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Weekender 11/15/19

November 15, 2019 Weekender 1 Comment

weekender 


Weekly News Recap

  • HHS OCR will review the HIPAA compliance of the “Project Nightingale” data-sharing agreement between Ascension and Google.
  • NextGen Healthcare announces plans to acquire patient portal vendor Medfusion for $43 million.
  • Ontario, Canada announces a Digital First for Health strategy that will give patients more online access.
  • Results of the Apple Heart Study find that 0.5% of 400,000 enrolled users received an irregular heartbeat notification, most of whom were found to have atrial fibrillation.
  • Premier launches Contigo Health, which will connect participating employers and health systems to optimize employee care using EHR-integrated clinical decision support.
  • Kaiser Permanente Chairman and CEO Bernard Tyson dies unexpectedly at 60.
  • University of Chicago asks to have its medical center to dismissed from a class action lawsuit that was brought by a patient who says its data-sharing agreement with Google violates his HIPAA rights.

Best Reader Comments

After dozens, maybe hundreds of healthcare organizations have partnered with analytics companies to share data and develop solutions, why are we just now becoming concerned that Google has entered the ring? (SkyNet)

Cerner makes money how? From recent earnings call: “As the acknowledged data source, we plan to develop a monetizable distribution model that provides access to legacy client segments and adjacent market prospects such as biopharma, payers and actuaries, to name a few.” (Vaporware?)

I agree it is patient’s data, but that is not the business model in other industries. What about credit information? Isn’t that consumer’s data, too? But credit agencies hog it and sell it without any explicit approval from the individual to collect / distribute it. (Data Business)

What bothers me is that many hospitals willingly give the data away or sell it to entities such as Google, but when the patient asks for copies of his or her own records, they are charged. (X-Tream Geek)

The letter urges that EHR vendors not create financial burdens for physicians trying to connect to state immunization registries and called on HHS to “hold information technology vendors accountable for creating a national standardized, easily accessible, accurate, robust immunization information system.” That’s a recipe to get some terrible software shoved down physicians throats. (What)

I think Mr. Segert has a surprisingly good handle on the [Athenahealth] business here. He’s right that the ambulatory market is consolidating and that Athena has the best ambulatory-only product. If you accept those facts, it seems that Athena should mop up the rest of the smaller vendors. Athena wasn’t making much progress on that because their focus and execution wasn’t there. They were spending their effort on tiny, low volume/$, rural hospitals who would bail out halfway through implementation and go back to CPSI. That was a great way for Athena to take large piles of investor dollars and set them on fire. Also looks like he has a good grip on the sales channels, which is the hardest and most important thing when selling software to the SMB or smaller enterprise market. (GoodFirstImpression)

Layoffs are almost always painful, but it feels worse during the holidays. As a recruiter, I get to see where the layoff leads. It’s remarkable how often it turns out to be for the best. I’ve seen so many people take layoffs hard, only to look back a few months later with gratitude that it led them to something better. (Jim Gibson)

The best way that most economic development agencies have found to lift families out of generational poverty in under-developed economies is to educate girls and women. Across the board, giving women access to education leads them to start businesses that provide economic stimulus to their entire community. Giving menstrual products to teen girls has proven to do just that. Giving a girl the opportunity to get an education is the fastest method to improving her life and the lives of those who depend on her. It is the same reason that diaper banks have proven to reduce sick baby visits and increase teen mothers’ ability to attend classes and work. A child who is constantly ill due to not being able to have a clean diaper is a drain on their parent. The parent can’t improve their economic situation if they can’t go to school and work. Just because a program is focused at the individual level doesn’t meant that it won’t lift up the community. (MEDITECH Customer)


Watercooler Talk Tidbits

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Nike will release the Air Zoom Pulse, a lace-free, protectively coated shoe (“a traditional clog made athletic”) that it designed to combat fatigue in testing at OHSU’s children’s hospital. Six young “patient designers” created their own versions of the shoe, profits from which will be donated to the hospital. I like the above design from 12-year-old Sawyer Miller, whose brain tumor was treated with surgery and 30 rounds of radiation therapy. I bet I could make a HIMSS20 splash walking endless miles in these.

University of Washington students petition the university to prohibit faculty members from requiring a doctor’s note for their absences due to “unavoidable” illnesses, saying that seeing a doctor for that purpose is expensive, requires students to explain their symptoms after the fact, disadvantages low-income and DACA students, and may result in the ordering of risky tests and procedures. The students add that doctors always write the notes anyway, so there’s no impact on their behavior.

Loyola University Medical Center tells a woman who was making inquiries into her mother’s unexpected death that its autopsy camera had been stolen and the photos on it lost. Nine of the 18 cases that had been recorded on the camera hadn’t been uploaded to the electronic files as health department policy requires because the camera didn’t come with a cable and the hospital didn’t have one.

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A 26-year-old woman undergoing breast cancer treatment is surprised when her boyfriend proposes to her in front of her Sloan Kettering treatment team on her last scheduled visit, after which they were married in an event donated by a wedding planning company.

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The gift shop of Park Nicollet Methodist Hospital (MN) adds a selection of hijabs for patients and employees, saying it’s the first US hospital to do so.

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UPMC Magee-Women’s Hospital dresses up newborns for November 13’s World Kindness Day in cardigans like those worn by Mr. Rogers, who spent most of his life and career in Pittsburgh. Other local hospitals and individuals did the same, encouraged by public TV station WQED, which created Cardigan Day in honor of Fred Rogers, who filmed 895 episodes of “Mister Rogers’ Neighborhood” at the station over more than 30 years through 2000. He died of stomach cancer in 2003.


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Morning Headlines 11/15/19

November 14, 2019 Headlines No Comments

Tyto Care Launches TytoHome Nationwide at Best Buy Stores

Best Buy ups its digital health offerings with the addition of TytoCare’s at-home telemedicine exam device and companion app.

AWS Announces AWS Data Exchange

Amazon Web Services launches AWS Data Exchange, giving users the ability to find, subscribe to, and use third-party data in the cloud.

Ontario Expanding Digital and Virtual Health Care

Ontario health officials announce a Digital First for Health strategy that will give patients the ability to book appointments online, access their medical records, and take advantage of more telemedicine services within the next three to four years.

ECRI Institute and Institute for Safe Medication Practices Join Forces to Enhance Patient Safety

Patient safety groups ECRI Institute and the Institute for Safe Medication Practices will merge, with ISMP becoming an ECRI Institute subsidiary.

Yale study links electronic health record systems to physician burnout, medical errors

The American Medical Association co-sponsors a study that finds that perceived EHR usability is poor and contributes to physician burnout.

News 11/15/19

November 14, 2019 News 7 Comments

Top News

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The HHS Office for Civil Rights will look into the HIPAA compliance of Google’s data-sharing arrangement with Ascension.

Google has pledged to cooperate with OCR investigators, stressing that its work with Ascension adheres to HIPAA and “comes with strict guidance on data privacy, security, and usage.”

The company added in an amended damage-control blog post that, “Patient data … is not used for any other purpose than servicing the product on behalf of Ascension. Specifically, any Ascension data under this agreement will not be used to sell ads.”

Google Cloud now knows that its parent company has a consumer image problem that, while not on the magnitude of Facebook’s, could still serve as a roadblock for its technical work that has nothing to do with search engine ads.

Perhaps most puzzling is why Google hasn’t enlisted its new high-profile healthcare hires to explain the project or to describe why it’s likely that patient data is more secure within Google’s systems than in those of any hospital or medical practice.

The odds that this deal violates HIPAA are zero. It only violates the data rights that consumers wish they had. 


Reader Comments

From RumorMonger: “Re: Allscripts. Reducing workforce today to cut costs, with a rumored 25-50 people let go.” Unverified, but reported to me by several readers, some of whom said weeks ago that the cutback was scheduled for November 18. Rumored areas impacted are Sunrise, support, and development.

From PizzaSlinger: “Re: Cerner layoffs. A manager apparently sent the layoff script to the associates he was laying off.” I hate that layoffs have become corporate business as usual, with companies unskillfully using them to (a) dump deadwood and high earners while dodging employment law issues; or (b) to quickly juice their financial numbers to arouse some bean counter. I get really worked up when the company cluelessly acknowledges the announcement with a cheery statement that while the valued (to a point) former associates will be missed, the company is hiring wildly otherwise. Maybe the “overall headcount increase” promise encourages investors and customers, but it throws salt in the layoff wound by clearly indicating that the affected “associates” aren’t worth retraining or reassigning. Still, I commend Cerner for sending its executioners a script – which was forwarded to me — to make the employee’s final contact with the company smooth. My summary of it:

  • Schedule the appointment ahead of time using an attached link (I assume using the link automatically alerts campus security to be close by at the designated time since that wasn’t emphasized nearly enough in the script otherwise).
  • “Anticipate their reaction so you can prepare.” Having laid people off myself, I don’t think you can do this with any degree of accuracy. Most employees are initially stunned, so the idea is to get them off campus without a working access badge before their Kubler-Ross’s “denial” turns to “anger.” I’m surprised that the instructions advised making the appointment ahead of time since that’s a sure sign of impending trouble, although it’s also awkward to have a layoff when some of those affected are on PTO and thus likely to hear from co-workers or a telephoning manager that they are now unemployed. It’s also a good idea to tell the survivors not to let their former co-workers into the building.
  • Coordinate with the co-worker who gets the fun job of marching the employee to the “offboarding support area” and then packing up their pitiful personal effects while they are getting the axe.
  • Don’t tell people their job has been eliminated while they are at a client site or driving.
  • Keep the conversation short, no more than 20 minutes, but book the room for 30-60 minutes so they can compose themselves without being kicked out of the room to make way for the next execution. 
  • Have Kleenex on hand.
  • Tell them not to return to the office, but advise them that they will remain an active employee through January 14, 2020.

HIStalk Announcements and Requests

The best lesson we can learn from the Ascension-Google controversy is that Americans are naive in thinking that HIPAA gives them broad privacy protection, so perhaps the shock – justified or not – that a company that most Americans know only for searching and serving ads is holding their medical data will open much-needed consumer privacy law discussion. Many people, even media types, seem shocked that HIPAA addresses only providers, or that they get a free pass under “treatment, payment, and operations.” I don’t question the data-sharing deal since it’s really not all that unusual other than consumers react more quickly when it’s Facebook or Google than if they found out that many, many other companies are sifting through their medical information, sometimes paying some other organization for the privilege. Bottom line – Ascension did nothing intentionally wrong, patient data is almost certainly safe, and both Ascension and Google now know they have a public trust issue that isn’t limited to just this tiny aspect of their businesses. I’m waiting to see if Ascension’s interest really is related to clinical outcomes rather than their own financial ones and whether anyone raises the issue of whether Ascension really has 50 million signed Notice of Privacy Practices forms on file (and whether those are valid if they were signed before Ascension acquired the original hospital). All this aside, the issue goes well beyond these two organizations.


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

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NextGen will acquire patient intake, scheduling, and payment software company Medfusion for $43 million. Medfusion will spin off its data services business into a separate entity named Greenlight Health. Steven Malik sold Medfusion in 2010 to Intuit for $91 million, then reacquired it in 2013. He owns the North Carolina FC of United Soccer League and North Carolina Courage of National Women’s Soccer League and is working to build a $2 billion entertainment complex in Raleigh.

