Former ONC lead Farzad Mostashari, MD spoke out against CMS’s recent decision to strip MU2 of its five percent view/transmit/download requirement, saying “If this proposed rule stands, it would roll back a lot of progress that’s been made incorporating patient engagement into workflows. To meet even a low threshold, providers have had to change their processes to engage patients.”
AthenaHealth follows in Cerner’s footsteps in announcing an Apple Watch app. Unlike Cerner, Athena’s app is aimed at providers, while Cerner’s will be marketed directly to patients.
Freeware EHR vendor Practice Fusion announces a program sponsored by AstraZeneca in which COPD and Asthma patients in Practice Fusion’s system whose care does not meet evidence-based clinical guidelines will be identified and their care providers alerted.
Ah, HIMSS. This year marks my fifth, and like the previous four, I doubt it will disappoint. There’s just no other event that can offer up such a unique mix of nonstop networking, educational sessions catering to every HIT acronym under the sun, exhibit hall #HIMSSanity, sleep deprivation, and over-the-top caffeine consumption. I genuinely enjoy it every year, mainly for the relationships made and fostered. HIMSS 2010 in Atlanta was, in fact, where I first heard about HIStalk and Mr. H’s predilection for walking around with a paper bag over his head to keep his anonymity in tact.
Speaking of Atlanta, my day started well before the sun rose on an overbooked Delta flight full of folks en route to HIMSS. Honeywell, Oneview Healthcare, Patientco, McKesson, and Gozio Health were all represented. I didn’t even attempt to enter the always notoriously long taxi queue at Midway in Chicago, instead opting to reach my hotel via a 20 minute subway ride that cost all of $3. I found myself further impressed with Chicago when the clerk at my hotel allowed me to check in at 10:30 a.m. A 30-minute lie-down after a 4:45 a.m. rise wound up being essential to staving off the aforementioned #HIIMSSanity.
Refreshed, and with a few hours to spare, I spent time wandering around Chicago’s Museum campus and nearby lakefront. The weather was slightly warm and sunny, with just a hint of the city’s famous wind. I had a thoroughly enjoyable time eating my first “Chicago-style” hot dog while people-watching on a park bench. It’s not often that I get to while away an hour and a half doing not much of anything. The lure of the convention center came soon after lunch, and I found myself walking three short blocks to grab the shuttle to McCormick Place. (Is it just me, or does the shuttle drop off in the dark bowels of the trade center remind anyone else of the Lonely Mountain?)
After grabbing my press pass, I ran into Sara Zellner at Health Data Consortium giving away “I Love Health Data” buttons. (I’m a sucker for fun “pieces of flair.”) She reminded me that HDC’s annual Health Datapalooza is coming up at the end of May in Washington, D.C., with HHS Secretary Sylvia Burwell and Acting CMS Administrator Andy Slavitt scheduled to speak.
From there, it was a quick quarter mile (kidding, it was probably only a fifth) to the Venture+ Forum, a day-long event featuring startups pitching in three-minute lightning rounds to a panel of devil’s advocates. I came in at the tail end of the forum, only getting to see full pitches from Heal, Medivizor, Sensentia, and Open Health Networks. Heal’s app for on-demand house calls caught my eye, as did the realization that anyone thinking of speaking in public should avoid saying “um” at the end of every sentence and remember there is a slide deck to scroll through at the beginning of the presentation, rather than halfway through. It seemed like the Forum was at capacity of around 150 or so, which probably means it will warrant a bigger space next year.
A number of other pre-conference symposia took place on Sunday, including the inaugural Revenue Cycle Solutions Summit. Patientco’s Josh Byrd sent me this report:
The Revenue Cycle Solutions Summit provided over 200 attendees with thought-leading presentations from providers who are paving the way for what the revenue cycle of the future will look like. The common thread weaved throughout was a focus on patient-centered care after the episode of care. Highlights included:
Mike Simms, VP of revenue cycle at Cone Health talking about how to choose vendors who align with your key revenue strategy;
Leigh Williams, director of revenue cycle at University of Mississippi, who shared how they engaged physicians in using HIT to achieve financial success;
Andrew Ray, manager of physician revenue cycle operations at Stanford Children’s Hospital, who talked about how to centralize and automate the revenue cycle to increase reimbursement and decrease denials; and
Key members of the HIMSS Revenue Cycle Improvement Task Force, who shared insights on how they are working together to bridge the gaps between payers, vendors, banks, providers, and other key stakeholders to create a better patient financial experience.
Josh told me that the attendee mix was mostly CEOs and CIOs, so it will be interesting to see how many CFOs attend next year’s event. Could HIMSS be looking to give the HFMA ANI conference a run for its money?
After a quick change into Roaring 20s-inspired flapper garb, I put in an appearance at the opening reception, which I found surprisingly well attended given the amount of smaller HIMSS symposia receptions taking place at the same time. The jazz band was great, and definitely got me excited about performances by Ross Martin, MD and Party on the Moon at HIStalkapalooza.
My next and final stop of the evening was the HIStalk Sponsor’s Reception, which was a great opportunity to meet and greet the people behind the companies whose support makes HIStalk happen. I can’t thank them enough. Special thanks to the lovely folks at Aventura who gifted me with these classic kicks, which I may have to put on tomorrow once the HIStalkapalooza red carpet shoe-judging festivities have concluded and the dancing is ready to begin.
Stay tuned for more updates. I’m off to get some shut-eye, still debating whether or not to start my morning off with some YogaEspresso. Down dog and healthcare IT seem like a natural combination, don’t you think?
HHS publishes a revision to the Meaningful Use program that shortens the 2015 reporting period to just 90 days and reduces the requirement that five percent threshold for view/download/transmit to just a single patient.
ONC submits its congressionally-mandated report on EHR vendor information blocking, acknowledging that there is only anecdotal evidence of information blocking practices, but also establishing a list of behaviors it would interpret to be detrimental to national information exchange efforts, including charging for information exchanges and developing systems in non-standard ways. In its conclusion, ONC recommends field-based certification requirements and mandated data exchange features.
PatientBond, a patient engagement solutions vendor, has acquired c2b Horizons which makes embedded consumer profiling tools. Financial details were not disclosed.
HHS proposes to shorten the Meaningful Use attestation period to 90 days for 2015 in an announcement released, as always, late on a Friday (they also seem to like to put out big news right before the HIMSS conference). It also proposes removing requirements that are duplicative or no longer needed. Interestingly, HHS wants to reduce the five percent threshold for view/download/transmit to just a single patient – if even one patient retrieves their information, then the capability has been proven and the requirement is met. That addresses the argument that providers can’t force patients to access their data who are unwilling or technically unprepared to do so.
Reader Comments
From Hermanically Sealed: “Re: Evan Nordgren lawsuit against Epic for not paying overtime. Stories reported that the employees were encouraged to donate their settlement money to the health center where Judy Faulkner’s husband works as a physician.“ Unverified. I haven’t seen anything about donation requests. Sounds unlikely to me and easy enough to prove if you’ve received such suggestions.
HIStalk Announcements and Requests
I’ll be posting differently this week, with less emphasis on the clutter of questionably interesting announcements and more on the conference. I may post more than once daily and Jenn will post separately, but I’ll probably send just one email blast daily to avoid overloading inboxes.
I VRBO’ed a little apartment in Bridgeport, south of downtown within a few blocks of US Cellular Field (the unfortunately and opportunistically renamed Comiskey Park, which was a replacement for Old Comiskey Park). It costs less than a boxy hotel room, is in a cool neighborhood with interesting restaurants within walking distance, and is a short Uber ride to downtown or McCormick place. It’s much better having a kitchen, plenty of room to spread out, and a bay window looking out at White Sox fans heading down the sidewalk to the game than sitting in an airless room in a sterile building packed to the gills with lost, badge-wearing geeky HIMSS peers clogging up slow elevators and chattering way too loudly from being jacked up on exhibit hall adrenaline.
Saturday was stunningly beautiful in Chicago, with temperatures in the mid-60s with blue skies and sunshine. The trees are still denuded, but the grass has greened up and daffodils are poking up. I did some site checking of the House of Blues (looking great there), walked around the river, took a boat ride, and went to the Bulls game courtesy of a reader who invited me. I even Uber’ed back after the game, got picked up quickly near United Center, and didn’t even get hit with the dreaded surge pricing.
I downloaded the HIMSS15 mobile app and found it to be pretty buggy, requiring a bunch of iPhone restarts and confusing password prompts that didn’t make it clear whether it was the HIMSS website password or a new one (I’m still not sure since I had to do a password reset just to get it going). It has pretty good information, although I’m not sure the educational session list will replace the need for the little spiral-bound book that I always carry, assuming they’re still printing them. I used to study the agenda carefully and plan which educational sessions to attend weeks ahead, but they’ve been disappointing in the past few years (too much vendor involvement, boring presenters, too much reliance on PowerPoint, etc.) and I’m going to fewer and fewer of them.
