News 8/9/17

Top News

UC San Diego Health (CA) moves from its self-hosted Epic system to an Epic-hosted, cloud-based system, the first academic medical center to undertake that particular migration.

UCSD says it is shifting away from running its own hosted centers to cloud-based systems because of cost and reliability. The Epic switch involved 10,000 workstations and integration of 100 third-party applications.

UC Irvine Health will move to UCSD Health’s Epic cloud-based instance in November 2017.

UC San Francisco announced a $10 million grant in late July that will fund a project to mine the combined Epic databases of all five UC medical centers to discover new insights and possibly find new uses for existing drugs.

Reader Comments

From Sister Sledge: “Re: Allscripts. One of the rags ran a map of where McKesson EIS had customers, claiming that geography matters to a vendor and that Allscripts will benefit from gaining more customers in the West. Think so?” I don’t think so. Geography can affect sales, but only for companies that have clear momentum and neither McKesson nor Allscripts have ever had that. My prediction is that Cerner, Epic, and maybe Meditech will benefit most when those customers start looking for replacement systems. It’s not at all similar to when Cerner bought Siemens Health Services and could offer them a lifeline from their rapidly sinking systems to a market-leading one. Allscripts can boast about a higher customer count or wider geographic reach, but a lot of those customers are likely to defect in the next few years as the Cerner and Epic train keeps rolling over everything in its path (accelerated by big hospitals buying smaller ones) and the acquisition encourages those former McKesson customers to review their positions. The direction of change in customer satisfaction post-acquisition will predict a lot. MDRX shares are at the same price as they were in mid-1999, so stock performance won’t create much confidence – Cerner shares are up 322 percent in the past 10 years, McKesson shares are up 167 percent, and the Nasdaq index is up 136 percent, all while Allscripts shares were losing 52 percent of their value. 

From Lucille Two: “Re: Epic’s response to Politico’s article about Joe Biden. Don’t you find Epic’s PR statement a bit confusing, saying that the VP was ‘consistently polite and positive’ unless it’s to cover their tracks? Wouldn’t Biden’s staffer, who has no reason to disparage him, know him well enough?” Politico excerpted comments from a video made at a conference’s fireside chat by Greg Simon, now president of the Biden Cancer Initiative, who said the VP and Epic CEO Judy Faulkner got into a heated exchange over why Biden might want his own full medical record. I wasn’t there and Simon was, but my observations from watching him tell the story on video are:

• Simon seemed a bit swaggering and over-the-top in the video, which left me feeling that his comments were more of an entertaining story for the in-person conference audience rather than a trustworthy, verbatim discussion of what was said by others in his presence.
• Simon’s tone in the remainder of his remarks was clearly anti-EHR vendor. I got the feeling that the Biden story was his chance to take a shot at them. 
• The conversation between Biden and Faulkner he described took place nearly seven months ago, resulting in zero reaction until the conference video from Simon’s session was published.
• Simon’s background: aide to VP Al Gore, lobbyist, charity founder, drug company executive. He’s long been a critic of the lack of data-sharing in healthcare, but he originally seemed to blame providers rather than EHR vendors in saying, “The technology of sharing has increased exponentially, but the willingness to share has not.” 
• Others in attendance (it was not a private meeting) have not corroborated Simon’s account, and in fact have said the meeting was, as Faulkner said, cordial and polite.
• Even accepting Faulkner’s supposed comments at face value, it’s a leap to assume that her message was dismissive, paternalistic, or defensive about patients accessing their data. Tone is everything and her supposed comment that Biden wouldn’t be able to make sense out of an Epic EHR data dump is generally accurate, although perhaps Biden took offense thinking he was being spoken down to.
• The bottom line for me is that it’s much ado about nothing regardless of whether Simon’s recap is accurate. It was a fun story for a couple of days, but not necessarily accurate or indicative of any particular trend or practice, especially in the absence of commentary from Biden himself. If he were that riled up, he’s had seven months to say so.

HIStalk Announcements and Requests

I notice that Rolling Stone has a profile of singer-songwriter Khalid mentioned on the cover of the current issue, mostly because I recommended his music in January 2017 with my summary, “Mark your calendars for six months from now – Khalid is going to be big.” 

