Monday Morning Update 10/28/19

Top News

From the Cerner earnings call:

• Chairman and CEO Brent Shafer says Cerner’s partnership with Amazon Web Services will create “advancement in the overall user experience” and will increase Cerner’s profitability.
• The company blames a lack of growth in managed services and support revenue on former Siemens Health Services customers who had decided to leave years ago and are finally doing so, although the retention rate in that business is still 80%.
• The termination of Adventist Health’s revenue cycle outsourcing agreement, which Cerner says was a joint decision, will reduce Cerner’s annual revenue by $170 million and triggered a $60 million charge this quarter. The company says it will become more selective in future RCM outsourcing deals based on potential margin and probably won’t offer full outsourcing going forward.
• The Coast Guard will begin its Cerner implementation this quarter.
• Cerner’s acquisition of government contractor AbleVets will involve a $75 million cash consideration and will contribute $90 million to 2020 revenue.
• Positive feedback on its attempts to fix its revenue cycle management problems has led several large clients to initiate a move to Cerner revenue cycle.
• An unnamed, previously dissatisfied Cerner academic system customer has become a top Cerner reference site and will convert 125 of its clinics from Epic to Cerner.
• The company believes non-US markets will remain attractive.
• 80% of Cerner’s clients are hosted.
• The first Cerner product to move to AWS will be HealthIntent in the first half of 2020.

Reader Comments

From Daddy Shark: “Re: health system CIOs. We just had a deal killed off by an overly aggressive CIO who I think just wanted to flex their power over the medical staff.” Here’s why CIOs and IT governance committees reject user requests for new software, just like parents often say “no new puppy” to their pleading / demanding children even if they promise to take care of it:

• It’s not in the IT budget. It doesn’t matter that the requesting department “has the money” as they always say – if IT is underfunded and departments have budget surpluses that allow them to make their own IT decisions, then the C-level people aren’t looking at IT strategy and costs correctly.
• Nobody has analyzed how much money and resources the project will consume over a 10-year useful life.
• The product is technologically risky, hard to support, or requires hard-to-find expertise.
• The vendor’s expertise or likely survival is questionable, the proposed contract terms and conditions are unacceptable, or the company has a reputation for under-delivering after the contract is signed.
• The software requires other departments that weren’t involved in the decision to do more work or spend more money.
• The user department has stars in their eyes from a vendor-provided, unrealistic vision of post-implementation bliss, forgetting that their department is resistant to changing processes, has failed to successfully manage previous projects, doesn’t optimally use the systems they already have, or are unlikely to be able to juggle the demands of a new implementation with routine departmental operations.

From Bob: “Re: old LP album. Found this in my mom’s collection. Health IT vendors used to commission albums of smooth background piano music.” Wow, that’s cool. The 1985 album, distributed by then-health IT vendor McDonnell Douglas Physician Systems Company, features space pop composer and pianist Charles Albertine, who died the following year at 57. Copies are available on Amazon and Ebay, but you can stream the whole thing on YouTube. It’s pretty good for what it is.

From Impending Doom: “Re: racial bias in AI. How is that even possible?” It’s the data or the process used to interpret it that is biased. AI simply creates a model that describes the data humans give it, so any bias that is implicit in the data or the process that created it will be faithfully replicated by AI. It’s the job of humans to fully understand the characteristics and limitations of available data before applying AI inappropriately. It’s also the job of AI scientists to watch for bias and to understand how the machine has reached its conclusions, which isn’t easy given the “impenetrable black box” nature of some AI / ML projects, especially the proprietary ones. I hope the technology companies that are pushing AI realize that their clinically focused products won’t get much traction unless they are willing and able to articulate how their algorithm works under the covers, since those who are using it are placing their professional licenses at risk.

From Racing for the Cure: “Re: breast cancer awareness. Lots of pink this time of year.” Working for health systems has jaded me to the gulf between individual human empathy and the corporate interests embedded within every aspect of healthcare, but I’ll at least acknowledge that good people are trying to show their support while having fun. Still, I can’t forget that a lot of companies and people wouldn’t be wallowing in cash if it weren’t for exceptionalistic Americans who think we just need to fight harder and give big corporations more money so we can rule the world and triumph over our own mortality.

HIStalk Announcements and Requests

Poll respondents place KLAS just head of “none of the above” for offering the most meaningful industry award. Next was the HIMSS Davies Award and it got ugly fast, with the HIT 100 (I don’t recall exactly what that is since I copied it over from a years-ago poll I ran) finishing dead last at 0.65%. The list was little changed from mid-2017, including the same top two finishers and the same last-placer.

New poll to your right or here: what are your HIMSS20 plans? I run this every year right about now, trying to get a general handle on how conference attendance is looking.

I finally decided to do something about the drawer full of memory cards that span many years and digital cameras. Solution: a 2-terabyte, USB 3.0 Western Digital Easystore portable hard drive that is nearly as fast as a flash drive and requires only the USB connection with no power cord. I just plugged it in and started copying 25,000 photos from an old Windows 8 laptop that was the temporary home of a bunch of these cards from a similar project that I abandoned previously. I hadn’t done the space calculation in my head, so I was surprised that the space consumed was barely a blip of the 2 terabytes. The next step is to move photos into individual folders for each month and year and then copy over the individual memory cards as I try to decide how to handle duplicate files, which with this much cheap storage may mean that I don’t even try to de-duplicate. I paid $59.99 on sale and shipping was free. The drive includes some seemingly well-designed backup software that I don’t need. The old memory cards will provide a backup since their capacity and speed make them obsolete.

Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.

Acquisitions, Funding, Business, and Stock

Vocera announces Q3 results: revenue up 6%, adjusted EPS $0.23 vs. $0.20.

Canada-based mobile healthcare system VitalHub acquires startup Oculys Health Informatics, which offers a hospital operations dashboard, for $4.2 million.

I notice that NantHealth shares are trading at $0.75, down an eye-popping 96% since the company’s splashy mid-2016 IPO and valuing the company at just $83 million. Related company NantKwest shares are at $1.19, down 97% from their IPO-day spike in July 2015. I also noticed that NantHealth’s 10-member executive team is all male except for the VP of human resources, while six of seven executives of NantKwest are male.

CNBC profiles Heal, which offers on-demand doctor house calls for $159 in nine cities. The company has raised $75 million from backers that include former Florida Governor Jeb Bush and singer Lionel Richie. I’m always fascinated by companies that pay professionals X but bill them out at multiples of X while adding what seems like minimal value.

Sales

• Beaumont Health will implement Mobile Heartbeat’s MH-Cure clinical communications platform in a partnership agreement that includes GE Healthcare.
• Children’s National Research Network will expand its implementation of the TriNetX global health research network to Children’s National Hospital (DC).

Decisions

• Huron Regional Medical Center (SD) will replace CPSI Evident with Cerner in 2020.
• Centra Southside Community Hospital (PA) will replace Omnicell automated dispensing machines with Cerner RxStation.
• Advocate South Suburban Hospital (IL) will implement Epic’s Beaker laboratory information system in November 2019, replacing Sunquest.
• Christus Good Shepherd Medical Center – Longview (TX) will replace Meditech with Cerner in 2020. CORRECTION: Definitive Healthcare rechecked with the client and verified that a reader’s report is correct – Christus is moving to Epic, not Cerner.

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

People

Cone Health (NC) promotes Ben Patel, MS, MBA to EVP/CIO.

Lisa Maki (PokitDok) joins Microsoft as GM of health alliance formation.

Other

A hospital in China goes live on blockchain-powered patient billing, in which patients can pay their QR-coded bill using the WeChat app. 

This is depressing. A high school volleyball team’s bake sale raises $1,650 to help Santa Ynez Valley Cottage Hospital (CA) buy a 3D mammography system. Clinical benefit to patients is questionable, but the financial benefit to the hospital is a sure thing. Also depressing is that according to tax filings, the donation would cover about three hours of pay for Cottage Health’s CEO. I wonder how many parents of these kids could afford a visit to the hospital’s ED with a volleyball-caused sprain?

Sponsor Updates

• StayWell partners with the California Department of Human Resources to sponsor 7,695 meals for the California Association of Food Banks.
• Glytec will exhibit at Becker’s CEO + CFO Roundtable November 11-12 in Chicago.
• A UCLA study finds that use of Healthwise’s shared decision-making tools in primary care clinics increased the participation of prediabetic patients in diabetes prevention programs.
• Netsmart and Vocera will exhibit at the LeadingAge Annual Meeting and Expo October 27-30 in San Diego.
• Mobile Heartbeat will exhibit at SC HIMSS November 1 in Columbia.
• Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the Maternal Health & Perinatal Safety Symposium November 1 Tenafly, NJ.
• PracticeSuite selects Relatient to power patient reminders, intake, surveys, secure messaging, and self-scheduling for 57,000 medical professionals.
• T-System and Wellsoft will exhibit at the 2019 ACEP19 Scientific Assembly October 27-30 in Denver.
• Over 100 top US health systems attend the 2019 Strata Decision Technology Summit to help bend healthcare’s cost curve.

