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News 10/17/18

October 16, 2018 News 6 Comments

Top News

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Radiation oncology and software vendor Varian Medical acquires Finland-based Noona Healthcare, whose software captures patient-reported outcomes and supports symptom management.


Reader Comments

From Managing Director, Otium cum Dignitate: “Re: HIMSS Form 990. Here’s the latest from Guidestar.” I should have been more specific in saying that I couldn’t find what I assume should be the latest HIMSS Form 990. I saw this one, which covers the year ending 6/30/16. HIMSS should have filed one last year and is due to file another one this year, but they haven’t responded to my request. More interesting is the title used by this semi-retired reader, who says he just likes the title “Managing Director” and the Latin from Cicero translates to “leisure with dignity,” which is about as cool a goal as someone could set for themselves (although the occasional episode of leisure with dishonor might keep it interesting).

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From No Mas: “Re: Athenahealth’s partnership with U of Toledo. The new product for academic medical centers was supposed to be complete by now, three years after you interviewed CMIO Bryan Hinch, MD. Maybe you can reach out for an update.” I’ve emailed Bryan to see what happened since our interview about the co-development of an inpatient EHR as University of Toledo Medical Center tried desperately to unload its problematic and expiration-dated McKesson systems.

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From Robert D. Lafsky, MD: “Re: this article. I think a big reason there’s so much lately about physician ‘burnout’ is that medical training teaches you to ask ‘why’ about everything. Even if it’s wrong, there has to be a theory. But when the EMR came along, it urged doctors to not ask so many questions, just do what it says. It’s remarkable that it took this long for a major medical journal to run a piece on the theoretical basis for computerized medical information.”  The NEJM article reviews the need for ontologies (controlled, descriptive terminology that describes the semantic relationships among concepts) to overcome the limitations of incomplete, incorrect, or unsourced EHR data since those systems were designed for billing, thus having no convenient way to store behavioral phenotypes, environmental exposure, genomic sequencing data, and information collected from mobile health sensors. It notes that use of ontologies on huge data sets can discover association and even causation to create new diagnostic and therapeutic insight. The authors also suggest that clinician data entry is not a good use of their time and advocates instead collecting device information and patient-entered information electronically and greater use of speech recognition.


HIStalk Announcements and Requests

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Need consulting services? Fill out my minimally intrusive “RFI Blaster” online form (which I just rebuilt) with details about your needs and then choose one or all HIStalk consulting firm sponsors you’d like to hear from. It doesn’t get much easier.

I had another moment of music-driven cognitive dissonance in the senior citizen-filled grocery store the other day when in between sappy, buy-more-stuff music (Beach Boys, Pilot) was inserted “Break On Through (To the Other Side)” from the magnificent 1967 debut album of The Doors. I smugly felt rebellious as I noted no reaction from the older shoppers, but then I realized they were probably just suppressing the fist pumps since they were likely in their mid-20s peak rebellion years when the song charted 51 years ago. Mr. Mojo Risin’ himself would be 74 if he hadn’t broken on through to the other side at 27 in 1971. As I often say, nursing homes are now occupied by those who want to hear Pink Floyd rather than Lawrence Welk.


Webinars

October 30 (Tuesday) 2:00 ET. “How One Pediatric CIN Aligned Culture, Technology and the Community to Transform Care.” Presenters: Lisa Henderson, executive director, Dayton Children’s Health Partners; Shehzad Saeed, MD, associate chief medical officer, Dayton Children’s Health Partners; Mason Beard, solutions strategy leader, Philips PHM; Gabe Orthous, value-based care consultant, Himformatics. Sponsor: Philips PHM. Dayton Children’s Health Partners, a pediatric clinically integrated network, will describe how it aligned its internal culture, technology partners, and the community around its goal of streamlining care delivery and improving outcomes. Presenters will describe how it recruited network members, negotiated value-based contracts, and implemented a data-driven care management process.

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


Acquisitions, Funding, Business, and Stock

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Medicare Advantage insurer Devoted Health raises $300 million in a Series B round, increasing its total to $362 million. The founders are Todd Park (Athenahealth, Castlight Health, White House), his brother Ed Park (Athenahealth), and some VCs. Also on the team are former Athenahealth CTO Jeremy Delinsky and  former US Chief Data Scientist DJ Patil.


Sales

  • Oregon will integrate its prescription drug monitoring program database with EHRs and pharmacy systems using Appriss Health’s PMP Gateway.
  • Legacy Health (OR) goes live on Vynca for capturing, storing, and accessing advance care planning documents.

People

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AAFP promotes Steven Waldren, MD, MS to VP/CMIO, where he will focus on the potential impact of AI and machine learning on family medicine and continue work on reducing EHR burden.


Announcements and Implementations

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A KLAS report finds that two-thirds of health systems are just beginning to implement opioid stewardship programs, with the less-advanced ones considering best-of-breed technologies (such as drug dispensing systems that detect or prevent drug diversion) while more advanced health systems expect their EHR vendor to deliver tools to prevent and treat opioid misuse. Epic is the most-used of all technologies used in opioid stewardship programs, while Cerner is least-used.  Customers expect their EHR to integrate with prescription drug monitoring program databases, to offer opioid-specific clinical decision support and toolsets, and to include opioid stewardship capabilities in population health management.

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This is smart approach: personal health record vendor HealthLynked publishes a plug-in that allows embedding its appointment-booking function in any of the 60 million websites that run WordPress. The screenshots suggest areas of needed improvement, however, since the dates run together and displaying appointment times down to the second seems silly.

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A Reaction Data report says that only 15 percent of radiology departments still use dictation and transcription, with speech recognition dominating (although not growing) and 81 percent of respondents using Nuance and basically none of them thinking about switching to another vendor. Just over half of respondents say their speech recognition is integrated with PACS, but integration with RIS and EHR is much lower even though user satisfaction with the integration of all three is high.

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Hospital grading organization Leapfrog Group will launch safety and quality surveys of the country’s 5,600 outpatient surgery centers, noting the need as evidenced by the Kaiser Health News/USA Today Network investigation that revealed poor oversight and substandard clinical practices. Let’s hope they call out the likely majority of those centers that refuse to participate (since until competitors start publicizing their good results, there’s no incentive). The organization issues grades for 2,000 US hospitals, just over one-third of the total.

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A hospital in eastern China goes live with facial recognition check-in on a system developed by Alibaba’s healthcare group. Anyone with health insurance and a mobile payment account can register without their ID cards or phones once they have linked their accounts to the Alipay mobile payment app. The system’s 3-D cameras link to Alipay’s biometrics and the Ministry of Public Security’s photo database, which is also used by police to identify the faces of fugitives in large crowds. 

A Philips study finds that the US healthcare system captures a lot of data compared to other countries, but suffers from lack of a universal health record and low consumer satisfaction and trust.


Government and Politics

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Telemedicine vendor HealthRight and its CEO Scott Roix plead guilty to healthcare fraud and fraudulent marketing of dietary supplements, skin creams, and testosterone that its doctors prescribed without realizing how massively the company was marking up the prices. A total of four men and seven compounding pharmacies were named in charges of running a billion-dollar telemedicine fraud scheme.


Other

Another healthcare information challenge – a person’s genetic test results could change from “normal” to “abnormal” or vice versa based on new research findings, but nobody has thought about the challenges in contacting those patients or their doctors to let them know or to have them retested. A recent study found that of 1.45 million patients tested from 2006 to 2016, reclassification of mutations would have changed the reports of 60,000 of them.

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UMass Memorial Health Care lays off 17 IT employees two weeks after going live with its $700 million Epic implementation. 

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MIT will spend $1 billion to create an artificial intelligence college that will begin instruction in the fall of 2019. MIT says the intentionally used term “college” reinforces that the new organization will work across all five of its existing schools (architecture, engineering, humanities, management, and science) rather than being a school itself. It adds that the college will emphasize ethical guidelines of how AI can be used for human good.

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Amazon posts job listings for data scientists with health benefits experience to work with partners – “including the new healthcare venture” – to create healthcare and population health management solutions. Most interesting is the responsibility to “leverage big data to explore and introduce areas of healthcare analytics and technologies” and preferred experience that includes working with claims, EHR, and patient-reported data. I have a strong feeling that if Amazon ever meets high expectations for healthcare disruption that this Atul Gawande-led group won’t be its weapon of choice – while the company will learn a lot about how healthcare works, the goal is to reduce its own costs, with no guarantee that those efforts will extend outside its four walls. The company’s real disruption opportunity likely lies elsewhere and that are more easily penetrated, such as in supply chain management.

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A jarringly moving obituary written by the parents of a 30-year-old mother who died of a drug overdose last week provides a sad reminder of the toll of drug addiction on families. Some excerpts (but you should read the whole thing):

It is impossible to capture a person in an obituary, and especially someone whose adult life was largely defined by drug addiction. To some, Maddie was just a junkie — when they saw her addiction, they stopped seeing her. And what a loss for them … During the past two years especially, her disease brought her to places of incredible darkness, and this darkness compounded on itself, as each unspeakable thing that happened to her and each horrible thing she did in the name of her disease exponentially increased her pain and shame. For 12 days this summer, she was home, and for most of that time she was sober. For those 12 wonderful days, full of swimming and Disney movies and family dinners, we believed as we always did that she would overcome her disease and make the life for herself we knew she deserved. We believed this until the moment she took her last breath. But her addiction stalked her and stole her once again. Though we would have paid any ransom to have her back, any price in the world, this disease would not let her go until she was gone.

If you are reading this with judgment, educate yourself about this disease, because that is what it is. It is not a choice or a weakness. And chances are very good that someone you know is struggling with it, and that person needs and deserves your empathy and support. If you work in one of the many institutions through which addicts often pass — rehabs, hospitals, jails, courts — and treat them with the compassion and respect they deserve, thank you. If instead you see a junkie or thief or liar in front of you rather than a human being in need of help, consider a new profession.

Bizarre: Sacramento police can’t figure out what charges to file against two high school students who handed out cookies at school that contained a secret ingredient – the cremation ashes of one of their grandparents.

Weird News Andy call’s “Rocky’s Revenge” as a New York State hunter dies of a brain disorder after eating the brain of a squirrel he shot. WNA says the incidence of the variant of Creutzfeldt-Jakob disease is high around Rochester, NY, which is a long way from Frostbite Falls, MN.


