Monday Morning Update 8/7/17

Top News

Allscripts will write down $145 million of its $200 million investment in NantHealth, whose shares have dropped 77 percent since the investment. Allscripts said in its earnings announcement, “This impairment is based on management’s assessment of the likelihood of near-term recovery of the investment’s value.” Shares in NH, which closed at $18.59 on their first day of trading in June 2016, are now at $4.20, valuing the company at $510 million.

Allscripts says it will exchange its NantHealth ownership stake for “certain technology assets and client relationships” of NantHealth as well as a commitment that NantHealth will buy Allscripts software and services.

Other items from the Allscripts earnings call:

• Allscripts CEO and long-time Cerner executive Paul Black opened the call by offering his condolences to Neal Patterson’s family and colleagues.
• Black says executives have been talking for some time about the need to boost the company’s inpatient EHR market share, with the McKesson EIS acquisition adding hundreds of new inpatient clients who present cross-selling opportunities for systems for EHR, post-acute care, population health management, and precision medicine.
• The company signed the largest Sunrise agreement since 2011 with a six-hospital system.
• President Richard Poulton said in response to an analyst’s question about why the company would take on the risk of buying McKesson EIS, “This is an industry that is going to continue to transition. You can go around the horn for both inpatient and outpatient competitors and you’d find several of them are either for sale actively, have been recently for sale, or will be for sale most likely in the not too distant future … as the market matures, consolidation is a natural occurrence and it’s inevitable.”
• Poulton says what’s left of the retired Horizon business will wind down within two quarters of the acquisition’s closing.
• Allscripts hopes to improve the McKesson customer defection rate that started when it announced plans to exit healthcare IT.
• The company says it will recommend Paragon for under-200 bed hospitals with simple product and service lines and Sunrise for larger, more complex health systems. Poulton admits that the company found it hard to sell Sunrise into small hospitals because of the effort required to implement it and the difficulty for a small hospital to get full value from it, adding that competitors have reached the same conclusion.
• Asked which McKesson solutions might appeal to Sunrise customers, Black listed lab, blood bank, surgery, anesthesia, the OneContent document management system, and supply chain.

Reader Comments

From Tater Consultancy: “Re: Epic. The contract from a just-signed Epic site says Care Everywhere is licensed via a transaction fee for each CCD exchanged with a non-Epic EHR. Epic made a big deal at HIMSS15 about waiving the $2.35 per record fee due to industry pressure. Looks like not much has changed, although a specific fee isn’t mentioned in the contract.“ Judy Faulkner said at HIMSS15 that data exchange via Care Everywhere would be free “at least until 2020.” Fees prior to that were $0.20 for each message sent to an HIE and $2.35 per year for a given patient for whom messages were received from foreign EMRs regardless of the message count. About that time, Athenahealth said it would pay customer fees for participating in CommonWell indefinitely and Cerner promised to do the same through at least 2017. I’m happy to run any fee updates from Epic, Athenahealth, or Cerner customers. I summarize with my common conclusion: Q: Why do vendors charge xxx? A: Because they can, and because customers keep signing those contracts. UPDATE: an Epic spokesperson says the company has not broken the 2020 promise — CCD exchanges are free, also adding, “In our new contracts, CCD exchanges with non-Epic EHRs are free indefinitely, and this is a standard we are applying to both new and existing customers, regardless of what their contract says.”

From Confused Consultant: “Re: Summa Health. Cutting 300 jobs to cover a $60 million operating loss. Implemented Epic from Catholic Health Partners last year while claiming they want to remain independent as the city’s largest employer, turning over what is likely their largest non-personnel expense line to a larger IDN who might be a likely purchaser. I’m not saying it’s the case here, but some mega systems wield Epic as an instrument to influence referral patterns or M&A activity, and industry narrative that has been largely unnoticed by trade media.” Summa made a PR and professional mess of its ED staffing change early this year and large physician groups started sending patients elsewhere due to quality concerns, both of which gave it a community black eye even before this latest financial bombshell. It’s also located in Akron, an industrial city whose population is declining and skewing older. Still, I agree that a larger, Epic-provisioning organization might get first dibs at acquiring a given hospital that uses its services. That could be for several reasons: a successful, non-competitive working relationship; the smaller hospital’s willingness to outsource a key service and its underlying motivation to do so; more transparent referral patterns; and if the organizations indeed express acquisition interest, access to better due diligence data and a potentially smoother transition afterward. My conclusion is that large health systems are acquiring smaller ones that stumble operationally or financially and technology makes it more attractive. Good or bad, we seem to be heading toward big regional and national health systems owning most hospitals, a situation that is almost universal in every industry outside of healthcare.

From Art O. Deal: “Re: VA. The taxpayer watchdog in The Hill makes the same point you’ve made about Shulkin (Trump) giving away leverage by no-bidding the VA.” The president of Taxpayers Protection Alliance says no-bid contracts have become the rule rather than the exception at many federal agencies, observing that the Department of Defense spent more than $100 billion in 2016 — more than half of its spending — via non-competitive contract awards. It questions the assertion of Secretary of Veterans Affairs David Shulkin that the VA “can do this cheaper for the taxpayers by essentially moving forward quickly without a lengthy process” when he has no idea how long the project will take or what it might cost. President Trump and White House advisor Jared Kushner both bragged on pushing the VA to choose Cerner without exploring the only viable alternative (Epic) or sticking with VistA, with Shulkin obediently framing the choice as obvious since the DoD is already implementing Cerner. The Trump clan brags about being skilled deal-makers – at least when it’s their money and not that of taxpayers —  but telling a vendor they’ve been chosen without first hashing out a contract is about as amateurish as you can get. I think everybody, especially Congress, was just sick of DoD and VA making excuses why they can’t exchange information, with active service military members starting over with a nearly blank page after transitioning to veteran status. 

From Compromized Consumers: “Re: Optum 360. Will obtain patient records of UnitedHealthcare members and dependents, not just claims and EOB, but also labs and prescriptions. They will then build a personal health record similar to Microsoft HealthVault. To avoid regulator and consumer rights backlash, they will partner with someone like Apple or Experian, with the final solution marketed as a consumer convenience under the partner’s name. This update will be shared with VIPs attending the Optum event in DC this week.” Unverified.

HIStalk Announcements and Requests

Poll respondents give their largest local non-profit health systems mixed marks on serving patients selflessly, with 44 percent grading them A or B, 29 percent a gentleman’s C, and 27 percent going with D or F.

New poll to your right or here: who will benefit most from the proposed acquisition of McKesson EIS by Allscripts?

HIStalk readers funded the DonorsChoose teacher grant request of Ms. M in Missouri, who asked for science books and weather kits. She reports, “You have awakened a love for science in my classroom! Our new materials have allowed us to get knee-deep into our content. Having the chance to put together a pulley system gave students the opportunity to really see how they work, and to decide for themselves that they do lighten the amount of work it takes to lift an object. The power of seeing this first-hand really helped the concept to stick! In the same way, the model we put together to show how the moon rotates around the earth gave rise to a number of interesting discussions. Students were able to seek answers to their own questions and share these with their classmates. This went so far beyond what a normal paper-and-pencil lesson could have done.”

This Week in Health IT History

One year ago:

• Theranos CEO Elizabeth Holmes announces in her AACC Q&A session that the troubled company will pivot into manufacturing the MiniLab sample processing machine.
• Drone delivery vendor Zipline says it will deliver medical supplies to areas of Maryland, Nevada, and Washington within a year.
• Senator Elizabeth Warren’s NEJM opinion piece recommends that underlying data from submitted journal articles, as well as from both successful and failed clinical trials, be shared openly.
• Hackers breach Newkirk Products, which issues BCBS insurance cards in several states.
• A New York Times article questions whether “did we control your pain” hospital satisfaction survey question encourages doctors to over-prescribe opiates since satisfaction scores impact their bonuses.

Five years ago:

• Massachusetts announces that it will create a statewide HIE, paid for by the federal government.
• McKesson announces Cardiology Inventory and Surgical Point-of-Use Integration Module.
• The VA begins implementing the first sites of its $543 million RTLS contract, with HP as the prime contractor.
• Allscripts CEO Glen Tullman says in an earnings call after the company fell short on earnings that Sunrise Financial Manager will be released in Q4, it expects to win more hospital business as competitors step away, and that demand for the company’s open, less-expensive hospital systems will grow.

Ten years ago:

• The CEO of Lawson Software says software-as-a-service won’t live up to its hype.
• Perot Systems acquires JJWild for $89 million in cash.
• IMedica reports that its customer base grew 76 percent in the first six months of the year.

Weekly Anonymous Reader Question

Responses to last week’s question:

• Chased love, laughter, and friendship, not money and fame. Crossed the finish line a WINNER.
• You can never have enough rope!
• Appears he didn’t hear us yell “Duck!”
• That reminds me of a story…
• When I die at the age of 103: “Life – like me – was short, but sweet.”
• The “Clean up Woman.”
• She put the fun in dysfunctional.
• Have a drink on me. (with a bottle opener mounted on the tombstone).
• When I am dead and gone and my time on earth has passed, I hope they bury me upside down, so my critics can kiss my a$$.
• I told you I was sick!
• It’s too hard not to have a good time.
• And now, for something completely different…
• Oh what a tangled web we weave when first we practice to deceive.
• Faithful to us here, we loved him to the last.
• He left life better than he found it.
• He found love, joy. and peace in family.
• S/He was born at a young age, and lived until the end.
• Adventure.
• Cheer up, there’s no hope.
• The measure of what a human being could be.
• He had nothing, but gave it his all.
• I told you so.
• Made a positive difference in numerous lives by being alive and was a great friend.
• She made a difference.
• Smart from the start, caring and overbearing, made a difference with little deference.
• The most difficult thing she ever did was live when all she wanted was to die.
• Veni, vidi, vici.
• That was fun!
• Mostly sorry for before 25. I spent the next 50 working to even the balance.
• Left this world wondering what difference she made. Hopefully will find out now.
• He tried every day to be the man his dog thought he was.
• Been there, done that.
• A joyful scoundrel gone, not forgotten.
• This was harder than I thought!
• Life is too important to be taken seriously. Smile.
• No situation is so bad that it can’t get worse.
• I tried really hard.

This week’s question: of the places you’ve experienced, where would you choose to live if job or money wasn’t a factor?

Last Week’s Most Interesting News

• Allscripts announces that it will acquire McKesson’s Enterprise Information Solutions business for $185 million in cash.
• The VA announces expansion of its telemedicine program, including allowing its employed providers to conduct sessions across state lines.
• A Politico report claims that then-VP Joe Biden scolded Epic CEO Judy Faulkner in a January 2017 meeting for her questioning him as to why he would want his complete medical records, which Epic says is an “inaccurate and misleading” description of his meeting with EHR vendors.
• Drug maker Merck warns that its manufacturing process is still being disrupted by its June 27 malware attack and warns of potential drug shortages and unknown financial impact.
• Athenahealth announces that it will target $100 million in cost savings and strips Jonathan Bush’s president and board chair titles in recruiting replacements.
• Quality Systems says it has received a Civil Investigative Demands letter from the Department of Justice and says it has heard of other vendors receiving the same letter, which involves a false claims investigation such as the one that cost EClinicalWorks a $155 million settlement.
• The White House’s opioid crisis committee recommends that state doctor-shopping databases be connected and that the government relax the HIPAA requirement that prevents addiction treatment professionals from sharing patient information with other providers without consent.
• A $10 million donation will fund the launch of a UCSF institute that will perform analytics-based drug discovery using a newly created dataset covering all five UC system medical centers.

Webinars

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

Decisions

• Wadley Regional Medical Center At Hope (AR) will go live with Cerner in December 2017.
• Sartori Memorial Hospital (IA) will switch from McKesson to Cerner in October 2017. Its clinic will remain on an Epic ambulatory EHR.
• Hereford Regional Medical Center (TX) will switch from Healthland (a CPSI company) to Cerner next month.
• Select Specialty Hospital – Danville and Gainesville (PA) plans to switch to Epic.
• Regency Hospital Of Central Georgia will go live with Epic in 2019.

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

The Madison business paper profiles the recent launch of Datica’s Digital Health Success Framework that helps startups get their products to market.

Privacy and Security

It’s tough to stay on the pedestal once placed there. The security researcher who single-handedly stopped the May 2017 WannCry ransomware attack is arrested at the Las Vegas airport while boarding a plane back home to the UK after attending the DefCon hacking conference, charged with creating and then selling malware that targeted banks in 2014-2015.

Siemens warns users of several of its molecular imaging systems that those systems could be easily hacked remotely because of bugs in their Windows web server and HP Client Automation Service software. The company is working on a patch, but recommends in the meantime that the Windows 7-powered machines be disconnected from the network or run on isolated network segments. 

Other

Pharma bro Martin Shkreli is convicted on three counts of securities fraud charges, for which he faces up to 20 years in prison. Prosecutors say Shkreli ran a Ponzi-like scheme in which he convinced people to invest in his hedge funds by falsely claiming he knew what he was doing, then lost a lot of their money and diverted some of the funds to start up a drug company while falsely claiming positive returns and giving the runaround to investors who wanted to cash out. All of that is unrelated to his turmoil-filled time at Turing Pharmaceuticals, which bought an old, cheap drug that is still sometimes useful in treating AIDS and raised its price by 5,000 percent. As I observed above: Q: Why do vendors charge xxx? A: Because they can. Behavior that some might find despicable isn’t necessary illegal.

Ireland’s Health Services Executive says the recently publicized national imaging system bug that caused the “less than” symbol to be omitted from reports was discovered in January 2016 by the system’s vendor, Change Healthcare, who didn’t let customers know about the problem until it was fixed in August 2016. Change Healthcare became the vendor in its recent merger with most of McKesson’s health IT business. The company’s Canadian subsidiary, McKesson Medical Imaging, reportedly sent out a field safety notice this week to all customers, many of which are in the US.

