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Morning Headlines 5/7/19

May 6, 2019 Headlines No Comments

Kaiser Permanente Launches Social Health Network to Address Social Needs on a Broad Scale

Kaiser Permanente will leverage social services coordination software from Unite Us as part of a new Thrive Local network that will connect members with community-based services.

DirectTrust Reports Record First Quarter Results in Direct Secure Messaging as Traffic Migrates into Trust Bundles, Messaging Use Expands Beyond Referrals

DirectTrust reports several Q1 accomplishments, including 49% increases in both participating organizations and messages sent.

Tennessee Diagnostic Medical Imaging Services Company Pays $3,000,000 to Settle Breach Exposing Over 300,000 Patients’ Protected Health Information

OCR fines Touchstone Medical Imaging (TN) $3 million for potential HIPAA violations related to a 2014 incident in which one of its FTP servers was left unsecured, enabling uncontrolled access to PHI even after the server was taken offline.

Arizona changes medical records law after Republic’s story about student’s fight

Inspired by the story of a student who couldn’t move forward with life-saving surgery because of an inability to access her medical records, Arizona Governor Doug Ducey passes a law requiring providers closing up shop to to give patients access to their files or face a $10,000 penalty and the denial of future facility licenses.

Curbside Consult with Dr. Jayne 5/6/19

May 6, 2019 Dr. Jayne No Comments

National Nurses Week is May 6-12 and I want to send a shout-out to all the nurses out there. I’ve worked with some phenomenal nurse informaticists over the years. Their perspective often varies from that of physicians and their input has been invaluable on numerous projects.

I’m also grateful to the clinical nurses who have had my back, whether it was in medical school, residency, or when trying to implement EHRs. Nurses have helped me formulate strategies to get physicians on board because they understand how clinical departments operate in ways that an administrator might not fully grasp.

We walk a lot about physician burnout, but we don’t always talk about nursing burnout as much as we should. Many nurses from my hospital have left traditional nursing and are instead working in fields such as administration, telehealth, case management, or with payers. One of my close friends became an elementary school nurse and another does case review for attorneys. In an anecdotal survey of why they left the patient care trenches, the top reasons include stress, unpredictable hours, and inadequate work-life balance. One who worked with me in the emergency department was mainly afraid of workplace violence, having been involved in several altercations involving patients or upset family members.

I had the opportunity recently to attend a seminar on workplace violence, which is something all of us that spend time in hospitals need to think about. Medical settings are the most common location for workplace violence. According to the Bureau of Labor Statistics, more than 70% of all workplace assaults happen in the healthcare and social services industry. Potential causes include the idea that healthcare has become less patient-focused and less personal; wait times have become longer; patients have unmet expectations; prescription drug abuse; and lack of mental health support services. Even with those facts, organizations tend to provide little education on how to de-escalate tense situations or how to respond when a violent episode occurs.

The seminar recommended that clinical staff receive formal training in spotting behaviors that could lead to violence and in learning how to manage situations so that they don’t escalate. Practices, nursing units, and facility departments should develop detailed procedures for addressing violent situations, including how to protect patients and themselves. They also recommended training in how to best interact with law enforcement should a violent episode occur. Last, they discussed conducting drills to test those procedures, much like an organization would have an EHR downtime drill or a mass-casualty drill. Although we hear a lot about intruder drills in the schools, we don’t hear a lot about them in healthcare settings. The speakers advocated the Run-Hide-Fight response to active shooter incidents, and I could tell these were new concepts for most of the people in the audience.

The majority of the seminar was spent on strategies for preventing violent encounters in the first place. We were encouraged to look for patients or family members with depressed mood, bizarre behavior, and changes in personality. These are readily identifiable by most healthcare professionals, along with findings such as paranoid ideations and delusional statements. Those were fairly subtle, but actual threats of violence also made the list of items that should trigger de-escalation maneuvers.

They went on to recommend that healthcare workplace training programs include situational awareness training during the onboarding process with annual refreshers. I would think that situational awareness would be one of the hardest skills to master in the healthcare setting since we often need to be laser-focused on the patient in front of us. We might not be aware of incidents occurring in adjacent patient rooms or at the clinical workstation.

When the situation is unfolding in front of us, clinical workers are encouraged to allow patients to verbally vent while showing empathy and understanding. If the situation deteriorates, we need to be able to alert others or get help; identify escape routes; and plan for self-defense. Like law enforcement teams, we were reminded to never turn our backs on potentially violent patients or family members.

The seminar also covered strategies for prevention that are fairly straightforward, such as securing doors, limiting non-employee access to critical areas of the facility, installing proper lighting in the parking lot, and changing door codes often if electronic locks are in place. Staff should wear name badges so they can be easily identified as belonging in key areas. The speakers also discussed the practice of “see something, say something” where everyone is empowered to bring attention to situations that might become problematic.

I’ve been in some tense situations and have encountered violent patients, but I’ve never personally experienced the types of violence that was discussed during several of the case studies. We were asked to role play various scenarios, including custody disputes, disgruntled employees, and unstable patients. We were challenged to create a draft emergency operation plan for our facility with ideas for policies and procedures on how to address various types of workplace violence.

Several of us had the most difficulty figuring out how we would protect patients as well as staff members, particularly if patients were immobile or critically ill. We talked about campus lockdowns and how to quickly alert patients and visitors to stay away from the facility if needed. We also talked about how to care for potential victims. Hospitals and emergency departments have different resources than ambulatory practices and we brainstormed ways to use the supplies on hand for different eventualities.

The last part of the course dealt with how to behave in an active shooter situation when law enforcement arrives. Especially if SWAT or other specialized resources are involved, those resources are trained to proceed in ways that might not seem intuitive to healthcare providers. Officers aren’t going to stop and render aid to wounded individuals until they are certain the threat has been stopped. They might treat everyone present as a potential threat while they gain control of the situation.

After the course, I was curious whether any of my friends that work for EHR vendors and routinely assist clients in healthcare locations had received any kind of training on workplace violence. Although my survey sample was small, no one had received any kind of training in workplace violence.

I’d be curious to hear how large technology vendors handle this and whether they provide formal training for staff members. Similarly, for hospitals and provider organizations, what’s your strategy? Leave a comment or email me.

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Email Dr. Jayne.

Morning Headlines 5/6/19

May 5, 2019 Headlines 1 Comment

U.S. doctors use medical records to fight measles outbreak

Doctors like those at NYU Langone Health are using EHRs to identify patients in measles outbreak areas who have not received the measles vaccine.

Grahame Grieve Named 2019 Glaser Award Recipient

UTHealth’s School of Biomedical Informatics names interoperability expert Grahame Grieve winner of the 2019 John P. Glaser Health Informatics Innovator Award.

Direct Recruiters and Sister Company Direct Consulting Associates to Integrate

Hospital IT staffing and consulting firm Direct Consulting Associates will roll into sister company Direct Recruiters.

A short thread on the real source of the uBiome fiasco. Hint: it wasn’t venture capital’s pressure for aggressive growth.

The former “citizen-scientist in residence” of UBiome – the microbiome testing vendor raided by the FBI after complaints of insurance overbilling – shares Theranos-like warning signs.

CareCloud raises $33M from inside investors

EHR and practice management vendor CareCloud raises $33 million, bringing its total raised to over $150 million.

Monday Morning Update 5/6/19

May 5, 2019 News 12 Comments

Top News

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From the Allscripts earnings call:

  • The company reported record first-quarter bookings despite revenue growth that was less than it had predicted.
  • One Paragon client was committed to switch EHRs until “they experienced the sales implementation by one of our competitors” and extended their Paragon agreement for five years. The hospital was Waverly Health Center, which would suggest that the abandoned replacement vendor was EClinicalWorks, who announced them as a new inpatient customer in April 2018.
  • The company says that recent development of a Paragon ambulatory platform has caused five clients to come back in the past 90 days.
  • CEO Paul Black notes that the company has “the longest-tenured leadership among the top three publicly traded companies in the marketplace,” which he says allows the company to focus on long-term priorities.
  • Black says Veradigm positions the company as a top provider to payer and life sciences markets, to the point that EHR competitor NextGen partnered with Allscripts instead of developing a competing product.
  • Acquisitions over the past five years have added $300 million in annual recurring revenue “at a net cost approaching zero.”
  • Black says Allscripts is the only one of three companies (I assume he’s referring to Epic and Cerner) that is making significant investment in core acute care solutions.
  • In responding to an analyst’s observation that company debt increased due to share buy-back, the company says it is comfortable with its leverage position.

Reader Comments

From Big System CIO: “Re: HIStalk interview. My experience is that going on record encourages the vendor community to overwhelm us in claiming they can assist, regardless of whether we need help or not.” BSC politely declined my interview request for a reason I hadn’t considered – mentioning an initiative in our conversation guarantees that vendors who read it will bug them endlessly to pitch their services. I guess cold-calling it must work at least occasionally or they would stop doing it. I’m interested in both the provider and vendor side of this issue – how do you feel about reps randomly dialing someone up at the hospital hoping for a hit?

From Just Asking: “Re: IT in faith-based health systems. You’ve said you had experience there. What should I look out for if I take the IT executive job offer in front of me?” I can only relate my personal experience, which certainly varies by organization. The top problems that my IT peers had in working for an organization whose faith wasn’t ours (and that was one of the more extreme ones, I suspect) were:

  • The culture was inbred, where everybody went to the same churches, graduated from the same unimpressive church-affiliated universities, and had been chosen since their diaper-wearing years for fast-tracking through various internship and training programs in traveling from one hospital to the next to the way to the top. It’s tough participating constructively in meetings where everybody except you as the IT person has longstanding, trust-based relationships that drive everything instead of knowledge or experience.
  • IT was the dumping ground for underperforming but well-connected junior employees who were untouchable and knew it, so their pathetic job performance demotivated everybody else.
  • IT felt like being an American contractor sent to work in a Middle Eastern hospitals – we were tolerated at best, never respected, and were forced to follow the corporation’s cultural-religious rules while having our own ignored. Be careful taking a job with any health system that declares itself to be a ministry unless you actually want to work for a ministry.
  • Just about every major strategic IT decision was made in meetings to which IT was not leading or even invited because, as one top-ranking executive said in being unaware that he was on a conference line, “Can’t we get one of our own in there?”
  • On the flip side, they paid me well, the benefits were unbelievable, the glass ceiling was obvious but tolerable unless you fancied yourself qualified to be on the executive fast track, and I think they were doing the best they could to integrate us interlopers into the organization in at least a clumsy, superficial way.