Response has been brisk to the gracious offer of Dana Moore, CIO of Centura, to meet in the HIStalk booth with anyone willing to donate $500 to DonorsChoose.org in return for 20 minutes of his uninterrupted attention. Six companies have donated and I’ve funded the first wave of classroom projects that their $3,000 is supporting. The donations paid for the full cost of these projects, all of which are for classrooms in high-poverty areas, most of which involve Teach for America teachers, and many of which include matching funds from other charitable organizations:
Two Fire HD devices for a middle school reading program in San Diego, CA
A projector for a kindergarten class in Erie, PA
Professional development books for kindergarten teachers in Charlotte, NC
A Chromebook for an elementary school class in Toppenish, WA
Algebra calculators for a high school class in Auburn, WA
A sand and water table for K-2 children, all with multiple disabilities, in Rosamond, CA
Headphones for K-2 classes in Portland, OR
A drawing tablet for the iPad for grades 3-5 in Lockhart, TX
Three iPad Minis for a sixth grade class in Oklahoma City, OK
I’ve already received appreciative emails from most of the teachers (it seems to be a pattern that good teachers work through the weekend) and I’ll follow up with photos, teacher comments, and student thank you notes once they put the materials to use. I also have quite a few more projects to fund given the generous response. A couple of companies have taken the “top spot” banners at the top of the page in the next week and most of that money will go to DonorsChoose as well.
Poll respondents favor disbanding ONC’s certification program after Stage 3, although a few folks wouldn’t mind seeing ONC keep the program alive but with more input from previously attesting users. New poll to your right or here, for those who aren’t attending the HIMSS conference: will you be working more, less, or about the same this week?
I’m puzzled at companies (HIMSS Analytics, among them most recently) that proudly boast via a grandiose press release of having redesigned their websites. People who already follow the company will see for themselves, while those who don’t aren’t likely to rush to the nearest browser to gaze in wonderment. More self-congratulatory marketing run amok.
Last Week’s Most Interesting News
The Texas Medical Board, protecting the interests of its members, prohibits prescribing medications for patients who have been examined only by telemedicine.
Health IT issues once again make ECRI Institute’s list of top patient safety concerns.
Allscripts agrees to pay $10 million to settle a shareholder class action lawsuit claiming the company’s executives misled investors with overly positive comments following its 2010 acquisition of Eclipsys.
FTC warns ONC about unintentionally limiting consumer choices in setting or approving interoperability standards.
Webinars
April 22 (Wednesday) 1:00 ET. “Microsoft: The Waking Giant in Healthcare Analytics and Big Data.” Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP of strategy, Health Catalyst. Microsoft has been quietly reengineering its culture and products to offer the best value and most visionary platform for cloud services, big data, and analytics in healthcare. This webinar will cover the Healthcare Analytics Adoption Model, the ongoing transition from relational databases, the role of new Microsoft products such as Azure and Analytic Platform System, the PowerX product line, and geospatial and machine learning visualization tools. Attendees will learn how to incorporate cloud-based analytics services into their healthcare analytics strategies.
SSI Group will announce Monday that it has acquired patient access management software vendor Provider Advantage. Readers who reported the rumor earlier almost got it right – the only part they missed is that SSI Group was the acquirer rather than the acquiree (and SSI’s response to my inquiry was truthful – they weren’t going to be acquired). I call that a win all around.
People
Parallon promotes Curtis Watkins to CEO of its technology business unit.
Truven Health Analytics hires former CMS Healthcare.gov official Kirk Grothe as VP of its federal government business.
Announcements and Implementations
MedEvolve, Salar, and Net Health choose VitalWare’s ICD Sherpa as their ICD-10 partner.
ARC Devices and Orchestrate Healthcare launch ARC VitalConnect, which transmits readings from ARC’s non-touch digital thermometer to EHRs.
Senior care software vendor PointClickCare joins the Surescripts network.
Government and Politics
ONC delivers its congressionally mandated report on information blocking, defining the term as when “persons or entities knowingly and unreasonably interfere with the exchange or use of electronic health information.” I’m not quite sure how a company could “reasonably” interfere with information exchange, although ONC later mentions possible patient safety concerns that I would take to mean mental health information. ONC admits that it doesn’t really know how extensive information blocking is since stories are anecdotal or how that practice could be assessed other than by in-the-field product reviews. ONC is clear on practices it considers detrimental to information exchange, including contractual restrictions, charging for information exchange, developing or implementing systems in non-standard ways that increase interoperability difficulty or cost, and practices that lock users in with regard to a particular technology (from vendor’s standpoint, good business practices, in other words). ONC’s recommended actions: start in-the-field testing as part of certification, tighten technical standards, increase product and vendor transparency (although ONC admits it can’t do much in that regard), mandate sharing, clarify to providers what information sharing is allowed under HIPAA, and refer obvious cases for review under anti-kickback statutes or even to law enforcement agencies where appropriate.
The problem with provider information blocking is that only patients could report it and they’re not likely to call up ONC to complain. Vendor practices, whether contractual or technical, are easier, so it seems to me the most effective way to move the market is to call them out publicly (800.ONC.BLOK, anyone?) It would also be nice for ONC to provide suggested contract boilerplate language for providers, especially medical practices that seem inclined to sign everything shoved in front of them by a exuberant salesperson without even reading it, much less altering it favorably. That’s assuming that providers even care about sharing information, which is the biggest unknown of all. I’d like my local paint store to electronically exchange information on textures and shades with their competitors so I have more freedom of choice, but I doubt they share my enthusiasm.
Sponsor Updates
Medicity CEO Nancy Ham pens a blog for HFMA entitled, “Do You Know Where Your Patients Are?”
MedData launches major upgrades to its client reporting portal and iPhone app.
Navicure releases an upgrade to its billing and payments platform.
NVoq offers “The Link Between the Simple Checklist and Improved Patient Safety.”
Experian Health/Passport launches a video contest to show how its solutions have helped improve client organization’s patient access processes.
PatientPay produces a video detailing its new solution that enables practices to get real-time pricing for patients who call to request estimated visit costs.
A PDS blog, “When I Was Your Age: The Challenge of Generational Patient Engagement,” is featured in the HIMSS15 blog carnival.
PMD offers “Apple’s Most Important iOS Security Update.”
Talksoft’s Hamilton, NJ office is featured in the local paper in a piece about recycled office spaces.
TeleTracking asks, “Are U.S. Hospital Operations in Need of an Operation?”
An HIT Moment with … is a quick interview with someone we find interesting. Eyal Ephrat, MD is founder and CEO of MedCPU of New York, NY.
What are the shortcomings of clinical decision-support modules of EHRs?
Decision support technology was designed with the best intentions, but accuracy remains a huge problem. Prompting the clinical staff with inaccurate or redundant prompts rapidly leads to frustration, alert fatigue, and loss of reliance on this feature. In most instances I’ve seen, decision-support prompts are ignored or turned off by a busy clinical staff, often because inaccuracy makes them unreliable and therefore unusable.
Roughly 70 percent of the patient’s clinical information exists today in free-form format such as dictations, follow-up notes and discharge summaries. As physicians, we just cannot communicate the clinical picture and plan of care through simple point-and-click pull-down menus and structured fields, so we opt for free-form notes. However, the computer cannot read free text, so the decision-support modules don’t see the 70 percent or 80 percent of critical information that exists exclusively in the free-form formats.
The clinical reasoning and thought process cannot be captured through simplistic “If-Then” rules. If the patient’s hemoglobin is 8gm/dL, it’s wrong to fire a simple prompt that alerts the physician to do something with it. There could be many reasons for such a low hemoglobin, ranging form chronic hereditary conditions that warrant no action to acute conditions that require emergency response.
How do you get the necessary data, including free-text information, to perform decision support?
The industry’s current technologies used for data sharing between systems – HL7 via interface engines and Web services – are not enough. They don’t provide all the data required, in real-time, for the accurate performance of the decision support modules. To resolve this critical barrier in information availability, MedCPU developed a unique Reader technology to collect all the data entered into the organization’s EMR via an API with the operating system (Citrix server, etc.) on which the EMR runs, without touching the EMR itself, without consuming computational resources, and without requiring integration to the EMR or the hospital’s IT infrastructure.
This allows us to see, for the first time in healthcare I believe, all the data entered in real-time. Combined with a limited use of HL7 feeds for getting information entered in the ancillary systems, such as dictations, radiology, and discharge summaries, MedCPU is achieving a complete picture about the patient, in real-time, from history until the present encounter.
What results have users seen?
I’ll give you a couple of examples. One hospital that was an early adopter of our VTE prophylaxis module has seen a significant improvement in compliance with the CMS’s VTE prophylaxis guidelines (above 90 percent from about 50 percent prior to the deployment of MedCPU) over a period of a couple of months. Another health system using our radiology module has seen a significant decrease in the amount of inappropriate imaging performed based on the ACR appropriateness criteria while generating higher revenues because of better appropriate documentation.
But we’re most proud of the daily events we see where the system actually prevents clinical errors. Seeing in the logs how the physician or nurse made a certain decision, got a prompt that the decision may be wrong, and as a result cancelled this decision and reverted back to the appropriate care path makes our huge efforts worthwhile.
What effort, expense, and expertise is required to deploy MedCPU?
The effort, expense, and expertise required is extremely low compared with the typical IT deployments we all know and have traditionally experienced. Using our Reader API, we request very little IT involvement on the part of the hospital, approximately 50 hours. The overall one-time deployment of the MedCPU platform in the organization takes about three to four months, during which time we also work with the organization’s clinical leaders in reviewing the best practice protocols contained in our decision support modules. The ability to deliver low-resourced deployment is critical when dealing with the often-overloaded IT departments.
What is the direction of the product and company going forward?
We want to become the high-precision decision support layer each organization critically needs on top of their existing EMR/IT infrastructure. We’re also really excited about our new initiative with the Health Management Academy. We’re launching a multi-health-system initiative that will foster collaboration in finding and testing advanced solutions in order to bring major improvements to their point-of-care clinical, operational, and financial performance.
