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Morning Headlines 6/18/19

June 17, 2019 Headlines No Comments

CMS proposes to update e-prescribing standards to reduce provider burden and expedite access to needed medications

CMS issues a proposed rule that will give providers the option to complete prior authorizations electronically and in real time so that patients can be assured their Medicare Part D prescriptions will be filled before going to the pharmacy.

New opioid treatment center ‘OneFifteen’ opens in Dayton

Stakeholders host a ribbon-cutting ceremony for the opioid addiction treatment center OneFifteen, soon to be a campus of tech-enabled recovery and social services launched by Kettering Health Network, Premier Health, and Verily.

Rite Aid Partners with Adobe to Drive Digital Transformation

Rite Aid will leverage Adobe’s Experience Cloud to gain better insight into customer preferences and habits, and to help its pharmacists better connect customers to the store’s health and wellness offerings.

A controversial startup that charges $8,000 to fill your veins with young blood and halted operations after an FDA warning now says it’s back up and running

Ambrosia resumes its “rejuvenating” blood transfusion service in San Francisco and Tampa, FL after shutting it down in February due to an FDA warning letter.

Curbside Consult with Dr. Jayne 6/17/19

June 17, 2019 Dr. Jayne 2 Comments

I wrote recently about a less than optimal shift where we had multiple intermittent issues with our EHR that impacted electronic prescribing and several other key functionalities. Although the issue was fairly serious, it turns out that a good portion of the lack of communication our users experienced was the fault of our practice leadership rather than the vendor. In trying to “protect” the clinicians from what they felt would be distracting, they erred in providing too little information. It turns out the vendor was communicating pretty well, but they weren’t passing on the information to those of us on the front lines.

This is a challenge for any healthcare organization – figuring out the right way to communicate about serious issues and knowing how often to provide updates, even if the update is “no update.” In organizations where clinical leaders work closely with the IT team, there can be good conversations around a service disruption and how to handle it. There can be discussions about user culture – whether they would benefit from more information or less and whether the disruption is more of an annoyance or a disaster. When clinical and technology leaders don’t work together, there’s an increased risk of erring too far in one direction or another.

I still encounter organizations that don’t believe it’s important to have dedicated clinician support for health information technology systems. When I put on my consulting hat, one of my tasks is to try to convince these practices that they can’t afford not to have clinician leadership where EHRs and other systems are concerned.

I recently pitched to a convenient care practice that has almost 100 providers. They have one nurse who spends a couple of hours each week working with the EHR, mostly responding to specific end user questions rather than working on global strategy. I spent a few days in the practice to identify potential opportunities for workflow improvement as well as long-term strategies.

The first thing I identified while watching physicians document was that none of the physicians were using medication favorites. Apparently they aren’t allowed to build their own favorites because the organization is concerned about upkeep. Instead, there are some global favorites that everyone can use, but that might not be aligned with current treatment guidelines. Providers can delete the global favorites, but can’t put anything in their place, leading to the opportunity for errors when physicians try to use the global favorites and edit them as they go.

There were some order sets available, but they weren’t very complete, and many common diagnoses didn’t have associated order sets. As a result of providers not being able to build their own order sets, I observed several clinicians using Word documents that contained their most common patient instructions that they would copy and paste into the free-text plan field. Some of these makeshift order sets didn’t seem terribly evidence-based and they varied dramatically from person to person. The diagnosis screens were cluttered with diagnoses that didn’t seem to be commonly used, while providers were having to search for conditions that they treated several times each day.

When I perform a practice analysis, I also dig into how the practice handles upgrades and changes to payer requirements or federal programs. It turns out that that when it’s time for an upgrade, the physician CEO and the EHR nurse evaluate the release notes and decide which features they will implement and how the end users will be trained. They don’t seek input from any of the users or even the physician group’s medical directors. The two of them personally deliver most of the training in a one-on-one fashion, which means that some users might get trained as much as six weeks prior to the upgrade. Others might just receive a PDF that they are supposed to review before launching into the new workflows. There’s not a lot of satisfaction around that process.

Understanding that process explained some of the issues I saw in the system, including a workflow for in-office medications that borders on dangerous. There are fewer than two dozen medications available in the office, many of which are in specific unit doses. Rather than configuring an order screen with those medications and defaulting in their strength, form, and administration instructions, providers are required to individually select every parameter for every order. Some medications can be ordered multiple ways.

For example, one drug can be ordered either as 3 ml or 2.5 mg. Since the medication is 2.5 mg/3 ml, either order is appropriate, but I saw several physicians click for 3 mg or 2.5 ml, neither of which were correct. The system didn’t flag these, but instead the clinical support staff was responsible for changing the orders. Incorrectly ordering albuterol at that scale isn’t going to cause significant harm, but for other drugs, those types of mistakes are far more serious. Beyond the safety issue, there’s the matter of the numerous clicks required to even order a single drug.

I identified all kinds of operational issues in the practice as well. Although they have a time clock system for both clinical and business office staff, they don’t have hourly providers use it. Instead, providers have to email their “stop time” every night and it takes a manual process to document the time in both the payroll system and the scheduling system. For the latter, they use one system for providers to request their schedules and another system to actually publish the schedules. They’ve switched payroll systems three times in five years, which makes me wonder whether it was really a software issue or something much more challenging to fix.

There were plenty of other issues to tackle, enough to keep several consultants busy for many weeks. I knew there were some internal disagreements on whether to bring in outside help, so I prepared a conservative proposal in multiple phases to allow them to get used to the idea of letting someone help them. The return on investment was easy to demonstrate, but as I presented to their leadership I could tell they weren’t interested. It was clear that the CEO believes his way is not only the best way but the only way to do things.

Although many of their technology struggles could be made better through the application of skilled assistance, they’re not ready for change. Given the challenges that will be upon them as healthcare continues to evolve, it will be interesting to see where they are in three to five years.

What’s the scariest CPOE system you’ve seen? Leave a comment or email me.

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Morning Headlines 6/17/19

June 16, 2019 Headlines No Comments

Nashville company ups IPO to more than $1 billion

Change Healthcare raises the amount of its IPO again, this time to $1.2 billion.

Accumen Acquires Halfpenny Technologies

Lab, imaging, and clinical optimization company Accumen acquires clinical data exchange vendor Halfpenny Technologies for an undisclosed amount.

Patients frustrated over computer system outage at Abrazo Health Hospitals

Patients complain that the Cerner system of Abrazo Community Health Network (AZ) has been down for several days, which the hospital says was caused by a Cerner upgrade.

Cisco and American Well are teaming up to let you talk to your doctor from your TV

Cisco is working with telemedicine vendor American Well to develop a device that will enable consumers to access virtual consults from their televisions.

Bribes and Backdoor Deals Help Foreign Firms Sell to China’s Hospitals

A New York Times investigation finds that GE, Siemens, Philips, and Toshiba are bribing poorly paid Chinese hospital officials to buy their medical equipment.

Monday Morning Update 6/17/19

June 16, 2019 News 4 Comments

Top News

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The local paper’s review of the June 2 ransomware attack on Estes Park Health (CO), which includes a 23-bed critical access hospital, contains interesting nuggets:

  • The ransomware took down the health system’s network, phones, and email.
  • The health system’s cyberinsurance company negotiated and paid the unspecified ransom.
  • Further ransom payments were required as the health system found additional encrypted files.
  • The health system defends paying the ransom because other businesses that have refused remained offline for weeks and “we rely heavily on this summer business to maintain our financial stability.”
  • The health system had to pay a $10,000 deductible of the total ransom paid,  which it says was money well spent because it generates more revenue than that in a single hour.

Reader Comments

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From Just a Gigolo: “Re: Allscripts acquiring ZappRx. Good move, do you think?” Yes, assuming that ZappRx’s underlying fundamentals are anywhere near sound after several years in business. The end of HITECH has given EHR vendors a breather that they both appreciate (in allowing them to get back to product development) and hate (they need something else to sell to avoid a drop in revenue). Allscripts is the best EHR vendor at running itself, as one HIStalk reader observed, like a health IT mutual fund of minimally related software products bought at a discount, and this acquisition seems to be well aligned with that strategy. Allscripts also likes working with pharma, which is another plus since that’s who pays for ZappRx’s services. You don’t really want to be a publicly traded EHR vendor (or a consulting firm dependent on their implementation business) as demand for your primary product drops, even if external factors such as HITECH expiration are to blame. Cerner is in the same boat, but seems to be pinning its diversification hopes to healthcare projects that don’t necessarily involve just software.

From Cutting Rejoinder: “Re: EHR bloat. How can technology fix that?” I always give the same answer, but nobody seems to agree with me – allow each clinician to tag the information (highlighted text or discrete fields) that they feel is important in the patient’s care, adding or removing those tags at any time and for any reason. That provides two benefits: (a) the provider could click a single button to display only the information they themselves have previously tagged, with date sorting / filtering that makes getting a quick refresher nearly instantaneous; and (b) someone plowing through the chart for the first time could look at what everybody else found useful, or perhaps that a particular clinician saw as useful (like a cardiologist). The underlying EHR data collection and storage would not require changes since it could keep collecting the junk as usual. It would be like highlighting a textbook or contract with the added ability of seeing what one or more others have highlighted. One more benefit is that the patient could then see the highlighted information in their electronic copy of their record to help them make sense of the 90% of the record that nobody will ever care about.


HIStalk Announcements and Requests

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More than half of poll respondents say their job description requires an applicant to have earned a bachelor’s degree, while 24% say it takes a master’s. Only 5% say that no degree is needed, although a maddening 17% observe that their employer ignores their own job descriptions if they really want to hire someone (meaning that the requirement isn’t really required, which is the kind of wishy-washiness that you often see in hospitals).

