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Morning Headlines 2/28/19

February 27, 2019 Headlines No Comments

Lawmaker Scolds VA Chief for ‘Stonewalling’ Probe Into Trump’s Mar-a-Lago Crowd

House Veterans Affairs Committee Chairman Mark Takano (D-CA) chastises VA Secretary Robert Wilkie for failing to turn over documents related to the Mar-A-Lago trio’s influence on VA software purchasing decisions.

Medsphere Acquires Wellsoft Corporation, the Leader in Emergency Department Software

Medsphere will integrate newly acquired Wellsoft’s EDIS software into a new health IT offering for urgent care centers.

Microsoft Employees Demand Company End $480 Million Contract With US Army

Microsoft employees demand that the company void its $480 million HoloLens 2 contract with the US Army after learning the headsets will be used in live combat rather than in more passive activities like vitals monitoring.

WellSky Acquires HCS, Entering Long-Term Acute Care and Inpatient Behavioral Health Markets

Multi-setting healthcare company WellSky acquires long-term and post-acute care health IT vendor HCS.

Morning Headlines 2/27/19

February 26, 2019 Headlines No Comments

Crossover Health Acquires Sherpaa Health Virtual Primary Care Platform

Two companies run by founders with health IT histories are joined as employee clinic operator Crossover Health acquires the patient-provider communications technology of Sherpaa Health.

Olive adding 100 jobs in Columbus as AI bot for healthcare takes off

Workflow automation company Olive (fka CrossChx) will more than double its staff over the next two years at its Columbus, OH headquarters.

Cedars-Sinai Taps Alexa for Smart Hospital Room Pilot

Cedars-Sinai will outfit 100 patient rooms with Amazon Echo Dot units running Aiva Health’s Alexa-powered patient care assistant, which routes the verbal requests of patients to the appropriate caregiver.

Lawmakers press VA officials on EHR modernization, workforce

Facing complaints about cost and delays, Veterans Health Administration Executive Richard Stone, MD tells lawmakers that Cerner has mapped all 131 versions of VistA and will soon combine them before migrating to the VA’s new Cerner EHR.

Over half of home health care clinicians say they lack adequate information from hospitals

More than half of home care clinicians say they don’t have access to the EHR information of referring hospitals, making it hard to sort out the majority of records that contain medication list discrepancies.

News 2/27/19

February 26, 2019 News 4 Comments

Top News

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Two companies run by founders with health IT histories are joined as employee clinic operator Crossover Health acquires the patient-provider communications technology of Sherpaa Health.

Crossover Health was founded in 2006 by Scott Shreeve, MD. He previously co-founded Medsphere with his brother Steve Shreeve and then left the company following a power struggle with the company’s board.

Virtual primary care provider Sherpaa Health was formed in 2012 by Jay Parkinson, MD, MPH, who had previously opened a New York City-based house call practice and then Hello Health, which offers EHR / PM / patient portal.

Sherpaa Health’s platform – which the company describes as a EHR built around online messaging instead of exam room conversations — supports patient questions, orders, referrals, and treatment protocols and adds components that resemble project management and customer relationship management.

Crossover Health, which provides services to Silicon Valley employers and was rumored to have been a potential Apple acquisition target in 2017, has raised $114 million in funding, while Sherpaa has raised $8 million.


Reader Comments

From Creative Loafer: “Re: BCBS of Massachusetts. Just sent this letter saying it will share information with providers to improve care – doctor visits, conditions, and treatments as required by Chapter 224 of the Acts of 2012. Wondering how this will work on the back end? Will my provider see the information in his Epic system? How will it get there? Will he not get information from self-pay visits?” I’ve inquired to BCBSMA.


HIStalk Announcements and Requests

I published most of the comments I received about HIMSS19 in detail. Thanks to everyone who took the time to respond. The overall themes are:

  1. The big draw is the opportunity to network and to efficiently meet with clients, prospects, and partners in a single location.
  2. Many attendees aren’t fans of Orlando as a host city due to traffic, the lack of nearby dining options, and the vendor buy-out of many of the nearby restaurants.
  3. The exhibit hall is so big that it’s hard to manage. The vendor expense involved to host a booth is off-putting when healthcare is already too expensive and many Americans don’t have the financial means to access it.
  4. The emphasis on interoperability was encouraging, but overall the industry may be stuck in a rut because of the domination of government, payers, and pharma that dictate technology decisions as a requirement for getting paid. 
  5. Keynotes were not inspiring and opinions were mixed as to whether educational sessions were worth attending and whether vendor involvement in them was excessive.
  6. The timing of the publishing of the draft interoperability rule took away some of the focus and energy.
  7. Some attendees griped about extra-cost conference events.
  8. CHIME’s event was well managed and dovetailed well into HIMSS19, although opinions were mixed about how many CHIME attendees remained for the week.
  9. The EHR market will become less of a focus in the absence of Meaningful Use money and health systems that have already made their long-term choices, which if hospital margins remain decent will open up budgets to more innovative technologies. This will likely change the nature of the HIMSS exhibit hall, especially as some vendor respondents said the return investment for exhibiting is becoming questionable.
  10. Some attendees said that HIMSS should limit the exhibit hall to purely health IT exhibitors rather than medical device companies, aiming for focus rather than maximizing revenue.

Listening: new from 25-year-old, Tony-winning actor Ben Platt, whose vocal range and emotional delivery of personal stories make his vibrato OK even though I don’t usually like it.

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It’s usually pretty quiet in the first couple of weeks after the HIMSS conference, so I was surprised to see that I had over 8,000 page views in 6,300 unique visits on Monday, similar numbers to all but one day during HIMSS19 (Thursday of that week had nearly 11,000 page views).

I was thinking about the patient engagement comments from my HIMSS19 survey. Vendors and providers might be creating solutions that focus on hospital and practice benefits rather than those of patients, giving little incentive for using them. Maybe patients don’t really want to see revenue-maximizing, spam-like reminders that are as impersonal as their actual provider visits. My thoughts:

  • We need to understand the degree and form of engagement that patients want – actually, what each individual patient wants.
  • We aren’t doing a good job addressing what patients want in their actual visits (like more time to talk to their doctor) and automated messages can’t fix that. I’m likely to ignore a doctor’s attempts to engage me as a patient with technology if that doctor made no effort to engage me when I was paying for my short face-to-face time with them.
  • The clinician’s job is to make sure the patient understands the health implications of what we’re messaging about.
  • The messaging should be actionable. We can message people using primitive EHR reminders for prescription refills, needed tests, or suggested lifestyle changes, but we don’t yet have enough experience with the psychology behind those messages (I’m sure Facebook could offer insight). Surely we’re far along enough now that patients could be surveyed about which messages spurred them to take a desirable action vs. which ones didn’t; how the frequency and wording of the messages impacted results; or how outcomes were improved because of patient engagement.
  • People need to feel accountable to other people, not to computer-generated nudges or provider policies. Computer-generated mass messages and chatbots probably have good cost-effectiveness (they cost next to nothing and scale attractively, so even slight improvements make them worth it) but perhaps studies should compare them to human-powered interventions, such as outreach telephone calls or easier, multi-channel access to clinicians. I don’t think I would trust a medical practice in which they want to blast out electronic demands but won’t allow me to email me the doctor whose name appears at the bottom.

Webinars

March 6 (Wednesday) 1:00 ET. “Pairing a High-Tech Clinical Logistics Center with a Communication Platform for Quick Patient Response.” Sponsored by Voalte. Presenters: James Schnatterer, MBA, clinical applications manager, Nemours Children’s Health; Mark Chamberlain, clinical applications analyst, Nemours Children’s Health. Medics at Nemours Children’s Health track vital signs of patients in Florida and Delaware from one central hub, acting as eyes and ears when a nurse is away from the bedside. Close monitoring 24 hours a day integrates data from the electronic health record, such as critical lab results, and routes physiological monitor and nurse call alerts directly to the appropriate caregiver’s smartphone. This session explores how the Clinical Logistics Center and more than 1,600 Zebra TC51-HC Touch Computers running Voalte Platform connect care teams at two geographically dispersed sites for better patient safety and the best possible outcomes.

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


Acquisitions, Funding, Business, and Stock

Children’s Hospital of Philadelphia Foundation will make a $741 million profit from the gene therapy spinoff it created in 2013, which will be acquired by drug maker Roche for $4.8 billion. The company’s blindness treatment drug costs $425,000 per eye and will generate $76 million in revenue this year, while a hemophilia treatment it developed has not yet reached the market. 


Sales

In Canada, Bluewater Health will replace its 20-year-old Meditech system with Cerner, joining several other hospitals in the region that will implement Cerner. 


People

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Jason Owens, MPA (HealthPoint) joins HealthInsight as CIO.

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John Douglass is named executive board chair of smart infusion pump and software vendor Ivenix. He was a co-founder of Sentillion and president of Capsule.


Announcements and Implementations

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KLAS looks at how well vendors share genuinely usable data — especially in light of the Carequality-CommonWell connection – with particular attention to contextual information such as notes and lab results. Leading the pack is Epic, which brings in problem lists, allergies, medications, and immunization history from any EHR and automatically ingests notes and lab results (automatically from other Epic sites, with configuration required for other sources). Cerner is #2 in allowing users to choose which documents they want to bring in for summarization in the chart. Both Epic and Cerner allow accessing outside data via a search bar to prevent users from manually managing CCDs. KLAS found no Greenway Health customers that are using outside data, while CPSI users must manually reconcile every data element, including manually matching patients. The report notes that Epic sends a separate CCD for each encounter, which makes it easier for non-Epic sites to automate data consumption, but that practice may surprise vendors or users who are expecting a summary CCD only.

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Cedars-Sinai will outfit 100 patient rooms with Amazon Echo Dot units running Aiva Health’s Alexa-powered patient care assistant, which routes the verbal requests of patients to the appropriate caregiver. It also allows them to control their TV or to play content such as music. Cedars-Sinai is an investor in the company, which graduated from its accelerator.

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A survey of hospital CFOs finds that physicians generate an average of $2.4 million each in net revenue to hospitals with which they are affiliated.


Government and Politics

ONC will offer a webinar on Thursday, February 28 to review HHS’s proposed interoperability rule. it will be recorded and offered for playback afterward. I hope they sprang for the high-capacity GoToWebinar subscription.