Blog Posts

• Maximizing the Value of Integrated Test Automation Scripts (Santa Rosa Consulting)
• Why Treating Depression Under PDPM is More Important Than Ever (Netsmart)
• Integrating Breast Cancer Detection with Value-Based Care: An Interview with Lightbeam’s Jessica Scruton (Lightbeam Health Solutions)
• Hospital Billing Practices are Under a Microscope and Providers are Responding to the Public and Political Scrutiny (Loyale Healthcare)
• When the Promise of Prehabilitation Meets the Power of Healthcare Analytics (Health Catalyst)
• 5 Technology Trends for Physical Therapy Practices (MWTherapy)
• Blockchain for the Future of the Healthcare Enterprise (NextGate)
• Are you ready for the Medicare Beneficiary Identifier? (Experian Health)
• What Does Medical Crowdfunding Mean for Patient Financial Responsibility? (PatientBond)
• Measuring Patient Engagement with … PEAs? (Patientco)
• How to Build Outcome-Based Partnerships? Start with Communication (Prepared Health)
• Can shadow IT work in healthcare? (Redox)
• 2019 Market Pulse Survey: If Time is Money, Then Identity Pays (SailPoint)
• Maximizing the Value of Integrated Test Automation Scripts (Santa Rosa Consulting)
• Surescripts is Helping Independent Pharmacists Spend More Time with Patients – and Less Time with Paperwork. (Surescripts)
• A HIPAA Risk Assessment is a Learning Experience (WebPT)
• ZeOmega Experts Join HHS-CODE Roundtable on Social Determinants of Health (ZeOmega)
• Gold Key Interventions Provide Road Map for Improving Quality Outcomes (Zynx Health)

Contacts

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

Weekender 10/25/19

Weekly News Recap

• Cerner’s Q3 revenue and earnings meet Wall Street expectations.
• Amazon will use the symptom checker and triage chatbox of just-acquired Health Navigator in its virtual clinic pilot.
• KLAS emphasizes physician EHR training to improve satisfaction.
• Viz.ai will use a new $50 million investment to expand the availability of its AI-powered stroke detection software.
• Recruitment and consulting firm Ettain Group acquires Leidos Health.
• Cleveland Clinic will expand its relationship with American Well to include a new digital health company, The Clinic, that will offer patients access to Cleveland Clinic providers through American Well’s technology.
• Cerner acquires healthcare security-focused government IT contractor AbleVets.
• England’s NHS gives Google access to five years’ of patient data from several hospitals despite the privacy concerns of critics.
• Google hires former National Coordinator Karen DeSalvo, MD, MPH (Dell Medical School) to the newly created position of chief health officer.

Best Reader Comments

I’m boycotting HIMSS. Not interested in attending when the keynotes get less and less relevant or even offensive. (Garrnut)

Re: 3D mammograms. I’ve also heard that more “stuff” shows up on 3D imaging, requiring more follow ups and six-month instead of one-year cycles, adding even more to the bottom line than the $50 bump in the initial fee. (Bob)

Discerning the financial health of an IT vendor in healthcare doesn’t require AI nor Machine Learning algorithms. Basic common sense is all that’s needed. The more cryptic the language, the more creative language used by executives to describe basic economics and forecasts , the more you know you’re listening to BS. It’s all in the numbers. (El Jefe)

Ancestryhealth. Interesting. People won’t willingly share a Social Ssecurity number with anyone, yet will gladly send off DNA to organizations who have no obligation to tell you exactly who / what they’re sharing with their partners. “You are not the customer, you are the product” – Pernille Tranberg. (ellemennopee)

Watercooler Talk Tidbits

Researchers find that an Optum-developed population health management algorithm introduced racial bias in ranking healthy white patients the same as sicker black patients. They found that adjusting the algorithm to predict the number of chronic illnesses a patient will likely experience in a year – rather than the cost of treating those illnesses – reduced the racial disparity by 84%, emphasizing the importance of understanding the data that was used to train the algorithm.

The Iowa Hospital Association fires its VP of communications for his criticism of the governor’s healthcare track record on Facebook, which he he claimed was supposed to be funny as it was “kind of in a Donald Trump language, kind of an over-the-top, hyberbole thing” that went wrong when a “small but powerful” group of hospital association members objected.

Investigation of patient abuse allegations at Laguna Honda Hospital yields 130 pieces of privacy-compromising evidence from photos and videos shared by six employees who have since been fired.

A National Academy of Medicine report finds that half of the country’s doctors and nurses are experiencing significant symptoms of burnout that increase patient risk, malpractice claims, absenteeism, and turnover at a cost of billions. They conclude that clinicians are bearing the brunt of a dysfunctional healthcare system that forces them to work long hours, mires them in bureaucratic record-keeping, keeps them worried about malpractice lawsuits, and forces them to work around a lack of resources. A co-author observes that laws are turned into regulations that are made into policies that take the most conservative path for legal protection, such as requiring clinicians to log in several times each day because of privacy concerns.  They also note that hospitals force doctors to complete long checklists full of often-irrelevant items so they can bill the maximum amount.

The Washington Post reports that President Trump will nominate MD Anderson radiation oncologist and chief medical executive Stephen Hahn, MD as FDA commissioner.

New York Jets guard Kelechi Osemele, apparently worried that his employer doubts his claims of a shoulder injury because they’re fining him for not showing up for practice, posts his doctor’s surgery recommendation to his Instagram.

In Case You Missed It

• News 10/25/19
• EPtalk by Dr. Jayne 10/24/19
• News 10/23/19
• Curbside Consult with Dr. Jayne 10/21/19
• Monday Morning Update 10/21/19

Get Involved

• Sponsor
• Report a news item or rumor (anonymous or not)
• Sign up for email updates
• Connect on LinkedIn
• Contact Mr. H

Morning Headlines 10/25/19

Cerner Reports Third Quarter 2019 Results

Cerner reports Q3 results: revenue up 7%, adjusted EPS $0.66 vs. $0.63, meeting analyst expectations for both.

Northwell Health launches LabFly in Manhattan, Queens, first health system app to facilitate blood draws at home or work

Northwell Health works with health IT vendor MphRx to develop an app that lets patients schedule blood draws from their home or office.

Ransomware and data breaches linked to uptick in fatal heart attacks

A study finds that mortality rates among heart attack patients increase at hospitals that have experienced a data breach, with as many as 36 additional deaths per 10,000 heart attacks occurring annually at the hundreds of hospitals studied.

Augmedix Announces Additional $19 Million in Series B Funding

Tech-enabled remote documentation company Augmedix raises $19 million in a funding round that brings its total raised to $82 million.

News 10/25/19

Top News

Cerner reports Q3 results: revenue up 7%, adjusted EPS $0.66 vs. $0.63, meeting analyst expectations for both.

The company issued mixed Q4 guidance.

Cerner shares dropped a few percentage points in after-hours trading following the earnings announcement.

Reader Comments

From AZ: “Re: Care Innovations, the Intel and GE joint venture. Heard they are in trouble and almost closed their doors a couple of months ago.” Unverified. The joint venture, formed in 2011 if I recall correctly, hasn’t had much to say beyond touting a remote patient monitoring system.

Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.

Acquisitions, Funding, Business, and Stock

NextGen Healthcare reports Q2 results: revenue up 3%. adjusted EPS $0.24 vs. $0.24, beating earnings estimates but falling short on revenue.

InterSystems will expand its work with partners in China after seeing revenue there increasing 18-20% annually as that country’s economy grows and its healthcare sector undergoes digital transformation. 

Viz.ai will use a new $50 million Series B investment to expand the availability of its AI-powered stroke detection software.

Amazon will offer newly acquired Health Navigator’s symptom-checker and triage chatbot service to its employees as part of its Amazon Cares virtual clinic pilot. Health Navigator founder and CEO David Thompson, MD is also know for his co-development of a set of globally-used telephone triage protocols.

Belgium-based digital imaging company Agfa is reportedly accepting bids for its health IT business. The company announced its intent to divest the enterprise imaging and integrated care business in 2017.

People

Pivot Point Consulting (The Christ Hospital Health Network) names Mauraan Schultz VP of delivery.

TriCore Reference Laboratories gives CIO James Brown the additional role of CEO of its Rhodes Group LIS and consulting subsidiary.

Announcements and Implementations

Northwell Health works with health IT vendor MphRx to develop an app that lets patients schedule blood draws from their home or office. The LabFly app comes with a $20 convenience fee and adds payment processing, lab-tech tracking, and access to lab results.

Verily will work with the VA health system in Palo Alto, CA and Atrius Health in Massachusetts on population health projects that will focus on improving care and outcomes for patients undergoing knee replacements, going through alcohol withdrawal, and recovering from heart attacks.

Nordic completes its move to a new Madison, WI office, doubling its square footage to 50,000 and giving employees views of the University of Wisconsin Arboretum through 12-foot-tall windows. 

Strata Decision Technology announces StrataJazz OnePlan, an advanced planning platform that streamlines budgeting and planning.

A new KLAS survey of 30,000 physicians via its Arch Collaborative finds that while physicians in some specialties (hospital medicine, pathology, pediatrics) are more satisfied with their EHR than others (plastic surgery, cardiology, orthopedics), it is not consistent and may be driven more by the quality of their initial training. Still, physicians in some specialties say the EHR is too bulky for their limited needs, while others report its inability to accept their drawings or images. More Epic-using specialists say they have the functionality they need vs. Cerner users, but users of both products report deficiencies in their ophthalmology and dermatology capabilities. The report concludes that the quality of initial training, availability of follow-up training, and assistance with personalization can improve satisfaction across all specialties. It would be interesting to see how physician personality type, age, and employment status drove the individual specialty scores.

Government and Politics

The HHS Office for Civil Rights fines Jackson Health (FL) $2 million for a three-year string of HIPAA violations related to losing paper records, failing to notify authorities in a timely manner about the loss, staff improperly accessing patient medical records and then posting PHI on social media, and a separate incident in which an employee attempted to sell PHI, among other privacy failures. Jackson Health is the same organization linked to an ESPN reporter’s posting of NFL player Jason Pierre-Paul’s medical chart on Twitter, with the report that he had blown off his finger with fireworks on July 4, 2015 derailing his $60 million contract negotiations with the New York Giants.

Texas Health Resources reports that 82,000 people have been impacted by a billing system error that led to it accidentally mail patient information to the wrong recipients.

Privacy and Security

A Health Services Research study finds that mortality rates among heart attack patients increase at hospitals that have experienced a data breach, with as many as 36 additional deaths per 10,000 heart attacks occurring annually at the hundreds of hospitals studied. The study’s authors found that it took an extra 2.7 minutes for a patient to receive an ECG at a hospital that had experienced a breach, with the lag time remaining as high as 2 minutes up to four years after the hack. Though the researchers didn’t analyze what, if any, additional cybersecurity controls were installed at the hospitals, they have surmised that increased software log-in and access times at these facilities have had a direct impact on heart attack mortality rates.

Other

An AP article questions the role stethoscopes have left to play in healthcare in light of their higher-tech counterparts. The advent of app-based, handheld devices that use ultrasound and artificial intelligence seem to slowly be edging out the traditional instrument invented by French physician Rene Laennec in 1816. While celebrity MDs like Eric Topol consider it to be obsolete, others working in the trenches of daily care have yet to be fully swayed by shiny new objects that come with considerably higher price tags.

And speaking of Eric Topol, he responds to Time’s latest cover story on the robot-ization of healthcare.

