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Morning Headlines 9/27/19

September 26, 2019 Headlines No Comments

Statement on new steps to advance digital health policies that encourage innovation and enable efficient and modern regulatory oversight

The FDA releases new draft guidance documents that cover the safe and effective use of digital health technologies, using a risk-based framework under its Digital Health Innovation Action Plan that addresses provisions of the 21st Century Cures Act.

emids Announces Investment from New Mountain Capital

New Mountain Capital acquires Nashville-based healthcare technology, services, and consulting company Emids.

GoodRx Expands Healthcare Services With Introduction of GoodRx Care

GoodRx acquires telemedicine vendor HeyDoctor, enabling it to add virtual visits to its prescription drug discount website and app.

VA to Pilot New Scheduling System at Same Ohio Facility that Tested the Last Solution

The Chalmers P. Wylie Ambulatory Care Center in Columbus, OH will become the first VA facility to replace Epic scheduling with Cerner next April.

Trump Administration Puts Patients Over Paperwork by Reducing Healthcare Administrative Costs

CMS releases the Omnibus Burden Reduction Final Rule to scale back regulatory requirements that the agency projects will save providers 4.4 million hours and $8 billion over the next 10 years.

News 9/27/19

September 26, 2019 News 11 Comments

Top News

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The FDA releases new draft guidance documents that cover the safe and effective use of digital health technologies, using a risk-based framework under its Digital Health Innovation Action Plan that addresses provisions of the 21st Century Cures Act. 

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FDA will focus its enforcement on software that hasn’t been approved as a medical device but that offers clinical recommendations to providers without transparency about how it derives those recommendations. Examples are flu detection functions that use EHR data and location; software that identifies patients with potential opioid addiction; and machine learning algorithms that predict postoperative cardiovascular events in diabetic inpatients. These software functions do not allow providers to see the underlying logic that is being used and are therefore considered to be medical devices.

FDA will also review software that analyzes or manipulates medical images; designs custom orthopedic or dental implants; monitors physiological signs to predict heart attack or narcolepsy; measures lesions to predict malignancy; and that analyzes images to differentiate between stroke types.

FDA is also interested in software that issues caregiver alerts when detecting life-threatening situations that require immediate action, such as stroke.

Also on FDA’s list of clinical decision support as a medical device is software that analyzes sleep apnea monitor data; calculates insulin doses; and that analyzes genetic variants to issue patient-specific treatment recommendations.

FDA considers consumer technologies to be medical devices if they recommend lifestyle changes for insulin-dependent type 2 diabetics; recommend treatment options based on questionnaire answers; and advise parents whether to take a child to the ED.

Software will not be considered a medical device it if meets these four conditions:

  • It doesn’t process medical images or signals.
  • It doesn’t display or analyze patient information.
  • It makes recommendations to providers to help them make patient care decisions.
  • It enables a provider to see how and why it made a particular recommendation for a patient’s diagnosis or treatment.

FDA makes it clear that software that matches patient information to reference information is not a medical device, such as displaying practice treatment guidelines; issuing warnings for drug-drug interactions and drug-allergy contraindications; checking drug or device orders to see if they follow FDA labeling; recommending additional tests or interventions; and calculating nutritional needs.

Comments on the proposed clinical decision support-related rules are due by December 26, 2019.


Reader Comments

From Going Epic: “Re: RWJ Barnabas. Has 90+ jobs listed that require Epic experience.” Reader Barnabas Rubble said back in a June rumor that they would be replacing Allscripts and Cerner with Epic, although CIO Robert Irwin ignored my resulting inquiry. You have to wonder what Northwell Health is thinking since they are one of few big US Sunrise sites left and they are supposedly making a keep-or-dump decision in the next few weeks. UPDATE: an equities analyst noted that while Allscripts said in its most recent earnings call in talking about new Sunrise sales that “extending and expanding” at Northwell is being decided soon, he thinks that its Sunrise and TouchWorks agreements were extended last year and run for several more. He’s thinking that it’s the IT outsourcing agreement that is expiring and thus being discussed. I think he is correct as I re-read the Q3 2018 earnings call transcript, in which Rick Poulton says that Northwell extended its TouchWorks agreement for five more years, the managed services  agreement is up for renewal but isn’t a high-margin business anyway, and Sunrise wasn’t specifically mentioned. Readers who know more are welcome to chime in. Thanks for the correction.

From Insider: “Re: Cantata Health. Continues to purge employees who have been around since the Keane days. They have abandoned the acute market, with NetSolutions as their only viable product under new leadership.” Unverified. A private equity firm acquired the health IT assets of NTT Data to form Cantata Health in 2017. The company’s website continues to list Optimum.

From Exec Checking In: “Re: your site. My onboarding with a very large global firm required me to sign up for HIStalk updates. It’s the only email I always click on. I have to be up to date on industry news at all times and your site is my best source.” That comment made my day, thanks. I like being required reading, although having people following me voluntarily is even better.


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor OpenText. The Waterloo, ON-based company’s cloud and on-premise Enterprise Information Management products for healthcare drive interoperability, improve information access, eliminate paper documents, and enable data-driven decisions. Among its solutions are RightFax (paperless, secure faxing that creates an organization’s most-connected device with minimal disruption); MedNX (lab report distribution); EMR-Link (lab and imaging orders and results integration and outreach); Intelligent Forms Automation (transition to digital processing); Documentum (information asset management); TeleForm (document-driven workflows); Covisint MIPS reporting; and Magellan (analytics and AI). Banner Health uses the company’s EnCase EDiscovery and EnCase Endpoint Investigator to assess potential cybersecurity issues and to respond accordingly, while Lahey Health uses Documentum to present outside unstructured clinical data within Epic with a single click. Thanks to OpenText for supporting HIStalk.

I noticed that a distant relative is working for a small-town behavioral and substance abuse facility whose website talks about “empowering people” and “putting clinical excellence above all else.” Corporate sleuthing reveals that, like much of healthcare these days, the organization is part of a chain owned by a private equity firm.


Webinars

October 2 (Wednesday) 1:00 ET. “Conversational AI in Healthcare: What About ROI?” Sponsors: Orbita, Cognizant. Presenters: Kristi Ebong, SVP of strategy and GM of healthcare providers, Orbita; Matthew Smith, AVP and conversational AI practice leader, Cognizant. Conversational AI holds great promise to drive new opportunities for engaging consumers and customers across all industries. In healthcare, the stakes are high, especially as organizations explore opportunities to leverage this new digital channel to improve care while also reducing costs. The presenter experts offer a thought-provoking discussion around conversational AI’s timeline in healthcare, the factors that organizations should consider when thinking about virtual assistants through chatbots or voice, and the blind spots to avoid in investing in those technologies.

Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

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Veteran health IT communications executive John Hallock shares insight into the PR run-up to the Athenahealth and Livongo IPOs, stressing that hard data helped craft a narrative that attracted the attention of investors, media, and influencers. Hallock’s comms resume also includes stints at Imprivata, CareCloud, and Change Healthcare.

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Best Buy expects to take in $50 billion in revenue by 2025, a move that will be driven in large part by a more aggressive push into senior-focused home healthcare services. The next five years will see the company scale its remote monitoring devices and services through its Geek Squad unit and partner with additional payers to add care coordination services.

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Digital stethoscope and ECG technology company Eko raises $20 million.

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New Mountain Capital acquires Nashville-based healthcare technology, services, and consulting company Emids for an undisclosed sum. Analysts have speculated that the purchase price is between $200 million and $225 million.

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GoodRx adds virtual visits to its prescription drug discount website and app after acquiring telemedicine company HeyDoctor.

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Sam’s Club partners with Humana to offer Care Accelerator, health-related discount bundles that include free prescriptions for popular generics, unlimited $1 telehealth visits, dental discounts, free lab tests, and prepaid health debit cards.


