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Morning Headlines 5/29/19

May 28, 2019 Headlines No Comments

Medically Home® Group Raises $10 Million Towards Its Virtual Hospital Series B Funding

Cardinal Health makes a $10 million investment in home medical monitoring technology and monitoring services vendor Medically Home Group.

Banner Health launches Banner Innovation Group

Banner Health (AZ) launches an Innovation Group, bringing together its incubators and innovation and digital business leadership team to support and commercialize homegrown technologies and services that benefit the patient experience.

MISSION Act’s new community care program ready for prime time, VA says

After three years and $7 million, the VA continues to struggle with the development, implementation, and certification of a new IT system that will manage the MISSION Act’s caregiver program.

NextGen Healthcare, Inc. Reports Fiscal 2019 Fourth Quarter and Year-End Results

NextGen Healthcare CEO Rusty Frantz says the company’s Q4 results exceeded revenue expectations thanks to growth in bookings and deal size, and the launch of integrated ambulatory care software.

News 5/29/19

May 28, 2019 News 3 Comments

Top News

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Cardinal Health makes a $10 million investment in home medical monitoring technology and monitoring services vendor Medically Home Group.

The company says that its remotely monitored “virtual hospital room” that it sets up in the patient’s home saves the 60% of the expense of hospitalization that is related to fixed costs, such as buildings.


Reader Comments

From Hospital Digital Marketer: “Re: Google. Did they ban healthcare systems from posting star ratings for doctors in search results? We pay a lot to our survey vendor to post these on our website, but the stars disappeared after Google updated its search engine results pages.” I’ll invite marketing folks to weigh in since this isn’t something I follow.

From Pendulous Appendages: “Re: management. What eventually happened to your software vendor employer manager who refused to alert customers to a problem that put patients in harm’s way?” I Googled him and turned up nothing, leaving me free to speculate hopefully that karma found him despite his apparent corporate fast track back then. I did locate his boss, the corporate suit who was parachuted into our office as a 20-something newly minted executive assigned to lend his vast knowledge to our failing operation – he later became CEO of several large healthcare companies (one of which he took public, another of which was sold to an especially scummy drug company) and is now an investment company partner. My takeaways from this:

  • The people who end up in charge have the drive, ambition, and personality quirks that set their direction early. They never spent time as programmers, clinicians, or cube-dwellers, having been chosen early on for internships and consulting assignments that skipped the hands-on layer. It doesn’t hurt to be a family friend or relative of a company bigwig.
  • Some of the anointed ones are screaming, petulant psychopaths (the CEO I mentioned above was the poster child for that), while others are generally amiable since they aren’t really emotionally invested in the assignment that they know is just a brief stop on their ascent to the summit. I didn’t mind working for the later-career ones who took the top job as a favor for our investors and therefore were more often bemused than tyrannical in realistically assessing their ability to do anything more than delay the inevitable.
  • They took every job with the next one in mind. Those of us rowing the boat saw a lot of captains come and go. We were happy to see most of them leave, apprehensive about which company man would be sent to our corporate hinterlands to replace them, and full of conflicting thoughts about their jobs and lives versus ours as we passed around the newspaper reports of their opulent home purchases and saw them wheeling their testosterone-boosting sports cars (all but one were male) into their reserved parking spots each day.
  • The rise to the top can be achieved even while running failing, doomed companies as long as you can make their corporate budget contribution look temporarily better than when you arrived (i.e., laying people off, cutting R&D, sunsetting products, increasing maintenance and services fees). This is not a good thing for customers, but then again, having a perpetually money-losing software vendor isn’t sustainable anyway.  
  • The victory lap for circuit-riding CEOs is in venture capital and other investment activity, which lines their pockets even more than running companies.

HIStalk Announcements and Requests

I occupied some of my time over the long weekend with binge-watching: all but the final couple of episodes of ”What/If” and continued progress on “Justified,” both of which I recommend for unchallenging yet engrossing entertainment. Next up is “High Seas.” It’s fun that so many series are available on the streaming services we use (Netflix, Hulu, and Amazon Prime) that when someone asks you what you’re watching or vice versa there’s an 80% chance the other person hasn’t heard of it, unlike the old “three networks” days when everybody talked about the same shows. I didn’t realize until getting engrossed in “Justified” that it’s an old series, having run on FX from 2010 to 2015, magically reborn to feed the streaming beast. 

I was browsing on my Chromebook as I often do (because it’s light and small, just right for a break in the easy chair) when I recalled that Microsoft Office 365 contains fully functional Web versions of the suite (Word, Excel, OneDrive, etc. – everything except Access) that run just fine on it. I could do nearly everything I do on a full Windows desktop on the Chromebook, although “nearly” still prevents a full switch. I suppose I could just get a small, lightweight laptop for these situations, such as a Surface, but I don’t really need one.

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Welcome to new HIStalk Platinum Sponsor Google Cloud. Solutions include unified, HIPAA-compliant and HITRUST CSF-certified data storage with Cloud Healthcare API access; the BigQuery managed, server-less data warehouse; the Cloud Machine Learning Engine and TensorFlow for building and training custom models; collaboration tools such as the G Suite productivity suite and Chromebooks; and Cloud Healthcare API and Apigee Healthcare APIx to bridge systems and applications with FHIR and DICOM support. Customers include Cleveland Clinic (extending its EHR and performing analytics via APIs); Lahey Health (collaboration); Hunterdon Healthcare (collaboration); and Colorado Center for Personalized Medicine (data warehouse for patient and genetic data for personalized diagnoses and treatment as well as research). Rush University Medical Center powers its MyRush app with Google Cloud, improving customer experience and patient outcomes with API-enabled services, use of 250 analytics variables, and management of the access gateway with OAuth, validation policies, and traffic management. Google Cloud offers a free tier that provides everything from storage to development tools, APIs, and analytics. CIOs can connect with the company at CHIME’s Fall CIO Forum in November. Thanks to Google Cloud for supporting HIStalk.

Here’s a panel discussion on “The Future of Health” from Google’s just-concluded Cloud Next 19 developer conference.


Webinars

May 30 (Thursday) 2:00 ET. “ONC Data Blocking Proposed Rule: What Health Systems Need to Know.” Sponsor: Philips PHM. Presenter: Greg Fulton, industry and public policy lead, Philips. Proposed data-blocking regulations could specify fines, disincentives, and de-certification of providers who don’t provide an API for patients to extract all of their data. This webinar will describe who is deploying APIs, the scope of data and third-party apps that can be used, the seven costs that do not count as a data-blocking exception, and the health system protections that don’t involve using a vendor. It will also provide examples of data blocking and further exceptions.

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


Acquisitions, Funding, Business, and Stock

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Change Healthcare files an amended prospectus for a $200 million IPO, double the value of its mid-March filing.

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Apple reportedly acquires Tueo Health, which is developing an app to monitor the nighttime breathing of asthmatic children. The deal was supposedly done in late 2018, but nobody noticed until now.

UCSF ends its plan to affiliate with Dignity Health’s four Bay Area hospitals, citing unresolved issues related to women’s reproductive services, LGBTQ care, and end-of-life options.


Sales

  • Loma Linda University Medical Center chooses QuadraMed for patient identity management.
  • Western Maryland Health System chooses PeraHealth’s Rothman Index for real-time monitoring of patient condition.

People

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Surgical automation and software vendor Caresyntax hires Tim Lantz (Sentry Data Systems) as president.

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Divurgent hires Bill Bottomley (HighPoint Solutions) and Mary Beth Seaman (HighPoint Solutions) as client services VPs.


Announcements and Implementations

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Muhlenberg Community Hospital (KY) replaces Meditech with the Epic system of its corporate parent, Owensboro Health, with the project coming in under budget at $2.3 million. 

Imprivata enables its Confirm ID EPCS solution to run under the Google Chrome browser, making it more accessible to Meditech users.


Government and Politics

A Kaiser Health News analysis reviews whether the reduced cost involved with healthcare overhaul could wipe out “the industry” (meaning providers, insurers, and others) that provides 20% of the country’s employment. The article quotes economists who previously worried that the bloated and growing healthcare sector was being used as a “wildly inefficient jobs program” to drag the country out of the Great Recession. A healthcare economist observes that hospitals make up the top six employers in Boston and two of the top three in Nashville, with the main source of healthcare cost savings being layoffs that he estimates would impact 2 million people, equally split between providers and insurers. Another economist agrees, but says high healthcare costs sap non-healthcare industries in ways that can’t be easily measured.


Other

I missed this earlier: HHS OIG report finds that ACOs (of the six it studied) that run a single EHR are able to to share electronic data in real time, whereas those using multiple EHRs are limited to phone calls and faxes. The report also notes that care coordination outside the network is hard even with HIEs (since they provide limited data) and that most ACOs aren’t using analytics to personalize care. 

A federal lawsuit questions whether hospitals are sidestepping anti-kickback laws by overpaying the salaries and perks of doctors they hire whose test and procedure volume generates hospital profits that exceed their specialty-specific losses. It highlights the aggressive practices of Wheeling Hospital (WV) to increase its market share, which include directly tying physician compensation to the hospital revenue they generate and hiding doctor payments within office lease terms that give some doctors incomes that are multiples of what their private practice counterparts are making. Meanwhile, CMS dropped the hospital’s quality star rating to one, the lowest possible score.

