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Weekender 6/7/19

June 7, 2019 Weekender No Comments

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Weekly News Recap

  • A breach of American Medical Collection Agency exposes the information of 19 million of patients of national lab companies LabCorp and Quest Diagnostics
  • The six former National Coordinators express their support for the proposed interoperability rules of ONC/CMS
  • CVS announces plans to reconfigure 20% of each drugstore’s space into HealthHubs that will offer health and wellness services as well as kiosks and digital health tools
  • A KLAS report on newly developed small-hospital inpatient EHRS from Athenahealth, EClinicalWorks, Epic, and Meditech finds that only Meditech has brought sites live 
  • Vendor members of the HIMSS Electronic Health Record Association raise “significant concerns” about proposed federal rules covering interoperability
  • Politico details problems with the implementation of Epic in Denmark’s Copenhagen region

Best Reader Comments

The cost of implementing a slicker front end essentially best-of-breed system [Athenahealth’s inpatient system) that presents great, but functions horribly in the real world, was too much. Hospital executives who were enamored by the presentation and sales pitch were not aware of the fact that best-of-breed was fully vetted and wholly rejected by the industry. They just got a front row seat and the results have not been surprising. It’s hard enough for a hospital who can afford the required staff to implement a complete proven system with proven implementation methodology. Imagine trying to do that with a IT staff usually one-fifth the size of most community hospitals who could afford a traditional cost structure install – – – as your vendor tries to piece together a system using interfaced stopgap third-party modules that are the absolute core elements for safe workflows within an acute care setting. (Freedom’s just another word for nothin’ left to lose)

Poor Judy got cheated. $3.6 billion? No way. The company grosses $2.9 billion per year and the typical successful high-tech company sells for over five times gross. She owns at least 80% per other stories I read, so 5 X $2.9 billion X 0.8 = $11.6 billion. I think she should sue Forbes for publishing fake news. Judy is numero UNO! (HISJunkie)

I’d be interested to see how many places are using Home Health from Epic. That’s a new market they entered. They have the skill and ability to create a new product. They could easily come up with a LTC product quickly, give a sweetheart deal to the first few clients to test it out, and then sell it. Another facet would be if we see more consolidation in the healthcare space. Maybe hospital chains start buying SNF and LTC chains. If that happens, Epic would be foolish to not move into the space. (Ex epic)

Interoperability became a regulatory issue because despite making all that money on MU largesse, EHR vendors were not moving the ball on interop. On the one hand, EHRA vendors talk about innovation, and on the other hand, they claim that creating an API-based, standardized data exchange system is too onerous for them? Some of the reasons that you laid out are valid, but they are a direct result of poor application and data architectures of these platforms. If I have to take a guess, these vendors, over the years, have added new functionality and features without taking a pause to re-architect some of the core aspects of their systems and without making an investment into paying down the technical debt. As a result, many, if not all of these systems are being held together by duct tape and baling wire and even the smallest change causes big ripples in an integrated system, leading to tremendous testing and bug fixing efforts. But if interop is important (which most people agree that it is), then EHR vendors just need to suck it up and do it. (NonInterOp)

Everyone forgets the complexity of the underlying terminology mapping and integration if the goal is seamless exchange of meaningful information. I don’t see M or SQL as barriers. There are training and adoption barriers, contextual barriers in the meaning of something someone is documenting, true issues in working with legacy documentation that was created before any semantic standards were defined, and most vendors have a potpourri of applications running in their suites. Simple API calls aren’t so simple, especially when clinical teams rely in the integrity of the information. (NonInterOp)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. P, who needed help paying for bus transportation to take her special education fifth- and sixth-graders to a farm and home museum in their rural Maine followed by a visit to a college campus. She reports, “Our trip to Page Farm and Home Museum was amazing! Our students enjoyed every moment of this experience. They were able to see many objects that they read about in ‘Farmer Boy,’ from oxen yokes to sleds, tinware, butter churns, ice harvesting tools, spinning wheels, looms, and more. All of these 19th century tools and implements were described in the book so it was exciting for students to see them for real. Another trip highlight was visiting the University of Maine campus and eating lunch at the student union. Our students used their money skills to choose and purchase their meals in a real-world setting. We then ate at tables in a cafeteria-type room, mingling with university workers and students, thus raising their aspirations to consider college as a future endeavor. In all, the field trip was a huge success. Thank you for your generosity in sponsoring this experience for our students.”

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A former intensivist pleads not guilty in Ohio court to charges that he intentionally killed 25 patients by ordering fentanyl overdoses. The attorney for William S. Husel, DO argues that he was practicing “comfort care” for end-of-life patients by ordering fentanyl doses of 500 to 2,000 mcg and several grams of midazolam, all of which were dutifully removed by nurse via overrides from the hospital’s Pyxis dispensing cabinet. It would seem that some nurses and pharmacists might need to have their professional conduct reviewed as well, and indeed some of them have been named in a civil suit. Dispensing cabinet overrides very often are the symptom of questionable technology, workflow, or clinical practice and there’s not much excuse for not monitoring them carefully.

Some great local journalism in Missouri profiles the “cast of characters” who have used struggling rural hospitals to bill insurers at higher rates for questionable lab tests. Among them is Seth Guterman, MD, president of EHR vendor EmpowerSystem, who is being sued by Aetna for taking control of a rural Oklahoma hospital under his People’s Choice Hospital company and running up its lab billing to $21 million per year, a process that a lawsuit says he repeated at other Aetna-affiliated facilities.

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A healthcare cyberattack report by cloud endpoint protection vendor Carbon Black notes that hackers are going after administrative records of physicians that can be used to fraudulently bill Medicare and other insurers. They are also breaching systems that contain medical insurance information, offering for sale such items as a forged BCBS insurance card and forged prescription labels that buyers use to justify drug test results and to carry drugs through airport security. 

I’m enjoying the tight, pleasurable LinkedIn writing of ED doctor Louis M. Profeta, MD, who also wrote the 2010 book “The Patient in Room Nine Says He’s God.” He explains why he searches for the Facebook of patients who died of overdoses or driving while drunk or texting before notifying their families:

I’m about to change their lives — your mom and dad, that is. In about five minutes, they will never be the same, they will never be happy again. Right now, to be honest, you’re just a nameless dead body that feels like a wet bag of newspapers that we have been pounding on, sticking IV lines and tubes and needles in, trying desperately to save you. There’s no motion, no life, nothing to tell me you once had dreams or aspirations. I owe it to them to learn just a bit about you before I go in. Because right now . . . all I am is mad at you, for what you did to yourself and what you are about to do to them.

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Virginia’s medical board finds that an urgent care doctor and owner left for a week-long vacation while requiring his unlicensed staff to continue diagnosing, treating, ordering tests, and prescribing controlled substances. The board found that Khaled Moustafa, MB created phony visit notes afterward to make it appear that he was following regulations and to bill insurance companies. The doctor’s license was revoked, but his clinic is still open for business, with patients been seen by the doctor’s wife, who is also a doctor.  

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The group that bought Athenahealth’s lakefront Maine corporate retreat in March announce just three months later that they will close it as a destination for weddings and other events, saying it presents too many problems to operate profitably. The couple whose hotel operating company eventually bought the 387-acre resort sued Athenahealth last year, claiming Athenahealth was reneging on its promise to sell it to their hotel operating company for $7 million. Athenahealth paid $7.7 million for the property, which the county values at $14 million, in 2011. It includes a gym, a bowling alley, two event centers with 40,000 square feet of space, 106 cabins, hiking trails, and a mountaintop executive retreat overlooking Penebscot Bay.

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A 22-year-old roofer in Scotland who was performing his signature party trick of swallowing a coin is rushed to the hospital when it becomes lodged in his throat. He’s probably not the best source of advice on the topic, but here’s his root cause analysis: “It was weird because it always goes according to plan, as it would come out in the toilet later. I could feel it in my chest but I just kept on drinking … my dad thinks I’m an idiot.”


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Morning Headlines 6/7/19

June 6, 2019 Headlines No Comments

Champion Healthcare Technologies Receives Investment from The Riverside Company

The Riverside Company acquires medical device tracking software vendor Champion Healthcare Technologies from Jump Capital for an undisclosed sum.

Bain Capital, 5 others in race to buy CitiusTech

Industry insiders say Bain Capital, Blackstone Group, and several other investment firms have advanced to a second round of negotiations for the purchase of health IT consulting, services, and software company CitiusTech.

OmniSYS Acquires Automated Pricing Solution Provider, Rx-Net

Pharmacy technology vendor OmniSys acquires Rx-Net and its ProfitMax automated prescription pricing software.

ChartSpan Raises $15 Million Series A Round led by BIP Capital

Chronic care management company ChartSpan will use its $15 million funding round to expand its services beyond the Southeast.

