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Morning Headlines 6/24/19

June 23, 2019 Headlines No Comments

Healthcare software provider Phreesia files for a $125 million IPO

Phreesia, which offers online appointment scheduling, revenue cycle, health risk screening, and check-in kiosks, files for a $125 million IPO.

Jobs in danger as Johns Hopkins All Children’s Hospital plans e-records transition

Johns Hopkins All Children’s Hospital (FL) will replace Cerner with Epic, which is used throughout Hopkins Medicine.

Electronic Health Records at 26 Hospitals Hit by Two-Hour Outage

Hospital operator Universal Health Services says 26 of its facilities were taken offline for two hours Friday due to Cerner data center problems.

Flatiron Health Expands its Headquarters in Manhattan’s Soho

Oncology EHR and research company Flatiron Health will nearly double its Manhattan office space and add 200 jobs by the end of the year.

Monday Morning Update 6/24/19

June 23, 2019 News 16 Comments

Top News

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Phreesia files for a $125 million IPO, hoping to list shares on the NYSE under ticker symbol PHR.

The company – whose platform offers online appointment scheduling, revenue cycle, health risk screening,  and check-in kiosks — lost $15 million on $100 million of total revenue in its most recent fiscal year.


Reader Comments

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From HISInside: “Re: Change Healthcare. Large-scale pre-IPO layoffs over the past few days. They also announced internally that they are selling the analytics business unit, including RelayHealth products.” Unverified, although reported on some of the layoff sites. Anonymous posters there attached a purported company email that said jobs were eliminated in the Software and Analytics business unit. I would be surprised if they are dealing off RelayHealth since it was the closest thing to a jewel in the McKesson HIT crown, but perhaps the potential payoff is too great to pass up.

From Max the Fax: “Re: fax machines. See this article. It’s embarrassing to be so far behind.” I’ll take your side if you show me documented proof that getting rid of fax machines improves outcomes or cost. Fax machines are an admittedly humorous example of “being behind,” but healthcare is also guilty of chasing the latest and greatest shiny objects (imaging machines, drugs, IT, architect-arousing buildings) that don’t move the health needle one bit. We need to become more critical consumers of resources of unproven value for which patients and insured consumers are forced to pay, especially given that big healthcare systems feel little competitive pressure to spend patient money wisely.

From Kabob: “Re: Slack. Wondering if you’ve used it?” I haven’t, but my curiosity has been piqued by all the pre-IPO coverage. I would be interested in hearing from anyone who has used it in a hospital setting and what benefits it provided. The most common criticism is that it sucks up time and saps creativity as users move their mental goalpost to never-ending but often pointless interaction, plus it leaves them in a social media-like dopamine frenzy to check it constantly for fearing of being one-upped while offline. Things I learned today: the name Slack came from the contrived acronym “Searchable Log of All Communication and Knowledge.” There’s a free trial for anyone interested. I played around with the free version of Microsoft Teams and wasn’t impressed.


HIStalk Announcements and Requests

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PCPs of an encouraging two-thirds of poll respondents had the records of their most recent hospital encounter at their next appointment. David says his PCP had his records and CT scans, while Monica reports that the notes, but not the x-rays, were sent to her specialist within three weeks. Peggy says her PCP had everything, while Proficient Patient and Flyonthewall said it was a snap because the hospital and PCP both use Epic.

New poll to your right or here: For those employed by others: what is the #1 reason that you don’t work for yourself?

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Welcome to new HIStalk Platinum Sponsor Greenway Health. The Tampa-based company offers the award-winning, cloud-based Intergy EHR/PM that delivers reduced clicks and personalized user experience; revenue cycle management solutions that decrease A/R days by an average of 32%;  practice analytics; patient engagement; care coordination; and interoperability options that include CommonWell and Greenway Exchange, a cloud-based health information network that has connected 1,400 vendor products in delivering 22 million messages per month. The company summarizes its areas of focus as: (a) delighting the caregiver; (b) inspiring practice transformation; and (c) restoring the “care” in “healthcare.” Thanks to Greenway Health for supporting HIStalk.

It’s almost July 1, when a fresh batch of scared (and scarily young) medical residents learn to answer to being called “doctor” in the hospital as they ply their chosen career for the first time, fueled by panic-induced adrenaline, low-quality but free cafeteria food, the pressure to please their attendings, and sleep deprivation. For the rest of us, it’s like a restaurant’s soft opening or a play’s first performance – you’ll be happier if you can hold off being a customer for a few weeks until routines replace reaction.


Webinars

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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UnitedHealth Group will acquire healthcare payments firm Equian LLC from its private equity owner for $3.2 billion. New Mountain Capital acquired the company in late 2015 for just $225 million. Industry long-timer Scott Mingee joined Equian in early 2013 in his first CEO job.

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Recently retired McKesson Chairman and CEO John Hammergren will receive a $114 million one-time pension payout, $10.5 million in stock vesting, lifetime medical benefits, lifetime financial counseling, and an office and secretary for the rest of his life. The total cost the company is around $141 million. He’ll also be paid $900,000 per year as chairman of Change Healthcare. The $10,000 worth of MCK shares you bought the day Hammergren started as CEO (February 1, 2001) were worth $42,500 the day he quit, although that’s barely better performance than the Nasdaq as a whole. In addition to his parting gift, Hammergren made more than $500 million in a 13-year span with McKesson, with a record one-year compensation of $145 million. The American healthcare system and its sick patients who paid those sums have thus thanked you for your service.

Three New York City hospitals (Montefiore, Mount Sinai, and Maimonides) sell the professional liability insurance firm they own (Hospitals Insurance Company) for $650 million to The Doctors Company. The hospitals admitted in 2017 to breaking state law in failing to disclose that they, like other hospitals, had formed a Cayman Islands-based insurance company that collected premiums that were used to buy less-expensive policies, generating more than $200 million in investment income. That practice is legal as long as hospitals disclose it. The Doctors Company says it is aware of the company’s history and will rename it Healthcare Risk Advisors. Mount Sinai will spend its $325 million of the proceeds on construction, while Montefiore will use its $163 million to buy software for cost management and value-based care.


People

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Megan Schmidt (CompuGroup Medical) joins PierianDx as SVP of product.


Announcements and Implementations

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Johns Hopkins All Children’s Hospital (FL) will replace Cerner with Epic, which is used throughout Hopkins Medicine. The 15-month project will kick off on July 1. Hopkins took ownership of the 259-bed hospital in 2011, its first expansion outside of Maryland. The hospital reported $50 million in profit on $469 million in revenue in its most recent tax year.


Government and Politics

President Trump will issue an executive order Monday that will require hospitals, doctors, and insurers to disclose their negotiated contract prices. This is great news if you are an attorney since the legal wrangling will take years before anyone sees confidential contract pricing, if indeed they ever do.

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Politico reports that Mark Roche, MD, MSMI has resigned as CMS’s first chief health informatics officer after taking the job just four months ago.


Other

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Modern Healthcare lists the 25 highest-paid executives of non-profit health systems for 2017. Topping the list is Kaiser Permanente Chairman and CEO Bernard Tyson at $16 million. The lowest guy on the list (and I say “guy” because all 25 are male) still made $5.3 million. The one that leaps out, though, is electrophysiologist Joseph Levine, MD of St. Francis Hospital (NY), whose $6.5 million payday represented 1.68% of the hospital’s entire payroll.

Hospital operator Universal Health Services says 26 of its facilities were taken offline for two hours Friday due to Cerner data center problems.

GoFundMe says it is running $10 million worth of campaigns by people who need help affording insulin. Why you would want to be running a drug company rather than being diabetic: a vial of insulin costs $2-6 to manufacture and you can charge 7 million Americans — who would die without using up to several vials per month – $250 or more per vial, multiples of what people in all other countries pay. Sweet. 


Sponsor Updates

  • Diameter Health is attending Qualipalooza in Orlando this week and will sponsor NCQA’s Digital Quality Summit in Boston July 16-18.
  • Live Process creates a CMS Emergency Preparedness Rule self-assessment quiz.
  • Waystar, Flywire Health, Experian Health, Recondo Technology, Relatient, and Sansoro Health will exhibit at HFMA June 23-26 in Orlando.
  • NextGate responds to the CMS FY20 IPPS proposed rule.
  • With help from AWHONN attendees, Clinical Computer Systems, developer of the Obix Perinatal Data System, donates $3,125 to AWHONN’s Every Woman, Every Baby effort.
  • OmniSys will exhibit at McKesson IdeaShare June 27-30 in Orlando.
  • PatientBond publishes a new white paper, “Psychographic Segmentation and its Practical Application in Patient Engagement and Behavior Change.”
  • Surescripts will exhibit at the ASAP Mid Year Conference 2019 June 26-28 in Washington, DC.
  • SymphonyRM will present at AAPL June 27 in Salt Lake City.
  • Voalte will exhibit at the AzONL 2019 Summer Forum for Nurse Leaders June 28 in Scottsdale, AZ.
  • Visage Imaging will exhibit at SIIM19 June 26-28 in Denver.

