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News 2/20/19

February 19, 2019 News 1 Comment

Top News

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Healthcare data expert Fred Trotter, health lawyer David Harlow, JD, MPH, and several patient advocates file a Federal Trade Commission complaint against Facebook over security problems with its Groups function. They say Facebook used AI to encourage users to sign up for private patient support Groups (based on their search history) knowing that their information (including real name, email address, city, employer) could be publicly downloaded.

The complaint also accuses Facebook of allowing its advertisers to target people using their identifiable health information.

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The complaint says Facebook Groups fits the legal definition of a personal health record, so Facebook as a PHR vendor should have notified users and the FTC that their protected health information had been exposed. It offers as evidence CEO Mark Zuckerberg’s endorsement of Groups for patient care collaboration and coordination.

It concludes that Facebook violated the FTC’s 2012 consent order and could face billions of dollars in penalties for failing to notify under FTC’s breach notification rule.

House Committee on Energy and Commerce Chairman Rep. Frank Pallone, Jr. (D-NJ) and ranking member Rep. Greg Walden (R-OR) have asked Zuckerberg to provide a staff briefing by March 1.


Reader Comments

From Sampan: “Re: Jonathan Bush. Did you see him at HIMSS? You should interview him again.” I didn’t see him there, but I would certainly enjoy interviewing him since it’s been awhile.

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From Waiting to Exchange: “Re: Cerner’s HIMSS19 slide bashing Epic over CommonWell. There are only 16 CommonWell sites available to query (see list above), although this is double the number of sites available in December. New sites are coming on board gradually. None of these organizations are in our region, so while our referring sites have an EHR capable of exchanging data, we are still waiting for the ‘marketplace’ to evolve.”

From Dyn Doc Diva: “Re: Cerner. Leadership is constantly undermining things with hype and hoopla versus functionality and usability. Cerner used to have a way for organizations to innovate with custom builds within Cerner and then sell those innovations to other clients, but I don’t think it was very successful. It will be interesting to see if the app experience is any better. Having a bunch of apps is just another fragmented way of getting people to pay more for extra modules instead of incorporating the features that people want and need into the base build. The adoption of Dynamic Documentation would not be languishing if it really did a credible job of reducing burnout – it was touted as revolutionary when still in the widely-promoted vaporware stage, but our organization has it and it’s good for quick dictated notes but requires a lot of upfront provider work to use for complex patients. Our department suggests that people not use it because it doesn’t do everything we need for regulatory and billing purposes, but Cerner isn’t fixing minor things in Powernotes that would go a long way to improve productivity. Cerner is trying to drive adoption of one half-baked solution over another.”

From Engine Brake: “Re: HIMSS. Maybe the demise of HIStalkapalooza had an impact on attendance. I always enjoyed the HISsies voting and pictures, especially shoes.” I doubt many people made their HIMSS conference attendance decision based on HIStalkapalooza, but maybe some did. Had I not also mercy-killed our expensive and ultimately pointless HIMSS19 booth, I could have designated a “shoe day” in which I would invite everyone to wear their finest footwear to the exhibit hall, then proceed to my “selfie station” of a downward-pointing camera that would catalog their feet for posterity and perhaps for online crowdsourced judging afterward.

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From InteropNerd: “Re: Epic App Orchard. Closed to new membership with no timeline on reopening.” A source tells me its open again after Epic updated processes related to safety, privacy, and security policies.

From Unbroken Yolk: “Re: HIMSS19. How were the logistics?” They were invisible, which is the goal. The only gripes I heard involved the convention center’s food vendors, which weren’t particularly inspired (or high value) and unlike in Las Vegas, you can’t easily go elsewhere. That’s not inconsequential since anyone running a conference will tell you that the major factors impacting attendee satisfaction are the quality of the food and having enough networking time built in, but given the scale of HIMSS19, it was mostly a good experience. It’s just a very different environment from Las Vegas, where the convention is just one small part of the Strip, but each city has its fans. Personally I like Orlando better (even without bringing along family members for doing tourist stuff) because costs are reasonable; I don’t end every day smelling like cigarette smoke; I can sleep without hearing drunken screaming and sirens all night; and there are no strippers, panhandlers, or barkers clogging up the walkways. Plus the sun-deprived can spend time at the beaches of either Florida coast before or after the conference. Both convention centers struggle with squeezing too many exhibitors into the hall, however, leaving those with low HIMSS point counts in the basement (Las Vegas) or back past the food court (Orlando).

From A Sheen Warlock: “Re: hospitals losing money after EHR implementations. Why isn’t this bigger news?” The headlines always claim that hospitals “blame” losses on their EHR implementations. However, most of them (the smart ones, anyway) had planned for the obviously higher short-term costs — much of it the labor expense of training employees — and the temporarily lower revenue due to intentionally reducing appointments to give ambulatory users time to get used to the system. It’s not all that different from a big construction project that involves high costs and business interruption, but that hopefully pays for itself for years afterward. Assuming, in both cases, that it is used wisely.

From Confused Parent: “Re: Epic. In MyChart under Health Trends, there’s an option to graph a patient’s vital signs. We clicked the button for our son and here’s what rendered.” I’m not including the screen shot since I know Epic goes crazy over that, but it’s just a bunch of vital signs trended onto a single graph. The reader didn’t say what they were looking at specifically, but I’m guessing that it’s the body surface area trend line, which shows up as close to zero. That’s a graph scaling issue since the child’s BSA would be 1 or less throughout and the single graph’s X axis runs 0-100 (so BSA is always going to be near the Y-axis line). Parents probably don’t care about BSA anyway since its primary purpose is to calculate drug doses, so displaying it is somewhere between pointless and misleading.


HIStalk Announcements and Requests

Here’s one last chance to tell me your thoughts about HIMSS19. I’m also looking to ride the wave of enthusiasm it created by interviewing health system CIOs, CMIOs, CISOs, or caregivers interested in technology. Email me at mrhistalk@gmail.com —  the interview takes only 20 minutes by phone, no prep is required, and you can remain anonymous if you like.

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The reader who was randomly chosen as a $50 Amazon gift card winner for completing my reader survey asked that I instead use the money to fund teacher projects. With some careful application of a couple of layers of matching funds, the prize funded these DonorsChoose teacher grant requests: (a) math and English manipulatives for Ms. H’s kindergarten class in Fresno, TX; and (b) word games for Ms. G’s elementary school class in Denver, CO. Ms. H responded immediately to say, “My students will be so surprised and happy to know that they will receive new learning materials thanks to an awesome donor! I am super excited to see their reactions. We will use the station materials for both reading and math. Thank you again for your kindness!” Ms. G also responded in expressing excitement that she can share the news with her students that they will soon have new resources to use for their sight words.

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I decided to keep my burner phone active for now. Add 818.722.1903 to your phone’s contacts and you can text me stuff quickly and easily. I appreciate the information and photos sent to me at HIMSS19.

Listening: new from Strand of Oaks, a project of Indiana-born Tim Showalter that spans indie rock, Americana, and mainstream pop.

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Welcome to new HIStalk Platinum Sponsor OptimizeRx. The Rochester, MI-based company gives life sciences companies a digital communication channel to healthcare professionals with a single connection point to 500 brands of EHR, allowing them to alert the prescriber within their workflow of available patient prescription financial support, such as co-pay offers and vouchers, that can improve prescription affordability. The EHR user can print or email the information to the patient or send it electronically to the pharmacy, also providing the patient with customized patient education materials. OptimizeRx helps drug companies launch new products by getting them added into e-prescribing and EHR drug data files. It recently announced its acquisition of CareSpeak Communications, which engages patients and families using multimedia text, chatbot, and other platforms to optimize adherence, support dose titration, provide fill and refill reminders, and manage side effects. Case studies found an 83 percent reduction in transplant rejection, a 50 percent decrease in asthma symptoms, and a 15 percent increase in heart drug adherence. Thanks to OptimizeRx for supporting HIStalk.


Webinars

March 6 (Wednesday) 1:00 ET. “Pairing a High-Tech Clinical Logistics Center with a Communication Platform for Quick Patient Response.” Sponsored by Voalte. Presenters: James Schnatterer, MBA, clinical applications manager, Nemours Children’s Health; Mark Chamberlain, clinical applications analyst, Nemours Children’s Health. Medics at Nemours Children’s Health track vital signs of patients in Florida and Delaware from one central hub, acting as eyes and ears when a nurse is away from the bedside. Close monitoring 24 hours a day integrates data from the electronic health record, such as critical lab results, and routes physiological monitor and nurse call alerts directly to the appropriate caregiver’s smartphone. This session explores how the Clinical Logistics Center and more than 1,600 Zebra TC51-HC Touch Computers running Voalte Platform connect care teams at two geographically dispersed sites for better patient safety and the best possible outcomes.

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


Acquisitions, Funding, Business, and Stock

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CPSI announces Q4 results: revenue down 7 percent, adjusted EPS $0.78 vs. $0.63, beating earnings expectations but falling short on revenue. Shares are up 8 percent in the past year vs. the Nasdaq’s 4 percent increase. From the earnings call:

  • 18 Centriq and Classic clients moved to Thrive in 2018.
  • The company added 29 new community hospitals for the year and expects the same for 2019 as “the acute EHR replacement market continues to experience churn.”
  • CPSI says new hospital sales are driven by hospitals that made bad long-term decisions based on Meaningful Use and clinicians aren’t happy with the systems they chose.
  • Quarterly MU3-related revenue dropped $9.2 million year over year.
  • The company expects ONC’s proposed information blocking regulations to benefit the company as those actions usually drive smaller competitors out of the market.
  • President and CEO Boyd Douglas says HIMSS19 was “a typical HIMSS” that provided little traffic from either existing or potential customers, adding that customers in CPSI’s market don’t have a lot of travel money and that they would be better off attending the company’s user conference. He also added that while more international visitors dropped by, you never know if any business will result from that.

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Healthstream announces Q4 results: revenue up 8 percent, EPS $0.09 vs. $0.10, beating Wall Street expectations for both. 


People

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Huntzinger Managment Group names John Hendricks (Residual Point Technology) as CTO.

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Computational pathology vendor Paige.AI hires Leo Grady, PhD (Heartflow) as CEO.


Announcements and Implementations

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A new KLAS report on patient engagement technology finds that it’s a “wide but shallow field” in which only CipherHealth, GetWellNetwork, and Press Ganey rise above the fray. Epic leads by far in EHR vendor patient portals and 92 percent of customers say it plays a significant role in their patient engagement strategy. Providers are looking beyond HCAHPS retrospective patient surveys in considering technologies for rounding, patient self-scheduling, care coordination, and targeted educational content delivery.

HFMA and Strata Decision Technology release the free, open-source L7 Cost Accounting Adoption Model, intended to help health systems measure their adoption and use of advanced cost accounting methods.


Privacy and Security

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Authorities in Sweden find that audio recordings of 2.7 million calls made to the country’s 1177 health information line were stored as .WAV files on a Web server that did not use authentication or encryption, allowing anyone to play them back on their browser. The service is operated by Thailand-based, Swede-owned MediCall, which says it will “soon release a statement” following the CEO’s initial denial that the breach occurred. MediCall recruits experienced nurses from Sweden who want to work “in an unusually sunny place.”


Other

HIMSS seeks comments on its proposed update to the definition of “interoperability.” My only observation is that it sees interoperability as a technical capability rather than a provider requirement. Every one of us has examples of our providers not sharing information, but let’s make Phase I simple – look only at hospitals and grade them (maybe in yet another Maturity Model) on how well they provide their patient information to other providers, how they accept and use information sent by other providers, and how well they perform in giving patients their own information quickly and inexpensively. Create the demand for interoperability and the technology will quickly follow.

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Israel’s national EMS service and tech startup MDGo develop a system that uses existing car sensors to analyze the impact of a crash, determining with 92 percent accuracy the extent of occupant injuries and then immediately calling for an ambulance with the accident’s location. The company estimates that non-pedestrian deaths can be reduced by 44 percent because the system eliminates the 5-7 minutes that elapses before a passerby reports an accident and also alerts EMS personnel of its severity so they can deploy the right resources. Co-founder and CEO Itay Bengad recently earned an MD degree and an MS in oncology and cancer biology.

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Connection provides a video update for the children’s bags filled at their booth by HIMSS19 attendees, introducing those who will take them to the children of their respective organizations —  Dan Lim, PhD (VP, AdventHealth University, which offers a children’s summer camp) and Kim Barkman, RN, MSIT, MBA (VP/CIO, Community Health Centers).

The physician humanities editor of Neurology resigns following retraction of an article that the editor-in-chief admits contained “racist characterizations.” The journal will also discontinue the Humanities section; require all articles to be reviewed for diversity; hire a deputy editor for equity, diversity, and inclusion; and offer awareness training. The retracted article by William Campbell, MD, MSHA (cached copy here) described Reggie (“a 60-year-old black man”) and digressed into a side story in which the author wrote, “I once shared a table at a fried chicken fast food establishment with a nice African American lady. Immensely enjoying her fries, she sat with the shaker in one chubby fist and liberally salted each individual fry. I knew the various ways lead could get into moonshine. And I was fluent in the lingo.” The author is a widely published 1970 medical school graduate of Medical College of Georgia and a retired US Army colonel who practiced in a Richmond, VA HCA practice.

Ochsner Health System (LA) partners with drug company Pfizer to make it easier for patients to participate in clinical trials via the use of digital tools. The organizations tested exchanging mock patient information between Ochsner’s Epic system and Pfizer’s clinical trials data capture platform to reconcile gaps and variances. The project will publish a model for using FHIR standards to collect clinical trials data from hospital EHRs.

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Vox runs another example of city-owned Zuckerberg San Francisco General Hospital sticking patients with high bills because it intentionally stays out of all private insurer health networks to maximize its ED revenue. A 19-year-old football player who was hit by a city bus is taken to the city hospital – also its only Level I trauma center — for six stitches and CT scan. Despite having insurance through his father, the hospital billed him for his $28,000 portion of the bill after his insurance paid $2,000. The hospital then turned his bill over debt collectors and placed a lien. He sued the city, finally getting a favorable ruling two years afterward in which San Francisco was ordered to pay his hospital bill (to itself, apparently) along with economic damages. This would be the point where rational people would demand that hospitals offer their lowest accepted prices to everyone, or at least prevent them from chasing private-pay patients for amounts exceeding what they are willing to take from Medicare or other insurers.

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Intel publishes a white paper describing its experience running a five-location, technology-powered employee ACO.  Health outcome improvements were modest, but user retention was high and employees benefited from better choices for appointments and faster responses to their medical advice requests. The company says its key strategies are contracting directly with providers, using health IT and measuring its use, and working with delivery systems to improve quality of care. Technology components vary by state, but include:

  • Data-sharing via EHealth Exchange and Direct messaging, connected to Kaiser’s Epic and Premise Health’s Greenway Health PrimeSuite (which has since been replaced with Epic at Premise).
  • Waiting for the HIE situation to resolve in Arizona and then using the Connected Care to connect with 125 provider EHRs.
  • Connecting to its partner IPA in California, which replaced NextGen Healthcare with Epic.
  • Using Epic’s Care Everywhere and Carequality connectivity in its San Francisco Bay region.
  • Using Direct messaging in Oregon to coordinate referrals with unaffiliated practices, then working with Epic to accelerate functionality development with regard to closing the loop with providers.
  • Using Providence’s Collective Medical’s EDie to obtain patient opioid prescription histories and PreManage ED and to send alerts to providers when their patients are seen in the ED, admitted, or discharged.

