Morning Headlines 2/12/19

Francisco Partners Acquires Qualcomm Life

Francisco Partners acquires Qualcomm Life from Qualcomm and will restore the name of Capsule Technologies, the medical device connectivity business that Qualcomm acquired in 2015.

HHS Proposes New Rules to Improve the Interoperability of Electronic Health Information

HHS proposes a new rule that would give patients instant electronic access to their health data from federally-funded providers at no cost, and that would require providers and payers to adopt technology to make this real-time data-sharing possible.

Critical Alert Systems to Acquire Sphere3® Consulting

Patient communications and nurse call vendor Critical Alert Systems will acquire nurse call analytics vendor Sphere3 Consulting.

Apple announces Health Records feature coming to veterans

Apple solidifies plans with the VA to give veterans access to their medical records via the Health Records app.

ImageMoverMD Raises $4 Million to Automatically Connect Medical Images with Electronic Patient Records

Medical image management startup ImageMoverMD raises $4 million in a financing round led by Bain Capital Ventures, Cultivation Capital, and Health X Ventures.

Dr. Jayne at HIMSS 2/10/19

I was eagerly awaiting my flight to the Sunshine State this morning, but the travel gods decided to conspire against me with an inch of ice that closed the airport and a good number of Interstate segments. I thought I was getting ahead by traveling in on Sunday instead of Monday, but no such luck. I’m sitting here with my re-ticketed flight, plus three others in hand, so that I can cover my bases and get there one way or another even if I wind up going through Tampa. Thank you, Southwest Airlines, for the beauty that is the fully-refundable ticket.

I’ll start reporting on HIMSS once I actually get there. In the meantime, I received a thought-provoking contribution from an anonymous CEO and I thought it was worth sharing.

Thirteen times in the past 14 years, I have ventured to HIMSS. Each year, at an earlier moment in the week, I regretted the decision to attend. It is mainly because I am missing work that doesn’t go away (because I have), but more and more it is because the show serves no actual purpose. In the following rant, I am going to lay out an argument for how to make the best of HIMSS now that you are on your way, as well as why many that are excited to be in sunny, humid, putrid Orlando are doing the fool’s errand in thinking this will be a worthwhile week.

Full disclosure: I have held (too) many jobs in healthcare IT over the past 12 years and have been on all sides of the HIMSS conference. I have worked a booth, represented companies that didn’t have a booth, paid my own way to join in the educational experience, paid for booths, been on stage, been on panels, and have even just gone to spy on competitors under a fake name and fake company. I’ve had all the badges.

For all parties involved, the juice is most definitely not worth the squeeze.

From a participant / attendee standpoint, I can learn the same from the sessions that I can from a simple Google search (Google Scholar, that is) or a dogged follow of specific influencers in healthcare IT. The sessions fall into distinct categories: (a) a health system employee getting that CV bump by reporting some of the details of something they did successfully; or (b) a vendor-driven presentation that solves no need I am aware of, with limited data and an obvious conclusion.

In the end, most people are nursing a hangover, catching up on real work, or looking to network their way through the presentation. Very, very little actual discourse is driving these educational sessions. It is not like novelty is a strong suit here.

Seeing all the vendors under one roof is both staggering and depressing. We’ll spend the same amount of money on “eradicating AIDS in the US” this year than HIMSS collects for booths with VR headsets, cushy lounge chairs, video demonstrations, DeLoreans, Vespa scooters, and random art and marketing collateral. Think about that. Is this conference on par with eradicating a horrible disease (or at least attempting to? I can’t say for certain if the Trump Administration’s promise is actual doable) What does the money actually go toward?

From a vendor perspective, it is highly unlikely you’ll get a return on your investment from HIMSS (and highly unlikely that your company actually provides an ROI to your customers, but that rant is saved for another day, cool?) The booths are mainly visited by the lookie-loos, the spies, the executives who are just getting their steps in before they go drinking, the swag shoppers, and the investors looking to defend their previous capitalization. Very few decisions are made at HIMSS that are business related, and many of the non-business decisions made at HIMSS are not good ones either (no one looks smart and successful at a business event that looks more like a 1990s wedding party, no one).

You’ll end up running out of your good swag and people will mill around just long enough to earn the larger gift you are hiding for the good prospects. The big award you give out — be it an Alexa, Apple Watch, Caribbean cruise, or gift card — will go to the best prospect you met that week, and we all know that. And if you don’t do that, take my advice, you should. If you are giving things out to everyone, splashing cash and gifts on anyone that comes by, we’re thinking of all the reasons you are able to do that … and let’s be honest, there is no good reason in healthcare to be that flush with money. But sending out those enticing emails for $50 to take a demo — are you sure that is the most enticing way to get your solution known? It’s trick-or-treating for professionals. Scan my badge and give me my prize. Boo!

If you are looking for a job, I actually give you a pass. It is an expensive way to get a new job, but I understand that for many in geographically inconvenient locations, this is the hiring fair that you yearn for. I just know that if you are convinced to get that 100 percent online master’s degree from the “Academics” arena, well, you are too easily parting with your hard-earned money. I have yet to encounter someone who went through those programs successfully. And I have been around a long time. I know people have been successful finding a new job at HIMSS, I am personally unsure how best to go about it, and quite certain that the readers of this blog would be incredibly excited to learn your story and tricks. (Tim, can we pay someone $25 for sharing their tale of recruiting at HIMSS?)

So, what is left? Who is really at HIMSS? Well, if you work for a big vendor in a sales role, you are there. If you are looking to invest in healthcare IT, you are probably there, too. If you are actually shopping for a new solution for your hospital, state, government agency, health system, or clinic, you are fooling yourself into thinking that you are buying what you are seeing — as vaporware is really the only commodity on the HIMSS market — but most likely your institution had a HIMSS budget and you won the lottery this year (and that was me one year and it was cool, except when it wasn’t). Beyond that, there are some media folks, some freelance marketers, consultants, and 14 licensed care providers. Even though you are at the largest healthcare IT conference in the country, if you fall ill or hurt, there will most likely not be a doctor available to help (excusing the ones that have the license but don’t practice because they are too busy “disrupting.”)

If you are presenting on a side stage, you have been conned. You’ve been convinced that being a vaudevillian sideshow act on the floor amidst 40,000 wanderers is somehow going to attract interest in your small company or solution. You are just noise. If you are in the hall where booths turn into small lockers with a monitor, you are lost beyond help and your best chance is to meet your neighbors and see if you can partner together. People floating into those dead-end sections are mainly there to steal a good idea for their idea-bereft big company. And you’re lucky if you get a chance to partner with them, otherwise consider your “innovative, breakthrough disruption and killer app” officially stolen. The deepest depths of the floor are always very interesting, but also reek of desperation and fear. If this doesn’t go well for so many of them, the prospects for their continued operation through next year is staggeringly limited.

For those that go to meet up with friends and old colleagues, I am sure your employer would wish you’d find a less expensive reunion in the future. But I get it, I have many HIMSS-friends from over the years that I only see there, and it is nice to bump into them and quickly swap stories and hugs before sauntering off.

Quick help on your attire: suits=rank-and-file employees; jeans=investors; ties=people who have been doing this longer than you want to know; cool shoes=posturing innovators and lemmings. Socks are clearly the new tattoo, so if you aren’t in a hip color, you may not be invited to the meet-up, party, or club, so choose appropriately. If you get blisters and complain about it, you should be banished. It is a big show, big floor, lots of standing. No one will besmirch the genius who desires to wear a comfortable, but unfashionable shoe. Medical personnel have been wearing Dansko clogs for millennia without any concern. (They are damned comfortable if you are ever in the market. It makes sense to me if you are on your feet for 18 hours to wear them, regardless of price).

I hate to rain on your parade down to Orlando (I actually don’t, but I know I should care about it), but the sideshow act that HIMSS has become is worth pointing out. They are in it for their own gain, not yours. HIMSS is not there to cultivate a better healthcare system for the world, it is there to separate you (and/or your employer) from money. They’ll put you on their television show, let you be retweeted or favorited on their social media, they’ll incent you to buy a bigger thing next year, all so long as you keep sending them money. They will bend over backwards to sell you whatever they think you will buy. They have become shameless.

We’ve oft joked that Vegas is best for getting people to part with their money. Paying unnecessarily for food, drink, events, and hotels. But Orlando has mastered this art. They do it for the entire family, the grift of the entire community is astounding, and they don’t even take a gamble on losing. Even for the most seasoned, there is always a regretful purchase or expense that is only possible when you are stuck in Mouseville with a million tourists. International Drive does not do discounts, sales, or market-based pricing.

So, given this, what should one do with HIMSS? My simple answer is to profit from it. And I mean that in the dirtiest way possible. “If it is free, it is for me.” If there is a contest, enter it. If there is a meeting that comes with a gift card, schedule it. If there is a party with an open bar and dinner, feed and imbibe to your heart’s content. If there is someone in an elevator, say hello. If there is a group of people that look interesting, introduce yourself. If you see someone in military regalia, thank them, offer to buy them a snack, and ask them questions since they are usually the most interesting people there.