Sponsor Updates

• Glytec becomes the third largest corporate fundraiser for the American Diabetes Association’s Step Out Walk to Stop Diabetes – Boston.
• Healthcare Growth Partners advises hospital laboratory consulting firm Accumen during its acquisition of 3DR Laboratories.
• EClinicalWorks will exhibit at the 2019 AAP National Conference & Exhibition October 25-29 in New Orleans.
• Ensocare will exhibit at the ACMA Oregon Chapter Annual Conference October 26 in Welches, OR.
• The Tampa Bay Business Journal names Greenway Health Senior Director of Organizational Effectiveness and Transformation Kirsten Schreiter a 2019 People First honoree.
• Hayes Management Consulting will exhibit at the HCCA Clinical Practice Compliance Conference October 25-27 in Nashville.
• KLAS Research ranks InterSystems among the top interoperability vendors of 2019.
• Kyruus and Prepared Health will exhibit at the HLTH Conference October 27-30 in Las Vegas.
• Redox publishes the results of its “Mobile Health Survey.”
• ZeOmega names five healthcare leaders to its Advisory Board.
• Pivot Point Consulting names Joe Clemons (Vancouver Clinic) director of advisory services.
• Spok publishes a new e-book, “Contact centers in healthcare.”
• Meditech publishes a new case study, “Physicians at Halifax Health Go Mobile with Meditech Expanse.”
• Optimum Healthcare IT publishes a white paper titled “ERP System Selection – Evaluating Options and Building Consensus.”

Blog Posts

• Overnight Transformations are Possible! (EClinicalWorks)
• Hunterdon Healthcare teams work more easily and securely using Chrome Enterprise and G Suite (Google Cloud)
• FDA Scrutinizing Predictive Analytics Software (HBI Solutions)
• Leading Thoughts: What Will You Be Famous For? (HCTec)
• Is Your EHR on Citrix Ready for the Workday? (Goliath Technologies)
• 4 Quick Tips to Achieving Prescription Renewal Protocol Consensus (Healthfinch)
• Connecting people by connecting systems (Hyland)
• PwC Study: Data Analytics Critical for Advancing Social Determinants of Health Efforts for Payers (Imat Solutions)
• Improve Your Coaching Skills by Listening and Learning (Impact Advisors)
• Pause to Consider: Vulnerability Threat Management (Fortified Health Security)
• How to Build Outcome-Based Partnerships? Start with Communication (Prepared Health)

Contacts

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

EPtalk by Dr. Jayne 10/24/19

I enjoy mentoring students and I am always excited when one of them is admitted to medical school. There is a lot of buzz around the schools that are offering free tuition or that are subsidizing a large amount of tuition, but most people in medicine don’t realize the financial barriers that occur upstream.

My student has to pay a $1,500 deposit in the next two weeks. Although he’s working full time in our office as a clinical tech, that’s a hefty amount of money after he’s already paid for the application process, travel and lodging for interviews, the MCAT exam, test preparation, and of course an undergraduate degree.

This is a timely topic that was recently covered in the New England Journal of Medicine. The article looked beyond the shocking costs to explore how they impact the types of people that apply. Not surprisingly, few applicants come from lower-income households and minorities continue to be underrepresented in the applicant pool.

Some schools are trying to reduce application costs by having students host applicants. Other programs may reduce the cost of the MCAT and applications or offer guaranteed admissions for students at a certain level of performance at affiliated undergraduate institutions. Schools are starting to look at virtual interviews as a way of lowering costs. It’s been suggested that schools should revisit their supplemental “secondary application” processes as a way of increasing the diversity of the applicant pool while reducing the cost burden.

All of us would benefit from a more diverse physician workforce, rather than having a full quarter of applicants coming from households with greater than $250,000 in annual income as the current statistics demonstrate. Still, it illustrates the pressures that clinicians have already been under before they ever enter practice. For those of us that look closely at clinician burnout, these are contributing factors that have already raised the stress game for those who haven’t even begun to stress around government regulations or burdensome technology.

Score one for AI. A recent study by researchers in NYU School of Medicine shows that an AI tool that uses machine learning can identify breast cancer with 90% accuracy. The tool was trained on over a million images and 14 radiologists reviewing 720 images were included in the study. The tool was able to identify “pixel-level changes” in breast tissue, but radiologists were able to use logical reasoning that the AI could not. The authors conclude that AI can augment radiologists.

It remains to be seen whether this can be extrapolated to other data sets and whether it can be brought into clinical practice, but for those of us in high-risk situations, such AI augmentation is welcome. I don’t personally read mammograms, but for those of us in age brackets where eyeglasses start appearing in our pockets, it’s a nice idea to have a set of extra “digital eyes” on radiology images.

I missed this a couple of weeks ago, but apparently Senator Rand Paul has introduced a bill to overturn what he considers the “dangerous provision” of legislation allowing the US to institute a unique patient identifier. He claims his physician creds make him an expert. Clearly he’s not an informaticist and has never had to disentangle the merged records of premature twin siblings Andrea and Andre, that were combined due to a faulty matching algorithm. He cites breaches as another reason. I’m pretty sure most data breaches that would reveal a universal patient ID would also reveal name, address, DOB, phone number, and often SSN, which are the current keys to your data.

Jenn clued me in on this article answering the question of, “What’s the best shoe for the busy physician?” Physicians were surveyed with 255 responses received, including 172 men and 81 women. The idea that shoe choice is important was nearly unanimous, with 40% expressing a fondness for casual shoes or loafers, 29% choosing dress shoes or heels, 20% wearing sneakers, and 11% wearing clogs or similar.

I was initially surprised to see that more younger physicians are choosing dress shoes since that demographic is often accused of being overly casual. However, it would make sense as they have less overall mileage on their feet compared to the rest of us.

According to the article, physicians suffer from flat feet, plantar fasciitis, pain, and bunions. Physicians are sometimes self-conscious about their shoes. One of my mentees started wearing what she considers “ugly” shoes because she had too many patient comments about her “cute” shoes and felt patients weren’t taking her seriously because of her choice of footwear. My personal favorite shoe, pictured above, is the Medimex Plogs line. They’re vented for breathability, have massaging nubs on the footbed, and are also autoclavable, perfect for whatever might be on the floor of a medical environment.

Speaking of people having opinions on how people dress, I was unsurprised to see this report about women at Ernst & Young being coached on how to dress. Even if a fraction of the allegations in the piece are true, it’s a fairly horrifying read. Unfortunately, I continue to see companies who have different expectations for employees based on sex and/or gender, and also those that have no idea what to do with non-binary employees.

I have been in a position where two executives debated another’s competence while making comments about her lack of artificial hair coloring, including comments on how “all that gray makes her look old.” From that conversation, I learned that apparently men with gray hair are distinguished, but women who go natural look old.

I worked for another client that required female employees to wear at least a two-inch heel and skirts, with no slacks allowed. They didn’t last long on my roster. I’ve seen assertive women labeled as “shrill” when their male counterparts are revered as “go-getters” in the last several months, regardless of publicity around discrimination and lack of equity or parity.

I recently attended a retreat hosted at a facility owned by a traditionally male-dominated company that had a large number of female participants. The company has made many public statements about its deliberate actions to increase female participation and empowerment. Interestingly, a visit to the newly created female showers at the athletic facility revealed a urinal in one of the two stalls. At least they created some individual showers rather than the group / open showers I had heard were in the male locker room area, but it’s hard to believe that organizations still think that group showers are OK for anyone in this day and age, regardless of whether they’re separated by sex or gender.

All the restrooms were clearly marked male or female, with no availability of non-gendered, family-friendly, or separate accommodations for those who might need additional assistance even though the facility is open to families. Nothing rolls out the not-so-welcome mat like inadequate restroom facilities, so I wouldn’t be surprised if they continue to encounter challenges in recruiting women or people outside their historical demographic.

Does your company have a corporate dress policy? Is it equitable regardless of sex or gender? What do you think about the current climate? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 10/24/19

AVIA Raises $22 Million in New Funding Round to Propel Service Expansion

Digital health innovation network and consulting firm Avia raises $22 million in a funding round led by First Trust Capital Partners.

Viz.ai Raises $50 Million Series B Round to Bring AI Powered Synchronized Stroke Care to More Patients

Viz.ai will use a new $50 million investment to expand the availability of its AI-powered, stroke-detection software.

DXC Technology Increases Presence in Conway Creating a Global Center of Excellence in Medicaid Services and Adding 1,200 Tech Jobs

IT and consulting services company DXC Technology will bring 1,200 new jobs to its facility in Conway, AR.

Amazon acquires start-up Health Navigator, its first health-related purchase since PillPack

Amazon will offer newly acquired Health Navigator’s symptom-checker and triage chatbot service to its employees as part of its Amazon Cares virtual clinic pilot.

Morning Headlines 10/23/19

Leading Talent Solutions Provider ettain group Acquires Global Employment Solutions and Leidos’s Commercial EHR Consulting Business

Recruitment and consulting firm Ettain Group acquires Leidos Health, announced in parallel with Ettain parent company NMS Capital’s sale of its Ettain stake to A&M Capital.

Medicomp Systems Secures Patent for its Method of Displaying Clinically Relevant Information Within Physician Workflows

USPTO awards Medicomp Systems a patent for its Quippe platform technology that identifies and filters relevant clinical data for presentation to clinicians at the point of care.

Clinical Trial Technology Startup SignalPath Announces Successful Close of $18M Series B Funding Round

Clinical trials platform vendor SignalPath raises $18 million in a Series B funding round.

Agfa Gevaert expects multiple bids for healthcare IT unit: sources

Reuters reports that digital imaging company Agfa has begun accepting bids for its health IT business.

News 10/23/19

Top News

Recruitment and consulting firm Ettain Group acquires Leidos Health, announced in parallel with Ettain parent company NMS Capital’s sale of its Ettain stake to A&M Capital.

Leidos Health, formed by the merger of Vitalize Consulting Solutions and MaxIT Healthcare, will be renamed Ettain Health.

I confirmed and published a reader’s accurate rumor report on September 18. Leidos said at that time that 850 employees will transfer to the new company.