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Weird News Andy only wishes this guy lived in the UK to support his fantasy headline “Doctors Remove a Third of a Stone of Stones.” Doctors in South Korea resort to surgery to resolve the stomach pains of a man who had ingested 4.4 pounds of coins and pebbles, which he admitted was his practice when feeling anxious.


Sponsor Updates

  • AdvancedMD will exhibit at the Association of Dermatology Administrators and Managers event February 26-28 in Washington, DC.
  • The Channel Company’s CRN brand names Avaya’s Mark Vella to its list of 2019 Channel Chiefs.
  • Bernoulli Health CNIO Mary Jahrsdoerfer, RN publishes a study on the key attributes of continuous clinical surveillance.
  • CarePort Health will exhibit at the Population Health Management Summit February 21-22 in Miami.
  • The National Cancer Institute awards Carevive with the only Fast-Track Phase I/II contract supporting the development of an innovative symptom management and electronic patient-reported outcome solution.
  • Staffing Industry Analysts names CTG President and CEO Bud Crumlish to its 2019 North American Staffing 100.
  • The VA issues an Authority to Operate for Diameter Health’s health data quality technology.
  • Divurgent publishes a new white paper, “Application Rationalization.”

Blog Posts


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Contacts

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

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Morning Headlines 2/19/19

February 18, 2019 Headlines No Comments

Missoula health care execs get $1.2M in venture capital for tech startup to better prepare patients

In Montana, PatientOne attracts $1.2 million in venture capital to hire additional staff and further develop its remote monitoring software for surgical patients.

USDA Prioritizes Investments in Telemedicine to Address Opioid Crisis in Rural America

The USDA will give funding priority to Distance Learning and Telemedicine program applicants who propose projects that provide opioid treatment services to patients in 220 at-risk rural areas.

Third Eye Health raises $7.25M to bring around-the-clock doctor support to nursing homes

Post-acute telemedicine company Third Eye Health secures $7.25 million in a Series A round led by Generator Ventures.

Reader Survey Results 2019

February 18, 2019 News No Comments

I survey HIStalk readers each year right around HIMSS conference time, soliciting feedback and ideas for both the short and long term. I appreciate every comment and find them valuable, especially since as an anonymous spare-bedroom writer I don’t get the chance to receive feedback in other ways.

My readership is diverse, so it’s hard to please everyone, and even if I did, and the result would be so bland that nobody would be reading anyway. I also realize that my readers are self-selected and keep coming back because they get something out of HIStalk, so I favor incremental change that can improve their experience rather than major changes that would be disruptive for readers and for me.

Each year’s survey has many responses that give me a warning of the “if it ain’t broke” variety. In fact, that is always the most common response by far.

Thanks to the 520 readers who responded. One randomly chosen of those readers won a $50 Amazon gift card, which he or she has asked me to donate to DonorsChoose. I’ll report shortly how I spent the money.

I have a few to-do’s from the comments below. I’ve also asked Lorre to review for action items since she can be more objective than I.


The TL;DR Summary of To-Do’s

  1. Investigate creating a subreddit for extending the discussion without having to take on user management myself.
  2. Redesign the bulk email that indicates when I’ve published something new.
  3. Consider summarizing the top news items in the email update like I used to do.
  4. Try to recruit some new contributors, especially from the provider front lines (CIO, CMIO, CISO, etc.)
  5. Consider whether HIStalkapalooza could be restored in a simpler form.
  6. Think about whether I should try harder to get new readers, especially those newer to the industry, via some sort of marketing.
  7. Consider writing longer-form pieces such as editorials.

Respondent Characteristics

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  • 81 percent of readers have worked in the industry for at least 10 years
  • 26 percent work for a provider organization
  • 7 percent are CIOs, 2 percent CMIOs, and 7 percent CEOs
  • 25 percent have provider purchasing influence of at least $10,000
  • 83 percent say they have a higher appreciation for companies that they read about in HIStalk
  • 41 percent say they have a higher appreciation for companies that sponsor HIStalk
  • 89 percent say reading HIStalk helped them perform their job better in 2018 (this is the statistic I care most about)

What Features Readers Like Most

The scored, weighted results give the top items in order as:

  1. News
  2. Humor
  3. Headlines
  4. Rumors

Suggested Changes

I should first say that every year’s survey contains one overwhelmingly prevalent response – don’t change anything. I’m open to ideas, but I also know that most readers who keep coming back like things just as they are. I have to resist the urge every year to change things just because someone suggested it.

Try to say something more productive about companies, especially startups.

I give an honest opinion based on what I see as an industry everyman. It isn’t always analytical, but I always check a company’s website, interviews, leadership, etc. before I comment (assuming I don’t already know that company). I think I say positive things when I like the product or marketing approach.

Parts I like, some I am indifferent to, navigating around them is easy.

You’ve neatly explained how I try to give everyone something they can use. Not everybody cares about sponsor updates, people moves, reader comments, etc. and I make it easy to skip those sections. I run the sponsor updates at the bottom of the page as a courtesy, but everything else on the page is something I thought interesting enough to mention. I have no incentive to pad out a given day’s news post with something I don’t think is useful. I try to earn reader trust that I won’t waste their time.

Explore an alternative website format to keep it fresh and in line with current website formats. A refresh every 2-3 years would be nice.

I’ve always waffled on doing this because it wouldn’t change the content, just the presentation, and I hope readers aren’t fickle enough to read or not based on initial appearance. Politics aside, Drudge Report is the ugliest website in the world, yet one of its busiest, because people want to read the content and have become comforted that the site will always look the exact same.

Write less about start-up financing.

I eliminated announcements involving funding of less than several million dollars, thinking that those companies that receive bigger investments are worthy of mention because they are likely to be up-and-comers, and to skip announcements of companies whose product isn’t purely health IT related.

You are jaded and paint every topic with your negative bias. Sometimes things aren’t as negative as you might think.

I admit that having been in the industry for a long time, I’m skeptical and sometimes cynical and my opinions reflect that. But I’ll also say that one of the reasons I started HIStalk was because the cluelessly cheery publications and websites didn’t reflect reality and I offered an alternative. I should make a sign for my desk reminding me to be more positive.

Add more commentary.

I’m challenged here because some readers want straight news and no commentary. I also don’t claim to be an expert in everything and therefore hesitate to provide what might be a poorly informed pinion. But I will consider the options.

Put the news bullets in the email update without requiring a click to see it on the website.

My goal isn’t to send out yet another industry newsletter that nobody reads. I can’t squeeze the dozens of items contained in a typical HIStalk post into an email and I’ve already culled out the 95 percent of items that aren’t worth running. I post everything in aggregated form, so all the links are going to take you to the same page anyway – I don’t write separate posts for each news item because that would be a flood of individual stories. I understand the argument that, “Maybe I won’t bother clicking over to the website if nothing sounds interesting,” but I’m willing to lose readers who find that onerous since I’m not doing them a favor by dumbing down the teaser. The thrice-weekly news posts are either worth 15 total minutes of your time each week to skim or they aren’t. 

Seek out more rumors. I started reading HIStalk to find about my competitors. Not all employees can be happy with Epic and Cerner.

Reader rumors are polarizing – most people like them, some hate them, and some like them only until their company is mentioned in a negative light and then suddenly rumors are evil non-journalism. I make it easy to submit rumors anonymously and I never divulge a source anyway, so the opportunity is there for anyone willing to contribute.

Reduce vendor-written Readers Write pieces.

This one is always hard to resolve. Anyone can send me a Readers Write article and I’ll post it if it passes the test of being informational and not a sales pitch, but the only people who send those articles are vendors and their PR firms. My biggest lesson learned from writing HIStalk is that everybody complains that too few people aren’t contributing articles or comments, failing to count themselves among them. I should be thankful because if everyone was wiling and able to write about the industry, I would be made redundant.

I love reading the comments, but wish there was an easier way to see them without clicking the comments link for each article. Maybe a “latest comments” ticker on the side or have them go to a subreddit? I realize you don’t want to have to deal with having readers sign up for accounts.

I’ve tried a lot of things over the years to raise the visibility of comments. There’s already a “latest comments” widget to the right, but it’s one of many things crowded in there. I’ve looked at Disqus and other commenting tools and wasn’t thrilled.

One challenge with comments is understanding how they are displayed on the site. Clicking the email link goes to the specific article (like yesterday’s news post, for example) and you see the comments on that same page and can enter your own. When you just go to the home page (histalk2.com) however, comments are not displayed and you can’t enter them without clicking the specific article’s title. That takes you to the same page as if you had clicked the email link.

I know next to nothing about Reddit, but I’ll check it out.

Emails don’t always include links.

This is a can of worms that I’ve opened and re-opened countless times over the years without being able to fix it. Companies and your own email client use all kinds of tools to block emails, block links, strip images, etc. and those wreak havoc on my emails that always contain links. Not to mention that overly aggressive email filters often categorize anything with an image or link as spam, meaning that (a) it won’t get delivered to your inbox; or (b) it gets delivered, but dropped into your spam folder where you’ll never see it. I don’t really have an answer except that I publish on a predictable schedule (news M-W-F, Dr. Jayne MF, weekender F, and irregular items like interviews or Readers Write usually on M or W) so email or not, you can expect to see something new every day except on the weekends.

Maybe others see value in the Weekender, but I never read it.

I started the Friday morning post because people were complaining about reading DonorsChoose updates and other non-news items in the regular posts, so I thought that was a good place to put them (being clearly labeled) and to put in some fun and sometimes upbeat items. It also contains the week’s best reader comments (which respondents in last year’s reader survey asked for) and a link to all the other items I posted for the week. I’m happy to stop writing it if nobody cares, though, since it’s just extra work for me.

Do away with the morning headlines. Seems duplicative and there are plenty of websites and emails that do this already.

The headlines are by definition duplicative – those who read the full news posts don’t necessarily read the headlines and vice versa. I wanted to give the skimmers a quick way to catch up the most important news items in just a few seconds each weekday, but I also make then invisible to those who don’t care by not sending them out as an email update. No changes here, sorry. Personally I love reading the headlines each morning since Jenn writes them and I never know what she has found.

Start blogging! You already do when you comment on a news piece, but maybe once a month pour out your thoughts on a health IT issue.

I will consider that.

Try not to become a walking advert for KLAS or Chilmark.

I don’t really mention Chilmark at all, but I do think KLAS reports contain some insights worth recapping and their analysis often makes good sense even though I gripe plenty about their methodology and business model. I skip mentioning any of their reports that I don’t find interesting.

Find some new columnists, especially those in the hospital trenches.

I offer regularly, but the folks who have the most to say don’t have the time or interest to say it, and those who have tried didn’t last long. Usually I hear nothing more once I say, “Sounds fun – send me a sample column and let’s see how it fits.” But if you are a provider IT person who is interested in writing (I can even keep you anonymous), then let’s explore.

Add interviews to the YouTube channel, do podcasts, and add commentary and engagement on LinkedIn.

I’m biased since I don’t watch YouTube interviews, listen to podcasts, or use LinkedIn, but maybe you can help me see the broad reader benefit. These might be areas where I need to enlist some help, perhaps some junior person who is good at social media but who wants to gain industry knowledge.

Appreciate the music recommendations.

Thanks. Several people said that, even being nice enough to say which bands they loved after I mentioned them.

Bring back HIStalkapalooza.

I might, but it would have to be in a radically different form that requires less financial risk and work. People told me at HIMSS19 that its biggest feature wasn’t the band or the expensive food and drink, but rather the chance to meet like-minded people – regardless of whether they work for a vendor, provider or other – in a setting where nobody is buying or selling something. Facilitating that networking opportunity without necessarily spending a bunch of money is certainly possible. I will think about how it could work.

Reduce the sponsor mentions.

I think the compromise I’ve reached is a good one in recognizing that they pay the bills. Sponsors gain no editorial advantage except that I include their less-newsy items (which I ordinarily wouldn’t mention at all) in the Sponsor Updates section, where you can easily skip them if you want. They have to earn mentions in the regular news sections like everyone else.

I would love to see a review of health and health IT books.

I do that sometimes if I think it’s worth me buying the book first since I don’t get free copies. The only problem I have is that I appreciate that someone wrote a book in the first place and I struggle with criticizing their effort (probably since I go through that myself).

You should start a conference.

I don’t have the time or expertise to do that alone, although I suppose I could hire someone to do something on a small scale. It seems we have a lot of conferences already, so I would have to find an unserved niche that I’m not envisioning at the moment.

Offer a weekly, high-level news summary for those who can’t keep with the regular emails, like a CEO version.

I could do that, although I kind of already do it in the Weekender, where I list the most important news items of the week with a one-sentence summary. I don’t know what I can add beyond that except maybe to make that a separate email.

Offer more thoughts from the investment community.

I would love to, but I suspect those folks are making too much money to spend time writing articles. The Healthcare Growth Partners folks are very good at it, for example, but they have their own audience.

The email format could be improved.

Good idea. That was on my list of to-do’s. It’s definitely a homebrew format that I threw together in about five minutes when the email service changed its editing tool unexpectedly, so I’ll get someone more artistic to help. I may revisit the idea of including news snips in some form, although the ironic consequence is that I would be convincing some readers not to bother visiting the site that day.

If I were Mr. H, I would retire to the soft sands of a private island knowing my work to expose the real health IT world has been completed in remarkable fashion, then turn over the site to someone else to live behind the lab coat in anonymity. Otherwise, enjoy life more and insert straight comedy, which might just be my warped sense of humor.

This is my favorite comment, although “retiring” suggests doing something I would enjoy more and there is no such thing. Writing HIStalk is still my favorite activity even after 16 years.


Representative Comments

Keep up the great work. And the music references. I spent a good hour catching up on Rival Sons the other week.

Love the snark, but more importantly how you cut through the bs to get to the core of an issue. That coupled with your ability to clearly communicate is priceless.

Gosh do I love this site. I love the people, I love the news, I love the interaction and decade+ learning. I am constantly amazed that there is more to learn, there is so much news, and that someone has the stomach to put it all together on a regular basis. Bravo HIStalk team, you had another marvelous year.

I just want to offer appreciation from a long time reader.  Your commitment to the daily grind of putting out material in a thoughtful, “call it as you see it,” and almost always objective manner is very much appreciated.

Useful and well balanced, I find it a reliable source at a time where stories are either too curated or not curated enough. It would be interesting to have deep dives on some stories, to help understand where a given story really goes or ends up, especially relative to competing solutions. I often have to go to KLAS or Definitive or other resources to get the context to a given story. I also appreciate that is a difficult task given the time required.

As a vendor person, I’ve always liked understanding who we are competing with and how our solutions are fairing out there in the real world. I wish more of my associates would understand the landscape better by reading HIStalk. I’ve been reading it for a long time, and I’ve been at three different vendors (but haven’t moved from the building ;). BTW, I’m a senior techie person, so I’m not directly selling anything, but understand that we are all really part of making a client / customer happy, which is in a way, sales. And I’ve always liked trying to help healthcare do better, since that affects all of us in the end. I do enjoy my daily fix of your stuff, so thank you.

HIMSS is stale. Pretty clear to all of us, but seems not clear to HIMSS because the org is not doing anything to change itself. Seems to me that your blog and to a lesser degree KLAS (because the data is warped too easily) is doing a lot of the work that HIMSS should be doing. How can that be fixed? Could you have any role in that?

