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News 8/16/19

August 15, 2019 News No Comments

Top News

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Navy Medicine awards Accenture a five-year, $79 million contract for program and project management support for EHR optimization and health informatics, virtual health, and AI initiatives.


Webinars

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

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


Acquisitions, Funding, Business, and Stock

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Ambrosia founder Jesse Karmazin says the anti-aging blood transfusion business has shut down for good. The company, which pitched transfusions of “young” blood to older people for $8,000 a liter, shut down for a few months earlier this year after receiving a warning letter from the FDA. Karmazin managed to get operations back up and running in two states, and now says he has started a new company called Ivy Plasma, which will offer transfusions from people of all ages.


Sales

  • Providence Health & Services (OR) will implement the Loopback Rx Platform from Loopback Analytics at its Credena Health pharmacy.
  • Quorom Health (TN) will implement Medhost’s clinical and financial software at 25 hospitals over the next 20 months.
  • HIEs OneHealthPort (WA) and Healthcare Access San Antonio select health data integration software from Diameter Health.

Announcements and Implementations

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St. Claire HealthCare implements emergency department information exchange software from Collective Medical through a partnership with the Kentucky Hospital Association first announced last December.

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Florida’s E-FORCSE PDMP uses technology from Appriss Health and Express Scripts to connect to the Military Health System PDMP, which now shares data and analytics with 39 state-based PDMPs.

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The People-Centered Research Foundation will use data de-identification services from Datavant to securely link patient data across its National Patient-Centered Clinical Research Network. Organized with funding from the Patient-Centered Outcomes Research Institute, the network comprises 70 provider and payer organizations that share data for research purposes. Datavant added de-identification capabilities to its health data management services when it acquired Universal Patient Key last year alongside a $40 million funding round.

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A new KLAS report covers payer care management, a term it uses to encompasses utilization management, disease management, case management, care coordination, and member engagement. ZeOmega and Cognizant are most often considered in new decisions, but VirtualHealth and AssureCare are making inroads as newer market entrants. Medecision is the vendor most often mentioned as potentially being replaced, while Casenet leads in overall satisfaction but is trending down due to missed expectations. 


Privacy and Security

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Intraprise Health develops BluePrint Protect security software to help enterprises with third-party risk management.


Other

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A handful of Queensland Health hospitals in Australia revert to paper for several hours after a routine overnight update to the state’s beleaguered IEMR system goes awry, making the medical records of male patients inaccessible. Hospital staff attributed the glitch to a later-than-normal start time.

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Developers of the Anura app claim its machine learning technology can accurately assess a user’s heart rate, stress level, body mass index, blood pressure, and risk for heart disease and attack from a 30-second selfie using transdermal optical imaging. Research published last week in an American Heart Association journal found that the app could measure blood pressure accurately 96% of the time.


Sponsor Updates

  • Elsevier Clinical Solutions will exhibit at NACDS TSE 2019 August 24-26 in Boston.
  • EClinicalWorks will exhibit at the East Hawaii IPA Annual Healthcare Symposium August 16-18 in Waimea.
  • Ellkay, Imat Solutions, and InterSystems will exhibit at the 2019 SHIEC Conference August 18-21 in National Harbor, MD.
  • Ensocare will exhibit at the ACMA Florida Chapter Annual Conference August 22-23 in Championsgate, FL.
  • Hayes Management Consulting names Craig Surette (Athenahealth) senior solutions engineer and William Heuschneider (Athenahealth) client success manager.
  • HCTec Marketing and Sales Operations VP Rob Borella joins the Tennessee HIMSS board.
  • Imprivata makes Identity Governance available to customers working with Microsoft Azure Active Directory.
  • Nordic releases a new podcast, “How to drive efficiencies between your ERP and EHR in OR and beyond.”

Blog Posts


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EPtalk by Dr. Jayne 8/15/19

August 15, 2019 Dr. Jayne 1 Comment

EHR vendors, get ready to make some updates: The US Preventive Services Task Force (USPSTF) plans to recommend screening all adults for illicit drug use, including inappropriate use of prescription drugs. The draft recommendation statement is open for public comment through September 9. As an EHR client, we expect these kinds of recommendations to play out in our EHR as soon as they’re published, but for many vendors it’s a long road between when a recommendation is issued or a guideline is updated and when it actually is in the hands of the majority of their clients. I’d be interested to hear from vendors how they approach these types of updates and how quickly they can get them to the point of care.

Speaking of recommendations and regulations that never become reality, here comes yet another delay for implementation of the Appropriate Use Criteria for advanced diagnostic imaging that was initially passed in 2014. NPR reports that the delay will continue, with 2020 as a “testing” year where Medicare will not block inappropriate scans. CMS won’t make a decision until 2022 or 2023 on whether (and when) penalties will begin. The reality is that Medicare and other payers continue to pay for unneeded diagnostic exams. These exams are often ordered because patients demand them, even though they show low clinical utility. Physicians increasingly worrying about being “dinged” on patient satisfaction scores that go along with it, often under duress. Advanced imaging services are a profit center for many medical institutions and physicians chafed at the idea that they’d have to log additional keystrokes in the EHR to document compliance with the criteria.

A friend of mine who used to work in corporate IT has recently moved into the world of healthcare IT. I’ve been enjoying his reactions as he learns about all the crazy stuff that we have to deal with, including managing claims, handling capitation payments, and more. He recently visited a practice that was processing data using stacks of papers to trigger the workflow and track who was doing the work. I’m thinking about prescribing him some muscle relaxers to counteract the ill effects of all the head shaking he’s probably doing. It’s always amusing, but sad in many ways, to watch someone experience the dirty underbelly of healthcare. It’s a mix of shock, disbelief, and outrage. Those are the same emotions I’m feeling while I read “Code Blue: Inside America’s Medical Industrial Complex” by Mike Magee. I had started it prior to my international medical adventures and resumed the read after hearing from my fellow volunteers. Hearing from them about how healthcare is delivered with lower cost and higher quality in their countries just makes my blood pressure rise. I sold any stock in EHR vendors long ago, but will be divesting some remaining pharma investments shortly. Shareholders are part of the problem, not the solution.

Corporate profiteering is everywhere, and I experienced it in another conversation today. One of my residency colleagues went to work last year for a group that does Direct Primary Care as an employee benefit. She’s been enjoying the work, especially the part where she has an hour for new patient visits and 30 minutes for regular visits, and feels like she actually has time to partner with her patients to improve their health. She wanted me to know that her company is expanding to my area and to see if I was interested in a referral to their recruiter. Since that’s a major aspect of primary care that I miss in my current clinical practice, I said I was game.

She proceeded to tell me a little more about the company, including that they were recently purchased by a PE firm and that there has been the addition of a good number of VPs that don’t seem to do anything but have titles in sales, marketing, and operations. That’s part of why and how they’re expanding; the PE money is an infusion but also increases the need to create some revenue from the system. Although their profit is largely driven by the difference between what the employers pay and the services the patients use, she agrees it’s only a matter of time before the nature of the practice changes. For providers in the trenches, though, it’s a difficult balance between practice paradigms that have good elements but some features that are unsettling. Her final thought was that it’s still better than the HMO she used to work for, so I guess there’s that.

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I’ve always wanted to visit Spain, and I wish I was still doing a reasonable volume of lab work so I would have justification to attend the upcoming LOINC Conference outside of Barcelona. Both the Laboratory and Clinical LOINC Committees will be at the same meeting for the first time, and the conference fee is low compared to other organizations. For those of you heading to the sun-drenched Mediterranean, enjoy!

The next couple of months are full of meetings and functions. ONC is hosting an interoperability forum  August 21-22 that has a good-looking agenda, but there are too many parallel tracks – I wouldn’t be able to pick just one to attend. There’s also a symposium on September 6 around patient matching for prescription drug monitoring programs. This also starts the User Group meeting season, beginning with the Aprima User Conference from August 22-25 in the Dallas area. I hear that’s a fun one, but have never been able to make it work with my schedule.

New Hampshire becomes the latest state to expand telehealth services, with Governor Chris Sununu signing a bill expanding the scope of services covered under Medicaid. Previous regulations limited telehealth services to specialists, but the new law mandates coverage for virtual primary care, remote patient monitoring, and substance abuse disorder treatment as long as the patient has already established care face-to-face. The definition for “originating sites” for those face-to-face services has been expanded from medical offices to include “the patient’s home or another nonmedical environment such as a school-based health center, a university-based health center, or the patient’s workplace.” It’s not as expansive as providers might like, but it definitely helps the state move forward. The law also creates definitions around asynchronous telehealth for non-urgent issues, which will help provide services when video visits might not be realistic.

I skim a lot of journals and publications, but have to admit I wasn’t aware of the Renal & Urology News before a reader sent me this snippet: A recent study looked at referral patterns at Wake Forest School of Medicine and found that patients with rare genetic conditions might be more likely to refer themselves to an academic medical center based on information they find on the Internet. The authors noted that primary care physicians might not be aware of certain rare conditions, so “If patients suspect a rare disorder that is undiagnosed by their physicians, actively pursuing self-diagnosis using the Internet can be successful.” Dr. Google, take note.

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Morning Headlines 8/15/19

August 14, 2019 Headlines No Comments

Grays Harbor Community Hospital Provides Notice of Recent Ransomware Attack

Grays Harbor Community Hospital and Harbor Medical Group in Washington confirm that a ransomware attack caused their downtime in June.

The founder of a startup that charged $8,000 to fill your veins with young blood says he’s shuttering the company and starting a new one

Controversial blood transfusion startup Ambrosia shuts down for good after receiving an FDA warning that prompted it to close its operations in all but three states earlier this year.

Ancestry’s CEO signals a major healthcare play is on the horizon

Genealogy and consumer DNA testing company Ancestry is actively building out its health team as it prepares to move into precision medicine.

Morning Headlines 8/14/19

August 13, 2019 Headlines No Comments

Mercy’s Tech Arm Launches a Nationwide Real-World Evidence Network to Pool Clinical Data for Advanced Analysis

Mercy Technology Services launches a real-world evidence database in which de-identified data from a consortium of health systems will be sold to drug and medical device manufacturers.

