Dr. Jayne at HIMSS 3/5/18

I was on the schedule to see patients yesterday, so I had to catch an early flight to Las Vegas. The gate area was full of people also headed to HIMSS, by virtue of this being the first non-stop flight to Las Vegas for the day. Plenty of logoed backpacks and polo shirts made it easy to pick out people headed to the show.

I normally avoid flying on Monday mornings because it’s such a zoo and today was no different, although it was possibly more challenging than normal. The TSA Pre-Check line was as long as I’ve ever seen it and TSA kept routing people out of it into other lines, causing tension and some line-jumping that led to angry words. My Southwest flight had plenty of people trying to save exit row seats despite the no-seat-saving policy, and I thought two passengers were going to come to blows at one point. Fortunately, cooler heads prevailed.

Travel seems to losing civility with every trip I take. On this flight, one man yelled at the flight attendant for touching his arm as she passed (his arm was hanging out into the aisle, making it nearly impossible for anyone to get by). Although we were on a nearly new aircraft, the wireless wasn’t working, which I’m sure raised anxiety for people who had planned on doing work during the flight. Regardless, a gentle note to travelers: if you have company logo apparel and luggage tags, you might want to behave accordingly. I made a couple of notes to try to see if some of the less-well-behaved passengers turn up in their respective companies’ booths.

There were plenty of in-flight conversations about the need for comfortable shoes and where people were staying – lots of people off the strip and several companies renting houses rather than being in the HIMSS room blocks. The general tone is that HIMSS has become all about the exhibit hall and networking and that the keynote speakers are largely irrelevant. Most of the people who were chatting around me on the flight are from the vendor side of the house and didn’t have opinions about sessions or the educational value of HIMSS because they’ll be stuck manning their booths or doing coffee runs.

I was reading some continuing medical education materials during the flight and my seat mate asked whether I was a physician. He was curious as to what I thought about Uber’s new foray into healthcare. I have mixed feelings on the offering, considering that the physicians, hospitals, and care providers are expected to foot the bill. Sure, it’s cheaper than an ambulance and cheaper than noncompliance, but for small practices that are not in risk-sharing arrangements, it’s going to be one more thing to pay for and less likely to happen. These practices are already paying for translation and interpreter services that usually negate any profit they would make from a given visit, so when you throw transportation in the mix, it only works when there is a larger entity at play to absorb the costs. I did note that if patients have the regular Uber app, the visit isn’t billed – it’s not clear however how the drivers will be compensated in that situation.

It will take a special group of drivers to care for the Uber Health population, drivers who are aware of the needs of medically complex patients who may have difficulty getting out of the house, who may have accompanying medical equipment, or who may have challenges related to their medical conditions. I assume Uber has this figured out since Uber Health has been tested for more than six months by a group of 100 hospitals and physician offices. Patients can be scheduled by the practice up to 30 days in advance, which certainly can help patients keep their visits. I was interested to see that the Uber tools are “compliant with HIPAA,” which makes me wonder whether name and address are the only PHI elements they’re tracking.

There are also liability questions. When we have patients at our practice who require transportation, we provide contact information for various community and commercial services. Our contact sheet has a disclaimer that we are not affiliated with or recommending these services and are simply providing it as a convenience. If the physician office schedules transportation and an accident occurs, do they share the liability? What if an office sends an Uber but an ambulance was really more appropriate? We’ll have to see how things shake out over the coming months.

I finally arrived in Las Vegas late morning, and although check-in at my hotel was quick, they didn’t have a room ready for an early arrival. I spent some time tidying up some project plans and people watching at the Palazzo shops before meeting a former colleague for dinner. We hit some of the shops afterwards and then made our way to the opening reception in Hall G. This year’s reception had a Pac-Man theme that I didn’t quite get, although I did get a kick out of seeing the arcade games scattered around the subterranean Hall G. There was a crush of people trying to find the buffet tables that were scattered around the hall, leading to long bar lines and questions about what was being served. Even though there was a map of offerings at the entrance, I never saw half of the options that were listed. Although many booths were fully manned, some were still being set up and still others were totally empty. I’m sure this is the largest influx of people into the basement level for the week, so if you weren’t trying to grab attention, you missed out.

LogicNets was building an oversized Jenga game in its booth.

Lightbeam Health Solutions wins my prize for being the first booth I saw that had our sponsor sign proudly displayed. I was pleased to see that the HIStalk booth with its smoking doc is ready to greet attendees tomorrow, just down the aisle from not only the Philippine Trade and Investment Center booth, but also behind the Nihon Cohden America booth, which wins my prize for some of the creepiest imagery. They have a 3-D female figure that has pictures of organs project onto it, I think they’re responsible for a guy who was wandering around with medical tape and electrodes on his head. I tried to get a picture of that, but he got away.

I felt sad for the empty “first time exhibitor” booths where perhaps the exhibitors ran out of money before they made it to the show. It looks like there are plenty of things to see in Hall G – I will have to go back and investigate what looked like a large slot car track and also a couple of interesting booths. Optiv is a first-time exhibitor, and although I didn’t have time to stop by to see what it is they do, the booth was well put together and the team seemed to be ready to talk to people. I saw one booth whose tables were covered by leftover buffet trash even though there was staff present, giving it the air of the aftermath of a college party.

I closed out the night with my first martini of the year (!) with a friend and am off to bed so I can be well-rested for tomorrow. Who knows what HIMSS Tuesday will bring?

Email Dr. Jayne.

From HIMSS 3/5/18 Part 2

HIMSS18 Day 1 is on the books. I’m not really sure if it’s Day 1 or Pre-Day 1, but it’s over regardless. There wasn’t a moment today where it didn’t feel like Sunday instead of Monday.

From Ulterior Motive: “Re: Fujitsu. They are exiting the healthcare vertical business even though they claim to focus on B2B with an emphasis on verticals. This aligns with the pending acquisition from Lenovo. That leaves the industry with Lenovo, HP, and sometimes Dell for mobile computing devices. Guess it is now time for Apple and potentially Microsoft if they can fix Surface.” Unverified.

Newsy Items

Cerner and Salesforce will collaborate to integrate to offer their combined population health management and CRM solutions, respectively.

We’re surrounded by grotesquely Americanized phony views of the real world and the worshiping of excess, debauchery, and conspicuous consumption. Sorry, wrong picture – I was looking for one from the exhibit hall.

It’s kind of like the running of the bulls in Pamplona, except that the slower-moving targets of rage are the health IT nerds thinking that they are expert multi-taskers in being able to screw around with their phones while walking and failing to notice that they’ve almost stopped mid-walkway due to lack of CPU cycles to smoothly accomplish both. They deserve to be trampled by tailgaters who are locomoting more decisively to their destination.

Change Healthcare has installed these cool device charging stations all over the convention center. You use your credit card to lock your charging device in its own little compartment and then retrieve it later. I brought external batteries saved from previous HIMSS conferences, so I should be set.

Cerner and Epic finally agree on something.

Hey, look at the HIMSS-provided free refreshment bar! I actually grabbed a few pens and notepads since those are hard to find (the latter, especially) in the exhibit hall. And an ice water.

Here’s our magnificent tribute to cost-effective exhibiting: two new pull-up signs ($75 each, free shipping), a new Smokin’ Doc standee ($75), and our old table cover and banner (which frankly could have used a touch of the iron after being hauled around for years in a duffel bag). Still, I’m excited that we at least accomplished something – a nearby Hall G booth neighbor caught Lorre before our booth was even set up and asked for the “Cellar Dweller Special” new-sponsorship bonus special I mentioned the other day. They’ll benefit for a full year at a fraction of their exhibit hall cost and we’ll feel a little bit better about squandering money on a booth. I’ll be sweating tomorrow that I’ll hear that our booth is dead.

A witty welcome gift – a sort of “found objects” art display — was awaiting us at our empty booth from our old HIStalk friend, Medicomp CEO Dave Lareau, who clearly understands our bifurcated feelings about the conference.

Actually, Hall G is much nicer than I remember, with reasonably high ceilings. Our aisle is pretty wide an inviting, with the only real negative being that it’s like a mall that has lost its anchor tenants and thus its foot traffic. I’m sure some great companies are down there with us, so show your discriminating taste in seeking out vendors that the hoi polloi can’t appreciate, like boutique wineries that aren’t interested in selling to the masses.

I caught my booth crew (both of them) wearing tee shirts I hadn’t seen, finally extracting their eye-averting confessions that they have a bunch of them with plans to use them for unstated purchases. I suppose I should overlook their lack of transparency, applaud their self-directed management,  and at least be happy that they chose to memorialize The Smokin’ Doc. I’ve already bet money that at least one person who feels gifted with unusual insight will loudly question why a doctor is smoking a pipe. It’s called intentional irony, humorless people of the world.

Lorre struggles every year trying to hang up our booth stuff by herself since the drape holders are taller than she is. Stepping in chivalrously to help was booth neighbor Bill Schriver, a US Navy veteran and senior manager from Atlanta-based consulting firm Avelead. Lorre wants to thank Bill in this way – show up at their Booth #11325, ask to meet Bill, and tell him Lorre sent you. The first three people that do that will get one of the tee shirts you see above. We apparently have both the usual men’s version as well as more flattering ones designed specifically for women, which isn’t always the case with giveaways. You might as well thank Bill for his service while you’re visiting.

Another booth neighbor is displaying this thought-provoking item, which I like to think is an abstract, wry commentary on the exhibit hall – the de-humanized protagonist has his mouth wide open talking loudly while carefully covering his eyes and ears to avoid being distracted by listening. Maybe I’m overthinking it.

The entire convention center now resembles the gambling machines that surround it, replete with ad-displaying monitors that feature eye-catching bright lights.

The first word I heard upon entering the convention center today was “blockchain,” part of too-fast, too-enthusiastic pitch some guy was delivering via his phone.

Great job on the backpacks, GE Healthcare. It’s a keeper – large, lightweight, and featuring nice straps and a magnetic closure. They chose well in designing it purely to work as a backpack, with symmetrical straps and a single, centered top handle that doesn’t try to emulate a handbag or briefcase and thus failing all possible use cases.

Hall WiFi was free and pretty good at 25 Mbps, although that will get dragged down significantly Tuesday when it gets overloaded by attention-deficit geeks desperate to mate with their electronica.

Food was a bit hard to find near the action today since most of the concessionaires operate only from stands inside the still-closed exhibit hall. I didn’t want to pay $30 for lunch, so I headed up to the Grand Canal Shoppes food court that had a lot of options for under $12. I had a pretty good Indian lunch from Curry Pot, whose naan and cumin seed basmati rice that came with the chicken tikki masala making the temporary carb loading worth it.

I attended the first part of the lackluster opening keynote session that didn’t start until 5:00. It led off with dull singing from TV talent show winners backed by pre-recorded tracks in singing irrelevant songs that ranged from “Hallelujah” to the retch-inducing “Don’t Stop Believin’” and finishing with the puzzling “Somewhere Over the Rainbow,” all of it embellished with gratuitous vocal gymnastics, background slides that missed “inspirational” while hitting “cliche” in trying to tie together with an emotional thread disasters both natural and intentionally caused, and the absence of the original songwriters or performers (it was karaoke, basically, and not in a “like Leonard Cohen sang it” sort of way). I can’t decide if I was more embarrassed when a few people cheered and clapped as though Better Midler had just belted out a number vs. the stern, besuited guys shown on the projection screens who seemed to fear that any show of emotion might burst their tightly buttoned collars. I guess it’s tough to program music for the older, button-down crowd that attend HIMSS, but I would rather have just skipped the music entirely to get us all out to dinner earlier.

They said in the opening session that the room was full at 7,000 people and that 43,000 people had registered for the conference, although I don’t know if those were official numbers.

Eric Schmidt, who has held (and lost) all the key positions at Alphabet/Google while amassing $14 billion, got off to a good keynoter start before I had to leave (HIMSS wasted a ton of stage time before he was allowed to start at 5:45). He talked about technology in medicine, calling AI-powered image analysis “a solved problem” in which machines performs far better than humans. He mentioned the new Google Cloud API and urged the industry to “run to the cloud” and get off their poorly managed and secured local servers (he sells the other kind, of course). I had to scoot and missed the rest of his talk, so let me know if he said anything interesting. The most interesting thing was how odd I felt seeing an actual person from Google – unlike Microsoft’s ever-present Bill Gates and Steve Ballmer, I had no idea what anyone from Google looked or sounded like despite my close, constant relationship with its products (Chrome, Mail, Android, search, and so on).