New poll to your right or here: For those treated by a hospital (inpatient or ED) within three years: did your PCP have your hospital records at your next visit? I don’t worry too much about practice-to-practice interoperability since that usually involves minimal urgency, but surely my PCP would be curious about what was done to me in the hospital during a recent inpatient stay or ED visit.

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Welcome to new HIStalk Platinum Sponsor HealthCrowd. The San Mateo, CA-based company offers a unified, cloud-based, end-to-end communications solution that allows organizations to deliver member-centric engagement at scale, moving communications from tactical to strategic. Its Unified Communications Platform (text, voice, email, and nanosites) drive members to action, backed by Clairvoyance campaign analytics. Case studies: (a) Aetna developed a sustainable digital outreach program for its Medicaid project; (b) a health plan used intelligent mobile messaging as part of its disease management program, nearly doubling screening; (c) a managed care organization used the company’s platform to communicate with Medicaid beneficiaries. Founder and CEO Bing Doh founded the company with the behavioral change and consumer analytics knowledge she gained in the online advertising technology world. Thanks to HealthCrowd for supporting HIStalk.

Listening: new from Midland, which if I’m ever going to like country music (which isn’t likely), this would be why. It’s not the usual Nashville city slicker pretty boys warbling with fake Southern accents over a few token pedal steel pop licks while wearing cowboy hats in places like midtown Manhattan or on stage at night where their only value is as a poser cowboy affectation. This recently formed Dripping Springs, TX trio sounds to me like the California country-rock of the 1970s Eagles with the occasional surf guitar, Spanish guitar, and moody minor chords skillfully blended in. Fun fact: they formed the band when one member was getting married and the other two were his groomsmen, jamming on the porch after showing up a few days before the ceremony and deciding that they could form a band. I’m not entirely sure this is really country music, so I’ll admit that I actually like it a lot. Audio of the excellent new single is here.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Change Healthcare raises the amount of its IPO again, this time to $1.2 billion. The original value from March filings was for $100 million. The company hopes to use the proceeds to pay down some of its $5.8 billion in debt.


Decisions

  • Lincoln Medical Center (TN) will replace CPSI Evident radiology PACS with Intelerad in June 2019.
  • Jefferson Memorial Hospital Radiology (TN) replaced GE radiology PACS with Change Healthcare on June 1, 2019.
  • The Orthopedic Hospital (IN) went live on Cerner in March 2019.
  • Ascension Seton Smithville Regional Hospital (TX) will go live on Cerner 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.


People

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Health First (FL) hires William Walders, MHA (VMware) as CIO. He is a US Navy veteran and served in a number of military IT roles, including CIO of the USNS Comfort and Walter Reed National Military Medical Center.


Announcements and Implementations

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CPSI offers users of Microsoft HealthVault – which will be shut down in November – migration of their data to the Lydia platform sold by its subsidiary Get Real Health.

Clinical Computer Systems, Inc. will distribute amniotic fluid lactate level monitoring technology developed by Sweden-based ObsteCare pending FDA clearance for its use in prolonged labor. 


Other

Patients complain that the Cerner system of Abrazo Community Health Network (AZ) has been down for several days, which the hospital says was caused by a Cerner upgrade.

Researchers are mining EHR data to determine when expensive medical helicopter transfer services make sense, especially those involving moving a patient from one hospital to another. They hope to create a checklist to help clinicians decide whether air transport is worth it, especially since patients often get stuck with exorbitant air flight bills after their insurance declines to pay.

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LifePod Solutions will offer its caregiver-managed voice service for home care on IHome’s consumer electronics equipment. It will provide monitoring, fall detection, real-time alerts, and reports that are driven by the senior’s voice alone.

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A New York Times investigation finds that GE, Siemens, Philips, and Toshiba are bribing poorly paid Chinese hospital officials to buy their medical equipment. GE salespeople offered one hospital administrator a $1 million bribe to buy a $4 million CT scanner. The companies inflate equipment price to cover the cost of bribes and kickbacks, refuse to underbid each other, and use shady third-party importing companies to cover their tracks.

An Atlantic article says that the US healthcare system is an expensive flop globally because Americans are the worst patients – we are hypochondriacs; we demand drugs that we don’t need but refuse to take those we do; our “cost is no object” beliefs trigger outrage when insurers decline to pay for expensive treatments that have been proven to offer little value; we sue providers so often that they order unnecessary tests and initiate treatment based on the results purely as malpractice defense; and we believe that heroic interventions are justified in delaying death. The author concludes,

It makes sense that a wealthy nation with unhealthy lifestyles, little interest in preventive medicine, and expectations of limitless, topnotch specialist care would empower its healthcare system to accommodate these preferences. It also makes sense that a healthcare system that has thrived by throwing over-the-top care at patients has little incentive to push those same patients to embrace care that’s less flashy but may do more good. Medicare for All could provide that incentive by refusing to pay for unnecessarily expensive care, as Medicare does now—but can it prepare patients to start hearing “no” from their physicians? 


Sponsor Updates

  • Lightbeam Health Solutions publishes a new case study, “Kootenai Care Network: ACO Automates GRPO Reporting.”
  • Mobile Heartbeat and Voalte will exhibit at the Organization of Nurse Leaders event June 20-21 in Newport, RI.
  • Waystar, Experian Health, Patientco, and ZeOmega will exhibit at HFMA June 23-26 in Orlando.
  • Netsmart will exhibit at the LeadingAge Collaborative Care and Health IT Innovations Summit June 23-25 in Baltimore.
  • Nordic will exhibit at HIUG Interact 2019 June 16-19 in Orlando.
  • ROI Healthcare Solutions will exhibit at the Midwest Infor User Group meeting June 19-20.
  • SailPoint will exhibit at Gartner Security & Risk Management Summit June 17-20 in National Harbor, MD.
  • Sansoro Health releases a new 4×4 Health podcast, “CMS & ONC Propose Big Changes for Payers.”
  • Surescripts and Wolters Kluwer Health will exhibit at AHIP June 19-21 in Nashville.
  • T-System will exhibit at the 2019 Western Region Flex Conference June 19-21 in Marana, AZ.
  • TriNetX applauds the House Appropriations Committee for supporting use of real-world evidence in the House Agriculture-FDA Spending Bill.
  • Visage Imaging will exhibit at the SIIM19 Annual Meeting June 26-28 in Denver.
  • Vocera will exhibit at HITEC 2019 June 17 in Minneapolis.

Blog Posts


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Contacts

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


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Weekender 6/14/19

June 14, 2019 Weekender 4 Comments

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Weekly News Recap

  • Allscripts announces plans to acquire specialty drug prescription prior authorization platform vendor ZappRx.
  • GE Ventures looks for a buyer for its stake in 100-plus startups that include 27 healthcare companies.
  • French company Dassault Systèmes will acquire clinical trials software vendor Medidata for $5.8 billion.
  • Epic will integrate Humana’s real-time prescription benefits checking tool within its e-prescribing workflow as the first of several steps in their newly announced relationship.
  • Switzerland-based medical Internet of Things vendor Medisanté enters the US market with the opening of an office in Bridgewater, NJ.
  • A physician’s New York Times opinion piece says corporatized healthcare is cynically taking advantage of the professionalism of doctors and nurses by assuming they will work extra hours without extra pay, with the biggest overtime culprit being the EHR.

Best Reader Comments

The reasons for interoperability failure are numerous. Different schemas, encoding sets, dictionaries, MoSCoW (Must, Should, Could, Won’t), CRUDE (Create, Read, Update, Delete, Exchangeable), document types, and enumerations. Until the vendors are required to align to a standard — the whole standard — they will not align. We also have a problem with how the documents or calls are made. Some vendors have the ability to deliver a longitudinal record selectively, others dump the whole file. Imagine a 6-8 year patient with multiple conditions and frequent visits. Take that same patient and realize that several of the technologies do not align the disease/treatment — so that longitudinal record is degraded to pure data — maybe not so pure at that. Thus you have lost information or knowledge of the patient and degraded it down to text or data. (Mr. SemanticInterop)

Those grown people find “adulting” tiresome and unpalatable in the context of their own health and every other aspect of their lives. If they do not care, the clinician still is required to or suffer the reimbursement pain unless you are in the ED, where they cease being your patient when they leave. (David Perlmuter)

As for the continued drum beat of a single-payer health system,  we would only be trading one corporate master for another, one run by politicians with ever-changing motives. At least corporate healthcare companies have a single motive in mind – profit. Politicians care about votes and they will be taking money from these large corporate healthcare companies to insure they get those votes. The only way out is for physicians to take matters into their own hands and move away from the employed physician model. (Van Sims)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. M in Georgia, who asked for math manipulatives for her third grade class. She reports, “Thank you so much for your generous donations to our classroom. Since receiving the supplies you helped us purchased, we have put them to good use! We use the sheet protectors every day in both reading and math. Students now have the ability to show their work without wasting paper by using the dry-erase markers we got, and it really helps to engage them in their learning. In addition to those supplies, the manipulatives we received have really helped transform our Guided Math centers. Students love using the color chips as counters as well as game pieces. Our classroom would not be the success it is without you, so again, thank you!”

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A 19-year-old who as a high school student noticed the facial changes of Michael J. Fox after he was diagnosed with Parkinson’s disease uses off-the shelf facial recognition software to develop a startup called FacePrint, which hopes to diagnose Parksinon’s from Facebook photos. Erin Smith has deferred her Stanford admission and is taking the product through clinical trials, also hoping to create a five-minute facial expression test that can be taken with any computing device that has a camera.