Sales

  • Tenet Healthcare signs a new multi-year agreement with NTT Data Services for application, infrastructure and security support and development services

People

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Greenway Health names David Cohen (Cerner) SVP of product management, David Millen (R1 RCM) SVP of product development, Sri Rajagopalan VP of architecture (SAP America), and Sagy Mintz (Allscripts) VP of quality assurance.


Announcements and Implementations

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A KLAS report finds that Cerner customers are more satisfied with advisory and implementation consulting services obtained from third-party firms than those provided by Cerner itself. Firms such as PwC, Atos, and Emids — which sometimes are engaged to fix a struggling Cerner implementation — had zero dissatisfied respondents. Customers complained that Cerner sends inexperienced fresh graduates while third-party firms not only decline to hire inexperienced employees, they often bring on former Cerner people. Customers also report that Cerner lacks a prescriptive implementation methodology, its consultants don’t talk to each other, and high costs and estimate overruns leave customers feeling that they aren’t getting their money’s worth.

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CoverMyMeds announces GA of AMP: Access for More Patients, an automated specialty prescription access and adherence support tool for patients developed with parent company McKesson.

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Relatient adds secure two-way messaging between patients and providers to its patient engagement software.

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Wolters Kluwer Health adds clinical natural language processing capabilities to its Health Language data extraction and integration software.


Government and Politics

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The VA’s OIG finds that its providers aren’t checking PDMPs regularly, placing patients who take opioids at risk because they don’t see their non-VA prescriptions.

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The Chalmers P. Wylie Ambulatory Care Center in Columbus, OH will become the first VA facility to replace Epic scheduling with Cerner next April, coinciding with the VA’s rollout of Cerner at facilities in the Pacific Northwest.


Sponsor Updates

  • AdvancedMD will host its global user conference, Evo19, October 2-5 in Orlando.
  • Elsevier Clinical Solutions will exhibit at the Emergency Nursing Association event September 29-October 2 in Austin, TX.
  • EClinicalWorks will exhibit at the APHCA Annual Conference October 1-3 in Gulf Shores, AL.
  • Ellkay and Healthwise will exhibit at AdvancedMD Evo19 October 2-5 in Orlando.
  • Goliath Technologies publishes a new solutions brief, “Goliath Technologies + IGEL: Improving patient care through proactive, fast and secure delivery of clinicians’ digital workspaces and EHR applications.”
  • Redox will host its third annual Healthcare Interoperability Summit October 15 in Boston.
  • Meditech maintains its momentum in the Canadian EHR market with 47% market share and a number of new customers and product expansions.
  • ITether adds access to Healthwise’s evidence-based curriculum to its outpatient care coordination and patient engagement software.
  • GetWellNetwork collaborates with Cerner to improve care coordination and patient engagement before and after hospital admission.
  • The Chartis Group publishes a new paper, “How Does Your Physician Enterprise Measure Up?”
  • StayWell’s My StayWell Platform and Krames on FHIR and Krames On-Demand products achieve ISO 27001:2013 certification for its information security management system.
  • Mobile Heartbeat collaborates with Eisenhower Health (CA) to improve emergency response communication.

Blog Posts


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EPtalk by Dr. Jayne 9/26/19

September 26, 2019 Dr. Jayne No Comments

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It’s US National Health IT Week, as promoted by HIMSS. I’m working with several organizations right now and none of them is doing anything to “celebrate” the occasion.

The reality of things is that we’re all exhausted by our health IT endeavors. Back in the early days, and before Meaningful Use gummed up the works, it was exciting to be on the cutting edge (and sometimes bleeding edge) of things. As an early adopter organization, we had some pull with our vendor and could demand improvements in the software. Now that they’re just trying to keep up with federal regulations and satisfy shareholders, there’s no initiative to make the customers happy.

If your organization is actually doing something to mark the occasion, I’d be interested to hear about it.

CMS has updated the Medicare Plan Finder website for the first time in a decade. Medicare beneficiaries can access it on Medicare.gov and use it to compare Medicare Advantage and Medicare Part D plan. The upgrade is supposed to be mobile-friendly with enhanced readability. I asked one of my favorite Medicare beneficiaries to tell me what they think of it and he couldn’t find it, probably because he was looking in Google Play rather than the website. I gave it a peek myself and it was pretty vanilla. Apparently the coverage I’d want costs a pretty penny in today’s dollars, so I better work on my skills for retirement savings. Approximately 10,000 people enroll in Medicare every day, so who knows if there will even be any money left for coverage by the time some of us get there.

Most of us are familiar with the Google influenza tracker that used to be available. Although it has been sunset, it used symptom searches to try to identify flu cases. I was excited to see this article in the Journal of the American Medical Informatics Association that looks at internet search data as a way to predict emergency department volume. The authors looked at whether Google search data can be applied to ED volume forecasting to improve accuracy compared to existing methods. The data was from Boston Children’s Hospital, local public school calendars, National Oceanic and Atmospheric Administration weather data, and Google trends. As they added data sources, the model became more accurate. I wish my facility would get on board with this kind of big data, because right now our staffing model is very, very off.

From CliqBait: “Re: hit man. Definitely a head-turner, if not also a head scratcher.” A former University of Iowa medical student goes to prison for trying to hire hit man. The Gazette details the story of a man who wanted to kill one of the university’s associate deans after he informed the student he could no longer attend. The accused pleaded guilty to a firearms charge, but the murder-for-hire plot increased his prison sentence. Pro tip: Don’t hire people to kill other people, especially when your supposed hit man is an undercover law enforcement agent. And if you do make the mistake of trying to do so, don’t offer illegal machine guns as payment for the deed.

Surprise, surprise: a recent journal article notes that data found in EHR visit notes doesn’t always match the examinations performed by physicians. Reviewers compared real-time observational data to EHR documentation and found that they could only verify the Review of Systems 40% of the time and the physical exam only 50% of the time. Most of the discordant findings were in clinical systems that were less clinically relevant to the patients’ presenting complaints. For example, patients who presented with gastrointestinal or genitourinary issues had a small number (5.4%) of findings in those systems that didn’t match. For the same patients, there were plenty of unsubstantiated ear / nose / throat exams (81.8%). One could surmise this happens because of overly-detailed defaults or copy/paste, but either cause culminates in physicians not proofreading and correcting their own notes. The authors call for additional studies to determine how extensive these findings might be since the physician subjects were residents in training and a small number (180) of patients had their encounters observed. They also encourage payers to remove financial incentives that lead to physicians over-documentation.

New England Journal of Medicine Editor-in-Chief Eric Rubin, MD, PhD is shaking things up by saying that “thought print may not be dead, it might soon need palliative care.” He plans to continue to bring the publication into the current century by making it more interactive with a greater online presence. There’s even talk about relaxing rules regarding authors who post copies of manuscripts on preprint servers, getting information into the hands of other researchers faster than the typical peer-reviewed publication pathway. Times are changing and it’s difficult for traditional media outlets to keep up. Print media continues to struggle. In a neighboring corner of the Midwest, the St. Louis Post-Dispatch just moved out of their historic building in downtown St. Louis. The new tenant: mobile payment technology company Square.

Mr. H mentioned this earlier in the week, but Amazon has moved into the telehealth space with its launch of Amazon Care. According to the public-facing website, the service offers virtual visits, in-person visits at home or office, and “prescriptions delivered to your door.” Services will include both urgent care and preventive scope of practice, including contraception and testing for sexually transmitted infections. Nurses can provide vaccinations and collect laboratory samples at the patient’s location. Eligibility is limited to Amazon employees and their families who are enrolled in an Amazon health insurance plan and who are based in the Seattle area. Employees who are enrolled in Kaiser Permanente plans are ineligible. The service is available Monday through Friday 8 a.m. to 9 p.m. and weekends from 8 a.m. to 6 p.m. Medical services are provided by Oasis Medical Group, which hopefully provides a layer of privacy for employees seeking care. Since this is a pilot program, employees have to request an invitation to participate. It will be interesting to see how this plays out in the coming months.