A study estimates the annual cost of physician burnout at $4.6 billion, or $7,600 per doctor per year. Now that WHO has added “burnout” as a rather vaguely defined ICD-11 diagnosis (symptoms: exhaustion, negativity, and reduced productivity), let’s hope we don’t medicalize it by paying for questionable treatment that then creates consumer demand as we’ve done for other newly defined conditions – we don’t want doctors to burn out from treating doctor burnout.


Sponsor Updates

  • Nuance customers in Colorado, Mississippi, and Ohio adopt the company’s CDI solutions.
  • Surescripts expands its White Coat Award to include categories for health systems, pharmacies, and pharmacy technology leaders, as well as EHR vendors.
  • FDB releases MedKnowledge Canada to support bi-lingual medication management app development.
  • The Chartis Group publishes a paper titled “Launching a Revenue Cycle Automation Strategy.”
  • Aprima will exhibit at the NJMGMA Practice Management Conference June 5-7 in Atlantic City.
  • In Argentina, Emergencias deploys Avaya’s IX Contact Center software to help save lives.
  • Bluetree will exhibit at the IPMI Healthcare IT Institute June 2-4 in San Antonio.
  • Burwood Group will exhibit and present at the Southern California CIO Executive Summit June 5 in Universal City.
  • PeriGen publishes a white paper titled “How to Reduce Exposure to Obstetric Megaverdicts with AI-Driven Technology.”
  • CompuGroup Medical will exhibit at the Arizona Medical Association Annual Meeting June 1 in Chandler.
  • CoverMyMeds will exhibit at the NG Healthcare Provider Symposium June 5-7 in Savannah, GA.

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Morning Headlines 5/28/19

May 27, 2019 Headlines No Comments

Physician burnout costs the US health care system approximately $4.6 billion a year

Researchers from the Mayo Clinic (MN), AMA, Stanford University, and the National University of Singapore determine that physician burnout costs the US healthcare system $4.6 billion a year, or $7,600 per employed physician.

WindRose Health Investors Commits $85 Million in Financing to Kidney Health Management Company Healthmap Solutions

Technology-enabled kidney health management business Healthmap Solutions raises $85 million from Windrose Health Investors.

Regulators approve $21M power line to serve Epic Systems’ growing needs

Utility regulators in Wisconsin approve a $21 million underground power line to accommodate Epic’s needs over the next several years.

Morning Headlines 5/27/19

May 26, 2019 Headlines No Comments

VA tells Senate no on more Cerner EHR oversight

The VA opposes a bill that proposes creating an independent advisory committee to oversee the $10 billion Cerner EHR implementation project.

Why the new HHS CIO is not your usual suspect

New HHS CIO Jose Arrieta, who comes to the role with a contracting and technology background, will make cybersecurity, cloud computing, and emerging technology his initial priorities.

Change Healthcare files for $200M upsized IPO

Change Healthcare increases its planned IPO from $100 million to $200 million.

Apple bought a start-up that was working on monitoring asthma in children

CNBC reports that Apple purchased pediatric asthma monitoring company Tueo Health late last year.

Monday Morning Update 5/27/19

May 26, 2019 News 4 Comments

Top News

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The VA skips a House committee meeting that addressed oversight of its Cerner implementation, but attends a Senate meeting long enough to oppose a bill that proposes creating an independent advisory committee to oversee the $10 billion project.


Reader Comments

From Anon E. Mouse: “Re: EHR timers. Cerner was the vendor that wasn’t directly mentioned in the article, although it’s obvious since Eva Karp works for Cerner. Cerner’s Lights On Network has been freely available with such timers for years and is used by many of their clients daily. Cerner invests a ton of effort in building additional timers as they introduce new software and functionality and then works to attack the problem areas to improve performance and clinical workflow.” Cerner’s write-up of Lights On Network describes its benefits: finding users whose system actions suggest that they could use help, identifying system bottlenecks, flagging unusual system settings, and benchmarking against other Cerner clients.


HIStalk Announcements and Requests

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A convincing 97% of poll respondents who have coordinated post-acute care for someone said it was hard, with the biggest issue being trying to coordinate the activities of the care team and family. Some comments:

  • Vicki says organizations served only their own interests in caring for her family members, such as a SNF that wasn’t interested in helping find a home health provider other than the one it owns.
  • Clark’s experience with transitions from ICU to LTAC, SNF, home care, and therapy providers is that nobody every had current patient information, creating both frustration and danger.
  • Brittany’s experience with hospice care is that medical equipment wasn’t delivered, transportation was delayed, and nurses misunderstood the family’s wishes and kept the family member over-sedated in denying them the chance to have meaningful final moments together.
  • Another reader reports that they experienced excellent coordination at Johns Hopkins, but had a “consistently horrendous” experience at their own hospital, where they are a physician faculty member. HIM dragged their feet on providing an electronic copy of the medical records, obtaining images required two trips and upfront payment of fees, a chaotic discharge process created delays that necessitated rescheduling home health appointments, refrigeration-required antibiotics were delivered early when nobody was home, prescriptions were sent to the wrong pharmacy, hospital nurses argued with the family over the medication list in insisting that their computer must be correct, and the hospital ran out of common medical supplies.
  • Caregiver Informaticist says their family member’s care was never coordinated in several trips between LTAC and the acute care hospital, with no information sharing after being falsely told that the LTAC’s doctors round at the hospital and attend joint care planning meetings.

New poll to your right or here: What is the main cause of burnout among employees of health IT vendors and hospital IT departments? My experience working for a crappy vendor makes “all of the above” attractive, but let’s focus on the most important item on the list. For me, that was incompetent, uncaring managers who interfered with our productivity in trying to add value to processes they would never understand, poring over their MBA textbooks in their spiffy offices with the doors shut before emerging into the cube farm to make a lofty pronouncement that after applying their exemplary insight to our operation, they had figured out the solution to our problems (we had tried it before and failed, but saying so elicited scorn that what we had been missing then was their keen leadership). Worst of all, they had no healthcare background and thus nothing but contempt for our users and the patients who depended on our systems – we were just a widget factory that happened to sell healthcare software. I made an impassioned, stick-figure level plea to one of the suits about a patient-endangering software defect that I had laboriously documented urging him to simply allow us to notify all customers of the problem since we hadn’t yet figured out how to fix it. His answer: “We don’t owe those clients a damned thing.”


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Monday is Memorial Day, created not to serve as a nonchalant kickoff to summer, but rather to set aside time to remember those who died while serving in the armed forces. It’s perfectly fine to pass on attending a ceremony or an increasingly rare Memorial day parade, but perhaps you know someone who lost a family member (especially if it happened within the past handful of years) who was serving and could drop them a quick email or social media acknowledgement of their loss. Here’s another idea – take flowers to a cemetery that has a section set aside for soldiers and leave one on each grave that doesn’t already have some.

In Flanders Fields
By John McCrae

In Flanders Fields the poppies blow
Between the crosses row on row
That mark our place; and in the sky
The larks, still bravely singing, fly
Scarce heard amid the guns below.

We are the Dead. Short days ago
We lived, felt dawn, saw sunset glow,
Loved and were loved, and now we lie
In Flanders fields.

Take up our quarrel with the foe:
To you from failing hands we throw
The torch; be yours to hold it high.
If ye break faith with us who die
We shall not sleep, though poppies grow
In Flanders fields.


Webinars

May 30 (Thursday) 2:00 ET. “ONC Data Blocking Proposed Rule: What Health Systems Need to Know.” Sponsor: Philips PHM. Presenter: Greg Fulton, industry and public policy lead, Philips. Proposed data-blocking regulations could specify fines, disincentives, and de-certification of providers who don’t provide an API for patients to extract all of their data. This webinar will describe who is deploying APIs, the scope of data and third-party apps that can be used, the seven costs that do not count as a data-blocking exception, and the health system protections that don’t involve using a vendor. It will also provide examples of data blocking and further exceptions.

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


People

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HHS promotes Jose Arrieta to CIO.


Announcements and Implementations

Lawrence General Hospital completes its implementation of Meditech Expanse under a fixed-fee implementation agreement with Santa Rosa Consulting.

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A new KLAS report covering opioid prescription intelligence finds that all vendors reviewed performed well. PastRx tops the list in pulling PDMP data into the chart for physician review, while AffirmHealth and Collective Medical were praised in their respective regional pain management clinic and ED environments. Appriss Health and DrFirst were seen as less helpful in developing an opioid stewardship strategy since they work with users only indirectly.

In England, Guy’s and St Thomas’ NHS Foundation Trust issues a 10-year, $225 million tender for a enterprise EHR that will be used by up to 35,000 employees of three London-based trusts.


Government and Politics

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The VA’s self-developed, open source workflow tool Light Electronic Action Framework (LEAF) wins a government health IT magazine’s innovation award. The team used the tool to develop a telehealth provider volunteer site for hurricane relief efforts (pictured above) within 24 hours.


Other

A data study finds that Canadian buyers of marijuana (where it is legal) avoid paying by credit card since they know their data is likely to be stored on servers in the US (where it isn’t legal). Also in play is that some employers enforce zero-tolerance policies for non-medical use. Canada’s own Office of the Privacy Commissioner recommends that buyers pay cash since the US government can access their credit card records without a warrant and could prevent them from entering the US.