Just curious, given the current M & A craze with health systems, maybe an occasional focus on the displaced CIOs or IT leaders out there. Where are they landing, do they choose retirement? It took me 11 months to land in another healthcare IT role, this time with a vendor.

Website design isn’t sexy, but who cares? (because the news is great)

I greatly appreciate the ruthless efficiency of HIStalk – very high signal-to-noise.

I’m surprised when I ask co-workers/peers if they go to your site and most say “no”. After they go, they tell me they go regularly. I’m not sure how big you want your site to be (unique visitors), but if you want to grow, then some marketing may be needed. I was trying to remember how I found out about you and honestly can’t remember, but you are at the top of my regular reading list!

Much of HIStalk still concentrates on hospitals and providers (inside the walls). Would like to some expansion to consumer engagement, telehealth, etc. Mentioned sometime but would like to see regular news, interviews, articles, etc.

Tone down some of the jaded comments. I always agree w/the sentiments you express, but the editorial comments border on bitter sometimes.

I love the non-news like music suggestions, Donors Choose, etc. News is usually a downer, so having some levity makes life better.

It is harder for the hospital side to buy and much harder for the vendors to sell these days. I would love it if we could get some articles from each (people that you pick that could write in, or volunteers?) on how we could better partner with each other, to help this sales cycle and process. Maybe this could be a regular series, every other month?? Just a thought.

You are my single source of truth and only source I depend on for keeping up to date on US news. That said, I’m continually impressed that you report Australian news before the local guys do. Keep up the good work.

As a healthcare sales rep, I find your website invaluable in staying up to date with industry trends and news. I always feel smarter after working my way through a Monday update and yet feel guilty because clearly, you spent a good portion of your weekend writing it. I would be fine with a Tuesday update if that freed up some of your precious weekend.

Weird News Andy is the best! I can’t wait for your HIMSS coverage. I love how you keep it real each year with your commentary.

Appreciate the fact that you are querying your reader audience.

I have worked for healthcare IT vendors for my entire career. I love your neutrality regarding the vendors, even your sponsors. I read your blog for the focus on healthcare delivery as a goal of healthcare IT. That is refreshing. If you doled out not-so-subtle marketing ads masquerading as news I would stop paying attention, like has been done with anything HIMSS touches (and I’m a HIMSS member).

I have always found your Sunday afternoon / evening news roundup extremely helpful to add some insight heading into the week. I have forwarded many of these news stories over the years to colleagues or followed them up myself. For someone who takes a dim view of healthcare journalists as a whole, you do a great service to them in addition to the rest of your audience. The harsher you are on us journalists, especially when you point out mistakes we have made, the more I respect you. A former editor loved it that you highlighted a colleague’s [multiple] mistakes and used it to remind us to be extra cautious that we double check proper nouns, source material, etc.

Set a time horizon for when HIStalk will end. I honestly wonder where I will go for solid news when you retire. I am afraid you will just power off some day. Or maybe Mrs. HIStalk secretly pulls the plug.

Just don’t turn into an over advertisement funded HIMSS or CHIME like service – you’re our only hope for honest reporting in the industry.

Don’t assume all vendors are ‘the bad guy’ – just because we’re selling something doesn’t mean it isn’t coming from a place of concern for patients or that we can’t offer intelligent solutions by collaborating with hospitals and healthcare systems.

As a former healthcare analyst and investor turned operator (I run a BU at a healthcare technology company), I absolutely respect and admire what you have done and the way you deliver content. Love your thoughtful insight, the way you filter through and interpret inbound content from readers (with the occasional shredding of an ask or perspective) and your wit is right up my dry wry alley. I have enjoyed your site for years and will continue to do so–hopefully for a long time. I also really appreciate your effort to make the world a better place through raising money and donating to kids/schools. Means a lot to me. I have long been meaning to reach out to say thank you, and this is the first time in 10+ years that I have done so. I apologize for the long delay. Seriously, way to go, I’m very happy for you!!!

Thank you for years of what I can only describe as virtual mentoring. You’ve made me a much better health IT professional and maybe even a little better person. I am truly grateful.

Improve the job section HIStalk is big enough in terms of audiences — help others find their dream jobs via your site: connect employers with potential employees.

I know the English language enough to get me to where I am, but I’m regularly in awe of your anal retentive approach to grammar. One of the many reasons I like reading your work! I always learn something. And I very much appreciate your sense of humor.

Thank you for what you do, it’s really appreciated. I most appreciate the various studies that you bring attention to as I don’t normally wade into those waters.

Love what you do and will hear colleagues discussing articles you’ve feature. Most recently that gem on mining system issues through alert comments.

I love the format, it’s very digestible, even on a busy day! I trust you, because you seem to seek balance, pursue the truth when possible, and consider things from many angles. You have a voice of independence, which includes the low budget no frills approach, but also the consistent attention to the charity donations to fund teacher projects. Keep it up!

Thanks for making me smarter about the industry without having to invest a lot of time.

In general it’s still routinely very good and occasionally hits great. Which after 15 years is pretty amazing. No one else does what you do.


Curbside Consult with Dr. Jayne 2/18/19

February 18, 2019 Dr. Jayne 2 Comments

I’m still recovering from HIMSS. What started as a slightly runny nose on Thursday has turned into a full-blown head cold with plenty of sneezing. At least it’s not influenza, however, so I’m grateful.

Any time you get that many people together shaking hands in flu season, it’s always a risk, but hopefully vaccination and lots of hand sanitizer has worked to keep the bad pathogens away. Unfortunately I’m spending the weekend in the clinic, making up for time out of office, and there isn’t much room for rest and recovery.

I mentioned the Arcadia-sponsored lunch I attended that featured John Halamka. I have been thinking about some of the things I learned during that presentation.

He talked about several countries and some of the challenges they are facing with healthcare. There was a lot to process. First, he talked about his experiences with China’s healthcare system and its approach to primary care, or lack thereof. The concept of coordinated care is just starting to take hold as China works to develop its primary care workforce. Until then, patients might self-select to a subspecialist physician based on what they think might be happening to cause their symptoms. He gave the example of someone waking with a headache and choosing to queue to see an academic neurosurgeon rather than seeing a primary care physician first. He is involved in a pilot project looking at care coordination that has one million patients in the cohort. That’s quite a bit larger than the pilot projects we’re used to in the US.

Next, he talked about healthcare in India, where a workforce of 600,000 physicians care for approximately 1.4 billion people. (Google shows the number at a bit closer to 800,000, but either way it’s a relatively small number for the care that needs to be delivered). Halamka has traveled to India multiple times and shared photos of his experience looking at x-rays that patients are carrying around with them as part of their personal medical record. There are significant healthcare disparities by region and the informatics community is starting to look at using clinical decision support to address issues where certain diseases such as tuberculosis might be more common in certain regions of the country.

He shared a story about a post-partum patient with abdominal pain and polled the audience (there were a handful of doctors in the crowd) about their thoughts. Nearly everyone thought about post-partum infection or complications like a retained placenta, but the real answer was abdominal tuberculosis, which isn’t even on the radar for most of us in the US, but is apparently fairly common in some parts of India. It really makes one think about how different healthcare experiences can be around the world.

The third country he talked about was Norway, where patients are expected to contribute their personal health information to the overall dataset of public health records. There’s not an “opt out” per se, which results in much more information being able for research and for investigation of health practices. I did some additional digging on this and found that although the Norwegian national Summary Care Record is in place for all citizens, the tool isn’t used as routinely in practice as it might be. Halamka also touched on the drinking habits in Scotland, which are among the largest per capita across the globe.

He also discussed interoperability in Australia, which is chiefly by PDF. This means there is no drug-drug or drug-interaction checking, no clinical decision support, and no common medication lists. There are, however, probably a great deal of duplicate data entry and wasted resources. He touched on Japan with its aging population and low birth date, where fewer clinicians are tasked with delivering care to a growing population, often with significant quality variation. Apparently in Japan it’s also illegal to host electronic health records on cloud-based services, which is going to need to change for optimal use of digital health resources.

Halamka paused from his round the world tour to address the role of artificial intelligence in healthcare, particularly the need to make sure that training sets used to build AI technologies aren’t full of biased information based on historical challenges such as delivering care to patients whose primary language is something other than English. We also need to take care with the use case for AI in healthcare — he used the lack of progress with Watson as an example. He doubted that the big EHR companies would really be doing much innovation, going on to say that the real innovation will be in a cloud of apps around those legacy systems and that the “24 year olds in the garage are the real innovators.”

He noted some of the challenges with interoperability in the US, namely with data sharing for adolescent patients, which must be controlled by policies and age ranges to meet the changing needs of children who are transitioning through adolescence and into the adult world. He mused on Apple’s partnership with Aetna, where patients will be given Apple watches as tools for health monitoring. It will be challenging for providers to figure out how best to use patient-generated data and for systems to figure out what data is important enough to act on.

He used his own example of a rapid heart beat as a test case. When it happens, it usually goes away in a minute or two. How will the system know not to act on it vs. to act on someone who is having a new onset of rapid heart rate or a more dangerous type? It’s one thing to have data, but another thing entirely to transform that data into information, knowledge, and wisdom.

There were good questions from the audience and Halamka went on to explain how he sees his role as “care traffic controller” for three generations of people in his family. I hadn’t heard that phrase before and I have to say I like it and will be stealing it for future conversations. Overall it was a solid session and I am even more curious about how other countries are handling various healthcare delivery crises and whether we’re really as bad off as we think we are. I’m going to have the opportunity to practice medicine with people from around the world this summer and I hope it will be a great learning experience.

What’s the best session you saw at HIMSS? Leave a comment or email me.

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Email Dr. Jayne.

Morning Headlines 2/18/19

February 17, 2019 Headlines No Comments

Porter Health Care System patients could get up to $5K from cyberattack settlement

Community Health Systems (TN) agrees to pay $3.1 million to settle a class-action lawsuit stemming from a 2014 data breach that impacted 4.5 million patients across the country.

FTMC welcomes new chief info officer

Fisher-Titus Health System (OH) hires Linda Stevenson (Cerner) as CIO.

Fairfield Medical Center posts $22.6M operating loss from medical records overhaul

Fairfield Medical Center in Ohio attributes its nearly $23 million operating loss last year to its Cerner implementation.

Nanaimo hospital says it’s making electronic gains; doctor disagrees

Physicians in several departments at Nanaimo General Regional Hospital in Canada are still using pen and paper to document patient encounters and order medications and labs despite the launch of a new Cerner EHR at Island Health facilities three years ago.

Monday Morning Update 2/18/19

February 17, 2019 News 8 Comments

Top News

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HIMSS gives a preview of the “evolution of the HIMSS Brand” (marketing-speak for “we had a new logo drawn up whose deep meaning requires 10 pages to explain.)” Meanwhile, the HIMSS social media folks are apparently fans of “The Dark Knight” or toffee candy bars.

The explainer video talks a lot about “re-imagining” and “reforming” the ecosystem. It also notes “member-driven impartiality,” which is as interesting as it is vague. It ends with a sinister-sounding call to “join the reformation,” which I think is really just a membership pitch.

I am impressed that the HIMSS marketing VP in charge of this project, Terri Sanders, has a long healthcare background (not all in marketing) and an MPH. Quibbles aside, I expect she will do a good job.

A couple of readers have emailed me to express their frustration that HIMSS ignored my request for their IRS Form 990 financial disclosure (which as a non-profit they are required by law to provide), so I’ve emailed the HIMSS media contact, Karen Groppe, with another request. UPDATE: Karen emailed me almost immediately, which is admirable given that we’ve just come off the most hectic week for HIMSS – my previous inquiry had apparently gone astray in Etherland. She will get me the forms. I pointed out that old versions are on Guidestar, but nothing for the previous two years that should have been filed by now. I appreciate the quick response.


Reader Comments

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From Rounding Error: “Re: Cerner’s HIMSS19 slide bashing Epic over CommonWell. Carequality was exchanging 11.5 million records per month when the CommonWell connection went live in July 2018. It hasn’t changed much since even though a dozen CommonWell sites have gone live in the last seven months. I suspect CommonWell doesn’t have many members live or those members aren’t exchanging much data, while Carequality has 1,250 hospitals, 35,000 clinics, and 600,000 care providers. It’s kind of lame of Cerner to say that Epic is the laggard. No wonder the government is stepping in.” I was surprised that Cerner has become either more aggressive or more desperate in calling out competitors by name, which it has never done.

From Over the Shoulder: “Re: this tweet featuring a selfie of one of the Twitterati. Notice anything unusual? Hint: it was taken by a third person as the tweet-prolific subject pretended not to notice!” I thought that was odd, too, as was his inclusion of the twitter ID of a PR firm that seems to specialize in pushing vendor thought leadership. Digging further, he’s apparently shilling for the PR company, creating video commercials for their customers right in the exhibit hall. Hopefully all those folks who were unashamedly cashing in on their questionable fame at HIMSS19 won’t need their credibility back now that they’ve sold it.

From DrJVan: “Re: HIMSS19. Kudos on your coverage. Did Allscripts use this year’s gathering to introduce the industry to their AI product, Avenel? It has been over a year now since they announced this product. Was it displayed or mentioned?” I didn’t visit the Allscripts booth, I didn’t hear anything about Avenel, and Avenel wasn’t mentioned in the Allscripts tweets. I’ll invite readers to comment.  


HIStalk Announcements and Requests

It’s a typically quiet post-HIMSS conference period since everyone (even the federal government) blasted out their big news last week. I expect a refractory period this week as everybody gets back to their real jobs, after which the news will return at a pre-summer level. It’s nice that we have nearly 13 months before doing last week all over in Orlando again at HIMSS20.

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It’s nearly an even poll respondent split on whether the VA made the right choice in ending its Epic patient scheduling pilot and plan a replacement with the Cerner offering. King Solomon provided a wise comment as a former Epic Cadence application analyst, saying Epic’s product is awesome at scheduling and can handle complex rules, but that the single-system argument should prevail.

New poll to your right or here: What is your impression so far of HHS’s newly proposed interoperability policies? Vote and then click the poll’s Comments link to explain.

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I’m still struggling to think of something conclusively profound to say about HIMSS19, but I’m beginning to lock into an overview along these lines:

  • We give HIMSS too much credit in thinking that we should draw meaningful industry insights from its conference. Nobody expects to be inspired and educated about imperiled marine life by attending a boat show.
  • HIMSS is a show about selling, not doing, and while the former drives the exhibit hall (and thus the conference itself), the latter improves outcomes and cost.
  • Exhibitors in the hall did a good job in minimizing the hype and the hyperbolic come-ons. Some good conversations took place there.
  • Health systems do whatever benefits them the most. Technology amplifies the effects of both their best and worst practices.
  • Sharks have been jumped. The HIMSS conference probably isn’t one of them since the lower attendance will probably inspire changes, but the signs were there among certain vendors, technologies, and concepts.
  • Some companies and sectors (and maybe even HIMSS itself) seem to be struggling to figure out their post-Meaningful Use futures.
  • The government can talk about information blocking all it wants, but it’s a paper tiger when it won’t even take action when hospitals refuse to give patients copies of their medical records or charge excessively for doing so.
  • Cybersecurity is an increasingly big deal, which unfortunately means that providers will be diverting a big chunk of money sideways just to maintain the status quo.
  • Most health systems remain lemmings in following others at a safe distance, but more of them are forging their own paths without endless hand-wringing fretting whether they should wait for 10 similar organizations to it first. The rise in health system-run incubators was driven by potential profit, but also by being able to influence product direction.
  • Health system consolidation will be a feast for some vendors, but famine for the others, as the big will get bigger on both sides of the fence.
  • We have plenty of digital innovation, but health system indecisiveness and ridiculously long purchasing cycles keep killing it off as startups can’t hang in there for years waiting for their first sale.
  • The only sure way to make money as a health IT startup is to create something that taps into the massive profit stream of drug companies.
  • Big technology companies could become a limited disruptor in healthcare, but their arrogant lack of knowledge about how the industry works and their focus on technology rather than patients will make it hard for them to succeed in an ethical way.
  • Most conference attendees want to do the right thing for patients, but are hampered by a healthcare system and business environment in which those patients aren’t the actual customer. The status quo makes all of us unhappy as patients, but it also creates our paychecks, and we struggle with that.