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Morning Headlines 9/26/19

September 25, 2019 Headlines No Comments

WELL Health Announces Agreement to Acquire EMR Service Provider OSCARwest

Canadian primary care and software company Well Health Technologies acquires consulting firm OSCARwest EMR Services.

How Best Buy plans to expand into home healthcare services, remote monitoring to help seniors age in place

Best Buy expects to take in $50 billion in revenue by 2025, a move that will be driven in large part by a more aggressive push into senior-focused home healthcare services.

AI-Powered Digital Health Company Eko Closes $20 Million Series B to Continue the Fight Against Heart Disease

Digital stethoscope and ECG technology company Eko raises $20 million in a funding round led by Artis Ventures.

UK HealthCare resumes diverting ambulance patients to other hospitals

After a similar situation several days ago, UK HealthCare once again diverts ambulance patients due to unspecified issues with its computer system.

Morning Headlines 9/25/19

September 24, 2019 Headlines 1 Comment

Amazon launches Amazon Care, a virtual medical clinic for employees

Amazon launches a Seattle-area pilot of Amazon Care, a virtual primary care clinic for its employees that includes a nurse house call option.

Ping An Good Doctor Has Become the First Online Healthcare Platform with More Than 300 Million Registered Users

China’s Ping An Good Doctor – which offers online consultations, hospital referrals, appointments, second opinions, and prescription delivery – reaches 300 million registered users, which represents one in three internet users in China.

Request for Information (RFI) For Patient Access to Health Data Issued by the New York eHealth Collaborative

New York EHealth Collaborative issues an RFI for patient-facing software that can access and aggregate patient medical records and support patient-provider messaging.

Provider groups ask Congress for help on info blocking

CHIME, AMIA, MGMA, AHIMA, AMA and two other groups ask Congress to modify ONC’s proposed implementation of the information blocking provisions of the 21st Century Cures Act.

News 9/25/19

September 24, 2019 News 6 Comments

Top News

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CHIME, AMIA, MGMA, AHIMA, AMA and two other groups ask Congress to modify ONC’s proposed implementation of the information blocking provisions of the 21st Century Cures Act, providing these recommendations:

  • Add more rules to address concerns.
  • Enhance privacy and security details, particularly those related to the use of APIs and potential disclosure of patient information to third parties, by requiring privacy notices and transparency statements.
  • Extend the timeline.
  • Encourage HHS to prioritize education and corrective action plans over monetary penalties.

Reader Comments

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From It’s Going To Be Epic: “Re: VCU Health. Announced last week that an RFP will be created to replaced the hybrid IDX/Cerner implementation with either full Cerner (PowerChart + Rev Cycle) or Epic. I’m in the camp that believes that Cerner can’t possibly win.” The forwarded internal email says VCU’s system selection will take three months, with demos in October. I have to think they have already made up their minds if the selection will be finished so quickly, especially since site visits aren’t mentioned. I’ll side with you that Epic is the favorite because: (a) VCU already uses Cerner and yet is going to market; (b) Cerner is weak in revenue cycle; (c) any selection process that is demo-centric favors Epic since it is really good at wowing clinicians; and (d) Bon Secours runs Epic.

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From Yusta Knowhim: “Re: Dave Cernio, formerly of Zynx Health. He’s now CEO of Envera Health.” Dave’s been in health IT for years, including stints at Microsoft’s Health Solutions Group, Zynx Health, Providence Health & Services, and WiserCare. He took the Envera CEO job last week. Richmond-based Envera offers health systems a centralized scheduling service, a consumer engagement line, and patient activation and follow-up campaigns. The company has raised $16 million in two venture rounds. Envera formed Careto a couple of years ago to operate the MedVirginia HIE and to connect life insurers with patient underwriting data.

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From Heart of Hearts: “Re: cardiac rehabilitation. An AHRQ program advocates setting the hospital EHR to automatically refer certain patients to cardiac rehab, which increases referrals up to 86%.” Sometimes I’m puzzled by the failure of doctors to do the right thing. AHRQ says that cardiac rehab is a class 1 recommendation for patients after heart surgery, MI, coronary intervention, stable angina, and heart failure, yet only 20% of doctors refer those patients, costing the country 25,000 lives and 180,000 hospital admissions. I’m all for technology helping doctors do the right thing, but what were all those docs thinking if this is really an evidence-based intervention? Do their patients know that they nearly always drop the ball unless software tells them what to do? If it’s a black-and-white issue as AHRQ suggests, let’s see the names of the biggest offenders so patients can look elsewhere. t’s like penalizing drug manufacturers and wholesalers for the ridiculous doctor overprescribing of opioids. Maybe doctors, like pilots, really do need AI’s help in applying science correctly and consistently.


HIStalk Announcements and Requests

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Dear ONC, HIMSS, and many of the PR people who email me stuff – EST does not exist until November 3, when EDT ends and EST pops up like a fake vampire on a Halloween hayride. Pro tip: just say “ET” if you can’t figure it out and you will always be correct. It’s a minor mistake, but to me, it’s like grammar and spelling errors that raise questions of intelligence and  attentiveness to detail (leading me to conclude that about 75% of Facebook users aren’t just inarticulate, but downright dim). The band Chicago called it on their “Chicago Transit Authority” album 50 years ago – ”Does anybody really know what time it is? Does anybody really care?”


Webinars

September 26 (Thursday) 2:00 ET. “Patient Education Data: A Key Ingredient for Improving Quality and Patient Experience.” Sponsor: Healthwise. Presenters: Victoria L. Maisonneuve, MSN, RN, director of the Nursing Center for Excellence and Magnet program, Parkview Health; Marta Sylvia, MPH, senior manager of quality improvement and outcomes research, Healthwise. Healthcare data is everywhere! It’s scattered across various systems and in countless formats, making it difficult to collect and glean actionable information. Knowing where to start depends on what your organization wants to accomplish. By focusing on your patient education data, you can drive quality improvement across your organization. Vicki Maisonneuve will share how her team analyzes data around the use of patient education. By combining different data sets, she can easily identify trends, gaps, and opportunities to improve quality and patient experience across Parkview Health

October 2 (Wednesday) 1:00 ET. “Conversational AI in Healthcare: What About ROI?” Sponsors: Orbita, Cognizant. Presenters: Kristi Ebong, SVP of strategy and GM of healthcare providers, Orbita; Matthew Smith, AVP and conversational AI practice leader, Cognizant. Conversational AI holds great promise to drive new opportunities for engaging consumers and customers across all industries. In healthcare, the stakes are high, especially as organizations explore opportunities to leverage this new digital channel to improve care while also reducing costs. The presenter experts offer a thought-provoking discussion around conversational AI’s timeline in healthcare, the factors that organizations should consider when thinking about virtual assistants through chatbots or voice, and the blind spots to avoid in investing in those technologies.

Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

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Meditech sells a Framingham, MA office building to discount retailer TJX (TJ Maxx, Marshalls, HomeGoods) for $120 million. The 450,000 square foot building at 550 Cochituate Road also houses the headquarters of Definitive Healthcare.

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Amazon launches a Seattle-area pilot of Amazon Care, a virtual primary care clinic for its employees that includes a nurse house call option.

Leidos Australia chooses as its partners for the Australian Defence Force bid MediRecords (EHR/PM), Coviu (telehealth), and Nous (consulting), all of which are Australia-based companies. 


Sales

  • Lake Health District (OR) chooses Cerner Millennium under the CommunityWorks model.
  • Connecticut Orthopaedic Specialists will implement Updox for collaboration.

Announcements and Implementations

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China’s Ping An Good Doctor – which offers online consultations, hospital referrals, appointments, second opinions, and prescription delivery – reaches 300 million registered users, which represents one in three internet users in China.

