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Readers Write: Uniting the Full Continuum of Care for the Individual: Why Digital Technologies Must Embrace Holistic Patient Engagement

April 17, 2019 Readers Write No Comments

Uniting the Full Continuum of Care for the Individual: Why Digital Technologies Must Embrace Holistic Patient Engagement
By Mary Kay Thalken, RN, MBA

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Mary Kay Thalken, RN, MBA is chief clinical officer of Ensocare of Omaha, NE.

More than half of healthcare professionals believe digitization is transforming the healthcare industry. Of adults 55+, 85% believe technology will improve healthcare in the next five years by delivering faster and more accurate diagnoses, curing diseases, and predicting and preventing diseases and conditions before they happen. However, 35% of seniors feel their health plans do not use any technology to improve access, information, or care, and they want more tech-enabled solutions.

Though the first two survey findings from 2017-2018 are encouraging, the third speaks loudly to this need: payer organizations as well as provider organizations must examine what is lagging in their technology offerings to better serve our biggest generation of people spanning the birth years of 1946 to 1964. From politics to fiscal projections, it’s reasonable to predict that Baby Boomers will have an outsized influence on the healthcare technology landscape for years to come.

The projected growth of this population has also caught the eye of Washington. In March, the US Task Force on Research and Development for Technology to Support Aging Adults and the Committee on Technology of the Science & Technology Council released the “Emerging Technologies to Support an Aging Population Report.” It identified six primary functional capabilities as being critical to individuals who wish to maintain their independence as they age and for which technology may have a positive impact:

  • Key activities of independent living
  • Cognition
  • Communication and social connectivity
  • Personal mobility
  • Transportation
  • Access to healthcare

Unquestionably, digitization is penetrating healthcare, including the burgeoning post-acute acute marketplace. In my role, I converse with leaders reshaping the patient’s continuing health recovery, from discharge to home health and hospice centers, skilled nursing facilities, rehab facilities, long-term care hospitals, or home. As a former nurse and provider business executive, it’s an exciting time to work in innovation on behalf of end users and patients who will benefit from enabling technology that unites the full continuum of care.

Why holistic patient engagement matters

Still, national survey results that look at the opinions of the senior population are a serious wake-up call, warning us all that a lot more work must be done – particularly in the critical area of patient engagement.

Granted it seems marginally small that only 35% of seniors think their health plans do not use technology to improve access, information, or care and have a desire for more tech solutions. Now consider this survey result in the context of the aging boomer population and their share of national health expenditures, which is expected to reach $6 trillion in less than 10 years. This powerful moment of clarity challenges the status quo, moving us forward in making tech-enabled patient engagement for adults 55+ a top priority.

Connecting digital technologies to the patient starts with a holistic view of that person’s entire care engagement experience. Subsequently, to unify the patient’s entire care experience through the use of technologies, we must zero in on what’s important to that person in terms of social determinants of health at every touch point. In short, we must create a tech-enabled, personalized experience specific to each patient’s individualized care and other needs, starting from within the hospital to discharge post-acute care facility or home.

The patient’s recovery or chronic care journey doesn’t stop there. Providers can address and integrate comprehensively the needs of patients who are spending more time outside instead of inside the brick-and-mortar walls of the hospital. We can effectively manage those patients — coordinate, personalize, individualize, and enrich their care alias tying all the disparate pieces together — to improve overall their experience, the goal of wellness, and outcomes.


Recommended best practices

On October 2, 2018, 48 health IT leaders from provider and vendor organizations gathered outside of Salt Lake City for one day to collaborate with KLAS Research. Participants developed a framework of key patient engagement initiatives and took part in discussions about best practices either observed or used. The following is those most often cited successful practices focused on the individual that healthcare organizations can use as a planning tool.

Technology

  • Create easy-to-use apps
  • Create cloud-based software solutions
  • Adopt telehealth capabilities

Analytics

  • Gather and analyze social determinants of health
  • Gather and analyze behavioral habits (travel patterns, transportation)

Convenient Care

  • Enable 24/7 access to care team
  • Enable communication with care team (text, email, phone, video)
  • Enable communication with patient (text, email, phone, video)
  • Enable families to communicate with care team (text, email, phone, video)
  • Allow patients to choose how they want to communicate

Right Care Setting

  • Direct patients to the appropriate care setting (nurse practitioner, urgent care, or primary care physician)
  • Let patients go to the care setting at which they will be best served
  • Bring the right care to the patient (24-hour nurse line, telehealth)

Personalized Care

  • Provide patient education and personalized discharge instructions
  • Assign health buddy or care manager to patients as they leave
  • Include patients in the process of setting goals and choosing interventions
  • Enable physicians and nurses to engage with patient during the encounter
  • Incent patients to participate in wellness activities and make healthy lifestyle choices

Provider Organization

  • Develop a patient engagement vision and road map
  • Adopt effective change management when implementing patient engagement strategies

Our industry is facing a colossal transformation over the next 30 years as value-based healthcare solidifies and Baby Boomers dominate the use of healthcare services. Despite their collective differences and perceptions, multi-generations—including the largest groups, the Boomers, Generation X, Millennials and Generation Z—working together creates the potential for creativity, community, coordination, and optimization of enabling technology solutions to enhance quality of life.

No doubt about it, a seismic shift to management and engagement of individuals is underway. To not prepare begets gaps in care that lead to poor outcomes and tremendous waste and spending.

Health System IT Professionals vs. Would-Be Disruptors: Unfairly Dismissive or Appropriately Skeptical of Outsiders?

April 17, 2019 News 2 Comments

I asked provider IT professionals to weigh in on this question, whose genesis was an outsider’s assessment via an HIStalk comment: do we health system IT people automatically dismiss potentially disruptive technologies (such as AI) because we are too entrenched or too well rewarded by the status quo?

The edited responses are below. Thanks to those who offered their excellent insights.


Outsiders have trouble with understanding the speed at which physicians want to move. They are one of few occupations still paid by the piece, not by the hour or a salary. Every second they are waiting for information to populate on a screen, the screen to flip, or the log-in sequence is a lot of money to them. Until you have a database faster than MUMPS, don’t waste my time. For that reason alone, blockchain is a non-starter.


I’ve been involved in minimally transformative ideas and projects that are shot down due to the (over) regulatory environment. A lot of industries are heavily regulated (airlines and nuclear power come to mind), but their regulations are generally around safety. In healthcare, the regulations are around both safety and the prevention of entities over-profiting (Stark). Sometimes these regulations contradict each other and the outsider only understands some of them.


I believe any technology that puts information and decision-making into the hands of the patient has the potential to be disruptive. This will not be a get-rich-quick application, Most people requiring our services are older and even less receptive to change than outsiders would perceive us to be.


They are correct. We actually look to see if incentives are aligned, like everyone else. We rapidly adopted pagers, cell phones, MRIs, and stem cell treatment when we were paid for it or it makes our lives easier. We didn’t rapidly adopt EMRs or other IT solutions when they made our lives harder and cost us money. The issue is not doing something new, it’s doing something reasonable. Make sure incentives are aligned with realistic business models before introducing anything new. One of my favorite quotes: “Incentives matter, whether you think they do or not.”


I think we probably are resistant to AI, but not solely because of incentives. There’s too much vaporware out there and it takes a lot of time to weed through the good and bad, with the good often being no better than the best systems already provide at the added cost of an AI system and/or of nominal value. If they want to blame someone, blame IBM, who taught us that you need to spend a year training your commercial software only to have it continue to provide inaccurate info. To be fair, it is providers that control the data that makes AI training work and our reluctance to share is probably an issue. On the other hand, Google did manage to wrestle millions of records away from the NHS and they still have nothing to show for it.


It’s the pot calling the kettle black. Everyone wants into the healthcare cash cow, but no one wants skin in the game when it comes to actual outcomes, and that includes providers.


Take a look at the technology adoption lifecycle. We’re still in the innovator phase and they’re not yet screaming from the rooftops to get on board. Technology adoption takes 10-20 years, even for consumer products (many of which in recent years had the benefit of being “free”). Why should they be expecting instant results?


We’re dragging our feet on AI when it comes to digital imaging so we don’t tick off providers. We provide a lot of exceptions where it may not work, yet we don’t fire the entire medical community when we have a misdiagnosis rate of 10%.


What disruptors don’t understand is that their solutions are typically unaffordable in the long term for health systems that like to spend more money building buildings than they do to support their existing IT infrastructure. The new shiny object may get some attention and might even get an executive to bite, but at the end of the day, it falls on IT to implement, support, and maintain that disruptive solution over time, all while our budgets shrink due to “cost controls.” The disruptors must demonstrate real-world (not hypothetical) ROI and in reality be at minimum a budget-neutral solution in order for us to take them seriously.


Treating people, while doing no harm, is an art in addition to science. Humans are not machines made to exacting specs that benefit solely from repeatable process. The chance of patient harm or malpractice is real with bleeding edge technology.


Everyone I know on the health IT side is very aware of our limitations and looking for any way we can help out the providers. AI/ML, although promising, so far has limited proven use cases. That, coupled with a very high barrier to entry due to the skills required, means that AI/ML often gets lumped into the “maybe, if we have money left over” part of the budget. Not a lot of healthcare organizations ever get to make it to funding that portion of the budget. Trust me, if you proved your ML model could improve clinical care and/or save lots of money, organizations would adopt it in a heartbeat. If you haven’t proven its value, then why would you expect us to adopt it?

Honestly, it sounds like a comment from someone who runs an ML-centric company and can’t find a partner to provide the training for their model. That’s a risk and investment for the healthcare organization, and typically the vendor gets most of the benefit if it works even though they tapped the provider’s knowledge and training to make the product. If you really want us to do that, show up with a fully-funded project, including our expenses, and we’ll consider it if you give us partial ownership of the successful project. At this stage of the game, that’s the only deal that makes sense.


You can kill people with the wrong tech, bad tech, or badly-implemented tech. As a clinician who supported clinical decision support, it is easy to talk it, but harder to prevent the medical misadventures that may happen to said Heath IT Outsider’s child.


Speaking as a provider who works in the vendor space, we prefer to wait and see what works in other industries before taking a risk and sinking big development dollars into expensive new solutions. Exhibit A: cloud computing, which went mainstream with Amazon Web Services in 2006, but only in the last few years have we seen this model take off in our industry with web-hosted EHRs. That’s why we’re always 15 years behind. None of the established players wants to spend $500m to develop a buzzword concept (remember “big data”?) that will fold or go out of fashion next year.


Next time you are sick, open your AI program get a diagnosis, prescription, and any blood tests. There is a place in healthcare for AI, but it is not replacing trained medical professionals


I’m guessing that comment came from a former Elizabeth Holmes devotee. Health IT outsiders have a long history of declaring the US health system stupid, launching a startup, then quietly giving up a year later. If our outsider had any real ideas, they’d have products in the marketplace making money. Optum, Health Catalyst, Arcadia, and many more aren’t waiting around for provider permission. They are innovating, pushing the quality-cost envelope, and growing. I don’t know if AI will truly move the needle positively in healthcare any time soon, but I’d have to hear a great conspiracy theory to believe provider IT people are protecting their EHR vendor from AI, open APIs, or any other technologies that would make the customers happier and their jobs more fulfilling.


As a health system CIO, Individuals who are flabbergasted by the risk-averse nature of the healthcare industry as a whole do not fully understand nor appreciate the current healthcare system business model. It has a customer (patient) market that is shrinking. It is becoming more segmented, with alternative specialized scope limited services. The net revenue opportunity per patient is shrinking as operating costs (especially labor and regulatory related) continue to increase.

Entrepreneurs by their very nature take financial risks if they see an opportunity for a high financial return when no one else does. There is a ton of cash flow within the healthcare industry, but no new opportunities for significant cash infusion The customers (patients) do not have any opportunity to shift their spending from one source to another. The industry players are protecting their revenue stream as best they can. Most healthcare providers and hospitals do not have an entrepreneurial spirit, nor do they have the financial reserves to take on the financial risks.