Reader Comments

From NI: “Re: informatics nurses. How are they perceived in health systems?” Very well, in my experience of having had those folks report to me. Physician informatics is a tougher job because it’s a small number of people, often just one, and peers are suspicious of a doctor who has crossed over to the “dark side.” This is often amplified by specialty rivalry, in which big-ego specialists scoff at the idea that an informatics doc from a different specialty can understand their needs. In contrast, nurses seem to appreciate their peers who have moved into nursing (applied) informatics, with no feelings of resentment that I’ve ever seen (they are still respected nurse colleagues regardless of job description). It helps that health systems wisely choose informatics nurses who are  experienced process change leaders and patient care advocates. They also benefit from their greater team numbers and their deeper process knowledge since they are usually hired from within. Lastly, they love patients more than computers and thus aren’t seen as token IT geeks stumbling around blindly on the floors. Informatics nurses are the unsung heroes of any health system’s IT successes, with “unsung” meaning that clueless doctors, ancillary departments, and executives often override them just because they can. I blame organizational culture and some degree of bias in that 90% of nurses are female in a male-dominated culture, they were not taught in nursing school to be Type A backstabbers and gunners, and they are usually less interested in organizational politics and ladder-climbing than they are in patient care. As I often say, without skilled bedside nurses, a hospital is just a consumer-hostile, poorly run, but fabulously profitable hotel.

From Rich Mandarin: “Re: grammar peeves. One of my favorite aspects of HIStalk is hearing your latest. As it’s been a while since you’ve posted some, are any currently at top of mind?” First, I promise that I didn’t make this comment up just to pontificate. I’m not a mistake-free grammar zealot who corrects others individually for their casual writing, but rather someone who respects the time and intelligence of business readers who don’t necessarily know me personally, which is why I might open Christmas presents wearing rumpled sweatpants and a King Crimson tee shirt that wouldn’t be my first choice around first-impression strangers at work or a conference. Good business writing should be concise and barely noticeable, free of distracting mistakes and quirky style. Peaking my peeve-meter lately, although not specifically limited to grammar, are these:

• Using the trendily pompous word “curate.”
• The possessive “its” being misused as “it’s” about 90% of the time, which I fear is a lost cause since social media has emboldened poor writers to just defiantly throw their mistakes and half-baked thoughts out there, often dictated into speech recognition apps without review.
• Starting sentences with “know” in an awkward attempt to convey phony corporate emotion, as in, “Know that we care about your health” instead of the identical “we care about your health.”
• Starting sentences with “so,” a Millennial-common writing crutch that turns everything into a bar story, as in, “So my grandmother died last week …”
• The informal usage of “Dr. John Smith” instead of the correct listing of John’s specific doctorate.
• Not using the serial (Oxford) comma, thus saving yourself one keystroke while forcing your reader to re-read your messy sentence. 
• Non-experts using “pop health” to make themselves sound like insiders, which is even sillier when what they really mean is “population health management,” or in most cases, “population health management technology.”
• The word “utilizes,” which is just a puffed-up way of saying “uses.” Ditto “leverages.” You’re trying too hard to sound smart.
• FHIR puns that weren’t even clever the first thousand times.

From HIMSS20 Keynote Speakers – Again?!: “Re: Alex Rodriguez. I just received an email that he will be the Friday afternoon HIMSS20 keynote speaker. What’s your take on the announcement?” High school graduate, stick-and-ball gazillionaire, and admitted steroid user (in between lying through his teeth about it) A-Rod commands a speaking fee of “$100,000 to $1 million” in yet another example of someone being paid exorbitantly for providing minimal societal benefit. Financially struggling patients must be thrilled to be underwriting the chance for the highly-paid executives of their local non-profit hospital – at least that handful that stick around until Friday afternoon — to jock it up in A-Rod’s celebrity glow as he opines on analytics (I’m pretty sure he’s no Billy Beane given that he never managed anyone other than himself in baseball, and even did that questionably except for mastering the art of saying “I’m sorry” while continuing to do what he was sorry for). This anemic HIMSS20 keynote lineup isn’t what the conference needs to stanch its attendance bleeding.

HIStalk Announcements and Requests

I need to replace my old Timex Expedition watch, but so many Amazon watch reviewers have complained that they were stiffed with a damaged or cheaper model or one that isn’t authorized for US sale. Amazon does little to police bait-and-switch sellers or those who create phony reviews even when it’s obvious and sometimes its reviews for several product variants are dumped into a single set of shared reviews, to the point that I’m beginning to look elsewhere for many items, the same problem that drove me from Ebay.

Webinars

October 24 (Thursday) 1:00 ET. “The power of voice: Will AI-drive virtual bedside assistants become mainstream?” Sponsor: Orbita. Presenters: Nick White, co-creator of DeloitteAssist and principal in Deloitte’s Smart Healthcare Solutions practice; Bill Rogers, CEO and co-founder, Orbita. Conversational AI and virtual health assistants are bringing new opportunities to care facilities to improve patient journeys and yield radical workflow efficiencies. Will the hospital rooms of the future continue to provide traditional bedside call buttons? Or will these be replaced with digitally reimagined, AI-driven, voice-powered agents? Learn from the expert who created today’s industry-leading, market-proven, virtual bedside assistant.

Previous webinars are on our YouTube channel. Contact Lorre to present your own.

Acquisitions, Funding, Business, and Stock

Clinical trials platform vendor SignalPath raises $18 million in a Series B funding round.

People

Blain Newton (HIMSS Analytics) joins electronic aircraft systems vendor Beta Technologies as CFO/COO.

Nuance promotes Jonathon Dreyer to VP of solutions marketing.

Hill-Rom promotes Trey Lauderdale to VP/GM of care communications.

Announcements and Implementations

USPTO awards Medicomp Systems a patent – its fourth since 2016 – for its Quippe platform technology that identifies and filters relevant clinical data for presentation to clinicians at the point of care.

Strata Decision Technology announces StrataSphere, a cost benchmarking platform that aggregates information from 1,000 hospitals that use the company’s StrataJazz product (financial planning, analytics, and performance) for gaining insights into best practices. Strata customers can opt in at no cost.

Privacy and Security

The Washington Post investigates a reader’s complaint that the privacy policy of the Allscripts Follow My Health portal of George Washington University’s faculty practice allows it to use patient information for marketing, including by “marketing partners.” She found no opt-out agreement. The paper contacted Allscripts, which says the company doesn’t disclose identifiable patient data to third-party marketing companies even though its privacy policy reserves the right to do so. The paper seemed surprised to learn that HIPAA doesn’t cover technology vendors, apparently as confused as laypeople in general in thinking that the badly aging HIPAA is a broad-coverage patient privacy law instead of a requirement only of covered entities and their business associates, all of which enjoy broad leeway under the guise of “treatment, payment, and operations.”

Other

The Dallas paper observes that not only is Children’s Health in Dallas paying $2.5 million for a high school football stadium’s naming rights, it will contribute nearly $3 million in other benefits to the school over the next 10 years. Reason: the high school is in a high-income, high-growth area that a competing health system is eying. It’s hard to believe, but there was a time when non-profit hospitals acted like charities instead of aggressive businesses that strong-arm patient collections for excessive bills while not paying taxes. No wonder private equity firms are buying all the healthcare businesses they can find – the system is now too big and politically well connected to fail.

Kaiser Health News finds that hospital and doctors are pushing 3D mammograms that haven’t been proven any better than traditional ones despite costing $50 more. Manufacturers (Hologic, GE Healthcare, Siemens, and Fujifilm) have paid doctors $9 million for promotional activities and most of the journal articles were written by doctors who have financial ties to the industry. The manufacturers are also spending big money for consumer marketing, paid celebrity tweets, and lawmaker lobbying that has successfully forced insurers in many states – both private and Medicaid — to cover the screening. The National Cancer Institute will spend $100 million of taxpayer money to determine whether the tests help or hurt the women who receive them, the burden of proof of which should have been on those companies that are raking in cash from their sale. 

The Lansing State Journal notes that a company has created dozens of 40 Facebook-promoted, politically one-sided websites whose names and appearance attempt to fool readers into thinking they are published by local newspapers or business publications. The same firm also publishes “FDA Reporter,” “FDA Health News,” and “Patient Daily.” The latter’s top story opines that it is time to modernize HIPAA, written by fresh college graduate who obediently quoted Joel White of the health IT vendor lobbying group Health Innovation Alliance (in which the kid wrote “HIPPA” five times vs. “HIPAA” once).

You might expect a journal’s PR company to spell the name of its editor-in-chief correctly (that being John Halamka, MD, MS), but I see quite a few other mistakes in the self-congratulatory press release (I count at least seven errors in the 16-word sub-headline alone). Publisher Partners in Digital Health has also come up with the most unwieldy and contrived conference name I’ve seen — ConVerge2Xcelerate.

Sponsor Updates

• The Collective Medical team assembles 1,800 pantry packs and 1,500 trauma kits for a local school district in under an hour.
• AdvancedMD will exhibit at the American Medical Billing Association conference October 24-25 in Las Vegas.
• Apixio, Datica, Clinical Architecture, and Diameter Health will exhibit at the HLTH Conference October 27-30 in Las Vegas.
• Artifact Health will exhibit at the CA ACDIS Conference October 25 in Davis, CA.
• Gartner includes Atlantic.Net in its “2019 Market Guide for Cloud Service Providers to Healthcare Delivery Organizations.”
• CompuGroup Medical will exhibit at the Louisiana Primary Care Association Annual Conference October 23-24 in Baton Rouge.
• Dimensional Insight will exhibit at the DV/NJ HIMSS 2019 Fall Conference October 23-25 in Atlantic City.
• EClinicalWorks congratulates customer The Family Clinic on winning the 2019 CPC+ Practice of the Year award.
• Optimum Healthcare IT publishes a Q3 healthcare data breaches infographic.

Blog Posts

• Pause to Consider: Business Associates (Fortified Health Security)
• A Buyer’s Guide to Intelligent Virtual Agents (Avaya)
• Struggling with readmissions? You’re not alone. (Bluetree)
• Solving Healthcare Compliance in a Post-Cloud World (Datica)
• 5 tips for being a better host to your EHR extension partners (Nordic)
• Windows 7 and Office 2010 End-of-Support: What’s Your Strategy? (Burwood Group)
• Discharge Planning Requirements of the IMPACT Act of 2014 (CarePort Health)
• First Annual Customer Forum a Smashing Success (Diameter Health)
• The State of Healthcare Interoperability in 2019 (Dimensional Insight)
• Windows 10 Projects: Three Key Milestones (Divurgent)

Contacts

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

Morning Headlines 10/22/19

UPMC moving forward to make former South Side hospital into an IT hub

The University of Pittsburgh Medical Center will turn a shuttered outpatient center into an IT center.