Tomorrow is the first day the exhibit all is open, so I’ll be cruising and possibly attending some educational sessions that I’ve highlighted. Email me if there’s something I should see or if you hear interesting news or rumors that I can use.

From HIMSS 3/5/18

The HIMSS war has begun, where the wide-eyed newbies huddle together in chattery excitement while the grizzled veterans with far-away stares trudge off to fight the latest of too many ugly battles.

Jenn, Dr. Jayne, and I will post as we have time and anything interesting to report. Experience has jaded me so that I don’t get wrapped up, as many people do, into cramming events into every waking hour. I’ll choose drifting peacefully with the health IT current instead of swimming hard upstream.

Reader Comments

From School Me: “Re: KLAS report on interoperability. It is painfully thin on actual details and is almost reckless in painting a misleading picture. Epic and ECW are routinely censured by industry associations, investigators, and the like for data blocking and KLAS gives them the highest scores for interoperability? It’s probably not a coincidence that this report landed one business day before HIMSS starts — I’ll bet you a Bellagio buffet that Epic has that report on 20-foot signs in its booth this week.”

From Skeptical: “Re: KLAS report on interoperability. I wonder if it’s an FTC violation that KLAS doesn’t disclose the financial relationships with the vendors they’re rating? Plus, wouldn’t it be valuable for CIOs to know how much each ranked vendor pays KLAS?” That’s always the question with KLAS. I suggest that KLAS implement a star system to indicate their relative income level from each vendor. They don’t have to tell us the exact figure ,but it would be nice to know when reading a report about Epic and Greenway that they’ve earned 10 KLAS payment ranking stars vs. two, respectively, although that gives vendors incentive to pay less instead of more.

From Gettin’ Jiggy: “Re: Allscripts. Elation, CareCloud, and Athenahealth will win business as the company starts charging for Practice Fusion without plans to enhance it. We still don’t know what will happen with the Care Otter product that’s being developed within a siloed organization that has shunned help from more experienced Allscripts resources. If it flies, they will surely sunset some of their reliable, stable EHRs, although client-server systems – especially for small practices – need to die. The company’s big product gap is not having a cloud-based PM product, which is needed to stem their customer losses over the past few years.” Allscripts has two problems with Practice Fusion: (a) most practices implemented it only because it was a free way to cash in on Meaningful Use money, and (b) whatever percentage of its users who are willing to pay for an EHR won’t necessarily find Allscripts products more attractive than the ample alternatives. I’m not sure any level of enhancement would help since the Practice Fusion customer base didn’t seem to care about functionality gaps enough to replace it. I also don’t know how Allscripts will mobilize a sales force to reach out to Practice Fusion customers before they start looking or digging back out the manila file folders. I’ve had one visit to a Practice Fusion-using practice and they only lightly used the online portal part – it was all paper forms otherwise even though they look like a “customer” to the company.

Newsy Items

Allscripts CEO Paul Black pens an editorial criticizing the just-released KLAS report on plug-and-play interoperability, which noted that Allscripts doesn’t participate in the highly-used Carequality or the lightly-used CommonWell. He says KLAS should have considered other available interoperability options such as point-to-point interfaces, HIEs, and APIs. Cerner is also apparently unhappy with the report, which said its CommonWell-centric approach has limited the connectivity options of customers until the CommonWell-Carequality connection opens up access to Epic-using sites.

VA Secretary David Shulkin convinced reporters last week that he had squelched VA insiders who were conspiring with White House officials to get him fired, but new reports suggest otherwise. VA OIG previously said Shulkin took a family Wimbledon vacation at taxpayer expense and an upcoming report will say he used his security detail to run personal errands. The Daily Beast cites several sources who said Shulkin is now “extremely paranoid” in posting an armed guard outside his office, cutting off access to his floor by those VA staffers he suspects of being disloyal, and attempting to fire several political appointees who were saved by White House intervention. He’s on the HIMSS agenda for Friday if he makes it that long.

CHIME CEO Russ Branzell will receive a Baldrige Leadership Excellence Award for his work in cybersecurity.

HIMSS Notes

Every year I write several times right before the HIMSS conference that companies are unwise in holding off their announcements for this week, when they are sure to be missed in the mayHIMSS, yet most still do.

This tip is courtesy of my Lyft driver last night. If you rideshare to or from the Sands, use the Venetian’s pickup and drop-off area since it’s a lot easier for drivers to get in and out. I used it last night and was impressed that the Venetian places a uniformed guy there to keep things moving and to remind people to choose the Venetian pickup option instead of the other two locations that Lyft also shows from that spot.  

Today will be the coolest of this Las Vegas week, with a high of 63 that runs up to 77 by Thursday. It got chilly quickly last night, making me glad I’d worn a long-sleeved shirt but sorry I didn’t bring a jacket.

Today we will set up our tiny booth and maybe check out the afternoon keynote and opening reception. More to come.

Jenn’s HIMSS 3/5/18

I’m up before the day has even dawned thanks to a stuffy hotel room and an inability to instantaneously adjust to the time difference here in Vegas. This will be at least my sixth HIMSS (not including the few hours I spent at the last HIMSS in Atlanta as a complete newbie both to the conference and industry), and I’m glad I got here a day early so that jet lag will hopefully wear itself out by the time the conference truly opens for business on Tuesday. I am so glad HIMSS will be in Orlando for the next several years.

Aside from connecting with readers and sponsors, which might be hard to do given the dungeon-like location of our booth, 11228, in Hall G, I don’t have a list of must-see sessions or exhibit hall meetings this go-round. The big keynotes hold little thrill, and I’ll unfortunately be on my home when the one session I do truly want to attend – It Takes a Community: Deliverying 21st Century Coordinated Care for Those in and Out of Uniform – with VA Secretary David Shulkin, MD takes place. When it comes to themes for this year’s show, I have a feeling we’ll all be playing plenty of buzzword bingo. (I’m kicking myself for forgetting to print out the card Mr. H put together last week.) I also predict that while vendors will be touting concepts and capabilities like AI, precision medicine, and [insert your buzzword of choice here], attendees will be shopping for far less sexy things like telemedicine and behavioral health add-ons.

I will admit that my interest will be piqued by companies touting blockchain capabilities, despite the fact that HIStalk readers voted blockchain the most overrated technology. (Check out HISsies winners here.) I received at least 25 press releases from companies touting such capabilities ahead of the show. I’m tempted to give my time only to those exhibitors who have solid use cases on hand, of which I predict there will be few. Companies like Change Healthcare, PokitDok, SimplyVital Health, and Patientory come to to mind as companies that may have customer success stories.

I should add that my interest in blockchain isn’t strictly tied to healthcare. Several family members have decided to invest in a cryptocurrency mining rig, and so the attendant blockchain concept has lately been a hot topic at family gatherings. I don’t understand all the ins and outs, but want to learn more. I find the evolution of the whole subculture fascinating. (As typical with tech, it’s dominated by “blockchain bros,” as this New York Times article points out.)

Perhaps the folks at Reaction Data can shed some light on how blockchain best fits into healthcare. They don’t have a dedicated market research report on the subject, but I bet it’s coming.

I do plan to highlight as many vendors as I can that have incorporated charitable giving into their show-floor activities, so please let me know via email or tweet if you come across any that I should check out. Datica Chief Data Officer Mark Olschesky will donate $1 to HIStalk’s Donors Choose efforts for every person that attends his 30-minute presentation on HIPAA/GDPR for developers on Tuesday at 12:30 pm in the Developer Innovation Lab on Level 1.

On my dance card today – ambling around the Venetian/Sands to get a feel for where everything is and hopefully run into a few familiar faces. Athenahealth has invited me to an opening-night event that will somehow incorporate VR, which I’m excited about for the novelty factor alone. Plus, I’m hoping to corner some of the top execs for their personal take on what’s going on with the company right now, especially given the activity of competitors like EClinicalWorks, which is making no bones in the pre-HIMSS media blitz about its intent to enter the hospital market.

I did get the chance to bend new Athenahealth chairman Jeff Immelt’s ear about the company’s trajectory. He says that, “In terms of storms that I anticipate Athenahealth and all players in the HIT industry will weather – it’s a going to be a ‘value game.’ In a market landscape post-government incentive, vendors will need to showcase and prove the value they can bring to the markets they serve.”

When it comes to growing the company, Immelt believes it will come down to listening to customers and delivering on that aforementioned value. “At GE, I was constantly trying to make a big company act smaller,” he explains. “Now Epic and Cerner are the ‘big guys.’ They’re the long-time incumbents and they’ve been masterful in navigating and establishing themselves in healthcare during the first wave of digitization. However, the companies that sustain market position or find new ways to gain market traction are those that deliver value and unleash the industry to fundamentally better ways of operating, sharing information, and collaborating.”

When it comes to HIMSS – and health IT – Immelt has been there since the beginning: “I’ve had a twenty-year love affair with healthcare and have watched the formation of healthcare IT from the beginning and seen HIMSS since it could’ve been held in a high school gym. I’ve seen firsthand from the likes of doctors, care staff, and healthcare leadership teams that they’re largely dissatisfied with the industry’s operational and technological current state. This is especially true when I compare healthcare with other industries. Healthcare has experienced its first wave of digitization and is primed for the next wave. I fundamentally believe that the companies that will have the most impact on an improved future for healthcare are those that combine a platform infrastructure, with a set services enabled by technology, and then sell their offerings in a way that are clearly aligned with delivering actual results and measurable value. I see this in Athenahealth’s model.”

I have a few other evening engagements planned after the VR fun, some of which may be curtailed depending on my level of fatigue. I doubt I’ll make it to the Pub Night hosted by Emids/Encore, but you never know. HIMSS has a way of making one footloose and fancy free with evening schedules. I tend to RSVP for far more activities than I could possibly attend, deciding on what events to attend based on how far away venues are from each other and whether I can coerce a buddy or two into party-hopping with me.

I’ve never had personal safety issues in Vegas – or at any conference for that matter, but I know they occur far too frequently, as the results of Mr. H’s latest poll can attest. Alcohol-infused networking events may be a contributing factor, as this article points out. I learned a long time ago – by watching several supremely drunk co-workers make fools of themselves at a company outing – that drinking while on the job, or even amidst co-workers during non-working hours – can lead to watercooler stories that take a long time for everyone to forget.

That being said, stay safe, have fun, and enjoy the #HIMSSanity.

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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Contact us.

Monday Morning Update 3/5/18

Top News

For those living on other healthcare IT planets who aren’t already aware, HIMSS18 kicks off this week. The screwy Las Vegas schedule has the full conference starting on Tuesday (since hotels won’t give up their weekend casino revenue for the usual Monday morning start), so the week looks like this:

• Monday: pre-conference programs, opening keynote at 5:00 p.m., opening reception to follow
• Tuesday: education sessions 8:30 to 5:00, exhibits 9:30 to 6:00
• Wednesday: education sessions from 8:30 to 5:00, exhibits 9:30 to 6:00
• Thursday: education sessions 8:30 to 2:30, exhibits 9:30 to 4:00
• Friday: education sessions 10:30 to noon

I will abandon the usual HIStalk format this week and instead will post daily reports from Jenn, Dr. Jayne, and me about what we see or hear. Email me if you see something I should check out.

Please visit us in Booth #11228, which can be reached by descending with justifiable trepidation down the well-disguised stairs to the lower level that looks like an IRS cubicle farm and then trying to find our microscopic booth by number in the bizarre layout. You won’t get rewarded for your trouble other than with gratitude and friendly conversation among our magnificent furnishings (total cost: $300, dragged in a beat-up, garage-stored duffel bag from one HIMSS to the next). That is, unless you want to take a selfie with the life-sized Smokin’ Doc, which people love to do for some reason (including the 18th Surgeon General of the United States, Regina Benjamin, MD, at HIMSS17 – the pipe must have puzzled her).