Other

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I hesitate to mention this just-published research paper since it uses observational data and surveys from Brigham & Women’s that were collected in May 2015 (an explanation should be interesting, especially since it finally ran in an open-access journal) and the hospital had just gone live with Epic back then, but here it is. Clinicians used Epic differently during morning rounds, as follows:

  • Epic was used on multiple device types — IPad, computers on wheels, nursing station desktops.
  • Most clinicians used the EHR before entering the patient’s room and some afterward, but few in the room itself.
  • Non-EHR workarounds such as written notes, emails, and verbal discussions were used.
  • Residents wrote down vital signs and lab results only because that process helped them remember the information.
  • Some residents printed out the patient summary reports to track patients and to write themselves reminders to be entered later.
  • Clinicians rarely used the EHR in the patient’s room, but when they did, their backs were facing the rest of the care team due to bedside computer placement and the clinician’s focus was on the screen instead of on colleagues.
  • Some participating clinicians complained about too many clicks in Epic and said the handoff process was so cumbersome that they just called each other with verbal updates.
  • One resident said, “in order to get a picture of something, if I need one piece of data that’s a lab value and one thing that’s a flow sheet and one thing that’s a radiology thing and one thing that’s an order and one thing that the nurse enters and one thing that the physical therapist enters and one thing that the physician enters, hard. Very very hard, it doesn’t integrate well.”
  • Most participants said the EHR is useful for care team coordination and teaching, but half said it doesn’t make rounding more efficient. 

Google Translate can translate ED discharge instructions into Spanish and Chinese with high accuracy, a study finds, but still isn’t good enough for handing out the result without a warning that the translation isn’t perfect. The authors suggest that clinicians use Translate to provide an on-the-fly translation of verbal instructions and only for instructions that don’t contain complex grammar and medical jargon. The authors did not assess the actual readability of the result or compare the output to that of human translators. They also suggested giving patients the English version anyway so English-speaking family members can compare them to the translated version.

Apple is testing sleep tracking for its Apple Watch, although fitness tracker competitors already offer that feature and its acquired Beddit product already measures sleep via a mattress sensor. Such use would require developing Watch batteries that can run longer between charges, a feature also already offered by fitness trackers.

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A CMS investigation of Baylor St. Luke’s Medical Center (TX) finds that employees mislabeled blood 122 times in four months, with the hospital taking no documented action in response to their expressed concerns about blood specimen handling. A patient died after the wrong blood type was transfused.

More than half of home care clinicians say they don’t have access to the EHR information of referring hospitals or clinics, making it hard to sort out the 90+ percent of records that contain medication list discrepancies.

This is depressing (no pun intended). Fifteen thousand low-paid Facebook contractors who review potentially inappropriate content experience panic attacks, PTSD symptoms, and depression from seeing the horrific material users have posted, resorting to on-the-job drug use and indiscriminate sex in hoping to forget on-screen murders, graphic pornography, bizarre conspiracy theories that eventually seem plausible, and hate speech. The whip-cracking, call center-like working conditions are depressing enough, but even more is the fact that Facebook users – some of them likely to be your neighbor, co-worker, or relative — are posting so much vile content that armies of moderators can’t keep up.


Sponsor Updates

  • AdvancedMD will exhibit at the American Academy of Dermatology meeting March 1-5 in Washington, DC.
    Impact Advisors expands its ERP offerings with program assurance services.
  • Arcadia will host its annual Aggregate conference April 24-26 in Boston.
  • The Chartis Group posts a paper describing the key takeaways from HIMSS19.
  • Gartner recognizes CenTrak as a Visionary in its January 2019 Magic Quadrant report for Indoor Location Services, Global.
  • CoverMyMeds will present at the PBMI 2019 National Conference March 4-6 in Palm Springs, CA.
  • Sansoro Health publishes its list of “50Best Health IT Blogs You Should Be Reading.”
  • Culbert Healthcare Solutions will exhibit at the AAAP conference March 1-4 in Savannah, GA.

Blog Posts


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Contacts

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

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Morning Headlines 2/26/19

February 25, 2019 Headlines No Comments

GE Healthcare IPO this year ‘looks unlikely’ after Danaher deal, CEO Culp says

GE shelves plans to IPO its healthcare business after selling its biopharma business to global conglomerate Danaher for $21.4 billion.

The FDA and Flatiron Health Expand Real-World Data Cancer Research Collaboration

Flatiron Health and the FDA’s INFORMED program renew their collaboration, which uses real-world evidence derived from de-identified EHR data to inform regulatory decision-making and enhance cancer research and treatments.

New milestones in helping prevent eye disease with Verily

Google and Verily launch an eye-screening program in India that uses a machine-learning algorithm to screen for diabetic eye disease.

Curbside Consult with Dr. Jayne 2/25/19

February 25, 2019 Dr. Jayne 2 Comments

I spent the weekend with one of my healthcare IT mentors. He’s been around the industry for several decades and I’ve been the fortunate recipient of some of his knowledge as he’s shared it with me over the years. He taught me much of what I know about building relationships with clients and constituents, along with how to cut through the noise that some in the industry constantly generate.

Over time I’ve been his customer, later his co-worker, and even did a brief stint as CMIO at an organization he led. Most of all, I’m grateful for his friendship as I’ve moved through this wild and crazy industry. He’s helped me weigh the pros and cons of various opportunities and reminded me to be true to myself, because the industry and the people in it can change with not even a moment’s notice.

Following the whirlwind of HIMSS, it was good to be able to sit by the pool and do nothing. When the most major item on your agenda is determining which movie you’re going to watch after dinner, life is good. (Note to readers: “A Quiet Place” is not so quiet of a film.)

It was nice to have a glimpse of retired life, although I can tell he misses the industry at least a little bit. He spent the majority of his career on the vendor side. We played the “who did you see at HIMSS” game and it was a trip down memory lane talking about everyone we’ve known or worked with over the last 15 or so years. Very few of our mutual friends are in the same places in the industry, with many having made the rounds among multiple EHR vendors over time. Certain executives seem to bring their entourages with them as they move, which leads to an exodus when they ultimately leave. It seems like some people just follow each other around the industry.

The people we’ve worked with have ranged far and wide, landing full-time gigs at academic medical centers, health systems, and with cross-industry vendors such as Salesforce or AWS. Some work in lobbying or the healthcare policy arena. Others have left the healthcare IT world altogether – one raises pygmy goats and another owns a hot yoga studio.

It’s always fun to hear about their exploits and to wonder where various people landed in later phases of their careers while pondering one’s own future. I’ve been a bit restless the last several months. Running your own business is challenging and making sure that the people who work on your behalf are meeting client expectations can be exhausting even with a small group of people.

I’ve explored a couple of opportunities to return to life with a Big Health System, along with one to move into the vendor space. None of them were particularly conducive to staying in practice, which ultimately led me to cross them off the list. I’ve had a couple of periods during my career where I didn’t see patients and I did miss patient car,e although I didn’t miss dealing with insurance companies or landlords.

In reviewing my recent foray into job hunting, I was frankly surprised by the inability of the provider organizations to come up with a clinical situation that would work. Often the emergency department or urgent care work has been contracted out to a staffing company that is reluctant to take on a part time physician.

One offered to add me part time to an existing internal medicine group. Trying to work as a primary care physician but only be in the office half a day a week is very challenging. I did it when I first moved into the CMIO trenches and there was much patient dissatisfaction with the arrangement, as patients were used to having advanced access scheduling with me as their physician. Not to mention that my partner constantly grumbled about having to cover for me even though he was being compensated for the extra work.

I can’t imagine trying to be a new physician to a practice but only be in the office half a day a week unless you were just seeing acute or overflow visits, and none of the organizations I talked to were offering that kind of arrangement. I don’t think that seeing patients is essential to being a good clinical informaticist or physician leader, but I do enjoy it and think it provides valuable context for being able to serve the organization.

The vendor role was reluctant to let me stay in practice at all, for fear that I wouldn’t devote my full efforts to the job. I think that was short sighted and they shouldn’t care what I do on my weekends. It turns out they have a “no moonlighting” policy for all employees, which was a bit of a red flag anyway. I don’t think employers should try to dictate what people do in their off hours unless it reflects badly on the company or interferes with the employee’s ability to complete their responsibilities successfully. It seems like many people have a “side hustle” these days, probably due to the uncertain aspects of the healthcare IT economy.

I’ve been looking into some telemedicine opportunities because they seem to be flexible and might be a bit more easily worked around a full-time informatics role. However, it’s not anything I have ever done, so it’s hard to gauge whether it would be a good fit. My friends who have done telehealth either really liked it or didn’t. I’m used to being adaptable, so we’ll have to see how things unfold.

I’ve got a major volunteer commitment this summer that I need to schedule around, so I don’t want to upset the proverbial apple cart too much unless an amazing opportunity comes along. A wise man once advised me to always keep my mind open to new opportunities and his advice has been spot on so far. Until the universe drops something spectacular in my lap, however, I’m perfectly content to sit by the pool, contemplate a nice glass of wine, and be grateful for the life I’m living.

If you could re-engineer your career, what would you do differently? Leave a comment or email me.

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Email Dr. Jayne.

HIMSS19 Reader Impressions

February 25, 2019 News No Comments

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Fifty-five HIStalk readers provided their thoughts on HIMSS19, which they graded overall as a B- (2.5) on a four-point scale. I’ve excerpted some of their thoughts here.


What did you like best?

It was my first HIMSS conference and it met my expectations (expectations were implanted from co-workers and reading HIStalk to some degree). It’s a great opportunity to get a physical snapshot of the HIT industry in one place and just see what’s going on.

Not in Vegas and not in Chicago in February.

Precision medicine and pharmacogenomics sessions. There is growth in these areas as AI and analytics become more mainstream and mature. It’s interesting to see there is actual ‘precision’ or ‘personal’ in the offerings versus hype.

Some of the presentations / information sessions were very interesting and educational. As an interface developer, I was impressed and overwhelmed by the amount of FHIR/API sessions. I also made an effort to get out of my lane and attended some great sessions on AI and Innovation in the healthcare industry. The opportunities to network, see old friends, and meet new people is always a prime benefit of the conference.

Ability to network with wide range of people from across industry. More signal, less noise this year. Opportunity to meet with some of the smaller innovative vendors that in some instances, have pretty compelling models

Networking and meeting over meals.

Vendor floor seemed manageable. 

Location.

Odd, as it may seem: The education session provided by hospitals about their struggle with real problems and the solutions (organization AND technology) they found.

Did not have to walk through a stinky, overwhelmingly bright and tacky casino.

Plenty of meetups and breakouts for even the most obscure discipline

HIMSS organization is a well run conference running machine. Audio works, wayfinding is superb. It’s all the little things that you don’t notice; because they’re taken care of.

Quieter than previous years, more level-headed discussion and less hyperbole.

Fairly busy, good discussions and less hype than normal.

I liked not spending 30-50k and talking to myself in a booth.

I went into this with some very specific goals and focused on those the entire time. While I did make connections with current vendors, I came away with some good knowledge and answered questions.

Great chance to catch up with vendors that we use and explore potential vendors quietly.

Reconnecting with industry friends and colleagues.

The cybersecurity command center where so many of the niche vendors could co-mingle and you could visit them without hunting all over the showroom floor.

Loved attending CHIME. Period. Cross over scheduled education and focus group sessions Mon, Tues, and Wed. These were hugely beneficial and pulled us away from standard HIMSS client sessions that were mostly rushed and nonsensical. Even keynote speakers at CHIME were better than HIMSS.