The planned merger of Sanford Health (SD) and UnityPoint Health (IA) to form one of the country’s largest health systems is called off, with Sanford’s CEO saying that UnityPoint Health’s executives “failed to embrace the vision.”


Sales

  • St. Joseph’s/Candler will implement Tabula Rasa Healthcare’s DoseMeRx precision dosing software across its facilities in Savannah, GA.
  • Willis-Knighton Health System (LA) selects Meditech Expanse.
  • Humana, GuideWell, and Trusted Health Plan will use Healow Insights integrated services from EClinicalWorks for interoperability among their networks.

People

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Surgical software vendor Provation Medical hires Daniel Hamburger, MBA, MS (Renaissance Learning) as CEO. He replaces Dave Del Toro, who will join the company’s executive board.

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Jamie Trigg (Seattle Children’s) joins Virginia Mason Health System (WA) as CTO.


Announcements and Implementations

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The St. Louis Children’s Hospital and Washington University Heart Center (MO) sends high-risk infant cardiac patients home with Locus Health’s remote monitoring app.

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Best Buy ups its digital health offerings with the addition of TytoCare’s at-home medical exam device and companion app. The $300 device comes equipped with attachments that can be used during a telemedicine visit with partners from several health systems and telemedicine companies.

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CHI Memorial Hospital (TN) implements Epic.

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WellSky develops the WellSky IO interoperability framework to help post-acute and community providers connect to patient data exchanges.

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The Michiana Health Information Network, Indiana Health Information Exchange, and HealthLinc will merge operations under the IHIE brand in January. IHIE executives believe the consolidation will create new value propositions and help scale services. IHIE has played around with several business models since launching in 2004, including its ThriveHDS clinical data repository services offshoot, which shut down after just nine months. The HIE’s CEO and COO presented “Said the HIE: ‘Reports of Our Death Are Greatly Exaggerated” at HIMSS earlier this year.

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Amazon Web Services launches AWS Data Exchange, giving users the ability to find, subscribe to, and use third-party data in the cloud. Healthcare use cases include subscribing to aggregated data from historical clinical trials to accelerate research activities, and subscribing to aggregated and de-identified healthcare claims and transaction data to improve care delivery.

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In Canada, Ontario health officials announce a Digital First for Health strategy that will aim to give patients the ability to book appointments online, access their medical records, and take advantage of more telemedicine services within the next three to four years. Providers will be given access to interoperable records, and enhanced data integration and predictive analytics.

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A KLAS report on remote patient monitoring finds that nearly all users get measurable outcomes, but the market is changing to demand products that are patient-centric, that engage patients, and that offer patient-provider interaction, all using consumer-based rather than proprietary medical devices. Health Recovery Solutions and Vivify Health are leading the evolution, but the report’s conclusions are incomplete because several vendors refused to participate (Resideo, Care Innovations, Medtronic, and Philips).

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Patient safety groups ECRI Institute and the Institute for Safe Medication Practices will merge, with ISMP becoming an ECRI Institute subsidiary.


Privacy and Security

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I can’t tell if this is satire or serious: Google’s alleged whistleblower takes to The Guardian to outline why he or she felt compelled to share concerns about “the Nightingale Project” with, presumably, the Wall Street Journal: “After a while I reached a point that I suspect is familiar to most whistleblowers, where what I was witnessing was too important for me to remain silent. Two simple questions kept hounding me: did patients know about the transfer of their data to the tech giant? Should they be informed and given a chance to opt in or out? In short, patients and the public have a right to know what’s happening to their personal health information at every step along the way. To quote one of my role models, Luke Skywalker: ‘May the force be with you.’”

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Health Care Cost Institute CEO and former CMS Chief Data Officer Niall Brennan tries to calm the masses.


Other

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The American Medical Association co-sponsors a study that finds that perceived EHR usability is poor and contributes to physician burnout. The article is paywalled so I can see only the highlights (except for the graphic above, tweeted out by one of the authors), although I notice that response rates weren’t good. The authors conclude that EHRs scored an F with self-reported doctor scores in the bottom 9% across all industries and then correlated those scores to burnout. The correlation versus causation issue would lead me to question, do EHRs burn doctors out, or do burned-out doctors hate EHRs as a tangible manifestation of their unhappiness? Also, I’m not sure that it’s fair to compare an EHR to Amazon, a Google search, or a microwave oven, especially since those tools are voluntarily chosen for personal benefit. Doctors are frustrated with their EHR, but they’re also frustrated with nearly everything else about their jobs (and many of them must be frustrated with the AMA itself as well, given that only a fraction of US doctors are members, so maybe the EHR vendors should study that phenomenon).

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STAT looks at the integral role remote healthcare coaches play in the success of headline-grabbing digital health companies like Omada Health, Livongo, and Fitbit. Omada Health CEO Sean Duffy admits that though he’s a big fan of tech, “It’s hard to recreate human accountability.”

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Results of the Apple Heart Study are in, leaving researchers with several solid takeaways regarding the Apple Watch’s ability to alert users to abnormalities. The eight month study of 400,000 users – one of the largest of its kind – found that the device notified two thousand of an irregular pulse; 84% of which were found to have atrial fibrillation. Researchers concluded that passive monitoring can be beneficial, but more work needs to be done for the Watch to be truly useful in helping at-risk, rather than young and healthy, populations. Apple just launched a separate Research app to study heart, movement and hearing issues, and women’s health.


Sponsor Updates

  • Apixio celebrates several milestones including its 10th anniversary, adding 17 new provider and payer customers in 2019, and making Deloitte’s 2019 Technology Fast 500 list of fastest-growing companies in North America.
  • Ellkay will exhibit at Momentum 2019 November 22-24 in Orlando.
  • Ensocare will exhibit at the 2019 Leadership and Physician Advisor Conference November 15-17 in Miami.
  • CarePort Health’s post-acute provider database and patient choice application, CarePort Guide, is now available in the Epic App Orchard marketplace.
  • HealthCrowd will present at the Florida Association of Health Plans 2019 Connect Conference November 19 in Orlando.
  • In Australia, Hyland integrates Medrefer’s referral technology with its OnBase enterprise information technology.
  • InterSystems will exhibit at Healthcare Providers Transformation November 18-20 in Denver.
  • Intelligent Medical Objects will exhibit at the AMIA 2019 Annual Symposium November 16-20 in Washington, DC.
  • Kyruus CTO Chris Gervais will present at Salesforce’s DreamForce November 20 in San Francisco.
  • AMIA inducts Clinical Architecture CIO Shaun Shakib into the 2020 Class of AMIA Fellows.
  • Recondo Technology announces that bookings for its automation solution for prior authorization transactions has accelerated in 2019 to 60 health systems, most of them Epic users.
  • ZDNet profiles Nuance.
  • Health Catalyst appoints Julie Larson-Green (Qualtrics) and S. Dawn Smith (Cologix) to its Board of Directors.
  • The Chartis Group publishes a new white paper, “Creating a Successful Physician Enterprise in Academic Health Systems.”

Blog Posts


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EPtalk by Dr. Jayne 11/14/19

November 14, 2019 Dr. Jayne 2 Comments

Many EHR aficionados view discrete data as the holy grail of information, but a recent article in the Journal of the American Medical Informatics Association looked specifically at data from unstructured clinical notes. The authors found that such “real world data” was more accurate for use with algorithms to predict coronary artery disease when compared to structured data.

The study looked at data from a six-year time span, gathering a specified set of clinical concepts through structured data gathered from standard query techniques as well as AI-driven analysis of unstructured data. The authors used data from over 10,000 clinical notes and looked at language around existing coronary artery disease, diabetes, and other clinical predictors of coronary artery disease. Food for thought for all those folks who are uncertain about the role that narrative documentation may continue to play as we move forward.

I was glad to see a recent ONC blog that noted that nearly one-third of hospitals can access prescription drug monitoring program (PDMP) data from within the EHR. However, it seems like that number should be much higher if we really want to move the needle on inappropriate prescribing of opioids. If providers aren’t viewing data from within the EHR, that means they have to access a separate system, which in itself adds a barrier to use. The piece didn’t mention rates of integration for ambulatory EHRs, which is where a lot of opioid prescribing happens.

Nearly all states have PDMP registries, with only Missouri lagging behind. (Interestingly, that state was one of the last to have a statewide immunization registry, which makes it look a bit like public health isn’t a priority for the legislators.)  I rarely prescribe opioids, and when I do, it’s usually for 10 or fewer pills, but I still access the PDMP whenever my suspicions are raised about a particular patient. Usually the PDMP confirms my impression, leading to a very direct conversation with the patient.

This hit my radar at the same time as a communication from the American Academy of Family Physicians about its recent vaccine-themed letter to the US Department of Health and Human Services. The letter urges that EHR vendors not create financial burdens for physicians trying to connect to state immunization registries and called on HHS to “hold information technology vendors accountable for creating a national standardized, easily accessible, accurate, robust immunization information system.” It also called for universal payments for vaccinations, which makes sense after my recent experience which I’ll call “A Tale of Two Vaccines.”

One member of my family received their vaccination at their primary physician office. The explanation of benefits statement lists a charge, an adjustment, a payment to the physician, and a patient responsibility of zero since the entire amount was applied to “well care.” I received my vaccination at my clinical employer. Although it’s required as a condition of employment, they bill it to insurance and then absorb any non-covered portion. My explanation of benefits lists a charge, an adjustment, and no payment to the physician since the place of service was “urgent care” and the entire amount was applied to my deductible. If I hadn’t been an employee, I would have paid the entire cost.

Insurance companies should either pay for a vaccine or not, regardless of the place of service, as long as the same CPT codes are being used for billing. Hundreds of patients receive their vaccines from my clinic because we’re fast, friendly, and accessible. I hope they’re not receiving the same rude billing surprises that I did.

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I’m skeptical about a new Facebook Preventive Health tool that is supposed to help empower people to seek out vaccines and other preventive services. They plan to use age and gender to identify target populations. My first concern at reading that is that perhaps they don’t understand the difference between sex and gender and how those contribute to the equation. Hopefully that was a lapse on the reporter’s part, since the official Facebook web page notes age and sex as the demographics it’s monitoring.

The official page also notes that it is referring patients to Federally Qualified Health Centers with its “find locations near me” for patients to get checkups and to the HealthMap Vaccine Finder for vaccines. It goes on to say that it “doesn’t verify locations on these lists and the lists may have inaccuracies.”

The feature is available only on the mobile Facebook app and doesn’t give specific sources for all of its recommendations. It did say that a mammogram was recommended for my age and sex and it should be yearly, citing the American Cancer Society as the source. There was no readily visible source for flu vaccination, blood pressure testing, diabetes screening, cholesterol screening, or cervical cancer screening, although they could be found by selecting a details arrow.

It also recommended I have an annual stool blood test for colorectal cancer screening, which is not in harmony with the US Preventive Services Task Force recommendations for my sub-50 age group. It went on to say that “test kits are free with most insurance plans” and I can guarantee that it is not free with my insurance, which covers only what is recommended by the USPSFT. The American Cancer Society (which Facebook cites as its colorectal cancer screening reference) even says clearly that insurers are not required to cover screening for individuals under 50 years of age. Those kinds of discussions will not be enjoyed by physicians when patients roll in with “authoritative” information from Facebook.