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I’m interested in your HIMSS19 experience and takeaways. Please complete my anonymous HIMSS19 Impressions form. I’ll summarize the submissions next week.

Along those lines, I would enjoy hearing an exhibitors narrative on the conference – setup day pains, good and bad visitor behavior, company expectations, and shoe tips for the zillion steps per day you took. I’ll keep you anonymous, so you can be honest. Send something my way and don’t worry about polishing it up since I will do that.

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I’ve worked from a 15-inch laptop all week, so my first impression upon re-docking at home is that my desk monitor was the size of a theater screen. I’m also enjoying playing with the Amazon Echo Dot that I won by scoring 10 of 10 on WellSky’s trivia quiz at HIMSS19 – it’s similar to my Google Home Mini with good sound for a small gadget, but the setup was easier with the Dot, it’s easy to find new skills in the Alexa library, it plays Spotify and Pandora well, and it can connect to a Bluetooth speaker. It costs about the same as the Mini at $50. Either device is worth it just for setting cooking timers and reading the weather forecast.

I enjoyed the HIMSS19 write-up of Garen Sarafian, who is surprisingly astute and patient-focused as a money guy. He concludes that HIMSS is out of touch in choosing its dopey “Champions of Health Unite” theme that has little to do with actual health or its champions (who are likely caring for patients episodically instead of juggling Orlando party schedules). Like me, he is struggling to detect any overall HIMSS19 theme, although he notes that population health management didn’t get much airplay and health systems aren’t all that interested in exchanging information outside their walls (and thus forced the need for the federal government to provide a push). 

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Welcome to new HIStalk Platinum Sponsor Practice Velocity. The Machesney Park, IL-based urgent care solutions vendor offers the VelociDoc EMR, just named a KLAS Category Leader for 2019 for urgent care. Urgent care providers can document a visit in under two minutes using its Chartlet one-page urgent care chart. It integrates with online registration, teleradiology, in-clinic dispensing, national labs, and payments, with full integration to its PVM practice management system. The company offers 365-day, US-based support. The company’s 150 urgent care billing specialists can help code, process, and monitor claims as a complete revenue cycle management solution, while its full-time contracting and credentialing team can reduce administrative burden in tapping its longstanding payer relationships to maintain contracts and perform comparative fee analyses. See the company’s top-rated urgent care EMR here. Thanks to Practice Velocity for supporting HIStalk. 


Webinars

March 6 (Wednesday) 1:00 ET. “Pairing a High-Tech Clinical Logistics Center with a Communication Platform for Quick Patient Response.” Sponsored by Voalte. Presenters: James Schnatterer, MBA, clinical applications manager, Nemours Children’s Health; Mark Chamberlain, clinical applications analyst, Nemours Children’s Health. Medics at Nemours Children’s Health track vital signs of patients in Florida and Delaware from one central hub, acting as eyes and ears when a nurse is away from the bedside. Close monitoring 24 hours a day integrates data from the electronic health record, such as critical lab results, and routes physiological monitor and nurse call alerts directly to the appropriate caregiver’s smartphone. This session explores how the Clinical Logistics Center and more than 1,600 Zebra TC51-HC Touch Computers running Voalte Platform connect care teams at two geographically dispersed sites for better patient safety and the best possible outcomes.

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


Acquisitions, Funding, Business, and Stock

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Cerner’s investor presentation from HIMSS19 (worth a look in its entirety if you follow Cerner) included Brent Shafer’s “new operating model,” with these comments standing out:

  • The big themes are (a) making it easier for clients to do business with the company; (b) increasing the speed of innovation; and (c) growing profitably over time.
  • Cerner is “structured in a way to not conducive to productivity” in growing to $10 billion, thus the need for change.
  • A key component is the Greenhouse, an incubator where innovative ideas can be nurtured without competing for operational resources.
  • Client relationships will be a strong focus.
  • Process improvement is important – accountability, shared goals, driving increased collaboration and transparency, common metrics and KPIs, a focus on life cycle, and doing a better job of partnering.
  • A consolidating market is creating bigger client footprints.
  • Examples of getting innovation to market faster and making adoption easier: Dynamic Documentation is well liked and reduces clinician burnout, but six years after launch, only half the client base has it. The company offers a network for sharing air quality information for asthmatics, which shows what is possible with network connections.
  • The company offers 30 third-party apps and expects that number to increase.

Decisions

  • University of Maryland Shore Regional Health (MD) replaced Meditech with Epic on December 1, 2018.
  • Haskell Memorial Hospital (TX) replaced Evident (a CPSI Company) with Athenahealth on October 1, 2018.

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


People

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Fisher-Titus Health System (OH) hires Linda Stevenson (Cerner) as CIO.


Announcements and Implementations

CPSI makes its EHR information available to patients via Apple Health Records on the IPhone. 


Government and Politics

FDA warns McKesson over incidents where the company failed to take action after finding that one of its employees replaced opioid tablets with some other product, with McKesson doing nothing to warn other customers to check packages of the same lot number.


Privacy and Security

A hospital in the Netherlands confirms that students who work part-time there were inadvertently given the ability to view the complete electronic medical records of all patients, caused by incorrect software settings. 


Other

Some Twitter fluke kept recommending #HIMMS19 as a hashtag, creating a ton of tweets going out under a misspelled HIMSS.

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Rapidly improving photo and video manipulation tools capable of “deepfaking” (like the AI-generated portrait above) will threaten democracy, justice, and commerce since you can no longer tell if what you are seeing on Facebook or anywhere else is real. Check out this AI-powered site to see how easily technology can create believable images out of thin air. We need some kind of digital certificate that verifies that photos and videos were taken with unaltered cameras and have not been changed by even one pixel (some kind of hashed signature embedded as a watermark, maybe?) 

Non-profit health system Atrium Health – the former Carolinas HealthCare System – paid its CEO $6.1 million last year.

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The busiest webmaster in the industry must work at for-profit, CHS-owned Bayfront Health St. Petersburg, which keeps removing executives from its leadership page. He or she is behind, however, as the CFO just quit, joining other recent departees. I notice that the guy at the lower right moved to an assistant CEO job after two years as a performance improvement intern, his first job other than marina manager and a football skybox attendant (although to his credit he did earn an MHA).

Beverly Hospital (MA) admits to the state’s Department of Public Health that a former pharmacy technician stole 18,000 pills – most of them opioids – by marking them as outdated in Pyxis and then either using them or selling them. The hospital finally caught her a year after the thefts began, blaming the delay on a former pharmacy operations director who it says wasn’t reviewing the Pyxis reports. 

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A sperm bank sends a cease-and-desist letter to a female customer whose daughter was conceived using sperm the woman bought from the sperm bank. The woman had her five-year-old daughter’s DNA tested by 23andMe, which identified another 23andMe customer as the child’s grandmother. The woman thought it “was a cool thing” to contact the grandmother to say she would be open to contact from her son the donor, forgetting that the the sperm bank’s terms prohibit such contact until the child is 18 and only then through the sperm bank rather than directly. The sperm bank threatened her with a $20,000 penalty and said it could withhold the remaining four vials of sperm it was holding for her, also reminding her that she’s not allowed to seek the identity of the donor through DNA testing or online facial recognition tools.

A woman’s cancer treatment is delayed after the copies of her CT scan she had overnighted to her clinical trials team never made it – the mailbox place’s owner was in foreclosure and took off.


Sponsor Updates

  • Oneview Healthcare publishes a case study describing how University of Iowa Hospitals & Clinics uses a combination of technology and empathy to improve the patient experience.

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Contacts

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

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Morning Headlines 2/15/19

February 14, 2019 Headlines No Comments

Texas Health System Selects CPSI SaaS Offering, nTrust

Mid Coast Health System selects CPSI’s NTrust program, which combines the vendor’s Thrive EHR, interfaces, and maintenance services with RCM support from TruBridge.

Health tech is so old-fashioned that Google had to adapt its cloud service to work with fax machines

At HIMSS, Google offers attendees a preview of the ability to fax medical information from its Google Drive cloud-storage service.

Hospital: Failure to read reports may have allowed pill thefts to go undetected

A pharmacy tech at Beverly Hospital (MA) alters computer records to cover up her theft of 18,000 pills over 13 months.

From HIMSS 2/14/19

February 14, 2019 News 7 Comments

News Items

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Veritas Capital is seeking a buyer for the API Healthcare workforce management software business it bought in its July 2018 acquisition of GE Healthcare’s software business. Veritas separated out API Healthcare with the acquisition and restored its previous operating name.

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Meanwhile Veritas-owned Virence Health, which merged GE Healthcare’s Centricity business with Athenahealth, confirmed on the HIMSS floor with me today that it will stop using the Virence Health name and instead move forward under the Athenahealth banner. Veritas Capital bought the GE Healthcare assets in July 2018, rebranded the business to Virence Health in October 2018, and then struck a deal to acquire Athenahealth five weeks later. It’s not surprising that the newly formed company couldn’t wait to shed its GE Healthcare albatross with a new name and then found itself owning a far more valuable one in Athenahealth, but a lot of money was wasted rolling out the Virence Health brand for its short run, including printing all those HIMSS19 totes. I told the booth rep that they should sell the trademark since it’s mostly a blank slate at this point anyway. 

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Adventist Health has laid off all 1,300 employees of Feather River Hospital (CA) and may not reopen the facility that was damaged in the November 2018 Camp Fire. That isn’t much of a reward for those employees whose dedication and heroics saved patients and provided shelter for local residents who were fleeing the devastating wildfire.


From the Burner Phone

“HIMSS sent this registration count for HIMSS19 – 42,595, with 39 percent representing provider organizations.” That’s down a bit from HIMSS18 and well short of the “45,000+” that HIMSS has been touting. Other leading stats for HIMSS19 that would be relevant are exhibitor count (and square footage), percentage of first-time attendees, and percentage of international registrations. My perception is that it was slower than in previous years, less focused given the absence of government mandates, and perhaps an expense that some exhibitors wouldn’t have committed to a year ago if they could have foreseen their now-obvious decrease in business.

“DoD, VA, and CMS take center stage with enormous agency-made booths and session after session talking about how they’re collaborating and leading. Maybe stay home and get your #!@$#!$@# EHR working?! A reminder that their ‘single instance’ has been ‘live’ for two years now and has yet to sniff a D- grade after two major tests. Not suitable, not operable, and most-certainly not INTERoperable.”


Observations

Today featured a beautiful, sunny morning that got even better as it warmed up. The cold and damp from yesterday were quickly forgotten on this last day of HIMSS19. I say “last day” because hardly anyone will stick around for the Friday afternoon wrap-up. This year’s schedule was a mess since the conference started on Tuesday instead of Monday, meaning that all those folks who could have been headed home for Valentine’s Day after the exhibit hall closed for the week on Wednesday now had to wait until this evening, most of them missing what should have been a special day at home.

You may remember the history of why we’re in Orlando this year and again next before returning to Las Vegas for HIMSS21. HIMSS got into a snit with Chicago Tourism in 2014 after finding out that RSNA was given lower hotel room rates and quickly lined up Orlando as a replacement for Chicago for HIMSS19, presumably with less flexibility on dates due to the relatively short notice. HIMSS17 was last in Orlando February 19–23, 2017, with the opening reception on the usual Sunday and the exhibit hall open Monday through Wednesday, a far better and more familiar schedule (I’ve been behind a day every single day this week, including Tuesday, when I was confidently telling everyone it was Monday). Las Vegas will probably always start later in the week because the casinos aren’t about to lose weekend gambling revenue for a conference. HIMSS20 is March 9-13, nearly a full month later than this round (yay – we have a 13-month break), but apparently still on the Tuesday through Friday schedule as this year. Maybe HIMSS has decided to try to synchronize Orlando and Las Vegas in avoiding the Sunday opening reception.

I was quite wrong about how this last day in the exhibit hall played out. I saw few pieces of luggage in booths, companies stuck it out, and reps were reasonably well focused. It was actually a really good day, where booth traffic was down a little and food lines were non-existent. It was quieter and I suspect the quality of the conversations was better. I think some vendors had already written today off and were happy to see fewer swag-seekers and more folks anxious to talk specifics and see demos. Good job not wasting the last day, everyone.

I continue to be amazed at how many men who are employed in healthcare leave the restroom without washing their hands. By the way, you are shaking those same unwashed hands when you visit a booth.

MedData scone trivia – the company brings their own ovens to conventions to bake and then ice the scones, which are made from frozen dough, and it’s all done with their own employees, not convention center catering people. They can do in-booth baking in every convention city except Boston and Las Vegas, where the trade unions are too strong and won’t allow it even if union members man the ovens.

I sat through a dull HIMSS Analytics presentation today, with the only slightly interesting takeaway being that 347 hospitals in 12 countries have achieved EMRAM Stage 7. And that HIMSS is starting yet another adoption model, this one for clinically integrated supply chain like medical devices and implants (H-SIMM). HIMSS sold off its data business to Definitive Healthcare recently, but is keeping the adoption model business, which includes consulting. I haven’t heard why it wanted out of the data business it so desperately wanted in when it bought a data company years ago.

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Good job, everyone (including me) who filled a bag with toys and supplies for hospitalized children at the Connection booth. Coincidentally I ran across an old friend today and found that she is CIO at an area facility – she had just learned that kids at her place will be getting a bunch of the bags. It felt good giving and I hope it feels good receiving.

I did get a memory blast from the past from the HIMSS Analytics presentation since the presenter referred to it – old school hospital wiring closets that, when you sent your network tech to reset a router, always required moving the mop and bucket the nurses had stashed there.

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Cerner previously never referred to its competitors by name, hoping to diminish them by leaving them anonymous. I was therefore surprised to see two slides from a very long deck playing on a huge monitor at Cerner’s main booth podium, the first of which called out Epic as being late to the interoperability party by not joining CommonWell, the second slamming Meditech with a headline of “Rebranding is not re-engineering” in claiming that Expanse is just a new name for an old product that wasn’t selling. I was surprised that they used the logos of both companies.

I heard from vendors all week that exhibit hall Internet connectivity was too slow to present demos. That’s surprising given what they pay for connectivity.

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I wondered if they made the consultants pedal?

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I don’t know why I find boxed water amusing, but here it is.

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I thought my photo included the name of the vendor that put out this very nice spread at the end of the last exhibit hall day, including some nice chocolate-dipped strawberries. Alas, I did not, but I appreciate whoever it was that sprung for impressive closing-day afternoon treats (the red velvet cookies were great).

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Optum made sure that every bench and table were labeled to discourage anyone from sitting on them without permission. They are owned by an insurance company, so they’re good at denials.

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I’m not sure what IBM was thinking in buying up the biggest floor space in the exhibit hall, then leaving it largely vacant. Either they over-estimated customer interest or Watson lost its mind trying to recommend a booth size.