Here’s the next-to-last installment of Vince’s series on Cerner from a few years back.

Sponsor Updates

• The Summit Healthcare team sorted through 10,000 pounds of food while volunteering at The Greater Boston Food Bank.
• The SSI Group will exhibit at the HFMA Region 8 conference August 7 in Kansas City, MO.
• ZappRx is nominated for Xconomy’s inaugural Life Science Awards
• A Datica podcast features an interview with Naomi Fried, PhD on digital health companies supporting drug company innovation. 

Blog Posts

• Digital health systems: A foundation for IT-powered innovation (Advisory Board)
• Women in Health Tech: Star Cunningham, 4D Healthware (Redox)
• Why CIOs and IT Leaders are Prioritizing Customer Experience (Salesforce)
• Healthcare Analytics Soar to New Sights (The SSI Group)
• Here Today, Gone Tomorrow: Alarming Trends in Patient Satisfaction (Solutionreach)
• St. Louis-based Health System Embraces Technology to Strengthen Care Coordination (Surescripts)
• Five tips for getting your proactive HEDIS runs to take off (Verscend Technologies)
• Even small hospitals have big communication challenges. (Voalte)
• 5 Keys for Exceptional Customer Experiences (West Corp.)

Contacts

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

Morning Headlines 8/4/17

Allscripts to acquire McKesson’s Enterprise Information Solutions business

Allscripts will acquire McKesson’s Enterprise Information Solutions health IT business for $185 million cash, planning to offer Paragon to small hospitals while continuing to market Allscripts Sunrise to larger health systems.

Remarks by President Trump at Department of Veterans Affairs Telehealth Event

The VA will expand its telemedicine program, already the country’s largest, with VA Video Connect.

Medicare and Medicaid Electronic Health Record (EHR) Incentive Program Requirements for Eligible Hospitals, Critical Access Hospitals, and Eligible Professionals;

CMS will allow hospitals to submit only one quarter of data for 2018 incentive payments and will allow using 2014, 2015, or a combination of CEHRT to satisfy requirements for CY 2018.

News 8/4/17

Top News

Allscripts will acquire McKesson’s Enterprise Information Solutions health IT business for $185 million cash. McKesson EIS offers Paragon EHR, Star, Series, Healthquest, Lab Analytics and Blood Bank, and OneContent.

Allscripts plans to offer Paragon to small hospitals while continuing to market Allscripts Sunrise to larger health systems.

McKesson announced in June 2016 that it was exploring strategic alternatives for the EIS business as it merged most of its IT offerings with Change Healthcare. It wrote off $290 million in October 2016 related to the EIS business. McKesson will apparently retain RelayHealth and its recently acquired CoverMyMeds, both network-focused, high-growth communications products that are aimed more at pharmacies and insurance companies than health systems.

Meanwhile, Allscripts reports Q2 results: revenue up 10 percent, adjusted EPS $0.15 vs. $0.14, meeting earnings expectations and beating on revenue. MDRX share priced dropped 18 percent in the past year in valuing the company at $2.1 billion.

Allscripts shares rose 16 percent in after-hours trading immediately following the acquisition and earnings announcements.

Reader Comments

From Bow Tie Is Really a Camera: “Re: EClinicalWorks interview. Will it lose a lot of customers following the Department of Justice settlement?” I highly doubt it. While various reports claim that a big chunk of ECW’s customers are considering mass defection, I don’t think that will ever happen since the incident doesn’t affect them personally. They either like the system or they don’t and the high-profile settlement doesn’t provide any new incentive to expensively rip-and-replace even though ECW is now on the hook to provide migration assistance should they choose to move to a new system. It’s not like painlessly boycotting a brand of soda by just reaching two shelves over for the nearly identical sugar water. In fact, the DOJ’s mandated company changes will probably make ECW’s software and support better. People subconsciously try to please a surveyor and to express indignation that they rarely act on. Customers might also appreciate the little-observed fact that ECW paid $155 million in settlement partly to protect them from having to individually repay their Meaningful Use incentives. I don’t think the settlement is going to have much effect on the somewhat stagnant ambulatory EHR market.

From Broken Tiller: “Re: the HIMSS-owned publication. How did they mistake Amazon’s healthcare projects as building an EHR?” There’s so much to dislike about this clickbait piece: the gratuitous “Wait! What?” plea for attention, calling Amazon’s rumored healthcare projects an “investigation,” and claiming in the headline that the companies are building EHRs when nothing in the CNBC article that they reworded into a lame story suggests any such thing .

From Weezy: “Re: Allscripts acquiring McKesson EIS. Why?” Good question. They bought it cheap, apparently, like day-old bread that the store is anxious to get rid of while it’s still sellable. I have to assume that the net present value of the EIS maintenance revenue stream will cover most of the acquisition price. I see no product synergy whatsoever and I seriously doubt that many Paragon, Star, or Series customers will have an interest in moving to Sunrise, just like users of the mothballed McKesson Horizon product – like the market in general — nearly universally passed on Paragon in favor of Epic and Cerner. Maybe the bottom line is that Allscripts just likes to acquire companies (Eclipsys, Misys, Jardogs, dbMotion, etc.) in hoping that it will either all come together or that investors will remain interested in a healthcare vendor that, like McKesson in years past, runs itself like a health IT mutual fund.

HIStalk Announcements and Requests

Listening: new from Alice Cooper, which has some pretty good tracks until things get even better in the final two songs, which feature the surviving members of the original Alice Cooper band, formed by the five Phoenix high school friends in the mid-1960s and named after a minor character in the “Mayberry RFD” TV series of that era. There’s also stunning new EP from Canada grungers Theory of a Deadman that brilliantly and savagely attacks our drug-happy culture. Finally, I’m enjoying outstanding old power pop from The Posies.

Webinars

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

Acquisitions, Funding, Business, and Stock

Medical imaging and data management vendor UltraLinq Healthcare acquires Northern Ireland-based Intelesens, which offers wearable vital signs monitoring devices.

Viome, which offers at-home kit that monitors  gut microorganisms to recommend diet changes, raises $15 million in a Series A funding round. Twice-yearly stool sampling and metabolic challenge tests cost $700 per year.

Aurora Behavioral Health signs a $20 million contract South Korea-based EZCareTech, which will create a US version of its hospital information system that is used by Seoul National University Hospital called Best Care 2.0B. They exhibited at HIMSS17, which I summarized as:

I was interested in Best Care, a Korea-based inpatient EHR whose monitors showed a cool-looking product that they are apparently trying to market to US hospitals. I tried to strike up a conversion with the stern guy standing there and he wouldn’t really talk to me. I tried again with another guy and all he said was that company is “from Korea, like K-pop” and then didn’t say anything else. I tried a third time in asking a different person on the other side of the booth if it was OK if a snapped a photo of the screen and they shooed me away. I think the company had best hire some US sales talent if they want to sell here.

Theranos settles the $140 million breach of contract lawsuit brought against it by Walgreens over its in-store Theranos lab sample drawing sites.

Sales

Cedar Valley Medical Specialists (IA) chooses EHR and population health solutions from EClinicalWorks.

People

Sutherland Healthcare hires Shailja Dixit, MD, MS, MPH (Intercept Pharmaceuticals) as chief medical officer and global head of digital innovation.

Health Systems Informatics hires Mary Beth Seaman (Pivot Point Consulting) as VP of business development.

Michael Jackman (GE Healthcare) joins imaging systems vendor Mach7 Technologies as CEO.

Announcements and Implementations

Caradigm integrates Insignia Health’s self-management survey into its Care Management solution.

Community Hospital Anderson (IN) goes live on Imprivata PatientSecure biometric patient verification.

Parallon Technology Solutions leads the migration of the two hospitals of Thomas Health (WV) to Meditech 6.15 from Meditech Magic and Siemens.

Government and Politics

A new CMS rule will allow hospitals to submit only one quarter’s worth of eCQM reporting requirements for incentive payments in 2018 vs. the previously required full year. It also allows hospitals to use either a combination of 2014 and 2015 Editions of CEHRT or either individual edition to satisfy 2018 eCQM certification requirements for CY 2018. CMS says it will determine requirements for CY 2019 and future years “in future rulemaking.”

The VA will expand its telemedicine program – the largest in the country — with VA Video Connect in a collaboration with Jared Kushner’s American Office of Innovation, offering virtual visits from 300 VA medical providers at 67 hospitals and clinics. President Trump said in a statement Thursday,

Today, I’m pleased to announce another historic breakthrough that will expand VA services to many more patients and veterans.  We will do this through telehealth services.  It’s what it’s called — telehealth services.  

We’re expanding the ability of veterans to connect with their VA healthcare team from anywhere using mobile application on the veteran’s own phone or the veteran’s own computer.  This will significantly expand access to care for our veterans, especially for those who need help in the area of mental health, which is a bigger and bigger request — and also in suicide prevention.  It will make a tremendous difference for the veterans in rural locations in particular.  

We’re launching the mobile app that will allow VA patients to schedule and change their appointments at VA facilities using their smartphones.  So this is something they were never able to do.  Technology has given us this advantage, but unfortunately we have not taken advantage of that until now.

CMS withdraws its plan to require hospital accreditors such as The Joint Commission to publicly list the problems they find and the steps being taken to fix them. CMS says federal laws prohibit it from disclosing inspection reports and fears such a requirement could be viewed as an attempt to circumvent the law.

Attorney General Jeff Sessions announces formation of a Department of Justice unit that will seek out opioid-related healthcare fraud by reviewing prescribing and dispensing data for suspicious patterns. The DOJ will also fund 12 assistant US attorneys for three years who will focus exclusively in investigating and prosecuting opioid-related healthcare fraud.

The GAO announces its 15 appointees to the HIT Advisory Committee that will make recommendations to ONC as established by the 21st Century Cures Act. The first five members listed were already appointed b HHS or as consumer advocates:

• Cynthia Fisher (entrepreneur)
• Anil Jain (IBM Watson Health)
• Steven Lane (Sutter Health)
• Steve Ready (Norton Healthcare)
• Patrick Soon-Shiong (NantHealth)
• Michael Adcock (University of Mississippi Medical Center)
• Christina Caraballo (Get Real Health)
• Tina Esposito (Advocate Health Care)
• Brad Gescheider (PatientsLikeMe)
• John Kansky (Indiana HIE)
• Kensaku Kawamoto (University of Utah Health)
• Denni McColm (Citizens Memorial Healthcare)
• Brett Oliver (Baptist Health)
• Terrence O’Malley (Massachusetts General Hospital)
• Carolyn Petersen (Mayo Clinic)
• Raj Ratwani (MedStar Health)
• Sasha TerMaat (Epic)
• Andrew Truscott (Accenture)
• Sheryl Turney (Anthem Blue Cross Blue Shield)
• Denise Webb (Marshfield Clinic Health System)

ONC announces a five-year plan to switch from its own custom EHR certification testing tools to industry-developed replacements.

Privacy and Security

A New York Health + Hospitals IT employee is arrested for using the hospital’s computer and network to download child pornography. Daniel Sherlock, 28, is on probation from a similar 2015 case in which he pleaded guilty. The conditions of that case prevented him from owning a computer, he told authorities, so he used his HHC one instead. He avoided registering as a sex offender in the previous case because his low IQ classified him as intellectually disabled, a situation that apparently did not prevent him from holding a $62,000 corporate account management job at HHC.

Other

A Politico report quoting a single source claims that Epic CEO Judy Faulkner told Vice-President Joe Biden at a private January 2017 Cancer Moonshot meeting, “Why do you want your medical records? They’re 1,000 pages, of which you understand 10,” to which Biden was reported to have responded, “None of your business. If I need to, I’ll find someone to explain them to me and, by the way, I will understand a lot more than you think I do.” The source was Greg Simon, now president of the Biden Cancer Initiative and a cancer survivor. Politico’s source material was apparently this video from Simon’s fireside chat at MedCity Converge conference this week in Philadelphia. I transcribed his full comments from the video:

I think everybody here is familiar with the problem with EHR companies, which is they’re billing systems, and yet we rely on them to track doctors’ visits, our treatments, our outcomes. But they’ve never been designed to be patient friendly. They’ve never been designed to be shared. They’ve never been designed to be interactive with other systems.

The EMR companies blame all that on their customers, the hospitals primarily, and large provider networks, and they have some guilt here as well. But the Cures act that passed in December requires data from electronic medical records to be shared in a digital, longitudinal way that can be used by patients.

When we had a meeting just before we left the White House with several EMR companies, hospitals, and others,  we had, as they say in the State Department, a candid exchange. The head of a company that won’t be named – Epic – said to Vice President Biden – I should have sold tickets to this part – “Why do you want your medical records? They’re 1,000 pages, of which you understand 10.” So Biden said what I knew he would say, “None of your business. If I want to nail them to the walls of my kitchen, that’s my business. I don’t have to understand 1,000 pages. I want my records. If I need to, I’ll find someone to explain them to me, and by the way, I’ll understand a lot more than you think I do because people with cancer and their families and their friends and themselves learn a lot. So don’t make assumptions.” And it went downhill from there …

How can I as patient make better use of my medical records than having them sit in my doctor’s office? … if your financial advisor says, “Why do you want your statement?” run to the nearest police station .. we did spend tens of billions of dollars to encourage people to buy their products and we made billionaires of the executives of these companies. They’ve had fun – now it’s our turn.

An Epic spokesperson sent me this response to the Politico article:

The recount of a portion of the January 2017 White House meeting is inaccurate and misleading. Vice President Joe Biden was consistently polite and positive to every person, including every vendor, in the meeting. Epic supports patients’ rights to access their entire record, something they have been able to do for decades. In the meeting, Judy raised an issue regarding the 21st Century Cures Act that would potentially require a patient’s EHR information be transmitted in a way that was “easy to understand.” She said that a requirement to translate EHR medical terminology into patient-friendly language could be a barrier to getting the medical record out to patients. Vice President Biden agreed, saying, “That’s actionable” and requested that one of his staff get the requirement fixed.