The Federal Communications Commission’s Intergovernmental Advisory Committee issued a recommendation last week regarding “State, Local, Tribal, and Territorial Regulatory and Other Barriers and Incentives to Telemedicine.” Not surprisingly, the major issues they cite include broadband access and a patchwork of laws and regulations that impede adoption. Looking at the broadband issue, redundancy is an issue for facility-based telehealth programs.

The report recommends that live video with appropriate image and audio quality be available so providers can accurately assess patients, adding that access to the full patient chart is desirable. They didn’t give much attention to consumer-facing telehealth. They note six policy areas where work needs to happen from a regulatory perspective: reimbursement, licensing, health information exchanges, insurance parity and malpractice overage, privacy-information sharing and HIPAA, and also being able to establish a doctor-patient relationship based on telehealth.

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Morning Headlines 11/14/19

November 13, 2019 Headlines No Comments

HHS to probe whether Google’s ‘Project Nightingale’ followed federal privacy law

The HHS Office for Civil Rights will look into the HIPAA compliance of Google’s data-gathering arrangement with Ascension.

Indiana HIEs Unify to Better Meet the Needs of the State’s Healthcare Community

The Michiana Health Information Network, Indiana Health Information Exchange, and HealthLinc will merge operations in January.

Steve Malik sells Cary firm Medfusion to California firm for $43M

NextGen will acquire patient intake, scheduling, and payment software company Medfusion for $43 million.

Morning Headlines 11/13/19

November 12, 2019 Headlines No Comments

Cerner lays off 131, but its hiring tops 4,000 in 2019

Cerner lays off 131 employees in a second round of cost-cutting in nearly as many months.

Apervita Secures $22 Million Investment to Fuel Future Growth

Value-based care clinical quality platform vendor Apervita raises $22 million from an incremental investment.

Premier Inc. Forms Contigo Health™ to Help Health Systems and Employers Work Better, Together

Premier launches Contigo Health, a network of member health systems that will use EHR-integrated, evidence-based clinical decision support to optimize care for the employees of its employer members.

UST Global Acquires Contineo Health, a Leading Healthcare Technology Consulting Firm Specializing in EHR Optimization

IT solutions company UST Global acquires EHR optimization vendor Contineo Health to strengthen its appeal to providers and payers.

Health Catalyst Reports Third Quarter 2019 Results

Health Catalyst reports Q3 results: revenue up 20%, with full-year revenue expected to be between $151 million and $154 million.

News 11/13/19

November 12, 2019 News 26 Comments

Top News

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Google announces Project Nightingale, a partnership with 150-hospital Ascension in which the company will gain access to the identifiable data of potentially all of Ascension’s patients to apply predictive analytics for patient care.

Business Insider reports that the information of 20 million patients has been uploaded to the cloud, with that of another 30 million patients scheduled for transfer in February.

The Wall Street Journal says the data being shared is not de-identified and is essentially the patient’s entire record. It also notes that at least 150 Google employees have access to the data.

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The organizations are testing EHR search software and tools that present EHR data graphically to clinicians.

Ascension’s patients and doctors were not notified of the project, except for the 2,000 doctors and nurses who are testing the EHR search function.

Ascension says the deal meets HIPAA requirements because Google has signed a Business Associate Agreement.

Quoted in the announcement was Ascension EVP / Chief Strategy and Innovation Officer Eduardo Conrado, who spent 26 years as a Motorola IT and marketing executive and four years as an Ascension board member before joining the health system’s executive team in September 2018.


Reader Comments

From Laid Off and Up: ”Re: recent layoffs. Why do companies fail to understand how bad they look laying off employees in November and December?” I assume that unrestrained desperation to make Excel cells jump forcibly through hoops to earn a bean counter hurrah outweighs the justified black eye that results from showing previously valued “associates” the door during the two-month holiday window. It’s never a great time to lose your job, but prospects are dim until after New Year’s, long nights invite depressing self-analysis, and it’s an unenviable acting job trying to appear upbeat along with holiday-spirited family and friends. Layoffs are a management failure, but November and December cutbacks suggest a higher level of knee-jerk incompetence. I’ll offer my advice from having served on both sides of the forced march out the door — you don’t want to work for a company that conducts regular layoffs anyway, so they’re doing you a favor by forcing you to choose a better employer.


HIStalk Announcements and Requests

I’m excited that my pre-ordered copy of “Man’s 4th Best Hospital” by Samuel Shem was deposited into my Kindle library upon its release today. I expect that will be the subject of my next book review. Meanwhile, if you think I should read a particular book and report on it, let me know.


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

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Cerner lays off 131 employees in its latest round of cost-cutting. 

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Value-based care clinical quality platform vendor Apervita raises $22 million from an incremental investment.

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Premier launches Contigo Health, a network of member health systems that will use EHR-integrated, evidence-based clinical decision support to optimize care for employees of its employer members. It will also identify available employer health and wellness programs. Premier acquired evidence-based clinical decision support vendor Stanson Health a year ago for $51.5 million, which I would guess forms a key part of this offering. This announcement is a pretty big deal – as big tech companies start trying to figure out this maddeningly complex market, publicly traded Premier knows it inside and out (supply chain, quality improvement, analytics, technology, clinical delivery, etc.) and has now, via Contigo Health, formed relationships with 35 health systems representing 440 hospitals as well as several national employers to address cost and quality issues (also note that health systems are longstanding Premier member-owners). I wrote here several years ago that Premier was the company to watch in terms of disruption and execution and this announcement doesn’t throw water on that prediction. If I were Google or Amazon and was anxious to get a healthcare foothold… well, let’s leave it at that.


Sales

  • Mercy will implement Bright.md’s asynchronous virtual care platform to provide online triage, diagnosis, and treatment for patients at any location at any time.
  • In Northern Mariana Islands, Commonwealth Healthcare Corporation will upgrade its Medsphere legacy system to CareVue EHR and revenue cycle.

People

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Jon Zimmerman (Athenahealth) joins Holon Solutions as CEO.

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Datica CTO Travis Good, MD will leave the company’s management team. He will remain a Datica board member and is starting a new venture that is focused on personal data and privacy


Announcements and Implementations

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Cricket Health Chief Product Officer Geoffrey Clapp builds VA Care Finder, a free Amazon Alexa skill that allows veterans to provide an address and to be given the closest three VA locations by driving distance (including traffic conditions), powered by the VA’s Facility API. The screenshot above is from an Echo Show device. He’s working on enhancements to use Alexa’s default home location, answer questions about specific facility hours or address, and answer questions about service lines, such as mental health, rather than all locations. Alexa’s limitations don’t allow him to link to external services or to use mapping tools. He’s hoping to explore the VA’s many other APIs to see if appointment scheduling is a possibility. He concludes in his Veterans Day post,

With these APIs — and there is much, much more than just the facilities subset API that I’ve exposed here — the developer community can now get access to data we only dreamed about back in the highly-mentally-scarring VistA integration days of yore. The fact that nearly all the data that is available to internal development teams at the VA or USDS is also available to every hacker, startup, and BigCo means we can do what APIs are meant to — OPEN THE DATA — and build stuff no one ever thought of (or, thought of but didn’t have the budget for…I see you, VA) and there are few populations as deserving of innovation as our Veterans.

A Black Book survey of health information management professionals finds that 93% are optimistic that AI can streamline document creation and capture a holistic patient history to improve outcomes and revenue integrity.

Prepared Health develops an API that users FHIR 4.0 to connect home care agencies and other providers to health plans and hospitals for referrals, care management, and billing.


Government and Politics

Politico reports that CMS Administrator Seema Verma signed a $2.25 million government contract to hire at least 40 consultants to polish her personal brand, several of them former Trump campaign workers who billed taxpayers up to $380 per hour to perform tasks that have always been managed by CMS’s civil servants. HHS cancelled the contract in April 2019 after Politico reported on it, but at least $744,000 had already been spent.


Other

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In Israel, Sheba Medical Center says it will create “the first fully VR-based hospital.” That’s certainly a press release stretch, unless the hospital plans to sell off all those buildings in the photo above and instead pass out VR headsets to patients. They calmed down a little further down the page, specifically listing that the hospital will use virtual reality for therapy services and education.

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The non-profit Health Care Cost Institute gains access to de-identified Blue Cross Blue Shield claims in a multi-year partnership agreement. UnitedHealthcare stopped sharing its claims data with the group earlier this year, citing privacy concerns about HCCI, which is a non-profit competitor to its claims data-selling Optum subsidiary.

The Environmental Protection agency is proposing to ignore the conclusions of academic studies in its rulemaking unless the authors submit all raw data, including any patient medical records that were reviewed, for public inspection. EPA says outsiders should be able to independently review all study data to verify the conclusions of the researchers. The measure would make it more difficult to pass new environmental laws because the personal health information that was involved is often collected under confidentiality agreements. EPA’s proposed standard would exceed those for published medical studies, which do not require investigators to submit raw data.

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A newspaper in India interviews Viren Prasad Shetty, the COO of India-based Narayana Health, which plans to expand from its 30 hospitals and 6,000 beds to 30,000 beds. Interesting points:

  • The company plans to create a virtual health network that involves apps rather than buildings in an Uber-like model that will allow it to grow more quickly at a lower cost.
  • He says India’s plan to add a new medical school in every three districts of India isn’t adequate because many of the graduates leave the country, noting that the US has more India-graduated nephrologists than India itself.
  • He predicts that “the biggest export-earning industry of this country will be our manpower,” specifically medical caregivers as declining populations leave Western countries with no one to care for their senior citizens.
  • Narayana’s 20% annual growth in cancer services eclipses that of its primary focus of cardiac services, so “we will want to convert all our hospitals into cancer hospitals.”
  • He says the company’s strength is that is led by a core group of doctors – including cardiac surgeon and CEO Devi Shetty, MBBS – instead of business executives, which makes it attractive to doctors.

A man who expected his hernia repair to cost around $10,000 is shocked at the for-profit hospital’s $116,000 bill for the 91-minute outpatient procedure, including $1,700 for a pair of scissors. He had passed on buying real health insurance and instead enrolled in a health-sharing ministry that pools medical bills among self-pay patients outside the purview of insurance regulations. He was approved for up to $50,000, but inadvertently chose the most-expensive area hospital and didn’t realize that patients who are covered by health-sharing ministries are billed at the same rate as uninsured or cash-paying patient without the benefit of heavy insurer-negotiated hospital discounts. The hospital refuses to budge on the $67,000 balance he owes. He’s demanding that Virginia’s consumer protection office force the hospital to write off his balance, but an attorney with Virginia Poverty Law Center says the hospital will probably just sell off his debt to a collection agency for 10 cents on the dollar. 

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An American Osteopathic Association survey finds that 75% of Americans feel lonely. My free advice – forget your pretend friends on Facebook and make an effort to interact with actual human beings instead of accidentally trampling them on the sidewalk while staring down in wonderment at your phone’s compelling but imaginary world. The most provocative art I’ve seen recently is by photographer Eric Pickersgill (above), who showed what real life would look like once the “small, cold, illuminated devices” of social media addiction are removed. He describes it as: “This phantom limb is used as a way of signaling busyness and unapproachability to strangers while existing as an addictive force that promotes the splitting of attention between those who are physically with you and those who are not.”


