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EPtalk by Dr. Jayne 9/27/18

September 27, 2018 Dr. Jayne No Comments

The request period for CMS to provide a MIPS Targeted Review is open for less than three weeks. Eligible Providers who participated in the Merit-based Incentive Payment System in 2017 can review their final scores and performance feedback on the QPP website. These scores will determine whether providers receive a positive, negative, or neutral payment adjustment for Medicare-covered services in 2019.

A Targeted Review can be requested if MIPS-eligible clinicians or groups believe that an error has occurred in the payment adjustment calculations. Examples where this applies include data quality issues, eligibility issues (such as being below the low-volume threshold but being assigned a penalty) or not being treated appropriately if qualifying for reweighted scores due to extreme and uncontrollable circumstances. Based on the chatter in the physician lounge, it seems that hardly anyone is reviewing these, so they’ll just be surprised when they find out if they’re getting an incentive or penalty. If you think you should have a review, requests can be made until 8 p.m. ET on October 15.

A group of 29 participants in the CMS Next Generation Accountable Care Organization program is uniting to work with CMS to ensure continuation of the Next Generation ACO program. This is in response to some pushback against the program, which allows organizations to take on greater financial risk in return for expanded flexibility for care coordination and other services. Some organizations feel the promised savings hasn’t appeared as quickly as expected. Participants in the coalition include Dartmouth-Hitchcock Medical Center, Henry Ford Health System, Mission Health, Carillion Clinic, and Trinity Health.

The group members plan to “focus on developing elements of future payment policy, network design, and beneficiary engagement.” They also plan to share best practices and show how risk-bearing arrangements can accelerate transformation in care delivery. Next Generation ACOs were responsible for more than $61 million in savings in 2016, when there were only 18 organizations participating. That number is now up to 51 organizations, which are focusing on chronic care and disease management as well as expansion of primary care services.

Speaking of healthcare savings, a new report from The National Council for Behavioral Health’s Medical Director Institute shows that simply getting patients to take their medications as prescribed could lead to substantial cost savings and improved clinical management. It’s long been quoted that nearly half of people who are prescribed medications don’t take them as instructed. The problem is complex and involves many factors: understanding the need for medication, being able to acquire it (cost or transportation issues), understanding how to take it, and actually taking it at the right time and under the correct circumstances each day.

The institute projects a potential $2 billion yearly savings from reduced hospital costs alone, assuming that a number of its recommendations are adopted over the next five to seven years. Some of the recommendations seem straightforward, such as “better communication between physicians and patients” and improved risk assessments to determine who might not take their medications. However, under our current fractured and stressed system, even something like communication is a challenge, with little time available to actually sit with patients and ensure they understand why they need medication, how to take it, and what to expect.

Of course, technology can help with some of these, such as embedding risk assessments into the EHR or serving them up via a patient portal, but the latter assumes patients have Internet connectivity and a certain degree of health literacy. Data sharing can be used to identify non-adherence – I love the medication history in my EHR that lets me see when patients refill their medications, which can be a proxy for not taking it as directed if the dates aren’t as expected. Other solutions require more cooperation from other parts of the healthcare system, such as expanding use of long-acting injectables as compared to daily oral medications and increasing patient access to pharmacy services.

The institute cites data that one in six Americans take psychiatric drugs and notes the risks to patients not taking medications as directed. I saw this in my practice the other day with a patient who came in for fatigue and lethargy, and it was most likely a medical misadventure with incorrectly administered psychotropic medications. It took me a good 30 minutes to get to the root of the matter, which caused a backup in the clinic and skewed my productivity numbers for the day. Sitting with the family was the right thing to do, but not all clinicians are going to do it (and I doubt my emergency department-trained midlevel providers would have). The patient hasn’t had a psychiatrist for six months due to insurance issues and I ultimately wasn’t able to “fix” the problem, but at least was able to point his family in the right direction.

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Most of the news coverage coming out of Washington, DC this week is swirling around the Supreme Court nomination, but I was glad to see that Congress is still at work trying to complete legislation dealing with opioids. A deal reached on Monday includes a measure to allow use of Medicaid funds for inpatient treatment of addiction. The so-called “IMD provision” (Institution for Mental Disease) lifts a ban on using those funds for treatment. The initial ban was put in place because of a concern that scarce funds would be paid to higher-priced inpatient facilities. It’s not like addiction goes away because someone is hospitalized, and since there generally aren’t enough beds to go around already, I don’t think the availability of funds is going to significantly impact utilization. It’s hard to charge for a bed that doesn’t exist. There are also waivers already granted for 15 states with waivers pending for 11 more, but that doesn’t cover everyone which explains why Congress is stepping in.

It’s hard to tell exactly what’s going on in the measure, though, because the final legislative text is not yet publicly available. According to my sources, the Senate bill lifts the ban, and the House version provides for treatment of all addiction, not just restricting it to treatment of opioids and cocaine. There is still some contention around HIPAA and confidentiality rules, with healthcare providers pushing to align the confidentiality rules with HIPAA so that clinicians could share information. It looks like the current law will stay in place, keeping additional protections for records of substance abuse treatment.

The House also blocked changes to the Medicare Part D “donut hole” that were requested by pharma. No one wants to be looking like they’re allowing pharma to benefit while allowing the proposed changes to ride the coat tails of bills targeted at the opioid epidemic. I’m sure we’ll see pharma trying to tack this onto something else as the legislative season continues.

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I’ve been struggling this week due to a catastrophic outage at my hosting vendor, whose disaster recovery plan completely unraveled. Apparently it started with a server administrator who was supposed to perform a “file system trim” but mistakenly executed a “block discard” instead. Needless to say, the storage platform immediately dropped all data and crashed everyone. In a serious of unfortunate events preceding that calamity, someone had disabled the snapshot functionality, so there was nothing to use to quickly restore data. Instead, they tried to access the off-site backup server in another state, finding an I/O capacity issue that limited restoration efforts.

I don’t mind my websites being down, but it also took out my email for several days. Although I was able to reach out to key clients and pass along an alternate address, I suspect a number of people think I’m just ignoring them and have no idea what I’ve missed. The outage was long enough that most mail servers would stop trying to redeliver.

Having been on the other side of outages, my heart goes out to the admin who created the problem as well as the company’s leadership who is finding out that “trust but verify” is a lot more important than they thought. As I followed their updates (which were extremely transparent) and the customer forum, I was amazed by the number of fellow customers that had no backup of their sites and no disaster recovery plan of their own. There was talk of how much money they were losing, but no discussion of business continuity insurance or even of disaster planning. There was a lot of screaming in all caps and little realization that flooding the support center with tickets asking them to “FIX THIS MESS NOW!!!!!!” probably wasn’t helpful, especially since they were posting real-time updates to all clients.

It’s a good reminder to make sure that your data is backed up in multiple places (and not just by your vendor, but by you personally) and that also your vendor is testing their backup system and restoration process frequently. Stuff happens, and having a plan makes it a lot less painful, that’s for sure.

When is the last time you tested your disaster recovery plan? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 9/27/18

September 26, 2018 Headlines No Comments

Maven Raises $27 Million in Series B Financing to Bridge the Gap Between Working Women and Families and Modern Health Benefits

Women’s virtual health company Maven raises $27 million in a funding round led by Sequoia Capital and Oak HC/FT.

Nordic CEO Bruce Cerullo announces long-term leadership succession plan

Nordic begins looking for a new CEO after Bruce Cerullo announces he will transition from the role to chairman of the board.

Healthcare IT Company Cerner Opening Office in Rosslyn

Cerner leases office space in Rosslyn, VA to house employees working on the company’s contract with the VA and DoD.

Readers Write: The Key to Population Health Management: The Convergence of Data, Technology, and Social Determinants of Health

September 26, 2018 Readers Write 3 Comments

The Key to Population Health Management: The Convergence of Data, Technology, and Social Determinants of Health
By Matt Miller, PhD

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Matt Miller, PhD is vice president of behavior science at StayWell of Yardley, PA.

Advances in technology are having a significant impact on the healthcare individuals receive. Patient DNA is used to personalize treatments with precision medicine. Artificial intelligence (AI) and machine learning are speeding diagnosis and helping providers determine the best courses of action. The Internet of Things (IoT) is enabling a wide range of remote clinical applications, from medication adherence to monitoring vital functions including glucose, heart rate, and blood pressure to configuring and gathering real-time data from medical devices such as pacemakers and defibrillators.

While these technologies are powerful on their own, the combination of these various patient-specific data streams can produce an exponential impact on improving patient outcomes when merged with behavioral and environmental insights. Integration of this diverse data, through electronic health records (EHRs) and other critical healthcare systems, will play an important role in creating an ecosystem that enables providers and patients to get the information they need, when they need it. In turn, this integration of data will support the larger goals of improving population health.