Microsoft welcomes new Chief Medical Officer Dr. David Rhew

David Rhew, MD (Samsung Electronics) joins Microsoft as chief medical officer/VP of healthcare.

Q-State Biosciences and 2bPrecise Announce Partnership

Allscripts backs a partnership that will combine the precision medicine data tools of 2bPrecise (in which Allscripts is the primary investor) with those of genetic sequencing vendor Q-State Biosciences.

News 8/14/19

August 13, 2019 News 4 Comments

Top News

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Mercy Technology Services launches a SAP-powered real-world evidence database called Real-World Evidence Insights Network in which de-identified data from a consortium of health systems will be sold to drug and medical device manufacturers.

Providers will be paid each time the data of their patients is accessed by a subscriber’s query. They can also use the analytics-generated evidence to help make their own business and clinical decisions.

The network will initially focus on orthopedics, cardiology, and oncology.

MTS notes that the SAP HANA database – which took 10 years to create – uses natural language processing to extract information from physician notes to provide deeper clinical intelligence.

Mercy previously announced three medical device manufacturers as customers of its own patient database – Johnson & Johnson Medical Devices, Medtronic, and BD.


Reader Comments

From I Was There: “Re: Vince Ciotti’s HIS-tory. I see quite a few inaccuracies that might only be noticed by those of us long-timers who have moved on.” Vince covered a massive amount of HIT ground going back five decades, so he has always solicited corrections and clarifications from those whose personal experience gives them a sharper memory into long-faded details. I’m sure he would still enjoy hearing from anyone who notices mistakes or can add their own interesting stories. Email him at vciotti@hispros.com and we will append your new information. Many of the industry’s pioneers from the 1970s and 1980s have retired, left the industry, or in some cases, passed away, so this is the last best hope to get the history nailed down for posterity.

From No See-Ums: “Re: paywalled newspaper and journal articles. Your links to them are frustrating since I can’t read them.” I link to paywalled articles only if I can find a reliable summary or abstract posted elsewhere since I can’t see them, either. I’m unwilling to pay for a subscription to a local or specialized publication that I would rarely use, which always leads me to conclude that someone should either sell a mass subscription or charge a low national price for reading just one article (vs. the high price that medical journals charge). The danger of ITunes-like news is, of course, that it would encourage the same bad practices for journalism as it did for music, unleashing a flood of clickbait and populist drivel. Craigslist,  Facebook, and vulture capital firms helped kill dead tree publishers, but their biggest problem is the lack of ongoing demand for intelligent, accurate news reporting. 

From Post-Acute Pat: “Re: post-acute healthcare market. I’ve been reading your site since 2010 and your blurb about hospice /nursing homes and Gordon Gekko was spot on. I don’t think the average person understands how private equity has gobbled up the entire post-acute market and none of them care about the patient or HCAHPS. I work for a huge, PE-owned home care and hospice provider that keeps merging with other PE-owned companies. See the attached email from our CEO, which came out right after we had massive layoffs, raises were cancelled, 401K match was eliminated, and hospice services such as music and physical therapy were eliminated and telehealth was greatly reduced to meet only payer contract minimums. Our PE owners require a 10% annual return and anyone who says that isn’t possible are shown the door.” The RN CEO urges his underlings to focus on revenue generation, earnings, and cash collections. That’s not unlike his non-profit health system peers, however. All of us pretend that when we need care, it’s going to be like in those golden, pre-Medicare years in which healthcare was run by empathetic locals who felt a calling to alleviate the suffering of their fellow citizens under a self-imposed honor system in which hospitals were modestly-run charities. Now it’s all about profits, cash hoarded to buy up (and screw up) competitors, or construction companies called in to soothe the organizational Edifice Complex with phallic towers. Odds are good that the first and last people you’ll see in your life are employees of profit-obsessed organizations. In between, you will be bounced around profit-maximizing health systems, clinics, insurers, drugstores, drug and device manufacturers, and ambulance services until either your health or your health insurance runs out. Then it’s off to PE-owned nursing home, hospice, home health, or rehab until finally your cooling corpse is trucked off to a PE-owned funeral home. Some or most of the frontline people will serve as a credit to their chosen profession and calling, sometimes defiantly treating patients in do-unto-others mode instead of how the corporate whip-crackers demand. Unfortunately, faceless money-lenders impact our life as Americans a lot more than we realize.  


Webinars

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

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


Acquisitions, Funding, Business, and Stock

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Allscripts backs a partnership that will combine the precision medicine data tools of 2bPrecise (in which Allscripts is the primary investor) with those of genetic sequencing vendor Q-State Biosciences. Q-State co-founder and board chair David Margulies, MD was the first CIO at Boston Children’s Hospital in the late 1980s and served as a Cerner executive from 1990 to 1996. 2bPrecise leadership is mostly folks from the Allscripts-acquired DbMotion. MDRX shares dropped in an up market following the news.

Point-of-care pharma promotional platform vendor OptimizeRx reports Q2 results: revenue up 37%, adjusted EPS $0.09 vs. $0.07. The company said in the earnings call that it has integrated with Epic and Cerner to present in-workflow patient savings opportunities, broadening its EHR reach following a previous agreement and integration with NextGen Healthcare.  

Business Insider reports that consumer DNA testing and family history company Ancestry will follow the lead of competitor 23andMe in offering genomics and individualized medicine products.

Performance-based collaboration platform vendor Apervita acquires Qcentive, which offers technology to support value-based contracting and payments.

Specialty-specific EHR/PM vendor Compulink acquires contact lens ordering site MyEyeStore, which optometrists and ophthalmologists can use to sell other retail products.  


People

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Struggling drugstore chain Rite Aid hires as its new CEO Heyward Donigan, who was previously CEO of healthcare shopping app vendor Sapphire Digital, formerly known as Vitals. RAD shares dropped 5.3% Tuesday after the announcement, down 77% in the past year vs. the Nasdaq’s 2.6% gain, valuing the company at $357 million.

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David Rhew, MD (Samsung Electronics) joins Microsoft as chief medical officer/VP of healthcare. 


Announcements and Implementations

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England’s Basildon Hospital rolls out Maternity Direct, a chat application that connects pregnant women with an NHS registered midwife who can answer questions and offer advice at no charge. Basildon and Thurrock University Hospitals NHS Foundation Trust developed the app along with software developer Acadiant.

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A new KLAS report on enterprise-level medication inventory management (MIM) finds that Omnicell’s optimization analytics solution leads the pack, although it has been implemented by only a few customers due to cost, the breadth of underlying Omnicell products that is required, and Omnicell’s need to educate prospects on the goals of MIM and how it is supported by the company’s IV room and robotic dispensing systems. Problems with newer versions of Omnicell’s automated dispensing cabinets have also led to customer wariness. KLAS says Epic’s Willow Inventory MIM isn’t used much because of limited reporting and par management capabilities that force customers to use the inventory systems of their equipment vendor. Cerner customers “have primarily been left to drive development themselves” and the company hasn’t integrated its own RxStation dispensing cabinet with its MIM software.

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Clinical Architecture releases Pivot, a turnkey data interoperability and data quality solution that processes inbound messages (in FHIR, CDA/C-CDA, HL7, and customer formats); applies Symedical normalization NLP, and clinical reasoning; and then delivers an outbound message that meets the requirements of the receiving system.

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CHI Franciscan Health opens the analytics-powered Mission Control Center in its clinic in Gig Harbor, WA, from which the health system will monitor patient care and capacity in eight of its hospitals. GE Healthcare is the health system’s partner on the project.


Government and Politics

CompuGroup Medical lauds the ruling of a federal appeals court in favor of the American Clinical Laboratory Association, which sued HHS in claiming that its implementation of the Protecting Access to Medicare Act (PAMA) oversteps its authority in collecting market-based lab data to set Medicare payments. ACLA says HHS’s exclusion of hospital labs via a change to the “majority of revenues” test will skew its market studies. The case will go back to the district court.


Other

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A Stanford School of Medicine study finds that privately insured patients are billed out-of-network charges in 43% of ED visits, 42% of inpatient admissions, and 86% of ambulance rides. Admitted inpatients faced a median surprise bill of $2,040, well beyond the financial resources of most of them. The study looked at claims data through 2016, so It’s probably reasonable to assume that the situation has worsened since. It’s interesting that more than 900 hospitals issued surprise bills for more than 90% of their ED visits, which one might speculate is an intentionally hospital-designed feature rather than a bug.

A newspaper’s investigation finds that Tennessee’s health department knew that Nurse Practitioner Jeffrey Young, who calls himself “Rock Doc,” was working without a doctor’s supervision, writing high numbers of opioid prescriptions, and having sex with patients that was described as “non-consensual,” but they didn’t shut him down during a four-year investigation. The state’s lead investigator admitted that she started carrying a gun to work after questioning Young about a patient’s overdose death. A follow-up article promises to disclose that Young was providing prescriptions to local police officers in return for favors. Young has been indicted by the federal government for prescribing 1.4 million opioid pills and 1,500 fentanyl patches in three years, after which a drug company sales buddy texted a death threat to the DEA’s lead investigator. “Rock Doc” also starred in a failed reality TV show pilot called “Rock Doc TV,” in which he kinds of looks like talentless but likeable TV food hack Guy Fieri while rapping against his “haters” who spread stories about him.

A Wall Street Journal report notes that health systems such as Geisinger, Mount Sinai Health System, and Mayo Clinic are selling the genetic profiles of patients to drug companies, reaping hundreds of millions of dollars without the patient’s knowledge or approval. 

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Cerner locks down its Continuous campus in Kansas City, KS after a man armed with an assault rifle claims to have killed his wife and says he’s going to the adjacent outlet mall next. He opened fired on responding police officers, who killed him. Nobody else was injured, although the man’s wife has been missing since Monday morning.

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A woman whose breast cancer required two surgeries and 20 rounds of radiation sues faith-based health-sharing ministry Aliera Healthcare, which is one of several companies that regulators in several states say are sham operations designed to bypass insurance regulations. Aliera refused to pay for the woman’s first surgery, for which the hospital billed her $195,000, saying her breast cancer was a pre-existing condition. Her attorneys say the company spends only 30% of its $180 million in annual revenue on medical bills, the rest being pure profit. Aliera responded to a TV station’s inquiry, “Healthcare sharing ministries provide members with a more flexible method for securing high-quality healthcare at an affordable price, something that is more important than ever to Texas residents who face increasing costs for traditional health insurance.” Washington’s state insurance commissioner fined the company $1 million last week, while Georgia has forwarded complaints about it to the FBI.

