other

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In the UK, Health Secretary Jeremy Hunt brings in Eric Topol, MD to lead a review of how to best train NHS staff on using new technologies including AI, digital health, robotics, and genomics. NHS is in the middle of its 100,000 Genomes Project, which aims to use genetic sequencing and big data to develop precision medicine programs.

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A new study in JAMIA finds that health system adherence to the ONC-funded SAFER (Safety Assurance Factors for EHR Resilience) guides developed in 2014 is lacking. Researchers found that only 25 recommendations were fully implemented at the eight health systems who participated in SAFER self-assessments. The study’s authors conclude that national policy programs are needed to ensure proactive SAFER assessments become a best practice.

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In his latest “Doctors Gone Wild” segment, Weird News Andy recounts the arrest of Georgia family practice physician Marian Antoinette Patterson, MD who threatened to slit the throats of her employees, and cut another’s head off for use as a hallway bowling ball. Her other unsavory activities, which some have attributed to intoxication but WNA thinks also exude a hint of physician burnout, include throwing water on employees and tearing her diploma off the wall and stomping on it.


Sponsor Updates

  • Surescripts will exhibit at the MicroMD User Conference 2018 May 2-3 in Warren, OH.
  • Vocera Communications will host its first Chief Experience Officer Roundtable April 25-26 in San Francisco.
  • WebPT publishes a new guide, “Retention, Please: Why Patient Dropout is Killing Rehab Therapy Practices – and How to Stop It.”
  • KLAS recognizes LogicStream Health as a high performer in its latest report on clinical process improvement.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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What I Wish I’d Known Before … Creating, Defending, or Managing a Hospital IT Budget

How your organization views IS/IT should be well understood. For example, are you viewed as just a cost center or are you tied to the organization’s strategic goals? If your organization leans more to the former, focus on telling the story of cost management. For the latter, focus more on capabilities and deliverables. And find ways to build in realistic contingency. This lesson stuck from one of my college professors – "Budgets are a guess. And what do we know about guesses? They are almost always wrong!"


That doctors are not luddites but they won’t fall for the next new shiny object either.


That at any time you can and will have your budget re-allocated for the " good of the health system." Meaning, that a pet project by a key physician leader needs to get funded before they jump ship.


How much the executives were really making.


That IT is viewed as a cost center, and as such it is subject to constant downward pressure as the CEO and CFO continually chase margin. Given that IT budgets have only one real variable cost, labor, you are constantly trying to defend your staff. You have to be ruthless in squeezing your vendors – they are not your friends no matter how many dinners they buy or how much fun at HIMSS they provide. The real challenge comes after you’ve implemented your EMR and the CFO is looking for the vendor-promised 10-percent efficiency gains, never mind that you’ve implemented 6X the amount of functionality and support complexity, and BTW, those legacy systems are going to have to hang around for another six years. Best strategy I came up with was appealing to the CEO’s ego by putting him out front as a "strategy leader" in "technology driven quality healthcare," got his picture in a few trade rags with quotes, kept us safe for a couple of budget cycles.


After a go-live, be real clear with the CFO on the difference between remediation and optimization. Twenty percent on top of the original TCO for optimization in ok, but if a buzz starts that the 20 percent is just to deliver things originally promised, that’s a problem.


That a boss at a previous employer was more concerned about giving his buddy some business he would move around project priorities based on which vendors got the bid rather than actual need. Which is how we ended up buying a metric crapload of servers and networking gear but no racks or power distribution to actually install them.


That leadership would not stick to the budget and would always find a way to fund special projects without any considerations of the resource planning that had already taken place. Especially when leadership bends the budget for non-IT departments to purchase new IT-dependent products without allowing for any increase in the IT budget for implementation and support.


That finance sets the rules and will let you know when you are not following them but do not necessarily tell you what the rules are. Always add a minimum of 10 percent to your best-guess cost projection to cover the unknown.


Previous budget data, operational metrics, and how more/less efficient the proposed budget is.


Weekender 4/27/18

April 27, 2018 Weekender 4 Comments

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Weekly News Recap

  • A proposed HHS rule would retarget the Medicare and Medicaid EHR Incentive Programs to “a new phase of EHR measurement with an increased focus on interoperability and improving patient access to health information.”
  • Kansas-based transcription firm Medantex takes down its customer web portal after security researcher Brian Krebs notifies the company that its audio recordings and site administrative functions were wide open to any Internet user.
  • Doctor on Demand raises $74 million in a Series C funding round led by Princeville Global and Goldman Sachs Investment Partners.
  • Rear Admiral Ronny Jackson, MD withdraws his nomination for VA Secretary after Senate Democrats publish allegations against him that include giving out prescription drugs to staffers, drinking to excess while on the job, and managerial misconduct.
  • The FDA launches a digital health incubator and announces it will tweak its pre-certification software program to better accommodate AI-powered technology.