Networking, networking, networking. It was great for introducing clients for partnerships.

Lots of CIO / VP level conversations on the show floor – it seemed more CIOs stuck around after CHIME.

Meeting a large volume of vendors in a short space of time. Saves admin time.

Easier to get around since it isn’t in the middle of a tourist crowd like Las Vegas.

Efficiency of seeing many vendor exhibits in one place, educational sessions with real customers, and networking with other attendees.

it was great to see real integration work with FHIR tech and payer/providers. Be interesting to see progress in real world.

Ability to interact with many colleagues and potential clients in one spot at one time.

Vendor exhibits.

It is what it is, and it brings a lot of people together which occasionally results in some useful side meetings.

There certainly is a lot of energy.

Seeing products I otherwise wouldn’t know of.

In contrast to recent past HIMSS annual conferences, it was very noticeable that none of the education sessions that I attended had vendor presenters. The educations sessions were very informative and valuable to me. There were no sales like presentations in the education sessions. I could have been lucky this year. Wondering if others noticed a difference.

A good place to knock out a lot of face to face meetings in a compressed time.

Networking opportunities. When you see people each year, then trust begins to build.


What did you like least?

I knew it was going to be big, but it’s too big. There are many large vendors, a goodly number of small vendors, but nothing in the middle. Seems like the fees from HIMSS cater to large corporations.

Sessions were a waste of time.

It’s over the top circus atmosphere of “Look at me, Look at me!” in both the vendor space and in the sessions. There’s too much chest-thumping and not enough serious, thorough, and thoughtful acknowledgment of where we are and where we need to go as an industry.

Another year of post-HIMSS cough.

There wasn’t a singular theme. Is our industry becoming boring?

The exhibit hall is WAY TOO BIG – you can’t tell me the ROI is there for the smaller booths and/or even the bigger booths. Dare I recommend that it goes back to one booth size so we can showcase innovation?

The one-hour queue on Thursday to pay $3 for someone to put your bag in a pile.

Keynotes were not as good (or as well known) as previous. Need to start looking for one or two more cities to have this. Attendance will be down next year due to Orlando AGAIN.

Long booth hours (as a vendor, there simply are no breaks) and after hours all the restaurants are loud. Voices seemed to be scratchy and fading by Thursday.

Transportation around Orlando is a pain because everything is so spread out, making 30k+ people arriving and leaving in the same ~1 hour window. Food options are terrible at the show (expensive, long lines, and bad food).

The late opening of the exhibit hall floor the first day to try to force people to go to the keynote. Keynote sessions that were the usual hype suspects but had no real stuff underneath.

The cost and waste of the trade show floor.

For the most part, the education sessions are a rehash of material we should have known about or read over the course of the previous 11 months.

Crazy hours and long days. Miss that break in the middle of exhibit hours of old.

Too many vendors and nothing really exciting.

Aggressive salespeople approaching you in the middle of the aisle and salespeople completely uninterested working in their phones (whoever told them to come to HIMSS, this is not helpful for those sales folks nor for your company).

Not dislike, but do think rules dropping Monday vs. the Friday before didn’t give many folks actually working at HIMSS time to digest and make actionable decisions / movements in what is already 6 a.m. to 1 a.m. days for many of us.

Had the feel of a very low energy, going-through-the-motions event. My informal analysis of the distribution of speakers by type for the “education sessions” indicates about 5 percent of speakers came from provider organizations, with the rest coming from vendors, HIMSS, and government (75 percent, 10 percent, 10 percent, respectively).

I find many of the sessions just to be vanity sessions. The presenters were all puffed up about how they have solved the latest whatever. And when you look honestly at what they are doing, it’s not far off from what the rest of us are doing.

Orlando and the shuttles.

Venue. Hosting in Orlando is impractical and frankly awful. Hotel options close enough to convention center book months in advance, forcing long commutes and traffic nightmares. Not enough food options, and even those nearby closed for events hosted by Google, Amazon, and the like. Vegas is truly the easiest location and we should be there annually.

The keynotes were ho-hum. I look to them for inspiration. My favorite was probably the closing with Susan Devore. I generally like ONC town halls, but might even put them above keynotes this year … not sure what that says.

Acres of concrete to walk on. Calves are still sore. Traffic congestion isn’t fun.

Walking miles among plastic palaces.

The size, but you take the good with the bad, so maybe it was my tired feet talking.

The opening ceremony was cringey, as was, frankly, the whole “Champions of Health Unite” theme. Totally absurd. Also, many of the talks I went to were pretty dull.

I miss having the daily morning keynote address from an industry expert. Many years ago I appreciated having the daily morning keynote address to kick off the day with some encouragement and purpose.

Feels like a death march.

Unproductive downtime.

Sadly lacking a dose of humility.

I firmly believe either HIMSS or the OCC was jamming data on the exhibit floor. I could take calls on my Verizon phone, but could not access data-driven services (e.g. email, text messaging) while on the exhibit floor.

Overwhelmed by the number of events and options. Probably cannot do much about that, but it takes planning to hit all the locations you want to attend.

The waste of healthcare money diverted to hype and glitz.

Fewer of my hospital clients attended this year. I had 11 scheduled client meetings in 2018 but only four scheduled this year. Nine of my clients who attended in 2018 did not attend this year; only one client attended that hadn’t in 2018.

Still too big. The focus is on selling products with each vendor trying to outdo the other. Less focus on actually sharing information.

Bus logistics and the organization of exhibitors.

Vendors are just out and out charlatans. Omg. The hype. There is too much hype overall for the conference to be serious.

As an exhibitor, it’s frustrating to see the attendee badge when I really want to see provider called out.

The size — it is just too much.

Nickel-and-dime charges for many “extra” items. Many formal social and networking events scheduled for same time (lots on Tues late afternoon/early evening). Government session on ONC API regulations would bore the dead! Wow was that painful. Not crazy about that stretch of Orlando; very congested and hard to move around.

It seems to be getting more and more impersonal each year and the transportation capabilities of HIMSS and the convention center itself are a joke. The bomb scare on Wednesday that prevented people who entrusted their bags to the convention center for safekeeping kept them away from those bags for a couple of hours while explosives dogs sniffed each bag (albeit not evacuating the HIMSS floor, just above it), resulting in many people missing their flights out and unable to re-secure the rooms they checked out of earlier in the day (because they were now booked?), resulting in them having to find alternative lodging in most cases out by the airport or downtown. Perhaps they should partner with Disney to figure out how to effectively get thousands of people in and out of an attraction (aka HIMSS).

The HIMSS self-infatuation. For all that has been spent to date via taxpayer dollars, we have not moved the needle on costs and quality, ever so modestly. Social media ambassadors. Champions of Health mantra.

Getting nickeled and dimed for different sessions. Traffic on International and the closing of the West entrance ramp which exacerbated the traffic.

HIMSS and vendor hype about capabilities. Also, the tendency to announce things that are not really new, and using buzzwords like AI that are not applicable to their products and services.

Extremely crowded, poorly run – tough to get food and drink inside and outside the convention center. Overall not enough focus on the sessions and topics of interest in healthcare. need to find ways to link vendors to the topics healthcare feels are important. It’s a huge missed opportunity – that many healthcare staff in one place should be talking about and strategizing toward something.


What company made the best impression?

Epic. You actually can have productive meetings with them if you are a customer.

Ada Health – nice tech to enable consumer self-triage.

Collective Medical – compelling model to address the community of care and has landed some interesting clients (both payers and providers).

Salesforce.com vision is global, strategic, and relevant to patient health improvement.

Uber and Lyft – smaller, understated booths that are actually making a difference in healthcare costs.

Nuance: combining vision and reality in great way. Microsoft: showing solutions with partners.

Rhapsody. Spun from larger company just months ago and ran a booth / show of veteran quality.

IBM because they seemed to be on the right track with a solid direction.

Wolters Kluwer. Inspired by some of the work they’re doing in UpToDate with care pathways and integration with ordering.

Accenture simply for the fact they provided some good booth presentations like Orlando Health’s Digital Front door. Good access to their leaders and all just showed general care and interest in what I was asking about. No hard sell, just can we help you.

Healthbox. Still a ways to go, but a centralized approach to innovation at a national level is beneficial for more health systems, all essentially trying to do the same thing in providing better care to our patients through technology.

Well Health. Interesting little start up. I found their approach reasonable and smart. I found their pitch to be humble and cautious. They were focused on what they can do and how they can fit in the ecosystem. These guys may be on to something.

The HL7 booth really did have a lot of useful information sessions. AWS next door was packing them in also. There were several smaller companies who were pitiably dwarfed by the big players, but had some interesting ideas.

Nuance. Their ambient clinical documentation has come a long way, feels like it’s straight out of science fiction, but the representatives on the show floor talked about it in a sober, level-headed way.

Google. They didn’t oversell and spent time explaining their steady entrance into the healthcare IT space.

Hyland – very friendly and engaging vendor.

IBM. They’re still around.

Epic: Seeing Judy Faulkner still discussing with customers ten minutes before the exhibition closed on Thursday.

Cerner, because of their Epic-bashing poster.

HIMSS actually. Love it or hate it, this is an impressive gathering of people across all aspects of automating healthcare. Easy to get lost complaining about why we aren’t twenty years further into the future, but this is how we get there. Learning from each other, standing on the shoulders of others, etc.

Epic and IMAT Solutions. Epic, the people are friendly courteous, do not talk about other companies and focus on their products. IMAT because the technology they bring in the “data world” is far superior to other companies who are in limited areas (like Diameter Health) or overhyped marketing campaigns (IBM Watson).

Epic, because they are real.

Humana people seemed to be everywhere talking about real world interop work they are making progress on with partners.

I liked Intermountain Healthcare booth. Talked to a guy from GoodData — maybe he was blowing smoke, but the guy loves his job. Never talked to anyone who was so positive about an employer/ State of Georgia — had a booth highlighting some of their tech companies — no other state had a booth like that, at least that I saw.

Orbita is making great strides in voice interfaces and their work with the Mayo Clinic is impressive.

AT&T FirstNet. To be able to provide that connectivity for EMS or in natural disasters is impressive.

I accidentally stepped into an overview of the artificial computerized heart and brain work by HP and wow! Unexpected and amazing work presented in a sales booth.

Several population health vendors. This is the second year I’ve set up appointments and really looked at these vendors. Last year’s weren’t any better than what I’m using today. This year all four of them really wowed me. Of course I need to dive deeper, but last year at this time I wasn’t impressed.

Google clearly made a significant investment this year.

Epic. Friendly, approachable, comfortable space, and offering demos for all.