Webinars

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

Acquisitions, Funding, Business, and Stock

Pharmacy supply chain technology vendor Swisslog Healthcare acquires Talyst Systems, which offers medication management solutions to acute care and long term care facilities. 

Evolent Health reports Q2 results: revenue up 89 percent, EPS –$0.13 vs. –$0.25, beating revenue expectations and meeting on earnings. News of the company’s plan to launch a $175 million secondary public offering  sent shares down 17 percent in early after-hours trading Tuesday.

Sales

Connecticut Children’s Hospital chooses InstaMed’s healthcare payments solution.

Toronto-based Baycrest Health Sciences selects Caradigm’s single sign-on and context management systems.

People

Stephen Grossbart, PhD (Stephen Grossbart and Associates) joins Health Catalyst as SVP of professional services.

Ingenious Med hires Girish Pathria (Visiant) as VP of products and insights and names Nancy Cunningham (Accord Services) as VP of implementations.

Susan Steagull (Novant Health) joins VCU Health System (VA) as CIO.

Announcements and Implementations

Fresno Surgical Hospital (CA) goes live on FormFast’s electronic signature solution in its Meditech environment.

Privacy and Security

The now-retired NIST manager who in 2003 was ordered to quickly develop password-setting guidelines says he was wrong about recommending that passwords be required to conform to bizarre rules that require mixed-case letters and special characters. New NIST guidelines recommend that passwords be created from long but easily-remembered phrases. Analysis found that a password like “correcthorsebatterystaple” would require 550 years to crack, while an old-rules version such as “Tr0ub4dor&3” could be broken in just three days. The guidelines also say that passwords need not be auto-expired, with users forced to change their passwords only if they are known to have been compromised.

In India, a hospital IT director and one of his former employees are arrested for stealing hospital data required for accreditation and selling it to other hospitals.

Other

A study of all US opioid prescriptions issued over a nine-year period finds that doctors who graduated from low-ranked medical schools prescribe a lot more opioids than those who attended top-tier programs, concluding that physician educational outreach might help with overuse. Based on the graph above, it looks like osteopaths (DOs) are a much bigger problem than just about everyone else, including foreign medical graduates, although that wasn’t the subject of the study. I’m not sure I buy the conclusion, however, since it would be interesting to also look at number of years since graduation and the practice location — I would bet that many graduates of top-ranked schools tend to practice locally afterward and have a different kind of peer group and big-hospital oversight that happens mostly in major teaching hospitals with employed doctors. The bottom-ranked schools, in case you are as interested as I am, are Drexel, University of Nevada, Michigan State, West Virginia University, and University of South Carolina, which might be especially concerning if your doctor finished at the back of the pack of his or her graduating class.

Oopsie.

A researcher observes with some alarm that post-Millennials are “on the brink of the worst mental health crisis in decades” because they spend all their free time on Snapchat or texting instead of physically interacting with people, with a steep drop-off in time spent with friends even though virtual interaction leaves them less happy. Those who proudly document their activities on social media also cause everybody else to feel left out or to obsess over how many “likes” they earn. In a somewhat related article, a small study finds that AI-powered analysis of Instagram photos (color, comments, likes, posting frequency) is much more accurate at diagnosing depression than face-to-face doctor visits.

Giving employees a healthcare price transparency tool didn’t reduce overall spending, a study finds, noting that only 12 percent of the employees even bothered to look at it. The price tool saved an average of 14 percent of the cost of advanced imaging studies, but only 1 percent of those patients consulted the tool before having the test performed.

We are so blessed in healthcare IT to have access to a $3,480 report written by obvious experts.

In Egypt, 10 doctors launch an operating room-themed restaurant that claims its food is safer because of the medical training of the owners.

Sponsor Updates

• Aprima will host its annual user conference August 18-20 in Dallas, TX.
• Besler Consulting releases a new podcast, “Preparing for the Social Security Number Removal Initiative.”
• Optimum Healthcare IT publishes a white paper titled “Epic Upgrades are Epic Events.”
• Nordic publishes a podcast titled “Why change management is critical to a successful EHR transition.”
• EClinicalWorks announces that users of its EHR have exchanged two million documents in the past 12 months through the Carequality Interoperability Framework.
• Dresner Advisory Services honors Dimensional Insight with its Industry Excellence Award for business intelligence expertise.
• Glytec showcases the impact its therapy management software along with connected device systems has on insulin management at the American Association of Diabetes Educators conference.
• Healthfinch VP of Operations and Finance Leah Roe will speak at Forward Fest Madison August 17-24 in Wisconsin.
• Influence Health announces the speaker lineup for its Influence! Healthcare Consumer Experience Conference September 27-28 in Orlando, FL.