New York EHealth Collaborative issues an RFI for patient-facing software that can access and aggregate patient medical records and support patient-provider messaging.

Cerner will add Simplee’s patient cost estimates and payment options to its revenue cycle system.


Government and Politics

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Former VA Secretary David Shulkin, MD has a book coming out on October 22. I’ll suck up the cost and review it if anyone cares, although I tend to discount the value of books written by (and words spoken by) politicians or pseudo-politicians.


Other

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University of Kentucky HealthCare ends ED diversion after fixing a registration system problem that was caused by a routine software update. I believe UK is running Allscripts Sunrise, but it signed with Epic two weeks ago and plans a mid-2021 go-live.

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An informatics physician lists the many national problems with health IT – clunky EHRs, questionable value, unclear paths to interoperability, poor clinical decision support, privacy issues, lack of patient engagement, and a shortage of visionary government leadership. On the plus side is the greatly beneficial unique patient identifier. Just in case that last item was as startling as the previous items were not, note that the author, David G. More, MB, PhD, is reviewing the state of health IT in Australia.

Guido Germano, PhD, the fired former director of artificial intelligence medicine at Cedars-Sinai Medical Center and UCLA medical school professor, is sentenced to five years of probation for possession of child pornography.

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A Bain & Company report says that medical technology suppliers need to market themselves to ambulatory surgery centers that now perform more than half of all outpatient surgeries at a cost lower than that of hospitals. The report observes that surgeons have greater control over product selection in ASCs, but the pressure to hold costs down means those centers are willing to switch to more cost-effective products. Health systems are doing exactly what you would expect  in serving themselves rather than patients – buying up ASCs to tap into their profits and acquiring physician practices to steer referrals to the more expensive, self-enriching option. 

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Movie director Richard Linklater will make a film starring Robert Downey, Jr. about Kansas physician (via a diploma mill) John Brinkley, who in the pre-FDA days of the 1920s claimed to have cured male virility problems and many other ailments with grafts of goat gonads, killing quite a few patients along the way. He built his own radio station, where he would talk endlessly about whatever interested him while hawking his goat gland treatments. He would have become governor of the state in a write-in campaign if the state attorney general hadn’t changed the ballot rules three days before the election. Brinkley became one of the country’s richest people, but died penniless after the IRS, FCC, and US Post Office cracked down. Fun fact: during the short transition from silent movies to “talkies” in the late 1920s, Hollywood added talking sequences to completed silent films to make them marketable, a term they called “goat-glanding.”


Sponsor Updates

  • Arcadia and CarePort Health will exhibit at the NAACOS 2019 Fall Conference September 25-27 in Washington, DC.
  • Avaya implements hybrid cloud solutions from IBM to expand its ReadyNow private cloud unified communications and contact center offerings.
  • The Chartis Group names Paul Murphy (ECG Management Consultants) a principal within its Informatics and Technology Practice.
  • CoverMyMeds will exhibit at the PDX Pharmacy Forum October 1 in Fort Worth, TX.
  • Diameter Health will host its annual customer forum October 2-4 in Dedham, MA.

Blog Posts


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Mr. H, Lorre, Jenn, Dr. Jayne.
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Morning Headlines 9/24/19

September 23, 2019 Headlines No Comments

Software issue fixed, UK HealthCare no longer diverting patients

UK HealthCare resumes normal operations after a software update caused its patient registration system to crash at three hospitals for several hours on Monday.

Heal makes first acquisition to expand its doctor house calls into NYC

App-based house call and telemedicine company Heal acquires New York City-based Doctors on Call for $15 million.

Fitbit’s 2-day surge hits 19% on reports the company is seeking a sale — and its bankers are eyeing a Google takeover (FIT)

Fitbit’s stock increases on the news that it has engaged investment bank Qatalyst Partners to advise it on a sale, with Alphabet named as a potential suitor.

Curbside Consult with Dr. Jayne 9/23/19

September 23, 2019 Dr. Jayne 7 Comments

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I have a standing date every couple of months to meet up with the physician who replaced me at Big Health System. Usually we do something outdoorsy that allows us to stroll, decompress, and be somewhere other than a conference room, then follow it up with lunch or drinks depending on the time of day we manage to escape.

It’s been challenging to schedule for the last couple of months, with several last-minute cancellations on both sides due to travel and family issues. Today we finally made it happen, and it was a breath of fresh air, both literally and figuratively.

Usually we start with updates on what we’ve been doing the last several months. I tell stories of the wild and wooly world of consulting and all the things I see in the field, some of which you would think were embellished if you didn’t know the players in the industry. He in turn fills me in on the happenings at my old stomping grounds, which are usually pretty run-of-the mill.

They have been going through a major rip-and-replace system conversion that isn’t always pretty, with physicians from different hospitals jockeying for control of various committees and trying to make sure their interests are protected. We typically talk about strategies for trying to get these folks to work collaboratively and to consider the larger picture. I usually have some advice to offer since I’ve done similar work at health systems that are much larger and more complex.

Today, however, he had all the bombshells. There have been some political maneuvers leading to the loss or marginalization of two of the best folks I know in the industry. One was frankly pushed out. The circumstances are complicated, but the backstory involves making a place for the spouse of a highly-recruited subspecialty surgeon, and said spouse happened to want a particular role in the organization that was unfortunately occupied by one of my former colleagues.

Needless to say, a reorganization occurred, the position was eliminated, and the spouse was hired into a new position with a different title and reporting structure, but with the same responsibilities and direct reports. The hospital had to pay a large settlement to avoid a lawsuit. Although the downsized individual landed on their feet, the entire experience was traumatic.

The second situation wasn’t so pretty and involved some C-suite squabbles that left a second former colleague and informaticist employed, but essentially in job purgatory. He was unable to win a showdown between the informatics team and two feuding chief medical officers, and unfortunately became collateral damage. Someone had to take the fall for failing to please either of the CMOs, who were clearly out of line but politically prominent.

The first CMO had a penchant for forcing the informatics team to make every single customization his physicians wanted, going deep into the weeds where he didn’t belong. The second was just overcommitted and never showed up to meetings, then had a fit when his opinions weren’t considered.

The feud between these two was big enough that I had heard about it at a HIMSS chapter meeting, but I was surprised to hear that the clinical informatics director took the fall for their failure to get along, being “reassigned” from the flagship EHR project to another peripheral effort. It sounds like he would have preferred being let go. It’s sad to see someone with so much knowledge and potential becoming a casualty of a turf war.

Unfortunately, these are the stories that are all too common in hospitals and health systems today. Decisions are often made based on squeaky wheels or the perception of a problem without fully understand everything the underlying situation. Certain personalities are coddled based on their admitting habits or how much revenue they bring to the facility, regardless of the path of destruction they leave in their wake. Good teams’ projects languish because they’re not exciting enough or don’t generate enough revenue to get the attention they deserve. People are treated as expendable despite their long-term contributions to the organization.

These are the same reasons I left Big Health System. It saddens me to know that they are still singing the same song, just a different verse. It’s hard to drive past the billboards extolling the virtues of their care when you know what goes on behind the scenes, and what that care costs, not only in a financial sense, but in the unappreciated human efforts needed to make it happen.

Unfortunately, these two scenarios are by no means unique. I see similar situations across the country. When I try to analyze the “why” behind some of this, the only conclusion I can arrive at is that these organizations are being run from a big business perspective and not in line with the ethical and moral considerations that we expect from a not-for-profit organization. It would be one thing if this were a for-profit entity doing this, but I think we expect more charitable behavior from organizations that try to wear their caring nature on their sleeves. At least the for-profit hospital organizations are more overt about what they’re doing and why, rather than trying to hide behind some measure of community benefit.

It was good that we were “getting our zen on” in a beautiful public garden because my blood pressure tends to rise when I hear about people being treated unfairly. My friend plans to try to ride it out at this place since he isn’t terribly far from retirement.