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Weekender 6/21/19

June 21, 2019 Weekender No Comments

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Weekly News Recap

  • A private equity firm acquires EHR/PM vendor Nextech for $500 million.
  • A group of health and technology organizations develops open source cancer data standards and specifications that can be incorporated into EHRs via FHIR.
  • Drug maker Sanofi and Google announce plans to for a virtual innovation lab that will use analytics to study disease and patient treatment response.
  • Change Healthcare increases the amount of its IPO again, this time to $1.2 billion.
  • Accumen acquires Halfpenny Technologies.
  • A 23-bed critical access hospital says it paid a hacker’s unspecified ransomware demand, all but $10,000 of which was covered by cyberinsurance.

Best Reader Comments

I’m thinking of a time-based layout, for example [for EHR information]. A little-used feature of Windows called the Reliability Monitor charts issues over time and shows a view of the health of your computer. All the information is summarized initially and you have to click on the various items to find out what they are. However by using the ideas of “What Changed” and “When,” you get a higher-level, more coherent view of what is going on. (Brian Too)

In frontline [radiology] care, I don’t necessarily need an answer, but I do need a plan. AI raising a question about something on a film can be enough. How many times do meat-based radiologists see something that “needs clinical correlation” to rule in or out something on a film? If questions remain, I can immobilize until a radiologist reading — or more likely, follow-up — gives a best answer. Incidental findings are by definition not the problem of the moment. (Randy Bak)

It’s pretty clear to me that [Vinod] Khosla’s venture capital roots require him to make profound-seeming announcements periodically, based upon the classic VC tropes that tech is always good, and disruption, so long as it is well-meaning(!), is also always good. I am reminded of Warren Buffet, who said that he only needed one good investment idea every few years. Missed opportunities were trivial in his world. For the successful VC ideas people, it is the opposite, very nearly. They announce 100 out of the next three Big Things and are proclaimed VC geniuses. (Brian Too)

[For EHR improvement], allow other groups of healthcare professionals (i.e., the ancillary healthcare professionals, such as nurses, dietitians, pharmacists, therapists, lab techs, etc.) to do the same [in highlighting and flagging chart elements as useful]. They are just as frustrated with note bloat. With good search technology, “group” (e.g., pharmacists) highlights would be able to be retrieved for future editing, reading, etc., by the intended “group.” (Woodstock Generation)

We found that the majority of healthcare practices either do not know what KLAS is or do not associate value with an HIT vendor who has a KLAS award. It often feels like we are doing KLAS’s marketing for them. The awards have become a competition between HIT vendors instead of the source of truth for buyers. (EMR vendor)

I’ve taught research methods (and survey research methods) at the University of Pennsylvania for over 30 years. I’ve published dozens if not scores of articles and books on the topic. KLAS is a marketing effort. It’s not a survey. Anyone who publishes KLAS ratings should be aware that they are not related to quality. Alas, KLAS’s business model is not based on anything other than sales. (Ross Koppel, PhD, FACMI)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. B in Ohio, who asked for supplies so her high school class could make paper roller coasters as a physics project. She reports, “Your contribution to our physical science classroom has had a tremendous impact on our energy conversion and forces and motion unit this year. My students used the donated cardstock and art supplies to design and construct their unique and epic roller coasters. Today they are analyzing the physical forces acting on their marble roller coasters, and at the end of this week, they will present their final designs and data to the class as well as several faculty members as part of a simulated marketing campaign for a coaster build at Cedar Point. The project truly embodies our school focus on engineering and has helped my students explore these important physics concepts in a hands-on and exciting way. Without your generous support, this project would not have been a possibility. The cost of supplies is one of the biggest limiting factors in education and your donations have eliminated this ceiling and helped my students to reach new heights. I hope you enjoy the photos and find as much reward in their success as I do.”

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NASA’s TRISH Launch Pad offers a 10-week program that will help health startups ”create a viable commercialization pathway to Earth’s health technology market and a secondary space market.” Areas of interest include:

  • AI-powered, EHR-integrated medical decision support that can guide deep space travelers through rendering treatment without a connection to NASA.
  • Games that can help prevent stress, depression, anxiety, and isolation.
  • A machine that can manufacture drugs and biologics in under 24 hours since the shelf life of most drugs is less than the three-year minimum deep space mission.
  • Health assessment via eye scanning.

Google says it will work on a problem called out by the Wall Street Journal, which found that at least 11 million fake businesses – most of them created for search engine optimization — show up in local search results via its Map app. A retiree called a Google-listed garage door repair company as she was stuck in her driveway, but a rogue contractor had replaced the company’s telephone number with his own. He worked on the door, demanded $728 by cash or check, then harassed her repeatedly afterward for payment even though his repaid work had to be redone. I wouldn’t assume that none of those phony listings involve medical services.

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A 46-year-old woman whose mother Brandy named her “Marijuana Pepsi Vandyck” earns her PhD, acknowledging that “Dr. Marijuana” sounds like a weed dispensary. Marijuana, who says she has never tried marijuana, did her dissertation on teacher perceptions of children with “black names” in white classrooms. She named one of her sons Heaven and he made Marijuana a grandmother with the birth of Egypt.

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In Myanmar, a 29-year-old doctor who had given up her patient care job to years ago to pursue becoming a “sexy model” loses her license when the country’s Medical Council declares that her refusal to take down social media photos indicates that she has a “behavior disorder.” The New York Times notes the irony of the country declaring her behavior immoral even as it employs military-led ethnic cleansing that has killed at least 10,000 Muslim Rohingya.

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The Internet resurfaces the story of a cosmetic surgeon in Singapore who re-evaluated his life when he was diagnosed with lung cancer and later died at 40. He had made millions when he switched from ophthalmology to aesthetics, noting that patients who refused to pay a PCP $15 for a visit would happily fork over several thousand dollars for liposuction and breast augmentation. He summarized that “patients were just a source of income, and I tried to squeeze every single cent out of these patients.” In the end, he sought comfort from people who loved him, concluding that “only when we learn how to die do we learn how to live.”

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A Texas man and his fiancé stage a mock wedding in the hospital room of Granny, his 100-year-old grandmother who was being moved to hospice care and wasn’t expected to live until the official ceremony. Granny, who was born the day World War I ended, has since been moved out of hospice and into assisted living.


In Case You Missed It


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Morning Headlines 6/21/19

June 20, 2019 Headlines No Comments

CityMD and Summit Medical Group Announce Plans to Merge to Deliver an Unparalleled Patient Care Experience

Private equity firm Warburg Pincus will buy NJ-based, 900-provider multi-specialty practice Summit Medical Group and merge it with its 120-location CityMD urgent care holding.

Leading Health and Technology Organizations Release Common Cancer Data Standards to Enable Sharing Across EHR Systems and Improve Patient Care

The American Society of Clinical Oncology, Mitre, and the Alliance for Clinical Trials in Oncology Foundation develop an open source set of common cancer data standards and specifications that can be incorporated into EHRs via FHIR.

AHN Partners with Mercy Virtual to Enhance Critical Care Services at Community Hospitals through Innovative Telemedicine Program

Allegheny Health Network (PA) will roll out telemedicine services from Mercy Virtual, a subsidiary of the Mercy health system in St. Louis, at its four hospitals over the next 12 months

News 6/21/19

June 20, 2019 News No Comments

Top News

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Private equity firm Thomas H. Lee Partners acquires EHR and practice management vendor Nextech in a $500 million deal.

The news comes nearly a year after Nextech owner Francisco Partners announced that it was putting the company up for sale.


Reader Comments

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From PitViper: “Re: ONC. Convened payers, health systems, associations, state agencies, federal agencies, and tech solution providers in Washington DC last week to dialogue on provider directory. Participants presented their initiatives and ONC reviewed a new FHIR implementation guide for provider directory. Attendees debated different topics around national solution (public vs. private, funding, and governance).” ONC held a Healthcare Directory Workshop on June 13-14.


Webinars

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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Dallas-based healthcare recruiting firm General Healthcare Resources will acquire the health information management consulting business of HCTec, according to an internal email. The change doesn’t affect HCTec’s health IT and managed services business.  

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Private equity firm Warburg Pincus will buy NJ-based, 900-provider multi-specialty practice Summit Medical Group and merge it with its 120-location CityMD urgent care holding. The firm said in the announcement, “The combined organization will offer patients a seamless experience across a full spectrum of high-quality primary, specialty, and urgent care.”

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Digital prescription startup Xealth adds $3 million to its $11 million Series A funding round that was announced in March.

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McKesson acquires NHS-integrated prescription delivery and medication management app Echo in an effort to gain a foothold in the UK’s nascent digital pharmacy market. McKesson’s ties to the startup include ownership of Lloyds Pharmacy, from which Echo gets most of its medication supply.

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Philips announces plans to open new research space at One Discovery Square, a medical innovation complex in Rochester, MN that is owned and anchored by Mayo Clinic. Tenants will also include Epic, which owns a nearby data center that it purchased from the clinic in 2016 for $46 million.

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Allscripts shares rose 5% Thursday after a stock analyst said in a research note that the market is undervaluing the potential of the company’s Veradigm payer and life sciences analytics business, which he says that despite representing only 8% of sales, will eventually either drive share price upward or make the company an attractive leveraged buy-out target.


Sales

  • Integris Health (OK) selects Vyne Medical’s Trace communication management software.
  • Bluestone Physician Services (PA) will implement Aprima EHR and practice management software from EMDs later this year.
  • Allegheny Health Network (PA) will roll out telemedicine services from Mercy Virtual, a subsidiary of the Mercy health system in St. Louis, at its four hospitals over the next 12 months.

