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Morning Headlines 6/28/19

June 27, 2019 Headlines No Comments

Change Healthcare’s shares debut below target

Shares of Change Healthcare began trading on the Nasdaq exchange, with shares opening at $13 and rising to $15 at market close.

Providence St. Joseph Health Acquires Bluetree Epic Consulting

Providence St. Joseph Health acquires Epic consulting firm Bluetree Network.

Google and the University of Chicago Are Sued Over Data Sharing

A former patient at University of Chicago Medical Center files a class-action lawsuit against the medical center and Google, alleging that the organizations violated HIPAA when they did not properly de-identify PHI that was used in a joint research project.

News 6/28/19

June 27, 2019 News 1 Comment

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Shares of Change Healthcare began trading on the Nasdaq exchange Thursday under the symbol CHNG. President and CEO Neil de Crescenzo rang the market’s closing bell.

CHNG shares opened at $13 versus the company’s target price of $16-19, but rose to $15 at the market’s close.

Majority owner McKesson congratulated the company in announcement that also included its intention to “exit its investment in Change Healthcare in a tax-efficient manner.”


Reader Comments

From Curious CIO: “Re: gag clauses. I just finished Eric Topol’s book ‘Deep Medicine’ and was struck by his claim that Epic’s contracts prohibit doctors or health systems from criticizing the company. I looked for that clause when we implemented Epic and other systems and found no hint of it in the contract. They are tight with publishing screen shots, but that’s IP protection.” I’ve read a lot of contracts without seeing any that specifically prohibit discussing the vendor’s product or related safety concerns. I’ve asked readers to send me examples and none have. Some contracts may include “non-disparagement” language, but that is likely not enforceable as long as the comments are truthful. My take is that health systems tell their people that their contract contains gag clauses when it really doesn’t, just to keep their vendor relationship harmonious when a discouraging word is about to be heard (I’ve never been muzzled by a vendor, but I have by a health system suit who just didn’t want to deal with any repercussions of telling the truth). I’ll ask again — if you have a contract that contains a gag clause, send it to me anonymously.

From Nailed Acrylically: “Re: NextGen Healthcare. The company is rumored to have cut 17% of the R&D work force in preparing to move those jobs to India as suggested in the quarterly earnings call.” Unverified. President and CEO Rusty Frantz said in the May 29 earnings call that “increased investment in our Bangalore development center will provide the best leverage … not engineered for R&D cost savings, but rather to increase our yield per investment dollar by adding significantly more of the right skill sets.” NXGN shares have dropped 3% in the past year vs. the Nasdaq’s 7% gain.


Webinars

July 18 (Thursday) 2:00 ET. “Healthcare’s Digital Front Door: Modernizing Medicine’s Mobile-First Strategies That Are Winning Patient Engagement.” Sponsor: Relatient. Presenters: Michele Perry, CEO, Relatient; Michael Rivers, MD, director of EMA Ophthalmology, Modernizing Medicine. Providers are understandably focused on how to make the most of the 5-8 minutes they have on average with a patient during an exam, but what happens between appointments also plays a significant role in the overall health of patients. Modernizing Medicine is driving high patient engagement with best practice, mobile-first strategies. This webinar will describe patient engagement and the challenges in delivering it, how consumerism is changing healthcare, and how to get started and navigate the patient engagement marketplace.

July 25 (Thursday) 2:00 ET. “Meeting patient needs across the continuum of care.” Sponsor: Philips Population Health Management. Presenters: Cindy Gaines, chief nursing officer, Philips Population Health Management; Cynthia Burghard, research director of value-based healthcare IT transformation strategies, IDC. Traditional care management approaches are not sufficient to deliver value-based healthcare. Supplementing EHRs with advanced PHM technology and a scalable care management approach gives health systems proactive and longitudinal insights that optimize scarce resources in meeting the needs of multiple types of patients. This webinar will address the key characteristics of a digital platform for value-based care management, cover the planning and deployment of a scalable care management strategy, and review patient experience scenarios for CHF and diabetes.

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


Acquisitions, Funding, Business, and Stock

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Integration technology vendor Sansoro Health and healthcare cloud and integration vendor Datica will merge under the Datica name, combining their operations at Sansoro’s Minneapolis headquarters. Sansoro co-founder and president Jeremy Pierotti will become president, while Datica co-founder and CEO Travis Good, MD will become CTO of the newly combined organization. Both have roots in Madison, WI, where Datica was formerly headquartered.

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Providence St. Joseph Health acquires Epic consulting firm Bluetree Network. The seven-state health system also owns Meditech consulting firm Engage.

Apple announces that Chief Design Officer Sir Jony Ive will leave the company to form his own design firm, with Apple as one of his clients.


Sales

  • Georgia Hospital Health Services chooses Audacious Inquiry to power its GA Notify clinician alerts when patients are admitted or seen in the ED.
  • The Nebraska Hospital Association’s NHA Services subsidiary will use PatientPing’s real-time care alert software to help its providers monitor patients diagnosed with carbapenem-resistant Enterobacteriaceae infections.
  • The Kentucky Hospital Association uses a $250,000 grant from the Anthem Foundation to equip the emergency departments of member hospitals with Collective Medical’s real-time event notification and care collaboration software.

People

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New York’s Healthix HIE promotes Todd Rogow to president and CEO.

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PerfectServe subsidiary Lightning Bolt Solutions names Mary Piepenbrink, RN (Pieces Technologies) as VP of sales.

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Experity, newly formed by the merger of DocuTap and Practice Velocity, names Steve Riehs as president and COO; Rick Cochran as CTO; Jennifer Wood as chief people officer; and Adam Steinberg as EVP of client experience.


Announcements and Implementations

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Livongo integrates its mobile disease management app with smartwatches to offer real-time alerts and healthy behaviors prompts.

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Apple will sell the IOS-integrated One Drop glucometer, which it has offered only online, in its physical stores. The monthly cost of the device, enough test strips and lancets for three tests per day, and help from a Certified Diabetes Coach is $49. Jeff Dachis founded the company in 2015 after starting several marketing companies.

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Hyland Healthcare announces GA of ImageNext vendor-neutral imaging workflow optimization software.

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Lehigh Valley Health Network (PA) implements FDB’s Targeted Medication Warnings for high-risk clinical scenarios including hyperkalemia, QT prolongation, opioid use, and pharmacogenomics.

Reliance EHealth Collaborative, an HIE serving providers in the Pacific Northwest, goes live on Virtual Health Record technology from Imat Solutions.


Government and Politics

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In Health Affairs, Dell Medical School professor and former national coordinator Karen DeSalvo, MD and Center for Digital Health Information Director of Policy Mark Savage outline four use cases for determining how much progress has been made five years into the federal government’s 10-year plan for interoperability, which calls for a nationwide learning health system by 2024:

  • Consumer and patient access to electronic health information. Standardized APIs should be implemented before the proposed January 2020 deadline.
  • Shared care planning and coordination. Simply collecting comments on the maturity of standards undermines the sense of urgency needed to ensure longitudinal care plans are available and active by 2024.
  • Person-generated health data. ONC needs to specify that new APIs offer both read and write access to ensure roadmap milestones are met. DeSalvo and Page also recommend that ONC prohibit API developers from charging patients read and write access fees and require them to conduct real-world testing.
  • Social and environmental determinants of health. ONC should move forward now with incorporating SDOH as new elements in the US Core Data for Interoperability.

Privacy and Security

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A former patient at University of Chicago Medical Center files a class-action lawsuit against the medical center and Google, alleging that the organizations violated HIPAA when they did not properly de-identify PHI that was used in a joint research project. UCMC began providing patient health data to Google in 2017 as part of a machine learning research project that involved several other health systems. The lawsuit claims the data was de-identified, but a timestamp was left on each file, allowing Google the ability to re-identify patients.

A small Spok survey of CHIME members finds that data breaches are the top concern when contemplating SaaS deployments, followed by compliance / data migration and internal attacks / user errors.


Other

Researchers at the Children’s Hospital of Philadelphia develop an algorithm that can match pediatric oncology patients with clinical trials.

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ProPublica dives into the collections practices of non-profit hospitals such as Methodist Le Bonheur Healthcare in Memphis, TN. The hospital, which has its own collections agency, has filed more than 8,300 lawsuits for unpaid medical bills over the last five years, even targeting its own employees. The lawsuit often involve low-income patients without insurance, after which their wages are often garnished. High hospital interest rates have left many patients with bills that have doubled since services were rendered.


