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Monday Morning Update 9/2/19

September 1, 2019 News 2 Comments

Top News

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Walmart will open a Walmart Health clinic adjacent to one of its stores in Georgia that will offer primary care, dental, labs, X-ray, audiology, and mental health counseling in a pilot project.

The company says the Dallas, GA store will provide “low, transparent pricing for key health services.”

Walmart already offers Care Clinics in stores in three states, but those are inside its stores.

Walmart Health will charge $60 in cash for a Medicare wellness visit, $40 for a sick or injury visit, and $40 for visits related to chronic conditions. Appointments can be scheduled online, apparently through Zotec’s MyDocBill.


Reader Comments

From Velvet Fog: “Re: Meditech. Hear it’s looking at a number of READY partners and the certification process, which is good news given that Jacobus is still listed but is out of business. It will be interesting to see how Meditech sales handles questions from organizations looking at READY partners vs. the company’s own professional services, especially when Meditech’s resources often come right out college.” Unverified. Meditech created its READY certification program in 2014. I’ve just told you everything I know about it.

From Spurned Intentions: “Re: jobs announcements. I take pleasure when former colleagues who I didn’t like take bad jobs or last only a short time in one. You?” I don’t have strong feelings, good or bad, about most of the co-workers and health IT people I’ve known over the years, but I can think of at least a half-dozen who exhibited a lack of integrity in personally wronging me (from my point of view, obviously) and historically I’ve enjoyed monitoring the downward trajectory of their careers (except for one who did well) on LinkedIn. I like to think that karma is smacking them upside the head gently but frequently, at least in those rare moments where they even resurface in my consciousness. The best revenge is barely remembering them.


HIStalk Announcements and Requests

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Few of HIStalk’s tech-savvy readers regularly use Apple Health Records to view health system EHR data, as more than half say their hospital doesn’t offer it and 20% say they could use it but don’t feel motivation to do so.

New poll to your right or here: Has your mobile device ever been a key driver of a life-changing improvement to your health? I’m pretty sure readers would love to hear further details of your “yes” vote, which requires only that you click the poll’s “comments” link after casting said vote. 

I was thinking about the volume consolidation that is being driven by mega-mergers among health systems, as organizations start reaching near-national scale. When that happened with banks, restaurants, and quite a few other industries, custom-developed technologies drove competitive differentiation. In healthcare, however, we’ve decided that technology isn’t our core competency and therefore we’ll just use the same Epic and Cerner systems as everybody else. It seems to me that the proprietary, competitor-squashing technologies will be: (a) analytics; (b) customer-facing apps that use back-end off-the-shelf systems without exposing them; and (c) customer convenience apps that allow patients and visitors to hospitals to park more easily, find their way to a specific location, make payments, and reach an actual human for non-trivial concerns. It’s good for patients but not necessarily a competitive advantage that an area’s big hospitals all use MyChart.

Listening: “Fear Inoculum,” the hotly anticipated first studio album in 13 years from Tool. It is impossibly precise and complex, not the kind of music you just turn on and start gyrating to. The title track has already set a record by being the longest song to ever make Billboard’s Hot 100 singles chart, clocking at over 10 minutes. The band announced a 26-date, US big arena tour that starts in October, which is pretty amazing given that they’ve been playing together for nearly 30 years in a barely commercial genre while releasing only five studio albums that are, as Variety says, “eerily enigmatic and algebraic.”

With Labor Day comes the end of our Summer Doldrums specials for companies starting a sponsorship or webinar, so contact Lorre if you’ve been riding the fence that is about to be pulled out from under you. 


Webinars

September 5 (Thursday) 2:00 ET. “Driving 90% Patient Adoption Across Your Network: How US Dermatology Partners is Showing Us The Way.” Sponsor: Relatient. Presenters: Michele Perry, CEO, Relatient; Sara Nguyen, VP of applications and integrations, US Dermatology Partners. US Dermatology Partners is helping its physicians reclaim time they can spend with patients and is turning patient engagement strategies into business results across its 90 locations in eight states. Attendees will learn how US Dermatology Partners defined its patient engagement objectives and physician-optimized strategies. They presenters will provide advice on starting or accelerating  patient engagement goals.

September 19 (Thursday) 2:00 ET. “ICD-10-CM 2020 Code Updates.” Sponsor: Intelligent Medical Objects. Presenters: June Bronnert, MSHI, RHIA, director of terminology mapping, IMO; Theresa Rihanek, MHA, RHIA, classification and intervention mapping lead, IMO; and Julie Glasgow, MD, senior clinical terminologist, IMO. The 2020 regulatory release is right around the corner. Join IMO’s top coding professionals and thought leaders as they discuss new, revised, and deleted codes; highlight revisions to ICD-10-CM index and tabular; discuss changes within Official Coding Guidelines; share potential impacts of the code set update; and review ICD-10-CM modifier changes.

September 26 (Thursday) 2 ET. “Patient Education Data: A Key Ingredient for Improving Quality and Patient Experience.” Sponsor: Healthwise. Presenters: Victoria L. Maisonneuve, MSN, RN, director of the Nursing Center for Excellence and Magnet program, Parkview Health; Marta Sylvia, MPH, senior manager of quality improvement and outcomes research, Healthwise. Healthcare data is everywhere! It’s scattered across various systems and in countless formats, making it difficult to collect and glean actionable information. Knowing where to start depends on what your organization wants to accomplish. Vicki Maisonneuve will share how her team analyzes data around the use of patient education. By combining different data sets, she can easily identify trends, gaps, and opportunities to improve quality and patient experience across Parkview Health.

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


Announcements and Implementations

Dubai Health Authority will update Epic in Q1 2020 to allow MyChart users to video chat with their doctor, ask questions, hail ride-sharing services, self-register for appointments, manage prescriptions, and automatically check them in when they arrive for an appointment by using geolocation services.

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AdventHealth opens its GE-powered $20 million Mission Control command center that will keep a real-time eye on its 2,900 beds and 2 million annual patient visits in Central Florida.

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EClinicalWorks and CEO Girish Kumar Navani make an unspecified donation to support the Bioengineering Teaching and Entrepreneurship Fund of Boston University, from which Navani graduated in 1991 with an MS in manufacturing engineering. The school will create the EClinicalWorks Digital & Precision Medicine Design Suite that will focus on wearable sensors, machine learning, medical image processing, and bioinformatics.


Other

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The New York Times lays out the financial problems of the labor union that provides insurance to a member whose wife and two children suffer from a genetic disease treatable only with a new drug that costs the union $6 million per year, or about $0.35 per working hour for each of its 16,000 members. The union may end up paying $60 million before the kids roll off the member’s insurance at 26 and are left to figure it out on their own. “You are one hire, one diagnosis away from this happening to you,” an insurance consultant warns businesses. The article notes drug companies can price new drugs however they want for “rare” diseases, which in total affect about 30 million Americans, about the same number who have diabetes.

The health plan of Oklahoma’s governor includes creating a statewide health information exchange. The state already has two, with the CEO of one of them noting that the federal government provides matching funds for development and maintenance to the tune of $80 million per state. He also suggests that HIEs work best when treated like interstate highways – a state should just choose one rather than having them compete.

An Alaska business site writes about the dozen hospitals there that are using Collective Medical’s platform in their EDs to share patient histories, coordinate care, and alert staff to known patient threats.

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Kaiser Health News describes the experience of an engineer who painstakingly calculated his out-of-pocket cost for hernia surgery by contacting Hartford Hospital, the surgeon, and the anesthesiologist (although the latter never returned his calls). Every estimate was incorrect, leaving him with an out-of-pocket bill of $2,300 vs. his expected $1,500. The article notes that unlike in basically every other industry, hospital estimates are often inaccurate, can’t take complications into account, and aren’t legally binding. The hospital says its estimate was based on an average price generated by software using the CPT code, but apologizes that the system is new and thus doesn’t yet have enough cases to estimate accurately. They eventually wrote off the balance after the patient kept pressing them. Healthcare cost transparency wasn’t exactly the winner here.

Bizarre: a reality TV star is blinded in one eye when a celebrant on the Spanish island of Ibiza sends a champagne cork flying into it.


Sponsor Updates

  • Loyale Healthcare publishes a new industry analysis, “More Patients are Choosing Urgent Care Centers. Here’s How Traditional Healthcare Providers are Answering the Challenge.”

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Weekender 8/30/19

August 30, 2019 Weekender 3 Comments

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Weekly News Recap

  • Life insurance startup Ethos, which uses predictive analytics based on a customer’s EHR data rather than a medical exam to predict lifespan, raises $60 million in Series C funding round.
  • A KLAS-convened customer review of Cerner’s revenue cycle management progress finds that the user base feels the Cerner is listening, but they are frustrated with lack of progress since the initial meeting a year ago and are questioning both Cerner’s ability to execute and its sense of urgency.
  • Epic holds its UGM in Verona, WI.
  • Private equity firm Warburg Pincus acquires a majority interest in therapy EHR vendor WebPT.
  • Health Catalyst files its first quarterly earnings report following its July 25 IPO.
  • Politico reports that the VA’s initial rollout of Cerner will be delayed several months to October 2020.
  • A VA OIG report finds major backlogs of paper records scanning from outside providers at eight VA facilities, with some records going back to 2016 still piled up in storage rooms.

