Morning Headlines 3/21/18

VA Open Application Programming Interface Pledge Gains Momentum to Shape a New Direction for Health Care

UPMC Chief Innovation Officer Rasu Shrestha, MD, MBA will lead the VA’s API project that was announced at HIMSS18.

Intermountain Healthcare employees brace for more job cuts as Utah’s largest employer readies to ‘adapt or die’

Intermountain Healthcare employees prepare for another round of layoffs as the Utah-based health system continues cost-cutting efforts to remain competitive with disruptors to the healthcare field like Amazon and Google.

VA-Cerner numbers skyrocket

The VA’s Cerner project will cost $16 billion instead of the previously hinted $10 billion, according to comments made in a House Appropriations Committee by Rep. Debbie Wasserman-Schultz (D-FL).

News 3/21/18

Top News

Houston-based RCM outsourcer Constellation Healthcare Technologies files Chapter 11 bankruptcy and will sell the business due to the servicing costs of the extensive debt it took on to fund its acquisition strategy.

The company says it fired unnamed executives who intentionally misstated its revenue and earnings.

A lawsuit filed in late 2016 claimed that CEO Paul Parmar masterminded a series of fraudulent acquisitions to allow him to falsify revenue numbers while misappropriating cash.

A private investment firm owned by former Blackstone executive Chinh Chu bought the company for $309 million in early 2017.

Reader Comments

From Stern Countenance: “Re: Tronc. Mike Ferro is out as chairman following allegations of inappropriate sexual behavior. Justin Dearborn, one of his cronies from his Merge Healthcare days, will replace him. Ferro was already a jillionaire with the sale of Merge Healthcare to IBM plus he was rich before he joined Tronc. Ferro gets a $15 million consulting contract as a farewell gift. Now Justin gets to be a jillionaire, too. These guys are no dummies when it comes to money, including running Merge into the ground by slashing and burning to make numbers that looked good enough to get IBM to buy the company.” There’s another healthcare connection – Tronc (the former Tribune Publishing) is selling the Los Angeles Times to NantHealth’s Patrick Soon-Shiong for $500 million in cash. I interviewed Justin Dearborn in early 2014; IBM bought Merge Healthcare for $1 billion in mid-2015 to expand its Watson offerings.    

From Obsidian: “Re: HLTH conference. Between JPMorgan and HIMSS I’ve seen 100+ billboards and ads for this new conference that’s supposed to be the greatest thing since sliced bread. What do you and your readers know about it?” The conference, taglined as “The Future of Healthcare,” will be held in Las Vegas May 6-9. They expect 2,000 attendees and will offer a smallish exhibit hall. The guy in charge is money guy and conference organizer Jon Weiner, who has zero healthcare experience in advocating for “disruptive innovation.” He has raised $5 million in funding to launch the conference. Among HLTH’s handful of sponsors are Change Healthcare, Optum, and UPMC. The massive roster of 250+ presenters includes the CEOs of Allscripts, Geisinger, 23andMe, Optum Health, Change Healthcare, Sharecare, Intermountain Healthcare, and Athenahealth. HIMSS (and its newly acquired Health 2.0) seems to have most of the bases well covered and JPMorgan is where the money guys and CEOs hang out, so I’m not quite sure how HLTH will convince people to spend another $1,850 registration fee and four days away from work to go back to Las Vegas (assuming most of its attendees will have just returned from HIMSS18). However, I shouldn’t underestimate the willingness of healthcare people to spend their employers’ money on conferences with questionable ROI to anyone except the attendee, who gains validation for getting his or her employer to foot the bill. Readers: are you going, and if so, what’s the draw beyond the HIMSS and JPM conferences?

HIStalk Announcements and Requests

I get excited by two Northern Hemisphere calendar days – the winter solstice on December 21 (after which daylight lasts longer every day through the summer solstice on June 21) and the spring solstice equinox (thanks for the correction) Wednesday, which is when spring officially begins. Actually I should add a third celebrated date that I call the HIMSS solstice, the last day of the HIMSS conference in which the crazy-busy health IT period that starts January 2 ends, replaced by a relatively lazy summer that lasts until Labor Day.

Webinars

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

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

Acquisitions, Funding, Business, and Stock

Parachute Health, which offers a durable medical equipment ordering system, raises $5.5 million in a seed funding round.

Sales

• Orlando Health extends its Affinity RCM contract with Harris Healthcare for three years with an additional one-year option.
• Piedmont Healthcare (GA) expands its use of Glytec’s EGlycemic Management System to all of its acute care facilities.
• Partners HealthCare expands its use Kyruus ProviderMatch patient access solutions.
• University of Maryland School of Dentistry will implement DrFirst’s mobility suite to help dentist prescribers meet the state’s July 1, 2018 prescription drug monitoring program mandate.
• Lawrence General Hospital (MA) will implement Meditech’s Expanse EHR.

People

Change Healthcare hires Fredrik Eliasson (CSX) as EVP/CFO.

UPMC Chief Innovation Officer Rasu Shrestha, MD, MBA will lead the VA’s API project that was announced at HIMSS18. The VA’s Lighthouse project involves standards-based data exchange via an open API framework. Organizations that have signed its Open API Pledge are UPMC, BIDMC, Partners HealthCare, Mayo Clinic, Cleveland Clinic, Fairview, Geisinger, Intermountain Healthcare, Jefferson, Rush, and VCU Health.

Steve Weichhand (Avaap) joins Divurgent as VP of professional services.

Charles Tuchinda, MD, MBA is promoted to the newly created role of EVP and deputy group head of Hearst Health and VP of Hearst. He will also continue in his role as president of Hearst-owned First Databank.

Announcements and Implementations

Diameter Health gives its clinical data management users the ability to track user-defined patient populations over time, with a sample use case being a health plan that wants to update its patient list with fresh HIE information on a specific schedule.

Healthcare sharing ministry Medi-Share will use payment processing systems from Liquid Payments. This is interesting mostly because of the business model of Medi-Share, which is run as a ministry but is effectively an insurer since its 375,000 members agree to share their healthcare bills that are discounted via Medi-Share PPO provider agreements. Faith-based plans, which don’t guarantee that they will cover medical bills and sometimes exclude preexisting conditions, require a pastor’s recommendation and the member’s pledge to avoid using drugs, smoking, and behaving immorally. The plans are not regulated.

Clinical Architecture releases Symedical on FHIR, a RESTful API based on the FHIR Terminology Service standard.