If you are stuck behind a booth in a job you’d rather not have, walk a row over and chat up your contemporaries. They know the drill, they know where the snacks are, the free beer and wine at 3:30, and the evening parties that are so big a formal invite isn’t necessary. They’ll get you through, show you the ropes, and maybe even become a friend. But eliminate the notion that you are going to learn about the future, become a better version of yourself, or grow your business, because that’s not what HIMSS is there for (unless they can profit from it).

Have fun, be safe, enjoy the show, and avoid the biggest mistakes you can. I’ve decided to cancel my reservations this year, as it appears I have finally graduated to recognizing my folly before I even leave for the show.

Acquisition Announcements 2/11/19

Francisco Partners acquires Qualcomm Life from Qualcomm and will restore the name of Capsule Technologies, the medical device connectivity business that Qualcomm acquired in 2015. The business also includes the 2Net medical grade mobile connectivity platform. Qualcomm announced in June 2018 that it was seeking a buyer for the Life division.

Patient communications and nurse call vendor Critical Alert Systems will acquire nurse call analytics vendor Sphere3 Consulting. 

Morning Headlines 2/11/19

Catholic Health plows $100M into electronic records

Catholic Health (NY) will spend $100 million to implement Epic over the next 18 months – its most expensive health IT project to date.

OCR Concludes All-Time Record Year for HIPAA Enforcement with $3 Million Cottage Health Settlement

OCR wraps up its record-setting  $29 million year for HIPAA fines with a settlement from Cottage Health, a California-based hospital operator that experienced breaches in 2013 and 2015.

R1 Develops Technology and Innovation Center in Collaboration with Intermountain Healthcare

After taking on hundreds of Intermountain employees last year, RCM vendor R1 will again partner with the health system to build a technology and innovation center in Salt Lake City.

VA announces mortality data collaboration with Centers for Disease Control and Prevention

The VA will use FHIR-based standards to share mortality data from its VistA EHR with the CDC’s Modernizing Death Reporting project.

From HIMSS 2/10/19

From Degree Checker: “Re: Hal Wolf. WTF on his undergrad degrees and no advanced ones?” I’m not quite sure how Hal’s undergrad-only degrees in business and textile management became the perfect qualification for running the sprawling HIMSS (although I bet he wears really nice suits), but quite a few people in the industry show little evidence of academic achievement or curiosity. However, my dichotomy is this: while I sometimes share the urge to belittle those whose educational accomplishments seem inferior to my own, I appreciate those who lacked the resources or connections to attend big-name schools (or to graduate college at all) yet made their mark purely on their ability and/or ambition. My classroom knowledge has often proved laughably simplistic as I mounted a feeble argument with someone who toils in the trenches every day. I remember that despite my freshly minted MBA, I struggled with the practical impact of depreciation and PTO balances on our health system IT budget until someone who didn’t have a degree provided stories that helped me keep it straight. Therefore, I will save my wrath for those who lack both education and work achievement, holding firm that Twitter-professed enthusiasm offsets neither.

From Overhead Opener: “Re: this article pitching a specific EHR vendor’s app. Looks like pure shill work.” I agree. I won’t mention specifics since what I’m about to say is unkind. The author is a notoriously self-promoting gasbag (I edited out the other kind of bag that I originally wrote) and the site isn’t exactly known for the purity of its journalistic endeavors. The author’s LinkedIn lists no degrees and no work experience outside of marketing, which is exactly what this crap piece smacks of despite being labeled as some sort of thought leadership. All of the author’s recent articles for that site pitch the products of specific companies under the guise of identifying big-picture trends.

From Green Around the Gills: “Re: Greenway’s DoJ settlement. There are a lot of extremely vindicated former (and current) Greenway / Vitera employees out there this week. Too bad Tee Green just got himself named chairman by Streamline Health. There really isn’t a lot of justice in the world.” I’ve learned from experience that those people at the top tend to stay there. My takeaway: when the captain of the ship sprints for the lifeboats, the rowers had best be considering their escape route, which probably doesn’t include the typical C-level exits of moving to another executive role, taking an investment firm job, or sitting profitably on company boards. Those aren’t rower benefits, but perhaps provide incentive to seek situations that are less dependent on the whimsy of those who are, like everybody else, mostly interested in their own outcomes.

Since I’m complaining about misleading clickbait posing as journalism, here’s my full disclosure: despite my headline, I am “from HIMSS” only mentally, not yet physically (that happens Monday at the last possible minute). This is just my pre-HIMSS19 warm-up stretch before the real exercise begins.

I criticize HIMSS a lot (because they give me ample reason), but let me be clear – they are unbelievably good at running conferences. Their slips won’t be showing this week. Everything will seem to unfold effortlessly, every microscopic detail will form one pixel of the big picture, and you will leave at the end of the week having seen a polished show in which the props, backstage workers, and a year of planning stayed out of the spotlight. Groups are often lured into starting their own conferences because HIMSS and others make it look deceptively easy to draw a satisfied crowd in the absence of a large staff or budget, but it doesn’t work like that.

This week’s Orlando weather is looking good, other than prediction of a slightly bleaker Wednesday that exhibitors will love because it will keep attendees inside.

Many attendees – including Dr. Jayne – aren’t so lucky with their weather at home, as folks are having their flights to Orlando delayed or cancelled. 

818.722.1903

Text me interesting news, rumors, and photos during the conference. It’s a burner, so I’ll likely ignore voice calls and block the inevitable PR spammers. I’ll just be cruising the exhibit hall and convention center hallways looking for examples to share of both good and bad behavior.

Thanks to Dimensional Insight, which celebrated its “Best in KLAS 2019” for business intelligence and analytics by increasing its level of HIStalk sponsorship.

Speaking of that, Lorre is offering a deal to companies that want to sign up as sponsors or upgrade their sponsorship, a reward you get only for having the perseverance and ingenuity to find our tiny, poorly positioned booth buried in the exhibit hall alleys (hint: it’s near the place where guys come out checking their zippers – no outside jokes allowed, please).

Buffalo-based Catholic Health will implement Epic. I think they’ve been on Cerner Soarian for many years.

Also choosing Epic – Saudi Arabia’s King Fahad Medical City. Cerner is usually stronger in that part of the world, but Epic’s go-live at Johns Hopkins Aramco Healthcare a year ago may have established a figurative beachhead.

I’m not too bothered by non-experts running underfoot throughout the exhibit hall snapping selfies and acting important, but charging vendors for in-booth appearances while riding the HIMSS social media ambassador coattails seems inappropriate. However, HIMSS itself rakes in a lot of vendor cash for providing exposure and access in blurring the ethical line, so at least it isn’t being hypocritical in insisting that pay-for-play be ended or even clearly noted. I should run a poll of how many readers have been “influenced” by each “influencer,” although I expect they would implore their Twitter followers to stuff the ballot box to validate their self-imagined importance.

Buzz suggests that ONC may announce its long-delayed information blocking rules this week.

Decisions, brought to you by Definitive Healthcare:

• Kenosha Medical Center (WI) will replace teleradiology from REAL Radiology To Envision Physician Services in 2019.
• Central Peninsula General Hospital (AK) moved from NightShift Radiology to REAL Radiology on February 1.
• Island Hospital (WA) replaced Nightshift Radiology with REAL Radiology on February 1.

Business Insider ponders the $1.8 billion paper valuation of Medicare Advantage insurer Devoted Health, started up by Ed and Todd Park (formerly of Athenahealth) even with zero customers or revenue so far. That must be one fantastic slide deck.

More birth tourism news: a couple from China who paid a company to get them into the US for their baby’s delivery hightails afterward back to China, leaving their hospital bill unpaid and leaving their baby still in NICU because it was born with birth defects. China’s one-baby policy was recently expanded to two and may be eliminated entirely as the country faces economic stagnation, which should reduce some of the barbaric health practices that the law caused.

Morning Headlines 2/8/19

Health Catalyst Secures up to $100 Million with Financing Led By OrbiMed

Health Catalyst secures up to $100 million in a Series F round led by OrbiMed, increasing its total to $392 million.

Leidos, Mayo Clinic to collaborate on scaling transformative innovation to benefit patients

Mayo Clinic and Leidos will build an accelerator that will foster research, development, and commercialization of technologies and therapeutics.

Facebook is about to launch a tool in the US that pings you to donate blood when there are shortages

Facebook will launch a tool that will allow hospitals, blood banks, and the Red Cross to ask for blood donations; and users to receive notifications of shortages in their areas.

News 2/8/19

Top News

Greenway Health will pay $57 million to settle Department of Justice allegations that the company falsified the certification process for Prime Suite EHR and paid kickbacks to customers who recommended its product.

DoJ accused Greenway of falsely obtaining 2014 Edition certification by modifying its software to look as though it used standardized clinical terminology. DoJ also says Greenway failed to correct an error in its calculation of the percentage of patients who were given clinical summaries, allowing Prime Suite users to inappropriately earn EHR incentive payments.