I’m fascinated by this: Elon Musk’s SpaceX uses its Falcon 9 rocket to launch the first 60 low-Earth, 500-pound satellites of its $10 billion Starlink broadband service, which will offer inexpensive broadband connectivity to the northern US after six launches, the whole country after 12, and the entire populated world after 30. The company will use the revenue from the broadband service to fund its planned colonization of Mars.

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An interesting op-ed piece by the co-founder of a clinician collaboration platform says that architects ruined healthcare by emphasizing grand, soothing aesthetics for visitors while eliminating the conference rooms and lounges where clinicians can interact with each other. He also opines that the Disney-created concept of hiding the “messy parts” of running a hospital means that the healthcare professionals themselves are the messy parts. He concludes that hospital design is now obsessed with distracting people from thinking about their health rather than making them healthy.

More evidence that Americans are too science-challenged to form rational healthcare opinions: people are OK with the widespread rollout of untested medical treatments, but object to randomized trials in which two equally acceptable treatments are applied to separate groups to determine which is better. Experts can’t explain the results, but think people might worry that consent is required from those who don’t get a particular treatment or that such tests should be unnecessary because experts should already know what works.

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A third-year UTHealth medical school student who has undergone six brain surgeries, survived on artificial nutrition due to gastroparesis, and had a stroke that left her temporarily paralyzed from the waist down says the experience (along with deficits in her hand function from the stroke) has motivated her to consider a career in physical medicine and rehabilitation and neurology.


Sponsor Updates

  • Meditech; NextGate; Clinical Computer Systems, developer of the Obix perinatal data system; CereCore; CloudWave; Experian Health; PatientKeeper will exhibit at the 2019 MUSE Inspire Conference May 28-31 in Nashville.
  • Waystar will exhibit at the EClinicalWorks Education Expo May 27-31 in Boston.
  • The Chartis Group publishes a white paper titled “Bridging the Digital Divide in the Healthcare C-Suite: Positioning IT for Success in the New Health Economy.”
  • OmniSys and Surescripts will exhibit at the PioneerRx Connect 2019 May 31-June 2 in Orlando.
  • Relatient welcomes its 100th employee.
  • Sansoro Health releases a new 4×4 Health Podcast, “Intellectual Property for Entrepreneurs and Investors.”
  • The SSI Group will exhibit at the South Carolina HFMA Annual Institute May 28-31 in Myrtle Beach, SC.
  • PatientKeeper will demonstrate its EHR optimization solutions this week at E-Health in Toronto and MUSE Inspire in Nashville.
  • Community First Health Plans goes live with ZeOmega’s Jiva LTSS for long-term care.

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Weekender 5/24/19

May 24, 2019 Weekender No Comments

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Weekly News Recap

  • Agfa is reportedly considering the sale of its health IT business
  • Medical drone delivery company Zipline’s latest investment round values it at $1.2 billion
  • ONC finds little interoperability improvement among office-based physicians since 2015
  • Google promotes Glass from its skunkworks division in releasing a new enterprise version aimed at software developers
  • JP Morgan buys medical payments processor InstaMed for more than $500 million

Best Reader Comments

Any complex software that you spend a lot of time in, you’d better learn it well. Most people do that but if you invest your time in resentment instead, you get nowhere. For highly skilled software users, they memorize key application pathways. It becomes second nature to them, to the point they don’t even think about it. Then for every work task, the only application questions that arise are: 1). Do I already know how to do this? 2). If I don’t, do I think my application can do it and I just need a nudge to get there? (Brian Too)

Cerner has this as well, it is called the Lights On Network. A current customer can log into LON (Lights On Network) and look at all of their timers, usability metrics, playbook scores as well as compare themselves to other like-sized Cerner Customers. It is a very useful tool if you choose to use it. You can see how many clicks it takes to fill out documentation, the amount of time a physician takes for a particular process and you can drill down into the individual users to determine who may be struggling or not even using the system. It is a very underrated tool. (Associate CIO)

Patients want to know who is grabbing their info. Follow-up: that part of the law got specifically wiped away. It’s also noted in the first comment of the proposed rule (long document, but it’s in there). (Richie)

As a former EHR implementer, specifically into physician practices, your article is honestly depressing. These are the EXACT same physician complaints that I heard when I was implementing over 15 years ago! NOTHING HAS CHANGED. You hit the nail on the head. Many docs are all too eager to blame the EHR for problems that have always been there (overscheduling, refill management issues, unwillingness to change habits). I worked with those groups for years and honestly gave up on it because I felt we couldn’t ever really win, as the EHR vendor. (Kallie)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. H in North Carolina, who asked for five laptops for her first grade class (they were out of school for six weeks following school damage from Hurricane Florence). She reports, “We absolutely love our new laptops. We use them every day. We are so very thankful for you kind generosity to our classroom. It has helped our learning in. So many different ways. Our new laptops have sparked so much new learning for all of my students.”

Journal of Hospital Medicine publishes a fun, informative article titled “I, EHR” that is written from the EHR’s perspective to its physician users. It includes tips for integrating an EHR into practice – explain to the patient what you’re doing in the EHR, stop typing and listen when the patients starts to tell a relevant story, use the EHR’s data and images to illustrate medical talking points, and add a photo of the patient and personal information about them to add richness to notes. It concludes,

I know I am annoying. I am over-programmed, leading to novella-length notes, “pop-up fatigue,” and overloaded in-baskets. Clearly, I am not the brains of the partnership (that will always be you). But talented medical informatics specialists are working hard to improve me. I dream of the day when I will create a truly seamless experience for you and your patients. In the meantime, I can foster a continuous integration of workflow, where all you have to do is talk to your patient. I take care of the rest … The future holds even more promising ways in which we may work together. My computer-aided image analysis could help you to improve the accuracy of your diagnoses. Perhaps telemedicine will further increase access to specialists in rural areas, so that we can continue to serve the most vulnerable populations. Machine learning algorithms may continue to enhance our ability to determine which patients require urgent hospitalization.The possibilities to put me to work are endless.

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CNBC describes the 34,000-square-foot Bel Air mansion built by a celebrity nose job plastic surgeon who expected to flip the $70 million property into a $180 million sale. His mistiming was spectacular – the luxury market was glutted and foreign buyers became scarce, so now he’s hoping to unload at $120 million, which would still net him $60 million in cash. The house next door that was listed at $250 million has been cut to $150 million. The doctor says he’ll just live in the house if he can’t sell it – he would just need to sell his existing $20 million home first. It’s hard to fathom that all of this excess is funded solely by people who don’t like how their noses look.

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Henry Ford Hospital says that someone stuffed an ED patient’s lice-infested clothes under the pad of a gurney, leading to a PR nightmare incident in which a patient who was the next gurney’s occupant was found covered in the bugs.


In Case You Missed It


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Morning Headlines 5/24/19

May 23, 2019 Headlines No Comments

Agfa to Consider Selling Hospital IT and Integrated Care Business

Global imaging and IT company Agfa considers selling off the health IT and integrated care parts of its European healthcare business.

Indiana Medical Records Service Pays $100,000 to Settle HIPAA Breach

Medical Informatics Engineering will pay OCR $100,000 to settle HIPAA violations stemming from a 2015 data breach that impacted nearly 4 million patients.

Amazon Is Working on a Device That Can Read Human Emotions

Amazon is reportedly developing a voice-activated wearable capable of detecting emotion that may also offer users advice on how to interact with others.

News 5/24/19

May 23, 2019 News 18 Comments

Top News

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California-based drone-delivery company Zipline announces $190 million in funding and plans to expand its healthcare-focused service to the US, starting in North Carolina.

Founded in 2011, the company initially focused on delivering vaccines, blood products, and medications to remote clinics in Rwanda and Ghana. CEO Keller Rinaudo says Zipline is now ready to provide similar services to remote areas in the US: “People think what we do is solving a developing economies problem. But critical-access hospitals are closing at an alarming rate in the US, too, especially if you live in the rural US.”


Webinars

May 30 (Thursday) 2:00 ET. “ONC Data Blocking Proposed Rule: What Health Systems Need to Know.” Sponsor: Philips PHM. Presenter: Greg Fulton, industry and public policy lead, Philips. Proposed data-blocking regulations could specify fines, disincentives, and de-certification of providers who don’t provide an API for patients to extract all of their data. This webinar will describe who is deploying APIs, the scope of data and third-party apps that can be used, the seven costs that do not count as a data-blocking exception, and the health system protections that don’t involve using a vendor. It will also provide examples of data blocking and further exceptions.

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


Acquisitions, Funding, Business, and Stock

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Helix lays off employees and closes two of its four offices after announcing earlier this month that it will pivot from direct-to-consumer DNA testing to a provider-focused population health management business. The company has raised $300 million over the last four years. Its most high-profile contract seems to have been with organizers of the Healthy Nevada Project, which had promised last spring to hand out Helix testing kits to 40,000 of its public health data project participants.

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Global imaging and IT company Agfa considers selling off the health IT and integrated care parts of its European healthcare business, the most high-profile part of which is its Orbis EHR. Analysts believe potential acquirers could include Cerner, Philips, or CompuGroup Medical, which made a purchase offer in 2016.


People

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Diabetes management software vendor Glooko names Mark Clements, MD (Children’s Mercy Kansas City) CMO.

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Russell Siebert (ZirMed) joins analytics company VisiQuate as EVP of growth.