People

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Sisu Healthcare IT Solutions promotes Kevin Boerboom to CEO.


Announcements and Implementations

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In Ontario, Hawkesbury General Hospital goes live on Epic.

Mount Sinai (NY) and LabCorp will establish the Mount Sinai Digital and Artificial Intelligence-Enabled Pathology Center of Excellence using IntelliSite pathology software from Philips.

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The American Society of Clinical Oncology, Mitre, and the Alliance for Clinical Trials in Oncology Foundation develop an open source set of common cancer data standards and specifications that can be incorporated into EHRs via FHIR. Cancer centers at Partners Healthcare (MA) and Intermountain Healthcare are piloting the new standards.

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A KLAS report looks at consulting firms that offer health IT advisory services, some of which have launched their offerings recently as implementation work tapers off. The most experienced and high-performing firms are Impact Advisors, Nordic, and Chartis Group, while Optimum Healthcare IT has the best track record among developing firms.


Privacy and Security

Grays Harbor Community Hospital (WA) and its Harbor Medical Group are recovering from unspecified computer issues that forced both organizations back to paper over the weekend. The hospital’s Meditech system is up and running, while the medical group’s eight clinics are unable to tap into their separate EHR (unnamed, but it appears to be Virence Centricity).


Other

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Researchers find that Facebook posts accurately predict 21 medical conditions as verified against patient medical records, although demographic data alone did about half as well. Hostile language and references to drinking were accurate indicators of substance abuse, while religious references correlated with diabetes.

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A Definitive Healthcare survey on outpatient care trends finds that investing in and implementing new technologies – especially those related to interoperability – is the top challenge, followed by keeping up with consolidation trends, managing staffing, and attracting new patients. The field of 200 respondents said that telemedicine, mobile apps, and streamlined patient technologies were among the top drivers of outpatient growth.

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A retrospective analysis of diabetic patients treated at Grady Hospital (GA) finds consistently improved outcomes for those who are managed by Glytec’s EGlycemic Management System.

In Canada, a hospital located near the border between Ontario and Manitoba struggles to share information across the provincial dividing line even though patients move freely across it in choosing the closest or most appropriate hospital.

Robocall spam is overwhelming the telephone systems of some hospitals that get little help from their telephone company or the federal government in keeping the calls out. Scammers have learned to spoof the incoming calling number to force hospital operators to answer thinking it’s someone local. They are also making residential calls with the hospital’s name spoofed in caller ID, hoping to convince locals to pay fake hospital bills.

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Thanks to DrLyle (Lyle Berkowitz, MD) for sending over a link to a new Vanity Fair article describing the shame that the Sackler family – which owns most of the drug maker Purdue Pharma — claims to be feeling for having made billions of dollars selling OxyContin, often via shockingly unsavory practices and lining influential pockets. A Massachusetts lawsuit against the company concludes that “eight people in a single family made the choices that caused much of the opioid epidemic.” The article notes that Joint Commission’s 2001 war on pain as “the fifth vital sign” – which arguably launched the opioid crisis in which 200,000 Americans have died of prescription opioid overdoses — came after Purdue gave $1 million to the organization. Article author Bethany McLean, DrLyle’s sister-in-law, was the co-author of 2004’s “The Smartest Guys in the Room: The Amazing Rise and Scandalous Fall of Enron.”

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UCSD researchers find that one-third of inpatients didn’t use the tablet-controlled room environment app that the hospital placed in every patient room, although interestingly, older patients used it more than younger ones, although the authors note that they can’t determine whether it was the patient themselves or their family members running the controls. They also note that accessibility issues may have been a problem in services such as neurology and surgery.  

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A study in JAMA finds that patients of surgeons who behave unprofessionally experience more post-surgical complications than those whose surgeons act more professionally. Negative behaviors included “unclear or disrespectful communication, poor or unsafe care, lack of integrity, and failure to follow through on professional responsibilities.”


Sponsor Updates

  • EClinicalWorks will exhibit at the California Primary Care Association Region IX Clinical Excellence Conference June 23-25 in Newport Beach, CA.
  • EPSi, InterSystems, and Nuance will exhibit at HFMA June 23-26 in Orlando.
  • HealthCrowd will exhibit at Qualipalooza: the 3rd Annual Rise Quality Leadership Summit June 25-26 in Phoenix, AZ.
  • Visage Imaging announces version 7.1.14 of its Visage 7 Enterprise Imaging Platform at SIIM 2019.
  • The Chartis Group publishes a new paper outlining a strategic framework for health system executives to evaluate their partnership strategy.
  • Redox launches a public bug bounty program with Bugcrowd to help keep customer health data secure.
  • Thrive Global profiles Kyruus co-founder and CEO Graham Gardner.
  • Frost & Sullivan recognizes Waystar with the 2019 North American Customer Value Leadership Award for automating claims resolution and streamlining process workflows.
  • ZeOmega achieves DirectTrust HISP accreditation.
  • Cantata Health announces a partnership with Ability Network to improve reimbursement and compliance for skilled nursing facilities.
  • Surescripts announces that several national, regional, and local PBMs and payers have signed on for its electronic prior authorization service, increasing the number of insured lives covered by the company by nearly 20%.
  • Nordic releases a new podcast, “How Managed Services can support your EHR extension partners.”
  • Prepared Health will present at the Collaborative Care & Health IT Innovations Summit on June 24 in Baltimore.
  • KLAS names Optimum Healthcare IT the top-rated developing HIT Advisory Services firm in its Advisory Services 2019 report.
  • Meditech will host its 2019 Revenue Cycle Summit October 8-9 in Foxborough, MA.
  • The Boston Business Journal profiles Definitive Healthcare.
  • Philips joins the Atlanta-based Emory Healthcare Innovation Hub.

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EPtalk by Dr. Jayne 6/20/19

June 20, 2019 Dr. Jayne 2 Comments

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There is hope: The US House of Representatives voted last week to lift the ban that keeps the Department of Health and Human Services from funding efforts for a national patient identifier. The ban began in 1999 and blocks HHS from participating in private sector initiatives involving a unique identifier. HIMSS, CHIME, and other organizations have been lobbying for two decades to have the ban overturned in hopes of improved patient matching. The language was added as an amendment to the 2020 HHS appropriations bill and was introduced by both a Democrat and a Republican. Getting appropriations bills passed and signed into law can be tricky, so I won’t be holding my breath waiting for it to continue its journey on the hill.

Telehealth provider American Well has partnered with Cisco for a solution which enables virtual visits through television technology. Participating patients would use a set-top device that integrates with American Well. The solution is targeted to patients with chronic medical conditions as well as to older patients who might need regular visits. Many baby boomers are perfectly happy using smartphones and laptops and I’m not sure having one more device is necessary. People assume the older generations are “digitally dark,” but they are more savvy than you think. My own mother has a cooler, newer phone than I have. Years ago when I finally gave in to joining Facebook, the first friend suggestion I received was my then 87-year-old grandmother.

Lots of chatter in the physician lounge recently about media reports on the inclusion of “burnout” as a diagnosis in ICD-11. The World Health Organization says that media have it all wrong, that it hasn’t been recognized officially as a medical condition. ICD-11 includes burnout under “factors influencing health status or contact with health services” The chapter also includes indicators such as “contact with health services for reasons associated with reproduction” and “presence of device, implants, or grafts.” The American Psychiatric Association also states that burnout is not a medical diagnosis or a disease. Either way, being able to categorize burnout with a standardized code will allow for data gathering and better analytics. You can’t manage what you’re not measuring, but it will be a long time before we see ICD-11 in the US, so I’m not going to get too excited.

Speaking of mental health, clinicians in California are testing an app that tracks everything users do on their phones. The goal is to identify when a user is about to experience an emotional crisis. Various cities and counties are involved in the project, which is being tested on patients using the Los Angeles County public mental health network. It looks at historical use data to determine whether behaviors are changing and sends a message to the user. About half of initial pilot users dropped, citing technical issues or lack of interest. It’s an interesting concept, but one which would have to balance the loss of privacy with the potential benefit to users. For those with significant health conditions or risk for self-harm, it might be worth it, but for others it might be too invasive.

My practice has both x-ray and CT scan capabilities. Although the CTs are read immediately by a radiologist, we’re responsible for the primary reads on our plain films and often the radiology over-read doesn’t happen until our shift is over. Especially in that context, I’m excited about using AI to help interpret radiology studies, and frankly for some of our films, it can’t come fast enough. Although some films are grossly abnormal, other findings are subtle. Sometimes the quality of the studies is limited by the physical size and bulk of the patient. It would be great to have some support for those of us that are reading films in the field. Needless to say, I was excited to hear about the FDA approval of Zebra Medical Vision’s product that assists with CT studies that are looking for brain bleeds. The solution can reduce turnaround time, which is always good for the front lines. Zebra already has FDA approval for a chest x-ray product that specifically looks for pneumothorax. Maybe sometime before I retire I’ll have a virtual radiology assistant that pre-reads my films.