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An man who made several ED visits for swallowing problems finally gets an accurate diagnosis eight days later – he had swallowed his false teeth during minor surgery. The dental appliance was then surgically removed, but repeated bleeding required further hospitalizations, blood transfusions, and emergency surgery for a torn artery.


Sponsor Updates

  • Aprima will host its annual user conference August 23-25 in Grapevine, TX.
  • Datica co-founder Travis Good, MD will speak at a Catalyst HIT Lunch & Learn on August 28 in Denver.
  • Diameter Health becomes the first organization to earn EMeasure certification from NCQA and ONC.
  • PMD successfully completes its second SOC 2 and HIPAA security audits.
  • CarePort will exhibit at ACMA Florida August 22-23 in Champions Gate, FL.
  • CompuGroup Medical responds to the Court of Appeals ruling in support of the American Clinical Laboratory Association.
  • Cambia Health Solutions features Collective Medical CEO Chris Klomp on its HealthyChangers podcast.
  • Clinical Architecture will exhibit at the 2019 SHIEC Annual Conference August 18-21 in National Harbor, MD.
  • Culbert Healthcare Solutions will exhibit at East Coast CORE August 14-16 in Boston.

Blog Posts


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Morning Headlines 8/13/19

August 12, 2019 Headlines 1 Comment

Akira Health Acquired by Telus Health

Canadian health IT company Telus Health acquires Toronto-based Akira Health, which offers app-based and in-person care.

CHI Franciscan introduces new healthcare hub at its acute care hospitals

CHI Franciscan (WA) goes live with a new Mission Control Center that uses predictive analytics from GE Healthcare to streamline patient care at eight of its hospitals.

Internet Brands’ WebMD Acquires QxMD

WebMD acquires QxMD, a Canadian company that offers providers digital point-of-care educational resources and medical calculators.

These health-tech veterans want to avert the next Theranos disaster with ‘medical diligence’

Former 23andMe VP Ruby Gadelrab and former Color Genomics CMO Jill Hagenkord, MD launch MDisrupt to help investors thoroughly vet health IT companies looking for financing.

Curbside Consult with Dr. Jayne 8/12/19

August 12, 2019 Dr. Jayne No Comments

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I had lunch with an old friend today and was surprised to learn that he has engaged with a telehealth client. Although he’s a database guy at heart, he’s also got a mind for developing solutions, and that’s how he wound up in the space.

He’s working for a group that is developing chatbot technology for health systems that want to incorporate asynchronous visits into their offerings. Rather than just script out various scenarios, however, they’re working to leverage existing data to design responses and offer care to patients, so I was intrigued. Right now they have some flexibility since they aren’t billing for the service (it’s being offered as a perk of being a patient in the practice) and don’t have to worry about checking boxes for claims and billing. It will be interesting to see where things go.

Telehealth is definitely at the forefront of many organizations’ strategic plans. Whether you’re a dedicated telehealth vendor or a practice looking at it as a solution to reduce revenue leakage, if it’s not part of your plan, you need to be thinking about it.

Physicians are looking at telehealth as a way to improve their work-life balance. Although many have been doing the equivalent of after-hours visits for free for decades, they’re now looking to be paid for their services and compensated for their time away from family (or away from sleep, in many cases).

Patients are also highly interested in telehealth from a convenience standpoint, although they’re not always well versed in whether the services are going to be covered. I’ve seen some backlash from patients concerned about being billed for a visit that they didn’t really consider to be a visit, since in the past they had talked to their physician after hours for free. There will definitely need to be education on what services are truly telehealth vs. phone calls after typical office hours.

As a physician who has started to deliver telehealth visits, I’ve found it challenging. You have to use different skills than you might in a face-to-face encounter, even if video is enabled. There are subtle differences in the interaction, and I feel like I’m drawing a lot on my experience as a physician in making sure I’m not missing anything.

As residency programs issued their new graduates at the end of June, I’ve heard of several new grads that are going straight to telehealth without ever having had a face-to-face practice. I remember how uncertain I was as a new grad in solo practice and didn’t have colleagues to bounce things off of. I would think that feeling would be magnified for a new grad, especially if their residency program didn’t really prepare them for telehealth. I don’t think there are that many programs that do, at least not in family medicine. If there’s any mention of telehealth, it’s as an adjunct to the traditional physician-patient relationship, not as a standalone.

Physician specialty organizations are eager to push back at the idea of standalone telehealth. The American Academy of Family Physicians recently highlighted a study about the value of the physical exam. The group describes the physical examination as “central to the relationship between physician and patient for millennia,” but notes recent “skepticism about tis role in patient care.” Researchers looked at a very small (16) set of family physicians to understand how they perceived physical examination experiences and what those physicians identified as objective and subjective benefits of the exam as part of patient care. Some described the actual examination as critical, with one saying that providers who don’t conduct exams are not good doctors. Others said they used the exam to confirm or disprove their suspicious after discussing the history of the present illness. One physician said there was an expectation to perform an exam, and therefore doing it helped build the relationship.

I have a different take on exams after staffing the World Scout Jamboree. Our exams there were entirely dictated by physician preference and the patient’s presentation, with no consideration given to billing, body systems, or bullet points. Some of our patients were healthy teens with self-limited problems that dictated a minimal exam, while others were diagnostic dilemmas that required more.

On the world stage, at least in that environment, I don’t think that doing more vs. less made a difference to the patients. One of my Swedish colleagues at the Jamboree noted that physicians there do a minimal exam. The focus is more about sitting down and talking through things rather than the laying on of hands, at least in his experience.

The study authors also note the emotions felt by physicians during the physical exam, especially when assessing sick patients. They also reveal their own emotions by saying that “we should not dismiss physical examination as nostalgia” in favor of technology.

I suspect that physicians that perform minimal exams in the face-to-face setting are doing so because it’s clinically appropriate. I too often see people examining unrelated body parts just out of habit or because they think they need to, regardless of whether it will affect the care plan. This is difficult to address when precepting students, but an important topic as we look at evidence and data-driven approaches to care.

I had a teacher once who insisted that no physical exam was complete without a rectal exam. He legitimately expected the interns to perform that exam on every single inpatient. Several of us refused, citing the odds of finding an incidental rectal cancer as completely out of balance with the invasive nature of the procedure and the discomfort caused to patients. That’s an extreme example, but I also see students and new grads that examine thyroid glands on every patient, just because it’s habit and regardless of the chief complaint.

Mysticism and romanticization of the exam aside, sometimes you just don’t need to see the patient, let alone examine them, and it’s entirely possible to deliver quality care without laying on of hands. That’s going to be difficult for many audiences to accept.

Pediatricians are also coming out with concerns about telehealth, particularly regarding over-prescription of antibiotics. That’s not been my experience as a telehealth provider, where the degree of antibiotic stewardship is highly visible and frankly much more strict than my face-to-face practice. I’m sure there are bad actors out there, but painting everyone with the same brush isn’t ideal. I also see plenty of traditional family medicine docs who call out a Z-Pack for upper respiratory infections even if the infection is most likely viral. I see those patients in the urgent care setting when they complain that their antibiotics didn’t work, and get to spend plenty of time counseling them on the differences between bacteria and viruses and exactly why their antibiotics didn’t work.

It’s important to also note that not all telehealth is direct to consumer. Some services are offered as part of a traditional practice, others are arranged by an employer, and still others are funded by insurance companies and other payers looking to keep costs down. It’s a complex solution that isn’t one size fits all and doesn’t always fall under similar models. The only thing I know for sure is that telehealth isn’t going away anytime soon.

How aggressively does your organization track antibiotic stewardship? Leave a comment or email me.

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Morning Headlines 8/12/19

August 11, 2019 Headlines No Comments

Mueller: Centra’s Billing a Top Priority

The president and CEO of Centra Health (VA) apologizes to the community for billing problems that followed its September 2018 rollout of Cerner, which it also blames for recent operating losses.

Nuance Communications (NUAN) Q3 Earnings and Revenues Top Estimates

Nuance reports Q3 results, noting that although its healthcare revenue increased 2%, its HIM and EHR implementation businesses underperformed.

Gates Foundation snaps up top Apple Health researcher to run a new digital health group

Apple healthcare expert and radiation oncologist Andrew Trister, MD, PhD leaves the company after three years to join the Gates Foundation, where he will help US digital health entrepreneurs take their products to the developing world.

Monday Morning Update 8/12/19

August 11, 2019 News 5 Comments

Top News

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From Thursday’s Allscripts earnings call:

  • Two Paragon accounts added ambulatory as part of their contract extension in the quarter, with 20 clients having signed long-term agreements since the Paragon business was acquired from McKesson in late 2017.
  • Two clients bought Sunrise, 61-bed San Gorgonio Memorial (CA) and an 1,100-bed hospital in the Philippines.
  • The company is negotiating a contract extension with its biggest customer, Northwell, and expects a decision to made by the end of the year.
  • Allscripts says it knew that the Department of Justice was investigating Practice Fusion pre-acquisition, and while the $145 million settlement amount “is not insignificant,” it is in line with settlements made by other EHR vendors that were under similar investigation and paying a settlement will allow Allscripts to put that history behind it.
  • Allscripts expects that “recoveries from a variety of third parties” will “help offset a portion of the amounts” of the $145 million DoJ settlement that is being negotiated.
  • Paul Black says that the company’s expansion into the high-growth payer and life sciences markets distinguishes it from its EHR peers.
  • The company continues to seek “strategically priced M&A” to drive growth.
  • Allscripts says its ZappRx and HealthGrid acquisitions haven’t made a significant impact on revenue so far.
  • The company is happy with its retention of the former Practice Fusion customers.

Allscripts shares dropped 4% Friday after the report.

The all-time high for MDRX was in early 2000, with shares since having shed 88% of their value. A $10,000 investment in Allscripts five years ago would be worth $6,456, while putting the same money into Cerner shares then would be worth $12,000 today.