It is also important to note that the financial industry and venture capitalists do not invest in healthcare providers nor hospitals. The risk is just too high for no foreseeable reward. Thus, it is not surprising at all to me that “health IT outsiders” looking to be disruptors are disappointed when they are not embraced with open arms. I predict that someday there will be disruptors who will change the business model itself with a better SYSTEM of mousetraps rather than just one highly effective mousetrap.


I don’t see provider IT people as being entrenched or particularly well rewarded. Rather, we insiders are pragmatic. Too often we’ve been sucked in by the breathless exuberance of the purveyor of the next big thing that will revolutionize healthcare, only to realize that it’s not nearly what it’s cracked up to be. Or worse, we take the blame for it not turning out to be what it was purported to be.

Technology is evolutionary, not revolutionary. Incremental advances by potentially disruptive technologies – once field tested – make their way into the mainstream. Let’s not forget that a mere 15 years ago, EHRs seemed revolutionary.

Look at FHIR. The bright shiny object du jour which will solve all problems in the delivery of healthcare. Will this technology magically address every issue? Absolutely not. Or will it even address any of the issues better than some long-existing technology? I’m on the fence. Is FHIR really even disruptive? Nope. Interfaces have been around since there was more than one computer. But by being a pragmatist and viewing FHIR as an incremental improvement, I get painted as a curmudgeon.


I think there is an extreme sense of being jaded from a long list of previous failures. People often don’t understand the complexities of healthcare, the countless variations, the messy data, the fickle users mixed with the extreme regulations of privacy and billing. Add all of that to hospital bureaucracy, understaffed IT departments, and low-salaried (and therefore often mediocre) IT staff and you have more sub-optimal systems than you can count.


Healthcare doesn’t operate financially as other industries. I’ve spent the majority of my career in community hospitals and it is difficult for them to sink money into disruptive technologies when you’re payer mix is 40-60% government. We would love to invest in disruptive technologies, but when replacing an EMR originally installed in the mid-90’s causes a financial burden, what’s a girl to do?


What’s the evidence of benefit to (a) patients and their caregivers first; (b) physicians, nurses, and other bedside technical caregivers second; and (c) then everyone else? As a 40+ year emergency physician and 20+ year medical informaticist, let’s see the evidence that AI and other disruptive technologies deal with the chaos of patient variability and sensitivity to initial conditions better than the competent, compassionate physician.


This is healthcare. Ultimately, people’s live are literally on the line. There is no room for alpha or even beta level products in a production environment. If AI can do my job and help save lives, so be it. But that is not now and it is not anytime soon.


The workplace dynamics of provider-based healthcare are different than any other industry. Who is the customer? Is it the patient, doctor, nurse, CFO, payer, government, or someone else? Or all of the above?  Outsiders have not not been able to solve that riddle yet, although things may be changing with consumerism on the rise.

Also, in my long experience as a CIO (25+ years), it is rarely the CIO who calls the shots. Hospital CEOs are notoriously risk averse with a huge herd mentality when it comes to IT. The history of the industry is littered with multiple failures of so-called IT solutions. In addition, CFOs control the purse strings, and if they do not control IT, are out to hamstring it.

I have seen several outside CIOs try to “fix healthcare” and they have all failed to recognize the unique cultural characteristics.


I’m not worried about protecting my paycheck. There are always positions available in my particular medical specialty and my current income isn’t that great anyway. What I am worried about are the costs and potential negative consequences of inadequately designed and tested “disruptive technology.”

Healthcare technology is not like trying a bunch of free or cheap apps on your personal IPhone to see if any generate major or disruptive improvements. Instead, with healthcare technology, there are significant upfront costs (often with no guarantees of benefit or acceptance), significant personnel costs for installation and training, significant changes to workflow, and potential for unintended consequences, including inefficiencies, lost revenue, and actual harm to patients if it doesn’t work correctly. Indeed, I’d be concerned that anyone who jumps on the bandwagon too quickly is impulsive and reckless.

Add to that all of the half-baked snow jobs that we’ve been sold over the years and it’s no wonder that HIT providers (and users) are cautious and skeptical.


I welcome the challenge, but I am more often than not faced with those who do not want to accept that they don’t know the extent of what they DO NOT KNOW about the unique specifications of the industry. If only the industry was established in the status quo. Most who make such proclamations dismiss the history to the why and how we are where we are. Case in point — the Jim Cramer declaration and folks like Chrissy Farr who just pass along without doing the basic journalistic research on Epic. If they came about it with some sort of due diligence, it might be a different story.


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Morning Headlines 4/17/19

April 16, 2019 Headlines No Comments

Activist investor Jeff Smith: There is a ‘huge’ value opportunity in Cerner

Starboard Value CEO Jeff Smith believes Cerner can increase its operating margins by as much as 9% within the next 18 months if it meets unspecified targets.

In African Villages, These Phones Become Ultrasound Scanners

The FDA-approved Butterfly IQ device transforms a smartphone into an ultrasound scanner, a capability that is having a huge impact on pubic health efforts in Africa.

Advocates battle over health record consent change

Politicians struggle with the privacy and legal issues over changing patient participation in the HIE operated by Vermont Information Technology Leaders from opt-in to opt-out, which VITL says is needed because low participation has caused low HIE usage.

Clearlake-Backed symplr Acquires IntelliSoft

Provider management, credentialing, and payer enrollment technology vendor Symplr acquires competitor IntelliSoft.

Ro, a direct-to-consumer online pharmacy, reaches $500M valuation

Direct-to-consumer telemedicine company Ro raises $85 million, prompting VCs to increase its valuation to $500 million.

News 4/17/19

April 16, 2019 News 6 Comments

Top News

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The New York Times reviews the use of an IPhone-powered whole-body ultrasound scanner in Uganda and other developing nations. The $2,000, US-made device addresses the issue that two-thirds of the world’s population gets no imaging at all due to cost, geography, and machine availability.

The sign that the device is real – it has earned FDA’s marketing clearance. The sign that it works disruptively for public health – one of the company’s backers is the Bill and Melinda Gates Foundation, which unerringly funds projects that deliver the biggest bang for the global buck.

It’s a beautifully written and photographed article.

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The tap-and-swipe Butterfly IQ device offers 18 presets for images such as cardiac and deep abdomen. It stores data in Butterfly Cloud to offer HIPAA-compliant image sharing with patients and peers.

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The inventor is DNA sequencing pioneer and Yale School of Medicine genetics professor Jonathan Rothberg, PhD, who I hereby elevate to the top of my “most interesting people in health IT” list (and that’s a short list).


Reader Comments

From OOB?: “Re: Epic and Cerner. This article says they’ll be out of business within 10 years because their EHR technology is outdated.” That’s just attention-seeking silliness since surely nobody who has any connection to health IT could be that uninformed. I’ll offer just three of the many dozens of counterpoints that come immediately to mind:

  • Seeing Epic and Cerner as offering just “EHRs” – which is an awful and misleading term in the first place – is marking yourself as a clueless technology fanboy who has never worked a day in hospital IT. Their systems run every hospital department and service, including non-clinical ones, and then roll the vast amount of information up into a single database for operational management, reporting, patient access, etc. With what, exactly, would they replace all those systems, which are integrated with every kind of clinical device made?
  • It would take even a tech giant probably five years and $1 billion to develop a competing system assuming they could recruit the right subject matter experts, and given the maze of governmental, regulatory, financial, and clinical minefields to be navigated, no publicly traded company would devote the resources to get Version 0.1 into testing, much less find buyers among conservative health systems who have little interest in bearing the beta testing pain. Even Microsoft and Google couldn’t give away their crappy consumer-targeted personal health records and ended up shutting them down, so don’t expect them run off and responsibly build a laboratory information system or IV barcode scanning.
  • No tech company is working on anything at this scale. They might try to cherry-pick a few seemingly easy targets, but they aren’t hiring armies of people who know how healthcare works to help them design a system that would actually function beyond offering sexy screens. You cannot build healthcare software with 23-year-olds sitting in a Silicon Valley and slinging rad code in between company-provided foosball and beer pong.

From Dignity Defined: “Re: Cerner. Do you you see them cutting back?” All vendors whose sales were goosed by Meaningful Use (note to self – that would be a fun song title) are already cutting back in various ways and will continue to do so. I asked the question publicly when Meaningful Use first came into play of how vendors who geared up for a competitive battle of a fixed duration would gracefully downsize once the feed trough had been licked dry. Nobody could look past the boom years. Hospitals and practices will continue to buy products that provide ROI (why wouldn’t they?) but now that government’s contribution to the equation has been eliminated, software and services will have to pay their own way, which will likely involve lower prices, more tangible short-term benefits, and recurring costs that align with the benefits delivered. Cerner, Epic, and Meditech have won the hospital core IT system wars and the independent ambulatory market seems to be consolidating pretty quickly, so the ripple effects will be seen every aspect of health IT, especially consulting. Cerner is particularly vulnerable because it is publicly traded and has underperformed despite winning billions in federal government business, so in the absence of a fiery, singularly-focused co-founder at the helm, it must now redirect its attention to Wall Street type (although it’s been doing that for years, just to a lesser degree). Note that Cerner Millennium and maybe Cerner itself would not exist today if Neal Patterson hadn’t told 1990s investors that it would take a lot of years and money to create a new hospital IT architecture and they would just have to suck it up until it was done.

From Pistolero: Re: clinical decision support to detect questionably beneficial orders. Why isn’t it more widely used?” I would say:

  • Some and maybe most doctors don’t necessarily think minimum-necessary when ordering – they think more along the lines of, it can’t hurt to get more information while we’re drawing blood anyway
  • But it can hurt – the descent into the medical misadventure maelstrom often starts with a pointless test whose value must be conformed to normal range by aggressive therapy that is unlikely to improve and may in fact worsen a patient’s outcomes as armies of uncoordinated niche experts ply their trade aggressively
  • Doctors are trained around the paradigm of every patient being unique, and given that they see only their own small number of patients, they don’t always see the big health picture in which their patient is one data point in a see of historical information that, along with the N-of-one experience, will determine likely outcomes
  • Even questionably beneficial orders are profitable as long as insurers continue paying for them

HIStalk Announcements and Requests

I use AP Stylebook standards about 99% of the time when writing HIStalk (big exceptions – I always use an Oxford comma and I use post office state abbreviations, in both cases feeling as though AP is way off base in mandating a less-readable form). You probably didn’t notice that I started writing “99%” this week instead of “99 percent” because they just changed their standard. Today I learned from them that “farther” refers to physical distance, while “further” is an extension of time, so now I can obsess about that. Thank goodness they don’t use “everyday” incorrectly (as “I brush my teeth everyday,” which drives me crazy) or incorrectly capitalize a noun that isn’t used as a title (“I sent my Mom a present,” which is wrong). I admit that I’m sadly out of touch in believing that you show respect to those who listen or read what you have to say by following the grammatical rules of the road as best you can, although I’m offended only by obvious indifference usually encouraged by text messaging and posting Facebook nonsense.


Webinars

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


Acquisitions, Funding, Business, and Stock

Interoperability platform vendor Bridge Connector raises $10 million, increasing its total to $20 million.

HM Health Solutions, a 3,200-employee insurance-focused IT vendor owned by Pennsylvania-based insurer Highmark, lays off 239 employees. 

London-based Medbelle raises $7 million to create what it calls a “digital hospital” that sounds more like an online marketplace for cosmetic and weight loss surgery practices that also includes a care coordination platform.


