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EPtalk by Dr. Jayne 7/4/19

July 4, 2019 Dr. Jayne No Comments

It’s that time of year when CMS releases updates to ICD-10 codes for the coming fiscal year. The files are now available and go into effect starting October 1. For those of you used to receiving a General Equivalence Mapping update along with your new codes, you’re out of luck. CMS previously announced that they would only update the GEMs files for three years after the implementation of ICD-10. It’s hard to believe it’s been that long since we kissed ICD-9 goodbye. I wonder how many clinicians are hoping they’ll be long-retired before ICD-11 comes around? Most World Health Organization member states are slated to start using it in 2022, but I’m betting it will be a long time before it makes it to the US.

Kaiser Health News reports some interesting data from the Food and Drug Administration database containing medical device malfunctions and injuries. Manufacturers sent data to this “hidden” database via Alternative Summary Reports rather than to the public FDA database used by researchers and patients. Top tidbits include: blood glucose meters had more incident reports (2.4 million) than any other device, with the majority of them being manufactured by a former subsidiary of Johnson & Johnson; dental implants comprised 2.1 million reports; 176 deaths were reported through the non-public workflow, including those related to insulin pumps, pacemakers, and ventilators; surgical stapler malfunctions numbered 66,000 in the hidden database vs. 84 in the public database; and breast implants accounted for nearly half a million reports. Despite the visibility of this issue, the FDA has replaced the alternative “hidden” reporting process with a new Voluntary Summary Reporting Program that may be just as hard to track as the previous Alternative Summary reports.

In the Virtual Assistant arms race, CNBC reports that Google Assistant does a better job than Alexa or Siri in helping patients with medications, although studies still indicate that voice assistants aren’t ready for prime time where health or medical data is at stake. The study looked at queries regarding the 50 most commonly prescribed medications and whether users received accurate information when asking a device to “Tell me about” a particular drug. Google Assistant identified 92% of brand name drugs and 84% of generics, with Siri scoring 58% and 51%, respectively. Alexa trailed at 55% and 46%.

It’s time to cut the cat videos. Nearly all of us have fallen down the rabbit hole that is YouTube and found ourselves minutes (or hours) later having watched video after video. (My personal favorite begins with the “Nope Ropes, Sneks, & Danger Noodles” offering  from Lucidchart and devolves from there.) New data shows that the number of people spending two hours a day or more watching TV or videos is high – 62% of children, 59% of teens, 59% of non-retired adults, and 84% of seniors. This inactivity places us at risk for obesity, chronic disease, and overall mortality. I made a pact with myself to only watch Netflix while I’m on the treadmill, so thanks to “Halt and Catch Fire” for helping me meet this month’s fitness goals.

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I literally could not contain my excitement when I stumbled across this option in Office 365 that allows me to display a third time zone. I’ve been wishing for that enhancement for a long time and it will make my life so much easier. Not that I don’t know how to figure out time zones, but it’s a nice check and balance to be able to confirm it on the screen. We’ve all been the victim of wrong time zone meetings and I certainly don’t want to be a perpetrator. Now if they could just come up with a calendar widget for scheduling recurring meetings on different days of the week (a la GroupWise circa 2011) my scheduling desires would be complete.

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A recent Journal of the American Medical Association article introduces the concept of a TACo, or Targeted Automatic e-Consultation. The TACo aims to bridge the gap between traditional sub-specialist consultations, which are time-consuming, and so-called “curbside” or informal consultations. Traditional consults are problematic because they require analysis of the chart, examination of the patient, and detailed documentation; subspecialists who are in short supply at some facilities can run themselves ragged trying to complete all their consultations. Curbsides are informal and might be limited by the information available along with lack of an examination; usually the recommendations aren’t documented in the chart because there isn’t a physician-patient relationship. Unlike other consultations which require a physician or care team member to initiate the consult, the TACo would be automatically triggered by certain laboratory or examination findings as they are documented in the chart. The receiving subspecialist would have access to a “customized view of the pertinent information” for virtual review and could then suggest focused advice, a formal consultation, or neither.

The approach is under evaluation by the diabetes service at the University of California San Francisco. The EHR identifies patients meeting certain criteria and presents key chart elements to the diabetes sub-specialist. Management suggestions are documented and most reviews take less than five minutes. The team published data showing improvement in diabetes management through reduction in both high and low glucose events. The outcomes have allowed the organization to provide continued funding to support the time spent in review by the subspecialists. They plan to expand the TACo concept to other services including hematology, metabolic diseases, and infectious diseases with an eye to common conditions that may be managed incorrectly and can be triggered by objective data mined from the EHR. The authors note that “if TACos prove to be beneficial, a convincing argument could be made for payers to reimburse them, just as care coordination and telemedicine ultimately became eligible for reimbursement.” Even if they were billable, organizations would still need to expend resources in managing the technology required to support the approach.

Is your organization considering something along the lines of a TACo, or is it just lunch food? Leave a comment or email me.

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Morning Headlines 7/3/19

July 2, 2019 Headlines 3 Comments

Government EHR proposals threaten patient privacy

The American Medical Association warns that proposed federal rules allow patient data to be shared with third parties who aren’t bound to keep it private.

Net Health to Acquire Optima Healthcare Solutions, Expanding Its Purpose-Built Electronic Medical Record Platform

Outpatient therapy EHR vendor Net Health acquires Optima Healthcare Solutions, which offers a contract therapy EHR.

Aggression Detectors: The Unproven, Invasive Surveillance Technology Schools Are Using to Monitor Students

A few hospitals are using publicly placed microphones and machine learning-analyzed speech in hopes of detecting aggression before it turns into violence.

Electronic medical record system for all M’sian hospitals, clinics to cost up to RM1.5b, says minister

Malaysia’s government will open a tender this year for an EHR to be implemented in its 145 hospitals and 1,700 clinics at an estimated cost of $360 million.

News 7/3/19

July 2, 2019 News 8 Comments

Top News

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Outpatient therapy EHR vendor Net Health acquires Optima Healthcare Solutions, which offers a contract therapy EHR.

Pittsburgh-based Net Health has quite a few industry long-timers on its management team:  Anthony Sanzo (TeleTracking), Kelley Schudy (Allscripts), Jason Baim (TeleTracking), and Mary Mieure (Vitera).


Reader Comments

From Rude Buoy: “Re: vendor gag clauses. Here’s an example.This is the most extreme example of a supplier looking to put parameters on impressions I’ve seen in decades as a CIO. Please keep confidential as the agreement is specific to our organization.” The agreement requires the health system to keep its “authorized users” from publishing falsehoods that are damaging to the vendor, which the vendor admits is subjective. The interesting aspects to me are:

  • The term doesn’t prohibit publishing negative content as long as it is factual, which should be the case in describing software problems that endanger patients. Therefore, I would argue that this is not a gag clause.
  • Health system users don’t sign the agreement and aren’t bound by it individually (as long as additional language isn’t buried in the system’s user agreement, if one exists). The health system might threaten to discipline an employee, but how would it deal with a community-based doctor (who is still its “authorized user”) who posts something untrue, perhaps without even naming the health system? Can the health system legally demand that the doctor either remove their comment or stop posting them?
  • I’m curious how terms like these have worked out in real-life examples where a vendor pressured a health system or practice over comments made by one of it users. I picture the vendor issuing a vague threat to the health system, who then issues a vague threat to whoever made the comment, who then removes or “corrects” their comment in fear of being fired or sued. Or maybe this has happened so rarely that nobody knows.

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From Legal Beagle: “Re: Texas Health Resources. Here’s what its execs told the US Senate under oath.” I remember writing about this when it came up in 2014. The THR ED nurse didn’t ask the Ebola patient about his travel history because that wasn’t part of the ED triage process. The primary nurse saw him an hour later and documented that he had just traveled from Africa, but the nurse didn’t communicate that information verbally to the doctor. Records show that the ED doctor reviewed the patient’s complete EHR record several times, including the location in which the travel history was documented. The patient was new and thus his record contained only the nurse triage and travel history, so it’s not like that information was buried in a big chart. The doctor discharged the patient with a diagnosis of sinusitis and abdominal pain. THR initially claimed in a press release that Epic didn’t automatically display the travel history to the doctor, also explaining that THR’s IT staff “relocated the travel history to a portion of the EHR that is part of both workflows.” Then THR recanted its original claim by admitting that “there was no flaw in the EHR.” My takeaway is that many hospital EDs would have missed the connection between Africa travel and vague Ebola symptoms, but in this case, the story was muddied because of miscommunication or perhaps intentional obfuscation by THR’s clinicians or executives.


