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Morning Headlines 4/9/19

April 8, 2019 Headlines 2 Comments

Apple’s Health Opportunity Could be Triple Smartphone Market

Morgan Stanley analysts determine that Apple’s piece of the consumer-centered health pie could eventually be between $15 billion and $313 billion.

NVIDIA and American College of Radiology AI-LAB Team to Accelerate Adoption of AI in Diagnostic Radiology Across Thousands of Hospitals

With help from Nuance and GE Healthcare, the American College of Radiology adds Nvidia’s Clara AI Toolkit to free software it will offer radiologists to help them develop and use AI for diagnostic radiology.

Deep Lens raises $14 million to improve clinical trial recruitment with AI

Digital pathology imaging and diagnosis startup Deep Lens secures $14 million in a Series A round led by Northpond Ventures.

Info for wrong patients possibly sent to thousands of West Virginia veterans

The Veterans Health Administration notifies 4,882 patients of a Xerox software and printing problem that resulted in PHI, including lab results, being mailed to the wrong patients.

Curbside Consult with Dr. Jayne 4/8/19

April 8, 2019 Dr. Jayne 4 Comments


I recently attended my medical school class reunion. It was my first time attending, and since it was a “big year” for our class, I figured I should go. I didn’t know what to expect, but it turned out to be a great experience.

The way our school handles reunions is that it has a major reunion event every year, celebrating the classes every five years starting at the 10-year mark. This year was primarily for the classes of 2009, 2004, 1999, 1994, and so on. Once you hit a certain point (possibly 50 years?) they welcome you at every year. We had about 20% of my class attend, and according to the organizers, that was a pretty good turnout.

The festivities started on the hotel shuttle from the airport, where we got to see members of the class of 1969 figure out that they were sitting next to each other and had no idea they were in the same class. Watching their faces light up as they figured it out was hysterical. They immediately started swapping stories about what it was like to be in school 50 years ago. For us relative youngsters, a lot of it was the same, even though times have certainly changed.

We had a member of the class of 1954 on the bus. In her class were four women, and she was delighted to learn that our class was the first one to have more women than men (even if it was only “more” by one person.) Doing the math, we figured she had to be close to 90 years old, but you couldn’t tell. She had a walker, but was carrying it folded up rather than using it.

From there, it was on to a cocktail reception, where two members of the third-year medical school class plopped down at our table. One of my classmates started probing them on “what is it really like to be a millennial,” which was pretty funny. We learned that most of the class doesn’t actually go to class since all the sessions are preserved on video. Back in our day, we had a “note-taking service” that tape recorded every class. The class then took turns transcribing it and highlighting the key points, leaving you with a great set of notes. Although the new students don’t have to attend class, they miss out on the distillation done by their peers, so I’m not sure they’ve really built a better mousetrap.

We must not have scared them too much since they stuck around for most of the reception, although I think they were relieved to not have to attend any other reunion events after that one.

The next day was full of continuing education sessions and tours of the medical center, parts of which have become unrecognizable in a research grant-fueled construction boom. The medical library has very few actual printed materials any more, with the stacks having been replaced by individual study spaces and administrative offices. A new computer lab allows for computerized administration of the tests that have to be taken during third-year rotations, and student-focused spaces now include lounge areas, video games, and areas for extracurricular groups to meet. It’s definitely more student friendly, although there should be more student-friendly resources given the more than doubling of the tuition since I graduated.

Our tour guide,  a fourth-year student who will be graduating soon, seemed surprised by the state of medical education back in our day. We were thrown out into the world to learn our craft on “real patients,” but they have state-of-the-art simulator labs where they are put through a variety of proctored scenarios so they are better prepared for their internships. The latter half of the fourth year provides opportunities to complete life support and trauma certifications, where we had none of that exposure until we walked in the door at our internships.

I have to say I was a little envious about the preparation they are receiving, I think it will make internship a lot less shocking. Our guide was surprised to learn that as recently as we had graduated, we were not subject to duty hour limitations. Her eyes were wide at learning how often we took call and for how many weeks of the year. On most of her rotations she didn’t take call, and when she did, it was one day a week and the shift was limited to 18 hours.

There were presentations from various medical school leaders, where we learned about upcoming curricular changes that are aimed to better prepare students for the realities of medicine. My school has a strong track record for cranking out researchers and academicians, and I was interested to hear that they’re attacking precision / personalized medicine as a way to reduce costs. I had never really thought about it in the way it was presented, that even with the high cost of some of those treatments, the real savings is in patients you’re actually not treating with standard therapies that might not be effective. It will be interesting to see how that plays out in reality. There were also discussions about whether our school will join the club of schools that are providing full tuition scholarships for the entire student body.

Of course the highlight of the reunion was hanging out with classmates and learning what everyone has been up to in the new century. Some are wholly career-focused and driven, others have dropped out of medicine entirely, and there are several of us in-between. As much as physicians tend to talk about the importance of work-life balance, I was surprised to hear one of my classmates make a negative comment about women who had children during their residency training. Instead of celebrating their ability to juggle that level of complexity, he commented “what a strain that must have been on the residency program.” He backtracked a bit when one of the women mentioned that she only took four weeks off after childbirth, because that was the amount of vacation allotted to all residents each year and she didn’t strain the system any more than her counterparts who went to the beach.

Based on our interactions with current students, I suspect there is going to be a lot more tolerance for work-life balance concerns. There may be a steeper learning curve in residency due to the changes in work hour restrictions as students are exposed to scenarios they haven’t seen before because they simply weren’t in the hospital overnight. On the other hand, they may learn faster or better because their brains won’t be mush from working hellish schedules.

I had the privilege of talking with a 90-year-old urologist and getting his thoughts on how things have changed over time. Based on his family history and state of health, the odds are good that I’ll be seeing him again in five years.

Have you ever attended a class reunion? Would you do it again? Leave a comment or email me.


Email Dr. Jayne.

Morning Headlines 4/8/19

April 7, 2019 Headlines 1 Comment

DocuTap merging with a competitor based in Illinois

Urgent care EHR/PM vendor DocuTAP will merge with urgent care solutions vendor Practice Velocity.

Data payday slow in coming for electronic medical records specialist

Crain’s Chicago Business says the attempt by Allscripts to diversify itself away from smothering competitors Epic and Cerner in a slowing EHR market hasn’t paid off for investors, as disappointing financial reports have sent shares down.

Hardin Memorial Hospital issues statement on ‘information technology disturbance’

Hardin Memorial Hospital (KY) is working to restore systems taken offline by a reported cyberattack of an unstated nature.

Monday Morning Update 4/8/19

April 7, 2019 News 13 Comments

Top News


Urgent care EHR/PM vendor DocuTAP will merge with urgent care solutions vendor Practice Velocity, the companies said in a teaser announcement that promises further details later. 

Reader Comments

From Not From Monterey: “Re: Cerner Rev Cycle. Can any site that has converted, including billing, say that claims are going out the door speedily, bills are being sent out, A/R is doing well, etc.? We have Cerner clinicals and a third-party reg/sched system. We need to either go all-Cerner or all-Epic and we’re not making any progress because of fear of Cerner Rev Cycle.” I’ll open the floor to readers.

From Weekend Warrior: “Re: Politico’s Morning EHealth. Cutting back to three days per week. Cue sound of bubble bursting?” Politico launched its free weekday newsletter in mid-2014 under the umbrella of “EHealth.” Healthcare technology has lost some of its luster due to the end of federal incentives, market saturation, the domination of a few broad-line vendors, and technology’s lack of success in improving outcomes, cost, or public health in general. As a result, HIMSS, other conferences, and low-value websites have had to trade their long-term credibility for short-term vendor cash where never is heard a discouraging word. Unlike those organizations, while I don’t find a lot I need to know from Politico and maybe 10% of any given issue at most seems relevant, they are good at bird-dogging government stories and that’s important. I think the toilet bowl water is already swirling around some poorly run sites and “curators” that can’t deliver decision-making eyeballs – the Reaction Data survey from a couple of years ago exposed the difference between having a enthusiasm-powered but expertise-light website, newsletter, or social media account that no C-level reader would ever follow.

HIStalk Announcements and Requests


Poll respondents are skeptical about any near-term benefits of artificial intelligence in healthcare. As they should be.

New poll to your right or here: Hospital software vendor employees: how are business conditions now compared to two years ago?

Thanks to the following companies that recently supported HIStalk (without gaining any editorial control for doing so, I should add). Click a logo for more information.