Best Reader Comments

State-specific regs are problematic for HIT and for clinical care in a broader sense, particularly when states have specific documentation or regulatory requirements that differ from national ones. State specific regs include those related to reportable conditions, privacy, mental health or substance use and complicate EHR design since they vary from state to state. Particularly in the electronic era, having a single standard would be much more efficient. (Federalist)

Insurance companies getting their hands on EHR data concerns me less since the ACA restricted what they can base premium prices on. (TheSnarkIsWhyImHere)

Medicare doesn’t hire doctors (like the NHS in England does, paying them salaries). Doctors submit bills to Medicare on a fee-for-service basis. Even Medicare Advantage (private insurers providing Medicare coverage for about 30-40% of the seniors) works through doctors sending bills to someone. There are projects underway to come up with other ways of paying doctors for Medicare, involving reward for achieving better overall costs and how well patients do, as measured in different ways. It still involves sending bills.The lament comes in because seeing patients and sending bills involves dozens of different payers and contracts and systems of rules and mechanics of getting paid. If there was just “one payer,” it would get simpler. (Randy Bak)

Although some like to point to foreign countries like Canada, Finland, etc. as good single-payer systems. every one of those countries has at least a two-payer system. The government system,and the private pay (or private supplemental insurance) to cover faster care or non-covered items. So I wouldn’t worry about the rev cycle folks being on the street to soon. (Frank Poggio)

I’m a fan of the Israeli healthcare system. They have several HMOs, under pretty strict government oversight. The result is a quasi-competitive system that offers a government-mandated basket of services. The cost of their healthcare isn’t outrageous, they have shown they can innovate within their economic structure (a common complaint about single-payer is stifling innovation), and the outcomes are better than the USA. I tire of the arguments against single-payer that suggest we do nothing. Clearly, we have a cost and quality problem in this country. Doing nothing is not a strategy for success. (Jim Bresee)

[With regard to health IT salespeople] I never misrepresent myself to employers or clients. That is how I can hold my head high, even when I’m in a room with one of my sales reps who decides to “do their job” despite my guidance. Because I will interject and say “technically” or “in the interest of full disclosure,” the client will light up with appreciation and the sales rep will be enraged. Those instances typically result in a successful long-term relationship with the client. As Mr.HISTalk shared, there are many good reps. But there are all way too many who are doing their job, which often times doesn’t align with being fully transparent. (Katie Goss)

[On clinical decision support systems replacing EHRs as clinician-facing technology] An EHR is a enterprise-wide. mission-critical transaction system. A CDSS is akin to a Mangement Decision Support System in commercial industry, and I know of no situation where a MDSS has totally replaced a SAP or Oracle transaction system. (Frank Poggio)

I’ve often noticed how many of the sales management folks (from directors to VPs and even to a couple of CEOs) have fallen from grace (they have quotas too!) and eventually end up down the food chain again. Sales is an interesting business and the people at the top making the big decisions and big bucks are not always the best strategists. Sometimes just the best BSers! (Eyes Wide Open)


Watercooler Talk Tidbits

Healthcare long-timer and Tincture editor Kim Bellard quotes an AI expert’s recommendation to substitute “magic fairy dust” for “AI” in any article that mentions it, which helps determine how realistically the author or expert is describing unproven technology. He also quotes healthcare debunker Jen Gunter, MD, who rails against bad information as well as click-desperate news sites that either misrepresent the latest medical study (intentionally or not) or label it with a misleading headline that will be echoed endlessly on social media with no critical review.

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An Atlantic writer spends $1,300 on products from the “pretty, blonde 20-somethings” working in the luxurious storefront of Gwyneth Paltrow’s so-called “wellness” company Goop. She emitted foul body order from some wacky vitamin combos, attracted attention with a $80 “healing energy” crystal water bottle, couldn’t figure out how to use the $42 tinted face oil, and found that the Martini Emotional Detox Bath Soak resembled raw sewage when dumped into her bath water. She liked some of the expensive products, but summarizes:

For these products to be considered successful, the result wouldn’t necessarily be a stronger, more resilient, more competent me, or a more peaceful relationship with my body. It would be a person who is better-dressed, who hasn’t succumbed to the indignities of visible aging, whose hair doesn’t frizz, who never goes back for seconds at dinner … the company’s products embrace one of America’s oldest health myths: that physical beauty is proof not only of a person’s health but of her essential righteousness. If the outside is perfect, the inside must be too … Wellness companies can feel predatory, even those not making Gwyneth Paltrow richer. It’s a largely unregulated industry, and it operates in an environment of open desperation. Many women justifiably mistrust the ways conventional doctors address their concerns and treat their pain. Goop, influential in ways that would make most gurus and healers envious, has helped introduce millions of people to “experts” who argue that HIV doesn’t cause AIDS and that drinking celery juice can treat cancer.

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NICU staff at Riley Hospital for Children at IU Health North (IN) hold a graduation party for baby born at 23 weeks weighing 20 ounces. Four months later, she was discharged weighing 8 pounds, 6 ounces. I’m assuming that other hospital employees were less enthused at the same moment in trying to collect the massive bill generated as a by-product of the miracle.

The FBI arrests a Michigan doctor who it says planned to kill a condo HOA lawyer and his own attorney by injecting them with fentanyl.

Leaked emails from a regulatory affairs physician with chemical company Monsanto show that the doctor wanted to “beat the sh*t” of members of advocacy group Moms Across America for urging the company to stop selling genetically modified seeds and Roundup. The president of an environmental group says that Bayer is “reeling” after paying $63 billion for Monsanto last year, only to be hit with negative publicity as “the company that gave us DDT, Agent Orange, and PCBs.”

A veteran running late for his appointment at the St. Louis VA hospital uses its valet service to park his new car, following the valet’s instructions to just leave his car with the keys on the dash. Afterward, the valet said someone drove off with it, but the third-party valet company isn’t returning his calls to explain why it would allow someone to take the car without presenting a claim ticket. The car turned up two weeks later damaged, empty of his personal belongings, and tricked out with a new window tint job.


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Morning Headlines 8/30/19

August 29, 2019 Headlines No Comments

University Hospitals awarded $1 million from Ohio Opioid Technology Challenge

University Hospitals in Cleveland takes home a $1 million grant after winning the Ohio Opioid Technology Challenge with its UH Care Continues software.

LogicStream Health Names Luis Saldaña Chief Medical Informatics Officer

Former Texas Health Resources CMIO Luis Saldaña will join LogicStream Health in a similar role.

Altais Teams Up with Aledade, Inc. and the California Medical Association to Offer Unique Patient Care Model Supported by Innovative Technologies

Clinical services and technology company Altais will team with the California Medical Association and ACO primary care business Aledade to help physicians succeed in value-based contracts with payers using the latest workflow technologies and services.

News 8/30/19

August 29, 2019 News 1 Comment

Top News

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University Hospitals in Cleveland takes home a $1 million grant after winning the Ohio Opioid Technology Challenge.

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The hospital’s innovation arm, UH Ventures, developed post-discharge software that helps providers assess a patient’s risk for opioid dependency, and keeps track of adherence to needed prescriptions as patients transition from hospital to home. A six-month pilot project of the UH Care Continues solution at a dozen UH hospitals kept 12,000 pills out of circulation.

UH CEO Tom Zenty says the award substantiates the health system’s decision to create UH Ventures, which launched in 2017 to help the system diversify its income stream.


Reader Comments

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From UGMbracer: “Re. Epic Cosmos. Other sites mentioned its announcement this week at UGM. Why not HIStalk?” Because it’s not new. Epic’s Cosmos research network was first announced at the 2015 UGM, with the only news being that nine health systems have signed up since.


Webinars

September 5 (Thursday) 2:00 ET. “Driving 90% Patient Adoption Across Your Network: How US Dermatology Partners is Showing Us The Way.” Sponsor: Relatient. Presenters: Michele Perry, CEO, Relatient; Sara Nguyen, VP of applications and integrations, US Dermatology Partners. US Dermatology Partners is helping its physicians reclaim time they can spend with patients and is turning patient engagement strategies into business results across its 90 locations in eight states. Attendees will learn how US Dermatology Partners defined its patient engagement objectives and physician-optimized strategies. They presenters will provide advice on starting or accelerating  patient engagement goals.

September 19 (Thursday) 2:00 ET. “ICD-10-CM 2020 Code Updates.” Sponsor: Intelligent Medical Objects. Presenters: June Bronnert, MSHI, RHIA, director of terminology mapping, IMO; Theresa Rihanek, MHA, RHIA, classification and intervention mapping lead, IMO; and Julie Glasgow, MD, senior clinical terminologist, IMO. The 2020 regulatory release is right around the corner. Join IMO’s top coding professionals and thought leaders as they discuss new, revised, and deleted codes; highlight revisions to ICD-10-CM index and tabular; discuss changes within Official Coding Guidelines; share potential impacts of the code set update; and review ICD-10-CM modifier changes.

September 26 (Thursday) 2 ET. “Patient Education Data: A Key Ingredient for Improving Quality and Patient Experience.” Sponsor: Healthwise. Presenters: Victoria L. Maisonneuve, MSN, RN, director of the Nursing Center for Excellence and Magnet program, Parkview Health; Marta Sylvia, MPH, senior manager of quality improvement and outcomes research, Healthwise. Healthcare data is everywhere! It’s scattered across various systems and in countless formats, making it difficult to collect and glean actionable information. Knowing where to start depends on what your organization wants to accomplish. Vicki Maisonneuve will share how her team analyzes data around the use of patient education. By combining different data sets, she can easily identify trends, gaps, and opportunities to improve quality and patient experience across Parkview Health.

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


Acquisitions, Funding, Business, and Stock

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Patient engagement vendor Luma Health raises $16 million in a Series B round led by PeakSpan Capital. The San Francisco-based company has raised $26 million since launching in 2015.

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San Francisco-based life insurance startup Ethos raises $60 million in a Series C funding round led by Google Ventures. The company uses predictive analytics to determine an applicant’s life expectancy, and then offers up a best-fit policy after an application process that takes just minutes to complete. The technology, which verifies health histories against an applicant’s medical record, eliminates the need for most to undergo a medical exam, according to co-founder and CEO Peter Colis. “You shouldn’t have to endure what’s essentially a medical and financial strip search in order to protect your family,” he adds.

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Rock Health founder Halle Tecco launches Natalist, a monthly subscription box company for women looking for clinically-validated products and resources to help them conceive. The company is taking a decidedly anti-Goop approach to its product line and marketing, assuring customers they won’t encounter “junk science” and explaining why they don’t carry products like fertility crystals and birth control cleanses.


People

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Eric Dishman announces he will transition from head of the NIH’s All of Us research program to its chief innovation officer.

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LogicStream Health names Luis Saldaña (Texas Health Resources) CMIO.


Sales

  • The University of Tennessee Medical Center taps Gozio Health to develop its mobile wayfinding and patient engagement software.

Announcements and Implementations

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In England, Gloucestershire Hospitals NHS Foundation Trust’s CIO says his organization is “one of the most digitally immature organizations in the health service” with primarily paper records, but it will implement Allscripts Sunrise while retaining its InterSystems TrakCare patient administration system in a “clinical wrap” approach that will move faster than implementing a new PAS first. Deployment started last month and go-live is planned for July 2020.

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UC San Diego Health implements provider information management software from Phynd.

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KLAS looks at Cerner’s revenue cycle improvement performance since an August 2018 big-hospital customer roundtable. Most participants say their relationship with the company has improved and two-thirds believe that RCM is a top Cerner priority, but 88% are not satisfied with tangible results in the year since the meeting and 56% can’t name a single delivered Cerner win. The top confidence-inspiring action by Cerner was making leadership changes. The biggest client concerns are Cerner’s ability to execute and its sense of urgency in proposing a multi-year roadmap.