Our conversation turned to the details of his current projects. Asynchronous e-visits are big on the list, although the primary care physicians are irritated that they are being completed by on-call nurse practitioners rather than the PCPs themselves. Patients love the turnaround time (less than an hour), which is significantly less than the time needed to leave a message at the office and get a call back. It’s cash on the barrelhead for the health system, which isn’t billing insurance for the visits and isn’t sharing the revenue with the PCPs. Since the PCPs aren’t likely to be able to turn those visits in less than an hour if they’re seeing patients in the office, and since they’re going to want the revenue if they perform them, neither of us see that paradigm changing.

Information blocking is also on the list. My friend readily admits that the health system is guilty. They won’t play nicely with the other hospitals in town and certainly won’t play nicely with independent physician organizations like my own, so they point the fingers at the EHR vendor and hope for the best.

Another hot topic is antimicrobial stewardship, although I laughed out loud when I learned his team is performing manual chart reviews to look at antibiotic use because they can’t get time allocated with the data analyst team. I was fighting that same situation before I left, but refused to perform the manual reviews because I didn’t have enough personnel to do it. Maybe it does make sense to pay nurse informaticists to painstakingly perform these reviews rather than having an analyst spend an hour a month running queries and pulling the data, at least as far as what the current leadership thinks.

It was good to get together and even better to spend an hour in a beautiful place contemplating the ornamental carp and the rock gardens. Given the time pressures we encounter during our work lives, you have to force yourself to carve out that time if you want it. We can each only do so much individually to combat the sheer madness we experience on a daily basis, but maybe if we stick together and support each other, or at least listen, we can make a difference.

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Morning Headlines 9/23/19

September 22, 2019 Headlines No Comments

CCH responds to ransomware attack

Campbell County Health (WY) goes on diversion and transfers some patients out after a Friday ransomware attack.

Former hospital employee accused of gaming drug dispensing systems

A former hospital pharmacy technician is charged with stealing 13,000 doses of controlled substances after she found a bug in its automated dispensing cabinet that allowed her to withdraw doses for inactivated nursing unit names.

Senior Healthcare Executives Bet on RubiconMD, Join Leadership Team

E-consult company RubiconMD names Fred Ronnau (CareAllies) CTO and Sarah Alexander (Lumeris) COO.

Monday Morning Update 9/23/19

September 22, 2019 News 5 Comments

Top News

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Campbell County Health (WY) goes on diversion and transfers some patients out after a Friday ransomware attack.


Reader Comments

From XModem: “Re: patients downloading their health data. The government is puzzled why it isn’t happening.” Several recent reports indicate that people aren’t interested in downloading their medical records even though the industry is working frantically to allow them to do so. I’m not a bit surprised since I don’t do it myself and I suspect most HIStalk readers don’t either, so imagine the vast majority of people with high-cost chronic diseases who lack technical knowledge, don’t have consistent insurance and thus aren’t spinning out webs of claims data, or who just don’t worry about their health until they need to. My personal reasons:

  • While the general concept of health is ongoing and far-reaching, healthcare is episodic and specific. I don’t really think about my data until I need it for some specific purpose. I don’t think of my health as being limited to what providers have done to me.
  • I’m not so sure that those providers have cracked the health code any better than I have, or if so, how much of it is relevant to me. Ample numbers of clinicians fail the “do as I do” test.
  • My information is scattered all over the place, much of it within individual provider portals that have their own logins, web addresses, etc.
  • I use software when it solves a problem, which is rarely the case with health data.
  • Providers aren’t going to look at my self-collected data from other providers anyway in my allotted 15 minutes, so it won’t save me money, prevent unneeded tests, or improve my outcomes.
  • Most of what’s important about my health is not available or easy to find in my health records, so the health picture that a provider would get from it would be no more accurate than looking at my car’s oil change history to figure out whether I’m leading a swell life.

From Banner Health Phoenix Nurse: “Re: downtime last week. Cerner went down first, then all the phones. I had noticed Pyxis acting up, monitor displays not connecting with heart monitors, the web-paging tool went down. It was brief, but phones going out all across Banner is crazy!” Unverified. IT people are regularly reminded that ubiquitous connectivity, application integration, and middleware means that downtimes are usually no longer limited to a specific department or physical location. We used to worry mostly about a backhoe cutting a fiber link, an overheated data center, or server failure, but now the potential problem areas are everywhere. You’re not a health IT expert if you haven’t had to explain to the C-suite why a IT-managed phone system, which is just another software application, has gone down and left the hospital disconnected from the entire world.

From Usurious Interest: “Re: readers. Are they Net Promoters of HIStalk?” I barely know what that means, but I’ve learned that regular readers go two ways: (a) they feel HIStalk is useful or enjoyable and want to share it with others; or (b) they are sort of embarrassed that they read amateur-produced news and opinion or they don’t want to share the competitive advantage with peers. The independent Reaction Data of CIOS and CMIOs found HIStalk to be #1 among major health IT sites in readership, influence, generating company interest, providing job-enhancing information, and being recommended most, but even then I’m sure quite a few of those folks don’t broadcast that they’re big fans of Weird News Andy or my musical meanderings. I write for myself, though with the knowledge that others may be reading over my shoulder, occasionally attracting curious passersby.

From Krill Cracker: “Re: hospitals. Business or charity?” Yes. I know of few legally created charities that run such huge and sometimes ruthless bureaucracies, unless it would be behemoths like Goodwill or American Red Cross or perhaps universities. It seems odd that our country in the mid-1960s decided that hospitals need to operate like any other business except with huge government payments, tax advantages, and a carefully crafted image of being selfless while ringing the cash registers.

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From Branding Is Life: “Re: new HIMSS conference name. Is it really global? Is it really health?” HIMSS is attempting to bolster its declining attendance by renaming the conference “The HIMSS Global Health Conference.” It is “health” in hawking technology for profit-maximizing providers and it is “global” because it is marketing itself around the world. Otherwise, it’s the same old exhibitor-powered boat show and, seems to me, should be portrayed as such. They say 80% of health has nothing to do with providers, so how is that represented on the show floor?


HIStalk Announcements and Requests

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Most poll respondents got their current jobs because of their work history or connections, so I take the career to-do’s as: (a) spend more time creating and maintaining your network; and (b) practice your interview skills.

New poll to your right or here: for those over 50, what do you regret most in life so far? Click the Comments link after voting to provide advice to the younger folks who might change their life’s course as a result of your wise counsel.

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The pundits from Pune gave me my best laugh of the weekend in their offer to share their deep health IT knowledge in a $3,500 report.


Webinars

September 26 (Thursday) 2 ET. “Patient Education Data: A Key Ingredient for Improving Quality and Patient Experience.” Sponsor: Healthwise. Presenters: Victoria L. Maisonneuve, MSN, RN, director of the Nursing Center for Excellence and Magnet program, Parkview Health; Marta Sylvia, MPH, senior manager of quality improvement and outcomes research, Healthwise. Healthcare data is everywhere! It’s scattered across various systems and in countless formats, making it difficult to collect and glean actionable information. Knowing where to start depends on what your organization wants to accomplish. By focusing on your patient education data, you can drive quality improvement across your organization. Vicki Maisonneuve will share how her team analyzes data around the use of patient education. By combining different data sets, she can easily identify trends, gaps, and opportunities to improve quality and patient experience across Parkview Health

October 2 (Wednesday) 1:00 ET. “Conversational AI in Healthcare: What About ROI?” Sponsors: Orbita, Cognizant. Presenters: Kristi Ebong, SVP of strategy and GM of healthcare providers, Orbita; Matthew Smith, AVP and conversational AI practice leader, Cognizant. Conversational AI holds great promise to drive new opportunities for engaging consumers and customers across all industries. In healthcare, the stakes are high, especially as organizations explore opportunities to leverage this new digital channel to improve care while also reducing costs. The presenter experts offer a thought-provoking discussion around conversational AI’s timeline in healthcare, the factors that organizations should consider when thinking about virtual assistants through chatbots or voice, and the blind spots to avoid in investing in those technologies.