April 10, 2015Dr. JayneComments Off on EPtalk by Dr. Jayne 4/10/15
For those readers attending HIMSS who might want to check out my shoes, you can catch me at the Medicomp Booth (# 2318) on Monday afternoon. This year’s celebrity contestants include Jacob Reider, Lyle Berkowitz, and Ross Martin. Medicomp will again be making donations to our favorite charities and I’m honored to have been invited back. They offered bodyguards to protect my anonymity as well as a swanky backstage green room, which should make for a fun afternoon.
After I get my game show on, I’ll be heading over to the Meditech booth for the official launch of their Web Ambulatory product. Quite a few legacy vendors seem to be trying to embrace the cloud, so I’m eager to see their take on it. Plus they’ve promised champagne, although I wonder if they’ll be sneaking in the good stuff given the typical trade show restrictions on food and beverage service. I spent a fair amount of time sorting through press releases and booth invites today (nearly all of them via email) and can report that misspellings of HIMMS are leading HIPPA 3 to 2. I’m definitely not putting those organizations on the priority list.
I received the final instructions for the HIMSS Wellness Challenge. It will be measured in steps taken on Monday and Wednesday and in distance walked for Tuesday. Entrants must be present at the Connected Patient Learning Gallery to win – times are 5:30 for Monday and Tuesday and 3:30 for Wednesday. Those times border on my social schedule, so I think I’ll have to take a pass. If you decide to hang in there, the prizes are $300 gift cards.
Our leadership is hoping that CMS uses HIMSS as the prime time to release the rule making official a 90-day reporting period for 2015 Meaningful Use. Regardless of when it happens, I suspect that quite a few organizations will be planning to attest as late as possible so that they maximize their timeframe for upgrades and workflow changes they might need to be successful. We’re historically conservative and planned for full-year reporting, so our monthly status reports continue to be amusing reads as providers have decided they don’t need to be compliant just yet.
I had a brief trip in the Wayback Machine this week when our newly-acquired community hospital started including me on its email distribution list. Apparently they can’t convince their physicians to actually use electronic charting, so they’re going to pilot scanning hand-written progress notes starting next week. They reminded physicians to “change the dial on the charts to yellow which will alert the staff to scan the note.” It’s been so long since I actually used a paper chart, I had forgotten about the colored dials and sliders we used to let unit secretaries know we had written orders.
On Monday, CMS opened the Dispute Period for Open Payments. Drug and medical device makers are required to report payments made to physicians and teaching hospitals and physicians have the opportunity to review the data for accuracy. The review period is open for 45 days. Although I have all the logins, I discovered reviewing the data isn’t as easy as it sounds. Physicians have to register for both the CMS Enterprise Portal and the Open Payments system. Enterprise Portal accounts are locked if there is no activity for 60 days and deactivate at 180 days. Based on other demands for our time, I doubt that too many physicians will be personally reviewing their data. Maybe CMS could try sending us our data using DIRECT addresses.
Earlier this week, Mr. H mentioned the ECRI Institute list of top patient safety concerns. Of course health IT-related issues are hot topics, but I was surprised to see managing patient violence as number three. Our hospital was on lockdown multiple times last fall and it’s always unsettling, but the high-profile events aren’t the ones I’m most worried about. I’ve been threatened several times by patient family members. I suspect some of our outlying physicians may have firearms at their offices despite our official ban.
What are you doing to keep your staff and patients safe? Email me.
The FTC sends a 14-page letter to national coordinator for health IT Karen DeSalvo, MD commenting on its interoperability roadmap, agreeing that its full implementation has the potential to benefit patients and providers, but also warns that both health systems and vendors may resist.
Former national coordinator for health IT Farzad Mostashari sits down with our own HIStalk Practice to talk about life since leaving ONC and his new role as the CEO of Aledale.
Cerner unveils an app for the yet-to-be-released Apple Watch. The app is designed for patients and will capture biometric and activity data and integrate it into their patient portal and EHR. It will also send health-related reminders and support disease management.
Arizona passes a law that will allow patients to order lab tests without going through a doctor, crediting Silicon Valley lab vendor Theranos for making it possible.
In Houston, firefighters are turning to tablets and telehealth to connect non-emergency patients with doctors, rather than driving them to the hospital and driving up the cost of care.
The Federal Trade Commission likes ONC’s interoperability roadmap for the most part, but observes that interoperability will continue to be hampered by the competitive interests of providers and vendors. It also gently warns ONC that its strategy of using policy and funding levers to create interoperability demand might encourage less innovation than if the government instead created market forces as a payer (i.e., Medicare). FTC says that its experience shows that vendor participation in creating standards and certifying products causes anti-competitive behavior, such as withholding certification from a competitor, excluding new products from meeting prior standards, rigging the standards-setting organization with vendor-friendly members, and not paying enough attention to patient rights. FTC is also worried that vendor-recommended standards will lock consumers onto a platform that may have been created with the intention of stifling competition. Lastly, FTC is concerned that any standards ONC chooses will be treated as law, so if they really want to get into the standards-setting business, they had better choose carefully.
Reader Comments
From Pulpit Bully: “Re: Georgia Medicaid Fair. Here’s a free training event for those who want to get some insight into why our industry is hopelessly complex. I hate to sound like a curmudgeon, but this is an ENTIRE DAY of sessions about how insurance companies and the government make it difficult for people to manage their health.” It doesn’t sound like a target-rich environment for booth swag.
From Nasty Parts: “Re: CPSI. Heard there is an ‘all hands on deck’ meeting on Monday and they have rented a large facility. Wonder why would they do this during the HIMSS conference?” Unverified. At least some of their hands won’t be on deck in Mobile unless they vacate their HIMSS exhibit. It’s probably their user group meeting in Sandestin, which is also next week.
From Beaker: “Re: self-ordered lab tests. This should end well.” A just-signed Arizona law that will take effect in July will allow people to order their own lab tests without a doctor’s involvement. It was pushed by Silicon Valley lab high-flyer Theranos. I like the patient-centered aspect, although certainly Theranos has executed a smart business coup in removing physicians as its sales bottleneck. The obvious unknown is how consumers will react to receiving abnormal results – treat themselves inappropriately, pester their doctors, or demand that their insurance pay for tests of questionable medical usefulness. Doctors serve both as clinical and utilization gatekeepers and it’s a brave new world when those roles are removed and consumers are turned loose with minimal knowledge.
From Epic Doesnt Market: “Re: Epic marketing. Not sure if you’d consider the $2 million that Epic pays KLAS as marketing, but I do.” I would. Every company does marketing. Epic is different only in that it’s a bit lower key about it and it doesn’t place actual ads most of the time. Marketing isn’t the same as advertising, as everybody who has taken an MBA marketing class knows, and while Epic does little or none of the latter, it does quite a bit of the former under the label of “events.” It milks its KLAS results hard, as anyone who has seen the giant displays plastered on its HIMSS booth knows, and those billboards didn’t just jump up on the wall without help.
From Epic Does Too Market: “Re: Epic marketing. If they don’t market, someone forgot to tell their employees, or maybe they don’t control the ones who have left. At least eight former Epic employees identify themselves as marketing people on LinkedIn and one career marketer (who has since moved to another vendor) says she reported directly to Epic’s CEO. They’ve had several spokespeople quoted. I see the work Epic produces on their website, fact sheets, slide presentations, dance numbers, etc. Whether they call it marketing or not, they must have full-time people engaged in producing it all.”
HIStalk Announcements and Requests
Welcome to new HIStalk Platinum Sponsor Recondo Technology. The Denver-based revenue cycle technology company’s patented, no-touch ReconBots find and assemble critical payer information to speed up eligibility, authorization, and claim status transactions. Its business office products cover claim data integrity, claim adjudication status, and payer follow-up, while the company’s patient access solutions include eligibility, registration quality assurance, point-of-service patient financial responsibility statements, prior authorization, and a real-time dashboard for reporting KPIs. Recondo’s rules, legacy integration, and data mining are used by 900 hospitals and 500 payers to ensure proper payments and financial clarity. You probably know industry long-timers CEO Jay Deady and Chief Growth Officer Ralph Keiser. The just-released Gartner report “Cool Vendors in Healthcare Providers 2015” notes Recondo as providing health systems with innovative technologies to help solve their evolving problems. Thanks to Recondo for supporting HIStalk.
Also supporting HIStalk as a Platinum Sponsor is Practice Unite, which offers a customizable, HIPAA-compliant mobile platform for delivering real-time care (secure communications, clinical data display, and customized workflow). Clinician-friendly communication and collaboration tools include consults, secure text, lab results, patients, on-call and hospital directory, news, events, and several others. Customers have reported six-times-faster inpatient-related communication, a 20 percent ED wait time reduction, easier MU Stage 2 compliance, and reduced network leakage. Check out the case studies. Thanks to Practice Unite for supporting HIStalk.
Here’s an overview video of Practice Unite that I found on YouTube.
Every year I tell vendors how stupid they are in listening to clueless marketing people who advise them to hold their big announcements until HIMSS conference week, which ensures they’ll sink without a trace in all of the confusion and real news happening there. Finally they’re seeing the light and making significant announcements this week instead. Reporters are too busy partying excessively or wasting time doing cookie cutter executive interviews to pay attention to self-serving HIMSS week announcements.
This week on HIStalk Practice: PointNurse partners with Swarm Fund to offer clinicians new telehealth business model. New York’s physician profile website stays alive. Montana Primary Care Association taps eCW for HEDIS help. AMA makes no bones about who it won’t support in the presidential election. Maryland creates a new accelerator for healthcare IT startups. Aledade CEO Farzad Mostashari, MD hints at the EHR features he’ll be looking for at HIMSS15. Thanks for reading.