Greenway also entered a five-year HHS OIG Corporate Integrity Agreement, pledging to:

• Hire a third party to review its software quality control
• Notify customers promptly of known software bugs that place patient safety at risk
• Offer free upgrades to the latest version of Prime Suite or provide free data conversion to another EHR upon customer request

HIStalk readers have been reporting red flag rumors for several weeks. Greenway recently recommended that customers file a MIPS hardship exemption because Prime Suite was calculating their measures incorrectly

Reader Comments

From CICIO: “Re: CHIME. In between extended breakfasts with consultants, strategic vendor partnerships lunches, and evening bashes to unwind from the long day, CHIME members can earn up to $2,400 by participating in focus groups while at HIMSS. To acquire that windfall you do need to spend almost 20 hours sequestered in hotel meeting rooms with vendors, so value will be in the eye of the beholder. There should be time to get to the booth of the vendor showcasing the AI powered blockchain bots for patient engagement.” I really dislike the idea of encouraging vendors to buy time with prospects, not to mention the HIMSS practice of segregating CIOs off on their own private conference tracks far from the unwashed so they can charge vendors more for access to them. Any time someone says it’s not the money, it’s the money, even if they do call it honoraria to make it sound less greedy. On the other hand, CIOs are paid plenty well enough that earning just $100 for fidgeting through a 90-minute vendor pitch shouldn’t be attractive. I should get someone to take names of the vendors and CIOs who play this rather seedy game. Imagine a CIO having to explain their attendance to patients of their hospitals who can’t pay their inflated bills.

From Imran of Imuran: “Re: sports spread. Explain again how it isn’t what people think.” Most sports betting in this country involves bookmakers setting a spread as a risk management strategy. It’s not the consensus opinion of sports experts of who will actually win or lose the game and by what margin, but rather the dynamically recalculated number that will attract an equal number of bettors on both sides. The bookmaker doesn’t care about the game, just having enough losing gamblers to cancel out the winners so they can pocket a predictable percentage as vig without risking wild gains or losses. The spread, therefore, reflects the belief of armchair quarterbacks rather than experts, rather like company share prices.

From Groundhog Day: “Re: HIMSS TV. Believe they got the year wrong.” Quite a few readers chuckled at last year’s email that was accidentally and obviously repurposed Thursday by HIMSS Media (you know, the journalism people). Still, I’ll forgive sending the wrong email a lot quicker than the fact that last year’s email called Las Vegas “Vegas,” which I detest since surely even we verbally challenged Americans can spit out three full syllables instead of two.

HIStalk Announcements and Requests

Welcome to new HIStalk Gold Sponsor Oneview Healthcare. The company’s inpatient solution helps patients (education, meal ordering, entertainment, and video chat) and caregivers (rounding, telehealth consultations, screencasting, and service requests) in improving patient experience, clinical outcomes, and caregiver productivity and satisfaction. It offers the Connect mobile app for outpatients, Pathways for managing clinical pathways, and a senior living solution. See them in #450 at HIMSS19. Thanks to Oneview Healthcare for supporting HIStalk.

It seems like only yesterday that I was turning down whiny hospital users who were demanding that part of our underpowered IT budget be used to replace their CRT monitors with the state-of-the-art, $1,500 15” flat panel versions that we approved only for HIM employees (as IT’ers know, employees are always asking for technology they don’t really need for their jobs in seeking a tangible love token of their value, a practice that will send a lot of people to HIMSS19 next week). I noticed a monitor deal I couldn’t pass up this week – a massive 32” Dell for $160. It dwarfs the desk, but it’s pretty great if you regularly open several windows on a single monitor (or if you just like to see really big text).

It’s been too long since I’ve run outdoors and my previous training app hasn’t been updated for years (even though it’s still listed in the app stores of Apple and Android), so I tried to find a “couch to 5K” type program that includes music to get back into shape without hurting myself. I came up blank except for an app developed by NHS England that unfortunately can’t be downloaded outside that country, as enforced by the app stores. However, NHS offers a great solution – a series of podcasts featuring a trainer’s instruction over music that can be downloaded and played on any podcast player. NHS continues to impress me. Can they open a branch here?

I see from a HIMSS email that pre-registered HIMSS19 attendees can pick up badges staring Saturday afternoon at the airport, outside the luggage “carrousels” (interesting spelling).

Speaking of HIMSS19, its speakers are dropping like flies as HHS Secretary Alex Azar finds that he can’t unite with all his fellow champions of health after all.

Here’s my HIMSS guide, which will help you find my sponsors in the exhibit hall’s vast ocean of commercial excess and check out their HIMSS19 activities. Lorre will be in #4085, hoping that you wash up as you leave the adjacent bathroom on the way to shake her hand. No offense to our fellow tiny-boothers, but other than National Decision Support, I’ve never heard of any of them. I might have to reconsider spending the money next year since the return is zero and I have to decide based on how much fun it provides.

I just realized today that I can post the HISsies winners at any time since there’s no HIStalkapalooza that requires fake drama, so here they are.

I won’t run a Weekender on Friday, so we’ll pick it back up here with a Saturday or Sunday post if I have anything interesting, then we begin the snarky booth commentary and skeptical review of mostly pointless announcements that vendors save up for the conference for some reason. Safe travels to everyone going to HIMSS19. 

Webinars

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

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

Acquisitions, Funding, Business, and Stock

Trinity Health will centralize patient billing in a move that will force 1,650 employees to change jobs or relocate. The 22-state health system will also transfer 450 IT employees who support legacy applications to Leidos as it moves to Epic.

Orion Health Group founder Ian McCrae plans to take the company private once again after four years on the New Zealand and Australian stock exchanges. He and several other colleagues will form a holding company to buy up the necessary shares to take controlling interest. The company’s stock has fallen since selling off its Rhapsody and population health units to private equity firm Hg last year.

Health Catalyst secures up to $100 million in a Series F round led by OrbiMed, increasing its total to $392 million. The new funding gives the company a paper valuation of $1 billion.

From the Cerner earnings call:

• The company will announce a “refined operating model” at HIMSS19.
• As usual, it was lower-than-expected low-margin technology resale that caused the revenue miss. I don’t really understand why the company can’t fix this since it bites them every quarter. Maybe they should create a separate company just for technology resale, or perhaps get out of that business entirely if it’s as low-margin as they always say.
• The company expects that “less than three percent” of its employees will leave under its voluntary separation program.
• The company added just one ITWorks client in the quarter, increasing its total to 32.
• ITWorks and RevWorks are single-digit margin contracts.
• The company formed a separate group to go after big health systems that are buying hospitals and practices and thus want to thin their EHR herd.
• Cerner will run “kind of an incubator concept” to get ideas to market faster.
• The EHR replacement market is declining.
• The company announced that it will start paying a dividend for the first time, saying that 80 percent of comparable S&P companies do it and more investors will buy shares if they earn dividends.
• Executive bonuses will be changed from just hitting EPS targets to also include revenue and free cash flow.
• The company expects the VA business to ramp up linearly from $250 million in annual revenue this year to $1 billion in four years.
• Cerner will look at acquisitions to round out its HealtheIntent platform.

People

Cambridge Health Alliance (MA) promotes Brian Herrick, MD to CIO.

MedAptus appoints Susan Sliski, DNP, RN (Harvard Pilgrim Health Care) as CNO.

Jay Colfer (Acorn Credentialing Solutions) returns to The SSI Group as COO.

Kevin Weinstein (Analyte Health) joins Apervita as chief growth officer.

Sales

• HIE NY Care Information Gateway selects the InterSystems HealthShare Patient Index.
• Children’s of Alabama selects medication safety and stewardship technology from Children’s Hospital of Philadelphia spinoff Bainbridge Health.
• Billings Clinic (MT) will roll out Health Catalyst’s Data Operating System as part of its population health initiatives.
• Franciscan Missionaries of Our Lady Health System (LA) contracts with Nordic for managed services for its 18 Epic applications.
• California-based health data network Manifest MedEx will implement HealthShare patient care record software from InterSystems, and de-duplication medical records software from Verato. 
• Atrium Health (NC) will use Koan Health’s population health analytics and consulting services.
• Reliance eHealth Collaborative, an HIE with members in Oregon and Washington, selects Zen Healthcare IT’s Gemini integration software.

Announcements and Implementations

MDLive announces GA of MDLive Go, chatbot-managed virtual visit capability that the company guarantees will return a physician-reviewed diagnosis and electronic prescription to the patient within two hours.

Mayo Clinic and Leidos will build an accelerator at the health system’s campus in Jacksonville, FL that will foster research, development, and commercialization of technologies and therapeutics.

Manifest MedEx rolls out Audacious Inquiry’s real-time Encounter Notification Service.

A new KLAS report on home health EHRs finds that while Homecare Homebase and Epic lead in mindshare, Thornberry (for small agencies) and Meditech (for agencies affiliated with Meditech-using health systems) top the satisfaction list.