From Bewilderment: “Re: succession plan. People joke about that of Judy Faulkner. What’s yours?” I don’t have one. I’ll probably just keep going until I drop dead and then the HIStalk page will be forever frozen on whatever I wrote last (hopefully something decent, unlike good Hollywood actors who died after making an awful last movie as their unplanned swan song). I won’t care at that point. If I quit by choice, I’ll say goodbye.


HIStalk Announcements and Requests

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Last week’s reader-requested poll was a good one. Universal interoperability won’t happen until at least 5-10 years (so say 42%) or more than 10 years if ever (46%). Some comments:

  • Until you get into the details of turning a clinical note into something transmittable between two systems, you cannot understand the complexity. I remember spending an hour in a meeting discussing what values should be in the “stool appearance” drop-down. Unless every provider uses the same list, or every interface engine has a translation table, how can one system send to the other? Things like that need to be done with thousands of ideas on what exactly a stool appearance drop-down should look like. Of course you can always transmit entire documents and notes, but if you want to make data interoperable, it needs years and clinical revamping.
  • Everyone everywhere? From legacy systems run by stressed organizations operating at the margin of survival? Patient-generated data, from outside of hospital/ clinic? Genomic data? Third-party analysis of same? Clinically relevant is the touchstone. Truly clinically relevant may be much smaller subset, but, still, you have to get to it. Patient-sovereign software, leveraging API-architecture through consent / authorization / access services and the patient’s right to their data, may be a route, which works because it flips the paradigm.
  • I still vividly remember attending an interoperability conference in 2003, at that time experts were sure that in 5-10 years, all systems would be talking to each other. What year is it now?
  • Data exchange will only move forward once EMR vendors and health systems understand they do not own the data, it belongs to the patient. And to get to that point may take payment penalties for those that do not share.
  • Ask five physicians what “all clinically relevant data” is and you’ll get seven different answers. The reality is that all all of the data you mention in your example can be shared today. Why isn’t it? Because doctors aren’t demanding it and because there remain competitive business reasons to not share data with providers (aka as competitors) outside an IDN. Interoperability remains mostly a business challenge, not a technology challenge.
  • There are aspects that will take longer (e.g., pathology), as today it is not widely digitized. More needs to be done to emphasize the need for the FULL relevant record – too much emphasis still today for making only PAMI (procedures, allergies, medications, and immunizations) data interoperable, as the least common denominator. Finally starting to see more recognition of interoperability needed for clinical reports, which is addressed in the next version of FHIR, but will still take a long time.
  • “All” clinically relevant information is casting a wide net, including all scanned documents, waveforms, diagnostic resolution MRIs and mammos and cine loops, and it also assumes that every internal niche clinical system in a large organization can participate in HIE or at least communicate with the primary system responsible for HIE. If that’s what you mean, it won’t happen in 10 years in this country with our broken fragmented healthcare system, and maybe never.

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New poll to your right or here: How would you react to your software vendor announcing a focus on boosting profits, including reorganizing and cutting products and headcount? I thought of the question because of Cerner, but we’ve seen plenty of examples over the years and I’m interested in what you think. Comments are welcome, so just click the poll’s “Comments” link after voting.

Dear everyone on LinkedIn and elsewhere: please stop describing yourself as having “over XX years experience.” It’s not like a toddler’s mom or a former addict who feels the need to proudly account for fractional years, so just round up if you are that insecure. Thank you.

Live Nation is offering $20 lawn seats to some mediocre outdoor concerts (mostly 1980s has-beens and country), but I still bought tickets to three of them. It’s worth $20 to create a summer memory of sprawling on the grass while listening to the B52s supplement their Social Security checks by cautiously frugging yet again through “Rock Lobster.”

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

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Webinars

May 21 (Tuesday) 2:00 ET. “Cloud-Based Data Management: Solving Healthcare’s Provider Data Challenge.” Sponsor: Information Builders. Presenters: Jeremy Kahle, manager of planning and business development, St. Luke’s University Health Network; Shawn Sutherland, patient and member outcomes, Information Builders; Bill Kotraba, VP of healthcare solutions and strategies, Information Builders. Inaccurate provider data negatively impacts revenue cycle, care coordination, customer experience, and keeping information synchronized across systems and functions. SLUHN will describe how it created a single version of provider data from 17 sources, followed by a demonstration of how that data can be used in reports and geospatial analysis. Learn how Omni-HealthData Provider Master Edition provides rapid ROI in overcoming healthcare organization provider data issues.


Acquisitions, Funding, Business, and Stock

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The former “citizen-scientist in residence” of UBiome – the microbiome testing vendor that was just raided by the FBI after complaints of insurance overbilling – lists Theranos-like warning signs:

  • The company didn’t hire a CFO until 2017, then fired him shortly afterward.
  • A long list of scientists endorsed the company’s tests, but it’s not clear if any of them ever actually tried them. He says that “too many advisors are really just outsiders with an ego.”
  • The company hasn’t released any clinical data despite listing thousands of partnerships with famous research institutes.
  • VCs lose money when they back what turns out to be a fraud, but the scientific advisors just walk away from the train wreck unnoticed.

Government and Politics

FDA shuts down its “alternative summary reporting” program for breast implants and says it will eventually extend the shutdown to include all medical device problem reporting. The program allowed manufacturers to submit summary reports instead describing safety incidents individually, thus hiding them from the public eye.


Other

Doctors are using EHRs to identify patients in measles outbreak areas who have not received the measles vaccine. It mentions NYU Langone Health, which has created alerts in Epic that notified doctors and nurses that a patient lives in a ZIP code that is experiencing a measles outbreak. Epic collected customer best practices for dealing with measles and published them into a how-to guide.

A woman who counts on getting emotional support from fellow breast cancer patients from a closed Facebook group complains that people like her are “trapped” after not realizing years ago how cavalierly Facebook manages and sells the private data of its users. She says, ‘’Our group cannot simply pick up and leave … how do we keep the same cycle from repeating on a new platform?” I will, as I often do, take the counterpoint. The group absolutely can leave Facebook and move to a platform that they control. Facebook’s most insidious tactic is hooking users on its wide-ranging services to the point that like Pavlov’s dogs, they will obediently waste hours each day in return for a reward treat that was paid for by those companies willing to buy ads and user data. Use an independent technology platform that isn’t funded by invisible, unethical data practices. Consider whatever cost is involved for the platform and its support to be the price of not having your medical information sold like at a Turkish rug bazaar.

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Interoperability expert Grahame Grieve is named the winner of the 2019 John P. Glaser Health Informatics Innovator Award. My most recent interview with him (from March 2019) is here. This is a nice summary by Robert Murphy, MD of UTHealth’s School of Biomedical Informatics:

As a physician and an informatician, I am singularly impressed by Grieve’s focus on pragmatic outcomes derived from a comprehensive array of tactics that are steadily moving us toward interoperability—notably, standards development, implementation, and adoption; open source and tool development and devising interoperability toolkits; enterprise architecture and governance; and clinical document and clinical interoperability solutions. He and his colleagues are extraordinary change agents within healthcare

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This seems largely pointless: a new hospital in South Korea will be crammed with tech gadgets that would appear to have zero impact on outcomes or cost – hologram images of isolated patients for “visits,” augmented reality-based wayfinding systems, facial recognition biometric access, and voice assistant-powered patient room amenities. A telecom vendor is co-building the hospital, so naturally it is bragging on 5G connectivity that always seems like hype more than anything. I’m picturing patients wandering around in gowns emblazoned with Nascar-like phone company ads. I am amused that one of Yonsei University Health System’s hospitals is named Gangnam Severance Hospital, which makes me picture Psy being marched off the premises with final check in hand following a musical restructuring.

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In England, former hospital CIO Richard Corbridge warns in an op-ed piece that NHS’s digital leaders are leaving for jobs in the private sector, frustrated by health secretary Matt Hancock’s unfunded push for a technology revolution such as “axe the fax.” Corbridge, who just left NHS after 23 years to join Boots as director of innovation, says hospitals can afford only 1% of their budget for IT after the cost of dealing with an aging population, historic underfunding, and staff shortages.

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In England, Guinness World Records tells a nurse who ran the London Marathon in scrubs to raise money for Barts Charity that her time won’t qualify as a record for “running a marathon while dressed in a nurse costume” because it requires the uniform to include a dress, a pinafore apron, and a white nurse’s cap. They also advised her that wearing scrubs could confuse people into thinking she’s a doctor. She notes, “I’ve certainly never seen a male nurse wearing a dress to work.” I might take the side of GWR, however, since it isn’t looking for occupational accuracy in certifying records of runners dressed as lobsters or telephone booths (why those records even exist is another issue), with its guidelines cautioning costumed record seekers, “No one wants to run 26 miles dressed as a rabbit only to find out their ears weren’t long enough.”