Modern healthcare is well positioned to reap the rewards of recent advances in technology. Silicon and graphene at the chip level and microelectromechanical systems (MEMS) in semiconductors are in devices used every day for diagnoses and treatment, such as CT scanners, X-ray machines, magnetic imaging, ultrasound, and for monitoring blood pressure, glucose levels, and other vital statistics. These components play critical roles in sensing, data processing, and controlling machines used to monitor and treat patients. Add data science – AI and machine learning – to the mix and the industry can begin to explore new frontiers in healthcare by expanding our ability to detect and interpret patterns.

We are beginning to see this convergence of new technologies emerge in targeted use cases. Computer vision and convolutional neural networks are helping radiologists identify malignant tumors, minimizing the pain, inconvenience, and cost of biopsies. Pharmacogenomics and precision medicine are enabling researchers to identify first-line medications for patients based on their genomes and develop therapeutics based on the unique characteristics of the individual and his or her disease.

These applications are just the beginning of innovations that will redefine healthcare in the 21st century. But there may be a simpler example of how today’s data capture technology can make an equally significant impact in improving population health. This approach involves integrating behavioral, environmental, and social data directly into physician’s workflows, so healthcare professionals can have a more robust understanding of a patient’s risk factors and take proactive steps to help patients remain, or become more, healthy.

Social determinants of health (SDOH) are macro-level factors responsible for influencing health risks and health outcomes. SDOH include economic stability, neighborhood and physical environment, level of education, access to healthy food and quality healthcare, available support systems, and stress. These factors contribute to an individual’s life expectancy, mortality, healthcare expenditures, health status, and functional limitations, according to the Henry J. Kaiser Family Foundation.

Research demonstrates the enormous influence of behavior and SDOH on patient outcomes. Clinical interventions impact only 10 to 20 percent of a person’s health outcomes, while socioeconomic and environmental factors determine 80 to 90 percent, according to The National Academy of Medicine.

Consider the possibilities if a physician had access to social and behavioral information alongside lab tests, imaging results, and other background information about the patient. Not only could the doctor see that his 50-year old female patient’s glucose is high and creatinine and hemoglobin are slightly off, he could also evaluate the impact of her adherence to taking prescription medicine, stress level, and the fact that she lives in an urban food desert and doesn’t have access to regular care.

These types of solutions are already coming to fruition, in a variety of forms and functionality. Consider the offering developed by Proteus Digital Health, which combines ingestible sensors, a small wearable sensor patch, and mobile application to monitor patient health patterns and medication adherence behaviors. The objective information collected by the Proteus system enables doctors to initiate, adjust and measure treatment effectiveness, saving patients and payers money while optimizing care and amplifying outcomes.

Johns Hopkins University School of Medicine was also recently awarded a grant to continue research of the Emocha mHealth app, which tracks medication details and care management for individuals with tuberculosis, a diagnosis where strict medication adherence is essential for positive outcomes. The app connects patients and providers for Directly Observed Therapy (DOT), in which patients record themselves taking prescribed medication. The video is uploaded to a telehealth portal, where providers can confirm the medication was taken correctly and collaborate with patients on care management. Early results show that Emocha app boosted medication adherence rates by 94 percent and saved almost $1,400 per patient in treatment costs.

Using multiple data points to triangulate a patient’s condition enables physicians to deliver healthcare with a more holistic perspective. Understanding the gravitational force SDOH has on health outcomes, physicians not only can address the symptoms of disease, but can also respond to variables known to cause and/or exacerbate illness. With these types of insights, they can make more informed decisions around diagnosis, treatment and the continuum of care.

It can be a challenge for physicians to get insights into social and behavioral factors. But the move to EHRs, plus greater integration and effective data exchange through standardization efforts like Fast Healthcare Interoperability Resources (FHIR), are beginning to make these promises a reality. By capturing more data points through EHRs and having access to complete records regardless of where healthcare services are delivered, physicians will have a more comprehensive picture of patients’ background and health, empowering them to provide the care and resources to meet the unique needs of each patient.

Several device manufacturers are already offering remote monitoring tools capable of capturing patient health data at home and uploading it to an EHR for physicians to track.

For example, Boston Scientific’s Latitude Home Monitoring System enables physicians to monitor implanted devices to manage heart conditions. A five-year study of the system showed that there was a 50 percent relative risk reduction of death as compared to patients who only went to the clinic for device checks. Honeywell’s Genesis Touch collects biometric information, such as oxygen saturation, blood pressure, and weight and shares them with physicians. The related mobile app also enables video visits between patients and physicians and offers an interactive teaching tool to demonstrate techniques to manage various conditions and ensure the patient understands the treatment protocols.

Now take this integration a few steps further. Imagine,that through the power of AI and machine learning, a physician could be proactively alerted to key data points about a patient, in real time, outside of a hospital or office visit. Machine learning would identify certain thresholds that trigger the need for the physician to send a message containing educational materials to the patient, change a prescription based on data trends, or even alert emergency services.

Lessons learned from these types of just-in-time, adaptive interventions can be extrapolated to improve population health services by empowering physicians to offer data-driven recommendations to their patients.

For example, many practices may offer a universal stress reduction program to their patients. However, stress can manifest itself in a myriad of ways for different people at different times in their lives. By using the full scope of data available to understand the stressors – physical, social, and behavioral – and other factors impacting each patient, providers can do more than simply and generically “manage stress.” They can develop an intervention that helps specifically manage that patient’s unique stressors.

The future of each individual patient’s outcome is brighter when you combine the nuance and tailoring of personalized medicine with the reach of population health. Advances in science, technology, and use of SDOH brings this future within reach.

Readers Write: Projects and Costs Out of Control? Take a Low-Dose Aspirin

September 26, 2018 Readers Write 3 Comments

Readers Write: Projects and Costs Out of Control? Take a Low-Dose Aspirin
By Frank Poggio

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Frank Poggio is president and CEO of The Kelzon Group.

A recent announcement in the news about the lack of effectiveness and risk of taking daily low-dose aspirin triggered my re-thinking about the age old question of, “Why is healthcare IT so far behind commercial industry?” or, “Why is healthcare delivery so costly and inefficient?”

“Experts” always say we can improve costs and quality if we practice evidence-based medicine. OK, I can buy that, but what if the evidence keeps changing every few years? I am willing to bet that in about five years some researcher will say that new data shows daily aspirin is good for you, so hope you didn’t stop taking it. How many times have we seen that with other foods like coffee, red wine, etc.?

And what about classic annual diagnostic procedures like Pap smears, mammography, and PSA tests? Or therapies like angioplasty, tonsillectomy, bloodletting, or frontal lobotomy? The list goes on. All deemed good one day in the past, but not so good or maybe deadly soon after.

This obsession with comparing medicine and healthcare to other industries falls apart if you look at a simple example. Say you are washed up and stranded on a large island. As it turns, out there is an abandoned cabin on the island with a motorized boat left at the dock. You also find a set of mechanic’s tools in a storage area, and lucky you, you happen to possess a little mechanical talent from your high school shop class. What you do not have is any documentation covering the boat or engine, but with your cursory experience with cars, you figure out how to start the engine. But alas, it will run only for a few minutes.

You tinker with it for days, but without any owner’s or repair manuals or other specs, everything you do is hit or miss. Of course you take an evidence-based approach, using trial and error and a little creativity. As you fail to make headway and start experiencing severe hunger pains, you take the engine apart to try to get a better understanding of its engineering and how it should function. Put it back together, try again, no luck, apart again, try again, and on and on.

Wouldn’t it easier if you had some documentation, like maybe a troubleshooting guide? Every boat engine that comes off an assembly line has one. If only the original owner had kept it, you could avoid all the time-wasting reverse engineering. And thank heavens the engine isn’t amorphous or biological, which brings us back to the human condition.

When you were born, didn’t the doctor give your mother your owner’s manual, troubleshooting guide, design specs, and of course a warranty? What, you say, you can’t find them, and the frustration is giving you a severe headache? Too bad, maybe try this aromatherapy — it worked for me.

Morning Headlines 9/26/18

September 25, 2018 Headlines No Comments

New Tool Can Help Patients and Family Caregivers Get, Use, and Share Health Records

Several provider organizations develop Health Record Request Wizard, an online tool that walks patients through submitting a request to providers for electronic copies of their medical records.

CenTrak Bolsters Security Solutions through Elpas Acquisition

CenTrak acquires the security solutions assets of Elpas Solutions, which include infant protection, wireless call, staff duress, man down, and wander management.

Google Assistant Investment Program Invests in Aiva Health, First Voice Platform for End-to-End Care

The Google Assistant Investment Program makes its first foray into healthcare with an investment in Aiva Health, which has developed virtual assistant-based patient engagement and care coordination software.

StartUp Health Raises $31M From Novartis, Ping An Group, Chiesi Group, GuideWell and Otsuka

Digital health investment collaborative StartUp Health closes a $31 million fund that it will use to invest in “healthcare moonshots.”

News 9/26/18

September 25, 2018 News 2 Comments

Top News

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Several provider organizations develop Health Record Request Wizard, an online tool that walks patients through submitting a request to providers for electronic copies of their medical records. It extends a previous form developed by AHIMA by adding branching logic.