Sponsor Updates

  • AdvancedMD will exhibit at the American Medical Billing Association National Conference October 18-19 in Las Vegas.
  • CompuGroup Medical will exhibit at the Arizona MGMA Annual Conference October 17-19 in Chandler.
  • Collective Medical partners with the Kentucky Hospital Association.
  • Imprivata’s Mobile Device Access completes validation for use with select Zebra devices.
  • CoverMyMeds will exhibit at the CBI Real-Time Benefit Check and ePrior Authorization Summit October 17-18 in San Francisco.
  • CTG will exhibit at the 2018 Northwest Arkansas Technology Summit October 22-23 in Rogers.
  • Cumberland Consulting Group will exhibit at the CBI Value-Based Oncology Management Forum October 23-24 in Scottsdale, AZ.
  • Direct Consulting Associates will exhibit at the Western PA Healthcare Summit October 19 in Cranberry Township.
  • Dimensional Insight will exhibit at the Value-Based Care Summit October 17 in Boston.
  • DocuTap is accepting nominations for its student scholarship program.
  • Redox will host its Healthcare Interoperability Summit November 13-14 in Denver.

Blog Posts


Contacts

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

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Morning Headlines 10/16/18

October 15, 2018 Headlines No Comments

Anthem Pays OCR $16 Million in Record HIPAA Settlement Following Largest U.S. Health Data Breach in History

Anthem will pay the HHS Office of Civil Rights $16 million to settle HIPAA violations from a 2015 data breach that impacted 79 million people.

Four Men and Seven Companies Indicted for Billion-Dollar Telemedicine Fraud Conspiracy, Telemedicine Company and CEO Plead Guilty in Two Fraud Schemes

HealthRight President Scott Roix pleads guilty to felony conspiracy charges related to a telemedicine scheme that bilked payers out of nearly $1 billion.

Varian Expands Cancer Care Portfolio with Noona Healthcare Acquisition

Cancer care technology company Varian Medical Systems acquires Noona Healthcare, a developer of oncology patient-reported outcomes software.

Dell Medical School Professor Joins Prestigious National Academy of Medicine

Dell Medical School Professor and former ONC head Karen DeSalvo, MD becomes a member of the National Academy of Medicine.

UMass Memorial Health Care lays off 17 workers

Faced with a $22 million operations shortfall, UMass Memorial Health Care lays off 17 IT staff as part of system-wide downsizing efforts that have included the closure of several facilities.

Curbside Consult with Dr. Jayne 10/15/18

October 15, 2018 Dr. Jayne No Comments

As an urgent care physician, I enjoy the satisfaction of being able to make a bad day better for many of my patients. Although I live in a major metropolitan area, there is a relative shortage of primary care physicians (at least ones taking new patients). For those patients who have primary physicians, there’s a shortage of same-day and after-hours appointments that mesh with patients’ busy schedules and their desire for convenience.

I’m happy we can meet our patients’ needs, but I’m often conflicted about the fact that delivering what is essentially primary care in an urgent care setting often contributes to the fragmentation of care. That’s in addition to the cost contribution, because a visit with us typically costs more than a visit to a primary care physician due to negotiated contract rates with payers and higher co-pays for patients.

The fragmentation could potentially be reduced through better technology, particularly better interoperability. Our EHR allegedly has all the interoperability bells and whistles, but local hospitals and their owned physician groups aren’t too keen on sharing data with competitors despite our desire to deliver better patient care. Our state HIE’s provider-centric pricing model makes it cost prohibitive for us to connect, given that the majority of our providers are part time. Even if it were more economical, our HIE is largely read-only, which doesn’t do a lot for the efficiency or accuracy of being able to bring patient data to life in the chart.

A good chunk of our patient volume happens before 9 a.m. and after 5 p.m., which is a testament to the fact that patients want to receive care at a time that is convenient for them, even if it might be more expensive. They also like being able to get care same day and not have to wait for 3-5 days for an appointment for straightforward medical problems. Many of our patients are hourly workers who don’t have paid sick time, and even those who have sick days may be challenged to find two or three hours to visit their primary physician during the work day.

I often think of the reasons behind why people choose to get their care when and where they do, so this Kaiser Health News article caught my attention.

The article covers the idea that millennials are at the forefront of wanting convenience when selecting their care and tend to choose urgent care, telemedicine, and retail clinic options. A poll of 1,200 adults found that younger patients were less likely to have a primary physician, ranging from 45 percent of patients ages 18 to 29 and declining to 12 percent for those age 65 and older. We see that play out in practice, whether it’s strictly due to the convenience angle or whether it’s due to a lack of available primary care capacity.

However, I’m seeing more patients in the Baby Boomer demographic who may have a primary physician, but choose to come to urgent care because they’re busy in their retirement and don’t want their schedules upset by needing to seek medical care.

I have several friends who are dabbling in telemedicine as an adjunct to their regular primary care practices. They report that patients have discussed their desire to handle medical issues at the time and place of their choosing, whether they actually get to interact with the physician face to face or not. Patients are used to transacting the business of their lives online, whether it’s banking or retail, and since healthcare has become a commodity, it’s no different.

One colleague notes that while the patients are glad she’s offering the service, many of them would be just as happy seeing any other physician and not specifically her. We’ve moved into a generation where patients no longer have a primary care physician for life. They may have one for three or four years and then have to change because their employer selected a different network, or they may change due to relocation and the more fluid lives that people tend to live now.

There are concerns that moving away from that continuity where physicians know their patients not only drives up costs, but also leads to inappropriate antibiotic use or misdiagnosis. We see patients who come in specifically because “my primary wouldn’t call me out a Z-pack” and spend a lot of time educating them about viral illnesses. At least we can send them home with medications to help with their symptoms, which makes them feel like they’ve done something to get better even if it’s not an antibiotic. There’s a powerful psychology in that.

We also see patients who have been to their primary care physician and also a subspecialist, but feel like their problem isn’t being addressed so they come to us “for another opinion.” It’s difficult to explain that we’re not experts and if they’ve been to a subspecialist at one of the local academic medical centers and there’s not an answer, that we’re unlikely to find one at the urgent care with our limited testing and radiology capabilities.

I’m particularly interested in the concept of delivering regular primary care via telemedicine, rather than just care for urgent and acute issues. Virtual visits have the power to revolutionize what we do, adding convenience for both patients and providers. In order to be successful, though, we have to get payers and policies aligned to pay for them so that physicians will be more likely to offer them. We also have to get technology aligned, including robust patient portals, the ability for patients to upload their own health data and documents, and better understanding from mid-career physicians that telemedicine isn’t going to suck away their evening and weekend hours.

I think about all the hours that my practice spent trying to track down patients and get them to come in for appointments back when I was in the primary care trenches. I would bet that at least half just disliked the process of going to the doctor and would have been game to do a virtual visit.

I’m excited about projects that pair community health workers with physicians to deliver a combination of in-home contacts with virtual physician visits, particularly in rural areas. A friend of mine recently received a grant in that regard, and I can’t wait to hear how it plays out in real life. I know she is having some challenges figuring out how to actually deliver the services, whether to try to integrate something with her EHR or to use a third-party telemedicine solution. It sounds like the options among vendors vary dramatically, so she is going to keep me posted on her progress.

Are you a physician who regularly incorporates virtual visits into care, or a healthcare IT person who supports one? I’d love to hear from you. Leave a comment or email me.

Email Dr. Jayne.

Readers Write: Hurricanes Michael and Florence Remind Us Why We Need a Data Backup Plan

October 15, 2018 Readers Write No Comments

Hurricanes Michael and Florence Remind Us Why We Need a Data Backup Plan
By Marty Puranik

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Marty Puranik is president and CEO of Atlantic.Net of Orlando, FL.

The immense flooding of Hurricanes Michael and Florence across the Florida Panhandle and southeastern areas of the Carolinas, respectively, is yet another business reminder of the omnipotent power of natural disasters. The devastating chaos and aftermath of the massive storms bring into sharper focus a humbling affirmation of the critical need to safeguard health data.

The data backup plan is a mandatory stage of HIPAA compliance requiring healthcare organizations to create, implement, and maintain a set of rules and procedures to follow when managing the backup and restore requirements of electronic protected health information (ePHI).

The data backup plan encompasses wider contingency planning processes that include your chosen business associate (BA) or managed service provider (MSP). The company engaged to remotely or on-site manage your plan must demonstrate a compliant backup service capable of backing up and restoring exact copies of ePHI. 

In choosing a backup service for business continuity and HIPAA compliance, it is critically important to understand the HIPAA Security Rule requirements. This rule demands a backup solution that adheres to the following criteria:

  • Use of data encryption. Backup data is expected to be encrypted at rest and in transmission. This encryption is achievable by using a storage hardware or operating system-level encryption techniques.
  • User authentication safeguards. Applying unique multi-factor password protection is accomplished using Active Directory and a token-based security key such as PKI.
  • Role-based access rules. Users are restricted access on a need-to-know basis following a least-privileged design. These measures help prevent access to backup data by unauthorized personnel.
  • Offsite storage capabilities. Backups must be stored in a separate location to production services.
  • Secure data center facilities. This measure applies to the facility security processes such as SSAE 16 SOC1 and SOC2 standards.
  • Detailed monitoring and reporting functions. Backups must be reported upon and alerts generated in the event of failure.

Moreover, leaving any best-laid plan involving patient data to chance opens to the door to security risks. Proactively test your data backup plan to ensure the MSP’s systems work harmoniously in any unexpected situation. Testing procedures can include:

  • File-level restore. A file-level restore involves one or several files restored to the file system. This can be set up on the original server or to a different location.
  • VM-level restore. If the MSP deploys virtualization technology, a full virtual machine restore can be performed. The server then can be tested for functionality.
  • Application-level restore. A common application restore is a database from inside a Microsoft SQL server instance or a mailbox from Microsoft Exchange. This test guarantees data integrity and verifies that correct permissions and security configuration are recovered.

I often recommend to providers to delegate the backup and restore responsibilities to a compliant cloud or backup-as-a-service (BaaS) offering. The MSP determines the type of backup media to use, which is usually disk-based storage. Once successful backups are achieved, the next step is the restore process for testing to validate the data’s integrity. The testing also assures the backup engineer’s ability to restore data in tandem with the precise speed of timing to complete the process.