Cleveland Clinic, American Well Partner to Launch Digital Health Company

Cleveland Clinic will expand its relationship with American Well to include a new digital health company, The Clinic, that will offer patients access to Cleveland Clinic providers through American Well’s technology.

Humana and Microsoft announce multiyear strategic partnership to reimagine health for aging populations and their care teams

Humana will use Microsoft tools including Azure Cloud, Azure AI, and Azure API for FHIR to develop predictive analytics, natural-language understanding capabilities, and on-demand and virtual medical services for its members and their providers.

Partners HealthCare Creates New Investment Funds to Accelerate Innovation in Medicine

Partners HealthCare funnels $80 million into two new investment funds that will support young companies that develop new technologies and medications based on inventions originating from Partners researchers.

Curbside Consult with Dr. Jayne 10/21/19

The past week has been entirely too crazy, working on projects for a couple of vendor clients whose offerings are starting to overlap with each other. Everyone is chasing after certain industry buzzwords, and if you can add a feature or two that gets you into a different space where people might be more willing to spend money than your current prospective clients, apparently you go for it.

It’s been challenging for me as it’s hard to keep track of what’s a real feature that is able to be delivered vs. something that is in the works, but only parts of it are actually in the code, especially in an agile development organization. It’s particularly challenging when company leaders talk about features under development as if they are actually part of a general release.

In a startup organization, words are thrown around much more freely than they typically are in publicly traded companies, who sometimes mind their language a bit to stay on the right side of the shareholders. With that in mind, I was excited when a reader clued me in to a recent analysis looking at corporations’ earnings call transcripts in an attempt to determine whether the words used in the calls are harbingers of credit risk. Researchers at Washington University in St. Louis looked at over 132,000 earnings call transcripts and used machine learning methods to create a measure of credit risk. The resulting information informs an algorithm that assesses elements from changes in credit ratings to risk of bankruptcy.

What if you could extrapolate those findings to examine the earnings call transcripts of EHR vendors to create a model that would let you know how much of what they were saying was possibly accurate vs. what might be considered creative accounting? What if you could use proxy words to identify impending layoffs or bad decisions that were about to make your stock drop? Mr. H follows some of the earnings calls much more closely than I do, but I have definitely heard some interesting comments on calls in the past that could be interpreted in a variety of ways:

“Our cash generation capabilities continue to expand our storehouse of dry powder.” I’m not sure using gunpowder as a comparative term is a great idea in this day and age. Does the company want to seem like it’s war-like and on the offense? Or perhaps it’s a commentary on the executive team’s ability to blow up the company by continued poor decision-making?

“Scary.” I recently read an earnings call transcript that used the word three times in a variety of contexts. Could there be something predictive about the state of mind of the people on the call?

“Our team is always impatient to go faster.” That’s the kind of reassuring language end users love hearing from vendors with a track record of under-delivering or overpromising on features. Not to mention that when you’re caring for people’s loved ones, you typically don’t want your primary tools to be fueled by a spirit of impatience.

Those are immediately attention-getting, but I’d be more interested in the subtle comments that show that something is slightly off or that there might be some level of obfuscation going on. One recent call characterized what clearly looked like a cost-cutting layoff as an effort to speed compliance with new regulatory requirements. With a training database of thousands of vendor earnings call transcripts, I bet you could come up with some very interesting themes and potentially useful indicators.

In the next year or so, I have to start thinking seriously about a performance improvement project so that I can complete it and check the box for renewal of my clinical informatics board certification. Maybe I could build a tool that would better enable the HIStalk team to detect language that would be most predictive of a company that might have juicy things for us to write about, or what their odds might be of winding up on the HISsies ballot. I doubt those applications would be approved by the folks at the American Medical Informatics Association, but they would be entertaining.

If I don’t come up with a project soon, I’m going to have to seriously think about letting my certification lapse. The required projects are actually referred to as “Improvement in Medical Practice” projects, and since I don’t actually practice clinical informatics where I practice clinically, that gets a little dicey. My primary clinical employer doesn’t want the physicians to have anything to do with the EHR – there isn’t even an informatics committee. The COO (who is a practicing physician) calls all the shots on whether we’ll implement new features and how they will be shared with the masses. The likelihood of my being granted any ability to query the data or perform any kind of project is exactly zero.

They do allow a diplomate to substitute a 360-degree evaluation project instead, where they survey a half dozen of their colleagues to find an area that needs improvement, then work on it and survey again. That doesn’t exactly work in the consulting model, where I think my clients might be generally appalled if I asked them to spend resources essentially providing job coaching to someone they’re paying as their expert advisor.

Doing these projects as a way to maintain certification is frustrating regardless of your specialty. During a time when I wasn’t practicing clinically, I had to do a mock “hand hygiene” project where I had to manually enter a downloaded data set and then analyze it. The goal was to simulate the paper surveys that my peers were getting from live patients, but I learned exactly zero sitting there and keying in the data. It’s just another hoop that physicians have to jump through to try to stay certified.

That takes me back to the earnings call transcript project. Maybe if I write it as an abstract with enough sexy buzzwords I can sneak it past the evaluators. Sprinkle in some artificial intelligence, machine learning, and blockchain to get the job done.

If any of you other clinical informaticists out there have creative ideas for what a consulting clinical informaticist can do as a project, I owe you a drink at HIMSS.

For the rest of you: what’s the wackiest thing you’ve ever heard in an earnings call transcript? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 10/21/19

Cerner to Acquire AbleVets Further Expanding Strategic and Technical Expertise in U.S. Federal Health Market

Cerner acquires healthcare security-focused government IT contractor AbleVets for undisclosed terms.

Mission Health data breach: e-commerce site contained ‘malicious code’ for 3 years

HCA-owned Mission Health (NC) notifies an unspecified number of consumers that its online store contained malicious code that was sending their payment information to an unauthorized person from March 2016 through June 2019.

Norton Healthcare, UofL Physicians & School of Medicine partner together for the kids

Norton Healthcare, UofL Physicians – Pediatrics and the University of Louisville School of Medicine will integrate their EHRs as part of a new partnership that will take effect in February.

Tower Health cutting 32 Pottstown Hospital jobs

Tower Health (PA) will eliminate jobs at two of its hospitals in a move that representatives say supports its recent Epic installation and the enhanced technology now available on its nursing units.

EverCommerce To Integrate AllMeds and iSalus Healthcare

EverCommerce will integrate subsidiaries ISalus Healthcare and AllMeds, both of which provide healthcare technology to physician practices, and open a new facility in Tennessee later this year.

Monday Morning Update 10/21/19

Top News

Cerner acquires healthcare security-focused government IT contractor AbleVets. Terms were not disclosed.

The company — formed by former Navy oncologist Wyatt Smith, DO in 2012 — reported $96 million in annual income and 345 employees for 2018. It counts among its clients DoD, VA. and HHS.

Cerner will operate the company as a wholly-owned subsidiary. AbleVets is a subcontractor for Cerner’s VA project.

Smith has an extensive health IT background, having served as VP of healthcare for Agilex, a consultant to ONC, deputy CIO for the Military Health System, and manager of the DoD’s AHLTA EHR. He is board-certified in internal medicine, hematology, oncology, and pathology.

The US Digital Service recommended in March 2019 that private-care eligibility software developed by AbleVets for the VA be scrapped because of flaws that were introduced by a rushed timeline.

Cerner previously hired David Waltman — who had led the VA’s VistA modernization program for two years before moving to AbleVets for a few months — six weeks after the VA chose Cerner in a $10 billion, no-bid contract.

CERN shares dropped 0.5% Friday following the announcement.

HIStalk Announcements and Requests

Most poll respondents would be wary about seeking treatment from a hospital that is known for suing patients over unpaid bills.

New poll to your right or here: Which industry awards do you find meaningful? I ran this same poll a couple of years ago, so it will be fun to compare results. I also added an “enter your own answer” option in case your favorite award wasn’t listed.

I saw someone on the new season of “Goliath” who looked a bit like Dennis Quaid, but quite different than the lithe, beaming HIMSS09 keynoter. It actually was Dennis, now 65 and no longer married to third wife Kimberly, who was the mother of the heparin-overdosed twins (born by surrogate in 2007 – Meg Ryan was wife #2) who were the subject of their medication error lawsuit against Cedars-Sinai that questionably earned him the HIMSS speaking spot. Cedars and its employees made all the mistakes, but Quaid went after the deep pockets instead in suing the manufacturer of the drugs and eventually settling with them (Cedars also paid $750,000 after the Quaids hinted that they were considering litigation). He formed a patient safety foundation, merged it almost immediately afterward with the Texas Medical Institute of Technology (it, too seems to have faded), made a couple of related documentaries, and hasn’t shown much patient safety interest in years. HIMSS gave his foundation a $10,000 check on stage back in 2009 in addition to whatever speaking fee he required. These days, Dennis is ripped like crazy, frolicking on the beach with his 26-year-old girlfriend (now fiancé, just announced), and always pictured by me as the swaggering Gordo Cooper in “The Right Stuff” in an acting tour de force that Tom Cruise can only wish he had delivered in “Top Gun.”

Webinars

October 24 (Thursday) 1:00 ET. “The power of voice: Will AI-drive virtual bedside assistants become mainstream?” Sponsor: Orbita. Presenters: Nick White, co-creator of DeloitteAssist and principal in Deloitte’s Smart Healthcare Solutions practice; Bill Rogers, CEO and co-founder, Orbita. Conversational AI and virtual health assistants are bringing new opportunities to care facilities to improve patient journeys and yield radical workflow efficiencies. Will the hospital rooms of the future continue to provide traditional bedside call buttons? Or will these be replaced with digitally reimagined, AI-driven, voice-powered agents? Learn from the expert who created today’s industry-leading, market-proven, virtual bedside assistant.

Previous webinars are on our YouTube channel. Contact Lorre to present your own.

Sales

• England’s Kettering General Hospital NHS Trust signs a 10-year contract with System C for an integrated clinical record and administration system. McKesson acquired System C in early 2011 for $140 million, then sold it and its other UK health and social care businesses to a private equity firm in mid-2014 for undisclosed terms.