A fascinating Bloomberg article profiles the 20-something brothers from rural Ireland who started credit card processing Stripe and built it into a company worth $9 billion and made themselves billionaires. The company just announced a deal in which it will process some of Amazon’s transactions in its goal to “increase the GDP of the Internet” and expanding its product line to help businesses incorporate, pay workers, and detect fraud so that “two people in a garage [will have] the same infrastructure as a 100,000-person corporation.” The frugal brothers moved the company into San Francisco office space previously occupied by Dropbox, immediately getting rid of the Lego room, sofa swings, and gourmet meals cooked to order, explaining, “It’s slow and indulgent to wait for food.” One of the brothers keeps a countdown clock on the wall that estimates how much time he has left to live, explaining, “When you talk to people who are old, some wish they had enjoyed themselves more, but not many wish they had wasted more time … It’s not that I don’t enjoy TV. If I had infinite time, I would watch it. This might be the entirely wrong optimization.” It’s Atlas division offers a startup toolkit that provides Delaware incorporation, a bank account, a Stripe account, and both free and discounted professional advice.

Ireland’s Healh Services Executive warns physicians that a bug in its image archive omits the less than symbol (<), so that reviewing a result that lists stenosis as “<50 per cent” would be displayed as “50 per cent.” At least 25,000 images are affected. The HSE CIO resigned right after the story ran, but HSE says his departure is not related to the glitch.

Hurley Medical Center (MI) will identify patients with food insecurity via two EHR questions, with positive responses generating a referral to the hospital’s food pharmacy that will dispense a two-day supply of healthy food. The hospital hopes to provide assistance to its Flint patients who don’t necessarily live in poverty, but whose financial circumstances may require them to choose between buying medications and buying food.

In England, a Business Insider investigative article finds that Google-owned DeepMind has paid Moorfields Eye Hospital $144,000 in expense reimbursement in a project to apply artificial intelligence to optical coherence tomography scans, hoping to automate the early detection of diabetes-related macular degeneration. The hospital performs 3,000 of the tests each week.

Sponsor Updates

• ROI Healthcare Solutions is sponsoring the RocketShot 5K on August 12 in Roswell, GA. 
• Learn on Demand Systems CEO and Chief Product Architect Corey Hynes receives the Microsoft Most Valuable Professional Award.
• Inc. profiles Logicworks CEO Ken Ziegler.
• Forrester names Salesforce Health Cloud a leader in its latest report on enterprise health clouds.
• MedData and Experian Health will exhibit at the HFMA Region 8 – MidAmerican Summer Institute August 7-9 in Kansas City, MO.

Blog Posts

• Clinical Simulation Bolsters EHR Readiness (Optimum Healthcare IT)
• What data can reveal about the drivers of hospital readmissions (Nordic)
• 5 Common Myths about Patient Engagement Debunked (HealthLoop)
• Why Modern Hospitals Need Encrypted Paging (Spok)
• Five Things Health Systems Leaders Need to Know About Access Centers (Kyruus)
• Carbondale’s Cosmic Event: The Liaison Connection (Liaison Technologies)
• CMS Home Health Emergency Preparedness (LiveProcess)
• When it Comes to a Hospital’s Revenue Cycle, Cost is King (MedData)
• Empower Your Revenue Cycle Team with 3 Tips from the Summer Vacation Playbook (Navicure)
• Connecting Digitally – a Must for Care Collaboration (Netsmart)
• Are you doing these small things to build a great client relationship? (Nordic)
• Parallon Technology Solutions leads Thomas Health to Successful Meditech 6.15 Large Scale Implementation (Parallon Solutions)
• Healthcare Innovation Doesn’t Happen Overnight (PatientPing)

Contacts

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

EPtalk by Dr. Jayne 8/3/17

The Food and Drug Administration releases guidance allowing Institutional Review Boards to waive informed consent requirements for clinical studies that have minimal risk. This is a major win for researchers trying to use big data to look at populations as well as those working on precision medicine investigations. Informed consent has been in issue when you’re looking at large banks of biological specimens and the clinical data that goes with them, or just large volumes of clinical data that are needed to identify trends and other areas for potential research. The FDA reserves the right to modify its guidance as needed, but this is a good thing for many of us.

In other government news, CMS announces that it has changed the name of the Social Security Number Removal Initiative (SSNRI) to “New Medicare Card.” Seems like something that should have been an obvious solution from the beginning, but who wants to miss out on another non-pronounceable cluster of letters?

CMS also recently released the 2016 Open Payments data. A couple of my colleagues are apparently raking it in, but most of the folks I work with all had less than $100 in annual payments. Looking at the local landscape, Novo Nordisk and Pfizer were the cheapest lunch players, followed by GlaxoSmithKline. Salix Pharmaceuticals led the pack with an average lunch cost of $24. I’m sure their mealtime presentations on their diarrhea and constipation drugs was a real showstopper.

I know I’m a card-carrying member of the Grammar Police force, but I want to again stress the need for people to be proficient in writing. I’ve been doing a little CMIO augmentation work and was presented with some documentation from a recent consulting engagement. Not only were there font and spacing issues in the document (to the point of being distracting), but there were basic grammar issues that never should have seen the light of day. There is a difference between “it’s” and “its” and also between “there,” “their”, and “they’re.” If you’re only doing spell check and not a grammar check, you’re missing out. And if you embed Excel cells into a Word document, you’re going to miss out there as well.

These are small errors, but frankly they reduce the credibility of your work. I know I’m guilty of sometimes letting a blog get out the door with some errors, but I don’t have the luxury of peer review and am usually writing from a plane, train, or automobile if I’m not writing from a half-crashed state in a hotel room. If you are charging $300 per hour for your work, you had better read it carefully and consider having a friend look it over before you send it to a CMIO. I can’t take you seriously when your work looks like it was styled by a middle school student.

The CMIO whose shoes I am filling passed away unexpectedly and at a young age. It’s been a heartbreaking assignment, because she was clearly loved and respected. Despite the depressing circumstances, people have been extremely accommodating as I begin to get up to speed and work through my plans to sort through the projects that urgently need my attention.

A search process is in full swing, but I suspect they will have challenges trying to fill the position based on how it is funded. It’s cobbled together with 40 percent administrative funding, 40 percent IT funding, and 20 percent clinical funding. The ideal candidate needs to not only have experience and knowledge, but be willing to try to serve three different masters whose needs are sometimes at cross purposes. I’m just covering the administrative and IT functions and that’s been hard enough.

We have some interviews scheduled over the next several weeks, so I am interested to see if they find someone who is up to the challenge (and also wants to relocate to a mid-sized market and to a role that does not have an associated academic appointment). If you’re on my interview schedule, may the odds be ever in your favor.

At HIMSS17, I was invited to join a virtual book club with a great bunch of women from across the country. Every month we read something and then get together on a conference call to talk about the selection. It’s a diverse group of people, with several from the healthcare IT space, one from engineering, a couple of entrepreneurs, and a retired educator. One of them mentioned that she just started reading the most recent MACRA offering in the Federal Register. She said she was thinking of making it her book club selection and giving everyone a section to read and provide a cheat sheet and their interpretation. I’m pretty she just subconsciously wants to be ousted from her book club president role, but I know most of us who have had to read it wish we could have assigned it to someone else. This month we’re discussing the book I picked, so I hope it hit the mark and they don’t vote me off the virtual book club island.

I spend an insane amount of time on the road, so I keep my eye out for services or products that can make my life easier. I have to say I am seriously intrigued by DUFL, a service that stores your business wardrobe and then ships it to your destination. As you depart, you ship it back to them for laundering so it’s ready to go again. The DUFL app displays photos of your catalogued clothes so you can pack your virtual bag for shipping. They charge $99 per trip to pack, ship, retrieve, and launder your clothes and $9.95 per month for storage. Depending on whether you’re going to have to pay to check a bag and how many items you may have to have dry cleaned when your trip is finished, the return on investment calculation looks pretty good. That doesn’t even include the time needed to pack your clothes so they don’t end up a wrinkled mess. They also offer a sports service to ship your equipment with care. I’d be interested to hear from any readers who may have experience with DUFL, because I hate going to the cleaners, as the pile of clothes on my dining room chair can attest.

Email Dr. Jayne.

Allscripts Will Acquire McKesson’s EIS Business for $185 Million

Allscripts announced this afternoon that it will acquire McKesson’s Enterprise Information Solutions health IT business for $185 million in cash.

The products acquired include the Paragon EHR, Star, Series, Healthquest, Lab Analytics and Blood Bank, and OneContent.

Allscripts CEO Paul Black said in a statement, “Adding these assets to Allscripts existing portfolio enables us to better serve our clients, increase our scale and further drive our investment in innovation. This transaction is expected to directly benefit our existing clients and our shareholders, as well as the Enterprise Information Solutions clients and team members we’ll welcome to our family. Allscripts is a critical strategic partner to thousands of healthcare organizations and our highest priority is to successfully meet their highly complex needs of today and in the future, as we enable them to lead the change to smarter care. The healthcare IT market remains highly fragmented. Today’s announcement is a proactive and strategic measure to maintain Allscripts long-term leadership and position Allscripts for continued growth.”

Allscripts says it will continue to offer Paragon to small hospitals while continuing to sell Allscripts Sunrise to larger health systems.

Morning Headlines 8/3/17

Cancer moonshot head recounts exchange with Epic’s Faulkner

Politico reports that Epic CEO Judy Faulkner told Vice-President Joe Biden at a private January 2017 Cancer Moonshot meeting, “Why do you want your medical records? They’re a thousand pages, of which you understand 10,” to which Biden responded, “None of your business. If I need to, I’ll find someone to explain them to me and, by the way, I will understand a lot more than you think I do.”

Merck Announces Second-Quarter 2017 Financial Results

The pharmaceutical giant says its June 27 malware attack continues to disrupt its manufacturing operations, possibly leading to shipment delays for some drug products, and says the company is not yet able to quantify the financial impact of the NotPetya-caused event. 

What Could Happen If The Administration Stops Cost-Sharing Reduction Payments To Insurers?

Tim Jost’s Health Affairs blog lays out the scenarios that could result if President Trump follows through on his threat to order the federal government to stop making cost-sharing reduction payments as a challenged law requires, dismissing the President’s contention that the payments represent a bailout to insurers.

Google Is Matching Your Offline Buying With Its Online Ads, but It Isn’t Sharing How

The Electronic Privacy Information Center complains to the Federal Trade Commission that Google is using secret methods to match a user’s in-store credit card purchases with their Google ad clicks, allowing it to sell ads based on how they perform in motivating offline sales.

Scientists successfully used CRISPR to fix a mutation that causes disease. This is huge.

OHSU researchers describe in a journal article how they corrected an inherited genetic disorder that causes heart problems using CRISPR, although they stopped short of implanting the embryos in a woman’s uterus. Some experts suggest moving forward with clinical trials, while others urge measuring societal perception to avoid charges of creating “designer babies.”

Morning Headlines 8/2/17

athenahealth Announces Strategic Initiatives to Drive Increased Levels of Profitable Growth and Enhance Shareholder Value

Athenahealth, under pressure from an activist investor, will target $100 million in cost saving and remove Jonathan Bush’s president and board chair titles in recruiting replacements, leaving him as CEO.

Outside Of Washington, There Is A New Vital Center In Health Care Reform

A Health Affairs blog post describes the changing opinions of the Affordable Care Act of a regularly polled panel, finding that they are frustrated with Democrats for not delivering on their promise of affordability but are also alarmed with the repeal efforts of Republicans.

Fees for Certification and Finances of Medical Specialty Boards

A JAMA research letter questions the high certification and renewal fees physicians pay to members of the American Board of Medical Specialties that have seen their income and assets swell from that income.

Quality Systems’ (QSII) CEO Rusty Frantz on Q1 2018 Results

NextGen’s parent company reports results that beat Wall Street expectations, its receipt of a Civil Investigative Demands letter from the Department of Justice, and its planned acquisition of analytics vendor EagleDream Health.

News 8/2/17

Top News

Athenahealth — under pressure from activist investor Elliott Management — will undertake an operational review and says it has already identified $100 million in cost-saving opportunities.

The company will also hire a president and will recruit an independent board chair, removing both responsibilities from Jonathan Bush in leaving him with just the CEO title.

ATHN shares rose 5.6 percent Tuesday.

HIStalk Announcements and Requests

Welcome to new HIStalk Gold Sponsor TriNetX. The Cambridge, MA-based company’s TriNetX Live health research network connects healthcare organizations, biopharma, and contract research organizations so they can collaborate, enhance trial design, accelerate recruitment, and bring new therapies to market faster. Members can analyze patient populations using search criteria across multiple longitudinal data points. Advanced analytics identify the most impactful criteria and the rate at which new patients present. Each de-identified data point can be traced to healthcare organizations that can then identify individual patients, allowing researchers to create virtual patient cohorts from real-world clinical trial settings. They can also find patients for studies and collaborate with peer research organizations. The network contains 84 million patients, 7.1 billion clinical facts, 3,554 protocols analyzed, and 757 trial requests, with all data de-identified to the user with all PHI remaining local. CEO Gadi Lachman is an industry long-timer, having held executive positions with TriZetto, Eliza, and American Well after he earned a law degree and a Harvard MBA and served as an officer in the Israeli Special Forces. Thanks to TriNetX for supporting HIStalk. 

Webinars

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

Acquisitions, Funding, Business, and Stock

Meditech announces Q2 results: revenue down 3 percent, EPS $0.39 vs. $0.44. Both product and service revenue dropped slightly quarter over quarter.