Integration within a wider contingency plan is also essential as a failsafe for the data protection. Most MSPs offer disaster recovery technology capable of failing over data and services to a secondary location almost instantaneously. However, be aware that backups are often considered the last line of defense in the event of a catastrophic system failure. The contingency plan authorizes instant data restoration capability in the worst possible case scenarios.

To meet HIPAA security rule requirements, the BaaS platform incorporates offsite backup technology that will offload entirely the ePHI healthcare infrastructure to an external location. The offloading is most frequently performed through site-to-site replication technology or even by shipping backup tape media to a compliant external location. Since backup data is transferred externally over a network, determining the network security being provided by the MSP is imperative to prevent breaches.

Hurricanes Michael and Florence clearly bring into focus the need for emergency preparedness to protect the security of patient data. Indisputably, losing data has huge consequences for healthcare providers who routinely handle sensitive and private ePHI. For example, if access to a critical pharmacy, lab or EHR system is severed, a medical practice struggles to recover and continue its business operations. Reputations are damaged. More importantly, patient lives are put at risk.

Like insurance plans, a data backup plan is there when you most need it as an integral part of your overall business strategy. Before the next natural disaster strikes, what is your backup plan?

Readers Write: The Compliance Difficulties of Medical Device Connectivity

October 15, 2018 Readers Write No Comments

The Compliance Difficulties of Medical Device Connectivity
By Abbas Dhilawala

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Abbas Dhilawala, MS is CTO of Galen Data of Houston, TX.

There are numerous challenges facing the global healthcare ecosystem today, including aging populations that require more healthcare products and services; rising costs across the industry (shared among consumers, insurance carriers, healthcare providers, and taxpayers); growing wait times for medical services; and a growing demand for convenient and personalized care.

To address these challenges, medical device companies are beginning to produce medical devices with cloud connective capabilities that promote the digitization of healthcare and promote better physician-patient engagement while driving down costs. The global market for connected medical devices is expected to increase from $21 billion in 2018 to $63 billion by 2023, an annual growth rate in excess of 25 percent, according to one report.

Still, the path forward for medical device companies that want to design the connected medical devices of the future and get them to market isn’t always clear and direct. Medical device manufacturers are subject to extensive regulations and compliance requirements for the medical devices that they produce. A recent survey of 237 medical technology employees by Deloitte found something important: 67 percent believe that the current regulatory framework will not catch up with what we can do with medical device technology today for another five years.

Medical device companies today face a fractured compliance landscape that can stifle innovation and lead to heavy expenditures in compliance activities at the expense of research and development. Medical device companies that wish to sell their devices in the United States must comply with the quality regulations set forth by the United States Food and Drug Administration (FDA) in Chapter 21 of the Federal Code of Regulations, Part 820. The regulations include guidelines for ensuring the safety and effectiveness of medical devices, including the establishment of detailed design control documentation, the creation and maintenance of processes for corrective and preventive actions when non-conforming products are discovered, and requirements for document control and approval.

Quality system regulations exist around the world in different forms. Canada uses the Canadian Medical Devices Regulations (CMDR), while medical devices sold in Europe must obtain a CE Marking through compliance with ISO 13485, the international standard for medical device quality. Each time a medical device company enters a new market, it must demonstrate compliance with the corresponding local quality system regulations. Sometimes this means conducting a gap analysis and addressing compliance issues internally, but it could also mean hiring a Notified Body to conduct an expensive and time-consuming third-party compliance audit.

To help ease the path to compliance for medical device companies and reduce the cost burden of compliance activities, regulators worldwide are working towards a Medical Device Single Audit Program (MDSAP) that can establish medical device compliance for global markets based on a single audit. While this measure should reduce compliance costs for medical device companies, it remains to be seen how connected medical devices will be regulated under a new system.

As healthcare innovators continue to develop connected medical devices, privacy is a growing concern for regulators and industry professionals. Imagine a future where in-home care is increasingly common and where patients use wearable and implantable medical devices that deliver patient data electronically in real time to a central repository of electronic medical records.

Such a future might not be far off. The EHR mandate already requires hospitals and medical clinics across the United States to use electronic medical records to track patient data, and connected devices with data transmission capabilities already exist. What doesn’t exist yet is a common framework that promotes interoperability between connected devices and patient databases or any kind of privacy and security regulations that would safeguard such a system against malicious attacks that could compromise patient data.

The final compliance issue faced by manufacturers of connected medical devices has to do with changing payment models throughout the healthcare industry. As the industry shifts towards a model that compensates healthcare providers based on the effectiveness of treatments and patient care outcomes, government regulators and payers are increasingly asking for objective evidence that medical devices are positively impacting patient outcomes. Manufacturers of connected medical devices may face additional compliance obstacles when required to demonstrate that their devices actually improve patient engagement, satisfaction, and outcomes.

Despite the compliance difficulties faced by the industry, medical device manufacturers are meeting the challenge head on by innovating new ways of doing business, including funding models that offer data as a service, the adoption of value-based pricing, and the use of real-world patient data to drive business decisions. The medical device companies of today are ready to advance healthcare into the future. Now it’s up to healthcare providers and regulators to keep up.

Morning Headlines 10/15/18

October 14, 2018 Headlines No Comments

Cloud-Based Digital Pathology Startup Deep Lens Exits Stealth Mode With $3.2 Million Seed Financing

Pathology image detection support system vendor Deep Lens announces $3.2 million in seed funding and availability of its free VIPER service for pathologists.

Athenahealth has multiple bidders for sale of the company

Sources suggest that four private equity firms and activist investor Elliott Management are considering placing a bid to acquire Athenahealth.

Sloan Kettering Researchers Correct the Record by Revealing Company Ties

Several prominent Memorial Sloan Kettering Cancer Center researchers update their conflict-of-interest disclosures in previously published journal articles, adding previously undisclosed financial ties to drug companies.

Theranos Criminal Case Is Broader Than Publicly Disclosed, Prosecutors Say

A judge rejects a bid by former Theranos executives Elizabeth Holmes and Ramesh Balwani to block prosecutors from accessing over 200,000 company documents, alluding to a broader investigation that may extend beyond the two defendants.

Monday Morning Update 10/15/18

October 14, 2018 News No Comments

Top News

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Pathology image detection support system vendor Deep Lens announces $3.2 million in seed funding and availability of its free VIPER service for pathologists.

Co-founders of the Columbus, OH-based company are CEO Dave Billiter, MBA (Cardinal Health) and President Simon Arkell, MBA (Predixion Systems).

The company is based on work first performed at Nationwide Children’s Hospital in Columbus.

I like an uncredited quote in a company blog post that says you can’t rely too much on company experts whose user experience still makes them “FORMER experts in the field.” It also notes that product feedback from anyone other than a customer should be politely answered with, “Your opinion, although interesting, is irrelevant.”


Reader Comments

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From Biometric Believer: “Re: biometric ID. Would you mind asking your readers why, with advances in technology and increased fraud, hospitals aren’t deploying more iris scanning to patient care locations?” Good question, although I would expand your question to include palm vein scanning, facial recognition, voice recognition, and other less-used forms of biometric ID that hold equally promising potential without the need to approach someone’s eyeball with a scanner. There’s no question that all of these technologies work, only that consumer perception isn’t always great and healthcare and other industries (even banking) have resisted accordingly despite its obvious utility in fraud prevention. Some problems I see:

  • Cost. Although technology costs are going down, deploying biometric readers broadly is a big expense and requires a coordination effort that you don’t want repeat often as those technologies change.
  • Workflow integration, which has been mostly solved, I expect.
  • The creep factor. Years ago I got the job of convincing nurses that our newly implemented fingerprint scanning for drug dispensing machines did not mean we were storing their fingerprints or checking them for criminal history.
  • If hackers breach your system or someone grabs a patient’s fingerprints or takes a picture of their face, your patient is screwed because unlike passwords, they can’t change their biometrics.

My conclusion is that perhaps all of these problems could be solved by using the patient’s own phone as the biometric reader. People are happily using fingerprint recognition, voice recognition, and in some cases with higher-end phones, facial recognition to identify themselves for their own security. You would think that the hospital’s reader could connect via Bluetooth, although that’s a minor patient setup issue as well. Or, to address that issue as well as the fact that not everyone has a cell phone, maybe the hospital could use its own cell phones, handing one over temporarily to the patient to provide a less-threatening biometric ID process using a familiar consumer device.

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For Biometric Believer, I created a poll for providers to say if they’re using biometric patient ID or why they don’t. Vote and then add a comment to elaborate.

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From Arthur Allen: “Re: HIStalk. I spotted a rare error in Friday’s update. The VA’s assignment of Paul Tibbits to executive director for the Office of Electronic Health Record Modernization is not a direct replacement of Genevieve Morris. Title-wise at least, Tibbits and Morris differ. She was CHIO, but was also ostensibly in charge of OEHRM. Tibbits is the exec director and they described his job a little differently as well,  more of a liaison with OIT, leaving Captain Windom in charge of OEHRM.” Good point, thanks. John Windom, III led the Cerner selection and rollout by the DoD. Arthur is Politico’s e-health editor who made me beam with his “rare” adjective.

From Kermit: “Re: pre-existing conditions. NPR has a good analysis of the nuances.” The article notes that Republican leaders recognize that it’s politically unwise to take a stand against pre-existing conditions since at least 25 percent of us have them, yet their continued efforts to dismantle the Affordable Care Act and to encourage junk insurance plans as an alternative are making them legal once again after several years. Medicare and Medicaid don’t have pre-existing condition limitations, so claims by Democrats that everyone would be impacted by ACA changes isn’t accurate. HIPAA is a factor since most Americans get health insurance through their employer and HIPAA doesn’t allow those insurers to deny coverage or price premiums based on medical history, but even that’s complicated since some HIPAA protections were moved into the ACA and might die along with it if ACA doesn’t survive legal challenges given the White House’s strategy of not defending it vigorously. TL; DR: everybody hates pre-existing conditions except politicians, who will throw those who have them under the bus if it helps their party.


HIStalk Announcements and Requests

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I ran this poll to encourage folks who are struggling with an involuntary career change. Respondents who were fired, laid off, or relocated a few years back overwhelmingly say it turned out to be a positive development.