Sponsor Updates

  • Gartner cites Lightbeam Health Solutions in several industry reports.
  • Mobile Heartbeat will exhibit at the Kentucky Hospital Association event May 8-10 in Lexington.
  • Waystar will exhibit at the Office Practicum 2019 User Conference May 9-11 in Orlando.
  • Netsmart will exhibit at LTC 100 May 5-8 in Naples, FL.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the HIMSS CSO Spring Conference May 10 in Dublin, OH.
  • OmniSys will exhibit at the HCP Spring Hospital Pharmacy Conference May 6-8 in Miami.
  • Experian Health will exhibit at the NCPDP 2019 Annual Technology & Business Conference May 6-8 in Scottsdale, AZ.
  • Redox will exhibit at the Prime Health Innovation Summit May 7 in Glendale, CO.
  • Relatient will exhibit at PNW MGMA May 8-10 in Tacoma, WA.
  • The SSI Group will exhibit at the Louisiana HFMA Annual Institute May 5-7 in Lafayette, Louisiana.
  • Surescripts will exhibit at the NCPDP Annual Conference 2019 May 6-8 in Scottsdale, AZ.
  • Hungary’s University of Debrecen joins the TriNetX network to increase collaboration and growth in commercial clinical studies.
  • Voalte will exhibit at the Kentucky Hospital Association Annual Convention May 8-9 in Lexington.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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Weekender 5/3/19

May 3, 2019 Weekender 3 Comments

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Weekly News Recap

  • Allscripts announces Q1 results that beat earnings expectations but fell short on revenue
  • Meditech’s Q1 saw reduced revenue, operating income, and net cash from operations although unrealized security gains pushing earnings dramatically higher
  • Capsule Technologies acquires Bernoulli Health
  • Cerner filings indicate that activist investor Starboard Value made its run on the company’s board two days after Brent Shafer announced his new “operating model”
  • A new KLAS report on hospital market share finds that Epic beat Cerner handily in new hospital gains excluding Cerner’s one-time VA deal, with Cerner losing 65 Millennium hospitals vs. Epic losing one
  • HHS announces that it will use its discretion to reduce maximum annual HIPAA fines based on level of culpability

Best Reader Comments

Life in rural America is in a serious long-term decline and has been for decades. De-industrialization has just piled on, especially in smaller towns in the Midwest, Northeast, and the South to a lesser degree especially since 2000. The only area that has avoided this trend is smaller (and relatively newer towns) in the SW and West which never had much, if any, of a manufacturing base to begin with. They have been able to pivot more easily to the current economic model especially if they attract tourists year-round and/or have a higher education institution which has remained competitive. If smaller towns are declining economically and demographically, there is going to be less of a need for community hospitals especially those with aging physical plants which are costly to remain and run. The trend is going to be ASC/outpatient wherever possible and more micro-hospitals/hospital-at-home. There will still be a need for facilities to treat emergency patients but that is going to be a much more complex issue from a political and economic standpoint. Coming back full circle, there is still going to be a market for community hospital IT software but it will be one that is in long-term decline and largely a maintenance market that lives of the 16-20% annual software and maintenance feeds vendors charge (more if they host it). What is likely going to emerge is software to support new models of care and much smaller facilities. It just won’t have the $$$ that an enterprise community hospital system has to it. (Lazlo Hollyfeld)

Being an IT person and a long time athlete who has used FitBits, heart rate monitors, and training logs, I figure that the right way to handle the data stream from personal monitoring devices, logs, etc. is for vendors to develop an integrated approach that uses certified devices, periodically calibrated if necessary, feeding data streams to repositories. For example, this could include a bundle of devices for an elderly person with CHF. These might include a few things. One would be a scale, expecting twice-daily readings to check for rapid weight gain due to non-compliance with diuretic. Another would be a smart pill dispenser to track medication adherence … Between the data stream and the clinician would be carefully tuned algorithms that would decide when to alert a licensed provider like an advice nurse in a call center … Once these packages are matured and the value in preventing admissions / readmissions has been demonstrated, I would envision PCPs ‘prescribing’ the bundles, with all of the associated intelligence and process, to their patients. Kaiser Permanente was doing some futures work on this kind of thing a couple of years ago. (Dr. J Fanboy)

I agree 100% with Vaporware and that Cerner has made a deal with the devil with the DoD contract. That is just an opinion based on my experiences. However what isn’t an opinion is that Cerner is a publicly traded company that has to answer to forces that Meditech and Epic do not. It is not an opinion that Cerner has caved to the pressure of profit-seeking investors and it will fundamentally impact the way the manage and pay their talent as well as their development and support expenditures. Do you honestly think that having to balance a huge contract with a notoriously difficult customer in the most open and public way, while at the same time trying to please shareholders demanding more profit now, is conducive to being a responsible steward for your private and community hospital partners? (You don’t need a weatherman to know …)

Whichever vendor you attach to the feed trough basically becomes the de facto in-house IT / development shop for the federal government. The in-house VistA talent that was swept out was expensive, but at least they made an EHR that worked when you turned it on. (Vaporware?)

Churn rate is of course a concern for all vendors not named Epic, however their entry in to selling directly in to hospitals they used to flat out say no to is indicative they know that the acquisition advantage they have is running out of targets. The cat is out of the bag that selling off to the large chain doesn’t cut costs for the community and it doesn’t improve services. The hospitals that have managed their money and capital commitments have been able to resist having to sell of to rid themselves of debt. Many communities take great pride in having their own independent hospital. In short the assumption that every community hospital will end up being owned by Epic or Cerner running systems isn’t set in stone. (Smartfood99)

I also am on board with you as it pertains to Cerner’s terrible attempts at RCM. I mean really, how hard is it to build a reliable financial system? That is what many of us though when Cerner bought Siemens, that Soarian financials would be the go-forward strategy. But instead, for the first three years post merger, Cerner actually still sold Millennium and Soarian Financials and customers were confused and pissed at the same time: why the option? With Cerner’s cash on hand and number of employees, why the hell can they not figure this out? They are so worried about always being first to market. Screw first to market, just make your product the best product. God rest his soul, but this falls on Neal. This should have been corrected years ago, but like that dog in the movie Up, Neal would pick a direction and then see a squirrel and completely lose focus. (Associate CIO)

I actually am more optimistic about Meditech beating Cerner than you. I think the Neal Patterson Cerner would have swallowed the entire lower part of the market and then there would be a Cerner-Epic duopoly. This private equity firm seems to be trying to move Cerner’s focus from gaining market share to milking their customer base. I doubt the corporate suit they have in charge now has the original vision or an alternative vision that he can articulate to the board and shareholders. That could drive the Cerner offering to a price nearer to Epic’s. With the cash-strapped community hospitals or penny pinching for-profits, that could make the cheaper, good-enough Meditech Expanse more tolerable. (SelfInfllictedWound)

I have come to a general conclusion about a lot of this. The EHR is a proxy for a lot of the irritants for clinicians, even if the EHR isn’t the underlying cause. To oversimplify while getting to the point, most physicians are employees now. As an employee, you do what your employer tells you to do. You can complain, but you’ll do as you are told. Or resign. Or get fired. Ouch. I can appreciate how this means some loss of status and independence for physicians. On the other hand, what do you think working life is like for most people? Medicine is a noble profession, but when you attempt to lean on that in order to support privileged working conditions, I don’t think that will go well. (Brian Too)


Watercooler Talk Tidbits

The local paper says that most dentists in Olean, NY haven’t implemented EHRs, some of them wary after seeing the “billing disaster” of Glens Falls Hospital in implementing Cerner. One local dentist uses digital imaging, but says, “When I need to read what I wrote about a patient, I have a paper record … because there can always be a system failure.” Most of the 48% of US dentists that don’t use EHRs question their value and security even though they agree that it’s easier to read online than on paper.

In England, the family of a 64-year-old woman who died in the hospital says that another patient was annoyed by the woman’s snoring, so she beat the woman on the head with a cup. The hospital expressed condolences, but says “it is clearly not possible for staff to supervise all patients individually round the clock.” It makes you wonder why hospitals can’t work like hotels, where rooms are locked to keep unauthorized people out, but employees use a master key whose activity is tracked. That wouldn’t work in hospitals with the illogical and universally despised “semi-private” (meaning not private at all) rooms.

A Mississippi anesthesiologist says he has spent $30,000 on lawyers and notification letters after someone broke into his practice’s offsite storage unit and stole the paper medical records of 14,000 patients. I had an immediate mental image of the “Storage Wars” gang shining flashlights onto his stacks of cardboard boxes in formulating their bidding strategy.

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The former girlfriend of a California radiologist captures security video of him crawling through her back yard and peering into windows. The doctor was already on medical probation for a series of arrests related to domestic issues and was previously fired as a locum tenens radiologist by a hospital for inaccurate reports, inappropriate behavior, and unstated mental issues.

An Idaho man whose wellness multi-level marketing company has given him a $4.5 billion net worth creates a $500,000 legal defense fund for people who are being pressured by medical debt collectors. He provides as an example Medical Recovery Services, which he describes as, “We’ve got an outfit operating in Idaho Falls, a debt collection agency, that’s more interested in running up attorney fees than they are in collecting medical debt,” describing one of his own employees whose unpaid bill of $294 was turned over to collectors who inflated it to $6,000.

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Bizarre: in England, a 26-year-old “serial prankster” who enjoyed startling his girlfriend by repeatedly faking his own suicide – by squirting ketchup on himself to look like he’d been stabbed and pretending to have an anaphylactic reaction from eating nuts while driving – dies from brain swelling after tying sweatpants around his neck to make her think he had hanged himself on the stairs. 


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Morning Headlines 5/3/19

May 2, 2019 Headlines 1 Comment

Allscripts announces first quarter 2019 results

Allscripts announces Q1 results: revenue flat, adjusted EPS $0.16 vs. $0.15, beating on earnings but falling short of revenue expectations.

CirrusMD Announces $15 Million in Series B Funding and New Plans to Improve Care Delivery For Veteran Population

CirrusMD raises $15 million in a Series B funding round, and announces that its chat-based telemedicine software will be implemented at three VA medical centers.

Insiders describe aggressive growth tactics at uBiome, the health start-up raided by the FBI last week

UBiome places its co-CEOs on administrative leave as the company deals with fallout from an FBI raid and highly questionable business practices that included pressuring doctors to approve its tests and billing payers multiple times without patient consent.

News 5/3/19

May 2, 2019 News 5 Comments

Top News

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Allscripts announces Q1 results: revenue flat, adjusted EPS $0.16 vs. $0.15, beating on earnings but falling short of revenue expectations. 