Webinars

July 18 (Thursday) 2:00 ET. “Healthcare’s Digital Front Door: Modernizing Medicine’s Mobile-First Strategies That Are Winning Patient Engagement.” Sponsor: Relatient. Presenters: Michele Perry, CEO, Relatient; Michael Rivers, MD, director of EMA Ophthalmology, Modernizing Medicine. Providers are understandably focused on how to make the most of the 5-8 minutes they have on average with a patient during an exam, but what happens between appointments also plays a significant role in the overall health of patients. Modernizing Medicine is driving high patient engagement with best practice, mobile-first strategies. This webinar will describe patient engagement and the challenges in delivering it, how consumerism is changing healthcare, and how to get started and navigate the patient engagement marketplace.

July 25 (Thursday) 2:00 ET. “Meeting patient needs across the continuum of care.” Sponsor: Philips Population Health Management. Presenters: Cindy Gaines, chief nursing officer, Philips Population Health Management; Cynthia Burghard, research director of value-based healthcare IT transformation strategies, IDC. Traditional care management approaches are not sufficient to deliver value-based healthcare. Supplementing EHRs with advanced PHM technology and a scalable care management approach gives health systems proactive and longitudinal insights that optimize scarce resources in meeting the needs of multiple types of patients. This webinar will address the key characteristics of a digital platform for value-based care management, cover the planning and deployment of a scalable care management strategy, and review patient experience scenarios for CHF and diabetes.

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


Acquisitions, Funding, Business, and Stock

Provider scheduling solutions vendor QGenda acquires OpenTempo, which offers clinical resource optimization tools.


People

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UC Health (one of many, in this case Cincinnati) hires Michael Legg (Yale New Haven Health) to the newly created position of VP/chief data and analytics officer.

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John Passchier (TAVHealth) joins Signify Health as RVP of community network strategy.

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Sean Tuley (LifePoint Health) joins Global Medical Response as SVP/CIO.

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Nat’E Guyton, RN, MSN, DM (Spok) joins University of Maryland Medical Center as VP of patient care services and chief nursing officer.


Announcements and Implementations

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Cedars-Sinai welcomes 11 startups to its latest accelerator class:

  • AMPAworks – surgery inventory tracking.
  • ClinicianNexus – clinical rotation matching.
  • Feedtrail – pre-discharge patient surveys.
  • FocusMotion Health – tracking the activity and recovery of orthopedic surgery patients.
  • Hawthorne Effect – keeping clinical study enrollees engaged.
  • Health Note – pre-visit patient questionnaire that populates the EHR.
  • Lantum – provider scheduling.
  • Notisphere – recall tracking.
  • OMNY – hospital sharing of oncology drug usage and supplies.
  • Parker Isaac Instruments – pathology tissue separation instrument.
  • Virti – virtual clinician training.

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Flexible office space vendor and WeWork competitor Convene will operate primary care clinics in most of its 28 locations, hoping to attract tenants by offering immediate access to health services similar to the onsite clinics offered by big employers. The clinics will be operated by Eden Health.


Other

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Researchers find that automatically generated EHR messages account for half of the 243 such messages the average doctor receives each week, with far fewer of their incoming messages originating with colleagues and patients. The auto-generated messages involved health maintenance reminders, prior authorization requests, and patient reminders. Researchers also found that doctors who say they are burned out are more likely to be receiving a higher number of automated messages. The study involve one health system using Epic, but that’s not the point – it’s yet another reminder that there’s a cost to “Revenge of the Ancillaries” where the desire of non-doctors to push information in the faces of doctors is allowed with the best of intentions but not necessarily the best of outcomes. A previous study found that PCPs spend 23% of their day managing their EHR inbox.

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At least one hospital is using a company’s questionably accurate “aggression detection” voice analysis software, whose machine learning algorithms constantly monitor the sound patterns from publicly placed microphones in attempting to detect verbal aggression before it turns into violence. Netherlands-based Sound Intelligence also markets its system for hospital patient monitoring

UF Health (FL) adds a gender identity section in its EHR as recommended by a LGBTQ+ employee advisory committee, in which patients will be asked their gender identity and pronouns at registration.

The American Medical Association says the proposed interoperability rules of CMS/ONC “threaten patient privacy” by requiring providers to share their information with third parties that aren’t required to keep it private, potentially creating a market for patient data to be sold. 

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Malaysia’s government hopes to implement EHRs at its 145 hospitals and 1,700 clinics at an estimated cost of $360 million, with an open tender to be posted later this year.

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Non-profit NorthBay Healthcare (CA) explains to bondholders that three big insurers have terminated their contracts because “we’ve been able to maintain very lucrative contracts without the competition” in a startling admission that the health system uses its oligopoly power to charge high prices. The health system has increased revenue by 50% in the past five years due to lack of competition, leading experts to conclude that the benefits of price transparency are minimal when consumers have few hospital choices. I didn’t see anything fun in the health system’s tax records other than four of its highest-paid employees are staff nurses who made $400K each. The CIO was paid $500K.

Piedmont Healthcare (GA) will require patients who don’t have insurance, as well as those who have high-deductible plans, to pre-pay 25% of the estimated cost upfront for non-emergency services, explaining that bad debt represents 8% of the health system’s revenue because patients can’t afford to pay their high deductibles.

The city of Lake City, FL fires its IT director after an employee’s opening of a malware-containing email introduced ransomware into the city’s computer systems, after which its insurer agreed to pay the hacker’s demanded $460,000 ransom. The malware was identified as a Triple Threat attack, which runs an email-contained macro that loads several types of malware, after which it notifies the hackers so they can decide if the organization is worth holding for ransom. Another Florida city that experienced a similar attack recently paid a $600,000 ransom, while Baltimore complied with a law enforcement recommendation to refuse to pay a hacker’s demanded $80,000 and is still attempting to recover after spending $18 million. I’m picturing a teen hacker sitting in a coffee shop in Eastern Europe watching their account bump up by an untraceable, untaxable $460,000.

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I’m thinking this DoD tweet trivializes the integration challenges ahead even as it uses “interoperability” in a bafflingly wrong way. I’m reminded of the absurdity of Allscripts CEO Glen Tullman proclaiming constantly a few years ago that all of the company’s multi-heritage EHRs were integrated by definition because they all used the Microsoft SQL database.


Sponsor Updates

  • Medicomp Systems CEO David Lareau is accepted into the Forbes Technology Council.
  • WebPT offers a report titled “The State of Rehab Therapy 2019.”

Blog Posts


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Contacts

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


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Morning Headlines 7/2/19

July 1, 2019 Headlines 2 Comments

QGenda Announces Acquisition of OpenTempo

Provider scheduling solutions vendor QGenda acquires OpenTempo, which offers clinical resource optimization tools.

Telemedicine apps are thriving because working moms love the convenience of their smartphones

Telemedicine providers say that mothers are their super users and advocates in their role as “chief medical officers of the family.”

Physicians’ Well-Being Linked To In-Basket Messages Generated By Algorithms In Electronic Health Records

Researchers find that EHR-generated messages account for half of the 243 such messages the average doctor receives each week, multiples of the number sent by colleagues and patients.

Curbside Consult with Dr. Jayne 7/1/19

July 1, 2019 Dr. Jayne 1 Comment

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One of the challenges we have in healthcare IT is figuring out whether different technologies bring an adequate return on investment. This can be particularly challenging when the expenditure falls to one team’s budget (such as information technology) but the cost savings occurs elsewhere (such as the central scheduling department).

Organizations use a variety of cost transfer mechanisms to try to sort this out, but often the calculations fail to fully represent the true work needed to deploy a new solution, especially on the part of the end users. This becomes even more complicated when the solution is a combination of technical tools and operational changes, such as might be required for a practice to advance through recognition as a Patient-Centered Medical Home.

As we move into value-based care, it will be more important for practices to understand the costs and benefits of new models of care. To be honest, many independent practices are not well equipped to try to figure this out. I was excited to see that NCQA has engaged with Milliman’s actuarial team to offer guidance on how practices can calculate return on investment for that type of clinical transformation project.

The NCQA white paper is publicly available, and even if you’re not knee-deep in one of these projects, it provides background for greater understanding of what it takes to re-engineer a practice. The hypothetic practice in the paper represents a 10-physician primary care practice with approximately 20,000 commercially-insured patients. The model concluded that there would be an increase in revenue, although it varied from 2% to 20% depending on payment models.