Best Reader Comments

All the hullabaloo around UIC’s Epic and Cerner mess is pretty pointless. And so are the Black Book and KLAS results. Nobody, absolutely nobody (and that includes providers, patients, IT support people) is delighted with either Cerner or Epic (13 clicks to get the right information out in ICU from Epic!!!). At the end of the day, these are two highly mediocre products with not much daylight between them in an industry that has traditionally not asked much from its IT vendors probably because as an industry, it itself doesn’t believe in excellence in customer service. To paraphrase an old computer science term: “mediocrity in, mediocrity out.” (John Yossarrian)

I’m not struck by the infighting or backstabbing; that’s par for the course at a complicated organization as you describe. I am struck — shocked even — that you’ve got physicians who want to be involved in decision making during the implementation. Maybe we all have finally learned that if you’re at the table, you get to make decisions. All too often, docs who were begged to come to meetings but are “too busy” are upset at the final result they see at go-live! (Craig Joseph, MD)

I have seen a mixed bag of tricks for these situations. There is no specific singular “path” for for every organization or hospital/medical center to follow. “Buy in” starts with ownership and who has control of the purse strings- for instance, one hospital contracted their anesthesiologist and the anesthesia group contracted their nurse anesthetist who did not want to use the electronic surgical record. “ Buy In” came when we worked with the anesthesia group to give them the “WIIFM” (What’s In It Form Me) benefits of using the EHR. Once we had anesthesia on board. We worked with the nurse anesthetist groups “key influencers” to gain their willingness. ultimately, the organization made the EHR trading mandatory and they agreed to pay for RNA’s time spent learning to use the EHR which turned out to be the biggest “buy in.” We worked out the residency problems by coming to the conclusion the organization would hire scribes in emergency areas. These methods may not have worked in another organization or another part of the country. It also depends on whether they have unions and the budget. (Lisa Hahn, RN)

On the whole conference thing and engaging the audience. If the purpose of a conference (or one of the main purposes) is to educate an audience, and if the lecture is one of the least effective methods for educating an audience, then it would follow that trying some different techniques to engage the audience would make sense. There’s a pretty great story of how Professor Eric Mazur changed his teaching at Harvard (physics), when he discovered his students really didn’t learn anything (just memorized). You can take a deep dive on that here. My point is not that a cheesy unmotivational speaker is good, but rather that most presentations done in a lecture format deliver far less educational value than methods that engage the learner. I get that you are a no-nonsense guy, and I really don’t want to hug people I don’t know either, but we can do better than a talking head and a PPT. (jp)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose grant request from first-year teacher Ms. P in Louisiana, who asked for math manipulatives and whiteboard supplies for her Grade 7-8 special education math class. She checks in, "Thank you for your support of my students in our classroom! Our class operates 2-5 years below grade level, but still needs to access seventh-grade material. With your help, our new math ‘toys’ have made a tremendous difference in their understanding and ability to conceptualize many abstract math practices. Thank you again for being a champion and cheerleaders for our class."

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In Australia, Royal Adelaide Hospital comes under fire for spending money on memos instructing staff on how to open doors that don’t even appear to be new. The hospital made news in February after a software failure led to a power outage during two surgeries.

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After being fired from the Texas Health and Human Services Commission for unspecified HIPAA violations, the agency mistakenly mails Tracy Ryans a box full of state assistance applications that include Social Security numbers, billing statements, check stubs, green card certificates and driver’s license copies. The matter has since been referred to the OIG, which is looking into any HIPAA-related transgressions.

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California investigators attribute the capture of suspected Golden State Killer Joseph James DeAngelo to DNA samples and genealogical websites, though 23andMe, Ancestry.com, and MyHeritage have denied any involvement. Privacy experts have been quick to point out that law enforcement can access genetic information from these companies.

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It’s all about perspective.


In Case You Missed It


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Morning Headlines 4/27/18

April 26, 2018 Headlines Comments Off on Morning Headlines 4/27/18

FDA chief moves to promote artificial intelligence in health care

The FDA announces it will tweak its pre-certification software program to better accommodate AI-powered technology, and the launch of a digital health incubator.

Trump’s VA pick bows out after allegations pile up

Rear Admiral Ronny Jackson, MD withdraws his nomination for VA Secretary.

Statement by VA press secretary Curt Cashour on VA’s near-term priorities under Acting Secretary Robert Wilkie

Despite a lack of leadership, the VA will move forward with near-term priorities that include signing the Cerner EHR contract, for which $1.2 billion has been allotted.

athenahealth Reports First Quarter Fiscal Year 2018 Results

Athenahealth announces Q1 results: revenue up 12 percent, with bookings down by $25 million for the quarter.

Comments Off on Morning Headlines 4/27/18

News 4/27/18

April 26, 2018 News 1 Comment

Top News

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Rear Admiral Ronny Jackson, MD withdraws his nomination for VA Secretary after Senate Democrats publish allegations against him that include giving out prescription drugs to staffers, drinking to excess while on the job, and managerial misconduct.

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The VA issues a somewhat bizarre press release confirming that, despite a lack of top-level leadership, it will move forward with near-term priorities including the Cerner contract now that “employees who were wedded to the status quo and not on board with this administration’s policies or pace of change have now departed VA.” A House appropriations bill released yesterday sets aside $1.2 billion for the software.


Reader Comments

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From JK: “Re: Stericycle. This article suggests that the company has turned to JPMorgan for financial advice on the potential sale of its communications services. Stericycle previously acquired NotifyMD and PatientPrompt.” The company hasn’t been on my radar since we exhibited next to them at HIMSS16. Perhaps it’s looking for cash to fund the fines it keeps having to pay to the Washington Department of Ecology for overwhelming the municipal waste plant in Morton with polluted wastewater from its nearby medical waste processing plant.