Government and Politics

After learning that the VA’s EHR project could balloon beyond its estimated $16 billion budget, lawmakers call for an interagency leader to oversee the EHR overhaul and integration efforts of the VA and DoD. The Interagency Program Office has assembled a task force to determine how to move forward with accountability for both projects and will release its findings by the end of the month.

Other

Facebook will launch a tool that will allow hospitals, blood banks, and the Red Cross to ask for blood donations. Users who opt in will receive notifications of blood shortages in their areas. The company launched a similar feature in Brazil, Bangladesh, Pakistan, and India, where users are allowed to approach one another with donation requests – a capability that has led to several shady black market blood deals.

An NHS report determines that aging IT systems have become detrimental to the health service’s 11 screening programs, which are maintained by a legacy database that depends upon a variety of IT systems that are between 10 and 30 years old. NHS came under fire last year for an IT oversight in its breast screening program that resulted in a failure to encourage 122,000 women to obtain screenings over a nine-year period, likely contributing to the early deaths of 270 women.

Sponsor Updates

• Formativ Health’s enterprise-wide scheduling solution, DASH, is now available on the Salesforce Appexchange.
• With the help of Meditech’s integrated supply chain functionality, East Tennessee Children’s Hospital will save $1.3 million in costs this year.
• Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the Society for Maternal *Fetal Medicine February 11-16 in Las Vegas.
• PatientBond identifies five psychographic segments through analysis of its fifth national market research study of healthcare consumers.
• VentureFizz profiles PatientPing and its new Boston headquarters.
• CB Insights names Qventus as one of 2019’s 100 most innovative AI startups.
• Sansoro Health’s 4×4 Health Podcast convenes experts to discuss health IT predictions for 2019.
• DrFirst and Meditech partner to give EHR users the ability to access California’s Cures 2.0 PDMP.
• SymphonyRM will sponsor and present at the Healthcare Marketing & Physician Strategies Summit May 21-23 in Chicago.
• TriNetX benefits from Snowflake’s data warehouse built for the cloud.
• Spectralink certifies Imprivata’s Mobile Device Access for its Versity enterprise smartphone.
• HGP publishes its January health IT insights.
• Nuance rolls out its virtual assistant technology to Dragon Medical One users.
• Holy Redeemer Health System expands its partnership with Prepared Health’s post-acute management EnTouch Network.
• Meditech adds an Opioid Stewardship Toolkit to its Expanse EHR.
• PCare integrates Mobile Heartbeat’s MH-CURE clinical communications and collaboration technology with its interactive bedside patient system.
• Collective Medical names Allison Barlow (Allison Barlow HR Consulting) head of people.
• Lightbeam Health Solutions releases Version 3.0 of its population health management software.

Blog Posts

• 6 Strategies for Growing Your Panel, Boosting Loyalty (Formativ Health)
• Quality Management is Key to Optimizing the Business of Healthcare (Hayes Management Consulting)
• Evangelical Hospital improves Physician and Healthcare Worker User Experience Related to Citrix, Allscripts, and Business Applications with Goliath Performance Monitor for XenApp & XenDesktop 6.5 (Goliath Technologies)
• Charlie by the Numbers: 2018 (Healthfinch)
• Extend healthcare interoperability to documents (Hyland)
• A proposed solution to the challenges of patient matching, in response to the GAO report (Imprivata)
• Uniting Healthcare for a Bright New Data-Driven Future at HIMSS19 (InterSystems)
• A Series on Chatbots: Using Chatbots to Deliver Self-Service Access to Care (Kyruus)
• Why Situational Awareness is Critical for Hospitals and Healthcare Teams (LiveProcess)
• The History of the Fax Machine (Vyne Medical)
• When Disaster Strikes (Netsmart)
• The Healthcare Financial Experience Matters When Patients Choose a Provider (Patientco)
• Presenting the New PerfectServe Family (PerfectServe)
• You Are Not Alone – The DNFB Challenge (ROI Healthcare Solutions)
• What is a Health Information System? (Sansoro Health)
• 5 things for hospitals to look for in an integrated communication platform. (Voalte)
• Founder Letter: Guts and Data – Why You Need Both to Make Better Business Decisions (WebPT)
• Simplify Nurses’ Lives: 5 Ways to Streamline Nursing Workflows (Spok)
• HIMSS19 – Champions of Healthcare Unite (Optimum Healthcare IT)

Contacts

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

HIStalk Interviews Nora Lissy, Director of Healthcare, Dimensional Insight

Nora Lissy, RN, MBA is director of healthcare for Dimensional Insight of Burlington, MA.

Tell me about yourself and the company.

I’ve been a registered nurse for over 30 years. I started out as a clinician, with the majority of my time spent in the emergency room. I then got interested in hospital operations and working with the operational folks and leadership. As healthcare evolved, I evolved with it and got into analytics, understanding numbers and outcomes. I used Dimensional Insight’s system in three different organizations in three different roles and found that I loved what I was able to do with it. I came on board with the company in 2013. I help organizations understand their information, their data, and to get the right data to the right people so that they can act upon it.

Do health systems underuse nurses and other clinicians in using data to make decisions?

Yes. Our president likes to talk about the “data gene,” which some people have and some don’t. Every organization definitely has pearls — not only nurses, but lab and rad techs who actually understand the global picture. There’s always one person in every department where everybody knows that if you need an answer, you go to them. Those people are usually data-driven to begin with, just naturally.They do get underutilized, or shall I say mis-utilized. They have their regular job, and then when they have a chance, we’ll  have them do reports and stuff like that for us. But some very strong care providers are also analytical and would be helpful in pushing forward the analytics process.

BI and analytics tools triggered a buying frenzy. What was the result?

Like you said, it was a frenzy. Everyone felt like they had to get it. Many people are influenced by pretty pictures, or they go down a path and they’ve got someone who’s caught their interest.

What I’ve noticed in working with customers and in the literature is that sometimes customers take on too much. BI is a journey. When an organization tries to do 15 projects at the same time, it’s inevitable that none of them will get finished. A project gets started. Then it’s like, OK, this is cool, we can use that same tactic over here. They start big project B before finishing big project A, with the same people working on both. Now you’ve pulled them in two different directions and nothing gets finished.

The successful ones that I’ve seen have stayed within the guidelines of their strategic plan. Some people feel it takes too long to get that done, but you need to have a plan, a path you’re going down. Not just say, “We’ve got BI and we can do everything.” Every tool can, but you have take the steps and do it and close the loop before you go to the next one.

I’ve worked in organizations that had four or five BI tools, so they had four or five reporting teams. They still had the same problem — my BI tool says this, your BI tool says that. They never really got together and said, what do we say as an organization?

Does BI get the credit way down the line when the decisions it influenced finally produces positive, measurable results?

I think so. What I’ve seen is that there’s a big fervor at first. Everybody gets it, they see stuff, and they go wow.  But a BI install suddenly provides access to a lot of information. That’s the other “aha” that gets you. We have all this data and we don’t know what to do with it. We had none, now we have too much. How do we core it down to what’s going to be meaningful to us?

That’s where I think the BI tool can come into play, to help us focus on what we need to focus on because we have so much out there. Healthcare is just loaded with data, and more comes in every day. We want to use these complex business rules and these algorithms, but we could have obtained the same answer if we had just used a quicker approach.

Health systems have all this new data, multiple teams, and a mix of acquired health systems and practices using different systems and different terminologies, plus trying to decide whether to centralize the analytics function. Do these factors make it tougher to do analytics right?

Absolutely. It’s an absolute challenge, everything you just said. You might have a hospital organization that has been using an embedded BI tool for years. Then all of a sudden they acquire, or they’ve been acquired. They decide that they don’t want A, or they really want B. Then you have to go through a conversion of what they’ve done. Aside from just the acquisition process, you have to work on linking and cross-walking different EMRs or even the same EMR implemented with different approaches.

I’ve worked in two organizations that had four or five reporting teams. We were chasing our tails. Who do you believe? Who has the loudest voice this month or with this leadership? The people who really need the BI, the operational and front-line people, throw up their hands and say, “I don’t even know what I’m getting any more, so I don’t even care.” You look at who is using the BI and there’s little utilization. The people we’re trying to help don’t even get all the information they need because there are too many competing answers.

I find that the best success is when you bring in not only stakeholders, which is your leadership, but also the people that you’re expecting this data to help. They need to be a part of the process. You can’t just put this together and say, here you go, you’re on your own, take it and run with it. You have to bring them into the process so that they understand the value they’re getting. It’s one thing bringing a BI tool in, but what’s the value I’m going to get from it? Is it just one more report that I have to go through, or will it give me value and make my day better?

My experience is that the people who use analytics the most are department managers and directors instead of C-level executives who don’t even have computers on their desk. Should the C-suite be involved or pay more attention to what data is available and how it’s being used?

I would say that over the last two or three years, I’m seeing more and more C-suite involvement. I have a couple of customers that if the information isn’t available when the CEO comes to work, he or she is calling and saying, where are my numbers? So I am seeing more senior suite involvement.