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor SailPoint Technologies. The Austin, TX-based company’s platform manages digital identities, allowing organizations to see and control access to apps (on-premise, cloud, web), devices, infrastructure, and structured and unstructured data. Deployment options include SaaS, AWS or Azure cloud, data center, or via a managed service provider. Specific functionality includes provisioning, self-service access requests, access certifications, separation of duties, user-managed password resets, file access management including Microsoft Office, and AI-driven reporting. Specific platforms supported include Epic, Cerner, SAP, Workday, Box, Dropbox, and SharePoint. PeaceHealth dropped its 28-day turnaround time for providing access to two days, is able to run yearly employee access certification campaigns, and has reduced provisioning contractor headcount by 25. Thanks to SailPoint Technologies for supporting HIStalk.

Listening: the new, final album from The Cranberries, completed by the band from demo tracks found on the hard drive of singer Dolores O’Riordan, who died in January 2018 at 46 of accidental drowning. The Cranberries have made recordings in that manner before — she poured so much emotion into the demos that her studio versions couldn’t match them, so they sometimes went with the first draft. She had been through a lot, so the new album is more wistful, reflective, and less angry than “Zombie,” of which I would say her 1995 performance on SNL is still one of the rawest and best in that show’s history from long ago when singers wrote their own songs, performed them with emotion, and used minimal stage equipment with no computers, Auto-Tune corrected vocals, or sequiny dancers. My expectation of just listening to the new album without emotion turned out to be unrealistic as I spent the afternoon looping the achingly perfect title track “In The End.”

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It’s a big holiday weekend, so happy Cinco de Cuatro to all.


Webinars

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


Acquisitions, Funding, Business, and Stocks

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CirrusMD raises $15 million in a Series B funding round. Its chat-based telemedicine software will be implemented at three VA medical centers.

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Medical device integration and patient monitoring company Capsule Technologies acquires clinical surveillance software vendor Bernoulli Health. Capsule Technologies was acquired by Francisco Partners from Qualcomm just before HIMSS, where it re-emerged from its Qualcomm Life brand as Capsule Technologies (before Qualcomm, it was Capsule Technologie).

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CBNC reports why the FBI raided venture-funded microbiome startup UBiome: the company was billing insurers multiple times without patient consent and pressuring its doctors to approve its tests (which it should be noted have zero proven clinical value). The company has placed its two co-founders – who are also its co-CEOs – on administrative leave.  

Medhost adds hospital business office outsourcing services.

ResMed announces Q3 results: revenue up 12%, adjusted EPS $0.89 vs. $0.92. 

Inovalon reports Q1 results: revenue up 57%, adjusted EPS $0.10 vs. –$0.04.


Sales

  • Oklahoma Spine Hospital selects Evident’s Thrive EHR.

People

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Netsmart promotes Kevin Kaufman to CFO.

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Mindy Heintskill (Walgreens) joins MDLive as chief marketing officer.

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Medhost promotes Jason Myers to CIO and Rick Brown to chief development officer.

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Cerner Chief People Officer Julie Wilson will retire on June 30 after 16 years in that position and 24 with the company.


Announcements and Implementations

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Cantata Health adds a resident referral portal to its NetSolutions EHR for skilled nursing facilities.

In Massachusetts, Lahey Health System and Tufts Medical Center implement secure communications and notification capabilities from Secure Exchange Solutions as part of the ELINC HIE.

Woman’s Hospital (LA) goes live on Meditech Expanse Point of Care.

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North York General Hospital in Toronto goes live on Spok’s Care Connect contact center technology.


Other

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AMIA announces its first group of Fellows (FAMIA) in applied informatics. 

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DirectTrust seeks members to serve on its Direct Standards Consensus Body.

Medlio co-founder Lori Mehen recounts her negative experience in applying for the Cedars-Sinai Accelerator, saying that the CIO (presumably Darren Dworkin) told her seven minutes into her 15-minute scheduled meeting with him that not only would he vote no, but that he would also “veto anyone who says yes,” describing his tone as “belligerent and hateful” in telling her, “We don’t need your help getting our patients to find our doctors.” (It should be noted that this is one side of the story and other companies, especially those who were actually accepted into the program, have spoken positively about their experience and Darren’s involvement). She concludes:

We’re certain that we’re not going to be accepted. Nevertheless, it was imperative that I write this before they make their final decision. I’ve discussed this with my partners and they both agree, in the off chance we would have been accepted, we want to go on record as saying Cedars can go f%&k themselves. I’m not supposed to say this because doing so will almost certainly cost me, but that’s exactly why I must. Not just for me, or for my co-founders, but for all the other startups he has abused and will continue to abuse.

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The University of Maryland works with local officials to deliver a kidney via drone to the University of Maryland School of Medicine three miles away, where it was successfully transplanted into a 44 year-old woman who had been on dialysis for eight years. Baltimore traffic must be awful to risk having a kidney-bearing drone come crashing to earth for such a short trip.

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I’m not sure if this is an example of social engineering hacking, incredibly bad security practice, or incredibly good cybersecurity humor.


Sponsor Updates

  • Securance Consulting gives Engage a five-star for the fourth year in a row for being a Best Practice Meditech Hosting Provider.
  • Elsevier will work with PhactMI to develop a new semantic search portal that will offer providers scientifically accurate, current, and unbiased information.
  • EClinicalWorks will exhibit at the 2019 AAOE Annual Conference May 4-7 in Nashville.
  • EPSi extends early-bird pricing for the Visis EPSi Summit, taking place October 22-24 in Austin, TX, through May 31.
  • HCTec publishes a new case study featuring St. Luke’s University Health Network.
  • Iatric Systems will exhibit at the NCHiMA Quad-State event May 5-8 in Myrtle Beach, SC.
  • InterSystems will exhibit at the DoD/VA & Gov Health IT Summit May 8-9 in Alexandria, VA.
  • Kyruus announces the availability of ProviderMatch DirectBook in the Cerner App Gallery for direct scheduling into Cerner Millenium.
  • OptimizeRx will integrate Eversana’s patient support and specialty distribution models into its real-time EHR network.
  • Artifact Health partners with HCPro to provide compliant, time-saving CDI templates for provider queries.
  • The Customer Relationship Management Institute awards Wolters Kluwer customer support teams the NorthFace ScoreBoard Award for exceeding customer service expectations.
  • Henry Ford Health System (MI) expands its use of CarePort software with the implementation of Guide, Connect, and Insight solutions.
  • ROI Healthcare Solutions launches a new “day-in-the-life” content series focusing on its project managers.
  • Dimensional Insight publishes a new white paper, “How Successful Are Healthcare Organizations with Clinical Analytics?”

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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EPtalk by Dr. Jayne 5/2/19

May 2, 2019 Dr. Jayne 3 Comments

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I’m continually surprised by the inability of EHR vendors to add fairly straightforward safety features to their systems. A reader sent in this screenshot that shows a patient’s pulse documented as 12,224 beats per minute. They also shared screenshots of other parts of the EHR with similar issues. The blood pressure field isn’t divided for systolic or diastolic entries, but rather requires the user to type a “/” between the values, leading to potential errors.

Since I’ve been on the vendor side of the house, I understand that it’s not as simple as it seems to make these kinds of corrections since they may require changes to the database. However, it’s not as difficult to make changes to the screens where data is entered. In this situation, they could limit the entered data to three characters. Frankly, if you need to enter a fourth digit, your patient has probably just died of rampant tachycardia.

When reporting these types of issues to vendors, we are often told that it’s not on the development roadmap, that it would be too technically difficult, or that it would require more development hours than are available. When we’re talking about data entry errors and patient safety, however, how much time is too much time to spend on something like this? Not to mention that if you’re trying to exchange data and want to be truly interoperable, this kind of bad data is going to be an issue for practices trying to consume data from flawed sources.

With all the certification requirements, why haven’t we mandated management of basic patient safety issues like this? As much as we’re told that paper kills, I doubt there were too many instances where a technician would have documented a pulse of 12,000 in a paper chart.

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You know people are desperate when felony colonoscope theft becomes an issue. Two men and a woman burglarized a Philadelphia-area hospital and made off with tools from the colonoscopy suite. Police fear the devices may be sold on the black market. If that’s the case, I hope they go through a thorough cleaning cycle first.

I had a conference call today with a potential employee who dialed into the meeting from a shared work space with little privacy. There were people walking back and forth in the background during the entire call, and in a couple of instances, the interviewee even turned around to see what was going on behind him. If this is the best environment he could come up with for a job interview, I wonder what his daily work environment might look like. He mentioned that he likes to work away from home because “it’s less boring,” but failed to elaborate. That’s a trip directly to the round file for this candidate.

Other occupants of the round file include people who try to conduct their entire lives from their phones, leading to emails saying they can’t open attachments on their phones or have trouble accessing various resources on their phones. Mobile is a great extender, but if you’re going to do a serious job in IT, you have to understand when it’s appropriate to use a more traditional laptop, tablet PC, desktop, etc.

In response to my recent piece about Ovia and other fertility apps, a reader shared this Washington Post follow-up that discusses ways women protect their privacy on these apps. One woman drew the line at providing the name and date of birth of her baby – she was willing to share her own personal information, but not that of her newborn.

Over 100 women responded to a request from the Post. Respondents “often said they felt trapped by an unfair choice: They cared about privacy, but they also found the digital trackers too valuable to give up.” Women used pseudonyms, logged only a minimum of information, and modified some data to preserve anonymity. Others noted that the apps weren’t that helpful. One commented that they “led to micromanaging my body and habits, which led to stress.” Another noted deliberate gaming of systems used by employers who are trying to get data on staffers: “If my employer was offering money for pregnancy tracking, I would probably do the same thing I already do with the fitness tracking and just input false content.”