Quality Systems (NextGen) announces Q1 results: revenue up 7 percent, adjusted EPS $0.17 vs. $0.15, beating analyst expectations for both. QSII shares rose 3 percent Tuesday.

From the Quality Systems earnings call:

• The company has received a Civil Investigative Demands letter from the Department of Justice. They’ve heard that other vendors have received similar letters, which are sent when the Attorney General believes that a person or company has material relevant to a false claims law investigation.
• President and CEO Rusty Frantz says NextGen isn’t seeing any increased market interest following the EClinicalWorks settlement with the Department of Justice, explaining that, “KLAS came out with a report that says a significant number of clients are looking to change, but if you read further down in that, only about 4 percent, according to them, were actually looking to change because of concerns with how they operated.”
• Frantz says his recent large-client user group meeting “was a little tough … we had some really unhappy clients out there” due to lengthy upgrades that the company is committed to improving.

Quality Systems will acquire analytics vendor EagleDream Health for $26 million in cash. The company has “a dozen or so” clients — none of them running NextGen — and generated a loss of $4 million on $1 million in revenue last year. It raised $1 million in a single funding round in May 2016.

Sales

Mercy Health Services (MD) will implement Bernoulli One to integrate perioperative suite anesthesia devices with Epic.

Vail Valley Medical Center (CO) chooses Spok Care Connect for secure mobile messaging, clinical alerting, emergency notification, physician on-call scheduling, and contact center efficiency.

Catholic Medical Center (NH) adds several Allscripts Sunrise products to its existing Acute Care, Critical Care, and Pharmacy modules including Ambulatory Care, Emergency Care, Surgical Care, Radiology, Financial Manager, Critical Care, and several others.

People

Roni Amiel (Frost Data Capital) joins Notal Vision as CIO.

OptimizeRX hires Miriam Paramore (Lucro) as president.

MD Anderson Cancer Center VP/CIO Chris Belmont announces that he will leave the organization.

Announcements and Implementations

Kootenai Health (ID) formally aligns with Providence Health & Services, with Kootenai’s CEO saying the biggest benefit is that his organization was already replacing Meditech with Epic, which will allow it to easily share information with Providence’s Epic system. 

Recondo Technology says bookings for its cloud-based RCM applications are up 72 percent, particularly for its Epic-integrated ClaimsStatusPlus system.

In the UK, Imperial College, Edinburgh University and Salford Royal NHS FT win the bid to run the virtual NHS Digital Academy, which will train 300 NHS digital leaders over the next three years in a year-long, part-time study program for CCIOs and CIOs in which Harvard Medical School will also participate.

Government and Politics

An interim report from the White House’s opioid crisis commission calls for the President to:

• Declare a national opioid emergency
• Eliminate Medicaid drug treatment limitations
• Require all DEA registrants to complete a pain management course
• Equip every police officer with fentanyl detection sensors as well as the opioid-reversing drug naloxone
• Provide technical support and funding to connect state prescription drug monitoring program databases to each other and to federal healthcare systems
• Remove the HIPAA limitation that prevents addiction treatment professionals from sharing information with other providers without written patient consent

An interesting Health Affairs blog post summarizes changing feelings about American healthcare, obtained by surveying the same panel of respondents every two years since the ACA’s passage in 2010. Some of its findings:

• Dissatisfaction rose from 45 percent to nearly 60 percent, mostly because Democrats largely failed to deliver on their promise to lower the cost of insurance premiums and healthcare services.
• Out-of-pocket costs and treatments that insurance doesn’t cover were big dissatisfiers.
• More than half of those polled think the ACA increased their taxes, which is probably not true since the high-income thresholds affect less than 2 percent of the population.
• More Americans prefer to improve ACA rather than repeal it.
• Even though few Republican respondents view the ACA favorably, its personal impact (such as coverage through age 26) is changing some of the party line perception.
• Americans aren’t disappointed with ACA coverage, but rather their lack of access to government coverage instead of private coverage. People of all political beliefs who are on Medicare, Medicaid, or a subsidy financed by the ACA are more satisfied with their insurance cost by a margin of 20 points.
• The study concludes, “Public opinion toward the ACA has been poorly understood because of an apparent contradiction. On the one hand, a growing share of the public harbor unfavorable views of the ACA as a whole, and proponents of repeal have seized on this dissatisfaction to claim a popular mandate. On the other hand, the discontent of Americans stemmed from disappointment with the ACA for not satisfying their expectations of genuine protection from the burden of costs. Far from wanting to be rid of the ACA, Americans are looking to it to deliver more effective protection.”

Lobbyists for physician groups and  insurance companies brag that a House-passed bill that would lower malpractice damage limits and limit attorney fees was nearly a word-for-word copy of what the lobbyists themselves drafted. Legal experts say it’s rare that a bill moves through a chamber without changes or public hearings and note that the bill was passed just four days after its introduction. The bill’s sponsor, Rep. Steve King (R-IA), acknowledges the industry’s involvement, but added, “I just don’t want to have to ride that horse again. Let’s get ‘er done.” 

The Senate’s HELP Committee will hold hearings in early September to craft a short-term plan to stabilize the individual insurance market, hoping to complete their work by mid-September when insurers make their final decisions on premium prices.

Privacy and Security

NIST and HHS OCR will co-host “Safeguarding Health Information: Building Assurance through HIPAA Security” September 5-6 in Washington, DC or via webcast. It seems strange that no food or beverages will be provided to in-person attendees and that webcast viewers pay nearly the same registration fee. It’s also ironic that webcast viewers are required to install Flash viewer, one of the most insecure software components on the web.

Innovation and Research

Inova Health (VA) will launch its Personalized Health Accelerator next month, offering chosen startups $75,000 in return for 10 percent equity and hoping to lead founders through a 4-5 month program that will enable them to attract outside investment and then apply matching Inova funds if they are successful. Those companies would then have access to Inova’s $100 million venture arm. The accelerator is looking for startups in predictive analytics, artificial intelligence, big data, and wearable devices. 

Other

A ranking of how well states are prepared for success in a data-driven economy places Massachusetts, Washington, Maryland, California, and Delaware at the top, with South Carolina, Alabama, Louisiana, West Virginia, and Mississippi rounding out the bottom 50. It’s perhaps unrelated that four of those five bottom-dwelling states (replacing South Carolina with Kentucky) have the highest obesity rates in the country, while Alabama, Louisiana, and Mississippi are also ranked among the five least-healthy states overall. They fare much better in college football rankings.

A JAMA research letter questions the high cost to physicians for earning and maintaining certification from the 24 members of the American Board of Member Specialties, which earn 88 percent of their swelling revenues from administering the exams, increasing their collective assets to $653 million. The study finds that doctors spend an average of $5,600 to take the exam — including the oral exam required by 14 of the boards — and then pay up to several hundred dollars each year to renew their certifications.

The local newspaper reports that the highest-paid hospital executives in Montreal, Canada are the fundraisers at McGill University Health Centre’s foundation, which ranks below average for donor accountability.

Sponsor Updates

• Optimum Healthcare IT completes its Level 1 call center support for the Epic go-live of Guthrie Clinic.
• Sphere3 offers a Gartner paper titled “Healthcare Moment: An Emergency Room Leverages The Real-Time Health System To Improve Efficiency.”
• Consulting Magazine recognizes Impact Advisors for the participation of its employees in a project that delivered 200 backpacks to patients at Florida Hospital for Children.
• Agfa Healthcare receives FDA clearance for Advanced Clinical Applications on the Xero Universal Viewer.
• Besler Consulting will exhibit at the HFMA Region 8 MidAmerica Summer Institute 2017 August 7-9 in Kansas City, MO.
• CoverMyMeds will exhibit at the Mediware Customer Conference August 7-9 in New Orleans.
• Glytec Chief Medical Officer Andrew Rhinehart, MD contributes to the American Diabetes Association’s new standards for diabetes self-management education.
• Healthwise will exhibit at Allscripts ACE 2017 August 8-10 in Chicago.

Blog Posts

• Three Key Steps to Maintaining Top-Notch Data Governance (Forward Health Group)
• 70 Companies Driving the Future of Healthcare Technology (Redox)
• Taking Approval Processes to School (Access)
• Are you READY to reinvent your EHR system? (Meditech)
• EHR vs. EMR: Differences Between Electronic Health Records Software (AdvancedMD)
• Summer Means MACRA/MIPS Fun (Aprima)
• What does it take to be a 100% HIPAA compliant cloud company? (Datica)
• Examining How Online Patient-Reported Outcomes Make a Difference in Cancer Care (Carevive Systems)
• Top 12 Strategies for a Successful Implementation – Part 2 (Casenet)
• You Only Fail When You Refuse to Try (CTG)
• Population health, then and now (EClinicalWorks)
• 5 Signs Your Pre-Registration Process Needs an Upgrade (FormFast)
• The Missing Link: Patient Responsibility for Health Records (Hayes Management Consulting)
• Healthcare Digital Transformation: What, Why & How (Part 1) (The HCI Group)
• Selecting Top Quality Hospitals for Maternal Care (Healthgrades)
• Preparing for cyberattacks: building a resilient infrastructure (Imprivata)
• Coach Your Healthcare Marketing Team to Consumer Experience Success (Influence Health)
• Time to Remove the Clutter (InterSystems)

Contacts

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

HIStalk Interviews Girish Navani, CEO, EClinicalWorks

Girish Navani is CEO of EClinicalWorks of Westborough, MA.

Tell me about yourself and the company.

EClinicalworks was founded in 1999. We have had significant success in the ambulatory electronic health records space.

What may not be very easily identifiable is the size at which we have had an impact. For example, last year more than 200 million electronic prescriptions and more than 270 million visits were recorded by a provider using EClinicalWorks EHR. I’d go as far as to add that in last 17 years that other than Epic, no other EHR company has had more physician EHR implementations than EClinicalWorks.

Additionally, over the last five years, we started building products for patient engagement under the Healow brand. We have had remarkable success in terms of acceptance. As an example, last year Healow providers sent 200-plus million reminder messages to patients regarding conditions and visit reminders.

That’s the summary of the company in terms of its footprint and how it gets used everyday in the healthcare space.

The company didn’t admit any guilt in the Department of Justice settlement involving falsified testing results, lack of data portability, and failing to keep customers informed of software defects. Given the limits of what you’re allowed to say based on the settlement terms, what’s the side of the story we haven’t heard?

First of all, let me say this. There are regulatory requirements that electronic health record users have to comply with and there are requirements that electronic health record vendors have to comply with. In 2015 and 2016, there were technical non-conformities identified by the government. Once identified, we addressed them promptly. These non-conformities were not intentional on our part, nor did we know about them and ignore them. Nevertheless, I respect the right of the regulatory authority to enforce the requirements.

We have to move forward. We addressed the non-conformities. We also found a meeting ground on the settlement that allows the company and me to focus on tomorrow. I have resumed my normal work activities, including my personal time with family that got compromised last year. We have developed a stronger compliance program and it has made the company stronger. I am more focused on developing our next EHR version and making a positive impact

Do you think the value of the settlement at $155 million reflected the DOJ’s desire to have a single point of resolution without having to ask your customers to pay back their Meaningful Use payments?

I can’t speculate on all parts of the question. But, yes, the settlement amount certainly represented a portion of the Meaningful Use dollars paid under the program.

How have your customers and prospects reacted since the settlement was announced?

I have received hundreds of positive, reinforcing emails. We’ve done well by our customers. My customers recognize it and I’ve received support from a large number of my customers. I have not seen any attrition attributed to the settlement.

Secondly, in terms of new business, June was our best sales month of 2017. We signed 100 new customers and over 1,000 new providers on the electronic health record side. We did well on the population health side as well, as five new ACOs picked our pop health product. Last Friday, we announced our Q2 2017 numbers. We had a strong June and second quarter in terms of new and existing business.

I would summarize by broadly saying that the customer base likes the product and loves the company. It is my commitment to everyone that uses our product that EClinicalWorks is going to be focused on a much brighter tomorrow and that message is strongly heard by my customers. I am dedicating a lot of my time to making the product and service better. I don’t see why an existing customer won’t be delighted with that information and I think it has been reconfirmed to some extent in June with our continued momentum

What progress has the industry recently made in interoperability and data portability?

I have positive data to share in this particular regard, not just for EClinicalWorks, but for many industry players. I would unequivocally say that Carequality has been successful. We’ve been able to connect many Epic customers on a regular and routine basis.

It’s not just connectivity in terms of data exchange, but the simplicity with which we are able to do it. We’re able to onboard practices within minutes. We built the Carequality Hub in the cloud and we can add new practices quickly. There was a recent article regarding an ECW customer, Eagle MD, a 61-provider group in North Carolina. They have a lot of patients in common with Cone Health, which is an Epic implementation. They talked about how patient care has improved because of Carequality.

CommonWell Health Alliance, which we are also a member of, has had success when it comes to Cerner Hospitals. Some of the other acute EHR vendors have not necessarily put the same energy behind it. I hope that changes and we see more success there.

Broadly, I am excited about the fact that these networks can become equated to Visa or Mastercard networks and interoperability becomes more of a trust model that providers have to activate versus custom software that vendors have to develop. We are there from a technology standpoint. It’s now a question of getting providers to start activating the trust relationships so they can retrieve and send data to any provider as patient care is being delivered.

It is happening. This is not hope for the future. We are seeing data exchange happening every day.

How would you assess the industry’s maturity in managing cloud-based systems based on the latest high-profile, extended outage?

The move to the cloud model is — not just for healthcare, but for the ecosystem of every industry — irreversible. We are seeing business models over the last decade facilitated by the cloud that just cannot be contemplated by on-premises and siloed implementations. Uber doesn’t own any cars and does not own the mapping technology, yet it is now one of the largest transportation companies.

Healthcare is no different. Healthcare has the provider side. Healthcare has the consumer side.