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Like many of my peers, I enjoy learning about the history of medicine. I crossed an item off my bucket list a couple of years ago when I visited the Mutter Museum and admired Albert Einstein’s brain along with the Hyrtl Skull Collection. I’m also a fan of literature, so I couldn’t contain my excitement when I learned about a treasure trove of clinical notes from 400 years ago. The collection contains handwritten notes on more than 80,000 patients in early 17th-century England, kept by two healers who were known to cure their patients by using cues from astrology. The notes include treatments with tobacco and horse manure and cover conditions from depression to gonorrhea. Researchers at the University of Cambridge have put transcriptions of more than 500 cases online and its been great entertainment to learn about a patient whose “spleen was not sound,” as diagnosed by the presence of “black stuff that comes from by his excrements.” Another patient complained of “fretting & choleric & melancholy.” Other hot topics include childbirth, infertility, and witchcraft. My favorite treatment apparently involves avian slippers with “a pigon slitt & applied to the sole of each foote.”

Telehealth is officially the fastest growing place of service, growing 53% from 2016 to 2017 in comparison to 14% for urgent care centers and 7% for retail health clinics. Emergency departments experienced a 2% decline. This data comes from New York non-profit Fair Health, which hosts a claims database. Their annual white paper on place of service trends shows that organizations that are not thinking about how to incorporate telehealth might be missing out. Telehealth is still a small portion of all claims – 0.11% in 2017 data compared to 2.6% at emergency departments and 1.2% at urgent care clinics. This will only grow now that payment parity has arrived and telehealth or virtual visits are covered similarly to in-person visits.

I recently joined the ranks of telehealth providers and was surprised by how satisfying it can be. The patients are genuinely grateful that you’re there to take their call at 11 p.m. even if it just results in self-care recommendations. My previous proposal for being a dedicated after-hours telehealth provider for one of our local health systems was met with lack of interest and I still think they’re missing a major opportunity. I care for plenty of their patients in person at my urgent care, so we’ll have to see how long it takes for one of them to turn up in my online queue.

Have you ever used telehealth services for yourself or a loved one? Leave a comment or email me.

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Email Dr. Jayne.

Morning Headlines 6/20/19

June 19, 2019 Headlines No Comments

THL snaps up Francisco Partners’ Nextech in more than $500 mln deal

Private equity firm Thomas H. Lee Partners acquires EHR and practice management vendor Nextech in a $500 million deal.

eSolutions Acquires RCM Software Vendor Practice Insight

RCM vendor Esolutions acquires competitor Practice Insight for an undisclosed sum.

Echo, the medication management app, has been acquired by LloydsPharmacy-owner McKesson

McKesson acquires UK-based prescription delivery and medication management app startup Echo.

VirtualHealth Raises Series B Funding to Revolutionize HealthCare with Unified Data

Care management company VirtualHealth wraps up a $15 million Series B funding round that brings its total raised to $25 million.

Morning Headlines 6/19/19

June 18, 2019 Headlines No Comments

Sanofi and Google to develop new healthcare Innovation Lab

Drug maker Sanofi and Google will establish a virtual innovation lab that will use analytics to understand diseases and to extract patient insights to understand which treatments work best.

Social Impact Startup Aunt Bertha Secures $16 Million in Series C Funding

Community-based organization referral platform vendor Aunt Bertha raises $16 million in a Series C funding round.

Fueling the next phase of our growth: What’s next at Collective Health

Collective Health, which offers a health benefits management system for self-insured employers, raises $205 million in a Series E funding round.

News 6/19/19

June 18, 2019 News 8 Comments

Top News

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Drug maker Sanofi and Google will establish a virtual innovation lab that will use analytics to understand diseases and to extract patient insights to understand which treatments work best.

Sanofi will also use AI to forecast sales and manage marketing and supply chain efforts and will migrate some of its business applications to Google Cloud. 

Paris-based Sanofi, which sells the expensive insulin Lantus, previously formed a join venture with Verily to offer virtual diabetes coaching and tools.


Reader Comments

From Struggling with KLAS: “Re: KLAS doing research on consulting firms. We had been ranked by KLAS for multiple years, but we’re no longer ranked in our category and KLAS can’t get us back up to the minimum number. Our category used to have 35-40 consulting firms ranked and now there are only 11. Has anyone else complained about this? We are seriously considering cancelling our membership. We just aren’t getting value.” I’ll open it up to readers.

From Kloc Programmer: “Re: doctors highlighting EHR data. I don’t get the point. They could miss something by not reading the whole chart. Isn’t all of it important?” Let’s say you’re doing a book report on a 400-page novel. You read / skim with a highlighter in hand, marking the most important points in separating the wheat from the chaff (the author’s job was to write a lengthy book that therefore commands a high price, while yours is to reverse engineer those pages back into an outline of the high points). You write our report and put the book back on your shelf. Two years later, you pick the book back up, and in 60 seconds, you can flip through the pages, read your previously highlighted text and margin notes, and instantly refresh your memory instead of plowing through all 400 pages again. That’s what I’m proposing for an EHR, which intentionally hides the few nuggets a chart contains into volumes of auto-generated and copy-pasted junk. It could work something like this:

  • You read through the chart on your first encounter with the patient, marking individual data elements or selected text as useful.
  • You add a comment if you like to give yourself a reminder, an explanation, or a question to research later. A margin note, if you will.
  • Next visit, you click the magic button that pops up just the information you have marked previously and then highlight anything newly added in the same way.
  • Information that no longer seems useful can be banished to the background by unclicking your highlight. That doesn’t affect anyone else and thus doesn’t need rigorous editing.
  • Individual highlights or comments can be marked as public or private. Everybody benefits when you flag your item publicly so everybody can see what you found useful, but you can any highlight or comment private.
  • The highlighting and review function wouldn’t change the EHR’s functionality. It’s like the annotation feature of Word or of Adobe Acrobat that sits above the hardcore editing tasks.
  • Comments could be handwritten via an electronic pen for on-the-fly notation that doesn’t require sitting at a keyboard.
  • An even simpler option would be to allow a one-click “I found this useful” marking option to make interesting data elements stand out.
  • The rewards for creating note bloat – most of them due to reimbursement or the EHR vendor’s passion for spitting out reams of useless text as a technical parlor trick — aren’t going away soon. At least give doctors a way to mark a chart once and then save time with every visit that follows.
  • It’s an EHR win since paper charts offer no way to do this, short of attaching Post-It notes to the front of the manila folder.
  • The bottom line is that it’s almost impossible to clean up EHR bloat at this point given the many masters it serves, so we might as well add a smarter, relatively easily implemented layer that makes its contents more useful.

From Right into the Trash: “Re: industry email newsletters. HIStalk I open to click the link. Others I zap unlooked. Am I missing any good ones?” The only one I find useful is Advisory Board’s daily briefing. Others lured me in initially with slick writing that unfortunately went nowhere, while others just blast out time-wasting clickbait links claiming to be “curated” but obviously not by an industry expert. I always tell Mrs. HIStalk that a particular restaurant or retail store has a “high hit rate” a high percentage of choices that I would actually buy and Advisory Board’s daily update has that. I also use my “high hit rate” standard to evaluate health and health IT websites to determine which of them are worth following consistently (spoiler: in my case at least, I haven’t found any).


HIStalk Announcements and Requests

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Friday is the first day of summer, so it’s time once again for my annual Summer Doldrums Special on webinars and new sponsorships, wherein I attempt to break through the industry inattentiveness and indecision that is caused by vacations and family activities. Talk to Lorre, who might even offer a little something extra to former sponsors who regret the “former” part. It’s between you and her since I don’t get involved – I have the luxury of being purely the writing, analysis, and snark specialist.


Webinars

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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Collective Health, which offers a health benefits management system for self-insured employers, raises $205 million in a Series E funding round, increasing its total to $434 million. Co-founder Rajaie Batniji, MD, DPhil (same as a PhD) was until recently a Stanford medical school professor. 

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Hospital laboratory consulting firm Accumen, which was acquired by a private equity firm in January 2019, acquires clinical data exchange technology vendor Halfpenny Technologies.

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Quartet Health, whose technology connects people who have medical conditions with mental health providers when appropriate, raises $60 million in a Series D funding round led by insurer Centene, increasing its total to $153 million. Two of the three co-founders have left their executive positions but remain on the company’s board.

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Community-based organization referral platform vendor Aunt Bertha raises $16 million in a Series C funding round. I interviewed CEO Erine Gray last month and reader response was really good.


Sales

  • Capital Caring (VA) chooses Netsmart’s MyUnity EHR to enrich person-centered care in hospice and palliative care.
  • Community Health Network (IN) will implement MModal’s conversational artificial intelligence to speed up Epic documentation and will also quickly roll out the company’s virtual scribing solution. 

People

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Justin Box (Mary Washington Healthcare) joins Driscoll Health System (TX) as VP/CIO.

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UCSF promotes Rohit Gupta to the newly created position of chief biobank officer, where he will oversee the use of human specimens for research, the creation of consent and processing protocols, and integrating genomic data with the EHR. He worked his way up from his first Stanford job as a clinical study research assistant as he was earning his only academic credential, a bachelor’s degree in biology.


Announcements and Implementations

St. Luke’s Health Care System goes live on Meditech Expense.


Government and Politics

The American Hospital Association wants ONC to restore the requirement that Qualified Health Information Networks support FHIR after it was removed from the second draft of TEFCA (Trusted Exchange Framework and Common Agreement).