Sponsor Updates

  • EClinicalWorks will exhibit at the 2019 CASCA Rocky Mountain ASC Conference & Trade Show June 27-28 in Denver.
  • EPSi partners with HFMA on an ongoing research and content series focused on analytics to help healthcare finance leaders guide their organizations in executing value-enhancing strategies.
  • Greenway Health will exhibit at the New York MGMA 2019 Medical Practice Leaders Conference June 27-28 in Verona.
  • HealthCrowd will exhibit at the ACAP CEO Summit June 28 in Washington, DC.
  • BostInno profiles Ivenix and its smart infusion system.
  • Life Image integrates NextGate’s Enterprise Master Patient Index with its Interoperability Suite.
  • Recondo Technology issues a statement on the Trump Administration’s Executive Order to promote healthcare price transparency.
  • OptimizeRx will join the Russell Microcap and 3000 Indexes on July 1.
  • DrFirst promotes Catherine Armstrong to senior director of marketing operations.
  • Dale Nellis joins Hayes Management as VP of business development.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
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EPtalk by Dr. Jayne 6/27/19

June 27, 2019 Dr. Jayne 1 Comment

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There’s been good uptake on the new Medicare cards since they began rolling out last year. Nearly 75% of claims are being submitted with the new Medicare Beneficiary Identifier as of last week. Both institutional and professional claims are at the top end of the range, with durable medical equipment vendors lagging around 64%. Our office staff has a number of word tracks they’re using to counsel patients on the need to get the new numbers on file and most of the patients seem to be aware of the transition.

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I’ve got an Echo Dot on my desk. Although I use it mostly for alarms, reminders, and shopping lists, I haven’t really explored many of Alexa’s skills or other abilities. I was curious about an article that discussed a tool to detect cardiac arrest by monitoring so-called “agonal respirations.”

This gasping-type breathing pattern is fairly common after cardiac arrest. Half of cardiac arrests occur outside the hospital and more than 90% of them die unless someone calls 911 or starts CPR. Researchers at the University of Washington School of Medicine reviewed 911 recordings from confirmed cardiac arrests and trained a machine learning model to identify appropriate respiratory patterns using Alexa, the iPhone 5s, and the Samsung Galaxy S4. The tool identified 97% of agonal breathing events from six meters away. They also used audio recordings from sleep labs and private residences to train the model on the normal range of sleep noises, resulting in a false-positive rate of 0.2%. The authors hope to use other 911 databases to further hone the tool, which might be useful not only in homes, but in elder care facilities and on hospital units that might not have intensive monitoring capabilities.

Fortune recently reported on record venture capital funding for digital health companies. The all-time record of $14.6 billion in 2018 is up from a mere $1.1 billion in 2011. I think I’m most excited about devices that will help in the virtual visit space, including home-use cameras to look at ear drums or to capture good photos of the back of a patient’s throat. I’m less excited about home EKGs, knowing that even in the office it’s sometimes difficult to obtain a good tracing. Healthcare continues to appear to many investors as a bottomless pit of money and demand even as payers try to ratchet down the expenditures. One thing is for sure, the next couple of years will not be dull.

Speaking of telehealth, reader Randy Bak had some questions about my recent experiences: “On your telemedicine foray, please update when you accumulate a run of data. My big hesitation: how much expectation is there for unnecessary prescribing (particularly of antibiotics) from patients, and more importantly, from management? Also curious how the telemedicine doctor is equipped to follow a case for a couple of days when needed, for clinical, liability, and professional satisfaction purposes.”

Since I’m relatively new to telehealth and am only a sample of one, I reached out to several colleagues who provide telehealth services to get their opinions.

The first colleague I spoke with is part of a telehealth pilot program through her employer, which is the outpatient physician organization for a large integrated health system. Their telehealth offering really doesn’t have any clinical guidelines, and since the providers are delivering services to their own practice’s panel of patients, there aren’t any specific requirements for prescribing or not prescribing. It sounds like the physicians are basically doing the work that used to be done by their triage nurses, but are charging for it as a virtual visit rather than giving it away for free.  Antibiotic usage data becomes part of their overall practice data, although she reports that patient expectations for prescriptions are high. Follow up is easy since they’re document the visits in the EHR and can always task their clinical support staff to contact the patient, or reach out to the patient directly.

The second colleague I reached out to works as an independent contractor for a nationwide telehealth group, but in a specialist capacity as a dermatologist. He spends most of his telehealth time doing virtual visits, where the patient is in the office with their primary care provider, often at a rural health clinic. It’s more of a second opinion consultation service rather than a direct-to-consumer model. Being specialized, the expectations are different than what you bring up in your question. He doesn’t believe his group is doing very much with data and doesn’t receive any clinical scorecards. Even though that’s not the flavor of telehealth you were asking about, I figured it was worth finding out. He said there isn’t much follow up.

The third person I spoke with works for a large organization that primarily markets their services to employers as an employee benefit and to payers as a way to reduce emergency department expenditures. As expected when a payer is footing the bill, the focus is on delivering the right level of care and keeping a tight leash on scope of practice issues. He receives regular clinical scorecards that include metrics such as patient satisfaction and timeliness of visits, but also on antibiotic stewardship and appropriate referrals to a higher level of care.

In hearing about some of the specific grading, I was truly impressed. The providers are coached on how to have those difficult conversations about the fact that they’re not going to give everyone a Z-pack, and it frankly sounds like they are keeping a tighter leash on inappropriate prescribing than my brick-and-mortar practice is doing. Management sounds supportive and provides clinical guidelines summarizing the evidence. Providers who want to follow up with patients have some messaging capabilities through a patient portal, but it sounds like it might not be too widely used as most of their virtual visits are for self-limited illnesses.

My personal experience is more along the lines of the latter, with encouragement to practice good evidence-based care and not to wildly prescribe antibiotics just because patients ask for them. My favorite chief complaint from my brick-and-mortar urgent care is, “I’ve got 20 people coming for Thanksgiving, I can’t possibly be sick, and Dr. X always gives me a Z-pack.” Needless to say, Dr. X was no longer employed at my organization and I wasn’t going to give antibiotics to a patient whose only symptom was a feared complaint, so I wasn’t very popular that day.

Now that there is parity in reimbursement for telehealth and face-to-face services in many states, I suspect the payers will be active in forcing telehealth providers to gather data and demonstrate their quality, or at least prove that they’re not being capricious. With many players in the market, vendors are going to be looking for ways to differentiate themselves. Additionally, as my small sample showed, there are many different varieties of telemedicine out there and direct-to-consumer is just one piece of the pie.

Have you ever badgered a physician into giving antibiotics even though you knew they didn’t want to? Leave a comment or email me.

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Morning Headlines 6/27/19

June 26, 2019 Headlines No Comments

Sansoro Health and Datica Announce Merger

Healthcare data integration companies Sansoro Health and Datica will merge under the Datica brand.

Omada Health Raises $73 Million to Accelerate Program Expansion

Digital behavioral health company Omada Health raises $73 million, bringing its total funding to $200 million.

Xtend Healthcare plans to invest $1.3 million in Sumner County

Revenue cycle management and technology vendor Xtend Healthcare will expand its operations in Hendersonville, TN with the addition of 200 employees.

Remedy Raises $10 Million to Bring Quality Care Closer to Patients

On-demand urgent and primary care company Remedy raises $10 million in a Series A financing round led by Santé Ventures.

Morning Headlines 6/26/19

June 25, 2019 Headlines No Comments

Healthcare Information Technology Leader, Vyne, Acquired by The Jordan Company

Private equity firm The Jordan Company acquires electronic health and dental information exchange platform vendor Vyne from PE firm Accel-KKR.

UNC Health Care Launches Innovative Fully Integrated Epic Telehealth Solution

UNC Health Care launches an American Well-powered, Epic-integrated telehealth solution that allows existing UNC Health Care patients to schedule video visits from MyChart that the provider conducts within the Epic environment.

Queensland Health boss resigns amid hospital software rollout issues

In Australia, Queensland Health’s director-general will resign following highly publicized cost and patient safety problems with its $1 billion Cerner implementation.

CommonWell Health Alliance Awards Change Healthcare Six-Year Contract to be the Provider of Clinical Interoperability Services

CommonWell extends its contract with Change Healthcare for the provision of clinical interoperability services such as document retrieval and patient identification and record locator services.

Electronic health record program launched nationwide

The first phase of Iran’s nationwide EHR roll out goes live.

News 6/26/19

June 25, 2019 News 5 Comments

Top News

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UnitedHealth Group acquires PatientsLikeMe, whose China-based key investor was forced by the US government to sell the company for national security reasons.


Reader Comments

From Asking for a Friend: “Re: Change Healthcare, Phreesia IPOs. I’m wondering if your readers have advice for interviewing with a company that is planning an IPO. Is it a good time to hire on, or does the IPO create its own type of workplace unrest?” I’ll open it up to readers since I have no experience in that area. My cheap seats observation is that companies are usually in go-go mode before doing an IPO and are not looking to cut back, making hiring on as a new employee attractive. However, Change Healthcare is an exception because it’s really more like a merger (Emdeon and McKesson’s IT business) in which synergies are being sought in reducing headcount and streamlining product offerings. Change is also challenged by factors that aren’t typical of an IPO company – being saddled with billions in merger-related debt, unimpressive revenue growth, a stable of cast-off products from its majority owner McKesson, and a rapidly changing health IT market that might not be the perfect time to start running on the quarter-by-quarter investor treadmill. Still, given that you can’t predict any company’s future, and given the ephemeral nature of much employment these days, I would say take the best job offer, with slight preference toward companies that are about to IPO. I’ve worked for both good and not-as-good organizations, and while a bad boss spoiled the former, a good one didn’t save the latter.