Previous webinars are on our YouTube channel. Contact Lorre to present your own.


People

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David Jones –- the Louisville lawyer who with partner Wendell Cherry created the country’s largest nursing home chain as a side business, then its biggest hospital chain in Humana, and then top health insurer Humana — died last week at 88.


Other

A small observational study finds that ED residents often create EHR documentation of their physical exam and review of systems that doesn’t match what they actually did. Cynics might note that documentation, rather than action or outcomes, drives payment and thus rewards creative writing.

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CNBC’s Chrissy Farr sits in on an Amazon PillPack new hire training session for empathy, in which the employees simulate the experience of the company’s senior citizen target audience by wearing mobility-limiting gloves and vision-blurring glasses while working against the clock to redistribute complicated prescription meds into individual day-and-time compartments (which is what PillPack does for them).

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A former hospital pharmacy technician is charged with stealing 13,000 doses of controlled substances after she found a bug in its automated dispensing cabinet that allowed her withdraw doses for inactivated nursing unit names.

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Weird News Andy titles this story “Left-Handed Compliment.” Surgeons in England create a new tongue for an oral cancer patient by using skin and an artery from her arm. The woman credits cancer psychology counseling sessions for her recovery.


Sponsor Updates

  • Lightbeam Health Solutions will exhibit at the AMGA IQL 2019 Conference September 26-27 in Las Vegas.
  • Health Catalyst will exhibit at the 2019 Patient Safety, Quality & Sepsis Symposium September 23-24 in Harrisburg, PA.
  • Waystar will exhibit at the MedInformatix MISummit 2019 September 24-27 in Pittsburgh.
  • NextGate will exhibit at the HIMSS Washington Chapter Innovation Summit September 26 in Seattle.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the Perinatal Partnership Conference September 22 in Concord, NC.
  • OmniSys will exhibit at the PDX Chain Link event September 28-October 1 in Fort Worth, TX.
  • CereCore congratulates partner Cuero Regional Hospital on its Leadership Culture Award from the Texas Organization of Rural Community Hospitals.
  • Phynd joins Epic’s App Orchard, allowing Epic users to search the company’s network of 4.6 million providers and enroll them directly in Hyperspace.
  • Experian Health will exhibit at the NAACOS Fall Conference September 25-27 in Washington, DC.
  • MadStartups features “Redox Cofounder Niko Skievaski’s journey through Madison’s startup ecosystem.”
  • ROI Healthcare Solutions celebrates its 20th anniversary.
  • Surescripts will exhibit at FMX 2019 September 24-28 in Philadelphia
  • TriNetX will host its annual Summit September 24-25 in Boston.
  • Visage Imaging will exhibit at the SIIM Conference on Machine Intelligence in Medical Imaging September 22-23 in Austin, TX.
  • Vocera will exhibit at the 2019 Illinois Health and Hospital Association Leadership Summit September 26-27 in Lombard.
  • Wellsoft will exhibit at Emergency Nursing 2019 September 28-October 2 in Austin, TX.

Blog Posts


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Weekender 9/20/19

September 20, 2019 Weekender 1 Comment

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Weekly News Recap

  • Australia’s Queensland Health struggles with its new EHR and ERP systems.
  • Alphabet restructures its DeepMind health business to report to Google Health.
  • Warburg Pincus acquires behavioral health and human services EHR company Qualifacts for over $300 million.
  • Jonathan Bush (Athenahealth) joins video and office visit provider Firefly Health as executive chair.
  • Leidos sells its Leidos Health EHR implementation and consulting business to private equity firm A&M Capital.
  • Specialty practice EHR, PM, PACS, and AI chat bot vendor OrbCare is reportedly nearing insolvency just six months after announcing a $2 million seed round.
  • Livongo’s shares drop below their July 25 initial offering price after its first quarterly report shows widening losses.

Best Reader Comments

I don’t think people in general really care that much about their information getting out there or the government having it. People hand all their data over to Facebook, there is no organized movement around data leaks, and there has been very weak opposition to the Patriot Act or the Snowden leaks. The reason that we don’t have a national patient identifier is largely a result of it being bad for special interests. In the US political process, if you have a large sum of money you can always drum up “grassroots” efforts to stall legislation or pay politicians in power to pretend to hold a view. (People)

The term “copy / paste” is used excessively in a way that obscures problems with current EMR use. Plagiarizing someone else’s free-text information should be seen as very bad. Regurgitating your own previous note with minimal or no changes is merely bad and more responsible to the note bloat issue cited. But talking about the “past medical history” that autopopulates most EMR notes as if it were somehow reliable and true is naive. At minimum it’s often either incomplete or redundant and, worse, internally contradictory. Worse yet, free text narrative history notes from specialists often contradict medical history imported elsewhere into the selfsame note. Are there any examples where this sort of thing had legal ramifications? (Robert D. Lafsky)

The real irony is that in 1965, the AMA was vehemently opposed to Medicare. They claimed it would ruin the doc-patient relationship and make docs wards of the state. They were right — it has ruined the relationship, and given their income levels today, most of which comes from taxes, they are wards. Poor things. They must be gleeful just thinking about Bernie’s Medicare for all. (Frank Poggio)


Watercooler Talk Tidbits

A sexual harassment lawsuit brought by a since-deceased ED doctor against her hospital employer continues, with her husband claiming that the stress of her boss’s rejected sexual overtures followed by his work-related retaliation led her to die of gallbladder cancer in 2017 at 53.

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Several biohackers who believed the health claims of “hydrogen-infused water” company Trusii say they were scammed into taking out high-interest loans of up to $12,000 to buy its home water fountain, with the company promising to send them monthly checks if they posted glowing social media reviews of its health benefits. Trusii’s owners say they’re the victims of mob mentality, it’s their competitors organizing the bad PR, and that they actually overpaid users, some of whom didn’t meet its testimonial requirements. The CEO was arrested in February for alleged scams related to his previous used car business.

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University of Michigan will build a $920 million, 264-room patient tower that it says is “an investment in Michigan Medicine’s mission of advancing health to serve Michigan and the world.” Existing semi-private rooms will be converted into private rooms, adding a net bed count of 154 (at a cost of $6 million per bed).

NPR notes that government-employed doctors in Venezuela earn less than $2 per month, forcing them to live on free food provided by local merchants and bus money offered by patients. At least half of the country’s medical employees have left the country or changed jobs, not just because of wages, but because Venezuela’s economic woes under an authoritarian government have left it without medical supplies, drugs, and hospital air conditioning as annual inflation rates have risen to 10,000,000%. Doctors report being fired or threatened for complaining about patient endangerment due to situations such as having to use their cellphone lights to perform surgery.

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A 23-year-old Iowa State football fan whose on-camera ESPN College GameDay sign asked viewers to Venmo him beer money receives $1,600 in donations, leading him to decide to buy one case of Busch Light and send the rest of the money to University of Iowa’s Stead Family Children’s Hospital. Anheuser-Busch – owned by Belgium-based InBev – promoted his cause and offered matching funds. The donation total now exceeds $350,000.


In Case You Missed It


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Morning Headlines 9/20/19

September 19, 2019 Headlines No Comments

Texas Health Care Fraud and Opioid Takedown Results in Charges Against 58 Individuals

The Justice Department charges 58 people in Texas, including three EHR hackers, for participating in Medicare fraud schemes and operating pill mill clinics that doled out 6.2 million pills at a cost of $66 million.

Queensland Health headaches continue as suppliers aren’t paid on time

Queensland Health Minister Steven Miles takes heat for spending $92 million on supply ordering software that crashed hours after launch.