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The reality is that personal health information is everywhere, whether people are providing it willingly with the understanding that they can’t control it once it’s out of their hands, or whether they want to use it for specific purposes. There is a great deal of discussion about the role of patient-generated health data in clinical care. Many clinicians are uncertain about its role in driving outcomes and contributing to clinical quality. There are also concerns about how to handle the data. Clinicians find the idea of receiving hundreds if not thousands of data points into their EHRs to be particularly daunting. Some of these physicians were concerned in the paper days about patients bringing in blood pressure or blood sugar logs, so it’s not surprising that they are uncertain about the data in the electronic world.

There are also concerns by both patients and providers about data security, but it’s hard to quantify the pros and cons. An article in the Journal of the American Medical Informatics Association notes that patients are open to various methods for data collection, whether it is through a medical history, patient questionnaires and surveys, or biometric and activity data. Researchers interviewed health system leaders, EHR vendor leaders, and leaders of third parties providing patient-generated health data tools to health systems. They also interviewed patients with chronic conditions, with half of those patients having experience with generating data. The number of survey participants was small, but the authors conclude that patient-generated health data really isn’t being pursued at broad scale, largely due to concerns about its value.

What do your providers think about patient-generated health data? Are you using it? Does it add more confusion? Leave a comment or email me.

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Morning Headlines 5/2/19

May 1, 2019 Headlines No Comments

Capsule Technologies Acquires Bernoulli Health

Medical device integration and patient monitoring company Capsule Technologies acquires clinical surveillance software vendor Bernoulli Health.

Teladoc Health Reports First Quarter 2019 Results

Teladoc exceeds analyst expectations, posting $129 million in revenue for the quarter, 4 million new members, and a 75% increase in visits.

AMN Healthcare to Acquire Advanced Medical

AMN Healthcare Services will acquire Advanced Medical Personnel, which offers healthcare staffing services that include telemedicine positions, for $200 million.

VA, DoD Electronic Health Records Still Aren’t Compatible, and Lawmakers Are Angry

Despite a decade’s worth of promises and billion-dollar expenditures, lawmakers continue to express outrage over the combined inabilities of the DoD and VA to merge EHR systems.

Morning Headlines 5/1/19

April 30, 2019 Headlines 1 Comment

Health Catalyst Aims to Raise $150 Million to $200 Million in IPO

The Wall Street Journal reports that Health Catalyst expects to raise up to $200 million in its IPO.

MEDITECH Announces Professional Services

Meditech launches a professional services division that will include quality initiatives, physician consulting, performing interoperability assessments, and lending expertise to analytics and population health projects.

Philips’ Q1 core profit misses estimates on bleak sales

Philips announces poor Q1 revenue and earnings that strong growth in China could not offset.

News 5/1/19

April 30, 2019 News 15 Comments

Top News

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Meditech posts Q1 results: revenue down 5.7%, EPS $0.97 vs. $0.08. The big bump in earnings was due to a $46 million year-over-year swing in unrealized marketable securities gains.

Product revenue dropped 21%, operating income was down 33%, and net cash earned from operations was down 44%.


Reader Comments

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From Dramatic Entrance: “Re: provider online reviews. This survey says patients find them critical when choosing.” This gives me an opportunity to illustrate how the headline of a survey’s results is often misleading or its methodology so shaky that the results mean little. For this particular one:

  • The survey’s 839 respondents were self-selected, recruited by using a survey tool’s survey bank and thus likely not validated in any way.
  • The survey question asked whether a positive online reputation is important, where a better question would have been, “How important was online reputation when you chose your most recent provider?” Never ask people what they think or believe when you could just as easily ask them what they actually do.
  • Half of respondents said they have submitted negative provider feedback but were never contacted, but the question didn’t ask how they submitted their criticism (Yelp? The practice website’s contact form? Complained to the front desk person on the way out?)
  • The survey lumped all providers together, everything from hospitals to dentists to doctors. That means the somewhat skimpy respondent count was then segmented further.
  • The company that performed the survey sells reputation management services. They did not engage an independent survey organization that would have followed defensible methodology.
  • Perhaps worst of all, lazy sites that are desperate for “news items” reworded the results into a pointless story with unrestrained headlines and no disclaimer about the obvious validity concerns.

From Ornery Cuss: “Re: health IT startups. Why do you let other sites offer more coverage?” My audience is mostly at the health system C-level, and as the lack of market success of most startups validates, those self-proclaimed disruptors don’t typically fare well trying to pass off half-baked outsider ideas to conservative health systems that are looking for solutions to real problems that offer quick return on investment. Sites that love writing about startups are usually run by people with minimal actual health IT experience who find their naiveté less of a hindrance when they write speculatively about companies nobody’s heard of. I’ll give those companies airtime once they’ve done something impressive enough to take up reader time, which right there excludes 90% of them. Otherwise, it’s like a major league baseball fan studiously following tee-ball games.


HIStalk Announcements and Requests

Listening: new from Interpol, Manhattan-based indie pop-rockers who have been at it since 1997 and who still sound great (think Joy Division). I was excited about hearing them for the first time, at least until I used the HIStalk search function to realize that I first recommended them in January 2009. At least I still do.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Philips announces poor Q1 revenue and earnings that strong growth in China could not offset. Its connected care group posted a 1% revenue drop, while its Personal Health businesses grew sales 5%. The company’s strongest segment was electric toothbrushes. The company said in the earnings call that “we are developing a much more end-to-end care orchestration environment that hospital and care providers are excited about,” but it is taking time to roll that out.

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Computer Sciences Corp accuses India-based Tata Consultancy Services of stealing its source code to develop a competing life insurance administration application. Epic won a $420 million trade secrets award from Tata in 2016, claiming that company employees exploited their role as Kaiser consultants to download proprietary Epic materials to help them develop competing software.

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The Kansas City business paper digs up some interesting Cerner SEC filings related to the involvement of activist investor and tiny shareholder Starboard Value, with which Cerner signed a legally binding cooperation agreement for reasons I can’t fathom other than Starboard’s swagger scared rookie Cerner CEO and board chair Brent Shafer into avoiding the kind of public battle that took out Athenahealth’s Jonathan Bush:

  • Starboard Value made its run at Cerner two days after Shafer announced his new “operating model.”
  • Two of Cerner’s four new board members were nominated by Starboard – former AliphCom President Melinda Mount (AliphCom was the original name of now-liquidated Jawbone) and former Cloudmark CEO George Reidel.
  • Cerner agreed in writing to implement profit-boosting cost cuts and operating changes and to announce those plans via a press release.
  • Cerner agreed to reimburse Starboard up to $275,000 for the legal fees the investor spent to force its way onto Cerner’s board.

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The Wall Street Journal reports that Health Catalyst expects to raise up to $200 million in its IPO.


Sales

  • Metro Health – University of Michigan Health chooses Glytec’s FDA-cleared EGlycemic Management System to standardize best practices in glycemic management.
  • HealtHIE Nevada and the Nevada Hospital Association will implement Collective Medical to provide point-of-care insights to reduce avoidable admissions by supporting care collaboration and event notification across EDs, hospitals, post-acute care, behavioral health, and ambulatory settings.
  • Catholic Charities of Baltimore will implement the SmartCare EHR from Streamline Healthcare Solutions.

People

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OptimizeRx hires Stephen Silvestro (Wolters Kluwer) to the newly created position of chief commercial officer.

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OurHealth names Brian Norris, RN, MBA as interim VP of IT.

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Impact Advisors promotes Erin Svarvari to VP of operations.


Announcements and Implementations

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A new KLAS report looks at hospital EHR market share and makes these points:

  • Epic gained a net 121 hospitals in 2018, losing just one existing customer.
  • Cerner’s net hospital gain was 100, mostly because of its VA deal that represented 167 hospitals, but it lost 65 Millennium accounts, nearly all of which moved to Epic.
  • Nearly all large hospitals and multi-hospital systems that are choosing EHRs (which is not all that many these days) are choosing Epic, while Cerner is selling mostly to smaller hospitals.
  • Meditech had a net loss of 18 hospitals, while Allscripts lost 28 while gaining only three.
  • Market share in hospitals of 500+ beds is mostly Epic, with 58% vs. Cerner’s 27%.
  • Meditech Expanse is selling well and customers are upgrading, but its users are mostly small hospitals, quite a few of which are being acquired by large systems that then convert Meditech to their corporate standard of Epic or Cerner.
  • Allscripts is losing Sunrise and Paragon customers to other vendors as few choose to replace their Allscripts-acquired legacy products with Sunrise.
  • Athenahealth has stopped hospital sales at least temporarily, while EClinicalWorks sold no new hospital contracts in 2018 and the hospital product has not yet reached beta testing.

Imprivata launches IAM Cloud Platform, a cloud-based identity and access management platform that is powered by Microsoft Azure Active Directory. The initial release includes Healthcare Seamless SSO single sign-on.

Meditech launches a professional services division, expanding its implementation offerings to include spearheading quality initiatives, physician consulting, performing  interoperability assessments, and lending expertise to analytics and population health projects.

Verisk will analyze EHR data collected by Human API for life insurer risk scoring and benchmarking.


Other

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Paychecks at 34,000-employee Hackensack Meridian Health are incorrect for the second consecutive pay period due to what it says are problems related to its Oracle PeopleSoft payroll implementation. One employee’s paycheck was for 19 cents, while others have reported that errors caused them problems in qualifying for a mortgage and avoiding bank overdraft charges.

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Bob Wachter makes an interesting observation – a doctor told him that he enjoys the companionship and collegiality of working with a scribe just as much as he enjoys their help with documenting patient care. I had never really considered that a typical practice or clinic doctor interacts only superficially with employees and even that might be awkward because of the perceived rank and authority issue. This reflects on what Dr. Jayne just wrote about in hospitals ending the old-school “medical staff dinners” where everybody got together with their peers for decent food, socializing, and hospital updates, building trust all around (as we say in IT, a lot of people like our employees but hate our department). I’ll also add my own observation – frontline doctors are an easy target for drug company reps who are trained to push emotional buttons (fake friendship, fake mutual interests, fake romantic interest) to generate more prescriptions. In fact, I’ll add observation #2 – doctors (especially procedure specialists like surgeons) often behave bizarrely and childishly when attending hospital-convened meetings because they live their work lives in a fluorescent caves where they are expected to issue curt orders while never really learning professional niceties, while hospitalists and other non-procedure docs who have to get along with patients and families are not much different from the rest of us in skillfully riding the conference room chairs. I bet I could sit here and cobble together a burnout remediation strategy around these factors.