Webinars

July 18 (Thursday) 2:00 ET. “Healthcare’s Digital Front Door: Modernizing Medicine’s Mobile-First Strategies That Are Winning Patient Engagement.” Sponsor: Relatient. Presenters: Michele Perry, CEO, Relatient; Michael Rivers, MD, director of EMA Ophthalmology, Modernizing Medicine. Providers are understandably focused on how to make the most of the 5-8 minutes they have on average with a patient during an exam, but what happens between appointments also plays a significant role in the overall health of patients. Modernizing Medicine is driving high patient engagement with best practice, mobile-first strategies. This webinar will describe patient engagement and the challenges in delivering it, how consumerism is changing healthcare, and how to get started and navigate the patient engagement marketplace.

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


Acquisitions, Funding, Business, and Stock

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Private equity firm The Jordan Company acquires electronic health and dental information exchange platform vendor Vyne from PE firm Accel-KKR, which bought the company five years ago.

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Humana will offer medication management services to its Medicare Advantage members through Aspen RxHealth, which links consumers to virtual visit pharmacists via the company’s consumer app.

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Call9, which offers nursing homes a 24×7 onsite first responder who is backed up by a remote ED doctor to prevent avoidable resident ED visits, shuts down and lays off 100 employees as it runs out of money despite having raised $34 million. The company hoped to share cost savings with insurers, but says value-based care was too slow in coming. High-profile investors included 23andMe’s Ann Wojcicki and Ashton Kutcher.

The Wall Street Journal reports that drugmaker AbbVie – which sells the #1 drug in the US, Humira, with $20 billion in annual revenue — will buy Botox manufacturer Allergan for $63 billion.


Sales

  • Hardin Medical Center (TN) will implement Cerner at a cost of $4.2 million, replacing Medhost, T-System, and Allscripts. 
  • Delta Regional Medical Center (MS) selects PatientMatters IntelliGuide to connect uninsured patients with available healthcare benefits.
  • CommonWell Health Alliance signs a six-year contract with Change Healthcare to provide record locator and document retrieval services, extending their previous five-year relationship.

Announcements and Implementations

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KLAS names Navigant as the #1 “would you buy again” revenue cycle outsourcer, while Cerner finished by far the worst, with 70% of its customers saying they wouldn’t sign up again. Navigant also finished first in the scope of services offered.

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ActX offers 23andMe customers a $95 professional interpretation of their genetic screening results and will screen physician drug orders via EHR integration. The company’s founder, chairman, and CEO is Andrew Ury, MD, who founded Practice Partner, an EHR/PM vendor that was acquired by McKesson in 2007. Seattle-based ActX has raised $3.9 million in seed and venture funding rounds.

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UNC Health Care launches an American Well-powered, Epic-integrated telehealth solution that allows existing UNC Health Care patients to schedule video visits from MyChart that the provider conducts within the Epic environment.

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Williamson Memorial Hospital (WV) goes live with Meditech as a Service.

JD Power will publish its first telehealth satisfaction study later this year, dividing the market into direct-to-consumer, payer-owned, and health system-owned services. 


Government and Politics

The White House’s executive order on healthcare provider price transparency raises some interesting reactions:

  • President Trump predicts that healthcare prices will come “way, way down” as “we’re giving that power back to patients.”
  • Experts say the order, which has no law behind it pending further rule-making, doesn’t say specifically what hospitals and insurers will be required to disclose.
  • CMS Administrator Seema Verma rejects the notion that the order is vague, saying that it specifically mentions disclosure of confidential negotiated payment rates.
  • Hospital executives say patients don’t pay the negotiated rates themselves and won’t help those patients make decisions, especially in emergent situations, also noting that previous price transparency efforts haven’t helped patients shop around or save money.
  • Employers may benefit since they don’t see individual provider pricing now — the information could help them steer employees to more cost-effective ones.
  • Economists note that price transparency could actually drive costs up, citing a much-loved 1990s example in which the government of Denmark forced concrete suppliers to disclose their negotiated prices in hopes of spurring competition, after which those companies were able to raise prices simultaneously since they then knew what everybody else was charging and they had little fear of new competition because of the high barrier to entry.

Other

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In Australia, Queensland Health’s director-general – the equivalent of CEO of the 90,000-employee state public health system — will resign following highly publicized cost and patient safety problems with its $1 billion Cerner implementation. Audio recordings of an internal meeting that were leaked two weeks ago caught Michael Walsh saying that he was forced to make positive public comments about the “messy” project in which delays were introduced after clinicians express concerns about patient safety.

IT employees of Regional Medical Center (IA) trigger a state investigation by reporting emails from which they learned that the hospital’s CEO and development director were passing off personal trips as hospital business to obtain expense reimbursement. Investigators found $255,000 in questionable payments, noting the CEO’s 566 “improper” trips and 267 “unsupported” ones. The development director was fired, the CEO resigned four days later, and both have been charged with first-degree theft.

California’s City of Hope cancer treatment and research center will spend $1 billion to build an Irvine, CA campus, two hours from its main location in Duarte.

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HIMSS cites a “leadership change” in explaining why it is vacating Cleveland’s Global Center for Health Innovation, where it is the anchor tenant occupying 30,000 square feet. HIMSS had extended its lease in October 2018 for three years. The HIMMS [sic] information page says the Cleveland building is “the perfect location for HIMSS to strive towards their mission to better health through information and technology.”


Sponsor Updates

  • The Boston business paper names Definitive Healthcare as the “#1 Best Place to Work” among large companies in Massachusetts.
  • Optimum Healthcare IT releases a mobile version of its Skillmarket platform that matches its consultants with upcoming projects.
  • Apixio will exhibit at Qualipalooza June 27-28 in Orlando.
  • Avaya publishes a new white paper, “AI: The De Facto for Contact Center Experience.”
  • Black Book publishes the top 12 highly-rated RCM analytics solutions vendors ranked on 18 key performance indicators in Q2 2019.
  • Boston Software Systems names Linda Stotsky marketing content manager.
  • CoverMyMeds will exhibit at McKesson IdeaShare June 26-30 in Orlando.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
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Morning Headlines 6/25/19

June 24, 2019 Headlines 1 Comment

UnitedHealth buys PatientsLikeMe, which faced Trump administration scrutiny over Chinese investor

UnitedHealth adds newly-acquired PatientsLikeMe to its research and development group.

President Donald J. Trump is Putting American Patients First by Making Healthcare More Transparent

President Trump signs an executive order requiring hospitals to publicly disclose what patients can expect to pay for services in easy-to-read formats, and giving stakeholders more access to data that will help in pricing transparency efforts.

CentralReach Acquires Pathfinder Health Innovations

Applied behavior analysis EHR and practice management vendor CentralReach acquires competitor Pathfinder Health Innovations.

Curbside Consult with Dr. Jayne 6/24/19

June 24, 2019 Dr. Jayne 2 Comments

I wrote last month about my experience with a dysfunctional registration process for imaging at Big Medical Center. I was sharing the story recently with a colleague who uses Epic at another institution and was gratified to learn that they have a much more seamless process. My Epic Jedi set up a demo for me, showing me all the bells and whistles on the system at his early adopter facility.

Like other vendors, Epic is working hard to get its clients up on the latest and greatest code. It’s certainly easier for support to have fewer versions live in the field. Several vendors are also starting to ship their upgrades with new functionality enabled, under the premise that clients won’t bother to turn the features off. Compared to what I saw with my Jedi, it sounds like Big Medical Center is either on an older version of Epic that doesn’t have some of the nice features for online check-in or has somehow failed to enable them.

My colleague and I discussed our shared belief that patients take more time when completing pre-visit activities at home. This might be because they can look up information they don’t know for sure, or call a family member, or because they’re not flustered because there is a clipboard standing in the way between them and their doctor.

We also talked about the release of results. My study results came by mail in 10 days, which was the same interval for their appearance on the patient portal. The results had been signed off by the physician within 24 hours of the study, so I’m not sure why the organization chooses to embargo them for another week when it’s a test that patients are allowed to have without a physician order. The old attitudes about protecting patients from their own results need to go by the wayside. He did show me some nice functionality for trending of patient-generated data that might be encouraging for physicians who are worried about incorporating that data into the chart.

The majority of my urgent care patients seem to be using MyChart, so we talked about some available features where patients can email their continuity of care documents to other providers via Direct. It seemed like it would be more nearly seamless than the “break the glass” functionality offered by Share Everywhere, with the added benefit of being able to actually consume and utilize the data not just view it.

We also talked about Epic’s Happy Together functionality that allows patients to see aggregated data across multiple instances of the system. For patients in my area where there are multiple competing health systems, it should be useful. It was a great conversation and gave me some ideas to help patients better manage their data when I see them in the urgent care.

Patients are embracing technology and are using apps during the office visit, whether it’s to look up a medication at the pharmacy or to show me lab results. According to recent data, more than half of all physicians are offering patients mobile apps for processes like appointment scheduling or retrieval of lab results. I know I would much rather interact with my providers’ offices through my phone or a laptop rather than have to call them and get stuck in the land of voicemail.