News 6/7/19

June 6, 2019 News 4 Comments

Top News

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LabCorp joins the roster of companies impacted by the American Medical Collection Agency breach, notifying nearly 8 million customers that their personal and financial data may have been exposed.

Opko Health’s 422,000 BioReference Lab customers were also caught up in the hack.

The records of nearly 20 million patients are involved in the breach of the medical billing company.


HIStalk Announcements and Requests

Listening: new from the newly reformed, all-female L7, my favorite 1990s Riot Grrrl group except for maybe Hole. Lead singer, Flying V guitarist, and songwriter Donita Sparks — who is still tough, angry, and foul-mouthed at 56 — is about as far as you can get from “singers” whose “concerts” consist of prancing and lip syncing to pre-recorded songs written by anonymous hit-writing consortia. I’m pretty sure that if some guy in the front row harassed her that she would leap off the stage and punch him out.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Pharmacy technology vendor OmniSys acquires Rx-Net and its ProfitMax automated prescription pricing software. The Dallas-based company’s last acquisition was its 2017 purchase of competitor VoiceTech.

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The Riverside Company acquires Champion Healthcare Technologies from Jump Capital for an undisclosed sum. Riverside will combine Champion’s tracking software for implanted medical devices with its HemaTerra Technologies business, which offers supply chain management software for hospitals and blood and plasma collection centers.

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Waystar acquires Paro Decision Support, a predictive analytics vendor that helps hospitals identify patients who are eligible for charity care.

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Industry insiders say Bain Capital, Blackstone Group, KKR, CVC Capital Partners, GIC, and ChrysCapital have advanced to a second round of negotiations for the purchase of health IT consulting, services, and software company CitiusTech. General Atlantic acquired a controlling interest in the company in 2014 with a $111 million investment. A final sale decision is expected next month.


People

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Data archiving company Olah Healthcare Technology hires Wayne Trochmann (Allscripts) as VP of sales.


Announcements and Implementations

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St. Anthony’s Memorial Hospital (IL) will soon switch from Meditech to Epic, wrapping up the Hospital Sisters Health System’s four-year, $112 million implementation project.

Northwell Health (NY) implements DataMotion’s Direct Secure Messaging to improve its HIE capabilities.

British Columbia’s Northern Health system adopts Nuance’s Dragon Medical One and Power Mic Mobile speech-recognition technologies.

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AWS announces GA of Textract, a service that uses machine learning to identify and extract text and data from documents in any format. Extracted data is available via an API that developers can then use to analyze and query for their own analytics projects. Use cases include patient registration forms and scanning medical charts for undocumented diagnoses that lead to referrals.

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In West Virginia, Williamson Memorial Hospital goes live on Meditech.

Black Book names the top client-rated software and services vendors for achieving financial digital transformation, derived from surveying 484 hospitals and 713 practices. Among the 20 winners:

  • Hospital inpatient accounting: Meditech
  • Patient access software: Recondo
  • ERP: Premier
  • Document management: Ciox Health
  • Charge master: NThrive
  • Ambulatory claims management and clearinghouse: Availity
  • Inpatient claims management: Waystar
  • Patient payment technology: Waystar
  • EMPI: Verato

Government and Politics

The VA issues a $140 million task order to Cerner for interface support over the next four years. The order is part of the agency’s original $10 billion EHR modernization contract with Cerner. The VA expects to begin piloting the new software at several sites in the Pacific Northwest early next year.

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The NHS has promised financial incentives to providers who use AI for diagnostics, screenings, and outpatient appointments as part of a system-wide effort to meet productivity targets. The health service agreed to those goals last year in exchange for an extra £20 billion a year.


Other

Politico rehashes stories reported here earlier about Epic implementation problems in the Copenhagen region of Denmark, adding more details:

  • A consultant says the group from Denmark “went to Epic and fell in love” in being overly influenced by its campus.
  • Doctors and nurses dispense medications directly rather than pharmacists and Epic won’t allow nurses to prescribe in emergencies as is done in hospitals there, leading to workflow problems.
  • Medical terminologies had to be translated using Google Translate, creating problems such as when surgeons were offered two choices for the leg they intended to amputate: “left” or “correct.”
  • An anesthesiologist working on the project says the first hospital that went live was in “indescribable, total chaos” as Epic recommended going live with no pilot sites, which he describes as “worse than amateurish” when doctors and nurses were forced to use a system they hadn’t seen, after which they were “weeping openly for days.” The regional health administrator admits that he was overzealous in trying to get Epic implemented quickly to avoid the cost and integration challenges of running it alongside the old system.
  • Epic still isn’t integrated with the national medical record system.
  • Eighty percent of patients in Denmark move casually from hospital to home or other care setting and back over long periods, creating problems for clinicians who are forced to follow the American standard of re-entering diagnoses and medications each time using different screens for inpatient and outpatient.
  • Discharge letters to doctors include “nonsense that’s a copy-paste of everything in the patient record … five pages of gibberish [in which] there are five lines the doctor probably should read but doesn’t.” The government hired a consultant to use AI to extract the useful information.
  • Physician satisfaction with Epic is at 12%, and the country’s physician association said of Epic’s offer to let them run its system free in their offices, “You couldn’t give us enough money to install Epic. We’ve seen how it works.”
  • A leading breast cancer surgeon concludes, “You have exported burnout.”
  • The rest of Denmark decided not to follow the Copenhagen’s region’s lead, selecting Systematic over Epic, leading some politicians to call for Epic’s replacement in Copenhagen, but the Health Ministry’s digital director says Epic is “too big to fail” after they have spent $500 million on it. 

Australia’s Queensland Health opens a search for a new EHealth Queensland CEO to replace Richard Ashby, who left in January over a conflict of interest issue.  His replacement will take responsibility for the over-budget Cerner project that has raised concerns from the auditor-general that Queensland Health has little negotiating leverage when contract extensions become due.

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Google Product Manager Prem Ramaswami reflects on the impact the company’s custom executive education program at Harvard Medical School has had on its healthcare endeavors. The 15-day course focuses on understanding the digital hoops patients jumped through to learn about treatments and clinical trials, physician interactions with EHRs, and ethical discussions on how the company could leverage its technology for global healthcare projects. “Taking this course, I felt like our work on health search would not be complete until doctors were prescribing Google to their patients,” he says.

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Here’s more savagely accurate satire from The Onion.


Sponsor Updates

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  • Ellkay sponsors Alpine Learning Group’s Go the Distance for Autism event.
  • EClinicalWorks will exhibit at the Telehealth Summit 2019 June 6-7 in Atlanta.
  • Ensocare will exhibit at the CMSA 2019 Conference June 10-14 in Las Vegas.
  • Hayes Management Consulting hires Paulo Santos as director of business development and Pej Ayandeh as client success manager.
  • HGP publishes “Health IT May Insights.”
  • Healthwise will exhibit at the Epic Michigan User Group Conference June 10 in Ypsilanti.
  • Information Builders showcases innovations for scaling advanced analytics and data management at its Summit 2019 user conference.
  • InterSystems will exhibit at the HL7 FHIR DevDays June 10-12 in Redmond, WA.
  • Intelligent Medical Objects holds a grand opening ceremony for its new headquarters in Rosemont, IL.
  • ConnectiveRx publishes a new white paper, “Communicating with HCPs based on their observed prescribing behavior.”
  • Halifax Health becomes the first member of the Access Million ESignature Club.
  • Greenway Health wins a 2019 Fortress Cyber Security Award in the application security category.
  • Frost & Sullivan awards Medicomp Systems its 2019 Customer Value Leadership Award for Clinical Decision Support for the Quippe suite of solutions.
  • Apixio achieves HITRUST CSF Certification.
  • Black Book announces the top client-rated software and services vendors that have achieved financial digital transformation.

Blog Posts

The Medtech Breakthrough Awards recognize:

  • Kyruus for its ProviderMatch for Consumers in Spanish
  • Vocera’s SmartBadge for “Best Internet-of-Things Healthcare Wearable Device”
  • Patientco’s payment software as the “Best New Healthcare Payments Solution”
  • Sansoro Health’s Emissary Platform as the “Best Healthcare Big Data Solution”

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EPtalk by Dr. Jayne 6/6/19

June 6, 2019 Dr. Jayne No Comments

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The American Board of Family Medicine takes a step towards interoperable encounters of the professional kind by becoming the first American Board of Medical Specialties member Board to implement automated licensure updates for US licensees. Instead of Diplomates having to log in and update their state licenses annually, ABFM will receive the data directly from the Federation of State Medical Boards. Licensure details will automatically update monthly and providers will receive notification when updates occur so that they can confirm accuracy. It’s a small thing, but can be a big issue for physicians who fail to update. Automation makes it one fewer thing to worry about.

I truly enjoy working in the realm of informatics, but would miss patient care if I didn’t get to do it as well. Being in a patient-centric practice environment helps since we’re all working together to ensure our patients have a great experience. Even when it’s a difficult day, it’s still better than a lot of the days I have had with other employers.