Marketing Guy was let go the same week he and his newly pregnant wife bought a new house, but he eventually got two job offers, took one that allowed him to move his family to Europe, and rose within that company’s ranks over 10 years. His advice is to keep working hard (even if that work involves job-hunting), keep learning, and stay positive. Hermanator was fired due to office politics from a company he had helped start, but he says it was the best thing that could have happened because he then started an even better company. He advises that folks take a break, reflect, learn from any mistakes they made, focus on their strengths, and find a new opportunity they can get passionate about.

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New poll to your right or here: which would you value most highly in your personal doctor? You don’t get an “other” or intellectually lazy “all of the above” option because it’s my poll and I know what I’m trying to assess, but those who feel deprived that they weren’t given an essay question can click the “Comments” link after voting and opine away.

Old friend of HIStalk Alex Scarlat, MD (we first corresponded sometime before 2011, I found by searching my old emails) is doing fun work on his own with machine learning. Check out his DogBreed.io, which can identify a dog breed from a photo with 97 percent accuracy (giving you some idea of the excitement behind using ML for diagnostic imaging analysis). He says he wrote it in under 50 lines of Python code. Alex has also done some work with weather prediction that is showing high accuracy. I have suggested that he consider writing a primer series on machine learning for clinicians for HIStalk, a non-technical review of what’s inside the black box and where it might be good (or not so good) for healthcare applications.

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I realized that my ancient Yahoo Mail account is a treasure trove of 80,000 emails going back to August 2004, 14 months after I started HIStalk (I don’t recall which email provider I used before then). Reading the names of defunct companies, seeing email from now-retired or deceased industry people, and marveling at my energy and exuberance in my emails way back then made me nostalgic. Yahoo Mail is still the best service I’ve used and its search is excellent, so let me know if there’s something fun I should search for (people, companies, unflattering terms, etc.) I found my first-ever interview from late 2004 that I thought was lost forever (with Meditech’s Howard Messing); planning emails from the first HIStalkapalooza in 2008; and threats from an industry magazine’s publisher who was unhappy that I ridiculed a newly assigned health IT reporter who was hired from a pastry magazine.


Webinars

October 30 (Tuesday) 2:00 ET. “How One Pediatric CIN Aligned Culture, Technology and the Community to Transform Care.” Presenters: Lisa Henderson, executive director, Dayton Children’s Health Partners; Shehzad Saeed, MD, associate chief medical officer, Dayton Children’s Health Partners; Mason Beard, solutions strategy leader, Philips PHM; Gabe Orthous, value-based care consultant, Himformatics. Sponsor: Philips PHM. Dayton Children’s Health Partners, a pediatric clinically integrated network, will describe how it aligned its internal culture, technology partners, and the community around its goal of streamlining care delivery and improving outcomes. Presenters will describe how it recruited network members, negotiated value-based contracts, and implemented a data-driven care management process.

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


Acquisitions, Funding, Business, and Stock

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Four private equity firms and activist investor Elliott Management are considering placing a bid to acquire Athenahealth, sources suggest. Pamplona Capital, which was previously rumored to be interested in acquiring the company and merging it with its NThrive holding, is not listed in the latest round of rumored potential acquirers but is presumably still in the hunt. ATHN will announce earnings on Thursday. Somehow you get the feeling that Elliott’s malicious manipulation isn’t going to be good for Athenahealth, its customers, or the health IT industry, but I’m sure some money guys will figure out how to enrich themselves while creating nothing more than mayhem.

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Valley Presbyterian Hospital (CA) tries to ride the coattails of the new Neil Armstrong movie “First Man” by reminding everyone that it was the first hospital to use telemetry-based patient monitoring back in 1966, when Spacelabs took NASA’s astronaut monitoring product into healthcare.


Sales

  • Drug maker Allergan joins TriNetX’s global health research network to analyze patient cohorts, choose study sites, and determine drug study protocol feasibility.
  • The Kentucky Hospital Association joins Collective Medical’s care collaboration network to allow state hospitals to identify patients with a history of substance abuse or treats to ED staff safety as well as to identify and support complex patients.

Decisions

  • Select Specialty Hospital-Johnstown (PA) will replace Medhost with Epic in 2019.
  • Maury Regional Health System (TN) will implement Cerner in November 2018, replacing Meditech.
  • Mercy Medical Center (MA) went live with Epic in September 2018.
  • Washington County Regional Medical Center (GA) will go live with Evident financial management on November 1, 2018.

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


People

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Wayne, PA-based behavioral health solution vendor Tridiuum hireshttps://tridiuum.com/tridiuum-expands-executive-team-with-cro/ Chris Salvatore, MBA (Halo Communications) as chief revenue officer.

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Intelligent Medical Objects promotes Eric Rose, MD to VP of clinical informatics.


Announcements and Implementations

Mayo Clinic has been going live with the Visage 7 Enterprise Imaging Platform along with its Epic go-lives, finishing up last week at its Jacksonville and Scottsdale campuses. Mayo now has a single enterprise imaging platform and diagnostic viewer along with Epic-driven interpretation workflow across its national network.

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Maitland, FL-based Therigy, which sells specialty pharmacy software for therapy support and patient assessment, says it has reached 100 million patient engagement activity and assessment responses. The company offers care plans and assessments for 20 conditions, with 900 assessments covering 400 medications.


Government and Politics

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A tweet by CMS Administrator Seema Verma implies that EHR vendors are responsible for the lack of interoperability adoption (which I’m wording intentionally as a combined technical and business problem as opposed to “lack of interoperability capability” as a purely technical issue). She says “doctors should be able to seamlessly exchange data between EHRs,” failing to note that many of them who are properly motivated already do in proving the product’s capability, while those using the very same EHR often remain as information silos.

The government of China expands its e-healthcare regulations:

  • Commercial companies can collaborate with providers to offer electronic diagnosis, telemedicine, or e-hospitals, but they can’t provide those services on their own.
  • Only licensed professionals with at least three years of clinical practice experience can offer online diagnostic services.
  • Patients can use online clinical services only for follow-up visits. Physicians must refer patients to traditional channels otherwise.
  • Remote consultation and prescribing is allowed as an adjunct to a hospital visit.
  • Controlled substances may not be prescribed as part of a telemedicine visit.

Other

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You won’t like this if you think HIMSS already has too much influence by running its own conference, media, and advertising empire and absorbing competitors by acquisition. HIMSS will help health services research organization AcademyHealth run Health Datapalooza 2019, which used to be a rather quiet conference targeting mostly federal government leaders and data wonks. You may take it to the bank (and HIMSS will) that the exhibit hall is going to get a lot bigger.

HIMSS haters might not like this, either. HHS will work with Healthbox (acquired by HIMSS a few months ago) to convene quarterly Deputy Secretary’s Innovation and Investment Summit meetings to ask investors which policies are standing in the way of innovation. Healthbox is a business accelerator that HIMSS acquired to expand its consulting, investment fund management, and startup assistance programs in uncovering yet another way to compete with its paying members.

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Speaking of HIMSS, they’ve yet to respond to my October 2 request for their non-profit Form 990 federal filing, which they are required by law to provide (but maybe not promptly), even though I notice that I fawningly and mistakenly said “please” twice in the same sentence. I’m always interested in its salaries, revenue by segment, and the occasional buried information about its acquisitions.

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The American Nurses Association’s journal celebrates National Health Information Technology Week with observations about EHR nurse documentation:

  • Data models do not accurately capture nurse assessment and interventions, focusing instead on patient demographics, diagnoses, and procedures instead of the actions that nurses take.
  • All care team members should be able to add to the electronic care plan documentation, including non-clinical information such as social determinants of health, and that documentation should be supported by health IT standards.
  • A study has found that the EHR requires 593 clicks for a nurse to complete the nursing admission assessment and that 31 percent of the required items were already documented elsewhere, motivating Vanderbilt University Medical Center to create a “click gatekeeper” team that must approve requests to add items to the nurse documentation record.

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Several prominent Memorial Sloan Kettering Cancer Center researchers update their conflict-of-interest disclosures in previously published journal articles, adding previously undisclosed financial ties to drug companies. One doctor added 31 company affiliations, while another’s updated long list of company ties includes being paid consulting fees, owning stock options, and co-founding a company. MSKCC says each journal has its own disclosure requirements and some require authors to disclose relationships unrelated to the study being published, complicating the issue.

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Weird News Andy titles this story as “CO and Old Lace.” In China, an anesthesiologist who was having an affair with the tutor of his children is sentenced to life in prison for killing his wife who refused to divorce him (his 16-year-old daughter also died as unintended collateral damage) by filling a yoga ball with carbon monoxide, removing the stopper, and placing it the trunk of his wife’s car. The deflated ball raised the suspicions of police, who then found that the doctor had ordered the carbon monoxide from his university employer claiming he needed it to perform animal tests.


Sponsor Updates

  • Intelligent Medical Objects chairman, chief innovator, and co-founder Frank Naeymi-Rad, PhD, MS, MBA will be inducted into the American College of Medical Informatics at AMIA’s annual symposium in San Francisco November 3-7.
  • InterSystems makes its IRIS Data Platform available in the Microsoft Azure Marketplace.
  • Waystar will exhibit at HFMA Region 2 Conference October 17-19 in Verona, NY.
  • Nordic will exhibit at the Georgia HIMSS Annual Conference October 16 in Atlanta.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the AWHONN Iowa Section Conference October 16 in Des Moines.
  • Recondo Technology will present at the Health Management Academy’s CFO Forum 2018 Meeting October 17-21 in Deer Valley, UT.
  • Experian Health will host its 2018 Financial Performance Summit October 22-24 in Dallas.
  • Redox partners with Smart Health Innovation Lab to help innovative healthcare startups accelerate time to integration.
  • Sunquest will exhibit at ASHG 2018 October 16-20 in San Diego.
  • Surescripts CEO Tom Skelton will keynote the Value-Based Care Summit October 17-19 in Boston.
  • T-System offers disaster relief sheets free of charge to hospitals in the path of Hurricane Michael.
  • Voalte will exhibit at the 2018 Michigan Nursing Summit October 18-19 in Lansing.
  • FormFast joins the Zen Healthcare IT Interoperability Community.
  • ZeOmega will exhibit at the 2018 CAHP Annual Conference October 22-24 in San Diego.