Government and Politics

The VA’s Cerner project will cost $16 billion instead of the previously hinted $10 billion, according to comments made in a House Appropriations Committee by Rep. Debbie Wasserman-Schultz (D-FL). Cerner will get $10 billion (which is probably where the earlier figure originated), the VA will spend $4.6 billion on infrastructure improvements, and another $1.2 billion will be budgeted for third-party project management (Booz Allen Hamilton has already been awarded $750 million of that). Another tidbit dropped in a House Committee on Veterans’ Affairs hearing: VA Secretary David Shulkin had planned to announce during his HIMSS keynote that the VA’s contract with Cerner had been finalized, although continuing delays took that topic off the table.

Former VP Joe Biden expands on the Seema Verma-Jared Kushner announcements at HIMSS18 in a Fortune opinion piece, recommending that:

• HHS should cite providers for data blocking if they don’t provide patients with an electronic copy of their EHR information within 24 hours of their request.
• The Center for Medicare and Medicaid Innovation should create a uniform patient data portal for storing and sharing patient information.
• HHS should expand its Sync for Science program in which patients can contribute their medical records to research.
• The National Cancer Institute should create a cancer data trust to hold EHR, diagnostic, genomic, and outcomes data.

The New York Times reviews the NIH’s $1.4 billion project to collect genomic, medical records, blood, and wearables information from one million Americans. The “All of Us” research program – still in beta testing — hopes to uncover new diagnostic and treatment insights, but hasn’t made much progress in its first three years even though its 2017 budget alone was $230 million. Geisinger gave back its $50 million participation grant because endless meetings and conference calls weren’t going anywhere, while Kaiser Permanente felt NIH just wanted its data without its insights so it passed, too. Both organizations are creating similar systems and so is the VA, which is making good progress for a budget of just $250 million over seven years. Researchers also say it’s hard because patient information is scattered across multiple provider EHRs and the US doesn’t have enough DNA sequencing machines to handle the load. 

Other

The US News “top medical schools” for research are Harvard, Johns Hopkins, and NYU, while the top three for primary care are UNC-Chapel Hill, UCSF, and University of Washington.

Epidemiologists are being robbed of their ability to track infectious disease activity by the shutdown of US local newspapers, which provide higher-quality information than social media. 

Sponsor Updates

• Optimum Healthcare IT publishes an infographic titled “The Complex ERP Lifecycle.”
• Aprima will exhibit at the Association of Independent Medical Software Value Added Resellers Annual Conference March 23-24 in San Antonio.
• CoverMyMeds will host TechPint March 22 in Cleveland.
• Nordic publishes a podcast titled “How will transitioning to Nordic’s maintenance and support affect my internal teams? Q&A with Loma Linda University Health.”
• HCTec publishes a new case study, “Outpatient CDI Model Increases Revenue Opportunities and Positions Health System for Future Success.”
• Healthwise will exhibit at the 2018 Midwest ACE User Group Conference March 21-23 in Chicago.
• Image Stream Medical will exhibit at the AORN Global Surgical Conference & Expo March 24-28 in New Orleans.
• Kyruus will exhibit at the Cleveland Health IT Summit

Blog Posts

• Bermuda Hospital Board Deploys Access’s eForms Solution to Enhance Registration and Integrate Patient Documentation with Cerner (Access)
• Common Risks Areas of ERP Implementation (Optimum Healthcare IT)
• Overview of the Current Administration’s Approach to HIT (Datica)
• Consultant’s Corner – Kathi Goovert (Huntzinger Management Group)
• HIMSS 2018: A Universal Agreement to Put Patients First (CarePort Health)
• The 3 Best Alternative, Non-Nursing Jobs for Nurses (CareSync)
• The responsibility of a leader (Meditech)
• Freezer Failure – How to Protect Critical Biomedical Materials (CenTrak)
• Framework for Success: Provider Workflow Optimization Hits New Heights (Crossings Healthcare Solutions)
• Have You Connected Your Patients to their Benefit & Estimate Information on your Organization’s Portal? (Culbert Healthcare Solutions)
• HIMSS 2018 Recap: By the Numbers (Direct Consulting Associates)
• 3 Takeaways from HIMSS18 (Dimensional Insight)
• Value-based Care Trends – What’s on the Horizon in 2018 & Beyond (Divurgent)
• Leaving Las Vegas: FormFast’s Recap of HIMSS18 (FormFast)
• 6 Questions to Ask When Preparing for a Legacy System Requirement (Hayes Management Consulting)
• What Patient Safety Means to Consumers and Hospitals (Healthgrades)
• Improving Patient Experience Through Innovation at HIMSS18 (Healthwise)
• What Works – IT Roadmap Providers Path to Operational Excellence (Huntzinger Management Group)
• Is your organization as healthy as you think? (Hyland)
• A Personal Story of Patient Safety from Impact Advisors’ President (Impact Advisors)
• Putting a Face on Effective Facebook Marketing Methods (Influence Health)
• Payment Device Questions – What Healthcare Organizations Need to Know (InstaMed)
• Health Systems Can Own the Customer Relationship (Docent Health)
• Nine Questions Urgent Cares Should Ask Before Hiring a Collection Agency (DocuTap)

Contacts

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

Morning Headlines 3/20/18

Constellation Healthcare Technologies Files Voluntary Chapter 11 Petitions to Facilitate an Orderly and Efficient Sale Process

Following earnings discrepancies, an executive exodus and investigation for fraud, Constellation Healthcare Technologies files Chapter 11 for several of its subsidiaries.

Joe Biden: To Save and Improve Lives Using Data, Details Matter

Former Vice President and founder of the Biden Cancer Initiative Joe Biden responds to the Trump administration’s MyHealthEData initiative with next steps that include mandating the provision of a patient’s digital health data within 24 hours of treatment.

Trump administration to seek stiffer penalties against drug dealers, reduce opioid prescribing

Trump administration officials share plans to fight the opioid epidemic, including the creation of national PDMP that would flag suspicious prescriptions.

Curbside Consult with Dr. Jayne 3/19/18

Many of the physicians and other health professionals I work with during consulting engagements are suffering from burnout. As I work with troubled organizations, I am finding an increasing number of non-caregivers experiencing symptoms of burnout as well. I’ve recently partnered with an executive coach to work on strategies that we can use to better assist these organizations. It used to be that teams became stressed during times of change or times of institutional uncertainty, but we’re seeing teams that are now under stress all the time. Budgets have been cut, positions have been eliminated, and remaining workers are expected to absorb the work of others regardless of their capacity for additional tasks.