There are two types of BI – the “how are we doing” numbers for the C suite and then the operational things, which are near and dear to my heart. The things that I had to do as a clinician or as a manager of clinicians. The things that I needed to arm them with. We can give that to them. Before, we would have to go through 15 reports to try to figure it out. It’s making their life easier.

There are so many rules and regulations coming out in healthcare. I have to remember to dot my I and cross my T. Maybe if I had a queue list to tell me that these are the three things I have to worry about, that would make my life easier.

It’s like anything else you do in life. It’s a daunting task if you have a room full of garbage and you have to decide where to start. You have to pick at it and say, I know I’m going to keep the stuff over there. That’s one fewer thing I have to worry about. From a BI perspective on the operational side, they see their page with their three things and they’re all green and they’re good. If one is red, they have to go focus on that. It’s helping them get through their day-to-day operational side.

We haven’t quite gotten the value from BI because healthcare and the operational side of things are complex. When I say operational, I’m thinking about your clinical folks. Was the assessment done in 24 hours? When was the last time case management saw these patients? There are standing operating procedures that are in place that if something goes wrong, we might stop and take a look at it. But generally speaking, it just goes along day by day until the holes in the Swiss cheese line up and you realize you should have been seeing this. But life’s busy in the hospital. We need to provide actionable information to the day-to-day providers so they can prevent the harm.

What new data elements are available for that alerting and trending analysis and how are they being used to impact individual patient care instead of just giving executives a stoplight report?

It’s more the capacity of how BI itself is evolving and how data is being pulled. The old world of BI was SQL queries. Now you’re getting into columnar databases that allow for a faster retrieval and for more data to be viewed at one time. That technology allows you to cipher through millions of rows of data. 

Think about it from a lab perspective. When I was at a healthcare organization in North Carolina, I worked with a clinical pharmacist to identify the five or six high-risk drugs that they wanted to have insight into. Then we got a tickler every time the lab values changed. We added the information to their hourly census, so that when the lab values came in and the patient was on this particular medication, they would see the trend before it got to a critical point. They would see that it’s been rising for the last two days by 0.2 percent each time, so we had better keep an eye on it.

It becomes more useful with the ability to visualize and manage more data at one time. I have another organization whose pharmacists use it to look at critical medications. They bring in over 40 million rows of data to use their work queues to improve their movement from IV antibiotics to PO antibiotics so they can lower cost, improve patient care, and hopefully get the patients out of the hospital sooner than later.

The BI approach uses technology to highlight exceptions to the defined desired values, while the machine language approach would be to throw a lot of data at the system to identify new problems or opportunities that humans have missed. How do those approaches co-exist?

Machine learning has a way to go, in my opinion. Someone still has to feed that machine some kind of algorithm, and it has to know what it’s looking for. Some are more sophisticated and can do patterning and I think that will become invaluable over time. It’s not mature yet, where physicians believe that it shows them what they expect. But it will be an invaluable asset as it continues to grow and as we continue to understand how all the data fits together.

Why have we stopped hearing the most overused term on the planet, “big data?”

Because everything is big data. It was just a catch phrase. I don’t know where it started, and then all of a sudden, it just went away and no one is even saying it any more. This may sound ignorant, but it’s the same thing when we talk about AI and machine learning. What do we mean by AI and machine learning? What concept do people have of that? What are the developer’s concepts? What do its potential users think? It raises the same kind of question as the term big data.

Do you have any final thoughts?

I really enjoy what I do now because I get to work within my passion in using analytics to help providers — who need it more than anybody else – and to help the operational folks with their daily operational process that is very difficult. There’s a lot of expectation that the people on the front line will get things done, remember all these rules, and do all these things. As we move forward in analytics, we will hopefully be able to make that life easier for them and help them focus on getting back to taking care of the patient.

EPtalk by Dr. Jayne 2/7/19

Physicians are always up in arms about quality reporting, having been burned by payer, federal, and institutional quality programs. The American Academy of Family Physicians released a position paper recently that hopes to help influence the development and use of quality measures in physician payment initiatives. The Academy plans to use the principles outlined in the paper in its discussions with payers, health plans, and healthcare IT developers.

The first principle involves differentiating between quality measures and performance measures, with a goal of using the former for internal clinical improvement while reserving the latter for comparative data and resource allocation efforts. AAFP supports the use of performance measures, not to drive penalties, but to show where investment should be made to improve access and equity in healthcare.

The second principle addresses integration of quality measures into an overall methodology, allowing for “a safe space to allow honest assessment of care without fear of punishment and without pressure to increase revenue or produce bonus payments.”

The third principle outlines the need for a single set of universal performance measures that “focus on outcomes that matter most to patients and that have the greatest overall impact on better health of the population, better healthcare, and lower costs.” A secondary goal is limiting the measures that are included in value-based payment programs since “giving in to the temptation to measure everything that can be measured drives up cost, adds to administrative burden, contributes to professional dissatisfaction and burnout, encourages siloed care, and undermines professional autonomy.” It goes on to say the standard set of measures should be used across all payers, programs, and populations.

Principle Four addresses the application of performance measures at the system level, with risk adjustment as needed for demographics, case severity, and social determinants of health.

Principle Five addresses primary care features such as access, coordination, patient and family engagement, and care management.

The sixth principle calls for health IT redesign, encourage automated data collection and quality measurement while eliminating the need for self-reporting. I’m not thrilled that AAFP left this one at the bottom of the list as it is so critical to the success of primary care moving forward.

I’m working with a couple of vendors that are taking existing EHR data and using it in novel ways at the point of care, focusing on making life easy for clinicians and improving outcomes for patients. It’s been refreshing to see their enthusiasm, but the rubber will meet the road as they begin integrating with EHRs since their products essentially replace clunky or non-existent EHR features that clinicians need and want. The future of healthcare IT is bright and there are many challenges to come, a good thing since unless I win the PowerBall, I’ll be here for a while.

My curiosity was piqued by a pre-HIMSS email for Edgility, a vendor that claims to be “bringing situational awareness to healthcare.” It’s always interesting when a phrase can be used in multiple contexts, and seeing “situational awareness” my mind went directly to my most recent self-defense class. If you’ve ever spent time with military or law enforcement people, you’ll know what I mean about situational awareness. You will have had to sit where you don’t want to sit so that someone else can have their back to the wall.

For those of you who might not be preppers, here’s a quick summary of how others think of the phrase. It’s amazing how the 10 tips provided in the article directly apply to what we do in healthcare IT: learn to predict events; identify elements around you; trust your feelings; limit situational overload; avoid complacency; be aware of time; begin to evaluate and understand situations; actively prevent fatigue; continually assess the situation; and monitor performance of others. Even the ad for the bug-out bag applies, knowing how hospital staffers coped with working during recent natural disasters.

One of the sessions that caught my eye for HIMSS is one covering a Centers for Disease Control project that is digitizing infectious disease guidelines to work within EHRs. The team’s goal is to create digital algorithms and guidelines that could be easily consumed by various EHR platforms, shortening the time that it takes to implement that kind of decision support within the EHR. In our global environment, there’s a need to stay vigilant about emerging diseases. My dermatologist’s office still has a sign up advising patients to let staff know if they’ve traveled from West Africa, even through it’s been years since Ebola was in the US.

It’s also important to be able to use guidelines for diseases that we see more than we should, such as the current measles outbreak. If this topic floats your boat, you can join me on Tuesday the 12th at 3 p.m. in room W311E.

Neurodiagnostics vendor Oculogica, Inc. recently received FDA approval for its EyeBOX concussion detection tool. It can be used on patients from five to 67 years old and employs eye-tracking technology to identify patients with suspected concussion. I regularly see concussions in clinic and not just from football any more. Some of the worst I’ve seen have been from water polo and field hockey. The EyeBOX solution doesn’t require documentation of a testing baseline for athletes and isn’t easily gamed by someone who is eager to return to play, unlike some of the alternatives.

I’m engaged in a health exchange project that happens to include a client using the Greenway Health EHR, so you can bet there was plenty of buzz today about the payment the company will be making to settle recent False Claims Act allegations. One of the key allegations was Greenway’s modification of the software that is used in the certification testing so that it appeared that Prime Suite had certain capabilities. News flash, folks — it’s not just Greenway. I suspect there are plenty of other vendors out there who cooked their software a bit to either pass certification more easily. I’ve seen functionality that was included for testing that was later implemented in a materially different way for the rollout to actual clients.

The only way to truly protect consumers is to require testing on off-the-shelf products by independent testers, not a dream-team of vendor employees who know how to grease their way through the defects. This is similar to what we saw with Volkswagen sneakily modifying test builds for their diesel vehicles. I’ve already heard other vendors bad-mouthing Greenway and all I’ll say is that people in glass houses shouldn’t throw stones.

I’ll be headed to sunny Orlando soon, so this will be my last post until HIMSS starts on Monday. Watch this space for all the news, rumors, party updates, and great shoes.

Email Dr. Jayne.

Morning Headlines 2/7/19

Electronic Health Records Vendor to Pay $57.25 Million to Settle False Claims Act Allegations

Greenway Health will pay $57 million to settle DoJ allegations that include misrepresenting the capabilities of its software during the certification process and doling out kickbacks to customers who recommended its products.