I was very impressed with the work that Nuance is doing with real time voice recognition of the provider and patient in the exam room. The system was then able to real time also populate with the appropriate medical language and yes, billing appropriate terminology into the EHR standardized format. While they are initially working in the outpatient specialty space (Orthopedics) at the moment, I could see this being very helpful with hospitalists patient visits in the acute care setting. This could be a very significant productivity and life/work balance enhancement tool for physicians, nurses, and other care givers.


What company made the worst impression?

It is a tie between Allscripts and IBM, wasting money on big booth space when both are empty suits.

Epic and its continual desire to bash competition with various signs rather than just focus on the long game and its ability to help improve the delivery of care. Such childish marketing. Sadly, Cerner seems to be co-opting that strategy

Nemours. Just didn’t get why they would have a booth. Altruism?

IBM. Big booth, nothing of substance to say.

Those in the exhibit hall that were too busy talking to each other and didn’t acknowledge I was roaming around their booth.

Cerner and Epic. It makes me wonder why anyone would pay for their software when they show a complete lack of fiscal discipline with those booths.

IBM. What were they thinking with that size booth?

Philips. Too much hype.

A number of unnamed ones that failed to engage visitors standing directly at their booth.

How does Epic maintain the same booth year after year with no changes (except the signs – can’t forget about the signs), without it falling apart? Perhaps they keep it in the purported hyperbaric chamber in the city of Epic – I mean on the Epic campus.

Cohesity had a game and a hawker with a microphone. It was so annoying.

Athenahealth. The company tone has changed. It feels like they are struggling to find their way with the change of leadership and the merger. I did not feel the excitement I have felt from them in the past.

IBM looked like a commercial for Trump’s wall. I didn’t see attendees trying to scurry over it much, either.

The printing companies as a whole — KM, Ricoh. They seem to be going backwards, not forwards. Still heavy on print, no clear interface engines that allow seamless work.

Allscripts.

IBM is still overselling everything about Watson Health with little real progress to report.

NantHealth. So glad I did not buy their stock.

Multiple large and small companies who have no idea how to engage people in a meaningful discussion and seem to only know their sales pitch. Rule #1 of selling is sell yourself, then you can sell your product.

ONC and CMS. A simple thank you for the the otherwise pretty thankless job of automating a very complex domain against a very silly ONC rulebook now would be nice. Sick of being scolded, sick of being compared to banking (which is trivial by comparison), and very, very sick of being harassed by those who want to take the data by force and fiat now to monetize it in ways that patients won’t begin to comprehend. ONC crams garbage rules out and gets applause from its fan club without regard for what it really takes to do and for how it steals innovative time away from developers. And, you’ll get your butt sued if you make even the most minor transgression.

Velocity Technology Solutions. Just no-showed the entire thing and had an empty booth.

Nuance. Lots of hype and good things coming along, but lacking on follow through.

Cerner. Can they get any bigger?

Splunk. Staff were not friendly. Seemed to not care if you were there or not.

IBM. No one from the old Truven, Phytel, Explorys team went to the world’s largest digital health conference!

Epic ‘s booth kind of reminded me of the floor of a car dealership. I didn’t learn anything, which is what I think creates a good impression. I did learn that a rug can be too soft though. I almost turned an ankle on it.

Virence – who sponsored the bags?

Many. All those with magicians or paid entertainers who have speeches full of every buzzword in the book. It is annoying.

Leidos. Is this a military show? Pushing some crazy C2C software. Unfriendly reps (all salespeople). They should stick with military presence. Not sure why they are in our market at all.

What the hell was IBM Watson doing in their booth?


What conclusions did you take away?

Feel there could be some very interesting changes coming in the industry, moved forward by the gains made in utilizing API technologies to access / exchange data. FHIR/API’s look like they may actually have legs, not just flavor of the month. APIs also look to be helpful with some of the AI initiatives.

The EHR market is done. Ability to sell extension apps (RCM, PHM, etc.) is key for any EHR vendor, but unlikely to be enough and consolidation will continue. HIMSS itself will become a much smaller event over time. Healthcare organizations are now focused on value and ROI in purchasing decisions.

Healthcare CRM is so important for prevention and proactive patient health.

It’s just too big to matter any more.

Nobody is doing anything until the government mandates it.

The next wave of solutions will be consumer driven – the race is on for someone to own “the market place” and interoperability / coopetition will win in this world

AI is the new buzzword. No one is really doing it. Blockchain, thankfully, was barely mentioned.

EMR vendors are becoming less important in the grand scheme of things. MDM is where the $$ will be spent.

Waste of money. Won’t go next year.

Social determinants of health are bubbling to top of mind.

Half the companies shouldn’t be on the floor and a fourth of them won’t be around next year

We spend a lot of money at this convention that could be put towards patient care.

Bigger, crazier, and less beneficial year over year. Thankful for CHIME planners wrapping their meetings into HIMSS.

New focus is on the consumer and consumer apps – most notably CRM.

The era of EHRs is reaching a plateau as the market shifts to replacement with few net new installations. Also, little progress on interoperability demonstrates the tendency of the industry to place profits over patients.

FHIR interoperability really does have a chance to sit at the big boys table along with AI and blockchain.

If the industry can’t get its act together, then the Feds will step in.

Some – notably larger – hospitals are doing impressive IT development and showed real outcome improvements achieved through IT deployment

Healthcare wastes a ton of money on this conference. Booth sizes should be smaller for all, lessening the footprint to be more manageable. If the goal is to expose folks to as many new products as possible, you don’t need an “epic” sized space, no pun intended. Most booths were empty and i couldn’t shake the feeling that its just about appearing bigger and better.

It is worthwhile and I’m looking forward to next year’s conference.

Patient engagement is everywhere – but interpretation on what that means and why its important vary wildly.

Health system executives were not there. My opinion, people are growing tired of HIMSS.

AI, cybersecurity, and patient engagement were the themes this year and they dovetail with what I am seeing in real life.

EHRs and innovation for doctors is being choked off by ONC at the behest of those who wish to monetize the data for secondary uses. Doctors will still blame EHRs, but that’s part of ONC’s game plan while they serve the moneyed interests of Silicon Valley. Maybe the app makers will usher in a new era or maybe we’ll take a trip down memory lane to Best of Breed Gone Amok (BOBGA) again.

HIMSS tends to make you feel like we’re making huge progress in our industry and solving all of the problems. Then you remember that your mom, dad, siblings, kids, spouse, etc. couldn’t get their health info when they needed it, and you realize that we’re doing great when organizations have money to burn but we’re really not doing enough to effect the everyday lives of patients.

Fewer community hospital CIOs and I T directors are attending; We are not members of CHIME, but it appears that a number of CIOs left after CHIME. I got the impression that if you were not looking for a new EMR, you were less likely to attend than in the past.

The Meaningful Use trough is empty. The next areas of interest will be the democratization of data using blockchain between different entities. And so maybe HIMSS can become more if a learning conference again and less sales focused.

HIMSS is a huge waste of time and money. Let’s cancel 2021 and have everyone donate half of what they would spend on the conference to a not-for-profit to help fix healthcare!

ONC should be dissolved or made part of CMS. Cerner is a government affairs shop that happens to make software.

There was a lot less BS this year. PHM no long taking center stage and words like AI and blockchain were at an all-time low. Definitely back to basics for most vendors

After years of gorging on Meaningful Use dollars, this year felt sleepy, as if everyone was still digesting what they’ve acquired. Vendors offering proven, pragmatic technology to solve bread-and butter problems seemed to get the most attention.

There’s nothing special in the industry and everyone is waiting or trying to figure out the next big thing after MU2 and the ACA.

Need to pay more attention to physician fatigue, and evaluate in our investments.

278 and Auth integration is a large opportunity for improvement in the industry.

HIMSS has lost its way. It’s about the patient was lost in the real lack of consumer access and engagement. I would love to hear how organizations engaged patients in their health and healthcare. I find that ONC does not understand that APIs (FHIR) does not give patients access to their medical information. It gives companies access to patient information and in turn potential access to patient. The lack of discussion on privacy and validation / certification around apps and APIs was glaring. How can I trust an app in handling of my information? HIMSS, HHS and ONC need to get on the stick here if they want to ensure patients understand the levels of trust or lack thereof they will see.

ONC is doing the right thing and it is possibly the most stable thing in government over difference administrations. Patients should have access to their data. It’s the right thing – just a bit overwhelming to think about.

Consolidation continues. I noticed many booths that were recently acquired, likely only as standalone because they already paid for a separate space. Moving to value is happening slower than I think most expected. Still a lot of work/effort to support fee for service.
Huge international push from HIMSS. I noticed much more attendees from overseas than I can ever remember. Going to be interesting what the vendor community makes of it since budgets are a fraction of what they are here.

This felt like the first year that the conference was a near exact repeat of last year.

Value of HIMSS in post-MU world is questionable. Value in the past was hearing from leading organizations that had the resources to be early adopters or seeing a product that you didn’t know about. Seems like the industry is in a rut that we can’t get out of due to the number of masters that control our industry (Gov, Payers, Pharma, etc). Innovation is dead due to the narrow lanes we have to stay in to get paid.

(1) Voice recognition ubiquitous adoption is very near or finally hit the tipping point in healthcare but only after the consumer market (Alexa, Google Home, etc.) has become commonplace for the providers of healthcare in their personal space. (2) AI and/or its sub component technology is gathering steam as more real world applications to productivity enhancement within healthcare are popping up. Not so sure yet about how quickly the usage of AI in diagnosis of ailments and diseases will achieve widespread usage. (3) Blockchain in healthcare has mostly vaporized. (4)  We all need to focus on the patient, not just about their ailments and diseases, but how we interact and communicate with them on the technology platforms that are in widespread use in our society. Today it is smartphones. Could be something totally different in the future. My thinking is the home based voice devices like Alexa and Google Home will become more a part of the healthcare ecosystem.


Comments

Hadn’t been to HIMSS in about 15 years; last time I went was at Orlando as well. Was impressed by the content. Don’t know if I had stars in my eyes or how much of the potential discussed is real. I’m more from the techie side and felt some of the technologies talked about have the potential to solve some major problems that the industry faces. Overall I had a great conference. The networking opportunities were great and about 75-80 percent of the sessions I attended were interesting or had some value.

Medical device firms have got to go. Keep it pure IT hardware, software, and services.

HIMSS has gotten too large. The HIMSS marketing effort and the desire to generate revenue seems to have outpaced the content. HIMSS needs to define what constitutes healthcare IT and limit exhibitors those companies that make IT used for patient care in some way.

After six years in health IT, I finally sat across the table from an Epic VP.  I now exist.

Need a better way to share really cool stuff fast. I spoke to colleague from other hospital on Thursday. He pointed out a solution that Imprivata launched at the show with physicians walking away from desktop, desktop automatically locks, and when they come back unlocks. If I would have known on Tuesday would have brought my CIO to the Imprivata booth to show. On Thursday he had already left.

ONC is finally taking concrete action on information blocking. Looking forward to seeing the first “wall of shame!”