Sponsor Updates

  • Apixio will exhibit at the Rise Annual Risk Adjustment Forum November 12-14 in Scottsdale, AZ.
  • Clinical Architecture will exhibit at AMIA November 16-20 in Washington, DC.
  • Diameter Health will exhibit at the Advent HEDIS 2020 Client Conference November 19 in Scottsdale, AZ.

Blog Posts


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Contacts

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Morning Headlines 11/12/19

November 11, 2019 Headlines No Comments

Our partnership with Ascension

Google clarifies its HIPAA-compliant work with multi-state Ascension after multiple media outlets report that its employees have questionable access to millions of medical records through a secret data-sharing project dubbed “Project Nightingale.”

KKR Makes Formal Approach to Walgreens Boots on Record Buyout

Walgreens shares rise on the news that New York City-based private equity firm KKR has submitted a proposal to take the company private.

Healthcare Leader Jon Zimmerman Named CEO at Holon Solutions

Former Virence Health President Jon Zimmerman joins Holon Solutions as CEO.

Access Physicians Receives Investment to Expand National Acute Care Delivery via Telemedicine

Acute care-focused telemedicine vendor Access Physicians raises $9.3 million in a Series A funding round.

Curbside Consult with Dr. Jayne 11/11/19

November 11, 2019 Dr. Jayne 2 Comments

My recent conversation with a local university student about how the US looks at public health efforts got me interested into digging in a little more into a local health system’s work to address social determinants of health. I reached out to a former colleague who is now in a leadership role. He asked to remain off the record, since not all of his views fully align with what he is working on as part of the health system’s efforts. I totally understand having to stay off the radar to keep your job, so I was happy to oblige.

One of the major pushes of the health system has been expanding access to care, whether it’s with a mobile unit to visit areas that don’t have providers or whether it’s creation of school-based clinics. They are finding that even those approaches sometimes aren’t enough.

One of the areas where they set up a school-based clinic has a high absenteeism rate, with girls posting higher numbers than boys. Digging deeper, they found that teen girls sometimes aren’t in school due to lack of access to menstrual products. As someone who has worked with a church group to sew reusable menstrual pad kits for girls in developing nations, this doesn’t seem like something we should be seeing in the US. The clinic set out to solicit donations for menstrual products, and guess what? The absentee numbers went down. It’s a great example of how we need to really understand all the factors that are driving health, education, and wellness.

This approach may resonate with practices who help care for high-risk patients by providing transportation or assist with obtaining housing or groceries. If patients aren’t able to meet their most basic needs, they’re not going to be focused on things higher up the hierarchy, like healthcare and medication.

My colleague said this approach is something he actually struggles with philosophically. Some programs focus on those individual social needs, but don’t look at how you need to go about improving the underlying social and economic situation in communities as a whole. The individually-focused interventions are cheaper than delivering more intense medical interventions for sure, but they don’t assist people who haven’t become patients yet or who aren’t in the healthcare system.

He recounted a recent meeting among community health stakeholders, where they spent nearly two hours debating and defining what they mean when they say “social determinants of health.” The phrase was being thrown around and meant different things to different people, and they felt it was important to get everyone on the same page.

Although I don’t doubt that it was probably a painful meeting, it sounds like it was necessary. As he was telling me the story, it reminded me about how people throw around “pop health” and “population health management” and various permutations that may not mean the same thing depending on who is using the phrases and where they’re coming from.

During one of their community-focused initiatives, they actually had quite a bit of resistance from a small segment of community members. Some felt that the hospital’s participation was a way of trying to “medicalize” issues that community activists want to have a much more social and/or services focus. Instead of heaving the health system lead the charge, they want to see it led by community centers, faith-based organizations, and other community-led groups.

In addition to concerns about medicalization, there were also concerns about the hospital staffers not reflecting the community demographic and the optics of having a primarily Caucasian outreach team working with a community whose makeup is predominantly African-American. That’s something that isn’t always thought about, but may certainly be part of how interventions are received.

Patients and community leaders are also skeptical about value-based care. Some see it as rationing by another name, especially when it’s being primarily led by the medical establishment. Others see it as a way for conglomerate health systems to increase their dominance, which can lead to the erosion of community-focused health services.

My colleague mentioned that he struggles a bit going back and forth between the community outreach projects and the health system’s flagship hospital, where he has an office. The hospital’s lobby looks more like a high-end hotel than a healthcare establishment, and executives regularly divvy up the organization’s luxury box tickets for events at the local stadium. When he sees what might be considered excesses, he immediately thinks of how many social services could be delivered using the money spent.

He also has a hard time wrapping his head around the half billion dollars that has been spent on a recent EHR implementation and associated consulting services when his repeated requests to add a social worker to his team have been rejected. He notes that the EHR project hasn’t been all bad since it has made it easier to obtain and use data about different outreach projects they’ve been doing. It’s been useful for clinical reminders and identifying gaps in care to try to optimize health for individual patients. They’ve also been able to use address data to refine locations for community-based health screenings and vaccination clinics. He notes that has been easier since his request for a 0.5 FTE data analyst position was approved.

Apparently there are some ongoing tensions with the local public health organizations, who feel that competing health systems are more about bringing attention to their facilities than about advocating for essential public health needs such as sanitation, preventive services, and immunizations. The health system is having a retreat in a couple of months to talk about its community health efforts and it will be interesting to check in with him and see if there are any major changes to strategic direction or if the plans remain status quo.

I wonder what that retreat would look like if they invited public health leaders, or better yet, also included representatives from the other major healthcare players in town? Maybe that could lead to a more coordinated effort, but I’m just hypothesizing. I wish there were words to describe the eye-roll that resulted when I made that suggestion.

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On a side note, I wanted to say thank you to all our readers who are veterans and also to their families and loved ones. We appreciate your service and your sacrifice.

How does your organization integrate with the local public health infrastructure? Is it working, or are there suggestions you would offer? Leave a comment or email me.

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Email Dr. Jayne.

HIStalk Interviews Bob Segert, CEO, Athenahealth

November 11, 2019 Interviews 8 Comments

Bob Segert is chairman and CEO of Athenahealth of Watertown, MA.

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Tell me about yourself and the company.

I’ve been a serial CEO. I have been working in the private equity space for the last 11 or 12 years. This is the fourth company that I have had the privilege to run as CEO. I’ve been largely focused on software and services. This is my first foray into healthcare.

Athenahealth is going through an interesting and fruitful transformation from being publicly held to privately held. This is providing significant opportunity for us to rethink some of the old paradigms and the ways we thought about the business. This allows us to reposition ourselves to ignite against our new vision, which is to create a thriving ecosystem that delivers accessible, high quality, and sustainable healthcare for all.

What do you bring to the table as someone with no healthcare experience?

The real advantage I have is that I can ask all the silly questions and not feel like I should already know the answer. That allows me to get to first principles.

We are all users of healthcare, so we’re all somewhat familiar with some of it, but it’s cursory knowledge. You understand some of the steps. That at least allows you to focus in and have an objective view on the data that you hear.

The value that I bring to this enterprise is that I’ve been a longtime software and services exec and I’ve been in a lot of different industries across the United States and internationally. That allows me to think about this platform business and the apps that we have a different way.

I think about Athenahealth as being a technology company that provides solutions that help doctors be more efficient and effective in what they do. But the underlying core assets that we need to continue to improve and drive value with are, fundamentally, software and services assets. That’s where my strength and background has been in for the last 20-25 years.

What opportunities do you see with the Athenahealth network that connects hundreds of thousands of users on a single platform?

It’s the most powerful asset that Athena has. We believe in an open ecosystem. That’s why our new vision is about creating that thriving ecosystem.

Ecosystems must be dense, resilient, utilized, and open. Think about Athena in that context. We are the only platform out there that has that type of capability. We are fundamentally a SaaS-based application. All our customers are on the same code. We don’t have versions of the code. We update our software every night. Everyone gets it. You don’t have to reinstall it. If you want to get a new code, just refresh your browser and it’s there.

This allows us to powerfully change our rules and change our workflows to be more reactive to changes in the healthcare system and ways to make things better. We don’t have to wait for the next release a year from then. We don’t have to wait another three years for our customer base to adopt it.

The other thing that we’ve invested in, which is an amazing asset, is the data lake. We’ve abstracted all data out of our relational tablespaces that we have for each of our customers into a data lake. We have a full API gateway that is opened up to that. With permission, any person can get into that network of data and provide additional services, whether that’s the hospital system or ambulatory system on their own or whether that’s a third-party provider that has authorization from that practice to access their data. They can now access that seamlessly through the data lake.

Our real advantage comes from the scale of that network and the openness of that network. We have 160,000 providers that are part of our company today. We process over 10 billion transactions every year. It’s a massively scaled platform, open at its core, that fundamentally will continue to be a vanguard and leader in interoperability. Healthcare needs platforms that break down the silos, the information asymmetries, and the incentive asymmetries to enable a fragmented system to thrive.

How does Athenahealth work with vendors that don’t sell EHRs but offer add-on or complimentary products?

We have the Athena Marketplace, with almost 300 partners. Frankly, I think we have underutilized the benefit and the potential of that. I’d like to see 2,500 to 3,000 partners in our marketplace.

We want to make our network open and extensible. We will let anybody come and play in that network and add value to our customers. We think it also adds value to the healthcare system. We think it drives better outcomes, whether it be accessibility, quality, or sustainability.

We are very open to driving that open marketplace and we will continue to invest in that. That’s a key part of our strategy as we think about the business going forward.

We are also committed to driving interoperable solutions at an experiential level, at a physician level. One patient, one chart. The ability to schedule and refer across ambulatory and acute care settings. We want to be able to do that with every single EHR out there that’s willing to connect with us.

Our goal is not to hoard relationships or try to be a closed system. Our goal is to enable better healthcare outcomes. If we can do that, we will prosper, and the American public will benefit.

Do you see a role in helping those companies develop a business?

We have done that in several cases, where we have worked with small businesses that are exclusive partners to Athena to help them gain traction with our customer base. We’ve provided lead referrals. We’ve provided free office space in our main headquarters building in Watertown so people can develop their products and solutions. We’ve been a big proponent of trying to help our partners be successful.

I think we have a lot more that we can do. There are investments we want to make in marketing and onboarding and enablement that will allow us to treat that with a channel support-type mindset so that we can enable the success of those partners.

Of course, there are always opportunities for us to have a broader relationship with the companies that really take off and are doing well within our customer base, for us to have a broader relationship with them. That could be a joint venture, a minority interest investment, or even ultimately an acquisition by Athena.

What is your relationship with Walmart and their use of Athenahealth systems in their Walmart Health pilot in Georgia?

We are doing work with Walmart. We see that as a significant opportunity for us as we move forward. It’s a pilot program right now, but we see that hopefully being able to expand to many more sites over the coming months. We have a lot of other programs in the retail space that will be similar. We think it will be a big growth area for us going forward.

We are seeing demand there because of our SaaS-based platform. People who are trying to use cloud-based technology, SaaS-based technology, to enable outcomes naturally gravitate towards the type of platform that we have. It is dynamic, flexible, configurable, and adaptable.