I made it a point at HIMSS12 and HIMSS16 to spend a full day cruising Hall G and writing about what I saw there because I felt sorry for the companies whose HIMSS hopes and dreams were crushed by low booth traffic for which they paid dearly. There’s likely quite a bit of innovation happening down here in the catacombs, so give those companies a look and wish them the success that will allow them to pay the necessary financial homage to HIMSS to get promoted to the main show floor in the HIMSS21 return to Las Vegas. 

Actually, we are giving away one pretty cool thing in our microbooth – the ever-popular Conference Survival Kits that we always make available with the folks from Arcadia (Booth #4221). The tastefully understated black bag contains essentials like Wet Ones, antiseptic cleaning pads, antacids, Band-Aids, breath mints, and Blistex. Perhaps we should play Arcadia Bingo to see whose misadventures cause them to use the highest number of the items before leaving Lost Wages. 

Our booth, almost drawn to scale. I’ve never heard of any of our booth neighbor companies and they probably haven’t heard of HIStalk. I’m secretly hoping that we get a lot of visitors while they’re standing around wondering what exactly we do.

I challenged Lorre to come up with something (anything) to put a positive spin on what I expect to be a lackluster HIMSS18 exhibiting experience. She’ll offer a first-year deal to any of our fellow Hall G outcasts that sign up as new sponsors, which gives them full-year exposure for a fraction of the cost of three days in the HIMSS basement. I decided to call it the “Cellar Dweller Special.”

My HIMSS guide describes what my sponsors will be doing there, including stuff they’re giving away and anything special they’re doing for HIStalk readers.

The Meditech folks seem to always run into Boston weather-related travel delays that cause them to arrive late to the conference. This year looks like more of the same, as severe weather has caused thousands of flights to be cancelled in Boston, Philadelphia, and New York. Hopefully the flight backlog will be cleared for Sunday and Monday HIMSS18 travelers. It’s stressful enough to arrive early as I always do, so I can’t imagine getting there later than expected.

Reader Comments

From Unconscious Power: “Re: HIMSS18 opening reception. First timer. Should I go?” I’m not qualified to opine since I almost never go – it’s too early in the week to be crushed in the wave of glad-handing humanity. I’m at least glad that HIMSS did away with drink tickets and upped the food game a bit, although the entertainment is always generic Disney-grade. It will surely be better than the first return to Chicago, when it was a half-mile hike to what looked and sounded like an airplane hangar as the blizzard raged outside. The best opening receptions were always in San Diego, out on the convention center’s patio overlooking the bay.

From Sheetal Shah: “Re: your tiny HIMSS booth. Be proud of that 100 square feet! As a startup, we went for the 0x0 booth this year and decided instead to become an HIStalk sponsor!” Sheetal is VP of SymphonyRM and I appreciate the support. It’s a struggle for me to decide between 10×10 and 0x0 since our little booth will end up costing something like $7,000. We’ll see what locations are available at HIMSS19. We usually end up, at best, by the restrooms and loading dock.

HIStalk Announcements and Requests

Seventeen percent of male poll respondents and 38 percent of females say they’ve experienced unwanted sexual attention or comments during a HIMSS conference. Here is my personal challenge to you for next week. If you see someone behaving badly, observe an attendee being made uncomfortable, or see someone who has over-imbibed in a compromising situation, don’t just walk away – get involved as tactfully as possible. I would also suggest that women consider downloading one of the personal safety apps that allow them to send their location to a friend, send a message with a single tap asking a friend to call them to get themselves out of a situation, or issue an SOS if they don’t get to their destination by the expected time. Get a handful of HIMSS colleagues in your circle and these apps will provide peace of mind and maybe more. Remember that unlike Orlando and former HIMSS cities, we’re sharing the Strip with a lot of shady people who know we’re tourists from our badges. I would also enjoy having someone who makes a gender- or sex-related comment within earshot of a bystander get taken down a notch for their boorish behavior, so tell me if you get to see that.

New poll to your right or here: What OS does your most-used smartphone have?

Thanks to those who responded with insightful answers to  “What I Wish I’d Known Before … I Quit My Job to Go to Work for Myself.” I’m saddened that folks who love working for themselves are being pushed back into working for someone else because they either can’t get health insurance at all or it’s too expensive as a one-person company. It’s ironic that even health IT experts are having their entrepreneurial ambitions dashed by our screwed up health system.

This week’s question: “What I Wish I’d Known Before … Taking my First Hospital IT Executive Job.”

Thanks to the following companies that recently supported HIStalk. Click a logo for more information.

Thanks, too, to long-time HIStalk supporter PeriGen, which has upgraded its sponsorship level to Platinum. They just announced that Qualcomm Life will resell their AI-powered Vigilance early warning system for OB.

Webinars

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

Acquisitions, Funding, Business, and Stock

HIMSS acquires Chicago-based business accelerator and venture fund manager Healthbox in its never-ending and sometimes puzzling expansion. Healthbox’s CEO is Neil Patel, who used to work with HIMSS President and CEO Hal Wolf at The Chartis Group. Patel joined the company in September 2016 after founder and CEO Nina Nashif left for unstated reasons (one might be that healthcare IT has too many poorly run startups being pursued by a surplus of underachieving accelerators that offer them little value). This is another example where some vendors that pay a lot of money to support HIMSS now find themselves competing against it.

I missed this earlier: global payment and receivables solutions vendor Flywire acquires OnPlan Holdings, the parent company of patient portal and payment solutions vendor OnPlan Health.

Sales

Comanche County Memorial Hospital (OK) will implement EClinicalWorks Acute Care EHR and RCM, replacing Allscripts Paragon for its 283 inpatient beds.

Rhode Island’s HHS chooses IMAT Solutions to implement a centralized ECQM reporting and feedback system.

Decisions

• South Peninsula Hospital (AK) will go live on an Evident (CPSI) EDIS this month.
• Tift Regional Medical Center (GA) will go live on Cerner on July 1, 2018.
• UPMC Pinnacle Lancaster (PA) will go live on Epic in April 2018.

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

Announcements and Implementations

A new KLAS report on plug-and-play EHR data-sharing capabilities concludes that it’s: (a) automatic for Athenahealth and Epic customers; (b) nearly so for EClinicalWorks; (c) limited for Cerner because of poor CommonWell adoption, at least until the CommonWell-Carequality connection is in place; (d) uncommon for GE Healthcare and Greenway Health users; and (e) not offered by Allscripts, Meditech, and NextGen. Epic and Athenahealth offer the highest likelihood of being able to connect to important partners, while Epic and Cerner offer the best doctor usability of the retrieved patient records. KLAS did the report because CommonWell’s hype that downplays its poor adoption has created distrust:

Most CommonWell EMR vendors require their customers to onboard one at a time, and only Athenahealth has driven adoption in mass. This is even true if you are using Cerner, who has been one of the most valiant and prominent CommonWell promoters. Because sharing among Epic customers is already universal, when CommonWell connects to Carequality, the entire Epic base will become available, creating instant value for most areas of the country. CommonWell will likely see a significant adoption increase with a solid Carequality connection. Since its launch five years ago, the tendency to overmarket the level of adoption of CommonWell has created apprehension and a lack of trust among potential participants and prompted this report, showing a snapshot of providers’ success.

Government and Politics

HHS will hold its free Startup Day in Boston on Friday, March 30, offering government speakers, breakout sessions, and “Shark Tank”-like pitches.

Other

A study led by the co-creator of the Bedside Pediatric Early Warning System (which was commercialized by Toronto’s Hospital for Sick Children) finds that use of the system did not decrease mortality or ICU resource utilization. An accompanying editorial by Memorial Sloan Kettering’s critical care medicine chief says that perhaps holding the system to an all-or-none mortality standard is unreasonable. He concludes with an appeal for AI-powered hospital informatics systems:

Now is the time for hospital leadership executives, medical informatics departments, interested clinicians, informatics vendors, and governmental-certifying bodies to move forward and apply artificial intelligence systems to the hospital setting to enhance processes of patient care and outcomes. Such informatics systems, which are broad in their data capture, analysis, learning, and therapeutic recommendations, are being developed … These programs should be welcomed into inpatient and ICU care to allow investigations to move away from single intervention-based studies, with simplistic but easily accessible primary outcome measures such as mortality, to a more technologically based approach to understanding health care data and studying therapeutic interventions.

Chorus, the fitness app and group encouragement tool started by former Twitter CEO Dick Costolo, shuts down after just eight months. The company ran into the Abstinence Violation Effect, in which people stop participating in their support group after they fail to meet its agreed-on expectations, such as missing a planned exercise session. He also found that people lost interest in motivating each other. Maybe Dick should have learned about dubious Internet comradeship from Twitter, whose never-ending stream of trolls, bullies, bots, and psychopaths similarly drive users away.

Without the usual HIStalkapalooza pomp and circumstance, here are your 2018 HISsies winners. Congratulations and/or condolences to those that were chosen by my readers.

Contacts

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

What I Wish I’d Known Before … I Quit My Job to Go to Work for Myself

How much you need to understand your strengths and weaknesses, and that just because you are great at a particular skill in your industry, it doesn’t you’ll be great a running a business in that industry.

That I would work harder and longer for myself than for any other boss or company. And that I would have more fun and freedom! Too bad healthcare insurance availability and costs for small businesses are pushing me back to working for an employer.

That I haven’t done it yet. “I don’t have an idea, what if I fail?” Fear is a shitty thing. For those who have, give those of us who haven’t hope, but don’t sugarcoat it!

I knew the cost of health insurance would be a large expense. However, I didn’t project that the cost would more than double from one year to the next.

I should have done it SOONER!

I wish someone would have hot me over the head making sure I comprehended the true cost to do business. Business registration at the state and local level, general liability insurance including automobile insurance, you’re your own technology shop, meaning you will have to buy and install all your software and hardware and configure it so it works. It is probably 25 percent more expensive than you think to start a new company.

Before I quit my job to go to work for myself, I wish I had known that 30+ years later I still would be happy having made that important decision.

That my finances were going to take a larger hit than I expected not because my business didn’t take off (always a known risk), but because it took me longer to get back into the job market than I had expected. Although I had very competitive job opportunities, my personal situation had changed while working for myself, precluding most travel or moving out of the metro area I was in.

That I had the skills, knowledge, expertise, and professional network to quit an established position and start our own firm. Wish that I’d had the confidence to do it a few years earlier.

That it doesn’t matter how successful you are right out of the gate — hire a salesperson. I didn’t because a series of old clients signed with me just after starting my new company and I became overconfident in my success. I know now that selling while you are successful sure beats trying to catch up when those early contracts start expiring. Also, as the owner, president, and chief guru, it takes a full time salesperson and you won’t have time to be that if you’re doing everything else, too.

Nothing. If I’d not been naive and ignorant, I probably wouldn’t have started the company. My ignorance allowed me to ignore the risks and take the leap.

Everything takes longer than you think. It is not easy for organizations to decide to work with small firms, even if the individuals at those firms have stellar resumes. The security blanket of a big brand name drives revenue, even if the quality of services from small firms is generally substantially better.

The sheer terror of the roller coaster ride of income and no income. It’s debilitating and drains every last ounce of downtime from what is already an oversubscribed schedule. Say goodbye to relaxing at the weekend or even on Sunday — you spend 24/7/365 working or thinking about work and where the next penny will come from. As for the clients and choices, it’s amazing how cheap companies can be when considering payment. They all seem to forget that at least 50 percent of any fees go directly to basic costs that are not covered when you are not an employee (billing rate vs. take-home rate).

Chasing after unpaid invoices is definitely one of the most unpleasant aspects of being self-employed. One positive impact I didn’t anticipate, however, is the way it makes you think about time and making every minute count, whether you’re working or not. Also, the sense of satisfaction gained from building your business and knowing you’re helping your clients is extremely gratifying.

You wind up being put in the tough position of actively having to sell your services simultaneous to having to wind down your existing assignment. That puts a strain on you, and for those of us who got into being solo to do more as opposed to sell more, it could be awkward to have to wear both those hats. It also reinforces the message that, as a solo practitioner, when you are not working, you are making zip. No PTO, nothing like that. A little extra pressure!

In a startup of one employee, I loved setting my own schedule, driving to my own goals, and working from home. But I realized I missed the interaction of other co-workers, being part of a team, and having my home be a home. If i was building a product, I would have stuck around longer to foster it, but I was doing consulting and contracting, which is hard to scale.