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor Bluetree Network. The Madison, WI-based company was founded by former Epic leaders to offer quality Epic expertise for solving the biggest health system challenges — staffing and support, training and mentoring, optimization, revenue cycle, analytics, managed services, and solving strategic problems. Health systems benefit from engaging patients and reducing provider burnout, making data a competitive advantage, and making more money. The company offers case studies from UCHealth, Cottage Health, WVU Medicine, Cambridge Health Alliance, and other health systems. Thanks to Bluetree Network for supporting HIStalk.  


Webinars

May 9 (Wednesday) 2:00 ET. “How to Make VBC Work for You: The Business Case to Transform Into the Health System of the Future.” Sponsor: Philips Wellcentive. Presenters: Mason Beard, co-founder and chief product officer, Philips Wellcentive; Scott Cullen, MD, principal, ECG Management Consulting; Seema Mathur, director of strategy, Sage Growth Partners. How well is your organization funding its transformation to VBC? This free webinar explains how to achieve ROI as your organization transforms to meet the future. You’ll learn how VBC is impacting healthcare system management, three strategies for funding your transformation, and what the healthcare system of the future will look like.

May 24 (Thursday) 1:00 ET. “Converting Consumers into Patients: Strategies for Creating Engaging Digital Experiences People Demand.” Sponsor: Healthwise. Presenters: Antonia Chappell, director of consumer solutions, Healthwise; Josh Schlaich, senior product manager, Healthwise. Nearly three-quarters of US adults use a digital channel to manage their health and the internet to track down health information. It’s clear that consumers have come to expect online interactions as an integral part of their overall patient experience. In fact, the Internet may be the first way people come in contact with your organization. They have more choice than ever on where to get healthcare services, and their decisions are increasingly influenced by how well organizations connect with them in the digital space. This webinar will show you how to create engaging digital and web experiences that convert casual consumers into patients and keep them satisfied throughout their entire patient journey.

May 29 (Tuesday) 1:00 ET. “Increase Referrals and Patient Satisfaction with a Smarter ‘Find a Doctor’ Web Search.” Sponsors: Phynd Technologies, Healthwise. Presenters: Joseph H. Schneider, MD, MBA, FAAP, retired SVP/CHIO, Indiana University Health; Keith Belton, VP of marketing, Phynd. A recent survey found that 84 percent of patients check a hospital’s website before booking an appointment. However, ‘Find a Doctor’ search functions often frustrate them because their matching functionality is primitive and the provider’s information is incomplete or outdated. Referring physicians need similarly robust tools to find the right specialist and to send the patient to the right location. Attendees of this webinar will learn how taxonomy-driven Provider Information Management improves patient and referrer satisfaction by intelligently incorporating the provider’s location, insurance coverage, specialty and subspecialty, and services offered that can be searched via patient-friendly terms.

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


Acquisitions, Funding, Business, and Stock

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Doctor on Demand raises $74 million in a Series C funding round.

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Athenahealth announces Q1 results: revenue up 12 percent; adjusted EPS $0.76 vs. $0.03, beating earnings estimates.


People

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Quantros names Trey Cook (Hill-Rom) president and CEO.

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AdvancedMD hires John Marron (InMediata Health Group) as VP and GM of its RCM division.

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Shawn Morris (Cigna-HealthSpring) joins Privia Health as CEO.


Sales

  • Jellico Community Hospital (TN) selects Artifact Health’s mobile app for physician queries.

Government and Politics

CMS Administrator Seema Verma announces at Health Datapalooza that the agency will release Medicare Advantage data to researchers, a plan it shelved last summer over questions about the data’s accuracy. Verma added that Medicaid and CHIP data will also be forthcoming.

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Also at Health Datapalooza, FDA Commissioner Scott Gottlieb, MD announces the launch of the Information Exchange and Data Transformation incubator, which will initially focus on the development of digital tools for cancer treatment and drug development. The FDA will also tweak its pre-certification software program to better accommodate AI-powered technology.


Announcements and Implementations

Central Georgia Health Network deploys Arcadia analytics as part of its population health management efforts.

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Redox develops single sign on capabilities to help improve connectivity between digital health vendors and their end users.

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Mercy Health wraps up implementation of PerfectServe’s clinical communications technology across 23 facilities in Kentucky and Ohio.


Other

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STAT looks beyond the investment rounds and hip office furnishings of telemedicine startup Lemonaid Health to highlight its trials and tribulations, including antiquated state regulations that have kept it from scaling beyond 18 states, drug-seeking patients who lie about their symptoms, those who call in to video consults from behind the wheel, and a burgeoning reputation for annoying competitors with complaints about them to state medical boards.


Sponsor Updates

  • Mobile Heartbeat will exhibit at the American Telemedicine Association conference April 29-May 1 in Chicago.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, completes SOC 2+ HITRUST CSF Certification.
  • Qventus will exhibit at the IHI Patient Care Summit 2018 April 26 in San Diego.
  • LogicStream Health releases a new podcast, “Patient care, policy and politics with U.S. Congressman Erik Paulsen.”
  • Meditech publishes a new case study, “Ontario Shores Improves Outcomes with Meditech’s Patient Portal.”
  • Ellkay will present at the Executive War College Conference on Laboratory & Pathology Management May 2 in New Orleans.