People

Oracle CEO Mark Hurd died Friday of unspecified causes at 62 following a month-long, health-related leave of absence. He was also CEO of HP from 2005 to 2010.

Google hires former National Coordinator Karen DeSalvo, MD, MPH (Dell Medical School) to the newly created position of chief health officer. She will report to former Geisinger CEO and David Feinberg, MD, MBA (VP, Google Health) and will join another recent Google / Alphabet hire, formed FDA Commissioner and Duke University vice-chancellor Robert Califf, MD, who will head up Google’s medical strategy and policy. DeSalvo and Califf will start their new jobs later this year.

Announcements and Implementations

Medical expert opinion software vendor Purview provides financial support to allow cancer patients to obtain a remote second opinion from Memorial Sloan Kettering Cancer Center, with medical records sharing facilitated by medical support services vendor PinnacleCare. Purview’s grant supports the Mike Shane Memorial Fund and will initially focus on bile duct cancer diagnosis. Purview investor Mike Shane died of the disease earlier this year.

EClinicalWorks announces that it supports interoperability with both Carequality and CommonWell.

Government and Politics

A CBS News poll finds that Americans are more worried about healthcare costs than whether everyone has health insurance. Less than half worry about the quality of care and 79% say they are satisfied with the care they receive. Nearly half say big changes are needed to the US healthcare system, while another 30% think it should be rebuilt from scratch.

Privacy and Security

NHS gives Google access to five years’ of patient data from several hospitals. Five of six trusts that had signed data-sharing deals with Google-acquired DeepMind have signed new agreements now that the company’s projects have been placed under Google Health. Critics say such agreements were previously ruled illegal, the hospitals won’t say how much Google is paying them, and patients aren’t aware that their data is being shared with a for-profit company.

HCA-owned Mission Health (NC) notifies an unspecified number of consumers that its online store contained malicious code that was sending their information elsewhere from March 2016 through June 2019. 

Other

Indiana University will use a $60 million donation from alumnus Fred Luddy —  founder of help desk software vendor ServiceNow – to establish an artificial intelligence institute whose initial focus will be digital health.

Yale clinicians describe their work to embed clinical decision support for ED prescribing of buprenorphine for opioid use disorder with its Epic system, after reviewing Epic’s capabilities and finding them insufficient. They created an EHR-integrated web app using Epic Active Guidelines (since Epic did not support SMART on FHIR at that time). The eventual integration was seamless, launched from the patient chart navigation bar in an iframe with direct, secure communication. The authors note that such a project involves challenges and recommends that customers focus on updating interoperability standards to support services such as Enterprise Clinical Rules Service.

EClinicalWorks held its national conference in Orlando this past weekend, October 18-20, as it celebrated its 20th anniversary. 

A ResMed-commissioned survey of 3,000 Americans finds that 56% monitor their health with at least one digital tool; 60% attempt to diagnose themselves via the Internet; and half want technology to improve communication with their PCP, specifically to be able to share information with them. The survey didn’t mention which tools that more than half of consumers are supposedly using, so I’ll remain skeptical in the absence of detailed methodology.

The Arkansas Department of Human Services shuts down parts of its claims portal following the arrest of an optometry practice’s office manager who discovered that she could “input any number she chose” without the system flagging questionable values. The woman, who is the wife of one of the practice’s optometrists, is charged with filing $600,000 in fraudulent manual Medicaid claims in cases where a patient was insured by both Medicare and Medicaid. Fun fact – the attorney general’s investigator who signed the charging affidavit is named Rhonda Swindle.

Sponsor Updates

• Lightbeam Health Solutions, Health Catalyst, Waystar, Recondo Technology, Prepared Health, Redox will exhibit at the HLTH Conference October 27-30 in Las Vegas.
• Mobile Heartbeat will exhibit at The Future of Nursing New York State Action Coalition event October 21.
• Netsmart will bring training opportunities to its home health customers to help them prepare for new regulatory requirements related to the Patient-Driven Groupings Model.
• Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the 10th Annual Nebraska Fall Conference October 22 in Omaha.
• OmniSys will exhibit at the McKesson Prescription Technology Solutions Customer Conference October 22-23 in Pittsburgh.
• SailPoint acquires Orkus and OverWatchID to deepen governance of cloud applications and infrastructure.
• TriNetX and Trialbee partner to accelerate patient-centric clinical trials.
• Vocera will exhibit at the New England Society of Clinical Engineering Symposium Vendor Expo October 22-23 in Framingham, MA.
• The Dallas Business Journal profiles ZeOmega.

Blog Posts

• OIG Series Blog 4: Managing Hospitalization (Lightbeam Health Solutions)
• Addressing Patient Financial Toxicity for the Oncology Industry (Loyale Healthcare)
• The Top Five Recommendations for Improving the Patient Experience (Health Catalyst)
• 2020: The Year of Revamped Alerting (Mobile Heartbeat)
• Don’t Miss Your Connection! (Netsmart)
• Security in a zero-trust world (OpenText)
• Simplifying Care Team Assignment Management. Yes, it’s possible. (PatientSafe Solutions)
• Patient Financial Communications – HFMA’s Best Practices (Patientco)
• The Future is in Code Learning and the Cloud – 4 Key Takeaways from Cerner Health Conference 2019 (Pivot Point Consulting)
• Build a Data-Driven Approach to Caring for Seniors: Prepared Health at HLTH (Prepared Health)
• A man on a heartfelt mission: Aldo Cipriotti (StayWell)
• Tracking telemetry trends and real-time, actionable alerts (Voalte)
• How to Deal with a Patient Data Breach (and Avoid One in the First Place) (WebPT)
• Insider’s Guide to ACEP19 in Denver (Wellsoft)

Contacts

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

Weekender 10/18/19

Weekly News Recap

• Microsoft and Nuance announce plans to work together to use ambient sensing and conversational AI to help doctors document encounters.
• Google hires former National Coordinator Karen DeSalvo, MD, MPH to the newly created position of chief health officer.
• Change Healthcare is reportedly looking for a private equity buyer for its Connected Analytics unit, which includes the Ansos staff scheduling system, at a potential price in the $300 million range.
• The VA pilots making telemedicine services available at local VFW posts.
• Northwell Health extends its Allscripts Sunrise agreement through 2027.
• A KLAS report finds that customers of acquired health IT vendors are equally split among being less satisfied and more satisfied, with just 20% saying nothing changed.
• Centra (VA) resumes billing and collections following a three-month hiatus that it says was caused by Cerner software problems.

Best Reader Comments

This is inspiring and has so much more potential for healthcare. So many new reimbursements focus on patient engagement (CCM, RPM, PCM, BHI, CoCM). Like Dr. Bhavan and her team at Parkland demonstrated, patient involvement / engagement creates better outcomes. We focus so aggressively on the delivery of healthcare, but who has studied the receipt? Think of this for a second: we’re at a place in healthcare where actively and persistently involving the patient is viewed as disruptive and innovative. Dr. Bhavan’s model included education and team work – to make it easy for the patient – and they certainly did their part yielding massive reduction in re-admission and higher satisfaction. (Matt Ethington)

For those of us who participate in this [Epic] market as HUMAN resources (FTE or contractor), it is a strange situation to learn that after working hard to be offered a role /,contract, your customer / employer will have to submit you to Epic for ‘approval’ before they agree to grant you access to both (a) the resources at Epic’s UserWeb and (b) potentially access to Epic at the client site (even if you’ve been hired). It’s a sobering moment to jump from one employer to another or in and out of the contractor-FTE world to learn that you are not actually in charge of the outcomes of your own decisions and that you never agreed to the terms that are being imposed on your life and livelihood. (Code Jockey)

The restrictions that Epic places on his customers, employees, and third parties on hiring is so frustrating. While I understand they want to protect their IP and reduce poaching, it creates such a toxic attitude among their employees and frustrations to employees who have life changes that require them to move away from Epic. Rather than being able to utilize your skills in the free market, they use a big stick to hold people hostage. They extend those restrictions on their own customers, keeping them from hiring really qualified people that could help make them successful and avoid really expensive consulting costs. It also make hiring Ex-Epic people in the Madison job market incredibly risky because many are just trying to burn their one-year non-compete rather than looking for a longer term role. (Epically Annoyed)

I’ve worked on two Cerner implementations and two Epic implementations. The Cerner implementations had, in my opinion, sleazy salesmen who showed up to take the director out to lunch, drinks, strip clubs, or whatever it took to get the sale and expand the services. The Epic implementations, I never saw any of that going on, not that some client sites didn’t want to be wined and dined and tried to get the Epic AC/AMs to do that. I think you are correct in stating that because Epic is not a public company, Judy does not have the Wall Street pressure, but I also think there is just a generally more clean approach from Epic overall. (X-Tream Geek)

While that [in-hospital employee] telemedicine booth is kind of odd, I think a lot of people still underestimate how much employees don’t want their employer to have permanent access to their full health record, regardless of what kind of end user confidentiality might sit between other colleagues and their data. I know a lot of people who would gladly talk to a booth over anyone that’s also employed by their employer. Though I would bet there’s some type of interoperability that exists between their existing records and this vendor. (Sam Lawrence)

Insurance exists because people overall are risk averse, but from your comments, that’s not you. You sound pretty confident of the outcome, so you prefer to gamble. It’s interesting that if you take the gamble and lose, it’s not actually you paying for it. If you’re uninsured or under insured today (because you don’t feel like you need it), and then a catastrophic event happens, your fellow taxpayers will be conducting a wealth transfer to you. Would you plan on refusing it because it’s unfair to them? You’re also gambling that by the time you need the healthcare system, all the Boomers will be gone and the rational Gen X, Gen Y, and Gen Z folks will vote in an affordable and responsible system. This is a huge gamble, and by George I’d love if it ended up going your way. However, the idea that once the Boomers are gone the way will be clear for sweeping reform is a massive oversimplification of US healthcare politics. (TH)

The youngest Baby Boomers are 54, so they have another 25+ years of living to do before they hit the median life expectancy, by which time us Gen Xers will be in our 60s and the Millennials will be experiencing back spasms, trick knees, and menopause, so we’ll all be oldheads together. GenZ is going to come along and wipe us all out, which is fine – they are the ones really inheriting the mess, so if they want to transform society “Logan’s Run” style, I can’t say I blame them. (HIT Girl)

Watercooler Talk Tidbits

A hospital doctor in England fails to convince a review board that the reason he squeezed a nurse’s bottom was euphoria that was caused by a drug interaction between his allergy pill and Pet Remedy, a calming spray he was using on his dog during a thunderstorm.