Competing vendors seem to be addressing a mature EHR market by either expanding into areas that haven’t been big EHR users or cultivating relationships with pharma. Are either of these areas attractive?

We’re not focused on the pharma space. That’s not where our strategic intent lies. You’re not going to see us pivoting into pharma, either from a data standpoint or a broader services standpoint.

Where you will see us focused is on alternative sites of care. You’ll see us increasingly in employer clinics, retail clinics, the ER, and eventually in virtual medicine and telemedicine in the home. We want to be able to meet our patients where they are and help our physicians create a seamless, end-to-end experience across the care continuum as we expand our service offerings and our capabilities in those spaces.

But fundamentally, where you’ll see us double down is investing in our fundamental clinical workflows at the front door of medicine. Peds, OB-GYN, internists, primary care physicians — that’s where we are going to focus. We’re going to focus a lot of dollars on improving that EHR, improving those workflows, and then enabling the exposure of data to help them close care gaps in real time, when the patient is in front of the doctor. That is the key thing that we think we can drive in the industry that others have a hard time matching.

It was a seemingly odd mash-up of cultures to combine the old Athenahealth with the GE business to form the new Athenahealth. How would you characterize the company’s focus and culture now compared to what it was in those previous companies?

I would say it’s evolving. We are leveraging some of the best traits of both businesses.

In Virence, the old GE Centricity business, you had some long-tenured, expert capabilities — specialty workflow experts, anesthesiology, cardiology. You have hospital-related capabilities and RCM. GE had discipline, while Athena was traditionally more freewheeling, with an entrepreneurial, founder-led culture and all those elements that has made Athena such an amazing place to work.

You take that additional expertise and specialty workflow capability and pair that with that front door capabilities that Athena had, where because of its SaaS-based platform, it could succeed with one- and two- doctor practices, because that the delivery model makes so much sense for them, whereas premise-based software doesn’t. It’s a nice mash-up between the two.

We are right in the middle of it since it has been around nine months since the transaction closed. The cultures are coming together nicely and it’s going to continue to evolve over time. You don’t move cultures quickly — cultures evolve. We’re committed to taking the best of both and bringing them together to be even a more dynamic and exciting place to work.

Athenahealth seemed to struggle in its final publicly traded days with a post-Meaningful Use mature market. How does that affect your business strategy?

There’s no doubt that Meaningful Use, the emergence of EHRs, and the incentive to adopt EHRs floated all boats. A lot of companies sprung up because of that. As the Meaningful Use hurdles get higher and higher each year and certification become more and more difficult, I think you’re going to see increasing pressure on some of the smaller EHRs that may not have the engineering wherewithal and financial background to be able to survive.

It is a replacement market. It’s going to be a consolidating market. You’ll see some of the smaller players thrive less than they did in the past. Some specialized small players will continue to do extremely well and grow based upon a focused strategy. You’re going to see some of the bigger players like Athena working to differentiate ourselves in the marketplace, trying to gain relative share as these opportunities come up for replacement.

My view, and what I’ve seen since being inside the tent, is that we have amazing products that people really, really love. We’re not perfect, but people love these products. When we get into a demo environment, when we get a chance to get in with the physicians and show them what Athena can do, we win more times than we lose.

Our big challenge right now is how to get market awareness of the brand, what we’re doing and the favorability around the brand, and to get more at-bats. We know when we get in the batter’s box, we tend to get a base hit or more.

Is it difficult to get the attention of those small practices cost-effectively to earn a sale?

I don’t know if difficult is the right word. Each market segment has a different set of tactics that you need to employ. Small groups, those practices with six doctors or fewer, make up a different market mix. It’s a lot more online advertising. It’s business development resources that are calling and trying to reach doctors and try to set up meetings.

It’s very fast deal cycle. You set up a meeting, have a phone call, set up a meeting two weeks later, and go do a demo. Two weeks after that, you have a signed contract. You literally need two weeks to 30 days to sign a contract. It’s more of a flow business. You must have the resources upfront to canvas the marketplace to make those phone calls. That must be supported with good marketing campaigns that are focused, with real content and intellectual property that gets the doctors to step up and notice.

In our major cities, we just launched the “State of the Smart” campaign. You’ll see a lot of out of home advertising. We just had a full page in the Boston Globe on Sunday. We’ll have another one coming up. You’ll see a lot more Internet-based advertising and print advertising as we continue to position our brand out in the marketplace.

Enterprise is a little bit different. Sales cycles are longer and it’s more of a direct sales relationship sale. But we have a strong engine. I would say almost 40% of our bookings are coming in the small group space. We see that as being increasingly an area of strength for us as we move forward.

Who are your most significant competitors, taking into account the spread of Cerner and Epic into smaller practices and Allscripts saying it will develop a new EHR?

It’s a very competitive market. We compete with all the major players. We compete with all the specialty EHRs when it comes to some specialty practices. We compete on a broader outsourcing model with the companies that are providing broader RCM solutions. It’s a dynamic marketplace for sure.

Everyone is focused on trying to create value for customers. We’re no different. We believe that our core advantage sits around our expertise, the type of people that we have. It sits around our platform and the open interconnectedness into it. It sits around our ability to drive value from data analytics and benchmarking from the real-time execution of our processes. That enables us to differentiate ourselves in the marketplace vis-a-vis some of those other competitors.

Hospital consolidation will continue, there’s no doubt. Hospital bed stays are going down. More and more procedures are moving into the ambulatory care setting. Clinical advances, along with patient experience and preferences, are driving that. We are going to continue to see a robust and valid market in our core segment of ambulatory care. Even if there is some additional hospital consolidation, it’s not going to take the lion’s share of the market. There’s plenty of room for us to continue to grow and thrive.

Are you still planning to release an inpatient hospital system?

We had developed an inpatient EHR platform and sold it to several customers. We will continue to maintain that platform, the rules engine, and certification. We are not actively selling that in the marketplace today. We are redirecting our full focus into core clinical workflows, rev cycle, and the ambulatory care market. But just to be really clear, we will continue to support that hospital product.

We are also strong in hospitals with our Centricity assets. If you look at Virence and the Centricity Business platform, it has a world-class central billing office capability that cuts across both the acute and ambulatory care settings. It is focused on large IDNs and research hospitals. It is one of the gold standard rev cycle products out there in the market today. We are fully committed to Centricity Business. We will continue to invest in that and we see that as being a long-term part of the Athena portfolio going forward.

What about Epocrates?

Epocrates is a part of our business. It’s a relatively small portion of the company today. We see additional opportunity in Epocrates. We believe that there’s more that can be done, more that can be leveraged as we think about how to extend the value of that platform to physicians.

We know that the people who use Epocrates love Epocrates. It’s got a very good brand reputation. We see people using the product and it influences their drug prescribing decisions. It has value in the market. We see that as an asset that can be further invested in and leveraged. Epocrates is part of our family. It’s a smaller part of our family, but we believe there are opportunities there.

Private equity acquisitions often involve cutting costs and selling off non-core businesses to boost profit, then flipping the company or going public three or four years later. How do you see Athenahealth’s future given your background working with companies that grew in different ways?

The right mindset to have with private equity is that they are equity investors. Whether it’s private or whether it’s public equity, equity value and firm value magnifies itself with growth. Every great private equity investor is trying to drive growth. Our investors are no different. This is not about us trying to maximize and take every cost dollar out of the system we can.

We have seen things that we think can be done better. We can be more efficient. We can reprioritize some of our assets and investments outside of areas where we were investing and reprioritize those in other areas. Private equity has a specific focus on value levers and how you drive value creation.

That’s the way you should think about our owners, as being people who want to invest in the business. We made a big, one-time investment in technical debt to improve the platform so that we have a more solid foundation to continue to innovate on. They are very focused on us driving growth. They are very focused on us being innovative.

They have been great partners in the process, and they’re all about creating a great company. They are not about squeezing every last nickel out of the business, because that’s not the way you create long-term value. It needs to be a sustainable enterprise.

My experience with private equity has not been about crash and burn. It’s been about focus, re-prioritizing investment on the things that drive the highest level of growth, and creating the most value for customers. If you create the most value for your customers, then you get to take some of that value yourself.

Do you have any final thoughts?

Athenahealth is an amazing company. It has an amazing heritage. It’s a business that has the right to succeed and the right to thrive. We have a set of unparalleled assets in our employees, our customers, and importantly, the platform and the ecosystem we’ve built. We now have a leadership team in place, a team that’s behind us, and investors who are focused that will allow us to make the smart investments that we need to make to reposition the business for long-term growth and prosperity. That will benefit all the physicians in the United States and the entire system as we create a thriving ecosystem that delivers accessible, high quality, and sustainable healthcare for all.

Book Review: It Shouldn’t Be This Hard to Serve Your Country

November 11, 2019 Book Review No Comments

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David Shulkin, MD, the ninth Secretary of Veterans Affairs, is the latest in the seemingly endless cavalcade of fired President Trump appointees whose tell-all books profitably pay penance for their participation in a divisive administration. The cash registers of websites, TV networks, newspapers, and booksellers everywhere can’t stop ringing from peddling controversy from both sides of the fence.  

I wasn’t going to read “It Shouldn’t Be This Hard to Serve Your Country,” to be honest. I’m wary of whitewashed stories told by humiliated former government officials and politicians who decide to bare their souls in a safe environment where only their own uncontested voice is heard. My experience with that kind of book is that the authors always claim to be misunderstood, selfless saints who just want to set the record straight in clearing their good name (as well as the path to future beneficial endeavors). An HIStalk reader sent me an Amazon gift card to cover the book’s cost and said he wanted to hear my take on it, so that guilted me into buying the Kindle version.

It’s a great title, by the way, referring to both veterans and to the author himself.

Shulkin is an internist who didn’t serve in the military, although much of his family did. He served in several medical school roles, was chief medical officer in an academic medical center, was president and CEO of Mount Sinai’s Beth Israel Medical Center in New York City for four years, and was then president of Morristown Medical Center (NJ) for five years before being tapped by President Obama to be the VA’s under secretary for health in 2015.

I generally believe Shulkin’s contention that he was a selfless advocate for the health of veterans, improving the VA system, and trying to protect the VA from the meddling of limelight-seeking members of Congress. Surely he could have found jobs that weren’t so soul-sucking if his goal was self-aggrandizement or lining his pockets.

Spoiler: Shulkin was fired because of the meddling of political appointees who want to see the VA system dismantled and by a president whose vanity requires him to distance himself from underlings who get bad press that interrupts the mandatory adulation.

The snips Shulkin mentions about President Trump suggest that the President has good intentions, values loyalty above all else, rules by executive order while refusing to talk to the other side, doesn’t have the attention span to analyze issues and relies on subordinates to form opinions for him, and is in far over his head in turning the government over to clueless power-grabbers who wage full-time war against career government workers who actually understand the issues. The Trump administration is dogged by infighting, revolving door cabinet members, and leaks of information that, whether factual or not, are often intended to discredit his legitimacy as President.