The move to the cloud is an irreversible process. It has to go through its trials and tribulations, but the same can be said for an on-premise system. I would not take this episode to be the barometer of whether the cloud is going to revolutionize the delivery of care. I think it will, and it is as we speak.

What significant changes in the ambulatory EHR market have occurred recently and what developments do you expect going forward?

Let me give you an analogy and then make my point. Microsoft Word, Excel, PowerPoint, and Outlook were mostly on-premise deployments with Microsoft Exchange servers. That has been replaced with Office 365. Not everybody has moved to Office 365, but if you look at both Microsoft and its customer base, Office 365 is the trend. I don’t think that is reversible. You want one cloud service that provides all end user capabilities and IT capabilities — storage, collaboration, and anytime, anywhere access.

You expect the same when it comes to not just ambulatory, but healthcare information technology in general. You need to have a unified cloud service that delivers capability, whether it’s scheduling, EMR, practice management, patient engagement, or population analytics. A customer should expect these to be an unified cloud service.

Will it require significant investment? Yes. It’s not 1, 2, 5, or 10 million dollars. It’s tens of millions in terms of capital, organizational investments, and processes that have to be invested. We’ve gone through this over the last 17 years. We know the effort and capital required. So if it results in any significant market change from a vendor standpoint, it will be based on the ability for those investments to be made.

Alternatively, there is Amazon Web Services and Microsoft Azure. It doesn’t preclude a smaller company from leveraging these platforms and building a cloud offering if they want to. But the product has to be architected first to be cloud-centric. It’s not about taking a client-server product and deploying via Citrix or Windows terminal server in the cloud and merely hosting the system. The true differentiator is a cloud collaboration platform that encompasses all capabilities we just talked about.

Companies that can deliver health information technology via the cloud will succeed over the next decade. The other models won’t survive. You and I don’t get electricity today through generators that we power our individual homes with. We expect the electric grid to deliver power. Users should expect the cloud to deliver data and information powering the devices and not having servers housed locally doing it.

What is the status of the hospital system ECW is developing?

We have two products to talk about. One is for the ambulatory surgery center market. Over the last two years, we developed our ASC offering and have had success with existing customers that have ambulatory surgery centers. This product took us in the OR space with anesthesia documentation, preference cards, surgery scheduling, etc. Our ASC product has been successfully rolled out and we’re able to get many of our customers to now implement it.

We have also, without too much fanfare, been developing our Acute Care EHR offering for many years. Our pathway is different. We don’t want to acquire a company to build the solution. Instead, we partnered with our ambulatory hospital customers as joint development partners, or JDPs. We worked with them to develop the Acute Care EHR solution.

We have a large team of product analysts working on site with our JDP hospitals. We have had good customer acceptance to the whole idea of a unified cloud-centric inpatient-outpatient system that will manage the breadth of the acute care space — from ER on one side to all of the ancillaries that include pharmacy, LIS, RIS, etc. We expect to go live with our JDP customers in the first half of next year.

What challenges do you see as you enter that market, which has had basically no new significant entrants for decades?

First, I see excitement, I am an entrepreneur who has a strong technology background. I thrive on the idea of change. Getting into an established market like inpatient, and to some extent, challenging it with a newer premise — a cloud-based offering — that’s exciting.

What challenges does it offer? It is a wide space. The Acute Care EHR requirements and the number of modules as we count them exceed 25. I would put ER as one module, LIS as another one, for example. There are 25 such modules that we have to develop. The breadth is substantial. It takes significant engineering work, product analysis, and product management.

We communicated to our customers that this was going to be multi-year journey. I am comfortable with the progress we have made. We are getting to the stages of user acceptance testing and integration testing in the second half of this year.

The challenge also is the mindset. Can per-bed, per-month pricing truly change the status quo? If you draw parallels, SAP used to dominate the ERP systems for a very long time. Then came Salesforce, with a different model. Salesforce initially succeeded in smaller footprint enterprises and then it stepped its way up the ladder to enterprise systems that have larger scale.

It’s not uncommon for me to be asked a question, will you be limiting this to a certain size of the hospital? It’s more intuitive for me to answer that we will start with the smaller ones and we’ll step it up. But we are not designing the product to meet the needs of a critical access hospital and ignoring larger hospital systems. The market will accept it on its own terms after we have proven success. I am patient while quite enthusiastic about investing in this space.

What is the population health management opportunity and how are you responding to it?

Population health is primarily being driven by the fact that payer reimbursement for care delivery is changing. EClinicalWorks has developed the analytics platform, the care management platform, and has additionally developed risk models and predictive analytics. From a market share standpoint, when it comes to physician groups that are accountable care organizations, we have one of the largest footprints in this space.

The next evolution is patient engagement. When it comes to home trackers, home monitoring, telehealth etc., we have a sophisticated product offering developed under the Healow brand.

In summary, I don’t see this to be a niche area. I see this to be an evolution of the digitization of healthcare. But then again, that’s how I have always visualized technology. I see this as a vertically integrated supply chain. You start from one end of the spectrum and you go to the other.

The first decade was about digitizing the provider space. The next decade is going to be about digitizing the patient experience and managing panels of patients. Companies that do well in that space will thrive and the ones that build a fully vertically integrated ecosystem will do even better.

You said in our 2008 interview that your goal was to work 15 years and leave behind a legacy of a stable software company that could be turned over to the next generation. We’re more than halfway into that 15 years. Where do you see the company going from here?

I have obtained the first goal that any entrepreneur founder has about a company, which is to have success that can be recognized in its industry. We have attained that.

Along the way, I have developed broader goals. To me, it was always about building a company that outlasts its initial founders. This was the premise that made us not go public or take on private equity.

This area of my thinking has been further enhanced over the years. I expect  in my next 10 years to serve a broader population of patients, I’d like to see digital healthcare result in positive health outcomes, I’d like to see our company participate in clinical trials and research. I would like to see genomic data become a part of electronic health records so that precision medicine can succeed.

I am energized and enthusiastic about the next 10 years. Over the last six weeks, I’ve rediscovered myself to some extent and I’m plowing forward. You should expect more from my company and me.

Do you have any final thoughts?

I love my work and I think the future of digital healthcare is bright. Every industry has to go through a maturation phase, I think we’ve attained that in the US healthcare system in terms of the adoption of the basic foundation of digital care.

What we need to now focus on are the benefits. Anytime, anywhere patient care via the use of telehealth and intelligent messaging, genomic data resulting in personalized medicine. I just don’t see why a patient in some part of the world can’t get a second opinion from a neurosurgeon in the US. Many of these broad goals can be attained with the use of technology. It will take some time, but it will happen in this lifetime.

Morning Headlines 8/1/17

White House panel urges Trump to declare state of emergency over opioid crisis

A White House commission addressing the opioid epidemic recommends that President Trump declare a federal state of emergency.

Republicans ignore Trump’s Obamacare taunts

Senate Republicans say they won’t try to repeal the Affordable Care Act despite the President’s tweets declaring that they should address no other pressing issues until they pass a healthcare bill.

Baltimore-based Evergreen Health to be liquidated

Baltimore-based HMO Evergreen Health, launched by a former city health commissioner, will be liquidated after investors withdraw their bids to acquire the company.

Spare America a do-over on health care. Seize the bipartisan moment.

Former CMS Acting Administrator Andy Slavitt says in a USA Today opinion piece that Americans should hold President Trump accountable for his threats to cut off Affordable Care Act insurance subsidy payments to low-income citizens and instead demand bipartisan healthcare support. 

Curbside Consult with Dr. Jayne 7/31/17

I wrote a little in the last EPtalk about the interview Atul Gawande recently did with Tyler Cowen. I find Gawande fascinating and appreciate his measured, real-world thoughts around some of the challenges we face in healthcare. There’s a lot of push to try to have technology solve everything and his respect for simple solutions, such as checklists, is refreshing.

One of the topics covered in the interview was medical education, specifically what is missing from the way we train doctors. Many of us recognize that there has been quite a bit added to medical education in the last few decades – genomics, precision medicine, and the concepts of clinical quality and patient engagement. I started my medical education at a time when schools were first realizing that non-science majors could be physicians and that we had other knowledge to bring to the table.

Gawande notes that there isn’t any education “around the fact that we are no longer a craft. It’s no longer an individual craft of being the smartest, most experienced, and capable individual.” He goes on to say that medicine has “exceeded the capabilities of any individual to manage the volume of knowledge and skill required” leading to care delivery via teams. Students need to know how to function as a team, how to manage when the team isn’t being effective, and more.

I’ve found that it’s not just in medicine that people are missing out on functioning as teams. Our culture has become so competitive, even down to the ranks of toddler soccer, and activities that promote teamwork and team development seem to sometimes fall by the wayside. Although sports can be an avenue for teamwork, I see more push towards individual performance and trying to advance to more exclusive teams than I see towards working to make sure the team is the best it can be.

I’m working with a client right now that is a case study for this. They have a small stable of individual contributors working on process improvement projects. They can each recite a long list of their achievements and how they have climbed the ladder, but they are struggling to grasp the concept of themselves as a team. Some of it resolves around trust in the team, and teaching people to trust each other is a lot harder than people think. With this group, I’ve never seen as many eye-rolls as I did when I asked the group to read “The Speed of Trust” by Stephen Covey.

He shares his thoughts on physicians of the future needing to operate more as trusted counselors who have increased dialogue with patients about their goals and needs. During my career, I’ve watched the physician-patient relationship evolve from a more paternalistic model to one of shared decision-making and patient empowerment. Being in a more consultative role makes sense, but unfortunately our current framework for compensating physicians doesn’t support that. Even with the transition to value-based care, physicians are being paid for outcomes, which means following population-based protocols that may or may not be right for a specific patient.

He mentions the mismatch between treatment and patient priorities as being a cause of suffering. Additionally, he notes that the change in how healthcare is financed has altered care: “Just the payment incentives alone dramatically affect whether my tendency is to give you overtreatment in certain situations and undertreatment in others.”

I did find it funny and a little bit ironic that Gawande said, “The most powerful tool that a clinician has is their pen, and has the power to order medications to test, to doing an operation.” I haven’t used a pen in the exam room for years and usually I only use one to sign return-to-work notes or controlled substance prescriptions. It just doesn’t sound as exciting to say the most powerful tool you have is your computer, although I think it’s true. For many of us, it’s not just about ordering tests – it’s about having immediate access to information from around the world and to be able to bring that information to the discussion at the point of care.

Gawande was asked about the FDA and whether the new drug development process should be liberalized. Some of us weren’t around when there was no such thing as the FDA and he has some good reminders in that regard. Although it was a time of innovation, it was also a time with horrendous medical endeavors such as the frontal lobotomy and the Tuskegee experiment.

He notes that the process of regulating medical treatments has been sped up by patient engagement efforts around HIV and has led to more discussion of the balance between risk and speed of innovation. Increased speed has led to more drugs being withdrawn as a result of post-marketing surveillance and he supports balance in the approval process. He also mentions his thoughts on the FDA not only regulating drugs and surgical devices, but in tracking outcomes for surgical procedures. Although procedures can have some variability based on the patient and the circumstances, he feels there is a fair amount of institutional variability that could benefit from tracking and analysis.

The interview was a far-ranging discussion, including Gawande’s thoughts on Stevie Wonder (was overrated, now underrated); Michael Crichton (both over and underrated); and Karl Knausgard (overrated). He tags wearables as underrated, largely because they don’t do terribly much right now.

He also talked about his work as the director of Ariadne, an academic center that is part of Brigham and Women’s Hospital and the Harvard Chan School of Public Health. The center looks to study how science and innovation impact healthcare delivery. They recently did work with the state of South Carolina studying how to encourage surgeons to use a surgery checklist without regulations or mandates. Their program achieved 40 percent adoption, but he noted that it would likely take mandates or another process to bring the other 60 percent of surgeons to use it. I have to admit, the center has been running for five years and I hadn’t heard of it, although it sounds like something I’d be very interested in. I have a good friend starting her MPH at Harvard this fall, so I’ll have to see if she can get me an insider view.

There were some other interesting statistics in the interview. The average American has eight operations in his or her lifetime. He’s particularly interested in that because surgery is “the highest-risk, highest-cost, highest-failure moment in your lifetime.” Personally, I think the idea of having eight surgeries is something to be explored in its own right and would love to dig into those numbers.

I also appreciated Gawande’s thoughts on building his team and hiring the right people. He encourages the hiring manager to come up with a list of accomplishments for the next two years and hire someone who can meet the goal rather than hiring someone that is likable or fun. He notes that people should Intend: “Do what you intend to do, and do it with intention. Over and over, that’s what people fail to do.” I see a lot of that in my own world, people treading water or going with the flow, and moving with intention is significantly less common.

The interview closes with Gawande’s thoughts on indie music. He recommends Scottish band Frightened Rabbit, who he describes as “bards of sorrow and nonetheless sticking it through.” He warns that “they’re Scottish, so there’s a whole lot of cussing going on.” Based on that recommendation alone, I’ll have to check it out.

Email Dr. Jayne.

Digital Health Fragmentation – Is Amazon the Answer?

Digital health updates are written by LoneArranger, an anonymous industry insider.

Thousands of startups in the digital health space offer a wide variety of features and functions, generally targeted at specific conditions and diseases or designed to address relatively narrow use cases. Relatively few of these are actually being prescribed by providers, and the most popular consumer apps do not typically ingest data from EMRs or other healthcare information systems.

They may have the capability to export data to these systems, but not necessarily in a way that yields any real value for providers or patients. Further, many are standalone tools or part of limited proprietary collections of loosely related applications that fail to offer the value proposition that would engage a large number of users.