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I was afraid of this door in the IBM Watson Health booth since I figured it might have been the last thing seen by all those older employees who IBM unceremoniously laid off in its attempt to “correct seniority mix.” Or maybe this is where the “Man Behind the Curtain” is sequestered.

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The line to have a custom t-shirt made by DSS stayed long even as the last afternoon of the conference wound down.

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A fun giveaway in the form of George Clooney’s tequila Casamigos. Life isn’t fair that someone with George Clooney’s looks and acting career then sells his tequila brand for $1 billion. At least I won one of the little bottles of it.

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I wouldn’t want to sit next to a stranger on seats like these.

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I admit that while I feel justified in questioning the credentials and intentions of some of the HIMSS Social Media Ambassadors, I’m casting the net too wide because some of them rise above the rest. Case in point is Dr. Nick van Terheyden (you can easily assess my respect because I follow only 133 Twitter accounts and his is one of them). Dr. Nick read that I was shut out from the cool helicopter socks being issued by Intermountain Ventures, and not only did he score me a pair and leave them with Lorre, he also included a pair of pink socks with a beautiful handwritten note that not only describes how he sees the Pink Socks movement, but also his own philosophy. I’m not ashamed to say that it choked me up a little – he was brimming with the positivity that isn’t my long suit. Thank you, Dr. Nick, for sending me not only a giveaway, but a takeaway.  

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The last view of the convention center from the shuttle bus. Taxis were loading up with people anxious to get to the airport and then home.

I’m too tired to keep working tonight, but this weekend I’ll try to arrive at some kind of conclusions about HIMSS19 and ask you for yours.

Dr. Jayne at HIMSS 2/14/19

February 14, 2019 News No Comments

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There was a shuttle immediately available at my hotel today, so I took it, figuring I’d give my feet a rest before hitting the show floor. It delivered me a bit before the doors opened but when I looked to find a place to sit, all the tables were covered with food and trash that based, on its content, was from yesterday. For as much as this conference costs, the tables could be wiped off overnight.

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People always ask me what is the best thing I saw in the hall on any given day, and this is the one. A good friend clued me in to WEconnect Health Management, which was over in the 888 booths. They’re using smartphones to engage patients along the addiction recovery process, delivering positive reinforcement in the palm of your hand. Families and providers can track compliance with care plans and patients who engage with their treatment plan can earn loyalty rewards. Founder and former professional tennis player Murphy Jensen was in the booth. Their content is evidence-based and they use a risk score algorithm to identify risk of relapse before it happens, so the care team and supporters can intervene. This is one of those solutions that I’m excited enough about to actually go home and try to get some of my colleagues to engage with it. My practice provides medical coverage for a residential treatment center and I think they’re going to be really excited about this company. A lot of people don’t spend any time in the small booth areas, but there are some gems for sure.

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Elsevier prominently displayed their sponsor sign.

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So did Santa Rosa Consulting.

I continued my quest to learn more about telehealth with a stop by InTouch Health. They’ve got a slick platform that’s geared to hospitals and health systems with offerings that span from stroke management to cardiology to ICU monitoring and beyond. The booth reps were friendly and knowledgeable and worked to get me the demo I wanted without making me feel like I was waiting. They have some impressive data on their network and connectivity stats that I hadn’t heard from other vendors I visited with this week.

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Intermountain Healthcare had awesome socks with air ambulances on them and were happy to give me a pair just for the asking.

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I was looking for 3D printing at the Hewlett Packard booth and spent some time talking to their team about Fitstation. It’s a device that performs a volumetric scan of the feet and collects data to enable 3D printing of custom orthotics at a fraction of the cost of traditional devices. The team was engaging and very enthusiastic about their product even though this isn’t a high-traffic show for them. They also happily added to my sock collection, supplying both running socks and fashion socks.

I ran into an old friend at Optum – reconnecting with people is really my favorite part of HIMSS (other than getting the required LLSA Continuing Education hours for my Clinical Informatics board certification). Some of the folks I happened across were people that I’ve walked through fire with (at least as far as EHR implementations go) and even though we hadn’t seen each other in years, it was as if had just seen each other yesterday. Several of them were job hunting, and knowing the caliber of people they are, it’s a loss for the employers they’re trying to leave. People are tired of being at risk for being reorganized, downsized, or streamlined and the good ones jump when they can.

Some of the reps were getting more aggressive today. One vendor’s team was halfway across the main aisle soliciting people to come to their booth. I’m pretty sure that’s some kind of violation of the HIMSS rules of engagement, and this particular rep wouldn’t take no for an answer. Once someone indicates they’re not interested, you’re not likely to convert them. Perhaps some additional sales education is in order.

Orchestrate Healthcare had their “booth babes” in short skirts again today. The putting green is such an overdone booth attraction and frankly I would take the company more seriously if they put the green attendants in funky golf pants or even just khakis. The skirts they were wearing were too short to pass the dress code at the last course I played and at least four inches shorter than the one golf skirt I own.

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I attended a lunch that featured FirstNet, powered by AT&T. Having spent some time in the emergency room trenches as well as volunteering with a rural fire department, I was interested to hear about their efforts to build an ultra-reliable wireless network for first responders. The lead presenter had one of their hardened smartphones and literally threw it across the room for attendees to see how rugged it was. It has an insane amount of battery life and can survive submersion and a drop from a seven-story building. One of the company’s goals is to deploy the network to 99 percent of the US population within five years and they’re running a year ahead of schedule, which is impressive. They’re creating a public safety app store where downloads will be fully vetted and guaranteed to have no back-end data capture. The network is used not only for disasters, but to enable ambulance teams to communicate reliably with emergency department medical control officers. They had a great use case of having a physician look at an EKG from the field and reroute the patient from the emergency department directly to the cardiac cath lab. The Orange County Convention Center butter pats were a nice touch.

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There were plenty of good shoes to be seen, although I wasn’t able to capture all of them. Props to the woman in the blue embroidered gaucho boots — they were amazing. There were also some memorable thigh-high boots on the floor today along with these numbers. I feel like a creeper taking the pictures at times, so I apologize if anyone was offended.

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The Colorado HIMSS contingent was ready for action. I spotted them at the Intelligent Medical Objects (IMO) booth where champagne and prosecco were being served in honor of Valentine’s Day.

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As was Dr. Nick van Terhyden. My own Valentine’s Day socks paled in comparison.

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The Allscripts booth had the tagline “Open up your possibilities,” but I found the booth oddly claustrophobic with its lowered illuminated ceiling.

A CIO friend told me about Nuance’s new offering that promises “clinical documentation that writes itself.” I am excited about what they have to offer – it’s Dragon-powered virtual scribe technology that links up with EHR documentation. The demo was slick and well prepared, although it’s hard for me to enjoy demos because my brain always gets sidelined by the super-simplified clinical content. They’re going to begin deploying to a subset of specialties soon, although I suspect it might be a while before they get to primary care. If they’re looking for a physician to continue to kick its tires and see if she can stump the dragon, I know where they can find someone.

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I mentioned this empty booth the other day. HIMSS filled it with tables and chairs, providing a much-needed place for weary travelers to rest their feet.

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The Howard Med Technology Solutions booth featured a diner offering ice cream, sodas, and Moon Pies. The staff was welcoming and happy to give refreshments to anyone who asked.

I’ve heard a lot of negative feedback about other vendors this week who weren’t willing to give out their swag, even when asked nicely. I experienced it myself, when one booth’s staff handed me off to three separate people before someone would finally agree to negotiate with me about some socks. Another vendor was only giving out their socks to people who fit a specific sales profile. If that’s your situation, then don’t put them out on the counter and instead keep them hidden for the right person to stop by.

If you have stuffed animals and someone specifically asks you for one to take home to a child, humor them. If you’re in a booth, you’re likely a road warrior yourself, and someday you might know what it’s like to surprise a kiddo with a cool animal that will be meaningful to them during a week where mom or dad was away. Typically on the last day of HIMSS people are a bit more free with their swag because they don’t want to send it home, but apparently not everyone thinks that way.

That’s a wrap on HIMSS19. I’m hanging out at the airport enjoying the free MCO Wi-Fi. Safe travels to everyone who is still at the show. I’ve never attended a closing keynote, so if you want to share your impressions, leave a comment or email me.

Dr. Jayne at HIMSS 2/13/19

February 14, 2019 News 1 Comment

Today was an absolute whirlwind and I am only going to be able to capture the bare minimum because it’s already after 1 a.m. and it’s been a very long day.

Wednesday morning started as a disaster. Everyone was taking the shuttles because of the rain. Three passed me by without stopping, so I decided to hoof it. Since I’m always prepared, I had an umbrella, and with the traffic still managed to walk to the convention center faster than one of the shuttles that passed me. I took advantage of the plastic umbrella bag provided by the convention team, but wasn’t pleased to find the still-wet and slightly mildewed umbrella at the bottom of my bag.

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Among the things I saw today that I liked: Vocera’s new Smartbadge, which functions like a cross between their flagship communications device and a mini smartphone. Users can save directories of favorites, filter calls and messages, and set up a list of favorite contacts. It’s designed to be nearly impervious to liquids and is easily sanitized, and weighs about 90 grams. My favorite feature is the panic button, which lets staff summon help without being too obvious. With the increasing reports of healthcare workplace violence, it’s a useful feature.

Since I’m trying to absorb as much as I can about telehealth, I stopped by GlobalMed to learn more about their workstations. I liked their HD camera, which helped me see in one of their staff’s ears with a picture clearer than my own otoscope at home. It also had a dermatology camera with polarizing features which helps see deeper into the skin layers. I’m glad they didn’t demo that piece on me! They truly are a global player, in use in more than 50 countries.

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The team at Lyft had pink sneakers for the gents and flats for the ladies. Even their visitor had great shoes.

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Medicomp’s wheel of prizes included chocolates and cash. You can’t beat that combination.

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Surveyor Health showed me their medication management system. It was pretty slick. The presenter’s t-shirt that said “I DO EPIC SH_T” was a nice touch.

Vivify Health showed me their Chronic Care Management solution, complete with a Bluetooth-enabled kit that patients can use to send biometric data back to the office. The kits can be configured with scales, blood pressure cuffs, pulse oximeters, and more. The system uses a tablet to gather data and responses to patient questionnaires, plugging them in to a health score algorithm that helps identify the most at risk patients. I had a relatively new sales rep do my demo and he did a great job.

Among the things I saw today that I wasn’t too fond of:

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Masimo had this creepy mannequin in a room mockup. Novarad also had their model patients laying on the table while attendees used VR goggles to do something with them. They do it every year and it’s still weird.

One of the ladies doing a demo at a startup booth was chugging Red Bull during the demo. Not a good look.

Back to the happy thoughts:

Epic’s carpet was ridiculously thick and comfortable. Just be careful not to break an ankle when you first step onto it, especially if you are moving at speed. 3M also had the mega-thick carpet.

I attended a lunch featuring John Halamka and learned quite a bit from it. I’ll save it for a future write-up as there were lots of good nuggets. He was wearing his trademark black jacket and tee, leading some audience members who had never seen him in person to speculate whether he was channeling Steve Jobs.

In the afternoon I stopped by the launch of Zynx Health’s Lumynz product, which I mentioned yesterday. The team outdid itself and painted the town orange (or at least the booth) in honor of its new release. There were plenty of chocolates and wine on hand as well. That event kicked off the evening social schedule, which was one of the more robust ones I’ve had in a while.

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I started off meeting with some old friends at the Rocks Bar at the Hyatt, where I captured these kicks. You can’t see the detail, but the socks say “Stop Talking” and I think I need a pair. From there it was off to MDLIVE’s get together at Urban Tide, which was full of engaging people who have an interest in telehealth. I heard a lot of different perspectives on where the industry might be headed.

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NextGen Healthcare’s party at The Pub was kiltastic. I chatted with one of their events staff because I’m always appreciative of the work that event planners perform. For those of you who don’t know the details behind how some of these booths, events, and parties are pulled off, there are many hard working people who make it happen. Thanks for a lovely time with a great band.

From there it was off to the Allscripts event at Del Frisco, with good food and nice wine along with their balcony which provided some much-needed cool air. The convention hall has been hot and muggy, at least to my senses, so I enjoyed the cool weather today after the rain stopped. The party really started swinging with the arrival of Matthew Holt and his entourage, and then we were off to the Google Cloud party at the House of Blues.

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These folks arrived from the awards gala. There were many other great shoes, but I couldn’t get good pictures without seeming like a creeper. Kudos to pregnant woman in the red dress who was wearing heels, they were super cute.

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I had a chance to spend some time with industry heavyweights who convinced me to come with them to Howl at the Moon, which was quite an experience. One of the physicians in the group hoped that this multi-straw drink had a high alcohol content to kill any germs that might wind up in the communal bucket. It was one of those memorable late-night experiences, although I had to make my exit early to go home and capture the day’s events before my eyelids snapped shut. One more long day to go!

Morning Headlines 2/14/19

February 13, 2019 Headlines No Comments

Veritas seeks buyer for API Healthcare, former GE workforce management unit

After acquiring Athenahealth, Veritas Capital considers selling API Healthcare, which it bought last year from GE alongside its enterprise financial and ambulatory care management units for $1 billion.

IBM Watson Health Invests in Research Collaborations with Leading Medical Centers to Advance the Application of AI to Health

IBM Watson Health will invest $50 million on research collaborations with Brigham and Women’s Hospital (MA) and Vanderbilt University Medical Center (TN) that will initially focus on how AI can improve the role of EHRs and claims data in patient safety efforts, precision medicine, and health equity.

BayCare Teams Up With Cerner, Lumeris and Salesforce to Improve Health of Senior Population

BayCare Health System (FL) will use Cerner’s HealtheIntent population health software, Salesforce’s CRM, and services from Lumeris to better care for senior patients enrolled in its BayCarePlus Medicare Advantage health plan.

Intermountain Healthcare and Trinity Health Make Growth Investment in AI Leader Jvion

Intermountain Healthcare (UT) and multi-state Trinity Health invest in predictive analytics vendor Jvion, which announced growth equity financing from separate investors last month. 

Casetabs Inc. Raises $2.5 Million From Investors

California-based surgery coordination software vendor Casetabs raises $2.5 million, bringing its total raised to over $13 million.

From HIMSS 2/13/19

February 13, 2019 News 9 Comments

From the Burner Phone

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“HIMSS hasn’t announced attendance because it is down thousands over last year. It would have been even worse except for the 10 percent of the attendees who were international.” I was expecting to see attendance figures released today, along with all the other standard announcements that go out on the same conference day every year. Traffic seemed markedly down in the exhibit hall and elsewhere. I will lose a lot of respect for HIMSS if they can’t put their ego in check and announce the conference stats as usual regardless of whether they are flattering, especially when they’ve been pushing “45,000+” in our faces for weeks. 

“Few CEOs were in the exhibit hall. Lots of dead booths and vendors complaining about reduced traffic.”

“We’re firing KLAS this week. Too little value for way too much money.”

“Quoting an ‘EHR extraction’ expert walking around at HIMSS. CMS is basically saying the Trump administration is wanting to prove that the Obama administration was sloppy with giving out all this MU money without any oversight. They are going after the big vendors to recover it. This is just the first of many.”

“It’s interesting how many executives were sitting in hotel lobbies Tuesday morning with their roller bags, obviously not planning to stick around for anything beyond the pre-conference team meeting and the first day’s booth opening. I bet that left some nice suites vacant from Tuesday night on.“

“Do all those social media ambassadors realize that their phones can be set to take photos toward the front instead of just facing themselves?”