Today I celebrated the best chief complaint ever and made sure to memorialize it in the chart: “Patient states: We were walking out of Starbucks and saw you open over here, so we decided to come in.” I probably wouldn’t have heard that one a decade ago, but it underscores that patients sometimes value convenience and accessibility more than other variables. The flip side of this was the patient who arrived at the front desk at 5:30 p.m. and wanted to be sure she could be out of the office by 5:50 since she had plans to meet someone for dinner at 6:00. We get 90% of our patients out in under an hour, but trying to squeeze it under the 20-minute mark is pushing it when there is only a single provider on duty and other patients are awaiting care.

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Device of the week: Researchers conclude that the home use of video goggles that measure eye movements can provide an early and accurate diagnosis of vertigo. Patients were instructed to use the goggles to record eye movements that can help confirm which specific type of vertigo is occurring so that providers can determine the best course of action. Since vertigo symptoms can wax and wane, this would be a benefit to patients whose symptoms might be gone before they make it to a provider, or who have issues limiting travel to see a clinician. I’ve had vertigo that forced me to crawl through the house because I couldn’t stand, so I can’t imagine the frustration of patients who have symptoms frequently but may not have a definitive diagnosis.

Speaking of devices, it might be time to fire up those Fitbits. An article recently published in JAMA Internal Medicine and presented at the American College of Sports Medicine 2019 Annual Meeting shows that the risk for all-cause mortality fell among older women who walked at least 4,400 steps per day. As the number of steps increased, the risks continued to fall, leveling off at 7,500 steps per day. This is great news for individuals who might not be able to meet the oft-touted but poorly-researched 10,000 steps per day.

The authors note that current US Health and Human Services physical activity guidelines recommend a weekly time goal for exercise, but that counting steps may be more easily translated into real-world practice given the widespread nature of step-counting devices. The mean age of women in the study was 72 and they were followed for a mean of 4.3 years. The study adjusted for other risk factors including age, smoking status, alcohol use, general health, and 10 other factors related to risk for cancer or cardiovascular disease. As with many studies, there were some limitations – participants were predominantly Caucasian and of high socioeconomic status, which may have made them more active than the general population, so the results may not apply to different demographics or to men.

Telehealth continues to be a hot topic, and Epic recently added the American Well telehealth app to the App Orchard. The app is supposed to add one-click virtual consult functionality within the EHR workflow. It includes control of remote cameras and digital collaboration for non-Epic sites.

I have a couple of colleagues who use Epic and are trying to get into the business of virtual consults, but their organizations haven’t committed to allowing providers to block time to handle the requests. It is becoming just “one more thing” that causes time pressures in the office. It’s disheartening to see that administrators think they can just add these programs without a thought since that’s a recipe for employee dissatisfaction. One of my former employers tried to add evening appointments and it was a bust – patients didn’t take advantage of the appointments as much as was hoped and providers felt they were losing even more time away from family.

A reader sent me this article about health skills for the Amazon Alexa platform. Functionalities include diabetes management tracking, virtual physical therapy, and general health management.

Although I don’t doubt that personal assistant-based technology can be a benefit, especially for patients who have access issues or who otherwise wouldn’t go to a brick-and-mortar healthcare facility, I would caution people about changing to this manner of care without data that shows it’s at least equivalent. The virtual physical therapy in particular makes me nervous. I have several friends who are PTs and understand how difficult it is to get patients to do exercises correctly even when they’re present in face-to-face encounters. Doing PT incorrectly can not only lead to stalled progress, but it can actually cause harm.

The author notes one of the major consumer concerns about telehealth, that “my doctors have long answered my questions and dispensed phone and email advice for free.” It’s difficult for patients to accept that physicians are not only tired of doing this for free, but that the constant ratcheting down of healthcare payments and the addition of administrative burdens have made it untenable. You wouldn’t call your lawyer for free advice and even my auto mechanic won’t talk about my car without a diagnostic visit (which isn’t free).

She notes that her OB offered great advice, but probably doesn’t realize that OB care for a pregnancy is part of a global fee that the OB is paid for the entire episode of care. Virtually no one outside the industry understands those nuances of healthcare finance. She complains about a $235 bill for a virtual visit, but never says what the accepted amount or the actual payment was. I bet it wasn’t $235.

What do you think of the rise of personal assistants in healthcare? Leave a comment or email me.

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Morning Headlines 6/6/19

June 5, 2019 Headlines No Comments

Carbon Health Secures $30 Million Series B Funding To Reimagine The Consumer Healthcare Retail Experience And Accelerate Expansion Into New Markets Nationwide

San Francisco-based primary and urgent care company Carbon Health raises $30 million in a Series B funding round led by Brookline Growth Partners.

LabCorp discloses data breach affecting 7.7 million customers

LabCorp joins the roster of companies impacted by the American Medical Collection Agency breach, notifying nearly 8 million customers that their personal and financial data may have been exposed.

Hospitals to get extra cash for using robots and AI to replace humans

The NHS has promised financial incentives to providers who use AI for diagnostics, screenings, and outpatient appointments as part of a systemwide effort to meet productivity targets.

Morning Headlines 6/5/19

June 4, 2019 News 2 Comments

Former National Health IT Coordinators Respond To Proposed ONC, CMS Interoperability Rules

All six former National Coordinators pledge their support for the proposed ONC/CMS interoperability rules, saying they will transform information flow, spur innovation, and empower consumers.

CVS turning 1,500 stores into HealthHUB locations with less retail, more health care

CVS will expand its HealthHub store layout pilot to 1,500 stores that will retool 20% of the floor space to offer health kiosks, digital health tools, and expanded MinuteClinics.

RxRevu – the Industry Leader in Prescription Decision Support – Secures $15.9 Million in Series A Funding Led by UCHealth

Denver-based RxRevu, which offers EHR-integrated prescription pricing decision support, raises $15.9 million in a Series A funding round.

Cerner Calls for App Ideas That Improve Consumer Access to Health Records

Cerner challenges developers to build apps on top of its platform that can help consumers access, understand, and use their EHR information in the 2019 version of its Code App Challenge.

News 6/5/19

June 4, 2019 News 11 Comments

Top News

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All six former National Coordinators pledge their support for the proposed ONC/CMS interoperability rules in a Health Affairs article. They say the rules will transform information flow, spur innovation, and empower consumers. They also observe that:

  • Rapid advancement of FHIR and APIs is critical.
  • Expanding interoperability requirements to health plans is “game-changing.”
  • Using Medicare’s Conditions of Participation to advance interoperability is a powerful tool.
  • Strong enforcement of information blocking provisions should be high priority and access to the USCDI data set via APIs should be free since “price has unacceptably been used in the past to ration electronic exchange of information or to block it outright.”
  • The federal government should work in parallel to create a consumer privacy framework, especially around third-party APIs and consent processes.
  • Stakeholder education will be important.

Reader Comments

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From Crown Victoria Secret: “Re: Atrius Health. Has become an allied member of The Permanente Federation.” The forwarded internal email announcement describes a vaguely defined collaboration that began on June 1 between the 715-doctor, Boston-based Atrius Health and the Federation, the leadership and consulting group for the eight Permanente Medical Groups that serve Kaiser Permanente members. The independent, non-profit Atrius has 75% of its nearly $2 billion in annual revenue tied to full-risk contracts. It just announced a $39 million profit for 2018.

From Orion’s Belt: “Re: executive coaching. What do you think of people earning a formal coaching credential and hanging out a shingle to advise executives?” I don’t know how many executives are seeking such assistance, and certainly just waving around a freshly printed certificate without a history of demonstrated personal success won’t be much of a draw (it’s a “those who can” sort of thing). I like the idea, though, and I even toyed with taking one of the (expensive and hard-marketed) certification programs not too long ago just because the courses sounded interesting. Certification requires quite a bit of hands-on training and completing a bunch of actual coaching hours that are critiqued by the person being coached, so it’s not a quick, cheap, or low-effort project, not even counting the fact that it’s all for naught if nobody hires you.


HIStalk Announcements and Requests

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Industry long-timer and friend of HIStalk Vince Ciotti tells me that he and his partners have closed down their consulting business, HIS Pros, after 30 years. His long-running “HIS-tory” PowerPoint series on the history of the health IT industry was housed on the now-shuttered website, but Vince is sending me the files so I can post them permanently on HIStalk. The companies and people he mentions shouldn’t be forgotten and some of them offer lessons that we can learn all over again. Plus they are a heck of a lot of fun to read, especially if you’ve been around awhile.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Denver-based RxRevu, which offers EHR-integrated prescription pricing decision support, raises $15.9 million in a Series A funding round led by Colorado’s UCHealth.

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Cerner challenges developers to build apps on top of its platform that can help consumers access, understand, and use their EHR information in the 2019 version of its Code App Challenge. Winners receive a year of assistance in getting their app ready to be published on Cerner’s app store. Last year’s winner in November 2018 was a smart glasses-powered EHR navigation and documentation tool that isn’t yet listed in Cerner’s store.