Healthcare informatics work is becoming more high stakes as systems are more deeply intertwined in care delivery. It’s not just about keeping systems in a state of high availability anymore. Now, healthcare IT teams are expected to monitor clinical quality calculations, enable reporting that has significant financial ramifications, and monitor updates and patches to ensure there are no changes to critical business processes or reporting processes. At one hospital where I have worked, there is no budget for clinical informatics, so the IT team is handling everything from system maintenance to ensuring physician adoption, with little support from medical leadership. The analysts are stressed all the time, caught between a mandate to ensure clinicians use the system properly and not having any authority to actually get the physicians to come to training. The turnover rate in the IT department is high, and leaders don’t seem to understand why people don’t want to stay.

The executive coach I’ve partnered with works with organizations to try to build resilience. The American Psychological Association defines resilience as “the process of adapting well in the face of adversity, trauma, tragedy, or stress – such as family and relationship problems, serious health problems, or workplace and financial stressors. It means ‘bouncing back’ from difficult experiences.” The people we’re working with are adaptable – they’ve watched the evolution of healthcare IT systems and some of them have worked on everything from basic billing systems to complex enterprise applications. They’ve watched the growth of technology at the bedside, and have seen the need for more transparency in the IT organization as the number of departments using technology has grown. They’ve coped their way through the rise of E&M coding, Meaningful Use, MACRA, MIPS, and ACOs.

Even with those changes under their belts, we see people struggling with the day-to-day stressors that impact their work. People are double booked for meetings and more than once I’ve been confronted by a conference call participant who appears to be inattentive who responds by saying he’s on multiple calls. (I still don’t understand how that works, but people do it, so it’s definitely a thing.) Workers are reluctant to take much-needed time off because they don’t have adequate coverage or feel that they’ll be buried when they come back. Others don’t want to burden their coworkers with the extra work that might shift their way if someone takes off. I see IT analysts that are continually frustrated by buggy software and delayed release schedules, who feel it acutely when they can’t deliver solutions to their customers. They’re caught between the vendor and the end user and may feel powerless to remedy the situation.

We’re working with groups in this situation by helping individuals analyze their individual work styles and better understand their own strengths. We help them identify situations they find challenging and develop strategies to work through them. Unfortunately, learning new strategies and figuring out how to incorporate them in the workplace takes time, and already-stressed teams struggle with finding the time to do this type of contemplation and reflective work. It’s often the management level that is feeling the most stress, because they have little control over budgets and priorities but are expected to deliver results regardless. When working with managers, one of the first steps we take is to help them complete a 360-degree evaluation, where they understand how they are seen by supervisors, peers, and direct reports. In one organization, we struggled with even getting the team to find time to respond to the surveys required to complete the evaluations.

There’s a concept that’s referred to in clinical circles called Moral Distress. It’s defined as the state of knowing there is a “right” thing to do but there are institutional constraints present that make it impossible to pursue the correct course of action. We typically talk about this when discussing nursing shortages and clinical staffing issues, when clinicians have to make difficult choices on how they deploy scarce resources. It’s thought that being unable to care for patients properly creates a particular kind of stress that increases the risk of caregivers quitting. A study of nurses performed in 2014 found that 20 percent of nurses surveyed intended to leave their current position due to moral distress.

Although it’s not quite as severe as moral distress at the point of care, we’re starting to see similar levels of stress in the teams that support front-line caregivers. Those support teams feel it acutely when clinical staffers can’t complete tasks or don’t have the technology they need to care for patients. I watched one IT analyst tear up as he tried to help a nurse figure out a documentation issue, when he understood that problems in the EHR were directly responsible for errors in care that negatively impacted a patient. He had reported the issue to his manager previously and they had been working with the vendor to try resolve it, yet he was told to move on to other priorities. He feels personally responsible even though there wasn’t anything he could have done, other than not follow the instructions that his leadership had given him. This isn’t the first time he’s been in a situation where patients were impacted by system issues, and he’s actively pursuing a job outside of healthcare.

As leaders, we need to figure out how to make sure our teams have the resources they need to do their jobs properly and ensure that the ultimate customer, the patient, is taken care of. We’re often between the proverbial rock and a hard place figuring out budgets and staffing while we prioritize projects. Maybe we need to be more forceful at saying no to implementing an on-demand meal ordering platform when our laboratory and radiology orders platforms aren’t at peak performance. Maybe we need fewer 70-inch TVs in patient rooms and more functional desktops and mobile workstations so documentation can occur quickly at the point of care. Maybe we need to stop adding bells and whistles to our systems when we haven’t fully implemented the basics. These are issues that the C-suite deal with regularly as our hospitals try to keep up with the Joneses across town.

I’d be interested to hear from any healthcare IT leaders who are taking a back-to-basics approach and trying to refocus energies on reducing stress while helping workers be more resilient. Have you found the recipe for the secret sauce? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 3/19/18

Technical glitch and market turmoil overshadow Healthineers IPO

Siemens AG raises $5.2 billion in its Healthineers IPO despite technical glitches that delayed the start of business.

Giving patients control of their health information will help give patients control of their health

CMS Administrator Seema Verma and presidential advisor Jared Kushner reiterate the Trump administration’s commitment to the MyHealthEData initiative.

Amazon is hiring a former FDA official to work on its secretive health tech business

Amazon hires the FDA’s first chief health informatics officer, Taha Kass-Hout (Trinity Health), to head up healthcare project business development on its Grand Challenge team.

Monday Morning Update 3/19/18

Top News

Despite technical problems that delayed business on the German stock exchange by an hour, Siemens AG raises $5.2 billion in its Healthineers IPO. Funds will be used to invest in molecular diagnostics and to acquire US-based health IT startups.

Reader Comments

From Lizzie Borden: “Re: Theranos board and advisors. It looks like at least one member of the infamous company’s scientific advisory board is getting proactive about making sure industry insiders know she’s distanced herself from the company.” The Washington University School of Medicine has indeed assured the media that professor Ann Gronowski left the Theranos board at the end of last year, even though the company’s website still lists her as a member. Sources report that two other advisers still remain on the SAB, which was formed in 2016 to lend credibility to the company’s under-fire efforts.

HIStalk Announcements and Requests

Thanks to those who responded to “What I Wish I’d Known Before … Taking My First Hospital IT Executive Job.” I can’t say I’m surprised at how frequently hospital politics came up.

The next installment of the series is your chance to help future patients and caregivers learn from your past experiences in the hospital or ED.

Meditech was the favorite in a highly unscientific poll that mostly garnered votes from IP addresses associated with the vendors listed.