This week on HIStalk Connect: ONC launches a resource center for states interested in incorporating digital health tools into care delivery. Rock Health releases its quarterly funding report on the digital health industry, noting a slight decline in funding this quarter compared to Q1 2014, but still generating $600 million in new investments. An MIT student is building the Stack Overflow for mental health in his new startup Koko. Weight Watchers acquires fitness social media platform Weilos for an undisclosed sum.
Dana Moore, SVP/CIO of Denver-based Centura Health, has generously offered to collaborate with me on a purely charitable HIMSS conference project. He’ll be in our booth (#5371) Wednesday morning 10 until noon. Vendors (or anyone else, for that matter) can have 20 minutes of uninterrupted one-on-one time with Dana in return for a $500 donation (I chose that value) to DonorsChoose.org since Dana and I both like funding education projects. Then, he and/or I will recap his impressions about your pitch right here on HIStalk to a pretty big audience. Contact me if your company is interested and we’ll book a time. It’s a heck of a lot cheaper than trying to get his attention and then flying to Denver to meet there, you’ll be benefitting a classroom, you’ll get prime HIStalk real estate, and Dana just might be interested enough in your pitch to want to speak further (startups take note).
Webinars
April 22 (Wednesday) 1:00 ET. “Microsoft: The Waking Giant in Healthcare Analytics and Big Data.” Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP of strategy, Health Catalyst. Microsoft has been quietly reengineering its culture and products to offer the best value and most visionary platform for cloud services, big data, and analytics in healthcare. This webinar will cover the Healthcare Analytics Adoption Model, the ongoing transition from relational databases, the role of new Microsoft products such as Azure and Analytic Platform System, the PowerX product line, and geospatial and machine learning visualization tools. Attendees will learn how to incorporate cloud-based analytics services into their healthcare analytics strategies.
Acquisitions, Funding, Business, and Stock
Specialty EHR vendor Modernizing Medicine signs a lease for new office space in Roseville, CA to expand headcount from 24 to up to 70 for the former Aesyntix Health, which it acquired in December.
NextGen parent Quality Systems, Inc. acquires healthcare analytics vendor Gennius.
UnitedHealth Group will pay $12 million in damages after a federal jury finds that its OptumInsight subsidiary infringed on physician efficiency calculation patents held by Cave Consulting Group, which offers several products including the CCGroup EfficiencyCare physician efficiency measurement module.
Sales
YourCareUniverse chooses VisionWare for master data management.
EvergreenHealth Partners (WA) selects Wellcentive to coordinate care of 400,000 residents served by the 500 physicians of the clinically integrated network.
Announcements and Implementations
McKesson announces Conserus, a vendor-neutral diagnostic imaging interoperability lineup that includes workflow, work lists, image repository, and data exchange.
Cerner will integrate visual analytics from Tableau Software into its enterprise data warehouse and analytics products.
Validic announces that it integrated with 27 additional digital health devices in Q1 and is beta testing its connectivity with Apple HealthKit. The company has also released a developer platform that provides API access to its marketplace.
MEA-NEA adds HIPAA-compliant email encryption from Virtru to its information exchange, storage, and attachment solutions.
ZeOmega adds a medication management module to its Jiva population health management system.
Awarepoint announces a Bluetooth Low Energy RTLS platform.
Caradigm’s latest release includes new modules for condition management and utilization management.
Aventura will offer biometric authentication for electronic prescribing of controlled substances.
Lifepoint Informatics offers free trial of an API toolbox for medical necessity validation and ICD-9 to ICD-10 crosswalk.
The non-profit, hospital-focused Center for Medical Interoperability, funded by a $10 million grant from the Gary and Mary West Foundation, names its initial board of directors.
Government and Politics
The Texas Medical Board is considering barring doctors from generating prescriptions for patients they haven’t met in a face-to-face visit, although the wording seems vague on whether “face-to-face” excludes video consultations. Dallas-based telemedicine provided Teladoc says the state is moving backward in prohibiting use of a technology that can help solve access and cost problems, but others think it’s the state’s job to avoid creating a double standard that devalues the traditional office visit and relies on new technology.
Privacy and Security
A painfully long and overwrought Wired article with the obligatory “click me please” headline (“Drug Pump’s Security Flaw Lets Hackers Raise Dose Limits”) prattles at length about the purely theoretical possibility that hackers could alter the drug libraries of smart IV pumps, meaning they couldn’t do much of anything other than altering the minimum and maximum allowed doses (not a given patient’s actual dose). Sometimes security analysts find real, previously undocumented security holes of major importance, but sometimes their announcements are more boastful than useful.
Innovation and Research
NPR covers the use of telemedicine by Houston firefighters, who instead of driving people with non-emergent needs to the ED, can instead connect them with a doctor using iPad video. They can assess the patient and connect with a doctor in real time to decide whether an ED visit is warranted, and if not, schedule them for a regular doctor’s appointment (including a free cab ride). The project addresses the fact that 40 percent of Houston ED visits are for non-emergent primary care issues.
Technology
Surescripts and Accenture join HL7’s Argonaut Project.
Box integrates with Carebox to support EHR integration and patient portals.
Doximity announces a secure clinician communication app for the Apple Watch that sends the user to their iPhone for more detailed information (since Watch does nothing without being connected to an iPhone). In a bizarre “only in healthcare” intermingling of old and new technologies, it will alert doctors when they receive a fax.
Cerner will release an Apple Watch version of its HealtheLife that will offer consumers push notification health reminders and data tracking while collecting biometric data to send to Millennium.
Other
In an HIStalk Practice interview, former National Coordinator Farzad Mostashari, MD (now CEO of Aledade) says he’s surprised that the certified EHRs he now has to deal with personally “can’t perform in a real clinical setting” and he’s happy that ONC is considering field testing and a mechanism to deal with EHR customer complaints. He says he’ll be cruising the HIMSS exhibit hall to look for systems for his participating practices that create “practice happiness,” meet MU requirements in a workflow-friendly manner, and are sold by vendors who are willing to work with third-party health applications. He adds that EHR vendor interfacing charges are “outrageous” and that every public and private HIE should offer ADT notifications. On fuzzy, buzzwordy topics like patient engagement, population health management and precision medicine, Mostashari says vendors should have embraced Meaningful Use enthusiastically as a roadmap that would have gotten them there, but instead took a compliance-only approach that frustrated their users.
Here’s a smart idea from HCS since HIMSS badges don’t make it clear what kind of organization an attendee works for: they’re offering badge ribbons that denote long-term care, behavioral health, and long-term care acute hospitals so that attendees with similar interests can find each other. Not to take away from HCS’s efforts, I had a similarly great idea for identifying attendees by their personal characteristics, but I’m hampered by limited attendee demand for badge ribbons that indicate “Self-Important Douchebag,” “Incompetent Despite Appearances,” “Obliviously Intellectually Challenged,” and “No, This Isn’t the First Sales Job I’ve Lied In.” Perhaps I should instead have them manufactured in the “Kick Me” back-attached variant that could be applied by observers who are more situationally objective than the wearer.
A New York Times article examines the trend of insurance companies trying to boost lagging life insurance sales by offering premium discounts to customers willing to share electronic data that includes real-time tracking of gym utilization and overall physical activity via a monitored Fitbit. A privacy expert questions how all of that consumer data will be used, while a law professor ponders whether the program is just a way for life insurance companies to weed out less-healthy customers: “The people who have the time to devote to jumping through all the hoops are likely to be better off than average, and those healthy enough to do wellness activities may be unrepresentative of the chronically ill. I believe that is one reason why there is empirical research severely questioning the value of wellness programs.”
A jury awards $1.38 million to a former billing supervisor of Harrison Medical Center (WA) who was fired after filing a whistleblower lawsuit in which she questioned why she was told to run a monthly Medicare billing program daily instead.
Sponsor Updates
VitalWare earns Service Organization Controls Reports (SOC) 2 Type 1 certification of its revenue cycle private cloud. It also announces that Epic consulting firm E-Volve Health will offer VitalWare’s revenue cycle solutions.
Medhost posts a video describing how its physician advisory board impacts product development.
Logicworks achieves Amazon Web Services partner network healthcare competency.
Extension Healthcare offers “Knowing is Half the Battle – Measuring clinical interruptions with advanced alarm management middleware.”
Impact Advisors posts “mHealth — The Newest Front Door to Your Organization.”
Galen Healthcare asks, “How does Mirth Connect stack up as an HIT Interface Engine?”
LifeImage writes “Medical Image Sharing for Trauma Care.”
Hayes Management Consulting offers “Making the Case for Physicians as Part of the EHR Project Team.”
The HCI Group offers “Technology Partnerships and Data Mergers: Challenges for Small and Medium-sized Hospitals.”
HDS CEO Bill Horne takes a pie in the face to raise money for the American Heart Association.
Healthwise earns certified status for data security and protection of health information.
Holon Solutions offers “Health IT Interoperability Must Be Built From The Bottom Up.”
Liaison Technologies offers “The Right Way to Address Today’s Data Challenges.”
Cleveland Clinic’s business development unit has launched a new company called ADEO that will resell digital health products to hospitals, practices, and directly to consumers.
A HIMSS Analytics survey of 119 healthcare executives finds that patient portals are not delivering on the patient engagement needs of customers. Still, a majority of respondents report that the driver for implementing a patient portals was to meet MU requirements, and not necessarily to improve patient services or quality of care. The full study will be published at the HIMSS conference next week.