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Business Insider tries DNTL, a New York City “walk-in dental bar” that offers online appointments, IPad form completion, a massage exam chair, and a TV in the treatment room. Its services are covered by dental insurance. Maybe the important takeaway here is that consumers value convenience and atmosphere topmost when they consider a service – such as teeth cleanings or even dental procedures — to be a commodity where outcomes are assumed to be similar everywhere (whether that’s actually the case is irrelevant). Contrast that with the average clinic or doctor’s office, where patients wait in uncomfortable waiting rooms to be seen later than scheduled, nobody really cares if they are comfortable or anxious, treatment is mostly episodic and impersonal, and it’s like cattle being prodded through an abattoir on the frustrating round-trip journey from and back to the sidewalk (hopefully in no worse shape).

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In China, police haul a thoracic surgeon away in handcuffs after he refuses to see a patient whose husband had jumped the line, then tells officers he can’t leave to make a statement because he has patients waiting. In a slight medical irony, the surgeon — perhaps aided by knowing where to punch when a scuffle ensued – broke the husband’s rib.

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Weird News Andy codes this story as W61.92 and expresses relief that the birds that were involved weren’t sick because that would have been “ill eagle.” A woman who is taking photos of a sky full of eagles is hit by a pair of them who were engaged in the mating ritual called “cartwheeling,” whereupon they drop from the sky, and in this particular case, into her lap. The happy couple flew away unharmed, but the accidental falconer required bandages and a tetanus shot.


Sponsor Updates

  • AdvancedMD will exhibit at ACOG May 3-6 in Nashville.
  • Mumms Software will integrate DrFirst’s e-prescribing and medication management software with its hospice EHR.
  • CoverMyMeds will exhibit at the NCPDP Annual Conference May 6-8 in Scottsdale, AZ.
  • CTG will exhibit at the KACHE event May 2-3 in Garden City, KS.
  • Diameter Health will present at the Annual DoD/VA & Government HIT Summit May 8-9 in Alexandria, VA.
  • DrFirst structures a new $17 million commercial financing facility with SunTrust.
  • Wolters Kluwer accelerates healthcare data mapping with artificial intelligence to bridge data silos.

Blog Posts


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Contacts

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

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Morning Headlines 4/30/19

April 29, 2019 Headlines No Comments

CareDx Agrees to Acquire OTTR Complete Transplant Management

Transplant patient-focused molecular diagnostics company CareDx acquires organ transplant patient tracking software vendor OTTR for $16 million.

HealtHIE Nevada, Nevada Hospital Association and Collective Medical Announce Collaboration to Reduce Avoidable Readmissions

The Nevada Hospital Association will leverage data and services from HealtHIE Nevada and Collective Medical to help its member hospitals better identify and support vulnerable patients at risk for readmission.

Michael J. Fox Foundation and 23andMe Launch Fox DEN, a Data Platform Combining Patient-Reported Outcomes and Genetic Information in Parkinson’s

The Michael J. Fox Foundation for Parkinson’s Research and 23andMe develop the Fox Insight Data Exploration Network to enhance the foundation’s online clinical study with improved analytics and data access.

Curbside Consult with Dr. Jayne 4/29/19

April 29, 2019 Dr. Jayne 2 Comments

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As much as we complain about our technology, there are days when I’m glad to have it. This week was one of those, when I was confronted with multiple patients who had been exposed to wild animals and I had to quickly determine whether rabies exposure was a risk in our area.

Barely a decade ago, this question would have required a fair bit of research and possibly a phone call to the county health department. Although we determined that being scratched by a squirrel wasn’t considered a risk factor because the incidence of rabies in the squirrel population in our area is relatively low, apparently the largest reservoir in our area is the woodchuck. I always thought they were a slow animal that doesn’t do much, but apparently when they are rabid, they will chase people. I’ll be on the lookout for any deranged woodchucks on my upcoming outdoor adventures.

It’s also fantastic to have data from the Centers for Disease Control at our fingertips – where we are in the current influenza season (almost done!), how many people have died this year (fewer than 55,000 compared to last year’s 80,000), and what the current recommendations are for our patients who are traveling to various parts of the world.

When I work with physicians who complain about having to use computers in the exam room, I challenge them to think of ways that computers are beneficial and how they might learn to better use the computer as part of the patient visit rather than fight it. Even the most reluctant physician can usually think of a handful of positives.

Some of the concerns I hear from physicians are part of a larger issue with organizational dynamics. I was pleased to see a recent editorial in the Journal of the American Medical Association addressing the need to build trust as part of relationships between clinicians and healthcare organizations. The authors note that although many books cover this in the business world, there is little addressing how it impacts clinician relationships with their employers or sponsoring organizations. They note that we have likely arrived at this place of mutual distrust due to the size of many healthcare organizations and the insertion of management layers between frontline clinicians and senior leadership.

Often changes that are being driven by payers or the market result in hostility towards organizational leaders. I see this often in the EHR trenches, as providers fail to fully understand the role of government mandates and payment incentives / penalties in driving EHR use.

The authors also cite poor communication as a key reason for lack of trust. I agree wholeheartedly with that assertion. I still see organizations that have fractured communication pathways. This may result in chain-of-command communications that reach clinicians at different speeds and sometimes not at all, or inconsistency in the messaging.

During some of my interim CMIO engagements, I’ve seen meetings canceled with no explanation, which leads to feelings of uncertainty and a lot of time spent by invitees in trying to figure out why it was canceled or whether policy has changed. It’s unfortunate because a simple explanation with the meeting cancellation would have created a lot of goodwill – “canceled due to schedule conflict, will be rescheduled” would go a long way to silence what I’ve seen turn into full-blown organizational conspiracy theories.

They note other drivers of distrust, such as “poorly conceived or implemented electronic health records, competing interests, and misaligned incentives” that add to the confusion. Other factors include a perceived lack of clinician input, overly rapid changes to processes or metrics, administrative burden, and inadequate support staff. They also note that clinicians struggle to buy in when standardized care processes are discussed along with other changes that might negatively impact clinician autonomy.

I agree with the authors that it is easy to violate trust and extremely challenging to rebuild it. They call on organizations to engage “leaders who are visible, available, and responsive and who know how to develop and foster positive relationships.” Having worked with several boorish leaders over the last several years, I’d also suggest that leaders be educated on their constituents and how they will perceive anecdotal stories that the leaders might throw out.

I worked with one CEO who constantly talked about his ski trips, his sailboat, and his house in Jackson Hole. Let’s just say that didn’t resonate with primary care physicians who were driving 10-year old Hondas. Nor did the story about the year he took off work to coach his son’s baseball team. Some background research on what made that particular group of physicians tick or what their economic status was might have been helpful and would have saved everyone a bit of angst.

I enjoyed the section that mentioned that “marketing slogans are no substitute for a clearly articulated purpose that is consistently and continually reinforced through action and policy.” One well-known health system had a campaign around “world’s best medicine made better.” What does that mean, exactly? What is the goal? How do frontline physicians play a role?

The authors note that although trust is a two-way street, “organizational leaders are best positioned to take the first step in establishing trust. Clinicians are unlikely to shift from suspicion and disengagement to being fully trusting unless they experience leaders who are trustworthy, but also must act in ways that engender trust.”

I was surprised that there weren’t more comments on the article, only one that identified lack of departmental meetings as a driver of distrust since face-to-face interactions were reduced. We used to have quarterly medical staff meetings at our hospital that were a big deal, with a catered sit-down dinner. Big issues were discussed and the majority of the medical staff made a point to be there. However, as costs were cut, those dinner meetings gave way to lunch meetings, which disenfranchised those of us who didn’t practice on the hospital campus. Those were in turn canceled due to “poor participation” and what used to be a vibrant discussion was reduced to the occasional email blast telling us about the hospital’s priorities.

I’m interested to hear what readers think about the state of trust in healthcare organizations. What is your organization doing well? What could use improvement? Leave a comment or email me. And watch out for rabid woodchucks.

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HIStalk Interviews Dan Dodson, President, Fortified Health Security

April 29, 2019 Interviews No Comments

Dan Dodson is president of Fortified Health Security of Franklin, TN.

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Tell me about yourself and the company.

I’ve been in healthcare for most of my career. I have always been inspired to give back to healthcare and patients. I have an MBA in health organization management and have always been intrigued at the concept of using my business degree to help provide better patient experiences. I’m blessed to do that at Fortified Health Security.

We are a cybersecurity company, a managed security service provider. We provide a wide range of managed services to healthcare organizations to help them combat threats and comply with regulatory requirements.

How does a health system decide where to focus their cybersecurity efforts and funding?

I have that conversation with organizations every day. The majority of healthcare organizations understand that it starts with a risk assessment. Pick a framework and do an assessment. From there, figure out where you have deficiencies or opportunities for enhancements. Every health system is different on what their next step will be, but the core of every good cybersecurity program requires performing an assessment of where you are, then driving your strategy from that.

Then, think about the perceived value of your cybersecurity spending and the actual value that you are receiving. A lot of organizations look to buy the next shiny security tool. The board and C-suite perceive that the purchase of that technology will better protect them from adversaries and from hackers. That is true to some degree, but when we implement those technologies within a healthcare environment and its many nuances, we lose sight of what we actually need to do to operationalize that technology.

I encourage organizations to think about not only how they are deploying capital for buying new technologies or implementing new services, but how they are making sure that they are working in concert with prior investments whether they are supporting them operationally to extract the value that they perceive those tools provide. Tools can be quite sophisticated, but they require people and process to extract their full value. We see a lot of under-implemented, underutilized technology in healthcare organizations that we work with.