New poll to your right or here: How far along are EHRs in delivering a "comprehensive health record" that paints a full patient picture?

Webinars

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

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

Acquisitions, Funding, Business, and Stock

Mazars USA opens a new office in Los Angeles.

Decisions

• Tri Valley Health Center (NE) will go live with Meditech on May 1.
• Morristown Medical Center (NJ) will go live with Epic in June.
• Northside Regional Medical Center (OH) will switch from Cerner to Meditech in June.

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

People

CNBC reports that Amazon has hired Taha Kass-Hout (Trinity Health) to head up healthcare project business development on its Grand Challenge team. Also known as the 1492 Lab, Amazon’s team stealthily launched last year to focus on projects related to medical records management and access, though not much has been heard from them since. Much is being made of the fact that Kass-Hout was the FDA’s first chief health informatics officer.

Announcements and Implementations

In Bermuda, the Hospitals Board integrates eForms from Access with its Cerner EHR at King Edward VII Memorial Hospital and the Mid-Atlantic Wellness Institute.

Medication management vendor DrFirst deploys FDB’s new Opioid Risk Management Module as part of its support of Nebraska’s PDMP. In January, Nebraska became the first state to require tracking of all prescription drugs.

Other

This sounds a bit Big Brotherish to me: Herman Miller introduces a smart office chair that, when paired with its smart desk and app, gives employers insight into how long workers spend at their desks, times of highest productivity, and whether they’ve gone to the restroom or left for the day.

Sponsor Updates

• Parallon announces a reseller agreement with Cerner.
• CommonWell Health TV interviews Redox Chief Customer Officer Devin Soleberg.
• ROI Healthcare Solutions launches the ROI Resource Group.
• Santa Rosa Consulting adds an analytics migration program to its business intelligence and analytics services.
• Philips Wellcentive will exhibit at the Population Health Colloquium March 19-21 in Philadelphia.
• Wolters Kluwer publishes its annual report.
• QuadraMed will celebrate Health Information Professionals Week, March 18-24, by providing HIP swag to any healthcare organization registering for a Lunch-N-Learn by March 30.
• Maryland Lt. Gov. Boyd Rutherford visits DrFirst’s headquarters to learn how the Rockville, MD-based company is fighting the opioid epidemic with Maryland-based partners MedChi, CRISP, and UMSOD.

Blog Posts

• How Healthcare’s Digital Transformation Can Drive Better Patient Engagement (Salesforce)
• Ambulatory Surgery Center Industry Updates and New Analytics Tool (The SSI Group)
• What Keeps a Hospital CIO Up at Night? (Summit Healthcare)
• Next-generation sequencing at scale: Guided variant assessment (Sunquest Information Systems)
• Surescripts Commends Congressional Leadership as EPCS Act Gains Traction in Senate, Following House Bill (Surescripts)
• Healthcare Marketing with HIPAA (SymphonyRM)
• Presumptive Eligibility for Charity Care: The Risk of Presuming Your Hospital is Compliant (TransUnion)
• A Training Revolution: Visage 7 Powers UF Health’s SIMulation (Visage Imaging)
• Close clinical communication gaps and avoid risks. (Voalte)
• Strengthening Patient Safety and Engagement Through System Standards (Vocera)
• A 10-Point Plan for Smart and Secure Electronic Communications with Patients (WebPT)
• Less clicks and more data at the point of care? It’s true. (Philips Wellcentive)
• 4 Pitfalls of Searching the Internet for Health Answers (WiserTogether)

Contacts

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

Weekender 3/16/18

Weekly News Recap

• Theranos CEO Elizabeth Holmes settles SEC fraud allegations by agreeing to pay a penalty, give up her company shares, and not serve as an officer or director of a publicly traded company for 10 years.
• A blog post from UCSF’s Center for Digital Health Innovation says EHRS can never be a “comprehensive health record” since important patient health information is created elsewhere.
• Epic CEO Judy Faulkner says the company won’t challenge the VA’s no-bid Cerner selection, but estimates the government could have saved at least $3 billion by choosing Epic.
• Inovalon announces that it will acquire Ability Network for $1.2 billion.
• Epic confirms that it will integrate Nuance’s AI-powered virtual assistants into its software.
• Cerner says the VA’s planned go-live will begin in Q4 2019 with pilot sites and will then involve 48 waves that will be completed in 2027.

Best Reader Comments

With respect to Holmes, she DOES still face jail time. The settlement with the SEC covers only civil – not criminal – charges. The SEC has no criminal enforcement capability. The DoJ can pursue criminal charges if they deem it worthwhile. (Debtor)

My opinion / observation is that CommonWell is vaporware and it’s largely due to Cerner’s leadership or lack thereof. Athena went elsewhere to do real exchange. McKesson and Allscripts stopped talking about it. Cerner used it to land the ultimate whale in the DoD and has delivered LESS THAN the Joint Legacy Viewer for interoperability. With the DoD and VA combined, my family of five is in for about $250 to Cerner. For that price, I think I’m entitled to my equivalent of a Yelp review. (Vaporware?)

It’s very much en vogue to simply say API over and over again, but the fact remains – at some magical moment in time, you need as much data as relevant to the situation in order to make the best decision possible. APIs don’t actually accomplish that in general, and in the contrived example where one might try, you’d have the slowest computer system known to man. (UCSF only semi correct)

Agree with the interoperability problems in non-medical systems. It is only because we users demand a high level of accuracy that we complain so bitterly about the difficulties and errors. There are less complex data systems out there that perform much worse than the top tier of EHRs, but lives are not on the line, so we let it ride and only complain under our breath. (Graduated When?)