My HIMSS Was Great — Hope Yours Will Be, Too! By Brian Weiss
So Much to Say… So Few Listening
Back in ancient times when not everything had to support this quarter’s numbers or the next funding round, I took a few college courses that were not directly related to my plans to become a software engineer. I don’t remember exactly which Something Interesting And Not Practical Career-Wise 101 course it was in which we pontificated about whether a tree falling in a forest that nobody hears makes a sound.
I wish I remembered the answer, as I think it may have some implications for vendor press releases on the first day of HIMSS. It may also be relevant for writers of HIStalk columns. But I was probably busy optimizing some assembly code interpreter written in Pascal (which engineering readers will recognize as potentially good material for the aforementioned college course).
Seems that almost every day for the past few weeks someone has been serving up another high fastball over my columnist strike zone. CommonWell and Epic trade barbs, MU3 guidelines are published, everything is “on FHIR,” patient-centric data exchange is all the rage, and the US Congress allocates more time to healthcare data interoperability than most hospital system executives. If you’ve followed some of my previous articles on CommonWell, FHIR, and consumer-centric healthcare IT, you can imagine I have a few things to say about some of this stuff.
But I haven’t yet submitted any of these articles in the making. I’m pretty sure I was the most prolific HIStalk column contributor who published nothing in the month of March. Thankfully, no trees have to fall in any forests each time HIStalk news updates land in my Inbox and I feel compelled to open up MS-Word and crank out my passionate thoughts about “whatever,” only to decide somewhere on Page Two that I don’t have anything dramatically new and insightful to add to what I’ve already said.
Besides, who is going to read this stuff I’m drafting with everyone busy preparing for HIMSS?
So instead, I’ll share with you a few of my thoughts about HIMSS itself. Given that I have only attended HIMSS once in the past (in a rather peripheral role) and this is my first HIMSS as a startup CEO, why would you want to read my HIMSS tips, insights, or analysis?
You wouldn’t! That’s why I’ll leave all that to Mr. H and the HIStalk team and all the others who already helped make sure that searching for “HIMSS tips analysis” returns close to half a million hits on Google. That should keep you busy enough on the way to Chicago, even if you are on the shuttle from Uranus and you need to find parking near the convention center.
Here are some of my somewhat contrarian views on HIMSS, though I reserve the right to change my mind about all of them at the end of next week (or whenever I’m certifiably fully awake).
It’s Floor Wax AND Dessert Topping
If you understood this section’s header, then I suppose you also didn’t have enough on your social calendar on Saturday nights in the 70s. If you didn’t understand, try Google (or don’t worry about it). Point is that HIMSS is undoubtedly many different things for different attendees and audiences. While I speak for nobody (perhaps other than myself — we are still debating that internally) I’m hopeful some of this will reflect other startup participants at HIMSS (and perhaps even some more established exhibitors) and thus, in the intended spirit of this column, provide a view into life “on the other side of the aisle” for those of you on the side with the very sore feet.
I have no idea how HIMSS attendees manage to have a productive visit to the massive HIMSS hall. Those of you who actually make it to the peripheral locations (which the HIMSS rules generally assign to new participants); the small, low-budget booths (that rich startups can afford); or the individual pods allocated to partners in various “sponsored pavilions” (where startups are most likely to be) have my sincere admiration. Not enough to get me to put down my cellphone and notice you, but certainly enough to feel a little ashamed when Mr. H takes me to task on that.
I don’t fully get what you think you are going to learn with all this legwork that you can’t more easily pick up with a tablet, a web browser, and your feet up on the couch. I get the part about collecting freebies, but I’m not bringing any, so it’s probably just as well that I’m polishing my BrickBreaker skills (I will trade in my rusting BlackBerry as soon as I get past level three). But, I’m glad you’re there racking up the steps on your fitness bracelet, because without you, there would be no HIMSS.
My HIMSS Was Great!
HIMSS for me was great. Yes, “was” — past tense. Next week might be good as well, I don’t know. But that’s icing (or floor wax) on the cake, from my perspective.
For me right now, HIMSS is first and foremost a “compelling event” that makes many other things happen in the weeks leading up to it. The value of those things is rather independent of — and I expect will prove to be of far greater value than — anything that happens at the event itself.
First and possibly foremost, HIMSS is the excuse vendor companies like mine need to force a refresh of our slide decks, web site, positioning statements, brochures, demo kits, etc. It even forces our R&D departments to do one of the most unnatural acts in software engineering – release a product version.
Next, and particularly important for a small startup like mine, HIMSS creates a compelling event for our work with partners. My company, Carebox, is going to be part of demonstrations in four locations at HIMSS. Yes, I’m dying to tell you where so I can feel like I’ve gotten free marketing benefits in exchange for writing this column when there are a million other things I’m supposed to be doing right now “before HIMSS.” But even if I caveat that with some clever, self-deprecating line like, “Here comes the shameless plug,” I actually would feel shame (and Mr H might edit it out). So, think of it as a scavenger hunt with no prizes. What could be more fun than that?
Now, where was I? Oh, right, looking for the Carebox presence buried in various booths at HIMSS. The point is that even though I don’t really expect any direct benefit from people noticing our presence in all those locations, I’m thrilled about each of them. Because we now have sales demonstrations and scripts, sandbox environments, and more importantly, working product integrations and/or go-to-market plans with all of those rather important partners.
With the exception of our primary host and partner at HIMSS, Box (Booth # 8714 – I couldn’t resist the shameless plug after all — oh, the humiliation), were it not for HIMSS, I believe we would still not even have started practical product and go-to-market work with the others.
The scheduled press releases for next week mentioning my company that Mr. H will ignore — and might have covered and called out this week, or most any other week, and I thus doubt you will even hear falling in the proverbial forest — matter to me as well. They’ll provide important quotes and links for my web site and presentations for months to come. And they create momentum with the partners that published them and within their internal sales organizations.
The obligatory “Will I see you at HIMSS?” e-mails, dinner invitations, etc. have all given me much-needed excuses to reconnect with dropped leads that are generating significant business opportunities as we speak.
There are many more examples, but I think you get the idea, and I’m well into Page Two of this article which is usually when I start boring myself (yes, and you).
While You’re at HIMSS, I’ll Be Very Busy …
I’ve never (yet?) attended the JP Morgan conference and thus enjoyed Michael Barbouche’s writeup a few months ago. My HIMSS schedule is shaping up a bit like what he described – a series of hourly slots in various locations, some at the event itself, others in nearby hotel rooms, some in local restaurants, and one or two in offices around town.
I still have a little time slotted to actually be “in the booth” as opposed to “in the closed holding cell in the middle of the booth constructed so that we can do conference meetings as if we were in the office and just trying to optimize travel logistics, but have to put up with all the noise around us and the other lousy environmental conditions for a meeting.”
But that’s only because I’m not really important (yet?), in which case you would only see me “in the booth” in the context of a journey to get liquids into or out of my body, or as per regulations for “minimum required time in the yard outside of the cell.”
Most of those meetings are definitely important to me and I suppose those constitute “part of HIMSS” and thus invalidate my claim that HIMSS is “past tense” for me, but I think logical consistency was part of that same course I wasn’t paying attention to back in college, so no worries there.
… With You?
If you think you might be a potential customer, partner, investor, or romantic interest (just kidding!) of Carebox, you can still claim my few remaining available minutes next week by reaching out and scheduling any open slots I still have. I’m told that by pre-allocating my time to pre-qualified interactions I can pre-impact the expected value from my HIMSS experience (and perhaps also finally understand why people actually board the plane during pre-boarding).
And then I suppose my HIMSS experience could be completely orthogonal to that of the thousands of people walking around the hall.
Except that won’t actually work for me. I don’t really know the statistical likelihood that a chance encounter in a booth at HIMSS will result in something that changes the trajectory of my company. Maybe that was also covered in one of those college courses I seem to have missed. But apparently the people who did really well in that course don’t buy lottery tickets and don’t start new healthcare IT companies.
So I’ll hopefully be the guy who remembered to turn off his cell phone and otherwise managed to follow a few of the thousands of “10 best tips” for HIMSS and maybe we’ll strike up an interesting conversation. And maybe next year before HIMSS I’ll write a very different (and better) article.
PerfectServe publishes findings from a study on communication tools used by providers and health systems, finding that most rely on follow up phone calls and patient portals to communicate with patients, and that less than 25 percent use their EHR to communicate with each other. 81 percent report being frustrated with having to use multiple, disconnected communication systems.
Cerner announces a partnership with Banner Health (AZ) that will include development efforts centered around patient engagement, population health, and financial management. Banner runs Cerner across 26 of its facilities, with 21 of them being HIMSS Stage 7 sites.
ECRI Institute names its top patient safety concerns for 2015:
Alarm hazards.
Missing or incorrect data in EHRs and other IT systems.
Patient violence.
Wrong IV line drug administration.
Care coordination problems due to lack of medication reconciliation.
Failure to perform double checks.
Opioid events.
Improper instrument sterilization.
Inadequate handoffs during patient transport.
Medication dosing errors due to weight confusion in kilograms vs. pounds.
Reader Comments
From Nature Valley Sweet and Salty: “Re: Beacon Partners. Guess the acquisition is true.” I see the slide that contains both company names, but I’ll have to say “Unverified” until something more definitive comes out. Everybody is holding their big news for next week, so we’ll know soon.