Wonder if vendors all really need to be there. Isn’t it possible to be more selective?

Make the anchor vendors move to the end. Move the end to the middle. Make it easier/ mandatory to see the important things. Vegas makes you walk through the casino to get to your room.

It would be great to get a summary of the education sessions – these seem to get forgotten and I’m not even sure of the themes. One thing I noticed was that vendors could sponsor sessions. This does not seem aligned with the HIMSS mission.

I have been going to HIMSS since 1995. I can’t decide if it is more of a circus or zoo, but a little of both. Disheartened by how big and useless it has become.

As a vendor, I was torn about attending. I have attended for several years, but the last 3-4 were really disappointing in terms of customers and leads. We opted not to go this year, no regrets and with more budget for activities that will net us some revenue.

I think the trade show is a pterodactyl taking its final few flights.

If all the money spent on HIMSS was used to help patients pay down medical debt instead, it would be money well spent.

More sessions like the precision medicine summit. Focused content with appropriate buyers and sellers.

As I was leaving the exhibit hall on Thursday afternoon, the thought that crossed my mind was, “How many promises were made that will never be realized?”


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Morning Headlines 2/25/19

February 24, 2019 Headlines No Comments

U.S. judge will not block Amazon-Berkshire-JPMorgan health venture’s new hire

A federal judge denies Optum’s efforts to prevent former executive David Smith from working for the Amazon-Berkshire Hathaway-JPMorgan Chase healthcare venture, despite the UnitedHealth subsidiary’s allegations that Smith could share trade secrets.

Warner Seeks to Advance Information Security in the Health Care Sector

Senator Mark Warner (D-VA), co-chair of the Senate Cybersecurity Caucus, calls on a dozen healthcare organizations to work with him to develop short- and long-term strategies that will reduce cybersecurity vulnerabilities.

Plan OK’d for patient access to 2 closed Arizona hospitals’ records

A judge approves a plan that will take $92,000 from the assets of two closed Arizona hospitals for a 90-day reactivation of their EHR so that patients can get their medical records.

Premier Health creates pilot program to transfer patient data from first responders to hospital

As part of a new six-month pilot program, Premier Health (OH) rolls out an interface that enables emergency responders to send patient data to its Epic EHR while en route to the hospital.

Monday Morning Update 2/25/19

February 24, 2019 News 6 Comments

Top News

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Allscripts shares closed down 11 percent Friday following its quarterly revenue and earnings miss.

A $10,000 investment in Allscripts on the day Paul Black was hired as CEO in 2012 would be worth $9,925 today vs. around $13,200 if you had instead bought a Nasdaq index fund.

From the investor call:

  • The company in Q4 signed three new Sunrise clients, one Paragon expansion, six FollowMy Health sales, and six new 2BPrecise clients.
  • The revenue and earnings problems were spread equally between the now-divested Netsmart and the rest of the Allscripts business, the latter primarily driven by delayed upgrades.
  • Black says the company will continue to look for “strategic assets” to acquire, as “the marketplace is littered with undersized companies, some of which have some pretty good technology.”
  • President Rick Poulton said that the company has spent a net zero amount on its acquisition winners and losers, including the turnaround acquisition of McKesson’s business and the “very speculative investment” the company made in NantHealth. He added that it’s frustrating to watch MDRX share price performance and further commented that the company needs to “balance why we buy somebody else’s earnings at a big premium when ours are trading so cheap.”
  • Poulton said that Allscripts will exploit its access to capital to bring technology to market faster, as opposed to “some of our larger competitors who have shunned acquisitions and have a model where they tend to want to do everything on a native, integrated basis.”
  • Poulton said that providers have stopped “spending money like drunken sailors” and it’s tough to assume that provider spending can drive revenue scaling, which is why the company is focusing on the faster revenue growth offered by payers and life sciences.
  • The Avenel EHR was not mentioned.

Reader Comments

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From Clippy: “Re: site. You love sites deceptively pretending to be American that clearly are not. Here is one you may have missed.” Thanks, it’s a gem – reading Healthcare Herald’s attempts to explain medical and technology issues in its comically fractured English (obviously written by folks whose origins lie in India) makes it a must-read for all the wrong reasons. The “Our Team” page lists several fake employees with their credentials. The photo of the chief content writer was lifted from news story, while that of her PhD co-editor is a widely used stock art JPG that they didn’t even bother to rename from “mature model man.” But the write-ups are pure poetry – the editor’s bio says, “I have been working in this company for seven long years. Since my day of joining till now, I have seen the company going through many thorns and pebbles.” The “About Us” proclaims, “The field of healthcare is also not an exception. There has been mass upgradation in this sector. Thorough research and in-depth studies have made it possible to even fight with disastrous chronic diseases. There is large-scale use of Artificial Intelligence and IoT in treatments which make it easier and more comfortable and hence also quite useful in most of the cases.” I like the word “upgradation,” which experts say is used only by India-based outsourced technologists, so I will try to work that into casual conversation, such as asking a server, “May I request an upgradation to the Caesar salad?”  

From Bone Apatit: “Re: HIMSS19. I am questioning the value.” I’ll recap what my survey respondents said soon, but my working thesis is this. Some people obviously want to spend a week away from work socializing, attending parties, and feeling important, so they at least fool themselves into thinking that their employer benefits so they can keep coming back. Others, especially vendor employees, attend because their employer requires them to, thinking that sales will result. Still others say they receive actual value, most likely in meeting with their vendors and fellow customers rather than sitting in educational sessions. HIMSS justifiably assumes that a heavy registration count (growing, at least until the last couple of years) is evidence that they don’t need to change much, especially in the exhibit hall that drives the entire trade show. Complaining after attending doesn’t reverse your already-cast vote for the status quo – you would have to do that by skipping HIMSS20.


HIStalk Announcements and Requests

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A majority of poll respondents like the draft of the federal government’s new interoperability policies. Recovering CIO says they will end up being toothless, however, unless the feds are willing to de-certify non-compliant EHRs and to eliminate the existing economic incentives for hoarding patient data. Nick says it’s an incremental first step,  especially the part that would prevent providers for charging to deliver care and then charging the patient again to provide a record of that care. George is happy that the proposed rules are patient-focused, force payers to the table, and include post-acute care.

New poll to your right or here: have you sent or received information via fax in the past year?

I rented “Bohemian Rhapsody” this weekend, and Oscar recognition aside, it failed to meet my low expectations. It’s a shame that Freddy Mercury’s extraordinary life, his unfortunate death, and Queen’s musical contributions were dumbed down to a sing-along cartoon in which nearly every important detail was either fictionalized or omitted, especially since dim moviegoers will think they have seen an authoritative, objective documentary.


Webinars

March 6 (Wednesday) 1:00 ET. “Pairing a High-Tech Clinical Logistics Center with a Communication Platform for Quick Patient Response.” Sponsored by Voalte. Presenters: James Schnatterer, MBA, clinical applications manager, Nemours Children’s Health; Mark Chamberlain, clinical applications analyst, Nemours Children’s Health. Medics at Nemours Children’s Health track vital signs of patients in Florida and Delaware from one central hub, acting as eyes and ears when a nurse is away from the bedside. Close monitoring 24 hours a day integrates data from the electronic health record, such as critical lab results, and routes physiological monitor and nurse call alerts directly to the appropriate caregiver’s smartphone. This session explores how the Clinical Logistics Center and more than 1,600 Zebra TC51-HC Touch Computers running Voalte Platform connect care teams at two geographically dispersed sites for better patient safety and the best possible outcomes.

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


Decisions

  • Four Winds Hospitals (NY) will move from an Askesis Development Group EHR to Streamline Healthcare Solutions in March 2020.
  • Samaritan Hospital (WA) will replace Meditech with Epic this year.
  • Cherokee Medical Center (SC) will replace Allscripts with Epic this year.

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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Ryan Walsh, MD, MMM (University of Texas Health Science Center at Houston) joins Memorial Hermann Health System as CIO of ambulatory services and population health.

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Sumit Nagpal (Accenture) joins Comcast NBCUniversal as SVP/GM of health innovation.

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Cambridge Health Alliance (MA) promotes Brian Herrick, MD from CMIO to CIO.


Government and Politics

A judge approves a plan that will take $92,000 from the assets of two closed Arizona hospitals for a 90-day reactivation of their EHR so that patients can get their medical records.


Privacy and Security

UConn Health says that an unauthorized third party access employee email accounts in December 2018, some of which contained patient information, potentially compromising the information of 326,000 people. 


Other

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In Japan, an alternative healing group that urged its followers to avoid vaccinations apologizes and recommends that its members adhere to normal vaccination schedules after nearly all of the 49 new cases of measles that were reported in one area involved its unvaccinated members.

Mount Carmel Health System (OH) – where 35 patients received pain medication overdoses under the care of a since-fired ICU intensivist – says five of those patients who died could have lived with proper treatment. The hospital has set maximum pain medication doses in its EHR, implemented an escalation polity for orders that do not follow approved protocols, restricted the ability to bypass pharmacy order review, and increased clinician education.

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This is good technology on top of bad policy. In China, Beijing hospitals are using facial recognition technology to identify known scalpers who make hard-to-get outpatient clinic appointments, then sell their tickets to others at inflated prices. The government says it will take legal action against the scalpers, including banning them from high-speed trains. The guy above was arrested for scalping an appointment for Beijing Children’s Hospital during winter vacation, when more parents bring their children for treatment.


Sponsor Updates

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  • Practice Velocity team members raise $10,000 for Rockford Rescue Mission.
  • Medicomp Systems announces a new solution to monitor and present hierarchical condition codes (HCCs) at the point of care.
  • Lightbeam Health Solutions releases Version 3.0 of its population health management software.
  • Mobile Heartbeat will exhibit at the Texas Organization of Nurse Executives conference February 28- March 1 in Dallas.
  • NextGate and IDology partner to mitigate patient identification risks.
  • Medhost features Clinical Computers Systems Inc.’s Key Account Manager John Murray in a podcast, “The Future of Healthcare, Worn on Your Wrist.”
  • Flywire Health (formerly OnPlanHealth) will exhibit at the 2019 HFMA Region 5 Dixie Institute February 24-27 in Mobile, AL.
  • CloudWave and Acmeware partner to offer data repository and SQL support services.
  • Experian Health will exhibit at the HFMA MD Beyond the Hospital Walls Conference February 25-26 in Annapolis.
  • PatientSafe Solutions adds integrated rounding and patient handoff capabilities, plus enhances user physician user experience on its PatientTouch Platform.
  • Sansoro Health adds FHIR support to its Emissary API platform.
  • TriNetX adds a Treatment Pathways analytic to its clinical, genomic, and claims data platform.
  • Vocera will present at the SVB Leerink Global Healthcare Conference February 27 in New York City.
  • NCQA certifies ZeOmega’s Jiva population health management software for 10 HEDIS 2019 measures.