Thanks for highlighting Dan Linskey’s session. I was huddled out in the Boston suburbs with my kids on those awful days, but last Thursday evening, I felt as if I was standing next to Linskey – heart racing – listening to “Channel 1” in the middle of Boylston street. I cannot recall a more emotionally immersive experience. I will wonder all year how it is that I stumbled upon that talk at 5:30 – bleary-eyed as I left the exhibit floor. (Neil)

KLAS for validation. CIOs I work with generally find KLAS credible because the comments they read reflect the experiences they’ve had. They also conduct their interviews in person, which helps. Maybe not statistically bullet proof, but still credible, IMO. (Ex Epic)

Thank you for including this comment: “I’ve been the recipient of a couple of sexist comments this week – things that people would never, ever say to a male CMIO – so we definitely have a long way to go.” So many of my male colleagues just frankly don’t believe or seem skeptical that this behavior is as widespread as it is, suggesting that it’s only the creeps who make comments like that and that the comments are rare. Nope. (Kallie)

Love or hate KLAS, they have made both the provider buyer community and the vendor seller community pay them for telling them what to do. First, you have to understand the founders of KLAS are all prior leaders of HIS vendors and topnotch salesmen from days gone by. They were very successful in that world and they simply used those skills and tools they honed selling hospitals IT systems to sell them on needing someone to measure the vendor community and the vendor seller community on needing someone to tell them what they clients wanted and what their competitors where doing. It’s the perfect storm of a sales job and all of you bought it. They knew no vendor could pass up the notion of competing against its competitor, as healthcare is such a lead/follow vertical that once any provider stated they used KLAS, then others just followed because no one wants left out. (Real KLAS)

Watercooler Talk Tidbits

Readers funded the DonorsChoose teacher grant request of Ms. C in New Jersey, who asked for take-home science kits for her elementary school class (note that the photos were taken in the homes of students). She reports, “As soon as I received the materials and displayed them in the room, the students went wild! They could not wait to pick a kit and take it home to do some extracurricular learning! What is so great about the kits is that the students will be able to use them year after year. I already have students in the upcoming grade looking forward to science because of the wonderful materials we now have in our room. Thank you so much for keeping our students engaged in learning in and out of the classroom! Your donation will reach many young minds this year and in years to come!”

Also checking in was Mr. M from Wisconsin, whose describes his school’s area as “hardest hit by poverty, lack of jobs, mental illness, childhood trauma, and civil unrest.” We provided STEM games, which he acknowledged with, “Our students are lacking critical math skills, but they find our math book to be too confusing. We are incorporating games like Farkle into our curriculum. It is really effective because the games are fun. There is a huge push away from procedural knowledge to conceptual knowledge. What this means is they want kids to understand why the math works, but they are moving away from actually being able to do the math. I find this to be foolish. So we are working on ways to memorize numbers and how to manipulate them.”

HIStalk traffic always spikes during the HIMSS conference, this year peaking at nearly 12,000 page views and 8,400 unique visits on Wednesday, March 7. That’s not quite a record – July 30, 2015 (DoD announcement day) saw 17,000 views on 12,000 visits, sporadically making my overloaded server (since upgraded) unavailable for some of that afternoon.

I didn’t get many responses to my question about the best and worst parts of the HIMSS conference, so I’ll just list them here:

• Best: the companies that exhibit are reaching out in more meaningful ways, with panel discussions, lunch and learning events. The worst: getting hit in the head or back by the ubiquitous overloaded backpacks. The carriers don’t seem to be aware that they have heavy luggage on their back.
• It’s always fun seeing old friends, but my favorite part of this year was having a virtual HealthTap doc stroll up to me while I was Facetiming my kids. We had a nice conversation with the doctor, who was very friendly, and although my kids are still confused about it, we’ve had some fun conversations around the type of work I’m in. Way to stick out, HealthTap!
• Best: networking opportunities and having a large number of products and vendors all in one place. Worst: not seeing any major new items or topics. I finished the conference thinking either I have reached some type of plateau in my knowledge and exposure to the industry and/or that the industry in general has plateaued. Considering focusing my time outside of HIMSS in the coming years.
• Was very disappointed in the Women in HIT networking event. I was really looking forward to it and encouraged many women to pay the $45 each to go. But I can’t figure out what the money paid for. Very crowded, cold, and barely food — had to pay for dinner afterward. I truly hope there was money left over for a nice donation somewhere. A speaker or sit-down event where you can hear people talk to each other would have been nice.
• The smoke was the worst. I enjoyed meeting folks and learning about their different technologies. As a fellow vendor, I think the other vendors were more engaging and just happy to chat. Seems attendees are truly afraid to make eye contact and get roped into conversation. I approached it truly wanting to learn about others’ ideas, needs, and experiences. Wish I had learned more from attendees.
• Worst part: Las Vegas. Disgusting place. Why have a healthcare conference in one of the unhealthiest cities in the US?
• While my sentiment likely won’t be popular, I was pleased to see the rise of non-native healthcare companies at the conference. High time for outside influence in what might otherwise be a generally stagnant field. The worst was hearing the perspective of first-time attendees who were disappointed to discover the lack of a patient presence. If anyone out there is ready to host a conference dedicated to patient panels, I’m all in!

I had to re-read this article carefully because it sounds like satire from “The Onion.” Elon Musk considered buying “The Onion” several years ago and has since hired its top two former executives and four other staffers to work on a secret comedy project. Musk’s reply to inquiries was, “It’s pretty obvious that comedy is the next frontier after electric vehicles, space exploration, and brain-computer interfaces. Don’t know how anyone’s not seeing this.”

Another “Onion”-worthy story involves startup Nectome, whose tagline is, “What if we told you we could back up your mind?” The company proposes to inject preservatives into the brains of dying people while they’re on life support, in essence killing them in the hopes that the stored memories in their brains can somehow be recreated later despite lack of proof that dead tissue actually stores memories. A neuroscientist critic says, “Burdening future generations with our brain banks is just comically arrogant. Aren’t we leaving them with enough problems?”

University of Michigan stirs up controversy by offering its donors concierge medicine services in a program it calls Victors Care that costs $2,700 per year. It promises that customers get “enhanced access and time with their primary care physician.” Its website lists just one participating doctor. Concierge medicine has become increasingly common, but is always offered by private practice doctors rather than public university hospitals.

A NEJM article ponders the ethical challenges of using machine learning in healthcare, saying:

• Machine learning may unintentionally offer recommendations biased against race or genetics because of the data it was trained with
• Private companies might develop algorithms that will recommend activities that are designed to artificially inflate quality scores or increase the use of profitable products without actually improving outcomes
• Diagnostic methods and treatment best practices may not be well enough defined to support a machine-generated conclusion
• Physicians need to understand how the algorithms work rather than treating them as a black box since ethical challenges may result otherwise
• Physicians are ethically bound to withhold information from the EHR to protect patient confidentiality, but that practice would skew the performance of machine learning that expects to find a complete data set

The physician reader who sent me the article notes that while the authors worry about the perceived authority of AI-powered systems, that’s what medical records technology pioneer Larry Weed, MD proposed 50 years ago – a system in which lower-level providers interview the patient and enter their findings into the EHR, after which the doctor is offered a computer-generated list of possible diagnoses before seeing the patient. Weed wasn’t thinking about AI, though – his idea was “problem-knowledge couplers” in which technology would analyze the available patient data to provide an objective assessment, avoiding the problem in which doctors who are faced with too much data make decisions using instinct instead of relevant facts. The illustration above came from Dr. Weed’s 1983 presentation at the SCAMC conference – he was running self-developed software on a Northstar Advantage computer with 64K of memory.