Blog Posts

• Why Can’t We Put Our Cell Phones Down? (Direct Consulting Associates)
• ONC Approves NCQA’s Alternative Electronic Clinical Quality Measure testing method (Diameter Health)
• The Downside of Data Science (Dimensional Insight)
• Experience (and Relationships!) Impact Our Health Outcomes (Docent Health)
• Changing nutrition habits to boost community health (EClinicalWorks)
• Rapid reviews and recognition are all the RAVE (Infor)
• Top Ways Meditech is Committed to Interoperability (Meditech)
• Redefining Awareness Month Success – Strategies for More Effective Breast Cancer Awareness Campaigns (Evariant)
• Overcoming 3 Healthcare Data Analytics Challenges with Intelligent Analysis (Hayes Management Consulting)
• Archiving: Your Healthcare Cybersecurity Strategy (The HCI Group)
• Hospital and Healthcare IT Survival Guide for the Post-EHR Era (Iatric Systems)
• How are Your Employees Motivated in a Crisis? (Impact Advisors)
• Community Hospital Anderson Ensures Positive Patient Identification (Imprivata)
• The Need for Speed in Healthcare CMS (Influence Health)
• The True Cost of Paper for Payers (InstaMed)
• Precisely Speaking – Part 2 (InterSystems)

Contacts

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

Morning Headlines 8/8/17

Internet-based EHRs gaining some customers but still a small segment

Modern Healthcare reports that cloud-based EHRs are increasing in popularity due to a perceived advantage in staffing and cybersecurity.

Anthem takes harder line on ER visits

In an effort to reduce unnecessary ER visits, Anthem warns its customers that it may start denying non-emergency ER services, leaving patients with the bill.

A shift in the fitness wearables market spells trouble for Fitbit

Fitbit’s share of the wearables market dropped from 27 to 16 percent in the last year, as Chinese consumer electronics manufacturer Xiaomi continues to expand its marketshare.

Tenet Reports Results for the Second Quarter Ended June 30, 2017

Tenet Healthcare Corporation reports Q2 results: revenue dropped 1.4 percent to $4.8 billion, resulting in an overall net loss of $56 million. Adjusted EPS –$0.17 vs. $0.40. Tenet also lowered its forecasted annual revenue, citing low patient volumes, which sent stock prices down 10 percent in afterhours trading Monday.

Curbside Consult with Dr. Jayne 8/7/17

I’ve been working on a project involving laboratory interfaces for a mid-sized multispecialty practice that is trying to integrate with multiple local hospitals. They’re valiantly trying to stay independent, which is quite a challenge given the rampant consolidation that is going on in nearly every healthcare market.

The practice’s leadership figures that if they interface with the hospitals in addition to the reference labs they already send to, it will make it easier to manage patients regardless of where they are admitted. As they were putting together this plan, however, they didn’t understand the complexity of working with organizations that aren’t entirely focused on earning the practice’s laboratory business like the national reference labs are.

Since the practice’s previous interface projects took 30 to 45 days, they assumed that working with the hospital would be the same. They also assumed that the hospital laboratory representatives who regularly come to the practice to tell them about new tests would be able to assist them in navigating the entire process, not realizing that those reps were more sales agents than true account managers.

The first surprise came when Hospital One told them it would be a minimum of three months before they could even talk about a timeline for starting a lab interface project, so they would have to stay on paper for the foreseeable future. It would be a fairly straightforward process to create a printable laboratory requisition so we could move the practice away from the hospital’s carbon-paper form and into EHR-based ordering. However, the lack of an interface had already created a significant amount of extra work for the nursing staff who was expected to manually key all lab results that were related to reportable clinical quality measures.