Sales

  • Jefferson Health chooses Prepared Health as its digital technology partner for connecting its 14 hospitals to post-acute, home care, and social determinants of health providers for coordination of hospital-to-home care transitions.
  • Fullerton Health, which owns 500 medical facilities in the Asia Pacific region, hires Health Catalyst to assess its data analytics potential. 

People

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Denis Zerr (Catholic Health Initiatives) joins Radiology Partners as CIO.

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Change Healthcare promotes Dan Mowery to VP of channel partner and customer marketing.


Announcements and Implementations

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PMD adds video chat capability to PMD Secure Messaging application, extending support for telehealth charge codes for interprofessional teleconsults and virtual check-ins.

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InterSystems adds HealthShare Provider Directory to the 2019.1 release of HealthShare, providing a single source of truth for provider demographics and relationships. The release also includes a renaming of HealthShare Information Exchange to HealthShare Unified Care Record.

NPR observes that rural areas whose local hospital closes take an economic hit — retirees move out or look elsewhere, heavy industry bails because there’s no ED, and medical practices close because doctors don’t want to drive 30 minutes to see their hospitalized patients.

Meditech announces Expanse Labor and Delivery, which includes status boards, mother-baby recall, flowsheets, and fetal monitoring integration.

A Solutionreach survey of healthcare providers finds that patient relationship software that includes text messaging improves outcomes through reminders, reduces no-shows, and decreases phone time while increasing revenue.


Government and Politics

Vermont politicians struggle with the privacy and legal issues over changing patient participation in the HIE operated by Vermont Information Technology Leaders from opt-in to opt-out, which VITL says is needed because low participation has caused low HIE usage. Only in maple syrup-producing areas (Vermont contributes half the US total) would a politician describe the maturation of a policy “as it sugars off.”

The VA issues a $1.5 million, no-bid contract to Minburn Technology Group for HPE Synergy server modules and frames that will be used to convert 131 instances of VistA data to Cerner.


Privacy and Security

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India-based IT outsourcing giant Wipro admits that its systems have been breached in a phishing campaign, with hackers using the company’s own systems to attack its customers. Wipro, which sells cybersecurity services, has hired another firm to investigate. Wipro has 170,000 employees and annual revenue of $8 billion.

Facebook actively planned to provide user data to companies willing to buy it or to advertise with Facebook while denying the data to companies that it saw as competitive, all while putting on a public face of protecting user data, an NBC News investigative report finds. Reporters found few examples where Facebook executives expressed any interest in user privacy except as a PR strategy or in profitably selling data access to app vendors.


Other

The DC business paper confirms Dudevorce’s reader rumor that I ran Monday – Inova Health System will stop offering its MediMap genetic testing for medication response after FDA warns it that the test is being marketing illegally. Inova says it was told it by someone unstated that didn’t need FDA’s approval, but FDA made it clear that patients were potentially being put at risk because the unproven tests could lead to bad medical decisions. 

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Clinicians at Bagram Airfield, Afghanistan are trialing a trauma digital documentation system from T6 Health Systems, which the company says can integrate with Epic, Cerner, Meditech, and Allscripts. USAF trauma surgeon Lt. Col.Valerie Sams, MD  of the 455th Expeditionary Medical Group (on the right above) is leading the trial.

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Zuckerberg San Francisco General Hospital changes its billing policy to eliminate balance billing and to set an income-adjusted maximum on patient payments, courtesy of some fine investigative reporting by Sarah Kliff at Vox. Let’s give her the credit instead of the hospital – until the expose ran, they were perfectly happy picking the pockets of patients by intentionally remaining out of network with EVERY private insurer so they could tap ED patients – many of whom didn’t have a choice because it’s San Francisco’s only a trauma center – with high bills that were quickly sent to collectors. One might reasonably expect that hospital heads should roll for creating and enforcing this policy in the first place, but that won’t happen. The hospital recently toyed with the idea of ditching the Zuckerberg part of its name (bought with a $75 million donation) over Facebook privacy shame, but at this point they’ve soiled their own name worse than Facebook.

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Internist and health polity researcher Dhruv Khullar, MD, MPP writes a brilliant Stat editorial titled “Healthcare needs less #innovation,” making these points:

  • The US healthcare system can’t even provide basic care safely and consistently, performing worse than almost all peer nations.
  • As others have suggested, we need more “chief imitation officers” who bring home best practices from elsewhere rather than chief innovation officers.
  • We have “a dissemination and implementation problem” in failing to consistently use medical developments for an average of 17 years after they have been proven.
  • It’s nice to be in a swanky single hospital room hooked up to monitoring and Alexa-powered nurse call systems, but even nicer to know you won’t die of a catheter infection because someone failed to follow a checklist or use antiseptics improperly.
  • Today’s culture favors using the latest shiny technical object as a solution instead of addressing problems the best way.
  • Today’s tech startups follow the Theranos model of making grand claims while studiously avoiding publishing peer-reviewed studies.

A randomized clinical trial finds no evidence that workplace wellness programs work, as a large US company’s employees who participated said they they exercised more and watched their weight, but data analysis found no measurable improvement in their health, their healthcare expenditures, or their employment outcomes in the following 18 months.

In England, NHS Director of Digital Development Sam Shah says that hot technologies from other industries such as AI, virtual reality, and quantum computing should be placed on healthcare’s back burner in favor of building the less-exciting but vital underpinnings that can give consumers easier access, incorporate technology into care delivery, and to integrate data across IT systems and hospitals.

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An India-based paper says that the number of India-based doctors serving as scribes for US hospitals is growing quickly, noting that US-based, $6 billion IKS Health employs 450 doctors in Mumbai and Hyderabad to support customers such as Massachusetts General Hospital and plans to increase doctor headcount to more than 1,000 this year. One doctor says it’s a good deal for young doctors who not only earn money, but prepare to advance their careers by learning medical best practices and documenting care in sophisticated EHRs.

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InstaMed publishes its ninth annual report on healthcare payment trends, noting:

  • 90% of providers still bill and collect using manual, paper-based processes
  • 77% of providers say they rarely get payments within the first month of billing
  • 91% of providers get paid by paper check by at least one payer even though almost all of them would rather have money sent by EFT

Sponsor Updates

  • Mumms Software adds DrFirst’s e-prescribing and medication management capabilities to its hospice EHR.
  • CarePort will exhibit at the NAACOS Spring Conference April 24-26 in Baltimore.
  • The Texas Hospital Association features Collective Medical in its latest podcast.
  • CoverMyMeds will host a block party instead of a groundbreaking as construction starts on its $240 million headquarters.

Blog Posts


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Morning Headlines 4/16/19

April 15, 2019 Headlines No Comments

You can do a vision test from home in 34 states and go buy glasses, but not in Indiana. Here’s why.

Visibly (fka Opternative) takes several Indiana state agencies to court to overturn a law that prohibits the use of online vision tests.

Medusind Has Secured Investment From H.I.G. Capital

EHR and practice management vendor Medusind secures an undisclosed amount of financing from H.I.G. Capital.

AMA, Sling Health expand engagement with physicians and entrepreneurs

AMA and student-run biotech incubator Sling Health develop the Clinical Problem Database to give physicians the opportunity to share their experiences with health IT and clinical services, and entrepreneurs the opportunity to develop solutions that improve those experiences.

Curbside Consult with Dr. Jayne 4/15/19

April 15, 2019 Dr. Jayne 3 Comments

I was out with a friend on Saturday, at least until he had to leave to go to a planned downtime event at work. He mentioned that in all the years he had been with his company, it was rare for a downtime or disaster-recovery prep event to go as planned.

Maybe his industry has less tolerance than we do in healthcare, but it got me thinking about the impact of downtime in the patient care environment. The Journal of the American Medical Informatics Association published an article on this recently: “Clinical impact of intraoperative electronic health record downtime on surgical patients.”

Many of us just read the abstracts, and a quick pass yielded some interesting information. Researchers looked at the impact of EHR downtime events lasting more than an hour over a six-year study window. Specifically, they looked at adult patients undergoing surgeries more than 60 minutes in length during an inpatient stay lasting longer than 24 hours. Since it’s hard to do certain kinds of controlled studies on events like this, they matched more than 4,000 patients exposed to one of 176 downtime episodes with 4,000 patients who weren’t similarly exposed.

Looking at the math superficially, this means that the facility was averaging more than 29 downtime episodes a year, each lasting more than an hour. That’s pretty striking – approximately one every 12 days. I’ve never worked in a facility that had that kind of downtime and I can’t imagine the anxiety that clinicians might feel in that situation.

The authors found that although the patients exposed to a downtime event had operating room times and postoperative length of stay that were slightly more than unexposed patients, the 30-day mortality rates weren’t any different. In short, there wasn’t an appreciable link between the length of the downtime event and significant adverse events.

I wondered whether the sheer volume of downtime episodes might have been protective in this facility and decided to dig deeper than the abstract to find out more about the study site. The devil is in the details in this scenario, especially since the data was gathered at the Mayo Clinic. The identified downtimes could have occurred in any of the seven applications considered core clinical systems in support of the operating room. These included the anesthesia information management system, PACS, CPOE, clinical documentation, an integrated clinical viewer, the surgical information recording system, and the surgical coordination system.

Researchers categorized the length of the downtime as well as its impact, whether limited functionality was available or whether it was a complete outage. Scheduled downtime events were excluded as were those less than 60 minutes long. When matching exposed and unexposed patients, the team looked at day of the week as well as time of day to control for any variation in staffing, facilities, and EHR load. The patients were also paired according to surgical specialty, emergency / non-emergent status, and physical status.

The typical downtime was on a weekday between 7 a.m. and noon and was not a complete outage. The most commonly impacted systems were the integrated clinical information viewer, PACS, and CPOE. Surgical subspecialties most commonly impacted included general surgery, orthopedic surgery, and cardiac surgery. The median age of patients was 61 years, with a range of 49 to 71.

Although 30-day mortality wasn’t impacted by downtimes, interoperative duration was about 10% longer for the procedures where there were outages or interruptions. Longer operative times have been linked to greater risks of complications and also can lead to higher costs to the facility. In my experience, this also impacts physician morale, with surgeons who feel their schedules have been delayed becoming irritated and at times agitated. The operating suite is one of the parts of the hospital where the adage about time being money is truly applicable. They also noted a 4% increase in length of stay, which also has cost implications. Both increases underscore the need to have strong plans in place to help staff contend with unplanned downtime.

The authors further conclude that there is a need for future studies looking at scheduled vs. unscheduled downtime and parsing it down to specific systems to determine impacts at a more granular level. They also note the need to look at data from different facilities and healthcare settings. They also identified a limitation in the matching, namely that procedures weren’t matched year by year. Since there are constant changes in surgical technique and significant changes in some procedures, the year could have been a confounder. They also noted that, “In this context, it is not possible to generalize the results of this study at our institution to the potential impact of resilience and specific contingency planning to other hospitals.”

I don’t see other facilities planning to line up to bare their downtime data. Additionally, investigators at other institutions may not have the robust longitudinal downtime data that these authors had access to and they may not have the full cooperation of information technology staffers. I still see hospitals where the culture of fear is alive and well and efforts to study incidents in order to improve processes may still be met with suspicion. There are also those where downtime processes are fairly disorganized and they wouldn’t be suitable candidates for study.

I got a surprise Saturday evening when my friend reappeared unexpectedly from his downtime event. His comment about his company’s events not going as planned was prophetic because they actually canceled the downtime before it even started. It was good for a chuckle, although the theoretical risk of downtime events in the patient care environment is no laughing matter.

I’d be interested to hear what readers think about this EHR downtime study and whether they believe their institutions would be willing to undertake that type of analysis of their own data.

Got downtime? Leave a comment or email me.

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Morning Headlines 4/15/19

April 14, 2019 Headlines No Comments

How elderly, sickly farmers are quenching China’s thirst for data

Private healthcare company WeDoctor sends medical vans to rural areas to perform mandatory exams on behalf of the Chinese government, enabling it to collect enormous amounts of patient data that it uses to train its AI-powered diagnostic engine.