How much happier I’d be. I’ve observed two kinds of consultants – those doing it to stay in the flow (and make some money) while waiting for their next real job and those for whom it is their real job. No right answer, but it helps to know which you are. Today’s technology (Google Apps, Dropbox, VOIP, Upwork, and more) make it easier than ever before. A few pointers: Get a domain name – Gmail suggests you’re not committed. Consider forming an entity like an LLC or S-Corp. There are great retirement benefits available such as solo 401(k), if your revenues allow it — remember that any savings match comes from you, so need to take it seriously. If your business can support it, a virtual assistant can give you great leverage for scheduling, invoicing, and other routine tasks. Take advantage of the flexibility it provides in your life, though the flipside is you can always be on call.

The cost of being self-employed. There are direct costs, such as self-employment taxes and insurance benefits: life, health, disability, and professional liability insurance, and indirect costs, such as handling business development for the next assignment while executing the current assignment. And handling contracts is brutal. I once had a government organization ask me to sign an 80-page contract for a job that was worth a couple of thousand dollars. We eventually got it down to three pages because I refused to sign a document that would cost me more in legal advice than the job would pay for my services.

You will need an accountant. You will pay for an accountant. Even if you think you can do it yourself or fall victim to the “QuickBooks will do my taxes for me” idea, you will need an accountant.

Weekender 3/2/18

Weekly News Recap

• Intermountain Healthcare launches a virtual hospital that brings its 35 telemedicine programs under one roof
• EClinicalWorks announces a cloud-based hospital system whose cost starts at $599 per bed per month with no upfront capital cost
• R1 announces that it will acquire Intermedix’s healthcare division for $460 million
• Apple’s plans to create an employee wellness clinic are disclosed by CNBC
• The Wall Street Journal describes OurNotes, the follow-up project to OpenNotes that will allow patients to share their own notes with their doctor
• Researchers find no relationship between hospitals implementing a new EHR and their credit ratings afterward

Best Reader Comments

These wellness ventures strike me as little more than internalization of the wellness programs bundled in with insurance products that work very poorly today. Per the article, Apple seems to be working with Stanford. If my goal was pop health/wellness, I wouldn’t take my advice from an academic medical center, particularly not one that’s currently trying to buy its way into the primary care market. The branding is interesting because it almost sounds more like part of Stanford’s strategy to put clinics on tech campuses (I believe they have a few in the works already). (Midwest User)

One positive of a travel-heavy job is that you have a chance to meet healthcare execs and leaders from all over the country and really get to know them versus only having a network of people in a city or metro area. Over years, it does incredible things to your professional network, not to mention giving you the ability to experience many different settings and organizations rather than just a few. (HIStalk Groupie)

Inherently there are still silos within managing the different applications, competing agendas on the vendor side and organization side, lack of integration between initiatives, and more importantly, involving IT with sign-off for any device and EHR enhancements or changes. (Sandy Walker)

Watercooler Talk Tidbits

Readers funded the DonorsChoose teacher grant request of Mrs. M, who asked for six Boogie Board memo pads for her high-poverty elementary school third grade class in North Carolina. She reports, “My students love using the Boogie Boards. They are fun, engaging, and offer a nice alternative to paper and pencil work. My students are in third grade and are in my bottom reading group. Their eyes lit up when they saw the Boogie Boards. It is often hard to keep them engaged. We use the boards during guided reading groups, math groups, and during word work. We plan to also use the boards to take notes from research and during quick writes. I can’t thank you enough for your donation.”

Also checking in was Ms. M from New Mexico, who requested STEAM center materials for her elementary school class. She was nice to provide this update: “Unbelievable! You have simply made the start of the new year fantastic! We have new translucent, magnetic blocks to use on our new light table! The sensory options are endless. We have new math games to collaborate with that cover all four operations. They are more than drill and skill – they involve problem solving. It’s been a great review station. We also received two Whack-a-Mole type of games that involve NOISE and LIGHTS and SOUNDS! Most teachers hers would cringe. Not this teacher! We are soooo excited. The bottom line is, you are changing our classroom. We have supplies such as dice for multiple review stations. We have rubber bands (seems so simple) to create geometric shapes on our geo-boards. We have a light table with manipulative to create patterns, work fractions, and all of it is bright, sensory, exciting, and engaging. We have amazing new wobble stools that allow my students to wiggle and move. All of this is because of you and your amazing generosity! Nothing we write can explain how sincerely we thank you or appreciate this gift. You have a lot of choices when donating and we are grateful you found us.”

An anonymous CIO reader working in United Arab Emirates made a very generous donation to my DonorsChoose project, to which I applied matching funds from my anonymous vendor executive and other sources to fully fund these classroom projects:

• A tablet, case, charging station, and 3D building blocks for Ms. B’s elementary school class in Forest Park, GA
• A wireless drawing pad, math games, and basic classroom supplies for Ms. W’s high school class in Houston, TX, which lost all of its classroom items during Hurricane Harvey
• Math and art supplies for Ms. Y’s elementary school class in Naples, FL, which was impacted by Hurricane Irma
• Two tablets and learning aids for Ms. W’s first grade class in Moscow, KS
• Math centers and games for Mr. M’s elementary school class in Northglenn, CO
• Math tools and games for Ms. S’s elementary school class in Denver, CO
• A trip to the state aquarium on Saturday Deaf Day for the deaf students of all 15 county schools by Ms. M in New Bern, NC

Federal authorities arrest two Southern California weight loss doctors who they claim cheated insurers and patients out of $250 million (!!) by falsifying test results to get insurers to pay for lap band surgeries. An unrelated newspaper investigation found that five patients died after having weight loss surgery performed there.

Every year we get the dregs of the HIMSS exhibit hall booths since we don’t spend enough money with them to earn HIMSS points, so I was too depressed until yesterday to look at the exhibit hall map knowing that we’ll be in Siberia. We certainly are – we’re in the low-ceilinged, cheerless basement (Hall G) among companies I’ve never heard of, with our tiny 10×10 space sitting next to what passes for an anchor tenant down there, the Philippine Trade and Investment Center. Hall G was so dead at HIMSS12 that HIMSS hastily posted signs practically begging people to head down the easily missed staircase and they even gave out a free lunch coupon that was good only in the Hall G food court thinking that might drive traffic (it didn’t, except to the food court). This might be the year in which I’m convinced that exhibiting isn’t worth the significant cost since booths aren’t any cheaper downstairs. I implore you to bring your miner’s lamp, descend with trepidation into the labyrinth of poorly-numbered booths, and soothe our shattered self-esteem that will be on full display at Booth #11228. We exhibit only to say hi to readers and we don’t really have anything to sell, so I’m trying to convince Lorre that she should offer a new-sponsor bonus of some kind to reward companies that are brave enough to seek us out in the catacombs.

The biggest booths at HIMSS18 in terms of square footage are:

• IBM (15,400)
• Cerner (14,200)
• Epic (10,610)
• Change Healthcare (9,000)
• Skipping a zillion more, HIStalk (100)

Things I’ll miss at HIMSS18:

• MedData’s amazing scones, since Sands Expo Center doesn’t allow baking on the show floor
• Bistro HIMSS, the moderately-priced, decent-quality buffet where we’ve held our CMIO lunches, since they don’t run it in Las Vegas
• The chance to breathe air not infused with cigarette smoke
• HIStalkapalooza

Also note that Daylight Saving Time (I just realized that the first two words should be hyphenated since they form a compound adjective) starts the Sunday morning after the conference.

Definitive Healthcare lists the top 50 hospitals by annual revenue, in which $2 billion doesn’t even get you into the top 20.

A Medgadget editorial says the site is struggling financially despite doing the right things journalistically – paying skilled writers, not running obnoxious ads, and not publishing clickbait or time wasting listicles. It blames Google (“an evil monopoly”) and Facebook, which control 70 percent of digital advertising even though they produce no content and use privacy-invading techniques to place ads everywhere you travel on the Web. 

Microsoft co-founder Paul Allen will invest $125 million to fund Project Alexandria, which will work on AI that exhibits common sense. Possible applications include medical diagnosis.

A Georgia pediatric cardiologist who admits he allowed a drug company sales rep to use his EHR password to find pediatric patients for the company’s $295,000-per-year specialty drug will get off with probation for the misdemeanor charge of wrongfully disclosing PHI.

CNBC covers the “positive stress” movement embraced by young Silicon Valley tech workers who hope that cryotherapy chambers, hot yoga, fasting, and extreme workouts will allow them to work more hours and/or to live longer.

A startup’s dating app matches people by assigning a compatibility score based on results of a cheek swab DNA test, the fourth company over several years to try to make a business of shaky science paired with sifting through the social media accounts of users trying to quantify love. I worry about “The Onion” since headlines like these are as goofy as any they could make up.

Apple is working with police near its Elk Grove, CA repair center to figure out why they’ve received 1,600 calls to 911 from phones waiting to be fixed.

My increasing frustration with my PCP’s incompetent office staff and the lack of alternate decent doctors who accept both my insurance and new patients led me to try concierge medicine. I’m delighted with it so far. I get unlimited access to my well-credentialed, mid-career doctor (his practice is solo), appointment scheduling is online, I have his personal cell phone number, he makes house calls when needed, and his panel is just 500 patients. Just about everything is covered in the annual fee: all visits, minor procedures such as wound repair and mole removal, EKG, flu shot, labs drawn right in the office with common labs either free or cheap ($5 for HbA1c or lipid profile), inexpensive imaging ($35 for an X-ray, $225 for a non-contrast CT scan), and he even provides maintenance medications at his wholesale cost — my 90-day supply of blood pressure med cost me $6 with no extra trip to Walgreens. All of that costs just over $500 per year, which is probably even cheaper than co-pays and deductibles. My new patient session lasted nearly 90 minutes as he took a thorough medical and social history and had me sign forms so he could retrieve my medical records from the other practice (assuming the incompetent people over there can find them). I was the only person in the tiny waiting room when I arrived, and when I went back to the exam room, he was waiting for me rather than vice versa. The only aspect of concierge medicine that I don’t understand is the pricing – other similarly credentialed doctors offer pretty much the same services for up to $7,000 per year, so I like to think I’m getting a deal. 

Vince digs through his March 1988 health IT archive with fond memories of the 1988 HMSS conference (that’s not a typo), Meditech winning the color monitor wars, and household names in laboratory information systems such as Antrim, Medizinische, Rubicon, and Hex FF. The big song then was Rick Astley’s “Never Gonna Give You Up,” which is entirely forgettable except for one thing – it later spawned the Internet meme “rickrolling,” a prank in which someone publishes a link to a video claiming to be one thing that instead launches the “Never Gonna Give You Up” video. I think I would prefer the link to launch a ransomware attack.

In Case You Missed It

• News 3/2/18
• EPtalk by Dr. Jayne 3/1/18
• HIStalk Interviews Colin Konschak, CEO, Divurgent
• News 2/28/18
• Curbside Consult with Dr. Jayne 2/26/18
• HIStalk Interviews Tom Borzilleri, CEO, InteliSys Health
• HIStalk’s Guide to HIMSS18
• Monday Morning Update 2/26/18
• What I Wish I’d Known Before … Taking a Travel-Heavy 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

Morning Headlines 3/2/18

Healthcare Consulting and Services 2018: Which Firms Deliver a True Partnering Experience?

A new KLAS report that asked providers to rate consulting firms they’ve worked with finds that Nordic and Deloitte were most often perceived as true partners, while Advisory Board was by far the firm providers would not use again because of disappointing outcomes and use of inexperienced consultants.

The SSI Group Announces Acquisition of ICA

The SSI Group acquires Informatics Corporation of America and its CareAlign clinical data aggregation and exchange platform.

Uber, but for Getting to the Hospital

Uber stirs up the healthcare hype with the launch of a HIPAA-compliant service that will enable providers to arrange rides for patients to and from appointments.