Although 2% still represents a positive return on investment, I’m not sure how many practices would be willing to embark on wholesale modification of how they do business for that small of a gain. Many practices pursuing Patient-Centered Medical Home recognition do so for other reasons, including the belief that it’s the right thing to do and/or that they will be able to provide better or higher quality care for their patients.

As with any calculation of this kind, NCQA points out that this is a hypothetical practice and our mileage may vary based on the actual characteristics of our practices. To further the effort, Milliman helped develop guidance for practices to develop a pro forma to calculate their own return on investment data. The guidance is clear on the fact that the numbers will vary based on:

  • Practice size and location.
  • Payer mix and payer models.
  • Medical complexity of the patient population.
  • Degree of change needed to practice processes, procedures, and reporting to align with PCMH.
  • Ability of the practice to meet quality targets.
  • PCMH program rules.

I frequently work with practices that are considering whether they will pursue recognition as a Patient-Centered Medical Home. Often, they jump straight to trying to figure out whether their EHR supports PCMH or whether their technology vendor has programs that will make it easier. Some vendors support a subset of PCMH standards but not others – a host of organizations have developed recognition programs, including HCQA, The Joint Commission, the Accreditation Association for Ambulatory Health Care, and the Utilization Review Accreditation Committee, not to mention other homegrown programs developed by practice networks, health systems, and payers. I find that educating practices on the differences between the different programs is a good first step beyond asking whether the EHR can support it. Often the burdens of a particular program will be a deal-breaker for a practice.

Practices must next consider whether they have the capacity to change, which often translates to whether the physicians have the capacity to change. If physicians are employed, this might be mandated by the organization, but in physician partnerships, it can be daunting if some partners want to move forward but others don’t. It doesn’t matter what the return on investment might be if you can’t get everyone on board. I’ve worked with physicians who aren’t able to delegate and don’t trust their support staff, so that makes the idea of team-based care a non-starter.

The white paper does a nice job listing out the costs during both the investment phase,  when it is figuring out how to manage the transformation, and during the maintenance phase, when they’re trying to sustain the change. They include the amount attributable to lost physician visits for the clinical champion along with time spent by a PCMH manager, other clinicians who lose time to huddles and quality improvement activities, care coordinators, etc.

In reality, many practices don’t allocate dedicated time for physicians to work on PCMH or other initiatives. Instead, they expect the team to perform these tasks on top of their usual workload, under the guise of “other duties as assigned.” I suppose under that model the return on investment becomes even greater from a purely monetary standpoint, although the job satisfaction element may be on the decline.

It goes on to note that contractual requirements for PCMH recognition are the strongest ways to drive provider behavior. The authors discuss the issue of multiple contracts with differing payers and the need to try to align those requirements in order to work efficiently and to not have to meet multiple PCMH standards. It provides a good list of questions for CEOs and CFOs to consider when contemplating a move to one of these care models.

Overall, I think the white paper provides an excellent tutorial for practices considering a change. There are definitions of key terms and explanations of the process along with the actual guidance for doing the calculations. Whether you’re on the tech side or the patient-facing side, it’s a nice primer to better understand what your organization might be getting into when they start talking about Patient-Centered Medical Home or other care models such as Comprehensive Primary Care Plus (CPC+) or Primary Care First, which are based on PCMH. Knowledge is power and I will definitely be using this tool as a conversation starter when working with practices who want to embark upon clinical transformation.

Has your organization found success under the Patient-Centered Medical Home Model? Leave a comment or email me.

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Readers Write: Five Emerging Imaging AI Workflows

July 1, 2019 Readers Write No Comments

Five Emerging Imaging AI Workflows
By Stephen Fiehler

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Stephen Fiehler is founder and CEO of Interfierce of San Francisco, CA. 

Medical imaging is one area of medicine that could significantly benefit from the implementation of artificial intelligence (AI). Applications that interpret chest x-rays, detect stroke, and identify lung cancer are already available. Many AI solutions have garnered FDA approval for commercial or clinical use.

However, few if any have mastered a “best practice” workflow that seamlessly integrates the application’s output with the hospital’s other clinical applications (i.e. PACS, EHR, dictation system). How should the application’s output be delivered? Who should see it first? The answers to these questions are dependent on the nature of the algorithm (i.e. stroke detection, chest x-ray, pediatric bone age), but five workflows are emerging for imaging AI applications.

Advanced Visualization

Many imaging AI applications are delivering their output to an interpreting radiologist within a separate application. The radiologist is commonly working out of PACS, the dictation system, and the EHR. The Advanced Visualization (or post-processing) workflow introduces an additional application to the radiologist’s workflow. Sending the study to the AI application, launching it, and running the images through the algorithm can add significant time to the interpretation process. The Advanced Visualization workflow sets a high bar for the value of the AI application’s output. If the application does not save the radiologist ample time or provide substantial value, the Advanced Visualization workflow is not viable.

Dictation System Integration

Some imaging AI applications are opting to integrate with the radiologist’s dictation system (i.e. Nuance PowerScribe 360). If an AI application has a discrete output that is independent of the images, it can send that value to the dictation system via Digital Imaging and Communications in Medicine (DICOM) structured reporting (SR). DICOM is the standard way of exchanging images and image related data in healthcare, and DICOM SR is discrete data associated with the imaging (i.e. left ventricle dimension in centimeters).

An example use case is an AI application that analyzes pediatric hand x-rays to determine the patient’s skeletal age can leverage DICOM SR to send its output to the radiologist’s report. The patient’s “Z-score” is conveniently embedded in the radiologist’s report as soon as she opens the study. She can then confirm the value or edit it before finalizing the result. Dictation system integration adds no time to the radiologist’s interpretation process.

PACS Integration

Computer aided detection (CAD) applications have been integrating with PACS for over a decade. CAD applications are designed to annotate images to improve the detection of disease, like breast cancer, and reduce false negative rates. These applications commonly integrate with PACS via DICOM secondary capture (SC), which adds additional annotated images to the study in PACS. Some AI applications use this same type of integration to send annotated images back to PACS to assist with the radiologist’s interpretation. DICOM SC requires the radiologist to navigate to the annotated images within the study, which can be cumbersome depending on the size of the study.

Worklist Prioritization

A popular type of AI integration is worklist prioritization. Many AI applications integrate with a reading worklist to prioritize studies that present signs of time-critical conditions, like stroke, spinal fractures, or pulmonary embolism. Rather than producing a complicated output like annotated imaging or DICOM SR, worklist prioritization simply elevates the priority of the study or flags it as a particular abnormality. This can help radiologists identify time critical studies more quickly in an effort to expedite patient care.

EHR Integration

To my knowledge, no imaging AI applications are sending results directly to the EHR. Yet direct-to-EHR may become the best practice workflow in the future for mature imaging AI applications.

Sending the output of the AI application directly to the patient’s chart in the EHR has many advantages and risks. The information would be immediately visible by other care team members who have the security to view preliminary results. Therefore, the report should adequately warn the viewing user that “THIS IS A PRELMINARY RESULT” and it has not yet been reviewed by a radiologist.

Careful consideration and planning should take place before implementing direct-to-EHR integration, but as AI applications mature in competency, it will become more common. Many hospitals opt to send an EKG machine’s automated interpretation directly to the EHR today. The result is clearly labeled “preliminary” and the inpatient or emergency room providers know it has not been confirmed by a cardiologist. However, the immediate availability of an imperfect result is valuable. I believe many imaging AI applications will eventually send their output directly to the EHR.

Morning Headlines 7/1/19

June 30, 2019 Headlines No Comments

Form S-1 Registration Statement – Livongo Health, Inc.

Diabetes management technology startup Livongo files for a $100 million IPO.

Public Comments on the Trusted Exchange Framework and Common Agreement Draft 2

ONC publishes the 100 comments it received for TEFCA Draft 2.

Demonstrating the Value of Nursing Care Through Use of a Unique Nurse Identifier

Authors recommend assigning nurses a unique identifier for use in EHRs and other systems that can help measure nursing contributions, improve nursing practice, and support research.

SA Health hunts for inaugural e-health chief

South Australia Health creates a new position for a top-level executive who will be tasked with salvaging its Allscripts implementation and developing a new digital health strategy.

Craneware shares plummet 34% as sales in US stall

Scotland-based revenue, cost, and financial decision support software vendor Craneware says sales volume and timing were off in the second half of the year, but it remains focused on being used by every US hospital.

Monday Morning Update 7/1/19

June 30, 2019 News 9 Comments

Top News

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Diabetes management technology startup Livongo files for a $100 million IPO.

The company’s SEC filing indicates that the company’s revenue doubled from 2017 to 2018 to $68 million, but losses also doubled to $33 million.