Highmark IT solutions company sheds 239 workers

After adding over 1,000 employees in the last five years, Highmark’s HM Health Solutions IT company lays off 239 workers.

Amazon Alexa is luring health developers, but it will be a while before we use it to call a doctor

Despite Amazon Alexa’s newly announced HIPAA compliance, privacy concerns will compel it to take baby steps in developing skills that will enable patients to connect directly with physicians.

British doctor-on-demand app Babylon bulks up US team to seize slice of projected $400bn market

After announcing last fall that it would spend $100 million to ramp up its hiring for its London-based operations, telemedicine company Babylon Health plans to more than double staffing for its US and Canadian operations.

Monday Morning Update 4/15/19

April 14, 2019 News 2 Comments

Top News

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A private company in China is deploying medical vans to rural areas to perform exams and to test urine and blood, but it’s not a benevolent government project. Private healthcare company WeDoctor (part of technology giant Tencent) offers the service so it can collect enormous amounts of patient data that it uses to train its AI-powered diagnostic engine.

Participation isn’t optional since the government requires villagers to submit to examination. They don’t necessarily know that a private company is involved.

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WeDoctor, whose valuation is several billion dollars, operates online hospitals, sells data to drug companies, and offers appointment scheduling and video visits. It is connected to 2,700 hospitals, 220,000 doctors, 15,000 pharmacies, and 27 million active users. The founder saw an opportunity to disrupt a clogged medical system in which patients wait in line for hours just to schedule an appointment or resort to buying timeslots from scalpers.

WeDoctor says it has the healthcare information of 180 million people, and while China has no laws that protect personal information, the company says it uses only de-identified patient data for its AI work.

China is gaining an edge in healthcare AI because government control allows collecting and using patient data in ways that would not be legal in most countries.


Reader Comments

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From Unilateral Disarmament: “Re: Cerner. The financial community is expressing amazement that Cerner paid so much attention to Starboard Value given the hedge fund’s low percentage ownership.” Quite a few experts are shocked that Cerner gave the Starboard Value hedge fund two seats on its board when it holds barely more than 1% of CERN shares. As one analyst said, 1% doesn’t give you much power to force change – just sell your shares if you don’t like the company’s operation, adding that two board seats usually comes only with a 5-10% position. Cerner rationalizes by saying it approved the new board members and they are well qualified (which they are), but the company did indeed capitulate quickly. They may regret that later now that they’ve invited a hedge fund into their house. Cerner also made it clear that they intentionally replaced visionary co-founder Neal Patterson (who, when healthy, would have told Starboard where to stick their ideas) with an “operator” in Brent Shafer, which sounds like a message that resonates better with a hedge fund than customers. He is an untested CEO and the whole “operational model” thing he keeps talking about sounds like something dreamed up by accountants rather than leaders, which if you are pandering to Wall Street, is probably the right thing to do. Maybe I’m just bitter in missing the competitive healthcare passion among pre-operator founders Neal, Judy, and Jonathan Bush.

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From Dudevorce: “Re: Inova Genomics. FDA warned them about illegally marketing their tests and predicting response to medications. Their MediMap web pages went down shortly afterward. Oncologist Donald “Skip” Trump, MD was hired by Inova to develop a cancer genomics program as the Inova Schar Cancer Institute. He recently disappeared from the Inova websites.” FDA issued a warning letter to Inova Genomics Laboratory on April 4, saying that its MediMap genetic tests for predicting medication response has not earned FDA’s marketing approval, also noting that the tests were being ordered by lab doctors with the results sent directly to patients without involving their own doctor. Links to the MediMap web pages now forward to Inova’s main site (I took the screen grab above from a cached copy). That other Donald Trump no longer appears under Inova’s “find a doctor” page.


HIStalk Announcements and Requests

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Most vendor poll respondents have seen business conditions slip in the past couple of years, whether than means reduced sales activity, provider consolidation that leads to bigger but rarer deals, or longer sales cycles.

New poll to your right or here: How much time do you spend each week reading healthcare and health IT news, online or in print, excluding social media but including peer-reviewed journals?

Listening: new from Darlingside, extremely likeable, Boston-based indie folkies who huddle around a single microphone and create amazing harmonies around thoughtful lyrics that sometimes involve a dystopian future of uncertain outcome. Perhaps I was just in the mood for it after spending extra time in bed Sunday morning reading old Rolling Stone interviews with John Lennon. You might picture him as having been bitter, cynical, and slightly wacky with regard to Yoko Ono, but only the last one is true – he was a troubled troubador who lacked confidence about his musicianship and just wanted to play 1950s American rock and roll as a guitarist who was “not technically good;” saw the Beatles through the lens of always being pressured to write songs even as he and Paul McCartney fought for album space and collaborated less and less over time; and worried about where the world was heading. It’s hard to believe how thoughtful, worldly, and searingly honest he came across even in early interviews in his 20s. You can feel his pain in this 1970 interview when he declared that the Beatles were the best rockers in Britain until Brian Epstein put them into matching suits and booked them for 20-minute shows instead of their usual 6-7 hours: “The Beatles music died then, as musicians. That’s why we never improved as musicians. We killed ourselves then to make it and that was the end of it. George and I are more inclined to say that. We always missed the club dates because that’s when we were playing music, and then later on, we became technically efficient recording artists – which was another thing – because we were competent people, and whatever media you put us in, we can produce something worthwhile.”


Webinars

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


Acquisitions, Funding, Business, and Stock

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The Detroit business paper profiles Detroit Medical Informatics, an EHR consulting firm started in 2015 by Hass Saad, MD. He says the company is generating $4-6 million in annual revenue, has four full-time employees, and works with 300 physician consultants in serving 20 clients.

A Stat editorial compares the proposed information-sharing rules of ONC/HHS to the Protestant Reformation, where information previously accessible only to priests was made available to everyone via the newly invented printing press, but notes that the final rule could be diluted through the influence of the AHA and lobbyists who are not fans of losing Medicare money when caught hoarding patient information out of competitive spite.

It’s interesting when member organizations change their names or membership criteria to spur growth outside their original mission, such as CHIME when it weakened its membership criteria to include non-CIOs. The latest is AONE (American Organization of Nursing Executives), which in realizing that the “executives” part of its name limits its membership count, has thus decided to rename itself American Organization for Nursing Leadership. The doors have been flung open to dues-payers who are “not just defined by your title, but above all by your actions.” Someone should do a study on how much hospitals spend on dues and conference attendance whose value is primarily driven by vanity.


Decisions

  • Humboldt General Hospital (NV) will replace Medhost with Cerner in November 2019.
  • Kingman Regional Medical Center (AZ) will implement Meditech this spring, replacing Cerner.
  • Van Wert Health (OH) switched from Cerner to Epic in June 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.


Other

Imprivata explains further the Windows API flaw it commendably discovered in testing its product against new Windows updates (and which Microsoft not-so-commendably broke with a failing API with no acknowledgment to developers who rely on it). I agree that the QE team deserves acknowledgement – I’ve been loaned out to testing teams over the years and it is thankless, unbelievably complex work where 99% of the tests turn up no problems, but some weird example fails only in a particular series of steps that must be replicated and documented for fixing. Those testing teams I worked on also got no love from developers, who were more exasperated than appreciative that their bugs were caught before code was shipped, so it’s nice that Imprivata gives those folks a shout-out:

Imprivata’s core Epic user switch functionality continues to work as intended with or without the Windows API. Instead, the feature that was affected by the API deprecation was a failsafe mechanism and not core functionality. For this to be seen at a customer site, a series of unfortunate events would need to occur, and we would define it as more of an edge case. However, due to the potential it has on our customer’s clinical workflows, we felt it important enough to notify our base as soon as we discovered it. Kudos to our QE team for finding this during our qualifications!

Researchers find that cancer surgery outcomes are poorer in affiliates of top-ranked cancer hospitals that share their name. The authors conclude that hanging the big-brand cancer center’s name on the affiliate makes patients think they will receive care as good as that delivered by the mother ship, but that doesn’t actually happen. To me, the fact that a cancer hospital is a desirable brand is a troubling in itself – having worked for a hospital that affiliated with one of the big names, we talked a lot about sharing protocols and tapping the Big Cancer Center’s expertise, but I’m not sure it really made a positive difference. The health system eventually dumped the affiliation for that of another Big Cancer Hospital, which should have raised all kinds of questions about the before-and-after advantages, the cost to rent the big name, and whether patient outcomes changed as a result.


Sponsor Updates

  • Netsmart will exhibit at the NHPCO Leadership and Advocacy Conference April 15-17 in Washington, DC.
  • Sansoro Health releases a new podcast, “Tacking Information Blocking with an ONC Expert.”
  • Surescripts will exhibit at the 2019 OCHIN Learning Forum April 16-18 in Portland.
  • Vocera will exhibit at the 2019 Argentum Senior Living Executive Conference & Expo April 15 in San Antonio.
  • Wolters Kluwer Health CEO Diana Nole discusses areas where AI will impact future patient care.

Blog Posts


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Mr. H, Lorre, Jenn, Dr. Jayne.
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Weekender 4/12/19

April 12, 2019 Weekender No Comments

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Weekly News Recap

  • Cityblock Health raises $65 million just three months after announcing a Series A round of $21 million
  • Partners HealthCare (MA) will equip its clinicians and researchers with the tools necessary to develop their own AI algorithms
  • Cerner bows to pressure applied by an activist investor by appointing four new board members as nominated by hedge fund operator Starboard Value
  • Microsoft announces that it will shut down its HealthVault personal health records service on November 20, 2019
  • Google Cloud opens its healthcare API for beta testing
  • Urgent care EHR/PM vendor DocuTAP and urgent care solutions vendor Practice Velocity announce plans to merge

Best Reader Comments

I’m assuming that the single-digit margin you refer to is the margin on your institution’s whole operation, and therefore represents money that is left over after the institution pays for all its costs (salaries, equipment, etc.). Your vendor’s 30% margin is, on the other hand, probably the margin on a single product – and the only costs that are covered before that 30% margin are costs that are directly related to that single product. The 30% margin goes on to pay for things like accounting department, promotional efforts including sales team (without which there would be no business), facility, investment in R&D for new products, and so on. It’s not really an apples-to-apples comparison. (Clustered)

If your primary purpose of going to HIMSS as a vendor is to get quantified leads and build sales pipeline, don’t get a booth if you are a small or mid-sized vendor. (Lazlo Hollyfeld)

I really don’t understand why half of Wall St. is just putting blind faith in Apple. This basically amounts to “healthcare is a big industry, Apple is a company that could take advantage of this industry”. Do any of these analysts realize that Apple devices and the App store are already used in healthcare? And that it’s not making an impact on patient outcomes or the company bottom line? (Elizabeth H. H. Holmes)

My understanding is Cerner is making the Soarian Financial customers migrate over to the Millennium financials. However if they are trying to meld the two together to make a super system in concert with the Millennium Clinical system (so actually three together) does anybody who has been in the EHR industry for the last 3-4 decades think that can really work this time? The EHR minefield is littered with craters of vendors who tried to create a synergy between technologies that were created under separate paradigms and methodologies. (Smartfood99)

If you are trying to attract CIOs from non-profits to your event at Pebble Beach, please don’t. Some younger CIOs may not appreciate that this could end their career. Experienced executives will know that events like this or like the one I have turned down three times – attend the Masters and then play at Augusta – are just not worth being fired for over a compliance issue. We may not like the rules, but if we choose to work in this industry successfully, we need to follow them. (Justa CIO)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. T in California, who asked for lap desks and floor cushions for her kindergarten class. She reports, “Thank you for your generous donation to give our class materials for flexible seating in the classroom. My kindergarten students were so excited to see the new lap desks and cushions. They love being able to move around the classroom more while they are working. The days are long for kindergarten students, and being able to have a more flexible seating arrangement is helping my students to have more fun while they are working. Sitting in a chair all day long is difficult, and gets boring for many students. The lap desks give my students a chance to sit in a different place in the classroom. They also feel special when they are using the flexible seating.”