Privacy and Security

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The National Institute of Standards and Technology seeks vendor insight and demonstrations of cybersecurity solutions for telehealth. The project will help NIST’s National Cybersecurity Center of Excellence develop a Cybersecurity Practice Guide for providers and vendors.

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ProPublica looks at the ways in which insurance companies are helping to perpetuate ransomware attacks on local governments and private businesses, noting that the FBI has even said that hackers are now targeting American companies that they know have cyber insurance. At the end of the day, the bottom line tends to trump moral outrage: “Paying the ransom [is] a lot cheaper for the insurer. Cyber insurance is what’s keeping ransomware alive today. It’s a perverted relationship. They will pay anything, as long as it is cheaper than the loss of revenue they have to cover otherwise.”


Other

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The next iteration of Fitbit’s Versa smartwatch will feature Amazon Alexa integration and access to the company’s new monthly subscription service that will provide a deeper dive into user health stats. Access to health coaches will be available for an additional fee later this year.

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The Atlantic highlights the strange ways in which medical debt collectors attempt to reach patients burdened with bills they’ve been unable to pay – some incurred by out-of-network providers brought in while patients were unconscious. A particularly creepy collector even went so far as to send a LinkedIn request to heart transplant recipient Joclyn Krevat, who remembers thinking, “Is this lady stalking me or does she really think we’d be good in each others’ professional networks?“


Sponsor Updates

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  • Definitive Healthcare raises and donates nearly $130,000 to fund cancer research at its fourth annual Jimmy Fund Golf Tournament.
  • EClinicalWorks will exhibit at CASA 2019 Annual Conference & Exhibits September 4-6 in Monterey, CA.
  • HealthCrowd and InterSystems will exhibit at the Florida Association of Health Plans 2019 Annual Conference September 4-6 in Orlando.
  • Google Cloud will work with NTT Data Services to develop and deliver digital offerings in cloud, analytics, and AI to help providers and payers improve the patient experience.
  • Vocera adds Imprivata’s authentication capabilities to its Collaboration Suite of shared clinical mobile devices and smartphone app.
  • The Medicaid Black Book gives Collective Medical a five out of five star rating in an overall assessment for Medicaid effectiveness.
  • Greenway Health congratulates customer Health Choice Network on its 2019 Quality Improvement Awards from HRSA.
  • Redox offers free support to customers who access patient data via the USCDI functionality on the FHIR standard.

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Mr. H, Lorre, Jenn, Dr. Jayne.
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EPtalk by Dr. Jayne 8/29/19

August 29, 2019 Dr. Jayne 2 Comments

There has been quite a bit of discussion in the physician lounge about recent articles looking at health outcomes and social spending in the US compared to other comparable countries. The authors used data from the Organization for Economic Cooperation and Development spanning 1980 to 2015 and compared relative spending on social services and healthcare.

Countries in the dataset included Australia, Canada, Denmark, France, Germany, Japan, the Netherlands, Sweden, Switzerland, and the UK. They found that non-US countries spent an average of 8.8% of their gross domestic product (GDP) on healthcare, but the US spent 16.8%. In comparison, the US spent 16.1% of GDP on social services compared to 17% in other countries. When education was included in social spending, the US spent 19.7% of GDP compared to other countries’ 17.7%. The authors also found that in the US, a greater portion of spending occurs for the elderly.

The findings contradict the belief that the US spends so much more on healthcare because it doesn’t spend enough on social services. Previous analyses found that US healthcare spending is greater due to labor, pharmaceutical, and administrative costs, which shouldn’t be a surprise to anyone who works in the industry.

Several of my colleagues who are department chairs were also in a heated discussion about CMS star ratings on the Hospital Compare. CMS recently announced that updates to the methodology behind the ratings will be delayed until 2021, although CMS will continue to publish the ratings. Many hospital organizations are asking for the ratings to be removed or suspended until the updates are implemented.

Although the ratings are better than having no information at all, they’re difficult for patients to use when making decisions. For example, my local academic medical center has a lower rating than the closest community hospital, but if I needed anything more complex than removing my gallbladder or appendix, I’d be headed straight to the lower-rated facility.

CMS received 800 comments within 145 letters from various organizations, many stating that they feel the ratings are overly vague, they are too complex, and they oversimplify quality measurement. Submissions asked for greater precision in the ratings along with improved apples-to-apples comparisons. CMS will use the comments to develop the proposed rule for release in 2020, so the current methodology remains in place. A public listening session will be held on September 19 to further discuss the ratings and proposed changes.

Direct Primary Care was also a hot topic, with one physician noting he’d like to make the jump “to get out from under the corporate overlords.” The DPC movement might get a boost if The Primary Care Enhancement Act of 2019 (HR 3708) becomes law. The Act would update the US tax code to allow patients with health savings accounts (HSAs) to use those funds for DPC payments. Currently, DPC payments are treated as insurance premiums, so patients trying to use HSA funds incur a tax penalty. The number of primary care physicians considering a move to a more direct model is on the rise. A previous bill failed to pass in 2017.

Paladina Health and SSM Health are forming a direct primary care joint venture in St. Louis. There are many different DPC models, and this one is of the direct-to-employer variety. Employers will pay a flat fee to cover physician services, including office visits, some medications, and labs. I have a friend who works for Paladina Health and he enjoys seeing fewer than a dozen patients a day ,with office visits that are long enough to actually tackle patient problems and discuss non-pharmaceutical interventions like diet and exercise. He’s skeptical about the joint venture with SSM because one of the draws for him to work for Paladina Health was getting away from being employed by a hospital system. SSM Health plans to offer direct primary care to its own employees who are covered under its health plan.

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The American Medical Informatics Association announced the keynote speakers for its annual symposium in November. CMS Administrator Seema Verma will keynote on Sunday, November 17, and patient advocate Peter Kapitein will speak on Wednesday, November 20. Kapitein hails from the Netherlands, and the part of his bio that caught my attention was his role in founding a fundraising bicycle ride up the Alpe d’Huez, one of the grueling highlights of the Tour de France. His bio also notes that his employer (the Dutch central bank) “facilitates him to work three days a week for the victory over cancer.” I can’t wait to hear more in person.

The Electronic Health Record Association (EHRA) has given its support for the new NCPDP SCRIPT version 201701 standard for electronic prior authorization (ePA) of prescription drugs under Medicare Part D. However, it did note some concerns around the deadline for implementation, recommending a full 24 months for implementation once the final rule is published. The standard is designed to allow pharmacies to communicate with practices using expanded electronic transactions, reducing the number of phone calls needed to complete prior authorizations. EHR and pharmacy vendors have to create updates and their clients will need to modify their systems, so it’s not a small undertaking. The current proposal requires implementation on January 1, 2020 and the new version of the SCRIPT standard isn’t fully backwards compatible, which could cause issues. EHRA is also recommended an update to HIPAA to reference the new standards since some individual states may be pursuing their own.

Individual state standards would be just about the worst thing we could interject into anything involving healthcare IT and especially interoperability. Clinicians practicing in cities close to state borders might be caught in the crossfire like they currently are with requirements for paper prescriptions, resulting in multiple workflows which doesn’t really help efficiency.

In my past life, we had to maintain multiple different paper prescription formats along with custom code to ensure the correct version was printed based on the patient’s pharmacy of record rather than the location of the practice. Our EHR vendor only supported script generation based on the latter, and contentious pharmacists across the state line refused to honor our prescriptions. In my current practice I have to deal with different local rules regarding controlled substances (you can purchase pseudoephedrine on one side of the street without a prescription, but must have a paper script on the other) and it’s a pain. It’s also probably one of the reason we dispense a lot of the drug from our in-house pharmacy, so patients just don’t have to mess with it.

I’ve also run into the differences in state standards in my recent foray into telehealth, dealing with different standards on reportable conditions ranging from sexually transmitted infections to dog and cat bites. For the latter two, most states require physician reporting, but the mechanism varies dramatically. In my home county, I can report via email, while in a neighboring county it has to be a phone call, and across the state line it has to be a faxed form. Thank goodness for Google, which helps me track it all down as the need arises.

What do you think about individual state standards for healthcare IT? Leave a comment or email me.

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Morning Headlines 8/29/19

August 28, 2019 Headlines No Comments

With a nod to disco era, Epic Systems Corp. looks to Cosmos, voice-activated software

Epic founder and CEO Judy Faulkner shares several developments in the works during her UGM executive address including the Cosmos project, which will gather and aggregate de-identified patient data from Epic customers to help them improve evidence-based patient care.

Rock Health Founder and Investor Launches Subscription Box Startup After Fertility Struggle To Help Women Get Pregnant

Rock Health founder Halle Tecco launches Natalist, a monthly subscription box service filled with clinically-validated products for women trying to conceive.

Patient Engagement Leader Luma Health Raises $16 Million to Accelerate Delivery of Modern Patient Access Technology

San Francisco-based patient engagement startup Luma Health raises $16 million in a Series B round that brings the company’s total funding to nearly $26 million.

NIST Wants Insight on Combatting Telehealth Cybersecurity Risks

The National Institute of Standards and Technology seeks vendors to participate in its research into the cybersecurity challenges of remote patient monitoring technologies, including video visits.

HIStalk Interviews David L. Meyers, MD, Emergency Physician Leader

August 28, 2019 Interviews 4 Comments

David L. Meyers, MD is retired from a long career in clinical medicine. He continues to consult, serves as a board member of the Society to Improve Diagnosis in Medicine, and is pursuing a master’s degree in bioethics at the Johns Hopkins Bloomberg School of Public Health.

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Tell me about yourself.

I’m an emergency physician. I trained at Cook County Hospital in internal medicine, before there was a board exam. Emergency medicine was emerging as a specialty. I stayed in Chicago and went right into emergency medicine practice instead of doing internal medicine. I dabbled a little bit in internal medicine at Northwestern and did some research, but basically I’ve been an ER doc all my life.

I ran an ER in Chicago for about 20 years and then came to Baltimore to run an ER here at Sinai Hospital . After a few years, we brought in EmCare, a private medical management company, to staff the place and hire the docs. I went to work for them and did a bunch of executive-type things over the next 10 years, including running a malpractice insurance company operation, their risk management claims management. It was a publicly traded company at the time and still is.

I continued to practice clinically once a week, commuting to Dallas for five years and coming back here after my Friday night in the ER so I could keep my hands in the nitty gritty of what’s really going on in the field. 

I retired a few years ago and decided I wanted to pursue medical ethics in more depth. I had been on ethics committees all my clinical career and found it really interesting and challenging with what is going on in healthcare. I’m not sure what I’m going to do with it. I have some ideas about the discrepancy between business ethics and bioethics. There may be some opportunity to blend those kinds of things to have a more humane and better healthcare system.