Privacy and Security

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Hong Kong Hospital Authority admits – after initially denying it — that it gave police a list of people who were treated in its ED after protesting a proposed law that would allow citizens to be extradited to mainland China for trial. The Hospital Authority claims it did not intentionally leak the information, but says that the hospital’s ED computers are always logged in and anyone can access the information it contains. An intercepted email from the Hospital Authority ordered employees to classify each ED patient as police, reporter, civilian, or other, while a hospital doctor publicly showed an EHR screen that was labeled “For Police.”

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The computer systems of Olean Medical Group and Seneca Nation Health System (NY) are brought down in ransomware attacks.


Other

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Vietnam’s Ministry of Health wants 90% of the population covered by an EHR by 2025, with district-level clinics scheduled for the first round of go-lives next month. The kick-off meeting was held June 14 in Hanoi. Project participants say they are challenged by lack of interoperability and missing connections between practices and hospitals. Hospitals and practices will not be allowed to use paper medical records after 2028.

In Canada, Ottawa Hospital reports 15-deep patient lines at its clinics following its June 1 Epic go-live on because of the time required to re-enter some patient information. Only in a polite country like Canada would the nurse’s union rep decline to rip the hospital when asked about the delays, instead offering the union’s support and remind the reporter that the delays were expected, adding her thought that “hopefully it will get better every day.”

Providence St. Joseph Health EVP/CIO BJ Moore — hired in January 2019 after a 26-year career working for Microsoft — says that Providence St. Joseph and the healthcare industry as a whole are 15-20 years behind in technology. His goals are to simplify the health system’s technology, improve its network performance, speed up employee onboarding, move systems from owned data centers to the cloud, and roll out Epic throughout the system to replace the 14 EHRs that its 51 hospitals use. He also wants to bring more external data into the EHR from consumer wearables.

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A one-star rated nursing home in New York is fined $48,000 after its medical director orders insulin over the phone for a resident whose hospital discharge note clearly indicated that she shouldn’t have it. The doctor blamed a nurse who he said didn’t read him the warning correctly, also speculating that the patient was admitted to the hospital in the first place because someone accidentally deleted her blood glucose readings from the EHR.

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Industry long-timer and North Carolina FC soccer team owner Steve Malik — who founded Medfusion in 2000 and remains its owner – proposes building a $1.9 billion stadium and multi-used develop in downtown Raleigh, NC to convince Major League Soccer to give the city a team in its expansion.

A Kaiser Health News report observes the sharp increase in the number of hospitals that offer ECMO (extra-corporeal membrane oxygenation), a “very expensive, labor-intensive and unsuccessful effort to cheat death” that creates cost and ethical dilemmas in keeping patients whose hearts and lungs don’t work alive even though few of them ever leave the ICU. It also forces family members to choose the moment at which it will be turned off, for which experts urge having the doctor set the date instead. A Brigham doctor concludes that ECMO is a great example of “just because you can doesn’t mean you should.” 

Only in healthcare: a hacker who installed ransomware in the computer systems of an Ohio urology practice sends their $75,000 ransom demand (which was paid) via the office’s fax machine.


Sponsor Updates

  • The Omni-HealthData analytics platform from Information Builders is named Best Overall Healthcare Data Analytics Platform in the 2019 MedTech Breakthrough Awards program.
  • Audacious Inquiry will offer users of its Encounter Notification Service the ability to share their data with CarePort Health for care coordination.
  • Location technology powered advertising platform Brandify will offer health system marketing programs a consumer-facing “providers near me” option, presenting optimized provider and location data from Kyruus.
  • Aprima will exhibit at HFMA June 23-26 in Orlando.
  • CoverMyMeds will exhibit at the EMDs 2019 User Conference & Symposium June 20-22 in Austin, TX.
  • ACAP selects Cumberland Consulting Group as a preferred vendor for consulting services.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
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Morning Headlines 6/18/19

June 17, 2019 Headlines No Comments

CMS proposes to update e-prescribing standards to reduce provider burden and expedite access to needed medications

CMS issues a proposed rule that will give providers the option to complete prior authorizations electronically and in real time so that patients can be assured their Medicare Part D prescriptions will be filled before going to the pharmacy.

New opioid treatment center ‘OneFifteen’ opens in Dayton

Stakeholders host a ribbon-cutting ceremony for the opioid addiction treatment center OneFifteen, soon to be a campus of tech-enabled recovery and social services launched by Kettering Health Network, Premier Health, and Verily.

Rite Aid Partners with Adobe to Drive Digital Transformation

Rite Aid will leverage Adobe’s Experience Cloud to gain better insight into customer preferences and habits, and to help its pharmacists better connect customers to the store’s health and wellness offerings.

A controversial startup that charges $8,000 to fill your veins with young blood and halted operations after an FDA warning now says it’s back up and running

Ambrosia resumes its “rejuvenating” blood transfusion service in San Francisco and Tampa, FL after shutting it down in February due to an FDA warning letter.

Curbside Consult with Dr. Jayne 6/17/19

June 17, 2019 Dr. Jayne 2 Comments

I wrote recently about a less than optimal shift where we had multiple intermittent issues with our EHR that impacted electronic prescribing and several other key functionalities. Although the issue was fairly serious, it turns out that a good portion of the lack of communication our users experienced was the fault of our practice leadership rather than the vendor. In trying to “protect” the clinicians from what they felt would be distracting, they erred in providing too little information. It turns out the vendor was communicating pretty well, but they weren’t passing on the information to those of us on the front lines.

This is a challenge for any healthcare organization – figuring out the right way to communicate about serious issues and knowing how often to provide updates, even if the update is “no update.” In organizations where clinical leaders work closely with the IT team, there can be good conversations around a service disruption and how to handle it. There can be discussions about user culture – whether they would benefit from more information or less and whether the disruption is more of an annoyance or a disaster. When clinical and technology leaders don’t work together, there’s an increased risk of erring too far in one direction or another.

I still encounter organizations that don’t believe it’s important to have dedicated clinician support for health information technology systems. When I put on my consulting hat, one of my tasks is to try to convince these practices that they can’t afford not to have clinician leadership where EHRs and other systems are concerned.

I recently pitched to a convenient care practice that has almost 100 providers. They have one nurse who spends a couple of hours each week working with the EHR, mostly responding to specific end user questions rather than working on global strategy. I spent a few days in the practice to identify potential opportunities for workflow improvement as well as long-term strategies.

The first thing I identified while watching physicians document was that none of the physicians were using medication favorites. Apparently they aren’t allowed to build their own favorites because the organization is concerned about upkeep. Instead, there are some global favorites that everyone can use, but that might not be aligned with current treatment guidelines. Providers can delete the global favorites, but can’t put anything in their place, leading to the opportunity for errors when physicians try to use the global favorites and edit them as they go.

There were some order sets available, but they weren’t very complete, and many common diagnoses didn’t have associated order sets. As a result of providers not being able to build their own order sets, I observed several clinicians using Word documents that contained their most common patient instructions that they would copy and paste into the free-text plan field. Some of these makeshift order sets didn’t seem terribly evidence-based and they varied dramatically from person to person. The diagnosis screens were cluttered with diagnoses that didn’t seem to be commonly used, while providers were having to search for conditions that they treated several times each day.

When I perform a practice analysis, I also dig into how the practice handles upgrades and changes to payer requirements or federal programs. It turns out that that when it’s time for an upgrade, the physician CEO and the EHR nurse evaluate the release notes and decide which features they will implement and how the end users will be trained. They don’t seek input from any of the users or even the physician group’s medical directors. The two of them personally deliver most of the training in a one-on-one fashion, which means that some users might get trained as much as six weeks prior to the upgrade. Others might just receive a PDF that they are supposed to review before launching into the new workflows. There’s not a lot of satisfaction around that process.

Understanding that process explained some of the issues I saw in the system, including a workflow for in-office medications that borders on dangerous. There are fewer than two dozen medications available in the office, many of which are in specific unit doses. Rather than configuring an order screen with those medications and defaulting in their strength, form, and administration instructions, providers are required to individually select every parameter for every order. Some medications can be ordered multiple ways.

For example, one drug can be ordered either as 3 ml or 2.5 mg. Since the medication is 2.5 mg/3 ml, either order is appropriate, but I saw several physicians click for 3 mg or 2.5 ml, neither of which were correct. The system didn’t flag these, but instead the clinical support staff was responsible for changing the orders. Incorrectly ordering albuterol at that scale isn’t going to cause significant harm, but for other drugs, those types of mistakes are far more serious. Beyond the safety issue, there’s the matter of the numerous clicks required to even order a single drug.

I identified all kinds of operational issues in the practice as well. Although they have a time clock system for both clinical and business office staff, they don’t have hourly providers use it. Instead, providers have to email their “stop time” every night and it takes a manual process to document the time in both the payroll system and the scheduling system. For the latter, they use one system for providers to request their schedules and another system to actually publish the schedules. They’ve switched payroll systems three times in five years, which makes me wonder whether it was really a software issue or something much more challenging to fix.

There were plenty of other issues to tackle, enough to keep several consultants busy for many weeks. I knew there were some internal disagreements on whether to bring in outside help, so I prepared a conservative proposal in multiple phases to allow them to get used to the idea of letting someone help them. The return on investment was easy to demonstrate, but as I presented to their leadership I could tell they weren’t interested. It was clear that the CEO believes his way is not only the best way but the only way to do things.