That assumes that the practice has an efficient online process as well, unlike the five days it took my ophthalmologist to respond to my appointment request through the patient portal. I can’t fault them too much, though. Just having an online appointment request is light years ahead of what some practices are offering or what they decide to “allow” patients to use. Plenty of clients decide not to embrace new features, which is why vendors are now in the position of having to “force” clients to use new features. I’m sure they’re tired of getting a black eye from patients and users when the real fault is in the client’s decision-making layer.

Vendors are getting better at serving up smaller, more frequent upgrades and updates that don’t overwhelm users or bring down the system for days at a time (with a few notable exceptions). This seems to make client leaders more comfortable with the process. In theory, as long as quality remains stable and the new features deliver what they promised, clients will be more willing to apply and use new code.

On the other hand, if an upgrade package is a dud (or worse, if it breaks any existing workflows) the vendor will have to work hard to regain its credibility. I’ve been on the losing end of a bad upgrade before and it wasn’t pretty, although it did lead to lifelong friendships made with the developers who spent weeks onsite keeping us in business. Without those relationships, it’s sometimes hard for customers to trust their vendors, which might be one reason that clients don’t like to enable new functionality that they don’t consider critical. Another issue is the fact that organizations are trying to deliver many initiatives at the same time, and when push comes to shove, something just has to be cut from the implementation and training schedule.

Hopefully over time vendors and their clients will be able to perfect that balance between delivering frequent releases of high quality while avoiding upgrade fatigue. We’re in a relative lull from a regulatory requirement standpoint, so it’s certainly a good time to catch up on new releases.

As a physician in a practice that seems a bit laggard, I have to confess I’m often jealous of early adopter sites that are embracing the bells and whistles. My organization is focused on expansion of new sites and growth of practice volumes, so it’s not surprising that they don’t want to spend a lot of time on technology projects. We’re also onboarding dozens of new staffers and a handful of new providers, so at the moment, stability seems to be the watchword.

How often does your organization take upgrades? Do you find them frictionless or irritating? Leave a comment or email me.

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Morning Headlines 6/24/19

June 23, 2019 Headlines No Comments

Healthcare software provider Phreesia files for a $125 million IPO

Phreesia, which offers online appointment scheduling, revenue cycle, health risk screening, and check-in kiosks, files for a $125 million IPO.

Jobs in danger as Johns Hopkins All Children’s Hospital plans e-records transition

Johns Hopkins All Children’s Hospital (FL) will replace Cerner with Epic, which is used throughout Hopkins Medicine.

Electronic Health Records at 26 Hospitals Hit by Two-Hour Outage

Hospital operator Universal Health Services says 26 of its facilities were taken offline for two hours Friday due to Cerner data center problems.

Flatiron Health Expands its Headquarters in Manhattan’s Soho

Oncology EHR and research company Flatiron Health will nearly double its Manhattan office space and add 200 jobs by the end of the year.

Monday Morning Update 6/24/19

June 23, 2019 News 14 Comments

Top News

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Phreesia files for a $125 million IPO, hoping to list shares on the NYSE under ticker symbol PHR.

The company – whose platform offers online appointment scheduling, revenue cycle, health risk screening,  and check-in kiosks — lost $15 million on $100 million of total revenue in its most recent fiscal year.


Reader Comments

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From HISInside: “Re: Change Healthcare. Large-scale pre-IPO layoffs over the past few days. They also announced internally that they are selling the analytics business unit, including RelayHealth products.” Unverified, although reported on some of the layoff sites. Anonymous posters there attached a purported company email that said jobs were eliminated in the Software and Analytics business unit. I would be surprised if they are dealing off RelayHealth since it was the closest thing to a jewel in the McKesson HIT crown, but perhaps the potential payoff is too great to pass up.

From Max the Fax: “Re: fax machines. See this article. It’s embarrassing to be so far behind.” I’ll take your side if you show me documented proof that getting rid of fax machines improves outcomes or cost. Fax machines are an admittedly humorous example of “being behind,” but healthcare is also guilty of chasing the latest and greatest shiny objects (imaging machines, drugs, IT, architect-arousing buildings) that don’t move the health needle one bit. We need to become more critical consumers of resources of unproven value for which patients and insured consumers are forced to pay, especially given that big healthcare systems feel little competitive pressure to spend patient money wisely.

From Kabob: “Re: Slack. Wondering if you’ve used it?” I haven’t, but my curiosity has been piqued by all the pre-IPO coverage. I would be interested in hearing from anyone who has used it in a hospital setting and what benefits it provided. The most common criticism is that it sucks up time and saps creativity as users move their mental goalpost to never-ending but often pointless interaction, plus it leaves them in a social media-like dopamine frenzy to check it constantly for fearing of being one-upped while offline. Things I learned today: the name Slack came from the contrived acronym “Searchable Log of All Communication and Knowledge.” There’s a free trial for anyone interested. I played around with the free version of Microsoft Teams and wasn’t impressed.


HIStalk Announcements and Requests

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PCPs of an encouraging two-thirds of poll respondents had the records of their most recent hospital encounter at their next appointment. David says his PCP had his records and CT scans, while Monica reports that the notes, but not the x-rays, were sent to her specialist within three weeks. Peggy says her PCP had everything, while Proficient Patient and Flyonthewall said it was a snap because the hospital and PCP both use Epic.

New poll to your right or here: For those employed by others: what is the #1 reason that you don’t work for yourself?

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Welcome to new HIStalk Platinum Sponsor Greenway Health. The Tampa-based company offers the award-winning, cloud-based Intergy EHR/PM that delivers reduced clicks and personalized user experience; revenue cycle management solutions that decrease A/R days by an average of 32%;  practice analytics; patient engagement; care coordination; and interoperability options that include CommonWell and Greenway Exchange, a cloud-based health information network that has connected 1,400 vendor products in delivering 22 million messages per month. The company summarizes its areas of focus as: (a) delighting the caregiver; (b) inspiring practice transformation; and (c) restoring the “care” in “healthcare.” Thanks to Greenway Health for supporting HIStalk.

It’s almost July 1, when a fresh batch of scared (and scarily young) medical residents learn to answer to being called “doctor” in the hospital as they ply their chosen career for the first time, fueled by panic-induced adrenaline, low-quality but free cafeteria food, the pressure to please their attendings, and sleep deprivation. For the rest of us, it’s like a restaurant’s soft opening or a play’s first performance – you’ll be happier if you can hold off being a customer for a few weeks until routines replace reaction.


Webinars

July 25 (Thursday) 2:00 ET. “Meeting patient needs across the continuum of care.” Sponsor: Philips Population Health Management. Presenters: Cindy Gaines, chief nursing officer, Philips Population Health Management; Cynthia Burghard, research director of value-based healthcare IT transformation strategies, IDC. Traditional care management approaches are not sufficient to deliver value-based healthcare. Supplementing EHRs with advanced PHM technology and a scalable care management approach gives health systems proactive and longitudinal insights that optimize scarce resources in meeting the needs of multiple types of patients. This webinar will address the key characteristics of a digital platform for value-based care management, cover the planning and deployment of a scalable care management strategy, and review patient experience scenarios for CHF and diabetes.

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


Acquisitions, Funding, Business, and Stock

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UnitedHealth Group will acquire healthcare payments firm Equian LLC from its private equity owner for $3.2 billion. New Mountain Capital acquired the company in late 2015 for just $225 million. Industry long-timer Scott Mingee joined Equian in early 2013 in his first CEO job.

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Recently retired McKesson Chairman and CEO John Hammergren will receive a $114 million one-time pension payout, $10.5 million in stock vesting, lifetime medical benefits, lifetime financial counseling, and an office and secretary for the rest of his life. The total cost the company is around $141 million. He’ll also be paid $900,000 per year as chairman of Change Healthcare. The $10,000 worth of MCK shares you bought the day Hammergren started as CEO (February 1, 2001) were worth $42,500 the day he quit, although that’s barely better performance than the Nasdaq as a whole. In addition to his parting gift, Hammergren made more than $500 million in a 13-year span with McKesson, with a record one-year compensation of $145 million. The American healthcare system and its sick patients who paid those sums have thus thanked you for your service.

Three New York City hospitals (Montefiore, Mount Sinai, and Maimonides) sell the professional liability insurance firm they own (Hospitals Insurance Company) for $650 million to The Doctors Company. The hospitals admitted in 2017 to breaking state law in failing to disclose that they, like other hospitals, had formed a Cayman Islands-based insurance company that collected premiums that were used to buy less-expensive policies, generating more than $200 million in investment income. That practice is legal as long as hospitals disclose it. The Doctors Company says it is aware of the company’s history and will rename it Healthcare Risk Advisors. Mount Sinai will spend its $325 million of the proceeds on construction, while Montefiore will use its $163 million to buy software for cost management and value-based care.


People

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Megan Schmidt (CompuGroup Medical) joins PierianDx as SVP of product.