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

Acquisitions, Funding, Business, and Stock


Crain’s Chicago Business says the attempt by Allscripts to diversify itself away from smothering competitors Epic and Cerner in a slowing EHR market hasn’t paid off for investors, as disappointing financial reports have sent shares down. It expresses some hope that selling patient data – through its Veradigm (the former Allscripts Payer & Life Sciences) and Practice Fusion businesses – will eventually boost financials, although analysts say competitors could easily enter growth markets such as population health with products better than those Allscripts sells. Above is the five-year share performance of MDRX (down 39%) vs. the Nasdaq (up 99%). Shareholders hate watching companies promising but failing to deliver, even with a good excuse such as being deep in a market that is receding and a consolidating customer base that is standardizing solutions from competing vendors.


I expected Inc.’s pretend letter to Apple CEO Tim Cook from Steve Jobs to be lame, but it was actually pretty brilliant in defining what Apple should be doing beyond sitting on a pile of cash, announcing late market entries in video streaming and credit cards, and allowing the Mac to age ungracefully. This is a great idea:

Google is our new nemesis, remember? They attacked our core business model with that Android PoC. But, Tim, c’mon… Google is weak. They can’t innovate worth beans and most of their revenue still comes from online ads, which are only valuable because they constantly violate user privacy. You could cut their revenues in half if you added a default 100% secure Internet search app to iOS and Mac OS. Spend a few billion and make it faster and better than Google’s ad-laden wide-open nightmare. This isn’t brain surgery.



Google Cloud healthcare vertical leader Greg Moore, MD, MS, PhD joins Microsoft as corporate VP, health technology and alliances. He was at Geisinger from 2010-2016.

Announcements and Implementations

Medsphere announces GA of its cloud-based Wellsoft Urgent Care, which includes the top-rated Wellsoft EDIS – which it acquired in late February 2019 — along with practice management and patient engagement applications.

Privacy and Security


Hardin Memorial Hospital (KY) is working to restore systems taken offline by a reported cyberattack of an unstated nature.


Dropbox pays a bounty of $319,000 for being made aware of 254 product security flaws that were documented by hackers who participated in a one-day security vulnerability bug hunt. The CEO of the hacker challenge company HackerOne suggests that companies not necessarily use the bounty programs to find their biggest vulnerabilities, but rather those with the most value at stake, such as systems that hold medical or customer data.



The Madison paper belatedly notes the 40th birthday of Human Services Computing, launched March 22, 1979 in an apartment building basement by its only full-time employee, a computer science instructor named Judy Faulkner. She later renamed the company to Epic Systems, which now has nearly 10,000 employees, $3 billion in annual revenue, and a billion-dollar campus. The company still insists on the personal touch – incoming calls are answered by a human rather than a machine and outbound mail always bears old-fashioned postage stamps rather than electronic postage.


A breathless Google-Harvard Medical School NEJM article sees a time in which AI reviews every medical decision for appropriateness, catches provider mistakes, and refers tough cases to experts for diagnosis. Sounds good, but I’m puzzled at what the future of medical practice will be when on one hand you have frightful deviation in diagnosis and treatment (use of outdated data, refusal to follow evidence-based medicine, hurried decision that are often wrong, and a tendency to over-treat rather than to wait patiently) versus having AI simply calling the shots by looking deeply and broadly at what has worked on similar patients. Or, embedded the practices of the best doctors for the benefit of the majority. Do you allow those poorly-performing doctors to keep their involvement, just as we did in anointing hospitals as the overseer of population health even though they showed zero interest and aptitude in it when nobody was paying? We should just admit science doesn’t always drive medical decisions and the practice of medicine can be inconsistent, illogical, expensive, dangerous to patients, and not necessarily a positive influence on patient outcomes. My conclusion – do everything you can to avoid becoming enmeshed in the rabbit hole of diagnostic and treatment Whac-A-Mole – a well-intentioned medical system can cause more harm than good in unsuccessfully chasing one problem after another in an uncoordinated manner, especially when they’re getting paid either way. 

The New York Times notes the frightening but seldom-reported spread of drug-resistant fungal infections, likely caused by rampant antimicrobial overprescribing and use in feed crops. Government agencies and hospitals don’t usually publicly acknowledge outbreaks because of fears of negative publicity and the fact that patients can’t do much about it anyway. You have to admire those bugs – while humanity is divided into whether it’s us or the cockroaches that run out the clock, the ever-transforming bacteria, viruses, and fungi just keep adapting to whatever we throw at them and may eventually kill us all off (if we don’t do it to ourselves first). 


A 39-year-old Villanova adjunct professor should probably have questioned why the health insurance she bought over the Internet cost her just $250 per month. The answer: it wasn’t real insurance, but instead was a short-term junk insurance plans like the White House is pitching that does not cover pre-existing conditions and pays only a fixed price for a short list of services. She says the agent for the publicly traded insurance broker lied to her about the Chubb-provided coverage even though the acceptance letter she signed made it clear that the non-ACA compliant plan doesn’t cover emergency services, either. The plan offered to pay a grand total of exactly $0 for her $22,500 worth of emergency sepsis treatment, with the hospital demanding to be paid upfront for the resulting foot amputation.

Sponsor Updates

  • MDLive and Redox will exhibit at ATA 2019 April 14-16 in New Orleans.
  • Meditech, Mobile Heartbeat, PatientSafe Solutions, and Clinical Computer Systems, developer of the Obix perinatal data system, will exhibit at AONE April 10-13 in San Diego.
  • NextGate and ROI Healthcare Solutions will exhibit at Cerner SERUG April 9-12 in St. Pete Beach, FL.
  • The local paper covers PatientPing’s partnership with the Lewis and Clark Information Exchange.
  • PerfectServe, Voalte, and Vocera will exhibit at ANIA April 10-13 in Las Vegas.
  • PreparedHealth will exhibit at ACMA April 13-17 in Seattle.
  • Optimum Healthcare IT announces a refreshed brand identity.
  • Sansoro Health releases a new podcast, “Pigs, Pain Management & Palliative Care.”
  • Surescripts will exhibit at the EClinicalWorks Health Center Summit April 9-11 in Boston.
  • TriNetX acquires Custodix NV’s InSite network, establishing the world’s largest clinical research network.
  • Wellsoft will exhibit at the Texas Organization of Rural and Community Hospitals event April 10-12 in Dallas.

Blog Posts



Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
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Weekender 4/5/19

April 5, 2019 Weekender No Comments


Weekly News Recap

  • PatientsLikeMe seeks a a buyer after the federal government’s foreign investment review committee demands that its majority investor, a China-base firm, divest its holdings
  • Amazon announces the availability of six new HIPAA-compliant Alexa healthcare skills
  • GAO officials tell the House Veterans Affairs Committee that the VA’s poor track record of CIO leadership has harmed its IT modernization projects and will continue to do so
  • FDA names Principal Deputy Commissioner Amy Abernethy, MD, PhD to the additional role of CIO
  • Walgreens says it will accelerate digitalization of the company, make executive team changes, cut costs, and redesign stores following poor quarterly results that sent shares down sharply
  • A two-doctor ENT practice in Michigan closes for good and its partners retire after they refuse to pay a hacker $6,500 to restore their ransomware-encrypted systems

Best Reader Comments

AI is about six different things, with different methods and different targets. The fact that it gets rolled up into an undifferentiated mass screams that these are merely magic words meant to attract… well, suckers. Second, I would agree that resources could be spent better on other fronts. You mention lifestyle and similar social determinant factors. This reminds me that serious thinkers wonder whether diverting the last trillion or so marginal dollars from health care to education might actually improve public health outcomes more effectively. (Randy Bak)

Regarding the inability of financial incentives to change patient health behaviors, are the folks designing these studies basing them on any established health behavior change theories? If not, then there are good reasons that these interventions fail. (Mark Hochhauser)

Going to be really interesting when an AI says that we need to address behavioral health issues in a good portion of the population, only for us to realize that 1) there’s a huge shortage of workers; and 2) the reimbursement is not there to operationally break even. (NotTheDataYoureLookingFor)

Transfer of patient information results in decreased use of the healthcare system. Why? Because having those records available results in earlier intervention and in fewer repeated diagnostic tests. Decreased utilization of the healthcare system is important to the survival of only two parties I can think of: (1) the patient (obvious benefit), and (2) the payor (cuts costs). Therefore, we should be looking at the patients to pay, or the payors to pay [for data exchange]. No one else seems to have a dog in this fight. I realize it sounds quite callous to put it this way, but I feel it is realistic. There are indeed providers who act for the greater good and act in support of transfer of patient records. However, hoping that all providers will support timely transfer of patient info – without some inducement to do so – may be misguided. (Clustered)

The patient does not own the data. The data are about them and they have a right to see and distribute. Can they modify their record? Do they pay a record storage fee to the HC org to hold their data? If not, it’s not owned by the patient. (Data owner)

Initially or always for a percentage of tests, it might be a better idea to only give the AI verdict after the radiologist has given their opinion. You don’t want the radiologist to start being lazy/biased and lose their diagnostics chops either. (AC)

Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. Z in Texas, who asked for STEM activities for her pre-K class. She reports, “They were so excited to see their new center materials. I enjoyed watching their creativity come to life and coming up with new things they could make. One of the lessons we did was using the 3 Little Pigs story and how they could come up with a house that was strong. They started coming up with so many different ways to use the materials and build houses. They were even coming up with things we adults didn’t even think of! I can’t tell you how happy and eager they were to go to their new STEM center and build their own creations! From the bottom of our hearts. we appreciate you giving these children the opportunity to expand their little growing minds!”