Reader Comments

From Imbued Dignity: “Re: patients participating in vendor product design and conferences. Aren’t all of us patients?” We are at one time or another, so “patient” in terms of industry involvement should probably mean “not working in health-related job.” So-called patient advocates (perhaps better labeled as “patient-advocates”) may add some value in hailing from outside the industry  — at least until they make a fill-time job from vendor payments — and may have gained more exposure to our system since they have chronic conditions. We all have our personal expectations and aspirations for healthcare and can obviously see (and say) when they aren’t being met, but we sometimes respond better to heart-tugging or indignation-raising stories about the frequent occurrences of where the system fails. Absent that aspect, we wouldn’t need patient advocates any more than we need advocates for using Facebook or paying the electric bill. The fact that healthcare and health IT executives are shocked, saddened, or motivated by the personal stories of patient advocates means that they are hidden away in their ivory tower. They just need to talk to real people, including their own employees. They also need to retain empathy after the heart-tugging speech is over, which may be their biggest challenge. Healthcare organizations and their executives may express support for a well-told patient story pointing out how the organization failed them, but I’m not too sure they go back home and actually fix the problems.

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From Craniotomy: “Re: physician assistant buying a closed hospital. What’s your guess as to why?” He got a big-footprint commercial building for just $200,000 in the form of closed Cumberland Regional Hospital, most likely wildly underpriced because it’s located in a rural area where specialized real estate demand and investment money is limited, so he has a lot of options for expanding his own clinic business and bringing in other healthcare tenants. He can also cherry-pick the most profitable parts of the unprofitable hospital’s business – probably the ED, which was also the service most valued by the community – without trying run run acute care or skilled nursing beds. PA Johnny Presley also just offered $1 million for the closed Jamestown Regional Medical Center, which is next door to a clinic he owns. Tennessee is a certificate-of-need state, so he says he will apply to reinstate some JRMC services, such as a freestanding ED, outpatient diagnostic center, and surgery center. It seems that he’s just interested in the real estate and not the hospital or home health license, so hopefully he won’t follow the steps of others elsewhere who made big promises about saving a rural hospital and then used it purely as a billing machine for lab claims that are paid at higher hospital rates. Local politicians are in a tough spot when a hospital closes and thus displaces a bunch of employees who vote, given them obvious urgency to get it re-opened under whatever terms and/or vague promises they can get. 

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From Exec Checker: “Re: Athenahealth. How much of the executive team remains from its days as a publicly traded company?” Not much. Veritas acquired the company in February 2019 and the eight-member executive team is mostly new – only one member joined the company before 2016. A couple of the execs have some healthcare experience, but the rest (including Chairman and CEO Bob Segert) do not. Here’s your “where are they now” moment looking back a few years vs. LinkedIn now:

  • Jonathan Bush, chairman and CEO – no current job listed.
  • Kyle Ambrester, SVP and chief product officer – CEO of Signify Health (clinical and social care coordination).
  • Dan Haley, SVP /general counsel – no current job listed.
  • Diane Holman, SVP/chief people officer – no current job listed.
  • Stephen Kahane, MD, president – no current job listed.
  • Prakash Khot, EVP/CTO – co-founder and CTO of Prekari Labs (privacy software).
  • Timothy O’Brien, chief marketing officer – CEO of Groups Recover Together (addiction treatment).
  • Jonathan Porter, SVP of network services – no current job listed.
  • Todd Rothenhaus, MD, chief medical officer – CEO of Cohealo (health system capital equipment software).
  • Karl Stubelis, SVP/CFO – CFO of Data Intensity (managed cloud services).

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From The Usual Usury: “Re: Meditech. You didn’t offer your opinion when the reader asked about what they should do to grow.” That’s a tough one. Their sweet spot is small to mid-sized hospitals that want a proven, functional, full-hospital system whose upfront and annual maintenance costs are a lot less than those of Cerner and Epic. That’s Meditech, but the problem is that those prospects  are either (a) being acquired by large health systems, or (b) are also prospects for running Cerner or Epic as either a remote-hosted or client-hosted service offering, which also gives them easy connectivity to the larger health systems that almost always run Cerner or Epic. That leaves few prospects for vendors like Meditech, CPSI, Medhost, and others no matter what advantages they offer. Meditech is finally moving toward product the market wants – with integrated ambulatory, cloud hosting, and good support for web and mobile – but I don’t have a good feel on how many prospects remain. The other challenge is that while cash-strapped hospitals might save a fortune in maintenance costs switching off Epic or Cerner to Meditech, few of the hospitals that bought and implemented those systems recently are likely to want to start over with another round of disruption, not to mention that hospitals in cost-cutting mode are probably targets for being acquired or marginalized anyway.

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From Green Machine: “Re: Cornerstone Advisors. Managing Principal Keith Ryan is no longer with the company.” Keith’s LinkedIn profile says he left Cornerstone in June 2019 after selling the company to cloud managed services vendor 8K Miles in December 2016. He has since turned his 500-acre farm in Tennessee into a hemp and CBD business. 


HIStalk Announcements and Requests

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Only a small percentage of poll respondents expect the Cerner-Amazon Web Services agreement to produce much in the way of healthcare innovation. Dan agrees that “Cerner in the cloud” isn’t all that innovative, but believes it may increase CIO confidence that the cloud is viable, provide easier access to data onto which innovation can be layered, and give Amazon direct experience in supporting health IT and HIPAA.

New poll to your right or here: What technologies did you find personally useful in your most recent provider encounter? Click the Comments link after voting and add anything I missed.

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A CIO asked me years ago to create the Consulting RFI Blaster, which provides an efficient, low-friction way to contact multiple firms by completing a single, simple form in which most fields are optional (like if you would rather be contacted by email instead of by telephone).

Listening: angry, dramatic music from Meg Myers, way too dark for one-time spin but loaded with nuance that grows on you.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Nuance reports Q3 results: revenue down 9%, EPS $0.31 vs. $0.28, beating analyst expectations for both. Healthcare revenue increased 2%, although the company’s HIM and EHR implementation businesses underperformed.

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CPSI reports Q2 results: revenue down 3%, EPS $0.50 vs. $0.34, missing analyst expectations for both. The company said in the earnings call that customers are taking longer to make decisions and aren’t driven by urgency. It adds that it’s tough selling TruBridge because small-hospital personal connections and community image make it hard for those hospitals to outsource their business offices, while larger hospital prospects are outside CPSI’s client base. CPSI shares are down 12.5% in the past year, valuing the company at $332 million.

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Apple healthcare expert and radiation oncologist Andrew Trister, MD, PhD leaves the company after three years to join the Gates Foundation, where he will help US digital health entrepreneurs take their products to the developing world.


Sales

  • Quorum Health signs an EHR deal with Medhost to continue using its EHR in transitioning off a previous agreement with Community Health Systems, from which Quorum was spun off in early 2016.

People

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Jacob Brauer (NextGen Healthcare) joins SymphonyRM as VP of engineering.


Announcements and Implementations

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Two senior facilities operators go live on Netsmart’s Referral Manager, which they say has decreased their processing time by 73%. The system can be used standalone or integrated with EHRs such as Netsmart MyUnity.


Privacy and Security

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Cybersecurity vendor UpGuard finds an Internet-accessible MongoDB database containing the health records of 37,000 people who had signed up with Neoclinical, an Australia-based clinical trials matching company. Neoclinical did not respond to emails or telephone calls, so public access to the information wasn’t removed until 25 days later. The psychology involved with helpfully telling a company that they are exposing sensitive information is complex, often leading to messenger-shooting.

Lehigh Valley Health Network (PA) admits that an admitted patient’s business partner – a plastic surgeon with whom he was feuding – inappropriately accessed his medical records in Epic. The patient, who is suing the health system, says it ignored his privacy complaints and did nothing for months. Investigation by the health system and the state health department corroborated the patient’s claim. The doctor insists that he had an active patient relationship with the patient, which the health department says wasn’t the case. 


Other

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In Canada, Nova Scotia closes registration to the MyHealthNS patient portal after McKesson Canada declines to renew its contract due to low registrations under the contract’s pay-per-user pricing model. The government says it will replace the system, which was rolled out in 2017. Less than 10% of doctors have enrolled despite the province’s offer to pay them up to $12,000 per year if they encourage their patients to sign up, respond to electronic messages from patients, and share their test results via the portal.

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The president and CEO of Centra Health (VA) apologizes to the community for billing problems that followed its September 2018 rollout of Cerner, which it also blames for recent operating losses. The health system says it spent $65 million on its first implementation phase vs. the $33 million that it originally budgeted under Cerner’s direction, much of that apparently related to the unexpected hiring of hundreds of consultants to train staff. Andy Mueller, MD, who took the top job in May 2019, says in an op-ed piece in the local paper:

I want to talk about one thing many of us in this community have struggled with, and that is Centra’s billing. Transitioning to a new electronic medical record last year seemed to compound an already weak process. From late bills, to incorrect bills to long wait times on hold for customer service — it has not gone unnoticed.  We must do everything in our power to help reduce the stress and anxiety of having to deal with health care bills. Plain and simple, we must do better, and we will. Period. We did not get here overnight, and correcting the system will also not be an overnight achievement. My ask for this community is to bear with us as we get our system corrected. We are working to review each account to ensure we have processes in place to make our billing accurate and more efficient. We’ve also embarked on additional system training and education for our staff. It’s all hands on deck here.

In Australia, Queensland Health Minister Steven Miles says the crash of its behind-schedule, over-budget SAP S/4HANA ERP system right after go-live was caused by user error. He says in response to media reports that it’s not unusual for employees to stockpile inventory or to buy items with their credit cards.

Research by Johns Hopkins Bloomberg School of Public Health finds that independent charities that offer drug co-pay assistance – most of which get their tax-exempted funding from drug companies — usually cover only expensive, brand-name drugs and exclude those patients who don’t have insurance, with the end result most likely being that they increase overall healthcare costs.

Six Philadelphia-area health systems bid a surprising $55 million for the 550 medical residency positions being auctioned off by bankrupt Hahnemann University Hospital. A notable legal objection comes from CMS, which pays more than $100,000 per year for each resident and says it will be precluded from recouping any cost-based overpayments once control is transferred to a different owner.