Blog Posts


Contacts

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

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Weekender 10/12/18

October 12, 2018 Weekender No Comments

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Weekly News Recap

  • Athenahealth is reportedly choosing from its options to accept acquisition bids from previously rejected suitors, sell out to NThrive, or continue as a going concern
  • Several hospitals evacuate patients and suffer damage from Hurricane Michael
  • The VA promotes Paul Tibbits to executive director for the Office of Electronic Health Record Modernization
  • The DoJ clears CVS Health to proceed with its $69 billion merger with Aetna
  • GE Healthcare’s former Value-Based Care Solutions Group, now owned by Veritas Capital, renames itself Virence Health Technologies
  • Mayo Clinic completes the final go-lives of its $1.5 billion Epic implementation
  • A study of 83 mostly top-rated hospitals finds that patients still struggle to get copies of their medical records

Best Reader Comments

Many states have information blocking (!) from their PDMPs. In fact, many state laws prohibit PDMP data from being exported outside the system to EHRs (it can only be seen in view-only mode on their web browser interface), making use in clinical decision support problematic. It’s not an issue of EHR vendor unwillingness, but rather that they can’t do an implementation if they can’t consistently get the data. (Harry Solomon)

Alerts seem like a perfect opportunity for an AI system rather than manual configuration files that will drive everyone crazy. (rxsdsu)

Tailoring every alert to each clinician requires work and maintenance far beyond the capacity, much less interest, of most IT departments. And, even people who rarely make mistakes still do make mistakes. Having a system that helps prevent that as a safety net is still relevant and helpful. I agree with you that too often a “one size fits all” policy is applied, which is inappropriate.  How much “tuning” can actually be accomplished is a yet to be seen outcome, but I’m not sure it is as much the hospital’s view of physicians as it is the financial and WorkStream reality we currently have. (Michael J. McCoy, MD)

As Warren Buffet has said, “When the tide goes out, it is easy to see who is swimming naked.” Jack Welch was really running a hedge fund within the GE Capital division. It accounted for over 50 percent of corporate profits many years. Everybody thought he was a management genius based on his PR announcements. Turns out he was nothing more than a hedge manager and the tide went out in 2009. He jumped ship and left the ruins to Jeff Immelt, who couldn’t turn it around for whatever reason. Now it looks like GE will follow many other firms like Xerox, Eastman, Alcoa, etc. Many years ago, I worked for GE and the inbreeding was smothering. (HISJunkie)

Totally agree with Mr. H about careers. Each time I was shown the door (boss conflict, downsizing, and failed salesmanship), I fell up to a better job, better pay, and more interesting work. Keep the resume ready, network all the time (it’s fun finding out who is where and what they are doing), keep records of your contacts, and keep reading HIStalk! (Laid Off)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. J-J, who asked for tablets and a printer for her Georgia class (whose 18 students, she notes, include six English language learners and three who are homeless). She reports, “The tablets we received allow students to work independently in small groups on lessons and activities that help to increase learning and comprehension. The printer has also been a huge help because now we can send information about school and additional practice work home to parents without hassle. I am beyond thankful that my class was chosen and was able to benefit from the generous donation that you sent.”

Here’s a summary of how my DonorsChoose project works:

  • I accept donations from individuals, but mostly companies willing to donate a significant sum in return for being included in my HIMSS-related activities, such as CIO/CMIO lunches.
  • Donors place their donation directly with DonorsChoose and thus receive charitable donation documentation directly from that organization for tax purposes. I never touch their money directly.
  • Their donation is matched by an anonymous vendor executive (who pretty much every HIStalk reader knows), doubling the original donation. That will continue until those matching funds are exhausted.
  • I choose STEM-related DonorsChoose projects that resonate strongest with me, most of those involving additional matching money from foundations.
  • I immediately describe on HIStalk the projects I chose, and when I receive updates and photos from the teacher involved, I post a summary. You don’t see them all right away since I run just one update each week, but I include all of them eventually.
  • As an example of the buying power of a donation, the project above totaled $735, which includes $30 to DonorsChoose for doing all the labor and an additional 20 percent general donation to DonorsChoose that I always select. Of that, the matching offer from Arthur M. Blank Family Foundation covered $368, and of the remaining $368, half of that was provided by my anonymous vendor executive. The original donor’s $184 donation thus provided this classroom with six Kids Edition Kindle Fire tablets and a Xerox wireless printer.

A researcher says high-profile cases, such as the Golden State Killer, that were solved through DNA forensics prove that just about every American could be genetically identified if just 2 percent of us have our DNA tested through consumer sites such as MyHeritage and Ancestry.com. Such matching requires only a third-cousin or higher relationship and the authors say that “such database scale is foreseeable for some third-party websites in the near future.” 

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Baylor St. Luke’s Medical Center (TX) threatened to punish an internist in “an assassination” in retaliation for his complaining about unnecessary services his patients received in the ICU. A private practice physician who serves on the hospital’s medical executive committee warned Tomas Rios, MD that “you’ve got to get the guy you’re going after and none of the people who were involved get implicated” and suggested that he resign instead. A hospital committee found Rios in violation of patient care standards just weeks later. The hospital says in response to his lawsuit that Rios is not a board-certified intensivist and opposes the closed ICU process that would place them in charge of all ICU patients, while legal experts have noted that hospitals have in some cases used peer review threats to silence doctors from speaking out about patient care issues.

Five New York City doctors are called “drug dealers in white coats” by the US attorney who has charged them with writing prescriptions for 5 million oxycodone pills to patients with no documented medical need who paid them $5 million. Neighbors called police several times to complain about lines of people at all hours outside of the office of one doctor who had two of his own employees, along with several patients, die of overdoses. Another doctor took in so much cash that he had to count it using one of those bill counters that banks use, after which he would hand out wads of cash to his employees. Another doctor prescribed 12,000 tablets for a single patient over five years. A pharmacist who received free lunches and a trip from a customer observed, “I guess you could call us licensed drug dealers. Oxy pays the bills around here.”

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A Chinese tech site finds that fitness trackers will display a heart rate when wrapped around anything cylindrical, most impressively a roll of toilet paper or the arm of a stuffed animal. Apparently the light sensors that attempt to detect a pulse rate are easily confused by reflections, although they still read a human pulse accurately.

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It’s all in the fine print: a small research study concluding that paper towels are better than air dryers in hospital handwashing was funded by the paper towel lobbying group.


In Case You Missed It


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Morning Headlines 10/12/18

October 11, 2018 Headlines No Comments

Athenahealth is reaching out to previously rejected suitors

The New York Post reports that Athenahealth is waffling between accepting acquisition bids from companies it previously rejected, merging with NThrive, or remaining as is.

2 Florida hospitals in wake of Hurricane Michael evacuating all of their 330 patients

Bay Medical Sacred Heart and Gulf Coast Regional Medical Center evacuate 330 patients after suffering extensive damage, including downed computer systems, during Hurricane Michael’s destructive trek through Panama City, FL.

Penn Medicine Launches Initiative to Transform Electronic Health Record Systems

Penn Medicine launches an internal EHR campaign that it hopes will get its Epic end users thinking about how to use the software more for care delivery than documentation.

News 10/12/18

October 11, 2018 News No Comments

Top News

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Bay Medical Sacred Heart and Gulf Coast Regional Medical Center evacuate a combined 330 patients after suffering extensive damage during Hurricane Michael’s destructive trek through Panama City in the Florida panhandle. Damage to the facilities included a collapsed roof, cracked walls, blown-out windows, and in the case of Bay Medical, cooling and plumbing issues and loss of its information systems.

Bay Medical cardiologist Sam Patel, MD told the local news Michael’s winds were, in his experience, worse than Katrina’s: “The wind damage was pretty phenomenal. Windows were being blown in and water was coming in. Luckily, none of our patients had any injuries due to the storm. It was about two to three hours of pure hell.”

The category 4 storm, which achieved wind speeds of up to 155 mph, caused the closure of four hospitals and 11 nursing homes in Florida.


Webinars

October 30 (Tuesday) 2:00 ET. “How One Pediatric CIN Aligned Culture, Technology and the Community to Transform Care.” Presenters: Lisa Henderson, executive director, Dayton Children’s Health Partners; Shehzad Saeed, MD, associate chief medical officer, Dayton Children’s Health Partners; Mason Beard, solutions strategy leader, Philips PHM; Gabe Orthous, value-based care consultant, Himformatics. Sponsor: Philips PHM. Dayton Children’s Health Partners, a pediatric clinically integrated network, will describe how it aligned its internal culture, technology partners, and the community around its goal of streamlining care delivery and improving outcomes. Presenters will describe how it recruited network members, negotiated value-based contracts, and implemented a data-driven care management process.

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


Acquisitions, Funding, Business, and Stock

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TransUnion acquires revenue cycle vendor Rubixis in an effort to strengthen its post-discharge revenue recovery services.

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Amazon patents speech analysis technology that may give Alexa the ability to detect illness and mood in a user’s voice, and then recommend and order products from Amazon’s marketplace. The patent filing also suggests that products and services from advertisers would be the first of Alexa’s suggestions.

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The DoJ clears CVS Health to proceed with its $69 billion merger with Aetna, which will operate as a standalone business once the deal closes at the end of Q4. First proposed late last year, the deal gained steam after Aetna sold off Medicity in May, and is now contingent on the payer selling off its Medicare prescription drug Part D plans. It has gotten pushback from trade associations like the AMA, which believes the merger will negatively affect patients by offering them fewer choices and, ultimately, higher prices.


Government and Politics

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The VA promotes financial management exec Paul Tibbits to executive director for the Office of Electronic Health Record Modernization. Tibbits takes over the role from Genevieve Morris, who resigned in August over differences with leadership in project direction.

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NASA pilots Wolters Kluwer Health’s UpToDate clinical decision support software aboard the International Space Station. To work around spotty Internet connectivity, astronauts are using the MobileComplete version, which gives them the ability to download content for offline access.


Sales

  • Sovah Health (VA) will implement lung cancer screening software from Eon at its Martinsville and Danville campuses.
  • Cornerstone Hospice and Palliative Care selects Netsmart’s MyUnity EHR for post-acute providers.

People

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AMIA will honor National Library of Medicine Director Patricia Brennan, RN with the 2018 Morris F. Collen Award of Excellence at its annual symposium next month.

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William Turner (GovernmentCIO) joins Healthcare Management Solutions as chief strategy officer.


Announcements and Implementations

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Penn Highlands DuBois (PA) goes live with tele-ICU capabilities from Advanced ICU Care that will connect its providers with specialists at UPMC.