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CVS, sweating under retail pressure from Amazon following its acquisition of Aetna, will expand its HealthHub store layout pilot to 1,500 stores that will retool 20% of the available floor space to offer health kiosks, digital health tools, yoga classes, dietitian counseling, expanded MinuteClinics. and SmileDirectClub teeth straightening (big companies really hate putting spaces between words). The space will come from reducing the inventory of slow-selling items such as greeting cards. The company’s #3 stated priority is to seamlessly connect digital and physical experiences, turn data into insights and action, and offer an intelligent engagement platform. CVS also expects big financial returns from chronic disease management.


People

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CoverMyMeds, which was acquired by McKesson for over $1 billion in early 2017, promotes David Holladay to president and Scott Gaines to COO. Co-founder and CEO Matt Scantland will leave the 1,000-employee company by the end of the year, while COO Michelle Brown will move into a different role. 


Announcements and Implementations

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A KLAS report covering recently announced inpatient EHRs for under-200 bed hospitals finds that only Athenahealth and Meditech have brought customers live, with those vendors having signed 115+ hospitals each. Just three hospitals each have contracted for ECW’s inpatient system and Epic Sonnet. Athenahealth customers worry about significant product functionality gaps (mostly clinical) and that the company has paused sales of the inpatient product during its corporate turmoil, with 22 hospitals cancelling their contracts in the past two years. Meditech Expanse earns high marks in both administrative and clinical areas, as does the company’s cost transparency. KLAS notes that Epic Sonnet isn’t really intended for small hospitals, but rather larger ones that are willing to start off with less functionality or lower cost with plans to eventually move up to the full Epic product, with Community Connect as provided by larger hospitals (rather than Epic itself) being the only real small-hospital option. ECW is losing prospects, most of them running CPSI or Allscripts Paragon, to other vendors due to delays in bringing any sites live. The bottom line is: (a) Meditech Expanse is the only successful new product; and (b) it’s not easy for ambulatory EHR companies to develop and implement a successful inpatient product.

Glytec will expand the capabilities of its EGlycemic Management System to create Therapy Advisor, a “Software as a Medical Device” platform that supports dosing and management of all diabetes medications, not just insulin. It will give providers evidence-based recommendations on product selection that also include patient affordability.

Sacramento-based non-profit medical technology startup support group MedStart shuts down, citing a drop-off in funding, plans by UC Davis to develop a similar program in Sacramento, and failed merger talks with other organizations. 


Government and Politics

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President Trump responds to a reporter’s question during a joint session with Prime Minister Theresa May by saying that any post-Brexit trade deal needs to allow US companies to sell to the National Health Service. Response was quick and unflattering from everyone from British politicians to clinicians who don’t like people, especially those from other countries, messing with NHS.

Coffey Health System (KS) will pay $250,000 to settle the federal government’s claim that it falsely attested to Meaningful Use in 2012-2013 by failing to perform a security risk analysis. The whistleblower lawsuit was filed by two people, one of whom I was able to find online as an employee of the 25-bed hospital’s compliance office. 


Privacy and Security

The information of 12 million Quest Diagnostics lab patients is exposed in a breach of the systems of American Medical Collection Agency, which provides billing services to Quest contractor Optum360.


Other

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Apple makes some health-related announcements at its WWDC developer conference, most of them pertaining to Watch:

  • WatchOS6 will add menstruation tracking, which will also work on the IPhone’s Health app
  • WatchOS6 will introduce a Noise app that will measure sound levels
  • Watch’s fitness tracking will be displayed as rings that tabulate daily movement, exercise, and non-sitting time and will roll those into long-term trend displays
  • WatchOS6 will allow using the App Store directly from the Watch
  • The IPhone’s Health app will be redesigned to offer notifications, favorites, and health highlights

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Verizon is hyping the heck out of its 5G service, with some of its questionable claims now including improving cancer treatment. The cell carriers like the opportunity to capturing market share, but 5G doesn’t seem like a silver bullet – it requires a ton of closely-spaced towers; it does nothing to bring broadband to rural areas where the cable company monopolies have stopped installing fiber and upgrading infrastructure; nobody has looked hard at what healthcare bandwidth limitations 5G expects to remove; and cell carriers (like the cable companies) provide notoriously poor user support. Eric Topol called them out for the TV commercial above, inviting them to show data proving that they improve cancer outcomes. I also winced at their use of the tired “fight” analogy.  

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Stanford professor and investor Phyllis Gardner is earning fame for her comments about Theranos and founder Elizabeth Holmes that were included in two documentaries about the company, some of those critical observations made long before a series of investigative reports brought the company down. She says:

  • She tried to tell Holmes early on that the company’s technology could not possibly work, but Holmes brushed her off and has since “been the burr under my saddle.”
  • Many smart venture capitalists sent Holmes packing when she invoked “trade secrets” in refusing to explain how the Theranos technology worked.
  • It was corporate malfeasance to load up the company’s board with people who had no science understanding, which she called “old men [whose] brains go to their groin.”
  • She knew the phony deep voice, black turtlenecks, and “the glammed-up look” of Holmes was fake, but says you could never see her real self.
  • “I didn’t find that many people at Stanford who thought she was amazing.”
  • She rips Silicon Valley’s “fake it until you make it”mantra for healthcare: “In medicine, you do not fake it. Ever. That is verboten, and that is why we have regulatory agencies … you don’t fail 10,000 times and get it right on the 10,000st. That is absolutely evil to say that.”

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Forbes releases its list of “America’s Richest Self-Made Women,” with Epic CEO Judy Faulkner coming in fourth with an estimated net worth of $3.6 billion. Wisconsin women took two of the top four spots, with #1 being Diane Hendricks of construction material vendor ABC Supply at $7 billion. The most bizarre winner – Suzy Batiz, whose toilet spray Poo-Pourri has sold 60 million bottles in giving her a not-so-crappy net worth of $240 million, tying Reese Witherspoon. 


Sponsor Updates

  • Dimensional Insight earns top scores for customer experience and vendor credibility in the annual Wisdom of Crowds business intelligence market study.
  • Avaya leverages Google Cloud to provide a wider range of global organizations with flexible, scalable communications and collaboration solutions.
  • Bluetree will exhibit at the Epic Michigan User Group Meeting June 10 in Ypsilanti.
  • Prepared Health will exhibit at the CMSA 2019 Annual Conference June 10-14 in Las Vegas.
  • KLAS recognizes CenTrak for standout industry performance in its 2019 report on real-time location systems.
  • CompuGroup Medical will exhibit at the New Mexico Primary Care Association Annual Conference June 13-14 in Albuquerque.
  • Collective Medical helps providers support and coordinate care for homeless patients.

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Morning Headlines 6/4/19

June 3, 2019 Headlines No Comments

Biden Cancer Initiative Announces the Oncology Clinical Trial Information Commons

Former Vice President Joe Biden’s cancer initiative will include data from nine organizations including IBM Watson Health and Ciitizen as part of a new clinical trial data sharing platform.

Quest Diagnostics Statement on the AMCA Data Security Incident

Quest Diagnostics notifies customers of a data breach at its billing services vendor, American Medical Collection Agency, that could potentially affect 12 million patients.

Best Buy takes new steps to grow its healthcare business

Best Buy acquires personal emergency response and telemedicine company Critical Signal Technologies.

Curbside Consult with Dr. Jayne 6/3/19

June 3, 2019 Dr. Jayne 1 Comment

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Maybe I am becoming less tolerant as I get older, but I seem to be very easily tired by people in this industry who talk a good game, but are unable to get any of their ideas to fruition. It’s especially tiresome when these folks are hired by major organizations at high salaries and they can’t seem to solve the basic problems that plague clinical technology projects.

I worked with one of these folks a year or so ago when he was hired by one of my clients as a senior vice president for clinical transformation. I had been doing clinical transformation work for them for almost a year, so I was excited that they were finally putting some leadership and visibility behind the effort other than just third-party consultants. What I immediately found, however, was that he had no experience with physician adoption or creating workable timelines. His only healthcare experience was in the finance realm, and he immediately alienated nearly everyone on the project who had been working hard for incremental change.

A lot of us asked ourselves how he was hired and came to the conclusion that the organization was looking for a social media wunderkind, someone who was an “influencer.” But it turned out he was only an influencer in his own mind. He curried favor with the physicians by agreeing with their (largely unfounded) complaints about the EHR and by offering to throw the entire project out and get the group moved over to Epic per their request.

This was during his first 30 days of employment. He didn’t bother to do the due diligence to find out that the EHR project was suffering because providers had contracts that financially rewarded them for bad behavior and refusal to use the EHR. He didn’t find out that the rest of leadership had no stomach for either changing the contracts or doing something else to change the behavior, but instead took the easiest route in condemning the vendor.