News 3/2/18

Top News

Intermountain Healthcare (UT) ramps up its commitment to virtual care with the launch of Connect Care Pro, a suite of services that brings together its 35 telemedicine programs under one roof at a new facility staffed by 150 clinicians. The “virtual hospital” will serve the health system’s 22 hospitals, 180 clinics, and nine unaffiliated facilities.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor OnPlan Health. The company, based in Bannockburn, IL, tailors the financial experience of patients and providers by offering a smarter way to manage out-of-pocket costs. Its automated payment support identifies that 50 percent of patients whose past payment history and financial information suggest they will need support paying their bill, then engages with them in creating a customized, pre-approved payment plan. Munson Healthcare found that two-thirds of its payment plans were activated by patients themselves to avoid the time and embarrassment of asking someone at the health system to create a payment plan for them. Rush-Copley Medical Center says that implementing OnPlan increased payments by 10 percent within eight months and lowered average term length while increasing pay-in-fulls. Providers also benefit from fewer placements to collections, reduced staff time, and increased payment security supported by point-to-point encryption and elimination of stored credit card information. Co-founder and CEO John Talaga founded “friendly billing” pioneer HealthCom, acquired by McKesson in 2006 as its first acquisition in forming RelayHealth. Thanks to OnPlan Health for supporting HIStalk.

The folks at Waystar Revenue Technology (the recently merged and newly renamed Navicure and ZirMed) will make a $1,000 donation to my DonorsChoose project to honor of the winner of a raffle that will be held at their Waystar Premiere Party at HIMSS18. A name will be drawn from those of attendees who RSVP for the event — which will be held Wednesday evening from 8:00 until 11:00 at the Marquee Nightclub and Dayclub at the Cosmopolitan —  and I’ll recognize that person here afterward as having made the company’s donation possible. Teachers, students, and I thank Waystar and the eventual winner for supporting education.

Webinars

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

Acquisitions, Funding, Business, and Stock

The SSI Group acquires Informatics Corporation of America and its CareAlign clinical data aggregation and exchange platform.

People

MDLive hires Lyle Berkowitz, MD (Northwestern Medicine / Healthfinch) as CMO and EVP of product strategy.

Dave Lundal (WellStar Health System) join consulting firm Evergreen Healthcare Partners as managing partner/VP of advisory solutions.

Jaffer Traish (Culbert Healthcare Solutions) joins Aunt Bertha – a public benefit corporation that offers an online social service directory that is used by 1 million people —  as VP of strategic partnerships.

Sales

Mercy Technology Services selects Commvault’s cloud-based disaster recovery and backup solutions.

University of Missouri Health Care expands its relationship with Cerner to include RCM services.

Announcements and Implementations

A new KLAS report that asked providers to rate consulting firms they’ve worked with finds that Nordic and Deloitte were most often perceived as true partners, while Advisory Board was by far the firm providers would not use again because of disappointing outcomes and use of inexperienced consultants. Chartis Group, Deloitte, and PwC were perceived as having the broadest range of services; Impact Advisors was named as having the most IT advisory depth; and clients said Nordic has the most implementation depth.  

RelayHealth Pharmacy Solutions and CoverMyMeds – both owned by McKesson—announce RxBenefitClarity, a real-time prescription benefits and prior authorization decision support tool that covers all payers.

In another attempt at relevancy in healthcare, Microsoft launches cloud-based AI and machine learning tools, plus security and compliance templates for moving health data to its Azure cloud. Early adopters include Ochsner Health System (LA) — which has partnered with its vendor Epic to determine if Microsoft’s AI can predict patient deterioration — and UPMC, which is test driving Microsoft’s new AI-powered transcription software.

Uber develops a HIPAA-compliant service that will enable providers to arrange rides for patients to and from appointments. Before everyone wets themselves with “Uber in healthcare” excitement, remember, it’s just a taxi service.

Cayuga Medical Center (NY) implements CloudWave’s real-time infrastructure monitoring and management services for its Meditech EHR.

InterSystems develops a FHIR testing environment for developers.

LogicStream Health announces GA of a clinical process module designed to help providers prevent opioid misuse.

A PatientSafe Solutions survey on clinical communication preferences finds that over half of IT respondents plan to deploy smartphone-based clinical communications, most within the next two years. 

Government and Politics

Military officials are pleased with the first-year progress of MHS Genesis, comparing the rollout of the Cerner system at four sites more favorably to similar implementations last year at three of Cerner’s private-sector customers. They are confident that full deployment will begin in 2019 and DoD-wide implementation will be finished in 2022.

Sponsor Updates

• SymphonyRM will present its HealthOS platform, which combines CRM and data science, at HIMS18’s VentureConnect session, one of six startups chosen.
• Qualcomm Life will resell PeriGen’s PeriWatch Vigilance, an early warning system for OB patient deterioration.
• Fortified Health Security is named Healthcare IoT Cybersecurity Company of the Year by Frost & Sullivan.
• Medhost delivers its largest-ever product release.
• Medhost’s largest product release in history also sets quality success records.
• The Surescripts Network Alliance helps improve prescribing accuracy by 26 percent.
• KLAS recognizes Lightbeam Health Solutions and Arcadia in its latest population health management report.
• MedData and Experian Health will exhibit at MGMA FMPC 2018 March 4-6 in Orlando.
• PerfectServe and Philips Wellcentive will exhibit at the AMGA 2018 Annual Conference March 7 in Phoenix.
• Docent Health adds mobile messaging capabilities from MPulse Mobile to its patient engagement platform.
• Ellkay will launch at HIMSS18 the LKClinicalDataExchange data exchange platform.  
• Wolters Kluwer Health expands its Reference Data Management tool to include professional services capabilities.
• Arcadia achieves high customer satisfaction marks the KLAS 2017 Value-Based Care Managed Services Report.
• Spok expands its partnership with Spectralink.
• InterSystems partners with critical care company Zoll Medical to improve exchange of PHI between EMS providers, physicians, and EDs.
• Black Book Research gives QuadraMed, a division of Harris Healthcare, top ranking for its EMPI software and clean-up services.
• Forbes profiles ZappRx CEO Zoë Barry.
• Diameter Health partners with the Kansas Health Information Network to publish a study highlighting the use of HIE data in the calculation of quality measures.

Blog Posts

• Medicity’s CEO Attends White House Meeting on Interoperability (Medicity)
• The Definitive Guide to the Business Benefits of Digital Transformation (Liaison Technologies)
• 5 Steps for a Cost-Efficient Migration to AWS Cloud (LogicWorks)
• 3 Ways You Can Recognize Patient Safety Awareness Week (Meditech)
• The CUREConnect InterApp API (Mobile Heartbeat)
• Advisors’ Advice: A More Formal — and Earlier — Role for IT in Healthcare Mergers, Acquisitions and Affiliations Processes (Huntzinger Management Group)
• Heating Up the Revenue Cycle at Little Rock Diagnostic Clinic (Waystar)
• Technology and data-driven decision drive best practices in patient collections (Experian Health)
• 5 Ways to Improve Clinical Communication and Workflow (PatientSafe Solutions)
• Securing the Future of Healthcare Data with Blockchain (PokitDok)
• Is your perioperative area struggling with the EHR? (Nordic)
• Patient Engagement: Not Waiting “Patiently” to Be Told What to Do (Leidos Health)
• 5 Reasons You Should Send Developers to HIMSS (Redox)
• 5 Reasons to Update Your Integration Software (Summit Healthcare)
• It’s Time to Go for Gold in Prescription Accuracy (Surescripts)
• Changing the Way Work Gets Done (Voalte)
• Hidden Connection: How Online Reviews Impact Patient Retention (WebPT)
• A VBID, risk-based approach to the opioid crisis (Philips Wellcentive)
• Top ten healthcare resources you can easily provide to your employees (WiserTogether)

Contacts

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

EPtalk by Dr. Jayne 3/1/18

The countdown to HIMSS18 is reaching its end and I’m in my final stages of preparation. I’ve developed some strategies over the years for making the meeting productive without being too exhausting. I was talking with a colleague who is attending his first HIMSS this year and he made the comment that what I was suggesting sounded a lot like the strategy he used when taking his small children to Disney World. I have a fondness for the chocolate-covered Mickey-shaped ice cream bar, but I don’t think I’ll be seeing any of those on the floor of the convention center. I guess I’ll (hopefully) have to settle for some fresh-baked scones.

My first general rule for HIMSS is to plan travel to arrive a day early if possible. This allows me to get settled in and possibly squeeze in a couple of social-style meetings on arrival day, such as a lunch or coffee, drinks, or dinner. It’s nice to be able to connect without all the hustle and bustle of the exhibit hall and sessions. It also makes it easier to meet with people that might have booth assignments during the show and who would otherwise be working the floor or too tired to get together.

I’m breaking my own rule this year for a couple of reasons. First, because we’re in Las Vegas, where the shift in the start/end times that happens when the meeting is there always throws a wrench in things. We also recently opened several new locations in my clinical world, so we’re a little thin on physician coverage and I have to see patients Sunday. I’ll be heading out before the sun arrives on Monday, though, so I should have time to meet with a couple of people and get settled.

My second general rule is to choose a hotel that doesn’t involve a significant commute, or if it does, that I’m OK with it. In the past, I’ve stayed at places that are a bit of a hike from the expo center, mostly due to cost, with varying degrees of shabbiness. I learned from experience in Orlando that you have to book early to get the hotel you want for the dates you want, so I book as soon as the room blocks open up.

The last time HIMSS was in Las Vegas, I stayed at TI due to closeness and cheapness, but I wasn’t thrilled with having to walk through the smoke to get to the elevator tower. This year I’m splurging and staying at the Venetian. I’m sure there will be smoke I’ll have to walk through, but the proximity to the meeting should be a bonus. I know Mr. H is a fan of staying off strip and you certainly can get more value for your money that way, but I don’t want to hassle with figuring out transportation. It’s kind of like staying on property at Disney – it’s more expensive, but it might just be worth it.

Planning what to wear always requires some thought, although this year I’m eerily relaxed because I don’t have to figure out what to wear for HIStalkapalooza or feel the pressure to find the perfect dancing shoes. The black cocktail dresses are staying at home, which also makes packing easier. I generally dress for exhibits and sessions in layers since the climate control at most convention centers ranges from arctic to subtropical. Since I’m not representing anyone other than myself (and HIStalk anonymously), I skip the suits and go for comfort. I’m not going to surf the hall in jeans, but I don’t think suits are mandatory. Unless you’re job interviewing, which a lot of people do at HIMSS.

Planning shoes is always a big deal and becomes more important as my feet get older. My favorite trade show shoes gave up the ghost last year, and despite having been comfortable for years, they became a liability because they were a little stretched out, resulting in blisters. This year is all about comfort, with some dressy clogs and cozy loafers. Usually I worry about being able to go day-to-night with whatever I’m wearing and throw an extra pair of shoes in my bag, but I’m hoping that being closer to the action will reduce the need to haul around a spare pair of shoes. If I get too tired, I’ll wear running shoes to the exhibits on Thursday, because by that point no one cares what you’re wearing.

Also like Disney, it’s important to plan what attractions (or booths in this case) are must-see, want-to-see, or just possibilities if there’s time remaining. As I hear about different vendors and products throughout the year, I keep a list of them and use it to create my HIMSS to-do list. I make appointments for the most critical things I want to see, but the rest are just drive-bys, partly to see how the booth team interacts with a random CMIO that walks in. I do also take a peek at all the mailings that arrive, to see if something catches my eye.

This year was slim on the mailings, with fewer than a dozen pieces arriving at the house. The Imprivata goodie box that I mentioned a few posts ago was an attention-grabber, but the rest of the mailings have been largely post cards, with only two of the “bring this to our booth and see if you’ve won” or “first 50 people to the booth get a prize” type of offerings. That’s way down from the past. Usually there is at least one vendor that sends a playing card or poker chip promotion when we’re in Las Vegas. Of course, that’s not to say that those mailings won’t arrive after I leave, which also happens. I typically find at least a handful of vendor marketing pieces in my held mail when I return.

Speaking of marketing pieces, the one mailing I received that really caught my attention is from a vendor that won’t be at HIMSS but didn’t acknowledge that in their mailing. Vendor advice: if you’re doing a mailing to launch a new product in February, you might want to mention “although you won’t see us at HIMSS this year, we’d love to hear from you, here’s how” or something similar. To not even acknowledge it makes you seem like you don’t know what’s going on in the industry. Even if you’re not a fan of HIMSS, it does exist and sucks up a lot of people’s attention.