Announcements and Implementations

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Johns Hopkins All Children’s Hospital (FL) will replace Cerner with Epic, which is used throughout Hopkins Medicine. The 15-month project will kick off on July 1. Hopkins took ownership of the 259-bed hospital in 2011, its first expansion outside of Maryland. The hospital reported $50 million in profit on $469 million in revenue in its most recent tax year.


Government and Politics

President Trump will issue an executive order Monday that will require hospitals, doctors, and insurers to disclose their negotiated contract prices. This is great news if you are an attorney since the legal wrangling will take years before anyone sees confidential contract pricing, if indeed they ever do.

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Politico reports that Mark Roche, MD, MSMI has resigned as CMS’s first chief health informatics officer after taking the job just four months ago.


Other

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Modern Healthcare lists the 25 highest-paid executives of non-profit health systems for 2017. Topping the list is Kaiser Permanente Chairman and CEO Bernard Tyson at $16 million. The lowest guy on the list (and I say “guy” because all 25 are male) still made $5.3 million. The one that leaps out, though, is electrophysiologist Joseph Levine, MD of St. Francis Hospital (NY), whose $6.5 million payday represented 1.68% of the hospital’s entire payroll.

Hospital operator Universal Health Services says 26 of its facilities were taken offline for two hours Friday due to Cerner data center problems.

GoFundMe says it is running $10 million worth of campaigns by people who need help affording insulin. Why you would want to be running a drug company rather than being diabetic: a vial of insulin costs $2-6 to manufacture and you can charge 7 million Americans — who would die without using up to several vials per month – $250 or more per vial, multiples of what people in all other countries pay. Sweet. 


Sponsor Updates

  • Diameter Health is attending Qualipalooza in Orlando this week and will sponsor NCQA’s Digital Quality Summit in Boston July 16-18.
  • Live Process creates a CMS Emergency Preparedness Rule self-assessment quiz.
  • Waystar, Flywire Health, Experian Health, Recondo Technology, Relatient, and Sansoro Health will exhibit at HFMA June 23-26 in Orlando.
  • NextGate responds to the CMS FY20 IPPS proposed rule.
  • With help from AWHONN attendees, Clinical Computer Systems, developer of the Obix Perinatal Data System, donates $3,125 to AWHONN’s Every Woman, Every Baby effort.
  • OmniSys will exhibit at McKesson IdeaShare June 27-30 in Orlando.
  • PatientBond publishes a new white paper, “Psychographic Segmentation and its Practical Application in Patient Engagement and Behavior Change.”
  • Surescripts will exhibit at the ASAP Mid Year Conference 2019 June 26-28 in Washington, DC.
  • SymphonyRM will present at AAPL June 27 in Salt Lake City.
  • Voalte will exhibit at the AzONL 2019 Summer Forum for Nurse Leaders June 28 in Scottsdale, AZ.
  • Visage Imaging will exhibit at SIIM19 June 26-28 in Denver.

Blog Posts


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Weekender 6/21/19

June 21, 2019 Weekender No Comments

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Weekly News Recap

  • A private equity firm acquires EHR/PM vendor Nextech for $500 million.
  • A group of health and technology organizations develops open source cancer data standards and specifications that can be incorporated into EHRs via FHIR.
  • Drug maker Sanofi and Google announce plans to for a virtual innovation lab that will use analytics to study disease and patient treatment response.
  • Change Healthcare increases the amount of its IPO again, this time to $1.2 billion.
  • Accumen acquires Halfpenny Technologies.
  • A 23-bed critical access hospital says it paid a hacker’s unspecified ransomware demand, all but $10,000 of which was covered by cyberinsurance.

Best Reader Comments

I’m thinking of a time-based layout, for example [for EHR information]. A little-used feature of Windows called the Reliability Monitor charts issues over time and shows a view of the health of your computer. All the information is summarized initially and you have to click on the various items to find out what they are. However by using the ideas of “What Changed” and “When,” you get a higher-level, more coherent view of what is going on. (Brian Too)

In frontline [radiology] care, I don’t necessarily need an answer, but I do need a plan. AI raising a question about something on a film can be enough. How many times do meat-based radiologists see something that “needs clinical correlation” to rule in or out something on a film? If questions remain, I can immobilize until a radiologist reading — or more likely, follow-up — gives a best answer. Incidental findings are by definition not the problem of the moment. (Randy Bak)

It’s pretty clear to me that [Vinod] Khosla’s venture capital roots require him to make profound-seeming announcements periodically, based upon the classic VC tropes that tech is always good, and disruption, so long as it is well-meaning(!), is also always good. I am reminded of Warren Buffet, who said that he only needed one good investment idea every few years. Missed opportunities were trivial in his world. For the successful VC ideas people, it is the opposite, very nearly. They announce 100 out of the next three Big Things and are proclaimed VC geniuses. (Brian Too)

[For EHR improvement], allow other groups of healthcare professionals (i.e., the ancillary healthcare professionals, such as nurses, dietitians, pharmacists, therapists, lab techs, etc.) to do the same [in highlighting and flagging chart elements as useful]. They are just as frustrated with note bloat. With good search technology, “group” (e.g., pharmacists) highlights would be able to be retrieved for future editing, reading, etc., by the intended “group.” (Woodstock Generation)

We found that the majority of healthcare practices either do not know what KLAS is or do not associate value with an HIT vendor who has a KLAS award. It often feels like we are doing KLAS’s marketing for them. The awards have become a competition between HIT vendors instead of the source of truth for buyers. (EMR vendor)

I’ve taught research methods (and survey research methods) at the University of Pennsylvania for over 30 years. I’ve published dozens if not scores of articles and books on the topic. KLAS is a marketing effort. It’s not a survey. Anyone who publishes KLAS ratings should be aware that they are not related to quality. Alas, KLAS’s business model is not based on anything other than sales. (Ross Koppel, PhD, FACMI)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. B in Ohio, who asked for supplies so her high school class could make paper roller coasters as a physics project. She reports, “Your contribution to our physical science classroom has had a tremendous impact on our energy conversion and forces and motion unit this year. My students used the donated cardstock and art supplies to design and construct their unique and epic roller coasters. Today they are analyzing the physical forces acting on their marble roller coasters, and at the end of this week, they will present their final designs and data to the class as well as several faculty members as part of a simulated marketing campaign for a coaster build at Cedar Point. The project truly embodies our school focus on engineering and has helped my students explore these important physics concepts in a hands-on and exciting way. Without your generous support, this project would not have been a possibility. The cost of supplies is one of the biggest limiting factors in education and your donations have eliminated this ceiling and helped my students to reach new heights. I hope you enjoy the photos and find as much reward in their success as I do.”

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NASA’s TRISH Launch Pad offers a 10-week program that will help health startups ”create a viable commercialization pathway to Earth’s health technology market and a secondary space market.” Areas of interest include:

  • AI-powered, EHR-integrated medical decision support that can guide deep space travelers through rendering treatment without a connection to NASA.
  • Games that can help prevent stress, depression, anxiety, and isolation.
  • A machine that can manufacture drugs and biologics in under 24 hours since the shelf life of most drugs is less than the three-year minimum deep space mission.
  • Health assessment via eye scanning.

Google says it will work on a problem called out by the Wall Street Journal, which found that at least 11 million fake businesses – most of them created for search engine optimization — show up in local search results via its Map app. A retiree called a Google-listed garage door repair company as she was stuck in her driveway, but a rogue contractor had replaced the company’s telephone number with his own. He worked on the door, demanded $728 by cash or check, then harassed her repeatedly afterward for payment even though his repaid work had to be redone. I wouldn’t assume that none of those phony listings involve medical services.

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A 46-year-old woman whose mother Brandy named her “Marijuana Pepsi Vandyck” earns her PhD, acknowledging that “Dr. Marijuana” sounds like a weed dispensary. Marijuana, who says she has never tried marijuana, did her dissertation on teacher perceptions of children with “black names” in white classrooms. She named one of her sons Heaven and he made Marijuana a grandmother with the birth of Egypt.

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In Myanmar, a 29-year-old doctor who had given up her patient care job to years ago to pursue becoming a “sexy model” loses her license when the country’s Medical Council declares that her refusal to take down social media photos indicates that she has a “behavior disorder.” The New York Times notes the irony of the country declaring her behavior immoral even as it employs military-led ethnic cleansing that has killed at least 10,000 Muslim Rohingya.

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The Internet resurfaces the story of a cosmetic surgeon in Singapore who re-evaluated his life when he was diagnosed with lung cancer and later died at 40. He had made millions when he switched from ophthalmology to aesthetics, noting that patients who refused to pay a PCP $15 for a visit would happily fork over several thousand dollars for liposuction and breast augmentation. He summarized that “patients were just a source of income, and I tried to squeeze every single cent out of these patients.” In the end, he sought comfort from people who loved him, concluding that “only when we learn how to die do we learn how to live.”

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A Texas man and his fiancé stage a mock wedding in the hospital room of Granny, his 100-year-old grandmother who was being moved to hospice care and wasn’t expected to live until the official ceremony. Granny, who was born the day World War I ended, has since been moved out of hospice and into assisted living.