It’s also clear that the so-called Mar-a-Lago Three – Marvel Comics chairman Ike Perlmutter, physician Bruce Moskowitz, and lawyer Marc Sherman – had the President’s ear, represented themselves as his personal emissaries, and demanded full participation in all aspects of the VA’s operation. Perlmutter reminded Shulkin constantly that he was meeting with President Trump all the time and summoned Shulkin and others to the President’s Florida resort to tell them what to do, not just with regard to the VA’s EHR project, but in all aspects of the VA’s operation. Shulkin insisted that the three “counsel” him individually rather than as a group since the latter could have been interpreted as an illegally operating “federal advisory committee” that requires public oversight. Shulkin says he wasted a lot of his day dealing with them, with Perlmutter calling him several times a day with one naive idea after another.

Shulkin notes that, like President Trump, none of the three had ever even visited a VA facility and declined opportunities to do so. Only Perlmutter is a military veteran and that was in Israel, not the US.

Shulkin spends a lot of pages defending the travel expense controversy that helped get him fired, providing details that he says prove just how ridiculous the claims were that he was junketing around with his wife on the taxpayer’s dime (which was certainly true of other Cabinet members, but not Shulkin, according to Shulkin). I actually believe him here as well, and while I’m skeptical of the whole “fake news” excuse for unflattering exposes, it seems that the Trump-created 24×7 frantic news cycle where tweets earn headlines has roped even credible media outlets into running poorly vetted stories hoping to wrest eyeballs from equally lurid sites. Once Shulkin got on the wrong side of the headlines, the former Obama-Trump golden boy had to be sacrificed to protect the President’s thin skin, not to mention that cabinet member travel excesses stories were all the rage for newspapers back then thanks to former HHS Secretary and jet-chartering Tom Price.

Shulkin describes some of the improvements he made to the VA, often decisively and with little support – fixing the wait time problems, publishing operational statistics, trying to modernize its HR policies of basically firing nobody regardless of their level of incompetence, and addressing veteran suicide. He observed that the competitive innovation model rolled out by former Undersecretary for Health Ken Kizer, MD, MPH – especially a star ranking system — encouraged VA facilities to hoard best practices to keep other facilities from stealing their stars. Shulkin rolled out five priorities for improvement – care access, employee engagement, care coordination, veteran trust, and best practices sharing.

President Trump’s election brought in a flood of political appointees who knew nothing about their assigned areas of responsibility. The “politicals” ran off career professionals, leaked false information to the press, and stabbed each other in the back. Shulkin notes that not only did the President have zero government background, most of the cabinet secretaries he chose didn’t either, and some of them had spent their careers opposing the agencies they were empowered to oversee. Shulkin said he was told to find jobs for 30 people, which he thought was reasonable given the size of the VA. The person the White House had assigned to dole out the plum jobs was a 24-year-old former Trump campaign intern whose father was a “Fox and Friends” host. Shulkin was told that he had to accept any appointees the White House sent over and was given a direct order not to fire them. 

Shulkin had an obvious problem with some of the appointees who claimed to represent the White House or who wanted to oversee other appointees. One of them followed Shulkin’s staff meetings with his own sessions that included only the politicals, who would then be told to do something else in dividing the department between the “secretary’s team” and the “political team.” He was also getting beaten up by members of Congress who told him privately that he was doing a great job, but warned him that they would be grandstanding with bitterly negative criticism once the cameras started rolling. He assigned one of the politicals – who he names specifically – to serve on a White House committee who then leaked false information, threatened outside groups who didn’t support specific bills, and ran his own agenda in claiming to represent the President.

He also struggled with high-level VA positions that remained unfilled because the White House didn’t like some of his choices, including “a former CEO from one of the country’s largest public health systems” who was rejected because he had once served on a healthcare advisory committee for Hillary Clinton.

It was surprising to me how much influence that veterans service organizations such as American Legion and Disabled American Veterans wield. One of those that had been basically ignored as lobbying group a by the Obama administration – the Koch Brothers-funded Concerned Veterans of America – was welcomed by the White House despite its agenda of privatizing the VA. That issue kept Shulkin in trouble – nobody wants to admit to voting veterans that they want to shut down their healthcare system, so everybody accuses each other of having a hidden privatization agenda.

Shulkin says he made the right choice to replace the VA’s skunk works-developed VistA software. It made the VA paperless and was widely known because two-thirds of doctors trained in the US rotate through the VA, but Shulkin says the VA had made a mistake in allowing each of its 130 medical centers to create their own customized instance of it. He also noted the lack of interoperability with the Department of Defense’s systems, the high cost of maintenance, and the estimated $19 billion the VA would have spent to modernize VistA.

He admits, however, that he was naive in not realizing how his job would be threatened by his decision to bypass traditional contracting and to simply choose Cerner outright because “I was convinced that immediate action was necessary” because of a never-ending lack of DoD interoperability.

The VA engaged with Cerner under a little-used government contracting option called “determination of findings,” which allows a detailed vendor discussion without a formal commitment. He denies New York Times reports that cited a White House leak saying that Jared Kushner was advocating for Cerner. He says he was instead being pushed by former DoD employee John Windom and members of Congress to get moving with Cerner so the VA could align with DoD’s implementation schedule.

Shulkin says his main requirement was interoperability and Cerner wasn’t convincing in that area, offering only minor sharing of administrative data and the dataset used for government reporting. Or as he put it, “The Cerner team was in full sales mode.” He told Cerner’s then-President Zane Burke that he was ending negotiations until Cerner stepped up to the interoperability plate.

Shulkin worked with outside groups and with academic medical center CIOs to make sure the Cerner contract was solid. However, he was getting pushback from the political appointees, some of whom started showing up uninvited to EHR meetings and reporting back to the Mar-a-Lago Three with their concerns about the contract. One of the politicals was telling everyone that Shulkin was rushing to sign a flawed Cerner contract, urging that he be fired before he did so. Which, as it turns out, was exactly what happened.

In the last conversation Shulkin had with President Trump, the President told him, “You’re killing me with all the bad press coming out of the VA” and asked about the Cerner contract, “Can’t you find a cheaper alternative?” Later that afternoon, Shulkin – who had learned he was being hired as VA secretary only when he saw it on TV news — was fired by tweet. Access to government email and phones had already been turned off. He wasn’t allowed to return to the VA to pick up his personal items or to say goodbye to his team. He then was warned by a colleague that the politicals were making up a story that he had walked off with sensitive government information after being fired, so he returned all his electronic devices at 10 at night.

Shulkin notes that seven weeks after he was fired, “The political appointees apparently determined what I had known all along: the options for IT modernization were limited and the Cerner contract was the best option for the VA and for taxpayers. In the end, the right decision was made, and the VA was on its way to gaining a cutting-edge system to propel it into the future.” He also notes that the President took credit for the VA’s accomplishments at a White House event to which no Democrats or VA professionals had been invited. Shulkin was surprised that the press didn’t pick up on a published email in which one of the politicals laid out the firing of Shulkin, his deputy secretary, and his chief of staff, which was to be coordinated by Citizen Perlmutter to happen only after the President was able to take personal credit for completing several VA initiatives.

Shulkin had a lot of problems with the VA’s OIG, a 1,000-employee, much-feared organization that he accuses  of being “secret police” that aren’t always fair or thorough in their investigations.

He says he worries most about the clueless politicals who have run off qualified employees who could have overseen the Cerner project, explaining, “Getting a contract signed is one thing, but carrying out the real work involved is quite another. My years of experience with EHR implementations taught me that doing this well will require participants with real experience and knowledge that is unfortunately in short supply within the VA’s political leadership today.”

I found this book to be interesting, but depressing. Government is even more dysfunctional than we probably all suspect, and the motives of those involved can often be traced back to pettiness and personal gain (and the same can be said of the press, most likely). I don’t have a clue about how to fix that, but I do believe that David Shulkin was doing good for veterans until that opportunity was taken away by partisan politicians who accept incompetence as long as it is cloaked in political loyalty, just like the politicians who came before them and those who will follow.

As a cheap seats observer, I didn’t find Shulkin’s explanation of why he needed to rush into a no-bid Cerner contract to be convincing, but he’s right that he didn’t have any great alternatives. The Coast Guard’s struggle with Epic probably killed its chances, self-development was a non-starter, and not choosing Cerner when the DoD had already done would have been politically risky. He gives himself a convenient excuse should the project fail, warning in advance that incompetent VA politicals aren’t capable of implementing Cerner. 

The book was more interesting than I expected. Glimpses into how government works were fascinating, although not always encouraging. Maybe Shulkin is the self-sacrificing saint he describes in his book or maybe he isn’t, but regardless, I’m left with a more positive impression of him than before (and I was fairly positive about him before). He was unanimously confirmed twice for high-level VA jobs under wildly different administrations, developed consensus that crossed party lines, and as far as I can tell made veteran wellbeing his agency’s top priority. I think veterans were better off when he was in charge.

Morning Headlines 11/11/19

November 10, 2019 Headlines No Comments

Kaiser Permanente CEO Bernard Tyson dies at 60

Kaiser Permanente Chairman and CEO Bernard Tyson died unexpectedly Sunday of unspecified causes. He was 60 years old.

Intelerad, Novacap-backed medical imaging software maker, heads to first rounds

Canada-based Intelerad Medical Systems is reportedly seeking a buyer.

U of Chicago wants hospital dismissed from class action accusing it of sharing patient data with Google

University of Chicago wants its medical center dismissed from a class action lawsuit that accuses it of sharing patient information with Google in an agreement that the plaintiff says violates his HIPAA rights.

Sony Scrubs In to Help Operating Room Devices Talk to Each Other

Sony expects to earn FDA clearance next month for Nucleus, an OR integration tool it acquired in 2016 that is sold outside the US.

Monday Morning Update 11/11/19

November 10, 2019 News 4 Comments

Top News

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Kaiser Permanente Chairman and CEO Bernard Tyson died unexpectedly Sunday of unspecified causes. He was 60 years old.

EVP/Group President Gregory Adams will serve as interim chairman and CEO.


Reader Comments

From Jake the Snake: “Re: health IT blog sites. Some of them seem to be violating FTC’s endorsement rules in running puff pieces that don’t disclose payments or business relationships.” The reader provided examples in which (a) a company rep’s thinly disguised sales pitch that wasn’t listed as a paid spot even though I’m guessing it was; and (b) an article that talked about an industry issue, but then made the leap to quoting someone from the company or pitching their product as a solution. The Federal Trade Commission’s endorsement guidelines prohibit making a statement that a consumer might reasonably assume is an honest opinion and not an advertiser message. That includes being shown using a product, being paid to mention a product (even if indirectly), or being given a product to try and then either making misleading claims or failing to disclose being paid to mention the product. I doubt the examples provided run astray of FTC’s guidelines. For me, I quit reading one local food site that was pitching particular restaurants, chefs, or menu items in a blatant pay-for-play “featured restaurant” manner without disclosing it, which was pretty obvious since the same handful of places kept popping up despite unenthusiastic online reviews.   

From Ghost in the Machine: “Re: Cerner’s acquired Siemens businesses. Norway is very small in the overall story. Some of the platforms from that deal will be put out onto the market. Apparently the German workforce has been told that its multiple offices will consolidate to Berlin. The changes are unrelated to the Sweden delays — they are part of the business focus on earnings and product portfolio.” Unverified.


HIStalk Announcements and Requests

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Eighty percent of poll respondents believe that their employer gets at least 50% of the benefit of their conference networking.