Conspiracy-obsessed Internetters are spreading rumors that rapper Nipsey Hussle was killed because he was working on a documentary about an alternative health guru who died in 2016 after claiming he could cure AIDS. The rumored conspirators behind both deaths are the always-collegial drug companies, medical societies, and regulatory agencies. Leading the charge with a list of 90 doctors who were mysteriously killed (by people such as their spouses or by auto accidents) is a “health nut” with no stated educational credentials whose website is full of anti-GMO conspiracy theories; vaccine theories; a recipe for a garlic soup that can cure flu and norovirus and a flatbread that “fights cancer with every bite;” and an online store that sells CBD skin serum and some seriously wacky products (all carefully disclaimed in the footnotes as not being a substitute for professional medical advice, diagnosis, or treatment). Her husband, a DO, runs a similar site, which she promotes in videos in which she languishes on a bed with little evidence of clothing.


An Arkansas man who is being treated at a hospital for bruises caused by bullets striking his bullet-proof vest tells staff and police officers that he and a friend were involved in a gunfight while protecting a mysterious man called “The Asset” who had hired them as bodyguards. His wife then arrived and set the record straight – the men were drinking on the back porch and dared each other to be shot while wearing a bullet-proof vest. The first man admitted that he was annoyed at being shot, so he emptied five .22 rounds into the second man’s back. Both are fine other than being charged with aggravated assault.


US Navy corpsmen are working at trauma units in Chicago, Cleveland, and Jacksonville to gain experience with gunshot wounds, burns, and hypothermia that are likely to occur in traditional warfare but that are seen less in the military’s terrorism-related activities in countries like Afghanistan. 


Johnston-Willis Hospital (VA) arranges for a dying mother to see her daughter graduate from high school in her hospital room, with the school principal delivering a brief commencement address followed by a  vocal performance by the college music fraternity of the graduate’s brother. The mother died the next day.


A baby who was born in drug withdrawal and who endured a five-month hospital stay without having a single visitor is adopted by the hospital’s nursing director.

In Case You Missed It

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Morning Headlines 4/5/19

April 4, 2019 Headlines 1 Comment

The Trump administration is forcing this health start-up that took Chinese money into a fire sale

PatientsLikeMe looks for a buyer after the Committee on Foreign Investment in the United States demands that its majority owner, a Chinese investment firm, divest its holdings in the company.

Introducing New Alexa Healthcare Skills

Amazon announces the availability of new HIPAA-compliant Alexa healthcare skills from organizations like Livongo, Cigna, and Boston Children’s Hospital.

Memorial Sloan Kettering Leaders Violated Conflict-of-Interest Rules, Report Finds

Memorial Sloan Kettering Cancer Center’s relationship with AI startup Paige.AI and other vendors triggers an outside review that finds the organization violated conflict-of-interest policies and fostered a culture that valued profits over research and patient care.

News 4/5/19

April 4, 2019 News 5 Comments

Top News


PatientsLikeMe looks for a buyer after the Committee on Foreign Investment in the United States demands that its majority owner, a Chinese investment firm, divest its holdings in the company. The personalized health network has raised $127 million in several venture rounds.

The Trump administration expanded the committee’s oversight last year as concerns heightened around national security and trade secrets, a move that caused Chinese investments in US companies to plunge from $46 billion to just under $5 billion over the last two years.

Reader Comments

From Sagebrush Sister: “Re: CIO vendor entertainment violations. Looking for examples, as my organization is hosting a Pebble Beach outing for key clients. They didn’t consider the healthcare folks and I’m trying to get them to add CEs, even if just for damage control.”

From John R. Public: “Re: America’s Health Insurance Plans whining. It’s funny that they are crying wolf after they’ve harassed providers forever for information while providing them with dated stacks of papers or confusing web pages that are not actionable.” AHIP says 2020 implementation of mandatory data sharing under CMS’s proposed interoperability rules is unrealistic given the effort required to comply with standards that aren’t yet defined.

From HIT OG: “Re: CareCloud. Laid off 40 employees yesterday via a conference call.” Unverified.

HIStalk Announcements and Requests


Readers have sent some great alternatives to buying a big swath of HIMSS conference exhibit hall space, which I’ll run shortly, Meanwhile, your suggestions are welcome.


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



Spok names Timothy Tindle (Harris Health System) as CIO.


Quil, the joint digital health venture of Comcast and Independence Health Group, names former Imprivata executive Carina Edwards as CEO.


Ascend Innovations hires Marty Larson (Greater Dayton Area Hospital Association) as president and CEO.


Michelle Blackmer (CareEvolution) joins Verato as VP of marketing.

image image

Jim Costanzo (Ernst & Young) will succeed Bruce Cerullo as Nordic’s CEO on July 1. Cerullo will become chairman of the board.


Sonifi Health hires Cheryl Cruver (Aetna) as chief revenue officer.


  • The Heights Hospital will implement RCM and health IT software and services from MTBC when it opens in Houston later this year.

Announcements and Implementations


UMass Memorial Health System will roll out video-based substance use disorder evaluation software at three of its EDs over the next three months. The technology, developed by four physicians from within its Memorial Medical Group, was the winning submission in the annual UMass Prize for Academic Collaboration and Excellence.

Innovaccer launches social determinants of health surveys that feed into its community resources referral program.

The Consumer Technology Association, organizer of CES, forms a working group with nearly 30 healthcare and tech companies to develop standards and best practices for AI in healthcare.


Healthgrades develops a customer data platform to help providers better aggregate and manage health data and power CRM systems.


ProMedica’s Coldwater Regional Hospital (MI) will go live on Epic next month. The Toledo, OH-based provider began a system-wide implementation in 2015.

InstaMed launches a blockchain-powered platform for payments.

Government and Politics


The FTC wins a $50 million court judgment against Omics International, an India-based scientific research publishing company that has for years been accused of deceptive business practices. A judge in Nevada, where the company has a mailing address, has also ordered the company to stop misleading authors about the legitimacy of its publications, marketing conferences with unconfirmed speakers, and failing to disclose fees.


Departing FDA Commissioner Scott Gottlieb, MD will return to the American Enterprise Institute to work on drug pricing. He joined the think tank as a resident fellow in 2002.

Privacy and Security


Amazon announces the availability of six new HIPAA-compliant Alexa healthcare skills. Organizations participating in the invite-only, HIPAA-eligible program include Express Scripts, Cigna, Livongo, Boston Children’s Hospital, multi-state Providence St. Joseph Health, and Atrium Health (NC).



The New York Times highlights the popular trend of “restaurant-style” medicine offered by prescription-on-demand companies like Roman, Kick Health, and Nurx. Medical experts point out these startups give consumers the power to choose their drugs and then have their choices validated by a remote physician, a service that typically omits any type of counseling about potential side effects. Detractors warn that despite their buzzy marketing, convenience, and multimillion-dollar fundraising rounds, consumers should approach these services with caution. The big question I always have – why would a doctor agree to practice in this type of arrangement that violates just about everything in the Hippocratic Oath? (answer: easy work for $$$). It’s too bad that our culture sees prescribing as just a minor speedbump to getting what we think we should have, regardless whether it’s likely to be beneficial or safe.


Bloomberg looks at the lengths hospital chain Narayana Health will need to go to in order to care for India’s poorest patients under the country’s new national health insurance plan. The company, which already offers assembly-style procedures at rock-bottom prices, was launched by cardiac surgeon Devi Shetty in 2000 with a $20 million loan from his father-in-law. Shetty has tapped his son to lead a software startup dedicated to analyzing and trimming costs from Narayana’s operations, which are already operating on razor-thin margins that, when all is said and done, result in outcomes equal to or better than those of US hospitals. Shetty says, “I would like in my lifetime for every citizen of this planet to get health care at a price they can afford to pay without having to beg or sell something.”

Meanwhile in the US, a West Health-Gallup survey finds that one in eight Americans borrowed a total of $88 billion last year to pay for healthcare services. Sixty-five million people deferred care altogether because of cost.