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A 12-year-old girl whose autoimmune disease requires regular IV therapy invents Medi Teddy, an IV cover that is shaped like a teddy bear to keep kids from getting scared of the IV. She’s running a fundraising project to cover the cost of 500 of the bears that she will donate to other children in the hospital.

Investor Vinod Khosla, who said years ago that technology would replace doctors, doubles down in claiming that “radiologists are toast” and that any who are left practicing 10 years from now will be “killing patients every day” because machines will do their job better. He adds that it it easier to automate the work of an oncologist than a factory worker.

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Employees of UMC Trauma Center in Las Vegas line the halls to pay respects to an 18-year-old organ donor who died in a motorcycle accident the day he picked up his high school graduation cap and gown.

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You could be the next “Doc Martin.” A fishing village in England creates a social media campaign (#WillYouBeMyGP) in hopes of recruiting a doctor to replace the one who is leaving. The brilliant promotional video features locals extolling the virtues of sunny Cornwall County and their hopes that a doctor will come there to take care of them.

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A Miami man with a long criminal record gets a cease-and-desist letter for walking around several local hospitals wearing a physician lab coat. He denies it, but he had also posted on Facebook a photo of him on hospital property wearing the coat, which contained his name, MD, and “OB-GYN.” He had also posted a photo taken at his claimed medical school graduation, although perhaps he should have realized that freshly graduated medical students would not have earned an “OB-GYN” credential before completing residency.


In Case You Missed It


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Morning Headlines 6/14/19

June 13, 2019 Headlines No Comments

Allscripts is buying ZappRx, a prescription drug start-up

Allscripts will buy specialty drug prescription prior authorization platform vendor ZappRx, according to reports, as it moves toward diversifying its EHR business.

General Electric wants to sell its stake in more than 100 start-ups

GE Ventures looks for a buyer for its stake in 100-plus startups that include 27 healthcare companies, as parent company GE attempts a turnaround.

Dassault Systèmes and Medidata Solutions To Join Forces To Accelerate the Life Sciences Industry Innovation For Patient-Centric Experience Through End-to-End Collaborative Platform

French company Dassault Systèmes will acquire clinical trials software vendor Medidata for $5.8 billion.

Sutter secretly sharing patients’ private info with Google, others, Sacramento lawsuit alleges

Two people file a class action lawsuit claiming that Sutter Health is sharing patient medical information with Facebook, Google, and Twitter so those sites can target Internet advertising.

News 6/14/19

June 13, 2019 News No Comments

Top News

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Allscripts will buy specialty drug prescription prior authorization platform vendor ZappRx, according to reports, as it moves toward diversifying its EHR business.

The acquisition price was not disclosed, but is reportedly less than the $41 million ZappRx raised in seed, Series A, and Series B round from 2013 through 2017. 

The acquisition will put other EHR vendors whose products use ZappRx in an interesting position – they will need to either remove the integration and force customers to go back to manual processes or pay the competitor who now owns the platform.

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I interviewed ZappRx CEO Zoë Barry in November 2017. She explained why the inefficiency in specialty drug prescriptions had been overlooked until she formed ZappRx in 2012:

Specialty drugs are only 2 percent of the volume, about 70 million prescriptions total, although they make up about 40 percent of the drug spend. You need a very different software and product that handles specialty prescriptions and you need a very different business model for something that accommodates only 2 percent of the market.


Webinars

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


Acquisitions, Funding, Business, and Stock

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French company Dassault Systèmes will acquire clinical trials software vendor Medidata for $5.8 billion.

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GE Ventures is reportedly looking for a buyer for its stake in 100-plus startups as parent company GE attempts a turnaround under a smothering $110 billion debt load and declining share price. Its active healthcare investments include Arcadia, Evidation Health, Iora Health, Omada Health, and Genome Medical.


Announcements and Implementations

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Lewis County Health System (NY) goes live on Meditech.

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Michigan physicians organization Answer Health deploys population health management technology from Lightbeam Health Solutions.

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Community Health Network (IN) implements MModal’s real-time speech recognition, mobile documentation, virtual scribing, and transcription software.

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Health Catalyst develops Population Health Foundations to help providers better analyze and understand clinical and financial performance.

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Lawrence General Hospital (MA) goes live on Meditech Expanse.

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Vocera incorporates AI and machine learning into the latest version of its mobile rounding app, and adds the Care Inform communication tool to its smartphone app.

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Rush University Medical Center in Chicago transitions to Google Cloud with help from consulting firm Maven Wave, which also helped the hospital map unstructured EHR data to SNOMED codes.


Sales

  • BMC HealthNet / Mercy Alliance will launch PatientWisdom’s digital member feedback platform to help it define the community health needs in Springfield, MA.
  • Houston Methodist selects dose optimization software from Tabula Rasa HealthCare’s DoseMe subsidiary.
  • Wake Radiology UNC Rex Healthcare will use Veriphyr’s patient data privacy monitoring to detect unauthorized access to medical records at its 14 locations in North Carolina.

People

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Washington Health System (PA) promotes Rodney Louk to VP/COO. He will also continue in his CIO role.


Government and Politics

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Secret recordings shared by a local news outlet in Australia reveal Queensland Health Director-General Michael Walsh’s opinion of the $1.5 billion Cerner IEMR project as “messy” and “not perfect.” He also admits to being required to publicly praise the project despite hearing end-user complaints about software glitches, costs, and skyrocketing stress levels. Thirteen hospitals have already gone live, and another 13 are scheduled to do so within the next two years.

Lawmakers express continued frustration with the lack of leadership over the VA and DoD’s EHR projects, calling the proposed Federal Electronic Health Record Modernization Program Office more of a concept than a concrete step towards joint governance. First proposed in March, FEHRM’s yet-to-be appointed director and deputy director will report jointly to deputy secretaries at the VA and DoD. Rep. Suzie Lee (D-NV), chair of the Subcommittee on Technology Modernization of the House Veterans Affairs Committee, didn’t hold back in her remarks on the bureaucratic foot-dragging:

For months this subcommittee has asked about a joint proposal to address longstanding problems with the existing [interagency program office]. There has been a name change, but we have seen nothing substantive. There is a one-page slide about a three-phase plan, but it is hard to find where the governance and accountability is in this plan. Based on the timeline for implementation it will come too late to address the critical decisions that need to be made now.


Privacy and Security

In China, police capture eight suspected hackers who used self-developed software to break into hospital registration systems and hijack appointment slots, which they then allegedly sold to the highest bidders.

Two people file a class action lawsuit claiming that Sutter Health is sharing patient medical information with Facebook, Google, and Twitter so those sites can target Internet advertising.


Other

The American Medical Association adopts a policy to support the education of physicians on the use of artificial intelligence in patient care.

An external review of University of Maryland Medical System finds that the health system issued no-bid contracts to companies of several members of its board, did not obtain full board approval for the deals, and pressured employees to use software sold by companies from which board members would benefit. Even the board’s financial auditor was caught assigning himself a no-bid deal. Baltimore’s mayor resigned after an investigation found that the health system spent hundreds of thousands of dollars on children’s book she wrote and four UMMS executives have resigned. Real Time Medical Systems founder and board member Scott Rifkin, MD says he provided analytics software to UMMS at no charge, but the review found that he tried to leverage the relationship to increase company sales and UMMS employees said they felt pressure to implement the software in skilled nursing facilities. The company raised $9.2 million in a February 2019 venture funding round.


Sponsor Updates

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  • ConnectiveRx team members spend the day helping Morris County Habitat for Humanity.
  • Elsevier’s Via Oncology wins a MedTech Breakthrough Award for “Best Computerized Decision Support Solution.”
  • EClinicalWorks will exhibit at the Northeast Regional Telehealth Conference June 17-18 in Portland, ME.
  • Hayes Management Consulting names Elizabeth Lavelle content product owner.
  • Healthfinch will host a focus group at the AMDIS Annual Physician-Computer Connection Symposium June 18-21 in Ojai, CA.
  • InterSystems and Intelligent Medical Objects will exhibit at the AMDIS Annual Physician-Computer Connection Symposium June 18-21 in Ojai, CA.
  • Kyruus will exhibit at the Patient Experience Transformation Assembly June 16-17 in Nashville.
  • Information Builders will host seminars in Atlanta, Pittsburgh, St. Louis, and Herndon, VA to demonstrate the new features of its Omni-HealthData Provider Master Edition.
  • KLAS recognizes Cumberland Consulting Group as a top-three consulting firm in its “2019 Payer Consulting IT” report.
  • ZeOmega achieves full HISP P&S accreditation from EHNAC.
  • Health Catalyst VP of Product Management Dan Soule joins the DirectTrust board.

Blog Posts


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Contacts

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


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EPtalk by Dr. Jayne 6/13/19

June 13, 2019 Dr. Jayne 1 Comment

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I’m an avid reader and was very excited to hear about “Code Blue” by Mike Magee. The author is a physician and chronicles decades of bad behavior by what he calls the “Medical Industrial Complex” of self-interested parties that drive our healthcare non-system.

Magee skewers physicians, hospitals, payers, pharmacies, drug makers, legislators, and other special interests. He notes that healthcare reform as been needed for decades, going back to a speech by President Nixon in 1972: “We need to work out a system that includes a greater emphasis on preventive care, sufficient public funding for health insurance for those who cannot afford it in the private sector, competition among both health care providers and health care insurance providers to keep down the costs of both, and decoupling the cost of health care from the cost of adding workers to the payroll.” It’s been a long time since we’ve seen a Republican call for greater public funding of health coverage for the poor.

Magee also calls out healthcare executives, physicians, and the American Medical Association. The worst criticism, however, is saved for pharmaceutical giants (it should be noted that Magee was a VP at Pfizer) who use profitability to determine which drugs will come to market. I highly recommend it, especially for newbies in the industry. It’s a steal at $16 on Amazon.