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 4/26/18

April 26, 2018 Dr. Jayne Comments Off on EPtalk by Dr. Jayne 4/26/18

It’s good to see data backing up things you know are true from an anecdotal perspective. Recent data from Black Book Research reveals that younger healthcare consumers prefer healthcare organizations that have greater technology capabilities. These respondents don’t want to engage hospitals and other healthcare providers in a traditional face-to-face way and often prefer digital interaction. This parallels the rise in social media usage as well as what I observe in the real world. On a recent trip with a youth group, I watched a crew of teens stand around texting each other rather than having an actual conversation. I’m not in the under-40 crowd that was mentioned in the survey, but I know that I prefer online bill pay and online scheduling to sitting on the phone trying to take care of things, or having to write a check or send my credit card information through the mail.

The piece goes on to note that hospitals still aren’t putting budget or priority behind patient engagement or interoperability as well as they could. Revenue cycle issues such as billing or payment continue to represent a low-point in the patient experience. After dealing with the bills related to a surgery last year, I would agree. Interoperability is still a barrier, whether you’re talking about hospitals or ambulatory practices. I had a recent cringe-worthy experience trying to track down some lab results from a practice that claims to have a patient portal but that in reality has failed to configure it so that patients can View/Download/Transmit or even see their CCDA. They don’t have online scheduling but do have online bill pay, but I haven’t been able to test drive it since they haven’t sent my claim to insurance yet, even though the visit was more than 30 days ago. That shows that they have opportunity for improvement in ways other than communication, and if I have to go back I’m going to be tempted to offer them my business card – especially since I know they attested for various incentives and lacking VDT capability is a big red flag.

The Net Neutrality repeal went into effect this week, even as members of the House Energy & Commerce Subcommittee on Communications and Technology debated so-called “paid prioritization” where Internet providers can charge higher fees to allow certain content to move faster. Paid prioritization was compared to TSA PreCheck, allowing better access for those who can afford it. Informatics advocacy organization AMIA submitted comments suggesting that Congress should thoroughly evaluate the issues and consider situations where prioritization might benefit the common good, such as telehealth service traffic. AMIA encouraged the subcommittee to think about broadband access as a social determinant of health, providing examples of mental health services in rural areas and noting that healthcare is increasingly delivered outside the walls of hospitals and healthcare facilities. So far, I haven’t noticed any appreciable slowness for any sites except LinkedIn, which is always a little squirrely anyway.

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There has been a fair amount of anxiety in the physician lounge as practices await their first encounters with the long-awaited new Medicare card. As seniors become eligible for Medicare, they will be issued the new cards, although existing beneficiaries may not receive their cards for months depending on what state they are in. The CMS website lists a wave deployment for the new cards, with 13 states and territories scheduled to receive their cards in May, and with everyone else listed as “After June 2018.” It boggles the mind to think that despite knowing how many beneficiaries are out there and how many cards can be produced in a given length of time, that they can’t be more specific than that. Practices that see a large volume of Medicare patients would be wise to try to update information while scheduling appointments and during telephone encounters so that they don’t bottleneck at the front desk once the new cards are widely distributed in their state.

Watch out for patients with the old Medicare card who might have read this article that recommends they don’t carry their card and instead carry a photocopy with the numbers blacked out. It suggests that patients should tell medical providers their SSN/Medicare Number verbally for a visit. That will go over like a lead balloon at most medical offices, and I can only imagine the denials from number transposition or other errors.

The Leapfrog Group released its Spring 2018 Hospital Safety Grades, scoring approximately 2,500 facilities across the country from A to F. Five formerly failing facilities made it to grade A this time, with a total of 46 hospitals earning an A for the first time. My favorite academic medical centers scored a B and C, while small community hospitals that handle few complex cases scored As. Although I appreciate the need to try to report data in a meaningful way, as a patient I would choose the academic medical center regardless of score in the event I needed a complex procedure.

CMS is again trying to make us crazy, with the recent release of nearly 1,900 pages of fun hidden in the guise of its Inpatient Proposed Rule for Fiscal Year 2019. I do like the idea that CMS wants hospitals to publish their charge masters on the Internet, but the charge master is less relevant than knowing what the range of accepted payments is on those charges. CMS has requested public comment on the latter, so it might be forthcoming as well. Whenever I have to transfer self-pay patients from our very cost-effective urgent care to the nebulous costs of the hospital, I always have the conversation with them about saying up front that they are self-pay and asking if there is a discount for paying promptly in cash. Especially with younger patients, they don’t know they could end up with collections agencies hounding them, bad credit, or even a medical bankruptcy.

Although there’s an increase in the overall inpatient payment rate, higher numbers of uninsured patients will lead to more delivery of uncompensated care. I’m a big fan of the proposal to eliminate duplicate measures across Pay for Performance and Inpatient Quality Reporting programs, as well as the elimination of reporting for measures identified as “topped out.” Even with high scores, generating, parsing, and distributing reports is a pain for technology and operations support teams. There’s always at least one provider who thinks he should have had 100 percent rather than a meager 98 percent, and demands a chart review to prove his point. The comment period is open through June 25 with an expected final rule due sometime around August 1, although we know those release dates can be fluid.

Have you read the 1,882 pages yet, or are you just waiting for the movie? Leave a comment or email me.

Email Dr. Jayne.

Comments Off on EPtalk by Dr. Jayne 4/26/18

Morning Headlines 4/26/18

April 25, 2018 Headlines Comments Off on Morning Headlines 4/26/18

Doctor on Demand Announces $74 Million Series C Financing

Doctor on Demand raises $74 million in a Series C funding round led by Princeville Global and Goldman Sachs Investment Partners.