Observations

Today started out surprisingly chilly and rainy, with people who were waiting on the shuttle buses forced to seek shelter or create impromptu head coverings from jackets or plastic grocery store bags. Many of them called Lyft, I noticed, also observing that I didn’t see any Uber riders even though I thought years ago that Uber would swat Lyft like a bug. Traffic was slow and my bus took 45 minutes to travel a couple of miles. My bus arrived at the convention center at nearly 10:00, fidgeting like smokers on a long flight as they contemplated the bleak picture of their exhibit hall booths open without them. They were not only late, but irrecoverably mussed from the rainy, windy start of the day.

The shuttle bus had a QR code on the wall, so of course I had to scan it. It brought up a YouTube safety video, which if you are sinking in a Florida drainage pond or feeling gasoline-fueled flames licking your legs, might not be the most productive use of your time.

I forgot to mention that HIMSS gave exhibit hall vendors orange badge lanyards this week vs. the black ones the rest of us have. That’s a step up for exhibit hall staff, though, since before this year, HIMSS gave nothing except the lowest-rent form of clip-on throwaway plastic badge holder like you would buy in flimsy boxes at Office Deport. The two-lanyard system recalls the old days of HIMSS, when the badges of vendors and providers were dot-matrix printed on different colored paper (yellow and blue, as I recall).

I mentioned yesterday that I decided that it doesn’t make sense for me to to spend a large fortune for a small, remotely located booth that draws few visitors, so I’ll pass on exhibiting at HIMSS20 for the first time in a few years. Our booth was quite busy today as a result, with readers paying their respects to the retiring Smokin’ Doc. It was actually kind of moving, like watching people honoring a retiring colleague.

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It was a big readership day today, with 9,000 page views. Thanks to every HIStalk reader, whether you keep coming back because you love it or because you hate it.

Tomorrow is exhibitor bug-out day, as it is not only the last (and shortened) exhibit hall day, but also Valentine’s Day. I guarantee that checkout luggage will fill booths in the morning and the hall will start emptying out by noon, as several vendor employees told me they’ve booked early flights to get home to their loved one. HIMSS policy has an unenforced requirement to stick around until the bitter end (which we never do) but nobody really cares, especially this year, when exhibitors may already be cranky about attendance and traffic. Walk the hall around lunchtime and all that good swag that vendors were protectively hiding will be freely available because they won’t want to pack it up and take it home.

AMA clarifies that the bar I saw set up outside their booth Tuesday afternoon wasn’t a happy hour, but rather the setup for an invitation-only event reception for women leaders in business. I wasn’t judging, but that’s good to know.

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This is definitely some odd wording, especially from an industry magazine’s email blast, although the whole thing had a lot of awkward prose and punctuation like maybe the author learned English later in life. A couple of readers sent this my way.

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I decided to wear my new socks from Fortified Health Security today, then the CoverMyMeds ones tomorrow.

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Nathan Grunewald, MD gave Epic’s Judy Faulkner a pair of pink socks and got her to pose for a photo besides. Note also that unlike most company CEOs who aren’t billionaires, Judy was working the Epic booth. I admit that despite trying to figure it out, I have no idea why pink socks have anything to do with healthcare or why people wearing them think they are leading some kind of movement, but having Judy among the socked will surely help. I assume she got a full pair without having to share it with the other person in the photo.

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The American Hospital Association is already blasting attempts to make its members share patient data, declaring that “CMS already has better levers to ensure the exchange of appropriate health information for patients.” Hospitals will do anything to prevent attempts to make them share information — that is both infuriating and embarrassing.

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Lyle Berkowitz, MD (MDLive) and Justin Graham, MD, MS (Hearst Health) dropped by to pay their respects to their retiring colleague.

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Epic’s booth was so big that they created their own aisle and demarcated it as a green, winding path. Epic booked 13,500 total square feet (behind only IBM) at a cost of around $200,000 per exhibit hall day not counting freight, furnishings, services, signage, the salary and expenses of booth staffers, and a bunch more stuff like electronics rental. Someone on the shuttle bus this morning said Epic had a large, impressive booth that must have cost a fortune, when another guy chimed in, “We’ve paid them $250 million, so we don’t care what they spend.”

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I dunno … that tall wall seems like a “bounds” to me.

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I really enjoyed talking to the super-nice and fun guys at the Philippines outsourcing booth. Vendors, they have a lot of clinicians (nurses, doctors, and even specialists and surgeons) ready to help with everything from utilization review to life sciences work, not to mention an army of well-trained folks who can supplement all kinds of projects remotely, such as revenue cycle management.

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I’ve observed in past years that BestCare has a cool-looking EHR, but the obvious cultural differences between its South Korea home and the US will make it a tough sell unless it hires US salespeople. Example: I counted 15 employees and zero visitors in its large booth. A guy comes up to scarf some free BestCare popcorn, and just to be nice, asks the company’s point person, “Do you have an EHR, or is it a dashboard that sits on top of the EHR?” The BestCare rep says, “We have both” and then just looks at the guy without saying anything more for several uncomfortable seconds, after which the guy took his popcorn and ran. An American salesperson would have been projectile vomiting out a stream of product superlatives in making the visitor earn his popcorn.

I stopped by Guardian Eagle upon seeing their first-time exhibitor sign. The St. Petersburg, FL-based company offers security systems and around-the-clock monitoring.

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I like coffee, but I’m simple – the cheap stuff is just fine as long as there’s plenty of flavored non-dairy creamer to make it more like a milkshake (hazelnut and Almond Joy are my favorites). I know nothing about the fake Italian descriptions Starbucks assigns to its sizes and Mrs. HIStalk has to order for me since I can never remember which is Americano, espresso, cappuccino, and all those other options. I’m happy, therefore, that PatientKeeper did what every coffee shop should – skip the showy vernacular and just tell us what it means, even if Starbucks coyly makes you say something other than “large” to get them to pour your cup. 

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Hearst Health not only had our sign out, but the First Databank subset of the company wrote a poem for the always-popular Health Policy Valentine’s Day in honor of the last HIMSS conference for The Smokin’ Doc: “Roses are red. Violets are blue. We’ll miss you Smokin’ Doc, but we know where to find you .” I’m not saying he won’t return next year, just not in an HIStalk-paid booth. Now that I’ve killed off HIStalkapalooza and exhibiting, I’ll be asking readers next week what, if anything, we should do at HIMSS.

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ESD is offering a new product called ARI (Virtual PM), a real-time automation tool for managing go-live activities, especially those involving contractors and consultants. The demo looked cool – consultants clock in by facial recognition, real-time updates show problem areas and workload, and trending shows which fires have been put out vs. those that need more resources. The real-time information stream helps health systems keep projects on time and budget by raising the visibility of problem areas and making sure consultants are being used optimally and billing correctly.

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I would consider this booth to be a contender for best design and theme in a modest space.

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This vendor (I forget who it was) is one of few offering those little heart-shaped candies and having a drawing for this guy.

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I had a creative idea for taking a picture with this cut-out, but it would have required a ladder and some privacy.

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This hero didn’t explain how he earned that honor, but he must have been granted the right to assign the exalted status to others since he had a lot of giveaway capes.

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I failed to notice previously how neon-like the AWS sign is, rather like that of Seattle’s Pike Place Market.

At least eight companies were offering to take professional headshots and had the equipment and photographer to do it. Pretty cool.

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Only in healthcare would you find “enterprise-class,” “API,” and “cloud” in the same tagline as “fax.”

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Capsule must have assumed that its freedom from Qualcomm Life shackles was inevitable since its booth looked pretty polished. The name change back to Capsule happened just a few days ago, although I don’t think it ever really went away. Although I do have one slight correction – the Francisco Partners acquisition announcement said the old name of “Capsule Technologies” would be restored, but the actual original name was the odd-looking “Capsule Technologie” because it was started in France, as I seem to recall.

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Big Nerd Ranch is my new favorite company name and logo. It offers developer training, noting that 21 of the world’s top 25 applications involve developers it trained.

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I find statements like these to be compelling. 

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I loved talking to Brent from PatientBond. I’ve somehow lost my notes, but he told me that the company uses psychographic analysis – obtained by having patients complete a 12-question quiz — to assign them a profile and to then engage them in ways that are likely to be most effective (it’s a nudge theory kind of thing). He said that “Willful Endurers” live for the moment and will ignore messages involving long-term management of their health, but will respond to a single “do this now” message that can then queue up the next one. Most astounding is that those Willful Endurers make up two-thirds of urgent care visits (not to mention a bunch of ED visits), and private equity firms that own those centers are using the information for marketing purposes. Brent used to work for Proctor & Gamble before leaving the dark side, so he knows how products are pushed and applying that knowledge to health is cool. It’s fascinating and it works – urgent care centers are snapping it up with an average sales cycle of just 30 days (since the product is incredibly inexpensive and has a 40x ROI) but hospitals are of course dragging their feet in the usual 12-24 month decision cycles. It’s like Cambridge Analytica except for good instead of evil.

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I dropped by WellSky, the new name for the former Mediware, which has assembled an impressive package of applications for home, hospital, practices, and community with 10,000 customer sites. The new CEO is Bill Miller, former CEO of OptumInsight, which became a juggernaut through well-managed acquisitions, a strong brand identity, and a relentless pursuit of growth. Not only that, I scored 10 of 10 on its trivia quiz, earning me an Amazon Echo Dot. Mediware was always kind of cool but niche-y, with no clear “what do you do exactly” identity and 30 individual brands. TPG Capital bought Mediware in December 2016 from Thoma Bravo. Annual revenue is nearly $300 million.

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I think I just heard a collective sigh of “awwww” from some of the ladies of health IT. I can say for sure that I heard it at the Stericycle booth, where the llama tee shirts were snapped up quickly.

I sat through an interesting presentation by Verizon on location services. Scenario: a patient enters a hospital campus, at which time a welcome message and parking instructions (based on their specific campus destination) pops up on their cell phone. A virtual beacon alerts the hospital that they have arrived. They are guided to their service area with turn-by-turn, inside-the-building instructions. They have their procedure and their family is notified when they can visit. That’s amazing on its own, but even more so when you remember that just a few years ago, hospitals were adamant that cell phones had to be turned off despite a complete lack of evidence explaining why, leaving patients, visitors, and staff offline permanently while at work. The hospital cell phone ban is even more embarrassingly dark ages to me than faxing.

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I think this is my first Wall O’ Doughnuts.

I talked to the folks at Goliath Technologies about their EHR performance monitor for Citrix and other infrastructure. It goes way beyond simple application monitoring. Here’s a real-life scenario from a hospital client. The hospital sees a massive EHR slowdown in certain areas. The app is running fine in the data center, but not on the desktop. The various IT teams – server, app, network – say everything is fine on their end (they always say that), yet the users are dying by hourglass. Some network guy takes a shot in the dark in recalling that a new driver was rolled out to every hospital scanner and suggests that each of those drivers be manually rolled back, which will take forever with the system still unavailable to users. Someone remembers that Goliath is running and checks its micro-detailed log – say, look at this, the slowdown happened early Sunday morning and seems to be network-related. Oh, Mr. Network Guy who wanted the drivers rolled back, did you make any system changes at that time? Why yes, as a matter of fact, but all we did was replace a switch that serves those specific units, although I can’t see how that would … OK, I’ll get a team on it. Goliath measures and logs everything that might degrade the Epic, Cerner, or Meditech user experience, giving IT a heads-up even before the users complain.

I checked out NextGate for an overview of the challenges and opportunities of patient matching. The state of the art is comparing current data from third-party sources to potentially stale EHR data that has outdated addresses or telephone numbers. The company offers location intelligence, where every EMPI patient address is geocoded for market research or locating the nearest doctor. 

NantHealth surely has the tiniest booth ever for a publicly traded company that is also a HIMSS Diamond Member – it occupied the same 10×10 space we did.

Note to presenters: the correct answer to “do I need to use this microphone?” is always yes. Despite your self-consciousness, it’s a little bit more work for you and lot more for your audience when you insist on giving a long talk without it (even if you do preface it with a chuckling reference to how loud your voice is).

I was drawn to Indigo Vision, which offers video security cameras that can be integrated with other applications. They showed a high-resolution camera streaming real-time crowd video that could track the movement of individuals by their attributes – male, red shirt, backpack, glasses, etc. That way it’s easier to look for someone suspected after the fact of doing something by querying the metadata to find video in which a guy with a red shirt and backpack was recorded. The company’s basic video system can be programmed with rules, such as triggering an alarm if anyone enters a garage after hours.

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That’s a wrap on what will be the next-to-last day of HIMSS19 for most attendees who, like me, will be departing Orlando either Thursday evening or Friday morning. I’ll be back with a final day’s report tomorrow night, but if you are leaving, safe travels and Happy Valentine’s Day to you and those who are waiting patiently at home for you.

Dr. Jayne at HIMSS 2/12/19

February 13, 2019 News No Comments

I started the day at the HIStalk booth seeing what Lorre’s plans were for the day. She’s riding solo at HIMSS this year and had a few take-home items on her list, including various stuffed critters from vendor booths. I was happy to help score her a Charlie from Healthfinch (#2790), but she’s still seeking a zebra and a giraffe for her menagerie. If you can help her score one, she can be found at #4085. You can also come by and have your picture taken with our iconic Smokin’ Doc and pick up a HIMSS survival kit from our friends at Arcadia (#2915).

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The folks at WatchGuard (#633) drew me in with their friendly smiles and bright shoes, which were accompanied by equally fun socks. I always love booth reps who reach out to greet you in a friendly way. Apparently, socks are a hot item again this year at HIMSS. I was also impressed by the reps at Kronos, who not only asked nicely if they could scan my badge, but looked at where I was from and asked some questions about my travel and whether I had a hard time making it to HIMSS. Those are the kind of people you want working your booth, those who can strike up a conversation without making it feel forced.

I dropped by First Databank (#1921) and saw some of their new solutions for targeted medication alerts. They are really helping to work to make alerts more meaningful for clinicians by using lab values to filter out alerts where they’re not appropriate because labs are being monitored and checked. They’re also doing some interesting work building out a database for veterinary medications. We love our pets, and especially with the entry of payers into the pet market, there is a need for better tools for those caring for our furry friends.

Just next door (also in #1921) was sister company Zynx Health, which was showing their new Lumynz solution. It’s really slick for those of us trying to lead the charge for value-based care, allowing clinical and financial leaders to easily see whether patients are receiving the evidence-based interventions they should be receiving, or whether factors of underuse or overuse are in play. The tool also measures compliance with order set use on a per-provider basis and helps clinical leaders educate their physicians on the evidence behind caring for a variety of clinical conditions. On the financial side, they’re helping CFOs understand how much they might be losing by under-delivering care. It will be great to see how it takes off and is well worth seeing.

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I managed to pick these up from VMware for the sock-lover in my life, who was very disappointed that I spent his birthday at HIMSS instead of being curled up under a quilt in the frozen north.

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Thanks to the following sponsors who were proudly displaying their signs: Visage Imaging (#1391); PatientBond (#4591); and Nordic (#2579). Thanks also to Lorre who ran around the sweltering convention hall this morning delivering them before the doors opened. I spent much of the day wishing I was wearing cooler clothes, so hopefully tomorrow will be a bit cooler.

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MySphera (#985) had this awesome Playmobil hospital setup, complete with operating room and IV bags. It brought a smile to my face during a long slog through the hall.