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MDLive appoints Kristen Lalowski (N-of-One) chief product officer.

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MD Anderson Cancer Center (TX) hires David Jaffray (University Health Network/Princess Margaret Cancer Centre) as its first chief technology and digital officer.

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Former FDA Commissioner Scott Gottlieb, MD returns to venture capital firm New Enterprise Associates as a special partner on its healthcare investment team.

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Mona Hanna-Attisha, MD receives the inaugural Vilcek-Gold Award for Humanism in Healthcare from the Vilcek Foundation and The Arnold P. Gold Foundation. The pediatrician discovered Flint, Michigan’s lead poisoning crisis by analyzing patient data in Hurley Medical Center’s Epic system. She has donated the $10,000 prize to the Flint Kids Fund.

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Provation names Rick Jennings (Teammate) CTO and Erin Surprise (Hoonuit) SVP of professional services. Wolters Kluwer Health sold Provation to Clearlake Capital last year for $180 million.


Sales

  • Consulate Health Care (FL) will leverage Collective Medical’s network for better insight into senior care transitions.

Announcements and Implementations

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Innovaccer announces GA of patient outreach management software.

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Reports surface that Amazon is developing a voice-activated wearable capable of detecting emotion that may also offer users advice on how to interact with others.


Government and Politics

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Travis Air Force Base’s David Grant USAF Medical Center (CA) will go live on MHS Genesis, the DoD’s new Cerner-based system, in September. Other facilities in the initial wave of implementations will include Naval Air Station Lemoore and US Army Health Clinic Presidio of Monterey in California, and Mountain Home Air Force Base in Idaho.


Privacy and Security

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Indiana-based Medical Informatics Engineering will pay OCR $100,000 to settle HIPAA violations stemming from a 2015 data breach that impacted nearly 4 million patients. OCR’s investigation determined that the EHR vendor hadn’t performed a thorough risk analysis before hackers broke into the system using a compromised user ID and password. Other sources have said the company ignored the recommendations of a cybersecurity firm hired at the beginning of 2015, which included strengthening weak login credentials created so that end users didn’t need individual user names and passwords. The company was named in a multi-state December 2018 lawsuit brought by 12 attorney generals over its lack of health data protection.


Other

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Burnout exists in the IT trenches, too, according to a local Madison, WI news outlet. It dedicates a good chunk of copy to the complaints of former Epic employees who have moved on to greener, less grueling pastures. Rachel Neill, CEO of health IT staffing company Carex Consulting, says Epic experiences a 20-30% churn in employees each year, with the majority of replacements coming straight out of college. “They’re looking for someone who can keep on going, going, going until they can’t any more,” she adds. Epic disputes that claim, saying that its actual voluntary turnover is about 10% per year, which is below average for companies in health IT specifically and in the Midwest in general, and that employees work about the same hours per week as salaried US employees overall. Epic Director of Human Resources Allison Stroud believes that most employees feel “happy and challenged, which ends up being one of the best ways to prevent burnout.”


Sponsor Updates

  • Elsevier Clinical Solutions, FormFast, Imprivata, and Intelligent Medical Objects will exhibit at the 2019 MUSE Inspire Conference May 28-29 in Nashville.
  • EPSi shares the updated features of its EPSi 19.1 financial decision support and budgeting software.
  • Hayes Management Consulting hires Yara Hentz (Monster) as client success manager.
  • Goliath Technologies releases an updated version of its Performance Monitor software.
  • Kyruus will host the Sixth Annual Thought Leadership on Access Symposium (ATLAS) September 23-24 in Boston featuring a keynote by Toby Cosgrove, MD.
  • Matter will feature Intelligent Medical Objects co-founder Frank Naeymi-Rad at a networking event on May 29 in Chicago.
  • HBI Solutions joins the Iatric Systems AI Solutions Center.
  • NextGate responds to requests for information by CMS and ONC on strategies to improve patient matching, underscoring the importance of standards, proven technology, and data governance.
  • Glytec receives patent allowances from regulatory bodies in Australia, Japan, and Israel related to systems and methods for insulin titration and glycemic management.

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EPtalk by Dr. Jayne 5/23/19

May 23, 2019 Dr. Jayne 2 Comments

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Tech pet peeve of the week: time zones. I am working with some folks who don’t know their EST from their EDT, let alone how to work with people in localities that don’t participate in Daylight Saving Time. I’m thinking maybe we just need to all go GMT so we can get along. Either that or Microsoft needs to give us additional time zone display options in Outlook. Two is just not enough for those of us who work coast to coast or sometimes trans-Pacific.

Non-tech pet peeve of the week: recruiters who don’t know their audience. I was contacted by a recruiter from a payer (whose name I will keep anonymous to protect the guilty) who apparently had me confused with someone in another generation. “We believe that you, as a rising star, will use your unparalleled talents… fulfill your dream.” Last time I checked, most physicians don’t dream of working for a payer (although some people are really into it) but the flowery language screamed insincerity. That’s not how I’d approach a seasoned physician exec, but it made for a fun conversation when I decided to just mess with him.

EHR pet peeve of the week: having to respond to laboratory “Ask at Order Entry Questions” that should be hard-coded. How many times have I had to free text “throat” as the source for “culture – throat” in the CPOE screens of my EHR? Seriously, folks.

Clinical pet peeve of the week: my mammogram visit at Big Medical Center. I was greeted by a volunteer, then sent to waiting room purgatory for 25 minutes despite being on time. The registrar who called me over had a coffee-stained desk (right where I was supposed to lean over and fill out paperwork) and the base of her monitor hadn’t been dusted since the Bush administration. There were rubber bands everywhere on the desk and I can’t for the life of me imagine where rubber bands would belong in the workflow. I was asked to fill out a paper clinical history, including all my demographic information, by hand, and then she peppered me with registration questions while I was trying to fill out the clinical history. Perhaps my time in the waiting room would have been a better time to fill that out?

The registration system popped up a phone number that I’ve been trying to have removed from the system for almost 15 years. She had to find someone else to find out how to try to remove it. I asked why I had to put my contact numbers on the paper history and was told “if the techs have to call you, they never look at the computers.” That’s reassuring in this age of interoperability.

The worst part was being informed that I would receive my results “by mail in 7-10 days.” Despite Big Medical Center’s high-risk breast cancer program, I think I’ll be having my next study at Independent Imaging, where I used to go and where results were real time and in person. Independent Imaging at least used their EHR to pre-populate the clinical history form and have patients just update it, which is exactly what I would have expected at Big Medical Center since they just spent half a billion dollars (literally) going up on Epic. Let’s see if they contact me after I gave them free consulting on their comment card.

That’s certainly a greater number of peeves than I should be allowed this week, so let’s talk about what went well.

I’m part of a pilot project with the American Board of Family Medicine to see if doing quarterly board exam questions can be substituted for the in-person, high-stakes exam. I did my second batch of questions and think I finally have my strategy figured out on which references to use and how to approach the questions. The system is pretty streamlined and they did make a few tweaks between the first and second quarters, so I’m looking forward to see if they make any additional enhancements for Quarter 3. Those of us who have hitched our wagons to this paradigm are likely in it for the next three to four years, so hopefully the improvements will continue.

From a mental standpoint, I definitely prefer it to the testing center, where you have to turn your pockets inside out and are practically frisked if you take your allotted breaks. Let’s hope the American Board of Preventive Medicine considers a similar approach before I have to sit for informatics recertification in 2024.

I also caught up on some of my journals, including Applied Clinical Informatics, which published a study validating what most of us already knew – that physicians don’t always document key components of a visit in the EHR. The authors looked at the documentation compared to recorded office visits and concluded that for some clinicians, EHR documentation is more challenging than paper notes. Other factors influencing curated documentation include overbooked schedules and patients with complex medical conditions. Social and emotional health issues were often left out of the EHR, and while primary care physicians may be aware of these details, there are other clinicians who would not be able to access that information in a different setting of care. These omissions may prevent hospital or consulting physicians from creating a workable care plan because they don’t know about patient-specific constraints.

The study is relatively small, looking at 10 unique patient encounters from 2016. All were from the same medical center and documented on the same EHR. Patients had an average of 14 chronic conditions and were on an average of a dozen medications. Chronic conditions were documented 90% of the time, preventive 89%, acute problems 84%, and social/emotional conditions just 30% of the time. Looking at the breakdown of the recorded visits, physicians were having the conversations real time, but just not documenting them.

This is a great place where technology could help. What if we could actually accomplish what virtual scribes are doing, but actually do it real time in the exam room? What if voice recognition was as good as we need it to be? Of course, clinicians would still need to review notes for accuracy after processing, but it would be more valuable use of a computer than we are currently doing. I know Nuance is working on the exam room of the future that would be able to collect some of this information, but last I heard, they were going to pilot it with subspecialists rather than tackle the tangled world of primary care. How long will it take until we finally make it there? Only time will tell, and perhaps it will tell us in GMT.

What is your pet peeve of the week? Leave a comment or email me.

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Email Dr. Jayne.

Morning Headlines 5/23/19

May 22, 2019 Headlines No Comments

Zipline, which delivers lifesaving medical supplies by drone, now valued at $1.2 billion

California-based drone-delivery company Zipline announces a $190 million investment and plans to expand its healthcare-focused service to the US.

DGMC to go live with new electronic health record in September

Travis Air Force Base’s David Grant USAF Medical Center (CA) will go live on the DoD’s Cerner-based MHS Genesis in September.