Sponsor Updates

  • Waystar publishes the results of a new study, “The Patient Financial Experience: Consumer Attitudes and Behavior.”
  • CloudWave launches a new website for multi-cloud healthcare IT solutions.
  • Wisconsin Women’s Health Foundation implements Redox’s health IT integration capabilities through the Redox Gives program.

Blog Posts


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Mr. H, Lorre, Jenn, Dr. Jayne.
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Weekender 8/9/19

August 9, 2019 Weekender 1 Comment

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Weekly News Recap

  • Allscripts announces mixed Q2 results, which include a $145 million charge toward settling any liability that results from the Department of Justice’s Meaningful Use investigation against its acquired Practice Fusion.
  • CVS beats Wall Street’s quarterly expectations and announces plans to expand its HealthHubs concept and to implement “next best action” programs for chronic care management.
  • England’s NHS announces plans to form an $300 million artificial intelligence lab.
  • Truman Medical Center pays ransomware hackers to regain access to its systems.
  • Duke Clinical Research Institute and Cerner announce a pilot project to study patient data from non-Duke sites as the initial step in forming Cerner’s Learning Health Network.
  • The DefCon cybersecurity conference creates a mocked-up hospital full of medical devices for hackers to play with.
  • A new funding round values London-based AI health services vendor Babylon Health at over $2 billion.
  • Guidehouse will acquire Navigant for $1.1 billion.
  • Beaumont Health responds to reports of IT-heavy layoffs and the recent departure of its CIO and CMIO.

Best Reader Comments

Are you getting your license in other states for telemedicine purposes?? It always interests me how you have to have to be credentialed in the state of the patient even though you are providing the service from a different state, right?. Then I think of weird examples, like if you are on the phone with a patient who is riding in a car and they drive across state lines. One second you are having a legal conversation with a person and the next second you might be breaking the law! (Creds)

Even the most tech-awarded CHIME and HIMSS hospital systems are relying on their insurance to protect the corporation (not patients’ privacy) from hackers, Shamefully, most hospital CIOs have maintained very small budgets for cyber protection solutions and put basic security on auto pilot. [Ransomware victim] Truman Medical Center is “Most Wired” since 2010, Stage 7 HIMSS Analytics since 2013, a 2015 Davies Enterprise winner, and a Cerner model show site in its home town. (Are CIOS Ignoring or Ignorant?)

We need a law that says that they can’t play around with “re-identifiable data.” At this point we’re all aware that de-identified really means “not immediately identified”, or “you have to put in some work to make identifiable again.” De-identified should become un-identifiable. Of course in order to do that, you’ll probably be destroying whatever value they’re getting out of it. But they shouldn’t get to call it de-identified, it’s still PHI/PII unless mathematically provable that you can’t use that data to get to the identity of the people. (AC)

Why is Eric Topol not brave enough to say it? If you are in hospital administration, the group that collectively lobbies for you is called the AHA. If you are a small business owner – physician, the group that collectively lobbies for you is the AMA. If you are an employee of either of those two, the group that collectively lobbies for you is called a union. Ask a nurse to explain it to you. (SelfInflictedWound)

Meditech’s sales revenue is declining again. The company’s progress seems to be one step forward, two steps back. Saying the company is profitable and the balance sheet looks good, as was heard at the shareholder’s meeting, is another way of saying they are surviving. Meditech has yet to explain to its shareholders why it suffered such a large contraction during the period of greatest expansion the market has ever experienced, placing it a very distant third behind Cerner and Epic. (Running on MT)

I’ve talked to 5+ doctors about the thought process that they use to diagnose patients. I would characterize it as being a “satisficing” approach and I don’t think that computers are going to help make it better. I’m curious, though, about the percentage of diagnoses people think are incorrect. It really depends on how you define a misdiagnosis. 10% seems reasonable. (IANAL)

What’s [tackling problems with more impact than misdiagnosis] worth in real dollars that real physicians or medical organizations are going to spend? Unless I can convince enough physicians to pay for that service, what good does that do? I have to pay for my rent and groceries, too. We can have as many clever ideas for improving outcomes and patient health as we like, but we can’t do it for free. (HIT Girl)


Watercooler Talk Tidbits

A doctor from University of Calgary’s medical school mines Alberta’s EHR to find 60 ED visits that contain the word “scooter” to determine the extend of e-scooter injuries, although he admits that word usage might compromise accuracy. He urges those using the scooters to wear a helmet, which few riders of the newly introduced rental e-scooters do. The city requires helmets for bicyclists but not scooter-riders and allows only scooters to be ridden on sidewalks. 

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Doctors eventually find that a Michigan woman who had choked on the first bite of a grilled hot dog and then experienced repeated problems afterward with breathing, talking, and swallowing had a wire embedded in her throat, which turned out to be a bristle from a grill brush. Doctors removed it and she’s fine. She urges people to use plastic grill cleaning brushes, explaining that her husband later passed a magnet over the grill and picked up 30-40 more bristles.

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A  man who was sentenced 20 years ago to jail and six months of psychiatric counseling for impersonating a doctor over a six-month period at UCLA Medical Center graduates from a Caribbean medical school at 47, admitting that it’s tough to get licensed and accepted into a US residency when his past includes forging prescriptions. His education probably isn’t helping his quest – a current student of the for-profit Saint James Medical School says the school has a minimum GPA of 2.0, an MCAT-optional admissions process, an attrition rate of 86%, an 8% first-pass NBME pass rate, and a low residency match rate. 

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Physician assistant Johnny Presley buys the recently closed Cumberland River Hospital (TN), pledging to open his fourth outpatient clinic there within four weeks and then possibly eventually adding a standalone ED. He paid $200,000 for the hospital, which had been bought for $6 million by a local hospital in 2012 that closed it after ongoing financial losses. He explains, “I might not be hardly as smart as some people or have as much money as some people, but I’ll outwork anybody. I just apply a lot of commonsense approaches. It’s a one-man show … I spent my life working in rural hospitals and rural communities and it’s a needed service in these areas. Unfortunately, it’s like time left those places, and it’s very sad. Growing up and working in them, seeing them all start to close is very sad.”

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The for-profit hospital operator that bought two Wheeling, WV-area hospitals two years ago announces plans to close them both. One started as a city hospital in 1890, while the other opened its doors in 1906.

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A jailed, 77-year-old pain management doctor in Detroit who is accused by the federal government of bilking insurers out of $500 million in a scheme involving opioid prescribing and spinal injections offers to turn his lakefront estate into a privately guarded prison if authorities will release him. Raj Bothra, MD’s most prolific prescriber, Eric Backos, MD – who “specializes” in “pain management, medication management, opioid detoxification, EMG/NCS testing to identify specific location of nerve injury, Botox therapy, and acupuncture” – prescribed 5.9 million pills from 2013 to 2018, with 86% of them being opioids and with at least two patients dying of overdoses following their visit.


In Case You Missed It


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Morning Headlines 8/9/19

August 8, 2019 Headlines No Comments

Allscripts Announces Second Quarter 2019 Results

Allscripts announces Q2 results that include a $145 million charge to settle all criminal and civil liability related to the Department of Justice’s Meaningful Use investigations into its Practice Fusion unit.

Experian acquires MyHealthDirect, strengthening leadership position in patient access and engagement

Experian Health acquires care coordination and appointment scheduling software vendor MyHealthDirect.

NHS to set up national artificial intelligence lab

In England, Prime Minister Boris Johnson allocates $303 million for the development of a National Artificial Intelligence Lab that will operate within the national health service’s digital innovation unit.

Castlight Health Announces New Customer Center of Excellence in Utah

Castlight Health will open a new Customer Center of Excellence in Salt Lake City next year, and hire up to 200 new staff by 2022.

News 8/9/19

August 8, 2019 News 3 Comments

Top News

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Allscripts announces Q2 results: revenue up 1%, adjusted EPS $0.17 vs. $0.19, beating earnings expectations but falling short on revenue.

GAAP earnings swung from a $65 million gain to a $150 million loss quarter over quarter.

The company announced that it has recorded a $145 million Q2 charge to settle all criminal and civil liability related to the Department of Justice’s Meaningful Use investigations into its Practice Fusion unit.

Allscripts had offered to buy Practice Fusion for up to $250 million in mid-2017, but pulled its bid when the federal government opened a review of Practice Fusion’s compliance with Meaningful Use requirements right after EClinicalWorks paid $155 million to settle similar charges. Allscripts eventually bought Practice Fusion for $100 million in January 2018.


Reader Comments

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From Considering MaaS: “Re: Meditech as a Service. Now that the first wave of sites has been brought live, I’m curious about feedback. I understand that they are now offering it to community hospitals, so I suspect that the trial run with critical access hospitals must have been successful.” I’m happy to report any firsthand experience reports that are sent my way.


HIStalk Announcements and Requests

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Vince Ciotti surprised me with a spiral-bound version of his HIS-tory series, which while highly useful in its bookmarked, searchable PDF form, is truly impressive as a thick book that makes you realize how much work he put into it.

A Google PR person responded to the reader’s question about the “Google Health advisory board” to which some industry folks list membership. They said Alphabet has a number of groups, but this particular Healthcare Advisory Board was created in 2013 and isn’t tied to a particular product, team, or strategy. They said the group is convened “from time to time,” which I interpret as being rarely since the link provided was some guy’s announcement of being chosen in 2015. I don’t know if this group is connected to the Google Health Advisory Council that was announced in 2007.


Webinars

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


Acquisitions, Funding, Business, and Stocks

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Experian Health acquires care coordination and appointment scheduling software vendor MyHealthDirect.

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CNBC reports that CVS and Walgreens pharmacists are denying prescription transfer requests from PillPack, claiming patients haven’t given their permission to make the change, perhaps after signing up for PillPack’s service accidentally or forgetting they had done so. CVS has told its pharmacists to make sure that people who ask about PillPack are told about similar CVS offerings, while some pharmacists have admitted to throwing away PillPack’s faxed (!) requests. Walgreens, meanwhile, will close 200 stores in the US as part of previously announced restructuring plans.