New poll to your right or here: Will the collaboration between Allscripts and Northwell result in delivery of a commercially successful EHR within three years? Click the poll’s Comments link after voting to make your case in ways that a binary response cannot.

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I’m becoming more uncomfortable with the idea that when I thank a service member, my motivation might be influenced by my urge to feel virtuous by throwing out that increasingly automatic and empty saying. It’s better to hire a veteran or their family member, donate to support groups, and vote for politicians who support veterans (and ideally, who are veterans themselves who understand the responsibility involved in sending people off in harm’s way). I’m also not to sure that someone who has served in the military necessarily gets good vibes from a “Happy Veterans Day” greeting or anything else that requires them to acknowledge my recognition. For today, I will just say to veterans out there that I know you made a sacrifice that I didn’t and thus will never fully understand, and for that, I honor you. 

I haven’t thought of Robert Lorsch of MMR Global very much since I interviewed him in 2013 after his company filed lawsuits against EHR vendors, Walgreens, non-profit hospitals, and the government of Australia for developing personal health record technology that he claimed – not very convincingly — infringed on his intellectual property. Turns out he died in May 2017 and the company seems to have met its maker before Bob. 


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

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Canada-based Intelerad Medical Systems is reportedly seeking a buyer. 


People

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Toni Laracuente, RN (Change Healthcare) joins Medicomp Systems as chief nursing officer.

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Accreditation Council for Graduate Medical Education hires Bruce Metz, PhD (University of Connecticut Health Center) as its first CIO.


Announcements and Implementations

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Michigan HIEs Michigan Health Information Network and Great Lakes Health Network will merge to form an organization with $28 million in annual revenue and 169 employees. The governor recently vetoed $1 million in funding for MiHIN.


Privacy and Security

University of Chicago wants its medical center dismissed from a class action lawsuit that accuses it of sharing patient information with Google in an agreement that the plaintiff says violates his HIPAA rights. The university’s motion says that while the plaintiff claimed that the de-identified information could be re-identified through timestamps and free-text notes, he never claimed that Google actually did so and that its contract with Google prohibits it from even trying to re-identify patient data. The university added that its Notice of Privacy Practices informs patients that their data might be used for research and they won’t be paid even if a commercially viable product results.


Other

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Sony expects to earn FDA clearance next month for Nucleus, an OR integration tool it acquired in 2016 that is sold outside the US. The hardware device displays multiple simultaneous images – including 3D and 4K — from video-based medical equipment that can also be recorded, broadcast, or routed to a different display.

In India, government-run Rajendra Institute of Medical Sciences will track its 300 doctors via GPS to make sure they are physically present in the building during their paid hours of  9:00 a.m. to 5:00 p.m. The hospital administrator says he expects doctors to eat in the building because leaving means they won’t make it back in their allotted one hour.

Weird News Andy awards an A for effort to this life sentence prisoner who argued that doctors who were treating his septicemia had to revive him with epinephrine, so that meant he was “dead” and thus had fulfilled his sentence. The appeals court disagreed, finding that life sentences aren’t satisfied just because doctors revive someone.


Sponsor Updates

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  • CereCore staff prepped and served lunch to over 400 people at the Nashville Rescue mission.
  • CMS selects Lightbeam Health Solutions as a stage 1 participant in its Artificial Intelligence Health Outcomes Challenge to demonstrate how AI tools can predict risk.
  • LiveProcess will present at the IAEM Conference November 15-20 in Savannah, GA.
  • Meditech congratulates customers recognized by CHIME as Healthcare’s Most Wired organizations, including Avera Health (SD), Frederick Regional Health System (MD), Lima Memorial Health System (OH), Woman’s Hospital (LA), and Doylestown Hospital, PA.
  • Mobile Heartbeat will exhibit at the Pediatric Trauma Society’s Annual Meeting November 11-16 in San Diego.
  • Nordic and Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the HIMSS Gulf Coast Chapters GC3 Conference November 13-15 in Biloxi, MS.
  • Gartner names OpenText a leader in its 2019 Magic Quadrant for Content Services Platforms.
  • PatientPing congratulates its national network of ACOs for generating more than $430 million in shared savings in 2018 under the MSSP.
  • Wisconsin Health News profiles Redox.
  • SymphonyRM publishes a new white paper, “AI Next Best Actions vs. Traditional CRM.”
  • Voalte will host VUE19 November 13-15 in Sarasota, FL.

Blog Posts


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Weekender 11/8/19

November 8, 2019 Weekender No Comments

weekender


Weekly News Recap

  • A study finds that only 10% of discharged hospital patients look at their medical information online afterward.
  • CompuGroup Medical is rumored to be a bidder for Agfa’s health IT business.
  • The VA makes patient records available on Apple Health Records.
  • A federal court orders behavioral EHR vendor ZenCharts to pay rehab EHR vendor Kipu Systems $19.5 million for stealing its trade secrets.
  • University of Rochester Medical Center will pay $3 million to settle OCR charges involving loss of two unencrypted mobile devices.
  • Google announces that it will acquire Fitbit for $2.1 billion in cash.
  • CMS delays implementation of a requirement that hospitals publicly share their negotiated contract prices.
  • Allscripts announces Q3 results that beat Wall Street expectations on adjusted earnings, but fell short on revenue.
  • Wake Forest Baptist Medical Center will bring registration and billing back in-house two years into a seven-year agreement with NThrive, which will eliminate 839 jobs in central North Carolina as a result.

Best Reader Comments

If you listen to the [Allscripts earnings] call, it is pretty clear that the Wall Street folks don’t buy it. They made Rick say twice that there wouldn’t be any increase in R&D spending due to the Northwell agreement. (TheyDidn’tBuyIt)

Most of the article [a physician’s New York Times complaint that Epic’s screen messages aren’t empathetic] could be rephrased as “I find my HIM department annoying.” (Iam)

I don’t consider myself an old fogey. but “pop-ups would float into view as small islands of empathy?” Seriously? In a NYT piece? Millenials these days, am I right? (CynicalIguess)

Epic has “unintelligible medical notes?” Nope, Epic has no such thing. I don’t think it has achieved sentience yet (thankfully). Talk to your co-workers who wrote the notes. “Urgent, intimidating, and tinged with allegation?” She’s looking for comfort and empathy from a computer system? (AC)

Everything about this op-ed by this physician is what is wrong with this country at this point. How in the world do people get through their day-to-day lives if every word that crosses their screen is “offensive” to them? It’s absurd. There are plenty of things wrong with EMRs in today’s world, but guess what — colors and “word choices” are not one of them. Not everything is about offending you, it’s simply just a word that by definition means something whether it hurts your feelings or not. Get over yourself. (EMR Snowflakes)

Would Epic benefit from having a better UI and more clinicians actively involved in software and workflow design? Absolutely. But the idea that “deficiencies” is something that Epic dreamed up and foisted upon their users? Come on, Epic configuration is heavily controlled by your own organization. You want Epic to be nicer to you? Talk to administrative and operational leadership at your organization. I’m sure they could ask IT to write an alert to pop up once a week to say “Great job!!” which everyone would then complain about being distracting and adding clicks. (AnonZ)

The authors rail against profit-seeking entities. Very slippery slope. No margin, no mission. Physicians can certainly fulfill their sense of moral mission and alignment in volunteer work, free clinics or other worthy ventures. Those skills are needed everywhere. (FreeMarkets)

Facebook design is meant to maximize engagement so that they can deliver the most ads. Do you want to maximize engagement with your EHR or do you want to make eye contact with the patient? (Lookatme)

One example that we started at a previous organization is to make sure there is a hyperlink (or text in the alert) that shows with each BPA (pop-up alert) which links to the decision-making body that approved it. Typically, it has a colleague on the committee that they know and can email directly or ask them about it. This provides accountability to the alert committee as well as the operational leaders that may have come up with the “software solution to a peopleware problem.” (David Butler)


Watercooler Talk Tidbits

Actor Will Smith creates a clever and disarmingly funny video as he undergoes his first colonoscopy. He said, “They said you can’t get to 50 million followers on IG without showing your butt.” Afterward, he finds that he had a pre-cancerous polyp removed during the procedure. He urges, “There’s a certain amount of commitment and embarrassment involved with being healthy. You just gotta do it, man.” I don’t watch many movies and thus have only seen Smith in “Independence Day,” “Men in Black,” and “The Pursuit of Happyness,” so I have to say this is my favorite of his films.

The former Hewlett-Packard Enterprise worker who shut down Oregon’s Medicaid computer system in October 2016 in retaliation for being laid off is sentenced to a year of home detention, 500 hours of community service, and four years of probation.

Fedscoop notes that HHS has two people who claim to be its chief data officer – one within the CTO’s office, and the other being the CIO, who says he is acting in that role until he can hire HHS’s “first chief data officer.”

A Pennsylvania nursing home assistant is arrested for taking photos of deceased residents and sharing them with with friends and co-workers. Stephanie Thomas says she took the pictures because her former boyfriend “liked that kind of thing,” but friends to whom she texted photos said she has an “obsession with death” and police examination of her phone turned up pictures of dead animals.

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A woman takes an after-work photo of her twin sister, a labor and delivery nurse who had worked 53 hours in four days, and posts it on Facebook with description of what the nurse deals with in a typical work day. She took the picture as her sister broke down after a day in which she helped deliver a stillborn baby. The post has earned 225,000 likes, 23,000 comments, and 133,000 shares. Her sister’s post explained what was going on:

Have you guys ever really thought about what a labor and delivery nurse sees? They see great joy in smooth deliveries and healthy moms and babies. They see panic and anxiety when a new mom is scared. They see fear when a stat C-section is called. They see peace when the mom has support from her family, because not all new moms do. They see teenagers giving birth. They see an addicted mom give birth to a baby who is withdrawing. They see child protective services come. They see funeral homes come. Did you know that they have to make arrangements for the funeral home to come pick up the baby? I didn’t either.

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A 57-year-old nurse adopts a 27-year-old man after he is ruled ineligible for a heart transplant because he has no family to care for him. He was in and out of hospitals for weeks, often discharged to a men’s shelter because he had nowhere else to go. Piedmont Newnan Hospital (GA) gave PACU nurse Lori Wood its President’s Award for going above and beyond for patients. She had known Jonathan Pinkard for just two days before suggesting that she become his legal guardian. He hopes to return to his office clerk job next month.


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Morning Headlines 11/8/19

November 7, 2019 Headlines No Comments

Most patients with access to electronic medical records not using it

Just one in 10 discharged patients go online to access their medical information, according to a study that looked at data from 2,410 hospitals over a two-year period.

American Well® Acquires Aligned Telehealth to Expand Behavioral Health Virtual Care

American Well acquires behavioral telehealth and telepsychiatry service provider Aligned Telehealth.

Elizabeth Holmes dodges questions about unpaid legal bills as charges fly over case documents

Lawyers for Elizabeth Holmes contend in a hearing that the FDA destroyed emails that are vital to her defense.

Michigan Health Information Network Shared Services integrates Great Lakes Health Connect

Michigan Health Information Network Shared Services and Great Lakes Health Connect will combine their HIE operations by the end of the year.

News 11/8/19

November 7, 2019 News No Comments

Top News

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Just one in 10 discharged patients go online to access their medical information, according to a study that looked at data from 2,410 hospitals over a two-year period.