Scoop: Former FDA head Scott Gottlieb rejoins VC firm

Former FDA Commissioner Scott Gottlieb, MD returns to venture capital firm New Enterprise Associates as a special partner on its healthcare investment team.

DNA-Test Startup Helix Cuts Staff, Closes Offices After Shift

Helix lays off employees and closes two of its four offices after announcing earlier this month that it will pivot from a direct-to-consumer DNA testing company to a provider-focused population health management business.

Morning Headlines 5/22/19

May 21, 2019 Headlines No Comments

Interoperability among Office-Based Physicians in 2015 and 2017

ONC finds that interoperability among office-based physicians didn’t improve from 2015 to 2017 even though more doctors used information from outside sources.

Google says the new Google Glass gives workers ‘superpowers’

With help from development partner Sutter Health, Google releases an updated $999 enterprise edition of Glass, promoting the product from its Google X skunkworks division to mainstream Google.

Comcast is working on an in-home device to track people’s health

Comcast will begin piloting an in-home health monitoring device later this year in hopes of bringing it to market in 2020.

News 5/22/19

May 21, 2019 News 8 Comments

Top News

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ONC finds that interoperability among office-based physicians didn’t improve a bit from 2015 to 2017 even though more doctors used information from outside sources. The percentage who sent, received, and integrated the information didn’t change and only 10% of doctors participated in all four domains.

Only 30% of doctors received an electronic summary of care record, 20% were sent ED notifications, and hospitals provided electronic patient discharge summaries to just 25% of PCPs.

Here’s a tip for ONC. Just about every hospital uses Cerner, Epic, or Meditech. The fact that some hospitals are able to do the right thing using those systems means the challenge is not a vendor or technology problem – it’s that some providers just don’t want to do it, no matter how much their patients might benefit. Think about this when you anoint these foot-dragging health systems as the official steward of everybody’s overall health. The jammed interoperability floodgates would magically open by Labor Day if their payments depended on it.

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In an accompanying report, ONC also finds that only about half of people were offered access to their online medical record in 2018, unchanged from 2017. About 60% of those looked at their information at least once. Most people said they have no need to view their online record.


Reader Comments

From AC: “Re: EHR internal timers and event log monitoring. Epic measures this. Customers should make sure they are getting an Executive Packet (Physician Well-Being section) and request access to Epic Signal. You should see if you can get Epic to interview with you on this topic or to share an overview. It might benefit their customers since not all of them take advantage of the tools available or even know about them.” I would like to hear more if someone from Epic or a client site is willing to share details. The study I cited suggests that tools like this can highlight EHR areas that could be streamlined and to quantitatively measure the impact of making system changes. It would also be interesting for an EHR vendor or its clients to compare the time and clicks required for specific functions across multiple health systems to identify best practices.

From Jack Ripa: “Re: HIMSS. Says investors are attending its conferences to follow trends.” MobiHealthNews (which is owned by HIMSS) runs a commercial from HIMSS TV (which is owned by HIMSS) that was recorded at HIMSS19 (which is owned by HIMSS) that says investors are finding value in attending conferences (that are owned by HIMSS). You, too have been (owned by HIMSS). Investors are there, of course, but I would assume everybody already knows that. Pro tip: despite appearances, the people wearing snappy suits are lightweights – the folks with real money (to whom the nattily attired genuflect) show up wearing clothes that are more commonly seen on golf courses and Applebee’s happy hour because they don’t need to impress anyone.

From Interview Analyzer: “Re: interviews. CEOs on occasion seem to get fresh ideas from your questions that I wonder, do they follow up with you afterward to pick your brain?” I’m pretty sure that my questions, while sometimes refreshingly off the wall or embarrassingly uninformed, have minimal business utility to someone who lives and breathes their particular niche. I attribute what you’ve read to: (a) interviewees who are being nice because they are HIStalk fans or who aren’t but hope to score flattery points; or (b) the interviewee being surprised at hearing thoughts from someone who lacks a verbal filter and who understands the race but has no horse in it. Neither party would have reason to continue the conversation offline and indeed that has never happened.


HIStalk Announcements and Requests

Readers recommended several folks for me to interview and that’s been fun. Let me know if you have suggestions of others who are interesting, doing good work, and confident enough to speak boldly about their area of interest.


Webinars

May 30 (Thursday) 2:00 ET. “ONC Data Blocking Proposed Rule: What Health Systems Need to Know.” Sponsor: Philips PHM. Presenter: Greg Fulton, industry and public policy lead, Philips. Proposed data-blocking regulations could specify fines, disincentives, and de-certification of providers who don’t provide an API for patients to extract all of their data. This webinar will describe who is deploying APIs, the scope of data and third-party apps that can be used, the seven costs that do not count as a data-blocking exception, and the health system protections that don’t involve using a vendor. It will also provide examples of data blocking and further exceptions.

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


Acquisitions, Funding, Business, and Stock

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Private equity firm TPG sells its chain of cancer hospitals in India to oncology device and software vendor Varian Medical Systems for $283 million, proving that healthcare as a profit-driven industry isn’t just an American concept.

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Inova Personalized Health Accelerator invests an unspecified amount in Ireland-based Deciphex, which develops AI-powered digital pathology triaging applications such as Patholytix Preclinical.

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A Signify Research report finds that the EHR market in EMEA (Europe, Middle East, and Africa) is highly fragmented, with Cerner being the only vendor that holds a double-digit percentage of the region’s estimated $3.7 billion in annual spending.

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Google parent Alphabet’s Verily signs deals with several drug companies to display study recruitment ads to people who search for certain symptoms. Verily’s Project Baseline, launched in 2017, invites people to sign up (it’s a 12-minute online process) to contribute their research data, participate in surveys and focus groups, and test new technologies in working with partners Stanford Medicine, Duke University School of Medicine, and the American Heart Association.

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PatientsLikeMe founder Jamie Heywood expresses frustration that the federal government’s Committee on Foreign Investment is forcing the company to sell itself because its key investor is China-based genomics company ICarbonX. PatientsLikeMe is expanding beyond offering people a platform for discussing their conditions and symptoms with others with the same condition, now collecting their blood samples for AI analysis to understood more about human disease. Heywood says the government was concerned about exposing de-identified patient data to Chinese investors and insisted that the company prove that its work presented no national security risks.


Sales

  • Camden Coalition of Healthcare Partners chooses ACT.md’s social determinants of health collaboration system, which will support its care model identifying high-utilization patients and visiting their homes to help with medications, transportation, and connecting with social services.
  • In England, Gloucestershire Hospitals NHS Foundation Trust will implement Allscripts Sunrise.
  • Baystate Health (MA) selects Artifact Health’s mobile physician query platform to give physicians a faster way to review records in its clinical documentation improvement program.
  • Central Ohio Primary Care will use Updox for document management and communications services.

People

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Greg Miller (Health Catalyst) joins TransformativeMed as chief growth officer.

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Hackensack Meridian Health hires Pam Landis (Atrium Health) as VP of strategic digital programs.


Announcements and Implementations

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Google releases an updated enterprise edition of its much-maligned Glass, promoting the product from its Google X skunkworks division to mainstream Google. The $999 Glass won’t be sold directly to consumers – its audience is companies that want to sell their productivity-enhancing industrial software. The new version has a beefed-up processor and runs on Android with easier API integration. Google’s blog post says that Sutter Health is a development partner, which probably relates to its use of (and investment in) the Augmedix remote scribe service.

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A new KLAS report on practice management systems for practices of 11 or more doctors finds considerable variation in performance even those systems have been around forever. Epic continues to lead in satisfaction by far as customers report lower A/R days and better cash flow, while NextGen Healthcare is steadily improving. Practices of 76+ doctors report growing dissatisfaction with Cerner, mostly due to the product itself, and only 40% of them expect to see improvement in the next year. Satisfaction with Athenahealth has also declined significantly as customers say the company’s changing culture has impacted product support. They also express uncertainty about the company’s merger with Virence Health. Greenway Health performed well in mid-sized practices and is improving.


Government and Politics

The TL;DR version of why Missouri is the only state that can’t figure out how to launch a prescription drug monitoring database: (a) politics; (b) a family doctor-state senator who keeps squashing legislative efforts over privacy concerns that he somehow links to federal meddling in gun ownership; and (c) proposed bills that would have made physician use of the system mandatory.


Other

A Harvard Business Review article describes how New York City Health + Hospitals uses data science to identify homeless patients and match them to community services. They look for patient records that contain:

  • A home address of a homeless shelter or hospital
  • The words “homeless” or “shelter” in the home address
  • 10 or more ZIP code changes in one year
  • Registration-collected “homeless” flags from those few facilities that record it
  • ICD-10 codes for homelessness in the problem list, diagnostic assessment, or billing record

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I’m a big fan of giving patients a way to communicate their self-assessed health status to clinicians via an electronic form. Patient-reported outcomes for early chemotherapy side effect detection is one example, where patients report how they’re feeling or problems they are having that can then trigger EHR alerts for quick follow-up. An oncology researcher found that cancer patients who were provided that method of feedback lived an average of five months longer than those who weren’t, which doesn’t sound all that impressive until you remember that chemo drugs that cost hundreds of thousands of dollars often can’t deliver even that modest life extension. This concept should be applied to routine encounters – why must doctors swoop into the exam room and immediately start reading an electronic or paper form for the first time to see why you are there and then ask you all over again, wasting a couple of the few minutes patients get? I can’t figure out why the SF-36 form with additional specific data collection isn’t used widely, other than (a) clinicians aren’t paid to review it; (b) providers aren’t really interested in a patient deep dive as much as cranking out billable work; and (c) providers are afraid of being sued for missing something that turned out to be important. I have never personally seen this form, or anything like it, used out there in the Wild West of healthcare’s front lines, suggesting that my providers don’t really want to open up a can of medical worms by asking how I’m doing overall except as the rhetorical question part of exam room small talk.