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CPSI announces Q2 results: revenue down 3%, EPS $0.12 vs. $0.02, missing expectations for both.

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CVS Health reports Q2 results: revenue up 35%, adjusted EPS $1.89 vs. $1.69, beating expectations for both and valuing the company – including its $70 billion acquisition of Aetna late last year – at $82 billion. CVS shares are down 13% in the past year vs. the Nasdaq’s 2% gain. The company said in the earnings call that it will convert 1,500 locations to HealthHubs in the first half of 2020 after seeing the uptick in Net Promoter Scores and increased store traffic that is driving sales. It is piloting “next best action” programs at its HealthHubs and MinuteClinics to close care gaps and improve chronic care management. CVS will also roll out CarePass nationally, for which members pay $5 per month to get free shipping, access to a 24/7 live pharmacist helpline, and a 20% discount on CVS Health branded products.


Sales

  • Plumas District Hospital (CA) will go live on Cerner Millenium through its CommunityWorks offering by the end of the year.
  • Missouri River Medical Center (MT) selects Evident’s EHR and TruBridge’s RCM services. Both are CPSI companies.

People

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CommonSpirit Health hires Suja Chandrasekaran (Kimberly-Clark) to be its first senior EVP /chief information and digital officer.

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Rick Schooler (Practical Advisory, LLC) joins Lee Health (FL) as CIO.


Announcements and Implementations

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HL7 CEO Charles Jaffe, MD announces the 23 organizations that will participate in real-world testing of its FHIR Bulk Data Implementation Guide. Developed with help from ONC and Boston Children’s Hospital/Harvard Medical School, the guide will also be used by CMS as part of its new Data at the Point of Care pilot set to launch next month.

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Advocare implements EClinicalWorks across its 200 practices in New Jersey and Pennsylvania.

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UCHealth (CO) works with AI company Avaamo to develop a virtual assistant skill for Amazon’s Alexa that can help patients find UCHealth providers, facilities, and content. It will soon integrate “Livi” with its Epic EHR and patient app.


Government and Politics

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In England, Prime Minister Boris Johnson allocates $303 million for the development of a National Artificial Intelligence Lab that will operate within NHSX, the national health service’s digital innovation unit. Initial projects will focus on treatments for cancer, dementia, and heart disease.

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Reuters reports that Merck has received a series of subpoenas related to a federal investigation into an unnamed EHR vendor – presumably Practice Fusion – acquired by Allscripts last year. Practice Fusion teamed up with the drug maker in 2014 to conduct a population health management study on the effectiveness of vaccine alerts within its EHR.


Other

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Pittsburgh Health Data Alliance researchers will use machine learning technology from AWS in eight projects related to cancer diagnostics, precision medicine, voice-enabled technologies, and medical imaging.

Nashville Public Radio looks at the progress Vanderbilt University Medical Center is making with the development of its VEVA EHR voice assistant. Built on Nuance technology and integrated with the hospital’s Epic system, VEVA is set to go live with a handful of physicians later this month. They’ll initially use it to familiarize themselves with patients before appointments.

It’s early days for hospital interest and investment in AI technologies, according to a survey of 115 hospital executives. Respondents were nearly evenly split with regard to awareness of available solutions and vendors. Twenty-three percent of survey takers plan to invest in AI today, while 50% plan to do so within the next two years. Executives believe supply chain and revenue cycle management, finance, and human resources will benefit the most from automation.

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Lawmakers in Australia accuse appointment scheduling app HealthEngine of misleading and deceptive conduct after a news investigation last summer revealed that the company sold or passed user information to insurance brokers and law firms. HealthEngine has also been accused of manipulating patient reviews, and promising its advertisers that ads could be targeted based on user symptoms and conditions. Co-founder and CEO Marcus Tan has assured customers that the company has shut down its third-party referral service and overhauled its practice recognition system: “We are working hard to rebuild the trust we’ve lost with our users.”

Apple, Eli Lilly, and data collection company Evidation Health have conducted a study to determine if information from Apple’s devices can be used to detect early signs of dementia. The 12-week study equipped participants with an Iphone, Watch, and Beddit sleep tracker. Those already diagnosed with cognitive decline typed more slowly and infrequently, sent fewer text messages, filled out fewer surveys, and relied more on support apps.


Sponsor Updates

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  • HCTec staff volunteer with the Nashville Food Project.
  • FormFast will exhibit at the Florida Society for Healthcare Risk Management & Patient Safety annual meeting August 15-16 in Orlando.
  • Hayes Management Consulting will sponsor the Epic East Coast CORE Summer/Fall 2019 event August 14-16 in Boston.
  • VentureFizz.com’s CxO Briefing interviews Imprivata President and CEO Gus Malezis.
  • InterSystems adds API management to its IRIS Data Platform.
  • PointClickCare adds Collective Medical’s care transition technology to its post-acute care EHR.
  • DrFirst uses Imprivata’s Mobile Device Access to develop single sign-on access to its HIPAA-compliant Backline messaging software.
  • Elsevier and LogicStream Health will align their respective Care Planning and Clinical Process Improvement and Control Software Solutions to help improve nursing documentation.
  • Norton Healthcare (KY) adds ProviderMatch for Consumers from Kyruus to its website to help patients find providers more easily.

Blog Posts


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Contacts

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

August 8, 2019 Dr. Jayne 2 Comments

I’m once again in the middle of a billing dispute with Big Medical Center, so I was excited to see this article about tech giants teaming up with healthcare companies to share claims data. One of the proposed applications is helping consumers avoid paying erroneous bills, which would apply in my situation. The group is using CARIN Alliance specifications and testing should begin first with Apple, which appears to be farther along in the process.

The goal is for patients to have broad access to their data rather than having to look at how they use health services across providers. This may enable patients to better understand how they utilize services before having to select health coverage each year. The same thing can be done using the paper Explanation of Benefits statements that most of us receive, although a fair number of people don’t seem to read them or keep them.

It’s been a week now since I called to complain about my erroneous bill and was bounced from the faculty practice billing service to the hospital billing service to the office, which doesn’t understand how I have two receipts for my payment even though one is from Epic and the other is a credit card slip. They declined my offer to scan copies to them, claiming they can only interact through the patient portal and patients can’t add attachments.

I have no hope of getting this straightened out anytime soon. The last time I had a billing dispute with them, they sent me to collections even though the aging on my patient balance was less than a week old. Apparently the fact that it took them more than a year to actually generate a bill during their Epic transition wasn’t a mitigating factor, since the system just saw it as way overdue.

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Up until I studied for the Clinical Informatics board certification in 2013, public health informatics wasn’t something I knew much about, let alone practiced. A lot has changed since then given the availability of rich data sets and the ongoing commitment by health organizations to try to reduce costs. Healthcare delivery organizations are also looking at outbreaks in an expanded way, from influenza to measles.

I was glad that we didn’t have to put the measles containment protocol into place during my recent gig at the World Scout Jamboree. The only suspected case turned out to be the relatively harmless Pityriasis rosea rash. Still, we were ready. Recent data from the Centers for Disease Control show more than 1,170 cases of measles this year with no end in sight.

One of my clients recently asked me to create a measles reporting package for them, looking not only at vaccination status among patients, but also to prepare to gather data for measles-related complications such as pneumonia and encephalitis. I spent entirely too much time immersed in ICD-10 finding all the right codes to look for, but hopefully it will help them be prepared if and when the time comes for them to need to do regular reporting. Kudos to them for being proactive even though they’re in one of the 20 states that hasn’t yet experienced a measles case.

Speaking of cost reductions, I was intrigued by this New England Journal of Medicine article that looked at ACO model participation with respect to levels of Medicare spending. Specifically, the authors found that ACO providers in rural or underserved areas had lower spending compared to non-ACO providers, at least during the first performance year. It’s important to note that the primary outcome of the study was spending – secondary outcomes were utilization-focused, including inpatient admissions, emergency visits, days in skilled nursing facilities, and inpatient readmissions. Key outcomes measures, such as mortality, were missing from the study.

I don’t disagree with the need to reduce Medicare spending so that there is some money left when the rest of us reach that age, but I think patients and physicians would be more likely to adopt new payment and care models if they are shown to make a difference in patients’ lives, either through quality of life or quantity of life. Medicare spending is seen by many patients as “someone else’s money,” so there isn’t as much incentive to go along with changes as if the money was their own.

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Another article about cost savings also caught my eye, primarily because it was talking about blockchain’s ability to save the healthcare industry $100 billion over the next half decade. Areas of potential cost savings include IT operations, personnel, and health data breaches. Other potential areas of savings are for drug companies using the technology to track medications and reduce counterfeiting.

I love some of the general statements in the associated report, including that blockchain can help solve widespread interoperability problems and non-standardization along with “overcoming the shortcomings and challenges associated with legacy systems.” The devil is always in the details when any technology is positioned as the ultimate solution to a multitude of ills.

Another proposed area for blockchain in healthcare is in physician credentialing, with an estimated 80% savings over the time it currently takes to complete the process. We could save some money without adding additional technology just by making physician credentialing rational. There’s no reason why I should have to provide my high school transcript to credential as a physician, even though I was recently told by someone that the state of Illinois requires it. I hope the requestor enjoyed reading the legitimate but decidedly sketchy document from the 1990s that I provided following a quick phone call to my high school registrar. The finished product looked like it could have been drawn up by anyone who owned a dot matrix printer and a photocopier.

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I’m an avid reader, so of course have to mark the passing of Nobel-winning author Toni Morrison. Morrison also received numerous other awards, including the Presidential Medal of Freedom and major awards from France. I didn’t really appreciate her work until some parents in my local school district tried to ban it, and I wish I had found it earlier. I leave you with her comments from a graduation speech in 2005:

Of course I am a storyteller and therefore an optimist, a firm believer in the ethical bend of the human heart, a believer in the mind’s appetite for truth and its disgust with fraud… I’m a believer in the power of knowledge and the ferocity of beauty, so from my point of view your life is already artful – waiting, just waiting, for you to make it art.

May each of us find the art within.

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Email Dr. Jayne.

HIStalk Interviews Peter Smith, CEO, Impact Advisors

August 8, 2019 Interviews 1 Comment

Peter Smith is CEO and co-founder of Impact Advisors of Naperville, IL.