The company’s standard boilerplate warnings note that it would have a real problem if Executive Chairman Glen Tullman were to leave. He and the 7WireVentures firm he manages with Lee Shapiro – they were CEO and president of Allscripts, respectively, until the company fired them in late 2012 — hold 9.4 million shares of the company, or 11.7%.

CEO Zane Burke was given nearly 1 million shares, 1.2% of the total, when he was hired in December 2018, two months after resigning as president of Cerner.

Livongo reports having 413 clients representing 114,000 diabetes members whose contracts are worth $155 million. 


Reader Comments

From Dippity-don’t: “Re: NextGen Healthcare. Laid of 100 employees Wednesday. All business analysts, developers, and QA for practice management’s financial, real-time transaction, and patient portal are now offshore. The Milledgeville office was also closed.” Unverified. I didn’t see anything on Georgia’s WARN site.

From I CIO J: “Re: contract gag clauses. Our Epic contract had no such clause and no one from Epic ever raised this concept.” I remain convinced that “gag clauses” are as mythical as the Loch Ness Monster, the subject of rumors spread by people who have never held a position of significant health system IT authority and have never seen an actual vendor contract. A vendor executive asking you nicely (or not so nicely) to remove the extensively detailed screen shots or product documentation that you posted widely for whatever reason isn’t a gag clause, it’s intellectual property protection, which is always part of an IT contract. You can’t assume that a gag clause exists just because your health system boss blames your vendor for shushing you – health system executives often bend too far in hoping to remain in good vendor graces, but that’s not a gag clause. Neither are general non-disparagement terms. It’s true that, this being America and all, companies are free to threaten and sue anyone they feel threatens them, but that’s outside the scope of enforcing a contract term. 

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From Clause or it Didn’t Happen: “Re: contract gag clauses. I wish you could ask Eric Topol directly what evidence he has – he has mentioned gag clauses, specifically calling out Epic, in his book and tweets.” I’ve emailed Eric Topol and will let you know what (if any) response I get.

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From HITPurist: “Re: Epic’s power over a health system. Remember how Texas Health Resources issued a press release about Epic not allowing the MD to see the Ebola patient’s travel history? THR retracted the statement, which implied that Epic’s attorneys forced them to. Can anyone share insight?” I talked to a couple of THR insiders right after the October 2014 event. My conclusion from those conversations was that THR was so anxious to shift the unfavorable PR spotlight elsewhere that its executives quickly threw Epic under the bus after performing little due diligence, not even asking its own IT folks to assess the EHR setup before proclaiming that as the problem. I’m sure that Epic complained vigorously upon being called out in a press release, as would any vendor who was publicly blamed for a high-profile error. In fact, THR’s press release in which it blamed Epic even included this wording: “Texas Health Dallas has relocated the travel history documentation to a portion of the EHR that is part of both workflows.” That suggests that THR corrected its own faulty Epic setup without requiring Epic’s help. THR’s handling of the Ebola patient was inept, to the point that one of its ICU nurses who was exposed to the patient sued the health for poor training and for disclosing her name and medical condition without her permission. A good post-mortem research analysis is here. The bottom line is that THR was no different than most US hospitals in being prepared to treat, but not diagnose, Ebola.


HIStalk Announcements and Requests

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The top reason that poll respondents don’t work for themselves instead of someone else is their concern about stable income and employment.

New poll to your right or here: What is the #1 factor that would motivate you to take a new job?

I have to work harder in the slow summer months (aka “The Doldrums”) to find new sponsors to replace those that have been acquired, run out of money, or made as our unresponsive contact a clueless marketing newbie who knows nothing about the industry. Contact Lorre to learn about:

  • A special deal on webinars
  • A bonus for new sponsors
  • A money-saving package for startups

Vince Ciotti’s HIS-tory Series

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Industry long-timer, iconoclast, and raconteur Vince Ciotti penned (PowerPointed, actually) the remarkable HIS-tory series that I ran on HIStalk over several years starting in 2011. Vince recently closed his firm of 30 years, H.I.S. Professionals and retired. He wanted to make sure that the HIS-tory series remained accessible, so I’ve combined all of the 125+ entries into a single downloadable, searchable PDF document. It works best if you download it, then open it in Acrobat Reader instead of directly in your browser.

This document of nearly 1,300 pages covers the history of our industry from the mid-1960s through 2000 or so. Vince captured information that might have been otherwise forgotten as health IT’s pioneers have changed industries, retired, or passed away.

I asked Vince if he might be up for adding new reader-contributed material, clarifications, corrections, etc. Vince jumped at the chance because, in his words, “I’m so bored with retirement that you wouldn’t believe it.”

Vince and I would be interested in your pre-2000 contributions as follows:

  • A “where are they now” update on the folks Vince mentioned who he has lost track of.
  • Scans of your interesting old magazine articles, ads, etc. like those he included.
  • Your anecdotes about the companies, products, and people that he mentioned.
  • Anything else that you think is fascinating or important about that health IT era through 2000. This might be the last chance to archive what you have or know for future readers.

I won’t update the original slides, but instead will invite Vince to create new ones that update the series with the new information you send. I’ll probably run those on HIStalk as he finishes them, hopefully generate additional reminisces, and then roll those into the PDF file above.

Thanks for your contributions. Email Vince at vciotti@hispros.com or me.


Webinars

July 18 (Thursday) 2:00 ET. “Healthcare’s Digital Front Door: Modernizing Medicine’s Mobile-First Strategies That Are Winning Patient Engagement.” Sponsor: Relatient. Presenters: Michele Perry, CEO, Relatient; Michael Rivers, MD, director of EMA Ophthalmology, Modernizing Medicine. Providers are understandably focused on how to make the most of the 5-8 minutes they have on average with a patient during an exam, but what happens between appointments also plays a significant role in the overall health of patients. Modernizing Medicine is driving high patient engagement with best practice, mobile-first strategies. This webinar will describe patient engagement and the challenges in delivering it, how consumerism is changing healthcare, and how to get started and navigate the patient engagement marketplace.

July 25 (Thursday) 2:00 ET. “Meeting patient needs across the continuum of care.” Sponsor: Philips Population Health Management. Presenters: Cindy Gaines, chief nursing officer, Philips Population Health Management; Cynthia Burghard, research director of value-based healthcare IT transformation strategies, IDC. Traditional care management approaches are not sufficient to deliver value-based healthcare. Supplementing EHRs with advanced PHM technology and a scalable care management approach gives health systems proactive and longitudinal insights that optimize scarce resources in meeting the needs of multiple types of patients. This webinar will address the key characteristics of a digital platform for value-based care management, cover the planning and deployment of a scalable care management strategy, and review patient experience scenarios for CHF and diabetes.

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


Acquisitions, Funding, Business, and Stock

Shares of Scotland-based Craneware drop 35% after the company reports disappointing second-half sales.


Decisions

  • Ascension Seton Smithville Regional Hospital (TX) will go live with Cerner in 2019.
  • Abbeville Area Medical Center (SC) replaced Evident (A CPSI Company) with Athenahealth in September 2018.
  • Kennedy Krieger Institute (MD) will go live on Epic on July 1, 2019.
  • Dupont Hospital (IN) went live on Cerner on March 1, 2019.

These provider-reported updates are supplied by Definitive Healthcare, which offers a free trial of its powerful intelligence on hospitals, physicians, and healthcare providers.


People

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Andy Crowder (Scripps Health) joins Atrium Health as SVP/CIO and chief analytics officer.

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CI Security hires Drex DeFord (Drexio Digital Health) as healthcare executive strategist.


Government and Politics

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ONC posts the 100+ comments it received about TEFCA Draft 2.


Other

England’s NHS will develop an app that allows patients to anonymously register any concerns they have about their treatment.

Lawyers for former Theranos CEO Elizabeth Holmes blame Wall Street Journal reporter John Carreyrou for unduly influencing FDA and CMS to shut the company down, claiming that he was “eager to break a story, and portray the story as a work of investigative journalism.” Holmes says the reporter prodded his sources to file government complaints about Theranos, then pressed those agencies to investigate them.

South Australia’s SA Health creates a new chief digital health officer position to lead the overhaul of its Allscripts-powered EPAS system that has struggled with project delays, cost overruns, and usability problems. The EPAS concept has been retired in favor of a change in direction as evidenced by the new position’s job description as described by SA Health’s CEO: “We’re looking for somebody to take us from that centrally controlled, large monolithic systems across SA Health to protecting our core data, protecting our single patient view, but capitalizing on an interoperability, best of breed, switch-in switch-out wave of innovation from small new technologies.” The new hire will serve as the government’s top executive for e-health and will develop its digital health strategy.