The Ohio Board of Pharmacy cites three former pharmacists at the now-closed Mount Carmel West Medical Center (OH) for failing to intervene when high doses of opioids were ordered by ICU doctor William Husel, DO, who faces 25 counts of murder involving inpatient overdose deaths. The board noted that the pharmacists sometimes did not verify drug withdrawals from automated dispensing cabinets until after the drugs had already been administered.

Experts say hospitals are creating an “epidemic of immobility” in which hospital patients are forced to stay in bed, contributing to muscle weakness that can cause life-threatening falls afterward. One study found that one-third of patients aged 70 and older left the hospital more disabled than when they were admitted. Patients are often forced to remain in bed, but may do so voluntarily due to pain or weakness, IV lines that make it hard to walk, a lack of employees to help them, and the reluctance to walk down hospital hallways in flimsy gowns.

Identical twins who work as nurses at Piedmont Athens Regional Medical Center (GA) work together for the first time in helping deliver another set of twins. That’s Epic photobombing behind them.

Peyton Manning stars in a fun video spot for the children’s hospital bearing his name at Ascension St. Vincent in Indianapolis, to which Manning has donated a reported $50 million since 2007. He played quarterback for the Indianapolis Colts for 14 seasons through 2011.  

In Case You Missed It

• News 10/18/19
• Book Review: HIT or Miss
• EPtalk by Dr. Jayne 10/17/19
• Readers Write: It’s More than the EHR That Is Causing Physician Burnout
• HIStalk Interviews Kavita Bhavan, MD, Chief Innovation Officer, Parkland Health & Hospital System
• News 10/16/19
• Curbside Consult with Dr. Jayne 10/14/19
• Monday Morning Update 10/14/19

Get Involved

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• Report a news item or rumor (anonymous or not)
• Sign up for email updates
• Connect on LinkedIn
• Contact Mr. H

Morning Headlines 10/18/19

Microsoft and Nuance join forces in quest to help doctors turn their focus back to patients

Nuance and Microsoft will co-develop ambient sensing and conversational AI software to enable physicians to pay more attention to their patients instead of on administrative tasks.

Google appoints former Obama health official Karen DeSalvo to new chief health officer role

Google hires Dell Medical School professor and former National Coordinator Karen DeSalvo, MD as its first chief health officer.

More than 190,000 without power as nor’easter lashes Maine

A Nor’easter takes down the EHR and other systems Thursday morning at hospitals that are part of Northern Light Health in Maine.

Change Healthcare kicks off process for Connected Analytics unit

Change Healthcare is reportedly looking to sell its Connected Analytics unit, which markets Ansos staff scheduling software, in a deal that could value the unit at between $250 million and $330 million.

News 10/18/19

Top News

Nuance and Microsoft will co-develop ambient sensing and conversational AI software to enable physicians to pay more attention to their patients instead of on administrative tasks.

Building upon Nuance’s ambient clinical intelligence software (on display at HIMSS earlier this year) and Microsoft’s intelligent scribe service, the new technologies will be rolled out to select end users early next year.

Initial capabilities will include ambient listening, wake-up word, voice biometrics, signal enhancement, document summarization, natural language understanding, clinical intelligence, and text-to-speech. 

Reader Comments

From Henry W. Jones, III: “Re: Epic’s redacted contract that appeared in the SEC filings of Ardent Health Services. Any assessment that the redaction is moderate and the contents are not worrisome (such as the absence of a gag clause) are overconfident. The redaction leaves holes and many provisions that could be contained but not shown (such as IP claims, liability shifting, unique terms and conditions). We know that Epic demands more redactions and secrecy than other EHR vendors and than vendors in non-medical industries. For example, the contract omits in its litigations listing the Epic vs. Tata saga, which involves over 1,000 court pleadings and an initial Epic jury verdict of $900 million (later reduced to $400 million per state statutes). Latency also yields uncertainty and this was a contract signed eight months ago and posted on the SEC seven months ago, so we don’t know what might have changed. The long-term, non-obvious industry impacts of locking customers into EHR contracts merits serious, granular analysis; the devil is likely to be in the many details that are missing here.” Hank is an IT lawyer and consultant. I interviewed him in 2016.

From Skimmer: “Re: HIStalk. How does anyone find the time to read it all?” Many readers think reading everything here provides positive ROI, and I certainly hope that’s the case. I’ve already surfaced the most important or interesting items among the junk, so it’s up to them to pick the parts of what I run that will be most impactful to their careers as professionals who should be taking the time for continuing (and continuous) education. But if they don’t have the time, the news posts run just three times per week (which is a minimal time investment since it’s broken out into easily skippable sections), the Weekender summarizes the week’s biggest news each Friday morning, and the absolutely most important stories appear in my daily headlines. I hope the 90% of readers who say reading HIStalk helps them do their jobs better are finding it worth their time and thus mine.

Webinars

October 24 (Thursday) 1:00 ET. “The power of voice: Will AI-drive virtual bedside assistants become mainstream?” Sponsor: Orbita. Presenters: Nick White, co-creator of DeloitteAssist and principal in Deloitte’s Smart Healthcare Solutions practice; Bill Rogers, CEO and co-founder, Orbita. Conversational AI and virtual health assistants are bringing new opportunities to care facilities to improve patient journeys and yield radical workflow efficiencies. Will the hospital rooms of the future continue to provide traditional bedside call buttons? Or will these be replaced with digitally reimagined, AI-driven, voice-powered agents? Learn from the expert who created today’s industry-leading, market-proven, virtual bedside assistant.

Previous webinars are on our YouTube channel. Contact Lorre to present your own.

Sales

• Novant Health (NC) will implement telemedicine services from TytoCare.
• SwipeSense selects health data integration capabilities from Redox to ensure that its RTLS applications are interoperable with any EHR.

People

Goliath Technologies names Stacy Leidwinger (Nuance) as chief marketing officer.

Heather Trafton (Steward Health Care Network) joins Arcadia as COO.

Announcements and Implementations

Champlain Valley Physician Hospital transitions to Epic as part of a $152 million system-wide deployment within the University of Vermont Health Network.

Mid-Valley Hospital and Clinic (WA) goes live on Cerner Millennium.

Lightbeam Health Solutions reports that ACOs that attained a positive savings rate using its population health management technology achieved $602 million in shared savings over the five-year Medicare Shared Savings Program.

A new KLAS report finds that the HIE technology market is moving to broader use of aggregated data, with advanced users of Allscripts and InterSystems most likely to be using those systems for advanced use cases. KLAS notes, however, that less-advanced users of the Allscripts DBMotion product report dissatisfaction with getting the system up and running, Health Catalyst is consistent in its support but behind in keeping technology promises, Orion Health users say the platform is too rigid to support innovative use cases, and InterSystems customers are strongly satisfied across the board, giving it the highest purchasing energy among the four companies.

WVU Medicine (WV) begins enrolling patients in the National Cancer Institute’s Cancer Moonshot program, one of six organizations funded to use technology to enable patients to report and manage their cancer treatment symptoms.  WVU will use its Epic MyChart to answer patient questions (which can include images or files) and to send out routine surveys, with the patient-entered information flowing back into Epic. 

Philips adds the new Sentry Score predictive algorithm to its ECareManager telehealth software, giving clinicians the ability to prepare for patient ICU interventions in under an hour.

Government and Politics

The VA launches a multi-site pilot program that will give veterans access to telemedicine services at local VFW or American Legion posts using Internet-connected healthcare pods developed and donated by Philips.

Former VA Secretary David Shulkin, MD authors “It Shouldn’t be This Hard to Serve Your Country,” a book about his 13 months working in the Trump Administration.

Other

The NFL is rolling out a prescription drug monitoring program as part of its more focused efforts on monitoring pain management and opioids. First announced in May, the league’s PDMP will also be used by unaffiliated physicians.

A Nor’easter takes down the EHR and other systems Thursday morning at hospitals that are part of Northern Light Health in Maine.

The Colorado Sun profiles the ways state-based hospitals are using AI and machine learning, with innovations ranging from “digital sitter” remote patient-monitoring efforts, to algorithms that predict and cut treatment time for patients at risk for sepsis, to algorithms that can help radiologists identify areas for concern more quickly and accurately. HealthOne CIO Andy Draper says, “We’re right in the very beginning of it. There are a lot of tools that will pop up and we should embrace and love them all and then over time we’ll see what their real potential is.”

Sponsor Updates

• EClinicalWorks will exhibit at the TACHC Annual Conference October 21-22 in The Woodlands, TX.
• Healthfinch will exhibit at the Group Practice Improvement Network Semi-Annual Conference October 23-25 in Portland, OR.
• The Chartis Group names Aaron Bujnowski (Texas Health Resources) director and leader of the company’s integrated delivery network segment.
• Healthwise will exhibit at Allscripts ACE HHS October 21-23 in Dallas.
• Glytec forms a Quality Team to help health systems adopt best practices in glycemic management.
• InterSystems will exhibit at the Gartner Symposium/ITxpo October 20-24 in Orlando.
• Yukon Health and Social Services in Canada will upgrade its Meditech system next year.
• Black Book names Nuance the top vendor for end-to-end healthcare coding, clinical documentation improvement, transcription, and speech-recognition technology.

Blog Posts

• Patient Transport Delays? Technology Holds the Answer (Ensocare)
• Best practices for password management, 2019 edition (Google Cloud)
• Pause to Consider: Leveraging Technology (Fortified Health Security)
• How to optimize practice revenue while improving patient care (Greenway Health)
• HGP’s Target Metrics for Emerging Growth Health IT Software (Healthcare Growth Partners)
• Showcasing End-to-End Visibility Across Cerner RHO and Health IT Infrastructure at 2019 Cerner Health Conference (Goliath Technologies)
• Creating new efficiencies with referral and medical records management (Hyland)
• Building an Electronically Integrated Hospital from Scratch (Impact Advisors)
• How AI and Machine Learning are Transforming the Way Discoveries are Made (InterSystems)
• 3 ways communication technology can help prevent workplace violence in healthcare (Spok)

Contacts

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

Book Review: HIT or Miss

Reading the third edition of “HIT or Miss” is like trying to reconcile memories of someone’s previously vibrant life with their coldly objective obituary. It contains dozens of examples in which the exuberance, high-fiving (especially by the vendor’s salesperson), and lofty goals of improving patient care via IT somehow ended up as flaming wreckage whose major contribution is to serve as a cautionary tale for the rest of us.