Boston Children’s Hospital sues a Saudi prince who volunteered to cover the treatment cost of a two-year-old girl with a rare genetic disorder, then ignored the hospital’s bills for $3.5 million. The hospital says they wouldn’t have admitted the child without his promise of financial backing.

Those who have never worked in a hospital can’t imagine what it’s like on the front lines of human misery and emotion and to have horrible images burned forever into your brain. Example: a Texas man whose grandchild was in the PICU after being severely beaten threatens to kill the hospital’s nurses and the grandchild because employees couldn’t give him information about the child’s condition.

Apparently there’s no limit to our demand for Elizabeth Holmes-related entertainment as the Theranos story will get yet another on-screen treatment, with SNL’s Kate McKinnon playing the disgraced CEO in a Hulu limited series. I’m sensing a missed opportunity here – Holmes is tarnished for life, so why not just do her own documentary, drama, or instructional video? I bet plenty of people would pay for personal coaching in how to run a personality-driven scam.

Tesla is reported to have strong-armed the doctor who runs its on-site factory clinic to keep worker injuries off the books to make its workplace injury record look better and to reduce its self-insurance costs. One of the doctors who could be counted on to give company-friendly diagnoses was about to lose his medical license for sexually assaulting two female patients.

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New York’s health department investigates Danielle Roberts, DO for branding women with the initials of Keith Raniere and actress Allison Mack as part of their NXIVM sex-slave cult, of which she was a member. You have to wonder what could have convinced her that this was OK. She’s now hawking memberships in a holistic healing group she formed. Now every time I hear Twitterati yapping about their anemic “personal brand” I’ll think of these images.


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Morning Headlines 4/12/19

April 11, 2019 Headlines No Comments

Better care, block by block.

Cityblock Health raises $65 million just three months after announcing a Series A round of $21 million.

Teladoc Health to Develop First Pediatric-Specific Consumer Telehealth Platform with Cincinnati Children’s

Teladoc Health will work with Cincinnati Children’s Hospital Medical Center to develop telemedicine software for pediatric hospitals.

Physician-researcher awarded federal grant to bridge evidence and practice for clinicians via electronic medical record

AHRQ awards Northwell Health (NY) SVP Thomas McGinn, MD a $1 million grant to further his work on developing a clinical decision support system that integrates seamlessly with EHRs and presents minimal disruption to provider workflows.

LRGH losing $1M a month

Hospital management company LRGHealthcare (NH) blames a a $13.3 million operations loss in 2018 on an expensive Cerner install and millions paid to service outstanding debt.

News 4/12/19

April 11, 2019 News 3 Comments

Top News

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Cityblock Health raises $65 million just three months after announcing a Series A round of $21 million.

The New York City-based company was spun out of Alphabet’s Sidewalk Labs in 2017.

The company offers care coordination services and technology that cater to Medicaid patients in underserved areas.


Reader Comments

From Ralestorm: “Re: Windows APIs. Check out this problem, in which a sign-off Epic user’s session is restored when a different user logs in afterward. I’ve seen this with other systems and vendors as a CMIO over the years.” This is a timely reminder that APIs create dependencies that can screw things up. Imprivata found out from internal testing that a Microsoft Windows 10 API is no longer working, so that when users switch within a XenApp session, the new user will be dropped back into the previous user’s session. The interesting aspects are these:

  • Microsoft has never told software developers who use the API that it is no longer working or why it’s broken. It has not been officially deprecated, but reports are widespread that it fails.
  • Imprivata caught the problem in its Windows 10 testing, which a lot of vendors might not have done.
  • The problem is technical, but the result could be clinical – users could sign on and inadvertently start entering orders on the wrong patient.
  • Imprivata has modified its OneSign agent to use a new Windows API and will post a hotfix before qualifying Windows 10 1809, a nifty bit of release coordination.
  • Microsoft is touting its new commitment to healthcare, and while this is not a healthcare-specific issue, it might make you wonder whether it really understands the critical nature of its internal APIs and has the communications channel in place to work with vendors who rely on them.
  • As quaint as it seems today as everybody pins interoperability hopes on APIs, this is the problem that healthcare software vendors avoided years ago by refusing to use third-party software components published by companies whose conduct and business outcomes were outside of their control. 

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From Jiggy Jardust: “Re: Cerner. Will it follow the path of Athenahealth now that an activist investor is embedded?” Maybe. My thoughts:

  • Cerner’s share price has been going in the wrong direction for quite some time, even now down considerably since before it signed huge contracts with the DoD and VA. Clearly the company wasn’t impressing investors.
  • The hedge fund activist investor Starboard Value wasn’t as venomous as the one involved with Athenahealth’s – which used some truly deplorable smear tactics to get Jonathan Bush fired so that the reputation-faded Jeff Immelt could broker a questionable deal to sell out – and Cerner was unusually pliable about agreeing to making changes even before the hedge fund had a chance to go low. Starboard wasn’t even a significant holder of CERN shares.
  • Brent Shafer had already laid out Cerner changes, but whether he will survive in his first CEO job reporting to an activist-heavy company board of nearly all new members is anyone’s guess.
  • Whether you like Cerner’s changes may well depend on whether you are an investor or a customer. The recent announcements seem to shift focus to the former, who like the idea of the latter covering the cost of higher company revenue and profit, and Starboard’s track record of making money from activist investing is outstanding. Customers, however, aren’t necessarily going to be big fans of plans to boost profits by cutting costs and increasing revenue.
  • Today’s Cerner is vastly different from the one that Neal Patterson was running until he died in mid-2017. The contrast between the publicly traded Cerner and its chief rival in privately held Epic was already sharp, but even more so now that Cerner is seeking fresh horizons and has involved hardcore Wall Street types for whom it’s just another investment to milk hard.

From Clinical Trials Curious: “Re: software to manage clinical trials. A researcher from a large academic medical center is surprised that we don’t have a platform for managing our clinical trials. We’re a medium-sized health system using an EHR, but manage trials outside it. Are people using specific software?” I’ll invite readers from similar organizations to respond. If you work for a clinical trials management software vendor that has community health system customers, I’ll waive my rule and allow you to give your company‘s information in your comment.

From CIO a NO GO: “Re: MD Anderson. Reportedly offered a candidate the CIO role after a long search with many fits and starts. The ‘recruit’ insisted on tenure status and that stopped the process. They are in desperate need of direction after the Epic Rollout Blowup but it doesn’t appear that they will budge or that anyone will jump into the deep end without a life jacket.” Unverified. I haven’t followed that position since Chris Belmont left in August 2017. The organization struggled with post-Epic financial problems (since resolved, apparently), a high-profile failure to make IBM Watson Health do anything useful, and the resignation of its president following investigation of institutional upheaval and a heavy-handed management style. The new president comes from Canada, so I don’t know how much relevant IT background he brings, especially regarding Epic.


HIStalk Announcements and Requests

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Provider IT people — here’s a final chance to explain to outsiders who think we drag our feet on implementing disruptive technologies. I’ll recap soon.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Multi-vertical records retrieval company Ontellus acquires medical records request vendor ChartSwap. Healthcare Growth Partners advised ChartSwap on the transaction. Ontellus President Newton Ross will lead the new ChartSwap division, while Dawn Toups (Verisma Systems) will join the company as VP of provider sales.

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Glytec receives another patent allowance for systems and methods related to its Therapy Advisor. When released, the new product will broaden the company’s capabilities beyond insulin optimization to include inhaled, oral, and non-insulin injectable diabetes medications.


People

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Patient transfer software company Central Logic names Matt Dinger (Epic) VP of professional services.

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Government health IT vendor Ventech Solutions promotes Tonia Bleecher to chief growth officer and hires Timothy Moore (Auburn University) as SVP of commercial health IT and Nathan Anthony (IBM Watson Health) as VP of healthcare enterprise solutions.


Sales

  • In Canada, Mackenzie Health will deploy patient engagement software and services co-developed by GetWellNetwork and FlexITy at a new hospital set to open late next year.
  • Summit Health Management will deploy population health management technology from Arcadia across its physician practices and New Jersey-based Summit Medical Group.

Announcements and Implementations

Partners HealthCare (MA) will equip its clinicians and researchers with the tools necessary to develop their own AI algorithms through its MGH & BWH Center for Clinical Data Science. The center collaborated with the American College of Radiology and computing company Nvidia to develop a similar set of software and services that will be offered for free to radiologists around the country.

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Frances Mahon Deaconess Hospital (MT) goes live on Meditech Expanse with consulting help from Engage.

Teladoc Health will work with Cincinnati Children’s Hospital Medical Center to develop telemedicine software for pediatric hospitals. The hospital opened a telehealth command center several years ago.


Government and Politics

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AHRQ awards Northwell Health (NY) SVP Thomas G. McGinn, MD a $1 million grant to further his work on developing a clinical decision support system that integrates seamlessly with EHRs and presents minimal disruption to provider workflows.


Sponsor Updates

  • EClinicalWorks will exhibit at the ACP Internal Medicine Meeting April 11-13 in Philadelphia.
  • Ensocare will exhibit at the ACMA 2019 National Conference April 14-17 in Seattle.
  • EPSI extends early-bird pricing for its 2019 summit through April 30.
  • Modern Healthcare ranks Optimum Healthcare IT as #2 among the largest healthcare IT consulting firms.
  • Healthwise will exhibit at ANIA April 11-13 in Las Vegas.
  • Mobile Heartbeat releases a new video featuring its clinical communication and collaboration work with Freeman Health System.
  • PatientPing transforms care for high-risk, high-utilizing patients across North Carolina through its care coordination platform.
  • Vocera will add Julie Iskow (Medidata Solutions) and Bharat Sundaram (Vizient) to its board.
  • SyTrue names former HMS Holdings EVP/Chief Strategy Officer Cynthia Nustad to its advisory board.

Blog Posts


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EPtalk by Dr. Jayne 4/11/19

April 11, 2019 Dr. Jayne No Comments

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The World Health Organization (WHO) has released its draft strategy on global digital health. Their goal is to “improve health for everyone, everywhere by accelerating the adoption of appropriate digital health.” The strategy calls for a united approach to the awareness and understanding of the role of technology while tailoring solutions for each country. The strategy has two major components: the first outlines four strategic objectives while the second creates a four-part framework for action. WHO is accepting public comments through April 30.

I had the chance to meet up for lunch with a former residency colleague who has also gone through the looking glass to health information technology as a career. He was interested to discuss the dissolution of Google’s AI ethics board less than one week after it was formed. The external advisory board, dubbed the Advanced Technology External Advisory Council (ATEAC), was designed to monitor how Google uses artificial intelligence, but the selection of members became problematic. There is so much to keep up with in the tech world that I hadn’t realized Google had been criticized for its role in a Pentagon drone project and since has said it won’t work on AI-related weapons systems. Google plans reconsider the role of an advisory board entirely, stating it “will find different ways of getting outside opinions on these topics.”

Since he works for a major health system, we also had a chance to discuss our thoughts on accountable care organizations and the shift towards value-based care. He wasn’t aware of recent survey data that shows that more than one-third of participants in the Medicare Shared Savings Program (MSSP) are considering leaving the program. Our friends in governmental organizations love renaming programs, but I’m not sure calling it “Pathways to Success” isn’t going to make it any more palatable for organizations that are concerned about their ability to take on higher levels of financial risk. This year’s survey data represented approximately 40 of the 200 ACOs. Those that are more likely to consider leaving the program included hospital-led ACOs, which have tended to perform below their physician-led ACO peers.