In Case You Missed It


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Morning Headlines 6/21/19

June 20, 2019 Headlines No Comments

CityMD and Summit Medical Group Announce Plans to Merge to Deliver an Unparalleled Patient Care Experience

Private equity firm Warburg Pincus will buy NJ-based, 900-provider multi-specialty practice Summit Medical Group and merge it with its 120-location CityMD urgent care holding.

Leading Health and Technology Organizations Release Common Cancer Data Standards to Enable Sharing Across EHR Systems and Improve Patient Care

The American Society of Clinical Oncology, Mitre, and the Alliance for Clinical Trials in Oncology Foundation develop an open source set of common cancer data standards and specifications that can be incorporated into EHRs via FHIR.

AHN Partners with Mercy Virtual to Enhance Critical Care Services at Community Hospitals through Innovative Telemedicine Program

Allegheny Health Network (PA) will roll out telemedicine services from Mercy Virtual, a subsidiary of the Mercy health system in St. Louis, at its four hospitals over the next 12 months

News 6/21/19

June 20, 2019 News No Comments

Top News

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Private equity firm Thomas H. Lee Partners acquires EHR and practice management vendor Nextech in a $500 million deal.

The news comes nearly a year after Nextech owner Francisco Partners announced that it was putting the company up for sale.


Reader Comments

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From PitViper: “Re: ONC. Convened payers, health systems, associations, state agencies, federal agencies, and tech solution providers in Washington DC last week to dialogue on provider directory. Participants presented their initiatives and ONC reviewed a new FHIR implementation guide for provider directory. Attendees debated different topics around national solution (public vs. private, funding, and governance).” ONC held a Healthcare Directory Workshop on June 13-14.


Webinars

July 25 (Thursday) 2:00 ET. “Meeting patient needs across the continuum of care.” Sponsor: Philips Population Health Management. Presenters: Cindy Gaines, chief nursing officer, Philips Population Health Management; Cynthia Burghard, research director of value-based healthcare IT transformation strategies, IDC. Traditional care management approaches are not sufficient to deliver value-based healthcare. Supplementing EHRs with advanced PHM technology and a scalable care management approach gives health systems proactive and longitudinal insights that optimize scarce resources in meeting the needs of multiple types of patients. This webinar will address the key characteristics of a digital platform for value-based care management, cover the planning and deployment of a scalable care management strategy, and review patient experience scenarios for CHF and diabetes.

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


Acquisitions, Funding, Business, and Stock

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Dallas-based healthcare recruiting firm General Healthcare Resources will acquire the health information management consulting business of HCTec, according to an internal email. The change doesn’t affect HCTec’s health IT and managed services business.  

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Private equity firm Warburg Pincus will buy NJ-based, 900-provider multi-specialty practice Summit Medical Group and merge it with its 120-location CityMD urgent care holding. The firm said in the announcement, “The combined organization will offer patients a seamless experience across a full spectrum of high-quality primary, specialty, and urgent care.”

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Digital prescription startup Xealth adds $3 million to its $11 million Series A funding round that was announced in March.

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McKesson acquires NHS-integrated prescription delivery and medication management app Echo in an effort to gain a foothold in the UK’s nascent digital pharmacy market. McKesson’s ties to the startup include ownership of Lloyds Pharmacy, from which Echo gets most of its medication supply.

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Philips announces plans to open new research space at One Discovery Square, a medical innovation complex in Rochester, MN that is owned and anchored by Mayo Clinic. Tenants will also include Epic, which owns a nearby data center that it purchased from the clinic in 2016 for $46 million.

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Allscripts shares rose 5% Thursday after a stock analyst said in a research note that the market is undervaluing the potential of the company’s Veradigm payer and life sciences analytics business, which he says that despite representing only 8% of sales, will eventually either drive share price upward or make the company an attractive leveraged buy-out target.


Sales

  • Integris Health (OK) selects Vyne Medical’s Trace communication management software.
  • Bluestone Physician Services (PA) will implement Aprima EHR and practice management software from EMDs later this year.
  • Allegheny Health Network (PA) will roll out telemedicine services from Mercy Virtual, a subsidiary of the Mercy health system in St. Louis, at its four hospitals over the next 12 months.

People

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Sisu Healthcare IT Solutions promotes Kevin Boerboom to CEO.


Announcements and Implementations

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In Ontario, Hawkesbury General Hospital goes live on Epic.

Mount Sinai (NY) and LabCorp will establish the Mount Sinai Digital and Artificial Intelligence-Enabled Pathology Center of Excellence using IntelliSite pathology software from Philips.

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The American Society of Clinical Oncology, Mitre, and the Alliance for Clinical Trials in Oncology Foundation develop an open source set of common cancer data standards and specifications that can be incorporated into EHRs via FHIR. Cancer centers at Partners Healthcare (MA) and Intermountain Healthcare are piloting the new standards.

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A KLAS report looks at consulting firms that offer health IT advisory services, some of which have launched their offerings recently as implementation work tapers off. The most experienced and high-performing firms are Impact Advisors, Nordic, and Chartis Group, while Optimum Healthcare IT has the best track record among developing firms.


Privacy and Security

Grays Harbor Community Hospital (WA) and its Harbor Medical Group are recovering from unspecified computer issues that forced both organizations back to paper over the weekend. The hospital’s Meditech system is up and running, while the medical group’s eight clinics are unable to tap into their separate EHR (unnamed, but it appears to be Virence Centricity).


Other

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Researchers find that Facebook posts accurately predict 21 medical conditions as verified against patient medical records, although demographic data alone did about half as well. Hostile language and references to drinking were accurate indicators of substance abuse, while religious references correlated with diabetes.

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A Definitive Healthcare survey on outpatient care trends finds that investing in and implementing new technologies – especially those related to interoperability – is the top challenge, followed by keeping up with consolidation trends, managing staffing, and attracting new patients. The field of 200 respondents said that telemedicine, mobile apps, and streamlined patient technologies were among the top drivers of outpatient growth.

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A retrospective analysis of diabetic patients treated at Grady Hospital (GA) finds consistently improved outcomes for those who are managed by Glytec’s EGlycemic Management System.

In Canada, a hospital located near the border between Ontario and Manitoba struggles to share information across the provincial dividing line even though patients move freely across it in choosing the closest or most appropriate hospital.

Robocall spam is overwhelming the telephone systems of some hospitals that get little help from their telephone company or the federal government in keeping the calls out. Scammers have learned to spoof the incoming calling number to force hospital operators to answer thinking it’s someone local. They are also making residential calls with the hospital’s name spoofed in caller ID, hoping to convince locals to pay fake hospital bills.

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Thanks to DrLyle (Lyle Berkowitz, MD) for sending over a link to a new Vanity Fair article describing the shame that the Sackler family – which owns most of the drug maker Purdue Pharma — claims to be feeling for having made billions of dollars selling OxyContin, often via shockingly unsavory practices and lining influential pockets. A Massachusetts lawsuit against the company concludes that “eight people in a single family made the choices that caused much of the opioid epidemic.” The article notes that Joint Commission’s 2001 war on pain as “the fifth vital sign” – which arguably launched the opioid crisis in which 200,000 Americans have died of prescription opioid overdoses — came after Purdue gave $1 million to the organization. Article author Bethany McLean, DrLyle’s sister-in-law, was the co-author of 2004’s “The Smartest Guys in the Room: The Amazing Rise and Scandalous Fall of Enron.”

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UCSD researchers find that one-third of inpatients didn’t use the tablet-controlled room environment app that the hospital placed in every patient room, although interestingly, older patients used it more than younger ones, although the authors note that they can’t determine whether it was the patient themselves or their family members running the controls. They also note that accessibility issues may have been a problem in services such as neurology and surgery.  

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A study in JAMA finds that patients of surgeons who behave unprofessionally experience more post-surgical complications than those whose surgeons act more professionally. Negative behaviors included “unclear or disrespectful communication, poor or unsafe care, lack of integrity, and failure to follow through on professional responsibilities.”


Sponsor Updates

  • EClinicalWorks will exhibit at the California Primary Care Association Region IX Clinical Excellence Conference June 23-25 in Newport Beach, CA.
  • EPSi, InterSystems, and Nuance will exhibit at HFMA June 23-26 in Orlando.
  • HealthCrowd will exhibit at Qualipalooza: the 3rd Annual Rise Quality Leadership Summit June 25-26 in Phoenix, AZ.
  • Visage Imaging announces version 7.1.14 of its Visage 7 Enterprise Imaging Platform at SIIM 2019.
  • The Chartis Group publishes a new paper outlining a strategic framework for health system executives to evaluate their partnership strategy.
  • Redox launches a public bug bounty program with Bugcrowd to help keep customer health data secure.
  • Thrive Global profiles Kyruus co-founder and CEO Graham Gardner.
  • Frost & Sullivan recognizes Waystar with the 2019 North American Customer Value Leadership Award for automating claims resolution and streamlining process workflows.
  • ZeOmega achieves DirectTrust HISP accreditation.
  • Cantata Health announces a partnership with Ability Network to improve reimbursement and compliance for skilled nursing facilities.
  • Surescripts announces that several national, regional, and local PBMs and payers have signed on for its electronic prior authorization service, increasing the number of insured lives covered by the company by nearly 20%.
  • Nordic releases a new podcast, “How Managed Services can support your EHR extension partners.”
  • Prepared Health will present at the Collaborative Care & Health IT Innovations Summit on June 24 in Baltimore.
  • KLAS names Optimum Healthcare IT the top-rated developing HIT Advisory Services firm in its Advisory Services 2019 report.
  • Meditech will host its 2019 Revenue Cycle Summit October 8-9 in Foxborough, MA.
  • The Boston Business Journal profiles Definitive Healthcare.
  • Philips joins the Atlanta-based Emory Healthcare Innovation Hub.