You may well chuckle at the naiveté and hubris of each (unnamed) hospital’s executive and IT teams for making some really bad decisions, but deep down you know your own organization isn’t any better even though its gaffes aren’t included. Hindsight is 20-20.

You also might question why this sort of HIT autopsy holds value and I see your point. The organizations that have yet to make such plus-sized IT mistakes aren’t likely to read the book like the Bible and declare themselves reborn. Every IT project is different and maybe the lessons belatedly learned by other hospitals either aren’t relevant or must be relearned by others.

Still, it’s made clear that the enthusiasm to “do this project right” – implicitly outperforming lesser-skilled peers whose cloak of invincible destiny turned out to be full of holes – can be crushed by a single, cancerous-like cell that metastasizes. Its genesis isn’t notable – a low-level decision made in an overcrowded conference room that smells of stale bagels, Type A executives who insist pushing on to recoup their eye-popping software investment by bringing it live at all costs so they can be photographed at the ribbon cutting, and leaders who allow the scope to creep to appease an influential department head or foot-stomping doctor. Any one of thousands of ever-moving parts can cause the whole machine to blow up once the big switch is pulled.

The biggest takeaway here – not surprising that AMIA was involved – is that hospitals should  listen to their CMIO, clinical IT folks, and patient care front-liners. I had “your vendor” on the list, but I’ll asterisk that – some vendors are determined to make their clients successful and possess the competence to do so, while others peak at getting the contract signed and may do more harm than good.

These examples, provided by and recounted by a stunning roster of industry luminaries and edited by Jonathan Leviss, MD, are representative:

• A hospital whose voluntary CPOE usage dropped from 60% during the pilot to 15% immediately afterward (and zero shortly after that) as the project team called it mission accomplished, took vacations, and shifted their attention to other priorities.
• Another (Hospital B) whose patient satisfaction dropped from the 70th percentile to the 5th as its health system parent tried to copy the successful ED implementation in its larger, newer, and more sophisticated Hospital B without involving Hospital B’s clinicians in the build and testing.
• A hospital that rolled out a legacy data viewer as it implemented a new EHR, but continued to send the viewer new data until its forced retirement three years later, at which time it was discovered that 40% of clinical users were still using it (instead of the new EHR) to look up lab results and clinical notes, after which staff complaints (mostly from surgeons) forced the hospital to reconfigure the new EHR’s screens to look like those of the legacy system.
• A decision to issue all drug interaction alerts to clinicians, with the intrusive pop-ups being overridden 95% of the time for drug-drug interactions and 87% of allergy warnings, wasting an estimated 12-18% of clinician time.
• A hospital that decided to implement a new medication reconciliation system and process across four hospitals without performing a pilot project, which had to be shut down two weeks later when the executive-estimated few seconds of pharmacist time required for each patient turned out to be 20-30 minutes.
• A barcode medication program that failed because IT and facilities engineering weren’t involved in choosing laptops, batteries, and carts and nobody had time to work the trouble tickets.
• A community hospital that slowly migrated from one ICU vital signs capture system to another as rooms were renovated, but each system interpreted and displayed information differently to the clinicians making decisions.
• The discovery that a newly implemented fetal monitoring system displayed information for the wrong patient because of a cable plug-in mix-up.

Each of the 48 case studies is interesting, even those that may now be mostly a historical curiosity now that integrated, single-vendor EHRs have eliminated some of the risk points of integration, upgrade timing, and multiple device use.

“HIT or Miss” was a lot more interesting and detailed than I expected. It recounts millions of dollars worth of bad decisions, unfortunate events, and vendor shortcomings that we wouldn’t have heard about otherwise. I’d like to think that no patients were harmed in the making of this book, but I’m certain that isn’t the case. And while IT sophistication grows linearly as health systems get bigger, complexity and thus the potential damage grow exponentially.

This is not my usual book review since it would be missing the point to focus on writing style or entertainment value (although both are excellent). Its value is to show what can go wrong when a project transitions from executive self-congratulation for choosing a bold IT path forward to their underlings trying to make it all work in an ever-changing environment full of self-interest landmines, competing pressures from all sides, and products whose shortcomings aren’t discovered until  analyst sleeves are rolled up.

Perhaps the takeaway is that it’s really tough to implement process change and ever-changing technology in meeting timeline and budget expectations while preserving the originally envisioned benefit to patients without harming them in the process. For that reason, IT leaders might want to stock up on copies to hand out to overconfident C-suiters and board members who feel that their executive insight justifies overriding the advice of those pessimistic, business-naive clinicians who won’t quite yapping about their “concerns” or the potential harm to patients that they can’t say with certainty will actually happen in standing in the way of lighting the candle. Worst is that they are right – you won’t know what you don’t know until you bring the system live and there’s never a perfect time to do that, so at some point you might was well just turn it on and be ready to fix what’s broken.

Thanks to attorney Henry W. “Hank” Jones, III, JD for sending me a copy of the book (he wrote Chapter 48 – “Explore HIT Contract Cadavers to Avoid HIT Managerial Malpractice.”) It’s $60 on Amazon.

EPtalk by Dr. Jayne 10/17/19

I had occasion recently to talk with a personal liability attorney, fortunately just socially and not professionally. He had some questions for me about the role of artificial intelligence in healthcare. Fortunately, I was able to point him towards a recent editorial in the Journal of the American Medical Association.

The article has a nice summary of the concerns that many in practice have about AI: communicating recommendations without the underlying rationale; poor training data sets used in the development process; and failure to reach an accurate result or recommendation. The JAMA article notes that case law on AI-related liability is lacking, but existing law can be extrapolated to cover these situations.

The authors’ examples support the use of AI as an adjunct to the existing decision-making process in order to prevent additional liability. However, as AI becomes engrained as part of the standard of care, this approach may necessitate more trust in AI systems at the point of care, in order to prevent the physician from making the error of underutilizing technology that could be of benefit. It’s a complicated equation, for sure.

The VA recently announced planned steps to increase data sharing with non-VA providers using the Veterans Health Information Exchange. They’re going to shift the current opt-in protocol to one where opt-out is the norm, so patients no longer have to provide a written release for the VA to share their data electronically. A quote from the VA in one of the articles I read about it states that community providers and organizations must have partnership agreements and be part of the VA’s trusted network to receive VA health information. I hope they meant to say that you have to be part of the network to receive information electronically, unless the VA isn’t covered by HIPAA, which allows providers to share information for Treatment, Payment, and Operations without a specific release.

The HIE plans to share information including: problem list, allergies, medications, vital signs, immunizations, laboratory reports, discharge summaries, medical history, records of physicals, procedure results such as radiology reports, and progress notes. Veterans who don’t want their data shared can still opt out, but they will have to be either all in or all out – previous mechanisms which allowed some data to be shared but not others will no longer be permitted.

Speaking of veterans, telehealth middleware provider Medici has launched “Operation 11/11” to provide no-cost virtual consults to all US veterans on Veterans Day, November 11. Proof of military service is required and participants can pre-register for services from 8 a.m. to 8 p.m. in their time zone on November 11.

Medici is welcoming four military advisors for the initiative and has also partnered with 2nd.MD to provide virtual second opinions for veterans with complex patients. Medici has an interesting model where providers pay to be on the platform and set their own rates for virtual visits. I can imagine it might be compelling for independent physicians, but struggle to see how it plays for the majority of physicians who are in employed situations.

I was intrigued to hear about Black + Decker’s new automated medication management and home health care assistant device, Pria (first covered on HIStalk nearly a year ago). It’s the first foray into healthcare from the people who brought us the Dustbuster. The voice-activated device tracks and schedules up to 28 medication doses along with reminders and timely dispensing. It also allows patients to have access to family members or caregivers using a built-in camera for video calls. It can also enable reminders for drinking water or other key health-related activities. The product is pricey at $600 plus a $10 monthly subscription.

I recently became aware of a club I have no desire to be a member of: telehealth providers who have licenses in all 50 states. Becoming licensed in a handful of states is enough work, so I can’t imagine wanting to have dozens of applications in process. The CNBC piece profiles a couple of telehealth providers who advocate for the approach as a way to treat patients more effectively particularly patients in underserved areas.

Data from the Federation of State Medical Boards indicates the club is pretty small, with only 14 physicians licensed everywhere as of 2018 data, up from six in 2016. The number will likely be higher for 2020 given the overall growth in telehealth. One interviewee notes the cost of procuring 50 licenses is around $90,000. In addition, there are annual fees to maintain them. If providers ever surrender a license, there’s also a process to explain that in future license renewals in other states, so if you’re going to do it, you had better be ready to maintain it. I’ve found telehealth compensation for physicians to be lower than pay rates in brick-and mortar situations. Unless you have the temperament to conduct, complete, and document visits every couple of minutes, I don’t see a lot of physicians opting for this type of practice.

An interesting potential use of artificial intelligence was detailed this week in The Wall Street Journal: prediction of marital arguments. Engineers and psychologists are using speech patterns, physiological data, and acoustic / linguistic information to detect potential conflict. One described use case is sending a text message to a highly stressed individual, warning them of an imminent conflict so they can take action.

The original 2017 study followed 19 Los Angeles couples and tracked data such as heart rate, perspiration, and activity levels. A phone app prompted them to document hourly reports on their feelings and also recorded speech content, pitch, and frequency in taking a three-minute recording every 12 minutes. Researchers were able to detect conflict with nearly 80% accuracy. The original data was gathered during a one-day period, which is a significant limitation along with the size of the sample.

A more recent investigation by the same researchers looked at 87 couples, using speed of speech and intonation to detect conflict. The research sounds promising. I hope they consider the next logical investigation, which would be parent-teenager interactions. I’m sure that would be a target-rich environment for conflict identification. Or, we could install such systems in healthcare IT conference rooms across the country – certainly there’s some conflict there!

What do you think about AI identification of conflict? Leave a comment or email me.

Email Dr. Jayne.