Telemynd Readies Plan For Mini IPO

Behavioral telehealth and analytics company Telemynd hopes to raise over $8 million in an IPO of its common stock.

News 9/20/19

September 19, 2019 News No Comments

Top News

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Alphabet brings AI innovation unit DeepMind underneath the Google Health umbrella as announced last year.

Alphabet acquired the British company in 2016 for $500 million. It has since embarked on several high-profile projects with the NHS and VA.

The transition comes several weeks after DeepMind co-founder Mustafa Suleyman confirmed an unexplained leave of absence. He headed up the organization’s division that looked for ways to use AI in healthcare and energy, with rumors suggesting that Google plans to take more direct control of that aspect of the business, leaving DeepMind to function mostly as an AI university.

The company, which will maintain its London headquarters, will now report to Google Health VP David Feinberg, MD, MBA, who joined after leaving Geisinger Health as CEO in January.


Webinars

September 26 (Thursday) 2 ET. “Patient Education Data: A Key Ingredient for Improving Quality and Patient Experience.” Sponsor: Healthwise. Presenters: Victoria L. Maisonneuve, MSN, RN, director of the Nursing Center for Excellence and Magnet program, Parkview Health; Marta Sylvia, MPH, senior manager of quality improvement and outcomes research, Healthwise. Healthcare data is everywhere! It’s scattered across various systems and in countless formats, making it difficult to collect and glean actionable information. Knowing where to start depends on what your organization wants to accomplish. By focusing on your patient education data, you can drive quality improvement across your organization. Vicki Maisonneuve will share how her team analyzes data around the use of patient education. By combining different data sets, she can easily identify trends, gaps, and opportunities to improve quality and patient experience across Parkview Health.

October 2 (Wednesday) 1 ET. “Conversational AI in Healthcare: What About ROI?” Sponsors: Orbita, Cognizant. Presenters: Kristi Ebong, SVP of strategy and GM of healthcare providers, Orbita; Matthew Smith, AVP and conversational AI practice leader, Cognizant. Conversational AI holds great promise to drive new opportunities for engaging consumers and customers across all industries. In healthcare, the stakes are high, especially as organizations explore opportunities to leverage this new digital channel to improve care while also reducing costs. The presenter experts offer a thought-provoking discussion around conversational AI’s timeline in healthcare, the factors that organizations should consider when thinking about virtual assistants through chatbots or voice, and the blind spots to avoid in investing in those technologies.

Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

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Robin Healthcare raises $11.5 million in a Series A round. The company’s digital Robin Assistant captures clinical notes through audio and optional video during an appointment and transmits them to the provider’s EHR.

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PE Hub reports that Warburg Pincus has acquired behavioral health and human services EHR company Qualifacts for over $300 million.


Sales

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  • In Kenya, Aga Khan University chooses Meditech Expanse, which it will implement in Kenya, Pakisan, Afghanistan, and Uganda.
  • Rush Health Systems (MS) will implement Epic as provided by Ochsner Health System (LA).

People

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Collective Medical names Vatsala Pathy (Rootstock Solutions) VP of policy.


Announcements and Implementations

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Covenant Health (TN) implements Wolters Kluwer Health’s UpToDate Advanced and Lexicomp interactive clinical decision support and drug information tools.

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3M Health Information Systems announces GA of AI-enhanced CDI software that incorporates natural language processing technology from MModal, which it acquired in February.

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Health First (FL) implements Privia Health’s proprietary practice management technology, including EHR, patient portal and app, and online scheduling.

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A new KLAS report on the use of Epic Community Connect in practices of 1-10 physicians finds that Epic performs better than most small-practice EHR vendors in the areas of value and system performance; the practices are happy with integration with local ACOs and IDNs; and nearly all would choose Epic again. However, Epic’s usability scores lagged due to deep but not necessarily relevant functionality and cumbersome workflows. Unrelated to Epic itself, most users aren’t happy with the support they receive from their host organization, with some striking deals with Epic itself or seeking a different host. 


Government and Politics

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In Australia, Queensland Health Health Minister Steven Miles assures the press that a full review of the recent five-hour Cerner EHR outage at 14 hospitals is underway. He’s also taking heat for the state’s $92 million supply ordering system, which crashed hours after launch on August 1. One frustrated politician says it’s become almost impossible for nurses to order basic items. “Nurses having to put Band-Aids on the corporate bank card is absolutely appalling. Last week I heard nurses were actually buying food for patients from Woolworths. This is just absolutely ridiculous.”

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The Justice Department charges 58 people in Texas for participating in Medicare fraud schemes and operating pill mill clinics that doled out 6.2 million pills at a cost of $66 million. Three of those charged broke into a provider’s EHR to steal patient data that they then sold to durable medical equipment providers and contractors for $1.4 million.


Other

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In Arizona, Summit Healthcare Regional Medical Center’s August 1 switch from eight separate systems to Allscripts Sunrise has left many patients frustrated by long waits, chaos in the ER, and difficulty obtaining prescriptions. Numerous down times have occurred, creating backlogs in several departments. An executive admits, “We did have issues and we know we had things that didn’t work at first. Going from eight systems to one, you practically have to reinvent the wheel.”

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A Colorado man whose bachelor party hangover led him to seek rehydration in a freestanding ED generates a bill for $12,600, double the cost of the wedding itself. For that, he received two IV bags of saline and a dose of the anti-nausea drug Zofran, which the facility says justified a severity of four on a five-point scale and thus a facility fee of $7,644. The insurer’s negotiated price and payment left him with a balance of $2,600, which he says he can’t pay. Rural Colorado has only eight freestanding EDs and all of them in affluent ski resort towns. This one is owned by publicly traded hospital operator HCA. It says it has to overcharge patients with insurance because it can’t turn away those who can’t pay. The article notes that a local, spa-like hangover treatment center offers basically everything the groom received for $168.  


Sponsor Updates

  • Elsevier Clinical Solutions will exhibit at CAP19 September 21 in Orlando, FL.
  • EClinicalWorks will exhibit at the AMA’s 2019 FMX September 25-27 in Philadelphia.
  • Ellkay will exhibit at the Mayo Leveraging the Laboratory event September 24-25 in Nashville.
  • Ensocare will exhibit at the ACMA Maryland Chapter Annual Conference September 21 in Hunt Valley, MD.
  • Greenway Health will exhibit at the Virginia MGMA Fall Conference September 22-24 in Williamsburg.
  • InterSystems will host Global Summit 2019 September 22-25 in Boston.
  • Kyruus publishes a new case study, “How Providence St. Joseph Health Increased Visibility into a Growing Provider Network to Boost Demand Conversion and Improve the Patient Experience.”
  • AlayaCare adds Waystar’s RCM capabilities to its home care software.
  • Madison Magazine names Nordic as the best place to work in Madison, WI. 
  • Nuance develops pediatric-specific versions of its clinical communication, documentation, and analytics software.
  • Kyruus adds Uber ride-sharing capabilities to its ProviderMatch appointment-booking software for hospital access centers.

Blog Posts


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EPtalk by Dr. Jayne 9/19/19

September 19, 2019 Dr. Jayne No Comments

Patient engagement is a hot topic in US healthcare, so I’m always interested to see how it plays out in other countries. A recent effort looked at the challenges of treating tuberculosis, specifically in ensuring that patients take their medications consistently during the six months needed to eradicate the disease. Patients in Nairobi, Kenya were enrolled in a program that delivered repetitive cellphone texts to encourage patients to take their medications. Those who participated had fewer negative outcomes compared to the control group. The texts ask patients to actively confirm that they have taken their medications. Those who responded were thanked and informed of their standings compared to other patients, including whether they made it to the “winners circle” for those with 90% adherence. Non-responsive patients receive additional texts, phone calls, and potentially in-person case tracking.