2018 Healthcare Prognosis

Venrock survey takers believe the Amazon/Berkshire Hathaway/JPMorgan deal won’t amount to much in the near-term, but do feel Amazon (and Apple) are poised to make big healthcare progress in 2018.

Trump After Dark: No Action Jackson edition

Senate Democrats publish allegations against VA Secretary nominee Ronny Jackson, MD that include giving out prescription drugs to staffers, drinking to excess while on the job, and managerial misconduct.

Comments Off on Morning Headlines 4/26/18

HIStalk Interviews Kevin Fleming, CEO, Loyale Healthcare

April 25, 2018 Interviews Comments Off on HIStalk Interviews Kevin Fleming, CEO, Loyale Healthcare

Kevin Fleming is CEO of Loyale Healthcare of Lafayette, CA.

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Tell me about yourself and the company.

I’ve been in financial services in the healthcare industry for about 30 years. I had a long career at Ernst & Young. I ran a nationwide M&A practice and did well there. I then transitioned to Electronic Data Systems, where I was an executive. I ran a large strategic business unit with healthcare and financial services companies, some of the largest in the nation. It was heavy lifting — IT outsourcing, business process operations, claims processing. Roll up the sleeves, serious heavy lifting type of operational and IT activities.

Then I got a greater good calling. I took over as CFO — and then as the turnaround CEO — of the first full risk-bearing accountable care organization in the United States called Paradigm Outcomes, based in California but with a nationwide footprint. A lot of Paradigm’s business model was baked into what we now know as accountable care organization standards and programs.

I tried multiple times to retire but failed miserably at each of those. I found that my calling in life was to work. I took on another greater good calling, which was to help patients and providers deal with what perhaps is the most complex, perplexing, and most important issue — or at least it should be on their plate — and that is the phenomenon of consumerism in healthcare. That’s why I joined EPay Healthcare, and we’ve since rebranded to be Loyale.

As the tagline suggests, Loyale thinks patient responsibility shouldn’t be a burden. It’s an opportunity to create lasting loyalty and Net Promoters out of patients. In fact, the very survival of a lot of what we call the healthcare delivery network today depends on being able to do that.

How much patient dissatisfaction is caused by the financial aspects of their encounter?

I think if there were an accurate capturing mechanism for that, it would probably be well north of 80 percent. The patient’s first experience entering a healthcare setting is often administrative and that immediately becomes financial — looking for a co-pay. Their last experience is making that final payment or some other outcome, such as not paying a collection agency.

We see a lot of companies avoiding even capturing the satisfaction with the financial dimension of the relationship. We think that’s not only fundamentally wrong, but dangerous. To some degree, it’s low-hanging fruit, something that could change in a hurry with a little bit of effort. It could change dramatically for the better with a real patient financial engagement solution. That’s what we’re all about.

Consumers are fine with other industries in which companies require payment upfront and that market selectively to those who can afford their product or service. How can a physician practice have a different kind of relationship with people they know are able and likely to pay versus those who are not?

That hits one of the critical success factors to patient financial engagement. It’s a critical part of patient satisfaction overall.

The number one issue now — even exceeding anxiety over the clinical procedure to be performed — is financial anxiety. The inability to deal with the responsibility that everybody knows is coming, especially with the proliferation of high-deductible plans. The patient knows it’s coming. They don’t know the exact amount, but they know it’s going to be negative.

Using segmentation upfront to understand where a patient is with regards to both ability to pay and propensity to pay is a wise thing to do. It’s wiser yet to use it to dictate how you to interact with the patient financially.

That should never mean, in any way, compromising the quality of clinical care delivered. In fact, it’s consistent with the Hippocratic Oath — do no harm. The harm that the patient is afraid of is not just clinical, it’s financial. If you’re identifying those patients who are going to have a hard time paying and giving them options up front — showing a plan, showing a solution to eliminate that anxiety — you’re helping them, and of course, helping yourself.

Studies have shown that patients, younger ones in particular, are willing to pay if given a convenient way to do so. Does technology play a greater role in financial transparency and ultimately collections?

Yes, very much so. There are five or six golden opportunities for healthcare in having a patient financial engagement business strategy and follow-through capability. That’s one that’s near the top of the list — having a powerful digital channel, a portal, a go-to place.

You probably saw some of the same studies that I did that suggest in the next five years or so, Millennials will be making 70 percent of all healthcare decisions in the United States. I don’t know if that’s true or not, but we do know that the percentage is increasing constantly. Sixty to 80 percent of Millennials want to do all their business online, including clinical interactions, including making payments.

That does a lot of good things for everybody. You’re servicing them in the channel where they want to do business. You’re servicing them better at a higher standard that can cover all things clinical and financial in one setting. Working with us, they’re exposed to financing tools and vehicles, a variety of them that they probably wouldn’t see elsewhere. They’re able to work out their own plan, their own financial solution if you will, to deal with their responsibilities.

I don’t think that’s unique to Millennials. Obviously as a demographic, especially as they move more and more into prominence by numbers, they’re focused more on healthcare decisions. We’ve found high pickup rates for almost all demographics, including those at the upper end of the Baby Boomer age range. It’s not unique. People want to be able to do business in a convenient setting and a digital portal is very much one of those options.

It also reduces dramatically the provider’s cost to collect. As you can imagine, once the automation is in place, the cost of service is pennies on the dollar compared to rendering physical statements. Maybe a lot of those statements, because you extend out to multiple collection cycles because the patient isn’t paying. To pay for a call center, to pay for facility staff who many times would just as soon not to be involved with this at all.