The organization is now in the throes of a significant software spend. They still have no governance, no change control, and no plan. But by golly, they’re going to be on Epic, so all their problems will be solved.

I continue to watch this individual on Twitter and am surprised he doesn’t have tendonitis in his shoulder from patting his own back so much. I still have some consulting work going on with the client, although thankfully outside of his area, and it’s been hard to watch the carnage. I wonder at times whether anyone above him has read the story about the emperor having no clothes. Most of the workers under and around him see through it, and I feel for them.

I was having flashbacks this week when I met someone at a conference who reminded me of him. He was full of great ideas about how his organization was going to use data to drive outcomes and change clinical behavior. It sounded great until it took a dark turn towards volume-based incentives. I watched others in the roundtable session nodding their heads and listening attentively and I wondered if they were missing the fact that he was talking about incentivizing providers for ordering more tests, medications, and procedures.

His independent provider organization is somewhat boutique-y and has a large population of young and middle-aged patients who value convenience. Due to their relatively low Medicare population, they’re not part of an Accountable Care Organization and they’re not worried about readmission rates. They offer a significant spectrum of cosmetic services along with all kinds of wellness testing that isn’t typically covered by insurance.

Essentially, his organization has come up with what I would consider bogus metrics, a “compassion index” that uses interventions as a proxy for good clinical care. Using point-of-care tests rather than medical knowledge or those pesky clinical decision rules raises a provider’s index. Prescribing multiple medications to treat patient symptoms also raises that index (however, over-the-counter medications that the patient might already be taking do not). He (and I assume the rest of the leadership of the organization, since the presentation was clearly bragging on their outcomes) has latched onto a word-track that “patients know we care by how much we do for them.”

I wondered for a minute if the presentation was straight out of The Onion. Certainly no one in the current healthcare environment would be talking about running up charges? As a former primary care provider, I always thought patients knew we cared by the fact that we sat down and talked with them, counseled them through their issues, and made sure they had follow-up.

I hid in the tall grass and waited for the opportunity to ask a question about what most of us would consider “real” metrics, such as antimicrobial stewardship or appropriate use criteria for advanced imaging. I asked it nicely, and it was fun to watch him blow it off saying that they don’t find those types of metrics to be relevant to their practice. You could see the light bulbs come on over a couple of the attendees’ heads because those types of actual clinical quality metrics have been so drilled into our heads, why would someone not use them?

He went on to describe some of their other metrics, which sounded more like defensive medicine than anything else. He explained their push for imaging as “patients feel better when they know beyond a doubt that nothing serious is going on,” which I immediately translated to “our accountant feels better when we radiate people.”

Nothing in medicine is “beyond a doubt” because there is great variability in patients and how their bodies react to various biological challenges. Medicine throws me curve balls all the time, including the patient last week who was very, very anticoagulated but still had a new deep venous blood clot form in his leg. Trying to use shotgun-style testing as a substitute for clinical intuition, experience, and evidence-based care is a dangerous construct.

He went on to talk about their interventions to drive clinician behavior and raise the “compassion index” alongside patient satisfaction scores. It sounds like they look for outlier physicians and sit them down and use peer pressure to try to raise the volume of order interventions. It didn’t sound like they overtly bonused physicians based on ordering volume, but instead use emotional hooks to try to keep clinicians on track. They do bonus physicians on throughput, which makes it easier for people to just order tests rather than sit down and explain a decision process to patients, since education and shared decision-making take time.

I found their bogus metric even more bogus when he explained that they judge the usage of interventions based on the documented chief complaint, not on the diagnosis. At this particular facility, the chief complaint is self-selected by the patient on a kiosk at check-in, so judging whether providers order testing based on that is particularly obnoxious. I’ve had patients who say their complaint is “throat pain” that is really poison ivy on the neck, so if a provider is going to be dinged for not ordering a strep test for throat pain that’s actually a neck rash, they’re fighting an uphill battle.

I can’t imagine working at a place like that. He did note that they have some issues with provider turnover. I’ve found that when people talk about their turnover issues, it’s kind of like talking about how much alcohol they drink – it’s likely to be underestimated.

I’m not sure how long payers are going to put up with this, or how long patients will keep coming back if they have to shoulder the bills for over-testing. Not to mention that over-testing is not a harmless intervention. Sometimes you find things that lead you to additional interventions when it would have been better if you hadn’t done the test in the first place. It falls into the “do no harm” piece of what we trained for as physicians.

I’m curious if this is a new trend or if this guy is as much on the fringe as I think. Have you seen anything like the compassion index in your area? Leave a comment or email me.

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Email Dr. Jayne.

Readers Write: Why the Interoperability and Patient Access Proposed Rules Matter for the Future of Healthcare

June 3, 2019 Readers Write 2 Comments

Why the Interoperability and Patient Access Proposed Rules Matter for the Future of Healthcare
By Russ Thomas

Russ Thomas is CEO of Availity of Jacksonville, FL.

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The Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC) have proposed new rules designed to give patients greater control over their own data and advance interoperability across the healthcare industry. Should the rule be finalized in its current form, millions of patients will have unprecedented access to and control over their own health information by 2020.

With some limited exceptions, including several related to privacy and security, the Interoperability and Patient Access Proposed Rule would make patient data exponentially more accessible and portable through open data-sharing technology and patient-facing apps.

Ideally, this would not only provide patients greater ownership of information related to their diagnoses, procedures, and tests, but also would mandate the seamless transfer of information from one healthcare organization to another as patients transition from physician to physician – enabling the promise of coordinated care within a complex healthcare system.

HL7 FHIR will be required as the standard for supporting all APIs under the proposal. Nearly 90% of hospitals and 70% of MIPS-eligible clinicians are using FHIR-enabled EHRs, according to ONC.

On paper, the rules are a logical extension of the Triple Aim—delivering better quality, better population health, and lower costs. Our industry has long advocated for the migration of patients to the center of the healthcare ecosystem.

However, empowering patients as consumers is only as effective as the tools they have to make more informed choices about their care. In this regard, healthcare is woefully behind the curve. Consumers can easily and securely access banking transactions and retail purchases over their smartphones, but not, say, their own clinical information, which is often tangled in a web of data silos, privacy rules, and vendor competition. Implementing and standardizing these rules will not be an easy lift.

In the real world of healthcare, the free flow of data and determining how, where, and when it is routed to the appropriate person is a daunting task with the highest of stakes. Although applying the proposed rules industry-wide will be time-consuming and resource-intensive, I believe the effort is both worth it and long overdue.

These proposed rules are a critical tap on the shoulder, a reminder that achieving healthcare’s future is impossible without first solving the foundational problems rooted in our present moment.

Healthcare technology companies should be at the forefront of supporting industry standards that drive efficiencies and interoperability and reduce costs and administrative burdens for their customers. Tools like FHIR enable healthcare organizations to efficiently exchange well-defined information.

I believe that this standardization is essential to the shift to value-based models of care, where payers and providers are seeking secure ways to better communicate and exchange information.

Standards, however, are only one part of the solution. Creating a more solid foundation for healthcare’s building blocks requires several key ingredients: widespread adoption of automation; more efficient channels for sharing and maintaining healthcare information; and modernization of laws governing healthcare data access and sharing, like HIPAA. It also requires evolution of business models to reward transparency and information sharing and penalize data duplicity.

On the payer side, many health plans still store provider data on legacy systems in multiple disconnected databases. As business requirements have evolved, insurance organizations have implemented incremental stopgap measures to address data limitations, but these don’t address the core challenge, the lack of a single source of truth.

It’s important to hear from all concerned stakeholders in order to get these rules right. However, I believe that at the core of these rules lies an essential truth. Unlocking and harnessing the power of data and providing patients the ability to access it is the truest course to a more sustainable and patient-centric healthcare system.

We have been presented an opportunity to fundamentally transform the American healthcare system for the better. It would be a mistake to miss it.

Morning Headlines 6/3/19

June 2, 2019 Headlines No Comments

EHR Developers are Aligned with Goals of Cures NPRM, Hope ONC will Remove Ambiguity and Reassess Timeline

The vendor members of the HIMSS Electronic Health Record Association raise “significant concerns” in draft comments about proposed federal rules covering interoperability.

Troubled microbiome startup uBiome to lay off some employees, refund payments from federal insurers

Microbiome testing vendor UBiome’s interim CEO warns employees of pending layoffs in the wake of federal investigations that have also prompted the company to refund government payments for its tests.

Kan. Hospital Agrees to Pay $250K To Settle False Claims Act Allegations

Coffey Health System (KS) will pay HHS $250,000 to settle claims that it falsely attested to conducting security risk analyses as required by the Meaningful Use incentive program.