An outside review of Memorial Sloan Kettering Cancer Center finds that the organization violated conflict-of-interest policies and fostered a culture that valued profits over research and patient care. MSKCC’s relationship with AI startup Paige.AI was one of the issues that triggered the review, as reports noted that it shared pathology slides with the startup as some of MSKCC’s top executives were given lucrative participation arrangements.


This is bizarre: People claiming to work for Passport Health Plan are showing up in an unmarked van around poor neighborhoods in Louisville, KY offering members $20 for DNA samples. Those who underwent a cheek swab were told they were being tested for cancer.


This is how obituaries should be written, as the family of 63-year-old Iowan Tim “Lynyrd” Schrandt describes him in a way that makes you wonder how he interacted with his doctors and nurses. The big finish is this:

Tim led a good life and had a peaceful death, but the transition was a bitch. And for the record, he did not lose his battle with cancer. When he died, the cancer died, so technically it was a tie! He was ready to meet his Maker, we’re just not sure the Maker is ready to meet Tim. Good luck, God! We are considering establishing a GoFundMe account for G. Heileman Brewing Co., the brewers of Old Style beer, as we anticipate they are about to experience significant hardship as a result of the loss of Tim’s business. Keep them in your thoughts.

Sponsor Updates

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


EPtalk by Dr. Jayne 4/4/19

April 4, 2019 Dr. Jayne 4 Comments

CMS has launched an Artificial Intelligence Health Outcomes Challenge. The three-state competition is planned to “accelerate artificial intelligence solutions to better predict health outcomes such as unplanned hospital and skilled nursing facility admissions and adverse events.” The CMS Innovation Center plans to use the data “in testing innovative payment and service delivery models.” Partnering with the American Academy of Family Physicians and the Laura and John Arnold Foundation, CMS will award up to $1.65 million during the three stages.

CMS has decided to be confusing by naming the three stages “Launch,” “Stage 1,” and “Stage 2” rather than just numbering them. Launch is essentially an application phase, with 20 participants selected to advance to Stage 1, where challengers will design and test their solutions using Medicare claims data. Up to five participants will move to Stage 2 where they can refine their solutions using additional Medicare data sets. The grand prize winner will receive up to $1M with a $250,000 award to the runner up. Launch is already underway and the program will run through April 2020.

If you’re wondering how to further translate the CMS-speak, the goal is to build “explainable artificial intelligence solutions to help front-line clinicians understand and trust artificial intelligence-driven data feedback to target scarce resources and improve the quality of care.” CMS Administrator Seema Verma explained this further: “For artificial intelligence to be successful in healthcare, it must not only enhance the predictive ability of illnesses and diseases, but also enable providers to focus more time with patients. The power of artificial intelligence will truly be unleashed when providers understand and trust the data and predictions.”

I was talking about this with a colleague, particularly the focus on diseases rather than health and prevention. There are so many factors that could immediately impact both individual and population health parameters that don’t require a challenge or competition. We already know what needs to be done, but lack funding to do it. These not-so-sexy solutions involve things like public health education, social workers, and strategies to eliminate food deserts and improve healthy behaviors. AI is a pretty distraction from the difficult work that could (and should) be happening.


Speaking of the challenges found in trying to improve healthy behaviors, there is much speculation on whether financial incentives make a difference. Many organizations including my own hospital have done this by increasing insurance rates for smokers or offering discounts for non-smokers or those who complete a biometric profile. Discounts for non-smokers seem to make sense because we know smokers have more illnesses thus higher healthcare costs; the benefits of a biometric screening, however, have not been proven. I know that for me personally, going for the biometric screening did nothing to change my behavior, but cost me a half day out of office.

A recent article in the Journal of the American Medical Association looks further at the effect of financial incentives on improving healthy behaviors. In a recent US-based randomized trial, lottery-based incentives tied to medication compliance didn’t lead to a significant reduction in cholesterol levels. Another study found lack of reduction of cardiac events or hospitalization even though patients could earn more than $1,000 for being compliant. Other studies including those looking at smoking cessation in pregnant patients do show some benefit for financial incentives.

The article looks at reasons why studies might not show successful incentive use, including bias created when patients self-select for a study, since those who self-select are more likely to be motivated to change behavior whether there is an incentive involved or not. These motivated patients “rarely represent the population most in need of support, yet they are most often targeted by trials.” There are also issues creating control groups and in timing study enrollment based on patients transitioning through “hot and cold states in which their motivation varies, potentially determining their response to incentives.” Another issue is offering an incentive that is too small for the desired behavior change, which can be a negative motivator when higher incentives may actually drive change.

The authors conclude that when incentive-based interventions are being designed, subtle factors need to be considered, including the size / frequency of the incentive, how it’s positioned, and whether the target population fully understands the incentive and the desired behavior.


From Midwest Afficionado: “Re: pastry therapy. Here’s some for you, Dr. Jayne, in the form of an edible book festival.” Apparently, this is the third annual edible book festival at Washington University School of Medicine in St. Louis. Although submissions were welcome from any genre, there was a special award category for “Most Edible Medical Book.” Submissions will be eaten promptly at 2:30 p.m. Previous entries included a “Checklist Manifesto” Rice Krispy Treat and a tribute to “Grapes Anatomy.”

Data from a recent Kaiser Family Foundation tracking poll indicates that patients aged 18-29 believe EHR technology has led to increased quality of care and has improved provider communication. The age bracket caught my eye since if you consider the pre-MU era (pre-2009) to be solidly pre-EHR, most of these patients weren’t even adults, so it might be a difficult comparison. General public perception of the benefits of EHR has decreased – in 2009, 67% of patients believed EHR would improve care, but a decade later, only 45% believe it has actually happened.

Still, only 6% of respondents said they felt EHR has worsened quality of care and 7% felt communication has worsened. More than 20% of patients said they or a family member has found an error in their chart. More than half of respondents voiced concerns about unauthorized access to the medical record, although younger adults (that 18-29 year age group) are less likely to be concerned than other age groups. I suspect that group is used to having their data used or mined by third parties, or that perhaps they’re just so used to hearing about data breaches that it is less concerning.

The American Medical Association shares sound advice on the use of wearable health devices in practice. They note four main possible issues that should be considered when adding devices to the care plan. Patients might disengage before the benefit can be realized, either due to convenience or perceived lack of benefits. They might also ignore symptoms and rely too much on devices. Others may obsess over the data, resulting in anxiety. Last, they might try to interpret the data without physician help, leading to false-positives and additional intervention. It was a nice little review of what to think about, and should be helpful for physicians who don’t have a lot of experience with wearables.


Email Dr. Jayne.

Morning Headlines 4/4/19

April 3, 2019 Headlines No Comments

UMass prize will fund telemedicine initiative

UMass will roll out video-based substance use disorder evaluation software developed by prize-winning physicians within its Memorial Medical Group at three of its EDs over the next three months.

VA’s IT leadership problem has infected modernization efforts

Officials at a House Veterans Affairs Committee Hearing say the VA’s abysmal CIO track record has hampered – and will continue to hamper – the success of its extremely expensive IT modernization efforts.

Quil, The Joint Venture Between Independence Health Group And Comcast, Names Carina Edwards Chief Executive Officer

Digital health company Quil names former Imprivata executive Carina Edwards CEO.

HealthVerity Announces $25 Million in Series C Funding

Patient data retrieval and management company HealthVerity raises $25 million.

Readers Write: Systems Integration with SMART on FHIR ─ We’ve Come So Far, Yet …

April 3, 2019 Readers Write No Comments

Systems Integration with SMART on FHIR ─ We’ve Come So Far, Yet …
By Dan Fritsch, PhD


Dan Fritsch, PhD is chief applications architect at First Databank of South San Francisco, CA.

When we first launched Meducation in 2009, we realized that we would have to integrate the application with electronic health records if we wanted clinicians to use it with their patients. The good news? Through our efforts, we’ve become industry leaders in such integration. The burst-our-bubble reality? Despite our success, even after 10 years, many integration challenges remain.

Because electronic health record (EHR) systems were not originally designed to accommodate third-party apps, we have found ourselves taking up the integration cause ever since we initially developed our cloud-based solution that enables healthcare providers to dynamically create fully personalized patient medication instructions in more than 20 languages.

While the integration nut is difficult to crack, we’ve experienced quite a bit of success. Case in point: In 2011 we won an Office of the National Coordinator for Health IT contest for our use of Substitutable Medical Apps and Reusable Technology (SMART) – an open, standards-based technology platform – to integrate our product with other systems.