They went to medical school, but now with the bleed-over effect, as we call it, instead of delivering medicine, they’re answering patients questions about, “Why is my estimate so high?” All that can be done extremely well in a digital portal. That needs to be a primary part of any provider’s financial engagement strategy, in our opinion.

Hospitals that don’t often have a strong reputation for being friendly or efficient with their billing and collection practices are increasingly acquiring, sometimes invisibly, practices and urgent care centers. Are you seeing patient engagement and loyalty changing as a result?

I had a front-row seat to consolidation in the financial services industry. We’re seeing a slightly different version of the same movie and the same end effect — a lot fewer entities. The banking industry consolidated almost by 50 percent in terms of the number of banks. A few large networks and regional networks were established. Specialty players came in, like PayPal, and picked up some very lucrative areas.

The same thing is happening in healthcare right now. Hospitals and healthcare networks are looking at that same near-extinction event as the financial crisis of 2008-9. They are over-leveraged and their operating cash flows are impaired for a lot of reasons. One at the top of the list is patient responsibility and the inability to collect. There are a lot of reasons that consolidation will pick up steam.

That’s one reason we were selected by the nation’s largest healthcare network, HCA, to be their platform and solution standards. The idea of episode of care. You can deal with a patient if they have a primary care physician or urgent care physician that they see ad hoc who then refers them to the hospital or outpatient setting, surgery centers, and so on. It doesn’t really matter. Our system will pick up all those physicians, all those caregivers, and amalgamate them into one financial episode of care.

The patient can see all of that at once. Instead of receiving five different bills and maybe one financing option or even maybe none, they’ll see a holistic solution for all the episodes of care coming from that healthcare network. In terms of consolidation, that’s an important thing to be able to do.

Part of this is you always want to service the patient better. But in terms of share of wallet, you want to be giving care in all those different modalities and stages and presenting an easy to understand financial bill instead of alternatives in aggregate for all of them. That’s a tremendous advantage.

Are providers recognizing that, as in other businesses, patients who are willing and able to pay cash up front would probably be more inclined to do so if they’re offered a discount?

The more forward-thinking ones are. We have a tool within our platform called Affordability Workbench. One of the doors, if you will, is our prompt pay discounts. Those would be highly apropos for self-insured patients who are not otherwise getting negotiated discount rates. The full charge master price without any discounts just isn’t going to work for them. There’s no way they can shoulder it.

I can’t say that’s universally applied, but we’ve specifically provided for it in the toolset for that very reason, to give the patient options that they don’t always see. Hopefully one of them works.

We also have a comprehensive array of payment plans that are extremely flexible. The patient is able to self-construct their own payment plan according to their cash flows within certain parameters that the facility controls. We have connections with all of the major third-party lenders, secured and unsecured facilities, and a pretty good idea of where they play well and where they won’t play well based on a provider’s requirement and patient financing needs.

Do you have any final thoughts?

The critical thing here is to get in the game and to play the game to win. If this plays out like the financial services industry consolidation, as many as half the healthcare providers in the country just won’t be there, probably within the next 10 years. You have behemoths like Walmart, Walgreens, Amazon, and CVS aligning with the mega payers. They are going to cherry pick some of the very best business in primary care, urgent care, and pharma. They are absolute experts and masters at consumerism given their retail origin.

It’s vital to play this game to win. Status quo is not winning. Just getting started is the biggest part of the battle. We have phased implementation with customers, so they can do it in pieces that they can absorb. Within 18 to 24 months, they’re all the way there.

The biggest message I would leave is to get in this game. This is the biggest issue on the table, the biggest elephant in the room. I know you’ve got a lot of other fires burning around you — value-based care, EHRs, filling capacity, and so on — but no patient, no mission. No money, no mission. Those are literally the table stakes here. Get in the game and get in the game to win.

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Morning Headlines 4/25/18

April 24, 2018 Headlines 2 Comments

CMS Proposes Changes to Empower Patients and Reduce Administrative Burden

A proposed HHS rule would retarget the Medicare and Medicaid EHR Incentive Programs to “a new phase of EHR measurement with an increased focus on interoperability and improving patient access to health information.”

Ping An healthcare unit maps out plan for $1.1 billion Hong Kong IPO

China’s largest Internet healthcare platform, insurance subsidiary Ping An Healthcare and Technology, plans a $1.1 billion IPO on the Hong Kong exchange.

Transcription Service Leaked Medical Records

Kansas-based transcription firm Medantex takes down its customer web portal after security researcher Brian Krebs notifies the company that its audio recordings and site administrative functions were wide open to any Internet user.

After Trump Hints V.A. Nominee Might Drop Out, an Aggressive Show of Support

The Senate postpones the VA secretary nomination hearing of Admiral Ronny Jackson, citing allegations of improper conduct in his military career that require further investigation.

News 4/25/18

April 24, 2018 News 9 Comments

Top News

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A proposed HHS rule would retarget the Medicare and Medicaid EHR Incentive Programs to “a new phase of EHR measurement with an increased focus on interoperability and improving patient access to health information.”

CMS proposes renaming the incentive programs to “Promoting Interoperability Programs,” noting that the word “incentive” is obsolete now that most payments have ended.

The rule would require using CEHRT certified for the 2015 Edition beginning with the 2019 covered year. It would allow a 90-day reporting period for 2019 and 2020.