This lack of critical mass has impeded broader adoption and limited the potential of digital health solutions to have a significant impact, at least in the near term. Other than the mobile versions of EMR portals like MyChart, few universally applicable solutions cut across large numbers of health systems and users. Even then, they may function differently depending on the sponsoring organization or local community policies. Just having a large number of mHealth apps in the major app stores does not constitute a critical mass for the purposes of delivering value that customers will actually pay for.

What is needed is a comprehensive, cohesive, and interconnected ecosystem that provides greater value for both providers and patients. The goal would be to create an environment that encourages innovation, but also provides a framework for connecting the myriad of applications into logical clusters and leveraging functionality and data that already exists in legacy health IT systems.

This may be the ultimate goal of the newly announced Amazon 1492 health research initiative. The 1492 group reportedly has been working on ways to streamline medical records management, to make the information more readily available to consumers and doctors. In addition, it reportedly has been considering a plan that could improve US healthcare for those with limited access to a doctor. The group is also exploring health applications for existing Amazon hardware, including Echo and Dash Wand. While there’s no evidence that the team is currently exploring connected health devices, it’s possible it could eventually do so.

Obviously Amazon has already built a comprehensive marketplace for selling and distributing a wide variety of goods and services, and global scale which puts it in a prime position to create a mass market once these new offerings are launched. It has existing relationships with many potential customers and through its portfolio of Cloud and other technology products and services has strong connections to enterprise customers, including many in the healthcare industry.

Amazon could use all of these capabilities to create a national framework for digital health delivery that could also provide local customization, working with leading health systems across the country. This would potentially enable patients to access a broad suite of connected apps and services that shared data across the ecosystem and also integrated with their existing patient records at various institutions where they existed. Data from all sources could be aggregated into a complete longitudinal record that could drive advanced analytics and artificial intelligence to enhance patient care and provide improved patient engagement and interaction with their providers to better manage their health.

This is one (but not necessarily the only) way that the true potential of digital health could be realized.

Morning Headlines 7/31/17

Mark Zuckerberg, Priscilla Chan Donate $10M to Advance Health Using Big Data

The donation will fund the launch of UCSF’s Institute for Computational Health Sciences, which will perform analytics-powered drug discovery using a combined EHR dataset from all five UC system medical centers.

Cerner (CERN) Q2 2017 Results – Earnings Call Transcript

Cerner says it will name a new CEO soon and acknowledges that it will serve as prime contractor in the VA project for which the contract is being negotiated.

Doctors use this software during patient visits. Now Big Pharma is tapping it to sell their drugs

Doctors in Canada question whether EHR vendor Telus Health should sell drug companies the chance to have their patient discount coupons pop up in their workflow.

Monday Morning Update 7/31/17

Top News

Mark Zuckerberg and Priscilla Chan, MD donate $10 million to launch UCSF’s Institute for Computational Health Sciences, which will perform analytics-powered drug discovery using a combined EHR dataset from all five UC system medical centers.

The institute is headed up by UCSF pediatrics professor Atul Butte, MD, PhD, who says, “This is among the richest and most diverse medical datasets in the world, much more than just a set of billing codes. Because the data come from our patients, the data are an incredible resource for UC hospitals to improve the quality of care we deliver throughout California.”  

The UCSF announcement describes the potential application of Butte’s “data recycling” project that will analyze existing data sets to gain new insights:

The results of his work can be surprising. By combing through databases, members of Butte’s lab have shown that it may be possible to combat liver cancer with a drug originally approved to kill parasitic worms. They recently developed another computational method that rapidly predicts what other drugs might treat cancer, again using readily accessible public databases.

These approaches may offer a more cost-effective way to discover drugs than conventional strategies. To bring these novel, computationally identified drug candidates into early clinical trials might require a few hundred thousand to $1 million, compared to the $10 million to $1 billion or more that a pharmaceutical company typically spends to bring a new drug fully to market.

But drug discovery is just one potential use of data, as both scientists and physicians acquire deeper computational sophistication. At medical centers like UCSF, electronic health records (EHRs) are increasingly being looked to for insights on how to improve the quality of care and to better understand disease. For example, UCSF physicians used the medical record system to institute a virtual glucose monitoring system that, over three years, reduced the proportion of patients who were hyperglycemic by nearly 40 percent.

Reader Comments

From UMMC_Breach: “Re: University of Mississippi Medical Center. Another breach. This time their Epic server was hacked, affecting 7,500 individuals.” HHS’s wall of shame says the breach, categorized as a “hacking/IT incident,” was reported three weeks ago. I haven’t seen details. UMMC paid $2.75 million a year ago to settle HIPAA violations related to theft of an unencrypted laptop and poor implementation of security policies and procedures. UPDATE: a UMMC source says it wasn’t Epic that was breached – it was a retired EHR from a facility UMMC acquired several years ago that was maintained by a third-party vendor who operated it on an isolated network. It was never running on UMMC’s network.

From Richard Head: “Re: must-read HIT blogger list. You are on it.” Thanks. I’m not too impressed by the list, which was put out by a publicity-seeking, vendor-produced magazine. The evaluator is the 24-year-old “senior editor” whose LinkedIn says she was working as a bar cook three years ago before landing a job in aviation publishing and finally meandering into healthcare a few months ago. She actually made a few good choices, but some of the sites appear dormant, don’t have anything interesting to say, or have resorted to running promotional articles written by paying vendors. I only read two of the sites listed — Politico Morning EHealth and John Halamka’s Life as a Healthcare CIO.

From Subdude: “Re: Epic’s hardline stance against hosting third-party systems with their new RHO offering. I’m surprised Epic since has many third-party dependencies, far from a full-service offering comparable to those of other vendors.” Subdude provided a list of systems that Epic won’t host, some of which are:

• PACS and coding
• Credit card processing
• Document management
• Supply chain systems
• Faxing
• Fetal monitoring
• Interface engine
• Lab instrument middleware
• Medical device integration systems
• Enterprise print management
• Single sign-on
• Telemedicine
• Speech recognition

From Vaporware?: “Re: Cerner’s DoD go-live at Oak Harbor. Zane Burke listed what went live in the conference call. What was missing: CommonWell, Cerner Network, or any kind of record exchange to the outside world. No connections Cerner to Cerner, to Athena, or to Carequality. The facility is literally on an island, but this is taking it a step too far.” I wouldn’t assume that failing to mention interoperability to a bunch of stock analysts means it’s not in place, but maybe someone in the know can elaborate further.

From Jade Warrior: “Re: provider. I would prefer that you not use that term – it’s demeaning to physicians.” Physicians tend to forget that they aren’t the only “providers,” which is why a more-inclusive term was needed to collectively refer to physicians, hospitals, nurse practitioners, physician assistants, podiatrists, and other non-MDs/DOs who see patients without over-the-shoulder supervision, prescribe medications, and bill for their services. I don’t even like the title “doctor” since physicians hijacked it from others who are equally entitled to use it, such as pharmacists, dentists, or nurses who have earned a PhD or DNP (in which case your nurse is a doctor). The proper response to someone who announces, “I’m a doctor” is, “In what field?” (or if you have a master’s degree, you could say, “Great, I’m a master.”) Maybe for individual providers (not hospitals) we should use the profession’s name to eliminate all confusion  – Physician Smith, Nurse Jones, Dentist Garcia. That still leaves the issue of someone who has earned the degree but didn’t obtain licensure or isn’t practicing, such as the late Monty Python co-founder Graham Chapman, MD or Argentinean revolutionary Che Guevara, MD.  

HIStalk Announcements and Requests

Cerner shares would be vastly preferred by poll respondents forced at gunpoint to choose one of those listed, with Athenahealth finishing a distance second. New poll to your right or here: how would you grade your largest local non-profit health system in terms of selflessly serving their communities and all patients who need their services? Vote and then click the poll’s Comments link to explain their score.

Welcome new HIStalk Platinum Sponsor InteliSys Health. The Las Vegas-based company offers RxStream, the first real-time prescription transparency platform. RxStream integrates into e-prescribing and EHR workflows to help doctors and patients make cost-effective prescription decisions based on real-time local pharmacy pricing of clinically equivalent drugs. It then offers prescription adherence alerts and reminders that are integrated into EHR workflow. Analytics power a feedback loop between prescriber and pharmacy that can prevent adverse events or avoidable encounters that are caused by non-adherence, also helping insurers understand the experience of their members with drug efficacy and outcomes as part of population health management beyond simple claims data. RxStream inventor and CEO Thomas Borzilleri saw firsthand as CEO of a pharmacy benefits manager that PBMs skim big percentages from prescription cost, driving their profits at the expense of not just patients, but also insurers and employers who lack access to the PBM’s opaque business practices and can’t tell whether a PBM is saving them money or actually increasing their cost. Thanks to InteliSys Health for supporting HIStalk.

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

This Week in Health IT History

One year ago:

• ONC issues a $250,00 funding opportunity to create a cyber-threat information sharing service.
• CMS adds star ratings to its Hospital Compare website.
• A disclosed Apple patent shows that the company is interesting in allowing iPhone users connect with a doctor, send them their HealthKit-collected information, and initiate a telemedicine session.
• Theranos CEO Elizabeth Holmes does a Q&A address the American Association for Clinical Chemistry, which one pathologist said is like having “Al Capone come and talk about his novel accounting practices.”
• Advocate Health Care Network (IL) agrees to pay $5.55 million to settle HIPAA charges involving three 2013 breaches of its medical group.

Five years ago:

• Defense Secretary Leon Panetta advises a House committee that DoD-VA integration won’t be finished until at least 2017.
• McKesson in its earnings call expresses confidence in its Horizon-to-Paragon strategy and its satisfaction with RelayHealth’s market position.
• Cerner predicts in its earnings call that Epic will suffer from trying to upgrade from its MUMPS-based platform and calls out Epic’s weaknesses as physician solutions, analytics, population health management, and interoperability.
• Roper announces that it will acquire Sunquest Information Systems from its private equity owners for $1.42 billion.

Ten years ago:

• Partners HealthCare signs a contract for Siemens scheduling, decision support, document management, community access, and payer connectivity.
• Misys Healthcare CEO Vern Davenport hints at acquisitions but agrees with his boss Mike Lawrie that the company’s healthcare performance remains poor.
• A hospital pricing company CEO argues that ambulatory EHRs don’t make sense unless providers are paid fixed prices for quality, questioning whether, “If the entire country implemented EMRs overnight, would we see significant overall improvement in healthcare productivity, efficiency, quality, and customer service?”
• An Eclipsys shareholder sues present and past company officers who he claimed defrauded investors.
• Health Affairs publishes a post-mortem on the failed Santa Barbara Project that was led by David Brailer’s CareScience, which had been replaced by CHCF, Perot, and Medicity.

Weekly Anonymous Reader Question

Responses to last week’s question:

• LOUD TALKER!
• Conducts all calls on speaker phone in a small office. His loud voice echoes through the hallway. Yes, he could close his door, but why be considerate of others?
• Someone who when asked a question always responds by saying they’ve sent you the information you are asking for “a long time ago” BUT they’ve never sent anything. After a few rounds like that at meetings, I just resorted to follow up with, “OK, thank you. Please resend the email.” they always end up sending a NEW email. Another one: when you’re leading a productive, decisive meeting and someone literally wakes up halfway into it and asks a long-winded question regarding a topic discussed wayyy at the beginning of the meeting. I simply smile and ask them to refer to their notes. Last ones: missing signatures in email or no out-of office contact information.
• Two women in leadership who just talk endlessly in meetings, even though 95 percent of what is discussed is already known. Waste endless time to be sure to get the 5 percent across. They apparently cannot see glazed eyes and blank stares and realize that the important 5 percent was probably missed when attendees only hear the “Peanuts” teacher voice after five minutes of regurgitation.
• The person who annoys me the most is someone who acts supportive and professional, then puts me down to my boss.
• My boss, who uses all our one-on-one time talking about herself and her work issues.
• When on conference calls or even team calls, the constant questions. This is especially annoying when someone has already provided the answer or has asked the question previously. I also dislike anyone that constantly complains. My philosophy is that if you don’t like where you work, then save us all your misery and just go work someplace else.
• They know enough to be dangerous and as if they are engaged and knowledgeable, but really are not and should defer to their knowledge experts. Ultimately results in more work and effort for all to proceed based on erroneous information by someone trying to fake it until they make it.
• I am a weirdo who generally likes the open office. However, on a different team across the aisle from me (<15 feet away) sits maybe the most infuriating person I’ve ever worked with, and I give him this highly competitive award without ever having had a single conversation – he sings. He sings and whistles, and he does these things LOUDLY and REALLY BADLY, and it’ll just be snatches of a song: there will be silence, and then MEEEET ME IN ST LOUIE, MEET ME AAAT THE FAIR and then NOTHING, and then just when your brain has stopped anticipating more, it’ll come through again. It’s like water torture. It activates a deep, primal rage in me. And this was happening before I got here, and I have NO EARTHLY IDEA why his teammates allow it.
  As I typed this, he whistled for about five seconds. God help me with patience and a cube rearrangement soon.
• Interrupting!
• The fact he has to mansplain everything over and over again. Also doesn’t realize that we’re all different life (and work) doesn’t revolve around spreadsheets. Also, “Does that make sense?” all the time. “No, it doesn’t make sense. Why don’t you mansplain to me again?”
• I work in an office building for a health plan. We have two small office kitchens on our floor. People seem to be either mess-makers or cleaner-uppers. I fall into the latter category. Why is it that whoever spilled the coffee grounds on the counter or got water all over the place, or slightly missed the trash can with a tea bag wrapper can’t be bothered to clean up? We’re not talking about mopping the floors and waxing the microwave here. It’s just basic. This is a first-world problem, I know. And it’s in the annoying category. The last place I worked had nasty office politics with back-stabbing and lies being told routinely. That’s not annoying. That’s career-threatening. I’ll take the mess on the counter any day over that, but still …
• I’m a big proponent of “”teach a man to fish” vs. just answering the question du jour. I give someone the URL or email that tells them how-to or where to go for FAQ, etc. But it’s so frustrating when they keep coming back saying, “I know you told me xxxx. Can you send me that email again? I can’t find it?” or just asking the same darn question three months later. it’s so lazy and disrespectful when they clearly think my time is not as valuable as theirs.
• I was going to answer, but I started getting really irritated listing all the traits. I figured I’ll just read other responses and be glad I don’t have to deal with those.
• No follow through. Tasks are assigned, sort of completed, and left hanging. Somehow I end up completing whatever it is because it needs to be done, and it drives me insane. I’ve mentioned it several times and there was always some lame excuse.
• People who complain about how difficult their job is because of the many obstacles they face instead of just doing the work.
• He chooses to call me to discuss issues that can be detailed in a two-sentence email or a 60-second conversation. Those phone calls last 20 minutes minimum due to his ability to belabor the point or jibber-jabber and fail to get to the point. Waste of my time! I avoid his phone calls at all costs.
• The thought that everything can just change instantly and therefore little thought is given to major requests which means we are in state of constant chaos resulting in rework and duplication that misdirects valuable resources. Hoping that all talk and little action or deliverables catches up with this person soon.
• My narcissistic VP, who will say and do anything (except deliver) to look good without ever accepting accountability. It’s always some other person’s fault.
• Instead of trying to solve/configure solutions or workflows for customers, they whine about the “fact” people don’t know what they want. Then find whatever excuse they can to avoid helping.
• People who pretend they are doing work, but get nothing done; don’t work efficiently, and hold every one else up.  People who lie about the state of affairs and expect you to take the fall. Lack of integrity. Males who’s egos are way to big for their britches.
• Slow response time.
• They want to be, and think they are my good friend. Add to that quite a sense of self-importance.
• Flatulence.
• Chatterbox who spends conspicuous time at work socially, distracting by itself. Also complains loudly about difficult and complicated projects, so transferred out of associated roles to keep the peace. Yes, management is the core problem here, not the employee. 🙁
• She treats most people horribly, yells at those who report to her constantly, is known for her back stabbing, and keeps getting promoted. We share an office wall so I hear too many of her cringe-worthy conversations belittling people, either in her office or on the phone.
• Late to every. Single. Conference. Call. Always.
• IT executives who are technically clueless and weigh in on every issue in every meeting whether they know anything about it or not to try and impress the CIO.
• Not aligning priorities to team project deadlines. Other team members then are assigned additional takes late in the project and are frustrated while working to meet the deadline or work on overdue tasks.
• The person who puts their phone on speaker while in their cube because they don’t like the ”feel of a headset.”
• Changing deliverables and approaches the last minute.
• Anal-retentiveness and risk-avoidance in the extreme.