Although many of their technology struggles could be made better through the application of skilled assistance, they’re not ready for change. Given the challenges that will be upon them as healthcare continues to evolve, it will be interesting to see where they are in three to five years.

What’s the scariest CPOE system you’ve seen? Leave a comment or email me.

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Email Dr. Jayne.

Morning Headlines 6/17/19

June 16, 2019 Headlines No Comments

Nashville company ups IPO to more than $1 billion

Change Healthcare raises the amount of its IPO again, this time to $1.2 billion.

Accumen Acquires Halfpenny Technologies

Lab, imaging, and clinical optimization company Accumen acquires clinical data exchange vendor Halfpenny Technologies for an undisclosed amount.

Patients frustrated over computer system outage at Abrazo Health Hospitals

Patients complain that the Cerner system of Abrazo Community Health Network (AZ) has been down for several days, which the hospital says was caused by a Cerner upgrade.

Cisco and American Well are teaming up to let you talk to your doctor from your TV

Cisco is working with telemedicine vendor American Well to develop a device that will enable consumers to access virtual consults from their televisions.

Bribes and Backdoor Deals Help Foreign Firms Sell to China’s Hospitals

A New York Times investigation finds that GE, Siemens, Philips, and Toshiba are bribing poorly paid Chinese hospital officials to buy their medical equipment.

Monday Morning Update 6/17/19

June 16, 2019 News 4 Comments

Top News

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The local paper’s review of the June 2 ransomware attack on Estes Park Health (CO), which includes a 23-bed critical access hospital, contains interesting nuggets:

  • The ransomware took down the health system’s network, phones, and email.
  • The health system’s cyberinsurance company negotiated and paid the unspecified ransom.
  • Further ransom payments were required as the health system found additional encrypted files.
  • The health system defends paying the ransom because other businesses that have refused remained offline for weeks and “we rely heavily on this summer business to maintain our financial stability.”
  • The health system had to pay a $10,000 deductible of the total ransom paid,  which it says was money well spent because it generates more revenue than that in a single hour.

Reader Comments

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From Just a Gigolo: “Re: Allscripts acquiring ZappRx. Good move, do you think?” Yes, assuming that ZappRx’s underlying fundamentals are anywhere near sound after several years in business. The end of HITECH has given EHR vendors a breather that they both appreciate (in allowing them to get back to product development) and hate (they need something else to sell to avoid a drop in revenue). Allscripts is the best EHR vendor at running itself, as one HIStalk reader observed, like a health IT mutual fund of minimally related software products bought at a discount, and this acquisition seems to be well aligned with that strategy. Allscripts also likes working with pharma, which is another plus since that’s who pays for ZappRx’s services. You don’t really want to be a publicly traded EHR vendor (or a consulting firm dependent on their implementation business) as demand for your primary product drops, even if external factors such as HITECH expiration are to blame. Cerner is in the same boat, but seems to be pinning its diversification hopes to healthcare projects that don’t necessarily involve just software.

From Cutting Rejoinder: “Re: EHR bloat. How can technology fix that?” I always give the same answer, but nobody seems to agree with me – allow each clinician to tag the information (highlighted text or discrete fields) that they feel is important in the patient’s care, adding or removing those tags at any time and for any reason. That provides two benefits: (a) the provider could click a single button to display only the information they themselves have previously tagged, with date sorting / filtering that makes getting a quick refresher nearly instantaneous; and (b) someone plowing through the chart for the first time could look at what everybody else found useful, or perhaps that a particular clinician saw as useful (like a cardiologist). The underlying EHR data collection and storage would not require changes since it could keep collecting the junk as usual. It would be like highlighting a textbook or contract with the added ability of seeing what one or more others have highlighted. One more benefit is that the patient could then see the highlighted information in their electronic copy of their record to help them make sense of the 90% of the record that nobody will ever care about.


HIStalk Announcements and Requests

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More than half of poll respondents say their job description requires an applicant to have earned a bachelor’s degree, while 24% say it takes a master’s. Only 5% say that no degree is needed, although a maddening 17% observe that their employer ignores their own job descriptions if they really want to hire someone (meaning that the requirement isn’t really required, which is the kind of wishy-washiness that you often see in hospitals).

New poll to your right or here: For those treated by a hospital (inpatient or ED) within three years: did your PCP have your hospital records at your next visit? I don’t worry too much about practice-to-practice interoperability since that usually involves minimal urgency, but surely my PCP would be curious about what was done to me in the hospital during a recent inpatient stay or ED visit.

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Welcome to new HIStalk Platinum Sponsor HealthCrowd. The San Mateo, CA-based company offers a unified, cloud-based, end-to-end communications solution that allows organizations to deliver member-centric engagement at scale, moving communications from tactical to strategic. Its Unified Communications Platform (text, voice, email, and nanosites) drive members to action, backed by Clairvoyance campaign analytics. Case studies: (a) Aetna developed a sustainable digital outreach program for its Medicaid project; (b) a health plan used intelligent mobile messaging as part of its disease management program, nearly doubling screening; (c) a managed care organization used the company’s platform to communicate with Medicaid beneficiaries. Founder and CEO Bing Doh founded the company with the behavioral change and consumer analytics knowledge she gained in the online advertising technology world. Thanks to HealthCrowd for supporting HIStalk.

Listening: new from Midland, which if I’m ever going to like country music (which isn’t likely), this would be why. It’s not the usual Nashville city slicker pretty boys warbling with fake Southern accents over a few token pedal steel pop licks while wearing cowboy hats in places like midtown Manhattan or on stage at night where their only value is as a poser cowboy affectation. This recently formed Dripping Springs, TX trio sounds to me like the California country-rock of the 1970s Eagles with the occasional surf guitar, Spanish guitar, and moody minor chords skillfully blended in. Fun fact: they formed the band when one member was getting married and the other two were his groomsmen, jamming on the porch after showing up a few days before the ceremony and deciding that they could form a band. I’m not entirely sure this is really country music, so I’ll admit that I actually like it a lot. Audio of the excellent new single is here.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Change Healthcare raises the amount of its IPO again, this time to $1.2 billion. The original value from March filings was for $100 million. The company hopes to use the proceeds to pay down some of its $5.8 billion in debt.


Decisions

  • Lincoln Medical Center (TN) will replace CPSI Evident radiology PACS with Intelerad in June 2019.
  • Jefferson Memorial Hospital Radiology (TN) replaced GE radiology PACS with Change Healthcare on June 1, 2019.
  • The Orthopedic Hospital (IN) went live on Cerner in March 2019.
  • Ascension Seton Smithville Regional Hospital (TX) will go live on Cerner in 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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Health First (FL) hires William Walders, MHA (VMware) as CIO. He is a US Navy veteran and served in a number of military IT roles, including CIO of the USNS Comfort and Walter Reed National Military Medical Center.


Announcements and Implementations

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CPSI offers users of Microsoft HealthVault – which will be shut down in November – migration of their data to the Lydia platform sold by its subsidiary Get Real Health.

Clinical Computer Systems, Inc. will distribute amniotic fluid lactate level monitoring technology developed by Sweden-based ObsteCare pending FDA clearance for its use in prolonged labor. 


Other

Patients complain that the Cerner system of Abrazo Community Health Network (AZ) has been down for several days, which the hospital says was caused by a Cerner upgrade.

Researchers are mining EHR data to determine when expensive medical helicopter transfer services make sense, especially those involving moving a patient from one hospital to another. They hope to create a checklist to help clinicians decide whether air transport is worth it, especially since patients often get stuck with exorbitant air flight bills after their insurance declines to pay.

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LifePod Solutions will offer its caregiver-managed voice service for home care on IHome’s consumer electronics equipment. It will provide monitoring, fall detection, real-time alerts, and reports that are driven by the senior’s voice alone.

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A New York Times investigation finds that GE, Siemens, Philips, and Toshiba are bribing poorly paid Chinese hospital officials to buy their medical equipment. GE salespeople offered one hospital administrator a $1 million bribe to buy a $4 million CT scanner. The companies inflate equipment price to cover the cost of bribes and kickbacks, refuse to underbid each other, and use shady third-party importing companies to cover their tracks.

An Atlantic article says that the US healthcare system is an expensive flop globally because Americans are the worst patients – we are hypochondriacs; we demand drugs that we don’t need but refuse to take those we do; our “cost is no object” beliefs trigger outrage when insurers decline to pay for expensive treatments that have been proven to offer little value; we sue providers so often that they order unnecessary tests and initiate treatment based on the results purely as malpractice defense; and we believe that heroic interventions are justified in delaying death. The author concludes,

It makes sense that a wealthy nation with unhealthy lifestyles, little interest in preventive medicine, and expectations of limitless, topnotch specialist care would empower its healthcare system to accommodate these preferences. It also makes sense that a healthcare system that has thrived by throwing over-the-top care at patients has little incentive to push those same patients to embrace care that’s less flashy but may do more good. Medicare for All could provide that incentive by refusing to pay for unnecessarily expensive care, as Medicare does now—but can it prepare patients to start hearing “no” from their physicians? 