How extensive is misdiagnosis and how do you assess the market for artificial intelligence to improve it?

Huge and huge. Misdiagnosis or diagnostic errors make up at least 50% of all harm-related medical errors. Most of the reliable information is based on claims data from medical malpractice, which is not a great marker for total number of diagnostic errors. But the ones that people are really concerned about are those that cause harm – significant disability, loss of limb, loss of the ability to work, and even death. Diagnostic errors are the most frequent cause of those high-harm results.

A recent study published out of by Hopkins David Newman-Toker and his associates looked at what turned out to be the Big Three conditions. They went to a big insurance database called CRICO, which insures about 400 hospitals and healthcare systems around the country, including Harvard and Hopkins and a bunch of other very prestigious academic medical centers. They looked at the claims data from this database to identify those conditions that were most often associated with high harm, that is, these disabilities and death. The categories turned out to be infections, of which sepsis, certain other paraspinal abscesses, and four or five other things were very prominent;  vascular conditions, mostly around strokes and heart attacks and similar kinds of conditions; and cancer. They called these the Big Three that are responsible for most of the significant harm-related categories.

This study is one of the best to flesh out how big of a problem this is. The total number of serious harm-related incidents ranges from 40,000 to up to 1 million, depending on how the analysis is done and what the source database is. It comes down to that a diagnostic error is associated with 5-7% of all patient encounters.There are hundreds of millions of diagnostic encounters every year. You’re talking about a large number of errors and then correspondingly large number of serious errors resulting in harm.

Is that misdiagnosis or failure to diagnose?

It’s a combination. It uses a definition of diagnostic error that came out of the Institute of Medicine, now called the National Academy of Medicine, that published a big monograph study on diagnostic errors in 2015. Their “To Err is Human” in 1999 said that the biggest problem is medication errors. That was the illusion of what was significant. While there were lots and lots of medication errors, they weren’t so much the cause of significant, harmful outcomes. Only in the last five or six years after this study was published was there an acknowledgement that the biggest harm-related cause was on the diagnostic side of things.

Is medical imaging analysis the most potentially useful deployment of AI in the care setting?

It is possible for an intelligent machine to look at millions and even billions of images in a very short period of time and then learn, through these neural networks and other mechanisms, how to recognize what’s a man, what’s a woman, what’s a cat. Companies have produced X-ray assistive artificial intelligence devices that can look at millions of images and be more accurate than radiologists. Sinai just got one of these artificial intelligence image analysis tools for looking at brain scans for hemorrhages. The studies show that Aidoc performs better than a panel of radiologists.

That’s not just in radiology, but in dermatology and other kinds of image recognition things. That’s where the first successes have been shown to be pretty good and where the greatest potential is right now, Then it could be expanded it to other areas where the appearance of something tells you what’s going on, such as diagnosing depression by looking at facial images.

In the the study of diagnosis, most errors occurred in the realm of cognition and cognitive errors — not considering a condition as the cause of the symptoms, not ordering the appropriate tests, or making decisions along the way that weren’t so obviously putting together a whole lot of data and saying, here’s the diagnosis.

At some point, I suppose we’ll have a Tricorder where we just put a bunch of information in and pass the patient through a CT scan type thing and it will come out with the diagnosis. But that is pretty far in the future. The thing now is, how are we going to help doctors be smarter cognitive players in the diagnostic process and assist them? 

Consider prompts and reminders. Can Epic, Cerner, or some of these other EHRs develop ways that the electronic record can say, “This is a middle-aged male with back pain who’s got hypertension and had pain radiating to his leg.” Then set up a tool that says, “This could be a patient with a significant risk, maybe 5% or more, of a leaking aortic aneurism.” Put that prompt on the screen to the doc to say, “Have you considered a AAA rupture or leakage in this patient?” 

We’re not there yet. They’re apparently not able to do that, although it seems that the technology is there. There’s a diagnosis tool called Isabel. It’s free on the Internet. You put in your symptoms and it will generate a differential diagnosis list, the things that ought to be considered as possible causes of the symptoms you’re having. 

The potential is there, but so far it hasn’t really been adequately exploited. Most of the effort seems to be looking at these deep learning things, where neural networks are used to teach machines how to recognize a mass on an x-ray or depression in a face or something like that.

Some of that is available now in the form of evidence-based clinical decision support, but doctors don’t always embrace it. What dynamic will need to be overcome to get doctors to see AI as a partner rather than a threat?

There’s still a lot of resistance. Physicians may be skeptical about how big of a problem diagnostic errors are. A lot of studies have shown that doctors are confident about their diagnoses even when they’re wrong. There’s this attitude that, “Maybe there’s a big problem, but I am not one of those problematic people. I’m above average.” Everybody thinks they’re above average in their diagnostic capabilities.The literature is telling us that it ain’t so, but getting doctors to believe it is another whole thing.

Then there’s the cost of all these AI-type things. EHRs themselves, as bad as they are, are a huge expense for hospitals. They’re already struggling to make theme cost-effective. Adding additional bells and whistles that the doctors may not even accept is a risky kind of proposition.

What about the ethical issues of AI in healthcare that have received widespread coverage lately?

Artificial intelligence tools are created by humans who have their own biases. There is recognition that those biases can be built into the tools of artificial intelligence. They aren’t yet totally objective. Health equity issues that plague humans and our biases may be built into those systems. Not consciously, but because it comes from human creation, it’s automatically saddled with human biases, even though they can be minimized. We haven’t figured out how to eliminate them yet.

What technologies hold the most promise for improving outcomes or cost?

In the long run, artificial intelligence is probably the key to better care and lower costs. But with regard to timeframe, I’m skeptical about whether we’ll be doing this on earth or doing it on Mars. It will be decades in the making for this to come to a point where it’s having such an impact, although imaging analysis has a very reasonable timeframe in the near future to make a difference. If we can have better imaging analysis and diagnosis, that will contribute to a significant reduction in harm and lower the cost of care.

There are predictive analytics systems that look at masses of records, collecting them and putting them into categories for making predictions. The Rothman Index, which I think is mostly done manually by nurses entering information into the patient record multiple times per day, looks at those inputs and recognizes patients who are potentially at risk. It gives an early warning to the staff using those 20 or 30 parameters from the nursing notes, vital signs, and other electronically collected stuff. It says, “This patient is going to need a rapid response intervention in the near future unless you intervene with some technique now.”

By aggregating millions of patient records, I think we’ll be able to predict who isn’t taking their medicines, using an Apple Watch type thing or something like that. We could say, “The patient isn’t taking their medicines. The patient gained weight. We have to send somebody out there to intervene. Maybe their heart failure is getting worse.”

That is where the potential for improving the care and reducing the cost is going to be. These predictive analytic tools, collecting data in the background and telling the providers, “Pay more attention to this guy. He seems to be on the verge of deteriorating.”

Morning Headlines 8/28/19

August 27, 2019 Headlines No Comments

WebPT Announces Significant Investment from Warburg Pincus

Private equity firm Warburg Pincus acquires a majority interest in therapy EHR vendor WebPT from Battery Ventures.

JLL Partners And Water Street Acquire THREAD

A PE firm and a strategic investment firm acquire Thread, which offers virtual clinical trials tools such as electronic consent, telehealth, sensor integration, surveys, and patient authentication and engagement.

2019 Black Book Advisory Survey: Bluetree Network Earns Top Strategy, Implementation & Support Consultants Rating Among Epic Systems Users

Black Book names Bluetree Network #1 among 33 Epic consulting firms.

News 8/28/19

August 27, 2019 News 5 Comments

Top News

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Private equity firm Warburg Pincus acquires a majority interest in therapy EHR vendor WebPT from Battery Ventures.

Co-founder and President Heidi Jannenga, PT, DPT will move to chief clinical officer, while industry long-timer Nancy Ham remains as CEO.

Other Warburg Pincus health IT investments include Intelligent Medical Objects, Experity Health, and Modernizing Medicine.


Reader Comments

From Snark Week: “Re: rumors and snark. Less, please – this is a news site.” Not to nitpick, but HIStalk is whatever I want it to be. Things I’ve learned in doing it for 16 years: (a) everybody loves rumor and humor except when it’s about their company, then they get all high and mighty about journalistic integrity; (b) nobody reads sites that just vomit up dull, inexpertly reported straight news; and (c) everybody thinks their opinion as a reader is representative and therefore their sometimes-cranky recommendations are by definition unerringly correct. I write HIStalk for myself, but everyone is welcome to read it with me.


HIStalk Announcements and Requests

Which would you hate missing most: (a) Epic’s UGM, or (b) the HIMSS conference?


Webinars

September 5 (Thursday) 2:00 ET. “Driving 90% Patient Adoption Across Your Network: How US Dermatology Partners is Showing Us The Way.” Sponsor: Relatient. Presenters: Michele Perry, CEO, Relatient; Sara Nguyen, VP of applications and integrations, US Dermatology Partners. US Dermatology Partners is helping its physicians reclaim time they can spend with patients and is turning patient engagement strategies into business results across its 90 locations in eight states. Attendees will learn how US Dermatology Partners defined its patient engagement objectives and physician-optimized strategies. They presenters will provide advice on starting or accelerating  patient engagement goals.

September 19 (Thursday) 2:00 ET. “ICD-10-CM 2020 Code Updates.” Sponsor: Intelligent Medical Objects. Presenters: June Bronnert, MSHI, RHIA, director of terminology mapping, IMO; Theresa Rihanek, MHA, RHIA, classification and intervention mapping lead, IMO; and Julie Glasgow, MD, senior clinical terminologist, IMO. The 2020 regulatory release is right around the corner. Join IMO’s top coding professionals and thought leaders as they discuss new, revised, and deleted codes; highlight revisions to ICD-10-CM index and tabular; discuss changes within Official Coding Guidelines; share potential impacts of the code set update; and review ICD-10-CM modifier changes.

September 26 (Thursday) 2 ET. “Patient Education Data: A Key Ingredient for Improving Quality and Patient Experience.” Sponsor: Healthwise. Presenters: Victoria L. Maisonneuve, MSN, RN, director of the Nursing Center for Excellence and Magnet program, Parkview Health; Marta Sylvia, MPH, senior manager of quality improvement and outcomes research, Healthwise. Healthcare data is everywhere! It’s scattered across various systems and in countless formats, making it difficult to collect and glean actionable information. Knowing where to start depends on what your organization wants to accomplish. Vicki Maisonneuve will share how her team analyzes data around the use of patient education. By combining different data sets, she can easily identify trends, gaps, and opportunities to improve quality and patient experience across Parkview Health.