From Consensual Sects: “Re: SSI Group. Acquisition by an unnamed company to be announced this week.” I heard that a couple of weeks ago, with the rumor reporter claiming the acquirer is Medhost. I asked my SSI Group contact and they flatly denied that anything is in the works, but then again companies always say that since “no comment” is the same as verifying the rumor. Consensual Sects was told it’s a West Coast-based patient access company with a recognizable name.
From One M Dammit: “Re: HIMMS. Here’s another sighting.” There are many, unfortunately, with even mHealth News (published by HIMSS Media) managing to misspell it as HIMMS. Googling “HIMMS” for news sources turns up 157 examples.
From Occupy HIMSS: “Re: Scripps. Check out the spelling on this LinkedIn article.” It was posted on April 1, so perhaps its Epic author, who looks almost old enough to buy his own beer, was going for subtle rather than unintentional humor.
From Senor CMIO: “Re: Tennessee-based Mountain States Health Alliance and Wellmont merger. Wellmont just installed Epic under a year ago (and may be suffering financially, partly due to this). MSHA runs Siemens Soarian. MSHA will likely have final control of the merged company since its CEO is chairman of the merged board. It will be interesting to see if Epic will be replaced by Soarian or if efforts at HIE will be ramped up successfully between the two systems.”
From Panko: “Re: Epic. I read a site’s in-depth profile about Epic that struck me as odd since there was no really newsworthy item. It basically read as a press release touting Epic ahead of the DoD’s decision and brushed aside interoperability criticisms. I was wondering what your take on this is? Epic supposedly does not do press or marketing, but this article seems to me to be the result of a really carefully orchestrated media push.” Epic has been making itself slightly more visible to the press. Some of its people have been quoted in articles and there’s no way that happened without Judy’s approval. It hired a lobbyist. It is mentioned in announcements every now and then. All of this happened after the DoD bid came up and the interoperability and cost criticisms started getting potentially damaging airtime. I’m pretty sure Judy Faulkner still doesn’t do interviews although her words from quick email responses are sometimes passed off as an “interview” by sites hoping to give the impression that they’re so important that Judy took the time to sit down with them (you can recognize those articles because they contain dozens of paragraphs of regurgitated common knowledge along with about two actual Judy sentences inside quotation marks). Epic says it doesn’t do marketing, which I’ll generously interpret as being true since the company doesn’t have employees whose full-time job is marketing. Epic gets visibility when it wants it most, so while it keeps a lower public profile than most vendors, doesn’t advertise, and doesn’t fawn over the press, it also doesn’t just sit in a Verona barn and crank out MUMPS code while ignoring the fact that it’s a multi-billion dollar market-leading company whose interests have always been competitive, With the DoD bid and the involvement of prime bidder IBM, Epic seems to be slightly more active in managing the press as public opinion dictates, but often in a minimally visible way.
From Belle: “Re: Epic overdose warning. Here’s our setup and the error that displays with a massive overdose as UCSF ordered.” This hospital keeps it simple by configuring Epic to order Septra DS by the whole tablet rather than in either mg or mg/kg of the trimethoprim component alone, which probably works great for adult patients but maybe not so for peds. The overdose warnings are pretty clear and even offer the choice of just switching to the maximum dose of two tablets per day with a single click. UCSF’s resident and pharmacist both received similar overdose warnings, which they didn’t heed. We talk about alarm fatigue when referring to patient monitors, but it happens a lot with CPOE drug warnings (dose, allergy, drug interaction, etc.) I’m sure someone has done a presentation on how to analyze and detune drug warnings in a way that is appropriate for a given hospital and/or provider since, as illogical as it seems, one size doesn’t fit all when it comes to such warnings. Reducing the clutter is better than just shutting off all alerts as some doctors claim they would prefer (until they get sued for missing a conflict, of course).
HIStalk Announcements and Requests
The HIMSS conference crunch has officially begun. Vendors are queuing up their announcements for next week, people are flooding my inbox with issues they think are important (although I often don’t share their level of excitement), and lots of people are packing up for their migration to Chicago. The weather is looking great with daytime highs in the 60s predicted, so it will be brown but comfortable.
Here’s the schedule of who will be holding court in our value-sized HIStalk HIMSS booth (#5371) next week:
Tuesday 11:00: Steve Blumenthal of Waller Lansden Dortch and Davis LLP, answering health IT legal questions, being way funnier than you’d expect for a lawyer, and giving away swag while Lorre attends our CMIO get-together lunch.
Tuesday 2:00: nVoq, dispensing Garrett popcorn and collectible pins.
Tuesday 3:00: Barry Wightman of Forward Health Group, signing copies of “Pepperland” and dishing on what it was like hosting HIStalkapalooza the night before.
We did a tweet chat Tuesday called “The Role of Patient Engagement and Advocacy in HIT” (the link goes to Jenn’s Storify recap). Thanks to those who participated, especially our patient advocate scholarship winners.
We’re doing video interviews with DrFirst at the HIMSS conference, asking folks for their impressions. Want to be included? Sign up here.
HIStalkapalooza
The HIStalkapalooza timeline looks like this:
5:00 House of Blues closes to the public.
6:30 House of Blues outside doors open only for HIStalkapalooza registered guests. Security will turn away anyone who wasn’t invited, so don’t plan to crash or to bring an unregistered guest (I don’t have any more invitations, so please don’t ask).
6:30 Pick up your badge, check your coat, and walk the red carpet to participate in the shoe and apparel judging. Visit the event sponsor tables and stake out a good spot. We’ll have caricature artists, a photo booth, videographers, and other activities to be checked out. Bars and food won’t be open yet – that way people can enter leisurely without trampling each other in a rush to get to the first visible bar.
If one of the event sponsors has invited you to their private opera box, use your sponsor-issued wristband to pass security to the third and fourth floors (everybody without wristbands will be limited to the first two floors). We’ll have food service on the third floor, bars open on both floors, plus cocktailer (that’s a new word I’ve learned) service to the opera boxes, which will also be stocked with appetizers.
6:45 Jazz combo starts playing dinner music on stage.
7:00 Bars and dinner buffet stations open in multiple locations.
8:30 (approximate) Party on the Moon’s stage performance begins.
8:30 House of Blues doors outside doors will be closed. No one will be admitted after 8:30.
10:00 Bars switch over from open to cash. I’m buying until 10:00, you’re buying after.
11:00 Event ends.
If you can’t make it to HIStalkapalooza or didn’t receive an invitation, event sponsor PatientSafe Solutions will be live streaming video from the event via Periscope, a new Twitter-powered video service. Follow @PatientSafeSoln on Twitter, install the Periscope app, and watch for live tweets tagged #HIStalkapalooza. Next time maybe I’ll just stay home and throw a viewing party with a keg and some Italian beef sandwiches.
Webinars
April 8 (Wednesday) noon ET. “Leveraging Evidence and Mobile Collaboration to Improve Patient Care Transitions.” Sponsored by Zynx Health. Presenter: Grant Campbell, MSN, RN, senior director of nursing strategy and informatics, Zynx Health. With mounting regulatory requirements focused on readmission prevention and the growing complexity of care delivery, ACOs, hospitals, and community-based organizations are under pressure to effectively and efficiently manage patient transitions. This webinar will explore the ways in which people, process, and technology influence patient care and how organizations can optimize these areas to enhance communication, increase operational efficiency, and improve care coordination across the continuum.
April 22 (Wednesday) 1:00 ET. “Microsoft: The Waking Giant in Healthcare Analytics and Big Data.” Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP of strategy, Health Catalyst. Microsoft has been quietly reengineering its culture and products to offer the best value and most visionary platform for cloud services, big data, and analytics in healthcare. This webinar will cover the Healthcare Analytics Adoption Model, the ongoing transition from relational databases, the role of new Microsoft products such as Azure and Analytic Platform System, the PowerX product line, and geospatial and machine learning visualization tools. Attendees will learn how to incorporate cloud-based analytics services into their healthcare analytics strategies.
Acquisitions, Funding, Business, and Stock
Livongo Health raises $20 million to expand its connected glucometer-powered diabetes management service. Former Allscripts CEO Glen Tullman started and runs the company.
Lexmark will consolidate its acquired brands, including Perceptive Software, under the single name Lexmark and a new logo. Perceptive will be placed under the Lexmark Healthcare banner.
Mansa Capital Management acquires Accreon with a $5.5 million investment and the participation of the company’s founders and management team.
Sales
Baptist Health (KY) chooses Capsule for medical device integration.
Meditech chooses Validic to integrate clinical, fitness, and wellness data into its applications.
People
Gary Meyer (Financial Chief) joins Cumberland Consulting Group as CFO.
Announcements and Implementations
A PerfectServe survey with decent methodology finds that 71 percent of doctors waste time trying to communicate with other care team members, the EHR is rarely used to communicate with external providers about complex issues, and respondents report extensive dissatisfaction with their clinical communications tools that often span telephone, texting, and other forms of messaging. Nearly two-thirds think HIPAA requirements impede care team communication.
Cerner and Banner Health sign a collaboration agreement that would seem to cement the strong possibility that Banner’s new acquisition, Tucson-based University of Arizona Health Network, will eventually be migrated from Epic to Millennium.
Healthgrades announces its annual awards for patient experience and patient safety, naming the top hospitals based on analysis of claims data, HCAHPS scores, and reported patient safety incidents. It’s interesting that some questions that formerly well correlated with “likely to recommend” now don’t, suggesting that consumer expectations are changing.