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Analysis by US News & World Report finds that Washington, New Hampshire, and Minnesota are the best states overall when taking into account everything from healthcare to the economy. Dead last at #50 is Louisiana, which beat out fellow cellar-dwellers Alabama, Mississippi, West Virginia, and New Mexico. The public health implications are significant given the key role of states in driving public health, setting spending levels on social services, and creating and enforcing healthcare-related laws. You might also assume that telemedicine could be important if skilled clinicians agree with the conclusions and elect to live elsewhere.

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I missed this story that illustrates how healthcare price competition should work if you buy the idea that care is a commodity. SSM Health will charge just a flat $25 for a questionnaire-based, call-back virtual physician visit. It appears to be a white-labeled service from Zipnosis. I wondered where the country would get enough pharmacists when chain drug stores were popping up on every corner, so with that fear proven to be unfounded, I can now wonder whether we have enough doctors to staff telemedicine services. Probably so given puzzlingly modest adoption, although being a telemedicine doctor must be like working as an Uber driver except the money is good, you can work from home in your pajamas, and your car stays clean (note to self: patent the idea of telemedicine surge pricing). It sounds potentially dehumanizing as a doctor, however, since the only important outcomes involve volume, patient satisfaction, and not getting sued since the patients have low-acuity needs that are being addressed episodically. Maybe it will devolve into those 1980s 1-900 telephone services for sex and psychics, although the objective there was to keep callers on the line with the meter running (there’s another note to self in maximizing profit from chatty patients). 

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An interesting study finds that the overconfidence of wealthy people makes everybody think they are more competent than they really are, proving that “fake it until you make it” and some level of snobbishness works, especially in one-off situations such as job interviews. I’ll add an unresearched postulate – executives often think they are smarter and more insightful than everyone else just because someone put them in charge, causing them to overvalue lone-wolf instinct instead of underling-assembled facts and analysis (I wrote about this way back in 2006 in describing what I called “Man of Action Syndrome.”)


Sponsor Updates

  • Dimensional Insight will exhibit at the 2019 MUSE Inspire Conference May 28-31 in Nashville.
  • Bluetree will exhibit at the HIMSS Southern California 2019 Annual Healthcare IT Conference May 23 in Los Angeles.
  • CarePort Health will exhibit at ACMA Northern California May 28-29 in Napa.
  • The Chartis Group publishes a paper titled “EHR Benefits: Unlocking the Secrets of Successful Organizations.”
  • Authority Magazine profiles Collective Medical CEO Chris Klomp.
  • CoverMyMeds will exhibit at the 2019 CMSC Annual Meeting May 28-June 1 in Seattle.
  • Hunt Scanlon highlights Direct Recruiters’ integration with sister company Direct Consulting Associates.

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Morning Headlines 5/21/19

May 20, 2019 Headlines No Comments

Facebook is mapping demographics, human movement, and network coverage to combat diseases

Facebook combines its data and AI capabilities with public and commercially available datasets to create maps that will aid public health workers in preventing the spread of disease.

After forced sale, PatientsLikeMe founder frets that U.S. policy could chill collaboration in biotech

PatientsLikeMe founder Jamie Heywood believes the federal government’s demand that the company extricate itself from its China-based investor will have a detrimental effect on future, potentially life-saving, healthcare collaborations.

Why Missouri’s The Last Holdout On A Statewide Rx Monitoring Program

Lack of action during Missouri’s latest legislative session helps the state continue its seven-year streak as the only one without a PDMP.

Nashville health-tech firm lands $7.3M in funding, with help from Jumpstart

Clinical decision-support startup EvidenceCare raises $7.3 million in a funding round led by JumpStart.

HIStalk Interviews Erine Gray, CEO, Aunt Bertha

May 20, 2019 Interviews No Comments

Erine Gray, MPA is founder and CEO of Aunt Bertha of Austin, TX.

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Tell me about yourself and the company.

Aunt Bertha focuses on the easiest way to connect people to health and human services programs through a simple interface. I experienced the need for this personally. My mom is permanently disabled. I have been her guardian for the last 17 years. Throughout this journey, I would find out about social programs after the fact. It was confusing to navigate.

I started the company nine years ago to offer an easier way to find programs and to connect to them directly and electronically. Some people call them referrals. We have 73 employees.

The concept of social determinants of health is suddenly popular, but for hospitals, it often just means having a place to record the patient’s self-reported information. Are they getting better at using that information to better transition their inpatients or ED patients to social organizations?

You’re right, there is a lot of talk about social determinants. It used to be called poverty and poverty alleviation. These are difficult problems to solve. The hospital system can do some things in many cases, but in a lot of them, they don’t have much control.

We have 175 customers, of which a good chunk are hospital systems. Many of them are just starting to record the assessments so they can at least uncover problems related to social care. Finding out if they need food or housing is a great place to start. They either turn on assessments in their EHR or they use our assessments.

That’s a great start, but some hospital systems that we’ve worked with have gone really deep. They have staffed social workers and teams who go the next mile and follow up with patients. In some cases, they actually buy wheelchair ramps, groceries, and other things if they find there’s a need.

I would say that the movement is still pretty early. It has been really neat to see how these hospital systems are experimenting.

Is it hard for hospitals to make a quick, clean handoff to community-based organizations that aren’t necessarily equipped to respond quickly?

Absolutely. You still have the issue of non-profit financing. A community-based organization, or CBO, could be a government program or a social service program. Many of them are dealing with long waiting lists and a lack of funding, Some can’t serve their existing population. It is a challenge.

The question then becomes, what is the health system willing to do to engage them further, and, in some cases, to allow for reimbursement for some of these services? We are starting to see the sector think about it. CMS is starting to think about allowing for reimbursement for non-medical services beginning in 2020 for certain situations, if that service is deemed by a doctor to be medically necessary.

The short answer is that it depends. Organizations that sit down with the community-based organizations, get to know them, and build a partnership with them have seen higher levels of success under that model versus just hoping that an underfunded social care network can handle even more demand for services.

These are hard problems. Healthcare should assume longer-term commitments to these financing issues. I don’t think software is going to fix it, to be honest. Even though we’re a software company, I think the broader conversation is, how are the health systems and the local community-based organizations working together?

It’s interesting that 50 years ago, hospitals weren’t very much different from other community non-profits. Somehow their paths diverged and hospitals became monolithic and highly profitable, while most of the rest struggled for funding and hospitals quit talking to them in focusing on delivering episodic services.

You’re reminding me of the book “The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry” by Paul Starr. It’s about how in the early days, people helped each other and how specialization within healthcare then happened. Your analogy is spot on. People did use to look after their neighbors a little bit more and there was tighter coordination. We’ve gotten away from that.

I entered the name of a remote, tiny town on your web page and it returned a list of 800 programs. It was nicely divided by the type of service and offered many simple but powerful ways to filter the list, mark favorites, make notes, and contact the organization. Your website says you have a large team manually maintaining that database versus other vendors who either unethically scrape your data or use a software bot to harvest information from the web. Why is it important to have humans doing the work?

It is incredibly important to us. If you put yourself in the shoes of a social worker or a doctor, they are sitting down with a patient and hearing about things that are happening in their lives. Maybe they need counseling, drug addiction help, or whatever the case may be. You learn very early on that the credibility of our users is on the line. The social worker is sitting down with a patient who is being vulnerable about their situation, which is hard enough. Referring to a program that doesn’t exist or that hasn’t been updated hurts the credibility of the social workers who are out there doing important work. We don’t always get it right, but we try really hard.

We determined early on that we wanted to build an operation of people for two reasons. One, because we think the product and the data will be better. That doesn’t mean we can’t automate some things along the way, and we’ve done some things to make those employees more efficient. But every listing is approved. We try hard to do this across the country, but we focus on states where we have customers and usage because we don’t have unlimited resources. That focus has allowed us to grow.

The team is 25 people and growing. That line item is one of the most expensive aspects of running the business. However, we’ve never spent any money on marketing or public relations. We’ve been able to get to know health systems, health plans, schools, foundations like AARP, and others just by providing a free search. We’ve started to get users that way. It has ended up being a good investment in the business in the long run.

Secondly, it’s a great way to find people in a growing organization. We’ve had many employees graduate from what we call the data fellows program, where they spend a year or two curating the data and verifying information. They become programmers, data analysts, and supervisors. We grow folks and get to know them. It’s a mutually trusted source. They end up doing great things with the rest of the organization.

It’s a win-win, the way we see it. There might be other approaches to maintaining a reliable database, but I don’t think they will win in the long run.

What is your revenue model and how does the community connection work?