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EPtalk by Dr. Jayne 6/20/19

June 20, 2019 Dr. Jayne 2 Comments

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There is hope: The US House of Representatives voted last week to lift the ban that keeps the Department of Health and Human Services from funding efforts for a national patient identifier. The ban began in 1999 and blocks HHS from participating in private sector initiatives involving a unique identifier. HIMSS, CHIME, and other organizations have been lobbying for two decades to have the ban overturned in hopes of improved patient matching. The language was added as an amendment to the 2020 HHS appropriations bill and was introduced by both a Democrat and a Republican. Getting appropriations bills passed and signed into law can be tricky, so I won’t be holding my breath waiting for it to continue its journey on the hill.

Telehealth provider American Well has partnered with Cisco for a solution which enables virtual visits through television technology. Participating patients would use a set-top device that integrates with American Well. The solution is targeted to patients with chronic medical conditions as well as to older patients who might need regular visits. Many baby boomers are perfectly happy using smartphones and laptops and I’m not sure having one more device is necessary. People assume the older generations are “digitally dark,” but they are more savvy than you think. My own mother has a cooler, newer phone than I have. Years ago when I finally gave in to joining Facebook, the first friend suggestion I received was my then 87-year-old grandmother.

Lots of chatter in the physician lounge recently about media reports on the inclusion of “burnout” as a diagnosis in ICD-11. The World Health Organization says that media have it all wrong, that it hasn’t been recognized officially as a medical condition. ICD-11 includes burnout under “factors influencing health status or contact with health services” The chapter also includes indicators such as “contact with health services for reasons associated with reproduction” and “presence of device, implants, or grafts.” The American Psychiatric Association also states that burnout is not a medical diagnosis or a disease. Either way, being able to categorize burnout with a standardized code will allow for data gathering and better analytics. You can’t manage what you’re not measuring, but it will be a long time before we see ICD-11 in the US, so I’m not going to get too excited.

Speaking of mental health, clinicians in California are testing an app that tracks everything users do on their phones. The goal is to identify when a user is about to experience an emotional crisis. Various cities and counties are involved in the project, which is being tested on patients using the Los Angeles County public mental health network. It looks at historical use data to determine whether behaviors are changing and sends a message to the user. About half of initial pilot users dropped, citing technical issues or lack of interest. It’s an interesting concept, but one which would have to balance the loss of privacy with the potential benefit to users. For those with significant health conditions or risk for self-harm, it might be worth it, but for others it might be too invasive.

My practice has both x-ray and CT scan capabilities. Although the CTs are read immediately by a radiologist, we’re responsible for the primary reads on our plain films and often the radiology over-read doesn’t happen until our shift is over. Especially in that context, I’m excited about using AI to help interpret radiology studies, and frankly for some of our films, it can’t come fast enough. Although some films are grossly abnormal, other findings are subtle. Sometimes the quality of the studies is limited by the physical size and bulk of the patient. It would be great to have some support for those of us that are reading films in the field. Needless to say, I was excited to hear about the FDA approval of Zebra Medical Vision’s product that assists with CT studies that are looking for brain bleeds. The solution can reduce turnaround time, which is always good for the front lines. Zebra already has FDA approval for a chest x-ray product that specifically looks for pneumothorax. Maybe sometime before I retire I’ll have a virtual radiology assistant that pre-reads my films.

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Like many of my peers, I enjoy learning about the history of medicine. I crossed an item off my bucket list a couple of years ago when I visited the Mutter Museum and admired Albert Einstein’s brain along with the Hyrtl Skull Collection. I’m also a fan of literature, so I couldn’t contain my excitement when I learned about a treasure trove of clinical notes from 400 years ago. The collection contains handwritten notes on more than 80,000 patients in early 17th-century England, kept by two healers who were known to cure their patients by using cues from astrology. The notes include treatments with tobacco and horse manure and cover conditions from depression to gonorrhea. Researchers at the University of Cambridge have put transcriptions of more than 500 cases online and its been great entertainment to learn about a patient whose “spleen was not sound,” as diagnosed by the presence of “black stuff that comes from by his excrements.” Another patient complained of “fretting & choleric & melancholy.” Other hot topics include childbirth, infertility, and witchcraft. My favorite treatment apparently involves avian slippers with “a pigon slitt & applied to the sole of each foote.”

Telehealth is officially the fastest growing place of service, growing 53% from 2016 to 2017 in comparison to 14% for urgent care centers and 7% for retail health clinics. Emergency departments experienced a 2% decline. This data comes from New York non-profit Fair Health, which hosts a claims database. Their annual white paper on place of service trends shows that organizations that are not thinking about how to incorporate telehealth might be missing out. Telehealth is still a small portion of all claims – 0.11% in 2017 data compared to 2.6% at emergency departments and 1.2% at urgent care clinics. This will only grow now that payment parity has arrived and telehealth or virtual visits are covered similarly to in-person visits.

I recently joined the ranks of telehealth providers and was surprised by how satisfying it can be. The patients are genuinely grateful that you’re there to take their call at 11 p.m. even if it just results in self-care recommendations. My previous proposal for being a dedicated after-hours telehealth provider for one of our local health systems was met with lack of interest and I still think they’re missing a major opportunity. I care for plenty of their patients in person at my urgent care, so we’ll have to see how long it takes for one of them to turn up in my online queue.

Have you ever used telehealth services for yourself or a loved one? Leave a comment or email me.

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Morning Headlines 6/20/19

June 19, 2019 Headlines No Comments

THL snaps up Francisco Partners’ Nextech in more than $500 mln deal

Private equity firm Thomas H. Lee Partners acquires EHR and practice management vendor Nextech in a $500 million deal.

eSolutions Acquires RCM Software Vendor Practice Insight

RCM vendor Esolutions acquires competitor Practice Insight for an undisclosed sum.

Echo, the medication management app, has been acquired by LloydsPharmacy-owner McKesson

McKesson acquires UK-based prescription delivery and medication management app startup Echo.

VirtualHealth Raises Series B Funding to Revolutionize HealthCare with Unified Data

Care management company VirtualHealth wraps up a $15 million Series B funding round that brings its total raised to $25 million.

Morning Headlines 6/19/19

June 18, 2019 Headlines No Comments

Sanofi and Google to develop new healthcare Innovation Lab

Drug maker Sanofi and Google will establish a virtual innovation lab that will use analytics to understand diseases and to extract patient insights to understand which treatments work best.

Social Impact Startup Aunt Bertha Secures $16 Million in Series C Funding

Community-based organization referral platform vendor Aunt Bertha raises $16 million in a Series C funding round.

Fueling the next phase of our growth: What’s next at Collective Health

Collective Health, which offers a health benefits management system for self-insured employers, raises $205 million in a Series E funding round.

News 6/19/19

June 18, 2019 News 8 Comments

Top News

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Drug maker Sanofi and Google will establish a virtual innovation lab that will use analytics to understand diseases and to extract patient insights to understand which treatments work best.

Sanofi will also use AI to forecast sales and manage marketing and supply chain efforts and will migrate some of its business applications to Google Cloud. 

Paris-based Sanofi, which sells the expensive insulin Lantus, previously formed a join venture with Verily to offer virtual diabetes coaching and tools.


Reader Comments

From Struggling with KLAS: “Re: KLAS doing research on consulting firms. We had been ranked by KLAS for multiple years, but we’re no longer ranked in our category and KLAS can’t get us back up to the minimum number. Our category used to have 35-40 consulting firms ranked and now there are only 11. Has anyone else complained about this? We are seriously considering cancelling our membership. We just aren’t getting value.” I’ll open it up to readers.