Researchers develop an open source template for a 3D-printed stethoscope, clinically validating that the $3 result works just as well as expensive models while being affordable to clinicians in developing countries. They got the idea after playing with a toy stethoscope and realizing that it actually worked pretty well.

In Case You Missed It

• News 3/16/18
• EPtalk by Dr. Jayne 3/15/18
• News 3/14/18
• Curbside Consult with Dr. Jayne 3/12/18
• The Smokin’ Doc Celebrates a Successful HIMSS
• Monday Morning Update 3/12/18
• What I Wish I’d Known Before … Taking My First Hospital IT Executive Job

Get Involved

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

What I Wish I’d Known Before … Taking my First Hospital IT Executive Job

That shifting organizational culture takes time and patience. When you actually succeed and the culture starts to change, your employees who were barriers to change will start to leave the organization.

That budgets are boring and the software in the space doesn’t help. Where’s the digital disruption in the budget planning space?

How political and backstabbing a faith-based healthcare system can be. And how adeptly a CFO can play the game.

Hospitals still may not value the role of IS leadership. Control of budgets can be limited to the point of requiring approval for PC purchases and everyone in the department is viewed as a help desk function. Strategic vision and focus on critical topics such as information security are lacking. In those cases, your role as an IS executive is to prove your department’s worth and role in the organization and drive cultural change. This effort takes many years with seemingly slow progress.

That even as a physician executive, my clinical credentials would be a point of debate among all the physicians with whom I had to interact. They challenged my authority constantly because I didn’t see as many patients as them, didn’t see as sick of patients as them, didn’t see patients in their specialty, etc. They had a host of excuses for why they shouldn’t listen to me and unfortunately our senior leadership wasn’t willing to tell them they were full of bull and needed to just get in line. I had the last laugh though when I led the (successful) initiative with the operations side of the organization to change their contracts to require compliance with EHR use and tied it to their bonuses. Surprisingly, they all got in line after seeing a drop in their bonuses once the new contract was in place.

Not much because I did a consulting project for them before they offered me the position. So I had a pretty good idea what I was up against and how long I would want to work in that type organization. I also made it clear that if they did not agree with the recommendations in my report, they shouldn’t hire me. I’d recommend that approach (if available) to others to minimize unknowns.

That the same projects I rolled out quickly and successfully (1-2 weeks) in the mid-sized physician office where I was the boss would take months to years to complete in a hospital-owned ambulatory setting. Change management is easier when everyone is on the same page, but much harder when duties are dispersed over multiple locations and individuals with varying skill levels. Partnering with a strong operations administrator with experience helps ensure success.

Healthcare IT is messy. Gaining physician cooperation in institutions where they are not employed (which is the majority) ranges from tough to nearly impossible. Healthcare economics are messy.

As a CIO, how much of my job would be pure politics, trying to placate high-production specialties practices and physicians whose productivity (and income) was negatively impacted by EMR implementations. That and the realization to whatever lip-service we received from the rest of the C-suite regarding “innovation” and “investing in technology to improve patient care,” IT was always viewed as a cost center, and when the inevitable cuts came, IT is at the front of the line. Having said all that, given all of the challenges, discovering how rewarding it could be when you accomplished despite the obstacles.

Most hospital CIOs are politicians, and as such, are reluctant to measure the value of their projects, like ROI.

Existing politics and relationships can be your death knell. When you arrive to your first C-suite job, be mindful about these two items. If you are not, it can put you in a very bad position. My advice is to use the two ears-one mouth ratio to listen and observe to figure out what is what. There are many reasons the team you just joined is there. They have most likely figured out how to keep their high-paying, high-perk jobs and they are not about to let the new person on the team mess that up.

Real power does not always lie with the obvious titles. Try to become aware of who is really running the show and who the CEO really relies on. Also, some CEOs promote politics more than perhaps they should. It then becomes high-stakes gaming where you, as the newbie, will lose if not careful. It is a harsh reality of many C suites, but it exists. I have worked in six organizations with various levels of C-suite politics. Four of them were fraught with really messed up, toxic behavior. Two were not.

Even with that said, I would not trade any of those experiences as it has helped prepare me for the job I have today. In my current role, while I have our office and company politics fairly figured out and know when to speak up and when to duck, it is a constant part of the job to help ensure I am not a casualty from an ill-timed or ill-placed remark or taking a stand when I could have just let it go. It is truly an art at this level and takes a lot of practice, observation, willingness to not die on every hill, and of course a bit of luck.

Morning Headlines 3/16/18

Mediware Announces New Headquarters In Overland Park

Mediware Information Systems will build a 66,000 square-foot global headquarters in Overland Park, KS that it expects to open in mid-2019.

UnitedHealth Group Announces Leadership Actions

Sir Andrew Witty (GlaxoSmithKline) will join Optum as CEO, replacing Larry Renfro, who will become a managing partner of Optum Ventures and its new $100 million fund.

Mount Sinai Announces Appointment of Joel Dudley, PhD, as Executive Vice President for Precision Health

Mount Sinai Health System (NY) taps Icahn School of Medicine Associate Professor Joel Dudley to lead its new Precision Health Enterprise, which will focus on external partnerships with technology companies as part of its strategy to develop personalized therapies for patients.

News 3/16/18

Top News

Theranos founder Elizabeth Holmes will pay the SEC $500,000 to settle charges that she and the company fraudulently raised over $700 million. Holmes will also give up majority voting control over the company, and some of her equity in it. She will also be banned from directing a public company for the next 10 years. Former Theranos President Sunny Balwani, who resigned from the company in 2016, also faces charges, which the SEC plans to litigate at a later date. None of the company’s star-studded board have been implicated.

Aside from the numerous alleged lies told to investors during presentations, media interviews, and product demos, Holmes and Balwani erroneously claimed that the company’s products were used by the DoD on the battlefield in Afghanistan and on medevac helicopters, and that the company would generate more than $100 million in revenue in 2014 – far above the $100,000 it actually pulled in. A separate criminal investigation is still underway.

My two cents: Investors should have done their due diligence instead of getting giddy from founder buzz. The Theranos hype machine, which the media dutifully fed on, made the company sound Silicon Valley hip instead of like a tiny-volume, would-be competitor to the fully-scaled big, national labs.