Road warriors take heart: London’s Heathrow Airport is installing new carry-on baggage scanners that can screen liquids and computers while they are still in your bags. Although some of us get a pass on the great unpacking routine in the US if we have TSA Pre-Check, perhaps this will clear the way to going back to a pre-2006 workflow at many more screening checkpoints. The story points out that it’s also an environmentally friendly option, helping cut plastic use since people won’t be using as many ziplocks. The technology, which is similar to CT scanners, has been in trials at Heathrow for two years and is also in use at several sites in the US, including ATL, ORD, and IAD although authorities still require us to pull out our baggies at those sites. I miss my road warrior ways, particularly since my airline status will likely sunset this year.

Speaking of road warriors, those of you on the clinical side might be interested in this Journal of the American Medical Association article on in-flight medical emergencies. I found it fascinating reading and learned a few things:

  • Emergencies occur in approximately one per 604 flights.
  • FAA-required contents of the emergency medical kit are rudimentary.
  • The most common issues are syncope / fainting, gastrointestinal issues, respiratory issues, and cardiovascular symptoms.
  • One-fourth of emergencies are handled by the flight crew alone,  half by physicians, and the remainder by nurses and other emergency personnel.
  • Diversion to a different destination happens in only 4% of inflight emergencies.
  • When flight crew request emergency medical services to meet the plane, only one-third of passengers are actually transported to a hospital and only one-third of those transported are admitted.

I’m a big fan of online medical journals, and this week I came across a JAMA Viewpoint piece explaining why we should consider eliminating or modifying the requirement for a Review of Systems (ROS) during patient visits. Although asking a variety of questions about body systems as part of the ROS has been part of the history-taking process for years, it became an annoyance a couple of decades ago when the number of systems reviewed was tied to the coding and billing process.

There hasn’t been much academic work looking at the validity of the ROS, although one study found that it only identified new diagnoses in 5% of cases. Other studies have noted that only a small percentage of issues identified during the ROS are even addressed.

The authors of the viewpoint article took into account that EHRs make the entry of ROS findings easy, especially if they are self-reported through a portal or kiosk, and wondered whether those findings that aren’t identified by the physician would be followed up even less. The authors go on to discuss “the fact that a complete ROS may be required by billing guidelines at times when it is clinically unhelpful.” They call for clinicians to “claim ownership of the determination of what clinical information is required for appropriate care in which setting.” Very few clinicians would argue this point. We’re tired of generating notes full of irrelevant information and we’re tired of reading it when we see it. Changing documentation requirements would certainly help with the “note bloat” we’re all subject to.

In that same train of thought, CMS is calling for additional input on its Patients Over Paperwork Initiative. The announcement claims that “since launching in the fall of 2017, Patients over Paperwork has streamlined regulations to significantly cut the ‘red tape’ that weighs down our healthcare system and takes clinicians away from their primary mission.” I spend at least half my time in the clinical trenches these days and haven’t noticed any significant change in paperwork or red tape during that time. I’m not sure where their purported 40 million hours and forecast $5.7 billion savings is happening, but it’s not on the average physician’s timecard.

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It’s that time of year. Hotel registrations for HIMSS20 are open, and even though it’s barely June, my preferred hotel is already booked for my preferred dates. The HIMSS Call for Proposals is also open through July 15. No word on keynote speakers and actual event registration doesn’t start until August. HIMSS is in Orlando again this year, and I never thought I’d say it, but I’m actually looking forward to going back to Las Vegas.

Due to some unexpected scheduling issues, I’ve had to spend more time in the clinic than I normally do. This week was punctuated by an entire day of EHR malfunctions, including failure of the system to talk to the pharmacy search API, which meant that we couldn’t do anything but print prescriptions if patients didn’t want them from our in-house dispensing system. Over the last decade, patients have gotten used to us sending their scripts to the pharmacy directly, whether electronically or by fax. The idea of printed prescriptions led to many requests for us to phone in the scripts and I rapidly discovered that not a single person on my staff that day had ever called in a prescription. Needless to say, we had a lesson because I wasn’t going to spend all day calling Walgreens.

We also had multiple random Citrix issues, chronic slowness, and random popups about some index failing to call the SOAP note. There was even an error message that cited my email address and I have no idea why it would even be listed in the EHR. I’m seriously disappointed in my vendor and their response – no resolution within 12 hours for sure, and at one point they stopped taking customer calls altogether. My practice suspected it had outgrown our vendor and I’m hoping that this is a wakeup call that it might be time to switch.

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Email Dr. Jayne.

Morning Headlines 6/13/19

June 12, 2019 Headlines No Comments

Congress Questions Leadership of VA Health Record Overhaul

Lawmakers continue to express frustration with a lack of leadership over the VA and DoD’s EHR projects, calling the proposed Federal Electronic Health Record Modernization Program Office more of a concept than a concrete step towards joint governance.

Queensland Health chief’s secret concerns about hospitals digital upgrade revealed in recordings

In Australia, Queensland Health Director-General Michael Walsh admits having to publicly praise the systemwide rollout of the Cerner IEMR project despite hearing end-user complaints about software glitches, costs, and skyrocketing stress levels.

Hospital to pay $300,000 in damages in medical records case

A jury awards Amy Pertuit $300,000 after determining that Medical Center Enterprise (AL) knew about and took no action against employee Lyn Diefenderfer, MD after she illegally accessed Pertuit’s medical records and passed PHI along to the lawyer of another patient involved in a custody battle with Pertuit.

HIStalk Interviews Gabriel Orthous, CIO, Central Georgia Health Network

June 12, 2019 Interviews No Comments

Gabe Orthous is CIO of Central Georgia Health Network in Macon, GA.

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Tell me about yourself and your job.

I’ve been in the business for 20 years. I started my career in revenue cycle, moved on to analytics and population health, and now we’re in the throes of value-based care and providing an understanding around the risk-based models that payers and CMS are presenting. Being accountable and at the forefront of provider engagement.

We support 1,100 providers in our network. Every single modality aligns with Navicent Health, which is our major hospital in this area of Macon. It’s a large footprint of the providers that we support from a PHO perspective.

My background is a technologist. I’ve been an expert apprentice of population health and value-based care. I also teach population health at a couple of colleges as an adjunct professor. I’ve been at this game for about five to six years, seeing the transformation from a quality-based PQRS kind of perspective into, how do we make these things actionable? How do we quantify the effectiveness of these programs to lower total cost of care? Because at the end of the day, that’s what we’re trying to do.

How do you see a clinically integrated network changing the relationship between independent physicians and hospitals?

I’ve worked as a consultant with several types of CINs, many different flavors of those. The relationship between a hospital and the community physicians varies throughout the United States. For us, we’ve always had a strong relationship with our hospital system, being more on a regional level.

It depends on the market. If you come from an educational hospital or a medical center that’s inside of the perimeter here in Atlanta, for example, it’s a little bit different on how they deal with their independent providers. There’s a lot more competition. We’ve been able to build that relationship. It is a bit of relationship building, understanding the priorities of those physicians and enabling them to do the things they need to do to make the hospital successful and vice versa.

Is the trend of hospitals acquiring practices changing the dynamic between independent doctors and hospitals?

I’ve seen in the past 10 years the ebbs and flows of that strategy of going after physician practices and becoming employed versus affiliated. Again, it depends on the health system. You have a “who moved my cheese” ideology of some of the physicians who are now employed, because now they have an 8-5 job or now they have a set of requirements or standards being imposed by their employer, which is in this case the hospital. For them, there’s not that risk of having to pay the light bill at the end of the month. It lowers the risk for those providers to go work for the hospital.

At the same time, the hospital now acquires that risk, and acquires the risk of making sure that the productivity — and in our old fee-for-service world, the RVUs – stay up. But now that dynamic is also changing, because now you have quality measures, specific programs that are requiring these physicians to do certain things in closing care gaps, HEDIS, etc. that now the hospital needs to be able to influence.

It is a hard proposition. These providers are already employed by the hospital, and having some providers do what they need to do to close the care gap, for example, when they may not see an immediate benefit in that performance. But as a whole system, you would.

The idea of affiliation is important to understand. Inside the walls of the hospital, you can enact certain change. You have one view of the world through your EMR, whether it’s Epic or Cerner or any type of hospital-based system. But when you get out into the community, you see more of a diversity of EMRs. It’s harder to enact change when things work differently from a workflow perspective. Epic-everywhere or Cerner-everywhere types of environments are few and far between. At the point of care, it’s important to have an understanding of the topology of that network and become the network of truth as opposed to a single source of truth.

What technologies are important when first moving toward value-based care?

One of the most detrimental phrases in today’s healthcare space is saying, “I don’t know what I don’t know.” Unfortunately, many organizations that I’ve worked with are always saying that. There are different views of the world of how you look at your data, how you look at analytics. One is the clinical focus, the EMR perspective of workflow and patient-centered focused around clinical things that have to occur. Usually those are part of a system of trying to identify CPT codes or ICD codes in order to get paid through a billing RCM model. You have dichotomies of political and revenue cycle. That’s just one component.

On the other side of the house, you have the payer view of the world, which is adjudicated claims that come with a three- to six-month lag of information, telling the providers, “You forgot to do an A1c” or maybe asking the provider to provide a supplemental data set to close the care gap.

The way I look at value-based care today, and to prepare for a technology stack that’s able to be nimble, is to have partners. If you have the money to create your own, that’s great. But have partners that are going to be nimble enough, that are going to be helping you through that data journey and that have flexibility in advocating that data and making it be purposeful.