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


Acquisitions, Funding, Business, and Stock

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Hound Labs, which is working on the first marijuana breathalyzer (the device also measures alcohol levels), raises $30 million, increasing its total to $65 million. Fun facts: “Law and Order” creator Dick Wolf is an investor in the company, which was founded by former deputy sheriff, SWAT team member, ED doctor, venture capitalist, and White House fellow Mike Lynn and his wife Jenny, who was a marketing executive and also a White House fellow.

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A PE firm and a strategic investment firm acquire Thread, which offers virtual clinical trials tools such as electronic consent, telehealth, sensor integration, surveys, and patient authentication and engagement. Former US Army paratrooper Jeff Frazier founded the company as Definitive Media in 2005.

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PeerWell — whose digital health platform addresses workers’ compensation surgery issues such as pain management, surgery avoidance, surgery optimization, and recovery — raises $6.5 million in a Series A funding round.


Sales

  • Lehigh Valley Health Network chooses IKS Health’s Scribble for asynchronous virtual scribing.

People

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Apervita hires Kevin Hutchinson (MyTaskit) as CEO.

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Ontario Systems promotes Jason Harrington to CEO, where he will replace retiring co-founder and CEO Ron Fauquher. New Mountain Capital acquired a majority share of the company last week.


Announcements and Implementations

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A new KLAS report on computer-assisted coding finds that 94% of customers would buy their existing product again. 3M and Optum showed improved satisfaction in the past three years, while Dolbey is most consistent at driving outcomes. Up-and-comer EzDI earns good marks for support, but half of respondents report problems with EHR integration.

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Black Book names Bluetree Network #1 among 33 Epic consulting firms. More than half of survey respondents say they will increase their consultant-led engagements in 2020 based on needs such as EHR optimization, analytics, revenue cycle transformation, and IT managed services.

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Epic celebrates #UGM19 (notably, the first year it has endorsed a conference hashtag) with its top 10 most-read customer successes on Epic.com so far in 2019. Among them:

  • Henry Ford’s ED triage protocol that identifies possible human trafficking victims.
  • MyChart price estimates.
  • Mackenzie Health’s patient check-in via MyChart and kiosks.
  • Mona Hanna-Attisha, MD’s use of Epic to discover of Flint, Michigan’s water crisis.
  • Nebraska Medicine’s standardized hand-off.
  • University of Utah Health’s neonatal weight gain program.
  • Piedmont Healthcare’s work on hospital-acquired infections.
  • Centura Health’s OR supply program.
  • Epic’s Happy Together unified, patient-centered view of MyChart.
  • Cambridge University Hospitals NHS Trust’s atrial fibrillation screening.

Baptist Health South Florida goes live on Kyruus ProviderMatch for Consumers as well as the Spanish language version, allowing consumers to search for providers and schedule appointments from its website.


Other

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An @EricTopol find: researchers find that AI can accurately predict age and sex from ECGs. The value of this study isn’t related to sex – it’s that ECGs are now known to contain information that we humans don’t fully understand that might be useful in diagnosis.

Hat tip to @Cascadia, who noticed an EHR integration manager job posting from BCBS insurer Premera. Its analytics team will use InterSytems HealthShare to review EHR and claims data for “enabling the translation of real-time clinical data from medical service providers into data models and dashboards in support of data science” to improve outcomes and reduce cost.

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A Japan-based business unit of contract research organization PPD (Pharmaceutical Product Development) will offer research services to clients in Japan, including development of EHR-enabled clinical trials. North Carolina-based PPD, started by pharmacist Fred Eshelman, PharmD in 1985 as a one-person consulting firm, was sold to an asset management company and a private equity firm in 2011 for $3.9 billion. It has since grown from 1,500 employees to 21,000, with offices in 48 countries. It recapitalized in 2017 with investment by the governments of Abu Dhabi and Singapore, valuing the company at $9 billion. Eshelman also started Furiex Pharmaceuticals, sold in 2014 to another drug company for $1.1 billion. Eshelman has donated at least $140 million to his alma mater, University of North Carolina’s School of Pharmacy, now named after him.

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A dermatologist’s op-ed piece in the Philadelphia newspaper observes that even with interconnected EHRs, doctors don’t usually know how their patients are doing or even when they have died. He was going through his patient list when an EHR pop-up told him that one of them had passed away six months before, making him sorry that he had missed the chance to console the family or even to send a card, but then wondered whether the family members, who he had never met, would find that appropriate anyway.  

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Clickbait headline of the day, from Forbes. The story is about a hospital in Egypt (not Oracle itself) that is using Oracle ERP, analytics, and workforce management for purely business functions. I’m sure the hospital will let us know when their payroll package cures cancer.


Sponsor Updates

  • Contract therapy EHR vendor Casamba chooses NVoq as its preferred speech recognition provider.
  • Dresner Advisory Services names Dimensional Insight an Overall Leader in its 2019 Industry Excellence Awards.
  • Williamson Memorial Hospital implements paperless registration using Access EForms following its go-live on Meditech as a Service.

Blog Posts


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Contacts

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


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Morning Headlines 8/27/19

August 26, 2019 Headlines No Comments

Visibly (formerly Opternative) recalls online vision test

Facing pressure from the American Optometric Association and the FDA, Visibly recalls its online vision screening test over lack of FDA marketing approval, and concerns with safety and efficacy.

HHS Proposes 42 CFR Part 2 Reforms to Increase Coordinated Care, Reduce Provider Burden, and Improve Substance Use Disorder Treatment

HHS publishes a proposed rule that will give providers greater access to the medical records of patients seeking treatment for addiction while ensuring privacy guardrails stay in place.

ACT Health opens tender for digital health record with full EMR and PAS capabilities

The Australian Capital Territory Health Directorate wants to replace its patient administration system with a new EHR that has helped other health systems achieve HIMSS Stage 7 EMRAM.

Curbside Consult with Dr. Jayne 8/26/19

August 26, 2019 Dr. Jayne 3 Comments

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I’ve received several post cards and also emails from Nuance lately, marketing their Ambient Clinical Intelligence product which they also describe as “the exam room of the future.” I’m pretty sure this is the follow-on to what many of us saw in their demo/theater at HIMSS.

The premise was this: the physician and patient interact in an exam room that supports speech recognition while also serving up EHR data to the provider upon request. The demo scenario was a 40-something woman with knee pain. The system helped the provider navigate to find information about previous visits as well as documenting the current one.

At the time, I spoke with some of the Nuance team and it sounded like they were really focusing on subspecialty situations where the workflows would be fairly standardized and/or predictable. In order for the technology to work, there needs to be a significant repository of data available as far as medical dictionaries, codified discrete data, etc. Then on top, you have to layer the typical exam findings, questions, and possible answers for different conditions, to ensure the system will be able to recognize what is being said without having to “train” the speech recognition portion. Beyond that, components of EHR historical data t have to be served up to help answer questions the clinician might ask, such as when a medication was first prescribed, etc.

Although the orthopedic demo was pretty flashy, it was obvious that the participants were actors and that they were working from a script, especially when the real-time-looking demo on the screen didn’t 100% match what had been said. Still, it was attention-grabbing enough to send me to speak to one of their reps about where they really were in development for other specialties. It sounded like they were a bit of a way out for what would be necessary to support workflows in primary care or urgent care, which can be the exact opposite of predictable. With the mailings and email ads, I figured perhaps they had made more progress and decided to follow up.

One piece on the website that caught my eye was something they’re calling “integrated machine vision” and is designed to “detect non-verbal cues.” I’d be curious to learn more about how they’re doing this, and what it might entail to create a library of non-verbal information that could be parsed to add context to notes. I’m also curious whether this applies only to the patient side or whether it’s skilled enough to pick up non-verbal input from the clinician. Would it be able to interpret the complete absence of a poker face that I exhibited recently when seeing the largest hernia I have encountered in my career? Could it interpret the glassy-eyed stare of my patient to determine whether they just weren’t paying attention or whether I should be asking more deeply about potential substance abuse? For clinicians caring for teens, I’d think that ability to quantify teenage eye-rolling would be the gold standard.

Another major component of the system is the virtual assistant piece, kind of like Alexa, Siri, or Google. “Hey Dragon” is the wake word to access information in the EHR, and as this technology evolves, it gets us closer and closer to what many of us have seen in the “Star Trek” universe over the years. Having toyed with a virtual assistant over the last couple of years, I know there are nuances in how the questions are asked to get the data you want to get. Somehow in “Star Trek” they don’t have to ask the computer three different questions to get the desired output. I’m hoping Nuance has been able to figure out the secret sauce needed to translate how physicians think and speak and adapt the system to match.

I was also intrigued by their “intelligent translation and summarization” comments on the website, where they note that it “turns natural language into coherent sentences.” That sounds a bit like physicians might have trouble being coherent, which probably isn’t far off the mark for many of us, especially at the end of a particularly long and brutal shift. I know I lean heavily on my scribes (when I’m fortunate enough to have one) to translate my often-wordy home care instructions into a bulleted list that patients will be more likely to follow once they get home.

Although some of us are skeptical about the power of AI, I was intrigued by some of the numbers presented on the website. The company claims 400 million consumer voiceprints, with 600 million virtual and live chats per year powered by their AI technology. Although I’ve used speech recognition in the past, I didn’t realize the growth in speech-to-text and the fact that they have 125 voices in 50 languages. If they could somehow work with Garmin to integrate the “Australian English Ken” voice I used to have with my stand-alone GPS, I’d be sold. I could listen to him all day, even if he was continually telling me to make a U-turn at the next safe intersection.

This type of technology could really be a game-changer for physicians, perhaps reducing burnout, decreasing medical errors, and making visits more efficient for patients and clinicians alike. I’d be interested to hear from anyone who is actually employing these types of features in practice, whether it’s a comprehensive suite as Nuance is promoting or whether it’s freestanding elements such as a voice assistant for chart navigation, data retrieval assistance, or something else.

I wonder how much research is being done in this arena outside of the vendor space, whether any of the institutions that have strong informatics programs are getting involved with similar initiatives, or whether it’s so expensive that the work is typically vendor-driven.

From a patient perspective, I’d love to see a voice assistant functionality that could make it a reality for me to simply ask it to “make me an eye appointment after November 3 using one of the open slots on my calendar” and have it connect with my provider’s practice management system and get the job done without two phone calls, a patient portal message, and a two-week timeframe like it took me to make my last appointment. Now that would be something, indeed.

What is your most sought-after voice assistant functionality? Leave a comment or email me.

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Email Dr. Jayne.