We also had some good conversation around whether medicine is still a vocation or whether it’s becoming commoditized like many other industries. He’s no longer in clinical practice, and like many of our peers, attributes the decision to hang up his stethoscope to the moral injury that healthcare providers face on a daily basis. The reality of clinical informatics is that you don’t have to tell anyone that they have cancer and that their insurance won’t pay for treatment, or have to try to figure out how to help patients pay for their medications when they’re barely covering the rent. I think a string of practice and hospital mergers and acquisitions probably also contributed to his lack of zeal for the primary care trenches.

He hasn’t lost his sense of humor, though, and one of the funniest comments of the day was about trying to address governance and adoption issues while his health system’s physicians are spending a great deal of innovative energy finding new ways to try to say no to technology. We discussed what it would look like if people spent that time learning and mastering a system or re-engineering their practices rather than just raging against the machine. The bottom line is that even across the country and with a different physician population, many of us are facing the same issues every day.

Over the last several decades, the healthcare industry has been increasingly concerned about the role of government in healthcare, so I was excited to see an editorial in the Journal of the American Medical Association on “Building Trust Between the Government and Clinicians.” Co-authored by former CMS Administrator Donald Berwick, it notes that building such trust “requires understanding, empathy, and humility.” It encourages clinicians and policy-makers to walk the proverbial mile in the other’s shoes. The piece calls out several data points that are important – that the US spends nearly double what other similarly-developed nations spend on healthcare without significantly better outcomes or quality.

It goes on to note that some policy makers focus on clinicians who put self-interest above the needs of our society, resulting in the creation of systems to “guard the public from them.” It uses the example of Medicare recovery audit contractors who are paid based on the number of issues they find, putting all physicians on the defensive when only a few are committing fraud. The authors note that “out-of-control oversight and policing for the 1% who warrant this type of scrutiny burdens the daily work of the 99% who do not.” I think most of us in the trenches would agree. In 20+ years in practice, I’ve never had a prior authorization request or precertification request denied, yet I have to continue to jump through hoops to order medically necessary tests.

The editorial calls on clinicians and policy-makers to find common ground that supports both stewardship of resources and the patient care mission. This resonated with me. For policy-makers, achieving fewer and more efficient regulations would be more likely if they spent time understanding the position of the clinicians whom their policies affect. The realities clinicians actually face should provide a lens to view and judge new policies. Unless and until policy makers trust with their heads and feel in their hearts that the vast majority of physicians and other health professionals are well intentioned, they will continue to design policies around the exceptions rather than the rule. Policy-makers should regularly spend time visiting physicians’ offices and hospitals to better understand the ripple effects of policies on those providing care.

It’s similar to having software engineers actually visit clinician practices using the systems they design and create, so that they’re not operating in a vacuum. I’d love to see them observe the folly that my staff had trying to get a CT scan approved after the fact (emergencies don’t occur during normal business hours) when the payer was pushing back because my documentation of the patient’s abdominal pain did not use the word “severe.” I finally asked if anyone at the plan had actually looked at the scan results. Had they done so and seen the enormous and life-threatening pancreatic tumor that was found, maybe they would have toned it down a notch. Instead, they were arguing over semantics. Perhaps they would have preferred to care for a catastrophic event when it eroded through a blood vessel rather than the controlled hospital admission we provided.

They also call on clinicians to learn how the other half lives, understanding policy needs and learning about healthcare spending during medical school. In turn, “the vast majority of physicians who deserve to be trusted” would be rewarded with fast-track of pre-check systems like those used by the TSA. It remains to be seen whether legislators and other policy-makers will heed this advice, but we can be ever optimistic that perhaps someone will see through the money and special interests and give it a shot.

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I’m constantly re-engineering my home office and it’s easy for me to take a break because I can just wander to the sofa and put my feet up. Having spent entirely too much time in cubicles and small circulation-less conference rooms, I was intrigued by the idea of a nap desk. Naps are supposed to help improve mental awareness, but I’m not sure I would want to sack out under my desk even if it is made of stylish lacquered wood, metal, and leather. The desk is just a prototype for now, and unless you have your own office, I can’t imagine it would be terribly restful.

What’s your strategy for catching a couple ZZ’s during the work day? Leave a comment or email me.

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Email Dr. Jayne.

Morning Headlines 4/11/19

April 10, 2019 Headlines No Comments

Partners HealthCare Embraces the Democratization of AI to Accelerate Innovation in Medicine

Partners HealthCare (MA) will equip its clinicians and researchers with the tools necessary to develop their own AI algorithms through its MGH & BWH Center for Clinical Data Science.

InTouch Health Unveils the First Fully Integrated Virtual Care Platform

InTouch Health develops telemedicine software that can be used in any type of healthcare setting.

Feds Charge 24 In Alleged $1.2 Billion Medicare Fraud Scheme

Federal prosecutors charge 24 people, including executives at five telemedicine companies, with $1.2 billion in Medicare fraud.

Concerto HealthAI Enters Precision Oncology Collaboration with Pfizer

Concerto HealthAI will work with Pfizer to advance AI capabilities for oncology using its proprietary AI technology, EHR software, and claims data.

HIStalk Interviews Luis Castillo, CEO, Ensocare

April 10, 2019 Interviews 1 Comment

Luis Castillo is president and CEO of Ensocare of Omaha, NE.

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Tell me about yourself and the company.

Ensocare is a care coordination platform that helps move patients to the right level of care along the care continuum. We’ve been doing this for about 10 or 11 years and I’ve been there five years.

I’ve been in healthcare IT for a long time. I don’t think I’ll ever go back to big company. I’m having the time of my life running this small company.

What are the benefits and challenges for hospitals in getting discharged patients placed and coordinating their care afterward?

The big EMR push, Meaningful Use, and even ICD-10 took people’s attention away from the post-acute care side. What happens once you leave the hospital? I lost my brother about two years ago and I remember trying to get him placed into hospice. I had to go to our network and ask my team. Who is available Des Moines area? What are their CMS scores? Because the hospital handed me what looked like the cardboard filler that comes in a shirt. It was laminated and had a bunch of numbers on it. Some were scratched out, some were written over.

They said, here you go, it’s up to you. Make some calls and figure out where to put him. There was no automation and no ability to tell me which facilities were better or which ones weren’t. That discharge and placement process is highly fragmented and not very process driven.

We put automation and technology behind this very manual place. Nurses typically stand in front of a fax machine for 5-6 hours a day getting this done, so we let them go back to working at top of license and get them back in front of the patient — case managers, social workers, and so forth. But we also impact length of stay, so if I can decrease it by a quarter-day for patient population, that’s big money over the year.

Hospitals sometimes leave placement decisions to the patient and family to make sure they aren’t accused of playing favorites or being held accountable for placements that don’t work out. Is their challenge in advising patients and families due to lack of knowledge or a reluctance to exert undue influence?

That’s a really tricky question. I still remember when health providers and payers couldn’t even be in the same room together. There was this hatred for each other. But now health plans own hospitals and hospitals create their own health plans. With some of the Medicare Advantage plans, people who are taking on risk can manage and direct patients to places if it’s their own population.

But you bring up a great point. The IMPACT Act says you have to give a patient choice. You have to disclose any financial relationship you have with that home care agency or that behavioral health provider that is affiliated with your IDN.

Our system lets you put all the choices in front of the patient and give them an unbiased score, such as the CMS scores for quality. They can flip through almost a Hotels.com interface on the tablet and look at the places that have a bed available. They can see if they are pet friendly, check which churches are nearby, see a picture of the area.

Hospitals aren’t supposed to direct people or to steer them. They have to manage that closely. Our application helps document that they gave the patient choices.

In the absence of something like a Tripadvisor that includes detailed reviews and scores from individuals, should I as a patient or family member trust the CMS star ratings?

We’ve been asked by our customers to do some kind of independent rating score for post-acute care facilities based on the data that we have, such as readmit ratios and quality scores. But I’ve been hesitant to do that. We offer the post-acute care network a free portal. We don’t charge them to belong to this, although some of our competitors do. We try to get them to be engaged, to answer inquiries within 30 minutes, and to keep their engagement level up.

We have something that is more on the predictive side on our roadmap. Predictive analytics that say, based on what we know of this patient and the performance of organizations in our network, here’s where we think this patient will do best. They need DME, infusion, dialysis, and these levels of care, and these places do really well with that. I don’t want to become a Class II device and make a clinical recommendation, but I will start scoring and show them a predictive model.

How important is it to have access to actual empathetic humans and not just technology and information when making what could be one of the most important decisions in someone’s life?

I remember when Gateway and Dell came into the PC market. Nobody thought they would ever pick a laptop or desktop off a pick list since technology was intimate in some ways. You wanted to see it and touch it. You would never buy it sight unseen. But the paradigm has shifted. We buy online, even for major purchases like cars, and just have it delivered.

You probably won’t pick a provider via technology, but you’ll get a list of 10-12 places that have a place for Aunt Betty. You take a look on the tablet at their quality scores and decide which three to visit because they meet the criteria. You’ll physically go and take a tour to see if it’s the right place.

The predictive modeling will make it more interesting in being able to show outcomes and recommendations. I’m not sure if I’m going to develop a Yelp-like thing, but people want to know what other people felt about their visit there and what it was like.

It’s also true that everybody is not in the same financial situation. We are looking at working with payers to provide an estimated out-of-pocket expense. That is powerful because you may not be able to afford the five-star rated place.

Given that not everyone is willing or able to pay for a Ritz Carlton, can someone with a Motel 6 budget at least look up how satisfied others like them with similar expectations were with a particular facility instead of just comparing absolute satisfaction numbers?

Not today. The closest thing involves discharges, although it’s hard to quantify with so many variables and I can’t say for sure if I’m impacting it. But we’ve seen a big change in HCAHPS scores. On discharge, people afterwards didn’t understand the discharge because it was in the wrong language, she spoke very quickly, they were pushing me out the door, the ambulance was late. They list all these things, but an HCAHPS-type measure does not exist for the post-acute care visit right now. But as you start managing populations, I think it’s coming.

What does a hospital need to do to get started with your program?

They start by listing their favorite facilities in the area, the ones they use frequently and discharge to most often. We build that into a quick list in the system. We reach out to all those post-acute care providers, train them on our portal, and get them to understand that there’s an engagement value here that says you have to answer referrals within 30 minutes. Seventy percent of Ensocare calls are outgoing as we are managing the network. That’s different from some of other solutions that just buy a CMS database, import it into their system, and call it done.

I build my database organically. Every time I do these outbound calls, I know which facilities aren’t responding. Our customer support people and customer experience people call them proactively to say, we notice that you aren’t responding to the referrals we’ve been sending you. Is there a problem? Many times it’s, oh, the lady that had the app on her phone left and we don’t know how to answer any more.

We deal with post-acute care facilities that are very technically advanced and are part of large national chains. But we also work with home care mom-and-pop organizations in rural parts of the country, so it can be challenging. But we actively engage and manage the network to make sure they are responding.

You wrote after HIMSS19 about how smart speakers like those powered by Alexa might be used in healthcare. What do you predict?

The interface is becoming more reliable. Nine times out of 10, Siri or Alexa gets it right. One of the biggest potential uses I see is managing the population after discharge. Once you get a risk score through LACE or some other technology, you know that this patient has two co-morbidities, is high risk, and has a lot of social determinants. The nurse wants to follow up, but they’re going to call you, ask you to enter information into a mobile device on an app. Many patients aren’t all that technology savvy. But if you send them home with a smart speaker, it could automatically populate population health platforms with vital signs. The nurse is now calling only the people who need intervention as opposed to calling everybody every day. That model is unsustainable.