Despite the headline proclaiming that it helps families obtain and share their records, it doesn’t – it addresses the 2 percent of the work involved in providing a standard user interface for such requests while neatly turfing off the 98 percent of technical integration to EHR vendors who may not see the value in supporting someone else’s front end. Only three health systems and no EHR vendors have pledged to support it.

Plus it doesn’t support the most prevalent and essential healthcare technology – the fax machine.


Reader Comments

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From HIT Medical Student: “Re: JAMA article. I think your readers will find the author’s conclusion as ridiculous and insulting as his title. How are physicians still using ‘autism’ as a pejorative in professional settings? At what point, if ever, are all physicians going to understand that EMR documentation is a vital part of patient care and population health management?” The JAMA Pediatrics opinion piece titled “The Electronic Health Record and Acquired Physician Autism” was written by Palmetto Health (SC) psychiatrist Peter Loper, Jr., MD. He blames a “fixation on the EHR” for his being “abrupt and crass” with patients, complaining that he had previously refused to use an EHR during encounters and admitting that he was “chronically behind on documentation.” His point is that focus on the EHR during encounters causes doctors to “exhibit the same behaviors that render this disorder so socially incapacitating for those on the autistic spectrum” while failing to note the humanity of the encounter and that the physician-patient relationship is key to disease management. He could have made his point without the autism reference, and had he done that, I would defend him since he’s a child-focused psychiatrist and EHRs (Palmetto uses Cerner) do little to improve his practice over paper other than to get him paid. He also suffers from the ubiquitous misperception that his N-of-one experience is generalizable to the entire medical profession and also fails to consider how his employer chose to configure the EHR and mandate its use, doing as doctors often do in shooting the EHR vendor messenger without realizing that it wasn’t them who made the workflow decisions.  

From Crass is Greener: “Re: Memorial Sloan Kettering and Paige.AI. Your update makes me wonder about its business relationships with IBM and Allscripts looks like, knowing that IBM needs to prove out Watson and Allscripts’ propensity for ‘doing deals’ (see Verity Health).” Hospitals excel at cloaking business deals behind lofty, altruistic proclamations (this is especially common with oncology and pediatrics since everybody is extra empathetic to those patients.) It would be interesting to see MSKCC’s contract with IBM, especially since reports suggest that Watson Oncology is more of a mechanical turk that just sends whatever recommendations MSKCC’s doctors manually offer while disguising it to look like machine-powered insight. I wouldn’t trust any deal involving Patrick Soon-Shiong’s Nant companies, and the apparent enthusiasm with which Allscripts did so suggests desperation on both ends of the transaction, leaving the now-bankrupt Verity in the middle of a Sunrise implementation they didn’t want and their financial Santa Claus moving on to other shiny objects after just one year. My life’s most relevant lesson learned is that people and organizations (including many non-profits and all health systems) do whatever benefits them the most, so follow the money.


HIStalk Announcements and Requests

Listening: new from Badflower, LA kids who can crank out some hard rock. They are touring tiny venues (like bars) right now – they’ll be in Madison, WI on October 12. I’m enjoying their music along with the best manufactured cookie I’ve had in years, Oreo Thins with pistachio (I expect the coconut to be equally wondrous). 


Webinars

September 26 (Wednesday) 12:30 ET. “How to Ensure Patient Records are Always Available.” Sponsor: Goliath Technologies. Presenter: Goliath Technologies engineering staff. This webinar will discuss how an early warning system can help your organization ensure your EHR systems and patient records are always available. You’ll also learn how to proactively anticipate, troubleshoot, prevent, and resolve end user experience issues before users or patients are impacted.

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


Acquisitions, Funding, Business, and Stock

CenTrak acquires the security solutions assets of Elpas Solutions, which include infant protection, wireless call, staff duress, man down, and wander management.


People

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Akron Children’s Hospital (OH) promotes pediatric hematologist-oncologist Sarah Rush, MD to CMIO.

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Intelerad Medical System hires Paul Lepage (Telus Health) as president/CEO.


Announcements and Implementations

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Cancer management and patient engagement technology vendor Carevive goes live with its patient care planning software at University of Missouri Health Care’s Ellis Fischel Cancer Center, where it is integrated with Cerner Oncology.

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I missed this earlier: a Rand report recommends that patients get involved with provider record-matching challenges, with these suggestions:

  • Implement a voluntary universal identifier, managed by an organization that does not store PHI
  • Implement a patient-managed public key
  • Expand the use of government-issued identifiers such as driver license numbers
  • Match records by asking patients to verify their identity by answering “what you know” type security questions
  • Use biometrics with demographics
  • Verify the identity of patients by sending one-time verification codes to their phones
  • Implement consumer-directed exchange
  • Use regional health record banks
  • Give patients a user interface so they can verify record matches themselves
  • Have patients supply their own record location information

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In urge-to-merge and marketing provider news, Greenville Health System and Palmetto Health will rename their South Carolina partnership to Prisma Health, while in Florida, Orlando Health and Lakeland Regional will end their affiliation October 1 after just one year due to their “different strategies and distinctive communities served” that were apparently not evident 12 months ago. One might assume it was an uneasy relationship between Orlando and Lakeland since the websites of both systems have been scrubbed of any evidence of the affiliation, including their rosy press releases from last year that predicted improved patient access and clinical quality. And in Maine, Eastern Maine Healthcare Systems (which oddly makes “system” plural) will rename itself Northern Light Health, following the lead of hospitals that have eschewed their confusing “health system” moniker to make a land grab for the “health” label even though hospitals have only a tiny impact on health while taking the lion’s share of healthcare expenditures.


Other

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Intermountain precision genomics director Lincoln Nadauld, MD, PhD decries EHR-generated PDFs as a crude form of interoperability, noting that a particular patient’s 143-page record could not be searched, viewing it caused it to re-default to 6-point font with each page flip, it could not display CT scan images, and it contained only the first page of genomic testing results. He advocates a patient-controlled, cloud-based, searchable repository, not surprisingly since he wrote the piece for Ciitizen, a pre-beta vendor that will offer such a sharing platform. It sounds a bit like CareSync, which unfortunately couldn’t make a go of offering a stellar service that also included having humans obtain the subscriber’s medical records (my CareSync experience was excellent). I’m ever-skeptical about a business model that expects patients to obtain and upload their own records since they historically won’t bother.

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An Associated Press analysis finds that despite the White House’s claim in May that drug companies would announce “massive” price cuts almost immediately, 2018 has seen 96 price increases for every one price reduction. HHS Secretary Alex Azar — a former executive of a drug company that dramatically increased insulin prices during his tenure — says he’s not counting on “the altruism of pharma companies lowing their prices.” Drug price hikes are often small but frequent and makers of competing products often raise prices in lockstep.

Former UN Secretary General Ban Ki-moon says the US healthcare system, the world’s most expensive by far, is morally wrong in that “nobody would understand why almost 30 million people are not covered by insurance.” He says drug companies, hospitals, and doctors are using their lobbying power to avoid universal healthcare. 

A Michigan jury awards $130 million to the family of a boy who in 2006, as a two-month-old, developed cerebral palsy that the family’s attorneys claim was due to a botched IV start at Beaumont Hospital. The family’s lawyers say the now-12-year-old is a “charming and beautiful boy” who needs help getting in and out of the bathtub.

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I’ve lost interest in the heavy-handed and unrealistic medical program “The Resident,” but  its Season 2 premiere this week borrowed an idea from year-old episode of “Grey’s Anatomy” by featuring a cyberhacking story line. The hospital’s drama-filled blackout turns out to be the work of a hacker who got herself admitted to the hospital so she could breach its systems from the inside (Hollywood loves “the call is coming from inside the house” as a shocker) in revenge for high medical bills that forced her to drop out of college. Least believable (and that’s saying a lot for this episode) is that the hacker was admitted for a UTI instead of being streeted with a prescription for antibiotics, and when confronted about the breach, she handed over a thumb drive backup that somehow fixed everything. Not unbelievable is that the hospital fired an uninvolved IT guy over the incident. 


Sponsor Updates

  • Crossings Healthcare Solutions will demonstrate its clinical decision support tools for physicians, nurses, and informaticists at the 11th Annual DV/NJHIMSS Fall Event this week in Atlantic City, NJ and at the Cerner Health Conference October 8-11 in Kansas City, MO.
  • ROI Healthcare Solutions is featured on the TV program “Newswatch.”
  • Kyruus will convene a CEO panel at the Fifth Annual Thought Leadership on Access Symposium in Boston October 15-17.
  • MModal and Enjoin will partner to offer a technology-driven clinical documentation improvement advisory solution to address population health.
  • The Wisconsin State-Journal profiles Nordic Data & Analytics Services Delivery Manager Eric Pennington.
  • Nordic’s managed services division has signed 20 clients and expanded to 100 consultants.
  • Healthwise launches its FHIR app in Epic’s App Orchard.
  • Aprima will offer HIPAA compliance programs from Abyde.
  • Mmodal partners with Enjoin to offer clinical documentation consulting services.
  • ZappRx partners with specialty pharmacy Dunn Meadow to speed up prescription access for oncology and pulmonology patients.
  • FDB publishes a new case study describing how Health First improved medication adherence with FDB’s Meducation in its Allscripts Sunrise EHR.
  • AdvancedMD will exhibit at WebPT’s annual Ascend conference September 28-29 in Phoenix, AZ.
  • Aprima, CoverMyMeds, CTG, Culbert Healthcare Solutions, and Direct Consulting Associates will exhibit at MGMA September 30-October 2 in Boston.
  • CarePort Health will exhibit at ACMA Maryland September 29 in Baltimore.
  • Change Healthcare will host Inspire 2018 September 30 in Phoenix, AZ.
  • Cumberland Consulting Group will exhibit at the MDRP Summit 2018 October 1-3 in Chicago.
  • Dimensional Insight will exhibit at 2018 IntegraTe October 2 in Davie, FL.