Monday Morning Update 6/3/19

June 2, 2019 News 11 Comments

Top News

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The vendor members of the HIMSS Electronic Health Record Association raise “significant concerns” about proposed federal rules covering interoperability. Their draft comments note that:

  • The rule limits EHR vendor profits and thus discourages innovation because it requires them to share their intellectual property. The proposed rule would require vendors to offer interoperability elements with “reasonable and non-discriminatory terms.”
  • The compulsory licensing rule would require developing documentation, APIs, and patents, creating a regulatory burden that might “outweigh the opportunity that remains.”
  • ONC’s definition of “interoperability elements” and “electronic health information” are overly broad and unreasonable, while some of the defined exceptions would be nearly impossible to enforce.
  • EHR vendors can’t deliver the programming necessary in the proposed 24-month timeline, especially when they are dealing with other CMS and ONC regulatory requirements.
  • The proposed rule includes ambiguous definitions such as “reasonable,” “as soon as possible,” and “near real-time,” which is risky when penalties can be issued of up to $1 million per infraction.
  • EHRA recommends publishing an Interim Final Rule this year to allow continuing clarification and feedback and to create a way that vendors can get quick answers to their questions.

The Health Innovation Alliance this week said the rule is too vague and contains too many loopholes, recommending that ONC and CMS “go back to the drawing board.”


HIStalk Announcements and Requests

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More than half of poll respondents say vendor and hospital burnout in health IT is caused by excessive workload and time pressure rather than organizational, management, and compensation issues. Furydelabongo says that work overload could be a symptom of having incompetent or overly ambitious managers, while Drex cites the nearly universal absence of good IT governance in hospitals that encourages employees work at whatever tasks they believe are important or that executives complain the loudest about.

New poll to your right or here: What method did you use the last time you communicated directly with a doctor who was providing care to you? I’m looking for your most recent exchange, the final one in your most recent encounter.

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Happy 16th birthday this week to HIStalk, which I started writing in June 2003. I think it was June 6, but I’m not certain since I sometimes think it was June 3. Back then:

  • Some big healthcare names were George W. Bush, Tommy Thompson, Tom Scully, Dennis O’Leary, Erich Reinhardt, Linda Kloss, Anthony Principi, and Neal Patterson.
  • Hospitals were struggling with early CPOE implementations.
  • Kaiser Permanente had just chosen Epic.
  • Cerner had just made its first UK sales and opened its new headquarters.
  • HIMSS offered HIMSS03 in San Diego (with keynotes from Jeff Immelt, Rudy Giuliani, and Patch Adams) following Summer HIMSS in Chicago and also launched Solutions Toolkit, the predecessor to HIMSS Analytics.
  • Computers ran Windows XP while users licked their wounds caused by Windows ME and awaited / dreaded the promised magic of Windows Vista as the effects of the “every other Windows release sucks” rule were about to be felt.
  • People sent messages on BlackBerry devices and talked on the Nokia cell phones that dominated the market.
  • Companies such as MercuryMD, Misys, First Consulting Group, Per-Se, IDX, Healthlink, Quovadx, Alaris, and Sentillion were making a few sales.
  • Health IT news came slowly and with little critical review other than from expensive, influential newsletters such as “Inside Healthcare Computing” and “HIS Insider.”

Listening: new from NF (Nate Feuerstein), a 28-year-old, Michigan-based, Eminem-influenced rapper whose lyrics are emotional but commendably free of profanity (a change he made in 2010, saying that he’s Christian even though his music is not) and misogyny. His vocal rhythms immediately embed themselves in your head even if the lyrics don’t. The link is for “Let You Down,” which is not only a dramatic video, but also a powerful song about the strained relationship between a disappointed father and his son who has bitterly decided that their superficial relationship is over.

Thanks to the following companies that recently supported HIStalk. Click a logo for more information.

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Webinars

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


Decisions

  • Bayhealth (DE) switched from Avaya To Cisco Systems for call center technology in April 2019.
  • Highpoint Health (IN) will replace Meditech with Allscripts in July 2019.
  • ProMedica Coldwater Regional Hospital (MI) replaced Meditech with Epic on May 1, 2019.
  • Chestnut Hill Hospital (PA) will go live on Epic in August 2019.
  • Baptist Health Floyd (IN) will replace Allscripts with Epic In June 2019.

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


Announcements and Implementations

SailPoint earns a US patent for its application of AI/ML to identify peers among system users to detect those whose access profile is unusual enough to warrant review for potential security concerns.


Other

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Eric Topol notes the nearly identical, relentless price increases for competing best-selling injectable arthritis drugs Humira and Enbrel, which generated a combined $28 billion in 2018 sales. Today’s price is more than double that of 2012, with cash-paying patients paying more than $5,000 per month even with the best coupon offered by GoodRx. The cost is much less in the UK, which doesn’t allow endless drug company patent filings and lawsuits that block competition for biologic drugs.

CDC reports that the number of US measles cases has broken the 25-year-old record even though we’re only halfway through the year. Measles is classified as “eliminated” in the US, but that achievement is at risk for the first time in a generation.

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I’m fascinated that Cincinnati-based Bon Secours Mercy Health will sell its majority stake of an RCM company it bought for $60 million in 2016 for $1.2 billion. The Catholic health system, former in September 2018 with the merger of Mercy Health and Bon Secours Health System, had just announced its merger with Ireland’s largest healthcare provider, a five-hospital system in Dublin, with intentions I don’t quite understand (unless they’re using Ireland’s favorable tax status to benefit their for-profit ventures).


Sponsor Updates

  • Sansoro Health announces an integration partnership with OpiSafe, which provides clinical decision support for opioid prescribers.
  • TriNetX will exhibit at Academy Health June 2-4 in Washington, DC.
  • A study finds that hospitals using Meditech Expanse outperformed Cerner and Epic clients in CMS quality and value measures.
  • Wolters Kluwer Health promotes Greg Samio to president and CEO of health learning, research, and practice.
  • The SSI Group will exhibit at the Alabama HFMA Annual Institute June 2-4 in Destin, FL

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Weekender 5/31/19

May 31, 2019 Weekender No Comments

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Weekly News Recap

  • The latest funding round of precision medicine platform vendor Tempus values the company at $3.1 billion
  • Cerner initiates a $0.18 quarterly dividend for shareholders, its first
  • Cincinnati-based Bon Secours Mercy Health announces plans to sell its majority share in a revenue cycle management subsidiary, netting $1.2 billion on its 2016 investment of $60 million
  • Cardinal Health makes a $10 million investment in home medical monitoring technology and monitoring services vendor Medically Home Group
  • Change Healthcare files an amended prospectus for a $200 million IPO that doubles the value indicated in its mid-March filing
  • The VA opposes a Senate bill that would create an independent advisory committee to oversee its $10 billion Cerner implementation

Best Reader Comments

Tempus got a $3.1 billion valuation without any peer-reviewed data on the veracity of its precision medicine claims? Without any randomized clinical trials? Oh, well. We live in a world where a company putting out green color scooters on city sidewalks can get valuation in billions of dollars, so why not? (TempusInATeapot)

I’m still trying to get my head around why people insist that privately held companies that are still very profitable are “struggling” because revenues are down. The key being the slight decline in overall revenues was clearly predicted in advance. Maybe the major shareholders have a little heartburn because of unreasonable expectations borne out of the MU honey pot days, but the companies still are very healthy. (Smartfood99)

I had an interesting interaction with an insurance pre-auth department. They claimed that they needed my knee MRI report faxed to them because of HIPAA. I told them I didn’t have a fax machine, and why didn’t they have a secure portal for these? They again claimed HIPAA, but said there were several third party websites I could use to upload a PDF to and they would fax on my behalf, and better yet, some had free trial periods. (Bob Smith)

I did consulting about a decade ago for a teaching hospital that was being built to advise on how to make sure the layout promoted it being “EHR ready.” I was handed the outlines of the medical ICU floors and they had left so little space that they were either going to have to choose call rooms or tiny conference / charting rooms on the same floor. When I pointed that out, I was told that they couldn’t change any of that, and the space was going to be offices for the ICU leadership, so no call rooms or conference rooms. Turns out a committee had put together their high-level requirements and handed it to the architects who had returned these designs, and at that point, it was too late to make any changes. (DrM)

The brand new multi-million dollar building at our medical center eliminated conference rooms and working areas for clinicians. This means there is no place to sit at a desktop computer and actually do work or make phone calls. The computers in the patient rooms are ergonomic disasters. Plus, it’s difficult to concentrate and write efficiently when patients or families are asking questions. Patient privacy will be infinitely more challenging without any available private areas to discuss clinical issues. They did, however, install a faux fireplace in the oncology infusion center to make it seem more welcoming and homey. (Anonymous)

Is Epic still growing? Not if you read between the lines. Last year they said they hired 400 new employees. Now they say turnover is 10%, others say 20,% maybe it’s 15%. Either way that’s means replacing at least 900 employees per year. Looks like they may be cutting back or at best be in a holding position. Makes sense since Judy said a few months ago in a news article they are done building, and with the end of HITECH money, that juggernaut is over. The hospital market is clearly saturated, and a month or so ago, an Epic VP stated they want to move into other levels of care, like LTC, rehab, etc. But those markets are also saturated with some very well established vendors and Epic does not buy other companies. Is the writing on the wall? (HISJunkie)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. A in Washington, DC, who asked for math manipulatives for her pre-K class. She reports, “The math manipulatives you have provided will help to develop math skills during our center time and small group instruction. My kids are using the math manipulatives to practice counting, measurement and sorting. They are so excited to practice math now! Each student has a favorite manipulative they like to use. They like to make groups of five and 10, find out how many items are needed to make the scale go up or down and mix up all of the manipulatives and sort them according to shape, size, or feature. Thank you again for your donation and for making math accessible and fun!”