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Medtronic recalls an older model insulin pump because of theoretical cybersecurity issues that it says can’t be fixed with an update, although skeptics question whether the company is using the flaw as a way to force users to buy newer models such as the 670G, with was found in a small study to have been abandoned by 40% of users because of usability issues.


Sponsor Updates

  • Loyale Healthcare will offer the CareCredit credit card as part of its Affordability Workbench patient financial solutions.
  • MHK integrates the prior authorization functionality of Surescripts into its member care platform.
  • The South Florida Business Journal profiles MDlive.
  • NextGate’s identity-matching solutions are now available in the Microsoft Azure Marketplace.
  • Thrive Global profiles PatientKeeper CMO Christopher Maiona, MD.
  • Relatient publishes a new case study, “How US Dermatology Partners Solved the Patient Intake Bottleneck with Mobile Registration.”
  • The American Academy of Nursing inducts Vocera CNO Rhonda Collins, DNP, RN into its 2019 Class of Fellows.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
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Weekender 6/28/19

June 28, 2019 Weekender No Comments

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Weekly News Recap

  • Change Healthcare goes public on the Nasdaq exchange.
  • Providence St. Joseph Health acquires Bluetree Network.
  • Sansoro Health and Datica announce plans to merge.
  • Vyne is acquired by PE firm The Jordan Company.
  • The director-general of Australia’s Queensland Health announces plans to resign following problems with its Cerner implementation.
  • UnitedHealth Group acquires PatientsLikeMe in a government-ordered fire sale.
  • The White House issues an executive order requiring providers to disclose pricing information.
  • Phreesia files for an IPO.

Best Reader Comments

From my reading of Change Healthcare’s filing, they mostly make their money from EDI and sending people bills in the mail. Is that correct? Their actual software revenue seems to be smaller and lower margin. That doesn’t seem good as software is supposed to be high margin and they will have a lot of future competition from EHR vendors on the provider side and payers’ own IT staff / Optum et al on the financial side. (WhatAreTheyCha(n)(r)ging?)

Many of our newer contracts for software require that we stay relatively current with upgrades, such as the being no more than one full release behind the current production release. These ‘N-1’ provisions seem to be good for our business and also for the vendor. The vendor doesn’t have to provide backward compatibility for five releases in use so they can put more effort into current fixes and future enhancements. They also work harder on the testing of new releases because if they don’t, half of their clients are going to be really mad because they’re taking that version. N-1 contracts also set an expectation internally with our departments. We tell them they’re getting on a treadmill and they don’t get to jump off without paying a hefty software maintenance premium for supplemental support. Upgrading also puts downward pressure on customization and shifts the emphasis to configuration, which is where it should be. (IT Vendor Mgmt)

Would be interesting to see the gap, perhaps chasm, between what Mark Roche thought the CMS chief health informatics job was going to be and what it actually turned out to be. (JeanneC)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose grant request of first-year teacher Ms. K in Washington, DC, who asked for math manipulatives for her kindergarten class. She reports, “We have been in the full swing of our addition and subtraction unit. These hands on math manipulatives have been AMAZING to help us learn! We’ve been practicing using the unifix cubes, counters, and various other objects. Having manipulatives to use has helped us to better understand the concept and to get accurate answers. Thank you so much for your support!”

A study of crowdfunding campaigns for cancer-related expenses in Canada finds that high-income, highly-educated homeowners in urban areas make up the majority of people who ask others to pay for their cancer treatments. The authors conclude that crowdfunding does little to solve problems with the healthcare system.

A Lyft driver says VCU Medical Center should have warned him that the discharged patient he was called to pick up there was delusional and talking to himself in a loud voice. Lyft says that medical facilities that are scheduling a patient’s ride should indicate whether the rider is a patient who might pose a risk to others. The hospital says it can only do so much since patient rides can be arranged by the patient themselves, their insurance company, or an outside transportation company.

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A Philadelphia pain management doctor is arrested for handing out “goodie bags” of oxycodone and muscle relaxers to patients, for which he then billed insurers more than $4,000 each.

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Wired magazine covers a University of Colorado ED doctor’s simulation class that addresses the medical realities that will be faced by astronauts on Mars. The program, held at the Mars Desert Research Station in Utah, emphasizes that the medical issues of astronauts will need to be addressed with the people and resources at hand. NASA is running risk assessments to determine which medical problems are most likely, also considering whether crew members could use videos to guide them through performing medical procedures and use 3D printers to create medical equipment.

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A newspaper fact-checking a candidate for the Florida House of Representatives who claimed to have to have — as an Orlando Health cardiologist and ED doctor — “removed 77 bullets from 32 people” after the Pulse nightclub shootings finds that she is neither a doctor nor an Orlando Health employee. State records indicate that Elizabeth McCarthy was a certified nursing assistant until 2005. She claims to have been an RN who went back to medical school who also played college basketball for both the University of Florida and Florida State University, which both schools say isn’t true.


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Morning Headlines 6/28/19

June 27, 2019 Headlines No Comments

Change Healthcare’s shares debut below target

Shares of Change Healthcare began trading on the Nasdaq exchange, with shares opening at $13 and rising to $15 at market close.

Providence St. Joseph Health Acquires Bluetree Epic Consulting

Providence St. Joseph Health acquires Epic consulting firm Bluetree Network.

Google and the University of Chicago Are Sued Over Data Sharing

A former patient at University of Chicago Medical Center files a class-action lawsuit against the medical center and Google, alleging that the organizations violated HIPAA when they did not properly de-identify PHI that was used in a joint research project.

News 6/28/19

June 27, 2019 News 1 Comment

Top News

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Shares of Change Healthcare began trading on the Nasdaq exchange Thursday under the symbol CHNG. President and CEO Neil de Crescenzo rang the market’s closing bell.

CHNG shares opened at $13 versus the company’s target price of $16-19, but rose to $15 at the market’s close.

Majority owner McKesson congratulated the company in announcement that also included its intention to “exit its investment in Change Healthcare in a tax-efficient manner.”


Reader Comments

From Curious CIO: “Re: gag clauses. I just finished Eric Topol’s book ‘Deep Medicine’ and was struck by his claim that Epic’s contracts prohibit doctors or health systems from criticizing the company. I looked for that clause when we implemented Epic and other systems and found no hint of it in the contract. They are tight with publishing screen shots, but that’s IP protection.” I’ve read a lot of contracts without seeing any that specifically prohibit discussing the vendor’s product or related safety concerns. I’ve asked readers to send me examples and none have. Some contracts may include “non-disparagement” language, but that is likely not enforceable as long as the comments are truthful. My take is that health systems tell their people that their contract contains gag clauses when it really doesn’t, just to keep their vendor relationship harmonious when a discouraging word is about to be heard (I’ve never been muzzled by a vendor, but I have by a health system suit who just didn’t want to deal with any repercussions of telling the truth). I’ll ask again — if you have a contract that contains a gag clause, send it to me anonymously.

From Nailed Acrylically: “Re: NextGen Healthcare. The company is rumored to have cut 17% of the R&D work force in preparing to move those jobs to India as suggested in the quarterly earnings call.” Unverified. President and CEO Rusty Frantz said in the May 29 earnings call that “increased investment in our Bangalore development center will provide the best leverage … not engineered for R&D cost savings, but rather to increase our yield per investment dollar by adding significantly more of the right skill sets.” NXGN shares have dropped 3% in the past year vs. the Nasdaq’s 7% gain.


Webinars

July 18 (Thursday) 2:00 ET. “Healthcare’s Digital Front Door: Modernizing Medicine’s Mobile-First Strategies That Are Winning Patient Engagement.” Sponsor: Relatient. Presenters: Michele Perry, CEO, Relatient; Michael Rivers, MD, director of EMA Ophthalmology, Modernizing Medicine. Providers are understandably focused on how to make the most of the 5-8 minutes they have on average with a patient during an exam, but what happens between appointments also plays a significant role in the overall health of patients. Modernizing Medicine is driving high patient engagement with best practice, mobile-first strategies. This webinar will describe patient engagement and the challenges in delivering it, how consumerism is changing healthcare, and how to get started and navigate the patient engagement marketplace.

July 25 (Thursday) 2:00 ET. “Meeting patient needs across the continuum of care.” Sponsor: Philips Population Health Management. Presenters: Cindy Gaines, chief nursing officer, Philips Population Health Management; Cynthia Burghard, research director of value-based healthcare IT transformation strategies, IDC. Traditional care management approaches are not sufficient to deliver value-based healthcare. Supplementing EHRs with advanced PHM technology and a scalable care management approach gives health systems proactive and longitudinal insights that optimize scarce resources in meeting the needs of multiple types of patients. This webinar will address the key characteristics of a digital platform for value-based care management, cover the planning and deployment of a scalable care management strategy, and review patient experience scenarios for CHF and diabetes.