A lot of times we get into these projects or these technology implementations that are more of a Connectathon. Just send me all the data. Being purposeful, starting with the low-hanging fruit, showing value initially, success factors, identifying the right KPIs, and then building upon that.

So I would say, one, nimble. Two, a technology stack that can aggregate data from disparate sources, including social determinants, care management, and all the other data sources that are out there. Of course claims and of course clinical. Then number three is letting you look at the view of the world through those different lenses. Just clinical, just clinical plus RCM, clinical plus RCM plus post-adjudicated, social determinants, That’s when you start identifying the right populations and how to target things that are going to be part of your performance contracts.

Will being exposed to those technologies encourage practices that are less technically savvy to consider the possibilities of using other technologies to enhance their practices?

Absolutely. You’re bringing up a great point, which is point-of-care analytics and using technology and data to enhance workflows, patient experience, and the things that you just mentioned. But there’s also another component, which is the network view of the world. What are the things that are going to get these physicians the most money for their risk contract? What are the things that they need to do at the network level to have a critical path for patients to follow so that they have better quality and lower cost of care?

Those are two separate things. One is more episodic, while the other is more longitudinal. The technologies and the data required are a little bit different, although they come from the same sources.

At the point of care at the physician level, having additional data sets that are external to “patient presents” is important. I’m going through an HIE implementation right now with a local HIE here in Georgia. I truly understand the physicians wanting to see what happens outside their doors. When the patient presents to the ED, they want to see those discharge notes. That’s an important factor. The problem with interoperability and intraoperability is that those files become convoluted quickly. A CCD as it stands today is a bulky file. It’s hard to read and it’s hard to realize what’s important and what’s not important in there. So we lose a little bit of the usability factor in the technology utilization that we have today.

There are many new technologies that are coming about that are helping the providers focus on what’s important for the patient that presents in front of them from that external actor. But unfortunately, we’re not there yet with all of these EMRs. I’m not talking about one EMR or another. All of them have a lot of work to do around interoperability and parsing the right data set for the right patient at the right time.

What frustrates most people about interoperability isn’t practices not sharing information with each other, it’s that hospitals and practices don’t share information. How do your members see that situation?

It’s a challenge of not knowing what happens outside your doors, whether it’s the walls of a hospital or the doors of the physician’s office. More information is the best around medication adherence, for example. It would be awesome to understand what types of medications are being prescribed outside of that one encounter that you have with your patient.

It’s easier on the commercial side of the house with payers because it’s different types of populations. But when you get into Medicare, ACO, or frailty, for example … frail patients who come in may be prescribed seven medications in seven points of care. It is a struggle and a challenge for providers to understand the full totality and the picture of these patients.

From a workflow perspective, having only 15 minutes to spend with a patient diminishes the amount of value add. A lot of these providers don’t have access to the data. Not just the data, but having enough time to be able to have a conversation with the patient and have that relationship being built.

We still have a lot of problems getting external data into the point of care where it can pinpoint the providers to do the right thing with the data that they’re seeing in front of them that is actionable. It’s kind of a buzzword these days that everything has to be actionable, but it is the truth. These EMRs are becoming more and more convoluted, built on top of version, on top of version, on top of version, and not necessarily making it easier for the provider as opposed to death by a thousand clicks.

Are practices maximizing the value of that 15-minute visit by collecting more information from the patient beforehand and then following up with them electronically afterward?

There’s definitely an art and a science in that gathering of data pre-visit and post-visit. It really depends on the engagement level of each individual patient. We can have predictive models as to which patients are more likely to fill out a survey pre and post. But in general, I’ve seen minimal impact and engagement from that factor.

I took my daughter to a doctor’s appointment the other and they gave me an iPad to fill out forms, which I loved as a technologist. A generation X-er given an IPad to fill out the information. I even paid my co-pay on the IPad. It was beautiful. They asked me a thousand questions and it was great. It was death by a thousand surveys type of thing as opposed to clicks. Then I’d go in and the HIPAA paperwork was on paper and I had to sign that.

We still have a lot to do from an engagement perspective. I’m sure that there’s a lot of new apps out there that are trying to streamline that process. It’s getting better. Now if you send me an email three days later asking me for an opinion or a survey on my engagement with the provider, I’m not going to fill it out personally. But that’s changing.

Do you have any final thoughts?

No matter what a vendor or a technologist says, value-based care is a hard journey. It will take us numerous years to figure this out. We have an entrenched system of fee-for-service and we’re starting to see models that can help us to ease the transition towards value-based care. For now, we have the two-payment problem of “having food in two canoes.” I’m still in one canoe, and maybe one of my fingers is in the other canoe. Different markets are doing it differently, but value-based payments are here to stay and we’re not questioning that any more.

My suggestion is to think about it more holistically, more of a long-term plan. Have a one-, three-, five-year plan around engagement with your providers, engagement with your patients, technology enablement, ROI on technology implementations, analytics, and data for actionable insights. All these things have to be addressed. Distribution models, so when the payer gives you a downside risk capitation, how do you distribute that money? How do you make it flow to your providers?

There are a lot of things to think about from a strategy perspective. Be patient. It’s not going to change just because you buy a technology. People and process must be outlined before technology comes into a CIN or a network like ours. But having that strategy beforehand is important.

Book Review: The 10 Principles of a Love-Based Culture

June 12, 2019 Book Review No Comments

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Industry long-timers Ivo Nelson and Dana Sellers hit a couple of massive health IT consulting company home runs. They created Healthlink and Encore Health Resources and then sold them to large companies in 2005 and 2014, respectively. Those brands have disappeared, existing only as a fond memory for the former employees who ended up working for companies (IBM an Quintiles as the original acquirers) whose corporate culture was considerably different than that of the “love-based” companies that are described in this book.

The Title

The title of this book will likely limit sales volume. It sounds pretty hokey, like those self-help books written by self-proclaimed gurus that can’t deliver on the title’s promise. I cringed every time I read “love” in the book because it doesn’t seem to fit what the book is actually saying. My observations:

  • The principles described have little to do with the squishy, feel-good concept of “love” within the corporate walls. Offering a customer a refund for poorly done work isn’t really love. The authors never claim to love all of their former employees or to have been loved by them. “Compassion” or “trust” are more accurate. I don’t remember any part of the book stating that anyone loved someone else other than family, although it contains examples of compassionate executive behavior.
  • I don’t think “love” and “business” share much common ground. I don’t expect to love my employer and I don’t expect them to love me. Our relationship is mutually beneficial, but I expect to get most of my emotional rewards elsewhere. My employers have admittedly operated far from the love-based culture described here and that makes me wonder whether any companies really follow the 10 principles.
  • Most corporate executives would not read a book with this title because they would correctly realize that they can’t just flip a switch to turn on love that they don’t really feel. They probably also aren’t looking to retool their management style by reading business self-help books. They  aren’t likely to make a gazillion dollars just by using the book’s ideas to create the next Healthlink.

The book’s subtitle is better even though it’s no more actionable: “How authentic business leaders trust their employees to do the right thing.”

The Actual Book

A lot of health IT books are poorly produced. Authors use a vanity publisher or ghost writer, don’t hire a skilled editor, skip performing research in favor of just spitting out folksy non-wisdom, or scrimp on the physical production of the book. The result is embarrassing, or at least should be — a lazy way to check a resume box in hopes of finding a better job or adding “author” to join the questionable “speaker” or “thought leader” on business cards.  

This isn’t one of those books. It is well written, edited well, and designed and printed professionally. It’s a real book, in other words. It isn’t super long at just over 200 pages in the hardcover edition, but it has good, easy-to read stories and examples.  

The Intended Audience

I’m struggling to understand the intended and desired outcomes of this book. Ivo and Dana created two consulting companies that grew like crazy. Starting from scratch allowed them to hand-pick their co-workers and to intentionally create and maintain the culture they wanted.

Most of the book’s ideas don’t seem to fit well with larger organizations: companies whose culture isn’t easily changed (which I suspect is nearly all of them); those organizations that sell products rather than services or to consumers instead of to other businesses; and for employees who aren’t in a position to change culture.

I’m picturing the average reader wishing that they could have worked for Healthlink before IBM screwed it up or that they could quit their jobs and find the rare employer that embraces even some of the 10 principles. The biggest takeaway for many readers might be that their employer is not a great place to work.

The 10 Principles

  1. Make every customer happy enough that they would offer a positive reference if asked.
  2. Put employee needs first.
  3. Make sure executives live the company’s core values.
  4. Define a purpose that goes beyond profits.
  5. Focus on long-term growth.
  6. Reward employees based on the overall value they provide to the company, even though such value is subjective.
  7. Create positive energy from company successes.
  8. Develop company policies and processes based on trust.
  9. Empower frontline employees to do what’s right for the customer.
  10. Hire executives who demonstrate that they care.

The Credibility Factor

Healthlink is the example given through the book. Ivo sold that off to IBM in 2005, so a critic might question whether what he and Dana learned there 15 and more years ago is applicable and relevant now. They did it again with the more recently formed Encore, however, so that’s a plus even though it was still in the go-go industry years that have cooled off considerably since.

The book mentions that Healthlink spawned at least 15 CEOs who carried on with a love-based culture. Hearing their stories would have been enlightening. What kind of companies are involved? What cultures existed, if any? Which Healthlink principles did they find useful and which did they skip? Were any of them involved with larger companies and thus on the hook for delivering quarterly results and changing a culture at large scale? Did they apply what they had learned at Healthlink to a turnaround situation? What kind of personalities did they have and how did that affect their leadership style?

Ivo and Dana say in the book that Healthlink’s culture wasn’t necessarily designed up front – it happened on the fly as a by-product of the team they assembled. I’m not so sure that a CEO would read this book and suddenly vow to make personal and corporate changes that would make their company look like Healthlink, especially if they didn’t create the company in the first place. Nor am I sure that I would expect great things from a CEO who had to learn concepts such as empathy and employee satisfaction from reading this book.