Blog Posts


Contacts

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

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Morning Headlines 9/25/18

September 24, 2018 Headlines No Comments

UMass Memorial Health Care Entities to Pay $230,000 to Resolve AG’s Lawsuit Over Data Breaches

UMass Memorial Medical Group and UMass Memorial Medical Center will pay $230,000 to settle a lawsuit related to employees improperly accessing patient medical records, and then using their data to open cell phone and credit card accounts.

Memorial Regional Health to request approval to sell dirt lot, wins $200K grant

Memorial Regional Health (CO) will move to Epic as part of a new affiliation with SCL Health St. Mary’s Regional Health System (CO).

Ochsner Health System, LSU Health Shreveport join forces to improve healthcare in north Louisiana

Ochsner Health System (LA) and LSU Health Shreveport will invest in EHR, digital health, and telemedicine enhancements as part of a new joint operations agreement.

Curbside Consult with Dr. Jayne 9/24/18

September 24, 2018 Dr. Jayne 1 Comment

Being in the consulting world, I am exposed to a large variety of practices, partnerships, health systems, integrated delivery systems, and more. It’s always challenging when clients and prospects want me to “find someone that looks just like us” before they agree to start working on a project.

I let them know that it’s not just a question of finding someone in my client base that has similar characteristics, but sometimes even finding someone in the healthcare realm that looks like them is challenging to impossible. Explaining this can be difficult, especially after clients have interacted with vendor sales reps who have done their best to convince them that as long as they talk to someone in the same specialty, or as long as they talk to a group of the same size, that they can expect to have comparable experiences.

I see this with both small and large clients, even with large health systems that think that just because XYZ health system on the other side of the country did a certain project a certain way, that they will have similar outcomes. There are so many variables that play into a project’s success, that it often becomes one of those “your mileage may vary” situations.

I ran across this recently with an organization that was looking to understand what size of a team they needed to support their ambulatory EHR needs after migration to a new system. They seemed rather upset that I couldn’t just tell them how many people to hire, without performing some level of discovery around the level of support they planned to provide, what their proposed governance structure would look like, what the organization’s support budget was, and what skill set they expected the team to have.

It’s a complex equation, and I always try to attack the idea of governance – both clinical and application – as the first step in figuring out what makes a group tick and what their needs might be. Organizations that understand the value of governance are like gold to me. They understand that decision-making is important, as is understanding who owns the application and who is responsible for making decisions related to implementation, maintenance, support, and upgrades.

When an organization decides to have tight governance, it can result in not only cost savings due to decreased variation, but also in measurable quality when providers understand that it’s important for people to deliver care in a standardized way. Many organizations do a good job with this during the design and build phases of an implementation, but once the system goes live it’s tempting to fall into bad habits.

Organizations may make customizations to appease a single provider or a small group of providers, which not only consumes resources in the present time, but also in the future, as those customizations have to be constantly evaluated against upgraded software versions. Some organizations I’ve worked with don’t even track their customizations, so they can’t possibly evaluate them. Each upgrade becomes a bit of a surprise as they try to figure out what the “out of the box” software looks like vs. what they have installed in their environments.

My first Lean Sigma project years ago was to work on an EHR upgrade, and I admit that the project itself failed – we ended up not taking the upgrade – but we learned a tremendous amount about the methodology needed to successfully evaluate a new release and get it through the upgrade process. We created an evaluation paradigm that I still use today, across multiple vendors and even outside of EHR applications.

Sometimes the decision to modify the application rests with a clinical committee, but other times it’s the nebulous “IT” that reviews requests and makes the changes. This is unfortunate because technology projects require care and feeding not only by the technical team, but by clinical and operational owners. However, it’s easier to blame “IT” rather than addressing inadequate or absent governance. Other groups may keep their governance structures after go-live, but they become weak over time due to shifting priorities, members’ attention being focused elsewhere, or outright neglect.

It’s great when things are ticking along just fine, but bringing your governance group together quarterly even if there aren’t major decisions to be made isn’t a bad idea. There may be issues that are brought to light or maybe the group just confirms that things are going well, but it’s one of those things that if you don’t ask, you might be missing problems that you didn’t even know existed. If you can’t even get people in the room, that might be a red flag for apathy or end users checking out rather than engaging.

Governance can be tightly linked to management, although it’s best if neither exists in a vacuum. Strong management helps ensure that decisions that are made are carried out in an effective and cost-efficient manner. Effective management is what transforms an organization to being reactive towards the squeaky wheel into one that can proactively look for issues and identify solutions before things turn into problems. It’s often difficult though to have strong management with physician groups, especially when there are numerous competing personalities and where organizational politics becomes a factor.

I’ve seen so many groups take a page out of “Lord of the Flies” rather than be willing to address difficult colleagues or tackle ineffective team members. When I work with them, I present techniques for communication and consensus-building and sometimes it seems like this is the first time they heard that there are “treatments” that can help get them through the rough spots just like there are remedies for medical conditions.

Both governance and management can be tightly linked to culture. I frequently encounter organizations that can’t articulate their culture, and I guarantee that if the leadership can’t even define the concept, they’re not doing a great job of carrying it to the rest of the organization. If leadership is preaching the need for strong governance and effective management,and then doesn’t deliver on those expectations at the highest levels, it becomes not only demoralizing, but often costly for the organization which ends up floundering. The importance of these relatively “soft” disciplines shouldn’t be underestimated.

It’s with all of these factors mind that I approach each organization I work with. One has to understand who they are, where they have been, where they are going, and where they want to be before you can make recommendations to help them. When you’ve seen one organization, you’ve seen one organization, regardless of how similar they may be in size, scope, specialization, etc. It’s tough to determine whether your experiences might be like someone else’s without asking some difficult questions.

I challenge organizations who are in the market as buyers to consider this concept when you are presented with a reference site or a case study that someone is trying to use to convince you to buy, or when you’re trying to determine your implementation or support model. You might find yourself asking some difficult questions of your own organization. Uncomfortable as it might feel, it’s a good thing.

How does your organization approach concepts like governance? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 9/24/18

September 23, 2018 Headlines 1 Comment

.@sloan_kettering sent a note to staff today after my story with @katie_thomas @nytimes.

Memorial Sloan Kettering Cancer Center leadership defends itself to its employees following reports that it gave for-profit AI startup Paige.AI exclusive access to its 25 million pathology slides in return for an equity stake for itself and several MSKCC executives

Longmont-based software company helped hospitals keep track of patients during Florence evacuations

Emergency response software vendor Knowledge Center played a vital role in the evacuation of 313 patients from hospitals in the path of Hurricane Florence.

Biden Cancer Initiative Recognizes MITRE Partnership’s Core Cancer Model

MITRE partners with Intermountain Healthcare, the American Society of Clinical Oncology, and ASCO’s CancerLinq subsidiary to develop a set of cancer data elements culled from EHRs that will help providers make better treatment decisions at the point of care.

Monday Morning Update 9/24/18

September 23, 2018 News 8 Comments

Top News

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Memorial Sloan Kettering Cancer Center leadership defends itself to its employees following reports that it gave for-profit AI startup Paige.AI exclusive access to its 25 million pathology slides in return for an equity stake for itself and several MSKCC executives (in essence, profiting from the work of its pathologists and the property of its patients instead of by creating new intellectual property). The health system explains that:

  • It is sharing only de-identified patient data and not actual slides (note: the Paige.AI partnership announcement specifically says it gained “exclusive rights to MSK’s library of 25 million pathology slides” that are “accompanied by de-identified pathologic and clinical annotation”)
  • The relationship between its executives and the company was vetted for conflict of interest
  • Board members and faculty who received equity won’t participate in company decisions
  • They’ll kick back some of the proceeds to the pathology department

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MSKCC’s recent bad press – including unreported conflicts of interest by a since-resigned key researcher who was raking in drug company money and skepticism about its relationship with IBM Watson Health – add it to the list of health systems whose high-falutin’ patient care proclamations fail to hide the fact that it often acts like any other self-enriching business whose own interests come first. It paid its CEO $6.7 million (plus he gets a company house), its CIO $1 million, and its chief fundraiser $1.4 million, according to its most recent tax forms.

In case you missed it, sick and frightened cancer patients are a highly profitable widget in this country. As is typical in healthcare, nebulous consent forms allow their data to be sold to any willing buyer without their permission or benefit.