We’re doing something different in healthcare. We try to make it simple. Smaller organizations can become a customer at a basic level, a professional level, or an enterprise level. We’ve learned that our customers don’t like seat licenses, per-user per-month models, or other models. We look at it differently than in classic health IT. We’re successful when we have thousands of customers out there paying us a modest amount. That de-risks us. If you are a health system, you can buy our enterprise version with a couple of add-ons at a set amount that is open, transparent, and explained on the website. That allows us to build trust with our prospects.

Once they become customers, we want lots of users. We don’t want to put anything in the way of that. The more users who are on the system, the more people who will get help and the more we’ll get our name out there. Our pricing follows models from outside health IT and it has worked well for us.

It’s also a lot more fun. We only have three salespeople and myself. When a sales team is getting 15 to 20 customers per quarter, they’re having fun. It’s an approach we feel really good about and our customers like that we keep it simple and transparent. This approach to pricing subsidizes the data operations team. We have been able to provide a free service at AuntBertha.com because we have enough customers to cover our costs.

Why is it important that you don’t require people to register before using your online service?

It’s understanding our users. We need to earn the trust of people who are in need, patients in the healthcare setting. We use the term “seeker,” which is basically anybody who is seeking services. Most people are not ready to identify themselves when they’re searching for help for their most intimate needs. Think of a breadwinner who loses their job. Maybe they’re not ready to identify themselves.

It’s an important principle that we allow people to look for things. We see what people are searching for. They are searching for sensitive situations, such as childhood trauma. They have the courage to at least search for help. We want to leave it as an opt-in situation because we build trust. Social workers who work in hospitals or community-based organizations also don’t like creating accounts, so we get their loyalty as users as well.

Once you start making referrals, you can identify yourself and make an account. But we are perfectly fine with users of AuntBertha.com and social workers who are using our platform to pick up the phone and call a non-profit directly instead. It’s perfectly their right to do so and we would not get in the way of that. But from a business perspective, that wins out in the long run and we get customers who want to opt in later.

How do you balance the company’s social mission as a public benefit corporation and your own advocacy work with running a business?

I don’t think they are conflicting. The trade-off in allowing for free users and that social mission side comes across during a deal cycle when we’re talking to hospital systems. Laying out what we’re about and what we’re trying to accomplish is a differentiator in that process. People can quickly tell the difference between an alternate approach that is on price maximization.

We are pretty close to break-even. Our growth and the number of potential prospects allow us to charge less, get lots of users, and still make a difference. We would not be getting into the doors that we’re getting into without the goodwill that we’ve built over the years by providing a free service.

Do you have any final thoughts?

I’m excited about the way healthcare finance is going. I’m certainly not an expert. I was a programmer by training. I worked in public policy with some state health programs. But what I see happening is that health plans and hospitals are starting to become interested in getting the basic needs of people met in non-healthcare or social care ways. They feel like it’s a win-win in the long run, for their government contracts if you’re a health plan, or under alternative payment models if you are a health system.

It’s an exciting time to watch this transformation happen. You’re starting to see teams being formed with the goal of, how can I interact with somebody in need at their moment of need? Could we as a health system or health plan solve that need by building a wheelchair ramp or getting them some groceries? It’s an amazing win-win. I don’t know what’s going to happen with government policy, but watching that is exciting.

Curbside Consult with Dr. Jayne 5/20/19

May 20, 2019 News 2 Comments

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In a recent issue of Applied Clinical Informatics, researchers from the Arch Collaborative detailed their examination of the relationship of EHR user satisfaction to the investment in training made by the users’ organizations.

This comes as no surprise to those of us who have spent time in the EHR implementation trenches. Those who have more effective training tend to be better users of a given system. Being a better user often leads to less frustration compared to those who are struggling with the system. In general, people who experience less frustration might tend to be happier with their workday, or at least with the tasks that have to be completed in the EHR.

The data was compiled from a survey of 72,000 clinicians across 156 provider organizations to identify which elements determine whether a user reports higher levels of user satisfaction. The authors noted, “If healthcare organizations offered higher-quality educational opportunities for their care providers – and if providers were expected to develop greater mastery of EHR functionality – many of the current EHR challenges would be ameliorated.”

I’ve seen health systems that would allow physicians to go live on a system with only a couple of hours of classroom training with no hands-on experience and no ability to personalize or configure the system even though the system had those capabilities. In my experience, users trained in this manner have a greater tendency to turn into raging EHR haters than those who receive training that includes laboratory scenarios and the ability to create favorites and defaults.

I’ve also seen plenty of go-lives at organizations that didn’t hold physicians accountable for mastering the EHR. “Difficult” individuals might be allowed to opt out of training altogether after putting up barriers to participation in scheduled sessions.

I watched one hospital bend over backwards to schedule training at the time and place demanded by each subspecialty department, only to have a large number of physicians no-show their scheduled sessions. Conversely, I’ve worked with hospitals that demanded their providers attend training sessions and complete practice scenarios before being allowed access to the production system. Of course the latter group of providers seemed happier with the changes in workflow brought by the EHR than those who fought the process. In the study, physicians who reported poor training were “over 3.5 times more likely to report that their EHR does not enable them to deliver quality care.”

The researchers looked at multiple organizations across a subset of EHR systems and noted that a smaller portion (20%) of variation in user experience can be attributed to the actual software, but a larger portion (50%) of variation resulted from differences in how users acted on the system. They were able to identify both successful and unsuccessful provider organizations using the same systems. They also noted nearly 500 examples where two physicians of the same subspecialty at the same organization used the EHR and cited markedly different user experiences. In almost 90% of those situations, the more satisfied physicians said they had better training or more effort spent on personalizing the EHR.

Ultimately, the authors recommend that organizations require at least four hours of EHR training if they want to avoid frustrating their users. I would suggest that four hours doesn’t scratch the surface of what it takes to be an EHR power user. Physicians often argue that systems aren’t intuitive and it shouldn’t take them that long to learn how to do it since paper is “a no brainer,” but I point them back at the countless hours that they spent as medical students, interns, and residents learning to write a good note. Only through time and practice are the 10-page history and physical documents generated by third-year medical students whittled down into a two-page admission note done by a resident and a one-pager dictated by an attending physician.

The authors use the example of the scalpel, which “is a tool that has a very simple interface and use, but using it with confidence and safety requires knowledge of anatomy and surgical techniques coupled with practice to use it skillfully. In other industries, it is well recognized that education and training are of paramount importance to the successful use of professional-grade software. We need to recognize that this also holds true for EHRs and the practice of medicine.”

The authors recommend standardizing EHR training paradigms, although they were not able to identify a single methodology that performed better than the rest. They did note that more training needs to be focused on user-level configuration or personalization. However, they also noted that improved user training “needs to be balanced with a parallel focus on better designed and smarter software that can better meet nuanced needs of healthcare.” They also note that “these findings do not negate the need for EHR developers to continue to improve their user interfaces to be more intuitive, nor do they negate the critical need to reexamine the current regulatory and billing requirements that drive so much of the clinical documentation burden faced by providers today …”

They look to the future in considering the growing role of decision support within EHRs and how it might impact patient care. “For this vision to become a reality, physicians will need to know the limits of their technology’s advice in the same way that pilots know the limits of a plane’s autopilot. Without clearly understanding the EHR’s limits or how to use the technology, care providers will not trust the technology they work with.”

I like the airplane analogy. One of the EHRs I’ve worked with is an extremely robust system and some users complain it’s too complicated. I used to say that it is like a fighter plane – you want a system that is completely capable in case you wind up in a dogfight, even though most of the time you are just going to be on patrol. Users need to understand how to efficiently and effectively use the features that make up 80% of their day, but they also need to know how to access the next level of features for when the one-off situations arrive in the office.

The authors made some forceful comments that made my attention, one being that “caregivers who do not understand EHR technology are a threat to quality care and will likely not realize an efficiency gains in using the EHR nor be able to use the technology fully to advance care quality.” They go on to “advocate for caregivers to adopt EHR technology expertise as a core competency of their profession.”

I’m sure some physicians reading the study might be up in arms over its conclusions. I’ve been known to say that if some physicians would spend the same amount of time actually learning the EHR that they do complaining about it, they’d find themselves in a different place. This piece seems to reinforce that sentiment.

What do you think about the impact of training on EHR user satisfaction? Leave a comment or email me.

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Email Dr. Jayne.

Morning Headlines 5/20/19

May 19, 2019 Headlines No Comments

JP Morgan buys health-care payments firm InstaMed in the bank’s biggest acquisition since the financial crisis

JP Morgan Chase will acquire medical payments platform vendor InstaMed for more than $500 million.

Patient Hurt by Do-It-Yourself Artificial Pancreas Prompts FDA Warning

FDA warns users of do-it-yourself artificial pancreas systems that the individual components, including software, don’t necessarily work together to accurately control blood glucose levels.

UPMC Starts Telemedicine Company to Fight Infectious Disease

UPMC (PA) commercializes the infectious disease telemedicine services it has provided to patients over the last five years with the formation of Infectious Disease Connect.

Health at Scale lands $16M Series A to bring machine learning to healthcare

Optum invests $16 million in San Jose, CA-based precision care delivery startup Health at Scale.

Monday Morning Update 5/20/19

May 19, 2019 News 7 Comments

Top News

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JP Morgan Chase will acquire medical payments platform vendor InstaMed for more than $500 million. It’s the bank’s largest acquisition since the 2008 financial collapse, when it took over the failing Bear Stearns and Washington Mutual.