My last piece of Disney advice is to be flexible. Sometimes you arrive to something you want to see and find a long line that you don’t want to deal with, There is no Fastpass available at HIMSS. Sometimes your attention is grabbed by an attraction you didn’t know existed and you rearrange to accommodate it. You never know what you’re going to see at HIMSS or who you’re going to run into, but there is always plenty to look at and learn.

I’m putting together my final lists today. I’ll see you in Las Vegas!

Email Dr. Jayne.

Morning Headlines 3/1/18

Intermountain Healthcare boosts digital care for Utah patients with launch of new, more centralized ‘virtual hospital’

In Utah, Intermountain Healthcare brings its 35 telemedicine programs under one roof – that of a 20,000 square-foot facility that will be home to the health system’s new Connect Care Pro virtual hospital services.

Officials say new military health records plan on track, already showing results

Military officials are pleased with the progress of MHS Genesis, comparing the roll out of the Cerner system more favorably to similar implementations last year at three of Cerner’s private-sector customers.

Microsoft rolls out more AI-infused healthcare services, software

In another attempt at relevancy in healthcare, Microsoft launches cloud-based computing tools for precision genomics and AI-powered transcription, as well as security and compliance templates for moving health data to its Azure cloud.

HIStalk Interviews Colin Konschak, CEO, Divurgent

Colin Konschak, RPh, MBA is CEO and managing partner of Divurgent of Virginia Beach, VA.

Tell me about yourself and the company.

I’m from south Jersey originally and I’m living in Virginia Beach currently. I went to school in Philly. I should have been an Eagles fan, but I ended up a Redskins fan, so I have some slight regret this year. My career started out as a pharmacist in retail, hospital, home health, and hospice. I moved on to some positions in pharma and biotech. My final pivot is where I am now in healthcare consulting, where we saw lots of things being done really well and lots of things that could be done better. That was the impetus for founding Divurgent.

Divurgent has been a pretty good story. We are in our 10th year and have had 10 straight years of revenue growth and profitability. I’m confident that if we talk next year, I can say that that number will be 11. I’m proud of the company. I think we’ve won “Best Places to Work” in Modern Healthcare five times and three times consecutively. Certainly performance aside, we appreciate culture.

What are the top three issues that health system CIOs are dealing with?

The top three are similar to what we’ve seen in the past — implementation and training, optimization, and activation. There seems to be a huge rush in ERP right now, so we’re building out capability in that area. Of course, security, and a lot of times, return-to-basics information technology infrastructure. Physician optimization, with a lot of requests around, “We have this system in place but physicians still aren’t as happy as we’d like them to be — can you come in and help us make that happen?”

You surprised me with ERP. What kind of activities are happening around that?

Now that folks have a lot of their EHR positions in place, they’re revisiting the other side of the house from a materials perspective and otherwise. The investment, it seems, is in the beginning stages of a move in that direction.

Are you seeing much activity with customer relationship management?

We are seeing a lot with customer relationship management, both from a “customer as the patient” perspective and a “customer as the physician or provider” perspective.

What gets CIOs fired most often?

Certainly it’s not like years past where you picked the wrong vendor. We’re past that. It’s around implementations. They get a little bit out of control still, even after as long as we’ve been doing this. They go over budget and people at the end of the day are surprised. Boards don’t like to be surprised. That’s the number one reason.

Do you believe that it’s not as much what a health system buys rather than what they do with it?

We believe that’s true. The systems are great now. The ones that are still left standing are great systems. Of course as consultants, we do our best to help however we can. Client culture is different. Everybody has different access to resources in different cultures that result in very different implementations. I couldn’t agree more. I don’t think it’s so much the technology now as about just getting it right.

Do health systems have the time and interest to pursue technology innovation?

We’re getting there. Those at the leading edge are thinking more about it. They’ve been implemented for many, many years and have moved past the optimization stage. It’s interesting to talk to our clients and especially interesting when they engage us to explore those innovation opportunities that they have. It’s a bell curve and not everybody is there.

Consolidation seems to be leading us to super-regional or national health systems. Will that change the picture of how healthcare technology is used?

I think it will and I couldn’t agree with you more. The merger and acquisition wave to super systems and super-regional systems is simply the future. There’s no way to avoid it. That’s going to provide a ton of business from a vendor perspective, which is great, but it’s going to give those health systems the scope that they need to do what they do. I hope with that scope comes tremendous amounts of data, tremendous amounts of resources, and hopefully at some point we don’t just implement technology, but we take that data and do really cool things with it. I don’t think we’re there yet.

Are you seeing more relationships between health systems and life sciences and an increasing interest in sharing data?

I do. Those that are there are at the forefront. It was interesting to see, as you reported, the Cerner-Surescripts opportunity. That’s something that I hadn’t really thought of, but what a great opportunity. Once we’re implemented a really good electronic health record, what a tremendous opportunity for the life sciences. I haven’t seen any good examples of it from a client perspective of Divurgent. Certainly I’ve read some of the things that you’ve read. There’s tremendous opportunity there, but we’re just at the implementation stage. I can’t wait to start pulling that data out and doing some of those very, very innovative and cool things with it.

People argue passionately both ways whether patients are true consumers as they are in all other industries. What do you think?

I couldn’t believe that premise any more than what you just said. I certainly believe there is, to a certain extent, an age gap. The younger you are, the more of a consumer you are in everything that you buy. That’s going to turn into healthcare. The move to consumerism, and the more that younger generation demands more from their healthcare providers, will will be one of the major things that push the industry further.

Have you seen anything promising on the technology horizon that would make insurers a more welcome participant in the provider-patient relationship?

We have. We’ve seen enough that we’ve launched, towards the end of last year, a payer division. We’ve seen so much interest, particularly from the payer side, in trying to align better with the provider side. At 10 years old, we have a good understanding and good subject matter experts on the provider side. We know what the payers are looking for.

I think it’s still about cost for them. Certainly I would hope that it’s about client satisfaction and pulling whatever data that they don’t have, which probably frankly isn’t a lot. I hope the goals are more than reducing costs and improving claims processing and those types of things. I think we can get way more out of it than that.

What kind of cybersecurity problems have you seen?

From our perspective, someone has done an audit previously of the client and they look to Divurgent to come in from a remediation and project plan perspective. That’s probably the number one source of security work for us. Then there are those clients that haven’t done that, realize they probably have weaknesses, and they want us to do the assessment. Those are the two biggest opportunities right now.

User management and patch management seem to be the items that get providers in trouble most often. Is there renewed interest in revisiting those practices?

It’s renewed interest in all of the above. The threat from within is still a major threat. The bad guys are getting sophisticated. It’s to the point where sometimes you have to double-check looking at an email — it just looks so good, so tempting to do what it’s asking you to do. The threat within is huge and I’ve seen renewed interest in trying to educate users.

What healthcare IT opportunities will be most significant over the next few years?

I think it’s still going to be driven by mergers and acquisitions. Some of the common theories around the constriction around implementations, optimization, all the work on the blocking and tackling that still needs to be done is missed on super systems and super-regional systems. That amount of merger and acquisition activity is going to generate a ton of business that is underestimated.

I don’t think it’s going to happen in the next three years or five years. It will will take a little bit longer. It’s going to be a lot more of the same. Unfortunately, one of the things you’ll see is that a Cerner-using system buys an Epic-using system or vice versa. Dollars that were spent are going to be reversed to get on that same platform.

What will be the biggest theme at HIMSS18?

Data analytics, artificial intelligence, cybersecurity. I think it’s still going around all of the data implications of what we can do with this. I predict this year maybe it’s around artificial intelligence. The HIMSS buzzwords and the HIMSS trends are usually a little bit ahead of the game.

Do you have any final thoughts?

First, kudos to you and your team. Your readers certainly realize that it’s not easy to do what you do, but what a valuable resource you’ve become.

As far as we’ve come, we feel in many ways that we’re at the starting line. We have highly capable systems implemented in most cases, but we’re taking very little advantage of them in the grand scheme of their abilities. We’re passionate, as are other firms, about taking advantage of those large investments and leveraging them into what they can inevitably do, whether it’s reduction in costs, improvements in patient care, and hopefully leapfrogging innovation with data, science, and technology. This is going to take many years. We’re in this for the long haul.

Morning Headlines 2/28/18

EClinicalWorks Launches Acute Care EHR & Revenue Cycle Management Starting at $599 Per Bed Per Month

EClinicalWorks launches a cloud-based hospital EHR/RCM system that will start at $599 per bed per month, with the first live hospital scheduled to be 42-bed Hamilton Healthcare System (TX).

R1 to Acquire Intermedix Corporation

Revenue cycle technology company R1 RCM will acquire Intermedix’s healthcare division, which includes physician and EMS RCM, practice management, and analytics service lines, for $460 million.

Does Fitbit have time to pull off its digital healthcare transformation?

Fitbit reports Q4 revenue of $571 million – $17 million less than analyst estimates, prompting stocks to tumble 15 percent and CEO James Park to stress that the wearables company will focus on “managing down” expenses while expanding its line of smartwatches.

Shulkin: ‘There’s one agenda … and anyone who doesn’t want to do that shouldn’t be in the VA’

At the annual American Legion conference, VA Secretary David Shulkin, MD hints at unrest within the ranks when he makes it clear that those staffers who aren’t on board with the department’s priorities – replacing VistA with Cerner, increasing access to care, and suicide prevention – should get their walking papers in order.

News 2/28/18

Top News

Apple will launch AC Wellness, an employee wellness clinic and primary care group that will begin with two Santa Clara County, CA locations.

I assume this was the end result of the rumor from last fall that Apple was talking about acquiring venture-backed Crossover Health, which runs Apple’s on-site medical clinic.

Open position postings call for “experience across EHRs,” which fits with the hint that the clinics will be run by “a dedicated independent medical group” that sounds like more of a network than an Apple-employed provider group. Nobody has mentioned Crossover Health in the context of this latest news.

Reader Comments

From Your Epic Host: “Re: Epic’s hosting volume. No way its several new March go-lives will increase the number of live hosted systems 4-5 times as the reader’s rumor reported. Concurrent users will increase by barely over single digits. Don’t ask me how I know, but I know. Epic will have no problem with all the new live hospitals.” Unverified, but the source is solid.

From Pliable: “Re: the study saying that it costs $215 to bill and collect for an inpatient surgical procedure. That seems low, especially if independent surgeons, radiologists, and anesthesiologists send out claims to a primary and secondary insurance carrier (that’s eight claims in total). Did the study include cost of AR management and pended / rejected claims processing?” I can’t say since the full article lives behind JAMA’s paywall. I’m getting increasingly annoyed that research – much of it paid for with taxpayer money – is inaccessible to those unwilling or unable to pay several hundred dollars per year to be mailed dead-tree magazines that take forever to publish submitted articles. Are publishers really adding that much value to the research process to justify their high margins and restrictive copyright practices that don’t allow authors to post their research findings elsewhere?

From HIMSS Stalker: “Re: HIMSS meeting requests. HIStalk should run a competition of who has the most meeting requests from the same vendor, showing the previous requests forwarded so you can see how shameless these people are.” We’re pretty close to the wire for starting a contest, but I’m interested – who has received the most HIMSS18 meeting requests from a single vendor? The other thing that puzzles me the “HIMSS18 Conference Deals” that HIMSS keeps emailing me, which they launched years ago as yet another way to spam me about high-paying event sponsors way back when Groupon was considered cool. My problem is that there’s no actual deal, just a pitch to visit some vendor’s booth for a demo or “free consulting session” that fails miserably to answer the “what’s in it for me” question.

HIStalk Announcements and Requests

“I should have done it SOONER!” is the most recent response to What I Wish I’d Known Before I Quit My Job to Go to Work for Myself. That is, until you add your thoughts.