Stanford Medicine has launched a digital consult service to assist in diagnosis of challenging patient cases. They parallel the offering on the “curbside consult,” where physicians ask their colleagues about a case, hoping to draw from experience and past patients. The Clinical Informatics Consult solution has been in the works for more than a decade, and is currently live as a research project that can query data from millions of patients. Clinicians submit a clinical query and receive a report with summaries of similar patients in Stanford’s clinical data warehouse, including how they were treated and what outcomes resulted. The team has responded to over 150 consult requests from Stanford physicians. Developers hope that other academic hospitals may be able to use similar technology to help their own physicians.

I was recently asked to provide a reference for a former employee. The process was conducted using an online portal called SkillSurvey. The company claims to provide a data-driven hiring approach to assist employers in identifying job-related competencies along with soft skills. According to their data, 85% of references typically complete the company’s online survey and most do so within two days. Employers receive a report that claims to be predictive of a candidate’s chances for a successful first year on the job. The data shows how a candidate ranked across multiple references which sure sounds like more fun than trying to compare screening notes from HR staffers that don’t completely hit the mark, as I frequently experienced in a past life.

They didn’t go into the detail of how a potential employee likes to do their work, which I think would also provide useful data points prior to hiring. I recently had to have a “counseling” opportunity with an employee who thinks that trying to do the majority of your work on a smart phone is a good idea. Consultants are always busy, but they need to figure out what you can get away with doing on a small-format device and what requires you to just park yourself in front of a laptop or desktop. The biggest issues I tend to see with phone-related work behaviors are these: failing to see all of the recipients on an email before replying to all (especially when the reply is inappropriate for the entire audience); failure to see email attachments; difficulty adequately managing the calendar because of limited screen real estate; increased typos; and failure to read the entire email before responding, leading to comments that waste other people’s time. I’m all about being able to be mobile, but sometimes you just need to do your work on a big screen and with a keyboard.

A colleague of mine keeps trying to recruit me to the Medici platform, which offers everything from secure physician-patient communication and referral routing to billable audio/video consultations and ePrescribe services. Their marketing is straightforward, listing three simple steps to allow you to “get paid for texting with your patients.” Many physicians might not understand the nuances of what it means to begin using a service like theirs, particularly with regards to how those patient-physician communications get documented in the patient chart (or perhaps not) and whether the auto-translation features it offers are accurate. The company also offers texting with other professionals, such as veterinarians. The Austin-based startup has raised $46 million and has used analogies to identify themselves alternately as the Uber of healthcare or the WhatsApp of healthcare. I’m not sure of the origin of their name, but of course it reminds me of the Medici family, who schemed their way through Tuscany in the 15th and 16th centuries.

Speaking of telehealth apps, Planned Parenthood has entered the telemedicine space with the launch of their new app, Planned Parenthood Direct. It offers birth control options, including contraceptive pills, patches, and rings, along with treatment for urinary tract infections. The app is live in 27 states and the District of Columbia, with plans to expand to all 50 states by next year. It also allows patients to book in-office appointments for other contraceptive services such as IUDs, implants, and injections.

I recently encountered a situation where an elderly family member was receiving unneeded screening tests on the recommendation of their physicians. Knowing the physicians in question, I had a couple of suspicions. The first physician is part of a large medical group owned by a hospital system that sees itself as a major player in value-based care, and I wondered whether it was easier for him to just order screenings rather than exclude the patient in their crazily complicated EHR. The second is an independent physician who was ordering tests that would mostly lead for profit for his practice, which was particularly disturbing because the tests in question are invasive. A recent article in the Journal of the American Medical Association adds another scenario, which is the possibility that physicians don’t want to stop ordering screening tests because it will make them seem like they’re giving up on their patients. The decision to provide less care for older patients is a difficult one, and I hope more physicians, patients, and families are up to the task given the size of our aging population.

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Sometimes companies don’t have the wherewithal to perform the difficult tasks that need to be done within an organization, so they bring in consultants. I’ve been on both sides as companies use consultants to downsize unwanted employees or deliver other reorganization strategies. It’s unsavory and has even been the stuff of movies such as “Up In the Air” with George Clooney. Having been party to horrific termination meetings in the past, I really enjoyed this piece about a New Zealand employee bringing an emotional support clown to his own firing. The clown mimed crying as the employee was fired and created balloon animals, even though they were a bit noisy. Kudos to the employee for having a sense of humor and being willing to spend $200 to give his former employer something to talk about.

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Morning Headlines 9/19/19

September 18, 2019 Headlines No Comments

Robin Healthcare Raises $15 Million to Build Digital Assistant for Doctors, Launches Partnerships with Leading Health Systems, and Adds Siri Co-Founder Tom Gruber as Advisor

AI-powered clinical documentation company Robin Healthcare raises $11.5 million in Series A funding led by Norwest Venture Partners.

DeepMind’s health team joins Google Health

Alphabet’s AI-focused DeepMind subsidiary officially becomes a part of Google Health.

Review under way into major Queensland hospital software crash

Queensland Health Minister Steven Miles assures the press that a full review into last week’s five-hour Cerner EHR outage at 14 hospitals is underway.

Warburg snaps up Qualifacts in $300 mln-plus deal, following larger bet for WebPT

PE Hub reports that Warburg Pincus has acquired behavioral health and human services EHR company Qualifacts for over $300 million.

Shared Medical Systems 50-Year Reunion

September 18, 2019 News No Comments

Vince Ciotti attended the recent reunion of former employees of SMS. He sent some photos, augmented by those of SMS veteran Bob Haist (his photos label those employees whose names he jotted down).


We held the 50th reunion of early employees of Shared Medical Systems (SMS) this past Saturday, September 14 in King of Prussia, PA, the location of its early HQ. An amazing count of 140 ancient “King of Prussians” showed up, about 100 former employees and 40 (bored) spouses. It was quite a treat to see so many old friends, recognize their faces, and actually remember many of their names.

The highlight of the evening was an introductory speech by Harvey Wilson, co-founder of SMS in 1969. Harvey founded SMS along with Jim Macaleer, who sadly passed away quite recently, and Clyde Hyde, who passed away far too many years ago.

You may recognize Harvey’s name as the founder of Eclipsys in the mid-1980s, an early EMR vendors that he later sold to Allscripts. It is incredible that one man could be the founder of two of the leading vendors in the HIS industry!


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Check-in (show your Medicare card).

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Amazing how good SMS co-founder Harvey Wilson looks after all these years!

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Harvey’s introductory speech gave most of the credit for the company’s success to its hard-working employees.

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On the left is Keith Phillips, an early marketing superstar, trying to stop me on the right from guzzling too much Chianti.

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Another leading SMS executive from those days was Karl Witonsky, VP of development, in center in the back in the blue sweater. He gave a moving speech about life in the early days of IBM mainframe computing.

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Another leading SMS veteran was Ken Shumaker, with a beard in the center, drawing a diagram of how he programmed Unifile.

See also a PDF of Bob Haist’s photos with names.

Morning Headlines 9/18/19

September 17, 2019 Headlines No Comments

Millions of Americans’ Medical Images and Data Are Available on the Internet. Anyone Can Take a Peek.

A ProPublica investigation identifies 187 Internet-accessible, unsecured servers that hold the medical information of 5 million Americans.

OrbCare is Bankrupt and Looking for a Buyer After Misrepresented Finances and Debt

Toronto-based specialty practice EHR, PM, PACS, and AI chat bot vendor OrbCare is reportedly nearing insolvency just six months after announcing a $2 million seed round.

Rush Health Systems and Ochsner Health System Announce Strategic Partnership

Rush Health Systems will gain access to Epic and telemedicine capabilities through a new partnership with Ochsner Health System.

Navigating Cancer, the Leader in Oncology Patient Relationship Management, Receives $26 Million in Oversubscribed New Funding

Oncology-focused patient relationship management vendor Navigating Cancer raises $26 million in a Series D round of financing.

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