I recently was at a hospital that had a warehouse full of 75 nurse navigators. All they do, all day long, is call people. I’m following up on your primary care visit. Did you pick up your prescriptions? Did you do these things? Tools like the smart speakers are going to begin to invade that space.

Do you have any final thoughts?

I worked for two large companies. Shared Medical Systems taught us how to be close to the customer. Siemens, true to its German engineering background, taught us all about process and engineering. A healthy combination of both of those things is appropriate.

But the one thing that can’t be supplanted, the one thing that you always have to keep at the top of your radar, is high-touch customer service. We have a person at the end of the phone each time. You don’t get routed and automated and have to press two and three to talk to a representative. We have a high-touch customer service that our customers appreciate.

Vendor Alternatives to Exhibiting at the HIMSS Conference

April 10, 2019 News 1 Comment

The HIMSS conference exhibitor roster turns over every year as a significant portion of companies either sign up for the first time or previous exhibitors decide not to return. I’ve heard from more of that latter group after HIMSS19 who are questioning the return on investment, which for most of them means generating sales leads.

Most vendors have no plans to stop exhibiting. Some are happy with the value they receive in having a lot of people they need to see who are in a single place at a single time. Others worry that their absence will be exploited by competitors as a sign of weakness or that customers will question their commitment. The exhibit hall is likely safe from mass defection, especially for long-established and large vendor players.

However, small and medium-sized vendors who rack up significant booth, travel, and staffing costs for just three frantic days may wonder if they should be spending the money elsewhere. That’s especially true as the industry has settled down into less of a land-grab mentality now that Meaningful Use money has been spent, major software decisions have been locked in at health system corporate levels, and health systems worry about margins as their core business faces unknown changes.

I asked vendor readers for ideas of how they might reallocate some or all of their HIMSS exhibition costs into efforts that would yield more tangible business results. Thanks to those who took the time to share their thoughts.


We don’t exhibit, but we send more than 10 people to HIMSS and get a meeting room instead. We set up meeting room appointments prior to the conference so we can use our time efficiently. We’ve gotten a lot out of this and plan to keep it up.


We use our budget to attend the shows where we already have a big client presence. We go as attendees, offering a dinner with our strategic client advisory board. We don’t get leads, but the partnerships lend to better product strategies and focus areas for the business. HIMSS isn’t a big lead generator for us, so the rest of the budget I would diversify into PR activities and a solid PR agency. We also do sponsored blog content and attend smaller conferences.


We go every year because we want our name on there and it’s an opportunity to meet with customers and partners. But we absolutely do not recover the cost of attendance in ROI. HIMSS is where vendors show off to each other, not where customers come away having made purchasing decisions.


We exhibited at one HIMSS conference 15 years ago as a startup selling a small departmental system and decided never again. Every year a few of us attend the show (we can always rustle up some guests-of-vendors badges), and we set ~20 meetings with current and potential partners. Every year we’re grateful we don’t exhibit. We’re still spending money attending the shows, so we’re not saving as much as we could be, but our expenses are less and we get good value out of the face-to-face meetings. We’ve never specifically allocated the funds we would have spent at HIMSS to other efforts, but the remainder has gone toward our general marketing budget.


We stopped exhibiting at HIMSS following the 2018 show. Even though we booked a booth for 2019 during the 2018 show, we forfeited our deposit because it was cheaper than following through and burning the hundreds of thousands we’d have to shell out to be present as we originally planned. Instead, we found smaller, more regional shows that offered more engagement with our specific target audience. We carried out some branding campaigns, spent more on content development and distribution, and sponsored some webinars that again allowed us to better target our outreach and drive the right people to our event.

We also invested in some technologies to help us connect with our target audience, including ZoomInfo and Definitive Healthcare. That way we could identify the accounts (health systems and hospitals) we wanted to contact and find out exactly who the people were who should be our target buyers. A quarter of a million to half a million dollars can go a long way when you spread it out to different activities and you identify those that will support your marketing and sales efforts. And we’re just a former 20×20 vendor. Think about the major players and all the floor space and investment they burn.


We will continue to exhibit, but an alternative would be to do a roadshow. We would evaluate which cities would be the best locations for existing and targeted prospects. Select an event marketing team to pick venues. Then use the money for team, rent venues, catering, AV, travel, swag, etc. A key component would be to pay to have featured customers and internal team members travel to and speak at event.


An alternative to paying for a large booth is to simply downsize and pay for a 10×20 or even a 10×10 booth. Your company will save a ton on expenses and will benefit from reduced staffing and reduced equipment, etc. But you still maintain a listing in the HIMSS guide so that customers and partners can find you. This will also force you to choose the most impactful people that need to attend and forces a decision on what products you really need to showcase. Sort of like downsizing when you move — it forces some tough decisions.


We stopped three years ago. We spent about $300,000 on a booth, had 90 leads (most were students) and only 12 actual decision makers. Twelve leads for $300,000 is a bad investment. Now we hold an industry breakfast and it has been a great event – CIOs, CTOs, and CMIOs only. We had 30-40 people for about $20,000, a much better investment. The attendees are the ones driving this and frankly we’ll spend our dollars elsewhere. This convention has become nothing but a money grab for HIMSS and the value is long gone.


I would invest those resources in organic PR, meaning I would take the time and effort to document client success stories, translate them to meaningful, educational information to prospects, and pitch that content to trade press, national media, etc. (not sponsored content). I would also consider investing in good, well-produced, reusable video content.


As a small company, we stopped having a physical booth at HIMSS a few years ago for many of the reasons you described — cost, being lost in caverns and hinterlands of the exhibit hall, very few real leads, etc. We still have what we believe is a strong presence for our size by doing other things — working with partner companies in their booths, leveraging healthcare ecosystem areas like the Intelligent Health Pavilion, and partnering with our customers to have educational sessions on the agenda. We also promote our attendance at HIMSS before the conference with customers and on our website / social media so we can make sure to connect with those who we need to see during the show. A few weeks prior, we do a press release about the various ways we will be participating at HIMSS, and during the show we are posting / tweeting “Live from HIMSS”. I guess you could say we have virtualized our booth for HIMSS!


Register as a participant, attend be at all the social events and relevant educational sessions, keep the elevator speech short (2-3 sentences), arrange for a Wednesday or Thursday evening offsite event that can be promoted over the week. Don’t try to cram so much in up front. Create some mystery and intrigue. Useful or unique bling (or chocolate) may help.


This actually occurred at my last company. We opted to host an event at HIMSS, a one-night, blowout event that was half the cost of the booth for the week. We spent months prospecting and getting folks to the event, while setting up meetings outside of the exhibit area (restaurants, hospitality suite, etc.) for 1:1 meetings. This works much better in Las Vegas than it does Orlando.


Is HIMSS a huge financial commitment? It sure is. And if all you’re going to measure is lead generation, then it won’t be worth it. The cost per qualified lead at HIMSS in my experience is north of $10K or even $15K. And clearly there are cheaper ways to get to leads if that is your only measure of success.

But HIMSS is also a place to get stuff done. Strategic partnerships, briefings with current and potential partners, window shopping for possible M&A, early look at emerging trends and competitor positioning, and … gasp … customer engagement (which shouldn’t be confused with lead generation.) A well-planned and executed HIMSS with proper organizational support yields far more benefits than simple leads.

Having said all that, if HIMSS were to disappear as an expo, I would not be all that disappointed. It’s become more of a place to be seen. The nuclear arms race of HIT marketing, if you will. Unfortunately denuclearization only works if everyone disarms. And we know that won’t happen. So we make the most of it with planning and outreach months in advance.

Finally let’s not forget the HIMSS points system. If you have years spent supporting HIMSS, pulling out for even one year knocks you back to zero. And suddenly you’re at the back of the bus in terms of booth selection, making it an even harder ROI to justify.


Have a party right across the street with free alcohol and food. Has that been done before?


Invest in breakfast briefings and lunch and learns as a way to drive targeted executives interested in your solutions and offerings.


As a provider, I don’t care if vendors exhibit, especially if I’m told in advance the reason for not having an actual booth. Having some company representation at the conference to meet with, even if not at a booth, is generally sufficient for my needs.


Exhibit at AHIMA and select state HIMA conferences.


No customers come to HIMSS,  just other vendors. I would rather invite customers and prospects to a smaller, more intimate event and invest in interesting thought leadership or education for that base. For example, physician roundtables with an industry thought leader.


Work with Becker’s and CHIME more closely.


Drive a subject matter interest thought leadership 1.5 day summit for 50 persons


Morning Headlines 4/10/19

April 9, 2019 Headlines No Comments

Cerner Announces Agreement with Starboard Value Regarding Board Refreshment, Operational Improvement Initiatives and Expanded Capital Return Program to Drive Next Phase of Profitable Growth and Value Creation

Cerner bows to pressure applied by an activist investor by appointing four new board members as nominated by hedge fund operator Starboard Value, which owns 1.2 percent of outstanding CERN shares.

Diameter Health Announces $9.6 Million in Series A-1 Funding Round

Clinical data integration vendor Diameter Health raises a $9.6 million Series A-1 funding round led by new investor Optum Ventures.

Microsoft is shutting down its HealthVault patient record service

Microsoft will shut down its HealthVault service on November 20, 2019.

Ontellus Acquires B2B Health Information Exchange ChartSwap

Multi-vertical records retrieval company Ontellus acquires medical records request vendor ChartSwap.

News 4/10/19

April 9, 2019 News 5 Comments

Top News

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Cerner bows to pressure applied by an activist investor — and perhaps as a result of its own self-examination led by Chairman and CEO Brent Shafer, who was hired in January 2018 — by appointing four new board members. Hedge fund operator Starboard Value owns 1.2% of outstanding CERN shares.

Starboard was less adversarial in this case than with previous targets, steering clear of public criticism of the company and not delving into operating minutiae with a public call for changes.

In a previous example, Starboard took control of Darden Restaurants despite owning just 10% of the company by observing that its Olive Garden restaurants are too generous with breadsticks, use non-standard sized drink straws, and over-salt the pasta. Starboard managed to get every member of Darden’s well-qualified board replaced in October 2014, since which DRI shares have since risen 169% vs. the Dow’s 60%.

The new, well-credentialed Cerner directors — former top executives of Hill-Rom Holdings, MedAssets, Jawbone, and Cloudmark, two of them nominated by Cerner and two by Starboard – now represent 40 percent of the board. Another board member will be retiring.

Chairman and CEO Brent Shafer stated previously and reiterated today that the company has identified opportunities to “unlock the company’s significant potential” in creating a new operating model and will focus on improving profits and efficiency along with ramping up innovation. He says Cerner has:

  • Replaced the president position with chief client officer
  • Eliminated the strategic business unit structure
  • Reviewed its product portfolio to maximize development resources
  • Centralized operational functions that were previously spread across multiple executives who reported to the COO
  • Announced plans to pay share dividends, repurchase more shares, and add free cash flow generation as an executive bonus metric
  • Expanded margins

Starboard Value was a significant shareholder and an activist investor in MedAssets a few years back. It also triggered the sale of physician services vendor Envision Healthcare to a private equity firm last year.

CERN shares were up 10% at Tuesday’s market close. They’re up 17% over the past five years vs. the Nasdaq’s 93% rise.

Perhaps I missed it, but I wasn’t aware that Cerner was being pressured by Starboard, although in this case the relationship seems more collaborative than Starboard’s history would suggest and Shafer had already implemented changes to reposition the company in ways that Starboard would likely have found aligned with its own areas of focus.