This week’s question: what life-summarizing phrase would you choose right now for your tombstone? Limit yourself to 15 words regardless of your wonderfulness level.

Last Week’s Most Interesting News

• The FDA announces a pilot certification program for digital health developers that will allow certified companies to get their products to market faster.
• HIMSS names Hal Wolf as its next president and CEO.
• A CNBC report says that Amazon’s 1492 healthcare skunkworks project is working on projects related to EHR data, telemedicine, and health applications for Echo.
• CHIME takes over the “Most Wired” survey.
• Nuance announces that its systems have not been fully restored nearly a month after its malware-caused outage, also warning investors of lower revenue and higher losses.

Webinars

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

Acquisitions, Funding, Business, and Stock

From the Cerner earnings call:

• The company is almost finished with its succession planning in which a new CEO will be named to replace the late Neal Patterson.
• Q2 bookings were the highest in the company’s history at $1.636 billion.
• The company says it is competing well against Epic because of predictable total cost of ownership, contemporary architecture, return on investment, and its commitment to an open and interoperable platform.
• Cerner is scoping the work required for its VA project and negotiating a contract. It is also selecting partners, noting that unlike its DoD role, Cerner will be the prime contractor.
• Intermountain’s revenue cycle is finished in the Salt Lake City area and the company will replicate its experience across its client base.
• Zane Burke, asked about potential new non-traditional health IT competitors, said the core, transactional EMR is safe and that clients are more interested in getting data from it and Cerner’s open systems make that easy. He said, “I actually don’t think that those that are rumored to be doing things in this space are thinking about how they’re going to create the next EHR. They’re thinking about how can they add value into the whole entire healthcare supply chain and how can they think about making the consumer experience a better one because all of us are about to have a better patient experience at the end of the day.”

Decisions

• Banner University Medicine (AZ) will replace Epic with Cerner in October 2017.
• Kingman Regional Medical Center (AZ) will replace Siemens with Meditech in September 2018.
• AnMed Health Medical Center (SC) went live on Epic in June 2017.

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

Government and Politics

The US Supreme Court will hear oral arguments on October 2, 2017 in several cases involving mandatory class action waivers, one of them Epic’s. Epic — which was involved in previous class action lawsuits involving unpaid overtime — now requires employees to agree to arbitration instead of class action lawsuits for employment-related issues. The court will try to settle the conflicting decisions of lower courts in determining whether such agreements violate the National Labor Relations Act in preventing employees from acting together as  condition of employment.

Privacy and Security

A Roanoke, VA accountant’s office complains to the local newspaper about receiving frequent faxes from local hospitals, medical practices, and pharmacies after his fax number – which is similar to that of a physician’s office – was widely circulated. The accountant tries to do the right thing and let each sender know, but he gets PHI-containing faxes without cover sheets or spends up to an hour navigating phone trees and trying to reach the right person. He jokes that maybe he should just let the patients know directly since they have more clout with the provider involved. This is like most forms of healthcare data breaches – a provider that’s using poorly managed technology shoots the messenger for finding their mistake. Regardless of cover sheet legalese, the fax recipient is under no obligation to do favors for the the sender of the errant fax.

Other

Doctors in Canada express concern over Telus Health’s decision to display prescription drug coupons in their EHR workflow, paid for by brand name drug manufacturers to discourage the use of less-expensive generics. The doctors worry that patients will infer that brand name products are better and that patients may perceive a conflict of interesting. Telus Health says the coupons display only after the doctor has already chosen a specific brand name product and offers doctors the option to turn the feature off. The company has enabled the voucher in two of its seven EHRs – PS Suite and Nightingale – and will add it to the rest of them.

Nuance offers these comments from my interview with Charles Corfield, CEO of Nuance competitor NVoq:

• The NotPetya malware does not spread by email, by email attachments, or by infecting other files.
• No Nuance customer information has been altered, lost, or removed by the malware.
• We have no indication that any file contents on affected Nuance systems have been viewed by unauthorized parties.
• We have seen no evidence that ePHI files were encrypted in this incident since the types of files in which Nuance stores ePHI were not targeted by the malware.
• Unlike some malware, patching alone would not have stopped the propagation of NotPetya.

A Reaction Data survey of 200 HR and benefits leaders from providers, payers, and employers finds that while the majority of provider clinicians would like to see a single-payer health system, just about every body else hates the idea. Most respondents, however, favor universal healthcare that guarantees coverage but with both public and private participation. In fact, respondents seem to fear the federal government’s involvement most, with one benefits manager saying that “government intervention is the cancer” and that the free market should rule, while another observes that “we are the only developed nation on the planet to fail to recognize access to healthcare as a right – is that what we want as our legacy?” Respondents seem to miss the same significant point as their elected officials – the biggest problem involves high costs and provider-driven overutilization that enrich hospitals, doctors, insurance companies, and drug and device manufacturers at the expense of patients and taxpayers. We all foot that bill in one way or another.

In Indiana, a cancer patient’s pain management doctor declines to write her an opiate prescription after explaining that he doesn’t think narcotics would be a good choice for her chronic pain, after which the woman’s husband returns to the doctor’s office, shoots the doctor dead, and then kills himself.

The president and COO of Women & Infants Hospital (RI) quits due to its pending acquisition by Partners HealthCare and financial losses caused by declining birth rates and reduced NICU usage due to healthier babies.

Here’s Vince Ciotti’s review of Cerner’s history from awhile back.

My weekly “this week in healthcare IT history” items inspired Vince to look even further back with a monthly contribution from his stack of old magazines (he must be an HIT hoarder) that will describe the big news items 30 years ago and the lessons we might learn from them. He is also interested in hearing from his fellow pioneers at vciotti@hispros.com. I got wrapped up in his complete, 100-plus episode HIS-tory series that he created for HIStalk years ago – the people, products, and companies he covers are fascinating.

Sponsor Updates

• QuadraMed, a Harris Healthcare company, will exhibit at the GHIMA Annual Convention & Exhibit August 6 in Savannah. GA.
• The Solutionreach Patient Relationship Management Platform joins the Allscripts Developer Program.
• Diameter Health publishes an explainer video titled “Healthcare IT Hero.”
• EClinicalWorks says 1,000 providers selected its EHR in June, its strongest month so far this year.
• Sunquest Information Systems will exhibit at AACC Annual Scientific Meeting & Clinical Lab Expo August 1-3 in San Diego.
• ZappRx makes it to the final round of BostInno’s Coolest Companies competition.

Blog Posts

• 7 Quick Ways to Improve the User Experience of a Home Page (Salesforce)
• Improving Hospital Claim Collection Rates (The SSI Group)
• Patient Referrals: 7 Quick and Easy Ways to Fill Your Schedule (Solutionreach)
• Think inside the box on FWA: introducing the provider decision quadrant (Verscend Technologies)
• Johns Hopkins study uses Versus RTLS to monitor patient ambulation (Versus Technology)
• 3 ways Spectrum Health boosted virtual visit volume by 183% (Advisory Board)
• Can you? Visage can: Interoperability (Visage Imaging)
• 3 ways to prepare for CMS’s imaging appropriate use criteria (Meditech)
• Top healthcare communication experts to speak at VUE17. (Voalte)
• ICare Partnership Extends Evidence-based Content to Post-Acute Care Providers (Zynx Health)
  

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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates. Send news or rumors.
Contact us.

Morning Headlines 7/28/17

FDA Announces New Steps to Empower Consumers and Advance Digital Healthcare

The FDA announces a new digital health certification process for software developers that will focus on certifying the vendor, rather than the software product itself.

Senate Health Care Vote: Disarray Over Narrow Repeal Measure

Four GOP Senators refuse to vote for a “skinny” ACA repeal bill without ironclad assurances that it will be followed with a comprehensive replacement bill. Lindsay Graham (R- SC) explains, “The skinny bill as policy is a disaster. The skinny bill as a replacement for Obamacare is a fraud.” Final votes on the bill are scheduled for Friday.

ECMC spent nearly $10 million recovering from massive cyberattack

Erie County Medical Center refused to pay a $30,000 ransom demanded by hackers earlier this year, but ultimately spent $10 million restoring its network following the attack.

Eye on Oversight – Electronic Health Records

HHS OIG publishes a video addressing the eClinicalWorks fraud settlement.

Amazon has a secret health tech team called 1492 working on medical records, virtual doc visits

Amazon has a sunkworks lab called 1492 that is reportedly focusing on health IT projects.

News 7/28/17

Top News

FDA announces its “Pre-Cert for Software” program that will certify digital health developers (instead of their individual products) for fast tracking to market.

Up to nine self-nominated companies that are working on software that meets the definition of a medical device will be chosen for the pilot.

FDA Commissioner Scott Gottlieb, MD says in a blog post:

The goal of our new approach is for FDA to, after reviewing systems for software design, validation and maintenance, determine whether the company meets the necessary quality standards and pre-certify the company. Pre-certified companies could submit less information to us than is currently required before marketing a new digital health tool. In some cases, pre-certified companies could not submit a premarket submission at all. In those cases, the pre-certified company could launch a new product and immediately begin post-market data collection. Pre-certified digital health companies could take advantage of this approach for certain lower-risk devices by demonstrating that the underlying software and internal processes are sufficiently reliable. The post-market data could help FDA assure that the new product remains safe and effective as well as supports new uses.

FDA also announces in its Digital Health Innovation Action Plan that it will hire more staff for the digital health unit of its Center for Devices and Radiological Health. It will also launch an Entrepreneurs in Residence program in the next few months.

Reader Comments

From Vera Gemini: “Re: Mediware. Bill Miller, former CEO of OptumInsight, is taking over from Kelly Mann as CEO.” Verified. Miller left OptumInsight in an April 2017 executive shuffle. Private equity firm Thoma Bravo sold Mediware to another PE firm, TPG Capital, in February 2017. Mann was hired as CEO in September 2007 following his 24-year career as SVP of marketing operations for 3M Health Information Systems.

From MDRX ACE Sponsor: “Re: Allscripts ACE user meeting in Chicago August 8-10. They don’t have the usual big party scheduled for the second evening, which has been a staple for the last dozen years with big acts. I’m curious if anyone knows why this was changed – financials, liability, McCormick Place issues?” The agenda lists ACE Fest for Day 3, although it’s running from 4:30 to 6:30 p.m., timing that sounds more like happy hour. 

From Health IT Watchdog: “Re: Politico’s article showing that big, tax-exempt health systems are profiting wildly post-ACA. That certainly puts Epic’s ‘more margin, more mission’ to bed. If it wasn’t already clear, your EMR is not driving the profitability of your health system. Epic’s largest clients show revenue up, charity care down – that’s one way to drive your margins.”

From The PACS Designer: “Re: Java 9 release. July 27 marks the release of the much-anticipated Java 9 by Oracle. Its many new features are expected to excite the software industry, so it will be interesting to see if healthcare is a field that can gain from deploying Java 9.”

HIStalk Announcements and Requests

A reader who wishes to remain anonymous donated $50 to my DonorsChoose project, which actually fully funded a $200 project thanks to a $50 match from my anonymous vendor executive and then a $100 match from State Farm. Ms. L’s first grade class in Texas will receive math manipulatives as a result.