Yet we weren’t able to fully utilize what we had developed. This SMART integration didn’t allow us to leverage real-time data, but instead required data to be transformed and stored in an alternative format. While we had established ourselves as a systems integration trailblazer, we still didn’t experience the live integration needed.

To make integration work, we had to custom-code the product for each EHR, to accommodate each unique data access framework and each underlying data model. This meant starting from scratch with each new integration. Because of this complexity, we often found ourselves relying on outside systems integration specialists for assistance, which is a costly proposition.

When Health Level Seven International (HL7) introduced the Fast Health Interoperability Resources (FHIR) standard, SMART developed code to support it. As such, we were able to run the product in this new SMART on FHIR architecture environment. This integration model made it possible to use the same FHIR resources to implement our product on various EHR platforms without having to significantly modify code. So, if we wanted to integrate our app into 10 EHRs, we didn’t have to reinvent the wheel with each one.

At the most recent American Medical Informatics Association (AMIA) conference in San Francisco, we demonstrated how a mature SMART on FHIR integration enables us to run an app on various EHR systems, something that many other app developers are still striving to accomplish. AMIA members ranked our demonstration as the top presentation at the conference and recognized us with the AMIA/HL7 FHIR App Showcase Award.

Yet, like all app developers, we are still struggling with a variety of integration challenges, such as:

  • Optimal workflow placement within the EHR. While some vendors allow our app to be launched in an optimal place – such as at the top of the discharge screen – others bury the app launch in the user interface menu, making it burdensome for an end user to find and use at the right time in workflow. We are constantly working to align with our EHR partners to realize that our application is valuable, not a threat to their autonomy.
  • Juggling multiple versions of FHIR. FHIR is a young and rapidly evolving standard. Since its introduction, three versions have been adopted and implemented by various EHR vendors. Each of these standards uses a slightly different data model. As an app developer, we have to know which version each EHR vendor is using so we can modify our code to support that particular iteration.
  • Coping with vendors’ interpretations of resources. To function optimally, our app needs to know the patient’s medication list at the point of discharge, which requires specific resources (specific pieces of information). This information is represented in FHIR by either the “Medication Order” resource or the “Medication Request” resource, or sometimes by a combination of both. As such, we often need to query both of those resources and run an algorithm that gives us the discharge medication list that we need. As FHIR becomes more mature, there will be more agreement among the vendors on what the resources mean, but for now, we need to continue to find ways to deal with each vendors’ interpretation.
  • Dealing with costs. As a developer, we have to cope with fees to enter developer programs; certification costs; legal fees associated with intellectual property protection; costs that sometimes arise when developers need additional integration assistance from vendors; and royalties paid to EHR vendors. These fees are costly and are prohibitive to many smaller companies.

So while we have been able to establish ourselves as integration leaders, especially around SMART on FHIR, we still, like all other app developers, have our work cut out for us. We look for forward to continuing to pave the way and challenging the status quo.

Readers Write: File-Sharing And HIPAA – How You Can Keep Health Data Secure in an Era of Collaboration

April 3, 2019 Readers Write No Comments

File-Sharing And HIPAA – How You Can Keep Health Data Secure in an Era of Collaboration
By Tim Mullahy

Tim Mullahy is executive vice-president and managing director at Liberty Center One of Royal Oak, MI.


Collaboration is at the heart of modern workflows, and file sharing is at the core of collaboration. That’s as true in the health industry as it is anywhere else. The difference with healthcare, of course, is that the risks of doing file sharing improperly — of distributing files without due attention to security — are higher.

File-sharing and collaboration are necessary for effective patient care. Medical and support staff alike need to be able to openly and readily share patient data with one another, communicating seamlessly both within hospital environments and without. The problem, of course, is enabling such collaboration without violating HIPAA.

After all, Protected Health Information (PHI) is some of the most sensitive data in the world. The penalties, should it fall into the wrong hands, are rightly strict. That isn’t to say that enabling file-sharing is impossible,  just that it needs to be done while keeping a few things in mind.

Encrypt all files

Although HIPAA doesn’t mandate file encryption (it’s recommended, not required), encrypting all data both in-motion and at rest is critical if you’re going to ensure that your files can be shared securely. In the event that a device containing HIPAA is in some way compromised, encryption will ensure that the data it contains remains safe.

I’d advise that you use SSL encryption and use some form of VPN or secure tunnel to keep your files protected when they’re shared across external networks.

Assign unique IDs to all staff

Every user with access to your file-sharing and collaboration platform needs a unique identifier. In addition to being useful for the purposes of authentication, these IDs will allow you to track data access and usage. The idea is that you need to know what data each of them have accessed and what they’ve done with that data at any point in time.

Implement multi-factor authentication

Usernames and passwords are an important component of access control, but they represent only a partial solution. To keep both your files and the platforms through which staff collaborate secure, you’re going to want multiple means of ensuring people are who they say they are. These could include:

  • Biometric (fingerprint scanners, facial recognition, voice identification, retinal scanners)
  • Behavioral (common login locations, common access and browsing habits, etc.)
  • Hardware-based (device recognition, hardware tokens)

Implement auto-logoff

Here’s one directly from the HIPAA guidelines. Any file-sharing or collaboration solution you use needs to have a timeout process built in. After a set period of inactivity (10 to 15 minutes is probably a safe bet), an employee account should be automatically logged out. This protects against unauthorized access via unattended devices.

Ensure that all software is HIPAA-compliant

Last but certainly not least, for each collaboration solution you implement, check with the vendor to ensure that it complies with HIPAA’s regulatory guidelines. Most vendors that support HIPAA compliance will be open about it. Moreover, their solutions will provide full logging and auditing functionality, alongside all the other security controls necessary to stick to HIPAA.

HIPAA need not represent an obstacle to effective collaboration. Provided you incorporate a compliant solution and take all the necessary measures to keep your data safe, you can enable your clinicians, support staff, and everyone else who needs access to collaborate for better, faster patient care.

Morning Headlines 4/3/19

April 2, 2019 Headlines No Comments

Walgreens Boots Alliance Reports Fiscal 2019 Second Quarter Results

Walgreens announces executive changes, store layout redesign, and cost-cutting measures following its announcement of disappointing quarterly results.

U.S. Department of Veterans Affairs Joins DirectTrust’s Accredited Trust Anchor Bundle

The VA joins DirectTrust’s anchor bundle, which will allow its employees to use Direct messaging and information exchange to communicate with 1.8 million providers.

Abernethy tapped as FDA’s CIO

Politico reports that FDA Principal Deputy Commissioner and former Flatiron Health executive Amy Abernethy, MD will become the agency’s CIO, taking over from CISO and interim CIO Craig Taylor.

Theranos Whistleblowers To Launch Tech Ethics Venture

Theranos whistleblowers Erika Cheung and Tyler Shultz will launch the nonprofit Ethics in Entrepreneurship to help connect startups with ethicists, more experienced entrepreneurs, and resources that will help them avoid the fate of the disgraced blood-testing company.

News 4/3/19

April 2, 2019 News 1 Comment

Top News


Walgreens announces executive changes, store layout redesign, and cost-cutting measures following its announcement of disappointing quarterly results Tuesday.

WBA shares closed down 13 percent Tuesday after the company released results that fell short of expectations for both earnings and revenue. They’re down 12 percent on the year and up just 14 percent over the past five years vs. the Nasdaq’s 96 percent gain.

In yet another example of the “healthcare is big business that takes money from the ill” paradigm, the company’s US pharmacy operations delivered disappointing results because of a mild flu season and a de-emphasis of tobacco.

The company says it has created a new digital leadership team and embedded Microsoft within it.

Reader Comments

From Clarence Oveur: “Re: exhibiting at HIMSS. We’re questioning the value. Wondering if you are hearing that from other companies?” I’ve heard from a couple of folks who asked me what I thought about moving their multi-hundred thousands of dollars of exhibit hall expense into something that might generate actual leads (which for them, HIMSS19 did not, and I’ve heard that quite a bit). Most of those who have toyed with that idea in past years got scared into paying up over fears (likely justified) that competitors would create innuendo around their absence. Consider these points:

  • Make sure customers and prospects don’t see an exhibit hall pullout as a sign of financial challenges. Tell them well beforehand why you’ve changed strategies and where you’ll spend the money instead.
  • You’ll still probably want a convenient way to connect with people during the conference, which might be an exhibit hall meeting room, a staffed HIMSS Bistro table (if they offer that service again), or either a single event or a series of dinners with an executive. HIMSS locks down basically everything in sight of the convention center and then some, so solve the real estate issue early (a la the JP Morgan Healthcare Conference, which to many attendees is held in unofficial hotels, coffee shops, and park benches because the main venue is sold out).
  • Don’t fail to work the hall even if not exhibiting in it. You might find a prospect, partner, employee, acquirer, or acquiree just from wandering around in the right places as a plain old registrant.
  • Figure out the kinds of activities that offer better ROI than a glitzy booth. Maybe it’s a series of webinars, regional events, testimonial videos, or sponsorships (OK, that was self-serving) that work all year instead of for just three days.
  • Take that tiny part of exhibiting that represents education and make that the focus instead of just watching unengaged passersby offloading swag from your podium.