ProPublica notes that its report didn’t create the MSKCC Paige.AI controversy – it was MSKCC’s own pathologists who complained that their work had been taken for the benefit of top MSKCC brass. Surprisingly, they didn’t complain that Paige.AI’s business model requires the company to characterize the work of human pathologists as subjective, error-prone, and inefficient compared to allowing a computer to do their work.

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MSKCC’s former pathology department chair Marc Rosenblum, MD wrote the most brilliantly sarcastic internal email I’ve ever seen last month (subject: “Department: Fleece(d)”) in offering suggestions to hold a Paige.AI naming contest with stock options as a prize to “fully embrace the entrepreneurial tenor of our times;” to create a department logo to “trumpet where we’re going” that would look good on a Patagonia fleece; and to create a department fight song. 


HIStalk Announcements and Requests

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Poll respondents are skeptical about the population health benefits of the Apple Watch’s EKG recording capability.

New poll to your right or here: would you be OK with having your social media activities monitored for health research or to trigger personalized health improvement suggestions? I admit I’m fascinated by the human aspect of expecting an insurer to cover huge financial risk while denying them relevant information, which then goes back to the argument about universal healthcare, under which such lifestyle forensics would be unnecessary since the entire country would make up the risk pool. Life insurers are allowed to require medical exams, getting auto insurance involves having your pre-existing condition (driving record) examined initially to set premium prices and having that price jacked up (or the policy cancelled) following a paid claim, and all forms of business insurance (malpractice, cybersecurity, etc.) come with the expectation of allowing the insurer to assess their risk by inspecting sensitive records. Only with health insurance are we offended at the idea that insurers need to learn more about our health before agreeing to pay to maintain it, an expectation that has risen due to out-of-control hospital and drug costs in the absence of political will to address the issue.


Webinars

September 26 (Wednesday) 12:30 ET. “How to Ensure Patient Records are Always Available.” Sponsor: Goliath Technologies. Presenter: Goliath Technologies engineering staff. This webinar will discuss how an early warning system can help your organization ensure your EHR systems and patient records are always available. You’ll also learn how to proactively anticipate, troubleshoot, prevent, and resolve end user experience issues before users or patients are impacted.

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


People

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Mazars USA promotes Gil Enos to leader of its healthcare consulting group.


Announcements and Implementations

Wolters Kluwer Health launches a new version of its Sentri7 clinical surveillance solution.


Other

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Researchers question whether it’s a good idea to apply Cambridge Analytica-type social media “digital phenotyping” to target people for population health interventions. They note that such activities incur the risk of public backlash (when social media users realize they’re being monitored and controlled) and having those users go underground by avoiding using words that all out their health-harming practices.

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An oncologist’s Wall Street Journal op-ed piece ponders the dilemma in which drug companies charge whatever high prices the market will bear irrespective of their actual research and manufacturing costs and the extent to which the drug improves an individual’s health, noting that the US is the only country that approves marketing of drugs without negotiating the allowed selling price:

The extraordinary cost of these treatments presents a tragic dilemma: We may soon have a miracle drug for cancer whose cost, when multiplied across the population that needs it, could bankrupt the country. Consider what would happen if the new drugs were used to treat 250,000 cancer patients per year—just 40 percent of the Americans who die annually from cancer. At $373,000 per patient, a Kymriah-type immunotherapy treatment would increase drug spending in the US by approximately $93 billion a year. This would mean an almost 20 percent increase in the country’s total annual drug spending—for just one drug. To put that figure in perspective, it amounts to $300 per American, or $500 if we include associated medical services.

Why we should have been lawyers: a Georgia jury awards the family of a baby whose penis was injured during a midwife’s circumcision $30 million.

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A fun Bleacher Report profile of Laurent Duvernay-Tardif, MD – who is also a right guard for the Kansas City Chiefs who signed a five-year, $41 million contract extension with $20 million guaranteed last year – reveals interesting facts:

  • He made good money at 12 years old selling pesto that he made himself, explaining that it had to be very good since “I wasn’t cute enough to get any sympathy purchases.”
  • His parents took the children on year-long sailing trips carrying only rice and canned vegetables to show them that money isn’t all that important.
  • The Quebec born Duvernay-Tardif graduated from McGill University’s medical school even though he spoke only French and all his classes were conducted in English, so he played lecture recordings at half speed while looking words up in a dictionary.
  • He was on call on NFL draft day, so he gave his phone to a nurse and asked her to say yes to any team that drafted him while he participated in an emergency C-section.
  • He is only the 10th player ever drafted by the NFL from a Canadian college and the first active doctor to be on a team’s roster
  • The NFL denied his request to add “MD” after his last name on his jersey, which he says is OK since “my name is Duvernay-Tardif, and it’s plenty long enough like that.”
  • He explanations the motivation required to master two difficult professions: “My biggest fear is doing nothing. When you start downsizing your expectations of what you can do with your time, it’s hard to go back. If I spend an offseason doing nothing, I don’t know if that drive will come back. That scares me more than anything.”

Sponsor Updates

  • Lightbeam Health Solutions launches the Pop Health Podcast with an initial episode on gaining patient buy-in for chronic care management.
  • MedData and Experian Health will exhibit at the HFMA Region 7 Conference September 26-28 in South Bend, IN.
  • Kansas State University’s College of Engineering names Netsmart its 2018 Company of the Year.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the CSO HIMSS Leadership Symposium September 28 in Cincinnati.
  • PreparedHealth will exhibit at the Regional DV-NJ Chapters HIMSS Conference September 26-28 in Atlantic City.
  • The SSI Group will exhibit at the HFMA South Texas and TAHFA Fall Symposium September 23-25 in San Antonio.
  • Surescripts and ZappRx will exhibit at the NASP Annual Meeting & Expo 2018 September 24-26 in Washington, DC.
  • TriNetX will host TriNetX Summit18 September 25-26 in Boston.
  • Vocera will exhibit at the Illinois Health and Hospital Association Leadership Conference September 25 in Lombard, IL.
  • Consulting Magazine names Huron a “Best Firm to Work For” for the second consecutive year.
  • Wellsoft will exhibit at Emergency Nursing 2018 September 26-29 in Pittsburgh.

Blog Posts


Contacts

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

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Weekender 9/21/18

September 21, 2018 Weekender No Comments

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Weekly News Recap

  • Pathologists at Memorial Sloan Kettering Cancer Center complain that its executives and board members received equity in pathology decision support company Paige.AI after MSKCC gave the company exclusive access to its archive of patient tissue slides
  • Boston Medical Center, Brigham and Women’s Hospital, and Massachusetts General Hospital collectively pay $999,000 to settle patient privacy complaints related to the in-hospital taping of the TV show “Boston Med”
  • Athenahealth shares drop sharply on the news that activist investor Elliott Management will pass on acquiring the company at its previously offered price of $160 per share, citing problems it found during due diligence
  • Waystar announces its acquisition of Connance
  • Aramark sells its Healthcare Technologies business to clinical engineering and asset management company TriMedx for $300 million
  • The impending arrival of Hurricane Florence in the Southeast motivates HIEs to connect their systems, hospitals to offer free virtual visits, and HHS to temporarily waive several HIPAA Privacy Rule requirements

Best Reader Comments

It’s not the one with the best algorithm that wins – it’s the one with the best data. (MLtrainedMD)

I expect we’ll see more unfortunate deals like the Paige one over the next few years as clinical organizations with good reputations cut deals with AI/ML companies. The AI/ML companies need someone clinical to provide them their training cases and the executives mistakenly think the data isn’t worth anything since it’s just “sitting there.” Lots of AI/ML companies are getting away with a treasure trove of valuable data very inexpensively. (DrM)

I think a lot of women exclude themselves from some pursuits early on in life (computers, science, leadership roles, etc.). Therefore they don’t develop those aptitudes, and therefore there just aren’t a lot of qualified women out there to be hired into those roles. (And therefore, when there is a qualified woman, they can be subjected to more skepticism and scrutiny than others.) Some say the solution is to hire by quota. But if there is an insufficient number of qualified female applicants, then that just results in hiring unqualified ones into roles that others may be better qualified for. Which is (a) not fair, and (b) also creates a credibility problem for the hapless woman. And it renders awards / promotions to women in these roles essentially meaningless, even if they were given based on merit (because people will assume they were quota-driven). Not an easy problem. (Clustered)

I’ve taught research methods and sampling methods for 45 years. I’ve written books and articles about research methods etc. KLAS is the example I use of the worst possible false “research” presentations. Only a fool would pay attention to a KLAS rating. It is a means of selling KLAS reports and of favoring vendors who pay for KLAS reports. I’m not saying they intend to deceive, but their design does that. Period. Thus, even if they wanted to be truthful, they can’t be with their research approach. It has no statistical validity. It’s an advertising tool. (Ross Koppel)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. E in Michigan, who asked for a handheld carbon dioxide meter and map printing supplies for the Girls Club air quality mapping project. She reports, “The members of my Girls Club love to do science activities, and taking them home with them to report back was even more exciting. The girls went through and took data for their own homes, businesses, and even the school. It was interesting to see the areas of high and low concentration of carbon dioxide at different places. Some were surprised at the results, especially the levels coming form our school! Thank you for bringing a science project to life that allowed my girls to become real scientists.”