Listening: new melodic metal from Finland-based Nicumo. I’m also digging deep into musical history in enjoying Crack the Sky, which has been playing commercially unsuccessful progressive rock (kind of Steely Dan-ish at times) since forming in the early 1970s in Weirton, WV and making no splash at all other than developing a small following in the Baltimore area. There’s also the amazing 1981 Buck Dharma guitar solo I ran across in live video from the underappreciated, low-cowbell Blue Öyster Cult’s “Veteran of the Psychic Wars.”

This week on HIStalk Practice: Commonwealth Primary Care ACO taps Sonora Quest Laboratories for testing, analytics. Orthopaedic Associates of Michigan enlists Code Technology for patient-reported outcomes program. Idaho and Utah connect HIEs. Patients place physician experience above all else in satisfaction surveys. Legislators launch the Medicare Red Tape Relief Project. ATI Physical Therapy develops patient-facing, portal-friendly app. McKesson Specialty Health’s Calvin Chock offers guiding principles for designing a useful healthcare mobile app. Privia Health grows like gangbusters in Georgia. Rehab therapists cite documentation as their biggest challenge.

Webinars

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

Acquisitions, Funding, Business, and Stock

Cerner reports Q2 results: revenue up 6 percent adjusted EPS $0.61 vs. $0.58, meeting earnings expectations but falling just short on revenue.

McKesson reports Q1 results: revenue up 3 percent, adjusted EPS $2.46 vs. $3.15, missing analyst expectations for both. Shares dropped slightly in after-hours trading and have shed 18 percent in the past year.

Amazon is running a Seattle-based healthcare skunkworks project called 1492 that is working on several projects, according to a CNBC report:

• Sending and receiving EHR information
• Developing a telemedicine platform
• Working on health-related applications for Amazon Echo and Dash Wand.

Heading up the 1492 team are Kristen Helton, PhD (above) — a bioengineer who co-founded body sensing technology vendor Profusa –and Cameron Charles, PhD, an electrical engineer whose background is body-worn consumer electronics. The 1492 group listed several open positions that were apparently removed once the article made the project’s existence widely known.

Sales

RCCH HealthCare Partners (TN) chooses Summit Healthcare’s Exchange interface engine and migration services for its 17 regional health systems in 13 states.

People

HIMSS names Hal Wolf as its new president and CEO, replacing the retiring Steve Lieber. His background is quite different than that of Lieber, who spent his career as an association executive. Wolf comes from a vendor (The Chartis Group),  but has also worked at Kaiser Permanente in IT and operational leadership roles. For those who know him, care to speculate how he will change the HIMSS agenda? Particularly since EVPs John Hoyt and Norris Orms announced their retirement in February 2016 (although both are working elsewhere), leaving Carla Smith as the only long-time senior executive.

Drew Madden (Nordic) joins newly formed consulting firm Evergreen Healthcare Partners as a co-founder and managing partner.

Tom Schultz (HealthStream) joins Evariant as chief growth officer.

Carex Consulting Group hires Casey Liakos (Huron Consulting Group ) as president.

Victor Arnold (Huron Consulting Group) joins University of Missouri-Columbia as executive director of University Physicians and associate dean of the school of medicine.

Announcements and Implementations

Four-bed Southern Inyo Hospital (CA) goes live on Medsphere’s OpenVista Cloud.

Government and Politics

HHS OIG creates a video describing the $155 million Department of Justice settlement with EClinicalWorks, saying that the first settlement with an EHR vendor means “we’re entering an entirely new area of healthcare fraud .. we take the certification process for EHR software very seriously … OIG will investigate any conduct that places patient safety at risk and that causes losses to the federal healthcare programs.”

Technology

Adobe will retire its perpetually buggy, security-challenged Flash graphics package at the end of 2020 as open web technologies such as HTML5 have largely replaced it. Steve Jobs basically killed Flash in declining to support it on Apple’s mobile devices because it is: (a) proprietary; (b) unnecessary given the H.264 video format; (c) the number one reason Macs crash; (d) a poor performer on mobile devices; (e) a battery hog; (f) incapable of supporting touch-based interfaces; and (g) pushed on developers by Adobe to write cross-platform apps even though Adobe is slow to adopt OS enhancements.

Microsoft’s Asia research group develops a usable prototype of Path Guide, an Android app that provides low-cost, plug-and-play navigation services for inside buildings without relying on the phone’s GPS satellite connection or requiring building infrastructure. A “guide” starts the app’s recording function and then walks to the destination to create a “trace”  that others can follow in real time as they walk. The guide can add photos, video, or voice recordings to explain further. This could be an amazing benefit to patients and families trying to navigate around illogically laid out hospitals.

Other

Erie County Medical Center (NY) has spent $10 million to recover from its April ransomware attacked, half of the money spent on computer hardware and software and the remainder attributed to overtime pay and lost revenue. The hospital says it was lucky to have beefed up its cyber insurance coverage from $2 million to $10 million a few months before the attack that took 6,000 of its computers down. ECMC says the hacker applied a brute force password attack to gain access to an incorrectly configured web server that was secured by an easy-to-guess password.

The local paper covers the 200-employee virtual hospital of CHI Franciscan Health (WA).

In Ireland, a review finds that 21 infants experienced care delays because their referrals were sent by fax, which is the standard method of 80 percent of hospitals there vs. those 20 percent that have switched to electronic referrals.

Twitter shares dropped sharply Thursday after the company announced that its global user count was unchanged in the most recent quarter as its US user count actually declined. Twitter says it will focus on trying to get people to use its platform every day to increase its attractiveness to advertisers.

NextGen Healthcare clarifies via a LinkedIn post that the HIStalk reader-reported rumor about hard-coded passwords in Medhost’s Connex – which is based on NextGen’s Mirth Connect – is not a problem with the Mirth Connect product itself but rather Medhost’s distribution of a forked version of the open source product.

Baltimore Ravens offensive lineman John Urschel retires – apparently after reading new studies about football-caused brain damage – and will pursue a PhD in mathematics at MIT. He has a Penn State bachelor’s and master’s in math and has published several journal articles, including “A Cascadic Multigrid Algorithm for Computing the Fiedler Vector of Graph Laplacians.”

Sponsor Updates

• The local paper highlights LogicStream Health in its look at Minnesota venture capital funding in the first half of 2017.
• LogicWorks CEO Kenneth Ziegler discusses AWS growth on the Cheddar Network.
• Nordic opens a 6,000 square foot expansion of its Madison, WI office.
• Meditech is recognized as a healthcare innovator in the latest “Best of Canada” report.
• Emmem Ekorikoh of Obix Perinatal Data Systems, developed by Clinical Computer Systems, joins the board of Black Diamond Charities.
• CloudWave joins the Cloud28+ global community of independent cloud service providers.
• ECG Management Consultants publishes a new white paper, “ASCs at a Tipping Point: The New Reality of Surgical Services for Health Systems.”
• FormFast publishes a new white paper, “Connecting Patients & Providers Through Document Workflow.”
• GE Healthcare names Catherine Estrampes president and CEO of GE Healthcare Europe.
• Healthgrades announces its 2017 Women’s Care Award recipients, and publishes a related report on how hospitals can provide optimal maternal care.
• InterSystems will exhibit at AACC’s Annual Scientific Meeting & Clinical Lab Expo July 31-August 4 in San Diego.

Blog Posts

• Advancing Access to Image Exams Helps Pediatricians Administer Critical Treatment (LifeImage)
• Uniting to Take Great Care of Your Patients (MedData)
• How to reduce burnout with a physician driven EHR design (Meditech)
• MACRA, a qCDSM and the Value-based Payment Modifier (National Decision Support Company)
• House Bill Proposes Pilot Program with Incentives for Use of EHRs and Care Coordination (Netsmart)
• How to nurture your passion project while you consult (Nordic)
• Rethinking the Approach to Care Transitions (PatientPing)
• Poor Communication is Still Endangering Patient Safety (PatientSafe Solutions)
• Patient-focused Finance Trends at 2017 HFMA ANI (Patientco)
• It is Better to Give … (PatientKeeper)
• How Can Population Health Management Align with Bundled Payment Models? (ECG Management Consultants)
• How Messenger Sustains Community Practice (EClinicalWorks)
• Leveraging Your Epic System in the 3 Revenue Cycle Streams (Hayes Management Consulting)
• 5-Step Epic Optimization Program (The HCI Group)
• How inefficient communication technologies slow down providers and jeopardize patient safety (Imprivata)
• Why Mobile Matters for Your Hospital Website (Influence Health)
• The Expensive Reality of Short-Changing Security and Compliance in Healthcare (InstaMed)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates. Send news or rumors.
Contact us.

EPtalk by Dr. Jayne 7/27/17

I stumbled across a story on Amazon’s “secret” team that is supposedly looking at healthcare, including electronic health records and virtual visits. It’s supposedly called 1492 (if they chose that as an homage to Christopher Columbus, they had better rethink some of the cultural baggage around his “discovery” of North America). It sounds like they’re exploring interoperability as well, along with figuring out whether they can use the Amazon home-based devices like Echo in a healthcare capacity.

I’ve been a big fan of Atul Gawande ever since “The Checklist Manifesto” and enjoyed reading a transcript of a recent interview with Tyler Cowen. His opening comments on artificial intelligence were realistic and balanced, which was refreshing given the hype we’re used to seeing with headlines like “Dr. Watson Will See You Now.” He concisely explains how challenging it can be to fully understand what the patient is telling you.

Those of us in the trenches know this, but folks on the technology side underestimate the power of the story vs. data points. Patients often point to problem areas or sources of pain and have trouble explaining whether the problem is more external or internal. Some can’t offer descriptive words at all. Then there is the issue of individual perception of pain or problems. Of course, algorithms could probe into that, but there could be hundreds of questions needed to include or exclude various decision points.

He disagrees with the IBM Watson decision to address this problem and notes that the issue is complicated by the fact that the patient data changes over time. Not only discrete data, but the patient’s perceptions change, as does the patient’s willingness to bring new symptoms to the clinician’s attention and also the understanding of the interviewer. He sees technology as more of an adjunct.

I think most of us caring for patients agree. I’m tremendously fond of clinical decision support and systems that help me ensure I’m not missing anything I should be thinking about with complex patients. I think automated checklists are fantastic, and rather than making me practice “cookbook” medicine, they are helping me deliver the same quality care to every patient every time, regardless of how rushed or distracted I might feel at any given moment. They help level the care we deliver when we are trying to see patients in six-minute increments rather than the 30 minutes many of us wish we had.

He specifically mentions Isabel, which I’ve had available in a couple of EHRs that I’ve used in the hospital setting. Isabel prompts you to think about diagnoses you may be missing in rank order based on the data.

Cowen asks his thoughts on the potential of gene editing with CRISPR, which he finds concerning due to the “unpredictable things that people will discover that you can try to do with gene editing.” When those edited genes are propagated in living organisms, they can spread rapidly, and he doesn’t “think we’ve thought through that in the least.” There’s also the risk that people will want to genetically select against characteristics that they feel are undesirable without fully understanding the implications. On the other hand, he notes that many conditions are the result of the interaction of multiple genes and aren’t something that CRISPR will be able to significantly modify.

Gawande also goes on to talk about safety in the operating room and how the rise of procedures where the patient is awake is changing culture. That patient can now be part of the team and not just a passive participant. These procedures have been common in neurosurgery, where brain mapping is needed to try to protect the speech and movement centers while working on other areas. He notes that he’s seeing them in non-brain surgeries, where the team can interact with the patient about their medical issues and goals for the surgery.

Other patients don’t handle awake surgeries very well, so he does note that sometimes you have to adjust on the fly. I know this firsthand since I once had a procedure under “light sedation” and the surgeon asked the anesthesiologist to put me out a bit more because apparently I would not shut up and was getting sassy with the scrub nurse, who I recognized as having hazed me during medical school.

He notes that while checklists have been effective in reducing errors, there are still barriers to success because people either check the boxes by rote or end up not using the checklists at all. The first problem is something that I’ve seen in many organizations I’ve worked in. It can be as simple as running out of a supply and discovering that someone initialed an inventory form just hours before that the exam room was fully stocked.

As a busy urgent care, that’s a major concern in our practice, but fortunately we don’t have a lot of problems with people falsifying their inventory checks. One of our execs is a former Naval officer and “gundecking,” where someone says they did something that they really didn’t do, is a cause for termination. Leadership makes it clear that when you falsify logs, you undermine our mission of care delivery and it is not tolerated.

The idea of people blindly marking a surgical checklist is frightening. He mentions that organizations can take checklists to extreme, taking one 19-item checklist to an 81-item level that was unusable. Administrators rather than clinicians had bloated the content, which essentially led to people ignoring it.

They go on to explore the disconnect between healthcare and health outcomes. He notes that data from coverage expansions like the Massachusetts healthcare reforms has shown that some interventions are more powerful than others – namely primary care, chronic illness care, and mental health care. He also notes the difference between death reduction and changes in quality of life. Still, we’re not getting the biggest killers under control, like high blood pressure. Organizations like Kaiser have been able to improve outcomes through more assertive management of barriers to care.

I see issues with coordination of care and comprehensiveness of care daily, as patients come to the urgent care for situations that would be better handled by a primary care physician. Some days I struggle with the fact that I’m part of the problem – perhaps if we weren’t as accessible, or convenient, or fast, patients would put more pressure on their primary care physicians to re-engineer how they’re delivering care. I still see plenty of physicians who don’t leverage the technology they have in front of them or who refuse to change their office policies and procedures to better support their patients. I have experienced botched prescription refills, botched appointments, and general chaos when trying to get care myself.

The interview also covered the state of medical education, the FDA, and his thoughts on indie music, but I’ll have to leave you hanging for my summary of those topics. Tune in to next week’s Curbside Consult for the rest of my recap.

Email Dr. Jayne.