Welcome to new HIStalk Platinum Sponsor IMAT Solutions. The Orem, UT-based company provides a flexible data management solution for hospitals, HIEs, and ACOs that was designed upfront to ingest thousands of data sources – including unstructured data such as physician and visit notes – in seconds, providing a solution that’s easy on the budget, compatible with existing software, and usable by non-technical clinicians who need to see a 360-degree view of every patient. Clients use it to analyze hospital and clinic population data to find disparities in care, conduct clinical documentation quality reviews, identify at-risk patients who are drifting towards critical, and reduce admissions. IMAT’s consolidated patient record and reporting interface provides an integrated view of data from multiple sources (HIE, PACS, lab, EHR), its EMPI performs record-patient matching, and its validation and normalization rules are applied to incoming data for accurate quality and population health reporting. Specific solutions address Meaningful Use reporting, population health management, and medical research. Drop by HIMSS18 Booth #11418 to get a peek under the hood or hunt and gather from their downloadable resources page. Thanks to IMAT Solutions for supporting HIStalk.

Webinars

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

Acquisitions, Funding, Business, and Stock

R1 acquires revenue cycle, healthcare analytics, and emergency preparedness technology vendor Intermedix for $460 million.

CNBC reports that Alphabet-owned Verily – the former Google Life Sciences – is talking to insurers about participating in at-risk population health management contracts.

The leaked Nokia internal memo from the company’s chief strategy officer paints a bleak picture of its recently acquired (from Withings) digital health business:

Rather than only falling in love with our technology, we must be honest with ourselves. In its entirety, our digital health business has struggled to scale and meet its growth expectations. Currently, we don’t see a path for it to become a meaningful part of a company as large as Nokia … We will continue to have opportunities to address the IoT opportunity in digital health with private connectivity solutions, platforms, and software, just no longer from a consumer product perspective … As I commented in our internal story today, “Failing fast isn’t failure, it is accelerated learning.”

Sales

Lancaster General Hospital (PA) chooses Mobile Heartbeat’s MH-CURE for smartphone-based clinical communications and collaboration.

Ascension expands its revenue cycle agreement with R1 to cover its medical group.

BJC HealthCare launches a Perficient-powered cloud-based enterprise data warehouse.

People

Healthwise promotes Elizabeth Beem to CFO.

Will Weider is named SVP/CIO at PeaceHealth (WA), where he was serving as interim.

Huntington Hospital (CA) hires Scott Groom (Bassett Healthcare Network) as SVP/CIO. He is a rarity in apparently having left no photographic evidence of his existence anywhere on the Internet that I can use here, so we’ll just have to picture him our minds.

Announcements and Implementations

Meditech renames its Web EHR to Expanse.

Healthwise publishes its patient education app on Epic’s App Orchard, with the app and its supporting API allowing health systems to integrate patient education content into Epic’s EHR and patient portal.

EClinicalWorks launches a cloud-based hospital EHR/RCM system that will start at $599 per bed per month with no upfront capital cost. The first live hospital will be 42-bed Hamilton Healthcare System (TX). That’s a pretty big deal given the lack of competition in the full hospital systems market as ECW and Athenahealth take their first steps into it.

Document Storage Systems (DSS) launches Juno EHR for acute care and behavioral health, which I assume (since the company didn’t actually say) is based on the VA’s VistA, as is its VxVistA product. 

Change Healthcare announces InterQual AutoReview, which automates the medical review process by extracting clinical data directly from the EHR that produces and submits a medical necessity review, then reports the result back to the EHR.

Wolters Kluwer Health launches UpToDate Advanced, a guided clinical decision-making solution.

Government and Politics

CMS says that as of March 3, teaching physicians no longer need to re-enter the patient information that was entered by medical students under their own name to get paid.

In Western Australia (which is apparently has healthcare problems similar to ours), a government-commissioned health report finds that WA Health has spent a lot of money on IT projects in questionable areas and with little benefit to patients. It broadly notes that Western Australia’s overall health budget has doubled in the past decade to now consume 30 percent of the total budget but hasn’t correspondingly improved health outcomes since “the system focus remains on treatments rather than keeping people healthy” and embraces a provider-focused health approach. It recommends that the government address lifestyle choices, implement a navigator service to connect people with the right parts of the health system, run telehealth pilot projects, redesign mental health care around patients rather than by service provider, and improve patient-level data sharing among public and private providers.

Technology

UCSF launches the My BP Lab app, jointly developed with Samsung for its just-announced Galaxy S9 and S9+ smartphones. It uses the phone’s built-in optical sensor and thus does not require an external blood pressure cuff. Users will be invited to join a UCSF study that will look at blood pressure and stress levels through the day.

Other

The New York Times describes the concept of “digital phenotyping,” in which companies analyze a person’s social media posting patterns or phone usage in trying to detect mental health issues, although concerns about efficacy and privacy remain unaddressed. 

Campbell County Health (WY) will lose up to $200,000 in Medicaid payments due to sending out delayed bills following its acquisition of a private surgery center. The hospital’s billing system was unable to handle billing as a hospital-based surgery center for more than a year after the hotly debated acquisition, requiring the surgery center to bill manually.

A JAMA op-ed piece questions whether high-IQ medical students make the best doctors, also noting that medical schools overemphasize MCAT scores and science grades that don’t correlate to intelligence anyway. The authors say it’s equally important for physicians and healthcare leaders to have high emotional intelligence (EQ) that allows them to work with others in leading teams, coordinating care, and motivating behavior changes. They postulate that team-based care of chronically ill and terminal patients has failed because participants have low EQs. The article suggests that medical school admission committees add an EQ test component to the MCAT and stop obsessing over pre-med science scores and require training in psychology and leadership.

I don’t know how “smart” this healthcare startup is in advertising on Craigslist for a “booth sales intern” for HIMSS18 in which candidates must send a “full body shot” to the unknown Craigslist advertiser. Somehow I don’t think two days working on the HIMSS exhibit floor is much of an internship, nor does it seem necessary to examine the full bodies of “local college students” to vet them as acceptable booth help.

Sponsor Updates

A Message from Medicity

The healthcare industry has seen a significant shift in how it creates, shares, and uses information. The key is to empower the complete exchange of clinical data and the ability to use it. As the industry unites in the pursuit of integrated, actionable data, Medicity is uniquely qualified to lead the next generation of interoperability. We collect patient data from any and all connected external sources. With just one click, providers can access a single, de-duplicated, comprehensive Continuity of Care Document (CCD). This clinical intelligence supports point-of-care decision making and gives providers more time to spend treating patients. See our video on Medicity Community Interchange or visit us at Booth # 2449 at HIMSS18.

• Optimum Healthcare IT matches the $5,000 raised by its client Southcoast Health for those affected by Hurricane Harvey, allowing a $10,000 donation to the American Red Cross.
• Mental Health Center of Denver adopts the Carequality interoperability framework via its Netsmart EHR.
• Frost & Sullivan recognizes Fortified Health Security with its Healthcare IoT Cybersecurity Company of the Year Award.
• AdvancedMD and ChartLogic will exhibit at the American Academy of Orthopedic Surgeons conference March 6-10 in New Orleans.
• Aprima Medical Software selects ChartSpan Medical Technologies as one of its primary CCM partners.
• IDC names Arcadia Healthcare Solutions a leader in US healthcare clinical and financial analytic BPO services.
• 904 Magazine recognizes CSI Healthcare IT as a “Company with Heart” for the third consecutive year.
• Culbert Healthcare Solutions will exhibit at the AMGA 2018 Annual Conference March 7-10 in Phoenix.
• Santa Rosa Consulting assists Harrison Memorial Hospital (KY) with its migration from Meditech Magic to 6.1.
• Divurgent publishes a new success story, “EHR Readiness Investment Yields Activation Savings.”
• Outcomes Rocket features Docent Health Senior Director Client Development Addison Hoover in a new podcast.
• Elsevier collaborates with the Beijing University of Chinese Medicine to enable deeper research into traditional Chinese medicine.
• EClinicalWorks will exhibit at the California Primary Care Association 2018 Quality Care Conference March 1-2 in Sacramento.
• Healthgrades publishes its annual list of America’s best hospitals.

Blog Posts

• Medicity’s CEO Attends White House Meeting on Interoperability (Medicity)
• Experts in Home Health Give Thoughts and Advice for 2018 – Part 1 (Netsmart)
• Four tips to improve office productivity & accelerate payments (AdvancedMD)
• Is a Virtual CISO Right for Your Organization? (Impact Advisors)
• La Sapienza Hospital in Rome and Agfa Healthcare discussing how to streamline the workflow for transplant patients, using the Integrated Care Suite (Agfa Healthcare)
• The FDA Digital Health PreCertification Program (Datica)
• Try These 5 Tips for Reducing Stress in Nursing (CareSync)
• Invest in the Relationship, Not the Technology (Casenet)
• When Code Becomes Magic: The Power of Interoperability (Spok)
• Key Elements in the 2018 ePA National Adoption Scorecard (CoverMyMeds)
• Introducing the Dimensional Insight Book Club (Dimensional Insight)
• Managed IT Services for Healthcare: 3 Must-Have Benefits (The HCI Group)
• SQL Tip: Parsing Packed Fields in Meditech 6.x (Iatric Systems)
• Trust in Healthcare: The Key to Our Future Technology Ecosystem (Imprivata)
• CRM: More Than a Marketing Play for Healthcare (Influence Health)
• What Vegas Can Teach Healthcare About Tokenization (InstaMed)
• Oceans, Elephants, and the Promise of Interoperability (InterSystems)
• Five Reasons Patient Access Requires a Multi-Channel Approach (Kyruus)

Contacts

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

Morning Headlines 2/27/18

New System Makes it Easier for Patients to Talk to Doctors

The Wall Street Journal describes OurNotes, the next step in the OpenNotes movement in which patients will be able to share their own notes with their doctors.

Hospital taking steps to resolve billing issues

Western Missouri Medical Center struggles with its billing system conversion to Cerner, notifying patients that they may receive catch-up bills going back to January 2017.

Apple is launching medical clinics to deliver the ‘world’s best health care experience’ to its employees

Apple will launch two employee clinics near its California headquarters called AC Wellness and is listing open positions for doctors, health coaches, and health behaviors program designers.

Curbside Consult with Dr. Jayne 2/26/18

I spent a good part of last week trying to help a client sort out their strategy for Patient-Centered Medical Home. The client is a mid- to large-sized multispecialty group, which started as a mostly primary care group that was forced to take on specialists as it acquired smaller multispecialty groups. They didn’t really think much about having to integrate the specialist documentation with the primary care documentation until they decided to enter into some risk-sharing contracts. They’re also trying to attest for just about every incentive program out there, including smaller, payer-centric contract bonuses, and trying to navigate from the older NCQA Patient-Centered Medical Home requirements to the redesigned program and are really struggling.

Their EHR vendor supports both primary care and specialty workflows, which are often siloed because of how the content was developed. For example, there’s a completely separate “urgent care module” that some of the primary care physicians have taken to using for the half days when they are assigned to see only acute patients. They like the separate module because the documentation is faster and easier than what they typically do for “regular” primary care patients, but the problem is that the data doesn’t always flow to the same tables used by the rest of the documentation screens. This is creating a problem with their Patient-Centered Medical Home reports, which were custom built by a third party that didn’t know the application and so only designed them to use data from a single workflow.

This isn’t the first EHR I’ve seen that works like this, with different pieces being built at different times and not being fully integrated with the rest of the application. In addition to the urgent care workflow, there are separate streams for documenting OB/GYN and GI procedures that account for integration with different ultrasound and imaging devices. This is frustrating to the client as well, since of course the supported devices aren’t the ones they use in their clinic. When they talked to the vendor about it, they were told that the specialty flows were built as contractual requirements for specific clients. When vendors enter into those kinds of agreements, it’s more likely to result in workflows that don’t necessarily meet the needs of the entire client base, but work well for a unique client.

As we began to dig deeper into the needs for Patient-Centered Medical Home, it became evident that the client had entered into some agreements that were going to cause challenges for designing an ideal documentation path. They recently agreed to work with embedded care managers from insurance companies, who will be documenting in two separate systems depending on the insurance coverage of patients selected for the care coordination program. The IT team decided that they would bring the documentation from those systems back into the client EHR as a PDF, which would then be inserted into the document management system. Of course, that means no discrete data and no availability for the Patient-Centered Medical Home reports to make use of the information that represents the work that has been performed.