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


Acquisitions, Funding, Business, and Stock

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Integration technology vendor Sansoro Health and healthcare cloud and integration vendor Datica will merge under the Datica name, combining their operations at Sansoro’s Minneapolis headquarters. Sansoro co-founder and president Jeremy Pierotti will become president, while Datica co-founder and CEO Travis Good, MD will become CTO of the newly combined organization. Both have roots in Madison, WI, where Datica was formerly headquartered.

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Providence St. Joseph Health acquires Epic consulting firm Bluetree Network. The seven-state health system also owns Meditech consulting firm Engage.

Apple announces that Chief Design Officer Sir Jony Ive will leave the company to form his own design firm, with Apple as one of his clients.


Sales

  • Georgia Hospital Health Services chooses Audacious Inquiry to power its GA Notify clinician alerts when patients are admitted or seen in the ED.
  • The Nebraska Hospital Association’s NHA Services subsidiary will use PatientPing’s real-time care alert software to help its providers monitor patients diagnosed with carbapenem-resistant Enterobacteriaceae infections.
  • The Kentucky Hospital Association uses a $250,000 grant from the Anthem Foundation to equip the emergency departments of member hospitals with Collective Medical’s real-time event notification and care collaboration software.

People

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New York’s Healthix HIE promotes Todd Rogow to president and CEO.

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PerfectServe subsidiary Lightning Bolt Solutions names Mary Piepenbrink, RN (Pieces Technologies) as VP of sales.

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Experity, newly formed by the merger of DocuTap and Practice Velocity, names Steve Riehs as president and COO; Rick Cochran as CTO; Jennifer Wood as chief people officer; and Adam Steinberg as EVP of client experience.


Announcements and Implementations

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Livongo integrates its mobile disease management app with smartwatches to offer real-time alerts and healthy behaviors prompts.

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Apple will sell the IOS-integrated One Drop glucometer, which it has offered only online, in its physical stores. The monthly cost of the device, enough test strips and lancets for three tests per day, and help from a Certified Diabetes Coach is $49. Jeff Dachis founded the company in 2015 after starting several marketing companies.

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Hyland Healthcare announces GA of ImageNext vendor-neutral imaging workflow optimization software.

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Lehigh Valley Health Network (PA) implements FDB’s Targeted Medication Warnings for high-risk clinical scenarios including hyperkalemia, QT prolongation, opioid use, and pharmacogenomics.

Reliance EHealth Collaborative, an HIE serving providers in the Pacific Northwest, goes live on Virtual Health Record technology from Imat Solutions.


Government and Politics

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In Health Affairs, Dell Medical School professor and former national coordinator Karen DeSalvo, MD and Center for Digital Health Information Director of Policy Mark Savage outline four use cases for determining how much progress has been made five years into the federal government’s 10-year plan for interoperability, which calls for a nationwide learning health system by 2024:

  • Consumer and patient access to electronic health information. Standardized APIs should be implemented before the proposed January 2020 deadline.
  • Shared care planning and coordination. Simply collecting comments on the maturity of standards undermines the sense of urgency needed to ensure longitudinal care plans are available and active by 2024.
  • Person-generated health data. ONC needs to specify that new APIs offer both read and write access to ensure roadmap milestones are met. DeSalvo and Page also recommend that ONC prohibit API developers from charging patients read and write access fees and require them to conduct real-world testing.
  • Social and environmental determinants of health. ONC should move forward now with incorporating SDOH as new elements in the US Core Data for Interoperability.

Privacy and Security

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A former patient at University of Chicago Medical Center files a class-action lawsuit against the medical center and Google, alleging that the organizations violated HIPAA when they did not properly de-identify PHI that was used in a joint research project. UCMC began providing patient health data to Google in 2017 as part of a machine learning research project that involved several other health systems. The lawsuit claims the data was de-identified, but a timestamp was left on each file, allowing Google the ability to re-identify patients.

A small Spok survey of CHIME members finds that data breaches are the top concern when contemplating SaaS deployments, followed by compliance / data migration and internal attacks / user errors.


Other

Researchers at the Children’s Hospital of Philadelphia develop an algorithm that can match pediatric oncology patients with clinical trials.

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ProPublica dives into the collections practices of non-profit hospitals such as Methodist Le Bonheur Healthcare in Memphis, TN. The hospital, which has its own collections agency, has filed more than 8,300 lawsuits for unpaid medical bills over the last five years, even targeting its own employees. The lawsuit often involve low-income patients without insurance, after which their wages are often garnished. High hospital interest rates have left many patients with bills that have doubled since services were rendered.


Sponsor Updates

  • EClinicalWorks will exhibit at the 2019 CASCA Rocky Mountain ASC Conference & Trade Show June 27-28 in Denver.
  • EPSi partners with HFMA on an ongoing research and content series focused on analytics to help healthcare finance leaders guide their organizations in executing value-enhancing strategies.
  • Greenway Health will exhibit at the New York MGMA 2019 Medical Practice Leaders Conference June 27-28 in Verona.
  • HealthCrowd will exhibit at the ACAP CEO Summit June 28 in Washington, DC.
  • BostInno profiles Ivenix and its smart infusion system.
  • Life Image integrates NextGate’s Enterprise Master Patient Index with its Interoperability Suite.
  • Recondo Technology issues a statement on the Trump Administration’s Executive Order to promote healthcare price transparency.
  • OptimizeRx will join the Russell Microcap and 3000 Indexes on July 1.
  • DrFirst promotes Catherine Armstrong to senior director of marketing operations.
  • Dale Nellis joins Hayes Management as VP of business development.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
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EPtalk by Dr. Jayne 6/27/19

June 27, 2019 Dr. Jayne 1 Comment

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There’s been good uptake on the new Medicare cards since they began rolling out last year. Nearly 75% of claims are being submitted with the new Medicare Beneficiary Identifier as of last week. Both institutional and professional claims are at the top end of the range, with durable medical equipment vendors lagging around 64%. Our office staff has a number of word tracks they’re using to counsel patients on the need to get the new numbers on file and most of the patients seem to be aware of the transition.

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I’ve got an Echo Dot on my desk. Although I use it mostly for alarms, reminders, and shopping lists, I haven’t really explored many of Alexa’s skills or other abilities. I was curious about an article that discussed a tool to detect cardiac arrest by monitoring so-called “agonal respirations.”

This gasping-type breathing pattern is fairly common after cardiac arrest. Half of cardiac arrests occur outside the hospital and more than 90% of them die unless someone calls 911 or starts CPR. Researchers at the University of Washington School of Medicine reviewed 911 recordings from confirmed cardiac arrests and trained a machine learning model to identify appropriate respiratory patterns using Alexa, the iPhone 5s, and the Samsung Galaxy S4. The tool identified 97% of agonal breathing events from six meters away. They also used audio recordings from sleep labs and private residences to train the model on the normal range of sleep noises, resulting in a false-positive rate of 0.2%. The authors hope to use other 911 databases to further hone the tool, which might be useful not only in homes, but in elder care facilities and on hospital units that might not have intensive monitoring capabilities.

Fortune recently reported on record venture capital funding for digital health companies. The all-time record of $14.6 billion in 2018 is up from a mere $1.1 billion in 2011. I think I’m most excited about devices that will help in the virtual visit space, including home-use cameras to look at ear drums or to capture good photos of the back of a patient’s throat. I’m less excited about home EKGs, knowing that even in the office it’s sometimes difficult to obtain a good tracing. Healthcare continues to appear to many investors as a bottomless pit of money and demand even as payers try to ratchet down the expenditures. One thing is for sure, the next couple of years will not be dull.

Speaking of telehealth, reader Randy Bak had some questions about my recent experiences: “On your telemedicine foray, please update when you accumulate a run of data. My big hesitation: how much expectation is there for unnecessary prescribing (particularly of antibiotics) from patients, and more importantly, from management? Also curious how the telemedicine doctor is equipped to follow a case for a couple of days when needed, for clinical, liability, and professional satisfaction purposes.”

Since I’m relatively new to telehealth and am only a sample of one, I reached out to several colleagues who provide telehealth services to get their opinions.