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Tell me about yourself and the company.

I’m the CEO and one of the two co-founders of Impact Advisors. We are a consultancy that is dedicated to healthcare and we are a technology-enabled process improvement firm. We focus on what your readers would consider to be the HIT market, as well as helping our clients optimize their processes across the organization.

Our clients are pretty much all flavors of healthcare providers — IDNs, all kinds of hospitals, physician clinics, and almost any entity in healthcare. We also do a little health plan work as well, but predominantly it’s the provider-based segment that we work in.

It seems like most big health systems are playing around with digital health, innovation projects, and consumer-focused initiatives, to the point that they’re creating C-level positions to oversee them. Is this a fad or are health systems really changing the way they do business in response to changing demand?

It’s a combination of both. We’re obviously seeing a shift in healthcare. Whether it’s the concept of moving towards value-based care or more consumer-directed care, there’s a lot of dynamics that are being backed up in terms of reimbursement models. We’re not there yet. I just gave another interview talking about organizations that have one foot in a fee-for-service world versus the new world. I fully recognize that we’re going to be in that state for a while.

But clearly we’re moving there, and that’s driving a lot of organizations to think about some of the things you just mentioned — digital health, patient and consumer access, how to create a digital experience for not only patients, but families. All of that’s coming into play. Organizations are optimizing the existing environment, but also thinking about how to start building technology services and processes in the new world in preparation for a shifting environment.

To answer your question, I think a good organization will not only retain what they’re doing and optimize it, but also think very diligently about how they move forward with things like digital health or optimizing their a future environment.

Health system competition is no longer just the other hospital across town, it’s regional and soon-to-be national health systems, drugstore chains, insurance companies, and research organizations that are coming in late to the health IT party. Do health systems have the level of expertise, both corporately and in the CIO office, to keep up with the new technology demands?

You’ve hit on a couple of major trends. Obviously many organizations are moving towards scale. Five and $10 billion a year organizations are becoming $20 billion because they need to get to a certain scale. Certainly from a managed care standpoint, to drive economies within the managed care world or the impending value- based care world.

I have a little empathy for folks who are running hospital systems right now. It is not an easy world. They’re getting hit from all sides as they have to aggregate and get scale to be competitive in a new marketplace. They have to create relationships with patients in a different way that I just described, and all the investment that’s associated with that.

Another major driver is what’s being carved out of their systems. Profitable services are being carved out by for-profit companies. If you’re running a large hospital system, you’re getting hit competitively from all angles. That’s a very tough place to be.

You asked particularly about leadership. You’re seeing some very progressive leaders in this space. Those are the ones who are going to be successful, who are thinking about their business models in a new and different way and maybe even challenging some of the traditional ways.

As health systems scale into multi-billion dollar revenue, will the people they choose to lead IT and innovation increasingly be hired from outside the industry?

You’ll start to certainly see that. But there’s a premium in terms of understanding healthcare and understanding healthcare technology. You’ll see entrants, some of them very good, from outside of the industry, but they will have a steep learning curve.

I don’t believe you’ll see a major tipping point where organizations are actively bringing people in from the outside of healthcare. But I do think that condition will exist, and in some cases, it will be very successful, while in others, maybe not. It will be predicated on the individual and what previous experiences they have had.

Providence St. Joe’s is in a geographic area where they have a lot of talent around them  — Microsoft, Google, and Amazon — but that access to talent might not exist in places in Nebraska. If you’re in those markets, you exploit the best talent you can. If they also come with healthcare experience, that’s an absolute bonus.

How does having larger but fewer healthcare systems as customers change your business?

We think about that every day. We recognize that in some parts of our business, we have to get to scale. Certainly in some of our implementation practices, we need to ramp up our recruiting to service clients in a much larger way than they have traditionally. When we were working for the mid-sized market — the $1 billion to $3 billion organizations that have IS departments of 100 people — we could serve as the whole team. Now we look at a scaling, not only of our internal resources, but how to partner with others to be a full-service providers.

Providence St. Joseph Health, Mercy, and other big health systems have blurred the line between provider and vendor, with the former hoping to create a billion-dollar annual revenue organization. How do you see that playing out?

I’m very interested in seeing it. I’ll even add a little twist to that, the Optum deal with John Muir that was announced about two weeks ago, a major platform play and potentially extending that platform beyond. This is not a new concept. Many IDNs have created some form of managed services organization over the decades. Some have been successful and some have not.

It’s going to be about leadership, client relationship management, and about how they execute. I think the concept is sound. How do you aggregate services in a better, higher-quality way at a lower price point? Those are sound objectives and the industry needs that. How they execute over the next year or two is going to be critical.

Providence St Joe’s is fascinating. Just in full disclosure, we’re doing work there, so we know a little bit about their designs on Community Connect and beyond. But these models can absolutely be successful. They will probably first be successful on a regional basis and they’ll use those as proof points and qualifications to possible extend beyond.

How do you see the movement toward cloud computing as Cerner announces a deal with Amazon Web Services? Will we see a lot more results of vendors moving to cloud services offered by Amazon, Google, and Microsoft?

We’re just on the tip of it right. In healthcare, most IT processing is on premise. You’re seeing companies that are moving to the cloud very quickly and having a lot of success.

Cerner is probably the best example of having success in their application management services model over the last decade. Epic is now having a lot of success. Workday in the ERP space is using that as a competitive differentiator and people are gravitating towards it because it implies a level of standardization. It makes your maintenance more predictable, your expenses more predictable, and you’re building a support environment that is homogeneous and high quality.

Health systems are increasingly spinning off startups and running incubators and accelerators. How will that change as they start to see the results of their early efforts?

It will absolutely continue. There’s a lot of variability in how people think about, develop, define, and execute innovation. On one hand, it could be just like a tech transfer function, to allow some form of liquidity for inventions or ideas that are coming out of their medical staff. That’s a very traditional look. In other areas, these guys are running shark tanks and small venture capital firms.

You’re seeing this incredible continuum of how they think about innovation and investment and how they want to monetize or get the ROI out of it. I preface my comments that it remains to be seen whether there will be a a common approach in our industry to innovation across the landscape. You’ll see some variability in how organizations think about it, but it will continue to be important part.

We do a lot of digital health planning and it always ends in a plan that is doing a couple of things. It’s leveraging technology that’s already exists in place, foundational systems like the EHR. It’s also buying or developing a series of solutions that might come out of your own innovation area, or you may buy them commercially, and building an ecosystem of digital health. As we get more mature in that space, those solutions will get rationalized and you’ll have greater platform players. But right now, successful organizations are moving in this continuum of knowing that they have to solution a digital world with many different partners and providers.

Are the three significant health system EHR vendors supporting that innovation by opening up their systems to other companies? Is interoperability more of a technical problem or a business problem?

In our business, we joke that the most difficult thing is integration between systems. Why it’s difficult is a combination of factors. One is the competitive factor, where a lot of healthcare organizations don’t want to share with their neighbor across the street because of the competitive advantage. It could also be a cultural, political, or technology reasons that can make it difficult.

It’s drastically improving. You’re seeing integration increase every single day in multi-platform environments, and that will continue. Will it ever be plug-and-play, immediate and easy? I don’t believe it will be, but it absolutely it is improving.

One of the reasons it’s improving relates to that scale we talked about. You’re now talking about $10 billion to $20 billion organizations that have 60, 70, or 80 hospitals across large geographical regions. You’re getting a level of inherent interconnection and integration among data. Things that had been fragmented or in separate organizational structures are now common and are exploiting the technology they have to to break down some of those cultural and political and competitive barriers.

What are the biggest challenges of healthcare IT consulting and staffing firms?

It depends on your entry point. We’ve just gone through a period of time that was the Wild West for consulting firms. We had a lot of entrants into this marketplace. There’s been a lot of work in our environment over the Meaningful Use period and beyond as people considered major platform changes.

You’ve seen a lot of entrants leave this market or have diminished performance because they didn’t have a long-term vision. We call them pop-up consultancies, companies that were taking advantage of a very hot market. God bless them for that, because everyone deserves an opportunity to do that. But we’ve seen a tremendous rationalization. The firms that are left in our space are the ones that had durable business models, paid attention to quality, paid attention to their associates, and most importantly, paid attention to providing value to their clients.

Only a few high-quality consulting firms are left that have weathered that transition. Those will continue to be successful. Our hope is that we’re one of those moving forward.

I guess there’s nothing inherently unhealthy that the industry flexed to meet the short-term demand and now has to flex back. What trends are swinging the pendulum the other way?

We feel really good about the next couple of years. This has been a very difficult or weird environment to manage a consulting firm. We’ve had boom and then site stabilization in this market. We believe that we’re back to a rational market right now, and the next five years will be a rational growth market within our space. Not boom or bust. We’re actually excited about moving forward. We think it will be much easier to run a business in this climate moving forward.

In terms of what we’re investing in as a strategy moving forward, digital health is number one. The concept of planning and solutioning digital health strategies for our clients is a big growth engine for us. The concept of virtual healthcare, whether it’s telemedicine or beyond telemedicine, helping our clients deliver healthcare in a virtual way is another big driver for us.

This market may not all be about our traditional provider space. There are other entrants into this market, these carve-outs. Even employer-based healthcare right now. We are working with employers that have geocentric employee populations, as an example, that are looking to develop internal healthcare systems. How you provide technology within those worlds is another of channel market for us, working outside our traditional marketplace.

ERP, enterprise resource planning, is another hot spot right now that many organizations are now looking at. Those systems have been in place for 20 or 30 years and now they’re replacing them after they’ve done their EMR. That’s another hot area for us.

Lastly, the thing that I think is going to be most important that’s driving a lot of our business is that after clients put in an EMR or have done a lot of their heavy lifting around some of their major systems, about four years after they convert, they take a look around and say, wow, we have an opportunity to kind of fix some of these processes. We maybe haven’t spent a lot of time and attention. We haven’t viewed it in a programmatic way. We had spent so much money on the systems and we’ve let them languish a little bit. So at about the four-year mark, a lot of our clients are popping up and saying, I need a programmatic way to optimize my clinical and revenue cycle solutions. This concept of optimization is going to be really big and we’re investing pretty heavily in that.