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CPSI featured Dave Maskin, The Amazing Wire Man, who is able to make anyone’s name out of wire. He got his inspiration for the craft after rewiring a lamp and is available for parties and special events. People were in quite a line waiting to have their names crafted. It seems like there are overall fewer catchy entertainers today, although I only made it through half of the hall.

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Cognosante had some great orange shoes.

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Sponsor Lightbeam Health Solutions (#4370) truly brought their A game, featuring this trio of dapper gents.

I attended a lunch sponsored by Cognizant, who had a lot to say about digital revenue cycle management. They’re advocating a sensible approach to automation, where people are used to handle exceptions and difficult situations but where routine tasks are automated. They’ve done some interesting work with claims and denials that is worth taking a look at. They also talked about using Blockchain for “smart contracts” between payers and providers along with real-time adjudication to create frictionless payments. They also offered wisdom on tackling small projects first and earning trust and demonstrating wins, rather than trying to proverbially boil the ocean as some organizations do.

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Healthjump brought their color coordination.

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These folks didn’t bring anything, since their 20×10 booth was empty.

Tonight’s social schedule included the New Media Meetup and a dinner with some potential clients, although bad traffic and inability to use Uber due to a cell connectivity issue conspired against me and kept me from making it to the Salesforce party. I’m disappointed but there wasn’t anything I could do, so hopefully they won’t blacklist me for next year.

I did manage to catch up with some former colleagues, which was time well spent. I always enjoy hanging out with people who are truly motivated to make life easier for their clients (and by translation the patients they serve) and who can see through all the bluster and noise that HIMSS brings.

Time to rest up!

From HIMSS 2/12/19

February 12, 2019 News 6 Comments

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News Items

CMS Administrator Seema Verma said in today’s opening session that previously announced hospital penalties and lower incentives for practices were supposed to encourage the industry to move forward on its own with interoperability, but the industry’s failure to do so resulted in this week’s proposed rules that are more prescriptive. She said the changes are aimed at insurers that refuse to share their claims data, although I’m not sure that comment was intended to be comprehensive.

Former White House CTO Aneesh Chopra agreed that the industry failed to self-organize to add more content, adding that the federal government’s initial data set was supposed to be a minimum, but the private sector didn’t take it further and the government had to create a new rule to get the entire medical record. Chopra said that CEHRT 2015 is a Roku and now we can add channels.

Verma added that this administration wants to deregulate, but the industry’s lagging behind the government required new regulations to get value for the $36 billion it spent on Meaningful Use. She also said that the next task is to bring in post-acute care providers.

University of Toledo issues an RFP for an EHR, apparently giving up its questionable project to help then-Athenahealth (now Virence Health) develop a new inpatient system. I expected that project to flounder once Elliott Management started pressuring the company, but there’s not much doubt that it will never see the light of day under new leadership.


From the Burner Phone

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“Hope you’re enjoying Orlando, and washing your hands regularly. This little tidbit just crossed my Twitter stream. I look forward to seeing it mentioned in the News section.” “Fox & Friends” TV host Pete Segseth says on TV that he hasn’t washed his hands in 10 years, adding in placing a second foot in mouth, “Germs are not a real thing. I can’t see them, therefore they’re not real.” He claimed later via Twitter (of course) that he was only joking and then returned to his real job of bashing Democrats, but here’s the punch line: he was President Trump’s frontrunner to replace soon-to-be-fired VA secretary David Shulkin. Imagine a guy who is running a sprawling medical enterprise like the VA who throws out comments like that, even if he is kidding.

“A company won a KLAS Best in Category and attended the KLAS event this week, but its attendees weren’t allowed to go on stage to receive their award because they weren’t wearing sport coats.” That might be the most bizarre thing I’ve heard this week.

“I was talking to someone fro the since-acquired HIMSS Analytics about their physician clinical data. Turns out they only have information for hospital and employed doctors – they don’t know anything about independent practices.”

“Is it just me or are some of these HIMSS Social Media Ambassadors losing all semblance of self-control? What is wrong with these people?” Some of them are like kids turned loose on Disneyworld after chugging a two-liter Mountain Dew, but HIMSS chose unwisely in anointing one highly questionable guy who doesn’t even seem be at the conference – his entire HIMSS-related output since the conference started is one retweet. Therefore, he’s my favorite one.


Observations

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I haven’t been to a HIMSS conference opening session for a couple of years (because they promised to be dull or vendor-led). My observations:

  • The slick media show that played before the session began was all about HIMSS, its influence, its acquisitions, and its grand plans to stick its nose into every aspect of health and healthcare. Gone are the days when a series of quaint PowerPoints were running that listed its committee members, Life member and Fellows, local chapters, and volunteers. It was a celebration of being large and influential rather than giving credit to the members who pay dues, attend events, and serve on committees.
  • HIMSS should be renamed HIS (Health Information Society) since Management Systems (the MS part of its name) has disappeared from the agenda and maybe as a career discipline since its 1980s heyday. Instead, HIMSS has decided that the “information technology” part of its mission statement will be split as “information and technology.”
  • HIMSS sees itself as an advisor, enabler, and media powerhouse, all of which sound like for-profit activities even though HIMSS is a non-profit.
  • The musical act was harmless enough, with a gospel choir of probably Disney day-jobbers singing dad rock (granddad rock, actually) in the form of Queen’s “We Will Rock You” and “We are the Champions” as the HIMSS logo throbbed obscenely in time with the music.
  • HIMSS pointlessly paraded its caped poster children Champions on the stage – where they danced awkwardly for a few seconds before thankfully getting off – and just seeing one of them who has been relentless with self-promoting tweets and selfies made me recoil physically. Probably nice in person, but unaware or unconcerned about an obvious need for constant attention.
  • The opening keynote celebrated the accomplishment of moving the industry from paper to electronic records, failing to look at the flip side of billions in taxpayer-funded incentive payments and the failure of that expensive technology to improve cost and quality.
  • Karen DeSalvo is a gem, whether she’s working in health IT or public health, and Aneesh Chopra seems fun and enthusiastic.
  • I really disliked having talking points popping up on the screen beside the speaker’s image. Reason: the practice reminds me that they’re just reading their presentation.

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Mayo Clinic CIO and HIMSS board Cris Ross, MBA (he’s not a doctor, despite what some Twitterers seem to think) was an outstanding speaker in describing his transition from helping get Epic implemented to seeing it used by his caregivers for treating his newly diagnosed cancer. He seemed genuine, empathetic to others who are facing a cancer journey, and optimistic about technology’s potential role in improving care.

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Our booth traffic was nearly non-existent today, the day in which we had to choose booths for HIMSS20 (for which we’ll always get the dregs given our lack of HIMSS spending). I’ve long questioned whether the high cost of exhibiting is worth it for little guys like us with no HIMSS vendor points, low budgets, and non-existent ROI, so I pulled the plug on exhibiting at future HIMSS conferences. The Smokin’ Doc will be no more, at least in standing guard in his own space. A reader said I would get far more value from having someone drop by vendor booths to explain the benefit of supporting HIStalk, so maybe that’s an alternative.

Speaking of dead exhibits, I can only imagine what it was like in the beyond-7000 sections past the food court. I doubt many attendees are noticing the signs begging them to keep going beyond the fake ethnic food booths.

It takes me at least five hours to recap my day here, so I’ve learned to hightail it out of the exhibit hall when it closes (or earlier) and get to work. Last night it was cheap Chinese and a burger the day before that, so who knows what culinary delights await tonight? The lunch madhouse at the convention center was as crazy as usual – long lines to buy overpriced and over-processed food, then the pleasure of eating it standing up next to a restroom door because the demand for seats exceeds the supply by fivefold.

Thanks to the reader who dropped me off a great backpack. It has been invaluable.

Show floor notes:

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Connection put out games and supplies for attendees to bag up for patients in the local children’s hospitals. I did it and it was quite satisfying. Good job.

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This nice lady whose name I forgot to write down insisted that I try the smoothie she had made. It was delicious, something with strawberries (and I don’t usually enjoy smoothies).

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I still can’t grasp pairing Centricity with Athenahealth, but the deal has been consummated.

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Meanwhile, I guess Athenahealth had already paid for its large space before it was led away on a leash, so it was turned into a basement rec room with basically nobody stopping by. Although to be fair, its bad booth location at HIMSS18 and installing Jeff Immelt as Jonathan Bush’s bumbling chaperone had already killed off the massive crowds that Athenahealth had drawn every year before the mess started.

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Here’s the MedData scone schedule. It includes the great pumpkin and cranberry orange that I’ve had before, but omits the best flavor of them all – their passion fruit.

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Epic always has calculatedly weird stuff in its booth, but this guy is creepy.

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Epic marketing posters. I didn’t get a shot of the one that said 80 percent of medical students or something like that are trained on Epic.

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This Epic poster includes a footnoted credit to healthcare equities guy Constantine Davides for his laborious plotting of the acquisitions over time of Allscripts, Cerner, and Epic (also crediting HIStalk since I ran it a few years ago and it was a big hit). Epic is picking up the torch in keeping the graphic updated, for obvious marketing reasons. Constantine is now at Westwicke, which was itself recently acquired. 

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Here’s what Cerner had to say on the matter.

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I remember years ago when Voalte’s tiny band of mostly industry newbies blew into the HIMSS conference bedecked in shockingly Pepto-Bismol colored pants. Voalte’s booth has grown along with its business and its people are now experienced, but the company has admirably continued to use pink as its trademark – you can spot someone from Voalte from way down the hall.

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Ellkay keeps honeybees on its roof, co-founder Lior Hod is the proud head beekeeper, and there’s always beekeeper’s gear around the office so visitors and the children of employees can visit the hives (they almost brought a live hive to HIMSS19). They have honey in their booth along with cool graphics and really nice people (thank goodness their “data plumbers” tagline didn’t steer them toward carrying plungers while wearing low-rider pants). 

AxiaMed has the nicest people I’ve ever met in a HIMSS booth. They offer a patient payments solution, and in my case anyway, some cool argyle socks.

AT&T was doing a demo of using Magic Leap virtual reality during surgery.

What I didn’t see today:

  • The usual magicians from Hyland and Cantata Health. The former used a different guy and I assume that the amazing Bob wasn’t at the Cantata booth that I couldn’t find. Update: a reader says Cantata, like quite a few other vendors, took a meeting room rather than a booth, so no more Bob.
  • Booth babes, at least not any obvious ones.
  • Demos involving hospital beds and non-clinicians wearing scrubs or white lab coats.
  • Food offered in booths during happy hour.

What I did see: people filming and recording everywhere, getting in the way of everybody else to record material that nobody cares about. And the same handful of “pay us and we’ll show up in your booth and promote it” folks.

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People of mobile device sterilizer vendor Seal Shield let me down in having non-clinicians running around in scrubs. I know it seems innocent enough, but clinicians earn those scrubs every day and resent having them worn by laypeople as conference costumes. They may actually be so turned off that they’ll seek out your competitor. You have been warned.

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This was over the top but kind of cool, although I don’t remember the vendor (which may say a lot). Update: a reader says its Intermountain Healthcare, something to do with launching an incubator / investment arm like every big health system seems to be doing (although Intermountain missed the unicorn in their back yard, Health Catalyst).

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Thanks, Phynd, for featuring our sign so prominently.

Identity Automation had a photographer and studio-type setup for taking professional headshots, for which demand should be high given the awful profile pictures I’ve seen on LinkedIn.

Google Cloud, Microsoft, and Amazon Web Services all had big crowds in their booths.

NextGen Healthcare gave me a quick look at its mobile EHR app, which despite some questionably motivated and questionably insightful recent praise, looked just fine, but not anything a knowledgeable observer would consider game-changing. In fact, NextGen didn’t even develop the app – they got it when they bought the money-losing Entrada for $34 million a couple of years ago.

A reader asked me to report on Nuance’s  “AI-Powered Exam Room of the Future” demo room. It was about what I expected since I saw something similar from them last year and liked it – a doctor conducts an entire patient encounter using only voice, in which speech recognition converts lay terminology to medical (and vice versa) to create a progress note, structured documentation, and orders, all ready to be signed. Voice biometric authentication is part of the package as well, as is a wall-mounted bank of 16 microphones that can sense location (such as which leg the doctor is examining). My recommendation – the instructions the “doctor” was rattling off to the patient were full of timelines, activities, and drug names – the doctor could send the voice recording or the layperson transcription to the patient to reinforce what they were told but likely forgot. Patient advocates should pick up that charge, although doctors probably fear malpractice exposure.

Speaking of which, I haven’t heard anything about the “voice assistants” that were all the rage at HIMSS18. Maybe they’ve graduate to actual use in the field already.

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Here’s your mysteriously unsung hero of the conference and of the last several years of health IT. Grahame Grieve is the always-modest guy who is basically the father of FHIR (at least as I understand it, but I’m sure one could argue the point). Think about that – one guy from Down Under makes it happen that Apple can develop health apps, that vendors can offer third-party APIs and apps, and that systems can exchange information to the point that the federal government becomes FHIR’s cheerleader. You can’t tell me this guy hasn’t done more than many of the self-important suits running around, yet he never demands credit or recognition and hasn’t earned a dime from his work. Did you hear when I said Apple? Do you get what we wouldn’t have without FHIR? Nearly everything you need to know about today’s interoperability opportunities and challenges are made clear in my 2015 interview with him. I asked him a final question of what he would wish for if he could wave an interoperability wand and he brilliantly said (or perhaps predicted), “I wish the clinicians would believe in clinical interoperability the way that the IT people believe in IT interoperability. We’ve had doubters in the past, but pretty much everybody believes in it now if only we can get there. I wish the clinical people thought that that was a clinical problem.” To which I might add, “I wish health system executives would see interoperability as a responsibility to their patients, not as a threat to their bottom line.”

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At least it was your apostrophe rather than your heart that was misplaced, HIMSS.

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This is kind of a fun look and appropriate, too.

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Brilliant, not to mention self-designed. I believe we may have struck a distribution deal.

I had a quick theater demo of an Alexa-powered patient scheduling app from EMedApps. It was OK, although the generic wording of “provider” as recited to the home user is awkward, even though we as industry people haven’t figured out the best term to refer to the alphabet soup of licensed people who could see a given patient.

I had never hood of Hook, a three-year-old company that connects to Epic and Cerner (via FHIR API and Sandbox, respectively) to present a single view of a patient’s information that can be filtered, sorted, and searched. NYU Langone is piloting and the company is looking for more sites.

CITI Healthcare offers data migration and has an app on Epic’s App Orchard. Steve was a good guy there.

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The younger crowd represent with skin-tight suits, wild shoes, and diligently differentiating accessories like bow ties. Those of use whose youth is behind us can attest that when we, too were trying convey confident rebelliousness by ironically dressing and acting the same way, that practice itself was obvious form of confidence-lacking conformity. I like that HIMSS is targeting the early-career folks with their own social events – let’s make them feel welcome. We’re at that interesting point where the people who created health IT from punch card readers and 80-character terminals are retiring and throwing the flag to those behind them.

My goal of the day was to get vendor-offered socks, especially the loud and unusual kinds. Sometimes they handed them over generously, sometimes they stiffed me in saying that the front-and-center displayed socks are for prospects only (hey, if it’s on the podium, it should be fair game), and in Intermountain Healthcare’s case, I couldn’t score a pair of the cool Life-Flight socks because the lady working there was deep into some kind of technical struggle from which her gaze did not avert.

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I was surprised that the AMA had a happy hour bar going. But then again, just about every booth had a happy hour bar going.