Sponsor Updates

  • Lightbeam Health Solutions publishes a new case study, “Kootenai Care Network: ACO Automates GRPO Reporting.”
  • Mobile Heartbeat and Voalte will exhibit at the Organization of Nurse Leaders event June 20-21 in Newport, RI.
  • Waystar, Experian Health, Patientco, and ZeOmega will exhibit at HFMA June 23-26 in Orlando.
  • Netsmart will exhibit at the LeadingAge Collaborative Care and Health IT Innovations Summit June 23-25 in Baltimore.
  • Nordic will exhibit at HIUG Interact 2019 June 16-19 in Orlando.
  • ROI Healthcare Solutions will exhibit at the Midwest Infor User Group meeting June 19-20.
  • SailPoint will exhibit at Gartner Security & Risk Management Summit June 17-20 in National Harbor, MD.
  • Sansoro Health releases a new 4×4 Health podcast, “CMS & ONC Propose Big Changes for Payers.”
  • Surescripts and Wolters Kluwer Health will exhibit at AHIP June 19-21 in Nashville.
  • T-System will exhibit at the 2019 Western Region Flex Conference June 19-21 in Marana, AZ.
  • TriNetX applauds the House Appropriations Committee for supporting use of real-world evidence in the House Agriculture-FDA Spending Bill.
  • Visage Imaging will exhibit at the SIIM19 Annual Meeting June 26-28 in Denver.
  • Vocera will exhibit at HITEC 2019 June 17 in Minneapolis.

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Weekender 6/14/19

June 14, 2019 Weekender 4 Comments

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Weekly News Recap

  • Allscripts announces plans to acquire specialty drug prescription prior authorization platform vendor ZappRx.
  • GE Ventures looks for a buyer for its stake in 100-plus startups that include 27 healthcare companies.
  • French company Dassault Systèmes will acquire clinical trials software vendor Medidata for $5.8 billion.
  • Epic will integrate Humana’s real-time prescription benefits checking tool within its e-prescribing workflow as the first of several steps in their newly announced relationship.
  • Switzerland-based medical Internet of Things vendor Medisanté enters the US market with the opening of an office in Bridgewater, NJ.
  • A physician’s New York Times opinion piece says corporatized healthcare is cynically taking advantage of the professionalism of doctors and nurses by assuming they will work extra hours without extra pay, with the biggest overtime culprit being the EHR.

Best Reader Comments

The reasons for interoperability failure are numerous. Different schemas, encoding sets, dictionaries, MoSCoW (Must, Should, Could, Won’t), CRUDE (Create, Read, Update, Delete, Exchangeable), document types, and enumerations. Until the vendors are required to align to a standard — the whole standard — they will not align. We also have a problem with how the documents or calls are made. Some vendors have the ability to deliver a longitudinal record selectively, others dump the whole file. Imagine a 6-8 year patient with multiple conditions and frequent visits. Take that same patient and realize that several of the technologies do not align the disease/treatment — so that longitudinal record is degraded to pure data — maybe not so pure at that. Thus you have lost information or knowledge of the patient and degraded it down to text or data. (Mr. SemanticInterop)

Those grown people find “adulting” tiresome and unpalatable in the context of their own health and every other aspect of their lives. If they do not care, the clinician still is required to or suffer the reimbursement pain unless you are in the ED, where they cease being your patient when they leave. (David Perlmuter)

As for the continued drum beat of a single-payer health system,  we would only be trading one corporate master for another, one run by politicians with ever-changing motives. At least corporate healthcare companies have a single motive in mind – profit. Politicians care about votes and they will be taking money from these large corporate healthcare companies to insure they get those votes. The only way out is for physicians to take matters into their own hands and move away from the employed physician model. (Van Sims)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. M in Georgia, who asked for math manipulatives for her third grade class. She reports, “Thank you so much for your generous donations to our classroom. Since receiving the supplies you helped us purchased, we have put them to good use! We use the sheet protectors every day in both reading and math. Students now have the ability to show their work without wasting paper by using the dry-erase markers we got, and it really helps to engage them in their learning. In addition to those supplies, the manipulatives we received have really helped transform our Guided Math centers. Students love using the color chips as counters as well as game pieces. Our classroom would not be the success it is without you, so again, thank you!”

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A 19-year-old who as a high school student noticed the facial changes of Michael J. Fox after he was diagnosed with Parkinson’s disease uses off-the shelf facial recognition software to develop a startup called FacePrint, which hopes to diagnose Parksinon’s from Facebook photos. Erin Smith has deferred her Stanford admission and is taking the product through clinical trials, also hoping to create a five-minute facial expression test that can be taken with any computing device that has a camera.

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A 12-year-old girl whose autoimmune disease requires regular IV therapy invents Medi Teddy, an IV cover that is shaped like a teddy bear to keep kids from getting scared of the IV. She’s running a fundraising project to cover the cost of 500 of the bears that she will donate to other children in the hospital.

Investor Vinod Khosla, who said years ago that technology would replace doctors, doubles down in claiming that “radiologists are toast” and that any who are left practicing 10 years from now will be “killing patients every day” because machines will do their job better. He adds that it it easier to automate the work of an oncologist than a factory worker.

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Employees of UMC Trauma Center in Las Vegas line the halls to pay respects to an 18-year-old organ donor who died in a motorcycle accident the day he picked up his high school graduation cap and gown.

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You could be the next “Doc Martin.” A fishing village in England creates a social media campaign (#WillYouBeMyGP) in hopes of recruiting a doctor to replace the one who is leaving. The brilliant promotional video features locals extolling the virtues of sunny Cornwall County and their hopes that a doctor will come there to take care of them.

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A Miami man with a long criminal record gets a cease-and-desist letter for walking around several local hospitals wearing a physician lab coat. He denies it, but he had also posted on Facebook a photo of him on hospital property wearing the coat, which contained his name, MD, and “OB-GYN.” He had also posted a photo taken at his claimed medical school graduation, although perhaps he should have realized that freshly graduated medical students would not have earned an “OB-GYN” credential before completing residency.


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Morning Headlines 6/14/19

June 13, 2019 Headlines No Comments

Allscripts is buying ZappRx, a prescription drug start-up

Allscripts will buy specialty drug prescription prior authorization platform vendor ZappRx, according to reports, as it moves toward diversifying its EHR business.

General Electric wants to sell its stake in more than 100 start-ups

GE Ventures looks for a buyer for its stake in 100-plus startups that include 27 healthcare companies, as parent company GE attempts a turnaround.

Dassault Systèmes and Medidata Solutions To Join Forces To Accelerate the Life Sciences Industry Innovation For Patient-Centric Experience Through End-to-End Collaborative Platform

French company Dassault Systèmes will acquire clinical trials software vendor Medidata for $5.8 billion.

Sutter secretly sharing patients’ private info with Google, others, Sacramento lawsuit alleges

Two people file a class action lawsuit claiming that Sutter Health is sharing patient medical information with Facebook, Google, and Twitter so those sites can target Internet advertising.

News 6/14/19

June 13, 2019 News No Comments

Top News

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Allscripts will buy specialty drug prescription prior authorization platform vendor ZappRx, according to reports, as it moves toward diversifying its EHR business.

The acquisition price was not disclosed, but is reportedly less than the $41 million ZappRx raised in seed, Series A, and Series B round from 2013 through 2017. 

The acquisition will put other EHR vendors whose products use ZappRx in an interesting position – they will need to either remove the integration and force customers to go back to manual processes or pay the competitor who now owns the platform.

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I interviewed ZappRx CEO Zoë Barry in November 2017. She explained why the inefficiency in specialty drug prescriptions had been overlooked until she formed ZappRx in 2012:

Specialty drugs are only 2 percent of the volume, about 70 million prescriptions total, although they make up about 40 percent of the drug spend. You need a very different software and product that handles specialty prescriptions and you need a very different business model for something that accommodates only 2 percent of the market.


Webinars

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


Acquisitions, Funding, Business, and Stock

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French company Dassault Systèmes will acquire clinical trials software vendor Medidata for $5.8 billion.

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GE Ventures is reportedly looking for a buyer for its stake in 100-plus startups as parent company GE attempts a turnaround under a smothering $110 billion debt load and declining share price. Its active healthcare investments include Arcadia, Evidation Health, Iora Health, Omada Health, and Genome Medical.


Announcements and Implementations

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Lewis County Health System (NY) goes live on Meditech.

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Michigan physicians organization Answer Health deploys population health management technology from Lightbeam Health Solutions.

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Community Health Network (IN) implements MModal’s real-time speech recognition, mobile documentation, virtual scribing, and transcription software.

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Health Catalyst develops Population Health Foundations to help providers better analyze and understand clinical and financial performance.

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Lawrence General Hospital (MA) goes live on Meditech Expanse.

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Vocera incorporates AI and machine learning into the latest version of its mobile rounding app, and adds the Care Inform communication tool to its smartphone app.

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Rush University Medical Center in Chicago transitions to Google Cloud with help from consulting firm Maven Wave, which also helped the hospital map unstructured EHR data to SNOMED codes.


Sales

  • BMC HealthNet / Mercy Alliance will launch PatientWisdom’s digital member feedback platform to help it define the community health needs in Springfield, MA.
  • Houston Methodist selects dose optimization software from Tabula Rasa HealthCare’s DoseMe subsidiary.
  • Wake Radiology UNC Rex Healthcare will use Veriphyr’s patient data privacy monitoring to detect unauthorized access to medical records at its 14 locations in North Carolina.

People

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Washington Health System (PA) promotes Rodney Louk to VP/COO. He will also continue in his CIO role.