I’m interested in what readers think about companies who decide to stop exhibiting at the HIMSS conference, so tell me here. Do you care? What other ways can they connect with prospects? I’m especially interest in hearing from companies that have moved their exhibit hall expense into other forms of marketing that turned out to be more effective.


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

Acquisitions, Funding, Business, and Stock


NTT Data Services acquires Cognosante Consulting, which provides services to state Medicaid programs. It will operate as NTT Data State Health Consulting.


The Knoxville paper covers PerfectServe’s three 2018 acquisitions, its 220 local employees, and the use of its secure provider communications solution by UT Medical Center.


  • In England, Great North Care Record chooses Cerner for information exchange.
  • San Francisco medical group Brown & Toland will implement Epic for ambulatory for its 2,500 independent physicians. The network manages insurance functions for its members and says Epic is the only system that can support both patient care and insurance administration.

Announcements and Implementations

UnitedHealthcare and the American Medical Association will work together to create 20+ ICD-10 codes related to social determinants of health that can be used to trigger referral to social and government services.


KLAS looks a patient privacy monitoring solutions, with Protenus, FairWarning MPS, and Maize Analytics topping the list. Purchasing decisions are often driven by reducing false positive warnings, at which FairWarning MPS was found to excel.


MIT Technology Review notes that DeepMind demonstrated a prototype of its AI-powered retina scanning device in London last week. The 30-second scan can detect retinopathy, glaucoma, and macular degeneration. It’s still years away from availability, however, since the company hasn’t yet submitted it for UK regulatory review.

Meditech expands its Meditech as a Service offering, which was initially offered only to critical access hospitals, to all community health systems.

Government and Politics


The VA joins DirectTrust’s anchor bundle, which will allow its employees to use Direct messaging and information exchange to communicate with 1.8 million providers.

Privacy and Security


“60 Minutes” visits Hancock Regional Hospital (IN) to talk about its January 2018 ransomware attack in which it paid a hacker $55,000 to regain access to its files. The hospital notes that not only was it back in business on the Monday following the Thursday attack, it has since learned that antivirus software that can only recognize a particular technical signature would not have helped (since the strain was new) and it has since added a system that instead looks for patterns of malicious behavior. The hospital also contracted with cybersecurity vendor Pondurance because “if we’re attacked by humans and the only thing we have to defend ourselves is software, then the humans will win.”


An Indian state’s health agency exposes the information of 12.5 million women who had undergone pregnancy-related testing by leaving the Internet-connected database unsecured. The agency didn’t respond to warnings that its information was exposed and the problem was fixed only when India’s Computer Emergency Response Team removed the health information three weeks later. The MongoDB server is still online and exposed, with other agency information still accessible by anyone. The medical data was especially sensitive since it involves data collected to support India’s ban on prenatal sex determination tests, which it implemented to prevent widespread selective abortion of unborn females.



Epic’s April Fools’ Day home page makeover contained some Onion-worthy gems:

  • Epic hires CNBC host Jim Cramer as a financial advisor after he urged Apple to buy Epic on “Mad Money.” The funniest part about that bit is Judy Faulkner’s actual response at the time, when she asked a reporter with puzzlement, “Who’s Jim Cramer?” which apparently annoyed him based on his tweets about it afterward.
  • The rollout of MyMom, which encourages a health lifestyle with “a dose of love, a firm hand, and perhaps a little guilt.” It will include “genetic test processing filters that predict the likelihood that one day, you’ll have one just like you, and see how you like that.”
  • Epic adds a 200-member support team for Fortnite by Epic Games after its reception employees take 400 calls per hour that were intended for the gaming company (that’s apparently a real statistic).


Dear PR people: “discreet” means watching what you say or being modest, which isn’t really an adjective you want to use when referring to data points (that would be “discrete.”)


Kaiser Health News calls out respected hospitals such as Swedish Medical Center, Mayo Clinic, Cleveland Clinic, and University of Miami for offering profitable but medically unproven stem cell-related therapies even as FDA tries to shut down clinics that do the same thing. Some hospitals are even employing informercial-like sales pitches and enthusiastic but anecdotal patient stories to lure cash-paying patients in. One area in which evidence is ample – hospitals and medical practices will do whatever people pay them to, regardless of scientific merit. Just because hospitals are non-profit, unlike medical practices, doesn’t mean they don’t relish bringing in the cash through any legal (and sometimes illegal) means.

Researchers find that Ontario’s experimental payment of bonuses of up to $36,000 for PCPs to keep their patients out of the ED created unintended consequences, with most of the money going to small-town doctors whose patients had fewer PCP visits, less after-hours care, more ED visits, and higher ambulatory costs. The bonus-earning doctors also had lower-acuity patients. The authors identify a problem in creating rewards for those who are already exhibiting the desired behaviors instead of changing those who aren’t, also noting that the payment rules encouraged doctors to send patients to the ED or to specialists instead of to a walk-in clinic.  

Pharma bro Martin Shkreli is sent to solitary confinement for using a contraband cell phone to continue running his renamed, price-jacking Turing Pharmaceuticals from his federal prison cell. I’m pretty sure we haven’t heard the last of him since people who are willing to do most anything for money somehow keep finding new ways to take it away from someone else.

Sponsor Updates

  • Imprivata will offer its PatientSecure biometric patient ID solution with Verato’s cloud-based MPI as a comprehensive solution to address patient identification and record matching.
  • PatientBond will exhibit at the 2019 UCA Urgent Care Convention & Expo April 7-10 in West Palm Beach, FL.
  • Meditech publishes a case study on the use of its CAUTI prevention and surveillance tool by RCCH Healthcare Partners.
  • AdvancedMD will exhibit at the American Society of Addiction Medicine meeting April 4-7 in Orlando.
  • Aprima will exhibit at the CORHIO Forum April 4-5 in Denver.
  • PatientPing and Lightbeam Health Solutions will exhibit at the National Association of ACOs spring conference April 24-26 in Baltimore.
  • Avaya works with Nuance to develop new self-service automation capabilities with easy-to-navigate conversational interfaces integrated in its Avaya IX Contact Center solutions.
  • CompuGroup Medical will exhibit at the AZ HIMSS Annual IT Summit April 11 in Phoenix.
  • DocuTap will present and exhibit at the Urgent Care Association Convention & Expo April 7-10 in West Palm Beach, FL.

Blog Posts



Mr. H, Lorre, Jenn, Dr. Jayne.
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Morning Headlines 4/2/19

April 1, 2019 Headlines No Comments

Brian Tyler Becomes McKesson’s New CEO

McKesson COO and President Brian Tyler succeeds John Hammergren as CEO.

NTT DATA Services Acquires State Healthcare Consulting Practice from Cognosante

NTT Data Services acquires Cognosante Consulting, which has supported IT projects for HHS departments and state agencies.

We’ve Got to Have More Time

Healthcare trade groups including the AMA, MGMA, and CHIME call for a 30-day extension of the comment period on the ONC’s 21st Century Cures Act proposal and the CMS interoperability rule.

Critical Alert Completes Acquisition of Sphere3

Former Sphere3 CEO Kourtney Govro becomes VP of Critical Alert’s business development and managing director of the its new Sphere3 Clinical Advisory Division.

HIStalk Interviews G. Cameron Deemer, President, DrFirst

April 1, 2019 Interviews 1 Comment

G. Cameron “Cam” Deemer is president of DrFirst of Rockville, MD.


Tell me about yourself and the company.

I’ve been president of DrFirst for about 14 years. DrFirst is primarily a technology platform company working in the medication management space. To de-jargonize that, we provide core technologies such as electronic prescribing, controlled substance prescribing, and a lot of things around medication history and interoperability. Those are often included in EHR platforms, hospital systems, HIEs, and pharmacies. We have a pretty broad footprint across the industry.

What is the best source for an accurate medication list other than asking the patient or their family members directly?

I would say DrFirst, of course. [laughs] Seriously, the medication history lists have come a long way. There has been a core medication history list provided by Surescripts for many years. We take that list and add medications to it from sources that aren’t providing their med history to Surescripts.

Getting a complete list is one issue. The other is making sure that the list is in a format that a hospital can intake into their own system. We do considerably massaging of the feed to make sure it has the right data elements. We clear up any discrepancies, such as around drug descriptions versus the NDC numbers and things like that. Then we help hospitals be ready to intake information from outside.