Morning Headlines 8/26/19

August 25, 2019 Headlines No Comments

Health Catalyst Reports Second Quarter 2019 Results

Health Catalyst reports Q2 results: revenue up 60%, adjusted EBITDA –$5.7 million vs. –$8 million.

$16B veterans’ health project hits major snag

The VA’s $16 billion Cerner rollout at three medical centers will likely be delayed from March 2020 to until October 2020.

Privacy Incident at Massachusetts General Hospital’s Neurology Department

Massachusetts General Hospital notifies 10,000 people that their information, which was stored in the databases of two neurology research applications, was accessed by an unauthorized third party.

Monday Morning Update 8/26/19

August 25, 2019 News 17 Comments

Top News

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Health Catalyst reports Q2 results: revenue up 60%, adjusted EBITDA –$5.7 million vs. –$8 million.

HCAT shares dropped 10% Friday after the announcement, valuing the company at $1.4 billion. They remain 49% above their opening IPO price on July 25, about the same price as they closed on that first day of trading.

Health Catalyst expects to lose $30 million on $150 million in revenue in 2019.

From the earnings call:

  • The company expects annual revenue growth of over 20%.
  • Professional services will contribute a meaningful portion of revenue, with a gross margin of 35%.
  • Medicity’s flat to declining $25 million in annual revenue will slow overall company revenue growth, but continues to present cross-sell opportunities.
  • Health Catalyst says M&A opportunities will result from the more than 1,000 companies that offer clinical, financial, and operational analytics.

Reader Comments

From Suspicious Minds: “Re: health IT salespeople. I’m one. Why wouldn’t you trust me? I’m just doing my job as a professional.” I’ve worked with countless numbers of IT, health IT, drug, and medical device company reps over the years. I have “liked” many of them and “trusted” some of them a little, but I always remained on alert knowing that (a) I was outclassed by the psychology they were exquisitely trained to use to make the sale in whatever way was required; (b) the information they had been provided about my organization and me that gave them a rich palette of ways to push whatever of our hot buttons that seemed most promising; and (c) they were brainwashed into believing that whatever they were selling was the perfect solution to every problem, as they sometimes confidently touted an obviously inappropriate product fueled by the cult-like programming that had injected into their heads at sales meetings. They weren’t necessarily being dishonest — they were just well trained and richly compensated to push whatever they had on their shelves. They got to walk away to the next deal while their peers in implementation, tech, and support were stuck with contrasting the vision we had heard with the reality of what we were getting (and would be stuck with for years). Salespeople often say they’ll walk away if it’s not a good fit, but I think that’s situational depending on company and quota pressure, not to mention that you would hope that the prospect isn’t so clueless as to require strategic guidance from a sales rep in the first place.

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From Jubilant: “Re: AI in healthcare. Rags are saying its healthcare future isn’t rosy.” To be fair, those same rags rode the AI hype hard in pandering for clicks with ridiculous stories claiming just how rosy healthcare’s use of AI was going to be. Now that the clicks have moved on, suddenly they are the voice of reason in proclaiming AI’s benefit as questionable. It’s the same crappy journalism model in which some news site misinterprets a poorly researched article in saying that coffee is a health hazard, only to follow up with another article that says it’s healthy. News sites get clicks only to the extent they can convince you that something is new even when it isn’t. The people writing for health IT sites generally understand the Gartner Hype Cycle only well enough to milk writing about the problems of a given technology only after they’ve exhausted the possibilities of fawning over it.

From Minister of Mayhem: “Re: mobile apps. I’m looking for companies that offer an app that’s a mixture of patient portal, scheduling, and communications with providers that can also push out patient check-ins. Either specific to oncology or adaptable to it.” I will open the floor to readers, who can leave a comment (I’ll waive my usual requirement that no vendors be named).

From Pod People: “Re: podcasts. I’ll say again – you need to start one. More listeners than ever.” I wouldn’t want to be one of those many podcasters who (as I surmise, at least, since I don’t listen to podcasts) have little to say or don’t say it very well, often the same people who exhibit those qualities in written form. Simply reading HIStalk or doing interviews into a microphone wouldn’t add much value.

From Roy G. Biv: “Re: HIMSS. You should hire someone dress up like your Smokin’ Doc and have him walk around the hall.” That idea is undignified and inappropriate and thus perfect. Lorre says every year how entertained she is by lines of CEOs and other booth-visiting dignitaries waiting for their chance for a Smokin’ Doc selfie, complete with their fingers curled in comradeship over his two-dimensional shoulder. An in-person variant would certainly be bizarre, although probably not embraced (literally or figuratively) by the HIMSS Police.   


HIStalk Announcements and Requests

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Not too many poll respondents burst with pride when thinking about their largest local healthcare system. I’m not surprised – of my health system employers, I recognize their competence in certain areas, but have seen as an insider the warts that make their communities rightfully wary.

New poll to your right or here: What is your experience using Apple Health Records to view your health system’s EHR data? The poll choices are terse by necessity, but click the poll’s Comments after voting to say what you really mean.

Thanks to the companies that offered Lorre a HIMSS20 exhibit hall pass. We’re set.


Webinars

September 5 (Thursday) 2:00 ET. “Driving 90% Patient Adoption Across Your Network: How US Dermatology Partners is Showing Us The Way.” Sponsor: Relatient. Presenters: Michele Perry, CEO, Relatient; Sara Nguyen, VP of applications and integrations, US Dermatology Partners. US Dermatology Partners is helping its physicians reclaim time they can spend with patients and is turning patient engagement strategies into business results across its 90 locations in eight states. Attendees will learn how US Dermatology Partners defined its patient engagement objectives and physician-optimized strategies. They presenters will provide advice on starting or accelerating  patient engagement goals.

September 26 (Thursday) 2 ET. “Patient Education Data: A Key Ingredient for Improving Quality and Patient Experience.” Sponsor: Healthwise. Presenters: Victoria L. Maisonneuve, MSN, RN, director of the Nursing Center for Excellence and Magnet program, Parkview Health; Marta Sylvia, MPH, senior manager of quality improvement and outcomes research, Healthwise. Healthcare data is everywhere! It’s scattered across various systems and in countless formats, making it difficult to collect and glean actionable information. Knowing where to start depends on what your organization wants to accomplish. Vicki Maisonneuve will share how her team analyzes data around the use of patient education. By combining different data sets, she can easily identify trends, gaps, and opportunities to improve quality and patient experience across Parkview Health.

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


Sales

  • UC San Diego Health chooses Phynd to manage provider information, integrating with the Epic system it shares with UCI Health.
  • Sunset Community Health Center (AZ) will implement MyHealthDirect for centralized call center patient scheduling and patient self-scheduling.

Announcements and Implementations

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Israel-based healthcare data analytics vendor MDClone raises $26 million in a Series B funding round, increasing its total to $41 million. The company’s technology translates patient data into a synthetic equivalent in which the actual PHI has been removed, allowing anyone to access and analyze patient-level data without compromising patient privacy. It’s a great idea with an uncertain market given that data and EHR vendors are happily selling patient data even without such protection and nobody seems to much care. Founder and CEO Ziv Ofek founded DbMotion and sold it to Allscripts for $235 million in 2013, while the chief medical officer and VP of innovation are also DbMotion alumni.


Government and Politics

Politico reports that the VA’s $16 billion Cerner rollout at three medical centers will likely be delayed from March 2020 to until October 2020.

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The VA’s OIG investigates how quickly eight of its medical facilities scan paper documentation sent by external providers (including incoming faxes) into the patient’s electronic chart, concluding that the VA’s backlog is a five-mile tall pile of paper of 597,000 documents going back to October 2016. HIM departments didn’t always complete quality review before the scanned documents were dumped into the shred bin, eliminating the possibility of correcting errors. The problems are usual VA ones — poor oversight, lack of monitoring, and short staffing.


Privacy and Security

Massachusetts General Hospital notifies 10,000 people that their information, which was stored in the databases of two neurology research applications, was accessed by an unauthorized third party.


Other

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Celebrities and wealthy people in Iran are hiring private ambulance services as “a taxi service with a siren,” allowing them to avoid Tehran’s never-ending traffic gridlock by running red lights and passing stopped cars, with overwhelmed police departments doing little to discourage the practice. Ambulance companies say the annoyed locals are now refusing to make way for the ambulances to pass, assuming that “it’s a celebrity going to get a haircut” instead of a patient in with a life-threatening problem.

In Zimbabwe, hospital administrators warn their underpaid nurses to stop eating patient food and bringing in refreshments to sell room to room.

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Epic kicks off its 40th birthday this week with UGM, whose theme is “Summer of ‘79.” Spoilers: musically that year, there was a lot of disco, drek from Barbra Streisand and Kenny Rogers, and some pretty good ELO. Small-diagonal, high-depth tube TVs played real-time programs like “M*A*S*H,” “Taxi,” “The Love Boat,” and “Dallas.” Few people ignored real life by staring at their phones unless they were counting down the minutes until cheaper rates kicked in. Clothing choices from back then best remain unexplored. “The Partridge Family” unfortunately went off the air a few years before 1979, otherwise Epic could paint one of the gazillion attendee buses in its trippy pattern and everybody could sing out the windows at puzzled Veronesi.


Sponsor Updates

  • Loyale Healthcare publishes a new industry analysis, “Healthcare Costs Continue to Soar as Patients Look for a New Kind of Provider Relationship.”
  • MDLive SVP Michael Farrell will present at the Connected Health Summit August 27-29 in San Diego.
  • Meditech recaps why it is positioned for continued growth in the UK.
  • Stratus Video partners with Mobile Heartbeat to enable access to interpreters on provider smartphones.
  • Netsmart will exhibit at the TAHCH Annual Conference and Meeting August 27-29 in Grapevine, TX.
  • Relatient and Unlimited Systems partner to make patient engagement easier for oncologists and cancer patients.
  • Surescripts will exhibit at Epic UGM August 26-29 in Verona, WI.
  • Vocera will present at several investor conferences in New York City in September.
  • NHSX and NHS England name Meditech as an accredited EPR supplier.
  • Aigilx Health selects Zen Healthcare IT’s Zen Stargate gateway solution for health information exchange.

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Weekender 8/23/19

August 23, 2019 Weekender 1 Comment

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Weekly News Recap

  • Revenue recovery software vendor Ontario Systems is acquired by an investment firm.
  • Allscripts announces availability of Apple Health Records in its EHRs.
  • A watchdog group publishes emails detailing the involvement of the “Mar-A-Lago crowd,” including an associate of President Trump, with the VA’s contracting with Cerner.
  • EHealth Exchange announces go-live of a national, single-connection gateway service.
  • A Nature article covers the responsible use of machine learning in healthcare.
  • Several investment firms are reported to be in discussions to buy Emids Technologies.
  • Ciitizen rates hospitals on how effectively they respond to patient requests for copies of their information.
  • An OIG report finds that the VA’s overdue, over-budget scheduling project is nearly finished, just in time to be replaced by its Cerner implementation.