TeraMedica will launch analytics and dashboard additions to its Evercore vendor-neutral archive next week.
Privacy and Security
Tulare County HHS (CA) suggests that 800 people change their email addresses after a county employee used CC: rather than BCC: in sending out emails to clinic patients. The department also disabled the exposed email addresses for its patient portal.
Other
Jamie Stockton, CFA of Wells Fargo Securities sent over his latest slice-and-dice of Meaningful Use data. For hospitals, nearly every Epic user has reached Stage 2, while users of Cerner, Meditech, CPSI, and McKesson are congregated at around the two-thirds mark.
Wells Fargo’s EP numbers suggest that Athenahealth customers lead the MUS2 pack at 71 percent, although not up to the 98 percent it boasted a couple of weeks ago that in reality measured the percentage of EPs that attempted MUS2, not the percentage of its overall customer base. Obviously EPs aren’t nearly as willing and able as hospitals to keep chasing HITECH money, and if they purchased these EHRs with intentions of getting it, they are likely not only disappointed, but potentially more likely to replace the systems they bought for that reason.
Carequality publishes collaboration and trust principles that data-sharing participants can legally agree to follow.
A Minnesota couple hears music playing from their child’s bedroom, finally realizing that an Amsterdam hacker had taken over their nanny cam. Theirs was one of thousands of cameras that had screen shots and live stream links posted online because the parents did like many people in buying an IP security camera and ignoring the instructions for changing the default password.
Sponsor Updates
CitiusTech launches a healthcare practice focused on big data and Hadoop.
ADP AdvancedMD offers the “Top 4 claim exclusions & resolutions.”
Health IT is heavily represented on ECRI’s annual Top 10 Patient Safety Concerns list, with alarm fatigue and poor alarm configuration taking first place, incorrect or missing data in EHRs taking second place. Poor medication reconciliation procedures, something surprisingly absent from all MU stages, also made the list.
The Health Information Trust Alliance announces that it will sponsor a broad, empirical study of health IT security threats aimed at analyzing “the methods, severity and pervasiveness of cyber threats targeting a variety of healthcare organizations.”
Doctors at CHI Health Good Samaritan (NE) have issued a vote of no confidence in the leadership of CHI. An ongoing dispute between CHI and Blue Cross Blue Shield of Nebraska is at the heart of the problem, with a small faction of local doctors leaving to build a new hospital rather than stay and work under CHI.
The run-up to HIMSS is typically packed with marketing, but this year has been incredibly slow. As I scanned the Monday Morning Update, this ad from First Databank caught my eye. I’m pretty sure no one in their right mind would electively join a Meaningful Use club (unless they had some sadomasochistic tendencies), but it was catchy and smart. In fact, so catchy and smart that I might borrow their “varsity” idea. We typically have a theme for each year’s major EHR upgrade and I’m liking the idea of awarding varsity letters to our next class of super users.
There are only four more postal days until I board the plane for Chicago, so if vendors were going to try to reach CMIOs by snail mail, they’d better already have their marketing pieces on the way. There are usually several pieces that arrive the week after HIMSS and I hope their senders at least got a bargain when they chose PR firms that wouldn’t get the message out on time. My administrative assistant is getting seriously depressed at the lack of entertaining pieces – usually he enjoys making fun of the poker chips and other items, but there hasn’t been anything interesting this year.
The weekend email did bring a heartfelt apology from Nordic President Drew Madden, who heard about my dis-invitation from their HIMSS event. It sounds like they’re still working on right-sizing given their venue and have been able to expand capacity. Being part of the HIStalk team, I certainly understand how crazy it can be to find your event turning into the hot ticket. If I can figure out how to re-RSVP and stay anonymous I’ll certainly give it a go. I appreciate the personal contact and his kind words.
Speaking of HIMSS events, I’ve finally locked in my wardrobe for HIStalkapalooza. I’m really a jeans and boots girl at heart, but do love dressing up. It looks like the Chicago weather is going to be fairly cooperative and I’ve got plenty of other casual-dressy events, so this year’s red carpet look is going to be decidedly formal. I was completely outdone by Lorre, last year so it’s time to catch up. I’m still waffling between two different pairs of stunning shoes and will be wearing them around the house this week in the hopes that I’ll be able to decide. There’s nothing that can make you feel classier than folding laundry in heels and pearls. Eat your heart out, June Cleaver.
There are very few people from my day job who will be attending HIMSS, so I have a long list of booths to try to visit. A friend of mine recently clued me in to Humetrix, which offers several different smartphone apps. Their iBlueButton offering allows patients to store, aggregate, and share personal health data. SOS QR allows patients to create a record of emergency health information and then generate a QR code that can be displayed on their phone’s lock screen. First responders or healthcare providers can use the code to access critical health information during an emergency. A premium version allows patients to send out SOS messages to their emergency contacts.
Although it seems like these would be good for older patients or those with complex health needs, for young active patients who might wind up with a concussion or sports injury, it’s a great idea as well. It took me all of three minutes to create my record and there’s a certain peace of mind knowing that if I get loopy during my next half marathon, someone might have access to better data than what I illegibly scribbled on the back of my race number bib. Humetrix announced their Tensio app at the Consumer Electronics Show and they’ll have it at HIMSS. I’m looking forward to seeing how they use HealthKit data to engage patients for disease management.
The annual HIStalk guide to HIMSS is out and lists sponsor booth numbers as well as blurbs about swag and other giveaways. Several sponsors are donating to charities if you stop by, so be sure to visit AirStrip, Divurgent, and Orion. The Guide is also a great way to plan your route for complimentary drinks and snacks (cocktails at Billian’s, coffee at First Databank, scones at MedData, smoothies at PatientKeeper, and of course candy at PerfectServe). HCS Health Care Software, Inc. is hosting “a night of baseball, beer, and burgers” near Wrigley Field – check out the Guide to see what else you might be missing.
What’s your HIMSS15 exhibit hall battle plan? Email me.
All I Needed to Know to Disrupt Healthcare I Learned from “Seinfeld”: Part IV – Are You the Master of Your Domain?
By Bruce Brandes
Was it Freud or Costanza who once said, “The ego is not master in its own house”? Ah yes, Sigmund Freud. Costanza said something else about being master of one’s domain. George Costanza also once rebuked George Steinbrenner for destroying the institution of the New York Yankees “all for the glorification of your massive ego”.
For an entrepreneur, ego is both a critical ingredient in the recipe to build success as well as a foundational risk to predestine failure. A keen self-awareness of when to intentionally fortify one’s ego versus the appropriate time to acknowledge the fine line between self-confidence and pride in order to relinquish one’s ego may dictate your fate as an early stage company.
Today we will discuss the importance of knowing when to have an ego … and its corollary of knowing when to check your ego.
Know When to Have an Ego
When you first come up with an idea or start a new venture, expect a resounding chorus of naysayers to tell you every reason why your assumptions are flawed, no one will buy from you, someone else has already solved the problem better than you could, etc. In the early days, the entrepreneur must maintain enough self-confidence and commitment to ignore detractors.
When AirStrip was conceived in 2004, think about what mobility meant. There were no iPhones, no tablets, no texts, no apps, no 4G speed. People carried flip phones, and if they were really progressive, they had a BlackBerry for emails. Remember the Palm Pilot? And yet the AirStrip founders were building a business betting that soon most everyone would be carrying a mobile device in their pocket that could eliminate the traditional geographical boundaries that have restricted healthcare.
Further, we would have to rely on securing the attention and support from large, closed EMR and medical device companies to collaborate with — what was essentially at the time — two guys in a garage. Not many people inside or outside the industry could embrace their vision at the time. Committed to their mission and confident in their vision and abilities, Cameron Powell and Trey Moore tuned out the noise, relied on sage guidance from trusted advisors, and maintained their focus to deliver.
Two years later, not only had they secured multiple patents and FDA clearances, AirStrip delivered live clients that reported actual clinical and financial outcomes. Their progress attracted attention from a global healthcare technology company which signed a distribution agreement to sell AirStrip’s first product. Like Kramer ignoring Elaine’s negativity regarding his idea for a coffee table book about coffee tables, the AirStrip founders had enough ego to overcome cynics to earn early validation that they were on the right path.
Further fortifying their boldness, a year later Trey had the vision to go “all in” on switching all development at the time to the newly announced iOS platform. Cameron had the intestinal fortitude to fire his Fortune 100 partner by canceling their distribution contract, believing that we could sell these innovations better ourselves by building our own team. Both of these bold strategies attracted a new round of confused critics. The following years would prove these decisions to be key factors foundational to AirStrip’s market success.
Believe in what you are doing and let your passion and growth mindset bolster your self-confidence.
Know When to Check Your Ego
While it is certainly important to have an ego, it is equally as important to know when to check your ego.
The best entrepreneurs surround themselves with others possessing complementary skills and experiences. Be honest with yourself to know your own shortcomings. Diversify your leadership team to actively invite alternate points of view to support you make the best decisions. Recognize that the skills required to launch a new venture are different than the skills needed to scale a company, which are different from those needed to manage a mature organization.
At AirStrip, after we secured Series A funding, our new investor wanted to hire a seasoned CEO to take that role from the founders. Cameron loved the company enough to bring in a proven healthcare technology executive to become CEO and catalyze the organization to a new level and scale, with Cameron enthusiastically serving as chief medical officer for the now rapidly growing company.
In contrast, consider the fate of the founder of a fantastic organization of which I was part in the early to mid 1990s. Many industry old-timers may fondly remember Enterprise Systems (or ESi) as a fast-growing, fun-loving pioneer of best-in-class resource management software for materials management and surgical services.