The bank’s head of wholesale payments says that 90% of providers still bill on paper. He says an acquisition makes more sense than starting from scratch since InstaMed has already created both the platform and its extensive network.

InstaMed, founded in 2004, had raised $134 million in funding. Co-founders Bill Marvin and Chris Seib were previously with Accenture. The 300-employee, Philadelphia-based company processed $94 billion in transactions last year.


Reader Comments

From Malted Milk Ball: “Re: ‘most powerful’ and ‘most influential’ lists. What is their methodology?” You’ve seen those click-baity “Best Hamburger in All 50 States” and “The Best Dog Breeds for Families” lists, compiled by some social media-savvy kid who has zero first-hand experience but who knows how Google and steal data from online sites. As far as I can tell given minimal transparency on the process, this is the same. Either someone is nominated (most likely by themselves) or aforesaid Googler simply heads over to LinkedIn. At least HIMSS is honest in accepting nominees for its “Most Influential Women in Health IT Awards,” although a committee of unstated membership makes the final decisions, gives preference to HIMSS members, and obligates nominees to contribute two HIMSS fluff pieces. It’s also good to remember that HIT fame is fleeting – Modern Healthcare’s 2008 “Most Influential in Healthcare” list was topped by Steve Case (Revolution Health Group) and Eric Schmidt (Google), then rounded out by some folks who have since passed away as well as those who are mostly forgotten, are now viewed less favorably, or who held a powerful role for a short time (former Hackensack CEO John Ferguson, short-term National Coordinator Rob Kolodner, and former FDA Commissioner Andrew von Eschenbach caught my eye among faded politicians and lots of people I’ve never heard of).


HIStalk Announcements and Requests

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A combined 53% of poll respondents take the federal government at its word in pushing interoperability to give patients more control and to save money, although a significant number believe its motivation is to benefit data brokers or to discredit previous administrations.

New poll to your right or here: If you’ve coordinated post-acute care for someone in the past five years, how hard was it? The bonus question, which you can answer by clicking the poll’s Comments link after voting, is how technology might have made the process easier or better.

Dear people who are writing for public consumption: please don’t start sentences with “there,” “so,” and “and.” It would also be nice if you didn’t mismatch a collective subject with a plural verb, as in, “The group of hospital CEOs are attending a conference.” Don’t misspell the possessive “its” as “it’s,” a mistake so prevalent that it seems more the rule than the exception. You can certainly write however you like when your readers are acquaintances — the folks with whom you would be comfortable wearing a ketchup-stained tee shirt or after having one-too-many glasses of wine —  but everybody else is forced to judge you on your thoughts and how well you express them. Most knowledge workers whose writing style is below average will see significant ROI from applying the slight bit of effort that is required to move to above-average (especially since the average is moving down). I’m preachy about this, but only because I want all readers to do everything they can to be successful.

Happy Victoria Day to readers in Canada.

Listening: Brooklyn-based Afrobeat band Ikebe Shakedown, a 1970s-style groove of big horns and wah-wah guitar funk. The Afrobeat genre was created long ago by the legendary Fela Kuti and is carried on by groups like Newen Afrobeat. I’ve seen an Afrobeat band live at an outdoor event and it gets people moving more than just about any other kind of music. I’m also still playing a lot of surf rock ran across the all-female, Canada-based Surfrajettes, which YouTubers compare to a Tarantino movie, what Austin Powers extras do on break, and “one of the best living room bands I’ve seen.”


Webinars

May 21 (Tuesday) 2:00 ET. “Cloud-Based Data Management: Solving Healthcare’s Provider Data Challenge.” Sponsor: Information Builders. Presenters: Jeremy Kahle, manager of planning and business development, St. Luke’s University Health Network; Shawn Sutherland, patient and member outcomes, Information Builders; Bill Kotraba, VP of healthcare solutions and strategies, Information Builders. Inaccurate provider data negatively impacts revenue cycle, care coordination, customer experience, and keeping information synchronized across systems and functions. SLUHN will describe how it created a single version of provider data from 17 sources, followed by a demonstration of how that data can be used in reports and geospatial analysis. Learn how Omni-HealthData Provider Master Edition provides rapid ROI in overcoming healthcare organization provider data issues.

May 30 (Thursday) 2:00 ET. “ONC Data Blocking Proposed Rule: What Health Systems Need to Know.” Sponsor: Philips PHM. Presenter: Greg Fulton, industry and public policy lead, Philips. Proposed data-blocking regulations could specify fines, disincentives, and de-certification of providers who don’t provide an API for patients to extract all of their data. This webinar will describe who is deploying APIs, the scope of data and third-party apps that can be used, the seven costs that do not count as a data-blocking exception, and the health system protections that don’t involve using a vendor. It will also provide examples of data blocking and further exceptions.

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


Acquisitions, Funding, Business, and Stock

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The Alabama Supreme Court rules that purchasers of all software, regardless of whether it is off-the-shelf or customized, must pay state sales tax. Russell County Community Hospital paid the state $18,000 in sales tax for its Medhost software and equipment (as correctly billed separately by the company to comply with state law), but the hospital then petitioned the Department of Revenue for a refund in arguing that what it had actually purchased was non-taxable “custom software programming.” The Supreme Court disagreed, ruling that “all software, including custom software created for a particular user, is ‘tangible personal property’ for purposes of Alabama sales tax.”


Sales

  • University of Rochester Medical Center joins the TriNetX research network to expand access to clinical trials and for cohort discovery.
  • KPMG will offer Waystar’s social determinants of health data to users of its clinical intelligence platform for care continuum optimization. 

Announcements and Implementations

Pivot Point Consulting launches HIM services that it will back with quality guarantees.


Government and Politics

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FDA warns users of do-it-yourself artificial pancreas systems that the individual components, including software, don’t necessarily work together to accurately control blood glucose levels. This follows a report of a patient who received repeated insulin overdoses due to incorrect blood sugar readings issued by their homebrew setup.


Other

A single-hospital review finds that adding internal timer functions to the EHR and monitoring its event log allows the hospital to reliably measure the before-and-after result of software changes. It this determined that streamlining the nurse’s EHR patient history function reduced user clicks and the time required by more than 70%. I like this work for two reasons: (a) it highlights the importance of focusing relentlessly on optimizing clinician EHR time; and (b) it provides an automated way to capture the result that goes beyond (or perhaps hand-in-hand with) user surveys and anecdotal reports from the more IT-friendly clinicians.

Unrelated but interesting: Uber and Lyft drivers who are waiting to pick up fares at Reagan National Airport are logging out of the company driver apps right before big planes land, with the AI of the apps then triggering surge pricing because of the driver shortage. The drivers then log back in a couple of minutes later and are paid at the higher rate. Maybe this is more relevant than I think in illustrating that software-enabled gaming of the system is likely happening all over healthcare.

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This might be the news item needed to convince movie studios to make a Theranos-like movie about microbiome testing company UBiome, which was recently raided by the FBI after complaints of billing fraud. Co-founder and co-CEO Jessica Richman, PhD lied about her age to qualify her for various low-rent “Under 30” awards even though she was 40 at the time. I pulled the photo above with Maria Shriver from her Twitter – the now-45-year-old Richman is on the left. In a Theranos-like poorly kept romantic secret, insiders also say she was in a relationship with her co-founder, Zachary Apte. It’s pretty obvious – online records I checked in the free parts of some people-searching sites show both of them living at the same address in Washington (the article says they have houses in two states) and voter records confirm that Richman is 45 and Apte is 34. Lack of age-checking leads me to ponder how organizations that have separate awards for women verify the nominations – do they go strictly by appearance or name and are slippery slopes inevitable?

Newly filed tax records indicate that UPMC CEO Jeffrey Romoff got a 40% raise in 2018, with $8.5 million in total compensation. Another two dozen of the health system’s executives exceeded $1 million. UPMC reported FY2017 profit of $189 million on revenue of $13.5 billion.

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I’m pretty sure this little guy who had just emerged from tonsil surgery at UPMC Susquehanna was happier to be comforted by Annie Hager, RN than one of UPMC’s million-dollar executives. He even brought her flowers for his follow-up visit, making it her turn to cry.


Sponsor Updates

  • Patient engagement and Next Best Action technology vendor SymphonyRM doubles its client base year over year.
  • Ken Congdon, content marketing manager at Hyland, publishes “EMR Optimization is the Hottest Thing Since … EMRs.” 
  • Lightbeam Health Solutions publishes a new white paper, “Data-Driven Solutions Providers and Payers Need for Value-Based Care Alignment.”
  • Mobile Heartbeat and Voalte will exhibit at NWone May 20 in Stevenson, WA.
  • Waystar will exhibit at the ECW Education Expo May 27-31 in Boston.
  • NextGate will exhibit at Cerner NARUG May 20-22 in Richmond, VA.
  • Netsmart will exhibit at the Leading Age TX Annual Conference May 19-22 in Austin, TX.
  • Flywire Health and The SSI Group will exhibit at HFMA Region 1 May 21-22 in Uncasville, CT.
  • QuadraMed publishes a new case study, “Atlantic Health System Entrusts Patient Identity Leader for MPI Cleanup Before Massive Epic Rollout.”
  • Vocera will exhibit at the Northern Ohio HIMSS Spring Conference May 23 in Cleveland.

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