Someone asked me at the end of the feet-ruining day what I saw as the big themes. I’m not sure I saw any so far, but I’ll say:

  • I saw few claims of old systems being suddenly AI-powered, and in fact not many companies were pitching AI at all and most of those that did were obviously using the term in a marketing rather than technical definition (they don’t actually have it, in other words).
  • The term “big data” was spoken by no one, having been yesterday’s tired fad (again, a marketing term than a technical one).
  • Certainly the new proposed CMS rule has diverted a lot of industry attention right as the conference started – it’s a huge document to digest and it has big implications to both providers and vendors.
  • Vendors didn’t seem all that excessive in their booths, although maybe I’ve just become immune to it.
  • I didn’t see all that many booth staffers screwing around with their phones or huddling for inter-employee chats instead of paying attention to visitors. In fact, I saw vendors having pre-opening scrums, going through orientation checklists, and describing the goals of the company to everyone involved.
  • It felt like maybe people are starting to see the HIMSS conference as more of a boat show distraction with the ever-present government action discussion thrown in and little of substance in between. Maybe system selection has been rationalized, health systems have locked in with their preferred vendors as those health systems expand, and the huge unknowns of genomic science and artificial intelligence fighting for air time with lack of interoperability (or lack of a market for it), questionable usability, and uncertain ROI. We’ll see if the HIMSS attendance – announced tomorrow, probably – is trending up or down (they predicted more than 45,000).
  • The US health non-system is not sustainable and expensive technology hasn’t improved cost or outcomes despite those neon gulches of previous HIMSS conferences in which vendors claimed to have the solution for every problem du jour. As Mike Leavitt said in today’s opening session, you can’t be on the world’s leaderboard if you’re spending 25 percent of your GDP on healthcare.

Tell me – what should I see or do Wednesday that would rise above my trite observations about booth snacks or lack of magicians?

Morning Headlines 2/13/19

February 12, 2019 Headlines No Comments

Partners Healthcare system back up following IT issue

Partners Healthcare (MA) rectifies Citrix connectivity issues that affected clinical and administrative systems at its 12 hospitals.

RTI International Launches Center for Health Care Advancement to Provide Evidence-Based Solutions to Problems in Health Care

Nonprofit research institute RTI International will develop the Center for Health Care Advancement to offer providers and payers insight into health IT, data analytics, population health, policy, delivery, and financing as they transition to value-based care.

MediQuant acquires DataEmerge, HeF Solutions

Medical records archiving vendor MediQuant acquires data extraction company DataEmerge and health data conversion business HeF Solutions.

Dr. Jayne at HIMSS 2/11/19

February 12, 2019 News No Comments

I was thrilled to finally make it to Orlando in one piece, and to not have to engage my backup plans of flying to Tampa and renting a car or having to come a day later. My HIMSS schedule this year is crazier than it’s ever been, with only a few scattered hours of free time. Missing all of Monday would have been a mess since I had several meetings with people I only see face-to-face at HIMSS. Fortunately, I connected with a colleague in Chicago that I hadn’t expected to see and we were able to spend a couple of minutes together doing some quality shoe-watching.

ONC jumped on the “let’s release things at HIMSS” bandwagon by posting the Notice of Proposed Rule Making for Interoperability since we’ll all have time to read it this week. Those of us who are at HIMSS are running around crazy, and the ones we left on the home front are running around crazy covering the work we left them. Proposed requirements include the ability to export electronic information in a computable format for not only single patients, but for all patients in the event of a provider switching EHRs. They missed the mark, however, since they’re allowing vendors to determine the export standards they will use rather than making a proscribed standard. They also clarified seven exceptions to the information blocking provision. If anyone has the time to read it and finds other interesting nuggets, leave a comment or email me.

I was glad to get out and pick up my registration materials in the morning before the sun began to beat down mercilessly. For those of us in frozen climates, being exposed to anything warmer than 50 degrees is likely to cause heat prostration. I met up with a good friend and planned our booth crawl strategy for tomorrow, so I hope all of you manning the booths have your game faces on. We’ll be watching for the best, worst, and most memorable booth teams. Despite the sun, I made the walk back to my hotel without melting, but opted to take the shuttle bus when I returned to the convention center for the opening reception.

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The reception was full of attendees donning superhero capes, some of them over their backpacks, which made for an interesting look. There were Spandex-clad entertainers dressed like Spiderman, Batman, and their masked colleagues. The room was pretty dark so it was difficult to take pictures without being totally obvious – I missed some great shoe pics for sure. The lobby outside the Valencia Ballroom had some faux food trucks serving as bars that looked like they had long lines – fortunately the lines inside were much shorter. HIMSS continues to not understand “cocktail reception food,” offering several items that required forks, making it difficult to figure out what to do with your drink. I also thought I saw someone eating something with chopsticks but was never able to find the buffet from which it came.

The reception is a great time to connect with friends old and new before everyone splits up to various vendor events and company dinners. I try not to sign up for more events than I can actually attend. My usual wing-woman was off to the KLAS dinner, so I opted for one of the regional HIMSS chapter events, which ended up being a good choice as I met several new folks who had some great stories to share. My dinner partner was a vendor rep who covers several states including two served by the chapter, and I learned a fair amount about a certain niche in the medical equipment market.

Key themes continue to include EHR optimization and workflow improvement. In talking to a few people at big health systems, I learned that there are quite a few organizations that aren’t anywhere near down the path to value based care as it might be assumed that they would be. In many areas there is still a lack of alignment between value-based contracting and physician incentives. It’s hard to get people to coordinate care and reduce utilization when they’re still being paid on a model that is largely based on production. I think those of us in the healthcare trenches assume everyone is trying to be on the cutting edge when in reality many groups are just trying to hang on. Since Mr. H doesn’t do the party circuit and Jenn isn’t here this year, I had to do my part for the team and whirl off to the next event.

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Nordic Consulting outdid itself as usual with its classy event at the Oceanaire Seafood Room. Just about every type of seafood was represented, along with a nice wine selection and a dessert bar that made a nice addition to the night. The room layout was conducive to conversation and I was able to recover from the loud volume yell-fest at my previous event. I’m always impressed by their staff, who print out badges and place them in reusable magnetic holders so you don’t wind up with sticky film on your clothes or holes from the pins given at some events. No wristbands, either.

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Upon returning your badge holder on the way out, you were presented with a Cards Against Health IT game, which I can’t wait to play. They assured me it is workplace appropriate, unlike the game that inspired it. I regularly attend a Halloween party with a number of local healthcare IT folks, so I know what I’ll be bringing this year along with my standard casserole full of hot artichoke dip.

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Lots of cool shoes at Nordic, reminding me of my wilder shoe days. I’ve needed cortisone shots after my last couple of trips to HIMSS, so I’ve dialed my footwear down quite a bit. I do have some sparkly numbers planned for tomorrow night and they’re comfy to boot.

There were several other parties tonight. I heard the one hosted by sponsor Redox was hopping, but I was pretty worn out after battling travel last night and surviving the relative heat wave today. As I headed for my low-rent but walkable hotel, I met up with an attendee who was trying to figure out how to walk to a hotel adjacent to mine, so we had a nice chat on the way. It was nice to get to know a woman in the startup space and learn more about what she is trying to accomplish with using technology to fuel smoking cessation and positive behavior change.

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Also on tomorrow’s dance card is an opportunity to crash the new HIMSS member ice cream social. If that doesn’t work out, there are plenty of in-booth happy hours to offer distraction. I’ve got a long list of must-see booths and will be waiting with the crowds for the doors to open. Until then, I need some beauty sleep!

From HIMSS 2/11/19

February 11, 2019 News 4 Comments

News Items

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HHS / CMS / ONC seem to have developed a knack for publishing important documents late on a Friday or immediately before the first day of the HIMSS conference. HHS released its long-awaited Notice of Proposed Rulemaking for interoperability, as required by the 21st Century Cures Act, on Monday morning, although legal experts note that the NPRM was posted online but not in the Federal Register. A few items I noted from a quick skim of the 724-page document:

  • Actors who spend money to support information exchange would be allowed to recover those costs by charging fees.
  • EHR vendors would not be allowed to charge for using their APIs, except in charging providers who use them or vendors who offer value-added services. Fees would be cost-based, objective, and consistently applied.
  • All EHR vendors would be required to support USCDI Version 1 as a standard.
  • APIs would be certified and vendors would be required to use the SMART Application Launch Framework Implementation Guide. They would be required to post API specifications publicly.
  • EHR certification would be expanded to include the product’s ability to export data to allow users to convert to another product.
  • EHR certification would be expanded to include pediatric care criteria.
  • Charging patients excessively to obtain their own information when they paid to have it created in the first place is information blocking. That’s going to be a big one that the American Hospital Association is sure to vigorously protest.

From the Burner Phone

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Text me news, rumors, photos, and booths I should visit this week, then watch for your items to appear anonymously in my daily recaps if I find them interesting.

“The Athenahealth – Elliott deal closed. Some ELT turnover was announced, including Paul Merrild. You should do some asking around about the hospital product, keeping an eye on the LinkedIn profiles of the company’s hospital-oriented employees.”

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“A Greenway client told me today that Intergy – not only Prime Suite – has 30 broken certification elements. I don’t pretend to understand what’s involved in fixing this list on ONC’s site (scroll down to ‘surveillance activities,’) so maybe it’s being overblown. I am following up with a solid inside source.” 

“As the US healthcare continues to struggle with protecting and securing our data, I suggest readers attend HIMSS19 Session 171 to learn real world experience of implement GDPR from two real professionals who have walked the talk, and have the callouses and boot blisters of the journey. I have no conflict of interest, do work for, or have financial interest – I’m just aware of their excellent work.”

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A couple of folks asked me about my burner phone, which actually is an app called Burner rather than a physical phone. It’s easy to set up, slick, and cheap ($4.99 per month, no commitment, unlimited texts and calls). You get a new phone number that you can give out freely since it’s not traceable (no caller ID) and is disposable (apparently it’s good for Craigslist, online dating, signing up for online services that require phone verification, and probably stalking). The texts and calls flow to your phone normally, but through Burner inbound and outbound, so your actual cell number is never exposed and your cell bill shows only your Burner number. Folks who are doing something far more sensitive than I can delete their Burner and all associated records by literally just pressing one on-screen button, which I suppose is a benefit if you anticipate an “FBI, open up” knock at your door. I’m just using it because I ran across it and was intrigued.


Observations

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I checked the online HIMSS shuttle schedule while waiting at the designated spot. It suggested using the real-time shuttle location app, which was actually a web page and not an app. Perfect – it said a shuttle would be arriving in one minute. Then the one minute changed to 23 minutes, then to seven, then to six, then to 16 … and by then I had waited quite awhile and gave up and called for a Lyft ride. Unlike the HIMSS bus “app,” Lyft’s was deadly accurate.

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I was anxious to pick up my conference backpack so I could transfer all the junk in my hands and pockets. That didn’t happen – for the first time that I can recall in my long HIMSS conference history, the official HIMSS bag is a actual tote instead of a backpack. It holds a lot less, but more importantly, it can’t be slung over my shoulder, meaning I’ll be spending all week with one hand dedicated to lugging it around. I nearly brought along my travel backpack from home since I didn’t want to be without it for even the few hours of travel (much less for a week), but alas, I made an incorrect assumption that its presence would be, as it has been every year, redundant. Vendors in the exhibit hall, this could be your moment in the sun if you brought giveaway backpacks – let me know and I’ll let everyone know (after first grabbing one for myself, of course).

Tote bag (literally) pick-up didn’t go so well for me today because I couldn’t understand a word of what the person at the desk was saying because of her strong accent. However, I celebrated whatever culture she is or was part of since it’s good reminder that the industry isn’t just white-bread tech geeks and frat boys salespeople any longer (having a clear memory of when it was, and when male nurses and female executives were unheard of). 

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The exhibit hall was like a summer day in Vietnam – swelteringly hot, loud, and dangerous with vehicles (fork lifts and tractors) careening in all directions following no apparent rules and with little regard for pedestrians. The heat levels, caused by having the massive load-in doors opened wide on an 82-degree afternoon, sent me fleeing for the comfort of the air conditioned main halls after just a few minutes watching the pre-game show of geeky IT guys and swaggering equipment operators who were slowly turning the unsightly mess of packing boxes and rolled-up carpet into what you will see tomorrow.

Tomorrow morning will be like Christmas. Vendors will be downing Starbucks in the hall after spending a tiring late night decorating the tree, stacking the presents, and turning on the twinkly lights. We kids will be pacing outside the doors, pressing our noses to the glass and fidgeting impatiently until the doors are flung wide so we can rush in to ooh and aah at the marvel of the tableau that was created just for us. It won’t be long afterward, however (Thursday, to be exact) before everybody will be sick of their new and often broken toys, the pre-holiday euphoria will have transformed into disillusionment, and various family members will have drunk too much spiked Kool-Aid and will have stormed off to their rooms in anger and then scheduled earlier flights home.

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Arcadia has once again put together these invaluable conference first aid kits that you can get from their booth (#2915) or ours (#4085).

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This vendor’s packing crates luckily arrived at the right place despite the spelling error, which I expect to see a few more times this week in locations that are, unlike this one, public-facing.

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Our magnificent edifice is fully constructed, requiring one Lorre and zero Teamsters to pack it all in from the Lyft drop-off area since it weighs in at maybe 20 pounds total. I’m sure some overnight HIMSS inspector will correct the beneficial mistake in which we have two power outlets (having paid for none), three chairs (having paid for two), and a backdrop that is larger than the carpet (having paid for a 10×10 carpet to cover the same-sized space). I’m not sure that paying $6,000 for a mostly-empty square of concrete that will hold maybe $300 worth of homebrew furnishings makes good fiscal sense, so I will reevaluate in our post-show briefing call, which basically means I’ll ask Lorre if she thinks it was worth it. Her outlook will be more positive if fun people keep stopping by or new sponsors keep signing up.

Special guests in our micro-booth this week (covering Lorre’s necessary intake and output since she’s working solo) will be:

  • Tuesday 2:00 – 3:00: Nancy Ham, WebPT CEO, will offer advice to women in health IT on negotiating with confidence.
  • Wednesday 10:00 – 11:00: Susan Newbold, PhD, RN, owner, Nursing Informatics Boot Camp.
  • Wednesday 1:30 – 2:30: Stuart Miller, CEO, MindMapUSA.
  • Thursday 11:00 – noon: Ben Rooks, founder and principal, ST Advisors.

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This video posted on Twitter shows KLAS celebrating its winners during HIMSS19. It’s nearly as cringey as that Siemens Healthineers forced merriment video from a couple of years ago, as the suit-wearing stiffs are cajoled by prancing funsters to sing along with the words on the screen (painfully woven to include the names of the winners in the lyrics) and to bang their sticks in appreciation as the script requires. Seriously, KLAS, shouldn’t you keep arm’s length from the vendors you purport to objectively review? Do you suppose Consumer Reports throws sing-a-long parties with car-makers after the April issue comes out? Would CR have lauded Volkswagen as a winner after the feds caught them falsifying their test results? Does everything in healthcare have to involve a party or self-promotional opportunity that might raise the question of WWPT—What Would Patients Think?

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Several folks sent me this odd feature of the opening reception, in which gloved hands protruded from topiary to offer drinks. I would have enjoyed hearing the HIMSS staffer pitching the idea of an alcoholic glory hole, or perhaps hearing the even zanier ideas that didn’t make the cut.

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