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Avera Health will use an $8 million grant to develop a behavioral health team at its ECare telemedicine hub in South Dakota. Virtual services will initially cater to ED and psychiatric hospital patients, then expand to first responders.

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Urgent Care Group implements DocuTap’s EHR and practice management software at its MedCare Urgent Care facilities in South Carolina.

Surescripts sees utilization of its Record Locator & Exchange service jump 40 percent since launching last year thanks to increased adoption amongst Epic, NextGen, and EClinicalWorks users.

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Northern Light Health’s A.R. Gould Hospital (ME) transitions to Cerner as part of what seems to be a nearly system-wide roll out that coincides with a rebranding from Eastern Maine Health System.

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Good Shepherd Health Care System (OR) will go live on Epic next month through a $3 million sharing agreement with Legacy Health.


Other

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Penn Medicine launches an internal EHR campaign that it hopes will get its Epic end users thinking about how to use the software more for care delivery than documentation. The transformation project will include an innovation tournament that will pair IT staff, data scientists, and clinical educators with clinicians to create software improvements.

Public hospitals in Melbourne, Australia rake in $45 million in car parking fees thanks to daily rates as high as $35, and government officials who don’t mind turning a blind eye despite promising to lower prices. The public’s outrage has also extended to Sydney, where its Eye Hospital has earned the dubious honor of charging the highest parking rate in the country – $64 for six hours.

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Children’s Hospital of Philadelphia researchers use EHR data from its Epic system to develop an automated malnutrition screening tool that alerts providers to at-risk patients.

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Cerner CEO Brent Shafer shows off his musical chops at the company’s closing night conference bash.

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Military Makeover host Montel Williams credits the use of telemedicine by NYC paramedics with helping to save his life after suffering a rare type of stroke while working out in a hotel gym.


Sponsor Updates

  • Primus Capital’s growth investment in Hayes will support continued development of its MDaudit Enterprise revenue integrity software.
  • Elsevier provides point-of-care tools to NHS Wales in the UK.
  • The EClinicalWorks National Conference attracts over 5,000 attendees.
  • FormFast will exhibit at Health Connect Partners Hospital & Healthcare IT Conference October 15-17 in Chicago.
  • Glytec publishes a new e-book, “Hypoglycemia in the hospital: Why is it costing you millions and what can you do?”
  • Hayes will exhibit at the 2018 Revenue Integrity Symposium October 16-18 in Phoenix, AZ.
  • Iatric Systems will exhibit at the HIMSS Healthcare Security Forum October 15-16 in Boston.
  • InterSystems will exhibit at Healthcare Providers Transformation October 16-17 in Denver.
  • The American Medical Informatics Association will induct Intelligent Medical Objects CEO Frank Naeymi-Rad, PhD, MBA into the American College of Medical Informatics.
  • Kyruus will host the Annual Thought Leadership on Access Symposium October 15-17 in Boston.
  • Meditech will host the 2018 Physician and CIO Forum October 17-18 in Foxborough, MA.
  • AxialHealthcare will incorporate medication history from Surescripts into its analytics-based pain management software.
  • Diameter Health earns ONC 2015 Edition Health IT Module Certification from the Drummond Group.
  • PatientPing congratulates its national network of ACOs on generating shared savings of $270 million.

Blog Posts


Contacts

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

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EPtalk by Dr. Jayne 10/11/18

October 11, 2018 Dr. Jayne 2 Comments

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I was excited to hear that Atul Gawande, MD has been booked as the opening keynote speaker for HIMSS19. Many of us were initially enthusiastic about the efforts by Amazon, Berkshire Hathaway, and JP Morgan Chase to revolutionize healthcare delivery. That enthusiasm was somewhat tempered by the clarification that they’re really focused on solving the issue for themselves as employers, although it may eventually be extrapolated to the world at large. Regardless, Dr. Gawande has significant street cred in the healthcare trenches, and as a practicing physician, I’d much rather hear from him than from some of the other recent HIMSS headliners.

I was also excited to hear some information coming out of the American Academy of Family Physicians annual meeting this week. The American Board of Family Medicine used the meeting to announce a pilot program starting in January that will “assess the value and feasibility of a longitudinal assessment option to the 10-year secure examination.” Completing educational opportunities on an ongoing basis rather than cramming for an exam every 10 years is much closer to what we do every day in practice and was the preferred choice for recent exam-takers who were surveyed by the University of Florida in conjunction with ABFM’s assessment of the role of the exam. The questions will be administered quarterly and providers can use resources to find the answers, which better demonstrates our ability to manage knowledge rather than memorize.

I’m doubly excited since I have to recertify in 2019, although I already spent nearly $1,000 on a self-study board review course. The proposal still has to be approved by the American Board of Medical Specialties Committee on Continuing Certification in November. There aren’t any details on how large the pilot will be or whether everyone who wants to participate can actually take part, so I might still have to take the exam. I’ll be crossing my fingers, though.

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The use of ride-sharing services as an alternative to ambulances for transportation to the hospital is getting some coverage in mainstream media. Data from 2011 shows that the US spent $14 billion on ambulance services, more than a third of which was paid for by Medicare. Inappropriate use is estimated at approximately 30 percent.

Although it sounds like a good idea from a cost perspective, I’ve found that in practice, patients don’t do the best job of determining whether an ambulance is necessary or not. We’ve had patients in the midst of active heart attacks at our urgent care who want to argue with us about an ambulance transport because of the cost. I’d hate to see someone in that situation summoning an Uber to their home because they’re worried about the money.

In order for this lower-cost transportation to be appropriate, patients are going to need education on whether it’s the right option for them. Maybe the ride sharing services need to add some screening questions to the app to not only help patients, but also to protect drivers from unwittingly picking someone up who needs serious medical attention. So far, what I have heard about Uber Health is that it will allow providers to order transportation, but doesn’t necessarily address the issue of patients trying to get rides on their own. I’m still up for some screening questions in the apps themselves.

Last week, the US Senate sent for presidential signature a bipartisan package fighting the opioid epidemic. The bill passed the Senate by a vote of 98 to 1, showing that political adversaries can and actually will cooperate when the circumstances are right. The only opposition was from Senator Mike Lee of Utah. The 600-plus page bill includes relaxation on Medicaid payments for inpatient treatment, increased surveillance on opioids being imported by mail, and allows certain midlevel providers to prescribe buprenorphine treatment. It doesn’t appear to have been signed yet, but I’m keeping my eye out.

The opioid bill is timed nicely with the release of the Surgeon General’s report on “Facing Addiction in America.” Assisting in management of opioid use (not only prescription, but illicit versions) is an area where EHR technology can be expanded for better support of clinicians. It’s not just about making it easy to link the EHR to the state prescription drug monitoring program (assuming the state has one, which one state does not) but in getting those links into the right part in the prescribing workflows and making the connections fast enough that they don’t impede provider workflow. It’s also about providing clinical decision support including morphine equivalents for drugs patients are already taking as well as those providers are considering for a new prescription. These should be relatively simple things to code, but don’t seem to be given much bandwidth on the development calendars of vendors.

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It’s National Health IT Week, but I didn’t see a celebration in the physician lounge. Most of my local physician colleagues still see healthcare IT as a threat, not necessarily because of what it offers at face value, but because it’s a proxy for the perceived decline of medical practice as they used to know it. National Coordinator for Health Information Technology Don Rucker, MD blogged on the HIMSS site about how automation in healthcare is transforming medicine. Rucker talks a fair amount about the 21st Century Cures Act and its prohibition on information blocking.

Despite being signed into law in December 2016, it hasn’t done anything to improve information blocking in my region, which is largely due to competing health systems that refuse to share data even though they could do it fairly easily if they wanted to, especially now that all of them are on the same vendor platform. As an urgent care physician, I can’t even get their physician-owned practices to give me a medication list over the phone (despite the fact that it’s permissible under HIPAA for treatment, payment, and operations), let alone gain access to their clinical data repositories to find out what testing has already been done for patients before they arrive in my exam room.

Speaking of automation (or lack thereof), I’m still battling a billing issue with the hospital where I had emergency surgery over a year and a half ago. They sent me a bill last month for which I had no explanation of benefits document, which is unusual since I save every scrap of documentation around my healthcare. I hadn’t yet had time to call my insurance and see what the story was, but in the mean time, the hospital sent me to collections less than 30 days from the date of the statement.

I hopped on the phone to the payer, who had no record of a claim for that date of service, then had to call back to the hospital’s outsourced collections company, which provided me a supposed claim number. I called back to the payer to learn that the provided claim number didn’t even fit the standard format. They dug a bit deeper and found a charge for the same amount, but on a different date of service. It turns out it was paid, no one knows why I didn’t receive an explanation of benefits, and no one can explain why I was billed more than 18 months after the fact or why I was sent to collections less than 30 days after the bill was mailed. I paid my co-insurance online after sorting it all out, so hopefully this adventure is at an end.

What’s the longest running medical bill saga you’ve ever seen or experienced? What are you doing to celebrate National Health IT Week? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 10/11/18

October 10, 2018 Headlines No Comments

CVS Health and Aetna $69 Billion Merger Is Approved With Conditions

The DoJ clears CVS Health to proceed with its $69 billion merger with Aetna, which will operate as a standalone business once the deal closes at the end of Q4.

Amazon patents new Alexa feature that knows when you’re ill and offers you medicine

A new patent suggests that Amazon’s virtual assistant will soon be able to detect when someone is ill through speech analysis, and then propose Amazon products to treat their illness.

VA Appoints IT Vet Paul Tibbits as Electronic Health Record Program Executive Director

The VA promotes Paul Tibbits from program executive officer for financial management business transformation to executive director for the Office of Electronic Health Record Modernization.

TransUnion Expands Healthcare Solutions with Agreement to Acquire Rubixis

TransUnion acquires revenue cycle vendor Rubixis for an undisclosed amount.

Morning Headlines 10/10/18

October 9, 2018 Headlines No Comments

Former GE Healthcare Value-Based Care Solutions Group Rebrands as Virence Health Technologies

GE Healthcare’s former Value-Based Care Solutions Group, sold to private equity firm Veritas Capital in April 2018 for $1.05 billion in cash, renames itself Virence Health Technologies.

Share Your DNA, Get Shares: Startup Files an Unusual Offering

Startup LunaDNA, backed by a DNA sequencing company, seeks SEC approval for its business plan to pay consumers for the right to sell their genetic information.