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 2/22/19

February 22, 2019 Weekender 1 Comment

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Weekly News Recap

  • Allscripts announces Q4 results that fall short of revenue and earnings expectations.
  • Provider management and credentialing software vendor Symplr will acquire workforce management tech company API Healthcare from Veritas Capital
  • Unsealed testimony reveals that a focus of the Amazon – Berkshire – JPMorgan healthcare organization will be to make health insurance and prescription drug prices easier to understand
  • Healthcare experts file a Federal Trade Commission complaint against Facebook over security problems with its Groups functions that exposed the personal information of patient advocacy groups
  • A patient of a closed Arizona hospital is prevented from obtaining life-saving surgery because her medical history is stored in an EHR that was shut down as creditors argued over payments
  • HIMSS gives a preview of the “evolution of the HIMSS Brand”
  • Virence Health will retire the company name it created in October 2018 and will instead operate as Athenahealth after acquiring that company five weeks later

Best Reader Comments

A Kaiser Permanente medical school makes a lot of sense for them to train physicians in how Permanente medicine works. (The Permanente Medical Groups are the for-profit physician partnerships that pair with the Kaiser Health Plans in various regions.) The KP group practice model is a different beast. They also have a mature and well-supported Epic implementation. They are able to do high-volume medicine with good quality because of the “system-ness” of how they approach things and the fact that most of their physicians don’t fight it. (KP Alum)

We have gotten a lot of value from CommonWell and have access to data in our region which is supporting care transitions. It would be helpful if folks like eCW would actually play ball with others to improve care. I am not worried about Cerner and Epic but rather the small players’ ability to share. (Patient advocate)

It’s almost shocking that hospitals in the US support their employees attending a sales show for a week, paying for expensive hotels and booze while hospital margins are slim to non-existent. (Donald Lyons)

[Pink Socks] is just a form of self-promotion and attention-grabbing that is legion at HIMSS. If you can name one objective and tangible thing Pink Socks has done, I’ll possibly change my opinion. (Lazlo Hollyfeld)

I almost feel a little bad and embarrassed for Cerner. It’s notable that MEDITECH’s “re-branded” and “old” EMR has scored higher in KLAS than Cerner’s flagship for the last two years. And celebrating your first plug and play exchange in the year 2019?! Two brave, pioneering Cerner sites are now connected to the world. Is the $5 billion DoD connected? (Vaporware?)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. W in Minnesota, who asked for MakerSpace supplies for her elementary school’s library. She reports, “Your generous donation has helped stock our MakerSpace for the next year. They enjoyed building robots and making them move with Littlebits, as well as building bird’s nests out of paper and fabric to hold eggs when suspended from boxes. They look forward to building new things that continue to teach them about the engineering process.”

A plastic surgeon covering a New York hospital’s ED stitches and splints a woman’s mashed mashed finger, complaining to her that he’ll make only $200 for his 15 minutes of work. He then bills her insurance company $56,000 for “exploring wound extremity” and “complex repair of finger” and he doesn’t accept the woman’s insurance. The hospital said it doesn’t control what he charges because he’s not an employee. The patient is lucky to be in New York, which protects patients from surprise ED bills caused by out-of-network doctors working in EDs.

Google adds drug disposal locations to its Maps app, hoping that drug abuse will be reduced by people securely discarding their unused medications.

Nebraska hospitals complain that law enforcement agencies all over the state are releasing people who are in custody while they are hospitalized, allowing the agencies to skip paying the individual’s bill because they are no longer under arrest and are thus responsible for their own charges. A newly introduced bill would prohibit releasing a person from custody just to avoid paying for their medical care.

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University of Iowa’s children’s hospital loses its second arbitration case brought by contractors that demanded more money, increasing the cost of the project that was budgeted at $271 million in 2011 to at least $370 million. The 190-bed hospital spent millions of dollars on temporary facades and overtime to prepare for its grand opening after making on-the-fly design changes that had already inflated the cost. Swapping the already-installed doors in some areas with automatic sliding doors required flying the new doors from Switzerland and operating a round-the-clock convoy to transport them from California in time for the grand opening, increasing the cost of the doors from $122,000 to $1.2 million.

The Medical Center, Navicent Health (GA) offers its heart patients the chance to donate their replaced pacemakers to dogs being treated at the University of Georgia’s veterinary school, which has implanted the refurbished devices in six dogs so far. 


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Morning Headlines 2/22/19

February 21, 2019 Headlines No Comments

Allscripts announces fourth quarter and 2018 full-year results

Allscripts announces Q4 results: revenue up 17 percent, adjusted EPS $0.20 vs. $0.18, falling short of Wall Street expectations for both.

The U.S. government and Facebook are negotiating a record, multibillion-dollar fine for the company’s privacy lapses

The FTC is in negotiations with Facebook over a multi-billion dollar fine that would put a stop to the agency’s nearly year-long investigation into the social media giant’s privacy practices.

China Uses DNA to Track Its People, With the Help of American Expertise

Thermo Fisher will stop selling its DNA testing equipment to China after discovering its government is secretly collecting the DNA of a predominantly Muslim ethic group and adding it to a surveillance database.

“She Never Looks Back”: Inside Elizabeth Holmes’s Chilling Final Months at Theranos

Vanity Fair recounts the icy atmosphere at Theranos during its final months, including the eerily chipper mood and lavish spending habits of CEO Elizabeth Holmes.

News 2/22/19

February 21, 2019 News 2 Comments

Top News

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Allscripts announces Q4 results: revenue up 17 percent, adjusted EPS $0.20 vs. $0.18, falling short of Wall Street expectations for both.

Shares dropped 8 percent in after-hours trading following the announcement.

MDRX shares are down 12 percent in the past year vs. the Nasdaq’s 3 percent gain.


Reader Comments

From Dr Ølsson: “Re: Epic in Denmark. Majority of doctors want to get rid of the Epic platform according to this January 23 article. Heaps of problems with medications and patients harmed. I do not understand how this company is the best of America.” Planned health reform in Denmark pushes the idea of a single IT system for the country instead of five regions making their own decisions, with 62 percent of doctors polled in the Capital Region where Epic is installed saying they are dissatisfied. The Central Denmark region of the Danish health service uses Systematic, and some think it has fewer problems and should therefore become the single hospital system.


HIStalk Announcements and Requests

We’re down to half a full complement of Monkees (aka “the pre-fab four” that were cast as TV actors while leaving the musical work to session players) as bass player Peter Tork has died at 77, presumably of the adenoid cystic carcinoma with which he was diagnosed in 2009.


Webinars

March 6 (Wednesday) 1:00 ET. “Pairing a High-Tech Clinical Logistics Center with a Communication Platform for Quick Patient Response.” Sponsored by Voalte. Presenters: James Schnatterer, MBA, clinical applications manager, Nemours Children’s Health; Mark Chamberlain, clinical applications analyst, Nemours Children’s Health. Medics at Nemours Children’s Health track vital signs of patients in Florida and Delaware from one central hub, acting as eyes and ears when a nurse is away from the bedside. Close monitoring 24 hours a day integrates data from the electronic health record, such as critical lab results, and routes physiological monitor and nurse call alerts directly to the appropriate caregiver’s smartphone. This session explores how the Clinical Logistics Center and more than 1,600 Zebra TC51-HC Touch Computers running Voalte Platform connect care teams at two geographically dispersed sites for better patient safety and the best possible outcomes.

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


Acquisitions, Funding, Business, and Stock

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Inovalon announces Q4 results: revenue up 19 percent, adjusted EPS $0.05 vs. $0.06, missing Wall Street expectations for both. Shares dropped 13 percent Thursday after the midday earnings announcement. They are up 15 percent in the past year vs. the Nasdaq’s 3 percent gain.

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Health IT’s web of vendor consolidation grows more tangled. A week after announcing it was looking for a buyer, Veritas Capital sells workforce management software company API Healthcare it to Symplr. API Healthcare has run through a number of hands, selling to Francisco Partners in 2008, nearly selling to competitor Kronos in 2011, and then to GE Healthcare in 2014. Veritas acquired it last year when GE sold off its Value-Based Care Division for $1 billion.

Stat reports in a paywalled piece that the main goal of the Amazon – Berkshire Hathaway – JPMorgan Chase joint healthcare venture is to make health insurance “more intelligible” and prescription drug prices less opaque. COO Jack Stoddard, testifying at a hearing on trade secrets brought about by Optum, said, “You can imagine our employers are … incredibly allergic to market inefficiencies.”

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Garfield County Hospital District (WA) CEO Julia Leonard says a nearly $1 million shortfall caused by the billing inefficiencies of the hospital’s new EHR has contributed to her decision to drastically cut staff and operating hours. The 25-bed rural hospital – the smallest in the state – seems to have consistently faced financial difficulties over the last several years, including MU penalties. It appears the district uses Athenahealth for inpatient and NextGen for outpatient services.

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Harris Computer Systems acquires long-term and post-acute care health IT vendor Collain Healthcare.


People

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Dan Monahan (Change Healthcare) joins MDLive as COO and CFO.


Sales

  • Mon Health will implement InteliPass RCM software and services from PatientMatters across its facilities in West Virginia and Pennsylvania.

Announcements and Implementations

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Imprivata announces GA of Proximity Aware, a Bluetooth-enabled solution that ensures PHI is protected on shared workstations.

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A new KLAS report on legacy data archiving lists MediQuant, Harmony Healthcare IT, and Legacy Data Access as having broad expertise, with MediQuant scoring highest in customer satisfaction. Ellkay scores high in customer satisfaction as it gains experiencing in moving beyond its initial focus of ambulatory clinical data.

Marshfield Clinic Health System (WI) launches a telehealth program for patients at its Heart Failure Improvement Clinic using software from Health Recovery Solutions.


Government and Politics

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HHS is hiring for a director of its information security and privacy group, who will also act as CMS CISO. The Baltimore-based position pays between $126,000 and $189,000.


Privacy and Security

In Ontario, the Toronto paper notes that an unnamed vendor of a EHR system used there is selling anonymized patient data to IQVIA, which uses it in pharmaceutical marketing.

UW Medicine (WA) notifies 974,000 patients of a data breach that occurred when internal files were inadvertently made public on the Internet via an unprotected server. A patient Googling themselves found the files and notified the health system.

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In Arizona, legal disagreements between the creditors of shuttered Florence Hospital at Anthem and Gilbert Hospital keep medical records wrapped up in red tape, preventing many patients from moving forward with treatment elsewhere. The records have been in limbo since the hospitals, both owned by New Vision Health, declared bankruptcy and closed last summer. Medhost, which repossessed the EHR servers after the hospitals closed, claims it gave patients access to their records six months after terminating its contract. Patients, however, say Medhost is holding the files hostage in lieu of an estimated $100,000 payment. The judge overseeing the legal wrangling says the records can’t be given to patients because of “the estate’s lack of funding, unilateral actions taken by creditors, technological challenges associated with migrating electronically-stored medical records, and other factors.”