Alphabet’s Verily is building a high-tech rehab campus to combat opioid addiction

Verily, Kettering Health Network, and Premier Health will develop a campus of addiction recovery services in Dayton, OH that will use technology to analyze and measure the effectiveness of interventions.

Trinity Health Announces Technology Changes and Revenue Initiatives Expected to Improve Patient Experiences

Trinity Health will offer 450 IT employees positions with its managed services partner, Leidos, as part of a multi-year restructuring effort that coincides with its transition to Epic.

Orion Health’s McCrae to take firm private – again

Orion Health Group founder Ian McCrae hopes to take the company private after a disappointing four years as a public business.

HISsies 2019

HIStalk Interviews Terry Edwards, CEO, PerfectServe

Terry Edwards is founder, president, and CEO of PerfectServe of Knoxville, TN.

Tell me about yourself and the company.

I started PerfectServe in the late 1990s after spending a few years in a technology company called Voice-Tel, which was one of the early pioneers in interactive voice messaging. At that company, I saw the need to improve communications in healthcare and later started PerfectServe. The company started in managing communications in the physician’s office, extending later into managing nurse-to-physician communication in the hospital and acute care environment while still doing the physician work. We evolved that over the last several years into one of the most comprehensive communication platforms in the industry.

How will the mid-January acquisition of Telmediq, the top-rated secure communications vendor, change your business?

PerfectServe was acquired by the Los Angeles private equity firm K1 Investment Management in the middle of last year. That was part of the plan to get our early venture investors out. They had been invested in PerfectServe for a long time and stood behind the company. We were able to give them a successful exit.

With that, we were also able to clean up PerfectServe’s balance sheet and to gain the backing we needed to execute on a broader strategy. As you and I have talked about in the past, the industry in which we operate is that outside the realm of the EMR, the technologies are fragmented. We started to see this just in the fragmentation of communications alone. But in addition, other technologies that are adjacent to communications could be part of a more comprehensive platform.

We surveyed the landscape and saw the opportunity to consolidate some of the stronger players within our category. Telmediq was at the top of that list. It had capabilities that we did not have, such as in the contact center and call center space as well as in nursing mobility. We thought those would be valuable to our customers. While there’s overlap in what both companies do, Telmediq was doing some things better than PerfectServe, and PerfectServe was doing some things better than Telmediq. By bringing these two together, we believe we’ve created the leading communications platform in the marketplace.

How important is it for a CEO to work with investors who can help take the company to the next level or help it clarify its acquisition and positioning strategies?

K1 is a growth investor. There are different kinds of private equity firms and different business models. Some will find slower growth opportunities with companies that might be growing five or 10 percent a year, then put two of them together and then take out costs and try to drive synergy.

K1 is a growth company where they are looking to invest. They are about building leaders in the category. As they evaluated PerfectServe, one of the opportunities was that PerfectServe could be the cornerstone of a much larger and broader care team collaboration product offering strategy. That led to the opportunity to acquire Telmediq.

We just announced two other acquisitions. Lightning Bolt Solutions, which is in the physician scheduling space, and CareWire in the patient communications space. Our broader strategy is to build the care team collaboration platform of the future. We will do this through both acquisition — and integration of the acquisitions — as well as organic development. That takes capital to do well, which is why we have K1 at the table with us.

Was the death of pagers greatly exaggerated?

[laughs] They are dying a slow death, but there’s a long tail.

Consumers seem to be using phones more often for texting more than for making phone calls or sending email, and now they are using speech recognition to drive that messaging. How is that  impacting healthcare communication?

I’ve been amazed to watch the adoption of texting as a mode of communication. When we started PerfectServe, everything was voice driven. In fact, the first version of the PerfectServe platform was purely an interactive voice response platform. All the communications were voice driven and interacting with the keypad.

We first entered the acute space in 2005. Due to the nature of the platform, 100 percent of the communications we were processing were over the phone, either as a live call or sending a page or text message. The text messages could be as an alphanumeric page or SMS and they were all system generated.

We later introduced our web interface and then our mobile interface. With mobile came texting. We started to see texting rise.

About 18 months ago, we introduced a new user object so that nurses could authenticate in the same way as our physicians. With that, we were able to facilitate bidirectional communication. A nurse can send a text to a doctor via the secure platform, then the doctor can reply. In our newest hospital environments, 90-plus percent of all the communication that’s running through the platform is text, and it is secure text, which has been fascinating to see. It’s convenient and that’s the benefit.

What is being done to make communications part of the overall workflow?

Gartner has classified us in the category of clinical communication and collaboration, or CC&C. They gave it that name to help communicate to hospital buyers that communication is more than just secure texting. Secure texting is a component of a broader communication strategy.

But as we’re looking at this — and I think it’s consistent with how Gartner is looking at this – the clinical communication platform is a core component or pillar of a broader care team collaboration platform. It needs to encompass the communication modalities of secure texting, paging, SMS messaging, email notifications, and voice calling, whether it’s a cellular, voice over IP, or landline. You have to have this omni-channel communications component.

The key to PerfectServe since Day One has been our workflow capabilities. We are automating a communication workflow to make sure that we can connect the initiator – a nurse or a doctor or some other caregiver — to the person they need to reach, who can then take action at that moment in time. Workflow is a component of this.

As you think about workflow, there’s not only the algorithms around routing, but also call schedules. PerfectServe as well as Telmediq built call schedules into our platforms, but they were limited to the schedules specific to a communication workflow. Medical groups, for example, have scheduling needs that are broader than that, that go across the whole workforce. That is where Lightning Bolt comes into play.

These adjacent technologies move beyond communications to staff scheduling, referral management, rounding, and integration into other technologies like alarms, alert systems, nurse call, and interactive patient care. Our vision is to build the most comprehensive care team collaboration platform, either by building or acquiring technologies that make sense to be a part of it, and then integrating with those that are adjacent but outside the domain, such as nurse call.

How have the communications needs of health systems changed as they acquire hospitals and practices?

I don’t think they are changing, but the expansion is enabling them to put in stronger governance structures to drive higher levels of standardization. One of our clients, Advocate Health Care in Chicago, has been a model in terms of saying, these are the parameters upon which we’re going to communicate with you. We’re going to have these minimum standards around fail-safe notification processes and escalation and things like that. This starts to move the organization away from letting doctors do it however they want, which might be might be efficient for them but not for nurses or colleagues who need to reach them.

What do you as a CEO do during the HIMSS conference?

[laughs] It’s usually a pretty packed schedule. I will spend a little bit of time in our booth, and that’s unstructured. But for the most part, I’ve got meetings scheduled, a mix of customer meetings, new prospect meetings, analyst meetings, and sometimes meetings with folks in the financial community. It’s usually a pretty intense time, one of those events that I look forward to, but that I also hope to never attend again.

Do you have any final thoughts?

I’m excited about where PerfectServe is. Not just for me personally or our company, but for our customers. I’ve been in this space for a long time and I’ve seen a lot of things. There’s this bigger vision that I started to see about three or four years ago and it is here now. PerfectServe and our customers have the opportunity to deliver even greater value than I envisioned. I’m excited about that and excited about the future.

Morning Headlines 2/6/19

Cerner Reports Fourth Quarter and Full Year 2018 Results and Announces Plan to Initiate Quarterly Cash Dividend

Cerner reports Q4 results: revenue up 4 percent, adjusted EPS $0.63 vs., $0.58, meeting earnings expectations but falling short on revenue.

CommonWell Health Alliance Launches CommonWell Connector™Program

CommonWell announces a Connector program in which health IT vendors can connect to its services through a CommonWell integration member without joining CommonWell themselves.

VA’s Health Record Overhaul Could Get Even More Expensive, Officials Say

After learning that the VA’s EHR project could balloon beyond its estimated $16 billion, lawmakers call for a much needed interagency leader to oversee the EHR overhaul and integration efforts of the VA and DoD.

Design and build digital services for the NHS

NHS Digital publishes its front-end code in GitHub to help third parties build mockups, prototypes, and working applications that connect to NHS’s websites and services.

PerfectServe Acquires Lightning Bolt and CareWire, Reinforces Vision of Care Team Collaboration Platform

PerfectServe acquires scheduling software vendor Lightning Bolt and patient engagement company CareWire.

News 2/6/19

Top News

Cerner reports Q4 results: revenue up 4 percent, adjusted EPS $0.63 vs., $0.58, meeting earnings expectations but falling short on revenue.

The company announced plans to start paying a quarterly dividend of $0.15 in Q3 2019.

Also in Cerner news, the company will lay off 129 employees at its Augusta, GA office on March 31, according to WARN Act filings. I assume that’s at Augusta University Health, which I believe outsourced IT to Cerner a few years back but seems to be using at least some Epic now.