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HHS proposes to replace the six Medicare EHR Incentive Program measures with four:

  • E-prescribing
  • Health information exchange
  • Provider-to-provider exchange
  • Public health and clinical data exchange

HHS also proposes two opioid-related e-prescribing measures for connecting to PDMPs and verifying treatment agreements that would be optional for the first year.

The proposed changes would also require hospitals to publish their charge master price list online every year, but asks whether more specific information might be useful to consumers, such as details on a hospital’s average discounted charges across all payers. HHS also asks if providers should be required to disclose a patient’s out-of-pocket cost for a service before performing that service, presumably to reduce surprise out-of-network charges.

The public’s comments about the 1,900-page document are due June 25.


Reader Comments

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From Stealthily Healthy: “Re: HLTH conference. I’ve been asked a dozen times if I’m attending and I’m uncertain. What do you think?” Beats me. The speaker roster is huge, which I expect is because the VC-funded first-time conference used its cash to pay expenses and hype it up a bit. They’re also offering free provider registration hoping to give vendors their money’s worth in corralling prospects. I’m not sure anyone’s thrilled at going back to Las Vegas in early May after just leaving HIMSS there in March. The big question is whether it will do well enough financially to warrant a repeat next year. The conference claims it will create “a much-needed dialogue focused on disruptive innovation in healthcare” even though it’s run by two tech guys with zero healthcare experience and the track record of folks waving the “disruptive” flag without understanding what they’re disrupting isn’t great. We have way too many healthcare conferences, but fortunately for those offering them, way too many people willing to spend their employer’s time and expense money to attend them with questionable outcomes beyond glad-handing self-validation. Ironically, I would bet that high-accomplishment conference presenters didn’t actually waste their early-career time attending those same conferences.

From System CIO: “Re: HIStalk. It’s a really valuable read for me. I’m not one of those CIOs who is constantly networking with everything and everyone in our industry to keep up (primarily because there’s so much work to do and time necessarily spent focused inwardly) but HIStalk allows me to see/stay connected more broadly. Thank you for all of the time and effort you spend to make it what it is.” Thanks for making my day.


HIStalk Announcements and Requests

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I’m getting good responses to this week’s question. I’m sure yours would be even better (hint).

Listening: reader-recommended The Prefab Messiahs, a barely-noticed early 1980s punk band that college students have rediscovered with their new album. It’s raw and I expected the typical garage band weak vocals, but they sound good when belting out wry, withering social commentary on songs like “The Man Who Killed Reality.”

I’ve seen video from recent conferences in which attendees were urged to hug each other, dance at their seats, or exchange high-fives, all of which seem not only to be crassly contrived, but straying way outside the comfort zone of many in the audience. I remember one hospital management event I attended where they hired a super-cheesy motivational speaker (some local guy who formerly played in an awful rock band with small talent and big hair) who demanded that we all “share” with our tablemates, which made me want to rip off his $2,000 suit and choke him with it. At the long-awaited end of his de-motivational speech, he brought up a slide of his wife and fake-cried about how much he loved her, leading all of us recent sharers to wonder what exactly we were supposed to do with that. Dear conference organizers and presenters – just do your presentation without expecting the paying audience to do anything except watch. Or just thrust your microphone Ozzy-style at the crowd and let them read the slides while you wiggle your hands approvingly as a conductor rather than performer.


Webinars

May 9 (Wednesday) 2:00 ET. “How to Make VBC Work for You: The Business Case to Transform Into the Health System of the Future.” Sponsor: Philips Wellcentive. Presenters: Mason Beard, co-founder and chief product officer, Philips Wellcentive; Scott Cullen, MD, principal, ECG Management Consulting; Seema Mathur, director of strategy, Sage Growth Partners. How well is your organization funding its transformation to VBC? This free webinar explains how to achieve ROI as your organization transforms to meet the future. You’ll learn how VBC is impacting healthcare system management, three strategies for funding your transformation, and what the healthcare system of the future will look like.

May 24 (Thursday) 1:00 ET. “Converting Consumers into Patients: Strategies for Creating Engaging Digital Experiences People Demand.” Sponsor: Healthwise. Presenters: Antonia Chappell, director of consumer solutions, Healthwise; Josh Schlaich, senior product manager, Healthwise. Nearly three-quarters of US adults use a digital channel to manage their health and the internet to track down health information. It’s clear that consumers have come to expect online interactions as an integral part of their overall patient experience. In fact, the Internet may be the first way people come in contact with your organization. They have more choice than ever on where to get healthcare services, and their decisions are increasingly influenced by how well organizations connect with them in the digital space. This webinar will show you how to create engaging digital and web experiences that convert casual consumers into patients and keep them satisfied throughout their entire patient journey.

May 29 (Tuesday) 1:00 ET. “Increase Referrals and Patient Satisfaction with a Smarter ‘Find a Doctor’ Web Search.” Sponsors: Phynd Technologies, Healthwise. Presenters: Joseph H. Schneider, MD, MBA, FAAP, retired SVP/CHIO, Indiana University Health; Keith Belton, VP of marketing, Phynd. A recent survey found that 84 percent of patients check a hospital’s website before booking an appointment. However, ‘Find a Doctor’ search functions often frustrate them because their matching functionality is primitive and the provider’s information is incomplete or outdated. Referring physicians need similarly robust tools to find the right specialist and to send the patient to the right location. Attendees of this webinar will learn how taxonomy-driven Provider Information Management improves patient and referrer satisfaction by intelligently incorporating the provider’s location, insurance coverage, specialty and subspecialty, and services offered that can be searched via patient-friendly terms.