Even though we couldn’t fix the interface problem, I helped them create a new workflow for keying the results, which involved their medical records staff in addition to the nursing staff, so the workload could be better distributed. Cross-training is always a good thing, and assuming adequate training and quality assurance review, there was no reason why the medical records staff couldn’t be part of the workflow. Still, given the nature of the one-off workflow to key results, compared to the interfaces with the reference labs, I didn’t foresee the practice sending any more orders to Hospital One than they had been with handwritten orders.

Hospital Two was a significantly more accommodating, probably in part due to the fact that the practice hadn’t been sending business to its lab previously. Although they didn’t have available staff to assist with a bi-directional interface project, they were willing to set up a results-only interface that would at least allow discrete results to come into the patient chart without the staff needing to be involved.

Unfortunately, the client’s EHR handles this type of situation by creating two orders in the patient chart — one for the actual order and one that is created when the unsolicited result hits the system. This leads to extra work because someone has to reconcile the orders and match them up, and it would leave the practice with the same amount of extra work as the first hospital. When I mentioned the inconvenience and asked if they were willing to help us implement a workaround that would function as a semi-solicited interface, they were eager to hear about what it would take.

Having done it with other clients, I knew the hospital’s lab system was capable of holding the client’s internal accession number, and that keying it on each order would solve the problem. Usually only about half the hospitals I interact with are willing to do this, often citing the risk of error or the magnitude of the extra work for their lab staff. However, this facility jumped at the chance to see if they could make it work in order to obtain a piece of the practice’s business.

They were so eager to move the project forward that they agreed to send someone to the practice to key in the orders for testing so that the practice didn’t have to hardly expend any resources. Once the orders were keyed, they resulted them promptly, faster than almost any hospital lab I’ve ever worked with. The entire testing phase took barely more than a week and they resolved any issues that were found by the end of the next business day. I have to admit, it was a dream project and the entire thing was done in less than four weeks.

Many of us in healthcare are a tiny bit superstitious (never say the word “quiet” in the emergency department) so I knew that given the success of the project with Hospital Two that the next project was likely to be a nightmare. My vague suspicion grew into actual worry when I met the IT project manager the hospital had assigned to the interface project. I could sense the rarified air around him as soon as I walked in the room and had to suffer through his overly complicated explanation of what an interface project entails. I think he assumed that as a physician I didn’t know anything and he totally missed the part where the practice administrator explained that I was their consultant and had assisted multiple clients with interface projects.

He went on for a good 20 or 30 minutes that seemed like a lifetime, talking about all the important work the hospital IT team would be doing to make the interface happen and how little the lab and practice teams would impact the process. When I finally was able to jump in and explain my experience and the practice’s goals and objectives, I was treated to a rainbow of colors on his face as he went from angry red to bilious green to white. I think it had honestly never occurred to him that anyone on the practice side could have a clue how things should be done.

Since he claimed he didn’t have a sample project plan to review with us, I provided him with my own, which produced an outstanding level of pallor as he realized he wasn’t going to be able to put one over on us. We asked him to review the proposed timeline and comment on it and he said he would be able to get back with us in the next couple of weeks. That’s never a good sign, but I couldn’t tell if he was actually backlogged or just being passive aggressive. As time went on and he haggled about everything from the selection of components for the test scripts to the way in which labs would be resulted, I knew it was the latter. The project has been stalled in every imaginable way, with various resources being unavailable or on vacation at various times despite the hospital having agreed to a project plan and timeline.

The practice’s pleas to hospital leadership have fallen on deaf ears. This week I’ll have to have a serious discussion about halting the project. We’ve been using too many resources with little return, and if this is how a hospital acts when a practice wants to send them their business, I doubt they’ll be responsive if there are issues. The other hospital’s semi-solicited interface has been working like a dream, and to the end users, it functions just like the reference labs’ bi-directional interfaces. There are a couple of kinks for the practice’s IT staff every now and then, but overall, it’s been a big success. There simply isn’t much reason to continue working with a competitor hospital that just puts roadblocks in the way.

It will be interesting to see whether the first hospital ever circles back to us or whether a halted project will bring the third one in line. I suppose some hospitals are simply so big that they forget about their base, or maybe leadership just lets certain constituencies run amok. I can’t say that healthcare IT will ever be dull and am grateful that organizations like this create job security for people like me.