Government and Politics

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Secret recordings shared by a local news outlet in Australia reveal Queensland Health Director-General Michael Walsh’s opinion of the $1.5 billion Cerner IEMR project as “messy” and “not perfect.” He also admits to being required to publicly praise the project despite hearing end-user complaints about software glitches, costs, and skyrocketing stress levels. Thirteen hospitals have already gone live, and another 13 are scheduled to do so within the next two years.

Lawmakers express continued frustration with the lack of leadership over the VA and DoD’s EHR projects, calling the proposed Federal Electronic Health Record Modernization Program Office more of a concept than a concrete step towards joint governance. First proposed in March, FEHRM’s yet-to-be appointed director and deputy director will report jointly to deputy secretaries at the VA and DoD. Rep. Suzie Lee (D-NV), chair of the Subcommittee on Technology Modernization of the House Veterans Affairs Committee, didn’t hold back in her remarks on the bureaucratic foot-dragging:

For months this subcommittee has asked about a joint proposal to address longstanding problems with the existing [interagency program office]. There has been a name change, but we have seen nothing substantive. There is a one-page slide about a three-phase plan, but it is hard to find where the governance and accountability is in this plan. Based on the timeline for implementation it will come too late to address the critical decisions that need to be made now.


Privacy and Security

In China, police capture eight suspected hackers who used self-developed software to break into hospital registration systems and hijack appointment slots, which they then allegedly sold to the highest bidders.

Two people file a class action lawsuit claiming that Sutter Health is sharing patient medical information with Facebook, Google, and Twitter so those sites can target Internet advertising.


Other

The American Medical Association adopts a policy to support the education of physicians on the use of artificial intelligence in patient care.

An external review of University of Maryland Medical System finds that the health system issued no-bid contracts to companies of several members of its board, did not obtain full board approval for the deals, and pressured employees to use software sold by companies from which board members would benefit. Even the board’s financial auditor was caught assigning himself a no-bid deal. Baltimore’s mayor resigned after an investigation found that the health system spent hundreds of thousands of dollars on children’s book she wrote and four UMMS executives have resigned. Real Time Medical Systems founder and board member Scott Rifkin, MD says he provided analytics software to UMMS at no charge, but the review found that he tried to leverage the relationship to increase company sales and UMMS employees said they felt pressure to implement the software in skilled nursing facilities. The company raised $9.2 million in a February 2019 venture funding round.


Sponsor Updates

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  • ConnectiveRx team members spend the day helping Morris County Habitat for Humanity.
  • Elsevier’s Via Oncology wins a MedTech Breakthrough Award for “Best Computerized Decision Support Solution.”
  • EClinicalWorks will exhibit at the Northeast Regional Telehealth Conference June 17-18 in Portland, ME.
  • Hayes Management Consulting names Elizabeth Lavelle content product owner.
  • Healthfinch will host a focus group at the AMDIS Annual Physician-Computer Connection Symposium June 18-21 in Ojai, CA.
  • InterSystems and Intelligent Medical Objects will exhibit at the AMDIS Annual Physician-Computer Connection Symposium June 18-21 in Ojai, CA.
  • Kyruus will exhibit at the Patient Experience Transformation Assembly June 16-17 in Nashville.
  • Information Builders will host seminars in Atlanta, Pittsburgh, St. Louis, and Herndon, VA to demonstrate the new features of its Omni-HealthData Provider Master Edition.
  • KLAS recognizes Cumberland Consulting Group as a top-three consulting firm in its “2019 Payer Consulting IT” report.
  • ZeOmega achieves full HISP P&S accreditation from EHNAC.
  • Health Catalyst VP of Product Management Dan Soule joins the DirectTrust board.

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Mr. H, Lorre, Jenn, Dr. Jayne.
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EPtalk by Dr. Jayne 6/13/19

June 13, 2019 Dr. Jayne 1 Comment

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I’m an avid reader and was very excited to hear about “Code Blue” by Mike Magee. The author is a physician and chronicles decades of bad behavior by what he calls the “Medical Industrial Complex” of self-interested parties that drive our healthcare non-system.

Magee skewers physicians, hospitals, payers, pharmacies, drug makers, legislators, and other special interests. He notes that healthcare reform as been needed for decades, going back to a speech by President Nixon in 1972: “We need to work out a system that includes a greater emphasis on preventive care, sufficient public funding for health insurance for those who cannot afford it in the private sector, competition among both health care providers and health care insurance providers to keep down the costs of both, and decoupling the cost of health care from the cost of adding workers to the payroll.” It’s been a long time since we’ve seen a Republican call for greater public funding of health coverage for the poor.

Magee also calls out healthcare executives, physicians, and the American Medical Association. The worst criticism, however, is saved for pharmaceutical giants (it should be noted that Magee was a VP at Pfizer) who use profitability to determine which drugs will come to market. I highly recommend it, especially for newbies in the industry. It’s a steal at $16 on Amazon.

Road warriors take heart: London’s Heathrow Airport is installing new carry-on baggage scanners that can screen liquids and computers while they are still in your bags. Although some of us get a pass on the great unpacking routine in the US if we have TSA Pre-Check, perhaps this will clear the way to going back to a pre-2006 workflow at many more screening checkpoints. The story points out that it’s also an environmentally friendly option, helping cut plastic use since people won’t be using as many ziplocks. The technology, which is similar to CT scanners, has been in trials at Heathrow for two years and is also in use at several sites in the US, including ATL, ORD, and IAD although authorities still require us to pull out our baggies at those sites. I miss my road warrior ways, particularly since my airline status will likely sunset this year.

Speaking of road warriors, those of you on the clinical side might be interested in this Journal of the American Medical Association article on in-flight medical emergencies. I found it fascinating reading and learned a few things:

  • Emergencies occur in approximately one per 604 flights.
  • FAA-required contents of the emergency medical kit are rudimentary.
  • The most common issues are syncope / fainting, gastrointestinal issues, respiratory issues, and cardiovascular symptoms.
  • One-fourth of emergencies are handled by the flight crew alone,  half by physicians, and the remainder by nurses and other emergency personnel.
  • Diversion to a different destination happens in only 4% of inflight emergencies.
  • When flight crew request emergency medical services to meet the plane, only one-third of passengers are actually transported to a hospital and only one-third of those transported are admitted.

I’m a big fan of online medical journals, and this week I came across a JAMA Viewpoint piece explaining why we should consider eliminating or modifying the requirement for a Review of Systems (ROS) during patient visits. Although asking a variety of questions about body systems as part of the ROS has been part of the history-taking process for years, it became an annoyance a couple of decades ago when the number of systems reviewed was tied to the coding and billing process.

There hasn’t been much academic work looking at the validity of the ROS, although one study found that it only identified new diagnoses in 5% of cases. Other studies have noted that only a small percentage of issues identified during the ROS are even addressed.

The authors of the viewpoint article took into account that EHRs make the entry of ROS findings easy, especially if they are self-reported through a portal or kiosk, and wondered whether those findings that aren’t identified by the physician would be followed up even less. The authors go on to discuss “the fact that a complete ROS may be required by billing guidelines at times when it is clinically unhelpful.” They call for clinicians to “claim ownership of the determination of what clinical information is required for appropriate care in which setting.” Very few clinicians would argue this point. We’re tired of generating notes full of irrelevant information and we’re tired of reading it when we see it. Changing documentation requirements would certainly help with the “note bloat” we’re all subject to.

In that same train of thought, CMS is calling for additional input on its Patients Over Paperwork Initiative. The announcement claims that “since launching in the fall of 2017, Patients over Paperwork has streamlined regulations to significantly cut the ‘red tape’ that weighs down our healthcare system and takes clinicians away from their primary mission.” I spend at least half my time in the clinical trenches these days and haven’t noticed any significant change in paperwork or red tape during that time. I’m not sure where their purported 40 million hours and forecast $5.7 billion savings is happening, but it’s not on the average physician’s timecard.

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It’s that time of year. Hotel registrations for HIMSS20 are open, and even though it’s barely June, my preferred hotel is already booked for my preferred dates. The HIMSS Call for Proposals is also open through July 15. No word on keynote speakers and actual event registration doesn’t start until August. HIMSS is in Orlando again this year, and I never thought I’d say it, but I’m actually looking forward to going back to Las Vegas.

Due to some unexpected scheduling issues, I’ve had to spend more time in the clinic than I normally do. This week was punctuated by an entire day of EHR malfunctions, including failure of the system to talk to the pharmacy search API, which meant that we couldn’t do anything but print prescriptions if patients didn’t want them from our in-house dispensing system. Over the last decade, patients have gotten used to us sending their scripts to the pharmacy directly, whether electronically or by fax. The idea of printed prescriptions led to many requests for us to phone in the scripts and I rapidly discovered that not a single person on my staff that day had ever called in a prescription. Needless to say, we had a lesson because I wasn’t going to spend all day calling Walgreens.

We also had multiple random Citrix issues, chronic slowness, and random popups about some index failing to call the SOAP note. There was even an error message that cited my email address and I have no idea why it would even be listed in the EHR. I’m seriously disappointed in my vendor and their response – no resolution within 12 hours for sure, and at one point they stopped taking customer calls altogether. My practice suspected it had outgrown our vendor and I’m hoping that this is a wakeup call that it might be time to switch.

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Reader Comments

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