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A new California law requires hospitals to make plant-based meals – as recommended by the AMA and the American College of Cardiology – available to patients.

Italy’s anti-establishment movement gets a law passed that allows parents to attest that their kids have been given 10 mandatory vaccines without providing proof, promoting personal choice in claiming scientific arrogance, drug company influence, and supposed connections to cancer and autism. One group of doctors publicly claims that eating nuts is more effective that vaccines for preventing illness (insert your own nut-related pun here).

California’s private surgery center accreditation agencies, which are paid directly by their surgery center customers, often approve facilities that have been decertified by Medicare; that are being run by medical professionals who have lost their licenses or who were caught practicing outside the scope of their training; or that have high complication or death rates. One of those private accreditors is Joint Commission. In a fun overlap of events, an endoscopy center earned its “widely recognized symbol of quality” the same day state health inspectors declared “immediate jeopardy” when they saw a newly hired receptionist disinfecting endoscopes.

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FDA’s warning letter to a Addison, IL pharmaceutical testing laboratory cites problems with quality control, staff training, unsuitable equipment, and the owner’s operation of a microbrewery in the same space where yeast counts were measured, with FDA dryly noting that “A brewery employee was also preparing beer kegs in this area. In addition, laboratory test media, open beer bottles, and brewing materials were co-mingled within the same refrigerator.” The website of Seery Athlone Brewing touts that its owner – who also owns the lab – has a degree in microbiology and “more than 30 years of experience in fermentation – perfect for brewing!”

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Life insurance company John Hancock will require policyholders to wear activity tracking wearables to earn its discounted premium rate, extending the practice of its Vitality program that offers discounted trackers such as the Apple Watch.  That company found that its policyholders lived 13-21 years longer than average, which instead of implying that using fitness trackers improves health, might instead suggest that those customers were healthier to begin with and agreed to prove it by having Big Brother monitor their exercise levels in return for life insurance discounts.

A  man is admitted to the hospital in critical condition after he and his partner, high on a date rape drug, decide (after what I’m sure was thoughtful deliberation) to boil 15 eggs and insert them into the southern rather than the northern opening of his alimentary tract.


In Case You Missed It


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Morning Headlines 9/21/18

September 20, 2018 Headlines No Comments

Sloan Kettering’s Cozy Deal With Start-Up Ignites a New Uproar

Pathologists at Memorial Sloan Kettering Cancer Center object to a deal that gave several MSKCC higher-ups an equity stake in pathology clinical decision support startup Paige.AI after it gave the company exclusive access to its archive of patient tissue slides.

Town Hall Ventures, Investment Firm Focused on Improving Health of Underserved Populations, Brings Together Providers, Payors, and Leaders to Announce Close of First Fund At $115 Million

Andy Slavitt’s Town Hall Ventures closes a $115 million fund and makes unspecified investments in payer Bright Health, home health provider Landmark Health, and chronic kidney disease company Strive Health.

Unauthorized Disclosure of Patients’ Protected Health Information During ABC Television Filming Results in Multiple HIPAA Settlements Totaling $999,000

Boston Medical Center, Brigham and Women’s Hospital, and Massachusetts General Hospital collectively pay $999,000 to OCR to settle potential privacy violations related to the taping of TV show “Boston Med” without prior patient approval.

Gawande-led venture taps consulting giant to hone strategy for chronically ill

The Amazon/Berkshire Hathway/JPMorgan healthcare venture led by Atul Gawande, MD hires Deloitte’s Monitor Group to help bring to fruition a strategy for improving care for the chronically ill.

News 9/21/18

September 20, 2018 News 2 Comments

Top News

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Pathologists at Memorial Sloan Kettering Cancer Center object to a deal under which several MSKCC executives and three of its board members received an equity stake in pathology clinical decision support startup Paige.AI after the health system gave the company exclusive access to its archive of 25 million patient tissue slides.

The pathologists say it’s unfair that equity created by their expertise was handed out.

Paige.AI raised $25 million in a February 2018 Series A funding round.

The pathologists also are expressing concern about sending anonymized patient data to the for-profit company.


Reader Comments

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From Former Healthx-er: “Re: Healthx. CEO Sean Downs and CFO Jim Meer were replaced a couple of weeks ago with guys who seem to travel together to fix broken companies. The COO and VP of product were released a few months ago. More than half the account management team was let go last week and cutbacks were made in services, sales, marketing, accounting, product development, and the chief people officer. More layoffs are expected this week.” Unverified, except for the newly announced CEO and CFO. New CEO Gene Cattarino has ridden the CEO circuit for SafeOp Surgical, Capsule, Lynx Medical Systems, Landacorp, Medicode, and TDS. Indianapolis-based Healthx offers a provider-member engagement portal to health plans.


Webinars

September 26 (Wednesday) 12:30 ET. “How to Ensure Patient Records are Always Available.” Sponsor: Goliath Technologies. Presenter: Goliath Technologies engineering staff. This webinar will discuss how an early warning system can help your organization ensure your EHR systems and patient records are always available. You’ll also learn how to proactively anticipate, troubleshoot, prevent, and resolve end user experience issues before users or patients are impacted.

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


Acquisitions, Funding, Business, and Stock

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Mercy Health (OH) becomes a minority investor in cloud-based medical image management vendor NucleusHealth. The 23-hospital system served as a beta site for company’s cloud-based PACS, eventually developing an image-sharing network across 300 facilities.

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Ooda Health raises $40.5 million in a funding round that led it to seek out investment partners with strong female leadership (of which there are few). Oak HC/FT and DFJ led the round. The San Francisco-based startup is working with Blue Shield of California to develop real-time claims payment software that will be piloted at Dignity Health and Hill Physicians. Co-founder and CEO Giovanni Colella, MD founded and led Castlight Health and Relay Health.

Telemedicine vendor SnapMD raises $7.1 million in a Series B round.

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InstaMed expands its Philadelphia headquarters with the addition of a 3,200 square-foot Collaboration Center.

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Town Hall Ventures closes a $115 million fund and makes unspecified investments in payer Bright Health, home health provider Landmark Health, and chronic kidney disease company Strive Health. Town Hall was launched in May by former CMS Acting Administrator Andy Slavitt, Trevor Price (Docent Health), and David Whelan (Rebel Labs) to invest in companies that cater to underserved populations.

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Details finally come to light about Nest’s secretive 2017 acquisition of Senosis Health, an app-based health monitoring startup out of the University of Washington. Parent company Google put strict parameters around publicizing the acquisition, so as to keep Nest’s digital health plans a secret. The company, which is now part of Google’s hardware unit, has yet to release a healthcare product, though it did throw its hat (unsuccessfully) in the Withings acquisition ring. Reports now suggest that Nest is working on devices to help seniors age in place.


People

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Emids names Tim McMullen (NTT Data Services) president and Dan Critchley (Optimum Healthcare IT) VP of its provider business. Tom Niehaus, who served as president since the company’s acquisition of Encore Health Resources last year, will retire at the end of September.


Sales

  • The Nebraska Health Information Initiative selects patient identity matching technology from 4medica.
  • St. Luke’s University Health Network expands its CarePort Care Management implementation to additional facilities in Pennsylvania and New Jersey.
  • La Clinica de Familia will implement EClinicalWorks across its 19 locations in New Mexico.
  • Spectrum Health & Human Services (NY) and Reeves County Hospital District (TX) select Cerner’s EHR and RCM technology.
  • Cottage Hospital (NH) will expand its use of Summit Healthcare’s interoperability solutions.

Announcements and Implementations

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Allina Health (MN) implements Vocera software to better connect its nurse call, patient monitoring, and communications systems.

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Provation develops cloud-based procedure documentation software, including automated coding, for ASCs and hospitals. Wolters Kluwer sold the company to Clearlake Capital Group at the beginning of the year for $180 million.

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Whitman Hospital & Medical Clinic (WA) goes live on Meditech’s Web Ambulatory EHR with implementation help from Engage.

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KLAS ranks WebPT as the #1 ambulatory therapy/rehab EHR vendor in both market share and overall performance, with Clinicient and Raintree also performing well. Casamba and Net Health customers say (75 percent and 46 percent, respectively) they wouldn’t buy the product again.

As part of its continued effort to pivot from a consumer wearable to a medical device, Fitbit creates an app-based virtual care and health coaching program for health systems, payers, and employers.


Privacy and Security

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Lutheran Health Network (IN) brings its IT systems back online after an attempted data breach. Lutheran Hospital diverted ER patients to other facilities during the reboot, which took several hours. Hospital administrators were quick to point out the incident was in no way related to known network stability issues. Lutheran is in the midst of a $30 million IT project that will replace outdated McKesson software with Cerner.