How does your hospital earn business from independent practices? Email me.

Email Dr. Jayne.

Morning Headlines 8/7/17

Allscripts announces second quarter 2017 results

Allscripts reports Q2 results: revenue increased 10 percent to $426 million, adjusted EPS -$0.85 vs. $0.05. The company announced it would write off $145 million of its $200 million investment in NantHealth, due to NantHealth’s poor stock performance.

Siemens, DHS warn of “low skill” exploits against CT and PET Scanners

Siemens warns customers of four software vulnerabilities in its molecular imaging systems that would allow hackers to gain remote control of the systems.

WannaCry hero Marcus Hutchins could face 40 years in US prison

The cybersecurity expert that stopped the WannaCry global cyberattack has been arrested in the US, where authorities say he helped create and sell malicious software that targeted bank accounts. He faces up to 40 years in prison if convicted.

‘Pharma bro’ Martin Shkreli found guilty of 3 of 8 charges, including securities fraud

Martin Shkreli has been found guilty of defrauding investors of his two hedge funds and paying them back with stock and cash that he stole from his biotech company, Retrophin.

Monday Morning Update 8/7/17

Top News

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

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

Other items from the Allscripts earnings call:

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

Reader Comments

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

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

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

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

HIStalk Announcements and Requests

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

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

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

This Week in Health IT History

One year ago:

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

Five years ago:

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

Ten years ago:

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

Weekly Anonymous Reader Question

Responses to last week’s question:

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

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

Last Week’s Most Interesting News

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

Webinars

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

Decisions

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

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

Announcements and Implementations

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

Privacy and Security

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

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

Other

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

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

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

Sponsor Updates

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

Blog Posts

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

Contacts

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

Morning Headlines 8/4/17

Allscripts to acquire McKesson’s Enterprise Information Solutions business

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

Remarks by President Trump at Department of Veterans Affairs Telehealth Event

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

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

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

News 8/4/17

Top News

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

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

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

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

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

Reader Comments

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

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

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

HIStalk Announcements and Requests

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

Webinars

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

Acquisitions, Funding, Business, and Stock

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

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

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

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

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

Sales

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

People

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

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

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

Announcements and Implementations

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

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

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

Government and Politics

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

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

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

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

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

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

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

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

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

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

Privacy and Security

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

Other

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

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

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

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

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

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

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

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

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

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

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

Sponsor Updates

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

Blog Posts

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

Contacts

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

EPtalk by Dr. Jayne 8/3/17

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

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

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

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

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

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

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

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

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

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

Email Dr. Jayne.

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

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

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

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

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

Morning Headlines 8/3/17

Cancer moonshot head recounts exchange with Epic’s Faulkner

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

Merck Announces Second-Quarter 2017 Financial Results

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

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

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

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

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

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

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

Morning Headlines 8/2/17

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

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

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

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

Fees for Certification and Finances of Medical Specialty Boards

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

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

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

News 8/2/17

Top News

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

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

ATHN shares rose 5.6 percent Tuesday.

HIStalk Announcements and Requests

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

Webinars

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

Acquisitions, Funding, Business, and Stock

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

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

From the Quality Systems earnings call:

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

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

Sales

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

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

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

People

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

OptimizeRX hires Miriam Paramore (Lucro) as president.

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

Announcements and Implementations

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

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

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

Government and Politics

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

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

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

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

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

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

Privacy and Security

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

Innovation and Research

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

Other

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

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

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

Sponsor Updates

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

Blog Posts

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

Contacts

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

HIStalk Interviews Girish Navani, CEO, EClinicalWorks

Girish Navani is CEO of EClinicalWorks of Westborough, MA.

Tell me about yourself and the company.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Do you have any final thoughts?

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

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

Morning Headlines 8/1/17

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

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

Republicans ignore Trump’s Obamacare taunts

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

Baltimore-based Evergreen Health to be liquidated

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

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

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

Curbside Consult with Dr. Jayne 7/31/17

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Email Dr. Jayne.

Digital Health Fragmentation – Is Amazon the Answer?

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

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

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

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

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

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

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

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

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

Morning Headlines 7/31/17

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

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

Cerner (CERN) Q2 2017 Results – Earnings Call Transcript

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

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

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