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Security experts warn that hackers can modify the USB ports of airport phone charging stations, allowing them to access user data or install malware. The fix is obvious – use your wall charger instead.

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A startup is developing software that can be used to deploy a drone in response to reported incidents or 911 calls, allowing first responders a live look at a fire or accident scene within 30-90 seconds even though they won’t arrive for 8-15 minutes. 

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An orthopedic surgeon opens a coffee shop in the lobby of Lake Health Beachwood Medical Center (OH), with 100% of the proceeds being donated to a local charity that helps single mothers buy homes. The Ethiopia-born doctor is one of the highest-volume shoulder surgeons in the US.

The Chinese scientist who was widely condemned by his peers for creating the world’s first genome-edited babies says he’s getting inquiries from shady fertility clinics offering to pay him to show how he did it so they sell those services .

The Chicago Tribune profiles a practicing 100-year-old optometrist who says he has no plans to retire. “I work because I feel I’m doing some good … I enjoy it. It’s not work as far as I’m concerned.”

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Fascinating: the doctor behind those ubiquitous online ads in which he begs us to “throw out this vegetable now” is found to be an integrative health MD who runs a variety of questionable websites that sell expensive herbal products and books for weight loss and constipation. He never says what vegetable everyone should throw it is and the ad uses photos of different ones, but it’s likely corn. The article also notes that the ads are known as “chumboxes,” sponsored pay-per-click content that baits people into clicking ads featuring miracle cures, ads triggered by the viewer’s IP address to offer what appear to be local services, and those that tease about something that is “weird.” Keep in mind that they exist only because people are stupid enough to click on them.


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Morning Headlines 5/31/19

May 30, 2019 Headlines No Comments

Tempus raises $200M at a $3.1B valuation

Precision medicine platform vendor Tempus raises $200 million in a Series F funding round that values the Chicago-based company at $3.1 billion.

Cerner’s initial quarterly dividend exceeds original estimate

Cerner initiates a $0.18 quarterly dividend, its first and $0.03 greater than it originally mentioned in February.

Apprio Announces New Commercial Health Division, ApprioHealth, to Meet the Specialized Needs of Hospitals and Health Systems

Government health IT contractor Apprio creates a new commercial healthcare division to market its RCM services to hospitals and health systems.

Welkin Health Raises $17.5 Million in Series B Funding from Altos Ventures

Patient relationship management vendor Welkin Health raises $17.5 million in a Series B round, bringing its total funding to $30 million.

News 5/31/19

May 30, 2019 News 3 Comments

Top News

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Precision medicine platform vendor Tempus raises $200 million in a Series F funding round that values the Chicago-based company at $3.1 billion.

CEO Eric Lefkosky, JD founded the company in 2015 after launching two marketing companies, a logistics technology company, and a venture capital firm. He is also chairman and co-founder of Groupon and formerly served as that company’s CEO. 


Reader Comments

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From Food for Chewing: “Re: KLAS’s new report on Cerner revenue cycle management. I’m curious to know if Cerner paid for or commissioned the report.” KLAS responded to me by saying that it was initially creating the report without Cerner’s involvement, but Cerner asked KLAS to convene a big-client summit that was hosted by Intermountain. The Cerner clients then asked KLAS to provide quarterly updates about Cerner’s progress. Cerner will engage around those results, and while KLAS tell me specifically that Cerner is paying, it’s not unreasonable since Cerner commissioned the follow-up. Cerner won’t get much immediate mileage from this initial report – the client feedback (at least as reported in the “Key Findings” summary, which is all I can see) is nearly universally negative, not surprising given the meeting’s genesis (no pun intended for you Cerner DoD MHS types).

From Crowdfunding Not for the Weak at Heart: “Re: HEAL Diabetes Clinic. Received an email indicating that after its StartEngine funding campaign, CEO Richard Koffler ‘surprised us by announcing his resignation from the company.’ The company decided that it couldn’t move forward without home, so it is shutting down and returning any leftover money to investors.” The company’s webpage says it has closed and Koffler’s LinkedIn indicates that he has resigned. It offered a ketogenic diet program.

From Non-Corporate Man: “Re: your experience with an HIT vendor owned by a large company. My experience was the opposite. I did just about every job you could think of in corporate HIT, did an MBA and law degree while working full time, and got the CEO job because I knew all the pieces.” My only for-profit experience was with this vendor, but it was eye-opening to see what happens when a Fortune 500 company acquires a failing software vendor that quickly disappears into the murk of the corporate balance sheet once it fails to meet overly optimistic expectations. They only bought us with the questionable hope that our sexy-sounding business would jumpstart their anemic growth rate, apparently actually believing our financials that must have been quite the work of fiction ( (I speculate our executives offered them the “Promises & Lies” version of our P&L).

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From Union Rep: “Re: HIT headlines. This one is surely among the worst.” I agree. As health IT wit goes, this is half. The story itself is basically a rewritten press release, so someone was anxious to show some poorly executed creativity in the headline in desperately punning “Sunrise.” I can only imagine the damage they would do in trying to work “Millennial” into a Cerner sales announcement.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Multi-state Bon Secours Mercy Health will sell a majority stake in its Ensemble Health Partners RCM and Epic optimization business to Golden Gate Capital for $1.2 billion.

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Cerner initiates a $0.18 quarterly dividend, its first-ever such payment and $0.03 greater than it originally mentioned in February. Opinions vary on whether companies that initiate dividend payments are showing signs of strength (making so much money that they might as well share it with investors) or weakness (management can’t entice people to buy the stock otherwise). I generally side with the latter. Companies that are doing well and expect strong future performance would be better off investing the money in their own business and let the success-driven share price increase reward its shareholders. But that’s just me, and if CERN shareholders love the stock, they can just reinvest the dividends themselves. CERN shares are down 3% vs. the Nasdaq’s 3% rise since Brent Shafer took over on January 10, 2018.

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Government health IT contractor Apprio creates a new commercial healthcare division to market its RCM services to hospitals and health systems.

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Talkspace raises $50 million in a Series D round led by Revolution Growth, bringing its total funding to $107 million. Optum’s behavioral health business has signed on for the company’s online therapy service.

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Pillo Health raises $11 million to complete its Series A round. Lead investor Stanley Black & Decker will work with Pillo to launch a direct-to-consumer version of its digital home health companion later this year.

Patient relationship management vendor Welkin Health raises $17.5 million in a Series B round, bringing its total funding to $30 million.


Sales

  • UCLA Health (CA) selects Microsoft’s Azure cloud computing services to speed up data analysis for researchers and precision medicine efforts.
  • The Louisiana Dept. of Health will implement provider credentialing software from Verisys.
  • Allegheny Health Network (PA) selects Vynca’s end-of-life care planning technology.

People

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Mount Sinai Health System (NY) names Andrew Kasarskis, PhD (Icahn School of Medicine) as EVP and chief data officer.

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Roni Zeiger, MD (Smart Patients) joins Facebook as head of health strategy.


Announcements and Implementations

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Woman’s Hospital (LA) goes live on Meditech Expanse.

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OHSU Doernbecher Children’s Hospital (OR) offers parents Locus Health’s app-based remote monitoring software for use post-discharge.

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PerfectServe announces GA of embedded messaging within Cerner.


Privacy and Security

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In Australia, auditors warn Victoria’s public health system officials that weak cybersecurity practices have left facilities vulnerable to attacks. A review of security measures at several hospitals within the state found similar weaknesses, including weak passwords, poor system and network monitoring, inadequate user access controls, and lack of appropriate governance and policy frameworks. Barriers to implementing all 72 of the recommended cybersecurity measures include lack of budget and staff, plus a lack of awareness around third-party vendor security protocols.

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Allegheny Health Network brings its Epic system back online after an unspecified network issue caused it to go down Wednesday morning. The outage affected all seven of its Western Pennsylvania hospitals.

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Indiana-based Medical Informatics Engineering and its subsidiary NoMoreClipboard will pay $900,000 to settle a multistate lawsuit brought against it last year by 16 state attorneys general over a 2015 breach that compromised the data of 4 million patients. Meanwhile, nobody is planning a PHI heist of 4 million clipboards.