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Boston Medical Center, Brigham and Women’s Hospital, and Massachusetts General Hospital collectively pay $999,000 to OCR to settle potential privacy violations related to the taping of TV show “Boston Med” without prior patient approval. New York-Presbyterian Hospital settled for similar reasons several years ago after allowing filming for “NY Med.”

A Springfield, MA gynecologist is sentenced to one year of probation for violating HIPAA by giving a drug company sales rep access to patient files. Rita Luthra, MD lost her medical license upon her arrest in 2015, forcing her to close her practice that served primarily indigent patients.


Other

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Intermountain Healthcare (UT) opens a $20 million Healthcare Transformation Center that will house a Healthcare Delivery Institute, Leadership Institute and Simulation Center, and CHIME innovation center.

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Hixny’s decision to expand its HIE services into nine new counties in upstate New York prompts HealthlinkNY to cry foul because of overlapping territories. HealthlinkNY Executive Director Staci Romeo believes cannibalizing on service areas will decrease overall data-sharing effectiveness. Both HIEs are part of the Statewide Health Information Network for New York.


Sponsor Updates

  • FormFast will exhibit at DreamForce September 25-28 in San Francisco.
  • LogicStream Health will exhibit at the MSHP 2018 Midyear Clinical Meeting September 21 in Brooklyn Park, MN.
  • Elsevier Clinical Solutions, InterSystems, and Intelligent Medical Objects will exhibit at AHIMA September 22-26 in Miami.
  • Meditech will participate in MGMA18 September 30-October 30.
  • EPSi will exhibit at the HFMA Arizona Fall Conference September 26-28 in Chandler.
  • Glytec customer Honor Health John C. Lincoln Medical Center’s Cardiovascular ICU achieves a silver-level Beacon Award for Excellence from the American Association of Critical-Care Nurses.
  • HCTec publishes a new case study on “Delivering Cutting-Edge Coding Solutions.”
  • Allscripts features Healthfinch’s Charlie Refill Management app as its Allscripts Developer Program September 2018 App of the Month.
  • Madison Magazine includes Nordic on its list of best places to work for the third straight year.

Blog Posts


Contacts

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

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EPtalk by Dr. Jayne 9/20/18

September 20, 2018 Dr. Jayne No Comments

This week is Prescription Opioid and Heroin Epidemic Awareness Week. There are several ONC resources available to help clinicians lean what technology is available to them, including prescription drug monitoring programs and electronic prescribing of controlled substances. My practice still hasn’t taken the leap to the latter since we dispense the majority of our controlled substances from our in-house pharmacy, although it’s now mandatory in some states.

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AMIA has issued a Call for Participation for its 2019 Clinical Informatics Conference in Atlanta. The CIC meeting has a greater focus on applied clinical informatics, clinical decision support, and health policy compared to the annual fall AMIA meeting. Atlanta is a fun town and I’ve heard the clinically-focused meetings are great, but I’ll miss it due to it conflicting with my annual stint teaching in an outdoor classroom program.

I had some great reader feedback on my recent piece about cultural competency. Readers seem to appreciate the articles that aren’t necessarily pure healthcare IT but touch on issues that many of us face in the workplace.

One reader shared their own experiences with cultural competency training that’s likely to be minimally effective. It’s being delivered as a single mandatory three-hour session and we all know how much information people really absorb after the first hour or so. The reader notes, “Everyone I’ve talked to has been longing for the olden days before text pagers, when you could go to a meeting, set off your own beeper by surreptitiously turning it off and back on again and then acting surprised before rushing out to respond to the ‘emergency,’ never to return to the dreaded mandatory activity.”

The training is also being delivered lecture-style to large groups, which is a shame because group discussion could really bring this topic to life. If care teams or groups of workers attended together, discussion could help them learn more about each other and how to work together effectively as a team as well as with their patients. The reader goes on to describe an institutional push to curb profanity, noting the need to start “whipping out thesauruses looking for allowable substitutes – maybe they should just put Ivory Soap dispensers in the hall to allow cleansing of tongues and improved hand washing in one swoop.” I suggested they consider the Elizabethan Curse Generator, which automates insults in Shakespearian English. Take that, thou distempered fat-kidneyed wagtail!

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I was glad that Jenn mentioned the annual Physicians Foundation report on the state of physician practice. The decline of independent practice continues, with barely a third of the 9,000 physicians surveyed using that term to describe themselves. Although Jenn covered some of the highlights, including that 80 percent of physicians feel they have experienced burnout, I found some additional statistics that were thought-provoking:

  • US physicians handle over 1 billion patient encounters each year across all settings of care
  • 12 percent of physicians are planning to find a non-clinical position
  • 61 percent favor either a single-payer health system or a single-payer system with a private insurance option; 27 percent favor a market-driven system; and only 4 percent think we should maintain the current system
  • 22 percent of physicians either do not see Medicare patients or limit the number they see
  • 32 percent of physicians either do not see Medicaid patients or limit the number they see
  • 47 percent of physicians are compensated based on quality/value, but only 18 percent believe that these payments will improve care or reduce costs
  • On average, each office-based physician supports about 17 jobs and pays a total of $1.4 million in wages and benefits.
  • 49 percent of physicians would not recommend medicine as a career to their children or other young people
  • 27 percent of physicians would not choose to be a physician if they had their career to do over
  • More than 68 percent of physicians do not believe that Maintenance of Certification processes accurately assess their clinical abilities
  • Physicians work an average of 51 hours per week

The report includes a listing of questions and responses aggregated by various demographic factors including age, employment status, gender, and specialty. It also includes direct comments from respondents, which start on page 50 if you’re interested.

One of the mechanisms that physicians use to combat burnout and reduce the amount of time spent interacting with the EHR is the medical scribe. JAMA Internal Medicine ran an article  this week titled “Association of Medical Scribes in Primary Care With Physician Workflow and Patient Experience.” The question posed was whether using scribes decreases documentation burden, improves productivity, improves patient communication, and enhances job satisfaction among primary care physicians. Not surprisingly, the study (although limited at 18 primary care physicians) showed that using scribes was linked to reductions in documentation time and improvements in productivity and job satisfaction.

I’ve been in a practice that uses scribes for the last three years, although I don’t always have a scribe during every shift. We deploy them based on volume of patients seen at our various locations, so if you are scheduled for a lower-volume location you may be on your own. When it gets busy and five or six patients walk in at the same time, you definitely wish you had a scribe. Although I’m fast with the EHR and have tons of personalized templates, macros, and order sets, it’s still not as fast or as accurate as working with a scribe who can document while you’re doing the exam and speaking with the patient.

Unfortunately, many of our scribes are pre-meds or post-baccalaureate students trying to gain admission to medical school or a physician assistant program. This means that once the admissions letters come out, we have to hire a fresh crop of scribes and attempt to turn them into Olympic athletes before influenza season hits.

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The new Medicare cards continue to roll out, with more than 35 million mailed to date. Medicare is processing claims and eligibility requests using the new Medicare Beneficiary Identifier and it seems to be going smoothly for the regions where the new cards have arrived. Cards should be mailed to all Medicare participants by April 2019. I polled a couple of colleagues on the revenue cycle side and haven’t heard of any major hiccups, but would be interested to hear from readers who are knee deep in it (especially any readers who are Medicare beneficiaries themselves.)

Email Dr. Jayne.

Morning Headlines 9/20/18

September 19, 2018 Headlines No Comments

Hacking attempt troubles Lutheran

Lutheran Health Network (IN) brings IT systems back online after an attempted data breach forces Lutheran Hospital to divert patients to other facilities.

Mercy Health Funds Cloud Medical Image Management Company NucleusHealth™

Mercy Health becomes a minority investor in cloud-based medical image management vendor NucleusHealth.

Nest’s digital health ambitions revealed in records from secretive purchase of Seattle startup Senosis

Newly released documents confirm Nest’s hush-hush acquisition of Senosis Health, an app-based health monitoring startup out of the University of Washington, is likely part of a broader move into digital health.

Morning Headlines 9/19/18

September 18, 2018 Headlines No Comments

Paul Singer balks at $160-per-share Athenahealth bid

Athenahealth shares drop sharply on the news that activist investor Elliott Management will pass on acquiring the company at its previously offered price of $160 per share.

Local health care technology startup Valify makes acquisition

Hospital purchased services technology vendor Valify acquires Lucro, which offers a hospital-vendor marketplace.

Kleiner Perkins is splitting up

Silicon Valley venture capital firm Kleiner Perkins will spin off its digital health group – which includes some of its most prominent partners, who have invested in Uber and Stripe – into an independent group.

News 9/19/18

September 18, 2018 News 5 Comments

Top News

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Activist investor Elliott Management — whose criticism of Athenahealth caused the company to fire founder and CEO Jonathan Bush, cut costs, and seek a buyer – joins several other would-be suitors that will pass on acquiring the company at Elliott’s previously offered price of $160 per share.

Elliot says its due diligence has turned up significant Athenahealth problems. ATHN shares dropped sharply on the news.

Athenahealth will extend its bid deadline by 10 days through September 27.