Sensationalistic headlines talk about theoretical risks that have never actually happened in the real world, such as medical device hacking and inserting malware in medical images, which doesn’t seem to offer much incentive for a hacker. Are hospitals chasing those hypothetical problems instead of the duller but more dangerous ones that don’t make headlines, such as the usual email-launched attacks?

Certainly some companies and folks are chasing those headlines with their solutions. No single bullet will protect you and secure you 100%. You have to take a layered approach that is appropriate for your organization.

We do a lot around medical device security. The threat to medical devices is real, but we are seeing it manifested by adversaries and hackers using them as a jumping-off point to get to the valuable data, not necessarily to disrupt the clinical performance of that device. They use the medical device to get to EPHI.

What new cybersecurity threats have you seen recently that are most worrisome?

We are seeing a lot of just the fundamental attacks, such as insiders and users and clicking on bad links in email. Those are still some of the highest threats that face organizations. Attacks such as phishing and vishing are increasing and becoming more sophisticated.

We encourage people to think about the fundamentals of a security program. The unsexy things — patching, making sure that they are doing vulnerability scanning, making sure that they are identifying where they have EPHI, monitoring the networks, and looking at logs. The traditional core fundamentals. Often when we peel back the layers of what happened in a big breach, a user inadvertently or purposefully did something, or there was a lack of internal blocking and tackling for security. We encourage folks to think about whether they are executing a good, solid fundamental program before investing in the latest and greatest gear and tech.

Organizations that are forced to admit that they have been breached always claim it was a sophisticated attack and sometimes imply that a state-sponsored hacker was involved, perhaps to make themselves seem to the public to have been more security-aware than they really were. That can lead the organization’s cybersecurity insurers to refuse to pay their claims because they can say that implicating state hackers suggests an act of war that their policy doesn’t cover. What is the level of threat from state-sponsored hackers in healthcare?

Healthcare is vulnerable. ARRA and HITECH spurred rapid digitization that wasn’t always implemented on modern, secure networks and infrastructure. The increased amount of valuable electronic health information is stored on the path of least resistance. State-sponsored attacks and hackers look for the path of least resistance, so we are vulnerable at the onset.

You brought up cyberinsurance, which is important to understand. Procurement of cyberinsurance in a healthcare organization may or may not involve IT or security. It might be procured by the legal or compliance department. A cyberinsurance policy’s actual insurance binder contains the requirements for that policy to be in force. It is important that organizations know what’s in that binder so if they have an incident, they actually get paid.

We are seeing that during the claim review process, cyberinsurers are doing claw backs or denying claims because the organization wasn’t meeting the requirements contained in the insurance binder. That’s a critical area of focus. Don’t get a false sense of security just from having cyberinsurance. You have to make sure you are doing whatever the binder requires. It has gone unfavorably for healthcare organizations that failed to do that.

Why do we keep seeing major information exposure from unsecured servers that are open to the Internet?

Networks have sprawled over time with health system acquisitions and consolidation. We see that every day. This cobbled-together infrastructure and process allows it to happen. We are all shocked when it happens and of course we want to avoid it.

It goes back to the fundamentals and looking at root cause. We need to have asset inventories, know where our EPHI is stored, and understand how it is performing on our network and within our environment. Spending time on the blocking and tackling fundamentals reduces the chance of finding yourself in that situation.

Quite a few breaches were caused by a health system’s third-party vendor. Has anything changed with regard to the role of business associate agreements in a security plan?

It is important to understand third-party risk, the types of data you are sharing, and how you are sharing it. The lines of responsibility have become blurred within the context of those types of relationships.

It’s important to have business associate agreements in place. I always chuckle when I say that because we still find people not doing that. Then it’s important to have risk stratification of those third-party partners to make sure that you understand what they’re doing from a security perspective to better isolate the data that we create and that we’re responsible for safeguarding.

How common is it for a health system to have a chief information security officer position that is staffed by someone whose credentials would qualify them to work outside of healthcare?

There’s a human capital problem in cybersecurity for all industries. Depending on what rags you read, millions of cybersecurity jobs are open worldwide at all levels. As you narrow that down to healthcare specifically, we see that a lot of the larger organizations have a CISO on staff full time. When you get to the mid- market, they probably have a person who is dedicated to security, but who has other functions as well. The organization may engage in some type of virtual information security offering to offset that, to bring in expertise and guidance without necessarily keeping somebody full time.

The big challenge is that the role turns over every couple of years. Folks do not tend to stay long in this job. That can cause challenges for the healthcare organization because they’re changing strategy every couple of years when the leader changes.

Do you have any final thoughts?

We are in an interesting time with cybersecurity and the threat landscape. I’m encouraged by the progress that most organizations are making in this space. I encourage everybody to continue to focus on the fundamentals. To those who have partnered with Fortified and our employees, thank you for driving our mission to increase the security posture of healthcare.

Morning Headlines 4/29/19

April 28, 2019 Headlines No Comments

Notification of Enforcement Discretion Regarding HIPAA Civil Money Penalties

HHS announces that it will use its discretion to set maximum annual HIPAA fines based on level of culpability, reducing the amount for those with no knowledge from $1.5 million to $25,000.

uBiome, the health start-up just raided by the FBI, had been double billing insurers

The FBI raids the San Francisco office of UBiome, which sells questionably useful AI-powered microbiome test kits for gut health and women’s health that are ordered by its own telemedicine doctors.

The future of health to have new home

Arizona State University and Mayo Clinic break ground in Phoenix on the Health Futures center, which will house a medical technology accelerator, research labs for biomedical engineering and informatics, and nursing programs.

Tech Billionaires Give $200 Million to Mass. General Hospital

InterSystems founder Terry Ragon and his wife Susan donate $200 million to Massachusetts General Hospital to endow a vaccine research center, piggybacking onto their $100 million donation 10 years ago to fund AIDS vaccine research.

Monday Morning Update 4/29/19

April 28, 2019 News 4 Comments

Top News

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HHS announces that it will use its discretion to set maximum annual HIPAA fines based on level of culpability, reducing the amount for those with no knowledge from $1.5 million to $25,000.

Above are the old vs. new penalty tiers.


HIStalk Announcements and Requests

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Nearly 40% of a large number of poll respondents don’t see Epic, Cerner, and Meditech getting new EHR competition in the next 10 years, although 25% of respondents think Silicon Valley firms could potentially enter that market. Holly says EHRs are a dying breed with the only hope being third-party add-ons to make it all work, while Bitbot foresees data science-driven workflows that will overshadow outdated databases and processes. DrLyle takes the long view that the future entails a lot more home care, virtualization, and at-risk entities setting up clinics whose needs could be met by a slimmed-down EHR for care tasks. Matthew Holt agrees that hospitals have tied themselves to Epic and Cerner and sees the threat being that chronic care will move to the home and hospitals see their business cut back to performing procedures and attending to dying patients.

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New poll to your right or here, as suggested by a reader who is COO of a health system that is making an EHR decision and looking at vendor interoperability capabilities and federal initiatives: When will every provider in every care setting be able to reliably exchange all clinically relevant patient information? (continuity of care document, consultation notes, discharge summary, imaging integration, DICOM diagnostic imaging reports, history and physical, operative note, progress note, procedure note, and unstructured document).

I’m interested in interviewing insightful, non-vendor people who are doing work that would inspire my readers. Let me know who you recommend. Many of those I reach out to don’t have the interest, time, or organizational approval to speak frankly (and some don’t have the courage to undergo an unscripted conversation), so I’m casting the net.


Webinars

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


Acquisitions, Funding, Business, and Stock

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From the Cerner earnings call following release of quarterly results that met Wall Street expectations:

  • Chairman and CEO Brent Shafer says the involvement of activist investor Starboard Value was consistent with the company’s existing efforts to improve company financial performance.
  • Cerner has engaged turnaround consulting firm AlixPartners to look for efficiency and cost-saving opportunities that won’t negatively impact Cerner clients.
  • Key projects include looking at management structure and costs, reviewing the company’s product portfolio, rationalizing its facilities, and reviewing non-personnel costs.
  • The company will be more selective in evaluating low-margin deals.
  • Cerner will go at-risk with providers to generate higher-margin business.
  • The company notes that while the EHR market is mature, it can cross-sell revenue cycle and ambulatory products to that client base.
  • Cerner admits that companies will likely issue “competitive messaging” to Cerner’s clients about its focus on increasing margins, but says those clients needs the company to be more efficient and to bring products to market faster.
  • Asked by an analyst about the apparent de-emphasizing of the RevWorks revenue cycle management business, the company says it contributes about $200 million in annual revenue but isn’t growing, suggesting that other opportunities are more promising. It also notes that Cerner uses its Works offerings “to more tightly align the client to Cerner” for additional software and services sales and it reviews the profitability of individual clients.
  • CFO Marc Naughton notes that Cerner’s $4.5 billion Innovation Campus was completely paid for by Missouri and Kansas City tax incentives.

Meanwhile, Cerner implements a hiring freeze, telling employees that “we can do better if we target our attention on areas that represent the largest and most profitable growth opportunities and drive client satisfaction and retention.”

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The New York Times notes the sometimes clinically sloppy practices of online birth control seller Nurx, which has used unlicensed personnel to dispense medications that had sometimes been returned by other customers, told its doctors to prescribe birth control to at-risk women as long as the patient agreed, and followed the Silicon Valley mantra of asking forgiveness rather than permission. The company responded to the article by saying that those practices ended a year ago with executive replacements.

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The FBI raids the San Francisco office of UBiome, which sells questionably useful AI-powered microbiome test kits for gut health and women’s health that are ordered by its own telemedicine doctors. Reports suggest that insurers complained about being overbilled by the company, while individual customers had previously filed Better Business Bureau complaints saying that their insurance was billed thousands of dollars for tests they thought they were buying in full for less than $100. The FBI is also apparently interested in how the company pays its doctors for referrals. In an interesting twist noted by CNBC’s Chrissy Farr, UBiome’s former product VP is now CEO at Nurx (see the item above).