Other

Canada’s Sunnybrook Health Sciences Centre will integrate its self-developed SunnyCare clinical workflow solution with CPSI Evident’s Thrive EHR. The organizations will also establish an outcomes innovation center in Toronto.

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A New York Times investigation finds that pediatric cardiologists at UNC Children’s Hospital (NC) were so alarmed at high death rates that they questioned — in secretly recorded department meetings obtained by the newspaper — whether they would send their own children there for surgery. From the Times article:

  • The hospital’s death rate was among the worst among the 82 institutions that publicly report it.
  • Cardiologists and hospital executives were all worried about the hospital’s high death rate, but didn’t know what to do about it.
  • Since 2015, the hospital had lost two of its pediatric cardiac intensivists and some experienced nurses, closed its CIC unit, and didn’t have a dedicated cardiac intensive care unit.
  • A transplant surgeon failed to show up to perform a heart transplant when a donor heart became available on a weekend, leading one cardiologist to say, “This is what you signed up for. Who is he to play God with some kid’s life?”
  • UNC said it has since replaced leadership that hospital administrators called “a dysfunctional group.”
  • So many hospitals offer complex pediatric heart surgeries that some hospitals, including UNC, perform few cases and thus have limited resources and experience. Several hospitals have shut down similar programs or merged with others in hopes that higher volumes would drive better outcomes.
  • UNC says mortality data alone isn’t a good measure and termed it “critically important” to instead look at risk-adjusted data, but then refused to release that data because it says the data doesn’t adequately reflect that its patients are sicker.
  • The since-retired head of the children’s hospital told cardiologists to follow their conscience if that included referring patients to other hospitals, but warned them that reduced surgery volume would hurt hospital revenue and possibly cost them their jobs.

Sponsor Updates

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  • HCTec employees volunteer with the Gentlemen’s Quest of Tampa and the United Way.
  • Elsevier Clinical Solutions will exhibit at ASCO June 1 in Chicago.
  • EClinicalWorks will exhibit at the SCPHA Association Annual Clinical Network Retreat June 7-9 in Myrtle Beach, SC.
  • Glytec publishes a new case study, “Paul Chidester, MD: How Sentara Healthcare Achieved the Standard of Care in Glycemic Management, and Your Organization Can, Too.”
  • Google Cloud releases a new video, “American Cancer Society: Powering cancer research using Google Cloud machine learning.”
  • Hayes Management Consulting will host a reception during the AAMC Compliance Officers’ Symposium June 6 in Washington, DC.
  • Audacious Inquiry celebrates 15 years in business by reflecting on 15 significant company milestones.
  • Nordic releases a new podcast, “How to build an effective hub-and-spoke relationship.”
  • NextGate publishes a new case study, “Enterprise Patient Matching Helps KeyHIE Establish Integrated Network of Accurate, Accessible Health Records and Drive Down Duplicate Record Rate to Less than 1%.”

Blog Posts


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EPtalk by Dr. Jayne 5/30/19

May 30, 2019 Dr. Jayne 1 Comment

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I’ve been following Diasyst for some time and was happy to see their recent win at the Webit.Foundation Founders Games in Sofia, Bulgaria. Diasyst was recognized as a finalist and was selected by Microsoft for Startups for $120K in awards to support growth, including assistance with investments and partnership development. Diasyst has an elegant solution that assists clinicians with diabetes management and currently partners with Emory University, the US Department of Veterans Affairs, and Georgia Tech.

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The state of Missouri closed its legislative session last week and remains the lone holdout in the US without a statewide prescription drug monitoring program. St. Louis County provides the leading workaround with its federally-funded voluntary PDMP; more than 70 additional jurisdictions including Illinois, Kansas, and Oklahoma share data with the system and it now covers 84% of the state’s population. Missouri legislators continue to cite privacy concerns as preventing Missouri from enacting PDMP legislations despite the support of new governor Mike Parsons. A Kaiser Health News piece covering the issue is worth reading. One of the main legislators who had opposed a statewide PDMP is a family physician, although he was finally term-limited. PDMP legislation has also been inexplicably tied up with gun rights issues. It should be noted that Missouri was also last to implement a statewide immunization registry. My favorite quote of the piece: “But if 49 other legislatures are saying ‘This is important, we need to save lives,’ I don’t understand why Missouri can’t find a way to compromise and do what’s best for its citizens.”

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It’s already been mentioned in HIStalk, but I’m intrigued by Amazon’s foray into wearables that can read the emotion of the wearer. It’s a step up from a mood ring, but I wonder how well Amazon is really doing with understanding user emotions and experiences at present. The company needs to do a better job selling its data in a way that I don’t keep seeing ads for products I’ve already bought. The device would supposedly analyze user voice patterns to determine their emotional state. I’m just trying to get my Echo to recognize my commands when I’m moving across the room or when there is background noise.

Artificial intelligence continues to be a headliner for buzzword bingo and the US government continues to expand spending. Early adopter agencies such as the Defense Department, the General Services Administration, NASA, and the Department of Health and Human Services are using AI to reduce backlogs or increase productivity of existing workers. Additional departments looking to leverage AI include the Departments of Agriculture and Veterans Affairs, along with the National Institute of Standards and Technology. Additionally, the Patent and Trademark Office wants to use AI to screen patent applications against more than ten million patents already on the books.

A recent report on federal AI adoption highlights the need to make sure agencies have solid business cases for AI and that they’re not building solutions in search of a problem. It also notes that government needs to get “beyond the belief that AI is magic. It’s not – it’s something that’s evidence-based that uses data.” The report also calls for a unified ethics framework that addresses difficult issues around AI transparency and accountability. Previous projects involving analysis of drone footage have been controversial.

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The US Food and Drug Administration (FDA) is fast-tracking an Apple Watch app to help individuals who experience nightmares from post-traumatic stress disorder (PTSD). The NightWare app uses biometric data collected during sleep and processes them with machine learning algorithms to identify the onset of nightmares. Vibrations are triggered to interrupt the nightmare without waking the user or interrupting sleep rhythms. The FDA granted “breakthrough status,” which is typically granted for life-threatening conditions with no approved treatments. Nightmares and nightmare disorder are linked to increased risk of suicide, heart disease, diabetes, memory loss, anxiety, and depression. An estimated 5 million Americans suffer from nightmare disorder. NightWare is conducting randomized clinical trials prior to applying for FDA priority review.

I’ve noticed an increase in the number of elderly patients who don’t have family nearby. They may continue to drive past the point where it is safe because they don’t want to be dependent on taxis or ride share services. As the Baby Boomers age, self-driving cars may be an appealing way to stay independent. IBM and British startup Cera Care are taking a deeper look at using the technology off the road to help elderly patients navigate within their homes. They plan to use lidar laser sensors from self-driving cars to monitor patient movements and daily routines. A change in movement patterns may indicate physical deterioration, psychological changes, or a fall. Lidar sensors are expensive at approximately $1K per room, but developers expect costs to fall over time.

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The University of Michigan finds that the DNA of new doctors ages six times faster than normal DNA during the critical internship year. Researchers looked at segments of DNA called telomeres, which keep the ends of chromosomes intact. The interns were compared against a control group of college students. The study showed that telomeres in stressed subjects shrank in an accelerated way. The data could be applicable to other populations exposed to prolonged stress such as military trainees, new parents, and those working for startup companies.

I had the chance to connect with an old friend and industry vet this week. It was great to catch up and to commiserate about the problems we’re trying to solve out in the client community. Some of the issues we continue to run across include clients who want to do the wrong thing despite our best advice, such as failing to flag deceased patients in the system. Nothing says “patient engagement” like a family receiving a colonoscopy reminder after their loved one has died of colorectal cancer. As we use increasing amounts of information across numerous applications and data streams, the need to ask “is this the right thing for the patient” becomes more important.

Does your organization constantly keep patients at the forefront? What are your pitfalls or a-ha moments? Leave a comment or email me.

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Email Dr. Jayne.

Morning Headlines 5/30/19

May 29, 2019 Headlines No Comments

Allegheny Health Network’s computers go down, delaying some procedures

Allegheny Health Network’s Epic system goes down Wednesday morning due to an unspecified network issue that has affected all seven of its Western Pennsylvania hospitals.

Talkspace announces $50M Series D, expands services to over 5M lives

App-based therapy company Talkspace raises $50 million in a Series D round.

Tennessee, 15 Other States Reach $900,000 Data Breach Settlement

Indiana-based Medical Informatics Engineering will pay $900,000 to settle a multistate lawsuit brought against it last year by 16 state attorneys general over lax security practices that led to a 2015 breach that compromised the data of 4 million patients.

Golden Gate Capital to Buy Stake in Billing-Services Firm

Bon Secours Mercy Health will sell its Ensemble Health Partners RCM business to Golden Gate Capital for $1.2 billion.

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