Roche Turns to App in Fight Against Multiple Sclerosis

Roche develops a symptom-tracking for MS patients in hopes of using aggregated, de-identified data to improve its treatments for the disease.

News 10/10/18

October 9, 2018 News 6 Comments

Top News

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GE Healthcare’s former Value-Based Care Solutions Group, sold to private equity firm Veritas Capital in April 2018 for $1.05 billion in cash, renames itself Virence Health Technologies.

The GE Healthcare products that were included in the acquisition are revenue cycle, ambulatory, and workforce management systems previously sold under the Centricity and API Healthcare brands.

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Virence Chairman and CEO Bob Segert, appointed in mid-September, has zero healthcare experience. Former GE VP/GM and industry long-timer Jon Zimmerman will report to Segert as president.


Reader Comments

From Red Red Wine: “Re: careers. Why would you say that co-workers aren’t your friends? I socialize quite a bit with my work family at [vendor name omitted].” The people who might give you a ride to work from your oil change since they might need you to return the favor won’t be nearly as willing to serve as emergency overnight dog-sitters, listen patiently as you tearily describe your mother’s dementia, or know when and how to reach out supportively when you miss a few work days without explanation. I should probably take my own “work is not life” advice by not holding a grudge against former co-workers who I think wronged me in some way – it probably wasn’t personal that they were back-stabbing opportunists who were forged in an ugly corporate health system crucible that resembled one of those psychology experiments where a test subject will apply deadly electric shocks to an innocent victim when an authority figure insists. I guarantee that within minutes of your also-friendly employer marching you off their property in a layoff, your “work family” members are going to be unemotionally circling like vultures to get first dibs on your cubicle stuff.

From Conference Liner: “Re: Cerner naming social media influencers for CHC. Is that a thing now that HIMSS has been doing it?” Beats me. I don’t really get the point of naming “social media influencers” unless it’s to give them free registration in return for the free advertising they theoretically offer in return. It’s not as though tweeting is so hard that only Twitter experts can figure it out, or that those folks possess industry influence that correlates to their Twitter stats (since those stats don’t indicate exactly who they are influencing beyond each other). At least the Cerner-named influencers are mostly accomplished people who hold responsible jobs as recognizable subject matter experts.


Webinars

October 30 (Tuesday) 2:00 ET. “How One Pediatric CIN Aligned Culture, Technology and the Community to Transform Care.” Presenters: Lisa Henderson, executive director, Dayton Children’s Health Partners; Shehzad Saeed, MD, associate chief medical officer, Dayton Children’s Health Partners; Mason Beard, solutions strategy leader, Philips PHM; Gabe Orthous, value-based care consultant, Himformatics. Sponsor: Philips PHM. Dayton Children’s Health Partners, a pediatric clinically integrated network, will describe how it aligned its internal culture, technology partners, and the community around its goal of streamlining care delivery and improving outcomes. Presenters will describe how it recruited network members, negotiated value-based contracts, and implemented a data-driven care management process.

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


Acquisitions, Funding, Business, and Stock

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Odd: the soon-to-be-renamed Adventist Health System / Florida Hospital signs up as a multi-year sponsor of Nascar’s Speedweeks, heretofore to be reverently referred to as “Daytona Speedweeks Presented by AdventHealth.” Nascar, which must be happy to have signed a new sponsor as its attendance, TV ratings, and sponsorships continue their sharp slide, declares that “the Daytona Speedweeks brand will provide another platform for Florida Hospital to amplify their new name.” Hopefully the terms did not include requiring Florida Hospital’s doctors to wear ads on their scrubs or surgical teams to swoop in with their instruments like a pit crew to complete an appendectomy in less than 20 minutes.


People

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The National Library of Medicine promotes Clem McDonald, MD, MS to the newly created position of chief health data standards officer.


Announcements and Implementations

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China-based Tencent – which developed the globally popular (except in the US) WeChat app — will work with England-based Medopad to assess the condition of Parkinson’s disease patients by analyzing video of their movements and to alert their doctors of any deterioration. Tencent is working on other AI-related healthcare projects.

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Office Depot-owned CompuCom launches Self Healing Healthcare, a service that monitors end user devices for problems, outages, and failures.

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Blockchain-focused, UK-based health data rights organization Hu-manity.co launches in Europe to push for patients to control and manage their own healthcare data under the #My31 movement that advocates making such ownership the 31st Human Right. They’re also launching a US-only app to allow users to specify such control.


Privacy and Security

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Startup LunaDNA, backed by a DNA sequencing company, seeks SEC approval for its business plan to pay consumers for the right to sell their genetic information, the opposite of companies like 23andMe that charge people to sequence their DNA and then profitably sell their information on the sly. Donors earn shares in the “biobroker” company and post their de-identified information up for bid on its marketplace to keep a share of the proceeds.

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Google shuts down its spectacularly failed would-be Facebook competitor Google+ after deciding not to alert users that a security hole allowed their data to be hacked over several years. A Google committee advised executives that owning up to the breach would damage the company’s reputation and trigger a regulatory response a la Facebook’s Cambridge Analytica scandal, so it decided to close Google+ instead. A splendid Twitter review by former US Digital Service Administrator (and former Google employee) Mikey Dickerson says Google+’s self-proclaimed “social spine” infected the company’s other products, such as YouTube’s shared log-in and the termination of Google Reader. He concluded with a brilliant observation above. We science types appreciate Mikey’s LinkedIn tagline of “Free Radical.”

DataBreaches.net reports that virtual visit vendor MedCall Advisors has, for the second time in a month, been caught storing patient data in an unsecured Amazon S3 bucket. CEO Randy Baker did not acknowledge the courtesy notifications that were sent to him or ask those who alerted him about the exposure to delete any PHI they accessed.


Other

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Researchers advocate that EHR-powered electronic trigger tools be used to detect possible diagnostic errors and to identify patients who are at high risk of adverse events. The most obvious immediate benefit would seem to be to identify gaps in care cause by poor coordination, such as when nobody seems to have followed up on critical diagnostic results. The most limiting factor is the extent of clinical information stored as free text.

A BMJ opinion piece says the industry needs to do a better job of reducing the number of unwanted EHR alerts that consume physician time. Here’s the dilemma – we don’t let doctors individually decide based on their own practice which alerts to turn off because those “unwanted” alerts are often important, at least in the opinion of the non-doctors who maintain them. That brings up the never-ending dilemma of the purpose of the EHR – is it intended to help doctors, or instead to force administrative policies and concerns on them? I’ve worked a lot on those alerts and found these challenges:

  • Alerts are not always personalized (or cannot be personalized). A warning about a specific drug for a patient with kidney disease might be useful to a surgeon, but not a nephrologist.
  • An overridden alert, where the intended action is completed as an order, means the user, rightly or wrongly, didn’t find that alert useful.
  • On the other hand, doctors routinely fail to read EHR screens (due to alert overload, poor UI, or sloppy behavior) and will happily override a warning that prescribing 1,000 Tylenol tablets might be unwise and leave their error for someone else to catch.
  • My most important conclusion is that the quest to apply alerts universally is an illogical reflection of the collective nature of how hospitals see doctors. They know which ones have marginal skills or a record of causing patient mayhem, but they punish all doctors instead of just those who clearly need more than an average amount of electronic help to avoid screw-ups. Doctors should be regularly graded on their clinical track record, experience levels, malpractice and discipline history, and history of alert compliance, with the sensitivity of clinical alerts tuned to prevent them from making mistakes while not hindering those who rarely do so.

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A review of virtual online consultation platforms, aka virtual second opinions – specifically Medscape Consult – concludes that medical crowdsourcing can reduce diagnostic errors and increase global reach. The most valuable takeaway is that most of the doctors presenting cases were young, but most of the expert responses came from doctors over 60 years of age, suggesting that: (a) younger doctors can benefit from asking more experienced ones to weigh in; and (b) older doctors are technically comfortable enough to provide such wisdom. The authors note that they don’t have any way to determine whether those second opinions improved diagnostic accuracy, but it doesn’t matter – even if the original doctor’s conclusion was correct, having experienced peer validation provides confidence and perhaps reduces further expensive diagnostic work. Having face-to-face contact with patients is important, but this is an example of where armchair quarterbacking can provide real patient value and an opportunity for older doctors to contribute purely as an intellectual challenge without dealing with reimbursement, the limitations of a 15-minute encounter, practicing defensive medicine, or managing a patient’s entire medical life instead of just recognizing what’s wrong with them and then moving on.

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A fascinating New York Times article covers the MD-PhD co-founder of drug maker Regeneron, whose cholesterol-lowering drug is so widely useful yet so expensive ($14,000 per year) that insurers often won’t pay for it. The kicker: that co-founder is the guy who invented the drug and yet he pays full list price for his own prescription (so he claims, anyway) since the company’s insurance doesn’t cover it. He says Regeneron spent $2.6 billion to get the drug on the market and annual sales are less than $200 million.

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Pediatrics professor and New York Times contributor Aaron Carroll says the Apple Watch’s new EKG capability has quite a few negatives – few people have undiagnosed arrhythmias that don’t have symptoms, false positives and negatives can be worrisome and expensive, a Stanford study found that most of the Watch’s EKG warnings were wrong, previous large-scale studies found little value in mass population EKG screening, and that the device’s cost (which isn’t covered by insurance) means that people who would benefit most from it won’t get it. He advises, “But I’m under no illusion [Apple Watch’s activity monitoring] will help me lose weight or exercise more or improve my heart health. I own one because I want it, not because I need it.”

A Washington Post review finds that millennials often don’t have a primary care provider and don’t want one, favoring the convenience, speed, and upfront pricing of walk-in clinics and urgent care centers to meet their infrequent needs instead of PCP practices that require making appointments well in advance, cover limited hours, and send patients to the ED on evenings and weekends. The dilemma is that patients have to give up the benefits of longitudinal care because they value it less than convenience.

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Cerner Chairman and CEO Brent Shafer provides Monday’s opening keynote at the Cerner Health Conference in Kansas City, MO.

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I enjoyed this recap of the beginnings of Flatiron Health by co-founder Nat Turner, who with his also-under-30 co-founder had previously sold their ad business to Google for $80 million. They  decided to do something about cancer, figuring Flatiron would be a non-profit until they realized that “great engineers don’t work at non-profits. They tend to go to places like Facebook.” Flatiron bought oncology EHR vendor Altos Solutions with Google investment money barely after not even knowing what an EHR is, but quickly figured out how to mine EHR data to assess cancer drug effectiveness. Drug maker Roche bought the company six years after its founding in April 2018 at a $2.1 billion valuation. Cancer has made a lot of people poor, but a few people rich.