Situations like this always lead to discussions of governance and a need for greater understanding of how this client’s situation evolved to put them in this place. The chief medical officer is apparently the one pushing the Patient-Centered Medical Home agenda, but the director of nursing lobbied the group to engage in the embedded care management programs. The nursing side of the house saw participation in the program as a way to get some flex on staffing since they were struggling with care management services, but didn’t understand the ramifications of having those coordinators documenting outside the EHR. To their credit, nursing worked with the IT team to make sure the patient contacts made through that program were represented in the EHR and IT found a relatively easy solution, but neither of those groups understood the impact on PCMH.

The CMO didn’t do a great job helping the rest of the team understand what was going on with Patient-Centered Medical Home and its requirements or that they were having customized reports created to meet those needs. IT wasn’t involved with the creation of the reports since the CMO outsourced them at a time when he perceived the IT team to be too busy implementing newly-acquired practices. And while the third party that built the reports did a great job creating really nice reports, they didn’t understand how the different specialties work together and just built what the CMO had described in a broad-strokes overview. It’s one of those situations where they built exactly what was requested but didn’t know that the request wasn’t completely formulated. As a result, IT is doing a lot of finger-pointing at the third party, which is defensive and doesn’t understand why their beautiful reports are being questioned.

The other wild card here is the group’s understanding of the redesigned Patient-Centered Medical Home program. They’re trying to make the transition from being at a low level of recognition under the previous program to being more robust participants in the new program, but haven’t identified sufficient resources to learn the new requirements and figure out how to mesh them together with what the group needs. They brought me in specifically to deal with the new requirements, but as is common with organizations like this that are trying to dive into many different pools at the same time, we’re peeling back the layers and finding out there are many more issues that need to be addressed.

My task for this week is to bring together the administrators and to lay out the various initiatives and how they interact and/or compete. The goal is to get them to prioritize which programs they want to lead with, along with getting them to all start moving in the same direction. No one has infinite resources and they’re not likely to be successful if they continue to try to do all of this at the same time and all of it in a way that is under-resourced and doesn’t really fit in with a long-term strategy.

Although it sounds easy to lock everyone in a room and lay things out, I’ll be particularly challenged by the fact that this group just came out of their annual strategic planning retreat and thinks they have a master plan and a strategy. Either these items weren’t discussed at the retreat (which I’d say makes it less than strategic) or they weren’t discussed in a way that had meaning for everyone and led to actionable decisions.

Sometimes these conversations can turn towards the consultant with a bit of hostility or there can be a lot of finger-pointing, so I’m readying my strategies to try to wrangle this meeting. I haven’t been working with them long enough to know if they’re open to some give and take, or it’s going to be a turf battle, or I’ll end up the bad guy. Consulting is like a box of chocolates – you never know what you’re going to get.

How does your organization prioritize initiatives? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Tom Borzilleri, CEO, InteliSys Health

Tom Borzilleri is CEO of InteliSys Health of San Diego, CA.

Tell me about yourself and the company.

I spent many years in the finance business. My first dive into the healthcare space was back in the late 1990s, having founded and operated the second-largest patient finance company in the country. As I progressed on through the years and had a successful exit of that company, I then moved into the PBM space in the mid-2000s. I spent five years founding and operating a pharmacy benefit management company, where I learned and deployed many of the processes and tricks of the PBM industry.

I realized that there had to be a better way to be able to address the market and deliver value, savings, and benefits to patients and companies across the board. I set out to create a solution that would disrupt what had become the status quo of that industry, or for a better description, the profiteering by the PBM industry, to specifically deliver the ability of true price transparency and ultimately deliver the absolute lowest drug cost for all patients, consumers, and at-risk stakeholders.

How do PBMs make money?

PBMs are exactly what they’re described as — pharmacy benefit managers. They manage the pharmacy benefit, or the prescription benefit, on behalf of plans, payers, insurance carriers, ACOs, and self-insured employers. Those functions include setting up a formulary and creating a network of pharmacies in which members can acquire their prescriptions through the plan.

PBMs negotiate the price of a drug with the manufacturer and then negotiate a contract rate with the pharmacy. They profit by creating an ingredient spread, the difference between the acquisition cost to what they are charging their clients or customers, which would be those clients, payers, ACOs, and insurance carriers.

Why are insurance companies willing to overpay for the PBM’s services instead of pressuring manufacturers to give them lower prices?

Their contracts are convoluted. Most insurance carriers really don’t understand or have an ability through the language in those contracts to determine what the actual acquisition cost is. There’s a lot of functions that the PBM fulfills, especially with regard to patient management and formulary management. The role of the PBM is as a buffer between the pharmaceutical manufacturers and doctors.

Pharma manufacturers used to send their reps into doctors’ offices, bringing in lunch or other compensation to doctors. That got them to prescribe their medication or their brand. PBMs took over the role of managing which drugs are included in that formulary. They acted as a buffer to eliminate what was called steerage, where it was illegal to compensate a doctor to prescribe a specific brand over another. It’s kind of like payola in the radio industry for playing songs on the radio many years ago.

PBMs acted as the intermediary, but at the same time, it also opened the door for them to set their profitability in acting as pseudo wholesaler, buyer, and then reseller of those prescriptions or drugs to the insurance carriers insuring those members.

How can technology help doctors answer the deceivingly simple patient question of, “How much is this drug going to cost me?”

We have brought together all the necessary components to offer true price transparency. First off, we have created our own network of pharmacies. We operate on what is called the no-spread model. Whatever the acquisition cost is of that drug, that’s what is being charged to the patient or insurance carrier at the end of the day.

A great deal of price disparity exists between pharmacy chains as well. You can go to a CVS or Walgreens and expect to pay anywhere from 30 percent to 75 percent more than you would pay at a local independent or even a grocery store pharmacy. It’s really amazing the price disparity that exists.

Consumers assume that the large chains buy in volume and therefore get the best pricing on drug ingredients, but that is far from the truth. Because they maintain such a significant footprint, they can command that price. Patients ultimately don’t know and they don’t have the time nor the resources — and that includes doctors as well — to do the research to find out find which chain or which store — which may be even a store closer to my home — has a price that’s 50 percent less than what they’re paying.

That goes for the insurance carriers as well. Insurance carriers are looking for convenience for their members. They’re forced to enter into these contracts to provide access to pharmacies so that when the patient arrives, they only pay their co-pay and then the insurance carrier will reimburse that pharmacy for whatever remains on the cost of that ingredient.

How do free consumer coupon programs like GoodRx work?

In my PBM, I administered what were called DDCs, or drug discount card programs. In the GoodRx model, they are signed up with multiple PBMs. Their mobile application searches out the lowest-cost drug discount card programs to provide the best discount to the patient.

But there are ingredient spreads that the PBMs have built into those prices, as well as very high admin fees. The patient who is uninsured or underinsured will save money, but until you strip out those admin fees and that ingredient spread, they’re not saving as much as they could.

DDC products, because they’re sponsored by the largest PBMs in the country using their networks, pricing spreads, and admin fees, generate $5 billion in annual profit for PBMs and programs like GoodRx.

Did you say $5 billion? Wow.

Between 60 and 100 companies are marketing these drug discount cards under a plethora of names. In some instances, it’s the same PBM and the same program. There are basically only five PBMs in the market today — following our exit four years ago — that still sponsor and administer these drug discount card programs.

So GoodRx isn’t some kind of disruptive organization demonstrating transparency, but rather just another way for PBMs to make money by working with consumers directly instead of through an insurance company?

That’s correct. GoodRx gives comparison prices across different pharmacy chains. I mentioned that there is price disparity across the pharmacy chains, but there is also price disparity across the PBMs that administer the drug discount card programs. PBM A will have a different price on an ingredient versus PBM B.

The GoodRx model looks at the discount card program pricing across multiple PBMs to give the lowest price — of those inflated prices — that all the PBMs are charging. It is a form of transparency, but it’s really not true price transparency because it is not providing the actual cost to the PBM on that drug.

Our model strips out all the ingredient spread. We strip out all the administrative fees that are built into these prices. It’s delivering the price that the PBM is paying themselves to the pharmacy down directly to the consumer. We’re undercutting and disrupting that entire drug discount card market with our tool.

Why did you decide to work with prescribers rather than consumers?

The primary objective of physicians is to get their patient on therapy, get them well, and create a better health outcome. They have a dog in the hunt because essentially their scores will increase based on their ability to get that patient well and have a positive outcome.

Physicians prescribe a drug based on a familiarity of the condition. Physicians have no idea whatsoever what the cost of the medication is. They leave that up to the patient to find out at the pharmacy. In many instances, the patient is hit with sticker shock.

In addition to that, patients may either not have insurance or they have insurance with high co-pays or high out-of-pocket minimums. There is such vast variety of insurance coverage currently on the market that patients don’t know what is going to be covered, if it’s on formulary, or if they’ve met their minimum. They know they have prescription coverage, but they don’t know what it’s going to cost until they get to the pharmacy.

Our software analyzes the patient’s plan information. We’re conducting a real-time benefit check on that patient, so we know what their co-pay will be based on the drug that the doctor has chosen. They will know at that time if the co-pay is inflated, meaning that there could be a cash price that is less than their co-pay, which eliminates a claim being processed through the insurance carrier and gives a lower cost to the patient.

It also looks at the drug that the doctor has chosen. As I said, doctors prescribe based on familiarity of a drug with the condition. That may not be necessarily the cheapest drug for the insurance carrier that’s going to pay them that claim. Our software analyzes the formulary of the plan and identifies, if one exists, a clinically and therapeutically equivalent alternative drug to what the doctor has chosen that will cost the insurance carrier the least amount of money.

Insurance carriers today have no idea what the doctor is prescribing. They only know what they have paid on after the claim has already been submitted and adjudicated. They’re in a very awkward position, a disadvantage, because they can’t control or they have no input and ability to be able to help that doctor choose the most cost-effective and most therapeutically-effective drug because they don’t find out until after the fact.

Our software brings that price transparency. The patient can see the drug price before it’s sent to the pharmacy, eliminating sticker shock. When they get hit with sticker shock, one of three things happen. They’re on the phone with the doctor, creating a second encounter that disrupts the workflow and takes staff time and the doctor’s time to re-prescribe because they just found out that their insurance company is not going to cover the drug or they’re going to have to pay a ridiculous amount of money out of pocket. Or if the doctor chose a brand drug when there was an available generic that could have been prescribed instead at a fraction of a cost and the pharmacist is on the phone with the doctor doing the same thing. Worst-case scenario, the patient abandons at pharmacy and never gets on therapy, which opens up the issue of financial risk on the part of the insurance carrier and obviously health risk on the part of the patient for never getting on therapy.

We can eliminate this in the encounter as we’re sitting in the exam room with that patient, providing actionable, beneficial, and valuable data to the patient and their doctor before that prescription is sent out. That is the most efficient method for addressing these problems.

What impact will the CVS – Aetna merger have?

It’s not going to be of any benefit to the patient. I think it’s going to reduce options and locations in which patients will be able to get their prescriptions filled.

Number two, I believe that they will try to herd patients into CVS to create pull-through revenue. Pharmacies don’t make their money in the pharmacy in the back of the store. Their profits are generated through products sold in the front of the store.

This is a mechanism in which that they may incentivize patients to go to CVS rather than going to Walmart or their local independent or grocery chain to get their prescriptions filled, to be able to pull patients out of other chains and herd them directly into theirs.

I think it’s going to eliminate options for patients. It may in turn increase cost for patients, because they’ll have fewer choices. Ultimately it will probably be a very profitable opportunity and enterprise for CVS and Aetna.

Do you have any final thoughts?

With our software and our technology today, we are addressing price transparency as well as price and drug affordability, which will benefit the patient, the payers, and somewhat the doctors. We will be introducing in the coming weeks a new product, which is a e-prescribe solution that was specifically developed and designed to address affordability for the doctors themselves, to help them save money and have positive and financial impact on them.

What’s so unusual about this solution is that there are over 400 EHR systems in the country that use third-party e-prescribing tools. Those doctors are forced to have to pay anywhere from $15 to $150 a month to be able to prescribe.

Our product will be 100 percent free to every doctor who uses it and every EHR system that integrates it. It will also create an alternative revenue center for the EHR company. We hope those profits will turn into savings and reduction on the rest of the subscription fees that these doctors have to pay to have access to an EHR system.

Our objective is to lower cost and bring benefit and value to the entire healthcare value chain across the board. That’s the focus of InteliSys Health.