Critics of Elliott’s tactics speculate that the firm is hoping that Athenahealth will accept a fire-sale price to avoid the public embarrassment of eliciting no acceptable offers.


Reader Comments

From NXGN Woes: “Re: Nextgen. Employees were told last week that two C-level executives are leaving the company. Operations employees will report to the CFO.” Unverified. NXGN Woes provided names, although I’ll decline to include them since their LinkedIn entries and the company’s executive page remain unchanged. UPDATE: a reader tells me that marketing SVP Tamra Rushing has been replaced and provides this internal email from CEO Rusty Frantz:

Due to personal reasons and effective immediately, Scott Bostick has made the decision to step down from his position as Chief Operating Officer and into an Individual Contributor role reporting directly to me. Please join me in thanking Scott for his leadership as he transitions into this new role. Further, in the coming weeks, the executive team will work with the senior leaders within the client services organization to ensure a successful transition under the leadership of our Chief Financial Officer, Jamie Arnold. The leaders who will now be reporting to Jamie Arnold include: Mitch Waters –  SVP, Sales, Colleen Edwards – SVP, Marketing, Allen Plunk – SVP, Managed Services, and Ben Clark – SVP, Client Services. At this time, we will not be backfilling the Chief Operating Officer role. We will move forward with a flatter organizational structure to ensure continued success of the commercial client facing organization.

From Jellico: “Re: KLAS. We dropped out of the relationship after they failed to contact any of the dozens of our consulting firm’s clients whose names we provided. All of the four KLAS reps we had been assigned over several years have left the company. I’ve kept in touch with two of those and both say they were uncomfortable collecting money from vendors they were rating. It will be interesting to see if Black Book gains traction. They appear to be more straightforward and they don’t accept monies from vendors they rate.” I’ve found KLAS’s market reports to be informative in how they broadly characterize a particular market segment. I have less confidence that they use enough statistically defensible methodology to rate individual vendors reliably. Still, the company’s business model is propped up by (a) the high-ranked vendors who usually keep paying in hoping of remaining on top, and (b) the also-rans who believe – accurately or not – that maintaining or increasing their KLAS payments will improve their chances of earning KLAS bragging rights. No CIO in their right mind would buy something based on KLAS scores and I suspect that few do, but anxious vendors are always looking for a competitive advantage and hope KLAS can provide it, even if indirectly. In KLAS’s defense, consulting firms (of which they are arguably one) often make recommendations to clients based on laughably subjective factors gleaned from casual conversations that they package up into impressive PowerPoints, so it’s hardly a new concept. I enjoy the Black Book survey results, where they survey huge numbers of people and then slice and dice their responses into a mind-boggling set of reports whose statistical underpinning and transparency seems reasonable. A significant deficiency of many of the survey-type reports I see is that they fail to categorize respondents (do they work for a single hospital, a health system in a corporate role, or a medical practice?) and they often fail to distinguish between a vendor and its multiple products (which Allscripts EHR were the respondents talking about?)


Webinars

September 26 (Wednesday) 12:30 ET. “How to Ensure Patient Records are Always Available.” Sponsor: Goliath Technologies. Presenter: Goliath Technologies engineering staff. This webinar will discuss how an early warning system can help your organization ensure your EHR systems and patient records are always available. You’ll also learn how to proactively anticipate, troubleshoot, prevent, and resolve end user experience issues before users or patients are impacted.

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


Acquisitions, Funding, Business, and Stock

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Waystar will acquire workflow and predictive analytics vendor Connance to enhance its revenue cycle management capabilities.

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Hospital purchased services technology vendor Valify acquires Lucro, which offers a hospital-vendor marketplace.

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Signet Accel, the Ohio State University spinoff that offers the Avec data integration platform, has reportedly downsized and parted ways with CEO John Raden. I also noticed that former EVP of Sales and Marketing Brenda Barry has gone back to her previous employer after one year on the job. Regenstrief President/CEO and AMIA board chair Peter Embi, MD, MS was a Signet Accel co-founder and medical advisor.

Aramark will sell its Charlotte, NC-based hospital medical equipment management and clinical engineering business to Trimedx for $300 million.

Silicon Valley venture capital firm Kleiner Perkins will spin off its digital health group – which includes some of its most prominent partners, who have invested in Uber and Stripe – into an independent group. The early-stage team will continue to operate under the Kleiner Perkins name. The firm’s healthcare technology investments include Collective Medical, Livongo, and Mango Health. It previously invested in Teladoc.

The Justice Department approves the $52 billion merger of insurer Cigna and pharmacy benefits manager Express Scripts.


Sales

  • Beacon Health System will implement MyHealthDirect’s patient self-scheduling system.
  • Children’s Health (TX) signs a 15-year, $75 million agreement with Philips for patient monitoring and PACS technologies.
  • DCH Health System (AL) chooses Santa Rosa Consulting to lead its Meditech Expanse implementation.
  • Cigna will expand its diabetes prevention program in collaboration with Omada Health.

People

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GetWellNetwork hires Peter Keating (Advisory Board) as chief people officer.

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Jeff Sturman (Cumberland Consulting Group) joins Memorial Healthcare System (FL) as SVP/CIO. He was previously SVP of IT there from 2004 to 2012, where he led its selection and implementation of Epic.

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PatientPing hires Sagnik Bhattacharya (Epic) as VP of payer and provider initiatives.

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Jesus Delgado (Rush University Medical Center) joins Community Healthcare System’s Community Foundation of Northwest Indiana as VP/CIO.

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Healthcare investor and innovator Tom Main, managing partner of 7wire Ventures, died Sunday.


Announcements and Implementations

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VisualDx launches Aysa, a consumer app that inspects a user’s skin condition photos, asks relevant questions, and then provides possible causes. 

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Meditech announces Greenfield, a third-party app development environment that supports FHIR and will offer a store of approved apps. 

Mercy Technology Solutions launches a cloud-hosted, pay-per-study PACS offering.

EPSi adds Ilerasoft’s medical equipment investment and usage capabilities to its capital budgeting system.

Ciox Health announces HealthSource Gym, a learning environment that will help healthcare organizations assess, train, and develop medical coders.


Government and Politics

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HHS publishes a report covering the state of its data sharing among its 29 agencies, noting problems that include a lack of standards for inter-agency data requests; variation in technical formats and approaches; the variety of statues that regulate data collection project; and the increased chance of privacy violations as data availability increases.   


Other

California doctors will be required to consult the state’s prescription drug monitoring program database before prescribing opiates under a law that takes effect October 2. The CURES system was developed in 1997 and updated in 2009 and 2016, but a 2012 newspaper investigation found that less than 10 percent of doctors and pharmacists had even bothered to sign up for access.

Amazon Web Services features Angel MedFlight Worldwide Air Ambulance’s self-development of an IPad charting application that uses AWS and Salesforce

In Africa, the governor of Nairobi makes an unannounced visit to a maternity hospital to follow up on complaints of negligence, orders an employee to open several unlabeled boxes and bags in a storage room. and finds the bodies of 12 infants. Reports suggest that the babies died when the hospital’s incubators lost electrical power. The government will follow up with investigations into rumored child trafficking and giving babies to the wrong families. Kenya’s public hospitals are mismanaged, underfunded, and staffed by doctors and nurses who have gone on strike over low pay and poor working conditions.

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A Cincinnati neighborhood creates a Christmas celebration for a two-year-old whose aggressive brain cancer is likely to kill him before December. Six neighbors of Brody Allen’s family put up their Christmas lights early, sent cards, and will have a Christmas parade that includes fire trucks and supporters driving their own cars. He is too weak to walk, so his siblings wheel him around the neighborhood in a Red Flyer wagon covered with blankets.


Sponsor Updates

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  • CenTrak donates $5,000 to the Kerala Flood Relief Charity Fund.
  • ACOs using Lightbeam Health Solutions achieved 1.7 times the savings generated by non-Lightbeam ACOs.
  • Cumberland Consulting Group will sponsor and present at the Medicaid Drug Rebate Program Summit October 1-3 in Chicago.
  • Formativ Health adds several new features to its Patient Engagement Platform including payment functionality powered by Patientco.
  • Wolters Kluwer highlights patients as an underutilized resource in the fight against sepsis.
  • AdvancedMD will host its EVO18 annual user conference October 3-5 in Salt Lake City.
  • Aprima and Direct Consulting Associates will exhibit at the Ohio MGMA Fall Conference September 19-21 in Columbus.
  • Jason Spurck (SOS Tech Group) joins Audacious Inquiry as support engineer.
  • TechVibe Radio features Arcadia CTO Jon Cook.
  • Datica publishes a new book, “Complete Cloud Compliance: How regulated companies de-risk the cloud and kickstart transformation.”
  • Burwood Group will host “Cloud Revolution with Burwood, Citrix, & Google” September 27 in Chesterfield, MO.
  • CarePort Health will exhibit at ACMA Kentucky/Tennessee September 24 in Nashville.
  • CoverMyMeds will exhibit at the PCMA Annual Conference September 23-25 in Scottsdale, AZ.

Blog Posts


Contacts

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