In short, would any of theses ideas actually work if Ivo and Dana weren’t involved? I’m not so sure. They give themselves too little credit in the book. Consulting is a people business, Ivo and Dana have a long industry track record and a Rolodex full of contacts to earn services business, and they are obviously outstanding entrepreneurs.

Fear-Based Culture

Ivo says that the opposite of a love-based culture is a fear-based culture. That’s the type of employer that nearly all of us know. The book provides a checklist to determine whether your workplace is fear-based, which I can assure you is both enlightening and depressing. Your boss thinks they are smarter than everyone else, people are promoted and paid illogically, everybody is afraid to speak up, and corporate backstabbers play a zero-sum game in trying to diminish everybody else to improve their own standing.

The challenge is, what do you do having read the book? Send a copy to the CEO and hope for the best? Demand that the CEO change the culture? Find a new job working for a company whose culture is love-based? You’ve read this book and are thus enlightened — then what? I worry that readers will be able to recognize a fear-based culture while simultaneously realizing that it is unlikely to change.

What Would Have Made This Book Better?

  • Provide examples that go beyond Healthlink to prove generalizable applicability.
  • Identify a large company that follows most of the 10 principles and interview the CEO about that company’s culture.
  • Interview the former Healthlink employees who are now CEOs to see how much of the company’s culture they carried over, especially for companies that aren’t in the consulting business.
  • Describe how a company could start the slow turn toward the culture described, or how to assess where they stand and what they might expect along the way.
  • Describe how a manager might use the principles even though they don’t have the power to change HR or financial processes.
  • Expand the chapter on governance into its own book to help startup or small-company CEOs understand how to optimally work with their boards and the executive team. This is where I would want to pick Ivo’s brain, along with having him explain how and when to sell a company.

My Ivo Interview

I interviewed Ivo as he and Dana were getting Encore Health Resources off the ground. It’s one of my favorite interviews because Ivo is honest, reflective, and likeable (we would all love to have Ivo or Dana as our mentors, no doubt). Just about everything he said was worth considering and remembering, but this stuck with me most:

I’m perfectly happy with having an expectation that says we’re going to hire really good people and we’re going to do great work for our clients and the growth is going to be whatever the market has to give us. If this is a 30, 40, or 50-consultant company in five years and we’ve got 100% referenceability and we’re considered the place to work in the industry and every time I talk to a consultant they tell me how much they love working for Encore, I consider that to be a grand slam home run.

If it’s 500 people and we’re not providing great services to clients and we’ve got people quitting because they hate working for Encore but we’re making a ton of money, I’ll consider the company a huge failure. Dana and I, we really just want to build a really good company that clients can be proud that we’re working for them and our consultants can be proud to say that they work for Encore …

Having been acquired and watched other similar companies get acquired, too, I think it’s extremely difficult to take a people company like a consulting firm and have cultures meshed with a technology company that’s more asset-based …

This is nothing more than me doing what I love to do. If it leaves a legacy, I think that’s OK, but I’m not sure what you really get out of that. When I’m hopefully up in my 80s or 90s and I pass away, the people that are going to come to my funeral are going to be my family. It’s not going to be clients. It’s going to be people that are close to me personally in my personal life, my kids and my sisters and a handful of friends probably that I have. That’s a legacy.

I asked Ivo several questions about company culture, starting a company, and consulting vs. other businesses. It’s worth a read to get to know him better. His philosophy is simple, although I think his ability to strategize, execute, and sell is always understated and he is disarmingly unaffected in person.

My Final Points

  • I enjoyed the book even if I can’t quite figure out how most readers who aren’t CEOs (me included) can actually use its concepts.
  • I enjoyed every story from Ivo and Dana and I appreciate their use of them to illustrate concepts.
  • This is a great book if you worked or Healthlink or admire its history, maybe less relevant or credible if not. Healthlink ceased to exist half a generation ago and people outside of healthcare IT have likely never heard of it.
  • The book’s jacket makes the simplistic promise that companies that follow the 10 principles (the “no-brainer steps”) will have happy customers, energized employees, and high revenue growth. That’s a stretch.

I would have enjoyed reading a company history of Healthlink or autobiographies of Ivo and Dana and this book contains some of those elements. Still, I found myself wishing for a broader range of stories that weren’t necessarily chosen to back the questionable argument that the 10 specific principles can be easily implemented to guarantee business success. I don’t think it’s nearly that straightforward.

You now know the 10 principles. You know that the book contains a lot of Healthlink anecdotes. You understand that Ivo and Dana have created some great businesses in somewhat unconventional ways. You therefore have enough information to decide whether you are likely to get $15 worth of useful ideas or entertainment from “The 10 Principles of a Love-Based Culture.” My guess is that you probably will, even if you aren’t convinced that a company can just flip the switch on a nice, round number of love-based principles and find Healthlink-like success. It’s a fun read that contains enough information to be useful to nearly everyone in business.

Ivo and Dana need to write more books. Cover topics that distill a lot of practical knowledge that CEOs need. Write anonymized stories about mentoring CEOs and observing their boards and executive teams in action. Find a large company with a fear-based culture, help the CEO turn it into a love-based culture, and describe the process and results. This book proves without a doubt that Ivo and Dana have a lot of good information and are highly capable of presenting it well.

Morning Headlines 6/12/19

June 11, 2019 Headlines No Comments

Humana and Epic to Enhance Patient, Provider and Payer Collaboration

Epic will integrate Humana’s real-time prescription benefits checking tool within its e-prescribing workflow.

EQT to Sell Press Ganey

Swedish investment firm EQT will sell healthcare advisory and analytics company Press Ganey to a consortium of funds managed by Leonard Green & Partners and Ares Management affiliates.

Genome Medical Raises $23 Million in Series B Financing to Advance the Adoption of Genomics in Everyday Medical Care

Telegenomics company Genome Medical raises $23 million in a Series B round led by Echo Health Ventures.

French tech giant Dassault is nearing deal to buy health software company Medidata

Dassault’s interest in acquiring clinical trials software company Medidata is intensifying, with insiders reporting that a deal is imminent.

News 6/12/19

June 11, 2019 News No Comments

Top News

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Epic will integrate Humana’s real-time prescription benefits checking tool within its e-prescribing workflow, giving prescribers drug efficacy and cost information at the time of prescribing.

Other elements of the relationship include work with prior authorization, provider data sharing, sending claims information electronically, and providing clinical insights within workflow, such as possible diagnoses and health maintenance activities.


Reader Comments

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From Barnabas Rubble: “Re: RWJ Barnabas Health. Moving from Allscripts and Cerner to Epic.” Unverified. I reached out to CIO Robert Irwin, but haven’t heard back. That’s a great phony name, by the way.

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From Grift Certificate: “Re: HIMSS. Stole the idea for your conference survival kits!” It was actually Arcadia’s idea for the survival kits going back several years – we just helped hand them out and they included our logo to be nice. I actually used the contents to get through the week. The HIMSS20 version from HIMSS will cost a sponsoring company $40,000 even though it’s not as cool as Arcadia’s judging from the photo of its contents. HIMSS must be desperate to stem the attendee headcount bleeding because anyone who pays to emblazon their logo on the kits also gets four full conference badges and 10 exhibitor badges. HIMSS is also offering other branded tchotchkes in attempting to monetize every object and space within a mile of the Orange County Convention Center. Its website says Athenahealth has already signed up to plant its name on attendee bags at a cost of $47,500, maybe because Virence Health paid for the HIMSS19 bags and announced as the show started that it was retiring that name and using Athenahealth instead (suggestion to the company – if your $47,500 buys the same crappy bags as you gave out at HIMSS19, please spend more for something people can use after the conference – isn’t that the goal?) I won’t have a booth at HIMSS20 because I can’t justify the cost, but I’m sure Arcadia will be handing out the kits as usual. Consistency is key in branding and this is a good example – I automatically associate Arcadia with the kits because they provide them every year and theirs are the best.

From Shrunk Costs: “Re: hospital cost. Why don’t we go back to the old days of paying them a cost-plus on top of their actual costs?” Because their actual costs are the problem. Hospitals spend enormous amounts on employees and buildings, and unlike for-profit businesses, they don’t have much incentive to cut costs since they’re just an impenetrable black box for which insurers are stuck paying (at least as long as a nearby equally desirable competitor doesn’t undercut them). Communities and patients love seeing the tall architectural wonders that non-profit hospitals buy with money taken from the sick people among them; they also love having hospitals as the biggest and probably least-efficient employer in their community. Limiting hospital margins by mandating cost-plus pricing is a drop in the bucket compared to cutting hospital financial waste. However, squeeze their margins in one area and they’ll make it up elsewhere since that’s what businesses are supposed to do. It will get worse as health systems sprawl by acquisition and exert more market control. Hospitals have unfortunately outgrown the honor system that used to keep prices in check before the nuns and empathetic locals ceded control to suit-wearing MBAs.


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor PCare. The Lake Success, NY-based company’s interactive patient experience solution helps providers engage, educate, and entertain patients across the care continuum, integrating with EHRs, patient portals, and mobile health apps to connect patients, families, and caregivers and to improve the lives of staff. It’s ranked #1 in KLAS’s Interactive Patient Systems for 2019 (and the three previous years as well) and can be deployed in an average of under 60 days. Patients get a personalized experience based on their orders, diagnosis, and their own actions that improves responsiveness, patient education, the care environment, and discharge and care transition. UPMC Children’s Hospital automated its patient education with Cerner integration, while Memorial Sloan Kettering Cancer Center integrated the PCare platform with a range of hospital technologies that manage RFID, HVAC control, dietary, and medical interpretation across multiple care settings. Thanks to PCare for supporting HIStalk.