The best source is really a hospital or a physician that is using a very strong industry feed. It’s continuing to get better all the time.

It has always seemed hard to get old medications off the list, which could be done either by asking the patient if they’re still taking it or checking their refill records. Is that still a problem?

One of the things that’s exciting right now is being able to involve the patient more in that discussion. Medications they are no longer taking are one thing, but probably the more relevant issue these days is that patients are deciding how to medicate themselves. For example, it’s difficult to get a good, complete list of nutritional supplements that a patient might be taking.

But the other issue is that if I prescribe you a drug and you have some kind of reaction to it, maybe you decide that you’ll only take half a pill instead of a whole pill. Or maybe you discontinue it for a few days, you feel better, then you take it again and you feel bad again, so you discontinue it. Knowing how you’re dosing yourself versus how the therapy was prescribed to you needs to be addressed. We’ve been working on that primarily through more mobile interaction with patients, helping them understand how the doctor views their medication records and giving them a chance to update those appropriately for the physician.

I’m interested in your Link app, in which the patient receives a message under their doctor’s name listing the medication that was ordered, where their prescription was sent, and how much money they will owe as their co-pay. It even allows them to schedule a pick-up time with the pharmacy. Does offering a patient-facing application give DrFirst a way to grow in a new way?

It does. You and I talked about two years ago when we were starting beta testing of Link. We went into full-blown production with it within the last several months and have sent it to millions and millions of patients.

The way it works is that we know you’ve been to your physician, so we will reach out to you and try to make sure that you don’t abandon your prescription. We try to deal with what’s on your mind at that time. How much is it going to cost? What am I taking this for again?

A survey we did recently found that nearly half of all consumers aren’t sure they can take the medicine the way they were directed to take it because they can’t remember. The physicians usually are in kind of a hurry and the patient’s not thinking because they’ve just been diagnosed with some issue. Imagine that you were just diagnosed with diabetes or with high blood pressure and you’re not sure what that means. You’re not sure how you’re going to tell your spouse about it. You’re worried about how it will affect you physically. You may not be listening that carefully while the doctor is running through how you’re supposed to take your medicine.

We try to fill those gaps by reminding the patient. These are the meds that were prescribed. Here’s the pharmacy that has your prescription. Here’s some information about that therapy to remind you of the things your doctor told you. If you’re worried about how much it’s going to cost, here is the co-pay amount. Here is a financial assistance program, or maybe a consumer discount card if you don’t have insurance, which a lot of people don’t these days, or maybe they’re in a high-deductible plan. We take that cognitive load off the patient of not being able to remember what to do, being afraid of what they might have to do, and worrying about it. We ease them into starting their therapy.

I’ve always felt less empowered with e-prescribing. Before, I had a piece of paper that I could carry around to shop prices, I could get the prescription filled whenever I wanted, and I could research the drug before going to the pharmacy. Now I’m barely out of the doctor’s office when Walgreens starts the robocalls telling me to come pick up my prescription. Does Link re-empower the patient?

That’s an excellent observation. I actually feel the same way when I get a text message from the pharmacy telling me to come pick up a prescription. I may not have even been thinking about that at all. It’s just all happening in the background somewhere.

Another element of that is the rise of patient portals. On the one hand, it’s positive that we’ve been getting federal pressure for patient portals to be available in every EHR system, every hospital system. But it’s another way of taking some control away from the patient. Their data gets scattered between many electronic systems. It’s hard for them to bring it all together in one place. It’s hard to even just remember how to get to your portal a lot of times.

By going after the patient with this mobile solution only when they need it, we are trying to empower the patient to have all of their information in one place so they don’t have to remember what to do in order to get their questions answered. That’s probably the key here. As things become more electronic, there’s no reason that the patient should have a miserable experience of trying to navigate those electronic pathways.

Is the prescriber notified if the patient uses Link and decides for whatever reason to not pick up their prescription?

Not today, but we will have that shortly. We are incorporating a secure messaging channel from the patient back to the physician.

This is a new concept. Historically, physicians haven’t communicated with patients through text messaging, secure text, for a number of reasons. But that recent survey I mentioned found that an enormous number of patients, like 90 percent, said they would rather receive a text message from their doctor than a phone call, being steered to a portal, or being contacted via any the other methods they would normally get. We’re trying to meet patients where they are and give them the tools to be able to communicate something back to their physician in a manner that’s efficient for both the patient and the doctor.

This is a brave new world of trying to address what we call the care triangle. Think of a triangle with the physician on the top, a pharmacy at one corner, a hospital at the other corner, and the patient in the middle. Everybody needs to interact with and talk to the patient. But also, everybody at the corners needs to communicate back and forth with each other. We’re using secure collaboration tools to let all of those entities talk to each other in a real grassroots way so that we don’t have enterprise boundaries any more, or divisions between the medical professionals and the patients they serve. Letting everyone have the tools to be able to talk back and forth.

We hope that will be an important next step in making sure that all of the people who are working on behalf of a patient can synchronize and coordinate their care and to allow the patient to understand what’s happening and to be a part of it.

It would be interesting to put the patient instead of the provider at the center, with each patient having their own Facebook-like page in which all those messages and the patient’s replies are collected in one place that the patient themselves controls. Is that possible?

That’s actually what it is today. From a provider’s point of view, when they’re in our secure collaboration tool, they’re seeing one thread for a patient. It’s like text messages, with topics bouncing all over in the thread. In the collaboration tool, it’s centered around this patient that the care team is working on. From the patient’s point of view, everything comes into one queue where they can see a consistent record of the communications they have had.

What is the impact of an app that targets the patient specifically?

Link is quite powerful. We’re seeing close to 25 percent improvement in prescription abandonment just through Link. But we know that some patients, and particularly those who care for patients, need a more persistent experience.

But we also know at the same time that patients don’t care as much about their health as we would like them to. They don’t consistently focus on it in a productive way, which is why we forget where our portals are. We’re not in them all the time checking on things and sending messages back and forth. It might be because people don’t want to be defined by their illness. It might be that it’s just too psychologically heavy to continually think about your illness. But we tend to be concerned in spurts when we’re ready to pay attention.

A key focus for DrFirst is reaching the patient only at those times that they really care. During the times when they have less concern, we are just being available if they need us. We aren’t trying to get their attention during those times. We think that most patient applications fail because they assume the patient will be interested enough to continually interact with the application. We’re trying to put ours together in a way that addresses actual patient needs when they are occurring without requiring a lot of other activity otherwise.

What’s being done with opioid prescribing?

With all the pressure for physicians to use EPCS, it’s now about efficiency. Physicians not only are required to order the prescriptions electronically, but they also have to check the PDMPs, the state controlled substance registries. That is such a burden.

I saw my family physician recently and his office gave me three pieces of paper when I walked in. The first one said, you need to acknowledge that we don’t write controlled substance prescriptions out of this office. They made me sign that. The second one said, if I do write you a controlled substance prescription, I’m only going to write a three-day supply, and then you have to come back and see me again and pay for another office visit. I signed that. Then the third one said, the state of Arizona requires me to check the PDMP and they won’t pay me to do that and neither will your insurance company, so you have to pay me $15 for every controlled substance prescription I write for you. I had to sign that.

That’s happening all over the country. Doctors are pulling back from prescribing opioids because they don’t want to check the PDMPs. It’s too onerous. We’re starting to create a crisis of pain as opposed to a crisis of overdose.

To alleviate that, we’ve been putting a lot of effort into making electronic connections to every available state PDMP and then bringing the information into the physician’s workflow. Instead of leaving your EHR, authenticating into another system, entering patient demographics, and then going back to your system and typing the information in — because typically you’re not allowed to download it, you have to retype it — we make it so that right in the process of writing the script the opioid history is just right there, with no effort required. This addresses what unintentionally has became the next issue of patients — their doctors being unwilling to care for their pain at all as a rebound to the epidemic in the form of “let’s just not write them.”

It has been gratifying to see how enthusiastic physicians have been about making it this intuitive. It ought to be this simple and we’re we’re making it work that way for them.

Do you have any final thoughts?

We’re entering a time when there is so much pressure on the EMR community to continue to build features into their EMRs. We’re starting to lose the connection to the patient. The next big opportunity is getting all this information that impacts patient care in front of the patient at a time when they are ready to accept it and in a format that they can put to practical use as part of their therapy.

Patients for too long have been treated like miniature doctors who are laser-focused on their care. People don’t really work like that. I’m excited about digging in at the grassroots level to provide solutions to the real problems patients have trying to initiate and maintain their therapies over time.