Tampa-based, Hearst-owned MHK (formerly known as MedHOK) moves to a new 30,000-square-foot office at Harborview Plaza this week. The company has 250 employees.

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Vocera announces Q1 results: revenue down 12%, adjusted EPS -$0.17 vs. $0.04, beating Wall Street expectations for both. From the earnings call:

  • The company had its strongest non-healthcare bookings ever in Q1, including a multi-million dollar deal with retailer Nordstrom that was triggered by a former IT person at a hospital customer site who joined Nordstrom’s IT group and suggested Vocera as a solution.
  • Provider consolidation is leading to larger deal sizes, which adds complexity to the sales and approval process, but benefits Vocera as a unified platform vendor.
  • The company is winning 70-80% of the deals it is involved with, with little competitive impact from Cerner CareAware and no effect so far from Hill-Rom’s pending acquisition of Voalte.
  • The company was awarded authority to operate with the Navy and Air Force.
  • Market acceptance of the company’s new Smartbadge has exceeded expectations.

Sales

  • SacValley MedShare HIE chooses Zen Healthcare IT as its data integration platform in the “integration as a service” model.

Announcements and Implementations

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InterSystems founder Terry Ragon and his wife Susan donate $200 million to Massachusetts General Hospital to endow a vaccine research center, piggybacking onto their $100 million donation 10 years ago to fund AIDS vaccine research. The couple, whose net worth has been estimated at $2.5 billion, has signed the Giving Pledge, in which they will give most of their assets to philanthropic causes. Terry Ragon founded InterSystems in 1978 as a vendor of the MUMPS (Massachusetts General Hospital Utility Multi-Programming System) that was invented by two eventual Meditech pioneers (Neil Pappalardo and Curt Marble) and MD/PhD student Robert Greenes (now a biomedical informatics professor at Arizona State University). MUMPS powers systems sold by Epic, Meditech, and many other health IT vendors as well as the VA’s VistA. Privately held InterSystems has since added sophisticated database, integration, HIE, and clinical systems to its portfolio for both healthcare and non-healthcare sectors.


Other

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Arizona State University and Mayo Clinic break ground in Phoenix on the 150,000-square-foot Health Futures center, which will house a medical technology accelerator, research labs for biomedical engineering and informatics, and nursing programs. The facility, which will open in 2020, will be connected to Mayo Clinic


Sponsor Updates

  • Lightbeam Health Solutions will exhibit at the BCBS 2019 National Summit April 29- in Grapevine, TX.
  • Qventus will present at the 2019 EDPMA Solutions Summit April 28-May 1 in Scottsdale, AZ.
  • Mobile Heartbeat will exhibit at the Trauma Center Association of America’s Annual Conference April 28-May 3 in Las Vegas.
  • Netsmart Director of Post-Acute Community Strategist Teresa Craig will speak at the 2019 Association for Home and Hospice Care of NC Expo April 29 in Raleigh.
  • Nordic will host receptions during Epic XGM on April 30 and May 7 in Madison, WI.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the AWHONN Michigan Section Conference May 3 in Frankenmuth.
  • T-System will exhibit at the 2019 EDPMA Solutions Summit April 28-May 1 in Scottsdale, AZ.
  • Redox will exhibit at Epic XGM April 29-May 10 in Verona, WI.
  • The SSI Group will exhibit at the Louisiana HFMA Annual Institute May 5-7 in Lafayette, LA.
  • Surescripts will exhibit at the AMIA 2019 Clinical Informatics Conference April 30-May 2 in Atlanta.
  • The Healthcare Rap podcast features SymphonyRM Director of Client AI Chris Hemphill.
  • Wolters Kluwer Health will present at the AMIA 2019 Clinical Informatics Conference April 30-May 2 in Atlanta.

Blog Posts


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Contacts

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

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Weekender 4/26/19

April 26, 2019 Weekender No Comments

weekender


Weekly News Recap

  • Cerner announces Q1 results that meet Wall Street’s revenue and earnings expectations
  • Seattle-based genetic testing and health coaching startup Arivale shuts down after burning through $50 million in funding
  • CPSI announces plans to acquire patient engagement vendor Get Real Health
  • Bain Capital hires financial advisors to help it assess the potential sale of RCM vendor Waystar
  • The FTC files an antitrust lawsuit against Surescripts for allegedly monopolizing the e-prescribing market
  • Athenahealth lays off 200 employees
  • HHS announces CMS Primary Cares, two value-based care payment models launching in 2020 that it says will cover at least 25% of Medicare beneficiaries and providers
  • HHS opens Draft 2 of its Trusted Exchange Framework and Common Agreement for public comment

Best Reader Comments

The EHR’s screen can be really busy and have many redundant ways of doing similar workflows. This causes some levels of frustration because various trainers or local support folks will show different ways to accomplish a task (at times it’s the incorrect / non-best practice way). I remain empathetic to my colleagues as I know that they are constantly flooded (brain blocking) from all the tech tips etc. However, I just encourage them to “make it yours” via personalization of the user interface and data entry areas a little at a time. Over a few months, they’ll find that they are recouping a few minutes a day. (Dave Butler)

I’ve not been directly involved with IBM Watson Health, but from its beginning, I have always seen Watson as a hammer looking for a nail. Not to say that it doesn’t work (I don’t know), but it is an expensive way to already do what humans do pretty well, like diagnose patients. At best, it probably is 10 years ahead of its time, before the needs and questions appear that it best answers. (Prof. Moriarty)


Watercooler Talk Tidbits

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Ms. V in Texas asked for an Apple TV for her Houston-area students — all of them English language learners and many of them living in temporary housing following Hurricane Harvey — via a DonorsChoose teacher grant request. She reports, “The Apple TV has impacted my classroom in ways I didn’t even imagine. I have seen students more engaged and excited about lessons in class. The students are eager to answer and ask many questions while learning! My students love when I use the iPad connected to the Apple TV. I am able to walk around the room while I teach. This allows me to keep an eye on student engagement as well as incorporate the students into the lesson. My students enjoy being able to show their work on the iPad as well. I have downloaded an app that allows me to put PDFs on my iPad, which include worksheets, textbooks, etc. With this app, I am able to teach from these items and students are able to write over them. It’s amazing! This technology has changed the way I teach for the better, I am so grateful for these wonderful resources!”

Wisconsin Public Radio covers the “My Life, My Story” project in which volunteers talk to hospitalized VA patients about their lives and enter their story into the EHR. One of the project’s organizers says, “”The [electronic medical] record is a mess. If you were to try to get a sense of someone’s life from that record, it might take you days.” The idea came from a VA medical resident who realized that residents rotate out of a given facility quickly, but patients in the resident clinic stay the same as they just keep meeting new doctors. A survey found that 85% of clinicians find it worth their time to read the stories of their patients to help them communicate with them as individuals.

I guess North Korea is out of network – the federal government reportedly approved paying (but apparently never actually paid) a $2 million hospital bill to gain the release of detained US citizen and University of Virginia student Otto Warmbier, who was sentenced to 15 years of hard labor for removing a hotel’s propaganda sign. It’s not exactly value-based care, either – Warmbier was returned in a coma and died shortly afterward, with a US court finding the North Korean government liable for his torture and death.

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A former pediatric resident who was fired by UK Hospital (KY) in 2017 for possessing child pornography on his work computer is charged with that crime. The Linkedin of Ryan Keith, DO extols his residency performance without noting its undistinguished end, but he has since found a career (likely not long-lasting, if I were betting, given new media exposure) as a quality associate at IV manufacturer Baxter Healthcare.

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In Australia, an ED doctor is suspended for six weeks for posting patient photos online, proclaiming that mental illness involves “the only language these people understand is the language of violence,” posting anti-gay comments, and posting explicit photos of his psychiatrist wife with the warning that a failed marriage “would end in murder.” A litany of his bizarre online commentary reveals some truly disturbing beliefs, which he says are irrelevant because he’s a great doctor.

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A 19-year-old “Instagram butt model” and “influencer” convinces a Beverly Hills plastic surgeon – himself a self-proclaimed influencer – to declare her posterior free of surgery in what she says is “the first certified real booty.” I’m torn among directing my scorn to the US healthcare system, to social media, or to those so easily “influenced” by vapid societal non-contributors. 

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An Oregon pediatrician who courts antivaxxer parents lobbies against a proposed bill that would eliminate non-medical exemptions for vaccination, all while pitching his YouTube channel, anti-vaccine book, nutritional supplements, and detox clinic.

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The local paper profiles Duke Health spinal surgeon Oren Gottfried, MD, who has earned 100 on-screen TV credits for creating medical plot lines for TV dramas and then ensuring that they are portrayed accurately. He’s about to get his first on-screen appearance on “Chicago Med.”


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Reader Comments

  • Vaporware?: Mr. H, you can add this little propaganda gem to your file of Top 10 Euphemisms (emphasis mine). You have one of those f...
  • Fred: Epic's response to burnout is precious. Yes, everyone is happy and challenged, excluding of course the thousands who hav...
  • Brian Too: Any complex software that you spend a lot of time in, you'd better learn it well. Most people do that but if you invest...
  • AC: I don't believe they give you raw click numbers yet (only PEP/NEAT score), although I think Feb 2019 release is bringing...
  • Dodele: We use Cerner's Lights On and Advance data extensively. There is a wealth of valuable information and it is continuousl...
  • Epic User: As someone that actually tried to dig into the details of Epic's signal data, I quickly became underwhelmed. No click co...
  • Frustrated Patient: " suggesting that my providers don’t really want to open up a can of medical worms by asking how I’m doing overall e...
  • AC: That's good to hear. So the major vendors have worked on this and provided tools. The question now becomes are organizat...
  • Associate CIO: Re: EHR internal timers and event log monitoring Cerner has this as well, it is called the Lights On Network. A curr...
  • Bob: Liked - "The jammed interoperability floodgates would magically open by Labor Day if their payments depended on it."...

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