Reader Comments

From Mark: “Re: HealthVault. Why can’t a company that’s worth $700 billion leave something running for probably $10,000 per year? They probably spend that on fancy coffee for management alone.” This is probably good news for Apple and other Microsoft technical competitors since MSFT tends to turn tail and run at spectacularly mistimed points after burning through a ton of cash and partner / customer goodwill with little to show for it as competitors find a way to sell their own versions of the same technology. This is the company that couldn’t figure out how to find success in offering a smartphone (Lumia and Windows Phone), a music player (Zune), a streaming service (Groove), a fitness tracker (Band), a browser (IE/Edge), a search engine (Bing), a smart speaker (Cortana), a tablet (Surface RT), a sophisticated movement tracker (Kinect), and now a personal health record even as Apple gets accolades for its own product and the government begins a hard push on giving patients their data. I’m being nice in not mentioning Microsoft’s healthcare-specific fumbling with Sentilion single sign-on and Azyxxi / Amalga / Caradigm. Keep that history in mind as the company starts playing the soothe-the-cobra music in trying to convince healthcare that this time, in the face of entrenched cloud competition from Google and Amazon, it’s serious about healthcare interoperability and AI.

From Spinal Screw: “Re: HIStalk. I find it hard to believe that anyone has time to read it all.” Not everyone does, but somehow quite a few folks – many of them running big provider and vendor organizations and some of them likely outcompeting you – invest the time in their success. I’m editorially selective and good at summarizing, but even I can’t tell you everything you need to know in a 30-second phone read in the coffee line or on the toilet and you may or may not be good at skipping stuff that you don’t think applies to you. I have no incentive to pad it out with fluff or verbosity. You might be in the wrong business or need a productivity makeover if you don’t have 5-10 minutes per day to follow your field.


HIStalk Announcements and Requests

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A reader commented that opinions expressed on HIStalk – both mine and those of readers – “reek heavily of cynicism of status-quo-ism” in always being skeptical of potentially disruptive developments (such as AI, EHRs, digital health, etc.) without offering alternative solutions, all because we’re protecting our hospital paychecks. This tension between would-be disruptors and those who keep the IT lights on today is important – we’re always going to be defending ourselves to impatient, often naive disruptors whose technology hammer is desperately seeking a healthcare nail to pound as we try to maintain a responsible, enterprise-driven approach. Here’s your chance to respond, perhaps considering these issues in your comments on the survey form I created. I’ll recap our collective thoughts in a few days.

  • Are provider health IT people really averse to investigating and using disruptive technologies or are we just jaded by a long list of previous failures?
  • What are the outsiders missing about what makes healthcare different?
  • What is the potential of technology-powered disruption in a mostly non-profit healthcare system that is heavily regulated and full of entrenched stakeholders ranging from hospitals to insurers to drug and device companies?

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Welcome to new HIStalk Platinum Sponsor Relatient. The Franklin, TN-based company offers a patient-centered approach to patient engagement that recognizes that “it’s not just a phone, it’s healthcare’s digital front door.” Solutions include appointment reminders and rescheduling, on-demand outreach for events such as weather delays, patient self-scheduling and waitlisting, satisfaction surveys, AR balance messaging, MDpay balance collection, and health campaign management (recalls, education, portal promotion). The service requires no app, no portal, and no password (since the service validates directly to the phone) and communicates with patients via their preferred channel (phone, email, or text messaging, the latter preferred by a startling 98% of patients vs. the basically zero who like patient portals). Patients are engaged as comfortably as they would be with friends and families, using behavioral science to meet their wants and needs without having a clumsy app inserting itself. An Epic-using pediatric hospital dropped its clinic no-show rate by 27 percent within six weeks, while a FQHC uses it to help meet the needs of diabetic patients with transportation problems. It’s integrated with a long list of systems that include those of Epic, Cerner, Allscripts, Meditech, EClinicalWorks, and Athenahealth. Thanks to Relatient for supporting HIStalk.

Listening: King Crimson, purely because the reclusive and formerly retired Robert Fripp — the only consistent band member as its 72-year-old guitar player — just did an amazing press conference for the band’s 50th birthday as reported by Rolling Stone. It’s a delightful, wry look at the challenges and rewards of playing in a band whose membership is constantly evolving (Fripp loves blowing it up and starting over to stir his creative juices) and whose epic progressive music plays great live even though each musician must count different time signatures in their heads in front of thousands of audience members in playing songs recorded decades ago by someone else. Their tour goes out in June and has some US dates. Certainly many (including me) enjoy the take-no-prisoners “21st Century Schizoid Man” (original vocals by ELP’s Greg Lake) or the mostly improvised “Asbury Park,” but my favorite will always be “Starless.” How cool it must be to bemusedly explain to your grandchildren that time in 1969 when, as an impossibly young man of 23, Grandpa was rocking half a million people at England’s Hyde Park weeks before Woodstock and the moon landing, and now he’s about to hit the road again.


Webinars

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


Acquisitions, Funding, Business, and Stock

Morgan Stanley predicts that Apple’s healthcare opportunity is $15 to $313 billion in annual revenue within the next eight years, with analysts speculating (with little evidence to back it up) that the company could roll out medical-grade wearables within AirPods, integrate sensor-powered apps into the Watch, get insurers to pay for the Watch, or buy healthcare companies. The prediction seems laughable given its assumption that the company’s 2027 healthcare revenue could exceed today’s total revenue even as Apple scrambles to defend its mature market position. People keep trying to make excuses for Apple’s unpleasant slide into middle-aged corporate mediocrity and often predict healthcare as its savior based on one-off ideas like Apple Health Records and the Watch EKG that are interesting to consumers but don’t have any kind of monetization path (Rule #1 in healthcare – patients do not pay. Rule #2 – neither do doctors.)

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Clinical data integration vendor Diameter Health raises a $9.6 million Series A-1 funding round led by new investor Optum Ventures.

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DocuTAP and Practice Velocity announce that their merged companies will be branded as Experity.


Sales

  • Acuity Healthcare, which owns three long-term acute-care hospitals, chooses HCS Interactant as its enterprise health IT platform. 
  • AdventHealth will implement Par80’s referral management system.
  • McKesson chooses Google Cloud as its preferred cloud provider for infrastructure, platforms, applications, and analytics.
  • Australia’s NSW Health signs a 13-year contract with Sectra for enterprise radiology imaging for its 11 Local Health Districts.
  • Signature Healthcare will implement Meditech Expanse.

People

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OptimizeRx hires Denys Ashby (CaptureRx) as VP of hospital and health systems.

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Jeff Fallon (Oneview Healthcare) joins patient experience technology vendor EVideon as CEO.


Announcements and Implementations

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Google Cloud opens its healthcare API for beta testing, offering an interoperability engine that supports FHIR,  HL7v2, DICOM, patient de-identification, and machine learning.

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Microsoft will shut down its HealthVault service on November 20, 2019. The notice – sent via email to registered users — expands the company’s January 2018 warning that it would retire HealthVault Insights and its December 27, 2018 announcement that Direct messaging would no longer be supported. Now the whole thing has been scrapped.

Fortified Health Security publishes its 2019 Horizon Report on the cybersecurity risks of connected medical devices.

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Montefiore St. Luke’s Cornwall Hospital goes live on Artifact Health’s physician query solution to expedite accurate coding just four weeks after the project began.

Saratoga Hospital goes live on integration of B. Braun Medical’s smart IV pumps with Meditech Magic as delivered by Iatric Systems.

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DirectTrust earns ANSI accreditation to develop interoperability and identity standards and invites industry stakeholders to participate.

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Recondo Technology announces record bookings and growth in Q1.


Government and Politics

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A jury finds a South Florida nursing home operator guilty of defrauding Medicare and Medicaid of nearly $1 billion via fraudulent billing. The best part of the story is this – he used part of the $37 million he pocketed to bribe a Penn basketball coach to get his son admitted into the Ivy League university. Former Penn basketball coach Jerome Allen, who has pleaded guilty to money laundering in connection with the incident, admits that he accepted $300,000 in bribes to get the son — Morris Esformes — admitted to the Wharton School, after which he never played a single second of Penn hoops. The son’s LinkedIn says he last worked as a summer analyst for merchant bank The Raine Group. Somehow I expected that – state-school guys like me who spent our summers sweating doing dirty, low-paid work outdoors (in my case, coal mines) always knew people with better-connected parents who got them clean, connection-creating jobs working as caddies or perhaps merchant banking. One guy I knew donated his daughter’s way into dental hygiene school (“I’ll buy the damned place if I have to,” he told everyone who would listen, which apparently included the admissions folks) and got his underachieving son into medical school despite the kid’s having been caught breaking into his undergrad college’s administration office to manually improve his grades.


Other

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In Australia, newly opened, 488-bed Northern Beaches Hospital delays its HIE project after it finds “unacceptable errors and omissions.” A sign that the grand opening wasn’t going well – the CEO quit the day after the ribbon-cutting ceremony.

Massachusetts Governor Charlie Baker, speaking at a Partners HealthCare innovation event, says he is skeptical of the promises of AI. He adds that healthcare is rightfully held to a higher standard than other industries and that patient privacy must not be compromised. Baker was the final decision-maker for AI projects in his previous roles in government and provider organizations and says AI was often less useful than its developers thought, it takes longer than expected to make it work, and the choice and formatting of input data complicates the issue.

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Ireland’s state data agency rules that people don’t have an absolute right to have their names spelled correctly, reviewing a TV producer’s complain that the fada (an accent or diacritic mark) in his name was omitted by University Hospital Galway because its software doesn’t support the special character.

Cigna’s PR people shrink from the glare of public spotlight as the insurer suddenly agrees to pay the out-of-network hospital ED bills of a woman’s two daughters who had attempted suicide – one by slashing, one by pills – by reversing its initial decision that neither event was life-threatening. The mother was relieved about the bill, but the story doesn’t provide any insight on what it’s like to have two daughters of unstated age who tried to kill themselves simultaneously.

Weird News Andy codes it as W61.42XA. A Detroit motorcyclist dies when one of several turkeys that were crossing the road take flight and hit him in the chest, causing him to lose control. WNA cautions, however, that we must escalate our coding work to keep up with the stupidity of people, providing as evidence this story in which a 10-year-old boy is critically injured after falling off the car driven by one of his parents as he “surfs” on the roof.


Sponsor Updates

  • Audacious Inquiry joins HL7 and IHE.
  • Spok announces its upcoming conference participation at AONE, the Healthcare IT Institute, and AMDIS PCC Symposium.
  • Impact Advisors is named as one of Modern Healthcare’s largest healthcare IT consulting firms.
  • Digital prescription savings company OptimizeRx announces integration with Cerner and Epic.
  • Aprima will exhibit at the ACP Internal Medicine Meeting April 11-13 in Philadelphia.
  • Audacious Inquiry joins Health Level Seven International and Integrating the Healthcare Enterprise as an organizational member.
  • CompuGroup Medical will exhibit at the Henry Schein National Sales Meeting April 11-13 in Denver.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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Reader Comments

  • Vaporware?: Mr. H, you can add this little propaganda gem to your file of Top 10 Euphemisms (emphasis mine). You have one of those f...
  • Fred: Epic's response to burnout is precious. Yes, everyone is happy and challenged, excluding of course the thousands who hav...
  • Brian Too: Any complex software that you spend a lot of time in, you'd better learn it well. Most people do that but if you invest...
  • AC: I don't believe they give you raw click numbers yet (only PEP/NEAT score), although I think Feb 2019 release is bringing...
  • Dodele: We use Cerner's Lights On and Advance data extensively. There is a wealth of valuable information and it is continuousl...
  • Epic User: As someone that actually tried to dig into the details of Epic's signal data, I quickly became underwhelmed. No click co...
  • Frustrated Patient: " suggesting that my providers don’t really want to open up a can of medical worms by asking how I’m doing overall e...
  • AC: That's good to hear. So the major vendors have worked on this and provided tools. The question now becomes are organizat...
  • Associate CIO: Re: EHR internal timers and event log monitoring Cerner has this as well, it is called the Lights On Network. A curr...
  • Bob: Liked - "The jammed interoperability floodgates would magically open by Labor Day if their payments depended on it."...

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