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


Acquisitions, Funding, Business, and Stock

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China’s largest Internet healthcare platform, insurance subsidiary Ping An Healthcare and Technology, plans a $1.1 billion IPO on the Honk Kong exchange. The 900-employee, AI-assisted service provides 370,000 free consultations each day and offers free, two-hour prescription delivery in major cities. Its network includes 3,100 hospitals and 7,500 pharmacies. Reports from a year ago suggested that investors were losing interest because of profitability concerns despite huge demand that is driven by dissatisfaction with China’s overwhelmed healthcare system.

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Twitter co-founder Biz Stone invests an unspecified amount in India-based Visit, which offers AI-supported video visits.


Sales

War Memorial Hospital (MI) expands its use of FormFast electronic forms and workflow solutions, integrated with Meditech 6.1.


Announcements and Implementations

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Mobile technology vendor Dictum Health adds a video laryngoscope to its Virtual Exam Room platform. The company offers a suitcase-sized patient examination system, an in-clinic telehealth system, and a medical telehealth tablet connected to cloud services.

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A small KLAS study on clinical process improvement finds that Stanson Health and LogicStream Health lead the way in analyzing clinician EHR use to optimize alerts and order sets, respectively, and identifying training opportunities for individual users. KLAS also finds that while many clinicians don’t trust the data presented to them or ignore recommended care guidelines and workflows, frontline doctors say that tools from Stanson and LogicStream are easily understood and useful.


Government and Politics

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The Senate postpones the VA secretary nomination hearing of Admiral Ronny Jackson, citing allegations of improper conduct in his military career that require further investigation. President Trump nominated Jackson via Twitter without the usual vetting process that would have resolved any confirmation issues outside the public eye. The New York Times says the issues were raised by anonymous White House associates of Jackson and involve his oversight of a hostile work environment, overprescribing of drugs, and claims that Jackson drank on the job. President Trump distanced himself in his reaction to the delay, blaming partisan opposition but admitting, “There’s a lack of experience.” He concluded, “If I were him, I wouldn’t do it.”


Privacy and Security

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Kansas-based transcription firm Medantex takes down its customer web portal after security researcher Brian Krebs notifies the company that its audio recordings and site administrative functions were wide open to any Internet user. Medantex says it had been attacked by WhiteRose ransomware and apparently misconfigured the servers it rebuilt, exposing them to the world. I tried to pull up the company’s public webpage and was blocked by Bitdefender’s malware detection system.


Other

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A small study finds that anticoagulation lab test and drug ordering improves when physicians use the CDC’s PTT Advisor app.

The family of Prince sues Trinity Medical Center (IL) for failing to correctly identify the counterfeit drug he had taken before the singer’s private plane made an emergency landing in Moline on April 15, 2016. They’re also suing Walgreens for filling his narcotics prescriptions that were written under his bodyguard’s name. Prince lied about his drug intake and refused all testing in the hospital in hopes of concealing his years-long addiction from the public, but the family says the hospital should have run extensive tests to determine that the black market drug he thought was Vicodin actually contained fentanyl. He died six days later of a fentanyl overdose. That’s the disadvantage of being a celebrity addict surrounded by sycophantic coat-tailers– your star-stuck doctor will write any prescription; your handlers will get it filled under their name and score illegal drugs to supplement when necessary; and you have enough time, money, and enablers to make addiction seem like a normal response to pain, stress, or disappointment.


Sponsor Updates

  • IMAT Solutions will exhibit at the National Association of ACOs spring conference in Baltimore April 25-27.
  • LabFinder.com will use Ellkay’s integration services to connect with physician office EHRs.
  • Obix Perinatal Data System vendor Clinical Computer Systems, Inc. earns SOC 2 and HITRUST certification.
  • AdvancedMD will exhibit at ACOG April 27-29 in Austin, TX.
  • Aprima will exhibit at AROC April 25-26 in Atlantic City, NJ.
  • Arcadia will exhibit at the NAACOS Spring 2018 Conference April 25 in Baltimore.
  • AssessURhealth publishes a new customer success story featuring LoCicero Medical Group.
  • CarePort CEO Lissy Hu, MD will present at ACMA National April 26 in Houston.
  • Netsmart receives the first ONC-Health IT 2015 Edition Certified solution for palliative care.
  • Spok and Bernoullli Health partner to improve clinical alarm management.
  • The local paper profiles CoverMyMeds after its top ranking as a best place to work in Columbus, OH.
  • CTG will exhibit at the Texas Regional HIMSS Conference April 26-27 in Dallas.
  • DrFirst VP Linda Fischer will participate in a panel discussion at the Critical Connections’ Opioid Crisis Symposium April 25-16 n Baltimore.
  • Consulting Magazine names Divurgent Principal Ralph Whalen a 2018 rising star in healthcare.
  • EClinicalWorks will exhibit at the 2018 Physician Practice Management & ASC Symposium April 25-26 in Nashville.
  • Healthwise will exhibit at GetWellNetwork’s getconnected 2018 conference April 30-May 2 in National Harbor, MD.
  • InstaMed will exhibit at the Georgia MGMA Annual Conference April 29-May 1 in Savannah, GA.
  • AWS features Kyruus in its coverage of hot startups for April 2018.

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