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The Washington Post reports that the FTC is in negotiations with Facebook over a multi-billion dollar fine that would put a stop to the agency’s nearly year-long investigation into the social media giant’s privacy practices. The biggest fine the FTC has ever imposed for similar infractions was the $22.5 million Google paid in 2012.


Other

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Kaiser Permanente’s new School of Medicine in California will offer its first five graduating classes free tuition in an effort to attract future professionals who won’t feel financially obligated to opt for higher-paying positions after graduation. NYU’s medical school announced similar plans last fall. Both organizations hope to encourage more students to pursue lower-paying callings like primary care that are facing nationwide staffing shortages.

China is offering “Physicals for All” to a predominantly Muslim ethnic group in one region that involves secretly collecting their DNA and adding it to a surveillance database. The program collected and catalogued DNA samples from 36 million people, some of them told by the government that participation was not optional. Hundreds of thousands of ethnic group members have been held in what the government calls job training camps, where DNA was also taken. Massachusetts-based DNA testing company Thermo Fisher will stop selling its equipment to the part of China that is conducting the tracking campaign. The company was receiving DNA samples in return that were added to a global database, raising consent issues. 


Sponsor Updates

  • EClinicalWorks will exhibit at the American Academy Allergy Asthma & Immunology Annual Meeting February 22-25 in San Francisco.
  • EPSi will exhibit at the Region V Dixie Institute February 24-27 in Mobile, AL.
  • The HCI Group publishes a new white paper, “Designing Smart Hospitals and Patient Rooms with 5G.”
  • Healthgrades announces America’s Best Hospitals.
  • Imat Solutions launches new health data platform Imat 8.0.
  • SyTrue creates an explainer video covering medical record audits for health plans.
  • Imprivata partners with Google Cloud to enable single sign-on access to Chrome devices.
  • The InterSystems Iris for Health Data Platform is now available on the AWS Marketplace, and on all major cloud providers.
  • IMO announces availability of Periop IT content through Epic’s Foundation System.
  • Herb Smaltz (CIO Consult) joins The Chartis Group’s Information & Technology Practice as director.
  • E4 will offer NextGate’s Enterprise Master Patient Index as part of its HIM and data-cleanup services.
  • Humana’s North Carolina Medicare Advantage plan will use PatientPing’s real-time patient alert technology.
  • Cooper University Health Care (NJ) renews its care management contract with CarePort Health and adds CarePort’s Connect and Insight capabilities.
  • Health Catalyst congratulates Thibodaux Regional Medical Center (LA) on being named a Top Innovation winner in its Patient Safety & Quality Healthcare Innovation Award program.
  • Meditech will host its Strategic Leadership Summit April 3-4 in Marina Del Ray, CA.

Blog Posts


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Contacts

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EPtalk by Dr. Jayne 2/21/19

February 21, 2019 Dr. Jayne 9 Comments

We’re officially post-HIMSS, because the emails have started arriving thanking me for my interest in various vendors’ products after I stopped by their booths at the show. Folks have had time to decompress and begin sorting through various business cards that were traded and notes that were made about follow up. 

I have my own stack of cards to go through, following up on new connections and seeing what opportunities might arise from the conference. As summer approaches, I tend to start putting together my strategic plan for the upcoming year. I’ve had some tempting offers to go back into the hospital trenches as well as some interest from the vendor side, so this might be a year full of change.

Normally I don’t spend a lot of time reading things from Healthcare IT News, but their interview with Judy Faulkner caught my eye. Part of the conversation was around physician burnout and relative happiness (or unhappiness) with EHRs. She brought up some good points that many of us in the trenches already know, but that large organizations seem to tune out at times. One of those points is that although EHR use can be associated with physician burnout, it’s not necessarily causal. There are burned out physicians that are happy with their EHRs, and EHR-haters that aren’t burned out. Other factors influence burnout including administrative burden, leadership issues, patient load, and work-life balance issues.

She also notes that clients need to stay current with their EHRs, installing the latest versions so they can benefit from usability enhancements that followed the post-Meaningful Use programming era. I’ve found that to be true with nearly all the vendors I’ve worked with, not just Epic. Once they cleared the certification hurdles, vendors often went back to customer enhancement request lists and started making good on old promises.

Another point she made was around training. Physicians that tend to do better with EHR adoption are likely to have had better training. That doesn’t always mean more hours of training, but it could mean more focused training or role-specific training, using the physicians’ time wisely and training them on the tasks they are most likely to perform in their work.

She calls for physician subspecialists to train their peers. That’s great in theory, but it’s not very easy to find physicians who want to dedicate themselves to learning how to train other physicians how to use the EHR. I’ve worked to mentor multiple CMIOs in this regard and not everyone has the aptitude or personality to be a trainer even if they want to do it, even when the hospital is willing to compensate them appropriately. In too many cases the compensation, isn’t remotely adequate, so it becomes a non-issue.

Faulkner does mention the idea of EHR personalization as a positive factor towards EHR happiness. She notes that it’s a challenge to convince health systems to do that for their physicians. My take on it is that it’s not just an Epic issue, but happens with most vendors and most health systems. It can also vary based on the degree of autonomy held by physicians outside the EHR.

One hospital I work with keeps its employed physicians on what many would consider a short leash. They’re fanatical about quality and reducing unnecessary variation, so physicians are expected to use order sets and standardized workflows. They’re incented on following the rules. Generally, people comply or they leave. The users tend to be satisfied with the EHR because they know what to expect and they know the rules of the game they’re playing.

At other organizations where there may be lots of competition for attending physicians’ patient volumes, I’ve seen hospitals bend over backwards to customize the EHR on an individual physician basis for fear that someone will take their surgical business elsewhere. This can lead to redundancy and confusion in order sets and workflows and costs more to maintain, but the organization feels it’s worth it. There’s definitely a need for vendors to make their systems easier to personalize and to allow user-level configuration rather than having to have IT teams involved in making small adjustments.

She goes on to note some data from KLAS that looks at EHR happiness and whether the health system is “agile,” meaning “If a physician wants a change made and talks to an IT person, how many committees does it have to go through? And if the answer is zero, that’s good.”

I understand the sentiment, but for those who haven’t waded into the muck that is EHR or IT governance, it’s an oversimplification. I’ve done hundreds of hours of work for hospitals and health systems “undoing” various changes that were made without any level of approval (and often without any documentation). Oversight isn’t a bad thing, but has to be crafted carefully to support the needs of the user and the goals of the organization. There should be a decision matrix that shows what kind of changes need what kinds of approval, and from whom. Simple things that don’t have downstream ramifications should happen quickly, where more complex issues that might have far-reaching consequences might need multi-level oversight.

Assuming the interview is a relatively straight transcription and didn’t go through much editing, it shows the level of understanding and insight that Judy Faulkner has into some of the issues her clients are facing. I’ve interacted with C-levels at many vendors and some of them don’t seem to have as much understanding of the challenges their clients are facing and how it impacts the end users. Many of them are good at using sound bites, but when it comes to getting into the details, they become quiet.

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I’m approaching a milestone reunion for my medical school class, and one can’t help but think about how much it cost to get here. Some of my classmates are still paying off their loans. A recent planning committee get-together led to some conversation about free tuition being offered at some medical schools. The brand new Kaiser Permanente School of Medicine in California has announced that it will waive tuition for all years for the school’s first five classes of students.

This led to quite a bit of discussion on the fact that Kaiser Permanente is opening its own medical school, unaffiliated with any university. Depending on how much influence Kaiser Permanente has on the students and what facilities they rotate through, there may be significant difference from the educational opportunities received at other schools. The first class will be relatively small (48 students) and the school names three academic pillars: foundational science, clinical science, and health systems science (which they describe as focusing on care delivery including population health, quality improvement, and social inequality). Students will participate in longitudinal clerkships starting in year one, hosted in Kaiser Permanente hospitals and clinics along with community health centers. It will certainly be interesting to see how this plays out.

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I was in the office yesterday treating lots of folks with influenza. At one point, all nine of our exam rooms were occupied by people receiving IV fluids. The flu is hitting people hard. I had a great team working with me. However, at one point, I noticed that probably all of them were young enough to be my children.

This thought came back to me later in the day, when one of them was using the EHR to print a label for a blood draw and asked aloud, “What did we do before we had Dymo printers?” They looked at me like I was from Mars when I started to tell them about the Addressograph machine, with which we used to print headers on patient chart pages and various labels. One of my jobs as a Candy Striper on the mother-baby unit was to stamp new chart pages for all of the patients on the floor. It’s funny the things you forget as technology moves on, but I think I can still smell the ink when I think hard enough.

What’s your favorite piece of extinct technology? Leave a comment or email me.

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Morning Headlines 2/21/19

February 20, 2019 Headlines No Comments

Clearlake Capital-Backed symplr To Acquire API Healthcare

Provider management and credentialing software vendor Symplr will acquire workforce management tech company API Healthcare from Veritas Capital for an unspecified amount of money.

Unsealed testimony reveals a goal of Atul Gawande venture: ‘Make health insurance intelligible’

Jack Stoddard, COO of the Amazon-Berkshire Hathaway-JPMorgan Chase healthcare venture, reveals that one of its main goals is to make health insurance and prescription drug prices easier to understand.

Letter from the CEO: Proposal for Change

Garfield County Hospital District (WA) CEO Julia Leonard says a nearly $1 million shortfall caused by the billing inefficiencies of the hospital’s new EHR has contributed to her decision to drastically cut staff and operating hours.

Data error exposes patient information

UW Medicine (WA) notifies 974,000 patients of a data breach that occurred when internal files were inadvertently made public on the Internet via an unprotected server.

Arizona college student could die because she can’t get copies of her medical records

In Arizona, legal disagreements between bankrupt Florence Hospital at Anthem and Gilbert Hospital keep red tape wrapped around medical records, preventing many patients from moving forward with treatment elsewhere.

Readers Write: EMR Direction Changes in the Post-Growth Era

February 20, 2019 Readers Write 1 Comment

EMR Direction Changes in the Post-Growth Era
By John Kelly

John Kelly is principal business advisor for Edifecs of Bellevue, WA.

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Healthcare acquisitions and mergers tend to give the industry an indication of where investors will go in pursuit of new revenue streams to secure growth in future business. The $5.7 billion sale of Athenahealth is no different. This EMR vendor consolidation represents a significant milestone in what might be a segue toward an end state for the major electronic medical record (EMR) vendor market.

What does this mean for the rest of the EMR market? At the highest level, we may anticipate EMR technology to evolve as a commodity, while the services revenue enabled by the technology will emerge as the primary source of long-term sustainability for EMR vendors. The Athenahealth and Veritas Capital move is an indication that venture investors are thinking just that. This will have long-lasting implications for healthcare technology vendors industry-wide.