As the company grew and took on outside investors, the founder and CEO, who passionately built an incredible business (which benefited earlier from his strong will and ego) resisted the changes needed to best position the company for its next chapter of growth. He was unfortunately removed from his own company, which created the opportunity for Glen Tullman, in his first healthcare CEO gig, to lead the organization through a successful IPO and eventual sale to HBOC.
Trusting the right investor is one of the most important decisions an entrepreneur will make to guide a founder’s understanding of his or her best evolving role. The wisdom of our Series A investor at AirStrip was invaluable as the company expanded leadership and attracted subsequent follow-on investment to give our founders confidence their company was in good hands as their roles changed.
After opening this column with words from Freud, consider Jerry’s prescription below to George to improve his life and how it may apply to improving your business.
“You know you really need some help. A regular psychiatrist couldn’t even help you. You need to go to like Vienna or something. You know what I mean? You need to get involved at the university level. Like where Freud studied and have all those people looking at you and checking up on you. That’s the kind of help you need. Not the once a week for eighty bucks. No. You need a team. A team of psychiatrists working round the clock thinking about you, having conferences, observing you, like the way they did with the Elephant Man. That’s what I’m talking about because that’s the only way you’re going to get better.”
Only through an understanding of human behavior by considering the unexamined intersection of Sigmund Freud and Jerry Seinfeld can an entrepreneur know when to be the master of your own house versus when to be the master of your domain. This may determine whether or not you are ultimately “in” or “out.”
Bruce Brandes is managing director at Martin Ventures, serves on the board of advisors at AirStrip and Valence Health, and is entrepreneur in residence at the University of Florida’s Warrington College of Business.
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I joined Medecision five years ago because of my belief that the convergence of big data and workflow applications were at the core of engaging consumers, hospitals, and physicians and achieving the Triple Aim. What I loved about Medecision is that it was uniquely positioned in the market, with a legacy and a history of serving health plans and doing exactly that. As we watch the shift from volume to value, it’s clear that a series of new capabilities is needed to support that business change. That’s what we do at Medecision.
If I’m a patient or health plan member, what do I see firsthand as my provider or my health plan implements population health management?
I’m so glad you asked me that question because it’s the single thing that we at Medecision are focusing on more than ever as we look at how we build capabilities for all of our clients who are bearing risk.
What patients should see changing very soon is transparency of data — the ability to see greater alignment, information, and decision-making between the previously fragmented players in the system, whether it be hospitals, physicians, the extended care team, providers of DME products, etc.
Consumers will soon be seeing mobile applications like one that we’re market testing right now — our InCircle product, in western Massachusetts – that will present their full electronic health records, that will be real time, and that will allow them to take charge and control of their health and the services that they need to maintain their health. It will all be much more seamless, transparent, and effective, but all of those three things being the Triple Aim.
Is it an unexpected benefit that consumers are becoming their own health quarterback?
I think there are a number of industry parallels that we could look at, whether it be banking, transportation, or the airline industry. Even in the business world, we’ve all become our own secretary. Yes, it is a natural outgrowth, but I think it’s also important to recognize that it is not easy. The work that we have to do as executives in the healthcare IT and healthcare industries is hard.
There’s an enormous amount of work that needs to be done in big data, analytics, and the engagement applications that take all of those difficult, challenging, and disparate systems and processes in healthcare and drive them to a big app that allows us to take charge of our health, to make decisions, and to share that information with those who we share the responsibility for our health with, whether it be a family member or a whole series of different providers if we have a chronic condition. That is really the Holy Grail — the ability to have information at our fingertips when we need it and be able to share it with everyone who has an important role in helping us maintain and improve our health.
Our interoperability goals have been paternalistic, where we expected providers to figure out how to share information without patient involvement. Is there more of an expectation that patients become responsible for their own information sharing rather than having somebody else do it invisibly behind the scenes?
All parties have an obligation for privacy and security. It’s something that we’re seeing in the headlines every day and that we’re all focused on. The challenge now is to push through those challenges and opportunities so that the consumer can become the quarterback of their care. Not only are there important issues to be dealt with from a regulatory, compliance, and privacy perspective, but also technology needs that will enable all of that to occur. That’s what we’re about at Medecision. It’s very rewarding after a 20-odd year career to see the pieces coming together from legislation all the way through consumer engagement.
In the old days, a technology vendor sold only to a specific niche, such as ambulatory practices or health plans. Now companies like Medecision have products for hospitals, practices, and health plans. Is is more difficult from a sales, marketing, and product development standpoint to serve all those markets?
It is very difficult. It is our everyday challenge.
When we engage in a dialog with a customer or a prospective customer, the first thing we have to figure out is where they are on the maturity scale from volume to value. How are they thinking about making the journey? That’s our first challenge. We know that we have the tools, the capability, the people, and the clinical components necessary to help our customers, but our challenge is meeting them where they are today and leading them to where they need to be in their business transformation.
It’s an enormous challenge. It’s far more than technical. It involves having consultative skills.
The irony, as has always been the case, is that technology is not the limiting factor. It’s more about how we view the change process, how we finance that, and how we manage it as individuals and as organizations. That’s where we’re focused — helping our customers make that transformation from volume to value and doing it in a way that is not only least disruptive, but provides the greatest return. Not only for them, but for their members and patients — the consumer.
What’s your experience in getting the data that you need from other systems, such as provider EHRs?
We have some very good experience. We have probably five use cases today where we are integrating data across multiple systems — EMR systems, claims systems, practice management systems, all of the historically disparate systems — to power population health and consumer engagement.
There are some interoperability barriers that tend to be as much policy oriented. We find that to be the case from time to time. But by and large, we are experiencing significant success in creating broad data sets across multiple sources for use in more effectively managing population health and engaging consumers. The going is much better today than it was three years ago and I expect it to accelerate incrementally almost by the month.
Your Aerial platform offers Web services and published APIs. Are you seeing, or hoping to see, other system vendors embrace those technologies as Medecision has?
The organizations that are going to be successful in the future in population health will recognize that transparency and interoperability — whether that be at the technical level such as APIs or at the policy level – are an absolute requirement for success. We’ve embraced it wholeheartedly. I came here five years ago. We started opening our APIs. We’ve gone from a handful of APIs back then to hundreds and we’re going to continue to do that.
That being said, a lot of companies view their capabilities as intellectual property. We view our capabilities as the combination of clinical expertise, technology expertise, and engagement expertise in how to engage providers and consumers in achieving the Triple Aim. It’s how all of those things come together, not whether or not you have them, that will ultimately make the company successful and the industry successful.
That seems true in other industries, such as when competing banks agreed to participate in the Visa network and everybody’s markets grew exponentially. Is the healthcare business case not as clear or are participants trying too hard to demand direct benefit for everything they share?
Being an economist, I think it’s fundamentally a problem associated with the economic structures in the industry. So long as we maintain a fee-for-service model as a primary or dominant model in our system, that economic relationship is in part what creates the barriers to free, open information exchange.
Using the banking analogy, there were regulatory things that had to occur. Some of those have occurred in healthcare. I’m sure others will continue to be promulgated to ensure that we have interoperability and transparency in a way that will make a real difference for American consumers. In the end, businesses like Medecision and others will figure out how to succeed, thrive, and prosper as we are subject to those rules.
We forced providers to behave as competitive businesses, but then we expect them to not be too cutthroat. Are the competitive lines becoming blurred?
We’re seeing so many different approaches across the industry. It’s just a time of experimentation. We have customers who have shared savings programs with just a small amount of economic risk transferring between the parties to create incentives. We’re seeing fully clinically integrated networks agreeing to share openly all of their information.
The answer to your question is yes. We are seeing a broad range of economic and business models being experimented with across the industry. I’m likening it to the gold rush. Everybody is in a covered wagon. Some people haven’t pulled off of the East Coast yet. We’ve got a few that have made it to California. But nobody’s found gold.
It must be tough to develop a company strategy as the industry unrolls in different directions. How do you create a multi-year strategic plan and what does it look like for Medecision?
Thank you for asking that question, because while it’s an obvious question and one that we deal with every day and discuss with our board, the answer is pretty simple. The risk-bearing entities of the future — whether they were originally a health plan, an integrated delivery system, a physician, or some other entity — need three things in order to be successful. Our business strategy is focused on those three core pillars of capability – big data and analytics, clinical decision support, and engagement applications.
While some of our customers may only use one of those three pillars today because of their readiness or their place on the journey to value-based care, we know that ultimately they will need those three capabilities. We will begin where they are and help them along the way on their journey to value-based care.
That’s our strategy. It’s a difficult one to execute on, but it’s one that Medecision has had success with historically. We expect to continue to have success as we help our clients along the journey.
Do you have any final thoughts?
A very important component of success for all of us in the industry, and particularly for Medecision, is around the ability to innovate. Our focus on innovation at Medecision over the past five years has been a significantly differentiating factor for us. We’re helping our clients win, and winning in the market, because we have innovative new solution capabilities, consulting services, and other components that help our customers transform their business.
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Allscripts will pay $10 million to settle a class action lawsuit with its shareholders stemming from its 2010 Eclipsys acquisition, which shareholders say was presented with overly optimistic integration plans and revenue projections.
Premier comments on ONC’s interoperability roadmap, suggesting that ONC develop comprehensive interoperability standards and mandate EHR vendor compliance through its EHR certification criteria.
The CEO sentenced to jail for massive healthcare fraud will get pardoned in a week.