Webinars

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

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

Acquisitions, Funding, Business, and Stock

Mediware Information Systems will build a new 66,000 square-foot global headquarters in Overland Park, KS that it expects to open in mid-2019. The company acquired Medicare billing company MedTranDirect in January.

NantHealth reports a 2017 net loss of $175 million, with revenue up 8 percent year over year to $87 million. Q4’s $22 million revenue fell a bit short of analyst expectations. No mention was made of its August layoffs or sale of its provider and patient engagement assets to Allscripts, aside from labeling them as discontinued operations.

People

Sir Andrew Witty (GlaxoSmithKline) will join Optum as CEO, replacing Larry Renfro, who will become a managing partner of Optum Ventures and its new $100 million fund for technology, data analytics, and healthcare companies. Witty was knighted in 2012 for his services to the British economy.

Divurgent brings on Jeff Sassenscheid to handle the expansion of its ERP, HRIS, and HCM service lines.

I missed this in the pre-HIMSS media frenzy: El Camino Hospital (CA) promotes Deborah Muro to CIO.

Announcements and Implementations

Northwell Health (NY) will implement GMed’s enterprise endoscopy solution at 20 hospitals and ASCs. GMed was acquired by Modernizing Medicine in 2015.

Millennium Physician Group (FL) selects population health management technology from Lightbeam Health Solutions.

In Illinois, Community Partnership of the Ozarks prepares to launch a Mediware-based software project that will help to eventually connect 16 healthcare and social services organizations across the region.

WebPT and Modernizing Medicine develop an interface between their respective EHRs to enable better data sharing between physical therapists and orthopedists.

Salesforce adds care gaps and assessments functionality to its Health Cloud CRM.

Medicomp Systems adds care management capabilities for opioid addiction treatment to its line of Quippe clinical solutions.

Other

A VA study of 100 heart failure patients finds continuously streaming data from stick-on chest sensors to an analytics-based smartphone app is just as effective at preventing readmissions as a more expensive implantable device.

Patients at Danbury Hospital (CT) express frustration with scheduling and procedure delays resulting from a system-wide Cerner implementation earlier this month at Western Connecticut Health Network. Announced in 2015, the roll out included Cerner’s Millenium EHR, HealtheIntent population health management software, and a Soarian upgrade.

@Farzad_MD tweets out the results of an “aromatherapy” study that found alcohol prep pads were more effective at quelling nausea in ED patients than customary anti-nausea medication.

Weird News Andy wonders about the ICD-10 code for “airhead” after surgeons discover a giant air pocket where part of an 84 year-old patient’s brain should have been. The man sought care after suffering a mild stroke, but had otherwise lived a normal life.

Sponsor Updates

• PerfectServe creates an Apple Watch app to give end users easier access to its messaging technology.
• Learn on Demand Systems hires Laura Faughtenberry (Dude Solutions) as director of marketing.
• The Athena Breast Health Network (CA) selects LifeImage-powered Mammosphere to provide network management of medical images and associated clinical information to conduct the WISDOM breast cancer screening study.
• Meditech publishes a new e-book, “The Essential Guide to EHR Value & Sustainability.”
• LiveProcess will exhibit at the ANA Quality and Innovation Conference March 21-23 in Orlando.
• Loyale Healthcare rolls out its Patient Financial Manager solution to select Parallon clients including 170 HCA hospitals and EPs.
• The LiveHelpNow Challenge includes Vyne in its list of top companies providing exception customer service.
• Meditech will exhibit at the 2018 Home Care Optimization Symposium March 20-22 in Atlanta.
• National Decision Support Co. will exhibit at the National Comprehensive Cancer Network Annual Conference March 22-24 in Orlando.
• Netsmart will exhibit at the National Association of Psychiatric Health Systems March 19 in Washington, DC.
• Clinical Computer Systems, developer of the Obix Perinatal Data System, achieves HITRUST CSF Certification.
• EClinicalWorks publishes a new case study highlighting Rainbow Pediatric Center’s use of telemedicine to improve ADHD patient compliance.
• Black Book Research ranks Optimum Healthcare IT number one for enterprise EHR implementation and IT advisory and customer satisfaction.

Blog Posts

• #HIMSS18 at All Levels: International, National and Local (Liaison Technologies)
• LifeImage LITE: Building Your Own Health Provider Network While Easing Your Access to Data (LifeImage)
• Machine Learning vs. Deep Learning (Lightbeam Health Solutions)
• Healthcare Team Communication Tools to Reduce Nurse Burnout (LiveProcess)
• Achieving the Healthcare Triple Play: Improving clinician engagement, patient care and utilization – Part 2 (LogicStream Health)
• 3 Benefits of Participation in BPCI-Advanced (Medecision)
• Why FHIR, APIs, and Apps are the Future of Interoperability (Meditech)
• Quippe’s Clinical Data Relevancy Engine: the diagnostician’s easy button (Medicomp Systems)
• Searching for That Treasured Pot of Gold (Navicure/Waystar)
• What Does Behavioral Health Have to Do with Home Health? (Netsmart)
• So you’re a vendor now: How to set expectations with your EHR affiliates (Nordic)
• Data-driven technology will transform the health industry (Experian Health)
• Four Questions Series: Joshua Jacobs, VP at Windsor Health Communities (PatientPing)
• Using a “Cookie” Mentality to Increase Patient Satisfaction and Collect More Payments (Patientco)
• Sugar. Butter. Flour. (PatientKeeper)
• How Smart Contracts Will Make Care Accessible to Telehealth Patients (PokitDok)
• Part 2: The “C” in ITSM (CTG)
• The National Sepsis Crisis – And How Health IT Can Help (Spok)
• The responsibility of a leader (Meditech)
• Prepare and Prevent Common Due Diligence Issues in Health IT Transactions: Operations Considerations (Part 4 of 6) (HGP)

Contacts

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

EPtalk by Dr. Jayne 3/15/18

Theranos CEO Elizabeth Holmes is charged with fraud and has agreed to a settlement without admitting guilt in the matter. People were eager to believe in the promise of new technology without proof. Various family connections and their endorsements added to the investment frenzy.

I see dozens of startup proposals every year and have a high degree of suspicion for vaporware or vaportech. I’m happy to sign non-disclosure agreements with organizations that legitimately want my opinion, but they have to be willing to show me what they’re doing before I’m going to get on board. I think some folks have lost their ability to perform due diligence given the constant hype around innovation and being the Next Big Thing. I feel sad for the lower-level investors who were caught up with Theranos and its deception.