The Athenahealth acquisition specifically highlights the fact that the path for growth in software sales in the EMR market continues to narrow, as the vast majority of providers with meaningful spending power have already made the transition to electronic records. The rip-and-replace phase by providers dissatisfied by their first-generation EMRs will continue steadily, but will not compensate for the major decline in new sales opportunities for the industry at large.

With the GE / Athenahealth consolidation of assets, the growth outlook for the five major EMR vendors left in the space (Epic, Allscripts, Athenahealth, Meditech, and Cerner) looks a little different.

Though Athenahealth’s high profile as an EMR vendor provides the primary brand recognition, the revenues associated with its revenue cycle management (RCM) line of business still represents the major portion of its value. The future for EMR vendors will mirror other industries, wherein technology is provided at a small margin in order to capture the high value and healthy profits generated by the information and business processing services tied to the use of that technology.

Early evidence of an emerging trend was seen in the $2.7 billion 2016 acquisition of MedAssets by Pamplona Capital Management. There we witnessed how strategic investors are keenly aware that administrative inefficiencies in healthcare still present big opportunities for gain-sharing on significant cost elimination initiatives. Veritas Capital has doubled down on this opportunity by recognizing the value in merging the RCM book of business at Athenahealth with the clinical software footprint from its GE assets acquisition. Further signaling this industry shift to garner new revenue by the top EHR vendors are the recent announcements by Meditech and Allscripts of their intention to implement consolidated managed services across their EMR and practice management software and services stacks.

The fact is, providers are paying billions of dollars to third-party vendors in outsourcing their RCM activities. Bill-and-chase is costing the providers between 6 percent and 13 percent of receivables (varies by practice setting and size). If the industry can bring those costs closer to the 2-3 percent spread, seen in industries like retail, both vendors and providers would be extremely happy. Outside investors see substantial opportunity here. As a result, EMR vendors left scrambling from the sharp decline in new system sales are beginning to consider a very different view of the future.

While there are many business decisions and regulatory changes that will impact revenue streams for payers, providers, and technology vendors alike, success and growth for EMR vendors in particular will be limited if they don’t embrace creative consolidation. The combination of Athenahealth’s medical records and revenue cycle technology with the existing Virence Health assets is not just a venture firm buying a major revenue cycle company with a great brand, but rather an intentional strategic move to change the nature of the EMR market, one that fosters continued growth and furthers technology stability across the industry.

Readers Write: Measuring to Drive Continuous Improvement in Digital Health Management

February 20, 2019 Readers Write No Comments

Measuring to Drive Continuous Improvement in Digital Health Management
By Mohammad Jouni

Mohammad Jouni, MS is is vice-president of engineering for Wellframe of Boston, MA.

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As health plans implement digital health management solutions to support the comprehensive needs of people outside the four walls, measurement is an increasing priority in order to quantify every aspect of the business and demonstrate tangible value. But measurement can also enable organizations to continuously identify areas for improvement, implement changes, and measure the effect.

The following examples are tangible ways data-driven improvements can take place from the individual patient level up to the executive board room.

Real-time interventions. A care manager noticed one patient’s falling medication adherence and reached out to ask about the issue. The patient explained she didn’t take her pills when she traveled on the weekends. The care manager mailed a new pill box, and her patient’s medication adherence rebounded to normal.

Daily improvements. Population reports indicated low comprehension of safe acetaminophen dosage. This finding, combined with the risk of misunderstanding medications, prompted a change in health education delivered directly after discharge to focus on safe dosing, resulting in an increase in patient-reported level of understanding.

Weekly staffing optimizations. Supervisors reduced the number of care managers focused solely on outreach for gaps in care when they noticed low patient satisfaction compared to a population in which care managers worked with patients more holistically, closed gaps more effectively, and saw higher satisfaction.

Monthly outreach adjustments. Claims and patient self-reports revealed falling attendance at PCP appointments. Care managers addressed this issue by switching to mobile channels to contact members before appointments and increase the frequency of reminders. Attendance rebounded to a higher rate than the baseline.

Quarterly care team reassignments. With newly-implemented technology, supervisors recognized tech-savvy staff early on and embedded them among less adept peers to share their tactics, bringing the whole group up to speed faster and with more camaraderie.

Yearly reinvestment in health management. After showing thousands of dollars in cost savings per member, executives increased the budget for health management to support increased recruitment efforts and extend health management services to more members in order to double down on those results across a broader population.

When your organization measures rigorously to demonstrate effectiveness and to continuously improve, executives will pay attention. Leadership will be able to not only justify increased investment to grow digital health management programs even further, but also apply the same data models to effectively predict the return on additional funding.

Ultimately, measurement allows health plans to make data-driven decisions that elevate the stature of care management from baseline requirement to strategic value center. In doing so, health plans will be able to amplify the effect of their programs and extend services to more members, doing incrementally and continuously better by each member.

Achieving these goals creates new opportunities to focus on member support by strengthening provider partnerships, differentiating to employers on service and outcomes, and driving retention and new sales. Through rigorous measurement and continuous improvement towards these goals, health plans are poised to quantify impact and capture significant value from the powerful data of digital health management.

Readers Write: Why Integrated Behavioral Healthcare is More Important than Ever

February 20, 2019 Readers Write No Comments

Why Integrated Behavioral Healthcare is More Important than Ever
By Christopher Molaro

Christopher Molaro, MBA is co-founder and CEO of NeuroFlow of Philadelphia, PA.

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The pieces are starting to fall into place. Mental health is becoming an integral part of the overall conversation around health. Mental health is discussed in sync with physical health.

It makes sense, too. One affects the outcomes of the other dramatically and the extra costs associated with mental health co-occurrences is staggering.

The question remains: how do we effectively integrate appropriate behavioral healthcare for individual patients when they need it and do so in a cost-effective and time-efficient manner? In other words, how can we align the interests of patients, providers, and payers?

The market is indicating that now is the time to integrate mental and behavioral health into the patient journey. Physical health and mental health are merged into just “health,” patients get the holistic care they need and deserve, and providers are empowered with the tools to improve outcomes and payers save in costs. The triple win is attainable.

Multiple leading commercial payers are reimbursing for certain collaborative care CPT codes released in 2017 and 2018, highlighting the growing awareness around the importance of mental health. As we shift towards a value-based care system, a focus on patient engagement, satisfaction, and outcomes will add visibility to the benefits – and cost savings – of integrated behavioral health.

Also, considering the enormous behavioral health expenses of employees — mental illness costs the US $193.2 billion in lost earnings every year, according the American Journal of Psychiatry — employers are equally willing to find new ways to provide their employees access to tools to address mental health.

The awareness efforts of non-profits, advocacy groups, and healthcare organizations to normalize the conversation around mental health have been invaluable. At the same time, leading athletes and entertainers opening up about their mental health conditions is eroding the historical stigma surrounding those who struggle with behavioral health. Heightened awareness begets healthier, more frequent discussions around treatments and solutions for the one in five Americans experiencing mental illness.

Aetna’s recent “Health Ambitions” study highlights that healthcare consumers recognize the importance of mental health. Over one-third of respondents say digital messaging would make them more likely to communicate with their doctors, and the majority of people ages 18-50 say they would be likely to use a confidential website or app to track health information.

This new narrative around mental health is getting louder, and it will only help to bridge the gap between mental and physical health and the solutions patients need. But numerous studies indicate that we still have a long way to go when it comes to providing digital health technologies that meet the expectations of the modern healthcare consumer.

The digital doctor’s office is no longer a future vision, but a present-day reality. While adoption of these innovative tools can be slow, healthcare providers are rapidly warming up to technologies that can improve patient outcomes while absorbing it into their workflow and existing EMRs.

With behavioral health integration, we’ve arrived at an alignment of incentives and mechanisms among payers, providers, and patients that is rare in the modern healthcare landscape. This is an exciting opportunity for the future of mental health and one that we as a community can’t afford to pass up. The data supports the opportunity as well. Decades of research highlight the effectiveness of collaborative care in psychiatry, and when patients stay engaged with behavioral health treatment, outcomes are improved drastically.

Eighty percent of people with a behavioral health disorder will visit a primary care provider at least once a year, yet we know that treatment and access are still major issues, as nearly 60 percent of adults with a mental illness didn’t receive mental health services in the previous year, according to the National Institute on Mental Illness.

While there is much work ahead, we are encouraged by the progress we’re seeing in hundreds of clinics around the country from pediatric / school settings to geriatric and Medicare populations. Mental health knows no bounds — it can affect anyone. As a health system, our effort in addressing mental health access and engagement should also show no bounds.

Morning Headlines 2/20/19

February 19, 2019 Headlines No Comments

FTC Complaint: Multiple Ongoing Patient Privacy Breaches in the Facebook PHR (Groups Product)

Healthcare data expert Fred Trotter, health lawyer David Harlow, JD, MPH, and several patient advocates file a Federal Trade Commission complaint against Facebook over security problems with its Groups function.

Ochsner Health System and Pfizer Partner to Develop Innovative Models for Clinical Trials

Ochsner Health System (LA) partners with drug company Pfizer to make it easier for patients to participate in clinical trials via the use of digital tools.

China Could Use Medical Data to Blackmail Americans, Report Says

A Congressional report says that Chinese investments in US biotechnology firms potentially gives China’s government access to American patient data that could be used for nefarious purposes.

Collain Healthcare Joins Harris Computer Systems

Harris Computer Systems acquires long-term and post-acute care health IT vendor Collain Healthcare.

NHSX: new joint organisation for digital, data and technology

In England, Health Secretary Matt Hancock announces NHSX, a technology-focused initiative that will work with public and private organizations to help the NHS improve patient access and care through digital tools.

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Reader Comments

  • Billy Bonka: I find it interesting that you pick on Epic for Share Everywhere and Lucy, while completely ignoring the impact of Care ...
  • JeanneC: Much of health care is driven by a "Show me the Business Case" model, not a "What is the best way to employ information ...
  • Fred: Epic does this from time to time; puts out apps it doesn't really care if anyone uses or solves any real problems, so th...
  • MAD: Pointing the finger at Epic Systems is not fair the issue is getting data out of the legacy systems that process is brok...
  • oofda: I wonder how many doctors would buy an EHR that didn't help them bill accurately or allow them to get their mad money fr...
  • Frank Poggio: Yep...get off the billing kick. Epic, Cerner and Meditech all started in the Lab. Did not do billing till they had hundr...
  • Oof: Every time I read the complaints from physicians about how the system was build mainly for billing, I have a "Get Out" h...
  • Yosemite: Yosemite is my favorite national park. The Valley is so stunning that photos taken from the scenic overlook Tunnel View...
  • Mr. HIStalk: They do, but unless diarrhea is involved, we're then talking about intermittent monitoring for men. It's just not fair!...
  • Tarō Gomi: But as you know... everybody poops!...

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