The analysis also found that patients at non-profit hospitals are more likely to take advantage of access than their counterparts at for-profit organizations, as are patients at teaching hospitals.

The authors conclude that “policy efforts have failed to engage a large proportion of patients in the electronic use of their data or to bridge the ‘digital divide’ that accompanies health care disparities.”


Reader Comments

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From Being There: “Re: HLTH conference. As a participant and attendee, I found this to be a first-rate event. Other than a couple of HHS speakers who seemed more intent on politics versus real healthcare, the rest were engaging, interesting, and first rate. I especially like the panel discussion format used in the tracks I attended. As an exhibitor, I was disappointed in the value provided for the cost incurred. Activity was low most of the time, including the happy hour which helped a bit, but not enough. My theory is that there is just too many good speakers and sessions which are running concurrently such that, if I didn’t have to be in the exhibit area, I would have been attending tracks and sessions instead. PS: the free Mimosas on Sunday morning were especially nice.”

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From Mandibular Process: “Re: HIMS. Why in the world would a company name themselves this?” I took “in the world” part of this question literally, assuming that a company that was started in 2014 would choose this name only if (a) it is clueless, or (b) it is brazenly hiding behind some other country’s less-litigious legal system. Not so. Even though the HIMS website does not list people or places (not uncommon with foreign companies trying to look domestic), I tracked them down to Arizona, where a postal race is probably unfolding to see whether our industry’s HIMSS or from the Viagra-selling website HIMS will land the first cease-and-desist letter.


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

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Reuters reports that CompuGroup Medical is one of two top bidders for the health IT and integrated care parts of Agfa’s European healthcare business.

American Well acquires behavioral telehealth and telepsychiatry service provider Aligned Telehealth.

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Lawyers for Elizabeth Holmes contend in a hearing that the FDA destroyed emails that are vital to her defense. The former Theranos CEO and co-defendant Ramesh “Sunny” Balwani –a former Theranos executive and romantic partner of Holmes — face up to nine counts of wire fraud and two counts of conspiracy to commit wire fraud. The FDA has admitted to having only partial emails from the former director of its diagnostics regulatory division, which it blames on a faulty email storage system.


Sales

  • The Ohio State University Wexner Medical Center will implement Visage Imaging’s Visage 7 Enterprise Imaging Platform in all of its radiology departments, replacing its legacy PACS.
  • Boston Health Care for the Homeless will use an addiction treatment-focused EHR from Netsmart to help care for patients with opioid use disorder.
  • Prisma Health (SC) selects telehealth technology and services from MDLive.
  • Health and human service agency network Innovative Management Solutions (NY) will implement population health analytics and risk management tools from Arcadia.

People

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Federal health IT vendor DSS names Christopher Kunney (Coker Group) chief of strategy and business development and Roy Hammar (Cerner) chief of client engagement.


Announcements and Implementations

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The National Council for Behavioral Health and disaster relief non-profit Americares pilot a text-based messaging program at eight Texas health clinics that uses patient engagement software from Epharmix to help patients with medication adherence.

California-based HIE Manifest MedEx and HBI Solutions develop MX Analyze, a predictive analytics tool designed to help providers manage high-risk patients and care transitions.

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A new KLAS report says that the patient engagement ecosystem is a complex and overwhelming area of health IT that spans 80 capabilities and “a slew of vendors claiming to offer them.” KLAS analysts didn’t interview clients in this case – they compared vendor claims to provider priorities. Among vendor-agnostic products, Allscripts, CiperHealth, and GetWellNetwork offer multiple solutions that align with market priorities. EHR vendor patient portals from Epic, Athenahealth, and NextGen, even though their use is limited, meet the key provider demands for bill payment and self-scheduling. Sonofi Health and PCare lead in the interactive patient systems category, Orca and Luma are notable outreach vendors, and Salesforce and Docent Health perform well in the broad category of CRM, rounding, and wayfinding. KLAS notes that providers reap most of the benefit of these systems, with only 20% of vendors claiming improved clinical outcomes.


Government and Politics

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The VA gives all veterans access to their medical records via Apple’s Health Records app following an earlier limited rollout.


Privacy and Security

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The Government of Nunavut in northern Canada prioritizes getting its health department’s Meditech system back online after a DoppelPaymer ransomware attack over the weekend crippled digital services across its networks. Officials anticipate returning to normal operations within a week.


Other

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Researchers at Emory University in Atlanta find a direct correlation between opioid abuse-related tweets and overdose deaths in several Pennsylvania counties. The researchers hope to further refine their machine-learning algorithm to help public health officials monitor opioid abuse within certain populations.

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Kyruus surveys 1,000 consumers for the third year in a row to better understand their healthcare access preferences. A few findings:

  • Consumers are relying more heavily on hospital websites than in years past when it comes to searching for healthcare information.
  • Scheduling appointments by phone, while still the dominant method, is losing losing ground to online booking.
  • Consumers care more about insurance acceptance and clinical expertise than a health system’s reputation or appointment availability.
  • Thirty-three percent of respondents say they would switch providers for access to virtual visits.

Sponsor Updates

  • EClinicalWorks and HealthCrowd will exhibit at the TAHP Texas Covered Health Care Conference + Expo November 11-12 in Austin.
  • Ensocare will exhibit at the 2019 Leadership and Physician Advisor Conference November 15-17 in Miami.
  • EPSi will exhibit at the HFMA Region 9 Annual Conference November 10-12 in New Orleans.
  • Formativ Health will sponsor the Wounded Warrior Project Carry Forward 5K November 9 in Jacksonville, FL.
  • Patientco celebrates new office space in Atlanta.
  • Healthwise, Imprivata, and Intelligent Medical Objects will exhibit at NextGen UGM 2019 November 10-13 in Orlando.
  • Hyland names the State of Minnesota Department of Health as the winner of its 2019 Government Innovation Award.
  • InterSystems debuts its PulseCast podcast, “John Halamka: Making the Most of Decentralized Data.”
  • Definitive Healthcare SVP of Strategy Kate Shamsuddin wins the Worcester Business Journal’s Outstanding Women in Business Award.
  • Glytec publishes a new study focused on the “Current State of Inpatient Diabetes Care and Glycemic Management.”

Blog Posts


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EPtalk by Dr. Jayne 11/7/19

November 7, 2019 Dr. Jayne 2 Comments

It’s been a crazy week, with a couple of days of travel being paid back with hundreds of emails in my inbox. Even as I unsubscribe and use filters, it seems like there is always something going on that generates more correspondence than it should (think reply-all apocalypse).

I’d love to sell services around creating an effective email policy to some of the organizations I work with. It seems to be a skill that is sorely needed both in the commercial space and in the volunteer space. I’m getting ready to head out for a week-long trip and am trying to pre-tie loose ends, and predicting what might need to be taken care of in my absence is always a challenging exercise.

The Drug Enforcement Agency is one of the major causes of increased email traffic in my inbox. It seems like my recent renewal has triggered enrollment in a number of mailing lists that have to be individually stamped out like a game of Whack-a-Mole. Some of them have forced me to go through the unsubscribe process twice to get them to stop. The mailing list preferences have names like “Prescribers” and “Prescribers-All” so you don’t know what you’re really unsubscribing. I like to have as little contact with the US Department of Justice as possible, so I hope I have finally gotten things back to where they were prior to my renewal.

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Registration is open for the 2020 ONC Annual Meeting, with the theme of “Connecting Policy and Technology: Bringing the EHR to the Patient.” The event will be held in January 2020 in Washington, DC. The published agenda only shows the various time blocks for sessions, with a note that the full agenda is coming soon. Personally, I like to see the agenda before I plunk down money on a conference, but I’m guessing that most of the people who attend the ONC meeting are going to go regardless.

I enjoy attending conferences as a way of learning new things and engaging with people in person, but the cost of many of them poses a barrier. Maybe we should start a “Send Jayne On the Road” conference fund so I could report from around the country and across the globe. Warm locations preferred between November and February, of course.

CMS is plugging information sessions for its new Kidney Care First (KCF) and Comprehensive Kidney Care Contracting (CKCC) Model Options, which are part of the Kidney Care Choices (KCC) model. They are targeted towards nephrologists and dialysis facilities along with accountable care organizations that focus on kidney disease, and build on the Comprehensive End-Stage Renal Disease Care Model structure.

It’s good to see a model with a goal to delay the need for dialysis and encourage transplantation, but the reality is there is still a shortage of kidneys out there. We also need to be spending money to reduce the causes of chronic kidney disease, including diabetes and hypertension.

I recently attended a local health IT event and sat with some students. One of them was from a different country and is in the US pursuing a master’s in public health. His big observation is that public health in the US is far less prominent (and less well-funded) than in his home country, which was a surprise because he had assumed that because the US has “rich resources” that we would have it together.

Public health often gets the short end of the stick. I learned a great deal about public health informatics while working towards my clinical informatics board certification. It’s a fascinating field that has great potential to positively help people.

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If you haven’t received your influenza vaccine, there’s still time, but the season is ramping up. Flu season officially began October 1 in the US and roughly two percent of all visits to healthcare providers in the past week were for influenza-like illnesses.

We’re seeing quite a bit of it at our facility, and even though the flu tests may be negative for influenza A or B, if it walks like a duck, quacks like a duck, and has a bill and webbed feet, we’re treating it as such. Louisiana leads the nation at reporting “widespread” flu activity, so make sure you’re prepared if you’re headed to the Big Easy.

Patients are always surprised when I quote flu statistics to them. I receive a weekly virology digest from our medical center’s infectious disease division that shows how many patients were tested and which viruses are prevalent in the community. I want my patients to know that we’re using evidence and data in their care and not just our best guess.

With Google recently announcing the decision to buy Fitbit, I’ve been asked a couple of times what I think about the company’s role in healthcare. A recent CNBC piece quoted Google Health head David Feinberg outlining plans to bring Google search technology to bear against EHRs as well as generally improving health-related searches on Google. Feinberg spoke at the recent HLTH conference and outlined some pretty far out sounding uses for auto-complete in the EHR as well as better enabling surgeons who visit YouTube before operating on patients.

I like my physicians to already have necessary skills before working on me and am not sure I want them watching a video to know what to do before they walk in the room. I just referred a patient to the emergency department this week because she needed a procedure that I haven’t done in 20 years and my physician assistant hadn’t done in 15. Although it was tempting to watch a refresher video and give it a go, that’s not the best care for the patient.

My clinical care recently has been challenging enough, and the root of much of what I have been seeing is our broken and chaotic healthcare system. One morning I saw a patient who had been briefly paralyzed after a fall, but who came to urgent care because he didn’t have insurance and didn’t want to go to the emergency department. The diagnosis was an unstable neck fracture that could have led to more permanent paralysis at any time, and yet he still refused our calling an ambulance to take him to the ED.

The following day, I saw a patient who qualified for Level 1 trauma status after a vehicular-pedestrian hit and run who also came to the urgent care because he didn’t have insurance. He at least consented to the ambulance transfer. The ED physician called me to give follow up and was shocked that patients like that come into the urgent care. We see them all the time, and unfortunately their visit to us just adds another layer of cost to the system. It’s a sad commentary for healthcare in general.

What’s the saddest commentary on healthcare you’ve seen recently? Leave a comment or email me.

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