Reader Comments

From Slack MF: “Re: Slack. Looks like it’s getting into healthcare.” The CNBC story suggesting that Slack will target the provider market for information sharing is is a stretch, based on the collaboration technology vendor’s security page being updated to say that its product is HIPAA compliant. It’s good practice for general tech vendors, especially those like Slack who are about to IPO, to make sure they meet HIPAA business associate requirements, but that doesn’t mean they will go after that (or any) end user market specifically. Slack is like Salesforce in offering the core technology and leaving most of the industry-specific content to third-party app developers, so I would expect its new HIPAA status to create interest among vendors to use its API to develop new healthcare tools, such as patient messaging and engagement. I wouldn’t expect Slack to suddenly delve into a specific healthcare product and sell it directly, especially as it tries to optimize its first few quarterly reports. A lot of time and energy is being wasted speculating on whether or how Amazon, Google, or other tech giants will invade healthcare instead of just waiting to see what they announce. Meanwhile, if you’re a health IT vendor dealing with PHI and are looking for a pivot or expansion area while riding some big coattails, give Slack’s API specs a look.

From Amish Avenger: “Re: ICD-10. It’s interesting that people can submit ideas for new terms.” An expert says CDC is overwhelmed and thus way behind in reviewing code requests for newly discovered rare diseases, with the ICD-10 codes being important for quantifying each condition’s prevalence and for performing research. The article also notes that ICD-11 is scheduled to take effect on January 1, 2022.

From Talking Dead: “Re: broadcasting from HIMSS19. Who is consuming all of those podcasts, fake TV shows, and audio and video interviews that clog up the exhibit hall aisles?” No one. It’s just a vanity project for the people who produce them. Just because someone lugs video gear around the exhibit hall or perches in front of the lights answering questions doesn’t mean anyone else cares. I recall few times that I’ve even glanced at those videos and no times that I missed anything when I didn’t. I notice that some questionable sites are taking vendor payoffs to do their interviews and gabfests directly in their booths, which should immediately evaporate whatever credibility they had in the first place (think Fyre Festival, and I’m resisting hard saying FHIR Festival).

HIStalk Announcements and Requests

Expectations were appropriately low for Super Bowl halftime performer Maroon 5 — which has racked up a puzzlingly long yet entirely undistinguished career peddling corporately-crafted drivel like “Moves Like Jagger” — but the bland – er, band – managed to underwhelm anyway. The dull show, which bisected a dull game, sent America to console itself in guacamole and wings. Here’s my too-late, Georgia-focused alternative of some real music: get REM to reunite, maybe with the B52s backing (as long as they don’t play “Shiny Happy People”). My set list: (1) “Texarkana;” (2) “What’s The Frequency, Kenneth?;” (3) “Losing My Religion;” (4) “Man On the Moon;” and (5) the obvious and appropriate closing number, “It’s The End Of The World As We Know It (And I Feel Fine).”

Dann, who started the HIStalk Fan Club on LinkedIn forever ago, tells me it has over 3,700 members. I don’t look at it unless someone’s asking me for a favor, in which case seeing that logo on their profile makes me a lot more likely to help.

Webinars

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

Acquisitions, Funding, Business, and Stock

Premier Inc. announces Q2 results: revenue up 3 percent, adjusted EPS $0.66 vs. $0.50, beating expectations for both. COO Mike Alkire said in the earnings call that the November acquisition of Stanson Health was highly strategic and its decision support product is selling well, although that business’s revenue is only in the $3-5 million range.

Sales

• Four hospitals in Europe choose Hyland Healthcare for enterprise imaging.

People

Healthwise hires Daniel Meltzer, MD, MPH (Blue Cross of Idaho) as chief medical officer.

Announcements and Implementations

A new KLAS report on EHR/PM systems for practices of 10 or fewer doctors finds that they’re looking for products based on functionality, usability, and support – they don’t care much about about outcomes or technology. NextGen Healthcare, CureMD, and Aprima were the vendors most aligned with those product attributes, while the lower user satisfaction with CareCloud, Cerner, and EMDs may be due to their technology focus.

MedStar Health’s National Center for Human Factors in Healthcare and the American Medical Association launch “See What We Mean,” a campaign for EHR safety and usability. It asks people to sign a letter asking Congress to push ONC to implement the EHR Reporting Program that was mandated in 2016 by the 21st Century Cures Act.

Baylor Scott & White Health and Memorial Hermann end their merger discussions.

In England, NHS Digital publishes its front-end code in GitHub to help third parties build mockups, prototypes, and working applications that connect to NHS’s websites and services.

CommonWell announces a Connector program in which health IT vendors can connect to its services through a CommonWell integration member without joining CommonWell themselves.

“A Machine Intelligence Primer for Clinicians” by Alexander Scarlat, MD is now available on Amazon. He wrote the 12-part series on HIStalk and he clearly knows his stuff from both a machine learning and MD perspective.

Other

The US Patent Office publishes a 2017 Google patent application for AI-powered software that would use aggregated EHR information collected via FHIR to predict and summarize medical events, sending its findings to individual providers as a patient timeline. The focus seems to be on mining valuable information that would otherwise be lost in the EHR clutter, including a quote, “A wealth information creates a poverty of attention.” I can’t figure out how some sites concluded from the patent application that Google is developing an EHR.

A study published in Health Affairs finds that hospital prices – not those of physicians who bill for services they provide in hospitals – are responsible for driving up healthcare costs, according to the first research to distinguish between the two. Hospital inpatient prices increased 42 percent over eight years. The data came from the Health Care Cost Institute, which made headlines recently when UnitedHealthcare said that it will no longer share its claims information with the organization.

We’ll need a new ICD-10 code for the time doctors spend debunking the dopey and sometimes dangerous health ideas of Gwyneth Paltrow’s Goop, which has bagged a docuseries deal with Netflix from which GP will dispense the “more strategic, bigger stories we want to tell,” presumably to gullible women who trust that Gwyneth’s “lifestyle brand” products (vitamins, sex toys, cookbooks) will help them lead the full lives that have otherwise escaped them. We’re in the public health danger zone when people trust obviously underqualified “experts” or their own “feelings” to decide which parts of proven science they choose to ignore.

Doh! The Super Bowl featured a male Nipplegate, so now we have a HIPPAgate.

A former nurse of Vanderbilt University Medical Center is indicted for making a medical error in which she injected an elderly patient with the paralyzing agent vecuronium (Norcuron) instead of the ordered sedative midazolam (Versed) that was intended to to overcome the patient’s claustrophobia before having a PET scan. The nurse withdrew the wrong medication from the automated dispensing cabinet after typing in the letters VE for versed, then after not finding the drug’s name, overriding the system to gain access to the vecuronium. The patient was left alone in the scanner for up to 30 minutes where she experienced cardiac arrest and brain death, then died the next day after life support was turned off. The Tennessee Bureau of Investigation charged the nurse with reckless homicide and impaired adult abuse after Vanderbilt fired her. So much for a non-punitive culture that encourages a review of errors to help prevent more instead of coming down hard on a professional who makes a mistake (which is all of them). Having reviewed thousands of medical error reports in hospitals over the years, I guarantee that the “Swiss cheese effect” was in place, where the nurse’s carelessness wasn’t the only procedural irregularity that day. For example, the CMS investigation contains these big red flags that go beyond an incompetent nurse going rogue:

• Pharmacy had not approved the nurse’s dispensing cabinet override.
• The nurse didn’t document the administration in the EHR after asking the charge nurse how to do it, being told that “the new system would capture it on the MAR.”
• I assume barcode verification was not used since it should have prevented the error, perhaps because the medication was administered in radiology rather than in the usual patient care areas.
• The nurse was assigned as a “help-all,” for which no specific job description exists.
• She was talking to an orientee who was assigned to her while she was working hard to obtain the wrong drug.
• The nurse was asked to administer the drug in the radiology department, but she wasn’t assigned to work in radiology, so she left the patient immediately after injecting her.
• The radiology control room had cameras, but they don’t show sufficient detail to detect whether a patient is breathing. The techs assumed that the patient’s eyes were closed because of the bright lights.
• The nurse gave the patient’s primary care nurse the bag containing the medication vial immediately after the injection, but that nurse didn’t look at it for 15 minutes because he was charting.
• The event occurred on December 26, 2017. I would have looked into whether VUMC’s Epic go-live on November 2, 2017 might have contributed to the error because of the related changes (ADC interfaces, labels, documentation, etc.)
• That date might have had its own impact – the radiology department told CMS they were swamped that first day after Christmas. Staffing levels may also have been affected in that vacation-popular week between Christmas and New Year’s Day.

A Canada-based cryptocurrency exchange says its clients will lose their $190 million in holdings after the only person who knew the password to its storage system – the company’s 30-year-old founder – has died. Questions are understandably being raised about whether perhaps his death was faked and he’s off somewhere having fun with the money given that currency-moving transactions have occurred after the account was locked. Not that cryptocurrency attracts scammers or anything.

Super Bowl viewers seemed mostly unimpressed with the all-important commercials, but this one from Microsoft is not only touching and relevant to the company’s business, but it’s also an ode to diversity, inclusiveness, and resilience that the country can certainly use.