Do you have any final thoughts?

We’re excited about the future for a couple of reasons. But the one thing that I’m most excited about is that our industry spends a lot of time putting in foundational systems, while the next generation is about getting maximum value out of these investments. When we move up that continuum, we’re getting closer and closer to moving the needle for the patients, consumers, and families that we all serve.

It used to be that EMRs were going to be the best thing in the world for patients. They are, but they’re used primarily by caregivers. This next generation of conductivity, this next digital world, will have a direct impact on patients and families in a measurable way. Not only better healthcare, but lower cost, with better digital connections and ease of access. All these things that we’ve been working our entire career on. That’s what I’m excited about.

Morning Headlines 8/8/19

August 7, 2019 Headlines No Comments

Apple and Eli Lilly are studying whether data from iPhones and Apple Watches can detect signs of dementia

Apple, Eli Lilly, and data collection company Evidation Health are working together to determine if information from Apple’s devices can be used to detect early signs of dementia.

Women’s health startup Genneve lands $4M to grow telemedicine service for menopause

Menopause-focused telemedicine and wellness company Genneve raises $4 million in a seed round led by BlueRun Ventures.

IN BRIEF: Merck says U.S. probing ties to electronic health record vendors

Drug maker Merck has received a series of subpoenas related to a federal investigation into an unnamed EHR vendor – presumably Practice Fusion – acquired by Allscripts last year.

Amazon’s AWS will help health researchers diagnose patients and monitor disease

The Pittsburgh Health Data Alliance will use machine learning technology from AWS in its development of diagnostic and disease-monitoring technologies.

Morning Headlines 8/7/19

August 6, 2019 Headlines No Comments

Cerner, Duke Clinical Research Institute Launch New Solution to Innovate Clinical Research

Cerner will work with Duke Clinical Research Institute to develop the Cerner Learning Health Network, which will aggregate de-identified patient data from both Cerner and non-Cerner EHRs to provide treatment insights to providers and drug and life science companies.

Optimum Healthcare IT Announces Expansion of Staffing Business with OptimumTech

Optimum Healthcare IT launches OptimumTech, a Nashville-based IT staffing division.

Truman Medical Center hit with ransomware, pays to get system access back

Truman Medical Center (MO) pays hackers a “small amount of money” to restore access to operational systems impacted by a ransomware attack early Tuesday morning.

News 8/7/19

August 6, 2019 News 9 Comments

Top News

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Duke Clinical Research Institute will work with Cerner on a pilot project in which de-identified data from University of Missouri Health Care and Ascension Seton will be analyzed to seek insight on the treatment of cardiovascular disease. The resulting Cerner product will be called Cerner Learning Health Network, which will aggregate de-identified patient data from both Cerner and non-Cerner EHRs.

The project’s results  will be published with drug company financial support.

The work will use Cerner HealthDataLab to convert the de-identified patient data into formats that can be analyzed with predictive models and algorithms.

Cerner SVP of Strategic Growth Art Glasgow, who was previously CIO of Duke Health, said in the announcement, “At Cerner, we’re committed to taking four decades of digitized data and transforming it into insights that can help clinicians make more informed treatment decisions. We have an opportunity to use clinical research and data-driven insights to develop an intelligent network of health systems that can truly improve health experiences and outcomes for patients.””


Reader Comments

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From John R. Brinkley: “Re: ‘Chasing the Cure.’ Any interest in watching it?” The TBS/TNT 90-minute program, which airs live in its Thursday night premiere, features a small panel of doctors that reviews the records of a patient with “unsolvable” medical issues who has submitted their “case file” (a handful of paragraphs of self-description, kind of a Kickstarter for illness, is what is displayed online) ,after which viewers are invited to weigh in using the program’s online community. My reaction:

  • I haven’t watched a non-streaming show in many years (easy for me since I don’t watch sports), so I won’t be tuning in. Netflix has spoiled me for being able to watch whenever I want without the intelligence-insulting commercials that take up a third of any program’s time slot.
  • I bet quite of the few advertisers are drug companies.
  • This concept goes back to the misconception that a bunch of people looking at minimal patient information can be stuck by a “House”-like moment of diagnostic brilliance in figuring out an obscure condition that has escaped their actual doctor.
  • People of unstated credentials are already offering advice to the case studies of individual patients on the show’s site, which shows the problem of having everybody and their brother playing doctor from their couches. A woman with joint weakness and pain has been advised to: (a) “eat clean;” (b) get a lumbar puncture; (c) have a contrast MRI; (d) obtain genetic testing; (e) seek stem cell therapy; (f) take a specific brand-name supplement; (g) take B12 shots; (g) get copper and mercury levels tested; (h) have tooth fillings replaced, and (i) try a gluten-free diet. Imagine the plethora of ideas – some wacky and ill-informed, some likely accurate due to a similar experience – that will be offered once the show actually airs. Then a the patient’s real doctor has to waste time sorting out the mess.
  • I would prefer having the patient’s doctor review and/or present the case, show the comments of vetted clinicians after the program airs, but display laypeople comments only after the patient’s doctor has reviewed them to make sure viewers aren’t recommending dangerous actions or wasting everybody’s time with bizarre suggestions that stray into “fake news” territory. People with way too much free time who confidently spout bizarre, ill-informed nonsense about everything from politics to unsolved crimes can now give health advice to people desperate enough to make a public plea on TV (note to malpractice and personal injury lawyers – this could be good for you).
  • My biggest question is, then what? Even if the armchair diagnosticians eventually turn out to be correct, how does the patient proceed from the show’s airing to resolution? Who’s paying for all the diagnostic work? Does the doctor who couldn’t figure out the problem originally get to explain why they missed it, allowing everybody else to improve?

HIStalk Announcements and Requests

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The dental hygienist told me today that she knew that I had arrived for my cleaning and how long I had been waiting because she gets alerts from YAPI, dental practice software that integrates with their Dentrix practice management system. It includes the tablet-based paperless check-in and records update that I had completed upon arrival, a room and patient dashboard that flags patients who are running over or who have waited excessively, team chat, appointment reminders and confirmations, a portal for communicating with patients and checking their appointments, a text message-based review function that routes negative responses to the practice and positive ones to social media, and pop-up patient information displayed with incoming calls from the patient’s phone number. Now I know why I suddenly feel so engaged with the practice, with “send C to confirm” appointment reminders, a follow-up review text message afterward, and not having to explain who I am when I call.


Webinars

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


Sales

  • Delta Regional Medical Center (MS) will implement MEDarchon’s Quarc for secure messaging and collaboration.

People

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Cameron Memorial Community Hospital (IN) promotes Scott Hirschy, RN to CIO.


Announcements and Implementations

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Epic will host its second day-long unUGM in Verona on October 3, where C-suite executives of non-Epic using provider organizations can learn how to connect with their Epic-using peers. Registration is open and costs $100.

Optimum Healthcare IT announces the opening of OptimumTech, a Nashville-based IT staffing division.


Other

Eric Topol, MD says in a New Yorker op-ed piece says that doctors need to organize to push back against EHRs, HMOs, and RVUs to improve burnout. He says, however, that the medical profession has been balkanized by the AMA’s decreased influence as members drop out in favor of joining specialty-specific member organizations. Topol discloses that he’s not paying his American College of Cardiology dues because the organization ignores patient needs, functioning instead as “a trade guild centered on the finances of doctors.” He’s also unhappy that medical associations pursue business themselves – the AMA has endorsed products, the American Heart Association “rents out its name” to use its logo on food products, and the American Academy of Family Physicians took Coke money to fund consumer education about its sugar water (he would have a field day with HIMSS). His overriding point is that medicine is being increasingly run by the non-physician bosses of doctors, as the number of healthcare administrators has grown by 3,200% in the past 40 years. 

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Medical Device Village will open Thursday as part of the Bio Hacking Village of the DefCon cybersecurity conference, expanding from the tableful of medical devices offered in past conferences to a 2,600-square-foot, mocked-up hospital’s radiology, pharmacy lab, and ICU departments full of devices for hackers to attack. A capture-the-flag like competition will be offered and reps from 10 medical device manufacturers will be on hand. The conference also invites attendees to “Bring Your Own Medical Device” for security research.

Psychologists find that while most individuals feel economically threatened when they hear about others losing their jobs to technology, they would actually rather lose their own jobs to impersonal tools like robots and AI instead of having another person take their place.

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The Onion weighs in on “Data Dump.”


Sponsor Updates

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  • The CoverMyMeds team serves meals to families staying at Ronald McDonald House Charities of Central Ohio.
  • Artifact Health will exhibit at the 2019 CTHIMA Annual Meeting August 16 in Rocky Hill, CT.
  • Burwood Group staff help out at the Boys & Girls Club of San Diego’s annual “Stuff a Bus” back-to-school event.
  • Meditech offers its Fall Risk Management Toolkit to users in Canada.
  • Fortified Health Security releases its midyear healthcare cybersecurity report.

Blog Posts


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Reader Comments

  • Robert D. Lafsky: The term "copy/paste" is used excessively in a way that obscures problems with current EMR use. Plagiarizing someone el...
  • FRANK POGGIO: Re: "He notes interestingly that Medicare created a physician golden goose in 1965 in virtually guaranteeing that medica...
  • Me Three: The central points are 1. that Carl is reading and deciding on low level department transfers and that is a huge waste...
  • Overcharged: Well private equity can jump in line of who all is screwing the consumer...bloated organizations, vendors charging 5x wh...
  • What: It's too late for Epic to develop a search engine as well. Them's the breaks....
  • Insider: Neither Brian Too or Me Three understand inner workings of Epic. Transfer involve a wide net of at least a dozen people...
  • Brian Too: I'm getting a lot of downvotes here, so I want to give this topic some time and space. Also, I've left out parts of my ...
  • Kevin Hepler: A classic case of important facts getting lost in the EHR, leading to a public health concern: https://www.medscape.com/...
  • NYer: Regarding "...He said in a conference this week that IBM and Google both considered developing an EHR, but it’s probab...
  • To be or not to be: I use PillPack and one of the things that appealed to me was that it took 5 minutes to sign up and they had my insurance...

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