The first colleague I spoke with is part of a telehealth pilot program through her employer, which is the outpatient physician organization for a large integrated health system. Their telehealth offering really doesn’t have any clinical guidelines, and since the providers are delivering services to their own practice’s panel of patients, there aren’t any specific requirements for prescribing or not prescribing. It sounds like the physicians are basically doing the work that used to be done by their triage nurses, but are charging for it as a virtual visit rather than giving it away for free.  Antibiotic usage data becomes part of their overall practice data, although she reports that patient expectations for prescriptions are high. Follow up is easy since they’re document the visits in the EHR and can always task their clinical support staff to contact the patient, or reach out to the patient directly.

The second colleague I reached out to works as an independent contractor for a nationwide telehealth group, but in a specialist capacity as a dermatologist. He spends most of his telehealth time doing virtual visits, where the patient is in the office with their primary care provider, often at a rural health clinic. It’s more of a second opinion consultation service rather than a direct-to-consumer model. Being specialized, the expectations are different than what you bring up in your question. He doesn’t believe his group is doing very much with data and doesn’t receive any clinical scorecards. Even though that’s not the flavor of telehealth you were asking about, I figured it was worth finding out. He said there isn’t much follow up.

The third person I spoke with works for a large organization that primarily markets their services to employers as an employee benefit and to payers as a way to reduce emergency department expenditures. As expected when a payer is footing the bill, the focus is on delivering the right level of care and keeping a tight leash on scope of practice issues. He receives regular clinical scorecards that include metrics such as patient satisfaction and timeliness of visits, but also on antibiotic stewardship and appropriate referrals to a higher level of care.

In hearing about some of the specific grading, I was truly impressed. The providers are coached on how to have those difficult conversations about the fact that they’re not going to give everyone a Z-pack, and it frankly sounds like they are keeping a tighter leash on inappropriate prescribing than my brick-and-mortar practice is doing. Management sounds supportive and provides clinical guidelines summarizing the evidence. Providers who want to follow up with patients have some messaging capabilities through a patient portal, but it sounds like it might not be too widely used as most of their virtual visits are for self-limited illnesses.

My personal experience is more along the lines of the latter, with encouragement to practice good evidence-based care and not to wildly prescribe antibiotics just because patients ask for them. My favorite chief complaint from my brick-and-mortar urgent care is, “I’ve got 20 people coming for Thanksgiving, I can’t possibly be sick, and Dr. X always gives me a Z-pack.” Needless to say, Dr. X was no longer employed at my organization and I wasn’t going to give antibiotics to a patient whose only symptom was a feared complaint, so I wasn’t very popular that day.

Now that there is parity in reimbursement for telehealth and face-to-face services in many states, I suspect the payers will be active in forcing telehealth providers to gather data and demonstrate their quality, or at least prove that they’re not being capricious. With many players in the market, vendors are going to be looking for ways to differentiate themselves. Additionally, as my small sample showed, there are many different varieties of telemedicine out there and direct-to-consumer is just one piece of the pie.

Have you ever badgered a physician into giving antibiotics even though you knew they didn’t want to? Leave a comment or email me.

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Morning Headlines 6/27/19

June 26, 2019 Headlines No Comments

Sansoro Health and Datica Announce Merger

Healthcare data integration companies Sansoro Health and Datica will merge under the Datica brand.

Omada Health Raises $73 Million to Accelerate Program Expansion

Digital behavioral health company Omada Health raises $73 million, bringing its total funding to $200 million.

Xtend Healthcare plans to invest $1.3 million in Sumner County

Revenue cycle management and technology vendor Xtend Healthcare will expand its operations in Hendersonville, TN with the addition of 200 employees.

Remedy Raises $10 Million to Bring Quality Care Closer to Patients

On-demand urgent and primary care company Remedy raises $10 million in a Series A financing round led by Santé Ventures.

Morning Headlines 6/26/19

June 25, 2019 Headlines No Comments

Healthcare Information Technology Leader, Vyne, Acquired by The Jordan Company

Private equity firm The Jordan Company acquires electronic health and dental information exchange platform vendor Vyne from PE firm Accel-KKR.

UNC Health Care Launches Innovative Fully Integrated Epic Telehealth Solution

UNC Health Care launches an American Well-powered, Epic-integrated telehealth solution that allows existing UNC Health Care patients to schedule video visits from MyChart that the provider conducts within the Epic environment.

Queensland Health boss resigns amid hospital software rollout issues

In Australia, Queensland Health’s director-general will resign following highly publicized cost and patient safety problems with its $1 billion Cerner implementation.

CommonWell Health Alliance Awards Change Healthcare Six-Year Contract to be the Provider of Clinical Interoperability Services

CommonWell extends its contract with Change Healthcare for the provision of clinical interoperability services such as document retrieval and patient identification and record locator services.

Electronic health record program launched nationwide

The first phase of Iran’s nationwide EHR roll out goes live.

News 6/26/19

June 25, 2019 News 5 Comments

Top News

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UnitedHealth Group acquires PatientsLikeMe, whose China-based key investor was forced by the US government to sell the company for national security reasons.


Reader Comments

From Asking for a Friend: “Re: Change Healthcare, Phreesia IPOs. I’m wondering if your readers have advice for interviewing with a company that is planning an IPO. Is it a good time to hire on, or does the IPO create its own type of workplace unrest?” I’ll open it up to readers since I have no experience in that area. My cheap seats observation is that companies are usually in go-go mode before doing an IPO and are not looking to cut back, making hiring on as a new employee attractive. However, Change Healthcare is an exception because it’s really more like a merger (Emdeon and McKesson’s IT business) in which synergies are being sought in reducing headcount and streamlining product offerings. Change is also challenged by factors that aren’t typical of an IPO company – being saddled with billions in merger-related debt, unimpressive revenue growth, a stable of cast-off products from its majority owner McKesson, and a rapidly changing health IT market that might not be the perfect time to start running on the quarter-by-quarter investor treadmill. Still, given that you can’t predict any company’s future, and given the ephemeral nature of much employment these days, I would say take the best job offer, with slight preference toward companies that are about to IPO. I’ve worked for both good and not-as-good organizations, and while a bad boss spoiled the former, a good one didn’t save the latter.


Webinars

July 18 (Thursday) 2:00 ET. “Healthcare’s Digital Front Door: Modernizing Medicine’s Mobile-First Strategies That Are Winning Patient Engagement.” Sponsor: Relatient. Presenters: Michele Perry, CEO, Relatient; Michael Rivers, MD, director of EMA Ophthalmology, Modernizing Medicine. Providers are understandably focused on how to make the most of the 5-8 minutes they have on average with a patient during an exam, but what happens between appointments also plays a significant role in the overall health of patients. Modernizing Medicine is driving high patient engagement with best practice, mobile-first strategies. This webinar will describe patient engagement and the challenges in delivering it, how consumerism is changing healthcare, and how to get started and navigate the patient engagement marketplace.

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


Acquisitions, Funding, Business, and Stock

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Private equity firm The Jordan Company acquires electronic health and dental information exchange platform vendor Vyne from PE firm Accel-KKR, which bought the company five years ago.

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Humana will offer medication management services to its Medicare Advantage members through Aspen RxHealth, which links consumers to virtual visit pharmacists via the company’s consumer app.

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Call9, which offers nursing homes a 24×7 onsite first responder who is backed up by a remote ED doctor to prevent avoidable resident ED visits, shuts down and lays off 100 employees as it runs out of money despite having raised $34 million. The company hoped to share cost savings with insurers, but says value-based care was too slow in coming. High-profile investors included 23andMe’s Ann Wojcicki and Ashton Kutcher.

The Wall Street Journal reports that drugmaker AbbVie – which sells the #1 drug in the US, Humira, with $20 billion in annual revenue — will buy Botox manufacturer Allergan for $63 billion.


Sales

  • Hardin Medical Center (TN) will implement Cerner at a cost of $4.2 million, replacing Medhost, T-System, and Allscripts. 
  • Delta Regional Medical Center (MS) selects PatientMatters IntelliGuide to connect uninsured patients with available healthcare benefits.
  • CommonWell Health Alliance signs a six-year contract with Change Healthcare to provide record locator and document retrieval services, extending their previous five-year relationship.

Announcements and Implementations

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KLAS names Navigant as the #1 “would you buy again” revenue cycle outsourcer, while Cerner finished by far the worst, with 70% of its customers saying they wouldn’t sign up again. Navigant also finished first in the scope of services offered.

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ActX offers 23andMe customers a $95 professional interpretation of their genetic screening results and will screen physician drug orders via EHR integration. The company’s founder, chairman, and CEO is Andrew Ury, MD, who founded Practice Partner, an EHR/PM vendor that was acquired by McKesson in 2007. Seattle-based ActX has raised $3.9 million in seed and venture funding rounds.