I found this recent PCare intro on YouTube.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Salesforce will acquire analytics software vendor Tableau in an all-stock deal worth nearly $16 billion. Fun fact: Tableau co-founder Patrick Hanrahan is not only now a billionaire, he’s also an Academy Award winner from his movie work at Pixar. He says he works only 20% of the time at Tableau, preferring to spend the majority of day as a Stanford engineering professor.

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This is good advice from the CEO of Box. Software vendors nearly always eventually overload their products with questionably useful and little-understood features, either to (a) differentiate the product from competitors and command a premium price; or (b) placate a small subset of vocal users who insist on adding fringe functionality that almost strays into custom software development. That second item is common with provider software since standardization across organizations is unheard of and everyone wants software to mimic their screwy processes from paper or other electronic systems. I might posit that the long-term success of a medical software vendor is to avoid pandering to clients (especially the loud ones from big hospitals) who demand the illogical and instead steer them toward the reasonable. A corollary would be that near-universal inpatient EHR adoption and the market shakeout to just a few dominant vendors has at least encouraged hospitals to standardize to the degree required to run off-the-shelf software.


Announcements and Implementations

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Invenix announces that its smart infusion system — designed from the ground up to meet FDA’s 2014 infusion pump guidelines — has earned FDA’s 510(k) clearance. The company says the new device has better usability with a smartphone-like user interface, saves nurse time, and adds patented adaptive control technology, all of which can reduce total cost of ownership by 40%. Legacy IV systems, including earlier-generation smart pumps, are involved with a lot of serious medication errors, so this is a pretty big deal.


Government and Politics

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Louisiana’s state auditor lists ethical problems with Louisiana State University’s creation of a private, non-profit organization to sell its self-developed, web-based physician inquiry tool called CLIQ that was implemented at Charity Hospital. LSU incorporated Louisiana Health Information Technology Foundation in 2014 to collect potential software revenue while bypassing state budgetary oversight. LaHIT later signed a licensing deal with a for-profit company who then hired several of LSU’s programmers, but LSU cut ties with both organizations in early 2017. LSU blames former EVP Frank Opelka, MD for overstepping the boundaries of his position.


Other

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Technology investor Mary Meeker’s just-released influential, annual “Internet Trends Report” contains these nuggets:

  • Global Internet penetration has risen above 50%, but new user growth will be hard to find and most of it will come from Asia.
  • Smartphone shipments are declining and, as usual, IOS device sales are dwarfed by Android.
  • Google and Facebook lead in ad revenue but Amazon, Twitter, Snapchat, and Pinterest are growing faster than both.
  • The average American adult spends 6.3 hours per day consuming digital media and 28% of daily video-watching minutes comes from digital.
  • 26% of Americans are online “almost constantly,” although the average daily time spent on social media is leveling off.
  • The number of Americans using wearables increased from 25 million in 2014 to 52 million in 2018.
  • Customers strongly prefer brands that provide personalized offers or recommendations, and most of them are willing to actively or passively share data to get them.
  • The US profit and loss swung deeply into the red starting in 2003, with Medicare and Medicaid being the biggest spending drivers in doubling and tripling their entitlement percentages, respectively, since 1988. Overall entitlement spending grew during that same 30 years from $1.1 trillion to $4.1 trillion per year.
  • The US leads peer nations in both preventable deaths and administrative healthcare spending.
  • Consumer adoption of digital tools is growing steadily, with an especially large percentage increase in telemedicine.
  • Major healthcare trends include research using data pools, aligning care teams, filling unused appointment slots, offering on-demand delivered prescriptions, participating in physician social networks, and using digital tools to reward health living.
  • Among Internet leaders, consumers are most willing to share the healthcare data with Google, Amazon, Microsoft, and Apple.

A study finds that patients who ask a hospital for copies of their radiology images are nearly always offered only a CD option, with 8% also offering emailed copies and 4% making them available via their online portal. Charges ranged from $0 to $75 for a single CD.

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A review of the LinkedIn profiles of former Theranos employees finds that some of them ended up working for tech companies (Apple was the #1 choice) and pharma; some tried to hide their previous employer by labeling them as an unnamed “biotech startup company;” and a few made light of their previous employment in humorously describing their work there. Former executives Elizabeth Holmes and Sunny Balwani still list their current jobs as working at Theranos even though the company shut down last year and Balwani left in 2016, although I doubt many companies are reaching out to put them on their payroll. I’m intrigued that the company’s compliance manager (a lawyer and an RN) still lists active employment there. My LinkedIn search ended prematurely at that point now that the Microsoft-owned site has limited people searching unless you pay “as little as $47.99 per month,” odds of which in my case are exactly zero. Facebook is the master of nudging people to take profit-generating actions that don’t cost anything, while LinkedIn beats users over the head with hammer in forcing casual users to log in so they can harass them with “try premium now” messages that, along with LinkedIn user-generated unsolicited sales message spam, have earned it my vote for most annoying site. Footnote: as I’m looking at the Theranos logo, I realize it’s a word jumble for “Sheraton.”

Intermountain Healthcare and it outsourced revenue cycle vendor R1 RCM open their 30,000-square-foot innovation center in Salt Lake City, the “innovation” being technology solutions that get insurers and patients to pay up (just in case it sounds like something that is beneficial to patients or that will advance medical knowledge). I don’t know exactly what’s in there unless it’s computers, collection letter printers, and sacks of cash.

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UC San Diego Health opens another of its “one-stop shop” comprehensive health centers, touting online “save my spot” booking, in-room 40-inch monitors so patients can see what the doctor is typing into the EHR, and UCSD’s mobile app that offers a location finder, provider look-up, directions and parking information, appointment booking, and Epic MyChart. 

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These reports always fascinate me. In India, the family of an elderly patient who died in the hospital ED attacks hospital employees and trashes the place, claiming that junior doctors were negligent and that handling of the patient’s body was delayed. One doctor was admitted to the hospital in critical condition, while 50 others later closed the hospital with a sit-in demanding better security. Bystanders say two truckloads of family members were joined by others to form a mob of 200 rioters who attacked the doctors as local police watched without intervening. The patient was a Muslim imam, and images being circulated suggest that a radical Muslim fundamentalist used social media to call for violence. I would like to think it couldn’t happen here, but I’m not so certain these days.


Sponsor Updates

  • A Black Book survey finds that health system CEOs seek financial team executives who possess experience with technology acquisition and implementation, data analytics, financial business strategy, and financial operations administration through technologies.
  • FDB will present at the UDI Conference June 11-12 in Baltimore.
  • SiliconSlopes.com features Collective Medical CTO Adam Green and CISO Wylie van den Akker on its Meat & Potatoes podcast.
  • CoverMyMeds will exhibit at the Greenway Health User Exchange June 13 in Columbus, OH.
  • Cumberland Consulting Group will exhibit at the AHIP Institute & Expo June 19-21 in Nashville.

Blog Posts


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Contacts

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Morning Headlines 6/11/19

June 10, 2019 Headlines No Comments

Connecticut and Illinois Open Investigation into Quest Diagnostics, LabCorp Data Breach

Attorneys general from Connecticut and Illinois launch an investigation into the cause of the American Medical Collection Agency breach, which may have exposed the data of 20 million people.

DLH Announces Acquisition of Social & Scientific Systems

Health and human services tech company DLH acquires Social & Scientific Systems, a public health research organization, for $70 million.

The AMA has a new president-elect

The AMA names allergist and immunologist Susan Bailey, MD president-elect.

Curbside Consult with Dr. Jayne 6/10/19

June 10, 2019 Dr. Jayne 2 Comments

As much as clinicians complain about EHRs, they can be powerful tools for data analytics. I’ve worked with a number of organizations that have embraced the ability of the EHR and practice management systems to help them understand why their schedules are backed up and also to implement strategies to improve things. Sometimes it’s a patient panel that’s too big, or inefficient scheduling, or getting a late start in the clinic every morning.

Now there’s new data that shows that appointment scheduling isn’t just a point of frustration. It can actually impact patient care. The authors looked at screening for breast and colorectal cancers and whether the time of day the patient was seen makes a different on whether the patient actually receives a screening referral. Patients who were seen in the morning were more likely to be seen than those with afternoon appointments. The study looked at family medicine and internal medicine practices in a variety of settings in New Jersey and Pennsylvania during 2014 and 2016. Acute and sick visits were excluded, so these were times that physicians should have been managing preventive care or chronic health issues.

The authors cite factors such as lack of time (possibly due to physicians being behind schedule) and “decision fatigue” as potential causes. The latter occurs when clinicians are less likely to have screening discussions because they have already had similar discussions multiple times earlier in the day. There’s also concern that patients who decline screening earlier in the day may make it less likely for physicians to bring it up in later appointments. Additionally, patients who are seen later in the day may also be under time pressure and may not want to discuss screenings.

The authors recommend using non-physician care team members to assist in addressing screening gaps and adjusting clinic workloads so that physicians can better focus on patient care during visits. It’s tempting for physicians to have a knee-jerk reaction to these recommendations because they are used to being the primary point of contact with a patient. I continue to come across physicians that are resistant to team-based care even when they are stressed and burned out.

There are plenty of patient engagement solutions out there that can assist with encouraging patients to receive preventive services, whether they are blast messaging through an existing patient portal, email, or text system or novel apps designed specifically for patient engagement. Those reminders can reach patients when they’re not preoccupied with other discussions during an in-person visit. Of course, patients might be just as likely to blow off those asynchronous reminders, but it’s another tool for practices to use to try to better address patient needs in a way that doesn’t impact schedules.