Best Reader Comments

[From the author of a report predicting that clinical decision support systems will replace EHRs as the primary physician interface] CDS are now mostly point solutions, but the CDS vendors are expanding their reach and are discovering something interesting: the more they expand, the more EHR data is required. At some point most of the data in an EHR is then in the CDS. We have not reached that point yet, but when that happens, it makes logical sense to invert the model, where an EHR gates most health It functionality and change it to a model where the EHR is actually subordinate to a more user friendly interface: likely one that looks a lot like a CDS … The essential notion is solid: EHRs are not user friendly, but CDS generally are. This is an unstable dynamic and we believe that someone will move to address the problem. Also, we did talk to practically every CDS vendor as well as every EHR vendor and healthcare delivery organization. The interesting thing is that the idea that CDS would take over did not come from the CDS community, but came from the healthcare delivery community. (Mike Jude)

[To the author of the report above] You make some sweeping assertions without any basis in fact. “EHRs are not user friendly, but CDS generally are” – what is this conclusion based on? You assert “CDS are often developed in response to specific pain points: new regulations, new dosing requirements, etc.” Are there any serious CDS systems certified for Meaningful Use AND in general adoption by doctors at the point of care? And on what fact base do you assert that EHR vendors don’t “incorporate human factors to ensure low impact human interactions?” (Supporting good decisions)

[Referencing an article on Apple Health Records] How will access to my EHR data help me “shop for high value health care services” and “avoid the need to repeatedly supply data for entry?” These discussions are without substantive support in any fashion that I can see. I hope my tax dollars did not pay for this. (FormerCIO)

The ACR AUC system is ridiculous for specialist physicians. I am a board certified orthopaedic surgeon who knows when I need an MRI or CT scan. At what point does the system trust me to make a decision about the care of my patients? After two MOC exams? After 20 years in practice? Am I an outlier with studies? No. So if ACR wants to do AUC, then have the radiologists do it, not me. I know what study I need and want to care for my patients. If you think you know better, then you take over the care of the patient when you deny the test. (meltoots)


Watercooler Talk Tidbits

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Millennials who document every potentially enviable aspect of their lives on Instagram are hiring professional photographers to shoot both natural and C-section childbirth, with full-time birth photographers elbowing doulas out of the way to charge up to $4,000 at trendy hospitals like Cedars-Sinai and UCLA. They leave business cards in exam rooms and with providers who hand them out. OBs aren’t always thrilled with the potential additional malpractice exposure of having everything recorded in photos or video and hospital policies are often inconsistent or non-existent.

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A dozen of Facebook’s low-paid content moderators – contracted from Accenture to review up to 800 pieces of disturbing user content such as child sexual abuse in a single shift – accuse Accenture of trying for force company-provided “wellbeing counselors” to disclose the details of their trauma sessions in what they say is a violation of HIPAA.

SimplyVitalHealth, which offers “blockchain-based solutions to emerging value-based healthcare programs,” returns $6 million to investors after the SEC charges it with conducting an unregistered securities offering in the form of an Initial Coin Offering.

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Google DeepMind co-founder Mustafa Suleyman takes indefinite leave from the artificial intelligence company.

University Medical Center of El Paso disputes President Trump’s claim that its surgeons left the OR to see him in during his post-shootings visit there, reassuring the public that in no case would that ever happen. The president said surgeons came out of ORs in both El Paso and Dayton in a spontaneous showing of “the love for me.” 

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A Miami plastic surgeon self-styled as “Dr. Slimthick” whose billboards offer Brazilian butt lifts financed at $30 per week is found to have falsified most of the credentials claimed on his website. The local paper checked his background in running a story about one of his patients, a 35-year-old woman who remains in critical condition a month after he performed her procedure. His cosmetic center is offering a silicone implants or liposuction for $3,500 if you’re in the market.

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A Texas woman faces 20 years in prison after being accused after subjecting her healthy son to 323 hospital and clinic visits and 13 major surgeries in the first eight years of his life in a case of Munchausen syndrome by proxy. She had also started several online fundraisers for the boy, claiming that he was dying from a genetic disorder and later from cancer. She had placed him on a lung transplant list and enrolled him in hospice care, caught only when employees of a Dallas hospital called child protective services. 

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Wolfson Children’s Hospital (FL) posts a video of 15-year-old Yanira Guzaman, who was able to stand for the first time and dance with her father at her quinceañera thanks to spina bifida treatments and a new power chair.


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Morning Headlines 8/23/19

August 22, 2019 Headlines No Comments

Crew Obtains New Docs on Mar-a-Lago Member’s VA Influence

Emails from VA officials obtained by a watchdog group provide greater insight into the influence President Trump’s “Mar-a-Lago crowd” had on the VA’s contract with Cerner.

Ontario Systems Announces Investment from New Mountain Capital

New Mountain Capital acquires revenue recovery software vendor Ontario Systems, which counts over 600 hospitals among its enterprise healthcare and government customers.

Apple Health Records Available for Allscripts Clients

Allscripts releases access to Apple Health Records to users of Sunrise, TouchWorks, and Professional EHRs.

Former military records technician accused of bilking millions of dollars from US soldiers and vets

The Justice Department arrests five people for stealing millions of dollars from soldiers and veterans by taking photos of their AHLTA EHR screens at an Army base in South Korea, then using that information to log in to DoD’s self-service system to steal bank account details.

News 8/23/19

August 22, 2019 News 5 Comments

Top News

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A watchdog group obtains emails from VA officials – invoking the Freedom of Information Act – as they discussed the so-called “Mar-a-Lago crowd” of non-experts who provided advice to the VA with the implied endorsement of President Trump, with much of that involving its contracting with Cerner.

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One of the emails contradicts reports that the group’s involvement was unsolicited and that then-Secretary David Shulkin, MD resented it. The VA’s acting CIO asked the group for their help as recommended by Trump associate Bruce Moskowitz, MD, a West Palm Beach internist. 

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John Windom, who heads up the VA’s EHR modernization project, said a scheduled meeting was a “grin and bear it” session, while that group’s former chief medical officer termed their questions as “ridiculous” and lacking even a basic understanding of systems and interoperability.

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Moskowitz emailed to insist that the trio be “on every call that the group is on to discuss the contract.”

One of the released emails contains a detailed list of questions that were posed to the VA in response to Cerner’s RFP in a conference call with the group, with the VA providing detail for such observations such as:

  • Any requirement of “true interoperability” would require contractual terms with both Cerner and other primary EHR vendors such as Epic, Meditech, and Allscripts. The VA said its contract only covers Cerner, but the VA is pursuing partnerships with other health system providers “to meet Cerner’s commitment to data sharing.”
  • Commenters noted Cerner’s weakness in medical imaging.
  • An observer asked why the contract doesn’t require a single Cerner instance shared between the VA and DoD.
  • One commenter said their experience with Cerner is that reports from outside providers are imported as CCD/CCA and labeled as “Outside Material” instead of within normal workflow.
  • Another worried that a lack of definition of interoperability, observing that DoD users are “rebelling” over unsuitability for their needs.
  • One comment said that Cerner has lagged in FHIR development and assigned few resources to it.
  • A reviewer worried that instead of creating a next-generation system, Cerner will “just add more unmaintainable code to the existing spaghetti bowl.”

Reader Comments

From Grahame Grieve: “Re: Apple Health Records. HIStalk responded to a reader comment in saying that healthcare ‘embraces the most proprietary technology vendor in touting Apple-only patient access.’ I would like to point out that Apple has implemented the Patient API as published in the Argonaut specification, and the same interface is used by other vendors, including AllOfUs, CareEvolution, Coral Health, Ciitizen, 1UpHealth, PatientLink, and many others. While Apple may have business advantages due to their size and significance, any other vendor is able to use the same standard interface, and they are welcome to join with open FHIR community to help them do so.” Grahame is HL7 FHIR product director. A couple of folks offered other reasons that most people can access their health records only if they are among the fewer Americans that use Apple phones instead of Android: (a) Google hasn’t added that capability to Android; (b) Apple must have worked around some Epic licensing issues; and (c) health systems may be reluctant to create and maintain access to their systems for Android.

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From Alias: “Re: Pulse Systems. Acquired by Amazing Charts, A Harris Healthcare Company, last Thursday. Announced to Amazing Charts employees this week.” Unverified. I ran this as a redacted rumor from another reader on Tuesday, waiting to hear back from my inquiry to a Harris Computer PR contact before naming names (they never did respond). Pulse Systems is (or was, if the rumor is true) owned by France-based Cegedim.

From For Closers: “Re: healthcare sales roles. After years (decades?) of reading HIStalk, I’ve seen several people show up more than once in the People section. Has anyone ever analyzed the number of retread healthcare sales roles? It seem a bunch of folks just flit from company to company to be VP of sales.” Good question, although hard to answer without of LinkedIn digging to (a) find experienced health IT sales VPs, and (b) count how many jobs they’ve had as sales VP (or the trendier chief revenue officer or chief growth officer titles). I’m also surprised at how often a CIO has been burned by a vendor’s oversold product, but then buddies up to the same salesperson who has moved on to another vendor. You might reasonably assume that a relationship history is not a plus when it involves lying and the resulting buyer’s remorse, but CIOs can be like doctors who let drug salespeople pull their strings – they can be manipulated to think that the salesperson is their trusted ally and personal friend.


HIStalk Announcements and Requests

Lorre asked me what we will do at HIMSS20 now that we don’t have HIStalkapalooza or an exhibit hall booth to deal with. I’m thinking we’ll just cruise around looking for news and rumors, although (a) Lorre could use an exhibitor’s pass if anyone has a spare; and (b) I guess our Smokin’ Doc standee will have to stay home since we don’t have a booth so passersby can take selfies, which is perfectly fine since his box is a pain to cart around. 


Webinars

September 5 (Thursday) 2:00 ET. “Driving 90% Patient Adoption Across Your Network: How US Dermatology Partners is Showing Us The Way.” Sponsor: Relatient. Presenters: Michele Perry, CEO, Relatient; Sara Nguyen, VP of applications and integrations, US Dermatology Partners. US Dermatology Partners is helping its physicians reclaim time they can spend with patients and is turning patient engagement strategies into business results across its 90 locations in eight states. Attendees will learn how US Dermatology Partners defined its patient engagement objectives and physician-optimized strategies. They presenters will provide advice on starting or accelerating  patient engagement goals.