This article from The Guardian was a hot topic in the physician lounge today. Physicians took immediate exception to the comparison of US physician salaries to those from other nations, noting that in other countries, physicians do not have to incur significant debt to complete medical training as they typically do in the US. No one disagreed with concerns around the cost of prescription drugs or administrative costs.

One member of the hospital administration noted that some of the starting administrators at Big Health System make more than starting physicians, which is a sad state of affairs since starting administrators often have minimal experience beyond their MBA coursework. Similarly, there was no disagreement with the US having worse population-based outcomes.

Every time I have to argue with a patient about unneeded tests, there is typically a comment from the patient along the lines of, “We have the best technology in the world and I deserve this test,” or, “I’m paying a lot for my insurance and it’s covered so I want it.” Patients often don’t see past their individual situations and don’t want to have decisions made based on populations and statistics rather than their own personal feeling about what should happen.

Culturally, we have issues with desiring invasive care, often to our detriment (take a look at some of the childbirth data) and not understanding the need to pursue lifestyle changes rather than medicating everything. We don’t want to wait things out. We want medication now whether we need it or not.

Also culturally, we make it difficult for people to access care. Many of my patients come to urgent care after 6 p.m. because they can’t take off work or have no sick days to seek medical care. Very few primary care offices in my area have evening hours, so the more expensive urgent care begins to fill the primary care void.

Having the worst maternal mortality rates among other “developed” nations is embarrassing and should be avoidable, but we’re not tackling it very well. Infant mortality is also nothing to be proud of. I’m shocked by how many Americans keep up with the Kardashians and a host of other celebrity or social media personalities, but can’t name things they can do to keep themselves healthy. Prevention isn’t sexy, nor is doing the hard work needed to lose weight or stay in shape. Insurance plans often don’t cover preventive treatments or put hoops in place for patients to jump through when they want to pursue non-invasive or non-surgical treatments for some conditions that might improve quality of life.

I had a patient recently who switched insurance plans and her new coverage won’t allow for replacement of her custom shoe inserts, which had broken down over time. The patient had previously been active and now has constant foot pain, which has limited her activities and probably has contributed to her weight gain. She was in to see me about a cortisone injection, and even just looking at the cost of my visit plus the cost of the injection and potentially a follow-up visit, it would have been cheaper to just pay for new orthotics than to treat the foot pain. The patient had lost her job and is working as a restaurant server, which isn’t helping her pain either. She’s diligently trying to save for a new set, but that’s hard to do when you’re living paycheck to paycheck.

HIMSS may be in the rear-view mirror, but the onslaught of emails and cold calls is just beginning. I’ve finally learned to link my HIMSS registration to a dummy email account so that the contacts can be sorted out. I used a burner phone number as well. A couple of the post-HIMSS emails have been personalized greetings from a specific resource thanking me for the interaction at the booth and making note of our conversation. Others follow a formula that doesn’t help me at all: Thank you for your visit to X Vendor, we are hoping to help your organization, we will be reaching out to you directly. A link to the company website or an attached product portfolio PDF might be helpful memory jogs and might be less easily deleted than the form email.

The best outreach I have received so far was from Formstack, with the subject line “Have you worn your green Formstack socks yet?” and asking for a follow-up. It definitely caught my attention, and yes, the socks were perfect for coming back from HIMSS. I’m sending my VMWare socks to my favorite engineer, so I can’t comment on their comfort. I wasn’t lucky enough to score Google Cloud socks. Socks were certainly on the menu this year. I did finally score some #pinksocks this year and they got some looks wearing them around town.

I’m still recovering post-HIMSS, most likely because I landed, unpacked, repacked, and immediately went cold-weather camping, which probably wasn’t in my best interest. From there, it was on to client work and clinical shifts. The 12-hour days are becoming more and more difficult. Maybe the longer daylight hours in the evening will lift my spirits. I don’t mind it being dark in the morning since I can sleep without the birds trying to drag me out of bed.

I’m putting together the list of meetings I want to attend the rest of this year and also planning for 2019, when I get to take my board recertification exam. What’s on your list of can’t-miss meetings? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 3/15/18

Theranos founder Elizabeth Holmes is not allowed to lead a public company for a decade

Theranos founder Elizabeth Holmes will pay the SEC $500,000 to settle charges that she fraudulently raised over $700 million. She will also be banned from directing a public company for the next decade.

Software snarl riles patients of Danbury network doctors and hospitals

Danbury Hospital (CT) patients express frustration with scheduling and procedure delays resulting from a system-wide Cerner implementation earlier this month at Western Connecticut Health Network.

Springfield agencies will soon get software to better connect and serve

Community Partnership of the Ozarks in Springfield, IL prepares to launch a Mediware software project that will eventually connect 16 healthcare and social services organizations across the region.

Morning Headlines 3/14/18

Electronic Health Record? Comprehensive Health Record? Connected Health Record!

A blog post from UCSF’s Center for Digital Health Innovation takes exception to Epic’s claim that it offers a “comprehensive health record,” pointing out that no EHR can be comprehensive since important information is also generated by numerous entities and sourced from non-clinical settings.

Cognizant Gobbles Up Another US Healthcare IT Services Provider

Cognizant will acquire Louisville, KY-based RCM services vendor Bolder Healthcare Solutions.

Presidential Order Regarding the Proposed Takeover of Qualcomm Incorporated by Broadcom Limited

The White House puts a stop to Broadcom’s hostile takeover of Qualcomm, meaning that medical device information systems and integration vendor Capsule Tech will remain a Qualcomm subsidiary.

Epic won’t challenge Cerner Contract

Epic’s Judy Faulkner says the company won’t challenge the VA’s single-source Cerner contract choice, but she estimates that Epic would have charged at least $3 billion less than Cerner and would have offered more interoperability with providers outside of the VA system.

News 3/14/18

Top News

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

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

Reader Comments

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

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

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

HIStalk Announcements and Requests

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

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

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

Webinars

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

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

Acquisitions, Funding, Business, and Stock

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

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

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

Sales

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

People

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

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

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

Collective Medical promotes Andrew Reeve to SVP of sales.

Influence Health promotes Mike Oakman to COO.

Announcements and Implementations

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

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

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

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

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

Government and Politics

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

Other

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

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

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

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

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

Sponsor Updates

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

Blog Posts

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

Contacts

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

Morning Headlines 3/13/18

Mercy Health launches new department

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

Lake Mary firm to close, lay off employees

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

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

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

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

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

Curbside Consult with Dr. Jayne 3/12/18

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Email Dr. Jayne.

The Smokin’ Doc Celebrates a Successful HIMSS

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

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

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

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

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

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

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

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

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

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

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