These types of issues are also part of what primary care transformation programs are trying to address. Initiatives such as Comprehensive Primary Care Plus (CPC+) are designed to provide additional care management payments that would include coverage for these interactions. Other programs such as Primary Care First are designed to reduce administrative burdens and make payments more streamlined which theoretically should increase the capacity for practices to deliver patient-centric services.

Of course it will take time to gather data on these programs. The CPC+ program has been live for a little over a year and initial reports on the program indicate that it’s really too early to determine what kind of impact the program might have on overall spending related to clinical outcomes.

It’s not just screening services that are impacted by the duration of the workday. The study notes that other investigations “have found higher rates of inappropriate antibiotic prescribing and opioid prescribing later in the day. In each of these studies, behaviors improved slightly after lunch (a short break for most clinicians).”

Organizations that want to tackle issues like time pressure and decision fatigue need to be careful in how they address this with their providers. One author recommended that physicians set aside time for breaks throughout the day to address the problem. This is easier said than done in office settings where providers often don’t have time to take a break to eat a meal, use the restroom, or interact socially with staff because they’re just trying to grind their way through the day. Offering those kinds of suggestions without fully understanding the problem can come off as patronizing or antagonistic. Personally, the last time I ate food during a 12-hour shift that did not involve nibbling while charting was never.

Physicians are also becoming increasingly resistant to the idea that they are responsible for changing patients’ behaviors. Physicians are supposed to motivate patients who appear tired or uninterested in a conversation about screening. The study’s author commented that patients need to be convinced that their decisions have an impact and that physicians need to think about how to best organize discussions around patients’ health.

I know I’m not alone when I admit that I’m tired of trying to persuade patients who don’t give a damn about their health that they need to take charge of, or at least get involved in, their own health. There’s a dearth of personal responsibility in our society compared to what I’ve experienced in healthcare in other parts of the world. It feels like we are no longer practitioners of the art of medicine but cheerleaders, salespeople, and at times parent-substitutes for grown adults who should be able to at least participate in their own well-being.

I think this is a major part of why we see primary care providers defecting to the urgent care or emergency department care environments. They are not expected to manage anything beyond the acute issue in front of them. Providers who gravitate to direct primary care or concierge practices are at least being paid better for their time and effort, so there is higher satisfaction among my colleagues who have made that jump.

In the mean time, the study is important to illustrate that many variables affect patient care and we can identify ways to address some of them. There are plenty of relatively simple solutions out there that practices are still resistant to implement.

I was in an office the other day where the entire staff walked in two minutes to opening time. They were waiting outside because they’re not allowed to clock in before 7:57 a.m. There is no way that any of them were prepared for patients arriving at 8 a.m., but such was the office policy. Until we begin to tackle those obvious issues, addressing the more subtle ones will remain out of reach.

What do you think about decision fatigue, appointment schedules, and personal responsibility? Leave a comment or email me.

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Morning Headlines 6/10/19

June 9, 2019 Headlines No Comments

Medisanté Enters U.S. Market and Chairs the Direct-to-Cloud IoT Activity Work Group in the Personal Connected Health Alliance

Switzerland-based medical Internet of Things vendor Medisanté enters the US market with the opening of an office in Bridgewater, NJ.

KRMC website shut down since April, possible security breach

Kingman Regional Medical Center (AZ) works to rebuild its website, down since April 8, after discovering that its configuration enabled unauthorized users to view information entered by KRMC patients.

NSA Cybersecurity Advisory: Patch Remote Desktop Services on Legacy Versions of Windows

NSA takes the unusual step of issuing a call for Windows 7, Windows XP, and Server 2003 and 2008 users to install a Microsoft-issued patch as a preemptive measure against the BlueKeep vulnerability.

Monday Morning Update 6/10/19

June 9, 2019 News 4 Comments

Top News

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A physician’s New York Times opinion piece says corporatized healthcare is cynically taking advantage of the professionalism of doctors and nurses by assuming they will work extra hours without extra pay, with the biggest overtime culprit being the EHR.

The article concludes,

In a factory, if 30% more items were suddenly dropped onto an assembly line, the process would grind to a halt. Imagine a plumber or a lawyer doing 30% more work without billing for it. But in healthcare, there is a wondrous elasticity — you can keep adding work and magically it all somehow gets done. The nurse won’t take a lunch break if the ward is short of staff members. The doctor will “squeeze in” the extra patients. The EMR  is now “conveniently available” to log into from home. Many of my colleagues devote their weekends and evenings to the spillover work.

The author, internist Danielle Ofri, MD, PhD, also notes that the number of healthcare administrators increased 3,200% from 1975 to 2010, leaving healthcare with 10 administrators (and their salaries) for each doctor.

The always-thoughtful reader comments, many of them from clinicians, nearly all criticize the EHR and the transformation of healthcare from a calling to a greedy business dominated by mega-corporations whose richly compensated executives are rarely clinicians.


HIStalk Announcements and Requests

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The most recent method use by most poll respondents to communicate directly with their doctor was patient portal messaging and in-person conversation, with telephone calls coming in a distance third and all others methods registering a negligible number of responses.

New poll to your right or here: What college education would be required of a candidate for your job title? I upset the longstanding apple cart at a previous employer by requiring two of my managers – hired before I came on board — who did not have college degrees to either start a degree-seeking program or accept a demotion since their job descriptions required it. It’s either a requirement or it isn’t, and in our case, it was, even though a wishy-washy predecessor had promoted them without it. On the other hand, good job candidates don’t necessarily possess degrees and employers often require those credentials only to reduce the number of applications they have to read. Worst of all are companies that waffle their job description language with “should have” or “preferred” rather than “must have” – the job description should describe only those credentials required to earn further resume review or an interview.


Webinars

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


Acquisitions, Funding, Business, and Stock

Switzerland-based medical Internet of Things vendor Medisanté enters the US market with the opening of an office in Bridgewater, NJ.


Sales

  • Integris Health chooses Health Catalyst’s Data Operating System for enterprise-wide performance improvement.

Decisions

  • The Mary Black campus of Spartanburg Medical Center (SC) will go live on Epic this month.
  • Baylor Scott & White Medical Center – Grapevine (TX) will go live on Epic in 2020.
  • Surgeons Choice Medical Center (MI), which replaced CPSI with Athenahealth in December 2017, will move back to CPSI this month.
  • Advanced Surgical Hospital (PA) will remain with CPSI instead of moving to Cerner because of cost considerations.

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


People

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Scott Hill (Allscripts) joins Change Healthcare as VP of strategic accounts.

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Geisinger hires David K. Vawdrey, PhD (New York – Presbyterian Hospital) as chief data informatics officer.


Announcements and Implementations

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Mobile Heartbeat adds secure mobile video chat to its MH-CURE clinical communication platform for face-to-face team member collaboration. Use cases include diagnosis, specialist consults, remote huddles, and staff training. It supports cross-platform use between Android and IOS devices. Meanwhile, Yale New Haven Health’s Bridgeport Hospital goes live on MH-CURE in all units, integrated with caregiver assignments in Epic and alarm management with Connexall. 

Clinical Computer Systems, Inc., which offers the Obix perinatal data system, announces the BeCA Fetal Monitor and the Freedom wireless transducer solution that allows cable-free monitoring during labor.

Healthcare Growth Partners summarizes the health IT funding themes for May 2019 as fitness technology manufacturers, telemedicine-related companies, and vendors of patient engagement technology.


Other

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Another female novelist’s New York Times editorial calls for curtailing the wellness industry:

The diet industry is a virus, and viruses are smart. It has survived all these decades by adapting, but it’s as dangerous as ever. In 2019, dieting presents itself as wellness and clean eating, duping modern feminists to participate under the guise of health. Wellness influencers attract sponsorships and hundreds of thousands of followers on Instagram by tying before and after selfies to inspiring narratives. Go from sluggish to vibrant, insecure to confident, foggy-brained to clear-eyed. But when you have to deprive, punish, and isolate yourself to look “good,” it is impossible to feel good. I was my sickest and loneliest when I appeared my healthiest.

A women and children’s hospital in Australia doubles its antenatal pertussis vaccination rate after changing the optional “did you offer the vaccine” clinician EHR dropdown field from optional to mandatory.


Sponsor Updates

  • Gartner includes Lightbeam Health Solutions in its report, “Healthcare Payer CIOs, Leverage Vendor Partners to Succeed at Clinical Data Integration.”
  • Waystar will exhibit at the Homecare Homebase Annual Users Conference 2019 June 12-14 in Dallas.
  • NextGate publishes a new case study, “Enterprise Patient Matching Helps KeyHIE Establish Integrated Network of Accurate, Accessible Health Records and Drive Down Duplicate Record Rate to Less than 1%.”
  • Nordic, Surescripts, and Vocera will exhibit at the Epic Michigan User Group Conference June 10 in Ypsilanti.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, adds Stephanie Martin, DO to its executive advisory board.
  • Recondo Technology partners with analytics vendor VisiQuate to reduce claim denials and shorten the process of correcting and resubmitting them to payers.
  • DoD program Employer Support of the Guard and Reserve honors CloudWave with its Pro Patria Award for its support of Guard and Reserve employees.
  • PreparedHealth will exhibit at CMSA June 10-14 in Las Vegas.
  • Redox will exhibit at the Innovation Conference 2019 June 13 in Santa Fe.
  • Relatient publishes a new case study, “Seven Hills Women’s Health Centers Recover Over 1,300 Patients to Bridge Gaps in Care Using Automated Health Campaign.”
  • Sansoro Health releases a new 4×4 Health Podcast, “America’s Opioid Crisis: How IT Enables Better Care.”

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