Sponsor Updates

• Mobile Heartbeat’s 2018 monthly active user count for its MH-CURE communications and collaboration platform doubled year over year, with hospitals averaging 1,150 regular users.
• Providence St. Joseph Health expands its use of provider data management and patient access solutions from Kyruus.
• AssessURHealth will participate in the Startup Grind Global Conference February 11-12 in Silicon Valley.
• Culbert Healthcare Solutions will exhibit at the WRUG Winter Conference February 14-15 in Las Vegas.
• UConn Technology Innovation Program’s first growth award goes to Diameter Health.

Blog Posts

• HSCC Releases New Framework For Medical Device Security (Fortified Health Security)
• Survey Says: Paper Informed Consents Used in Up to 93% of Cerner, Epic and Meditech Hospitals (Access)
• Optometry can advance 3 of your top strategic goals. Here’s what you need to know. (Advisory Board)
• The Engage Suite Series #5: Who needs a Care Plan? Engaged patients and informed care teams (Agfa Healthcare)
• Healthcare Hosting Checklist 2019: What is HIPAA Compliant Healthcare Hosting? (Atlantic.Net)
• How To Get Your Unified Communications “Flow” (Avaya)
• MEDITECH and NTT DATA Reduce Supply Chain Costs by $1.3M for East Tennessee Children’s Hospital (Meditech)
• Part II: Preparing a successful downtime preparedness strategy (Bluetree)
• Re-Imagining the mission of patient safety technology (Bernoulli Health)
• 4 reasons to connect with Nordic at HIMSS19 (Nordic)
• HIMSS 2019 Survival Guide (Datica)
• The Transition to Post-Acute Care: A Challenging Juncture in the Patient Journey (CarePort Health)
• This Time of Year Sees a 54 Percent Increase in PA Requests. Are You Prepared? (CoverMyMeds)
• Meet with DCA at HIMSS 2019 (Direct Consulting Associates)
• 3 Ways Analytics Can Help with Adolescent Mental Health (Dimensional Insight)
• Why I Love Being a Docent (Docent Health)

Contacts

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Contact us.

Morning Headlines 2/5/19

Amazon-led health venture hires technology chief to work under Gawande

The healthcare venture of Amazon, Berkshire Hathaway, and JP Morgan hires former Zocdoc CTO Serkan Kutan to head up technology efforts.

Providence St. Joseph Health Announces New Enterprise Population Health Company, Ayin Health Solutions

Providence St. Joseph Health spins off new population health management company Ayin Health Solutions.

Slack is setting itself up for the $3.5 trillion health-care sector

Slack files a confidential IPO and adds HIPAA compliance language to its security page, leading analysts to predict a foray into enterprise healthcare messaging.

Google Has Its Own EHR Plan

Google submits a patent for an EHR that incorporates predictive analytics to give physicians a better idea of which patients need their immediate attention, and what data is most relevant to that patient’s care at that time.

Curbside Consult with Dr. Jayne 2/4/19

Our EHR friend John Halamka, MD co-authored a piece in the Harvard Business Review earlier this month regarding strategies for making EHRs less time-consuming for physicians. Their ideas are sound, although I’d like to expand on them a bit from the trenches.

The first point made is the need to “standardize and reduce payer-imposed requirements.” On the surface, they’re talking about the documentation requirements for an office visit, which in the US is approximately 700 words. This is significantly longer than the average note in other industrialized nations, including Canada, Australia, and the UK.

CMS is attempting to provide leadership here in blending the codes for certain Evaluation and Management (E&M) codes, therefore “reducing” documentation in some areas, but it doesn’t go far enough. Instead of trying to describe complex rashes, why can’t we upload pictures and have that count for payer documentation? Instead of trying to describe a trauma or laceration, we could fully document it. In those situations, the adage about a picture being worth a thousand words is true.

Getting relief from onerous workflows in the EHR is one thing, but if you want to impact clinician satisfaction and reduce burnout, I’d go a step beyond to look at other payer-driven workflows such as pre-authorizations, pre-certifications, and peer-to-peer conversations that waste clinician time.

I was called recently to provide documentation to prove why I needed to order a CT scan of a patient’s abdomen since an insurance reviewer felt I hadn’t given the right information. I asked the reviewer if she bothered to look at the patient’s CT scan result. Perhaps the large pancreatic tumor that was discovered — based on my clinical suspicion and corroborating exam findings — should be enough to prove why the CT scan was necessary. She stated she didn’t have access to the reports. Instead of using their own resources to review the outcome, they wasted my time trying to prove something that turned out to be obvious.

The second point made by Halamka et al is that EHR workflows need to be improved. I whole heartedly agree with the need to remove non-value-added steps from the workflow and to minimize disruptive or unnecessary alerts. Information needs to be available to the people who need it, at the time they need it, and at the appropriate level of detail. Our EHR went haywire for a while and every user was seeing a popup declaring that “Eligibility Checking has returned on John Doe,” which was ridiculous and took several days to correct.

No matter how much improvement vendors make in their workflows, however, there is still the tendency for practices to misapply those workflows, either through lack of understanding or lack of skill. Our EHR continues to throw errors whenever we try to prescribe certain medications because the NCPDP codes aren’t mapped. I know our vendor uses the premier database for medications, so I have to assume that it’s poorly implemented in the practice. If there are risks that a client might not keep their formularies up to date or might have implementation issues, then vendors should consider process that provide automatic updates so that physician workflows are preserved. A nice side effect is that confidence in the vendor will increase, since physicians rarely understand that their own practice has misapplied the technology and tend to blame it on the vendor.

The team’s third point is that the EHR user experience needs to be improved. I don’t know of a physician out there who wouldn’t agree with this point. I continue to see EHR “upgrades” and “enhancements” that are downright silly. One EHR that was shown to me by a client had a title bar that was blue and displayed the patient’s name and information. Since the EHR would allow you to have multiple patient charts open at the same time in separate windows, the title bar was essential so you could not only see quickly which patient was loaded, but also so that you could tell which window was active. In the interest of making the screens more “vanilla,” the vendor removed the blue title bar, making it much more difficult to see which window was active, forcing users to go to the Windows taskbar and click on the different taskbar buttons to cycle them and reactivate them. The upgrade was definitely a downgrade, and since it’s been that way for a year, I doubt the vendor thinks it’s an issue.

Another EHR claims to be “mobile friendly” but the screens don’t fit on a standard mobile device, requiring right-to-left scrolling of popups, which isn’t very mobile friendly. When trying to use it on my Microsoft Surface, it won’t accept the native handwriting recognition input and instead makes me use a tap-tap-tap keyboard to enter data. What a waste of time. The same EHR doesn’t have restricted fields for blood pressures, allowing nonsense values such as 80/1000 to be entered. For years, vendors used the ongoing proliferation of regulatory requirements as an excuse for why they couldn’t develop “nice to have” features that end users had requested. Now that those requirements have slowed a bit, I don’t see vendors sinking vast amounts of R&D funding into usability.

I continue to see healthcare IT products that don’t include basic elements of usability, such as using indicators beyond color to indicate whether lab values are high or low. Someone who is red/green colorblind isn’t going to see your red/green schematic – they need other indicators, such as graphics or text, to provide meaning. I see vendors that include password requirements that don’t meet current NIST recommendations, such as requiring overly long passwords with high degrees of complexity or mandating changes every 30 days. Clients can’t opt out in many cases and are stuck with a vendor’s interpretation of security needs that is out of date or untenable. I see EHR searches that can’t handle partial strings or aren’t intelligent enough to recognize typos.

I can’t wait to get to HIMSS next week and see what vendors have been up to and whether they should move up in my Hall of Fame or should be relegated to the Hall of Shame. I’d like to see some bold new user interfaces with lots of bells and whistles intended to keep physicians happy. I hope I’m not sadly disappointed.

If you’re a vendor and have bells and whistles you want to show off, leave a comment or email me. I’ll be sure to drop by anonymously and check it out.

Email Dr. Jayne.

Morning Headlines 2/4/19

3M Completes Acquisition of M*Modal’s Technology Business

First announced last December, 3M wraps up its acquisition of MModal’s technology business for $1 billion.

Why You Should Be Careful About 23andMe’s Health Test

The New York Times warns that 23andMe’s consumer DNA testing performs poorly in predicting the risk of developing chronic diseases because it only recognizes a few relevant genetic mutations and thus isn’t a substitute for medical office testing.

‘Flawed’ privacy in Queensland Health’s electronic medical record, expert says

A law professor questions why any doctor at Queensland Health in Australia can change the medical record of any patient in the nine hospitals where IEMR is live.

CommonSpirit Health™ Launches as New Health System

Dignity Health and Catholic Health Initiatives complete their merger to form the 142-hospital, $29 billion CommonSpirit Health.

These 3 high-profile DOD systems have persistent operational flaws, according to testing

The DOD Office of the Director of Operational Test & Evaluation’s 2018 report finds cybersecurity vulnerabilities within MHS Genesis that lead it conclude that the EHR “is not survivable in a cyber-contested environment.”