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UNC Health Care launches an American Well-powered, Epic-integrated telehealth solution that allows existing UNC Health Care patients to schedule video visits from MyChart that the provider conducts within the Epic environment.

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Williamson Memorial Hospital (WV) goes live with Meditech as a Service.

JD Power will publish its first telehealth satisfaction study later this year, dividing the market into direct-to-consumer, payer-owned, and health system-owned services. 


Government and Politics

The White House’s executive order on healthcare provider price transparency raises some interesting reactions:

  • President Trump predicts that healthcare prices will come “way, way down” as “we’re giving that power back to patients.”
  • Experts say the order, which has no law behind it pending further rule-making, doesn’t say specifically what hospitals and insurers will be required to disclose.
  • CMS Administrator Seema Verma rejects the notion that the order is vague, saying that it specifically mentions disclosure of confidential negotiated payment rates.
  • Hospital executives say patients don’t pay the negotiated rates themselves and won’t help those patients make decisions, especially in emergent situations, also noting that previous price transparency efforts haven’t helped patients shop around or save money.
  • Employers may benefit since they don’t see individual provider pricing now — the information could help them steer employees to more cost-effective ones.
  • Economists note that price transparency could actually drive costs up, citing a much-loved 1990s example in which the government of Denmark forced concrete suppliers to disclose their negotiated prices in hopes of spurring competition, after which those companies were able to raise prices simultaneously since they then knew what everybody else was charging and they had little fear of new competition because of the high barrier to entry.

Other

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In Australia, Queensland Health’s director-general – the equivalent of CEO of the 90,000-employee state public health system — will resign following highly publicized cost and patient safety problems with its $1 billion Cerner implementation. Audio recordings of an internal meeting that were leaked two weeks ago caught Michael Walsh saying that he was forced to make positive public comments about the “messy” project in which delays were introduced after clinicians express concerns about patient safety.

IT employees of Regional Medical Center (IA) trigger a state investigation by reporting emails from which they learned that the hospital’s CEO and development director were passing off personal trips as hospital business to obtain expense reimbursement. Investigators found $255,000 in questionable payments, noting the CEO’s 566 “improper” trips and 267 “unsupported” ones. The development director was fired, the CEO resigned four days later, and both have been charged with first-degree theft.

California’s City of Hope cancer treatment and research center will spend $1 billion to build an Irvine, CA campus, two hours from its main location in Duarte.

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HIMSS cites a “leadership change” in explaining why it is vacating Cleveland’s Global Center for Health Innovation, where it is the anchor tenant occupying 30,000 square feet. HIMSS had extended its lease in October 2018 for three years. The HIMMS [sic] information page says the Cleveland building is “the perfect location for HIMSS to strive towards their mission to better health through information and technology.”


Sponsor Updates

  • The Boston business paper names Definitive Healthcare as the “#1 Best Place to Work” among large companies in Massachusetts.
  • Optimum Healthcare IT releases a mobile version of its Skillmarket platform that matches its consultants with upcoming projects.
  • Apixio will exhibit at Qualipalooza June 27-28 in Orlando.
  • Avaya publishes a new white paper, “AI: The De Facto for Contact Center Experience.”
  • Black Book publishes the top 12 highly-rated RCM analytics solutions vendors ranked on 18 key performance indicators in Q2 2019.
  • Boston Software Systems names Linda Stotsky marketing content manager.
  • CoverMyMeds will exhibit at McKesson IdeaShare June 26-30 in Orlando.

Blog Posts


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Contacts

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Morning Headlines 6/25/19

June 24, 2019 Headlines 1 Comment

UnitedHealth buys PatientsLikeMe, which faced Trump administration scrutiny over Chinese investor

UnitedHealth adds newly-acquired PatientsLikeMe to its research and development group.

President Donald J. Trump is Putting American Patients First by Making Healthcare More Transparent

President Trump signs an executive order requiring hospitals to publicly disclose what patients can expect to pay for services in easy-to-read formats, and giving stakeholders more access to data that will help in pricing transparency efforts.

CentralReach Acquires Pathfinder Health Innovations

Applied behavior analysis EHR and practice management vendor CentralReach acquires competitor Pathfinder Health Innovations.

Curbside Consult with Dr. Jayne 6/24/19

June 24, 2019 Dr. Jayne 2 Comments

I wrote last month about my experience with a dysfunctional registration process for imaging at Big Medical Center. I was sharing the story recently with a colleague who uses Epic at another institution and was gratified to learn that they have a much more seamless process. My Epic Jedi set up a demo for me, showing me all the bells and whistles on the system at his early adopter facility.

Like other vendors, Epic is working hard to get its clients up on the latest and greatest code. It’s certainly easier for support to have fewer versions live in the field. Several vendors are also starting to ship their upgrades with new functionality enabled, under the premise that clients won’t bother to turn the features off. Compared to what I saw with my Jedi, it sounds like Big Medical Center is either on an older version of Epic that doesn’t have some of the nice features for online check-in or has somehow failed to enable them.

My colleague and I discussed our shared belief that patients take more time when completing pre-visit activities at home. This might be because they can look up information they don’t know for sure, or call a family member, or because they’re not flustered because there is a clipboard standing in the way between them and their doctor.

We also talked about the release of results. My study results came by mail in 10 days, which was the same interval for their appearance on the patient portal. The results had been signed off by the physician within 24 hours of the study, so I’m not sure why the organization chooses to embargo them for another week when it’s a test that patients are allowed to have without a physician order. The old attitudes about protecting patients from their own results need to go by the wayside. He did show me some nice functionality for trending of patient-generated data that might be encouraging for physicians who are worried about incorporating that data into the chart.

The majority of my urgent care patients seem to be using MyChart, so we talked about some available features where patients can email their continuity of care documents to other providers via Direct. It seemed like it would be more nearly seamless than the “break the glass” functionality offered by Share Everywhere, with the added benefit of being able to actually consume and utilize the data not just view it.

We also talked about Epic’s Happy Together functionality that allows patients to see aggregated data across multiple instances of the system. For patients in my area where there are multiple competing health systems, it should be useful. It was a great conversation and gave me some ideas to help patients better manage their data when I see them in the urgent care.

Patients are embracing technology and are using apps during the office visit, whether it’s to look up a medication at the pharmacy or to show me lab results. According to recent data, more than half of all physicians are offering patients mobile apps for processes like appointment scheduling or retrieval of lab results. I know I would much rather interact with my providers’ offices through my phone or a laptop rather than have to call them and get stuck in the land of voicemail.

That assumes that the practice has an efficient online process as well, unlike the five days it took my ophthalmologist to respond to my appointment request through the patient portal. I can’t fault them too much, though. Just having an online appointment request is light years ahead of what some practices are offering or what they decide to “allow” patients to use. Plenty of clients decide not to embrace new features, which is why vendors are now in the position of having to “force” clients to use new features. I’m sure they’re tired of getting a black eye from patients and users when the real fault is in the client’s decision-making layer.

Vendors are getting better at serving up smaller, more frequent upgrades and updates that don’t overwhelm users or bring down the system for days at a time (with a few notable exceptions). This seems to make client leaders more comfortable with the process. In theory, as long as quality remains stable and the new features deliver what they promised, clients will be more willing to apply and use new code.

On the other hand, if an upgrade package is a dud (or worse, if it breaks any existing workflows) the vendor will have to work hard to regain its credibility. I’ve been on the losing end of a bad upgrade before and it wasn’t pretty, although it did lead to lifelong friendships made with the developers who spent weeks onsite keeping us in business. Without those relationships, it’s sometimes hard for customers to trust their vendors, which might be one reason that clients don’t like to enable new functionality that they don’t consider critical. Another issue is the fact that organizations are trying to deliver many initiatives at the same time, and when push comes to shove, something just has to be cut from the implementation and training schedule.

Hopefully over time vendors and their clients will be able to perfect that balance between delivering frequent releases of high quality while avoiding upgrade fatigue. We’re in a relative lull from a regulatory requirement standpoint, so it’s certainly a good time to catch up on new releases.

As a physician in a practice that seems a bit laggard, I have to confess I’m often jealous of early adopter sites that are embracing the bells and whistles. My organization is focused on expansion of new sites and growth of practice volumes, so it’s not surprising that they don’t want to spend a lot of time on technology projects. We’re also onboarding dozens of new staffers and a handful of new providers, so at the moment, stability seems to be the watchword.

How often does your organization take upgrades? Do you find them frictionless or irritating? Leave a comment or email me.

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