September 26 (Thursday) 2 ET. “Patient Education Data: A Key Ingredient for Improving Quality and Patient Experience.” Sponsor: Healthwise. Presenters: Victoria L. Maisonneuve, MSN, RN, director of the Nursing Center for Excellence and Magnet program, Parkview Health; Marta Sylvia, MPH, senior manager of quality improvement and outcomes research, Healthwise. Healthcare data is everywhere! It’s scattered across various systems and in countless formats, making it difficult to collect and glean actionable information. Knowing where to start depends on what your organization wants to accomplish. Vicki Maisonneuve will share how her team analyzes data around the use of patient education. By combining different data sets, she can easily identify trends, gaps, and opportunities to improve quality and patient experience across Parkview Health.

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


Acquisitions, Funding, Business, and Stock

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New Mountain Capital acquires revenue recovery software vendor Ontario Systems, which counts over 600 hospitals among its enterprise healthcare and government customers. NMC has also invested in healthcare companies like Ciox Health, which it acquired in 2014 back when it was known as HealthPort.


Sales

  • University of Maryland St. Joseph Medical Center will offer the Babyscripts app and remote monitoring support to expectant mothers.
  • Wentworth-Douglass Hospital (NH) will implement Epic in October through a software-sharing arrangement with parent company Partners HealthCare.

People

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RCM and analytics vendor AGS Health names Patrice Wolfe (Medicity) CEO.


Announcements and Implementations

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Allscripts releases access to Apple Health Records to users of Sunrise, TouchWorks, and Professional EHRs. Test sites include Sharp HealthCare, Erie County Medical Center, and Sarasota Memorial Health Care System.

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UCHealth affiliate Ivinson Memorial Hospital (WY) will go live on Epic this weekend.

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Appriss Health develops SMART on FHIR capabilities for its PMP Gateway integration software for state PDMPs.

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Adventist Health’s Rideout Hospital (CA) implements Cerner. The company took over management of the multi-state health system’s revenue cycle and clinical applications IT staff last year.

Einstein Medical Center (PA) keeps its Cerner Millennium go-live on schedule by migrating data from several legacy systems using the robotic process automation and integration platform of Boston Software Systems, avoiding manual entry and creating  a consistent, low-complexity process to make appointment and registration data available for go-live.


Government and Politics

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Politico reports that Genevieve Morris will run for office as a Republican in Maryland’s second congressional district. Morris spent a year as ONC’s principal deputy national coordinator and then just two months as the VA’s chief health information officer, a role she relinquished last summer after realizing that her vision for the Cerner implementation differed from that of her colleagues.


Other

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The Justice Department arrests five people for stealing millions of dollars from soldiers and veterans by taking photos of their AHLTA EHR screens at at Army base in South Korea, then using that information to log in to DoD’s self-service system, which provides access to 70 military systems with a single username and password. One of those systems stores the individual’s bank account and routing numbers to which government payments are sent, allowing the conspirators to transfer money, sign up for loans, and have VA payments made directly to them. One of the group’s “money mules” was a military dependent labeled as “GH,” who the conspirators threatened for slow payments by looking up GH’s own AHLTA record to find family members they could threaten.

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In an interview with Xconomy, John Halamka, MD weighs in on the hype surrounding AI in healthcare, noting that its usefulness will likely come from enhancing behind-the-scenes clinical workflows rather than the more headline-grabbing notion that AI will eventually replace physicians: “Machine learning is very good, but empathy and respect and active listening – that would not be the first use case I would pursue.”

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Cancer patients in Port Arthur, TX say they will pursue legal action against the Medical Center of Southeast Texas for abruptly closing a cancer center last year, a development they contend has prevented them from accessing their medical records and continuing treatment elsewhere. The center’s majority owner, Trip Chaudhury, MD, contends the center closed due to a dispute with MCST over repairs that needed to be made, while hospital representatives say the center was closed for non-payment of rent by Chaudhury and that he was (and still is) responsible for equipment maintenance and records access.


Sponsor Updates

  • Einstein Medical Center (PA) leverages software and consulting services from Boston Software Systems to migrate appointment data from its legacy systems to Cerner Millennium.
  • Elsevier Clinical Solutions, Healthfinch, Healthwise, InterSystems,  and Intelligent Medical Objects will exhibit at Epic UGM August 26-29 in Verona, WI.
  • Ensocare will exhibit at the ACMA Louisiana Chapter Annual Conference August 24 in Baton Rouge.
  • Hayes Management Consulting names David Rajfer (Athenahealth) product manager and Lizz Fuller (Athenahealth) implementation project manager.
  • Gartner includes Imat Solutions in its report on “The Current State of Clinical Data Integration Among US Healthcare Payers.”
  • ConnectiveRx will exhibit at NACDS Total Store Expo August 25-27 in Boston.
  • Redox announces that its customer base grew 33% over the first half of 2019.
  • TransformativeMed renews its Core Workflow Suite contract with VCU Health (VA), and announces it will become a strategic development partner to fast-track mobile notifications and messaging into EHR workflows.
  • As a payment facilitator, Patientco gives health systems more flexibility to address patient payment needs.
  • A new report from Surescripts covers the ways in which the Surescripts Network Alliance has helped improve e-prescription accuracy by 64% over the last three years.

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EPtalk by Dr. Jayne 8/22/19

August 22, 2019 Dr. Jayne No Comments

Time is ticking for practices that haven’t completed the full transition to the new Medicare Beneficiary Identifier numbers. Claims submitted with the previous numbers will be rejected starting January 1, 2020. At this point, the new MBI is only being used for 77% of Medicare fee-for-service claims. Given the duration of the transition period, I’m surprised to hear that nearly a quarter of claims are still going out under the old numbers.

Telehealth is of interest to many young active patients, but clinicians are concerned about how well it might work for older patients for whom technology might be a challenge. A recent research letter details findings on video visits that were used with homebound geriatric patients. Physicians in New York state piloted the program from June to December 2018 as they sought to identify cost-effective ways to care for older adults. The authors labeled the program as “not yet ready for prime time” even though most patients and medical social workers involved in the study felt that when a video visit was successful, it met their needs and was preferred over long wait times for in-person visits. The difficulty apparently stems from inability to successfully complete the visits, with only a 49% completion rate. Installation of the telehealth app was performed by researchers after patients were identified from a pool of enrollees in a home-based primary care program.

Of 500 eligible patients, only 56 were enrolled. Patients were assessed to ensure they were cognitively and technologically capable of conducting a visit and that there was a family caregiver willing to participate as well. Even with those controls, there were a number of technical and equipment compatibility issues, with only 39 patients completing at least one video visit with their medical social worker. The average visit length was 18 minutes. The average patient was 85 years old and issues cited included failure to remember their Apple ID or passwords. Another issue involved two-factor authentication, where patients had to receive a code to access the app before they could enter the video conference.

There are significant shortages for home-based primary care for the frail elderly who want to remain in their homes. I’d argue that even with the challenges, if we could manage a percentage of patients via video, that might be better than the current state of affairs. Using technology that doesn’t require an Apple ID (especially since Apple is no longer the darling many people once thought it was) and relaxing the need for two-factor authentication might increase the percentage of successful visits. The authors next plan to pilot a device that connects via a patient’s home television and allows use of a TV remote, which might be a better option for the target population.

There are so many publications from CMS and other governmental entities that I occasionally miss something interesting. Apparently deep within the interoperability proposed rule is a provision that requires hospitals to inform primary care physicians about patient admissions, transfers, and discharges. Although Accountable Care Organizations want access to the data, hospitals are pushing back. One stumbling point is the need to inform physicians of these activities electronically.

Another is the requirement of this notification as a condition of Medicare participation for the hospital. It also would require hospitals to determine which physician might be the most appropriate to notify. I’ve worked with the attribution issue for several of my clients and it’s never straightforward, especially when patients might have recently changed primary care physicians or when they might be admitted for a problem that is primarily under the care of a subspecialist. Patients and patient advocates are also wading into the discussion, claiming that notifying physicians without express patient consent is a violation of privacy. The comment period on this particular proposed rule closed in May, so we’ll have to see what changes might be made.

For those of us who closely monitor Medicare spending, not only professionally but personally (hoping there will still be some money available when we get to the magic age), take a look at this piece on wasteful drug spending. One of the tricks commonly used by pharmaceutical manufacturers to extend their revenue streams is the creation of drugs that are nearly identical to existing drugs, but that are different enough to have their own patent. A recent study looked at spending on these drugs and found that Medicare could have saved nearly $17 billion from 2011-2017 by substituting 12 older drugs for the newer agents. There is little clinical evidence that these newer drugs deliver better outcomes than their older generic precursors. Researchers used the Drugs@FDA database to identify drugs that had been approved and analyzed both Medicare and patient out-of-pocket spending on the drugs. The out of pocket spending by patients could have been reduced by $1.1 billion on top of the Medicare savings.

Healthcare IT could be positioned to help educate prescribers and patients about this issue through a variety of strategies. One might be displaying relative cost at the point of prescribing. Another might be showing therapeutic equivalents as a part of clinical decision support. Payers are already trying to stem the tide by putting the higher-priced drugs on higher formulary tiers, which are easily identified in some EHRs. I wonder if the development of some of this functionality in current EHRs is being stymied by the vendors’ engagement with pharmaceutical companies, since several are selling patient data behind the scenes.

Another option would be to use clinical decision support to prompt lifestyle interventions before prescribing some of the drugs and enrolling patients in care management programs to ensure they can be successful with lifestyle change. Those are more high-touch options that are less popular in our US culture, however. It’s easier to take a pill and many patients find taking the latest and greatest drug to be desirable regardless of the cost.

Mr. H scooped me with his report on the Patient Record Scorecard, which grades hospitals on how effectively they respond to records requests from their patients. I had heard about it in a different context, when a reader clued me in to a site called MedRxiv (prounced “med archive”) which describes itself as “The Preprint Server for Health Sciences.” Essentially, the site is publishing manuscripts that are preliminary in nature and haven’t yet been through a peer review process. The site was founded by non-profit Cold Spring Harbor Laboratory, Yale University, and BMJ and operates as “a platform for researchers to share, comment, and receive feedback on their work prior to journal publication.” I hope the authors of the Scorecard can ultimately get their findings published since they seem consistent with what many of us are experiencing.

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Reader Comments

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  • Robert D. Lafsky: The term "copy/paste" is used excessively in a way that obscures problems with current EMR use. Plagiarizing someone el...
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