Anxious healthcare startups love to compare themselves to Uber or Facebook, but here’s a legal case where Uber can call itself the Epic of ride-sharing services. A court rules that Uber’s driver arbitration agreements are legal based on the US Supreme Court’s ruling in Epic Systems Corp. v. Lewis, which found that such employer-mandated terms preclude employees from undertaking actions as a class to address labor disputes.

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Tuesday was Ada Lovelace Day, honoring the mathematician – and arguably the world’s first computer programmer — who recognized the potential of the Analytical Engine theorized by Charles Babbage. She died at 36 in 1852 after doctors treated her uterine cancer with bloodletting. Her father was Lord Byron, although he bailed on Lady Byron early on and his daughter never knew him.


Sponsor Updates

  • Ellkay is exhibiting this week at the Cerner Health Conference, where it will demonstrate its LKArchive data archiving solution for accessing information from decommissioned legacy systems. 
  • Spok’s Connect 18 annual conference attracts 150 attendees to Scottsdale, AZ this week.
  • Smart Health Innovation Lab will offer Redox’s integration platform to companies that have graduated from its market accelerator program.
  • Howard Medical will offer Imprivata Medical Device Access on some of its medical storage carts.
  • AdvancedMD will exhibit at the American Society of Dermatologic Surgeons Annual Meeting October 11-14 in Phoenix, AZ.
  • Aprima and CompuGroup Medical will exhibit at the AAFP Annual Meeting October 10-12 in New Orleans.
  • Audacious Inquiry hires Christina Caraballo (Get Real Health) as director.
  • Arcadia will exhibit and present at the SRHO 2018 annual conference October 11-12 in Dallas.
  • Bluetree and Direct Consulting Associates will exhibit at the Health Connect Partners Hospital & Healthcare IT Conference October 15-17 in Chicago.
  • Bernoulli Health will present at the Connected Health Conference – Immersion Day October 17 in Boston.
  • Datica will present at the Cloud Native PDX meeting October 12 in Madison, WI.
  • CarePort Health will exhibit at ACMA North Carolina October 12 in Asheville, NC.
  • Diameter Health will speak at the HIMSS NE Health IT Advocacy and HIE Day October 10 in Worcester, MA.

Blog Posts


Contacts

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

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Morning Headlines 10/9/18

October 8, 2018 Headlines No Comments

Mayo Clinic completes installation of Epic electronic health record

Mayo Clinic wraps up its system-wide Epic implementation, dubbed the Plummer Project, with go lives at facilities in Arizona and Florida.

Liberty IT Solutions Awarded $11.4MM Computerized Patient Record System (CPRS) Enhancements Phase 2 (EP2) Task Order

The VA awards government technology contractor Liberty IT Solutions (a partner on the Cerner VA EHR project) an $11 million contract to further enhance the VistA-integrated Computerized Patient Record System.

Ochsner develops new approach to opioid prescribing in primary care

Ochsner Health System (LA) connects its Epic system to the state’s PDMP as part of an effort to help its primary care physicians avoid overprescribing opioids.

Curbside Consult with Dr. Jayne 10/8/18

October 8, 2018 Dr. Jayne 1 Comment

Although the majority of my work is in the CMIO space, I occasionally do some work for vendors. Depending on the vendor and the situation, it could be anything from participating in a focus group to helping design and execute on usability studies.

I’ve worked with vendors who truly get it and are just looking for supplemental input or outside validation for their strategies, but occasionally I work with a vendor that has some significant gaps. This week included successful interactions and one that left me perplexed, so I’ve decided to put together some thoughts for vendors on what to do (or not do) when seeking input from physicians.

First, vendors need to know what they hope to accomplish by interacting with physicians. Do you want an actual practicing physician, and if so, in what specialty or what setting of practice? If not, do you just want someone who “thinks like a physician” and can take you through typical diagnostic or management options? Do you want to work with physicians who understand both the clinical and informatics spheres, so they can provide input on the end user experience but also strategies for solving the problems they may help you identify? Do you want someone who can help with clinical guidelines only and needs no understanding of software and technology?

Working with physicians can be costly since many expect compensation for their time equal to what they would have earned seeing patients during the time they spent with you. It’s important to not only make sure you have the right type of physician, but also that you are prepared to spend your time with him or her wisely.

I worked with a company early in the week that knew exactly what they wanted. They provided a brief synopsis of the project and the assumptions they wanted to test with a physician. They provided that information with enough lead time that I could review it thoughtfully prior to our call. They made sure to let me know that they wanted to interact over video, which let me know that I shouldn’t be in my pajamas or look like I just came off the treadmill, which is occasionally my habit depending on how many calls and meetings I have in a given day.

When I joined the call, it was clear that all internal resources had joined with enough time to be set up and oriented and they were ready to introduce themselves and describe their roles on the project. They also asked me to say a few words about myself and my background, which allowed for adequate level-setting all the way around.

We worked through a product prototype first at a high level, with me giving initial impressions and the team documenting any questions I raised or elements that I didn’t understand. That allowed us to get through the entire workflow without being derailed by details or issues with the mock-ups. Then, we took a second pass through the prototype and addressed the areas where I had questions or didn’t understand where the workflow was going.

I think it was helpful to them that I understood that we were working with some enhanced wireframe designs and not actually software on some of the screens, so that I could phrase my questions around whether what I was seeing was just an artifact of the mock-up or whether it was actually a design element. We then took a third pass through the workflow, with the team allowing me to identify areas where I thought the flow could be enhanced or where functionality could be added to better meet the original design intent.

It was clear that the team was experienced in respecting the time of their audience and also that they had prepped for the call, knowing approximately how much time to allot for the different phases of review. It didn’t feel rushed, we didn’t end with a lot of time left over, and there weren’t too many items that needed additional follow up. They clearly took good notes during the call because they were able to come back to different comments I had given and read them back to me almost verbatim, asking for clarification or expansion on what I was thinking. The whole experience was challenging and fun, and I hope they’ll be interested in my feedback as the project progresses.

The vendor I worked with later in the week provided a polar opposite experience. It was a bit of a different situation to begin with, since the vendor is trying to introduce a new spin on existing workflow and technology rather than moving forward with an innovative product. In my opinion, that makes it challenging since anyone looking at their offering is judging it against their current technology whether consciously or not.

They were asking me to evaluate a new way to do work that I’ve been doing electronically for nearly two decades across half a dozen platforms with numerous upgrades on each. Although one could take the strategy that it would be good to have an experienced clinician who can provide feedback on what other vendors are offering or have tried in the past, the developer kept interrupting the conversation and going on and on about not allowing “the experience” to be hampered by “the technology of today.”

I didn’t realize there were going to be developers on the call. That’s always a tricky one since sometimes when you provide feedback, they can take it personally, and especially since they weren’t introduced when the call began. Having silent parties on a feedback call that suddenly jump in and start a conflict with your research subject usually isn’t an effective strategy.

The product owner tried to calm him down, but it wasn’t working. I tried to explain that unfortunately the workflow they’re trying to address is hampered by a litany of external requirements that they hadn’t addressed, such as governmental and payer regulations. It doesn’t matter what your UI looks like if it is going to force the end user to behave in a way that is going to cause trouble in the case of an audit.

Part of the exercise was for me to work through an alpha version without direction or training to evaluate how intuitive the workflow was. At one point, someone who probably thought he was on mute but wasn’t actually said, “She’s doing it wrong. Why is she clicking there?” When I replied, “I clicked there because every other screen has the ‘save and close’ button in the bottom right corner and that’s where my hand naturally flowed,” there was just a stunned silence. At that point, another member of the team took over the call and we moved forward in the workflow, but I had a hard time thinking of the product vs. whether someone was getting schooled out in the hallway.

The session ended about 30 minutes early. I wasn’t sure whether they were out of material or whether they were just flummoxed. Frankly I was glad for it to be over, because it was stressing me out and my treadmill was calling. I’m happy to help, but there’s a level of dread that they might ask me to work with them again. We’ll have to see how the next sprint cycle unfolds for them. I hope if they’re working with other physicians (they had better be, because when you’ve heard one physician’s opinion, you’ve heard one physician’s opinion) that it’s a more successful experience.

Do you have any advice for software vendors who are seeking physician input? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 10/8/18

October 7, 2018 Headlines 1 Comment

Assessment of US Hospital Compliance With Regulations for Patients’ Requests for Medical Records

A study of 83 mostly top-rated hospitals finds that patients still struggle to get copies of their medical information, with many facilities ignoring a federal requirement that they provide information in the patient-requested format.

These young cardiologists are opening tech-infused health clinics all over New York 

Cardiology practice startup Heartbeat is opening offices in New York City that will offer online tests, virtual care, and treatment plans that include exercise and nutrition components.

DoD rolls out new GENESIS sites, with hopes of fewer complaints about electronic medical records system

The DoD rolls out its Cerner-powered MHS Genesis EHR at a second round of facilities that includes Mountain Home Air Force Base in Idaho and three facilities in California.

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Reader Comments

  • The Trip: Love your new Get Involved section. Don't you know that I will be contacting you shortly!...
  • Vaporware?: No such thing as bad PR, i guess? If I was Cerner (or CommonWell ... is there a difference anymore?) I would not wan...
  • Ross Martin: File under HIMSS19 Advice... Here's a taste of the steady diet of marketing and life wisdom I've been sampling from g...
  • Lazlo Hollyfeld: Why would anyone assume a random poster on Seeking Alpha has much credibility when they write an overview of a publicly-...
  • Kyle: Sounds like CCF didn't employ very good "Rizk management"....
  • Lazlo Hollyfeld: Well the DoD just spent another $100M, now well over $6B, on an audit of its spending that was years overdue, failed aby...
  • Vaporware?: I thought Travis Dalton did a good job not insulting our intelligence and not lying... "hard lessons," "should have done...
  • DrJay: Thank you on the follow up and explaining what Black book says the process is. From my own personal experiences be...
  • Oh Really, Harold?: I just get red flags all over the place from this: * how does 2,194 round to 3,000? * why use two decimal places on KP...
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