Curbside Consult with Dr. Jayne 4/1/19

April 1, 2019 Dr. Jayne No Comments


It’s time for a trip through the reader mailbag. I apologize that I’m not able to respond to emails as often as I’d like, but sometimes it’s hard to manage not only a full-time job but my HIStalk gig and the volunteer work I do. I love hearing from readers and I feel like I’ve really gotten to know a handful of them even though we’ve never met or spoken. I’m always impressed by the thoughtful comments that people send my way.

Props to Epic’s MyChart team, who reached out to me in response to last week’s Curbside Consult detailing my experiences with Share Everywhere. They are concerned that it seems to not be working as designed and offered to troubleshoot it for me. I don’t want to risk de-anonymizing myself by revealing the institution, but they did have some good questions to help me further explain what I’m seeing so they can take a look. 

I also asked them to help me understand how patients are supposed to report issues since the hospital hasn’t seemed interested in the past at hearing about technical problems I was having with the billing side of MyChart. I would be interested in hearing from readers at other Big Health Systems on how they handle patient concerns about their patient-facing systems, whether Epic or not. It might make for a good post.

A reader sent some comments on my experiences with Share Everywhere vs. MyChart, further illustrating the issues with client-configurable features.

Like many tools made available by Epic, the healthcare organization makes choices and configuration decisions regarding MyChart, Care Everywhere, Share Everywhere, and Lucy. At our organization, problems, allergies, medications, test results and immunizations are all displayed with date information at the summary level as well as at the visit or encounter level. I had not looked at Share Everywhere for some time and was surprised that we do not display provider office notes in the Share Everywhere view. We do make office notes available to our patients, however. We need to explore whether this is an Epic limitation or a configuration option that we have not enabled. New functionality that we are almost ready to enable is sharing radiology images across the Care Everywhere network. Again, Epic provides the capability, we are responsible for configuring and enabling as is every other Epic customer that has chosen to participate in Care Everywhere. We also must choose to make incoming images available to our caregivers, just as other organization will need to decide if they choose to accept and make available images.

No props for the handful of emails I found in my box from people asking if I’m interested in guest posts from the people they represent or asking how they can contribute to HIStalk. It’s immediately obvious when I see those that they’ve never actually read the site or they would know about Readers Write.


Props to the couple of people who reached out to wish me a happy Doctors Day. Although it’s celebrated on March 30 in the US, other days are used in other countries. For example, Iran commemorates it on Avicenna’s  birthday, at least according to Wikipedia. In the US, it recognizes the anniversary of the introduction of general anesthesia using ether in 1842. I’m truly glad we don’t have do bite-on sticks after a slug of whiskey and that we now have less-flammable options.

However, I’m giving negative props to the American Academy of Family Physicians, whose celebratory email offered a discount on AAFP products and conferences, but only for the day. Most physicians I know have AAFP communications routed to their work email addresses and it was a Saturday, so I wonder how many takers they had. I would think they’d have a better handle on how busy their members are and consider offering the discount for at least a couple of days to allow people to take advantage of it.

One of my favorite correspondents sent some thoughts on interoperability and mental health and substance abuse data. They also sent their comments around my mention of the Duke whistleblower settlement:

As to whistleblowing, I was much more idealistic in my youth and pointed out issues to people in authority at my institution that I thought were problematic (generally related to serious patient safety issues, occasionally compliance issues).  Suffice it to say, these minor attempts at whistleblowing never went well for me and never resulted in any significant changes either. I’ve been tempted to “drop a dime” on my hospital to Joint Commission or the department of health, but they always seem to eke through CMS visits with immediate jeopardy in the balance, so the likelihood of any action on a higher scale seems minimal.  It is clear that hospital and departmental leadership can be vindictive to people who throw shade on them despite touting a “just culture.” Without an airtight case, which is virtually impossible to get, whistleblowing seems like more trouble than it’s worth. For every person who gets a big cash payout for whistleblowing, I’m sure there are many more well-intentioned people who will struggle to find another job as a result of their efforts.  For these reasons I’m much more circumspect in my old age and focus on flying under the radar and not making waves.

I’ve had that experience as well, being branded as “frequently dissatisfied” in an evaluation by one member of my residency’s faculty because I used to bring suggestions for improving the program or making things better for the learning environment. I learned quickly that they didn’t see feedback as a gift and that any suggestion would be received as a criticism. Needless to say, when I was selected to be chief resident, my first order of business was to implement the majority of things I had been asking for since I was an intern. Rumor has it that the “New Intern Handbook” we created that year is still in circulation, providing information that no one tells you in medical school, such as how to pronounce a patient dead when you get that call in the middle of the night.

On the topic of EHRs being responsible for the downfall of the patient-physician relationship:

Not too long ago, our group surveyed members and only one person made any remarks about the computer and that was “the EMR sucks.” Everyone else mentioned low salaries, poor communication from leadership, deteriorations in workplace safety and increased staff injuries, excessive emphasis on RVUs, and lack of respect for clinicians by leadership. I really don’t believe EHRs are the root of all evil.

I didn’t have to worry about anonymizing the comment, since those are the same issues I heard at the last meeting I attended of my hospital’s emergency medicine attending physicians.

I’m going far into the wayback machine on this one, but I posted in February about my flashback on the Addressograph machine. Apparently extinct technology is a hot topic:

The addressograph brought back memories! One of my first tasks in healthcare was to write program for the machine that produced those cards. We reprinted those cards every other day for inpatients because the numbers and letters would wear out. Later when I was in management I worked to replace them with stickers. The ward clerks did not want to give up their addressograph machines!

Addressographs were definitely a lot of fun! (Though the smell wasn’t quite as good as freshly printed mimeograph,) They were also very practical in terms of quickly getting an index card with the key patient info at the top that could be used to keep signouts much more efficiently than our current electronic physician handoff page. A saved index card was also like gold when the patient bounced back, unlike the current physician handoff that gets deleted at discharge.

I had forgotten about those signout pages. For those of you who are not on the provider side, when the resident physicians leave for the day, they sign out to the on-call team, which is responsible for covering patients they may never have met. In the olden days, we would meet with the on-call resident before we left the hospital. We would pull those sheets from our white coat pockets and give a brief rundown on the patients we had been caring for. The sheets might have included med lists, labs, problem lists, and other tidbits of information that would help the on-call team know what to do if an issue came up with the patient. Some of us even got fancy and created templates for our sheets to ensure we wouldn’t forget important information. The size limitation forced you to be concise and only focus on the most important information, which is probably becoming a lost skill from the voluminous charting we have in the EHR.

Another reader waxed poetically about dial up modems:

I also found there was something satisfying about hearing the sounds that meant your modem had connected and the old acoustically coupled dialups (where your phone receiver went into the rubber connector) were very amazing at the time.  It definitely beat standing in line at the computer center with a giant stack of keypunched cards (praying that you didn’t drop them and have to put them back in the right sequence.)


The “antique” technology that had the most mentions isn’t antique at all since it’s still in use at many hospitals — the beeper:

My favorite old technology has to be the old versions of beepers. When I was an intern, beepers just beeped. Nothing else. You called the paging operator and they gave you your message. These beepers had two advantages: you could cross your arms in a boring lecture and surreptitiously turn them off and back on again, which would make them beep. Then you could quickly escape to go outside to the hall phone and address your “page.”

The Motorola Adviser was my workhorse pager during residency, and according to one reader:

It has been granted eternal life. We still have them (and fax machines). Everyone has been saying for years that we should switch to cell phone “paging,” but there are cell phone dead zones and the beepers have much better coverage.

I’m closing up the mailbag for now. Keep those virtual cards and letters coming!


Email Dr. Jayne.

Morning Headlines 4/1/19

March 31, 2019 Headlines No Comments

West Michigan doctor’s office hacked, doctors held for ransom

A two-doctor ENT practice in Michigan closes for good and its partners retire after they refuse to pay a hacker $6,500 to restore their ransomware-encrypted systems.

Queensland Health rejects call to pause electronic medical record rollout

Queensland Health officials reject the Australian Medical Association of Queensland’s calls to halt the rollout of the Cerner-powered IEMR, saying all of AMAQ’s issues with the software have been resolved or are in the process of being addressed.

UM Health Spinoff Fifth Eye Nabs $11 Million VC Round

Post-operative patient monitoring startup Fifth Eye raises $11 million in a Series A round.

Mount Sinai and Hasso Plattner Institute Launch New Institute for Digital Health

Mount Sinai Health System (NY) and the Hasso Plattner Institute will spend $15 million to develop an institute that will develop digital health products with real-time predictive and preventive capabilities.

University Healthcare System to invest $170 million in new medical record technology

University Health System (TX) will spend $170 million to implement Epic over a three-year period.

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