From Kloc Programmer: “Re: doctors highlighting EHR data. I don’t get the point. They could miss something by not reading the whole chart. Isn’t all of it important?” Let’s say you’re doing a book report on a 400-page novel. You read / skim with a highlighter in hand, marking the most important points in separating the wheat from the chaff (the author’s job was to write a lengthy book that therefore commands a high price, while yours is to reverse engineer those pages back into an outline of the high points). You write our report and put the book back on your shelf. Two years later, you pick the book back up, and in 60 seconds, you can flip through the pages, read your previously highlighted text and margin notes, and instantly refresh your memory instead of plowing through all 400 pages again. That’s what I’m proposing for an EHR, which intentionally hides the few nuggets a chart contains into volumes of auto-generated and copy-pasted junk. It could work something like this:

  • You read through the chart on your first encounter with the patient, marking individual data elements or selected text as useful.
  • You add a comment if you like to give yourself a reminder, an explanation, or a question to research later. A margin note, if you will.
  • Next visit, you click the magic button that pops up just the information you have marked previously and then highlight anything newly added in the same way.
  • Information that no longer seems useful can be banished to the background by unclicking your highlight. That doesn’t affect anyone else and thus doesn’t need rigorous editing.
  • Individual highlights or comments can be marked as public or private. Everybody benefits when you flag your item publicly so everybody can see what you found useful, but you can any highlight or comment private.
  • The highlighting and review function wouldn’t change the EHR’s functionality. It’s like the annotation feature of Word or of Adobe Acrobat that sits above the hardcore editing tasks.
  • Comments could be handwritten via an electronic pen for on-the-fly notation that doesn’t require sitting at a keyboard.
  • An even simpler option would be to allow a one-click “I found this useful” marking option to make interesting data elements stand out.
  • The rewards for creating note bloat – most of them due to reimbursement or the EHR vendor’s passion for spitting out reams of useless text as a technical parlor trick — aren’t going away soon. At least give doctors a way to mark a chart once and then save time with every visit that follows.
  • It’s an EHR win since paper charts offer no way to do this, short of attaching Post-It notes to the front of the manila folder.
  • The bottom line is that it’s almost impossible to clean up EHR bloat at this point given the many masters it serves, so we might as well add a smarter, relatively easily implemented layer that makes its contents more useful.

From Right into the Trash: “Re: industry email newsletters. HIStalk I open to click the link. Others I zap unlooked. Am I missing any good ones?” The only one I find useful is Advisory Board’s daily briefing. Others lured me in initially with slick writing that unfortunately went nowhere, while others just blast out time-wasting clickbait links claiming to be “curated” but obviously not by an industry expert. I always tell Mrs. HIStalk that a particular restaurant or retail store has a “high hit rate” a high percentage of choices that I would actually buy and Advisory Board’s daily update has that. I also use my “high hit rate” standard to evaluate health and health IT websites to determine which of them are worth following consistently (spoiler: in my case at least, I haven’t found any).


HIStalk Announcements and Requests

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Friday is the first day of summer, so it’s time once again for my annual Summer Doldrums Special on webinars and new sponsorships, wherein I attempt to break through the industry inattentiveness and indecision that is caused by vacations and family activities. Talk to Lorre, who might even offer a little something extra to former sponsors who regret the “former” part. It’s between you and her since I don’t get involved – I have the luxury of being purely the writing, analysis, and snark specialist.


Webinars

July 25 (Thursday) 2:00 ET. “Meeting patient needs across the continuum of care.” Sponsor: Philips Population Health Management. Presenters: Cindy Gaines, chief nursing officer, Philips Population Health Management; Cynthia Burghard, research director of value-based healthcare IT transformation strategies, IDC. Traditional care management approaches are not sufficient to deliver value-based healthcare. Supplementing EHRs with advanced PHM technology and a scalable care management approach gives health systems proactive and longitudinal insights that optimize scarce resources in meeting the needs of multiple types of patients. This webinar will address the key characteristics of a digital platform for value-based care management, cover the planning and deployment of a scalable care management strategy, and review patient experience scenarios for CHF and diabetes.

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


Acquisitions, Funding, Business, and Stock

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Collective Health, which offers a health benefits management system for self-insured employers, raises $205 million in a Series E funding round, increasing its total to $434 million. Co-founder Rajaie Batniji, MD, DPhil (same as a PhD) was until recently a Stanford medical school professor. 

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Hospital laboratory consulting firm Accumen, which was acquired by a private equity firm in January 2019, acquires clinical data exchange technology vendor Halfpenny Technologies.

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Quartet Health, whose technology connects people who have medical conditions with mental health providers when appropriate, raises $60 million in a Series D funding round led by insurer Centene, increasing its total to $153 million. Two of the three co-founders have left their executive positions but remain on the company’s board.

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Community-based organization referral platform vendor Aunt Bertha raises $16 million in a Series C funding round. I interviewed CEO Erine Gray last month and reader response was really good.


Sales

  • Capital Caring (VA) chooses Netsmart’s MyUnity EHR to enrich person-centered care in hospice and palliative care.
  • Community Health Network (IN) will implement MModal’s conversational artificial intelligence to speed up Epic documentation and will also quickly roll out the company’s virtual scribing solution. 

People

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Justin Box (Mary Washington Healthcare) joins Driscoll Health System (TX) as VP/CIO.

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UCSF promotes Rohit Gupta to the newly created position of chief biobank officer, where he will oversee the use of human specimens for research, the creation of consent and processing protocols, and integrating genomic data with the EHR. He worked his way up from his first Stanford job as a clinical study research assistant as he was earning his only academic credential, a bachelor’s degree in biology.


Announcements and Implementations

St. Luke’s Health Care System goes live on Meditech Expense.


Government and Politics

The American Hospital Association wants ONC to restore the requirement that Qualified Health Information Networks support FHIR after it was removed from the second draft of TEFCA (Trusted Exchange Framework and Common Agreement).


Privacy and Security

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Hong Kong Hospital Authority admits – after initially denying it — that it gave police a list of people who were treated in its ED after protesting a proposed law that would allow citizens to be extradited to mainland China for trial. The Hospital Authority claims it did not intentionally leak the information, but says that the hospital’s ED computers are always logged in and anyone can access the information it contains. An intercepted email from the Hospital Authority ordered employees to classify each ED patient as police, reporter, civilian, or other, while a hospital doctor publicly showed an EHR screen that was labeled “For Police.”

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The computer systems of Olean Medical Group and Seneca Nation Health System (NY) are brought down in ransomware attacks.


Other

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Vietnam’s Ministry of Health wants 90% of the population covered by an EHR by 2025, with district-level clinics scheduled for the first round of go-lives next month. The kick-off meeting was held June 14 in Hanoi. Project participants say they are challenged by lack of interoperability and missing connections between practices and hospitals. Hospitals and practices will not be allowed to use paper medical records after 2028.

In Canada, Ottawa Hospital reports 15-deep patient lines at its clinics following its June 1 Epic go-live on because of the time required to re-enter some patient information. Only in a polite country like Canada would the nurse’s union rep decline to rip the hospital when asked about the delays, instead offering the union’s support and remind the reporter that the delays were expected, adding her thought that “hopefully it will get better every day.”

Providence St. Joseph Health EVP/CIO BJ Moore — hired in January 2019 after a 26-year career working for Microsoft — says that Providence St. Joseph and the healthcare industry as a whole are 15-20 years behind in technology. His goals are to simplify the health system’s technology, improve its network performance, speed up employee onboarding, move systems from owned data centers to the cloud, and roll out Epic throughout the system to replace the 14 EHRs that its 51 hospitals use. He also wants to bring more external data into the EHR from consumer wearables.

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A one-star rated nursing home in New York is fined $48,000 after its medical director orders insulin over the phone for a resident whose hospital discharge note clearly indicated that she shouldn’t have it. The doctor blamed a nurse who he said didn’t read him the warning correctly, also speculating that the patient was admitted to the hospital in the first place because someone accidentally deleted her blood glucose readings from the EHR.

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Industry long-timer and North Carolina FC soccer team owner Steve Malik — who founded Medfusion in 2000 and remains its owner – proposes building a $1.9 billion stadium and multi-used develop in downtown Raleigh, NC to convince Major League Soccer to give the city a team in its expansion.

A Kaiser Health News report observes the sharp increase in the number of hospitals that offer ECMO (extra-corporeal membrane oxygenation), a “very expensive, labor-intensive and unsuccessful effort to cheat death” that creates cost and ethical dilemmas in keeping patients whose hearts and lungs don’t work alive even though few of them ever leave the ICU. It also forces family members to choose the moment at which it will be turned off, for which experts urge having the doctor set the date instead. A Brigham doctor concludes that ECMO is a great example of “just because you can doesn’t mean you should.” 

Only in healthcare: a hacker who installed ransomware in the computer systems of an Ohio urology practice sends their $75,000 ransom demand (which was paid) via the office’s fax machine.


Sponsor Updates

  • The Omni-HealthData analytics platform from Information Builders is named Best Overall Healthcare Data Analytics Platform in the 2019 MedTech Breakthrough Awards program.
  • Audacious Inquiry will offer users of its Encounter Notification Service the ability to share their data with CarePort Health for care coordination.
  • Location technology powered advertising platform Brandify will offer health system marketing programs a consumer-facing “providers near me” option, presenting optimized provider and location data from Kyruus.
  • Aprima will exhibit at HFMA June 23-26 in Orlando.
  • CoverMyMeds will exhibit at the EMDs 2019 User Conference & Symposium June 20-22 in Austin, TX.
  • ACAP selects Cumberland Consulting Group as a preferred vendor for consulting services.

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